The after effects of oral surgery vary per person, so not all of these instructions may apply to you. After surgery post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if these instructions are followed carefully.

Do not disturb the surgical area

• Don't drink with a straw.
• Don’t rinsing or spitting for 48 hours as this may elicit bleeding.   
• Don't pull on your lip to examine the surgical site or probe the area with your tongue, any objects, or your fingers. This could cause the stitches to loosen, or open the incision which can jeopardize and delay healing
• Don't smoke for at least 2-3 days after surgery as it will delay healing.

Bleeding

Slight bleeding for a number of hours following surgery is not unusual. Your saliva may be tinged with blood for up to 48 hours. If heavier bleeding is still present a few hours after surgery, place a gauze over the surgical area and bite down firmly for 30-60 minutes. If bleeding persists, this may be due to the gauze pads being clenched between the teeth rather than exerting pressure on the surgical site. Try repositioning the gauze. If bleeding persists or becomes heavy, please call our office.

Swelling and bruising

Swelling is to be expected and usually reaches its maximum in 48 to 72 hours. To minimize swelling, cold packs or an ice bag wrapped in a towel should be applied to your face over the surgical area. This should be applied for 20 minutes, then remove for 20 minutes, and repeated during the first 12-24 hours after surgery. After 24 hours, it's best to switch from using cold packs to applying a moist warm heat to the area until swelling has gone down. Those who bruise easily may anticipate some discoloration of the skin (bruising). It usually takes a week for the discoloration to completely disappear.

Wound care

Starting the day after surgery, start rinsing your mouth with warm salt water (1/2 tsp. salt with 1 cup water) every 2-3 hours. Continue this for several days, then rinse 3-4 times a day for the next 2 weeks. You may start gentle tooth brushing the day after surgery, except in the operated area. Rinse your toothbrush under hot water to soften the bristles and avoid vigorous rinsing. It's important to keep your mouth clean, since accumulation of food or debris may promote infection.

Rest for a few days

Bed rest immediately after surgery with the head elevated by a pillow is also recommended. By limiting your activity on the day of surgery, you will significantly limit the degree of swelling. Trying to do too much too fast increases the swelling which increases your pain. You should be able to resume light activity in a day or two. If you become lightheaded, you should stop exercising immediately.

Diet

Increase your fluid intake (no straw) after surgery and maintain a soft diet. Avoid carbonated beverages (soda) and very hot foods or drinks. It may be hard to chew and open your mouth due to tightness of the jaw mussels. This should improve gradually over the next week. Keep your lips moist with cream or vaseline to prevent cracking. A nutritious but soft diet throughout the healing period is very important for your comfort and healing.

Medications

Please discuss all prescribed, holistic and over the counter medications you are taking with Dr. Banks. If Dr. Banks has prescribed pain medication for you, please take these medications ONLY as prescribed. Otherwise you may use an over the counter medication such as acetaminophen or ibuprofen, providing you have no allergies or take medications that may cause drug interactions. If you have questions regarding possible drug interactions, please ask Dr. Banks or your pharmacist before taking them. After surgery we recommend that you take your pain medication as soon as possible. Be sure to eat something before taking the pain medication to help your stomach. After the initial dose take the pain medication on a schedule for the first 24 hours. For moderate pain take Ibuprofen (Advil, Mortin, Nuprin). Ibuprofen works very well for discomfort following oral surgery. Ibuprofen is most effective if you take it on a schedule. You should take 600 mg of Ibuprofen (3 of the 200 mg tablets) every 6 hours with food for the first 3 days following surgery. You may find that this is the only pain medication you need; however, you may take your pain medication as directed for “breakthrough” pain. The prescribed pain medication may make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists (throbbing, aching, keeping you up at night pain), it may require attention and you should call the office. If Dr. Banks has prescribed other medications, such as antibiotics, steroid medications for swelling or prescription mouth rinse, follow the directions exactly. You may be prescribed an antibiotic after surgery. Please take the medication as instructed. Failure to take them as directed may increase your risk of infection. If you were prescribed an antibiotic and currently taking an oral contraceptive you should also use an alternate method of birth control for the remainder of your current cycle. If you develop severe or persistent diarrhea, please call us. If you notice rashes, hives flushing or any other side effect of the medications call the office immediately. If you suspect you are having a severe allergic reaction with difficulty breathing, swallowing or drooling call 911 and seek emergency care immediately.

