After Tooth Extraction of a Permanent Tooth

Immediately Following Surgery

No two patients are the same and every surgery is different.  It is important not to accept well intended advice from friends or relatives. Dr. Maranon and his staff are best able to effectively speed patients healing and make their recovery uncomplicated.  The following are general instructions for after surgery.  Patients are given specific instructions depending on their particular procedure.  The following can be used as a reference.  If there are any questions, it is important to contact the office.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon.  Gauzes pad placed over the surgical area should be kept in place for the first two hours after surgery.   The gauze pads should be changed every 30 minutes.  The gauze pad should be removed slowly and discarded.  Patients must not spit it out or rinse after removing the gauze pads.   Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, sit upright, apply ice packs and avoid exercise. If bleeding does not subside, call for further instructions.  For more information see Bleeding and Bruising. 

Patient should not rinse or brush for the first 24 hours.  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.

Swelling

Swelling is the body’s normal reaction to surgery and eventual repair and is usually proportional to the procedure performed. Swelling around the mouth, cheeks, eyes and sides of the face can occur. The swelling may not become apparent until the day following surgery and patients may feel that ice is not necessary.  Swelling may not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Ice packs and compression dressing may be provided to patients if they are indicated after surgery.  If ice packs are not available they can be made using Jip Lock baggies filled with ice and then wrapped in a dish towel.  Ice packs should be applied on the face over the surgical site to keep swelling and pain to a minimum and reduce pain. These packs should be used 20 minutes on and twenty minutes off as much as possible for the first 36 hours. If a compression dressing was provided, patients should sleep with the dressing.  The ice does not need to be used while sleeping.  After 36 hours, ice has little beneficial effect on swelling.

After 36 hours, the swelling begins to subside.  At this point, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling and improving jaw stiffness and soreness.  If ice packs were provided, these packs can be heated in hot water and applied to the area of swelling or jaw stiffness. Care should be taken that these packs are not too hot when they are applied to avoid burns of the skin.  Heat pack should also be used on 20 minutes on/20 minutes off schedule. For more information see Swelling.

Pain

It is best to think of pain on the scale of 1-10 (10 being worst). Patients should take the pain medications as soon as you begin to feel discomfort (3/10).  This will usually coincide as the effects of the local anesthetic diminish. It is important not to wait until pain becomes worse.  Pain medication should be taken on a schedule and not in response to pain.  Dr. Maranon and the staff will clarify the schedule of pain medication for each patient.  For more information see Pain and Discomfort and Pain medication.

If prescription strength pain medication was prescribed, take these medications directed. The prescribed pain medicine may make patients groggy and will slow down reflexes. It is important that patient not drive an automobile, work around machinery or participate in activities that can cause injury while under the effect of anesthesia or whole taking prescription pain medication. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.   Dr. Maranon and the staff will discuss strategies for alternating prescription pain medication and over the counter pain medication with each patient. 

For mild to moderate pain, adult patients may take one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four hours or Ibuprofen (two-three 200 mg tablets may be taken every 4-6 hours.  These medications should not be used if they are contraindicated by a medical condition or interaction with other medication.

Fever

It can be normal to have an intermittent low-grade fever on the first two days after surgery.  Tylenol or ibuprofen should be taken to reduce the fever. Infections after surgery are rare.  If a patient’s temperature reaches 101 degrees, if patient has chills, has elevations of temperature more than three days after the procedure,  is not eating or drinking well or if there are concerns about infection, Dr. Maranon should be contacted immediately.

Antibiotics

Antibiotics may be given to help prevent or treat infection. Patients prescribed antibiotics, must take the mediation as directed. Failure to take the medication as prescribed can actually lead to a worsening infection.  In the event of a rash, diarrhea or other unfavorable reaction to the medication, contact the office.

