Try not to disturb the wound and temporary stitches. Avoid rinsing, spitting, or touching the wound on the day of surgery. In most instances, there will be a metal healing abutment protruding through the gingival (gum) tissue.

BLEEDING

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call for further instructions.

SWELLING

Swelling is a normal occurrence after any surgery and it is most noticeable on the 3rd to 5th day. This is a physiologic phenomenon called “third-spacing”. To minimize the swelling apply cold compress for the for the first 2 days. After surgery we will provide you with a specially designed ice compress to help you with this task. Additionally, you can use any over-the-counter ice bag, or a plastic bag filled with frozen vegetables, or towel filled with ice on the cheek. Apply the ice as much as possible, 20 minutes on; 20 minutes off.

DIET

Drink plenty of fluids. Avoid extremes of temperature: hot or cold liquids or food. Soft, non-chewing diet and liquids should be the mainstay of your diet for the first few days. As you feel yourself feeling normal once again, you can return to your regular chewing diet. During your daily routine, if you do anything that induces pain, that is your body telling you to slow-down and take a step back. Try to stay hydrated and avoid caffeinated beverages. One of the most common cause of post-surgery nausea is dehydration!

PAIN

You should begin taking pain medication as soon as you get home, before the “numbness” feeling of the local anesthetic wears off. As with most medications, try to eat something before you take the pain medications. On an empty stomach, the medications may cause nausea and vomiting. Each doctor will prescribe a series of pain medications. Please follow the instructions closely and feel free to call us 24/7 if there are any questions or concerns. We are here for you, anytime!

ANTIBIOTICS

Be sure to take the prescribed antibiotics as directed to help prevent infection. This sometimes provided on select patients who present with pre-existing signs of infection or those who are immuno-compromised.

ORAL HYGIENE

Good oral hygiene is essential to good healing. You must maintain good hygiene for the surgery to be successful. This includes cleaning your mouth every time you have a meal. When brushing use extreme care to avoid the areas of surgery, but cleanse the other areas of the mouth. You may be given a prescription mouthwash called “Peridex”. Start using it the following day, at least twice a day or after every meal. Be sure to hold the liquid in the mouth for at least 30 seconds then gently let it out over the sink. Try not to swish to vigorously, as this may disturb the healing site and the temporary resorable stitches. In the absence of Peridex, you can create warm salt water rinse (One teaspoon of salt in an 8 ounce cup of warm water).

ACTIVITY

Keep physical activities to a minimum immediately following surgery. This is specially true for the first 2 days, if you are interested in keeping the swelling to a minimum. Anything activity that increases your blood pressure will lead to throbbing pain or new-onset of bleeding. If this occurs, you should discontinue the activity and try to reduce your heartrate and hence blood pressure.

WEARING YOUR PROSTHESIS

Partial dentures, flippers, or full dentures should not be used immediately after surgery and for at least 10 days. This was discussed in the pre-operative consultation.

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.

IMMEDIATELY FOLLOWING SURGERY

• The gauze pad placed over the surgical area should be kept in place forthe first 30-60 minutes. After this time, the gauze pad should be removed and discarded. Over the next few days you will notice minor bleeding or oozing, which is normal. But it should progressively become less and less as the days pass.
• Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
• Take the prescribed pain medications as soon as you begin to feel the onset of pain and discomfort. This will usually coincide with the local anesthetic becoming diminished. The first few days try to stay ahead of the pain and this will only aid in you getting some rest and healing as fast as possible/
• Restrict your activities the day of surgery and gradually resume normal activity when you feel comfortable.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

BLEEDING

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

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 3-5 days post-operatively. However, the swelling may be minimized by the use of ice packs for the first 2 days. After surgery we will provide you with a specially designed ice compress to help you with this task. Addtionally, you can use any over-the-counter ice bag, or a plastic bag filled with frozen vegetables, or towel filled with ice on the cheek. Apply the ice as much as possible,20 minutes on; 20 minutes off. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery.

PAIN

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

DIET

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment should be taken regularly. You should 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 a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. 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 for one minute before standing-up.

KEEP THE MOUTH CLEAN

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently while avoiding the site of surgery. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.

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.

