Post-Operative Instructions
PETER H. PRUDEN, D.D.S., P.C.
Diplomate of the American Board of Oral and Maxillofacial Surgery
Fellow of the American Dental Society of Anesthesiology
75 Prospect St. Rear Bldg, Huntington, New York 11743
Phone: 631-421-2471 Answering Service: 631-476-3304 Fax: 631-547-6809
www.drpeterpruden.com reception@drpeterpruden.com
INSTRUCTIONS FOR HOME CARE FOLLOWING
ORAL SURGERY OR EXTRACTION OF TEETH
Pain and Discomfort: A certain amount of pain following extractions is not uncommon. It may radiate from the jaw to the ear, throat, or side of the head. For pain, follow these instructions:
Take an over the counter non-narcotic, pain medication such as Advil (ibuprophen) 2-3 tablets every 4-6 hours or Tylenol (acetominophen) 2 tablets every 4 hours or the prescribed non-narcotic pain medications as directed.
It is best to take one of these non-narcotic pain medications before the local anesthesia wears off.
It is best to take any pain medication with food to prevent nausea and gastric distress.
As the local anesthesia wears off and you begin to feel some pain, take one of the narcotic pain medications prescribed (such as Tylenol # 3 or Vicodin (hydrocodone)).
If after waiting 30 minutes and the pain does not improve, take another one or one-half tablet of the prescribed narcotic pain medication. Do not take more than two of the prescribed narcotic pain medication in a 3-4 hour period. If the pain worsens, please call our office.
Clot: Do not disturb the clot. Its yellowish appearance and slight odor do not indicate an infected condition. Protect the clot from breaking down by avoiding hard foods and refraining from smoking.
Bleeding: You have just had oral surgery and a piece of gauze has been placed over the extraction site to stop bleeding. Remove the gauze after 20-30 minutes and replace with new gauze until bleeding stops.
If Bleeding Continues and is Extensive (Use Tea Bag Method – See Below):
Bleeding is expected following even the simplest extraction, and may last for about 24 hours. If bleeding is extensive, follow these directions:
Sit upright and avoid exercise. Rinse mouth gently with warm water only once.
Use clean gauze or tissue to wipe away all blood clots NOT IN THE TOOTH SOCKET.
Bite on a large piece of moistened gauze, tissue or paper towel placed directly over the socket. Pressure should be applied for 20 minutes. Repeat if necessary.
A TEA BAG (enclosed with your wisdom tooth instructions) may be helpful. The tannic acid in the tea acts as an astringent. The tea bag must be steeped by pouring a small amount of boiling water over it and let it COOL in a cup. The strong tea can be applied to the wound with a gauze pad or the cooled, dampened tea bag can be placed over the wound. Pressure should be applied for 20 minutes. Repeat if necessary.
Call our office if the bleeding persists. You may require additional suturing. If after hours, call the doctor’s service at 631-476-3304 to reach the doctor.
Swelling: Swelling is usually greatest after two days and often lasts for one week. It is not necessarily a sign of infection. An ice bag may be applied to the face for 20 minute intervals during the first 24 hours only. After 48 hours, a heating pad or hot water bottle may be placed against the face in the same manner that you have used the ice bag.
Dry Socket: Though the cause is unknown, 2-3% of dental extractions are followed by a condition known as "dry socket". Symptoms, which begin two to four days following extraction, include loss of the blood clot from the socket and moderate to severe pain. The treatment usually requires packing the dry socket with medicated gauze. If you think you are experiencing a dry socket, call our office for an appointment.
Sutures (Stitches): Dissolving sutures most likely were placed to close the surgical wound. If they are light in color, they are dissolving and will fall out after 2-3 days. If they are black, they are silk and will have to be removed by the doctor. We would have made a post op appointment in that case before you left our office.
Diet: Do not attempt to chew any solid food until the local anesthesia has worn off, you could bite your cheek, lip or tongue without being aware of it. Start with a clear liquid diet, such as tea, apple juice, clear broth, etc. If this is well tolerated, advance your diet beginning with soft foods which require little or no chewing such as: apple sauce, yogurt, soup, jello, pastina, scrambled eggs, pancakes, etc. Avoid chewing in the area of the operation. Eating an adequate diet is important for good healing. Drinking adequate fluids, 2 quarts per day, is important to prevent dehydration. However, DO NOT DRINK THROUGH A STRAW as this may dislodge clotting at the extraction site.
