After the Removal of Multiple Teeth
Instructions if you have received intravenous sedation
Following intravenous sedation or general anesthesia, it takes a considerable period of time for the full effects of the drugs to subside. As a result:
1) You MUST be accompanied home by a responsible adult, who can either drive you home by car or take you home by taxi, but not by public transportation. A responsible adult must stay with you for the rest of the day and that night.
2) You MUST remain quietly resting at home for the remainder of the day.
3) If you feel dizzy you MUST immediately lie flat until the dizziness is gone.
4) You MUST NOT leave your home on the evening of your surgery.
5) You MUST NOT smoke for at least 10 days after surgery.
6) You MUST NOT consume alcohol for at least 48 hours after surgery.
7) You MUST NOT operate motor vehicles, power tools, firearms or machinery for 24 hours.
8) You MUST NOT operate or be responsible for aircraft for 5 days.
9) You MUST NOT sign or enter into any legal contract for 48 hours.
Home Instructions After the removal of multiple teeth
As the removal of multiple teeth is a significant surgical procedure, proper post-operative care is extremely important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.
Following Oral Surgery
It is essential that you:
- Maintain continuous firm pressure on the gauze pads placed over the wounds for 30-60 minutes. After this time, if the bleeding has subsided the gauze pads may be removed and discarded.
- Take pain medication before the local anesthesia (freezing) wears off.
- Do not touch or otherwise disturb the wounds after the surgery. (This may initiate bleeding by causing the blood clots that have formed to become dislodged.)
- Do not rinse your mouth today after the surgery. (This action may initiate bleeding by causing the blood clots that have formed to become dislodged.)
- Do not spit, suck on straws or brush your teeth today. (These actions may also initiate bleeding by causing the blood clots that have formed to become dislodged.)
- Do not smoke for at least 10 days. (The “negative pressure” created when smoking is likely to dislodge the blood clots, which will initiate bleeding. Smoking also leads to other complications as it delays healing of the delicate cells/tissue which are trying to heal the surgical wounds. Furthermore, smoking increases one’s susceptibility to the development of “dry socket”.)
- Do not drink alcohol for at least 48 hours following surgery. (Alcohol consumption delays healing and may lead to complications.)
- Restrict your activities the day of surgery. (It is very important you do not engage in excessive physical activity.)
- Apply ice packs to the side(s) of your face where surgery was performed.
- Please refer to the sections below for imperative and more thorough explanations.
After the removal of multiple teeth, blood clot formation is important not only to stop the bleeding, but to begin the healing process as well. A certain amount of bleeding is to be expected following surgery, and some bleeding, oozing and redness in the saliva is not uncommon for the first 24-48 hours. If bleeding is more than slight, place a fresh damp gauze roll directly over the bleeding site, bite firmly for 30-40 minutes and lie quietly with your head elevated. If the bleeding or oozing persists, place another damp gauze roll and bite firmly for another 30-40 minutes, continuing to rest quietly with your head elevated. If bleeding continues, to restrict the flow of blood from the surgical site, bite on a moistened black tea bag for 30-40 minutes. (The tannic acid in the black tea helps a clot to form by contracting bleeding vessels.) To minimize further bleeding, do not become excited. If you have been received an immediate denture, do not remove it unless the bleeding is severe. Some oozing around the side of the denture is normal and is to be expected. If bleeding does not subside after 3 successive attempts to address it as noted above, please call our office at (250) 614-1828.
After the blood clot has formed, it is important not to disturb or dislodge the clot. You must therefore avoid any actions that create negative pressure, as such activities may dislodge the clot. This may cause bleeding to begin again at the surgical site, or lead to a “dry socket” developing, both possibilities hindering the healing process. As a result, you should not rinse your mouth vigorously, nor engage in any “spitting” action following surgery. (Refer to ORAL HYGIENE section below for more detailed instructions on how to avoid disturbing the clot, while carefully attending to a proper hygiene regimen.) You must not drink from a straw for at least 10 days following surgery, as the negative pressure created by doing so will disturb the clot. For the same reason, playing wind instruments must be avoided. To prevent dislodging the delicate blood clot, one must also not smoke for at least 10 days post-surgery. Smoking will hinder proper healing in a number of ways. The harsh chemicals in cigarettes damage the cells/new tissue that is trying to heal the surgical site, even beyond the initial 10 day healing period. For your overall health, this would therefore be a beneficial opportunity for smokers to quit smoking altogether.
