Post-Op Instructions in Gaithersburg, Silver Spring and Frederick, MD
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Oral surgery procedures tend to be associated with small amounts of bleeding or oozing post-operatively. This is typical for the way that your mouth heals. It is a very vascular area and it is in constant motion. You will be given some instructions when you leave the office specific to your situation. Below are some general guidelines to help you after your procedure.
Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding can be controlled by firmly biting on a gauze pad (or wet paper towel or tea bag) placed directly on the bleeding wound for 20 minutes. Gauze pressure can be repeated 2-3 times as necessary. The gauze may appear red and saturated. Remember that this is a combination of the oozing from the site mixed with your own saliva. Please keep in mind that a relatively small amount of oozing will make all of your saliva appear blood tinged.
Try to avoid rinsing and spiting for the rest of the day of your surgery. This tends to disturb the blood clot that is forming and can prolong bleeding and healing.Saliva can be swallowed, even if slightly blood tinged. It is typical to have blood-tinged saliva for a few hours but this does not necessarily require you to have gauze in your mouth continuously. It is unlikely there is active bleeding but the gum tissue may ooze slightly. Because of this, keeping gauze in your mouth throughout the whole day without putting active pressure on it can be counter-productive because it may disturb the initial healing/clotting process that is occurring.
However, if bleeding continues, it is helpful to replace the gauze in the mouth for 10-15 minutes with constant firm biting pressure. After 10-15 minutes remove the gauze (your jaw should feel tired at this point); try to tolerate having no gauze in your mouth for 20-30 minutes. If you feel that it is necessary, replace the gauze with firm constant pressure for another 10-15 minutes and remove for 20 minutes and repeat as necessary.
Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, or a plastic bag, or towel filled with ice on the cheek in the area of surgery. Apply the ice approximately 20 minutes on and 10 minutes off, as often as possible, for the first 24 hours. After the initial 24 hours, ice will not usually help with the amount of swelling but may make the area feel more comfortable. Feel free to continue cold compress application if you find it helpful.
Drink plenty of fluids. Avoid hot liquids or food for the rest of the day, especially because your lip and tongue may feel numb and not sense the temperature of the hot food/liquid. Softer foods (the consistency of fish and pasta) and liquids should be eaten for 2-3 days. Return to a normal diet as tolerated unless otherwise directed.You will often know depending on how you feel when you are ready to advance your diet to more substantial foods. In some cases, though, your surgeon may ask you to continue a softer diet for an extended period of time based on you particular situation. Please call us with any questions.
Post-operative pain is understandably a primary concern for most patients. We will do our best to make the surgery as minimally traumatic as possible. However,pain after surgical procedures is unfortunately often unavoidable. Please keep in mind that swelling from surgical inflammation usually peaks in 48-72 hours. Do not become overly alarmed is you become more swollen 2-4 days after your procedure than you were the night of the procedure. We have included some post-operative pain recommendations here, but please do not hesitate to call us if your are concerned about your particular pain or post operative healing.
You should begin taking pain medication as soon as you feel any signs of pain. It is better to treat pain sooner than later, rather than try to “catchup” with it after it becomes uncomfortable. Ibuprofen (Advil or Motrin) is a preferred initial pain medication that helps with pain and anti-inflammation. Naproxen is also an anti-inflammatory and may be effective as well. Tylenol (acetaminophen) may be taken instead of ibuprofen but it is typically not as effective for oral pain.
For severe pain, please use the prescribed medication from your surgeon. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside progressively especially after 3-4 days. If pain persists, it may require attention and you should call the office.
Ibuprofen (or other anti-inflammatory medication) can be used in conjunction with your prescribed medication. In this way, it is often effective to take ibuprofen every 4-6 hours and use the prescribed pain medication for “breakthrough” pain that is not adequately controlled with the over-the-counter medication. This will allow you to taper the prescribed pain medication and allow you to limit the side effects of the prescribed medications if desired. Anti-inflammatory medications often has cumulative properties that help prevent inflammation, so we encourage you to continue its use with other prescribed pain medications even if the benefits are not immediately apparent.
“Dry socket” is a term used to describe a slowly healing extraction site that is taking more than a couple of days to heal properly. If you feel that your pain after an extraction is not improving for 4-5 days after an extraction, please call our office. We may ask you to come in for an evaluation to help provide you more comfort as possible.
Please do not hesitate to call our office if your are concerned about your personal prescription regimen or if you feel like you may have an adverse reaction to any of your medications.
