Oral Surgery


Post-Op Care

3 most important things after the procedure:

  1. Keep the extraction sites clean
  2. Control the pain with pain medicine
  3. Read the post-operative instructions below.


Keeping extraction sites clean

After the surgery, the stitches will loosen up and fall out on their own. When they do, the gum tissue will open up and create a hole. This is totally normal. In order for the hole to heal correctly, it will have to be kept clean with the plastic syringe provided in your post-op plastic bag. In order to keep it clean, you must make sure the syringe tip is in the hole (where the tooth was removed). Flush out the hole (the extraction site) with tap water or salt water before you go to bed each night. Salt water is better. Sometimes you need to retract or stretch your cheek out with your pinky finger or index finger to help see the hole. !f the hole bleeds when you're rinsing it out...that's ok. That's normal, just keep rinsing until it's clean arid no food particles are still in there. As long as you can keep the holes clean and free of food particles the tooth socket should heal appropriately. If the extractions site are not cleaned every day, the extraction site can become infected. If the infection is small, we can usually take care of it in the office, BUT if the infection is big and aggressive then you will need to go to the hospital to have it treated by another doctor. So keep everything clean, it is the patient's responsibility. You will need to keep it clean until the hole closes up completely .... usually about 1-3 weeks ... it's different for everyone. The hole will heal from the bottom up, so gradually the hole will just keep getting smaller and smaller and then eventually it will just be gone. Hopefully these diagrams will help:

Diagram-1.  Diagram showing how to irrigate and clean the area where the surgery was performed.

Pain Control

Just to let you, if you need to take 2 percocets every 4-6 hours that is ok. I used to be able to write: take 1-2 percocets every 4-6 hours as needed for pain but the pharmacy won't let me do that anymore. So just to let you know that if you need to ... you can take 2 percocet pills every 4-6 hours instead of just 1 pill every 4-6 hours. In my opinion, the best way to take the pain medicine is: 1-2 percocets every 4-6 hours and then sneak an ibuprofen dose in between the percocet doses. Hopefully this diagram will help:

Diagram-2.  Diagram depicting time line of when and how often to take pain medication.

Post Operative Instructions / Information (PLEASE READ)

PAIN: After the nerve blocks wear off, it will definitely begin to hurt. (I know from personal experience). Both pain medications (Motrin and Percocet) can be taken at the same time. Percocet (oxycodone and acetaminophen) is a narcotic pain medicine and Motrin (ibuprofen) is a non-narcotic pain medicine. If taking one Percocet is not controlling the pain then you can advance to 2 Percocets every 4-6 hours. You can also take one Motrin in between Percocet doses if necessary. Remember, that you have 1 refill on the Motrin prescription. If you are having trouble swallowing the pain meds than. you can crush them and take them with juice or ice cream or smoothie or something similar. A pill crusher can be purchased at any pharmacy and they are usually very inexpensive. Also, Percocet is for severe pain only. If you're not e,cperiencing severe pain then just take the Motrin. Percocet should help with the pain but if you have to take it more than a week, it can be habit forming and/or cause constipation. So try to use Percocet for the first 3-5 days (if you can) and then try to control the pain with Motrin only after the 5th day (if you can).

SWELLING / STIFFNESS: It's normal for your cheeks and jaws to swell and feel stiff after the procedure. We usually give you a dose of IV corticosteroids to keep the swelling down. However, once the steroid begins to wear off, some swelling can still occur. It is usually the worst on the second or third day after the procedure. It will go down, just give it some time. If it does not go down in a week then call the office and make a follow up appointment so we can take a look at you. Also, applying ice to your face (20 minutes on and 20 minutes off) will help keep the swelling down. This works best if you begin applying it for the first 48 hours right after the procedure.

ROUTINE MEDICATIONS: Unless a doctor or pharmacist tells you otherwise, it's ok to take your routine medications just like you normally do. (Typically, they should not interfere with the drugs we have prescribed for your post-operative care).

NAUSEA/VOMITING: If you experience any nausea or vomiting, then stay hydrated and take the Zofran (ondansetron) or Phenergan (promethazine) as directed.

