Post-Operative Instructions in Caldwell and Florham Park, NJ
It is our goal at the NJ Center for Oral Surgery that your recovery be as smooth and comfortable as possible. By carefully following these post-operative instructions, you will minimize any pain and swelling and lessen the chance for infection and complications.
Read all of these instructions carefully before calling the office. If after reading these directions you still have questions, please call the office and your doctor will be happy to speak with you.
- PAIN MEDICATION –
- Ibuprofen (Advil, Motrin): If instructed by your surgeon, you should take 600mg every 8 hours continuously for the first two days. Take the first dose immediately after surgery and before the local anesthesia has worn off.
- Acetaminophen (Tylenol): If instructed by your surgeon, you should take 650-1,000mg every 8 hours continuously for the first two days. This should be taken at the same time as Ibuprofen for optimal effect.
- Narcotic pain medication (Vicodin): If you have been prescribed narcotic pain medication, you should use it only as a rescue medication and if you have already taken the above over-the-counter (OTC) pain medication and you are still uncomfortable. Allow the OTC pain medication at least 1 hour to take effect before considering narcotic pain medication.
- GAUZE PRESSURE – Bite down firmly on the gauze packs that have been placed over the surgical areas while making sure they remain in place. Do not change them for the first 30 minutes unless the bleeding is heavy. After 30 minutes, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 20 to 30 minutes). It is best to slightly moisten the gauze with tap water and loosely fluff for more comfortable positioning. Bleeding from oral surgery may take 24 hours to fully stop.
- ICE PACKS – Swelling is common following oral surgery. Swelling can be minimized by using cold packs or a bag of frozen peas applied firmly to the cheek nearest to the surgical area. Ice should be applied twenty minutes on and twenty minutes off during the first 24 hours after surgery. You may continue to use ice for up to 48 hours after surgery to help reduce pain.
- PROTECTING THE BLOOD CLOT – Do not rinse vigorously or drink with a straw for at least 48 hours after your surgery. If you have been prescribed an antibiotic mouthwash, you may begin to use it gently at bedtime the night of your surgery.
- SMOKING AND VAPING – The chemicals in tobacco/marijuana smoke and all vaping products are caustic and will significantly delay healing and increase post-operative pain, swelling, risk of infection, and risk of dry socket. Do not smoke or vape for at least two weeks after surgery.
- HYDRATION – You may begin drinking clear fluids (water, Gatorade, Pedialyte, juice without pulp) immediately after surgery. You should drink plenty of fluids in the first four hours after surgery. Slowly progress to soft foods later in the day (see below EATING/DIET). DO NOT USE A STRAW UNTIL 48 HOURS AFTER YOUR SURGERY.
- PROBIOTICS – may prevent and relieve some of the common side effects of antibiotics such as nausea, upset stomach, and diarrhea. Probiotics are considered safe and are naturally contained in products such as yogurt. We recommend taking probiotics while you are taking the oral antibiotic pills we prescribe for you. Probiotics are available over-the-counter, come in several forms, and can be purchased at your local pharmacy or supermarket. They should be taken at least 2 hours before taking antibiotic medications. It is important that you notify your doctor if you experience side effects of antibiotics as this may be a sign of serious conditions that may require medical attention.
AFTER THE FIRST HOUR
- PERSISTENT BLEEDING – Mild bleeding or oozing is normal during the first 24 hours after surgery. If necessary, reposition the gauze packs directly over the surgical site. If bleeding persists or becomes heavy, you may substitute a tea bag (soaked in water, squeezed damp-dry and wrapped in a moist gauze) for 20 or 30 minutes. Tea leaves contain a beneficial chemical that locally constricts blood vessels. If bleeding remains uncontrolled after a full hour of using the tea bags, call our office. Remove the gauze while you eat and sleep. Place an old towel over your pillow, as one drop of blood will turn a mouth full of saliva red. It is completely normal to experience mild oozing of blood from the surgical area for a full 24 hours after surgery. Once the bleeding has stopped, you do not have to use anymore gauze.
- STEROIDS – If you have been prescribed a steroid medication to minimize swelling, be sure to take it as directed on the box. You should take the “1st Day” pills all together at bedtime the night of your surgery. If your doctor administered steroid medication during your surgery, 3 pills will be missing from the “1st Day” dose of the steroid pack you are given.
- MOUTH OPENING EXERCISES – Jaw stiffness is common following oral surgery. You can reduce this stiffness by stretching your mouth open with two fingers each hour.
- MANAGING POST-OPERATIVE PAIN – Unfortunately, most oral surgery is accompanied by some degree of discomfort, and you may be given a prescription for narcotic pain medication. To best manage your discomfort, you should take the first dose of over-the-counter medications before the numbness has worn off (see further instructions above). If you find you are taking large amounts of pain medication at frequent intervals, please call our office. If you anticipate needing more narcotic pain medication, you must return to the office during normal weekday business hours. Pharmacies will not accept narcotic refills by telephone.
