General Post-Operative Care

It is our desire that your recovery proceed as quickly and easily as possible. The effects of oral surgery can be quite variable so not all instructions will apply in all cases. Please read our instructions carefully, they should answer most if not all of your questions. Following these instructions will assist you, however, if you have any questions about your progress, please call our Norwood office: Norwood Office Phone Number 781-762-7077, or Mansfield office: Mansfield Office Phone Number 508-543-3754 / (508) 339-6200.

The primary goals of post-operative care after oral surgery are: control the bleeding, good nutrition, adequate pain management, excellent oral hygiene, and proper wound care. Good post-operative care is very important. The risk of infection, excessive pain and swelling can be minimized if instructions are followed carefully.

Immediately Following Oral Surgery

• To control bleeding apply direct firm pressure to the surgical site by biting on a moistened gauze pad placed over the surgical area. Direct pressure should be maintained for 30 to 60 minutes.
• After this time, the gauze pad should be removed and discarded.
• 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 pain medication as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
• Avoid strenuous exertion on the day of surgery.
• Immediate application of ice packs to the sides of your face where surgery was performed will help to minimize swelling and bruising.

Please review the more detailed instructions below.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is normal. Excessive bleeding may be controlled by first wiping away large clots from your mouth, then creating firm direct pressure on the surgical site by placing a moistened gauze pad over the area and biting firmly for 30-60 minutes; repeat if necessary. If bleeding continues, create direct pressure on the surgical site by biting on a moistened tea bag for 30-60 minutes.

Tea has tannic acid which is an astringent. The firm, direct pressure, and the tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, try to relax, sit upright, and avoid strenuous exertion. Slight blood-tinged saliva or blotting blood on gauze may persist off and on for a day or two after surgery. In general, this does not require management with gauze pressure. If active bleeding does not subside, please call the office for further instructions.

Swelling

Significant swelling and bruising will not occur in all cases. The amount of swelling, bruising, and jaw stiffness that one experiences is usually proportional to the extent of 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 is part of the healing process. Swelling may not become apparent until the day following surgery. If significant swelling is anticipated it can be minimized by the immediate use of ice packs. Baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed.

The chemical ice packs provided by our office should be replaced with real ice as soon as you arrive home. The ice packs should be used continuously or as long and often as possible while you are awake. Ice is most helpful during the first 24 hours following surgery. After 72 hours, ice has no beneficial effect. If swelling or jaw stiffness persists for several days, there is no cause for alarm; this is a normal reaction to surgery. Swelling will usually reach its peak approximately 72 hours after surgery; then it will begin to slowly improve.

Pain

For slight to moderate pain, one or two 325 mg tablets of Tylenol may be taken every four hours. Ibuprofen 200mg tablets (Motrin or Advil) may be taken as follows: two tablets every 4 hours, 3 tablets every 6 hours, or 4 tablets every 8 hours.

For severe pain, take the prescribed pain medication as directed. The prescribed pain medication may make you tired, impair your judgment, and slow down your reflexes. Do not drive an automobile or work with machinery while taking narcotic pain medication and avoid alcoholic beverages.

If the prescribed narcotic pain medication does not provide satisfactory relief, you can take ibuprofen (Advil, Motrin) along with the narcotic. Adults and adolescents may take two 200mg tablets every 4 hours, three 200mg tablets every six hours, or four 200mg tablets every eight hours. This can be taken simultaneously with the narcotic or between doses.

Narcotic pain relievers prescribed by Dr. Turesky are a mix of narcotic and Tylenol, so do not take Tylenol along with these pain prescriptions. You are already getting a full dose of Tylenol in your prescription, taking more will not help.

Many post-operative pain medications such as Tylenol #3, Percocet, and Vicodin contain narcotics. These medications can make you dizzy, sleepy, impair coordination and judgment. If you are taking narcotic pain medication you should remain at home. Do not operate complex equipment (such as a lawnmower), drive a car, or make important decisions while taking narcotic pain medication.

