POST OPERATIVE INSTRUCTIONS WISDOM TEETH

Wisdom/Surgical Extraction of teeth 

IMMEDIATE POST OP PERIOD: (24 hours after surgery)

• Your lip, tongue, and cheek may be numb for up to twenty-four (24) hours. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation.
• Avoid hot food and drinks for the first twenty-four (24) hours. Consume cold, soft foods and fluids. Protein shakes are encouraged for nutrition.
• You will leave the office with gauze placed over your surgical sites, you will change the gauze packs every 15 to 30 minutes; for 1-2 hours until the gauze is only "splotchy" with blood and/or absent. 
• Oozing from the surgical sites is normal for 2 to 3 days.
• No heavy lifting for twenty-four (24) hours, it can increase bleeding.
• Discomfort is normal after surgery. It can be controlled but not eliminated by taking the ibuprofen and pain pills the surgeon has prescribed. 
• TAKE YOUR IBUPROFEN FOR THE NEXT FOUR DAYS REGARDLESS OF YOUR PAIN! 
• First, within one hour after your surgical procedure take your ibuprofen, within three hours if the pain is not controlled then you may take your prescribed narcotic pain medication
• Your narcotic pain medication is only for "break through" pain. (see section on pain)
• Swelling is normal and you can apply a cold compress on your jaw over the treatment area, alternating 10 minutes on and 10 minutes off. 
• If you received IV sedation and/or are taking prescription pain medication, for the next twenty-four (24) hours: do not stay alone, operate machinery, make critical decisions, or care for children.
• The medication given to you in the IV and the prescribed pain medication can make you feel dizzy and impair your judgement. You should be careful going from a lying to a standing position. You should sit for one minute before getting up to a standing position.
• It is advisable to have someone help you while walking, climbing stairs, or using the restroom during this time.
•  Rest and relax, set in a recliner or place pillows behind your head while in bed to keep your head elevated for the next twenty-four (24) hours.
• It is advisable to have someone at home with you to assist you for the next twenty-four (24) hours.
• DO NOT SLEEP/EAT/DRINK WITH GAUZE IN YOUR MOUTH

 GENERAL POST OP INSTRUCTIONS: (days 1-14)

Instructions specific to discomfort:

• Peak Day of discomfort is day 4 and should gradually decrease daily.
• The majority of your post op pain should be controlled by taking your prescribed ibuprofen every 6 hours for the next 4 days REGARDLESS OF YOUR PAIN.
• First day of surgery, take your prescribed ibuprofen, within the first hour.
• If your pain is still uncontrolled after three hours, THEN you should take 1 of the prescribed narcotic tablets.
• Do not drive, work, operate machinery, make critical decisions while taking narcotics.
• Do not drink alcohol while taking narcotics.
• Chart your medications and times administered.
• Apply a cold compress immediately to help decrease pain and for potential swelling. (See section for swelling)
• Opioids can be highly addictive and should be used only as directed.

Instructions specific to bleeding:

• If uncontrolled or excessive bleeding occurs, get a timer and set it for 15 minutes, do not talk, elevate your head, bite down firmly on a folded moistened gauze or place pressure with your finger over the surgical site, using the moistened gauze. After the 15 minutes, access the bleeding and repeat the process again. If bleeding doesn't decrease or stop then call our office, 859-525-0022.
• Blood tinged saliva can ooze from the surgical site(s) for 2-3 days, it is normal.  A small amount of blood with normal saliva (spit) will appear as a large amount of blood
• You may also, moisten a tea bag in warm water for about a minute, remove excess water;place it over the site and bite down for thirty minutes, the tannic acid helps form a clot by contracting vessels.
• Do not become excited, sit upright, don't talk excessively, and avoid exercise to help with bleeding if it becomes excessive

Swelling:

• Peak Day of swelling is day 4.
• Swelling is not uncommon and is the body's normal reaction to surgery and eventual repair and/or healing.
•  Swelling may be minimized by immediate use of a cold compress. There is no cause for alarm if swelling persists for several days; Normal reaction to surgery. 24 hours after surgery, the application of moist heat to the sides of the face is beneficial, ten minutes on and off.

