After Exposure and Bracketing of An Impacted Tooth
Do not disturb the wound. If surgical packing was placed, leave it alone. The packing helps to keep the tooth exposed. If it gets dislodged or falls out do not be alarmed.
BRACKET: If you have a chain and bracket in your mouth, be careful while eating and brushing your teeth around the area. If the chain or bracket comes loose, contact our office.
PRESCRIPTION MEDICATIONS: It is essential that you get something soft and cold to eat or drink immediately after the surgery. Start the pain medication AFTER you get something to eat or drink but BEFORE the pain sets in. Start your next dose of antibiotics a couple hours after you start taking the pain medication. If you have been given a prescription Vistaril 50mg, this medication has 3 functions: taken with your Percocet or Vicodin, it acts as a booster to help with the pain, helps to prevent any nausea, and also works as a sedative to help you sleep. Take the antibiotics as instructed until they are finished.
For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed.
EATING: Make sure to take the gauze out while eating. For the first 24 hours after surgery soft COLD foods are best, eat/drink. After the first day, soft warm things are fine. Examples of soft foods to eat: ice cream, milkshakes, pudding, Jello, yogurt, smoothies, applesauce, soups, mashed potatoes, scrambled eggs, soft cooked cereals, pasta. Make sure to drink plenty of fluids. Continue to stay on a soft diet for the 1st week after which you can usually slowly advance your diet as it pertains to your situation. Nothing hard like (chips or nuts) for 3 weeks.
- Using straws for 3-4 weeks following surgeries
- Foods with small seeds, berries, popcorn, nuts, chips, or grained bread that may get lodged in the socket areas.
- Alcohol or carbonated drinks for 4 days following surgery – can increase the possibility of prolonged bleeding
GAUZE PACKS: You will have gauze tucked in at the extraction sites. The gauze will help control the bleeding after surgery. Take the gauze out when you eat and replace with new gauze after eating. You should have received a packet that contains individual pieces of gauze. When changing the gauze, take one individual piece of gauze, fold it in half, then fold that in half again and then place them over the surgical areas. Instruct the patient to bite down on the gauze and maintain good, firm pressure. Remind the patient every 5-10 minutes to keep biting firmly on the gauze because they will tend to relax and not bite down. If the gauze is light red, it generally implies that the majority is saliva mixed with a little bit of blood and is not a problem, therefore it may not require changing yet. Keep an eye on the gauze and replace when it becomes dark, red and heavily saturated. It is normal to experience some bleeding following surgery throughout the first 24 hours after surgery, however there should be a trend that it will taper down. In general the gauze should be removed before the patient goes to bed for the night, however sometimes the gauze can be removed earlier in the day and remain out, if the bleeding has stopped. If bleeding continues after that, you may have the patient bite down on a dry Lipton tea bag over the surgical site for 1 hour while applying pressure. Contact our office if bleeding persists.
ICE PACKS: Ice packs should be applied on the outside of the face immediately after surgery, on each side where there were extractions for 3 days following surgery. Have the patient ice as much as they can tolerate for the first 3 days, which will help to minimize the swelling, (crushed ice, frozen peas or corn) wrapped in a damp towel. Have the patient wear a hooded sweatshirt and tuck the ice packs on each side so they can stay in place while the patient is resting.
MOIST HEAT: On the 4th day, apply warm moist heat to the surgical areas on the OUTSIDE cheek area of the face (moist hot towels, hot water bottle, heating pad). This will help to soothe those tender areas. This will help to decrease swelling and stiffness.
SWELLING: It is normal following surgery for swelling to occur. The peak swelling day is on the 3rd day. After 3 days the swelling should slowly decrease. Swelling that increases after the fourth day of surgery should immediately be brought to the attention of our office. You may swell More or Less than average during this period but you will swell and don’t be alarmed.
RINSING: Do Not do any rinsing, spitting or sucking for 24 hours following surgery since this could prematurely dissolve the blood clot. Keeping your mouth clean after surgery is essential.
Warm Salt Water: Warm salt water GENTLE rinsing is important to start 2nd day after surgery. After the 48 hour period, more vigorous rinsing is advised. Mix a small amount of warm water and some table salt to rinse around in your mouth for 30 seconds to 1 minute and then gently spit out. Do this as frequently as you can throughout the day (10-15 times a day if you can). Make sure to rinse after any meals or snacks throughout the day. The more rinsing you do, the cleaner the areas will be and help with the healing. Avoid doing this within 1 hour of rinsing with the Peridex rinse. *Continue doing salt water rinsing for 4 weeks
Peridex Rinse: We have prescribed you an antibiotic rinse to start using the following day after surgery. This is to be used twice a day (once during the day and once right before bed). Try to use this rinse right before bed to ensure it stays on the tissue. Do not eat or drink anything 1-2 hours after you use the rinse.
*After you return for your post-op appointment and are given further instructions, you still need to continue using the Peridex rinse however, rather than rinsing your entire mouth, apply a small amount of the Peridex using a (q-tip, toothbrush, or syringe) to the surgical areas only. Peridex can leave a residual stain on your teeth if you use it for any prolonged period of time- longer than 1 ½ – 2 weeks.
TOOTH BRUSHING: You may brush your teeth starting the day after surgery, but avoid the surgical areas to prevent disruption of the blood clot. Once you return to our office 7-10 days later, it is necessary that you brush on the surgical areas to help with the healing and keeping the areas clean.
SMOKING: DO NOT SMOKE or use other tobacco products for at least 24-48 hours and ideally to go as long thereafter without smoking, since it is very detrimental to healing. SMOKING WILL INCREASE PAIN AND DELAY HEALING. IT IS DIFFICULT TO CONTROL PAIN CAUSED BY WOUND DAMAGE CAUSED BY TOBACCO PRODUCTS.
SUTURES: A variety of sutures may have been used as a part of your treatment. The sutures will either dissolve on their own or come out on their own (usually within 7-10 days) or be removed at the appropriate postoperative appointment. Do not try to remove or pull on the sutures. Sometimes these will come out at different times but that is normal.
ACTIVITY: Avoid excessive physical activity during the immediate post-operative period (1 week). Use caution in your activities during the time you are under the influence of pain medication. Obtain adequate sleep.
Musical Instruments: If you play any musical wind instruments, the general guideline is to avoid playing them for 1 week after surgery.
Contact Sports: Ease into physical activity and don’t do anything that would risk the face being bumped or hit (basketball, football, wrestling or other contact sports) for at least 1 week.
Retainers:If you normally wear a removable orthodontic retainer, typically you can resume wearing it as soon as it is comfortable for you. Usually keep out 1-2 days then resume wearing.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office. Please try to call during office hours; however a 24-hour answering service is available for after hours contact with a doctor. The after hours telephone number is (253) 770-1000.