Swelling is a normal occurrence and is to be expected following surgery. However, the swelling may be minimized by the immediate application of ice. Place an ice pack (or a plastic bag or towel filled with ice cubes) on the outside of the cheek(s) and/or lip(s) in the area where the surgery was performed. Apply the ice as much as is possible for the first 36 hours post-surgery. In those waking hours, try to apply the ice on and off for periods of at least 10-20 minutes each hour. (As a substitute for ice, a bag of frozen vegetables, such as peas or corn, may be applied to help minimize swelling. As this will involve thawing and re-freezing, however, these vegetables should not be consumed.) Thirty-six hours following surgery, ice applications will not have a beneficial effect. However, the application of moist heat to the side(s) of the face where surgery was performed, will be helpful in reducing any swelling that persists.
In some cases, bruising of the skin follows swelling. The development of black, blue, green, or yellow discolouration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may appear 2-3 days following surgery. In some cases, bruising may extend into the mid-face and/or beneath the eyes and/or involve the neck. Moist heat applied to the area may speed the resolution of skin discolouration.
Nausea and Vomiting
Nausea may be experienced following administration of an anesthetic, or as a result of the use of some medications. In the event of nausea and/or vomiting following surgery, Gravol® (an anti-nausea medication) may be purchased without a prescription. Follow the instructions on the package. Do not take anything else by mouth for at least one hour, including the medication prescribed by Dr. Özcan. To further help with nausea, you may sip on flat cola, 7-Up®, ginger ale or tea. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin drinking other liquids as well as taking the prescribed medicine.
To avoid significant discomfort following surgery, we recommend you begin taking pain medication as soon as you feel the local anesthetic (freezing) wearing off. One or two tablets of 325mg Tylenol® or 500mg Extra Strength Tylenol® may be taken every 3-4 hours. Adults are not to exceed 3000mg of Tylenol® or Extra Strength Tylenol® daily. Ibuprofen (Advil® or Motrin®) may be taken instead of Tylenol®. Over-the-counter Ibuprofen is available in 200mg tablets, of which 2-3 tablets may be taken four times daily. Adults are not to exceed 3200mg of Ibuprofen daily. Patients of smaller stature, elderly patients, and those under the age of 18 should take a smaller dosage daily, and therefore please contact us to determine the appropriate amount of pain medication to be taken under such circumstances. Although you should not take Tylenol® and Ibuprofen at the same time, these medications may be effectively alternated if experiencing “breakthrough” pain, in which case please contact us to receive the proper instructions to do so. Please do not take Tylenol® or Ibuprofen, however, if you have ever experienced an allergic reaction to either, and/or have been instructed by your Physician not to take Tylenol® or Ibuprofen.
Tylenol®, Extra Strength Tylenol® or Ibuprofen are effectively able to manage moderate pain. If experiencing more significant pain, however, the prescribed medication should be taken as directed and as noted on the bottle. Pain medication is best taken with fluid or food in your stomach. While taking prescription pain medication, dizziness may be experienced, and therefore one cannot drive a vehicle or work around machinery. Alcoholic beverages must also be avoided. Pain or discomfort following surgery should subside more and more with each subsequent day, with most discomfort generally resolved in about 5 days. If pain persists, it may require attention and you should contact the office at (250) 614-1828.
If antibiotics have been prescribed for you, it is very important that they are taken as directed, and for the full recommended period of time until completed. This will help prevent infection from developing, as well as prevent one from developing “antibiotic resistance”. Should you experience a rash or any other unfavourable reaction, however, discontinue antibiotic use and contact our office immediately at (250) 614-1828. Under certain circumstances, Dr. Özcan may recommend prescribing another antibiotic for you. When taking certain antibiotics, patients who are also taking oral contraceptives should be aware that oral contraceptive effectiveness may be decreased. Consequently, alternate means of birth control should be practiced for the remainder of the cycle.
