General Post-Surgical Instructions

Post-surgical / Home Care Instructions

Instructions for Home Care Following Extraction of Teeth,

Biopsies or Dental Implants

PAIN:
Some pain following surgical procedures is not uncommon. For mild to moderate pain, take two aspirin (if not bleeding) or aspirin substitute tablets and/or NSAIDS, (non-steroidal anti-inflammatory drugs), (Bufferin, Anacin, Empirin, Tylenol, Advil, Alleve, etc.) every 3 to 4 hours. Children, especially young children, should receive similar doses of between ¼ and ½ the adult dose, and only if necessary. (DO NOT GIVE CHILDREN ASPIRIN IF FLU SYMPTOMS EXIST=RISK: REYE’S SYNDROME). Please consult package labels and/or your pediatrician for correct dosages. A prescription(s) has been given to you for additional pain relief. Use the prescription(s) as directed, or together with aspirin or Advil, as necessary.  Try not to take the narcotic medication unless absolutely necessary, as they can make your nauseous, dizzy, weak, itchy, etc.; and don’t drive/operate machinery while taking narcotics.
MEDICATIONS: (consult your physician prior to use)
Space out timing of different medications approximately 15-30 minutes apart to prevent upset stomach. Example, take pain med, wait 15 minutes, then take antibiotics, wait 15 minutes, then take anti-swell, etc. You must take your pain medication on time and you must take it with food, or you risk the onset of pain and gastric distress. Over-the-counter Pepsid or Zantac may also be taken in conjunction with pain medications to help prevent stomach upset.  Take the second dose on schedule before you begin to feel discomfort after you have been given something to eat (soup, applesauce, etc). You may repeat pain medication every 3 to 4 hours as needed for discomfort. For example, take 1-2 Advil every 3-4 hours (not more than 2400 mg adult dosage per day), then 1 Dolobid 4 hours after that. (Dolobid is taken every 8-12 hours). Therefore, to repeat: every 4 hours, take Advil, then 4 hours following that , take Dolobid. (ie. Advil, Dolobid, Advil, Dolobid, etc.) It is not unusual to feel drowsy or dizzy as long as you are taking pain medication, especially if it is a narcotic, for example: Tylenol #3 or 4, Vicodin, Norco, Percodan, Percocet. Narcotics help you perceive pain differently (not care about it), where as non-steroidal anti-inflammatory or NSAIDS (Advil, Dolobid), stop pain mediators before they are released.

Therefore, keep taking these so you achieve an effective blood level and therefore possibly not have any pain. Take antibiotics as directed until finished. Do not take on an empty stomach, even if the pharmacist puts a label to do so because you may experience nausea. It is recommended, therefore, to have something in your stomach, even though this would cut down on the absorption of the antibiotic to a certain degree.

If any unusual symptoms should occur, (ie. Nausea, vomiting, skin rash or hives, diarrhea, etc.), discontinue the medication immediately and call the office. Consult your M.D. with respect to non-steroidal anti-inflammatory & Medrol if you have asthma or ulcers or are on blood thinners or have diabetes. Don’t take Seldane if on Erythromycin.