Dizziness

Caution: If you suddenly sit up or stand from a lying position you may become dizzy. Dizziness or fainting is caused by a drop in blood pressure which can be exacerbated by a sudden change in position. There are several factors that may be responsible for this during the early postoperative period including dehydration, low blood sugar, anxiety, pain or side effects from narcotic pain medication. If you are lying down following surgery, make sure you sit for one minute before standing; get up slowly. If you feel dizzy, lay down for several minutes, this will improve blood circulation to the brain and help to relieve dizziness.

Diet

After oral surgery, liquids should be consumed initially. Do not use straws, drink from a glass or cup. The sucking motion required to drink from a straw is often difficult to do after oral surgery. It is less efficient than drinking out of a cup and can cause more bleeding by dislodging the blood clot. Avoid hot beverages and hot foods on the day of surgery which can unintentionally burn you if the mouth is still numb or prolong bleeding. Cool or warm soft food such as yogurt, applesauce, ice cream, pudding, Carnation Instant Breakfast, juice, milkshakes, scrambled eggs, mashed potatoes, oatmeal, cream of wheat, cool or warm soup, very soft pasta (the consistency of Spaghetti-Os) is ideal on the day of surgery and during the first few postoperative days. On the first post-operative day, you may eat hot, warm, or cool food. Over the next several days you may gradually progress to more solid food such as fish, chicken, meatloaf at your own pace. If you experience pain while chewing go back to softer food for a day or two then try solid food again. Your body requires nourishment after surgery; high calorie, high protein intake is very important. Please do not skip meals; good nutrition is essential for good healing.

You should prevent dehydration by drinking fluids regularly. Your food intake may be limited during the first few days after oral surgery. You should compensate for this by increasing your fluid intake. At least 6 glasses of liquid should be consumed daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you are well-nourished.

Keep the Mouth Clean

If bleeding is well controlled, you may brush your teeth carefully and rinse gently the night of surgery. The day after surgery you should begin brushing your teeth at least twice a day using a soft-bristle toothbrush and toothpaste, and rinsing at least 5-6 times a day especially after eating. Rinse with a cup of warm water mixed with a half teaspoon of salt. If Dr. Turesky has prescribed Peridex (chlorhexidine) oral rinse, this may be started either the night of surgery or the next day. Peridex (Chlorhexidine) oral rinse should be used full strength, swished in the mouth for approximately one minute then spit out twice a day after brushing for 10 to 14 days. Full instructions will be found on the bottle.

Discoloration

In some cases, discoloration (bruising) 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 not be apparent until 2-3 days after surgery. Moist heat applied to the discolored area may speed up the removal of the discoloration. Do not use heat during the first 72 hours after surgery, this could increase swelling and bruising.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics are given in some cases to help prevent infection. Discontinue antibiotic use in the event of a rash, hives wheezing or other unfavorable reaction and call the office immediately. Women need to be aware that antibiotics may interfere with the effectiveness of oral contraceptives; other methods of birth control must be utilized during the remaining portion of the menstrual cycle.

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 juice, 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. Pain medication can be upsetting to the stomach. It is best to take pain medication with food in the stomach to help buffer the stomach.

Additional Post-Operative Considerations

If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. Please call our Norwood office at Norwood Office Phone Number 781-762-7077 or our Mansfield office at Mansfield Office Phone Number 508-543-3754 or 508-339-6200 if post-operative numbness persists for more than 24 hours. We would like to examine all patients who experience post-operative numbness within 10 days of surgery.

