Home Instructions After Surgery

 

Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.

The following instructions are general guidelines that apply to the vast majority of surgical procedures (ex: teeth extractions, dental implants, impacted tooth exposure, etc.), however not everyone is the same and some patients may be given different instructions.  Dr. Dyke will inform you of any different instructions on the day of your consult.

* Dr. Dyke and staff will clarify with you in detail what to do. 

* Pre-operative written & verbal instructions will be provided to you on the day of your consult.

* Post-operative written & verbal instructions will be given to you on the day of your surgery.  If you receive IV sedation your escort will also be given these instructions.

The general guidelines below are to help you prepare for surgery and also are for use in case you may have forgotten something. If there are exceptions to the rules below then these will be explained to you during your consult.  You may always call us if in doubt or to clarify. 

Immediately Following Surgery

  • The gauze pad placed over the surgical area should be kept in place for 30 minutes. After this time, the it should be removed and discarded.  It will look wet with blood, which is normal and no cause for concern.  
  • Vigorous mouth rinsing and/or repeatedly touching the area with your tongue following surgery should be avoided. This may initiate bleeding by dislodging the blood clot that has formed and will delay healing.
  • Begin taking the pain medications as soon as you are able to after surgery.  Start with Ibuprofen or Tylenol first (unless you have been instructed not to take these medications by your physician or Dr. Dyke).  If you had sedation, wait until you are sufficiently awake to drink water and take medications. The goal is to start the pain mediation before the local anesthetic (numbness from the injections) wears off.  If you are still experiencing moderate to severe pain, you may then take narcotic medications if they were provided to you. 
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable enough to do so and only if you are not taking narcotics.  You should restrict yourself from rigorous exercise for a few days after surgery.  Most of the time you may resume normal exercising around 3 days after surgery if you can do so safely and comfortably.  If you’re unsure, don’t push yourself and take off some more time.
  • Place ice packs to the sides of your face where surgery was performed.  You’ll want to use ice packs as much as you can tolerate for the first 2-3 days. 
  • Avoid lying flat for 24 hours after surgery.  You should sleep with a few pillows behind your head or in a recliner.  This will elevate your head and help to minimize bleeding and swelling.
  • Drink plenty of fluids and eat a soft diet the first 2-3 days after surgery.  Avoid small, hard things like chips or seeds that can get stuck in the surgical site.
  • CAUTION: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit up for one minute before standing.

Scroll down or click the links below for additional detailed information on what to do after surgery.

Bleeding

A certain amount of bleeding is to be expected following surgery.  Slight bleeding, oozing, or redness in the saliva is normal.  A few bloody spots on the gauze after removal is normal and not considered excessive bleeding.  Do not lie flat for the first 24 hours.  Sleep in a recliner or with a few pillows behind your head to reduce swelling & bleeding.  Excessive bleeding may be controlled by placing additional gauze pads (2-3 folded together) over the area and biting with gentle pressure for thirty minutes.  Repeat if necessary.  If bleeding continues, bite on a moistened black tea bag for thirty minutes. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels.  If bleeding does not subside, call our office for further instructions, or if after business hours contact an emergency department.

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 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs, should be applied to the sides of the face where surgery was performed. The ice packs should used throughout the day, 20 minutes on then 20 minutes off, while you are awake.   After 48 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.  Swelling will start to decrease after 3 days and can take as long as 7-10 days to fully resolve.  3 days following surgery, the application of warmth to the sides of the face can help with comfort and reduce swelling.  If we gave you gel ice packs you may warm these (5-10 seconds in a microwave) or use a warm washcloth.  Use the same 20 minutes on 20 minutes off technique as with the ice packs.  Be careful to check the heat of the packs prior to applying them to avoid injury.  We are not responsible for injury due to overheating of the gel packs. 

Pain

WARNING: Do not take Ibuprofen (Motrin or Advil) or Acetaminophen (Tylenol) if a physician or Dr. Dyke have instructed you not to. 

Following these instructions carefully is very important to ensure you have the best experience with as little discomfort as possible.

