After the Removal of Multiple Teeth
Home Instructions After the Removal of Multiple Teeth
- The removal of many teeth at one time is quite different from the extraction of just one or two teeth. Usually the surrounding bone must be shaped, contoured and smoothed, especially prior to the placement of a denture. Sutures will have been used and these may be tan or black.
- If you received an immediate denture or partial denture, see section below.
IMMEDIATELY FOLLOWING The extractions
- The goal is to have a blood clot form within the surgery sites or sockets.
- We use 4 x 4 gauze pads:
- If you did not receive an immediate denture or partial denture, then one or two gauze pads are folded and placed over the surgical or extraction sites, and held in place with pressure from biting and holding the jaws closed. The gauze should be kept in place for half hour periods of time. After each 30 minute time period, the gauze should be removed, discarded, and replaced as needed. Also, saliva will soak into the gauze which will make it less effective. It may take a few hours for the bleeding to stop and a clot to form.
- If you did receive an immediate denture or partial denture, then you may place loosely folded gauze between your denture teeth and against your cheek. Remove this when the oozing stops. Refer to the section below for denture or partial denture care.
- Vigorous mouth rinsing and/or touching the wound area should be avoided. This may initiate bleeding by causing the blood clot that has formed within the surgery sites and sockets to become dislodged.
- Take the pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
- Restrict your activities the day of surgery and gradually resume normal activity when you feel comfortable and as tolerated.
- Place an ice pack or packs to the region of your face where surgery was performed. Refer to the section on swelling for a more thorough explanation.
- You should be careful going from the lying down position to standing. You could get light headed from low blood pressure, low blood sugar, or the medications. Before standing up, you should sit for one minute before getting up.
Denture or Partial Denture Care
- You may have received placement of an immediate full denture or a partial denture. Do not remove these unless the bleeding is severe. Expect some oozing around the side of the denture.
- Later during the first day, you may remove the denture briefly for cleaning. This will allow you to take a gauze pad and wipe any loose and free clotted blood or mucous off of the uninvolved gum areas, tongue, and roof of your mouth. Then gently wash and clean the denture under cool running water. Immediately replace the denture back into your mouth.
- You will see us or your dentist the next morning for a 24 hour check. After this, it is okay to take out the denture and gently clean and rinse 3 to 4 times a day.
- At some point in time, you may need to see your dentist for denture adjustment.
- A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon.
- Excessive bleeding is rare. If this occurs then you will need to remove the denture. Bleeding may be controlled by taking a piece of gauze and wiping any old loose clots from your mouth or that might be on the gum tissue near the surgery sites. Then place a folded 4 x 4 gauze pad over the area and bite firmly for thirty minutes. Repeat if necessary. Replace the denture after the bleeding has stopped. To minimize further bleeding, do not become excited or active. If bleeding does not subside, call our office or the on-call doctor.
- Do not smoke, drink through a straw, or spit for 24 hours after surgery. All of these actions cause a vacuum or suction to occur, which may dislodge the clot.
- The swelling that is normally expected is usually proportional to the surgery involved. There is often minimal swelling associated with a few straightforward extractions. However, multiple and more complicated extractions with local bone revision can be associated with some local or regional swelling. Swelling around the mouth, cheeks, lower eyes, and sides of the face can occur. 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 after your procedure.
- Swelling will occur, but may be minimized by the immediate use of an ice pack starting as soon as you arrive home from the procedure. You can use either a baggy filled with ice that is covered with a damp washcloth, or a standard old-fashioned ice bag that may be purchased at a drugstore. This should be applied to the region of the face where surgery was performed. The ice pack can be left in place continuously while you are awake. If needed, the ice pack can be move from one side to the other side of your face every 30-45 minutes. After 36 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.
- Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling as well as creating a feeling of comfort.
Remember that dosing is determined by your weight, age, and medical status. Below are standard guidelines.
For mild to moderate pain,
- One or two tablets of Tylenol or Extra Strength Tylenol may be taken every 3-4 hours, not to exceed 3,000mg (reduced from the previous recommendation of 4,000mg maximum).
- Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3,200mg daily for an adult. Consult our practice for individuals under 18.
For severe pain,
- If prescribed, the narcotic medication should be taken as directed.
- Do not take additional Tylenol with this prescribed narcotic medication. This medication already contains Tylenol.
- If you are able to take Ibuprofen (Advil or Motrin), this may be used along with the prescribed narcotic medication. A suggestion is to stagger these medications at 2-3 hour intervals.
- There are many instances where a narcotic medication is not indicated or needed, and will not be prescribed.
- Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. Discontinue use in the event of a rash or any other unfavorable reaction and contact our office or the on-call doctor immediately.
- Do not drive an automobile or work around machinery. Some pain medications can cause drowsiness/sedation and impair judgment.
- 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 or the doctor on call.
- If you received IV anesthesia, only liquids should initially be consumed.
- Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot.
- Always remove any gauze packs when eating or drinking.
- You may eat anything soft. Chew away from the surgical site. This food may be warm, cool, or cold. A high calorie, high protein intake is very important. General suggestions may include items such as soups, stews, meatloaf, chicken pot pie, shepherds pie, lasagna, scrambled eggs with hash browns or grits. Nourishment should be consumed 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 any meals. 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 up for one minute before standing.
KEEP THE MOUTH CLEAN
- If prescribed Chlorhexidine (PERIDEX) then gently rinse as directed, then gently release from your mouth.
- Otherwise, no rinsing or spitting of any kind should be performed until the day following surgery.
- The day after surgery you should briefly remove the denture or partial denture and begin gently rinsing at least 5-6 times a day with a teaspoon of salt mixed into one cup of warm water. This can also be performed after meals. While the denture is removed, carefully clean it under cold running water.
- Brush any remaining teeth, but avoid teeth adjacent to any surgical sites until healing has progressed.
- 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.
- If you have been placed on antibiotics, take the tablets, capsules, or liquid as directed. Antibiotics will be given to help prevent infection.
- Birth control pills may not be effective while taking antibiotics. This includes the entire cycle.
- There are many instances where an antibiotic is not indicated or needed, and will not be prescribed.
- Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office or the on-call doctor immediately.
- Some types of antibiotics can cause significant gastrointestinal upset or even severe, cramping diarrhea. If this does occur please call our office or your medical doctor.
- Call the office if you have any questions.
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.
- If the nausea and/or vomiting continues, please call our office or the on-call doctor.
OTHER COMPLICATIONS AND ISSUES
- If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, 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. Please contact us if you have any questions.
- Keep physical activities to a minimum immediately following surgery. If you 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.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office or the on-call doctor. Tylenol or ibuprofen should be taken to reduce the fever.
- 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 or chapstick.
- Having what feels like a sore throat and pain when swallowing is not uncommon. The muscles in this area can become inflammed. The normal act of swallowing can then become painful. This will subside in 2-3 days.
- Stiffness (Trismus) 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.