• Slight elevation of temperature immediately following surgery is not uncommon. If your temperature is 101 degrees F. or greater at any time, or a low-grade fever persists after the first twenty-four hours, please notify the office immediately. Tylenol or Ibuprofen may be taken to reduce the fever.
• Sleeping with the head slightly elevated by using an extra pillow during the first three or four nights after surgery will help ease the management of oral secretions and minimize swelling.
• Occasionally, patients may feel hard projections of bone at the surgical site with their tongue. These projections of bone usually smooth out spontaneously, if not, they can be removed by Dr. Turesky.
• Suture knots will often feel like hard projections in the mouth. Most sutures placed by Dr. Turesky are dissolvable and will fall out after several days.
• The corners of your mouth may become dry and crack. Your lips should be kept moist with an over-the-counter lip balm or Vaseline.
• Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for several days following surgery. This is a normal post-operative event that will resolve in time. Gentle exercise of the jaw by opening wide and stretching the muscles will help to clear up the trismus more quickly.
• If you have an orthodontic retainer, it should be worn after surgery as soon as it can be done comfortably, usually within three days post-operatively.
• There will be a small cavity or hole where the tooth was removed. This will gradually fill in with healthy tissue over the next four to six weeks.
• Please avoid drinking alcoholic beverages and smoking for at least three days after surgery, preferably a week. These activities can slow healing and promote increased post-operative pain.
• If you are involved in regular exercise it is important to understand that you may be weakened due to reduced nutritional intake. If you become light-headed or experience throbbing at the surgical site stop exercising, wait a day or two, then try again. Wait for swelling and pain to resolve before resuming your exercise program.
• It is best to walk, move about, and/or sit in a chair. Short naps in bed are acceptable. Lying in bed for a prolonged period of time during the day with minimal movement is not healthy; it only enhances your fatigue and slows your recovery. You will feel stronger and better faster if you get your body moving.
• No two mouths are alike. Do not accept well-intended advice from friends. Dr. Turesky is readily accessible through the office and available to answer any questions you have regarding your surgery or post-operative experience.

Sinus Precautions

The maxillary sinus is a hollow area in the upper jaw. It is located above the roots of the posterior (molars and premolars) maxillary (upper) teeth and below the eye socket. The maxillary sinus drains into the nasal cavity (nose). Some procedures in the upper jaw may result in an opening into the sinus cavity. If you are advised of this following your surgery, please follow these sinus precautions for two weeks. Patients who have had sinus lift grafts must follow these instructions for a minimum of four weeks. Do not blow your nose or hold your nose to suppress a sneeze. These activities will increase pressure within the sinus and could result in creating an opening from the sinus into the mouth. This would necessitate additional surgery to close the opening at a future date.

Flying in pressurized aircraft may also increase sinus pressure and should be avoided for at least two weeks. Scuba diving should be avoided for at least two months (sinus lift graft patients must avoid scuba diving for at least three months). Oral decongestants such as Sudafed, Drixoral, or Dimetapp should be used to help relieve sinus congestion and reduce pressure in the sinuses if necessary. The saline nasal spray is often helpful as well and may be used as frequently as necessary. Avoid playing musical wind instruments and blowing up balloons during this two-week period (at least four weeks for sinus lift graft patients) since these activities can also increase sinus pressure. Please do not smoke. An antibiotic will be prescribed if necessary. Please follow post-surgical oral hygiene instructions discussed earlier in this section.

Sutures

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help to heal. Dr. Turesky usually places dissolvable sutures which fall out by themselves. If the sutures become dislodged, this is no cause for alarm, just remove the suture from your mouth and discard it. Non-dissolvable sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. Suture removal takes only a minute and there is no discomfort associated with this procedure, so it’s really nothing to worry about. Some dissolvable sutures used in socket preservation grafts, sinus lift grafts, and other bone grafting procedures are long-lasting and may not fall out for two or three weeks.

Dry Sockets

A dry socket occurs occasionally after tooth extraction when the blood clot breaks down and becomes dislodged prematurely from the tooth socket. Symptoms of a dry socket typically present three to five days following surgery with sudden severe aching pain at the surgical site often with referred pain to the ear and/or forward into the jaw and teeth. Some people are more prone to developing dry sockets than others. Dry sockets are particularly common among people who smoke. Management includes oral pain medication, Peridex (chlorhexidine) oral rinse, sometimes an antibiotic is prescribed. If the pain is not adequately controlled with oral medication, a medicated dressing can be placed within the socket to help provide additional pain relief. Dressings require replacement approximately every three days until the pain subsides. Dressings should not be left in the sockets for more than five days at a time. All dressings must be removed. As healing proceeds over the next 10 to 20 days, the pain becomes more manageable; it gradually diminishes and eventually disappears.

After 72 hours your swelling should slowly start to improve and you should gradually start to feel better. If you do not feel that you are beginning to improve after 72 hours please call our office. If at any time you have any questions please do not hesitate to call our Norwood office: Norwood Office Phone Number 781-762-7077, or Mansfield office: Mansfield Office Phone Number 508-543-3754 / (508) 339- 6200. Please call during normal office hours if possible; however, we always have coverage twenty-four hours a day, seven days a week.