Multiple Extractions

After the Removal of Multiple Teeth

After extraction of teeth or other surgical procedures of the mouth, certain steps must be followed to minimize postoperative discomfort, and improve surgical outcomes.

Please read and follow the instructions carefully.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Persistent bleeding may be controlled by gentle rinsing or wiping any old clots from your mouth, followed by placing a folded gauze pad over the area and biting firmly for 45 minutes. Remember, it is the pressure over the surgical site, not the absorbency of the gauze that results in clot formation! Change the gauze packs every 45 minutes four or five times over three to four hours. If bleeding continues, make sure that the gauze packs are positioned directly over the extraction sites, and the patient is biting on the gauze with good firm pressure.

Elevating the head with 2-3 pillows or sitting up in a recliner will also help stop the bleeding by decreasing the blood pressure in the mouth.

If bleeding persists, bite on a moistened tea bag over the extraction site for 30 minutes. The tannic acid in the tea bag helps to form a clot.  To minimize further bleeding, do not become excited, sit upright or lay with your head elevated, and avoid exercise and strenuous activities. If bleeding does not subside, call for further instructions.

Pain

For severe pain, take the pain medication as prescribed. The prescribed pain medicine may make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, or increases after 36 hours, it may require attention and you should call the office.

For moderate pain, those patients who are able to take Ibuprofen (Motrin or Advil), taking 600mg by mouth every 6 hours as needed for pain is usually sufficient.

Some patients also find that Ibuprofen (Motrin or Advil) works well in conjunction with their prescribed narcotic pain medication. If the narcotics are not effective, try 600mg of Ibuprofen (Motrin or Advil) every 6 hours in addition to or in-between scheduled doses of the narcotic medication.

Remember, all pain medications have the possibility of causing an upset stomach.   To decrease the possibility of an upset stomach, always take your pain medications with some food when possible.

Nausea and Vomiting

Nausea can be caused by the anesthesia, the blood in your mouth and stomach from the surgery, or the prescribed pain medication. In the event of nausea and/or vomiting following surgery, stop taking 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 15 minute period. When the nausea subsides, you can begin eating solid foods. Before trying the prescribed medicine, try taking Ibuprofen or Tylenol for pain. There is less chance of nausea with these medications. You may find that they are completely effective at managing your discomfort.

If nausea and vomiting persist, please call the office for instructions.

Swelling

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 generally become apparent until the day following surgery and will not reach its maximum until at least 2-3 days postoperatively; however, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 12-24 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is usually a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face may be beneficial in reducing the size of the swelling.

It is normal to have generalized swelling for the better part of the week following wisdom teeth extractions. Should you have an increase in swelling after 72 hours, please give us a call for instructions.

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 postoperative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Diet

Initially, after general anesthetic or IV sedation, liquids should be taken. Do not use straws for at least 5-7 days. Drink from a glass. The sucking action through the straw 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. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days so 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.

Keep the mouth clean

Until the day following surgery, no vigorous rinsing should be performed. You can gently brush your teeth the night of surgery but remember to rinse gently. The day after surgery, begin gentle rinsing at least 5-6 times a day, especially after eating, using a cup of warm water mixed with a teaspoon of salt.  If your doctor has prescribed any special mouth rinses, perform these rinses as directed.

Antibiotics

If you have been placed on antibiotics, take them as directed. Antibiotics may be given to help prevent infection or treat an existing infection.  Most patients, however, do not need antibiotics. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and please notify the doctor. Call the office if you have any questions.

Dry Sockets

A dry socket is a condition that occurs when the blood clot dissolves or gets dislodged prematurely from the extraction socket. It results in increased symptoms of pain at the surgical site that often radiates to the ear. If a dry socket occurs, it typically occurs 4-7 days following surgery. They are not dangerous but can be very painful requiring attention. If you experience increased symptoms like these, call the office as soon as you can if these symptoms occur as it can be treated more easily if caught early.

Infection

Infection following multiple extractions is very rare, but can occur. Typically, this will occur 2-5 days following surgery. Signs and symptoms include increased swelling after 3 days or failure of the swelling to begin subsiding after 4 days along with increased pain or development of a fever. Infection is typically managed by antibiotics, but can sometimes require drainage or other procedures. Should you experience these, please call the office for instructions.

Other Conditions or Complications

  • 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. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation, so be careful. If the numbness continues after 72 hours, please call the office for instructions.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists after 48 hours, notify the office. Meanwhile, Tylenol or Ibuprofen should be taken to reduce the fever.
  • You should be careful going from the lying down position to standing. Taking pain medications can make you become lightheaded/dizzy, or to faint since you haven’t been able to eat or drink normally. Before standing up, you should sit for one minute, then get up.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are either the bony walls, which supported the tooth or the stitches. These projections usually smooth out spontaneously. If not, they can be removed by the doctor.
  • If the corners of your mouth were stretched, they may become chapped, dry out and crack.
  • Your lips should be kept moist with an ointment such as Vaseline.
  • Sore throat 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.
  • 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 generally resolve over one week.

Finally

Dissolvable sutures are typically placed in the area of surgery to minimize postoperative bleeding and to help healing. They are intended to last between 2-14 days on average. Eventually, they will become dislodged. When this happens, there is no cause for alarm; just remove the loose portion of suture from your mouth and discard it. In spite of the use of stitches, there will still be a hole where the tooth was removed. The hole will gradually heal over the next month and 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.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get lightheaded, stop exercising.  Ask the doctor about when you can begin exercising and what exercises are appropriate while you heal.