We attempt to tailor all recommendations for each unique patient. You may be prescribed antibiotics after your procedure to help treat (or prevent) an infection. Antibiotics are not always necessary after procedures and could be detrimental if prescribed inappropriately. Antibiotics have side effects and risks just like any other medication. Our primary concern is always your health. If you are concerned about your antibiotic prescription (or lack of prescription) please do not hesitate to ask us. We would be happy to discuss the decision process with you.
As always, do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it. Please do not hesitate to call our office if your are concerned about your personal prescription regimen or if you feel like you may have an adverse reaction to any of your medications.
Good oral hygiene is essential to good healing. Please brush your teeth like usual before your appointment (even if your required to have nothing by mouth before your appointment). You may brush your teeth the evening of the procedure if it possible for your to avoid contacting the surgical wounds. Rinsing and spitting is discouraged for the first day of your procedure so please be gentle as possible and let the water fall out of your mouth rather than firmly expectorating. There may grooves, divots or holes in gum tissues after your procedure. The day after your procedure you will feel more comfortable and clean if you gently rinse the areas 4-5 times a day especially after meals. Salt water (one tablespoon per eight ounces of water) is generally the most comfortable rinse. However, it this is not convenient, do not hesitate to use regular water. Avoid using any mouthwashes (unless specifically prescribed for you by your surgeon) for two weeks until your are given approval by your surgeon as these may be too caustic to gum tissue that is still healing.
Keep physical activities to a minimum immediately following surgery for 2-3 days depending on the procedure. If you are considering exercise, please be advised that throbbing or bleeding may occur in the surgical site. If this occurs, you should discontinue exercising. Keep in mind that you are probably not ingesting your normal diet. This may weaken you and further limit your ability to exercise.
Wearing Your Prosthesis
Partial dentures, flippers, full dentures, or orthodontic retainers are usually not be used immediately after surgery and for typically 1-2 weeks. However, in some cases, a prosthesis can and should be worn immediately after surgery. This will be discussed with you as each patient is unique.
Sutures (stitches of thread) may or may not be used after your procedure depending on the situation. They typically are self-resorbing sutures that will dissolve over 3-7 days. They will become soft and fall out. Do not be alarmed if you think you may have swallow a small piece of suture as they are bio-degradable. Multiple sutures are typically placed and some may fall out in 1-2 days because the gum tissue is constantly in motion when you move your mouth to talk and eat. If you feel that the sutures need to be cleaned; please feel free to gently wipe the sutures with a moist cotton swab (rather than use a toothbrush to brush the sutures.) If you any concern regarding your sutures please call us.
Occasionally, sutures are placed that do not dissolve on their own. These will be removed at subsequent follow-up appointments. This is generally a painless procedure that does not require any type on anesthesia.
Nausea & Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on Coke, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking soft food and the prescribed medicine as needed.
Smoking is known to inhibit healing after surgery. The suction caused during inhalation will increase the initial clot formation. The pollutants within the smoke and the absorbed nicotine also cause decreased healing and increase likelihood of pain and infection. Please discuss this with your surgeon if this is a concern to you.
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal postoperative occurrence, which may occur two to three days post-operatively. It often resolves 6-10 days after the procedure. Please let us know of any areas of concern during your follow-up appointments.
Instructions for after a Sinus Graft Procedure (or Sinus Entry after a Tooth Extraction)
The maxillary sinus is anatomically directly above your upper jaw towards the back of your mouth. It is an empty cavity that drains through your nose. Therefore, it is typical to have some increased drainage through your nostril after a procedure in this area.This drainage may appear blood-tinged and is typically related to the clotting process that is occurring. It is advisable to follow some precautions to allow as little disturbance to the healing process in the sinus and jaw bone.
Some precautions after a procedure that includes your maxillary sinus include:
- Do not smoke. The suction of smoking the cigarette, and also the nicotine and carbon, monoxide of the cigarette can impair the healing process.
- Do not suck through a straw. The suction will tend to disrupt the healing process that has started.
- Do not blow your nose. Though you may notice some drainage; it is better to wipe your nostril than to vigorously blow your nose. Blowing your nose is counter productive as it will tend to disrupt any healing that is already occurring.
- Do not sneeze with your mouth closed. This creates excess disruptive pressure in your nose and sinus. Please sneeze with your mouth open.
- Do not lift up your lip repeatedly to look at the wound. This will stretch the tissues and put unnecessary tension on the sutures.
- If bone grafting was done you may notice small granules in your mouth for the first few days. You may also occasionally feel granules in your nose. It this happens repeatedly; please contact our office.