Removal of teeth, post-operative instructions after tooth removal

Removal of teeth

The term extraction usually sends shivers up people's spines along with all sorts of thoughts of pain. The truth of the matter is that having a tooth pulled, even an involved one such as a wisdom tooth is not painful at all. An anesthetic such as Novocain (or Articain) is given.
After the tooth has been pulled there may be tenderness in the area where the tooth was. This is normal, having a tooth pulled is a form of surgery, and any area would be tender after such a procedure.
Your dentist / oral surgeon will give you complete instructions on care after the procedure has been performed and in a few days healing will be almost complete. Please speak with your dentist, he or she can answer any questions you may have and help make you more comfortable.

Post-operative instructions after tooth removal

Please note: These instructions are for the benefit of the dental patients treated by our office. Patients being treated by other dentists may receive the same instructions or instructions that have been modified based upon the individual care they have received. Should you be experiencing either unusual pain or swelling or both, please call your dentist immediately!

1. Bleeding is to be expected following extractions and other surgical procedures. The gauze that has been placed in your mouth before you left the office should remain in position for at least 45 minutes. At the end of the 45 minutes, please take two or three pieces of gauze, fold in half and if needed fold again and replace the gauze that is in your mouth and continue biting very firm on the gauze for another 45 minutes - total time biting on gauze is approximately 1 hours. Should the bleeding continue after this, repeat the process, placing gauze for another 45 minutes. Should there continue to be excessive bleeding do as follows:

wipe off excessively large blood clots with sterile gauze
place folded gauze over the bleeding area
bite firmly on pad and maintain gentle pressure for 45 minutes
contact the office or call the emergency telephone number if bleeding persists.

2. Pain. Some discomfort is normal following surgery. Please take two aspirin or TylenolT or AdvilT or other over-the-counter analgesic as soon as you arrive at home. Continue to take the analgesic every three to four hours at least for the first day to minimize any discomfort. If you have been given a prescription for pain medication, please take as directed (Do not drive, work with machinery, or drink alcoholic beverages for at least 6 hours after taking any prescribed pain medication). Some pain medications may make you nauseous and should be discontinued if this takes place. If you have a reaction to the medication, stop the medication and call the office immediately.

3. Antibiotics. If antibiotics are prescribed, take as directed. Be sure to take all the tablets prescribed. If any reactions occur, such as a rash or itching, discontinue all medication immediately and immediately call the office.

4. Rinsing. Do not rinse your mouth, do not spit and do not use mouthwash, as any of these will lead to a possible loss of the blood clot which protects the healing extraction site and will then lead to pain.

5. Swelling. Following surgery some swelling is expected. It will reach its peak on the second day following surgery and it will begin to resolve on the fourth day. To minimize swelling, apply a covered (with towel) ice bag to your face for 20-minute intervals, removing the bag for 10 minutes in between intervals. Continue ice packs for 4-6 hours after surgery.

6. Temperature. Following surgery it is quite common to have a slight elevation in temperature. Rest, 2 aspirin or TylenolT or other over-the-counter analgesic every 4-hour, and plenty of fluids will return temperature to normal. If you are taking pain medication, they will also aid in controlling fever and additional aspirin or TylenolT or other over-the-counter analgesic will not have to be taken.

7. Eating. A well balanced diet is important for proper healing. A soft, bland diet is suggested for the first few days. Drink plenty of fluids as soon as possible, especially if you have been given antibiotics. Avoid hot foods, hot liquid and avoid smoking for at least 48 to 60 hours after surgery. (Smoking will delay the healing process.)

8. Impacted teeth. The removal of impacted teeth is quite different from the extraction of erupted teeth. The following conditions may occur, all of which are considered normal:
¨ swelling and bruising can be expected. Minimize by using ice packs
¨ moderate to severe pain can be expected. Do not wait until the pain is severe to take medication. Have the prescription filled and take the first dose at once
¨ trismus (tightness) of the muscles may cause difficulty in opening the mouth. Should this happen, moist heat applied to the area should help. A sore throat may also develop
¨the corners of your mouth may dry and crack. Keep moist with ointment or petroleum jelly.

Dry socket

A dry socket can occur after a tooth has been extracted where the blood clot fails to form or disintegrates without undergoing organization. It can be accompanied by neuralgic pain but without suppuration (infection / pus). A dry socket usually occurs as a result of too much rinsing or "spitting" and thus the blood clot is dislodged or never really forms. The blood clot acts as a bandage over the recent extraction site. Symptoms can include a constant throbbing over several days - "it doesn't seem to go away". If you think that you have a dry socket, your dentist should be contacted.