After the Removal of Multiple Teeth
The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone often must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:
- The area operated on will swell reaching a maximum in 2-3 days. Swelling and discoloration around the eyes and below the chin may occur. The application of a moist warm towel will help eliminate the discoloration. The towel should be applied continuously for as long as tolerable beginning 24 hours after surgery (remember ice packs are used for the first 24 hours only).
- A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
- If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline. There may be a slight elevation of temperature for 24-48 hours. If temperature continues, notify our office.
If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.
Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized by following these instructions .
Immediately Following Surgery
- The gauze pad placed over the surgical area should be kept in place for 30-45 minutes. After this time, the gauze pad should be removed and discarded.
- Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
- Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the effects of the local anesthetic becoming diminished.
- Restrict your activities on the day of surgery and resume normal activity when you feel comfortable.
- Place ice packs on the sides of your face where your surgery was performed, use the 20 minutes on and 20 minutes off regimen described below in the section on swelling.
CAUTION: If you suddenly sit up or stand from a lying or reclined position, you may become dizzy. If you are lying down following surgery, make sure you sit up straight for one minute before standing. It is recommended that you stand up with assistance to prevent falling.
A certain amount of bleeding is to be expected following surgery. Mild bleeding, oozing, or blood tinged saliva is common. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a fresh, moist gauze pad over the surgical site and biting firmly for 30-45 minutes. Repeat if necessary. If bleeding continues, bite on a moistened black tea bag for 30-45 minutes. The tannins in the black tea cause blood vessel contraction which helps decrease bleeding. If you are experiencing bleeding, sit upright, remain calm and minimize activity. If your bleeding does not subside, call the office at 970-498-0196.
You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 tablets of Acetaminophen (Tylenol) may be taken every 4 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 6 hours as needed for pain. For severe pain, the prescription pain medication should be taken as directed. Do not take your prescription pain medicine within 4 hours after taking Acetaminophen (Tylenol). Do not take any of the above medications if you are allergic, or have been instructed by your doctor not to take it. If you experience a change in the nature of your pain 3-5 days following surgery with symptoms such as: throbbing, ear ache, sore throat or pressure in your teeth, it is possible that you have a dry socket. Please call the office at 970-498-0196 for further instructions.
Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for an hour including any prescribed medication. You should then slowly sip on cool, clear fluids such as water, ginger ale or 7-up. A cool, moist compress to the forehead may also be useful. When the nausea subsides, you can begin increasing the intake of clear liquids and resume taking the prescribed medication. If nausea and/or vomiting continues, please call the office at 970-498-0196 for further instructions.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice, or ice packs should be applied to the areas of the face and jaws where surgery was performed. The ice packs should be left on for no longer than twenty minutes at a time, with a twenty minute break between applications. After twenty-four hours, ice has no beneficial effect, and can actually increase the incidence of swelling. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Twenty-four hours following surgery, the application of moist heat to the affected areas of the face and jaws is beneficial in reducing the stiffness in the jaws.
After general anesthetic or I.V. sedation, clear liquids should be taken initially. You may eat soft, cool foods and avoid chewing near the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 eight ounce glasses of liquid should be taken daily. Try not to skip meals. You will have more strength, less discomfort and heal faster if you maintain proper nutrition.
Good oral hygiene is essential for proper healing. The night of surgery, use the prescribed chlorhexidine oral rinse before bed. The day after surgery, the chlorhexidine rinse should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 60 seconds before spitting out the rinse. Warm salt-water rinses (one teaspoon of salt in an 8 ounce cup of warm water) should be used as well, especially after meals. You can gently brush your teeth near the surgical areas. On the fourth day following surgery, you may use the curved syringe given in the packet with your gauze to gently irrigate the extraction sockets with the chlorhexidine rinse twice daily.
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 following surgery. Moist heat applied to the area may speed up the fading of the discoloration.
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office at 970-498-0196 if you have any questions.