EATING/DRINKING:In short, you can eat or drink whatever you can tolerate but I recommend starting with clear liquids and then advancing to soft simple foods. DO NOT USE ANY STRAWS. Instead, use a spoon for a milkshake or smoothie. Examples of soft foods include milkshakes, ice cream, smoothies, scrambled eggs, mashed potatoes, pasta, etc. AVOID any foods that have little nuts or seeds in them because they can get caught in the extraction holes and start an infection (which is a whole other headache for both of us). If you are having soft foods (like ice cream) that is fine, just try to make sure you are consuming soft (cooked) vegetables as well. I am a big believer in having the right nutrition and in my opinion, this will help you heal faster. Also, sometimes you may be eating a food and notice that the extraction sites begin bleeding again. Don't worry, that is not unusual. It just means that the tissue got stretched a little and probably tugged on a stitch or maybe a stitch came out. It's not a big deal and not a cause for concern. Just continue to keep everything clean .... that's the most important thing.

CLEANSING: Salt water will be your best friend for a week or two. You.should start warm gentle salt water rinses 2 days after the procedure, If you rinse before this time you may disturb the blood clot and this could lead to a dry socket. As far as the salt water goes, the saltier the water the better, so get it as salty as you can stand it. Salt water is very medicinal and will help the tissue heal faster. Also use the syring􀂃 that we provided to help keep the e)(traction sites (holes) clean. Just draw up some salt water with the syringe and gently rinse out the extraction sites (especially the bottom wisdom teeth, if you had bottom wis.dom teeth removed). Due to gravity, food gets caught in the bottom ones more often. You should begin rinsing out the sockets 48 hours after the procedure. The reason for the delay, is that you don't want to rinse out the blood clot that has formed where the tooth was removed. If the blood clot is dislodged, the bone can become exposed and it could lead to a dry socket. So give it 48 hours and then start rinsing. Depending on the how impacted your tooth was the tissue will normally be stitched shut. (If the tissue or part of the tissue wasn't stitched shut that means your tooth was beginning to come out of the gum tissue already and a natural hole will be there and won't be stitched shut...not a problem). As the gum tissue heals, the sutures will fall out.. .. as the sutures fall out the tissue will begin to "open up" and create a hole where the tooth once was. Just make sure that the tip of the syringe is gently placed into the socket (hole) in order to flush food and debris out of the socket. If the tip of the syringe is not placed correctly in the corner (in the hole), it may not be removing as much debris as it should. Occasionally, some patients will begin to rinse before they have read these instructions, if you have done this then don't worry just stop rinsing for now and continue again as you should have 48 hours after the procedure. Also, I understand that rinsing after every single meal can be difficult. If that is not possible, it's ok. Just make sure you are at least rinsing every night before you go to bed. Also, it is important to note that for some patients they may not notice the holes yet because they have been sutured shut. However, as the stitches dissolve the tissue will open up and the holes will become more visible. Now that you can see them, make sure you are keeping these holes clean.

HEALING: Everyone heals at a different rate. The tissue will eventually find itself and come together. The bone where the teeth were removed will eventually fill in with more bone. The extraction sites (where the teeth were removed) will heal from the bottom of the extraction site to the top of the extraction site. They heal from the bottom up. Little by little, the extraction site will get smaller and smaller. So you need to keep everything clean until the tissue closes completely. Usually that's within 2-3 weeks but it's different for everyone. It could take longer than that or it might be sooner than that.

BRUSHING: It's definitely OK (and encouraged) to brush your teeth and keep your mouth clean while you are healing. Just be careful when you get back to where the teeth were removed. Brush very gently ir,i this area. And definitely DO NOT brush the sockets where the teeth were removed. If a stitch comes 􀁃ut while you're brushing it is not a big deal. Just continue to keep everything clean and you'll be fine.