Skin Discoloration: Bruising of the skin near the surgical area and at the site of the intravenous injection may occur after a day or so. This will usually resolve on its own within a few days. Application of warm moist soaks to the arm at the IV site with elevation is advised. If the IV site should become red or painful, please contact the office.
Nausea: Nausea and vomiting may occur in certain individuals following general anesthesia. If this is the case limit your intake to clear liquids only, such as tea, water, soda, etc. until symptoms subside. Narcotic pain medication is known for causing nausea in many individuals, therefore, discontinue these and limit your pain medication to the non-narcotic pain medication such as Tylenol or Advil. If nausea and vomiting continues, contact our office and a prescription can be phoned in for an anti emetic suppository.
Fever: Your temperature may be elevated for the first 24-48 hours following treatment. Taking Tylenol every 3-4 hours; drinking plenty of fluids and getting adequate rest will help lower your temperature. If your temperature should persist, please notify our office.
Mouth Rinse and Tooth Care: You may rinse your mouth gently with a warm water or warm saline solution (one half teaspoon of salt in eight ounces of warm water), after eating and before going to bed starting on the second day. This will flush out particles of food debris which may lodge in the operated area. Do not use mouth wash or water pick. The other teeth should be brushed as usual, avoiding the area of the operation. Good oral hygiene promotes healing.
Rest: Avoid fatigue. Go to bed early and rest during the day. Avoid exercise, jogging, and running up and down stairs etc. By taking it easy you will minimize bleeding and promote healing.
Smoking: Use this opportunity to quit today. It increases bleeding, delays healing, and can cause a painful dry socket.
Bone Fragments: During the healing process, small sharp fragments of bone may loosen and work through the gum. These fragments, which are not roots, usually work out of their own accord; but if annoying, return to our office for their removal.
Numbness: Paresthesia (numbness or abnormal sensations of lip, tongue or gums) may occasionally occur after surgical removal of impacted teeth and other surgical procedures. This is a result of the proximity of the sensory nerves to the area of surgery. This will usually resolve in time, but occasionally may be permanent. Often soft tissue swelling at the surgical site may cause a temporary numbness, which will resolve as the swelling resolves.
Immediate Dentures: Patients with immediate dentures should not remove the dentures for 48 hours or until they return to their dentist for adjustment. Usually your dentist will prefer to see you approximately 24-48 hours after the extractions and placement of the immediate denture. If you should remove the dentures prior to the visit, swelling might take place which would prevent replacement of the dentures at that time.
Infections: If you were treated for an infection with a surgical incision and drainage procedure, it is not uncommon to be more swollen following the procedure due to surgical swelling. Apply warm moist heat to the swollen area of your face (to increase the circulation of antibiotics in the area). Warm to hot rinses should be performed as often as tolerated on the inside of the mouth to stimulate drainage from the infected site. The drain will probably be removed at your next appointment. If the infection should get worse and you are experiencing double vision or difficulty swallowing or breathing, please call our office immediately and/or go to the hospital immediately.
Birth Control Pill Warning: Please be advised that birth control pills are ineffective when taking antibiotics. Please use an alternate birth control method for the month. If you have further questions, please contact our office or your OB/GYN physician.
PLEASE CALL OUR OFFICE AT: 631-421-2471 during office hours below if you have any questions regarding your surgery or care. If necessary, additional instructions and information will be given. If you call during these hours, we can most effectively serve you.
Our normal office hours are:
Monday 9 am - 7 pm Thursday 9 am - 7 pm
Tuesday 9 am - 7 pm Friday 9 am - 7 pm
Wednesday 9 am – 7 pm Saturday 9 am – 2 pm
IF AFTER HOURS, PLEASE CALL OUR ANSWERING SERVICE AT 631-476-3304 and ask for the doctor to return your call. The doctor can be reached at any time 24 hours a day by calling our answering service. If you do not receive a response from us within 20 minutes, please call the answering service (631-476-3304) AGAIN and ask for the doctor to be paged. If any medical emergency should occur, please seek care at the nearest HOSPITAL for the following conditions:
If significant bleeding persists beyond four hours (more than oozing)
If your temperature remains elevated or goes above 101 degrees F
If there is any difficulty breathing or swallowing
If any allergic reaction to any medication occurs
If any other unusual signs or symptoms causes concern
The greatest compliment our patients can give us is the referral of their friends or loved ones. We appreciate your trust and confidence in our office team.