The First 24 Hours Following Your Surgery
Should I expect any bleeding?
Yes, bleeding should be expected following surgery for 24-48 hours. Gauze packings are placed at the surgery sites. Gauze is to be changed every 30-45 minutes for the first 3 hours. Some residual light bleeding will continue after the first 3 hours, but leaving gauze in any longer will actually promote more bleeding. Please try to stop using the gauze at approximately 3 hours after surgery. Your saliva contains an enzyme that will dissolve new blood clots in the mouth, so it is normal for you to have some minor, intermittent bleeding for 48 hours or more.
What is unusual bleeding?
Normally you may have to change the gauze pack over the surgery site every 45 minutes until bleeding slows. If the gauze packs completely fill with blood within 10 minutes AND your front teeth begin to get red, change the packs, make sure to place the gauze over the surgery site and bite down firmly. If this fails two times within 30 minutes to slow the bleeding, then call the office. If you have had Platelet Rich Plasma or Platelet Rich Fibrin your bleeding will probably have slowed enough by the time you leave the office so that gauze packs will not be needed.
Will I be in pain?
Within three hours following the procedure, start taking your pain medication. This will minimize any discomfort you might have when local anesthesia begins to wear off approximately 4-6 hours after the procedure. Take the medication as directed thereafter if pain persists.
May I blow my nose after surgery?
Patients who have been told that they have had a sinus closure, or that the root of the tooth is near the sinus should avoid blowing their nose for at least 5-7 days after surgery. After that time, you may blow your nose gently only when needed for an additional 7 days. If you have chronic sinus problems or a runny nose, you should take a nasal decongestant, i.e. SUDAFED® or Actifed, which can be purchased over the counter at your local pharmacy.
When and what can I eat? Should I brush my teeth?
Only after arriving home following your surgery, should you have clear liquids or carbonated drinks, i.e. water, tea, Coke, Sprite, ginger ale or juices. Drink only small amounts, since drinking too much may upset your stomach. Next start with soft foods, i.e. pudding, ice cream, yogurt, grits, applesauce, mashed or baked potato, soup, etc. By the evening, you may eat anything that you want. If your stomach is upset, take two tablespoons of Maalox® every four hours. Starting the night of surgery, brush your teeth gently, and avoid brushing over any stitches.
Should I have any blood in my stool? Should I have loose stools, diarrhea or stomach cramps?
You should ABSOLUTELY NOT have any abdominal cramps, bleeding or loose stools. Call the doctor immediately at the first sign of this type of problem and he will instruct you on which medications might be causing the problem and on what to do. Do not ignore this problem.
Should I rinse my mouth on the day of surgery?
You may very gently rinse your mouth on the day of surgery with mild salt water, but be extremely careful NOT to rinse the blood clots out of the socket. Most patients should avoid rinsing on the day of surgery.
Should I rinse with any particular mouthwash?
You should start to rinse the day following your surgery with a 50:50 mixture of Listerine and hydrogen peroxide twice each day for two minutes. If you get a prescription for Peridex™ or PerioGard®, this rinse should be used twice each day for two minutes instead of the Listerine and you need not mix the Peridex™ with hydrogen peroxide. Additionally, you should not eat or drink for one hour after rinsing. Either rinse will lessen your chance of developing a dry socket. Do this especially if your tooth was infected prior to surgery! If Peridex™ was prescribed, please use it for at least 10 days after surgery.
How much swelling should I expect? Why not use ice?
Most patients have minimal swelling. This will depend on the level of difficulty of your case. You were given an anti-swelling medication through your I.V. Also, you were given 2-4 Decadron tablets that are to be taken as directed; these will aid in minimizing swelling. Swelling will continue to increase for three to four days after surgery. This is the normal body response to surgery. DO NOT USE ICE. Ice will temporarily help swelling by slowing the blood flow to the surgery site—however, after the ice is stopped, the blood flow will be much greater than normal to the area creating more pain, swelling and bleeding. Some patients will note that their jaws or other teeth will feel sore or sensitive—this is normal and will resolve within a few days.
What should I expect after “gum” surgery?
Most patients who have had gum surgery will have a pastel-colored periodontal pack placed over their teeth. This pack looks a little like bubble gum. The pack should stay in place for at least one week and usually longer if a connective tissue graft has been performed (10 days). If the pack becomes loose, press it back into position. Make sure NOT to chew near the area where the pack is placed, since chewing can dislodge the pack. Soft foods are usually the least likely to dislodge the pack.
What should I not do?
- No Drinking through a straw —dislodges blood clot
- No Smoking —increases dry socket problem, nicotine dissolves blood clots
- No Ice Packs —as explained previously
- No Strenuous exercising for 3-4 days —may induce bleeding or fainting
- No spitting —increases dry socket problems and dislodges the blood clot
- Do Not Pick at your Bone Graft —Try your best to leave any bone graft site undisturbed
Most patients will have some discomfort for a couple of days following surgery. Make sure to take your medications as prescribed by the doctor. You will want to try to switch from the Vicodin [Hydrocodone Bitartrate] pain pills to ibuprofen 600 mg (i.e. Advil®, MOTRIN®) or Extra Strength TYLENOL® as soon as possible. This will minimize any stomach upset and make you feel better overall. Please try to resume as much normal activity as possible. Physically active patients have a much faster recovery! Patients who are couch potatoes have more swelling and more discomfort.
If 3-4 days following surgery the pain persists, gets worse, begins to throb where the surgery was completed or begins to radiate to your ear; contact the office for an appointment since you may have a dry socket. The doctor will pack the socket with medicated gauze that will relieve your pain. This may have to be done repeatedly until you have been pain free for at least two days. There is no charge for this service or for removing the sutures placed at surgery. Please make sure to start exercising your jaws to avoid muscle aches or spasms: Open your mouth as wide as possible several times each day [five times in a row, five times per day] by the third day after surgery to keep your jaw muscles working normally. You will not hurt the surgery sites by opening your jaw as wide as possible.
