Post-Surgical Care and Instructions:

You would have been given a handout with the appropriate post-operative instructions for the procedure you had done.  If you misplace these, please refer to the instructions below.  If you have any questions or something doesn't seem "right" please call!
Special Instructions:
Wisdom teeth, other dental extractions,
and other oral surgery (e.g. biopsies):
Implant procedures, bone grafting, sinus lifting:
Eating / Drinking: 
 
 
 
 
 
 
 
 
 
 
 
 
 
Oral Hygiene / Oral Care:
 
 
 
 
 
 
 
 
 
 
 
Discomfort:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bleeding:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sutures (stitches):
 
 
 
 
Swelling
 
 
 
 
 
 
 
 
Medications*:
*note: this is not a substitute for a pharmacist's consultation.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Don'ts...
 
 
 
 
Special instructions:
Sinus Precautions:
 
 
 
 
 
 
 
Immediately-Placed Dentures
 
 
 
 
 
 
 
 
Jaw Fractures
 
 
 
 
 
 
 
 
 
 
 
 
 

Try to begin re-introduction of fluids and then other food as soon as you can.  However:

  • Avoid using straws as this may introduce air into the tissues.

  • Avoid crunchy, hard, spicy, hot food or beverages (you could burn yourself while you're still numb). You could also tear the sutures placed.

  • Start with a trial of "clear" fluids, if you have no issues with that, try a 'Frosty', or other thicker drink (with a spoon).

  • Most implant procedures are not that hard on patients.  But, if you find eating is too tough at least make sure you stay well-hydrated with broth, juices, Gatorade-type beverages with electrolytes.

    • Getting behind on fluid will make you dizzy, feel more run-down, increase your nausea and may mean you'll need IV fluids.

 

 

 

Please do your part to help the success of your implant(s), bone grafting or sinus surgery:

 

  • Brush your teeth as normal unless directed otherwise; getting as close as you can to the extraction sites without disturbing them. 

  • Use the mouth rinse you were prescribed (Peridex) as labelled (15 mL twice a day for 30 seconds, try not to eat or drink for 30 minutes after). 

  • In-between meals, rinse your mouth with mild salt water rinses (around 1/4 teaspoon of salt per glass of warm water).  The rinse should not be more salty than broth.

  • After 5 days, use an extra-soft toothbrush dabbed in Peridex and gently brush over the sutures and surgery site.

 

 

When it comes to pain management, prevention is best.  However, in the instance of bone grafting and implant placement, pain is not typically severe.

 

Also, there are data in the orthopedic literature suggesting that NSAID pain relievers (e.g. naproxen, ibuprofen, ketorolac) may inhibit bone healing. For that reason, we ask you avoid these medications and suggest controlling your discomfort with Tylenol or Tylenol with a narcotic as prescribed.

 

Before local anesthesia wears off, please take one to two Tylenol and see if this is adequate.  If not, consider using Tylenol #3 as prescribed instead of regular Tylenol.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your bleeding may be essentially finished before you even leave our office.  If not, apply slight pressure with gauze to the area that's bleeding. Take care especially - if bone grafting was performed - to not disturb the grafted area(s) or sutures.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No special care is needed for the sutures as they will be expected to dissolve away on their own.  Often the sutures for these types of procedures are slower to dissolve.  This may take up to 2 weeks.

 

If the sutures seem to 'pop' and open up right after the surgery, please call our office.

Try to begin re-introduction of fluids and then other food as soon as you can. However:

  • Avoid using straws as this may introduce air into the tissues.

  • Avoid crunchy, hard, spicy, hot food or beverages (you could burn yourself while you're still numb).

  • Start with a trial of "clear" fluids, if you have no issues with that, try a 'Frosty', or other thicker drink (with a spoon).

  • If many teeth or surgical extractions were done (e.g. Wisdom teeth), stick with a diet requiring minimal chewing or opening.