Other Instructions

Sinus precautions

Because of the close relationship between the roots of the upper teeth and the sinus, an opening between the sinus and the mouth sometimes results from surgery. It sometimes heals slowly and with difficulty. If you notice an unexpected flow of air or liquids between your mouth and nose, please let us know immediately. Certain precautions will assist healing, and we ask that you faithfully follow these instructions:

• Do not forcefully blow your nose for at least 2 weeks, even though your sinus may feel “stuffy” or there may be some nasal drainage. 
• Try not to sneeze; it will cause undesired sinus pressure. If you must sneeze, keep your mouth open.

Slight bleeding from the nose is not uncommon for several days after surgery. Scuba diving and flying in pressurized aircrafts may also increase sinus pressure and should be avoided. Avoid “bearing down” – when lifting heavy objects, blowing up balloons, playing musical instruments that require a blowing action, or any other activity that increases nasal or oral pressure. Decongestants will help reduce pressure in the sinuses. It is important that you keep all future appointments until this complication has resolved.

Numbness

Most surgical procedures will require DR. Banks to numb the area. Often a long lasting anesthetic is used. 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 them without feeling it. So be careful when chewing.

Partial loss of sensation of the lower lip and chin may occur, usually following lower wisdom teeth removal or sometimes after lower implant placement. This is usually temporary and disappears within a few days or weeks. Occasionally, some numbness may persist for months due to the close association of the roots of the teeth or the implant to the nerve that supplies sensation to the areas described.

Diet following your surgery

After surgery, especially after general anesthesia or IV sedation, liquids should be initially taken. Drink plenty of cool fluids. Do not use straws, drink from a glass. Using a straw with sucking motion can cause more bleeding. Avoid carbonated beverages or very hot foods or drinks.

A soft, non-chewing diet is recommended for 10 days to 2 weeks after surgery to allow the gum tissue to heal. Chop food in small pieces or use a blender to puree. Eat any nourishing food that can be taken with comfort. Patients who maintain a good diet of soft foods, generally feel better, have less discomfort and heal faster. Avoid foods that may cause trauma to the gums, such as chips, popcorn, nuts or shells. Over the next several days you may progress to more solid foods.

Recommended food and drinks

• Juice, water, milk, coffee, tea.
• Cooked cereals, such as oatmeal or cream of wheat, yogurt.
• Scrambled eggs, cottage cheese, applesauce.
• Home cooked broth, bouillon, soups.
• Ground beef, baked or broiled fish, broiled or stewed chicken (finely chopped).
• Macaroni and cheese, soft bread, baked or mashed potatoes.
• Jell-O, puddings, pound cake, milkshakes, ice cream.
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Temporary teeth

Temporary removable dentures, “flippers”, or fixed teeth are often used after tooth removal procedures or dental implant insertion. The proper fit of these temporaries after implant insertion is crucial. After surgery, the surgical site is swollen, so the temporary may not fit properly. Do not wear a temporary flipper until the numbness in the area is gone. It is very important when temporary teeth are placed that they do not touch the gums in the area of the surgery, nor do they put pressure on the implant. They may need to be adjusted, and re-adjusted again after the swelling has subsided. Until your post-operative appointment, do not eat with your removable temporary teeth. If you are in a social situation that you will want to wear your dentures and need to eat a meal, choose a diet that is soft and does not require chewing.

Common occurrences after surgery

• Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
• In the event of nausea or vomiting following surgery, do not take anything by mouth for at least one hour, including the prescribed medication. You should then sip on tea or ginger ale (no straw), slowly over a 15 minutes period. When the nausea subsides, you can begin taking liquids and the prescribed medication.
• Occasionally after IV sedation the arm or hand near the site where the needle was placed to administer IV drugs may remain inflamed or tender. Application of heat to the area usually will correct these symptoms.
• Resorbable sutures are often placed to the area of surgery to minimize post-operative bleeding and to help healing. Since they are resorbable, they do not need to be removed. Sometimes they become dislodged, or they may slide out of the gum as they dissolve. This may cause a little bleeding, but it is no cause for alarm. Just remove the sutures from your mouth and discard them.
• You should be careful going from the lying down position to standing. If you were sedated, you were not able to eat or drink prior to surgery. After surgery it was also difficult to take fluids. 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.
• If the corners of the mouth are stretched, they may dry out and crack. 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.