Discoloration:

• You may experience some discoloration that usually coincides with swelling, may appear 2-3 days after surgery and can last 7-14 days. This occurrence is normal.
• Warm compress to the area may help with the subsiding of it.

Stiffness

• You may experience jaw muscle stiffness and limited opening. This is normal and will be improved by actively opening and closing your mouth as wide as possible for  a duration of 60 seconds, 5 times a day. 
• You make apply a warm compress to the outside of your jaw, over the surgical site, for 10 minutes on and off, after 24 hours.

Antibiotics

• You have been prescribed an antibiotic to help prevent infection, finish the medication until finished. 
• Antibiotics can also decrease the effectiveness of contraceptives.
• If a rash or other unfavorable reaction occurs, stop taking the antibiotic and call our office, 859-525-0022.

Nausea:

• Nausea is not uncommon after having IV sedation or when taking prescription pain medications. 
• Nausea may be reduced by eating small amounts of food prior to taking your pain medication. 
• The prescription Phenergan will provide some relief.
• If you vomit, try not to consume anything by mouth for an hour;Including prescription medication.
• After an hour, sip sprite, Pedialyte very slowly over a ten minute period. If you can consume the fluids and do not vomit within ten minutes, then y9ou may resume your medication.

Diet: 

• Do not spit or suck through a straw; this can cause bleeding.
• You should prevent dehydration by taking fluids. Aim for 5-6 glasses (8 ounces) of liquid daily. Your overall nourishment declines after the procedure, so the extra fluids compensate.
• Protein shakes are encouraged.
• Soft, cold foods for the first day.
• High calorie and high protein meals.
• Avoid spicy or hard foods, like tortilla chips.
• Resume normal regular meals as soon as possible after surgery. 
• Avoid skipping meals
• Avoid alcohol and smoking THEY HINDER HEALING and can disturb the blood clot

Wound Care / Oral Hygiene: 

• Do not smoke for 5 days following extractions
• For the first 8 hours, do not brush your teeth. After 24 hours, rinse with warm salt water. (8 ounces of water with 1/4 tsp of salt)
• After the first 8 hours, brush your teeth gently, but avoid the area of surgery 
• *NO ALCOHOL BASED MOUTHRINSES-HINDERS HEALING AND MAY CAUSE IRRITATION
• Rarely you may feel, hard projections at/or around the surgical site with your tongue. The hard projections are the bony walls that supported the teeth/tooth. Usually they will go away, smooth out; Sometimes they do not and thus have to be removed by Dr. Stigall.
• You may experience cracked lips, dry corners of the mouth. Apply some Vaseline or Chapstick for relief.

Rest:

• After 24 hours, start back to your normal activities slowly, as much as you feel comfortable with, "listen to your body."  
• Rest is essential to healing. 
•  If you take any narcotic pain medication, you are advised not to work or go to school. If your pain isn't gradually getting better after day 4, then feel free to call our office, 859-525-0022.

Stitches: 

• If stitches have been placed, they will dissolve on their own after your tissue has healed. 
• Usually, within 7-10 days. They do not need to be removed. 

MAY OR MAY NOT BE APPLICABLE (you will be informed after the surgical procedure)

Sinus Precautions:

• NO NOSE BLOWING
• NO CLOSED MOUTH SNEEZING
• Do not blow your nose for 4 weeks.
• Do not use a straw for 4 weeks.

Bone Graft:

•  Small granules of the bone graft may migrate into your mouth and feel like sand granules; NO NEED TO WORRY. 
• Dr. Stigall over packs the surgical site, to allow for optimal results and can be expected as healing occurs. 
•  A small biocompatible covering, like a band aide, it is hemostatic and can liquify over a period of time or it may fall out as well within a few days after the procedure.

Dr. Stigall and Implants and Orofacial Surgery Specialists strives to get you back to your normal daily activities, following these guidelines is very important in obtaining that goal. Remember to call us with any questions or concerns.

For an EMERGENCY issue not stated above, call Implants & Orofacial Surgery Specialists at 859-525-0022.