  • If you find eating is too tough at least make sure you stay well-hydrated with broth, juices, Gatorade-type beverages with electrolytes.

    • Getting behind on fluid will make you dizzy, feel more run-down, increase your nausea and may mean you'll need IV fluids.

 

 

A clean, hygienic mouth is less conducive to infection, 'dry socket' and prolonged healing.  Once bleeding has stopped make sure to:

 

  • Brush your teeth as normal getting as close as you can to the extraction sites without disturbing them. 

  • In-between meals, rinse your mouth with mild salt water rinses (around 1/4 teaspoon of salt per glass of warm water).  The rinse should not be more salty than broth.

  • You may use mouthwashes (e.g. Listerine which has essential oils) after 24 hours.  Use only as directed and discontinue if there is too much discomfort.

 

 

 

 

 

 

 

When it comes to pain management, prevention is best.  Therefore,

  • Before your local anesthetic wears off, take 600 mg of ibuprofen*.

  • From this point onward, take an additional 600 mg of ibuprofen* every 6 hours unless you experience stomach upset.

  • This should bring your discomfort to a level of 3 to 5 out of 10 which should allow you to sleep.

If you experience pain beyond the ability to rest calmly or sleep, you should then add in any ONE of the following:

  • Take one to two Tylenol #3* and allow this to take effect (45 minutes).

    • If you experience nausea or stomach upset with the codeine then,

  • Instead of Tylenol #3, take up to two Extra Strength Tylenol*.

 

If you are having pain beyond this and you are due for both ibuprofen and Tylenol, then take the following: 800 mg of ibuprofen along with two Tylenol #3 - all at once*.  Once pain is controlled then begin to alternate Tylenol and/or ibuprofen.

 

* note: this assumes you are an average-sized indvidual over 60 kg.  If not, down-adjust the dose accordingly or call our office or a pharmacist. 

You may substitute ibuprofen with one Aleve (naproxen) every 8 hours or two every 12 hours.

 

** If you have been doing well for the first couple/few days then develop pain (especially in the lower jaw) that: throbs and pulsates, radiates to the ear/temple/neck, is associated with a bad smell/taste please call our office as this may be "dry socket".

 

 

 

Because you are numb from the local anesthesia used, you will be tempted to talk and my also not appreciate how little you're actually biting on the gauze. Think of your extraction site as an open cut on your arm.  You need to apply firm, constant pressure with gauze until the bleeding stops.

  • Take advantage of the fact that you're still frozen/numb and bite firmly on the gauze.  Once the freezing wears off, many patients have a hard time biting on gauze.

  • Do not change the gauze more frequently than every thirty (30) minutes - all this does is disturb the clot that's trying to form.

  • When you change the gauze, take one to two 4x4s, fold them in four and place the square over the extraction site.  Apply firm pressure by biting down and don't talk for 20 minutes (this is a good time to utilize the text feature of your phone).

 

IF, after several gauze changes there is still bleeding and/or an excessive mass of clot-like material appears to be protruding from the wound:

  • Rinse your mouth out ten (10) times very vigorously with warm water to dislodge any excessive, dysfunctional clot,

  • Instead of gauze, use a moistened black tea bag and apply firm pressure for 45 minutes.  Tea contains tannic acid which is believed to encourage clotting.

 

Note:

  • Bleeding should be done 'oozing' by two to three gauze changes (2 hours).  A slight amount of redness in your mouth may persist for as much as a day or two after surgery.

  • Patients on certain medications (e.g. aspirin, warfarin, platelet inhibitors) may expect to bleed longer than normal (e.g. twice as long is not uncommon).

 

 

No special care is needed for the sutures as they will be expected to dissolve away on their own within 5-7 days.

 

If the sutures seem to 'pop' and open up right after the surgery, please call our office.

Understandably, patients are concerned about the degree of swelling after their surgery. Swelling is a hallmark of inflammation and not necessarily - nor usually - infection.  The extent of inflammation and swelling is determined by: the nature of the procedure, its difficulty, its invasiveness, your predisposition as well as other factors.

