Multiple Tooth Extractions

Immediately Following Surgery

• A gauze pad will be placed over the surgical area. Firmly bite on the gauze for half an hour. Remove the gauze pad after 30-45 minutes and discard it. 
• Do not rinse the mouth vigorously or touch the wound area. Doing so may dislodge the clot that is forming and cause bleeding. 
• You will be prescribed pain medication. Take the first dose within one hour of being discharged from the office. This will usually coincide with the effects of the local anesthetic wearing off.
• Rest on the day of surgery and resume normal activity when you feel comfortable.
• To help reduce swelling, place ice packs on the side of your face where the surgery was performed. 

Bleeding

It is normal to experience some bleeding or redness in your saliva 24 hours after the procedure. If you experience excessive bleeding, place a moistened gauze pad directly on the wound and bite down for at least 30-45 minutes. If the bleeding persists, bit down on a moistened black tea bag. Black tea contains tannic acid, which contracts blood vessels and helps form a clot. Call for further instructions if bleeding persists after 5-6 gauze changes. 

Once the bleeding stops and a clot forms do not:

• Spit
• Use a straw
• Rinse vigorously 
• Smoke for 72 hours
• Drink alcohol for 72 hours

Doing any of the above will dislodge the clot and slow the healing process. 

Swelling

Swelling is our body’s natural reaction to surgery and eventual repair. The amount of swelling you experience will depend on the extent of the surgery. It is normal to experience swelling of the cheeks, eyes, sides of the face, and around the mouth. Swelling will not be visible until the day after surgery and will not reach its maximum until the second postoperative day. Swelling can be minimized by applying ice packs immediately following surgery. Apply ice packs continuously during the first 36 hours, 20 minutes on, 20 minutes off, and sleep with your head elevated. After 48 hours, the ice is no longer beneficial. 

If swelling and jaw stiffness persists for several days, do not be alarmed, this is a normal reaction to surgery. Forty-eight hours after surgery, you may begin to apply moist heat to the outside of your face, this will help to further reduce swelling. 

On the day of surgery, begin aggressive oral stretching and manual massage to the sides of the face. This will help with muscle tightness and reestablish a normal oral opening. Sleep with your head elevated at a 30-degree angle for the first two days after surgery. Following these instructions will ensure a quick recovery with less swelling and post-operative pain.

Pain

As with any surgery, some degree of discomfort is to be expected. You will usually be given a prescription for pain medication. We recommend taking pain medication before the numbing medication has worn off for the best pain management. You will experience the most severe pain within 6 hours of the anesthesia wearing off. After that, your need for pain medication should decrease.

For moderate pain, take a dose (400-600mg) of Ibuprofen (Advil or Motrin) every 4-6 hours as needed for pain. Do not exceed the maximum daily dosage suggested on the bottle.

Do not take Ibuprofen if you:

•  Have an intolerance to it
•  Take blood thinners 
•  Have a history of stomach ulcers 
•  Have a history of kidney disease 

For severe pain, the prescribed medication should be taken as directed. To avoid stomach upset, take the pain medication after a meal or with a small snack. If you have allergies to any medications above, do not take them. If your doctor has advised you not to take any of the medications mentioned above, do not take them.

While taking pain medication, do not:

• Operate a motor vehicle
• Operate machinery (lawn mower, etc.) 
• Drink alcohol 
• If you had I.V. anesthesia, do not drive for the first 24 hours after surgery.

If you still experience significant pain that is not improving 3-5 days after surgery, notify the clinic. Prescription pain medication has the potential to be addictive, so it’s very important that you only take it if you are experiencing significant post-operative pain. If you do not finish all your prescription medication, take the unused medication to the police station or a pharmacy, and they will dispose of it responsibly. Never leave unused medication in your medicine cabinet at home. 

We recommend the following protocol for optimum pain management:

Take each medication with a small snack and a full glass of liquid.

Immediately Following Surgery: 1 Prescription pain pill

3 Hours Later: Ibuprofen dosage

3 Hours Later: 1 Prescription pain pill

3 Hours Later: Ibuprofen dosage

NOTE: The dosage of the prescription pain medication can be increased to 1 1/2 to 2 pills if needed for pain management.