BLEEDING:        
A certain amount of bleeding is to be expected following tooth extraction. If bleeding occurs, place a small folded pad of gauze, slightly moistened, directly over the bleeding area. Then place a larger wad of gauze over the first piece and bite or hold down firmly for 30 minutes to 1 hour. Remove any large excess jellied blood clots gently before applying pressure if present. Repeat the above process if necessary, but only after 30 minutes. If bleeding persists, avoid hot liquids and stop all mouth rinses or sucking motions, (i.e. no straws). Sit or sleep upright (at 45° angle) and avoid exercise. Intra-oral moist hot pads may be added. Placing hot caffeinated tea bags wrapped in gauze directly onto the extraction site helps stop bleeding. (Tannic acid cauterizes and warmth and coagulates the proteins in the blood.) If bleeding continues, call the office. It is normal for your saliva to be slightly colored for 1-2 days, since a few drops of blood in a lot of saliva looks like more than it really is. It is also normal to wake up with blood on your pillow in the morning, so do not be alarmed. Don’t sleep with gauze in mouth, and keep one end of the gauze exiting the oral cavity when resting to avoid swallowing gauze.
POST- OPERATIVE SWELLING:
To reduce ordinary immediate post-operative swelling, apply an ice pack or washcloth saturated with ice water to the face over the operated site immediately for 6-8 hours. The ice pack should be applied for 5-10 minutes on, then 5-10 minutes off, etc. for the first 24-72 hours for best results. Swelling, discoloration, and restricted jaw movements are expected, (maybe greatest on the second post-operative day or as the Medrol steroid pack tapers off). Keeping your head slightly elevated (while awake and asleep) will limit the tendency to swell. After the 3rd day, ice may be discontinued.  The Medrol dose pack is prescribed to help reduce swelling, and therefore pain (children: take half the adult dosage).  If one chooses not to take this pack, expect to have more swelling, accompanied by more pain.  The steroid pack can also mask an allergic reaction, so if a rash/hives occurs at the end of the week following surgery, suspect a possible allergic to the antibiotic or other medication taken during that week.
NAUSEA:
As with all sedation/general anesthesia cases, some nausea and vomiting may occur in certain individuals .Initially limit intake to clear liquids only, such as tea, water, apple juice, broth, soda, etc. until symptoms subside. If nausea continues, contact this office for assistance. A prescription can be called in for your convenience in either oral or suppository form. Leaving the gauze packs in place will help prevent blood from seeping into the stomach, which can also cause nausea. In addition, narcotic prescriptions are known for causing nausea in most individuals, therefore, discontinue these and limit your pain medicine to the non-steroidal anti-inflammatory medications such as Advil and/or Dolobid with food. You may need to take an over-the-counter medication, such as Pepsid, Zantac, Prilosec, Nexium, etc. to decrease upset stomach and/or coat your stomach with Pepto-Bismol before taking medications.
SKIN DISCOLORATION:
Some discoloration of the skin in the surgical area and/or at the intravenous site may occur after a day or so (even up to one week later). This, again, is a normal body reaction and will resolve on its own within a few days or up to 2 weeks. With some procedures where water-tight closure is obtained to protect the surgical site from the bacteria in the saliva in the mouth, the blood will back up in the tissue and cause soft tissue bruising   In cases of the IV site, an application of witch hazel and warm moist soaks to the arm at the IV site with elevation of the arm, plus anti-inflammatory medication, is advised. Should the IV site become red or painful, please contact the office immediately as well as call the anesthesia department at (631) 862-3629 and seek immediate attention.
MOUTH RINSE:
Vigorous mouth rinsing may stimulate bleeding. Therefore, do not rinse the mouth following extraction surgery. You may brush your teeth and let the water run out gently, but do not spit or rinse, or you risk spitting out your blood clot and getting a dry socket which can be very painful for up to 10-14 days and require packing with a sedative dressing.
TEMPERATURE:
Temperature may be elevated for the first 24-48 hours following treatment. Tylenol, every 3-4 hours and fluids will help alleviate this condition, as well as rest. If the temperature should persist, please notify this office and/or your M.D.
