After the Removal of Multiple Teeth

The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, bleeding, swelling and discomfort may be more significant.

If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.

The removal of multiple teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain, swelling and complications such as infection can be minimized if instructions are carefully followed. Avoid spitting, smoking or using a straw for 1 week.

Gauze

Leave gauze in place for a duration of 20-30 minutes. Apply constant firm pressure on the gauze – do not chew. It is not unusual to need to replace this gauze. Replace gauze every 20-30 minutes until the bleeding has stopped.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is expected. Excessive bleeding may be controlled by placing a gauze pad over the area and biting firmly (not chewing) for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes while placing ice over the face area. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. If a denture is place after multiple extractions  To minimize further bleeding, sit upright, and avoid strenuous exercise. If bleeding does not subside, call for further instructions.

Ice on the First Day

Place ice packs to the sides of your face where surgery was performed (30 minutes on and 10 minutes off, while awake). Refer to the section on swelling for explanation.

Swelling

The amount of swelling is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs may be applied to the sides of the face where surgery was performed. Ice is most beneficial when used during the first 24 hours following surgery. Jaw swelling or stiffness may persist for several days and is not a cause for alarm.

Pain

Do not take pain medicine on an empty stomach. If possible, take one dose of the prescribed pain medication prior to the local anesthetic (numbness) wearing off. Advil/Ibuprofen/Motrin may be taken as needed between scheduled doses of the prescription pain medication. Up to four Advil/Ibuprofen/Motrin tablets (800mg) may be taken every eight hours. The prescription pain medicine may make you a little groggy and slow down your reflexes. Do not drive an automobile or work around machinery while taking pain pills. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

Diet

After general anesthesia or I.V. sedation, drink plenty of liquids. Drink from a glass. Do not use straws for the first 2 days following surgery. The sucking motion may cause more bleeding by dislodging the blood clot. On the day of surgery, consume liquids, like soups and shakes, and advance to soft foods as tolerated. Work your way back into regular foods as much as you feel comfortable. Do not chew hard or crunchy foods like pretzels, carrots, chips or nuts for four weeks. Avoid food with small pieces like rice, which may become trapped in the surgical site. High calorie, high protein intake is very important. Nourishment should be taken regularly. Prevent dehydration by taking fluids regularly and increasing your fluid intake. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.

Keep the mouth clean

Avoid rinsing until the day following surgery. You can brush your teeth gently the night of surgery, but minimize rinsing. After 24 hours, begin gently rinsing following meals. Use warm salt water (¼ teaspoon of salt per 1 cup of water) and let the water and saliva drain out of your mouth over the sink. Do not spit. Vigorous spitting or touching the wound area following surgery may initiate prolonged bleeding and therefore should be avoided.

Discoloration (Bruising)

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively and take 2-3 weeks to resolve.

Antibiotics

If antibiotics have been prescribed, please take the tablets or liquid as directed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions or reactions.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then slowly sip on coke, tea, water or ginger ale over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. Call if nausea or vomiting persists.

Rest

Restrict your activities the day of surgery and resume normal activity when you feel comfortable. Avoid excessive physical activity like sports, exercise, bending over or heavy lifting for 3-5 days following surgery.

Other Complications

Slight elevation of temperature immediately following surgery is expected. If the temperature persists, notify the office.

Anesthesia and pain medicine can make you dizzy. Please be careful and move slowly when moving from lying down to standing. You may get light headed when you stand up suddenly. Before standing upright, allow your blood pressure to normalize for one minute in the sitting position.

If you feel anything sharp or unusual with your tongue, it is unlikely a tooth particle or tooth root. It may be a small piece of the bony socket wall or a stitch. These issues are usually self-limiting and will resolve on their own. However, if the sharpness persists, is painful, or is cutting your tongue, please call the office.

The corners of your mouth may feel dry or become chapped. Your lips should be kept moist with an antibiotic ointment, vaseline or lip balm.

Sore throats and discomfort when swallowing are common following surgery. This will subside in 2-3 days.

Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.

Finally

Sutures are sometimes placed in the area of surgery. Do not be concerned if they become dislodged. Most of the sutures used in our office are resorbable and will dissolve on their own.

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions.

There will be a hole where the tooth was removed. The space will fill in gradually with new tissue. In the mean time, the area should be kept clean especially after meals.

Please brush your teeth taking care to be gentle at the surgical sites.

A dry socket occurs when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of increased pain at the surgical site or pain to the ear may occur 2-5 days following surgery. Please call the office if this occurs.