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, the following conditions may occur, all of which are considered normal:

The area operated on will swell reaching a maximum in two days. Swelling and discoloration around the eye may occur.
A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
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.

Immediately Following Surgery

The gauze pad placed over the surgical area or between your dentures should be kept in place for two hours with gentle pressure. After this time, the gauze pad should be removed and discarded. If there is continued bleeding, a new gauze should be folded and re-inserted. This process may need to be repeated several times until the amount of bleeding becomes minimal.
Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
You may begin drinking clear liquids as soon as comfortable.
Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive 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 two hours. Repeat if necessary. If bleeding continues, you may subsitute a moistened tea bag instead of gauze. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling

The swelling that is normally expected 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 should be applied to the sides of the face where surgery was performed. The ice packs should be on for 20 minutes then off for 20 minutes while you are awake. After 36 hours, ice has a minimal effect. Swelling or jaw stiffness is a normal response to surgery, there is no cause for alarm unless you feel that it is increasing with time. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

Unless there is a contraindication (bleeding disorder, kidney disease, stomach problems), you should begin to take Ibuprofen as soon as your are able – well before the local anesthesia begins to wear off. Tylenol (Acetaminophen) may be taken instead of Ibuprofen, but this should not be combined with the stronger prescribed pain medicine as this medicine already contains Acetaminophen. Ibuprofen however, may be combined with the stronger prescribed pain medicine as these two medicines act on you body in different ways. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 4-6 hours as needed for pain. For severe pain, the prescribed medication may be taken as directed. Do not take any of the above medication if you are allergic to it, or have been instructed by a doctor not to take it.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. While taking: do not drive an automobile or operate any potentially dangerous machinery for 24 hours. Do not drink alcoholic beverages in combination with pain medicine. 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 anesthetic or I.V. sedation, clear liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. After three hours, you may drink full liquids (milkshakes, protein shakes, etc.) or have anything that you do not have to chew (yogurt, ice cream, scrambled eggs, etc.). Smoothies are not a good choice because they may contain small seeds and particles. High calorie and high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.

Discoloration

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. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

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 sip on a “flat” carbonated beverage, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods. Nausea is most often caused by the prescription pain medicine; minimizing your use of this will result in less nausea.

Other Complications

If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call Dr. Ericson if you have any questions.
Slight elevation of temperature immediately following surgery is not uncommon and often indicates that you are dehydrated. Tylenol or Ibuprofen should be taken to reduce the fever, and you should increase your intake of clear, non-caffeinated fluids. If the temperature persists, notify the office.
You should be careful going from the lying down position to standing. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
Occasionally, patients may feel hard projections in the mouth with their tongue. They are not parts of a tooth, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Ericson.
If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as vaseline.
Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. 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 as the inflammation surrounding the surgical area subsides.

Finally

Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm.

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 the office for instructions.

There will be a cavity where a tooth was removed. The cavity will gradually close over the next month and fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses or as instructed by Dr. Ericson.

Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your problem with the person best able to effectively help you: Dr. Ericson.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. Start out very lightly. If you get light headed, stop exercising and allow additional time before re-attempting