As a clean wound heals better and faster, good oral hygiene is essential to proper and timely healing. The night of surgery, “swish” with the prescribed Peridex® Oral Rinse before bed. Be careful not to spit following “swishing”, as the pressure created could dislodge the delicate clots, causing bleeding. Instead, allow the Peridex® to “fall” out of the mouth and into the sink. The day after surgery, use the Peridex® Oral Rinse twice; after breakfast and before bed. Be sure to rinse for at least 30 seconds before allowing the rinse to “fall” out into the sink. Continue using this prescription mouth rinse twice daily as indicated, until finished. Warm salt water rinses (one teaspoon of salt mixed into one cup of warm water) should be used at least 4-5 times a day as well, especially after your other meals. Performing these rinses is very important in promoting proper healing. In the first couple of days following surgery, continue to make sure not to use a “spitting” action but more of a “falling” action at the completion of rinsing, as the surgical sites are still vulnerable to the clots dislodging. One day after your surgery, you may begin gently brushing your teeth after meals and before bed, although be especially careful to avoid the surgical areas during the initial days of the healing process. Avoid “spitting” while brushing as well. If you were given an irrigating syringe, start to use it gently. Three days following surgery, brushing your teeth may begin to incorporate a light “spitting” technique. Likewise, regular rinsing after meals and before bed may begin to take on a more conventional “spitting” action following the 30 seconds of swishing. Rinsing following brushing will help to remove any remaining debris. Three days following surgery, you may also begin gently brushing your teeth in the surgical areas. You may return to flossing your teeth before bed as well. Lubricating your lips with ointment may help with comfort throughout your post-surgery oral hygiene regimen.
Following your surgical procedure, your jaw may be stiff, your throat sore, and your mouth tissues will be tender. Therefore, it will be difficult to eat following oral surgery, and this may be experienced for 1-2 weeks. As a result, you may wish to take a multivitamin supplement, and initially, only liquids or soft foods should be consumed. Drinking should begin on the same day as your surgery. Drinking plenty of fluids is very important for a timely recovery. You may drink soups such as chicken or beef broth, water, fruit and vegetable juices, and food supplements such as Ensure® or Instant Breakfast®. Drink as much as you are able to. Small amounts should be taken frequently. Drink from a glass, and do not use straws for ten days. (The negative pressure (suction) created when drinking from a straw may dislodge the blood clots, which will cause more bleeding from the surgical sites.) When eating soft foods, chew away from the surgical sites. A high calorie, high protein intake is very important, as is regular nourishment to provide your body with the energy for recovery. It is especially imperative to prevent dehydration by taking fluids regularly. As discomfort may limit your food intake for the first few days, you should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss any meals, keeping in mind that nutritionally dense liquids can serve a vital role in achieving your caloric requirements at this vulnerable time. You will experience less discomfort, have more strength, feel better overall, and heal more quickly the better you are able to meet your nutritional needs. More solid foods can be introduced to your diet as soon as they can be comfortably managed. Avoid eating/drinking very hot and very cold foods/liquids, as extremes of temperature will be uncomfortable on your delicate and healing tissues.
For a number of reasons, exercise and other physical activities should be avoided following surgery. Exercise increases blood pressure, which may cause more bleeding from the extraction sites. With the increased blood flow that occurs with exercise, throbbing may also be induced. In addition, while recovering from surgery, it is difficult to maintain proper nourishment, which weakens one’s ability to safely exercise. Furthermore, energy should not be diverted to activities (such as exercise) that may adversely affect one’s ability to recover from a surgical procedure as quickly and uneventfully as possible. It is important to have sufficient rest in the early days following your surgery, and only begin light exercise several days post-surgery, when the healing process is successfully under way. When resuming activity, however, please do so gradually, and be mindful to stop immediately if you experience any lightheadedness.
Sutures (stitches) are placed in the area of surgery to minimize post-operative bleeding and to help the healing process begin. Sutures are made from different materials. Some sutures dissolve on their own in approximately 7-10 days, and therefore a separate appointment is not required for their removal. Sutures made of other materials, however, will require removal by Dr. Özcan. You and your accompanying chaperone will be informed of the type of sutures that were indicated for your particular circumstances. If you have had sutures placed that require Dr. Özcan to remove them, you will be scheduled for an appointment approximately one week post-surgery. This is a very minor procedure taking only a few moments, for which no anesthesia (no freezing) is necessary. Sutures sometimes become dislodged before they dissolve or are scheduled for removal. Should this happen, there is no cause for alarm. Simply remove the suture from your mouth and discard it. However, please do not try to remove sutures that remain securely in place.
specific CONSIDERATIONS for those receiving Immediate dentures
If your treatment involves immediate dentures, they will be inserted at the time of your full mouth extractions. Your immediate dentures should remain in place overnight following your surgery, and be removed the next morning for cleaning and rinsing your mouth. Following this, the dentures should be worn throughout the remainder of the day and overnight again as well. In the morning, please remove your dentures for cleaning and rinsing your mouth. Repeat this regimen for two more days and nights. On the evening of the fourth day post-surgery, your dentures should subsequently be removed every night while sleeping, and placed back in the mouth in the morning. Although wearing your immediate dentures overnight initially helps with the healing process, wearing dentures through the night beyond this vulnerable time, is not healthy for the mouth tissues. Wearing dentures at night beyond this limited post-surgery healing period is not advised as this hinders the mouth tissues from resting and prevents them from being able to “breathe”. This makes the oral tissues susceptible to development of fungal infections. Wearing dentures continually also exerts additional pressure on the ridges supporting the prostheses, which can promote deterioration of the bone.
