Postoperative Instructions

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Oral Surgery Post-Operative Care

Following your oral surgery procedure, it is important that you take the appropriate care to manage pain and care for the surgical site. These instructions are provided to assist you with that care

READ ALL OF THE INSTRUCTIONS CAREFULLY.

Sometimes the after-effects of oral surgery are quite minimal, so not all of these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office for clarification at (425) 391-8284.

When You Get Home

• It is very important to follow the home care instructions provided to you for proper healing. Do not disturb the surgical area today.
• During the ride home, bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure that they remain in place.
• When you get home, remove the gauze and take your medication with food.
• Place fresh gauze on the surgical area and continue to firmly bite down.
• If active bleeding persists after one hour, replace the saturated gauze with enough new gauze to create pressure over the surgical site.
• Change the gauze every 30-60 minutes while awake. Be sure to remove the gauze before you eat, drink or sleep. Do NOT sleep with the gauze in your mouth.
• Continue to change the gauze until the bleeding stops. Bleeding may persist 3-4 hours after surgery.
• The gauze may be dampened to prevent sticking to the surgical area. 

Bleeding

• Intermittent bleeding or oozing is normal for 48 hours after surgery. It may be controlled by placing fresh gauze over the surgical area(s) and biting down firmly for 30-60 minutes.
• Elevate your head with a couple of pillows.
• Bleeding should never be severe. If it is, it usually means that the packs are being clenched between your teeth rather than applying pressure directly to the surgical area(s). Try repositioning fresh packs.
• If heavy bleeding persists or becomes very heavy, you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in moist gauze) for 20-30 minutes.
• If bleeding remains uncontrolled, call our office at (425) 391-8284.

Diet

• It is important to drink 8-10 glasses of water or other clear liquids each day. You may experience temperature intolerance due to dehydration if you do not drink enough clear fluids.
• Eat any nourishing food that can be taken with comfort.
• Avoid extremely hot foods.
• It is sometimes advisable, but not required, to confine the first day’s intake to bland liquids or purred foods (creamed soups, pudding, yogurt, milkshakes, eggs, pasta, etc.)
• Avoid foods like nuts, sunflower seeds, popcorn, gum, etc. for 7-14 days or until sockets or incisions close.
• Over the next several days, you may progress to solid foods at your own pace.
• DO NOT USE STRAWS FOR 7 DAYS.
• It is important that you do not skip meals!
• Decreased appetite following surgery is not uncommon; however, you will need to continue to take nourishment regularly. You will feel better, gain strength, have less discomfort and heal faster.
• If you are diabetic, maintain your normal diet as much as possible and follow any special instructions given by Dr. Narra or your physician regarding your insulin schedule.

Exercise Care

• No strenuous exercising for a minimum of 5 days following your procedure.

Swelling

• Often there is swelling associated with oral surgery.
• Minimize this by applying ice packs for the first 24-48 hours after surgery while awake. Apply the ice pack to the face or cheek adjacent to the surgical area for 20 minutes, alternating ice 20 minutes on the site and 20 minutes off of the site throughout the day.
• The swelling peaks on the 3^rd day after your surgery and starts to decrease after that.

Nausea

• Nausea is not an uncommon event after surgery and may be caused by stronger pain medications.
• Precede each pill with a dairy product or a small amount of soft food to reduce nausea.
• Try to keep drinking clear fluids and minimize the pain medication. Call our office if you do not feel better or if repeated vomiting is a problem.

Dizziness

• You may experience dizziness following your oral surgery. Be sure to request assistance while moving about after surgery to prevent injury.
• Do NOT drive if you are experiencing dizziness. 

Pain

• Most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication and an anti-inflammatory.
• When you get home, take the first pill before the numbness has worn off. This may help lessen the discomfort as the numbing subsides.

Day Zero

• This is the day of surgery. Follow instructions regarding gauze application, diet, medications and applying ice to the surgery area(s).
• Discomfort may be most intense for the first 6-24 hours; this is common after oral surgery. Pain should begin to subside after 24 hours.
• The surgical area(s) will begin to form a blood clot. It is important that you do not disturb the clot.

Day One

• Begin your normal oral hygiene routine (tooth brushing, etc.) 24 hours after surgery
• Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth comfortably.
• Do NOT rinse vigorously, spit or probe the area with your fingers or any objects.

Day Two and Beyond

• Keeping your mouth clean after surgery is essential.
• Use ¼ teaspoon of salt dissolved in an 8-ounce glass of warm water.
• Gently rinse with small amounts of the solution, taking five minutes to use the entire glassful.
• Avoid vigorous swishing or spitting.
• Repeat as often as you’d like, but rinse with saltwater solution 3-4 times daily for the next 5 days.
• Begin introducing more solid foods into your diet.
• DO NOT SMOKE for at least 72 hours! Smoking is extremely detrimental to the healing process and increases your risk of dry sockets.

Day Three and Beyond

• Moist, warm compresses may be applied to the skin over the surgical area(s), replacing the ice therapy. Use the same intervals, 20 minutes on and 20 minutes off.
• Application of moist-warm compresses combined with deep massage of the muscles will help decrease swelling, ease stiffness, minimize muscle spasm and soothe tender areas.
• It is important that you are able to open your mouth to 3 fingers width, massage will help with this. Gently open and close your mouth to minimize pain and discomfort.

Day Five and Beyond

•  Begin using your syringe filled with saltwater solution or diluted mouthwash on day 7. Use daily after every meal and before bedtime for a minimum of 3 weeks. Continue rinsing until all sites are healed, typically 4-6 weeks.
• If sutures (stitches) were placed, they will dissolve by themselves, typically in 5-7 days unless you were specifically told that non-dissolvable sutures were used.
• Sutures may loosen or come out prior to your next appointment if non-dissolvable sutures were placed.
• If you feel sharp edges in the surgical areas with your tongue, it is probably the bony walls that originally supported the teeth.
• Occasionally small slivers of bone may work themselves out during or after healing. Call our office if this occurs at (425) 391-8284.
• Normal healing after tooth extraction is as follows:
• The 2^nd-3^rd day of surgery is usually the most uncomfortable and there is some degree of swelling and stiffness.
• The 4^th day on should mark the remainder of your post-operative course.
• The 4^th and 5^th day you will generally be far more comfortable, although still may be swollen. You may usually begin a more substantial diet.
• If a DRY SOCKET occurs (loss of blood clot from the socket, usually on 3^rd-5^th day) there will be a noticeable, distinct, persistent throbbing pain in the jaw that often radiates toward the ear and along the jaw causing other teeth to ache.
• If you do not see steady improvement during the next few days, don’t suffer needlessly. Call the office and report your symptoms so that you can be seen as soon as possible.

Call our office immediately if you experience any of the following symptoms

• Excessive swelling
• Persistent pain that increases despite pain medication
• Increased muscle stiffness
• Increased redness
• Difficulty swallowing
• Increased difficulty in opening your mouth
• Fever and chills

It is our desire that your recovery be as smooth and pleasant as possible. To this end, these instructions are provided to assist you. If you have any questions about your progress, call our office at (425) 391-8284. Please try to reach our office during business hours as this will result in a faster response. A 24 hour answering service is available for after hours contact with Dr. Narra or the doctor on call.

Anti-inflammatory Medications

Take Ibuprofen first, wait 3 hours, then take the prescribed narcotic (pain medication) if needed. Continue alternating these medications as needed for pain. Take ALL medications with food to prevent upset stomach.