  • Begin taking these medications as soon as you are able to after surgery. (If you had sedation you may need to rest for several hours until you feel awake enough to start the medications.)  Do not wait for the pain to start or for the numbing injections to wear off.  Taking the medications before these things happen will help to keep you ahead of the discomfort and avoid playing “catch up.” 
  • Ibuprofen &/or Tylenol should be taken per these instructions for 3 days whether or not there is pain. Again this is to help you stay ahead of any discomfort.  Take all medications with food to prevent an upset stomach. 
  • Narcotic medications should only be taken as needed if you still have moderate to severe pain despite the ibuprofen.
    * Narcotic medications are not given to everyone.  They are given on a case by case basis depending on the type of surgery and your medical history. 
  • Pain & swelling reach peak at their maximum about 2-3 days after surgery.  Some discomfort or pain after 2-3 days is normal and expected.  Lingering discomfort or occasional sharp “stabs” of pain are normal, sometimes even 7-10 days after surgery.  The discomfort should slowly start to lessen and improve after 3 days and it should continue improving a little bit each day.  If the discomfort continues improving daily, even if only by a small amount, then that is normal and means your body is healing itself appropriately. 
  • If after 4-5 days the pain is worsening, then you may need to be seen by Dr. Dyke.  If this happens, please call our office during regular business hours to schedule a follow up appointment.  

Please note:

  • Take all medications with plenty of fluid and try to take them with food if able.
  • If you are unsure of a medication please discuss this with Dr. Dyke.
  • Do not take other NSAIDs (ex: Celecoxib, Meloxicam, etc.) if you are taking Ibuprofen.  Advil & Motrin are brand names for Ibuprofen, therefore do not take any of these at the same time. 
  • Do not drive or operate machinery while taking narcotic pain medications.
  • Do not drink alcohol while taking any of these medications
  • Do not take a medication listed below if you have a history of allergic reaction to it.

 

Children ages 12 years old and below: 

Dr. Dyke may prescribe pain mediations.  However if not, and you are instructed to use over the counter medication, use Ibuprofen solution or chewable tablets and follow the instructions on the label.  The child should take this medication for 3 days regardless of whether or not there is pain in order to stay ahead of the discomfort.  Take with food.  The child should not take ibuprofen if previously instructed not to by a physician or Dr. Dyke.  If you are unsure, please discuss with Dr. Dyke.

 

Ages 13 years and above:

ONLY for patients 13 years and older
The following instructions apply only to patients 13 years old and above

 

Over the Counter (OTC) Medication Instructions

For most surgeries and patients without contraindications due to their medical history (you likely already know if you have a contraindication, additionally Dr. Dyke will tell you):

Stagger Ibuprofen & Acetaminophen with each other every 3 hours is the goal (unless you cannot take one or both of these medications).  Start with Ibuprofen, then 3 hours later take Acetaminophen, then 3 hours later take Ibuprofen, and so on.  Dosages listed below.

Patients 13 years and older:

Ibuprofen (aka Motrin or Advil):   200mg OTC tablets

  • Weight <135 lbs:  take 600mg (3 tablets) every 8 hours 
    Weight >135 lbs:  take 600mg (3 tablets) every 6 hours
  • Always start with Ibuprofen (unless instructed not to take it).  In addition to decreasing pain, it will also help to decrease swelling due to its anti-inflammatory properties. 
  • Dosing should never exceed 3200mg Ibuprofen daily. 

If you were given 600mg or 800mg prescription strength Ibuprofen tablets you may use these in place of the OTC tablets.  Do NOT use both.  


Acetaminophen (Tylenol):   500mg (Extra Strength) Acetaminophen OTC tablets 

  • Take one 500mg Acetaminophen every 6 hours. 
  • Take in between Ibuprofen doses, staggering the medications with each other every 3 hours  
  • Do not exceed 3000mg of Acetaminophen daily.

Unable to take Ibuprofen / Unable to take Acetaminophen:  If you are able to take one of these medications but not the other, then just take the appropriate medication once every 6-8 hours for 3 days (per above instructions).  After that you may take it as needed. 

 

Prescription Medication Instructions

Ibuprofen:  as above, take 600-800mg (depending on what Dr. Dyke prescribed) every 6 hours for 3 days, regardless of whether you have pain or not.  Always start with Ibuprofen and take as soon as you are able to after surgery. 
*Do not take ibuprofen if you have previously been instructed not to by a physician or Dr. Dyke.

Mild Pain:  If you are experiencing mild pain despite the Ibuprofen then you may take OTC Acetaminophen per the instructions above in the OTC section.

Moderate to Severe Pain:  If you are experiencing moderate to severe pain despite having taken Ibuprofen, then you make take the prescription narcotic provided by Dr. Dyke.  Usually this will be either Norco (Hydrocodone & Acetaminophen) or Oxycodone.

WARNING:
Be mindful of how much Acetaminophen (aka Tylenol) you are taking daily.
Norco (Hydrocodone & Acetaminophen) & some other medications also have Acetaminophen in them. 
Do not exceed 3000mg of Acetaminophen daily. 
If you are unsure, then do NOT take any OTC Acetaminophen (Tylenol) with your narcotic pain medication. 