- NAUSEA – Nausea can occur after anesthesia or surgery. It generally improves within 4-6 hours. Nausea following anesthesia is best managed by avoiding all foods until you are feeling hungry. Try sipping small amounts of clear liquids to prevent dehydration. If the pain medication is the cause, try taking Maalox immediately before the medication and drink plenty of water. Try to keep taking clear fluids and minimize dosing of pain medications, but call us if you do not feel better. Classic Coca Cola may also help with nausea.
- EATING/DIET AFTER DENTAL IMPLANT SURGERY – You should avoid eating on the side where the implant was placed for one week. After the first week, you may begin eating soft food on the side that the implant was placed. After two weeks you may resume a normal diet.
POST-OP DAY #2 AND BEYOND
- ORAL HYGIENE – Keeping your mouth clean after surgery is essential. In addition to any prescription mouthwashes you may have been given, you may use warm salt water (1/4 teaspoon of salt dissolved in an 8-ounce glass of warm water) to gently rinse your mouth. Repeat as often as you like. Avoid commercial mouthwashes as these contain alcohol and may irritate the surgical site. Avoid brushing the surgical site directly for the first week. We do encourage you to brush and floss all other areas of your mouth as you normally would. You may begin to gently brush the surgical site after one week. Good oral hygiene is essential to post-operative healing.
- HEALING – Normal healing after oral surgery should be as follows: The first three days after surgery are generally the most uncomfortable and there is usually some swelling. On the fourth day you should begin to feel more comfortable and, although still swollen, can usually begin a more normal diet. The remainder of the post-operative course should be a gradual, steady improvement. If you do not see continued improvement, please call our office.
- DRY SOCKET – Dry socket is a painful condition that results from premature loss of the blood clot. Major risk factors for developing a dry socket are 1) smoking, 2) wisdom tooth surgery, 3) after extraction of painful or infected teeth, 4) patients on oral contraceptives or blood thinners. Symptoms of a dry socket typically occur on the 3rd or 4th post-operative day. Severe throbbing pain, which is not responsive to pain medications, as well as bad breath, are the usual complaints. This condition requires an office visit where your surgeon will gently place a medicated dressing into the tooth socket. Pain relief is often immediate once the site is treated. Several visits may be necessary in some cases.
- SUTURES/STITCHES – You may have had sutures/stitches placed. They will begin to dissolve about 5 to 10 days after surgery, but may come out even earlier than that. If they fall out early, do not worry. Dissolvable stitches begin to melt away as you heal and can be gently pulled free if they are very loose.
- SHARP EDGES – If you feel hard or sharp edges around the surgical areas, it is likely you are feeling the healing socket or the ends of the sutures/stitches. Occasionally, small slivers of bone may work themselves out from the surgical site during healing. This is normal, but if they cause concern or discomfort please call the office.
Following these instructions will assist you, but if you have questions about your progress, please call our office. Calling during office hours will result in a faster response to your question or concern.
PLEASE NOTE: You are required to come to the office during normal business hours if you request refill of any narcotic pain medication. Pharmacies will not accept narcotic refills by telephone.
NARCOTIC MEDICATION PRECAUTIONS
- INDICATIONS FOR USE – If you have been prescribed narcotic pain medications, your doctor has determined that these medications may be useful as an adjunctive treatment for post-operative pain management. These medications are to be used only for pain that is not sufficiently managed with scheduled over-the-counter pain medications such as NSAIDS (ibuprofen/Advil/Motrin, naproxen/Aleve) and acetaminophen/Tylenol.
- MINIMIZING USE – While narcotic pain medication is a useful adjunctive pain treatment, the use of narcotics should be limited whenever possible as they have a high potential for addiction and/or dependency.
- SIDE EFFECTS – Additional side effects of narcotic medications may include, but are not limited to, skin rash, constipation, sedation, confusion, depression, increased sensitivity to pain, and impaired motor skills. As a result, while taking these medications you should not drive a motor vehicle, operate machinery, make important decisions, or take care of other people.
- DO NOT TAKE WITH OTHER NARCOTICS, ALCOHOL, OR SEDATING MEDICATIONS – You should not take narcotic medication more frequently than prescribed. Additionally, you should not take the prescribed narcotic medication if you are already taking any other narcotic medication or sedating medication. Do not drink alcohol while taking narcotic medication. Noncompliance with these restrictions may result in drug overdose causing severe sedation, respiratory depression, and possible death.
- STORAGE – The narcotic prescription you have been prescribed is for your use only. Narcotic medications should be stored out of reach of children and away from anyone who may abuse them.
- DISPOSAL – Any unused narcotic medications should be disposed of properly by flushing them down the toilet. Note that this is the FDA-recommended method of narcotic medication disposal.