After the Removal of Multiple Teeth
The removal of many teeth at one time is quite different from the extraction of just one or two teeth. This is a serious surgical procedure that often includes the shaping and smoothing of bone in preparation for a denture. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.
Immediately Following Surgery
- If you received intravenous sedation or general anesthesia, you may feel drowsy for several hours. Remember do not drive a vehicle, operate any machinery, or undertake important matters for 24 hours following your anesthesia experience and plan to rest for the remainder of the day.
- Keep the gauze pad in place over the surgical site with firm biting pressure for one (1) hour. After this time, the gauze pad should be removed and discarded. A new gauze pad does not need to be placed unless bleeding continues or recurs.
- Avoid vigorous mouth rinsing, sucking on straws, smoking, and/or touching the wound area following surgery. This may initiate bleeding by dislodging the blood clot.
- Take the prescribed pain medications before you begin to feel discomfort. This will usually coincide with the start of the local anesthetic wearing off which typically occurs 4 to 6 hours after surgery.
- Restrict your activities the day of surgery and avoid exercise. Lie down upon returning home with your head elevated on two or three pillows or sit up in a recliner and take it easy.
- Place ice packs to the sides of your face where surgery was performed to help minimize swelling.
- Drink plenty of fluids – at least five to six glasses of water a day.
- If you received an immediate denture at the time of surgery keep this in place for 24-48 hours, until you see your general dentist.
A certain amount of bleeding is to be expected following the extraction of teeth. Slight oozing or blood-tinged saliva is not uncommon for the first 12-24 hours. Excessive or continued bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for an additional hour. Repeat as necessary. If you have an immediate denture in place you may have to remove the appliance to apply these instructions. If bleeding continues you may bite on a moistened black tea bag in the same manner. Tannic acid in the black tea helps blood clot by contracting bleeding vessels. To minimize further bleeding, try to remain relaxed, sit in an upright position, and avoid strenuous exercise. If bleeding does not subside, please call our office for further instructions.
Swelling is normally expected after most surgical procedures and is usually proportional to the extent of the surgery performed. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to surgery. Most swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, swelling and discomfort may be minimized by the immediate use of ice packs. Ice packs (bags of frozen peas work great) should be applied to the sides of the face where surgery was performed. These ice packs should be applied for 30 minutes on and 30 minutes off for the first 24 to 48 hours while awake. After 48 hours ice has no beneficial effect. Instead, the application of moist heat to the sides of the face may be helpful in reducing the size of the swelling more quickly. On occasion, some residual swelling may last a week or longer. If you are wearing an immediate denture and have to remove it withing the first 48 hours, you may not be able to replace it in your mouth for several days due to this swelling.
In some cases, discoloration of the skin may follow swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues of the mouth and face. This is a normal post-operative occurrence that may occur 2-3 days after the extraction of multiple teeth and will gradually fade away over the following one to two weeks.
Take the prescribed pain medications before you begin to feel discomfort. This will usually coincide with the start of the local anesthetic wearing off which typically occurs 4 to 6 hours after surgery. Taking pain medication on an empty stomach may cause nausea, so it is recommended to take the pills with food or drink. Pain medication may make you groggy and slow your reflexes. Do not drive a vehicle, operate any machinery, or undertake important matters while medicated. It is also best to avoid alcoholic beverages. If you do not achieve adequate pain relief you may supplement each pill with an over-the-counter pain medication such as ibuprofen. When appropriate you may transition from the prescribed pain medication to an over-the-counter pain medication such as acetaminophen (Tylenol) or ibuprofen (Advil/Motrin). Discomfort following surgery may increase on the second or third day following the procedure and should then improve each day thereafter. If pain persists or worsens after four (4) days, please notify the office as it may require attention.