This is the time that sutures are normally removed. Most patients will have dissolvable sutures that will start falling out at this time. This is normal and there is no need to worry. If you did not receive an appointment on the day of surgery, please call the office at this time for a follow-up visit. Patients who have had grafting procedures will note additional soreness near this time period. Either MOTRIN® [ibuprofen] or TYLENOL® should relieve the discomfort in the area. If it is not relieved, please call the office. Grafting patients may have their first post-operative visit scheduled 8-11 days after surgery.
One week or longer
If swelling or pain reoccurs after your surgery, call the office for an appointment since you may have a postoperative infection. There is no way to evaluate this over the telephone. Most patients who have their wisdom teeth removed should expect to be sore and have achiness after eating or talking for 2-3 weeks after surgery. This is the normal healing pattern; if it is bothersome please take 2 Advil or 2 Tylenol every 4-6 hours for this type of discomfort. If this level of pain control does not work, please call the office for an appointment to be seen.
Always feel free to call the office (770-442-1022) if you have any questions. Our Patient Care Coordinator will always be available to help you. If you need to contact the doctor after hours or on weekends, just call the office number above or our answering service directly at 770-509-2102, and they will promptly contact the doctor who will return your call. If you do not hear from him within 20 minutes call the answering service again.
Medications: ****** Read this section carefully! ******
- First, you will normally receive two or more prescriptions after surgery. There will usually be two medications for discomfort: Vicodin or [Hydrocodone Bitartrate] this should be taken approximately two hours after conclusion of the surgery in the office. This medication will probably be necessary on the day of the surgery, but you should stop taking it if possible the next day since it will make you slightly dizzy and prevent you from safely driving your car. This medication is a mild narcotic.
- Second, you will probably receive ibuprofen (Advil®, MOTRIN®), which will help control pain, inflammation, swelling and post-operative soreness. This medication is the foundation for your pain control and you will add the Vicodin to it as you feel necessary. It is recommended that you take each tablet with food every 8 hours for approximately 4 days. You may supplement any of those medications with two regular strength TYLENOL® tablets, every 4 hours, if you feel the need. You can start this medication at the same time you start the first medication, Vicodin [Hydrocodone Bitartrate] for pain. You do not need to wake up during the night to take these medications—take them as close to the schedule as possible, i.e. MOTRIN® every 8 hours and Vicodin [Hydrocodone Bitartrate] every 3-4 hours. Please try to take these medications with food; the medications will work better and your stomach will thank you.
- Third, is the antibiotic medication, which you should start to take at the same time as the first pain pill. These will usually be: Amoxicillin, Cleocin (Clindamycin), or Keflex. Ladies, please remember that the effectiveness of birth control pills is significantly reduced during the entire month that antibiotics were taken. We recommend using an additional form of birth control during this time. You should also avoid alcohol use completely while you are taking antibiotics, since alcohol may deactivate the antibiotic you are taking. You should take these medications approximately every 6 or 8 hours as directed on the bottle. Remember to call the doctor if you have any change in bowel movements.
- Fourth, will usually be your anti-swelling pill: Decadron or [Dexamethasone] that you should start the next morning following the day of surgery and should be taken with breakfast. Since you only take one of these tablets per day, you will only receive two to four tablets. Please carefully follow the directions for use of these medications printed on the bottle by the pharmacist. On very rare occasions this drug may cause sleeplessness or nervousness. If you experience these symptoms, STOP taking the drug and call the doctor.
- Fifth, taking Vitamin D3 will help you heal much faster. Please take 10,000iu of Vitamin D3 each day for 2 weeks then decrease to 5,000iu thereafter. Ester Vitamin C is also helpful: 500mg /day.
Please remember that these medications were given because they each will help in specific ways to allow you to heal faster and better after surgery. All medications have some side effects but the ones that we prescribe have a very low incidence of creating problems with our patients!
Please remember that any medication may upset your stomach and eating when you take pills will help prevent that problem. Antacids, club soda, Tagamet, Zantac, TUMS® or PEPCID® (Famotidine) may also help settle your stomach if it does become upset. Do not ignore an upset stomach; start one of the medications noted above to help yourself before the problem gets to be significant.
After healing is complete, most patients will have small holes or pockets where lower wisdom teeth or molars were removed. This is normal and usually will fill in with bone and gum tissue over a period of several weeks. You will be given a small plastic irrigator to flush out any food that might collect in these pockets at your final postoperative visit. Do not use a Waterpik® to clean out these areas since the spray is much too strong and you may damage the socket or flush out part of the healing tissue.
On behalf of the staff and doctor, we hope you have a smooth and trouble-free recovery. Remember, we are always here to help you! Please do not hesitate to call us if you have any questions or concerns.
If the need arises during non-office hours, our paging service will promptly contact Dr. Boc for you. If the doctor does not return your call within 20 minutes, call back. This means that Dr. Boc did not get the page. If the office telephone number 770-442-1022 does not automatically forward to the answering service after office hours, simply call the service directly at 770-509-2102.
If you are not doing well or are having a problem with medication, call the doctor. Talking to your family doctor, dentist or friends in the medical field is never a substitute for speaking with the surgeon who did the operation.
WE HOPE YOU HAVE A GREAT WEEK AND A SPEEDY RECOVERY!!! If you have questions not covered in this handout, please call our office to avoid any worry or confusion. There is always someone available 24/7 to address your concerns.