After the Removal of Multiple Teeth

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 45 minutes. After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. That is why we ask you to bite on a moistened gauze pad for 30-45 minutes after the appointment. If the bleeding or oozing still persists, place another moistened gauze pad and bite firmly for another 45 minutes to one hour. You may have to do this a few times. However, excessive changes (more than four or five) or frequent changes (less than every 30 minutes) are most often the cause of an excessive bleeding problem due to disruption of the clot trying to form. If bleeding continues, then biting on a moist tea bag placed over the site for 30 minutes to 45 minutes may help stop the bleeding. In order to avoid bleeding problems, do not drink hot liquids, avoid exercise, and elevate the head for the first 24 hours. If bleeding persists, call our office immediately. Do not remove an immediate denture until your 24 to 48 hour follow-up appointment with the restorative dentist unless the bleeding is severe. Expect some oozing around the side of the dentures for the first day.

Use ice packs (externally) on the same side of the face as the operated area to reduce swelling and pain. Apply ice for the first day and no longer than 24 hours. The ice should be applied intermittently 20 minutes on and 20 minutes off on the face to the area of surgery continuously for the first day while you are awake. Keeping the head elevated at 30 degrees while resting or asleep will also help minimize swelling from surgery.

Use the pain medication as directed by Dr Chun and his staff at the surgery and or consult appointment. To review, you should begin taking pain medication as soon as you feel the local anesthetic wearing off. For mild to moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 6 hours for patients over the age of 12 years. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol and is often reported to work better. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every six to eight hours for patients over age of 12 years as needed for pain. For severe pain, the prescribed narcotic medication should be taken as directed. You should not drive, operate machinery or make important decisions while on narcotic pain medications. If the medication doesn’t seem to be working then call the office for further instructions. If the pain does not begin to subside in 3 days, or increases after 3 days, or you do not think it is working please call our office for advice.

If you have been placed on antibiotics, take the tablets or liquid as directed for the duration indicated on the prescription. Antibiotics will be given to help prevent infection. Missing one dose time is usually not a problem if you have been on it for a couple days but take the next dose as soon as possible and in this case doubling the next dose usually is not necessary. Missing more than 24 consecutive hours of antibiotics within the first 3 days of dosing schedule can be a problem and a call to the doctor is recommended to discuss the situation. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Rash, itching or swelling with use could indicate an allergic reaction and you must alert the doctor of these findings immediately. Swelling of the neck and face other than at the surgical site accompanied with difficulty in breathing is a life threatening allergic problem and calling 911 and/or going to the nearest emergency room is advised. Other problems that antibiotics could cause that you may need to advise your doctor of is sudden development of diarrhea as this could signify a antibiotic induced colitis of the bowels that may need treatment.

Call the office if you have any questions.

Drink plenty of fluids. If many teeth have been extracted, it may be difficult to chew to eat solid foods and therefore you must at least remain hydrated. We advise drinking at least six glasses of clear liquid (apple juice, grape juice, Gatorade or water) the first day after surgery. Milkshakes, protein drinks, breakfast drinks, and nutritional supplement drinks such as Ensure also will help to satiate your hunger pangs, give you energy to function, and improve your nutritional status which ultimately helps your wound healing.

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 (at least four to six times a day) to flush out particles of food and debris that may lodge in the operated area. Dissolve one half to one teaspoon of normal table salt in a glass of warm water to use for your rinses. After you have seen your dentist for denture adjustment, take out denture and rinse at least 4 to 6 times a day until your surgical follow-up appointment with Dr Chun.

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 for maxillary (upper jaw) teeth extractions. The application of a moist warm towel for two to three minutes alternating with cold compress for one to two minutes will help to quicken the elimination of the discoloration and any swelling that may have occurred. The intermittent hot and cold compresses should be applied continuously for as long as tolerable beginning 3 days after surgery (remember ice packs are used for the first 24 hours only). The lower jaw may have swelling over the jaw line or cheek in the lower jaw area and this also can be treated with application of intermittent ice packs to the cheek for the first 24 hours and then the intermittent hot and cold compresses after the third day of surgery.
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 one to two days. In the first 24 hours this may indicate an under medicated status for the pain medication dosing.
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 but this should not exceed 100 degrees Fahrenheit or 37.8 degrees Celsius via oral or temporal artery monitors. If temperature continues, notify our office.

If immediate dentures have been inserted, sore spots may develop or the denture may be loose. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots and adjust the fit of the denture. Failure to have this follow-up appointment for adjustments with the restorative dentist may result in severe denture sores over the first week which may prolong the healing procedure and pain.