ANTIBIOTICS

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction. Then call the office to notify us of the situtation.

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. Many times this is due to the sedation or taking medications on an empty stomach. As with most medications, usually take eat something before taking any medications – Unless otherwise directed on the prescription bottle.

OTHER COMPLICATIONS

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, 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. So be careful. Call Drs. Sodeifi and Massoomi if you have any questions.
• Slight elevation of temperature immediately following surgery is not uncommon. If a temperature of >101.5 persists over 12 hours, please notify the office first, then take some Tylenol or ibuprofen to reduce the fever.
• You should be careful going from the lying down position to standing. Since you were not able to eat or drink prior to surgery, your body is in the state of dehyrdation. Should you suddenly stand-up it may make you lightheaded and “pass-out”. This may in turn lead to nausea and vomiting. This is why it is important for you take adequate amounts of fluids after surgery, to replish the fluids.
• 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, on rare occasions they can be smoothened by Drs. Sodeifi and Massoomi a few days to weeks later.
• During surgery the corners of your mouth are stretched by our instruments. This may lead todrying out and/or crack. Your lips should be kept moist with an ointment such as vaseline.
• Sore throats and pain when swallowing are not uncommon. The muscles that move your jaw are manipulated during surgery and may become swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
• Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.

FINALLY

Resorbable sutures or stitches are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures will eventually fall-out spontanously or be removed when the gums are fully healed. This may take a few weeks. Typically the removal of sutures requires no anesthesia or needles. It takes only a few seconds and there is no discomfort associated with this procedure. So it’s really nothing to worry about.

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call my office for instructions.

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

Your case is individual, no two mouths are alike and no two teeth are alike. All four sites will act independent from one another. Do not expect all four site to feel the same way. Some days the lower left will be bothersome, the next day it wasy be the upper right. Just take things in stride and as long as things are progressively improving, then you are making great strides. Try not to accept well intended advice from friends or family. Typically its the people with the worst experience that voice their opinions. Most studies put expected complications at less than 3% of the millions of third molars extractions that are performed each year. We are here to answer your questions. Please discuss any question or concern with Drs. Sodeifi.

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 to the ear may occur 2-3 days following surgery. Call the office if this occurs, as this may require a special packing to be placed in the extraction site.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. You may not have the energy to exercise, furthermore exercising may weaken you. If you get light headed, stop exercising. Take it easy for the first two days, you will thank yourself later!

Do not disturb the wound. If surgical packing was placed, leave it alone. The pack helps to keep the tooth exposed. If it gets dislodged or falls out do not get alarmed.

BLEEDING

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding which results in your mouth filling rapidly with blood can frequently be controlled by biting with pressure on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call for further instructions.

SWELLING

Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag or a plastic bag or towel filled with ice cubes on the cheek in the area of surgery. Apply the ice continuously as much as possible for the first 2 days.

DIET

Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

PAIN

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength. Tylenol may be taken every 3-4 hours. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed.

ORAL HYGIENE

Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can. Rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete.

REMEMBER: A clean wound heals better and faster.

ACTIVITY

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. That’s why we ask you to bite on a gauze pad for 30-60 minutes after the appointment. If the bleeding or oozing still persists, place another gauze pad and bite firmly for another 30 minutes. You may have to do this several times for the next few days.

After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 2 days as this will increase blood pressure and may cause more bleeding from the extraction site.

After the tooth is extracted you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed.

Use the pain medication as directed. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.

It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean.

After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call our office immediately.

A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding continues, a moist tea bag can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture for the first few days.

Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 2 days only. Apply ice continuously while you are awake.

For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 3-4 hours. Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 3-4 hours.

For severe pain use the prescription given to you. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, finish your prescription regardless of your symptoms.

Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day.

Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt water rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One half teaspoon of salt in a glass of lukewarm water). After you have seen your dentist for denture adjustment, take out denture and rinse 3 to 4 times a day.

Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.

The removal of many teeth at one time is quite different than the extraction of 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 two days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning2 daysafter surgery (remember ice packs are used for the first 2 days 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 2-3 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 temperature of >101.5 continues for 12 hours, notify our office first, then take some Tylenol to reduce the temperature.

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