DIET:
Start with a clear liquid diet, such as tea, apple juice, clear broths, soda, etc. If this is well tolerated, light soft foods such as: pastina, apple sauce, soup, Jell-O, scrambled eggs, etc., which require little chewing may be taken. Avoid chewing in the area of the operation. An adequate diet is very important to healing. Don’t eat foods too hot or too cold. You may use Instant Breakfast, Dietary supplement, Ensure, etc. Consume at least 2 quarts of fluid daily. DO NOT DRINK WITH A STRAW. NO DAIRY PRODUCTS FOR AT LEAST 24-72 HOURS, such as: yogurt, ice cream, cottage cheese,  etc. should be taken since bacteria love to grow in milk and could enhance infection. Some milk in your coffee/tea beverage is acceptable, as is hard cheese..  If you do have milk for any reason, please follow it with drinking water so as to dilute the area and prevent caking up. Do not eat foods with pieces that could get stuck in the surgical site or hard foods that could damage the surgical site.  Do not chew on implant site(s) for 8 weeks, as the pressure will jeopardize the outcome of your healing.  Keep up your protein and vitamin C intake to aid in healing. You can resume your vitamin intake of vitamin E if not bleeding.
SUTURES:
Sutures, (stitches), may have been placed in order to minimize post-operative bleeding and to facilitate healing. They will be removed at a subsequent visit. Depending on the type of surgery, dissolvable stitches may be placed, but even these may be removed after sufficient healing has taken place as clinically determined. It often takes 10 to 20 days for fibrous healing to take place.
IMMEDIATE DENTURES:
Please consult your dentist as to their preferences regarding removal/cleaning of the denture after surgical extractions. In some cases, the dentist will advise patients with immediate dentures not to remove the dentures until they return to the office of the general dentist and that they should stay on a very soft diet. The general dentist usually prefers to see the patient approximately 24-48-72 hours (following the extractions and placement of the immediate denture) according to his/her preference and scheduling. Should the denture(s) be removed prior to the visit, swelling may take place that would prevent replacement of the denture(s )at that time. The denture will be adjusted by the dentist should denture sores occur. Notable, however, is that if the post-operative pain is severe, removal of the denture will alleviate the pain, and is therefore a personal choice if it is not necessary to wear the denture for any social reason.
REST:  
 Avoid fatigue. Go to bed early at night and get adequate rest during the day. Avoid exercise, jogging, bending, lifting, an/ord running up and down the stairs for one week following surgery, etc. because relapse and bleeding can occur; as well as clot loss that can lead to a painful condition called a “dry socket”.
IMPACTION AND OTHER SURGICAL PROCEDURES:
Paresthesia (numbness or altered sensation of the lip chin, gum or tongue) may occasionally occur after surgical removal of impacted teeth or other surgical procedures. This is a result of the proximity of the sensory nerves to the area of surgery. This will usually resolve in time, but occasionally may be permanent. Often soft tissue swelling at the surgical site may cause a temporary numbness, which may resolve as the swelling resolves.
BONE FRAGMENTS:
During the healing process, small sharp fragments of bone may loosen and work through the gum days, weeks or months later. These fragments, which are not roots, usually work out of their own accord. If annoying, please return to the office for examination and/or removal of suspected bone fragments or spicules. If the bone spicule is covered by tissue and not exposed, it is best to let nature smooth it down (or remodel it) in time and not surgically intervene.
SMOKING:
Avoid smoking after surgery. It increases bleeding, delays healing and can cause pain. (i.e. dry socket). It can also cause bone graft and/or implant failure.
BIRTH CONTROL PILL WARNING:
Please be advised that birth control pills are ineffective when taking antibiotics, which could lead to pregnancy. Please use an alternate birth control method for the month. If you have further questions, please contact our office or your OB/GYN.
NOTE FOR WOMEN TAKING ANTIBIOTICS:
Please be advised that the possibility exists that while you are taking an antibiotic, a vaginal yeast infection may occur. If this is the case, please contact our office or your OB/GYN, and we will call in a prescription for you (Diflucan pill and/or you may obtain Monistat in cream or suppository form).