Diet

After general anesthesia or I.V. sedation, clear liquids should be initially taken. Do not use straws for the first 24 hours. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. 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 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.  For more information see,

Hygiene

Good oral hygiene after oral surgery and proper wound care following oral surgical procedures will hasten recovery and prevent complications.  Dr. Maranon may give specific recommendations to some patients about brushing and rinsing. No rinsing of any kind should be performed until the day following surgery. The day after surgery, patients can also begin to rinse gently with warm salt water (1/2 teaspoonful salt a 6 oz. glass of warm water) every 3-4 hours, and after they eat, for one week. Patients should also start to brush their teeth the way they normally do being careful around the surgical sites.  It is important brush teeth next to the surgical sites well.  If plaque collects on these teeth a secondary wound infection can occur.

A small amount of bleeding can occur when patients first start to brush.  This is normal and the bleed should stop.  Patients may also use dilute (one part mouthwash in 3 parts of water) non-alcoholic non-prescription mouth wash.  This may improve breath and make patient’s mouth feel fresher and cleaner.   Regular tap water can also be used to rinse if warm salt water or mouthwash is not available.  After the first 48 hours, patient should start to rinse more vigorously after every time they eat.   Patients should especially rinse vigorously if they have pain after meals.  Food particles left in the surgical sites can cause pain, slow wound healing and invite infection. 

Occasionally, patients are prescribed an anti-bacterial mouth rinse.  This rinse is used twice a day after brushing the teeth.  “Bad” breath can occur after surgery and is usually a sign the oral hygiene needs to be improved. 

Bruising and 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.

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.

Healing

Initial healing is completed in the first week.  Complete healing may not occur for a few more weeks.  There may be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the meantime, the area should be kept clean especially after meals with salt water rinses or a toothbrush.

Patients must rinse their mouths well after meals to keep the surgical sites clean.  Food particles can collect in the surgical site.  It is important to rinse these particle out of the surgical site as they can cause pain, delay wound healing and cause infection.  It is important to keep fingers and the tongue away from the surgical sites.

After the third or fourth day, patients can expect to make steady improvement.  Depending on the extent of the surgery, this process may occur slowly.  Worsening symptoms like redness around the surgical site, swelling, fever or pain after patients start to recover from their surgery may be a sign of problems with healing. Patients must not ignore worsening symptoms and Dr. Maranon should be contacted immediately so that the surgical site can be evaluated. 

Sutures

Sutures are placed 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 form your mouth and discard it. The sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.

Activities

Patients should restrict activities on the day of surgery.  They should be careful going from the lying down position to standing. .  Before standing up, patients should sit up for one minute before standing.  They may need assistance walking for a few hours.  This is especially true for patients who had their procedure performed under general anesthesia of IV sedation.  Patients may have difficulty drinking fluids and eating after surgery.  They may be dehydrated and nutritionally depleted.  Taking pain medications can make patients dizzy or lightheaded.  Patients should not be left alone while under the effects of anesthesia or narcotic pain medication.  When patients start to feel better they may resume normal activity progressively.  Patients must be aware that their normal nourishment intake is reduced and that their body is devoting significant amounts of energy to heal. Vigorous activities should be deferred for three to five days. For more information see Healing and Activities.

Numbness

If numbness of the lip, chin, or tongue occurs there is no cause for alarm. The effects of the local anesthetic can sometimes persist for many hours.  The numbness is usually temporary in nature. Patients should be aware that if their lip or tongue is numb, they could injure their lip or tongue while chewing and not feel the sensation. If numbness persists after the first day or if there are questions about numbness, the office should be contacted.

Other Frequently Asked Questions

Bone Spicules:  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. Maranon.

Chapped Lips:  If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with Vitamin A&D ointment or Chap Stick.

Sore throats:  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.

Jaw Stiffness:  Stiffness (Trismus) 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.  

The Post-Operative Appointment

Dr. Maranon needs to monitor the recovery of every implant patient.  Patients will have a number of implant post-operative appointments in our office.  It is important that patients keep every appointment, even if they feel they are healing well. Those appointments must be kept except for unforeseen circumstances.  If a patient must change an appointment, it is important that they arrange another appointment as soon as possible. Dr. Maranon prides himself on his many implant successes. Patient participation and communication play a big role in the success of the implant treatment.

We hope that this information is helpful, and that your recovery is uneventful.  Again, should you have any questions, do not hesitate to contact the office at any time.