September 28, 2011

Dental Post-operative Instructions

The mouth is a unique place compared with the rest of your body.  For one thing infections are usually not life threatening and a tooth, in some situations, can actually rot  out of the bone without too much discomfort.

SUTURES (Stitches): Most extractions do not need to have a suture placed.  The gums will heal over the site just fine. When a suture is placed, it is placed in your mouth for a reason. Usually because the gums needed to be pushed back for access to a root or to remove  bone around a tooth.  Extraction sutures are nearly always resorbable.  This means they will dissolve and fall out on their own over a period of time (10 days). Sutures placed during implant surgery, periodontal surgery or with a non-resorbable membrane over a bone graft are not usually resorbable and need to be scheduled for a post-operative removal appointment 1 to 6 weeks after.

ANESTHETICS: The amount of time you are numb after a dental prodecure varies depending on the type and amount of anesthesia you have received. During the time your mouth is numb you should be careful not to bite or chew on your lips, cheeks, or tongue. The anesthetic should subside within a few hours, but if it does not go away by the next day, contact your doctor immediately. If you do not like the prolonged numbing effect of the local anesthetic then you can ask for a reversal agent called Oraverse.  It can remove the numbness in 15 to 30 minutes.  There is a $20.00 fee for this reversal agent because the company charges a lot for their product. If you had an IV sedation, it will be normal to experience drowsiness for several hours after the procedure. Be aware that pain control prescriptions can increase this drowsiness. Do not drive an automobile or operate machinery for 24 hour after an IV sedation or while you  are taking prescription pain medications.

BLEEDING: A gauze packing for the extraction site should be rolled up, and pressed on the extraction site gums, NOT held between the adjacent teeth.  The purpose of the gauze is NOT to soak up the blood, but instead to place pressure over the extraction site to prevent blood from freely flowing out of the socket.  This ‘back pressure’ of the gauze is what allows a clot to form inside the socket, and to initiate the bodies healing response.  The gauze should be moist, and have some blood inside of it at all times.  If you chronically check the gauze after an extraction by removing it, and placing new dry gauze, then you will be guilty of ‘milking the clot’.  Milking the clot will pull the established clot out of the socket and could lead to a ‘dry socket’. A dry socket does not mean it is really ‘dry’, but instead means you have lost your clot of blood and another blood clot will not form back.  In healthy individuals bleeding should stop at a point of not needing gauze in about 30 minutes to an hour.  Some bleeding/oozing may persist for 24 hours or more.  Remember, a little bit of blood mixed with saliva looks like lots of blood.  If excessive bleeding does occurs to a point that you start getting large clots forming in your mouth, then call the office immediately for a follow-up appointment. If unable to contact Dr. Kraver, then go to the nearest hospital emergency room for possible treatment. (Understand that the ER doctors may just place gauze over the extraction site in the proper position, and have you bite to stop the bleeding like you were instructed to do in the first place).

SWELLING: Some facial swelling is normal after most extractions. It is the bodies way of bringing in the ‘groceries’ to feed the damaged tissues so they can begin to reorganize and heal. Applying cold compresses on the face for 20 minutes and then removing for 5 minutes for the first 4 to 8 hours can be helpful, but in most cases not completely necessary. If swelling occurs, it will normally increase for the first 3 days, and and then be gone in about a week.  Black and blue marks can sometime occur on or just below the outer skin of the surgery.  This is unfortunate, and usually occurs in the elderly.  This is because the facial collagen fibers are not as tightly bounded together, and the blood in the tissue is able to move larger distances before the body is able to corral it.  Additional swelling can occur for post-operative biting trauma.  This usually happens in children and the elderly. Children can think chewing on their numb lips, and cheeks feels ‘funny’.  Believe me, it is NOT funny.  The elderly  bite their lips and cheeks for a different reason. Lack of tight collagen fibers can cause cause the lips to be easily folded between the teeth when they talk.  Avoid talking, and chewing whenever numb!

PAIN: If you have been given a pain medication prescription, please take it as directed.  May times you do not need to take more than just a few pain pills post-operatively.  If you have pain, and have to work with heavy machinery, then you can try over-the-counter medications of 600 mg ibuprofen and 500mg Tylenol taken together up to 3 times per day.  Otherwise, 800 mg ibuprofen usually does the trick.  If you notice the discomfort subsiding, then on about the 3rd day pain comes back worse than before, you probably have a ‘dry socket’.  This is the loss of the blood clot inside the extraction socket.  There are various reasons a clot can be lost in an extraction site which include: smoking, sucking, rinsing with an alcoholic mouthwash or peroxide, drinking carbonated beverages, drinking alcoholic beverages, and spitting.  Occasionally, the cause is completely unknown.  If you cannot control your post-operative discomfort then call the office for further consultation.  Your Cape Dental Care doctors are on call 24/7 @ (239)549-8921.

ORAL HYGIENE: DO NOT rinse your mouth for the first 24 hours after an extraction or surgery.  Avoid brushing your teeth following surgery until the next day.  Starting 2 days after the surgery gently rinse your mouth with supersaturated warm saltwater (add just enough salt in warm water so the salt doesn’t completely dissolve).  Gently rinse (not turbo swishing) with warm saltwater in the morning, after each meal, and  before bed so not to aggravate the blood clot. Rinsing after each meal keeps food ‘left-overs’ out of the extraction site. Avoid using other mouthwashes during the healing period.  Begin brushing your teeth using care in the surgical areas the day after surgery.  Brush the tongue to help eliminate the bad breath, any unpleasant taste and the build-up of bacteria that is common after an extraction.

DIET: You will usually know what you can tolerate after an extraction or surgery. Liquid/soft diet of juices, clear or cream style soups, milkshakes, fruit smoothies (without seeds), yogurt, and pudding are a good start.  A well balanced diet is very important for the body to provide the essential nutrients for proper, and quick healing.  Soft foods that are high in nutritional value are recommended. You can return to your normal diet as soon as possible. Avoid small particle foods such as rice and corn as they can easily lodge inside the extraction sites.  Eat cool or lukewarm foods so not to increase the blood flow in the oral cavity. Fluid intake following surgery should be increased (but not through a straw because  sucking might dislodge the clot) to help hydrate the body for a faster healing response.

SMOKING: Ideally, DO NOT smoke for at least 2 weeks before and 3 days following surgery. Cigarettes are a nicotine delivery system.  The nicotine enters the bloodstream through the lungs, and travels to every cell of the body.  Nicotine is an anti-healing drug, slowing the healing process, and is the major cause of dry sockets.  It is always a good time to quit smoking!

EMERGENCY: Call the office at (239)549-8921.  If unable to contact Dr. Kraver, then go to the nearest hospital emergency room for possible treatment.