 

To that end understand that swelling:

  • Is a normal and an expected result of tissue manipulation and surgery,

  • Typically peaks by 72 hours post-surgically and resolves quickly thereafter,

  • Is more profound in certain areas where surgery is performed (e.g. around the upper mid-jaw where sinus lifting is done, the back of the lower jaw where lower wisdom teeth are removed).

 

To reduce swelling you can:

  • Take your medications (especially corticosteroids if prescribed),

  • Apply ice packs as follows: 20 minutes on one side then switch to the other side (if applicable) and repeat during waking hours.  This can be continues for the first 24-48 hours and shouldn't be done beyond that where it may delay the resolution of swelling.

  • Rest and sleep with your head elevated as much as comfortable - 30-45 degrees is recommended,

  • Mimimize physical activity that may increase blood pressure.

 

 

 If you acutely (suddenly) develop: a severe allergic reaction (i.e. throat swelling/closing, severe swelling, faintness, sudden uncontrollable vomiting/diarrhea) call 911 immediately and use an Epipen if one is available.

 

Antibiotics:

  • Please finish the entire course of antibiotics if you were prescribed one.

  • Reactions and adverse effects:

    • Some degree of loose stools or mild diarrhea is common with most antibiotics. If this is severe, or associated with a fever, discontinue its use and contact our office or your medical provider.

    • Secondary yeast infections can occur especially in the vulvovaginal area.  If this happens, please contact our office or your physician for a prescription for an appropriate antifungal (e.g. Diflucan).

  • Consider using a probiotic or a live culture yogurt (e.g. Activia) to reduce the incidence of secondary yeast infections or diarrhea.

 

Pain medications and opioids:

  • Use as little pain medicine as you can to rest calmly, obtain reasonable sleep, and conduct your daily activities. 

  • Reactions and adverse effects:

    • Itchiness (pruritis), redness (erythema) can result from opioid pain medications. If your symptoms are limited to this, you can try taking an antihistamine such as Gravol or Benadryl.

    • Constipation is common with opioid narcotics.  Make sure you take fibre supplements, a stool softener such as Colace can be helpful as can drinking prune juice.  

    • Nausea/vomiting may occur with opioids.  If taking the medication with food or milk doesn't help, discontinue its use.

    • Sedation, dizziness and uncoordination can occur while on narcotic pain medications. Do not operate machinery, drive, engage in potentially unsafe actions (e.g. climbing a ladder) or contemplate important decisions until you know how these medications affect you.

    • Tylenol is a potential cause of liver failure if taken excessively.  Do not exceed the recommended doses.

    • NSAIDs (e.g. ibuprofen, naproxen, ketorolac, diclofenac) can:

      • rarely: exacerbate pre-existing asthma, lead to kidney problems, worsen or lead to stomach ulcers

      • more commonly: cause nausea and/or vomiting

        • take with food and/or milk

 

Abuse and overdose of prescribed narcotic medications is a growing cause of teen deaths.  One million Canadians are currently addicted to narcotic pain medications. Please:

  • Divert any unused narcotics to your pharmacy

  • If you have a predilection towards an 'addictive personality', have a trusting person give your medicines to you only as needed.

  • Never share your medications with friends - you could be liable ethically and legally for what happens to them.

 

 

Steroidal anti-inflammatories (e.g. dexamethasone, prednisone, hydrocortisone):

  • This may be prescribed to: reduce inflammation around a nerve, reduce post-trauma swelling, reduce inflammation in the TMJ.

  • Reactions and adverse effects:

    • Insomnia, restlessness, jitters, euphoria or possible anxiety/depression.  These effects dissipate once the medication is stopped.  If the effects are intolerable, discontinue the medication and call our office.

