Post-Surgical Considerations

Instruction highlights
Management of pain
Oral hygiene
Dry socket
Post-operative Infections
Transitional prosthesis

Instructions highlights

The healing process is different in every individual. It depends on multiple factors including health, age, healing physiology, tissue health surrounding the surgical site, type of surgery, and post-operative care. Following are basic instructions for post-surgical success.

  • Bite firmly on gauze; replace it every 30 to 45 minutes until bleeding stops.
  • Ice for 24 hours; 20 minutes on, 10 minutes off.
  • Avoid spitting or using straws for 24 hours.
  • No strenuous activities for 48 hours.
  • Do not rinse or brush on evening of surgery.
  • On the day after surgery, begin oral rinses with water or salt water (saline) every two hours; continue for at least 10 to 14 days.
  • Do not smoke for seven to 10 days (first 24 hours for bleeding problems, thereafter to avoid healing complications such as dry socket, infections, or poor closure).
  • Eat a soft diet for three to five days; advance as you feel comfortable.

Do Not Be Alarmed By…

  • Slight bleeding up to six to eight hours or very slight oozing into the next day.
  • Increase in swelling 36 to 48 hours after surgery.
  • Bruising of skin over neck or chest areas.
  • Sutures loosening.
  • Small openings of incision site.
  • Radiating pain to different parts of head and neck.

Call Your Oral Surgeon Immediately If…

  • Pain increases after three to five days.
  • Swelling increases three to five days after surgery with pain and drainage.
  • Significant bleeding continues for more that eight hours after surgery.
  • Any drainage or infection marked by swelling and increase in pain.
  • Rashes, hives, or itching following use of medications.
  • Significant opening of incision lines over grafted regions.

Management of pain
It is best to start pain medications while local anesthesia is still in effect. Take medications with plenty of water. For additional pain relief, narcotic pain medication (Vicodin, Tylenol #3) may be supplemented with ibuprofen (200-400 mg) or Tylenol, staggered every two hours. 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

An increase in pain three to five days after surgery without swelling is most likely due to localized inflammation from inadequate oral rinses. In this instance, increase oral rinses aggressively every two to three hours. However, an increase in pain with swelling is most likely a sign of a developing infection. Continue your antibiotics and pain medications as prescribed and call your oral surgeon for instructions.

Swelling is expected for more invasive oral surgical procedures. Surgical swelling reaches its maximum in 36-48 hours after surgery. It will gradually resolve over three to five days. To minimize surgical swelling, apply ice to the affected facial area for 24 hours. Place an ice bag over the face for 20 minutes on and 10 minutes off. 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.

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. Remove the gauze sponges that have been placed in your mouth one hour after surgery. Replace with a clean gauze and bite or press down with pressure. Repeat every 30 to 45 minutes until bleeding stops.
If there is continued bleeding after six hours, do the following: Place a folded gauze pad directly over the extraction socket. 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 both cause bleeding by creating suction in the mouth. If you are still unable to control the bleeding, call your oral surgeon.

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. DO NOT USE A STRAW. This will cause bleeding by creating suction in the mouth. A soft diet is recommended for three to five days. Chew on the opposite side of the surgical site if possible. A diet high in protein and carbohydrates is best. Homemade eggnog, using fresh milk, eggs, and blended fresh fruit, 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 for five to seven days. If bowel habits are irregular, we suggest you take a mild laxative such as Milk of Magnesia.

Oral hygiene
Do not rinse or brush on the evening of surgery. On the next day begin frequent oral rinses with warm salt water or plain tap water, every two hours, especially after meals. Continue this for seven to 10 days. You can brush your teeth as usual, but avoid the site of surgery or be very gentle in that area. After the first 24 hours, you may be more aggressive with oral rinses.  A special irrigating syringe may be used to improve cleansing, if necessary. The key benefit of rinsing is washing away of plaque and food, therefore salt or regular water equally work well.  Avoid use of mouth washes containing alcohol for seven days.

Dry socket
An increase in pain three to five days after surgery may be indicative of dry socket, although it is very rare. Continue on antibiotics and oral rinses. The site should not be packed unless a definitive diagnosis of dry socket is made.

Post-operative infections
An increase in pain or swelling three to five days after a surgery may be indicative of a developing infection. Pus or drainage may also be present. Continue with aggressive rinsing and antibiotics. (The antibiotics may be changed to Augmentin 500 TID or 875 BID for 10 days or Clindamycin 450 mg q6h- if allergic to penicillin.)

Transitional prosthesis
Following extractions, site preservation grafting, or other bone augmentation procedures, the transitional prosthesis must be adjusted to prevent tissue pressure. A very light or no contact is acceptable. Patient should be instructed to avoid chewing with the transitional prosthesis as it may cause pressure on the tissue and disrupt healing. Full dentures are relined at our office with light body material and should be relined again in 10-14 days.