For patients whose treatment involves immediate dentures, the bone must be shaped and smoothed following the extraction of a number of teeth, and prior to the insertion of dentures. Due to the nature of the surgery required, the development of sore spots is expected following insertion of the dentures. In most cases, your dentist will be seeing you 24-48 hours following surgery to make the necessary adjustments which will help to relieve the sore spots. It is important to keep follow-up appointments which have been scheduled for you. Failure to have sore spots addressed may result in severe denture sores developing, which will prolong the healing process. When denture adjustments have been made, continue with the proper denture wearing regimen as well as the rinsing regimen which have been described above, as this will help healing to progress more uneventfully.
- The removal of a number of teeth at one time varies significantly from the extraction of only one or two teeth. For patients receiving immediate dentures following the extraction of multiple teeth, the bone must be shaped and smoothed prior to the insertion of a denture(s).
- If numbness of the lip, chin, or tongue is experienced, there is no cause for alarm. As reviewed in your consultation, this is usually temporary in nature. You should be aware, however, that if your lip or tongue is numb, you may not feel the sensation when biting, which could cause trauma to these tissues. Therefore, be mindful when chewing, especially initially. Please contact our office at (250) 614-1828 should you have any questions or concerns.
- Experiencing a slight elevation in temperature immediately following surgery is not uncommon. If a temperature persists beyond 48 hours, please notify the office at (250) 614-1828.
- Please be careful to avoid sudden changes in position following your surgical procedure. Due to low blood sugar and/or the effect of medications, dizziness may be experienced if one is lying down and attempts to stand too quickly. Therefore, to prevent dizziness, please sit upright for one minute before slowly standing up from a lying down position.
- Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots. They are the bony walls which supported the tooth. As the extraction site heals, these projections usually smooth out. If they do not, they can be removed by Dr. Özcan.
- As stretching of the corners of the mouth is unavoidable when undergoing oral surgery, the corners of your mouth will be susceptible to drying out and cracking. You should therefore keep your lips moist by regularly applying an ointment such as Vaseline®.
- Following surgery, a sore throat and discomfort when swallowing are commonly experienced. This develops as a result of swelling of these muscles which are inter-related with the tissues approximating the extraction sites. This generally begins to resolve in 2-3 days as swelling begins to subside.
- Trismus (stiffness) of the jaw muscles is also likely. As a result, difficulty and discomfort in opening your mouth may be experienced for a few days following surgery. This is normal post-operatively, and will resolve in time as healing progresses.
Although pain and swelling tend to peak Day 3 post-surgery, following this, gradual improvement should be noted with each subsequent day. If post-operative pain and/or swelling become more significant beyond Day 4, and/or other unusual signs or symptoms develop, please contact our office for instructions at (250) 614-1828.
When a tooth is removed, there will be a noticeable void. The void will gradually fill in with new tissue over approximately four weeks. It is very important for you to follow the detailed oral hygiene instructions noted above, for the first week post-surgery. Over the subsequent few weeks, maintain good oral hygiene by continuing to use salt water rinses after meals and before bed, supplemented by gentle toothbrushing and flossing in the area(s) of surgery, and regular brushing and flossing of your other teeth.
A possible complication some may experience following a tooth extraction, is a “dry socket”. This develops when the blood clot becomes dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site, possibly radiating (extending) to involve the ear, may occur 2-3 days following surgery. Please call the office if this is experienced.
As having multiple teeth extracted is a significant surgical procedure, one must recover sufficiently from surgery before returning to regular activities and routine exercise. Exertion prior to sufficient recovery will actually lengthen one’s recovery time, and possibly create other post-operative complications. Before resuming activity or any type of exercise regimen, please be aware that your altered diet and reduced nutritional intake related to your surgical procedure, will decrease your effective energy output. Experiencing any light-headedness is your body’s warning sign that you should stop exercising immediately.
Please keep in mind that every individual’s case and circumstances are unique. Therefore, please discuss any questions or problems you may be experiencing with the trained professionals best able to effectively help you, those being Dr. Özcan, your General Dentist or another dental professional. Feel free to contact our office at (250) 614-1828, so that we can properly assist you in achieving optimal oral health in as timely a manner as possible.