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.

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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.