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After Tooth Extraction

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Post-Operative Instructions
After a Single Tooth Extraction
The removal of a single tooth can be very simple or may be complicated depending on the circumstances of your case. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully. If your tooth was a simple or surgical extraction, please follow these directions
Immediately following surgery:
Bite on the gauze pad placed over the surgical site for an hour. After this time, the gauze pad should be removed and discarded and replaced by another gauze pad.
Avoid vigorous mouth rinsing or touching the wound area following surgery. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
To minimize any swelling, place ice packs to the sides of your face where surgery was performed. 
Take the prescribed pain medications as soon as you can so it is digested before the local anesthetic has worn off. Having something of substance in the stomach to coat the stomach will help minimize nausea from the pain medications.
Restrict your activities the day of surgery and resume normal activity when you feel comfortable. If you are active, your heart will be beating harder and you can expect excessive bleeding and throbbing from the wound.
A certain amount of bleeding is to be expected following surgery. On the skin where the surface is dry, bleeding clots in 10 minutes. In the mouth where things are wet, it takes 6-8 hours for the clot to gel up and the bleeding to subside. Slight bleeding or oozing causing redness in the saliva is very common. For this reason, the gauze will always appear red when it is removed. Saliva washes over the blood clots and dyes the gauze red even after bleeding from the sockets has actually stopped.
Excessive bleeding may be controlled by first GENTLY rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for sixty minutes. Repeat as necessary.
If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. This can be repeated several times.
To minimize further bleeding, sit upright, do not become excited, maintain constant pressure on the gauze (no talking or chewing) and avoid exercise.
If bleeding does not subside after 6-8 hours, call the dentist for further instructions.
The swelling that is normally expected is usually proportional to the surgery involved. Simple tooth extractions generally do not produce much swelling so it may not be necessary to use ice at all.
If there was a fair amount of cheek retraction involved with your tooth extraction, then it would be appropriate to apply ice on the outside of the face on the affected side. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively.
The swelling may be minimized by the immediate use of ice packs. Sealed plastic bags filled with ice, ice packs, should be applied to the side of the face where surgery was performed.
The ice packs should be applied 20 minutes on/20 minutes off for the afternoon and evening immediately following your extraction. After 24 hours, ice has no beneficial effect.
Thirty-six (36) hours following surgery the application of moist heat to the side of the face may help some in reducing the size of any swelling that has formed.
If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. Soft, puffy swelling that you can indent with your finger after oral surgery is very normal.
Bright red, rock hard, hot swelling that does not indent with finger pressure which is getting bigger by the hour would suggest infection. This usually would develop around day 3-4 after surgery when you would expect swelling to be going down, not up.
Pain or discomfort following surgery is expected to last 4-5 days. For many patients, it seems the third and fourth day may require more pain medicine than the first and second day. Following the fourth day pain should subside more and more every day.
Many medications for pain can cause nausea or vomiting. It is wise to have something of substance in the stomach (yogurt, ice cream, pudding or apple sauce) before taking prescription pain medicines and/or over the counter pain medicines (especially aspirin or ibuprofen).
For severe pain take the tablets prescribed for pain as directed.
If prescription pain medications are required beyond 4 days, further treatment may be indicated
Antibiotics are NOT given as a routine procedure after oral surgery. The overuse of antibiotics leading to the development of resistant bacteria is well documented so careful consideration is given to each circumstance when deciding whether antibiotics are necessary. In specific circumstances, antibiotics will be given to help prevent infection or treat an existing infection.
If you have been placed on antibiotics take the tablets or liquid as directed. You should take them on schedule until they are completely gone.
Discontinue antibiotic use in the event of a rash or other unfavorable reaction.
Drink plenty of fluids. Try to drink 5-6 eight glasses the first day.
Drink from a glass or cup and don’t use a straw. The sucking motion will suck out the healing blood clot and start the bleeding again.
Avoid hot liquids or food while you are numb so you don’t burn yourself.
Soft food and liquids can be eaten on the day of surgery. The act of chewing doesn’t damage anything, but you should avoid chewing sharp or hard objects at the surgical site for several days.
Return to a normal diet as soon as possible unless otherwise directed. You will find eating multiple small meals is easier than three regular meals for the first few days.
You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
Oral Hygiene:
Good oral hygiene is essential to proper healing of any oral surgery site.
You can brush your teeth the night of surgery but rinse very gently. Vigorous rinsing should be avoided until the day following surgery.
The day after surgery you should begin rinsing at least 5-6 times a day especially after eating. Salt water (cup of warm water mixed with a teaspoon of salt) is ideal but plain water is also OK.
Mouthwash has an alcohol base to it so it may be pretty “zingy” when it comes in contact with fresh oral wounds. After a few days, dilute the mouthwash in half with tap water and rinse out your mouth. This will make it taste and smell better. You can gradually build up to full strength mouthwash as you feel more comfortable.
No smoking for 48 hours after surgery. Smoking retards healing dramatically. Nicotine constricts blood vessels which slows the formation and expansion of the healing blood clot in the socket. This leads to the painful complication called a “Dry Socket”.
Therefore, if there is any question about smoking.....DON'T DO IT.
You should keep physical activities to a minimum for 6-12 hours following surgery.
If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising.
Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.