 

 

  • Don't smoke - smokers heal half as fast (or less) as non-smokers, have a higher risk of post-operative infection, a higher risk of 'dry socket' and a higher rate of bone graft failure.

 

  • Don't drink alcohol in excess - while small doses of alcohol are probably okay (except with narcotics), excessive alcohol consumption may depress immunity, impair healing and prolong bleeding.

 

  • Don't exercise excessively, lift weights, or resume usual athletic routines for a minimum of three (3) days after your surgery.  This could result in a risk of re-bleeding. Some surgeries may need longer - this will be discussed with you where appropriate.

 

 

Your tooth extraction or procedure was close to or involved the sinuses, in order to prevent the formation of a communication between the sinus and the mouth, please:

 

  • Take your medications (e.g. antibiotics, decongestants) as prescribed.

  • Refrain from blowing your nose for seven (7) days unless otherwise discussed.

  • Refrain from sneezing through your nose - instead, direct sneezes through the mouth.

  • In addition to prescribed medications, it is advised to take a non-sedating antihistamine (e.g. Claritin, Reactine).

  • Stay well-hydrated to keep mucous thin.

  • Refrain from smoking and using straws.

 

 

 

 

Your denturist or dentist prepared your denture(s) so that it can be inserted at the same appointment as your surgery.  Unless your denture(s) couldn't be placed, we recommend you:

 

  • Wear your denture(s) without removing it/them until awakening the next morning.

  • The next morning, remove the denture(s) and clean your mouth out by rinsing it out with mild salt water.  Clean the blood off the denture.

  • Replace the denture(s).

  • Do not remove the denture(s) for any extended period of time for the first 24 hours as swelling may preclude them fitting again until the swelling resolves.

  • You should have an appointment with your denturist or dentist within 72 hours (ideally within 24 hours) to adjust the denture if needed.

 

Removing multiple teeth is an inexact science and, even though we strive to smooth the bone during the tooth extraction process, it is impossible to predict how nature will ultimately heal your mouth.  Bony projections, spicules of bone, undercuts are all possible sequelae and it is important that you return to our office so these may be addressed.

 

 

 

Your jaw may or may not have been wired shut.  Either way, it is important to remember that a fracture can only heal if the bones are kept immobile (i.e. don't move).  In addition to instructions you may have already been given:

  • Take your medication as prescribed,

  • You will be given a handout for a blenderized/non-chew diet.  Some people have fun with this and come up with unique ways to 'enjoy' food they normally would have been chewing.

  • If your jaws aren't wired shut; this isn't a license to eat at-will.  This is simply saying that your fracture is minimal enough that we feel healing would not be aided by wiring the jaws together.  Further, we have ascertained that you will be compliant with the directions given.  Most importantly this means:

    • Avoid placing your hands on your jaws during posturing or resting - this may displace the jaw segments,

    • Do not attempt to chew food, gum, pens, fingernails or any other object that could place pressure on the jaw,

    • Yawn carefully without unduly moving the jaw,

    • Do not talk excessively,

    • Do not attempt to 'rehabilitate' the jaw at this point by stretching it open.  This will come later.

    • If your teeth no longer match up or it feels like you're no longer biting on your back teeth the way you used to, let our office know as soon as possible.  Your jaw segments may have slipped out of alignment and may need to be repositioned.

  • If your jaws are wired shut:

    • Do not attempt to loosen or remove the wiring unless there is an emergency (e.g. seizure, medical emergency requiring intubation/suctioning).  The wires can be released with your supplied wire cutter in these instances.  Doing so may compromise healing so always let us know if the wires are loosened or removed.

    • If the wires loosen, please let us know immediately so they can be tightened.

  • Always maintain impeccable oral hygiene!  This is especially important if your jaws are wired shut as the wires can trap food, debris and bacteria.

    • A Water-Pik-type of appliance can be invaluable in removing debris.

    • Use your prescribed antiseptic mouthrinse as prescribed.

    • At the very least, brush your teeth, gums, and wires three times a day.