After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. That’s why we ask you to bite on a gauze pad for 30-45 minutes after the appointment. You may have to do this several times. If bleeding still persists, biting on a moist tea bag wrapped in gauze may help control the oozing from the surgical site. Tea has an ingredient that promotes blood clotting.
After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Does not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.
Failure to comply with the above instructions will result in dislodgement of the clot and severe throbbing pain at the extraction site, since the bone is now exposed to the oral environment. After the tooth is extracted you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours.
Use the pain medication as directed. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.
It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean. After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call our office immediately.
In addition to the above instructions, it is important to remember a few additional points if you have received a graft within the socket site after we removed your tooth.
The bone graft is made up of many fine particles. You may find some small granules in your mouth for the first several days. Do not be alarmed by the presence of these small granules. It is completely normal for some granules to become dislodged from the graft site, but there are some things you can do to minimize the amount of granules which become dislodged:
On the first day it is best to let the area settled and allows the blood clot to stabilize the graft material. Therefore, do not even rinse your mouth the first day. After the first day you may begin gentle rinsing with warm salt water, but avoid rinsing vigorously and avoid forced spitting.
Depending on the type and extent of the oral surgery, several conditions may occur, all of which are considered normal.
Swelling: will vary depending on the individual and the difficulty of the surgery. Swelling is usually biggest after two days and often lasts for a week. Ice packs applied to the area for 24 to 36 hours after surgery will often reduce the amount of swelling. After 36 hours, switch to warm, moist heat.
Bleeding: will vary depending on the type and extent of surgery. Active bleeding can be seen for several hours and should be controlled by placing folded gauze pads over the area and biting down to apply pressure. These gauze pads should be changed every hour or so depending on when they become soaked. Small sized tea bags are recommended if bleeding is brisk. Dampen one tea bag and place it over the area that is bleeding. Tea bags are also easier to use than gauze pads for patients that have braces. Ice packs on the face are also helpful to control bleeding. While bleeding is active, do not lie down flat, keep your head elevated on pillows, avoid hot liquids or food as heat will increase bleeding, do not use straws as the suction will increase bleeding, and do not take Aspirin as it can prolong bleeding. After the active bleeding has stopped, it is not unusual for a small amount of oozing of blood to continue for 2 to 3 days.
Pain: will vary in intensity depending on the type and extent of the surgery and the individual. Pain may last for several days following surgery. A slight earache, headache, and / or sore throat may develop. The other teeth possibly will ache temporarily. This is referred to as sympathetic pain and is a temporary condition. For mild pain, non-prescription (over the counter) pain medicine may help. For more severe pain, take the prescription pain medication as directed on the medication instruction sheet.
Numbness: or tingling of the lips, chin, gums, tongue, cheek, or teeth is usually temporary. It may persist for several weeks, months, or in remote instances, permanently.
Trismus: (tightness) of the muscles may cause difficulty in opening the mouth for a few days following surgery.
If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with Vaseline.
There may be a slight elevation of temperature for 24 to 72 hours.
The skin of the face may turn black and blue. This will gradually disappear and is no cause for alarm. If you were given an injection in the arm, the site of the injection may turn black and blue and remain sore for 3 to 4 days.
A DRY SOCKET may occur where a tooth was removed. This is a delay in healing in which a blood clot does not form in the socket or is dissolved a few days after the surgery. This results in an open socket where food and bacteria can collect. The area will become inflamed and ache or throb. Dry sockets are most common in lower third molar sockets and in smokers. Following the instructions below on cleaning the mouth will help, but dry sockets can occur in spite of all precautions. Call the office if you think that you are developing a dry socket.
CLEANING THE MOUTH A bad taste and odor can be expected after oral surgery. Only gentle rinsing with cold water or mouthwash is recommended for the first 24 hours after surgery. This rinsing should not be done too frequently or too vigorously as continued bleeding could result. Beginning the day after surgery, the mouth should be kept as clean as possible to reduce the chance of infection or delayed healing. Rinse with warm salt water, (1 teaspoon of salt in 8 ounces of water), every 2 hours and after meals. Mouthwash can be added for taste. Brush teeth gently but thoroughly several times a day. If you were given the oral rinse, Chlorhexidine, begin using it the morning after surgery. If you were given an irrigating syringe, begin using with warm salt water to flush out sockets two days after surgery.
