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Oral Surgery Post Care Guide

 

 

 

Dr Ramzi Matar (Winter Park Dentistry):

Hello everybody, this podcast is about post operative instructions and after surgery. If you’re watching this and you’re one of my patients, it’s because you had surgery today, and if not, if you’re watching this anybody else, feel free to take this as general advice for how to manage after you have dental surgery. Generally I’m speaking of tooth extractions, in this case, not any more complicated mouth surgery.

First thing you need to worry about is your numb lip, you’re going to leave pretty numb, and sometimes your lips are also numb. Specifically on bottom teeth, you’re usually numb on the lower lip, so you have to be very careful not to chew food, and if you are, you have to be very careful not to chew your lip. It’s very painful to chew up your lip, you’ll have no idea you’re chewing on your lip when you’re numb, and you’ll find out a few days later because the lip will swell up and it looks terrible when you chew up your lip. So be very careful, preferably do not chew anything, have a milkshake, have some ice cream, have some oat meal, soft-boiled eggs, something like that, certainly until the numbness wears up. If you have to eat, ice is a good idea, lots of ice, keep ice on there on and off, frozen food, if you have a specific ice bag, that’s going to reduce the chance of swelling, usually the best for the first two or three hours after surgery.

You should leave the office with gauze, biting down, you want to keep pressure on the site, that’s what helps control the bleeding. So you want to use the gauze and pressure generally the entire day and into the night, until maybe bed time, once you make sure the bleeding’s under control. Generally speaking you’re going to see the blood pinker, which means it’s becoming less blood and more saliva, and as you change out the gauze you’ll find that there’s less and less blood, until there comes in a soft pink trouble. If you’re having trouble with the bleeding, one thing you can try is take a tea bag, soak it in some water, just to get the tea saturated in water, and bite on that. Black tea has what’s called tannins, and that helps stop the bleeding as well, if you’re having trouble after several hours.

Pain, you want to manage your pain with pain medicine, mostly. Ice does help, but you want to start thinking of pain medicine as soon as possible. You ideally do not want to wait for the pain to set in. You want to take Advil or Tylenol, usually I’m giving my patients Tylenol, before the surgery. If not, if you have a prescription, or what not, but usually get whatever you can on board, before the numbness wears off. It is a lot easier to keep away, than it is to get rid of once it sets in. So definitely stay on top pain medicine. I usually tell people, use it for two or three days, even if it’s just Tylenol or Advil if you have to work or drive, because pain will usually peak about two or three days after surgery. What that means, if you’ve ever worked out or injured yourself with some sort of exercise, you probably remember it’s not until two or three days after your work out or climbing upstairs or your run, that your muscles really get sore. So that achiness sets in after about two or three days. So you get a false sense of security, a lot of people call the next day saying they feel great, no problems. Two or three days later they’re coming back with a lot of pain, because they stop taking their pain medicine and they felt like they were going to be fine but the reality is two or three days, you want to stay on top of pain medicine. Same thing with exercises and smoking, again, lots of people, go home, feel fine, the next day I talk to them, “yes I’m out”, and I say “Gee, I really would like for you to not exercise, I don’t want that blood pressure going back up, because you can start bleeding a day later. Not as common, but you can”. Specifically, with exercise, a lot of times they’ll get back into their jogging or running or whatever their form of exercise, and two or three days later, after the pain seems to subside, it starts peaking again, so be more careful with that.

Cleaning it. People sometimes do not want to clean the site, because it hurts or they’re afraid of ruining something. Best thing to do is, if you can get what’s called a Monoject Syringe, or an Irrigation Syringe, you can get one at my office, I typically give them out or if not you can get them at any drug store, it looks like a little syringe, with a little tip on it that’s not sharp, and you can just rinse out the area with some salt water, or just plain water. The idea is just to get any food debris out of it. You don’t have to go jamming it into the site, you just got to lightly rinse it off. If you don’t have that, you can use a cue tip, a wet cue tip, works pretty well, if you’re afraid that toothbrush would be too tough. But you want to start cleaning it that night, you don’t want to be too aggressive, but you do want to keep it clean as that’s how infection sets in.

Stitches. Usually you have about a week’s worth that the stitches are in there. In general, certainly at my office, most commonly the stitches will come out on their own, so often times what I find is people come back a week later and what’s annoying them is the stitch. Everything else feels fine, and they say “boy, I have this piece of celery looking” – you know, the little strands of celery that’s stuck in there and that’s annoying you and your tongue. It’s constantly playing with the stitch, and that’s often times what’s remaining a week later, it’s that stitch and it’s kind of annoying and they want me to cut it out or they’ve cut it out sometimes, but the reality is that stitch will generally almost always come out on its own. And I probably would not advise for you to try cutting it out on your own. But often times, a week later, if you come by to see me, I’ll take it out if everything looks to be okay. Of course, generally people tell me “well how long is it going to hurt?”, usually I say 7 to 10 days is about normal, again, it peaks around 3 or 4 days, and it starts gradually tapering away. A week later, which is when I usually see my patients back, they'll probably report “I have like a bruise” or feel like a bruise, they’re generally eating what they want again, I try to have them avoid things like popcorn, because the shells can get in there, or pretzels, some things that can be sharp, I try to have them avoid that for maybe two weeks. But in general, about a week later, you’re doing fine. Always, always, if things take a turn for the worse, you have pus come out, I want to say a “bad taste” but sometimes you have a bad taste just because of your blood, but if pain has gone away after three or four days and it comes back significantly on day five, or six or seven, it is time to give my office a call, if you’re my patient, or your dentist or your oral surgeon, whoever, a call. Because generally a week later, if things have taken a turn for the worse, it’s that sometimes some food got in there, maybe it’s getting infected. It usually can be resolved easily. Hope this helps, thank you.