BLEEDING / GAUZE: It is normal for the extraction sites to bleed "off and on" for 24-48 hours. There are only three things that will stop the bleeding: pressure, pressure, and more pressure. Just apply the gauze to the extractions site and bite down hard. Just make sure the gauze has been placed in the right spot (where the tooth was removed). Otherwise the pressure will be applied to the wrong spot and the bleeding will continue. For example, if the gauze is placed just between your teeth and not behind your teeth (where the teeth were removed), the bleeding will continue. Once the bleeding has stopped or slowed down, you don't have to keep the gauze in. Just go ahead and take it out, if the sockets start to ooze blood again, it's not a problem just fold up some new gc)uze and place it back at the extraction site. There is no special time frame for replacing the gauze. Everyone will be a little different. If you run out of gauze you can go to a pharmacy and get some more. If for some reason you can't get to a pharmacy, then you can always bite down on a folded napkin or paper towel or T-shirt ..... but gauze is what we recommend. Also, as long as there are white or pink edges around the gauze then that means the bleeding is slowing down. Just because there is some blood on the gauze that doesn't mean that you are still bleeding "a lot". Again, if there is white or pink around the edges, that means the bleeding is slowing and will eventually stop. Obviously, there might be some dark red blood in the middle or in certain spots ... this is totally normal. Many times, patients have a little bit of blood in their mouth and a lot of saliva; but because the blood mixes with the saliva ... it's all red. So patients think they have a lot of blood in their mouth and get scared. Do not worry, it's just a little bit of blood and a lot of saliva ... you're not bleeding profusely and it is not a cause for concern. If you are really unsure if you are bleeding a lot after reading this then just ta􀀡e a picture of the gauze and TEXT it to me.

STITCHES / SUTURES: The stitches will eventually fall out on their own and the holes will open up. If you swallow them, it doesn't matter ... they just dissolve. Usually the stiches fall out in a few days but it's different for everyone. It is not unusual after the surgery, for a stitch to "pop" and fall out the day or night of the surgery. If that happens, it is not a big deal just keep everything clean and you should heal up just fine. Also, when the stitches fall out and the tissue opens up a little then you need to make sure to keep it clean.

EXERCISE: I would highly recommend taking it easy for at least 1 week after the procedure. No heavy exercise and no heavy lifting. No running or swimming. Walking or very light exercise is ok. Usually after 7 days you can resume your normal routine. Also, avoid any exercise where you can catch an elbow or a blow to your face or jaw. Any significant undue stress to your jaw can cause it to fracture. This is a pretty rare occurrence but I have seen it happen. So stay out of harm's way for a little while and heal up. As soon as you have healed, you can go back to your normal routine.

DRY SOCKETS: If you are experiencing severe jaw pain as well as ear pain around the 4th or 5th day after the surgery, you may have what is called a "dry socket". This means the bone is exposed and the clot that normally covers and protects the extraction site has dissolved. It is very painful and ear pain usually accompanies it. If this happens, the extraction site will have to be rinsed and dressed with a soothing medicine. Hopefully this won't happen, but if you suspect that you have a dry socket then contact the office and make a follow-up appointment and I will see you and dress it.

ORTHODONTIC BUTTONS AND CHAINS: If you have had an orthodontic button placed you will need to call the office of your orthodontist and schedule an appointment to have the chain activated. The chain that is on now has no tension or traction force. The orthodontist will cut off the black stitches and remove a rew links on the chain and then tie the chain to the wire with another wire to activate the movement. Typically, this is done in 2-3 weeks after the surgical exposure and placement. Continue to keep everything rinsed clean with the provided syringe (regular water or salt water will work fine). Food and debris can get caught in the exposure site and delay the healing or get infected. There are 2 reasons why you may need the procedure done over again: 1. The button has fallen off and will need to be re­bonded. 2. The orthodontist does not like the placement of the button and a new button will need to be placed at a new position on the tooth. If either one of these situations occurs there will not be a new or additional charge for the patient ... they are replaced at no charge.

If you have any questions AFTER reading this information then do not hesitatE;! to contact me through TEXT ONLY or you can call the office.

If you follow these instructions, stay on your medications, rinse with salt water and keep everything clean ... your recovery should be uneventful.

Good luck, have a good night, and God bless. Dr. Bertetti (text) 917-226-6003