Pain or discomfort following surgery should subside more and more each day. If pain is worsening after 4-5 days you may require attention and should call the office.

Dry Socket

You may have heard of “Dry Socket.”  The correct term for this is Alveolar Osteitis, which means inflammation of your jaw bone.  This is an uncommon complication that typically occurs with the following:

  • Blood clot at the surgical site is dislodged or malformed
  • Smoking 
  • Coagulation disorders – for example with Von Willebrand disease, or being on anticoagulant medications, ie “blood thinners”

This can usually be prevented by following these rules:

  • If we provided you with a syringe to irrigate the surgical sites, do not start using it until the 6th day after surgery.  For example, if you had surgery on Monday then you will start using the syringe on Sunday.  When irrigating with the syringe, gently place the tip of it into the site and flush the food and debris out gently.  Do NOT irrigate forcefully or with a waterpik.  Irrigate with warm saline (tap or distilled water with added salt).
  • Do not use a waterpik for 2 weeks after surgery, if you have one.  You may use normal flossing thread instead during this time.
  • Do not spit forcefully or frequently.  If you need to spit, lean over a sink and gently let any saliva or blood fall out.  It is okay to swallow the small amounts of oozing blood from the surgical site, do not try to spit it out frequently.  This will help the blood clot to form and stay in place.
  • Avoid sucking through straws forcefully.  This can create a negative pressure and potentially dislodge the blood clot. 
  • Do not smoke while you are healing.  Try and avoid smoking 2 weeks prior to and 2 weeks after surgery.

Sometimes dry socket can happen despite following these measures, however it is uncommon and you should not worry about it.  However, if your discomfort or pain beings to worsen 4-5 days after surgery and continues worsening, then you may have dry socket and should contact our clinic.  We may choose to place a medicated dressing in the site to help keep you more comfortable while the dry socket resolves itself.

Diet

You may begin eating as soon as you feel ready to after surgery.  If your mouth is still numb be careful not to bite your lips, cheeks, or tongue as you will not feel the trauma until the numbing medication wears off.  Do not drink very hot liquids until the numbness has completely worn off in order to avoid burning yourself.  Try to avoid chewing directly on surgical sites.  Drink plenty of liquids.  Eat pureed and very soft foods for the first 2-3 days.  A few examples of these types of foods are soups, shakes, oatmeal, apple sauce, mashed potatoes, and eggs.  Do not eat small, hard, or sharp foods like chips or seeds for 1 week after surgery.  These small, hard foods can get stuck in the surgical sites and result in infection or delayed healing.  After 3 days you may begin advancing your diet as tolerated.  Start with soft foods like breads and sandwiches (not toasted), or meats cut into small pieces.  

A high calorie, high protein intake is very important for the healing process. Prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss any meals. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.  If you are taking a narcotic it is important to stay hydrated to avoid constipation.

Hygiene

It is very important to maintain good hygiene after surgery to avoid infection and optimize healing. 

No rinsing or brushing of any kind should be performed until the day after surgery. The morning after surgery you should brush your teeth twice daily, every morning and every evening.  Brush carefully and gently near the surgical sites.  Start rinsing at least 2-3 times a day with an OTC mouth rinse or, if prescribed, with Peridex.  Try to rinse after meals and before going to sleep.  Do not use peridex more than 2 weeks as it can start to stain your teeth.  

Syringe irrigation with saline:  If you were given a syringe you should start using it 6 days after surgery to clean the surgical sites.  Fill it with warm saline (tap or distilled water with salt added) and gently irrigate.  For example, if you had surgery on Monday then you will start using the syringe on Sunday.  When irrigating with the syringe, gently place the tip into the site and flush the food and debris out gently.  Do NOT irrigate forcefully or with a waterpik.

After 2 weeks you should gently start to brush the surgical sites.  This means you need to brush your gums at the site.  Start gently and advance to where you are brushing the gums like a tooth.  Continue doing this until the gums are completely healed over, which usually takes at least 3 weeks.

Bruising

In some cases, bruising or discoloration of the skin may occur. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative finding which manifests 2-3 days after surgery.  Warmth applied to the area with the gel pack or a warm washcloth may help the discoloration resolve more quickly.  Depending on the individual, bruising may take as long as 2 weeks to fully resolve.  If you are on an anticoagulant medication you will likely experience bruising, which at times can be quite profound.  With time it will resolve.

