POSTOPERATIVE INSTRUCTIONS –  TOOTH EXTRACTION

BLEEDING:  You will be discharged biting on gauze.  Remain biting on the gauze for 30 minutes.  The gauze is applying pressure to the gums where the surgery was done.  Having the gauze between your teeth does not slow the bleeding.  The pressure must be on the gums.  Gauze usually does not have to be replaced (unless you take a blood thinner and have more oozing).  Once again, place the gauze directly on the surgery site.

Please swallow your saliva, otherwise you will have a lot of drool mixed with only a little bit of blood.  This will make all the saliva red and it will look like a lot of bleeding.  If the bleeding continues after the above measures, soak a tea bag in water, squeeze damp-dry and wrap it in gauze, place it firmly in the area of the bleeding for 30 minutes.  If bleeding is excessive and you are concerned, please call the doctor at the phone number listed below.  (Remember that a lot of saliva and a little blood can LOOK like a lot of blood).

Make sure you don’t fall asleep with gauze in your mouth as this can be a choking hazard.

SWELLINGFacial swelling is normal following extractions and can be significant.  Swelling can be minimized by keeping your head elevated with the use of 2-3 pillows when lying down and application of ice packs over the surgical areas during the first 48 hours.  A cold compress can be used for 20 minutes on and 20 minutes off for the first 48 hours.  Your doctor MAY prescribe a steroid taper (methylprednisolone/Medrol dose pack) to help with swelling – follow the written instructions inside the medicine box on how to properly take this medication.  You can start the steroid medication the next morning after your surgery.

Following the first 48 hours after surgery, warm moist compresses (i.e. a washrag that you soak under warm running water and then ring out) are better than ice at helping the swelling resolve.  Gently massage the areas with the warm moist compress for 20 min, every hour or so. 

Rapid swelling is NOT normal.  Call our office immediate if this occurs.

BRUISING: Bruising is highly variable and differs from patient to patient.  Some patients experience little to no bruising, others have extensive bruising under the eyes, chin, down the neck and under tongue.  Variables such as age, tissue laxity and medication profile can all effect bruising.  Bruising will generally resolve after 2-3 weeks and may become more yellow as it is resolving.

PAINYour jaw and lip may remain numb for approximately 6 hours.  Ideally, pain medication should be consumed with food.  Begin your pain medication while you are still numb to prevent the onset of pain.  Take the medication as prescribed and discussed.  Remember that the maximum 24 hour dose of Tylenol is 3000mg and Ibuprofen is 3200mg.  Swelling and discomfort will be at its maximum on the fourth day, each day after that you should see improvement.  If you take a narcotic for pain, do not drink alcohol, drive or operate heavy machinery. 

DIET:  You can eat as soon as you’re ready.  Soft non-chew foods are recommended for the first 2 weeks after the surgery, intentionally avoiding the surgical site.  Soft non-chew foods are anything that you can squish through the tines of a fork (examples include mashed potatoes, soup, yogurt, ice cream, macaroni and cheese).  Cold foods are recommended for the first 24 hours after surgery.  DO NOT suck fluids through a straw. AVOID spicy foods, acidic foods (lemonade, soda) for 1 week.  Avoid caffeine for 2 days.

If you are a diabetic, maintain your normal eating habits as much as possible and follow instructions for your insulin given by your physician.

ORAL HYGIENE:  Start brushing your teeth the next day after surgery.  Brush gently and avoid brushing near the surgery sites.  Use a soft bristled brush so that you do not injure the tissues in your mouth.

A prescription rinse may be prescribed after surgery (Peridex/Chlorhexidine Gluconate).  Rinse your mouth with Peridex for 1 min and spit out.  Do this three times daily and do not drink or eat anything for 1 hour after using Peridex to allow it to work.  Peridex rinse should not be used for more than 2 weeks as it may cause staining that is easily removed with a dental cleaning.  An alternative to Peridex is to rinse your mouth with tepid salt water (1 teaspoon salt in 8 oz. water) after each meal for 2 weeks.  Vigorous rinsing should be avoided (only gentle rinsing).

DO NOT rinse with Scope, Listerine or Hydrogen Peroxide for 2 weeks.

TRISMUS:  Stiffness of the jaws is nature’s way of resting the jaws to allow for body repair itself and usually relaxes about 7 days after the surgery.

NAUSEA:  Nausea after surgery may be the result of swallowed blood, pain medications and/or effects of the anesthesia.  Reduce nausea by always having food in stomach before taking each pill followed by drinking a large volume of clear fluids.  Try to keep drinking clear fluids and minimize the pain medication if vomiting persists.

FEVER:  A slight elevation in temperature is common on the evening of surgery.  This is not necessarily due to infection.  Following surgery, the body may have an elevated temperature as the early stages of inflammation occur.  The temperature should exceed 101 degrees.  If this happens please contact the office.

INFECTION:  Infections may occur a day or even several days following surgery.  A sudden increase in swelling, throbbing pain, high fever and/or a foul tasting drainage may indicate infection.  If you suspect an infection, you should call the office as soon as possible.  If you were prescribed an antibiotic, please finish the entire amount as directed.  Antibiotics can sometimes reduce the effectiveness of birth control pills.

SUTURES:  You may have sutures in your mouth.  They usually dissolve on their own 2-3 weeks after the surgery.  If they don’t dissolve in 3 weeks, we will remove them for you.  If sutures come out earlier, this is okay.

RECOVERY RESTRICTIONS: 

If you were sedated, DO NOT drive, operate complicated machinery or devices, or make important decisions such as signing documents for the first 24 hours. 

– Smoking should also be avoided for 2 weeks, as it retards healing.  However, if it is not possible to quit smoking completely, try to severely limit your smoking during the first 2 weeks for this time period. 

– DO NOT use a waterpik around your surgical site for 2 weeks. 

– DO NOT drink alcohol for 1 week after surgery.

SINUS PRECAUTIONS:  Upper molar and premolar roots can be near or protruding into the maxillary sinus. If you had upper jaw molar and premolar teeth surgery , then for TWO WEEKS:

  1. DO NOT blow your nose
  2. DO NOT use straws, vape, smoke, hookah
  3. DO NOT play wind instruments
  4. If you need to sneeze, sneeze with your mouth open
  5. DO NOT fly unless approved by Dr. Igor

DENTURE/FLIPPER WEAR:  Your denture, partial or flipper should not be worn until it has been properly adjusted.  The time you will be instructed to refrain from wearing your denture will be determined by the surgeon and will vary from patient to patient.  The success of your implant(s) will depend on your compliance. Whenever dentures or partials are worn over implant sites, they must be worn for appearance only, not for eating and chewing.  Chewing may cause implant loss.

These numbers are for EMERGENCIES only and ARE NOT to be used for scheduling or any other questions.

EMERGENCY NUMBERS:                                Cell #:

Igor Tikhonov DDS, MD                        206-719-8396    

For ALL calls during business hours, scheduling or other questions, please call our office at:

972-366-0065