After the Removal of Multiple Teeth

Immediately Following Surgery

1. Keep relatively quiet and relaxed the first 24 hours after surgery. It’s best to be in more of an upright position with pillows propping up your head and in a recliner.
2. Keep lots of ice wrapped in a towel or a cloth ice pack placed on the outside of the jaws for the first 48 hours. Be sure to remove the ice every 20 minutes to allow the skin to rest and not to burn the skin. This should be done up until your caregiver goes to bed for the evening.
3. Please do not rinse or spit. The gauze in your mouth is to help apply pressure and stop the bleeding. If you rinse or spit, bleeding will continue since a blood clot will not form. Extra gauze will be given after surgery. Fold the gauze into small squares and place directly over the sockets. Be sure to wet the gauze and wring it out before placing it in the mouth. You should keep gauze in your mouth only until the bleeding stops. Gauze should be removed before drinking fluids or eating. If the sockets are still bleeding by the evening, take an ordinary tea bag, activate it in a glass of cold water, wring it out and place directly over the socket for 30-45 minutes. This should clot off the bleeding after2 or 3 cycles. Light bleeding is normal, heavy bleeding is not. Call Dr. Gunn immediately if heavy bleeding continues into the afternoon. Be sure to remove gauze at night before going to bed, even if there is still slight oozing.
4. Drink plenty of liquids following surgery, preferably water. This is important for the healing process. Hydration is important. No carbonated beverages for the first 7 days. Drinking carbonated beverages can cause dry sockets. Since the mouth is numb, only cold or room temperature food and liquids the first 24 hours is recommended. The mouth will probably be numb for several hours following surgery, and the patient will not be able to distinguish hot food temperatures. Jell-O, ice cream, and milkshakes are all suitable following surgery. After the first 24 hours you can begin to eat food that you can mash with a fork, such as potatoes, eggs, oatmeal, chicken and dumplings, spaghetti,macaroni and cheese, etc. For the first 72 hours, stay away from pure citrus drinks such as orange juice.You should avoid chips, pizza, hamburgers, steak, etc. the first week following surgery. These foods can sometimes irritate the extraction site.
5. Medications: Take only post-op medications that Dr. Gunn prescribes for you. Not every patient needs an antibiotic following surgery, so do not be alarmed if you are not given a prescription for antibiotics. If you are given a prescription for antibiotics, and you are taking birth control medications, please be aware that some antibiotics can interfere with the effectiveness of birth control medications. Alternative contraception methods should be used if a patient is sexually active while taking antibiotics to avoid pregnancy.
    
   Pain medications are usually given in two categories.
   Anti-Inflammatory Medications
   A. Motrin (Generic Name: Ibuprofen)
   B. Tylenol 325 mg (Generic Name: Acetaminophen)
    

   If you are aspirin sensitive or asthmatic, do not take Motrin/ Ibuprofen. Please read the warning labels. These medications will do the best job of controlling pain after surgery. If Dr. Gunn prescribes these medications, take them immediately following surgery, before the numbness wears off. If pain is not subsiding, these medications can betaken as frequent as every 4 hours the first 24 hours. After the first 24 hours, try only taking these medications every 6hours. It is best to take these medicines on a constant basis, so the medicine can stay in the bloodstream and be effective. These medications are anti-inflammatory and will help reduce swelling and subsequent pain related to surgery. Also try to take these medications with food.

   Narcotic Medications
   A. Demerol (Meperidine) & Phenergan (Promethazine)
   B. Percocet (Oxycodone). This medication has Tylenol already in it.
    

   Please take medications as directed on the label. Do not exceed taking these medications beyond every 4-6 hours the first 24 hours. If you need to take these medications after the first 24 hours, be sure someone is monitoring you and absolutely do not consume alcohol or drive any vehicles. Again, please read the warning labels that come with the prescriptions. Patient should be closely monitored the first 24 hours after surgery. (Someone should assist the patient to the restroom for the first 24 hours.) Someone should attend to small children during this time and while the patient is taking narcotics.

6. If a suture is placed, usually they are the type that dissolve on their own. Do not be concerned if they unravel quickly after surgery. They are designed to be temporary. This will not affect the healing.
7. No showers for the first 48 hours baths are fine.