Antibiotics

Dr. Dyke does not routinely prescribe antibiotics, however at times he may choose to do so to treat or prevent infections. If you have prescribed antibiotics, take them as directed until finished.  Make sure you take them completely and do not stop part of the way through, even if you feel like you’re better.  Doing this may kill the weaker, more susceptible bacteria and leave behind stronger, more resistant bacteria.  This leads to antibiotic resistance in bacteria and makes it harder to treat infections in the future for both yourself and others. 

Discontinue antibiotic use in the event of a rash or any other unfavorable reaction.  Taking OTC Benadryl may help with rashes or itching.  If your reaction is severe or you being experiencing difficulty breathing then immediately go to the Emergency Department or call 9-1-1.

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 coke, tea, 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.

Sutures

In some surgeries sutures are used to minimize bleeding, stabilize bone or gum grafts, and to help healing.  Usually they are the type that dissolve on their own, starting after 1 week and dissolving almost completely after 2 weeks.  Gently brushing the sites starting 1 week after surgery will help the sutures to dissolve.  At times non-resorbable, ie non-dissolvable, sutures are used.  If that is the case our team will inform you and these are usually removed in 2-4 weeks. 

Sometimes sutures can become dislodged, especially the dissolvable kind.  This is no cause for alarm.  Simply trim off that piece of dangling suture to where it meets the gums or knot.  If you need to return for suture removal, planned or otherwise, it is a simple procedure that requires no anesthesia or needles.  It takes only a minute or so, and there is usually no, or minimal, discomfort.

Other Complications

  • Numbness: If numbness of the lip, chin, or tongue occurs it is no cause for alarm.  The majority of the time this is temporary in nature, however it can take several weeks to many months to resolve.  Nerves heal very slowly and can take up to a year at times.  If you have any questions or concerns please contact our office.
  • Fever: Slight elevation of temperature immediately following surgery is common.  This is a normal inflammatory response to the insult, or surgery, your body experienced.  It is highly unlikely to be an infection as this usually takes 5-7 days to form.
  • Fainting: You should be careful going from the lying down position to standing. You may experience light headedness from low blood sugar or medications. If lying down, you should sit upright for one minute before attempting to stand. 
  • Sharp spots: Occasionally, patients may feel hard projections near the surgical site with their tongue. They are not roots or pieces of tooth structure that were missed; they are the bony walls which supported the tooth. These projections usually smooth out spontaneously, or they may shed or slough off on their own.  At times they are more tenacious and cling to the gums, which can be quite uncomfortable despite being a very simple thing to fix.  If this happens you may use your tongue, a Q-tip, or even a tweezer to simply pluck it out.  However, if you have any concerns or do not want to do this please call our office and we will make a quick appointment to easily remove it.
  • Stiffness (Trismus) of the jaw muscles usually occurs after surgery and is due to inflammation and swelling.  This can make it uncomfortable to open your mouth fully for several days. This is a normal post-operative event which will resolve with time as you being chewing normal foods and start placing warm gel pads/washcloths on your face 4-5 days after surgery.
  • Sore throat and pain when swallowing are not uncommon.  This is also due to the inflammatory process and swelling. This will start to subside after 2-3 days.
  • Chapped lips:  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.

In Summary

Your case is unique, no two patients are identical.  Sometimes unforeseen problems or complications happen.  In these events, or any time you have concerns or questions, please contact us and know that we are always here for you.  Our goal is to provide you with the optimal treatment in the best, most comfortable way possible.  If your experience is ever less than optimal please let us know so that we can improve the situation.

Remember, lingering discomfort, swelling, and bruising is normal after surgery, sometimes for several days.  As long as these things start to improve after 3 days then you are on the right track, even if the process is slow.

Brushing your teeth & rinsing after surgery is okay, just make sure to start the day after surgery and not the day of surgery.  Be gentle near the surgical sites.

Do not irrigate with the syringe until the 6th day after surgery to avoid damaging the blood clot.  Not everyone receives a syringe (they are usually only for wisdom teeth).

Not every receives antibiotics.  Dr. Dyke will prescribe them as needed.  If you didn’t receive a prescription for any, then don’t worry about it.

If you can take ibuprofen, then always start with that.  Take it every 6 hours for 3 days, whether you are experiencing discomfort or not.  This helps minimize swelling and keeps you ahead of the pain.

A “dry socket” is when the blood clot gets dislodged prematurely from the tooth socket.  This will feel like worsening pain 4-5 days after surgery.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.  Give your body the chance to heal itself.  Take things slowly and don’t push yourself.  Remember to drink plenty of fluids and keep up with your nutrition.