After the Removal of Multiple Teeth

Home Instructions After the Removal of Multiple Teeth

Post Anesthesia Care:

  • If you have been sedated for your procedure, it is not uncommon to be drowsy or tired after.
  • It is also common to experience a wide range of emotions upon waking from sedation such as sadness, happiness or being stoic. Being shaky when you wake up from sedation is also very normal.
  • It is important to have a responsible adult with you for 24 hours after the procedure to ensure you are safe.
  • The medications used can alter and delay your decision-making capacity for 24 hours. Do not drive or make important legal decisions in this time period.
  • For the first two hours following your surgery- consume only clear fluids. If fluids are tolerated well, you may advance diet to soft foods.
  • Nausea is the most common side effect of anesthesia. This can be combated with a steady intake of clear fluids and the use of anti-nausea medications as needed.
  • You may remove the bandage from the IV site after 8 hours. Replace this if you experience more bleeding.

Bleeding/Gauze

  • Stay biting on the gauze for 2 hours initially. The pressure of biting down is what helps build up the clot and the clot is what helps it heal.
  • After 2 hours, remove the gauze and check the coloration of it, if the gauze is still heavily saturated and red in color, bite down on new gauze for an additional 2 hours. If the gauze is lightly saturated and pink in color, you are down with the gauze.
  • After 4 hours, if the gauze is still heavily saturated and red in color, take the black Lipton tea bag we provided you and get it wet with warm water, squeeze out any excess water. Wrap the tea bag in a piece of gauze and bite down firmly at the site of extraction for 2 hours without removing the tea bags. The tannins in the tea will help stop the bleeding.
  • After the tea bag is removed, rinse GENTLY with warm water and wait 5 minutes. Observe the extraction site(s) to see if any further bleeding is present. If there is a slight ooze from the extraction site, this is typical for 24 hours and you are done with the gauze. If there is bleeding present that is pooling in your mouth, repeat instructions with a new tea bag and piece of gauze for another 2 hours. Observe for any further bleeding. If heavy bleeding remains that is pooling in the mouth, please contact Dr. Kyles directly on the number provided on this sheet.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on for 20 minutes and taken off for 20 minutes, following this pattern while you are awake. After 24 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. 72 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling-if heat is used prior to 72 hours post surgery, it can actually increase swelling.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Suction

  • It is ok to gently use a straw for thin liquids like water or juice. Avoid drinking thick fluids (milkshakes, smoothies etc.) through a straw. This can create suction and could pull out the clot and possibly result in “dry socket”. If you would like a shake or smoothie, you can use a spoon to eat it or sip it out of a cup.
  • Avoid spitting as this can create suction that may dislodge the blood clot.

Diet

After general anesthesia or IV sedation only clear liquids should initially be consumed. If you are tolerating liquids well, you may start to eat food. A high calorie, high protein intake is very important. 

  • Eat soft foods for the next 4-7 days. Anything that is fork tender is great such as noodles, scrambled eggs, mashed potatoes, soups, yogurt, avocado, soft, cooked vegetables and soft meats that pull apart easily.
  • Slowly advance your diet as comfort dictates after at least 4 days of exclusively soft food.
  • Avoid any food that is too hot, spicy, or crunchy/pokey, high in acidity and/or citrus for 2 weeks. These foods will irritate and hurt the surgical area.

lower tooth extractions

  • We have given you a syringe to flush food debris out of the extraction sockets. DO NOT use the syringe for at least 10 days. If you use it too early, you could forcefully push out the clot and possibly cause “dry socket”.
  • After meals, use warm salt water and place over the extraction site, not in the socket, and give a gentle burst of salt water and it will push out any debris.

Pain control/prescribed medication use

  • Pain typically peaks on day 3 following surgery and will gradually improve thereafter. Surgery day is considered “Day 0”.
  • You can take 400mg Ibuprofen 4x a day if you have no kidney dysfunction or stomach ulcers. (DO NOT exceed 600mg every 6hrs.)
  • You can take 1000mg Tylenol 3x a day if you have no liver dysfunction. (DO NOT exceed 4000mg a day)
  • Take the Ibuprofen and Tylenol whether you are experiencing pain or not for the first 72 hours following your surgery. This will help reduce the inflammation that is present or may become present.
  • The antibacterial mouth rinse (Chlorhexidine) is to be started the morning following surgery and used 3 times per day for 10 days. No heavy swishing, just gentle rinsing.
  • If you were prescribed an antibiotic, take as directed on the bottle. **Note: Not every patient is prescribed an antibiotic.

things not to do

  • Do not apply heat to the face for the first 72hrs, this will increase swelling. You may apply heat after the first 72hrs. 10 minutes on, 15 minutes off.
  • Avoid strenuous physical activity for 4 days, this includes any activities which cause heavy breathing as this may cause renewed bleeding.
  • Smoking: Try not to smoke for the next 7 days as this will increase the chance for infection and “dry socket”. We would be happy to prescribe you nicotine patches if necessary.
  • Also avoid any vigorous rinsing. Let your head do the work when using mouth rinse and let the rinse simply fall out of your mouth into the sink.

Oral hygiene

Please continue to brush your teeth as usual but be very gentle with your brushing the night of your surgery and when brushing near extraction site(s). We recommend using an extra soft bristled manual toothbrush, which is available at most grocery stores, for 7 days.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour, including the prescribed medicine. You should then sip on water or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.

Other Complications

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. Call Dr. Kyles if you have any questions.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
  • You should be careful going from the lying down position to standing. You could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting up.
  • 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. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Kyles.
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.
  • Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
  • Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days to a few weeks following surgery. This is a normal post-operative event which will resolve in time.

Finally

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. That being said, not everyone gets sutures. For just extraction procedures (no grafting), dissolvable sutures are used and tend to come out/dissolve on their own in 4-10 days. This is no cause for alarm. Just remove the suture from your mouth and discard it. If you do not feel comfortable removing the suture yourself, you may contact our office to be seen. 

The pain and swelling will worsen initially and after 3 days following surgery should subside more and more each day thereafter. If your post-operative pain or swelling worsens after noticing some improvement or unusual symptoms occur, call our office for instructions.

There will be a void where the tooth was removed. The void will fill in with new tissue gradually over the next month. In the meantime, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.

Your case is unique, no two mouths are alike. Discuss any problems with the trained experts best able to effectively help you: Dr. Kyles or your family dentist.

Brushing your teeth is okay – just be gentle at the surgical sites.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain near the ear may occur 4-5 days following surgery. Call the office if this occurs.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced and exercising may weaken you. If you get light headed, stop exercising.

The removal of many teeth at one time is quite different from the extraction of just one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:

  • The area operated on will swell, reaching a maximum in three days. Swelling and discoloration around the eyes may occur. After 72 hours, the application of a moist warm towel will help eliminate the discoloration. The towel should be applied continuously for as long as is tolerable, beginning 72 hours after surgery. (Remember: ice packs are used for the first 24 hours only).
  • A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 3-4 days.
  • If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline. There may be a slight elevation of temperature for 24-48 hours. If your temperature continues to rise, notify our office.

If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery to make the necessary adjustments and relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.