DIET will vary depending on the type and extent of surgery and anesthesia. Liquids and soft foods that can be swallowed without chewing are generally recommended on the day of surgery. Begin with clear liquids. If there are tolerated without any nausea, then the diet can be advanced to dairy products and semi-solid foods. Avoid hot liquids or foods while bleeding is still active. Begin soft foods with light chewing the day after surgery and then advance the diet as tolerated.
ACTIVITY will vary depending on the type and extent of surgery and anesthesia. Physical exertion that may cause increased bleeding or swelling should be avoided. Operation of motor vehicles or complicated machinery or equipment that could result in injury should be avoided while taking the prescription pain medication.
DENTURES - If dentures were placed in your mouth at the time of surgery, your new dentures may feel strange to you. Try to be as “natural” with them as possible. As you become accustomed to them, this odd feeling will leave. You will find the chewing of foods difficult until you are able to master more coarse foods. Drink plenty of fluids for a few days. Sore spots may develop under your dentures. You should contact your general dentist who will help with relief of those areas. After surgery, dentures should be left in until the next morning unless otherwise instructed. Your dentures will require adjustments by your general dentist, and you should contact his or her office for an appointment.
SMOKERS - Medical studies on healing following surgery show that smokers have a much higher incidence of complications and delayed healing. Oxygen is essential at the tissue level for healing to take place. Reducing or stopping smoking for several days before and after the surgery will help prevent complications
IMPORTANT INFORMATION FOR PATIENTS WITH PARESTHESIA
Oral surgery, like any surgery, has risks that can occur despite the best of care. You may remember discussing these risks before surgery. One risk we discussed was the possibility of a change in sensation of the lip, chin, gums, and/or tongue. This change in sensation is called paresthesia, and it requires close follow-up care.
What Causes Paresthesia?
The nerves that give sensation to the lip, chin, gums, and tongue are very close to where your surgery was performed. When these nerves are disturbed during surgery, they may not function normally. It is important to note that these nerves affect sensation only, not movement. Therefore, you may feel numb or your food may taste different, but the affected areas should move normally. You should be able to smile, speak, and chew as usual.
How Long Will Paresthesia Last?
The duration of paresthesia is unpredictable. It may last days, weeks, months, or, in rare cases, it may be permanent.
What Is The Treatment For Paresthesia?
Paresthesia usually gets better by itself over time. You may notice tingling or other sensations while your nerves are repairing. On the other hand, your sensation may return so gradually that you might not be aware of any improvement. It is possible that all or some of your sensation will return. However, nerve repair surgery, if performed in a timely manner, is sometimes an option for extreme cases of paresthesia. If you decide to have a nerve surgery, it is recommended that you consult with a nerve surgery specialist (microsurgeon) and have surgery between two months and six months following your extractions in order to have the best chance of a successful nerve repair.
It is very important for you to keep all your follow-up appointments so that we can evaluate your progress and develop the best treatment plan for you. During your follow-up appointments, we will perform tests that will enable us to monitor your nerve response and document any changes in the area affected. It is by monitoring changes in your symptoms over time that we are able to advise you of your prognosis and best treatment options. Your failure to return for regular follow-up care may prevent us from helping you regain your sensation to the best possible extent.
We hope that this addresses some of the concerns you may have about paresthesia. We know that paresthesia can be upsetting, and we want you to understand your condition so that we can work together to develop the best treatment plan for you. If you have any questions or concerns at all, please feel free to give as a call. We look forward to seeing you at your next scheduled appointment so that we can work together for the best possible result.
Because of the close relationship between upper back teeth and the sinus, a communication between the sinus and mouth sometimes results from surgery. That complication has occurred in your case, which often heals slowly and with difficulty. Certain precautions will assist healing and we ask that you faithfully follow these instructions:
Please keep our office advised of any changes in your condition, especially if drainage or pain increases. It is important that you keep all future appointments until this complication has resolved.
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