Nausea and Vomiting

Nausea and vomiting are common side effects of anesthesia and pain medication. To reduce nausea, eat a small snack before taking the medication and drink a large amount of fluids when you take the medication. If you are nauseous and/or vomiting after surgery, avoid eating, drinking, or taking pain medication for at least one hour. After the hour has passed, sip ginger ale, tea, or coke. Sip slowly over a period of fifteen minutes. Do not use a straw. You may begin taking solid foods and the prescribed medication when you no longer feel nauseous. To help with nausea and vomiting, do not take medication on an empty stomach.

Healing

What to expect following surgery:

• Day.1 & 2: Usually the most uncomfortable. Expect some swelling. Swelling will peak on the second day. 
• Day.3: You should start feeling more comfortable and notice a reduction in your swelling. You will be able to eat a more substantial diet. 
• After day three, you should start to feel better and see steady and gradual improvement. If you do not see steady improvement, call our office for further instructions. 
• Day 14: If non-dissolvable sutures were placed these will be removed at this time and you will notice your remaining bone discomfort and gingival irritation will resolve.

Diet

Take only fluids until the feeling in your mouth has completely returned. Do not use a straw for drinking as this can dislodge the clot that forms in the socket. Eat soft foods and chew away from the surgical sites. Until the feeling returns, it’s best to eat soft foods that don’t need to be chewed, such as yogurt, pudding, mashed potatoes, etc. Eat a high-calorie, high-protein diet. Eating regularly and not missing a single meal will help you to feel better, have more strength, and heal faster. 

Drink plenty of fluids throughout the day to ensure you remain well-hydrated. Since your food intake will be limited for the first 1-2 days, you should compensate by drinking at least 1-2 liters of fluid per day. 

Caution: You may feel dizzy or faint when standing up from a lying or sitting position. If you are lying down after surgery, sit up slowly and place your feet on the ground.  Stay seated with your head elevated for one minute before standing. On occasion, a patient may faint following sedation/anesthesia due to a lack of blood flow to the brain. If the escort witnesses the patient fainting, please elevate the patient’s legs above their head for 30 seconds. This will allow oxygenated blood to return to the patient’s brain and restore consciousness. Staying well hydrated following surgery will help prevent fainting. 

Antibiotics

If you had a bone graft placed in the tooth extraction site or if you had an infection or bone graft, you may have been prescribed an antibiotic. Take the prescribed antibiotics as directed to help prevent infection. If you experience a rash or an unfavorable reaction to the antibiotic, discontinue use and notify our office. Be sure to take the prescribed antibiotics as directed to help prevent infection. Complete the entire course of treatment. If you experience an upset stomach, we recommend taking acidophilus or a pro-biotic along with your antibiotic. 

Oral Hygiene

Keeping your mouth clean following surgery is essential to good healing and is one of the best ways to avoid infection. You should brush and floss your teeth the night of surgery, avoiding the surgery site. Brush carefully when cleaning the surgical areas. You can mix 50% hydrogen peroxide/50% water. Dip a Q-tip in the solution and gently wipe over the surgery site. This will ensure plaque doesn’t accumulate on the sutures or teeth surrounding the area. Do not rinse your mouth until the day after surgery. 

The day after surgery, rinse with warm salt water at least 5-6 times a day, especially after eating. To make the salt water rinse, mix one teaspoon of salt with a cup of warm water. If you were prescribed a bottle of Chlorhexidine mouth rinse, begin using it after brushing and flossing. This mouth rinse should be used twice daily until gone. Rinse for at least 30 seconds before spitting it out. Do not drink or eat food for 15 minutes after using the mouth rinse.

Discoloration

You may notice that your skin turns blue, green, black, or yellow in the days following surgery. This is a result of blood spreading beneath the tissues. Applying moist heat to the area may help the color fade. 

Nausea and Vomiting

If you are nauseous and/or vomiting after surgery, avoid eating, drinking, or taking pain medication for at least one hour. After the hour has passed, sip ginger ale, tea, or coke. Sip slowly over a period of fifteen minutes. Do not use a straw. You may begin taking solid foods and the prescribed medication when you no longer feel nauseous. To help with nausea and vomiting, do not take medication on an empty stomach.

