How much pain is there after oral surgery?
Level and duration of pain depends on the complexity of the surgery, technique, and patient’s tolerance. Most patients experience three to four days of elevated pain, commonly managed with pain medications such as Vicodin or Percocet. As pain gradually diminishes over the next two to three days, Ibuprofen (Advil) or Acetaminophen (Tylenol) can be used. After seven to ten days, most patients no longer have pain and may stop their medications.
Pain management following your surgery: It is best to start pain medications while local anesthesia is still in effect. Take medications with plenty of water.
- For mild to moderate pain: Take Ibuprofen 600 mg (3 Advil) + Tylenol (500 mg) TOGETHER every 4-6 hours
- Note: Ibuprofen Sodium (film coated) has been shown to be more effective than regular Ibuprofen. It is available over the counter in 200 mg tablets.
- For moderate to severe pain: Add Opioid medication, as prescribed or desired according to the recommended dosage. You may add Ibuprofen 600 mg in staggered dosages in between Opioid medications for enhanced relief.
- Caffeine 100 mg twice daily boosts the analgesic effect of Ibuprofen for added relief
An increase in pain three to five days after surgery without swelling is most likely due to localized inflammation from inadequate oral rinses. Increase oral rinses aggressively every two to three hours. However an increase in pain with swelling is most likely a sign of developing infection. Continue your antibiotics and pain medications as prescribed and call Dr. Kazemi for instructions
Pain persisting even after initial dose of pain medications:
Once you take 2-3 continuous dosages of the pain medications, the pain generally subsides. If you do not feel too drowsy from on tablet of pain medication, you may take an additional half to one tablet. But please be cautious. Follow the prescriptions on the bottle and only increase dosage if pain is not relieved and you are not feeling too sleepy or drowsy. Most narcotic pain medications may be taken every 4-6 hours although it may be increased to one every 3-5 hours depending on your tolerance, weight, and clinical effect. Consult with Dr. Kazemi before changing the normal recommended dosages.
Nausea from pain medications:
If nausea develops, discontinue the narcotic pain medication and take only ibuprofen (Advil, two to three tablets). It is normal for discomfort to last up to five to seven days, gradually decreasing each day.
Increase in pain:
An increase in pain three to five days after surgery without swelling is most likely due to localized inflammation from inadequate oral rinses. Increase oral rinses aggressively every two to three hours. However an increase in pain with swelling may be a sign of developing infection. Continue your antibiotics and pain medications as prescribed, rinse with salt water every two hours aggressively, and call Dr. Kazemi for instructions.
What to expect after surgery:
Facial swelling is expected for more invasive oral surgical procedures. These include deeply impacted wisdom teeth and bone grafting procedures. Surgical swelling reaches its maximum in 36-48 hours after surgery. Most people feel great the day following surgery and then notice increase in swelling the following day. This is absolutely normal and there is no need to be alarmed. The swelling will gradually resolve over the next three to five days. No or minimal swelling is expected if the surgical procedure was performed in a conservative fashion. These include most extractions and dental implant procedures.
How to minimize swelling:
To minimize surgical swelling, apply ice to affected facial area for 24 hours. Use the ice pack provided with your instructions and packet. Place the ice bag over the face for 20 minutes on and 10 minutes off. The ice packs are reusable. Simply place it in your freezer for about 15-20 minutes and restart using it.
Swelling after 3-5 days after surgery:
If swelling develops three to five days after surgery, this is most likely due to infection. In this case, continue with prescribed antibiotics and call your oral surgeon for instructions. Do not put ice or heat over the area.
Gum tissue swelling:
Your gum tissue around the surgical site may also be swollen for a few days. It is normal. It gradually resolves in 5-7 days after surgery. Make sure to continue aggressive rinsing and be gentle with your diet.
What to expect immediately after surgery:
Bleeding gradually diminishes in three to four hours after surgery and often stops completely in four to six hours. Occasionally, it may ooze until the next day. One hour after surgery, remove the gauze sponges that have been placed in your mouth. Replace with a clean gauze and bite or press down with pressure. Repeat every 30 to 45 minutes until bleeding stops.
Important instructions to stop the bleeding:
- Rest with your head elevated
- Do not spit. If there is any saliva / blood, gently wipe it with a tissue
- Bite down firmly on the gauze
- Do not use straw to drink- Simply sip from a glass
- Do not smoke
When to stop using gauze?
As bleeding decreases, the gauze will be less and less red and saturated with blood. Eventually become pink and then only small amounts of blood is visible when you change it. Keep using the gauze until all the bleeding has stopped. When the gauze is completely white 30 minutes after changing (no blood on it) then you can stop using them. Gauze may be used cautiously during sleep.
Bleeding persisting beyond 6-8 hours:
If there is continued bleeding after six to eight hours, continue using the gauze directly over the extraction socket and bite down firmly and hold for 30 minutes. Sit upright and remain quiet. Repeat every 30 to 45 minutes as necessary. If bleeding continues, dip a caffeinated tea bag in cold water and place directly over the extraction site. Avoid spitting or using straws as that causes bleeding by creating suction in the mouth. If you are still unable to control the bleeding, call us.
Bleeding continuing 1-2 days after surgery:
Rarely, small amount of blood oozing may continue day or two after surgery. This may occur if you have taken Aspirin or perhaps blood thinning medications. Continue with gauze and firm pressure as instructed. Avoid rinsing until the bleeding completely stops.
Oral rinsing with salt water is a simple and effective way to prevent inflammation or infection after oral surgical procedures.
- Make sure to rinse with salt water (or water if not available) every 1-2 hours for 10-14 days after your surgery (the duration of rinsing may be modified based on type of procedure you have had. Consult with us on specific recommendations)
- Rinse gently for first 24-48 hours; then more aggressively after to assure food, mucous, or other debris is well washed away from the surgical site.
- How much salt? Follow these suggestions:
- Use 1/2 teaspoon of table salt in 1 cup of room temperature water
- A typical water bottle holds about 3 cups of water, so add 1.5 teaspoons of salt for the same concentration.
- Or you can also make a gallon (about 16 cups) of salt water by adding 8 teaspoons (about 2.5 tablespoons) of salt.
Key dietary recommendations following surgery:
As soon as you get home, you can start liquids or a very soft diet. Drink plenty of fluids such as orange or tomato juice, ginger ale, water, tea, etc. Drink at least six to eight glasses of liquids daily to avoid dehydration. Soups, yogurt, mashed potato, eggs, and puree foods are great for immediately following surgery. Avoid hot liquids or food for the first 24 hours.
Diet in the next 2-3 days:
Continue on soft / liquid diet only. A diet high in protein and carbohydrates is best. Homemade eggnog, using fresh milk, eggs, and fresh fruit blended into it, is an excellent source of both. We also recommend soups, soft pasta, soft rice, Jello, soft boiled eggs, yogurt, soft cereals, and mashed potatoes. Avoid hard or crispy foods at this time.
Diet 5-7 days after surgery:
Don’t change your diet yet. Many people make the mistake of starting harder food which can cause irritation and pain. Continue on the same diet and consistency
Diet after 7 days:
You might be ready to gradually advance to a more normal diet but only if you feel comfortable. Advance slowly over the next few days as the surgical site continues to heal and is less tender. It is still too early for really hard foods like bagels, meats, chicken, or pizza. You should be able to try your regular diet in 10-14 days after surgery.
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