What should I not do following surgery?

1. No smoking for 7 days after surgery. Smoking, even a couple of drags, will increase your chances of getting a dry socket, which is a bone infection. It will also delay the gum tissues ability to heal. Symptoms of a dry socket are aching, throbbing pain in the jaw. The pain is as severe as an abscessed tooth. Pain medication will not relieve these symptoms. There is a medication that must be placed directly in the socket by Dr. Gunn. Please do not smoke.(Covering the sockets does not prevent dry sockets.)Additional charges may be incurred if a patient is non-compliant.
2. Do not replace contacts until the next day.
3. Do not use a straw for 1 week.
4. Do not breast feed for 24 hours after sedation and 24 hours after your last narcotic.
5. No lifting of objects (including children or pets) over 5 lbs. for the first week after surgery. This can increase your chance for a dry socket due to the subsequent pull on the gum flaps.
6. Do not wear orthodontic retainers for one week.

What should I be doing after 48 hours?

Begin rinsing with warm salt water 48 hours after the bleeding has stopped. This can be done along with the mouth rinse. At this time you can brush the tongue and teeth that are three teeth away from the extraction site. Brushing too close to the extraction site can cause bleeding. Normal brushing can resume in approximately 1 week. Also, ice use can be stopped at this time.

What should I do after 72 hours if my jaw is still stiff and swollen?

Maximum swelling is expected in 48 hours and may last for several days. Discoloration and slight stiffness of the jaw can be normal postoperative events. Do not be alarmed. If the jaw is still swollen and stiff 72 hours after surgery, you may take a washcloth and place under warm water. Apply to the face. Place the washcloth on the outside of the face, 20 minutes on and 20 minutes off. This will help reduce the swelling. Do not apply heat sooner than 72 hours. If heat is applied sooner than 72 hours, you may actually increase swelling. Also our head wraps have blue gel packs that are hot or cold packs. Heat them as directed on the package, wet the head wrap and slide the packs in and use this 20 minutes on and 20 minutes off.

When should I use the irrigation syringe?

An irrigation syringe will be given after surgery. In 4 solid days (96 hours) after surgery, start using the irrigation syringe on the lower sockets. Place warm salt water in the syringe and place above the socket to irrigate. (Not directly in the socket). It is important to use the syringe for lower sockets only, but not prior to the 96 hours. If you use the syringe any earlier, you can introduce bacteria into the sockets and this will prevent proper healing. The syringe is for use on the lower sockets only and should be used after each meal. Someone needs to help you rinse all lower sockets at night and in the morning to insure that all food particles are out. Gravity and rinsing will keep the upper sockets free of debris in most cases. Syringe use is very important to help prevent a delayed infection caused by trapped food particles.

If the sinus is entered during surgery, or the roots are close to the sinus, please follow the instructions below:

1. No nose blowing for one week.
2. No smoking until further notice.
3. Do not blow a wind instrument for one week.
4. Take all prescribed medications as directed.
5. IF YOU FEEL AIRFLOW AT THE EXTRACTION SITE, PLEASE CALL.
6. Do not bend over for one week.
7. Do not use a straw until further notice.
8. Try not to sneeze, if you must, do so with an open mouth sneeze.
9. No exercising until further notice.

Depending on the size of the exposure the above restrictions may be longer than a week. Please consult with Dr. Gunn on post op about the time frame.

Discoloration

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 post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration after 72 hours.

Nausea and 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 fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. If symptoms persist, please let the office know.

Other Complications

1. If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call Dr. Gunn if you have any questions.
2. Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
3. You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
4. Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Gunn.
5. If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as vaseline.
6. Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
7. Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.

Finally

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures we use in the office are dissolvable and will fall out on their own.

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call my office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals.

Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Gunn and his staff.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of severe pain at the surgical site and even pain to the ear that is not alleviated with pain medication may occur 4-5 days following surgery. Call the office if this occurs.

No exercising for one week.

If you have any questions or concerns, Dr. Gunn can be reached by calling our office phone number: Clarksville Office Phone Number931-648-0819.