The Extraction of Deciduous (Baby) Teeth
On the day of surgery, children may still feel the effects of local anesthetics. Pain is usually well controlled with either prescription strength or over-the-counter pain medications. On the second or third day children may be sore and or their jaw may be stiff. Pain after the extraction of deciduous teeth is rare and soreness should lessen daily. If a child’s pain becomes worse after a few days, (generally 3-5 days after surgery), this may indicate a problem in in their recovery. It is important that Dr. Maranon is contacted and arrangements to have the child evaluated.
Other teeth on the same side of the surgery may ache temporarily. You may have a sore throat or earache for a few days. Advil is best for these symptoms.
Patients should bite on the gauze placed in over the surgical site with continuous firm pressure for the first two hours after surgery. This will help control and stop bleeding. This may be difficult for some children. The patient must not chew on the gauze, or spit out, as it will prolong bleeding. Some blood in the saliva for 1 or 2 days is normal. If heavy bleeding occurs, it may be controlled gentle rinsing and wiping blood from around the wound. A fresh moistened gauze pack, folded into a two inch square, or non-herbal tea bags should then be placed over the wound under biting pressure for 30 minutes. Remember that a lot of saliva and a little blood can look like a lot of bleeding. If the bleeding continues, or if there are concerns about bleeding, Dr. Maranon should be contacted immediately.
A blood clot should form in the extraction socket. This is a normal part of the healing process. It is important to avoid vigorous rinsing, spitting out, or using straws to drink through, in the first 24 hours. All of these activities can dislodge the blood clot. If the blood clot is dislodged, bleeding may continue or healing may be delayed. Finally, parents may want to cover their child’s pillowcase or use an older pillow since a small amount of bleeding while sleeping can be expected and is normal.
Swelling is normal after surgery. Swelling may increase until the second or third post-operative day and resolves in about a week. To minimize swelling, ice or cold packs should be applied to the face over the surgical site for the first 24-36 hours after surgery. These should be used alternating on and off every 20 minutes. Moist heat may be applied over the surgical site after the third day. This can reduce swelling and help to relieve jaw stiffness and soreness. The temperature of these packs must be checked prior to placement to avoid burns. Light physical activity the day after surgery will help reduce swelling.
Hydration and nutrition is very important to healing. This may be difficult for some children after oral surgery. Children may start to have liquids after 1 hour. Clear liquids such as clear juices, Jell-O, Gatorade, Coke, or 7-up should be started first. Diet can be advanced to full liquids (ice-cream or yogurt) as tolerated. After a few hours, a soft diet may be resumed. Children must also drink plenty of fluids. It is important that the surgical sites not be disturbed by the tongue or finger. Patients should avoid chewing on the surgical site. Children can be expected to be on a soft diet for up to one week. The effects of the local anesthetic (numbness) may last for sometime. Foods must be checked to make sure that they are not too hot. Children must be observed so that they do not chew on their lips or tongue.
Menu and Food suggestions will be provided and discussed by the office staff. Children may be more comfortable if they avoid acidy, salty or spicy foods. They should avoid hard and crunchy foods like popcorn, nuts, and potato chips for two to three weeks.
Sutures are occasionally placed after the extraction of deciduous teeth. If sutures were placed they generally “fall out’ on their own in three to five days. They are typically white or straw colored and are sometimes thought to be bone, tooth fragments or food. If there are any questions about concerning sutures or the healing of the surgical site, the office should be contacted for instructions or to have the site evaluated.
The effects of the local anesthetic may last for several hours. Special care should be taken not to burn, bite, or otherwise traumatize your lips and tongue. Very rarely, a numbness of the lower lip, chin, or the tongue may occur on the same side as the surgery and persist for months or longer. This is not usual and it usually disappears in time. If this occurs, it must be mentioned at the child’s post-operative visit.
Rarely patients will experience nausea and/or vomiting as a side affect of the anesthetic medication. This typically resolves quickly. Even though nausea and vomiting is uncomfortable and distressing, supportive care is often all that is necessary. Dr. Maranon recommends slowly starting with ice chips or popsicles. 7 Up or Ginger ale diluted with a little water may also be helpful. Dr. Maranon recommends that children avoid dairy products or solid foods until symptoms improve. If the symptoms persist or if there are concerns or questions about nausea or vomiting, the office should be contacted as soon as possible.
It is not always necessary or appropriate to take antibiotics after oral surgery. If a child was prescribed medication is is important to have the prescription filled and they should take all the medication according to the directions on the label. If antibiotics were prescribed the first dose of antibiotics should be taken 6 hours after the the surgical appointment unless instructed otherwise. An antibiotic medication must be taken until completed to prevent infection. Prescription strength pain medication is sometimes needed. Dr. Maranon perfers that pain medication be taken on a schedule and not in response to pain. Specific instructions concerning the use of pain medication will be given. As soon as possible ibuprofen (Advil, Motrin or Nuprin), should be substitued if adequate relief is given. It is important that choldren eat something prior to taking pain medication. Prescription pain medication causes drowsiness.
If a child develops a rash or itching, the use of medications must be stopped immediately and Dr. Maranon should be contacted immediately. Nausea, vomiting, diarrhea, urinary problems or fungal infections may also be side effects of medications. Should there be any questions concerning a possible medication reaction, the office should be contacted as soon as possible.
Children should not rinse or spit out for 24 hours. After 24 hours, if bleeding has stopped, gently rinse with warm salt water (add 1/2 teaspoonful of salt to a glass of warm water) every 3-4 hours and after you eat for one week. After 24 hours, brush your teeth carefully, but do not disturb the wounds. Proper wound care following oral surgical procedures will hasten recovery and prevent complications.
There may be a “hole” in the gums after surgery. With time, this will fill in. Starting the day after surgery, children must rinse their mouth after meals to keep it clean. It is important to keep fingers and the tongue away from the wound. It is important that children not swim for three to five days after the procedure to reduce the risk of infection.
Bony edges or small sharp bone fragments may work up through the gums during healing. These are not roots or parts of teeth. If they are noticed or if there are any questions about wound wound healing, the office should be contacted as soon as possible.
If the corners of your mouth are cracked or sore from the retractors used during surgery, keep them lubricated with Vaseline, Chap-stick, or Vitamin A & D ointment.
It is normal to have intermittent low-grade fever for a couple of days after surgery If a child’s temperature reaches 101 degrees or if the child appears sick or not doing well, Dr. Maranon should be contacted immediately.
Recovery after Intravenous Sedation or General Anesthesia
Children must supervised closely for 24 hours after surgery. They should rest on the day of surgery. Care must be take when children stand after sitting or lying down. This may cause lower blood pressure, dizziness, fainting, or falling. The should not stand for long periods of time on the first day. Drowsiness, nausea, and vomiting are not uncommon following intravenous anesthesia, and usually disappear after 24 hours. Children must not participate in activites that can cause harm or injury, until the day after surgery when they are not under the influence of anesthetic or prescription pain medications.
Post Operative Appointment
It is important to Dr. Maranon to evaluate every patient he treats after surgery to monitor their recovery. After their procedure, children are given a post-operative appointment in the our office. If an appointment is not made after surgery, parents should contact the office to arrange that appointment for 7 – 10 days after the surgery. If the post-surgical appointment must be changed, it is important to contact the office to reschedule. It is a very important appointment, even if parents feel their child is healing well.
Dr. Maranon hopes this information is helpful, and that the recovery from surgery is uneventful.