WARNING: Please be advised that antibiotics can cause a serious condition of colitis and abdominal cramping during usage or up to weeks later after termination.  Please contact our office and your physician immediately should this occur and start a diet of Bananas, Rice, Apples and Toast (B.R.A.T.).

INFECTIONS:
For infections, remember it is not uncommon to be more swollen after an incision and drainage (I and D). Since surgery has been performed in the site of an infection, warm moist soaks should be applied to the outside of the infected area (to open the vessels and remove the toxins and decrease the swelling). Hot rinses should be performed as often as tolerated on the inside of the mouth to drain out the pus from the infected site (every hour on the hour during waking hours). The drain may be removed a few days following the I&D. For upper jaw infections, the eye may swell. If double vision should occur, call the office immediately and/or go to the hospital immediately. For lower jaw infections, the infection may cross the midline of the jaw. If difficulty in swallowing and/or breathing should occur, call the office immediately and/or go to the hospital immediately.
IMPLANT CASES:
Do not put prosthesis back in mouth after surgery unless adjusted by your dentist or by Dr. Pierri so as to not touch the surgical site.  Ideal is not to put the prosthesis in for 1 to 2 weeks following surgery.  Do not eat on the implant(s), if possible, for 8 weeks so as not to jeopardize the outcome of your case.
CYST REMOVAL:
Please be advised that it is within normal limits for an impacted (wisdom) tooth to still maintain its follicular, odontogenic or tooth sac. We perform a cystectomy procedure and send the cyst-like material away as a biopsy for histological examination to a pathology lab. Since the potential exists of the sac to enlarge and cause destruction of anything in its path , as well as turn into an aggressive tumor, it is therefore routine policy of our office to biopsy any soft tissue removed from the body. Written information from our oral pathology text concerning why it is important that every such cyst be biopsied based on the potential for the cyst to grow will be provided to you upon request. Upon receiving this specimen, the lab will send the patient a bill for the histological examination of the cyst, which can be covered under the patient’s medical insurance. Once our oral surgical office receives the biopsy result, we immediately send a copy of the result both to the patient and to the referring doctor. At this time, the patient may call to discuss the result of the biopsy. The biopsy usually states: cyst of the maxilla or cyst of the mandible. This is considered a routine cyst which requires no additional follow up. Any other diagnosis can be discussed with the doctor at the time of the post operative evaluation or by phone.

At the time of the post operative visit for extractions, a monojet curved plastic syringe is often given. In order to use the monojet syringe, simply pull back on the insert, draw solution into the syringe, and angle it into each socket to flush out the food particles that collect there. It is advisable to do this after every meal. It is also advisable to stay away from anything with small particles such as sesame seeds, poppy seeds, popcorn kernels, chopped nuts, seeds from tomatoes, or soups with small particles in them. The patient is permitted to eat anything processed in a blender. Stay away from milk products for a few days because bacteria like to grow in milk. Italian ices and tofutti are allowed because they are not milk products. We prefer that you do not have cottage cheese, yogurt, or ice cream for the first few days. The irrigating solution should consist of plain water, (it could be warm so it doesn’t shock the teeth next to it) or you could make a solution by adding a dash of salt and/or a dash of peroxide to the solution. Peroxyl is a pleasant tasting peroxide mixture that may be purchased as an over-the-counter drug. It comes in a bottle that looks like a peroxide bottle except the colors are aqua and white. If you cannot find it at your nearest pharmacy, call and request that they get it for you. Some find it too strong to use and therefore dilute it. The diluted solution can be used to squirt into the socket or may be used just as a refreshing mouth rinse to oxygenate any existing bacteria to kill them or rid the mouth of unpleasant odors from the remaining blood. Please do not use Peroxyl on implant/bone graft cases, but use the prescription Peridex/Perioguard (Chlorhexidine) diluted instead as directed. The monojet syringe is to be used until the sockets are completely closed, which can take anywhere from weeks to months depending on the individual patients’ healing. If the case is being done under intravenous/general anesthesia or in the hospital, the patient can begin taking all their medications approximately 4 – 6 hours after discharge since most of the medication will be given in the facility that they’re being treated at. If you have any of the following questions, please seek advice:

  1. If significant bleeding persists beyond four hours (more than just normal oozing).
  2. If the temperature remains elevated beyond four hours or goes above 101 degrees F.
  3. If there is any difficulty breathing or swallowing.
  4. If any allergic reaction to any medication occurs.
  5. If any other signs or symptoms causes concern.

Proper care following surgery will hasten recovery. If necessary, additional instructions will be given. It may be necessary to be seen a few times following surgery. If any unusual symptoms occur, please call (631) 360-0266.  If after hours, please use the cell phone 631-804-8048. Leave message with name, time, and phone number. We will call you as soon as possible. We can be reached 24 hours a day. For any reason should this system fail, please seek care at the nearest hospital for any medical emergency.