Post-Operative Instructions

PAIN MANAGEMENT

• Stay ahead of the pain for the first 48h.  This is important!!  Take your first pain pill before the anesthetic has worn off, and then repeat every 5 hours for the first 48h. After 48h, you can move to less frequent dosing as needed until you are able to wean yourself onto over-the-counter (OTC) meds only (after 5 days on average).  It is normal to take OTC meds for up to 10-14 days.
• Always take the pain medicine with at least a small amount of food.  This will prevent most instances of nausea.  Use the anti-nausea medicine (Ondansetron/Zofran) if needed for nausea with the pain meds.
• Supplement pain meds when awake with an OTC anti-inflammatory between pain med dosing (600mg of Ibuprofen/Advil every 6 hours, or 440mg of Naproxen/Aleve every 12 hours).  Most prescribed pain meds already contain Acetaminophen/Tylenol.  Do NOT supplement your pain med dosing with Acetaminophen/Tylenol.

SWELLING

• Some swelling is normal and can be minimized (not necessarily eliminated) with the following:
• Ice Pack: Apply 20 min on and 20 min off during the first 12 – 24 hours after surgery. AFTER 24 hours, you may switch to WARM applications (20 min on and 20 min off). The warmth will help decrease soreness and stiffness.
• If you are prescribed steroids, the first dose should be taken ASAP after surgery.  With a Medrol dose pack, take all pills indicated to catch up to that point for the day for the first dose (for example, if the first dose is taken at lunchtime, then take the first day’s morning dose AND the lunchtime dose together as the first dose) and then follow directions from that point forward.  Steroids are more effective when taken EARLY in the inflammatory cycle, so a larger dose up front is beneficial for maximum effect.

SIX THINGS TO AVOID FOR THE FIRST 72 HOURS IN ORDER TO MINIMIZE COMPLICATIONS/DRY SOCKET

• DO NOT use a straw.  This can dislodge the clot (suction) and promote dry socket.
• DO NOT smoke, as it is compromises blood supply and can promote dry socket.
• DO NOT rinse vigorously with mouthwash or water for the first 48h (mild swishing with peridex is okay). It can dislodge the clot and promote dry socket.  After 48-72h, rinse vigorously with Peridex!
• NO hot liquids (lukewarm coffee, tea or soup is fine) while numb.  Don’t burn yourself!
• NO spitting; Just swallow normally.  You swallow saliva all day, every day. This should be no different. Spitting can dislodge the clot and promote dry socket.
• NO carbonated beverages. These can dissolve the clot and promote dry socket.

DIET

• EAT, EAT, EAT!!  Be sure to eat nutritious food and drink plenty of liquids.  Do not skip meals, if you eat nutritious foods, you will feel better, gain strength, have less discomfort and heal faster.
• Avoid foods that will be difficult to irrigate out of the sockets (small things such as nuts, sunflower seeds, popcorn, potato chips, rice, etc.) that may get lodged in the socket areas.
• Softer foods (mashed potatoes, pasta, scrambled eggs, etc.) are OK for the first 48 hours (since the swelling and discomfort will gradually increase and peak at 48h).
• Beginning as soon as possible, but definitely by 48h after surgery, CHEW, CHEW, CHEW!! Avoid the common mistake of being on a soft/liquid diet for a week.  Your jaw muscles are used to eating and talking all day, and not using them for 3-4 days in a row will result in spasms and cramps in the muscles as well as limited mouth opening for you!  THIS IS A VERY COMMON MISTAKE AND CAN REQUIRE MUSCLE RELAXANTS TO CORRECT, SO AVOID IT!
• You can avoid the muscle spasms and cramps by chewing (this exercises the chewing muscles) as well as stretching your jaw back to a normal range of motion.  You should be easily chewing and return to a normal range of motion (being able to open your mouth as wide as you normally can) by the end of the third day after surgery.

IRRIGATING SYRINGE

• THIS IS THE MOST IMPORTANT THING TO DO FOLLOWING EXTRACTIONS IN ORDER TO HEAL PROPERLY!! (for wisdom teeth extractions and other extractions without grafting)
• The lower sockets (and upper sockets if necessary) should be kept clean using an irrigating syringe (which we will provide to you) beginning on the 2nd day after surgery.
• This means aggressively removing ALL food particles from the sockets anytime after eating.  A common mistake is ineffective irrigating.  Irrigating should cause some discomfort (for the first few days) and a little bleeding (first few days).  If not, then you probably need to be more aggressive with your irrigating.  Allowing food to remain in extraction sockets is by far the most common cause of dry socket (inflammation of the bone) after surgery.
• This is usually necessary for a minimum 10 to 14 days after surgery.
• Irrigate with room temperature salt water or with a 3:1 mix of saltwater and Peridex.
• If you have had an IMPLANT and/or GRAFTING, then you will NOT use the irrigating syringe in those areas. DO NOT CHEW on implant/grafted sites. (Chewing on your implant and/or grafted area can cause failure/loss of the graft or implant.)

A few THINGS TO REMEMBER

The surgical area will swell. This peaks around 48 hours following surgery.  So expect to wake up more swollen the second morning after surgery than the first.You may have a slight earache.  This is not common but is referred pain and temporary when it occurs.

You may develop a sore throat.  This is not common but is usually due to not chewing your food properly (and swallowing food boluses that are too large or too rough) during the first few days after surgery. Be sure to chew!

It is not unusual to develop bruising in the area of extractions.

Your main goal is to avoid disruption of the blood clots for the first 48-72 hours, and then keep the sockets/area as clean as possible from that point forward.

Nausea is not uncommon after surgery, usually caused by stronger/narcotic pain medicines. A small amount of food and large amounts of clear fluids while taking the medication almost always helps reduce nausea.  You will also have anti-nausea medication (ondansetron/Zofran) should you need it.

Your other teeth may ache temporarily. This is referred pain and is a temporary condition.

We want you to heal as comfortably and quickly as possible.
If you have ANY questions, do not hesitate to call our office, as we are happy to assist you.