Continuing to eat a nutritionally balanced diet is essential for feeling better, regaining strength, experiencing less discomfort, and more rapid healing after surgery. Try not to miss a single meal. It is understandable that your food intake will be limited for the first few days after your procedure. It is best to wait until your local anesthetic has completely worn off before beginning to eat. Start with plenty of fluids during the first 24 hours. At least five to six glasses of liquid a day will help prevent dehydration. Drink from a glass and do not use a straw as this encourage more bleeding by displacing a blood clot. Avoid hot foods and liquids the first day after surgery. Begin with soft cool foods and chew away from the surgical sites. It is best to progress to more solid foods and return to your normal diet as soon as possible.
Begin gentle, warm salt water rinses (1 teaspoon of salt in 1 cup of warm water) the morning after surgery. Rinsing with salt water at least 3-4 times a day, especially after eating, will help to reduce inflammation and will gently flush food particles away. If you have an immediate denture remember after the first 48 hours to remove it prior to rinsing. Dr. Conquest may prescribe an antibiotic mouth rinse to use in place of salt water and an irrigating syringe may also be provided for use starting a week after the procedure. Continue to brush your teeth 2-3 times a day as best you can – being careful to avoid the surgical sites for several days.
Antibiotics may be prescribed for certain patients after a surgical procedure to help prevent or cure an infection. If you have been placed on antibiotics, take the tablets or liquid as directed until gone. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. If you were prescribed an antibiotic and are currently taking oral contraceptives, you should use an alternate method of birth control for the remainder of this cycle.
Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least half an hour including prescribed medications. You should then slowly over a fifteen-minute period sip on coke, tea, or ginger ale. When the nausea subsides you can begin taking solid foods and the prescribed medicine again. Postoperative nausea is most often due to the prescribed pain medication. Remember to take this medication with food or drink. If nausea persists or you have trouble keeping anything down, notify the office as an anti-nausea medication and/or a change in pain medication may be necessary.
If persistent numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, this is almost always temporary in nature. It may persist for a few days to several months, but rarely is permanent. Should any numbness or altered sensation persist after the first 48 hours please notify our office.
Any time a tooth is removed there is always the possibility of developing a dry socket. Please notify our office if severe radiating pain develops between postoperative days 4 and 6 which is not relieved by your pain medication and is accompanied by a foul odor or taste in the mouth. Dry sockets are quickly and easily treated in the office and should not cause undue alarm.
What Else Should I Know?
If immediate dentures have been inserted after the extractions, sore spots may develop along your gum tissue. In most cases, your dentist will see you within 24-48 hours after surgery to make the necessary adjustments and relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.
You should be careful going from the lying down position to standing, upright position. You may get light headed standing up too quickly. Before standing up, you should sit for one minute, then get up slowly.
Slight elevation of temperature immediately following surgery is not uncommon. If an elevated temperature persists or a fever (>101.5) develops, please notify the office.
Keep your lips moist with chap stick or an ointment such as Vaseline. Due to stretching of the mouth during surgery, your lips may dry out and crack – especially at the corners.
A sore throats and pain when swallowing are not uncommon due to swelling and inflammation of the nearby muscles. This will usually subside in two to three days.
Stiffness (Trismus) of the jaw muscles may occur and cause difficulty when opening your mouth and during chewing for several days following surgery. This is a normal post-operative event which will resolve on its own after several days. Taking an anti-inflammatory medication such as ibuprofen (Advil/Motrin) may help.
You may have sutures in your mouth to minimize bleeding and to help with healing. If one or two of these sutures fall out early, there is no cause for alarm. Just remove the suture from your mouth and discard it. Unless Dr. Conquests informs you otherwise, the sutures we place will dissolve and fall out on their own in 1 to 2 weeks.
There will be holes where the teeth were removed. These depressions will fill in with new tissue gradually over the next month. Be sure to keep the areas clean with salt water or a tooth brush to promote better healing.
You may feel hard projections in your mouth with your tongue near your surgical sites. These projections are not forgotten tooth roots but the bony walls of the empty tooth sockets. These projections usually smooth out as the surgical sites heal. If not, Dr. Conquest will smooth them off.
If you are involved in regular exercise, please be aware that your normal nourishment intake is reduced and you may be dehydrated after surgery. Exercise may further weaken you. Please avoid strenuous exercise for 2-3 days following surgery.