Smoking

DO NOT SMOKE for a minimum of 4 weeks following surgery. The toxic chemicals and heat in cigarette and marijuana smoke increases the likelihood of infection and are harmful to healing wounds. 

Wearing Your Prosthesis

If you have flippers or partial dentures, they should only be worn in social settings. When you are at home, you should remove your prosthesis to allow the healing extraction sites to breathe. If you had all of your remaining teeth removed and were given a complete denture,  leave the denture in place for 24 hours after surgery. If you remove the denture before then, you will not be able to get it back into your mouth due to soft tissue swelling. An appointment the day after your surgery will be scheduled for you to have the dentures adjusted to relieve any sore spots you may have. After the first 24 hours, remove your dentures and clean them every night. Important: Do not sleep with your dentures as this will cause pain and inflammation. 

Sinus Precautions

The upper back teeth and the sinus are very close together. As a result, a communication (an unnatural space) between the sinus and mouth can occur. If we informed you at the conclusion of your procedure that this occurred, please read the following instructions. Your sinuses may feel stuffy or you may experience some nasal drainage, but it is important that you do not blow your nose for at least 14 days after surgery. You may experience slight bleeding from the nose for several days after surgery. To avoid pressure on the sinuses, sneeze with the mouth open for two weeks after surgery. 

Take all medications and nasal sprays as prescribed. Do not smoke for four weeks. Only eat soft foods for several days and chew on the opposite side of your mouth. Notify our office if drainage or pain increases or if you experience any changes in your condition. Sinus exposures often heal slowly and with difficulty; therefore, you must keep all of your scheduled appointments until you have fully recovered.

Other Complications

• You may experience numbness of the lip, chin, or tongue. If this happens, do not be alarmed.  As stated before surgery, this is usually temporary. If your tongue or lip is numb, you could bite it and not realize it, so be careful. Call Dr. Benjamin Foley and Dr. Thao Le if you notice the numbness persisting after the first 24 hours. The doctors may prescribe you additional medication.
• Immediately after surgery, you may notice a slight elevation of temperature. You may take Tylenol or ibuprofen to reduce the fever. If the fever persists, notify the office. 
• Because you were not able to eat or drink before surgery, you may feel dizzy. Taking pain medications can also make you feel dizzy. Be careful when going from lying down to standing. You could get lightheaded and faint when you stand up suddenly. Before standing, sit for one minute and then stand up.
• Sometimes, patients can feel hard projections in the mouth with their tongue. These are the bony walls that supported the tooth. They will usually smooth out on their own. If not, they can be removed by Drs. Benjamin Foley and Thao Le.
• The corners of your mouth may feel stretched and may dry out and crack. Apply ointment such as Vaseline or lip balm to your lips and corners of your mouth.
• It is not uncommon to have a sore throat or pain when swallowing. This will subside in 5-6 days.
• You may feel stiffness (Trismus) of the jaw muscles. This may make it difficult to open your mouth for a few days following surgery. This is a normal post-operative event that will resolve in time. Massaging the muscles on the side of the face and performing oral stretching exercises will decrease muscle stiffness and pain.

Finally

Your surgeon will place sutures in the area of surgery to minimize post-operative bleeding and to help with healing. The sutures may become dislodged; do not be alarmed if this happens. Remove the suture from your mouth and throw it away. The sutures are dissolvable and do not require removal.  

The pain and swelling associated with your surgery should decrease more and more each day. Call our office for instructions if the pain or swelling worsens or if unusual symptoms occur.

There will be a hole where the tooth was removed, and it will gradually fill in with the new tissue over the next 6-8 weeks. In the meantime, keep the area clean by rinsing with salt water rinses after meals. 

Every surgical case is unique, do not accept well-intended advice from friends. 

It is important to keep your mouth clean while you heal. This will reduce your risk of infection and lead to a speedy recovery. Brush any remaining teeth the night of surgery. Brush gently around the surgical areas. 

After a tooth is extracted, a blood clot forms at the extraction site. If that clot gets dislodged you will experience dry socket. You may experience pain at the surgical site and/or pain to the ear may occur 3-5 days following surgery. Call the office if this occurs.

Your nourishment intake will be reduced, which can lead to weakness. If you regularly exercise, you may feel weaker than usual. If you experience lightheadedness, stop exercising.