Postoperative Instructions

What to Expect after Surgery

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Bleeding
Pain
Swelling
Discoloration
Nausea
Difficulty opening your mouth
Numbness
Sharp Bony Edges
What To Do After Oral Surgery
Reaching the Doctor

Bleeding:

It is common for the surgical area to bleed or ooze for several days following surgery. Bleeding will be most apparent following eating or activity. Should the surgical area start to bleed suddenly, place a moist piece of gauze over the wound and bite down firmly for 10 minutes. The bleeding should have slowed during this time, and the gauze can be discarded. Occasionally, this procedure will need to be repeated until the bleeding slows. If you are bleeding excessively: Be calm and realize that even a small amount of blood in the mouth increases the flow of saliva and makes it looks as though there is more bleeding than there actually is. If you are concerned that the surgical area is bleeding more than one might expect, do the following:

Gently rinse out your mouth. Then wipe the inside of your mouth and teeth with a dry piece of gauze. Look in a mirror or have someone look in your mouth to determine the exact point of bleeding. If there are large loosely hanging blood clots present these should be removed by grasping them with clean gauze. Should the blood clot seem adherent to the soft tissues, it is better left alone.

Roll a moist piece of gauze or clean cloth into a shape that will fit into the bleeding area. Place this moist dressing over the surgical site and bite down on the pack so that you feel firm pressure over the surgical area. You should feel firm pressure on the bleeding point when the jaws are closed. Hold constant biting pressure without interruption for 10 minutes. It is important to limit activity during this time. Try to maintain a comfortable sitting position. Lying down tends to increase the bleeding. Avoid excitement or activity.

Do not spit. This creates suction in the mouth and will increase or prolong bleeding. To remove blood or saliva from your mouth, lean forward and let the fluid run out of your mouth into a towel or receptacle. Then wipe your lips as necessary.

If after following these steps you feel that the bleeding is still excessive please call Dr. Rottman at 419-343-2863. Prolonged excessive bleeding can be life threatening; if your call is not returned within 10 minutes, it may be prudent to present to the emergency department at the nearest hospital for evaluation.

Pain:

Significant pain is common after oral surgery. It is very important to take appropriate pain medication on a regular basis to keep discomfort under control. It is best to start taking pain medication before the numbness wears off from surgery. For mild pain, medications such as tylenol or aspirin work very well; The nonsteroidal pain medications such as ibuprofen (motrin) and anaprox (naproxen sodium) are also excellent pain relievers. Most pain medications do not stay in your system very long; it is important. therefore, to take them on a regular basis.

We have found that many patients (who are healthy and have no known allergies to medications) do very well with alternating doses of tylenol and ibuprofen.  We recommend (for a patient with no history of liver or kidney disease) that for the first couple days  that doses of 600 mg of ibuprofen be taken on an alternating basis with 1000 mg of tylenol.  For the first few days doses of these medications may taken on the following schedule:  600 mg ibuprofen, two hours later 1000 mg tylenol, two hours later 600 mg of ibuprofen and so on.  Care must be taken with this schedule as the total recommended daily dose of these medications can be exceeded; when possible the medication schedule should be extended to 3 hours between medication doses.  As postoperative swelling and discomfort decreases the dose and frequency of medication should be decreased.

For more severe pain you may need to take narcotic pain medication such as tylenol with codeine or percocet; if you have not been given a prescription and are not having relief with the over the counter medications such as aspirin, tylenol and motrin then you should call the office for further information. Prescription medications such as tylenol with codeine, hydrocodone and oxycodone are all narcotic pain relievers and are very strong. These pain medications will work very well when taken in an appropriate manner. but they can also cause problems. It is common for these medications to cause nausea especially if your stomach is empty. These medications are better tolerated if they are not taken on an empty stomach.  Even so, some patients may not tolerate one or all of these particular medications well; if you are having trouble taking one of these narcotic pain medications, you should call the office for advice; sometimes patients may tolerate a different medication better.  Often, narcotic pain medications make patients tired and dizzy; you should not drive, operate machinery or attempt any potentially dangerous task while taking these medications. Feelings of dizziness can be minimized by lying down after taking these medications. Narcotic pain medications may also cause constipation; if this occurs it is best to discontinue or minimize the use the medication. If this problem persists, please call the office.

Each patient tolerates medication differently. Allergy to these medications is possible; should you have a reaction to any medication that you have taken it is very important that you stop taking that medication and call the office for further information. It is important to remember that some patients just do not do well with some medications, if you find that the medication you are taking is just not working, then please call the office for help.

Pain and Dry Socket:

Usually, the intense surgical pain experienced on the first 2-3 days decreases to a moderate soreness over the next few days. Pain that increases on the 3rd or 4th postoperative day may indicate the presence of a dry socket. Often this pain is very intense and will spread to the ear, chin and neck. Dry sockets are seen following up to 15% of extractions; they are not dangerous and do not represent infections, but they are very painful. If you experience late postoperative pain that is increasing rather than decreasing it is appropriate to call our office. Medicated dressings can be placed in affected sockets to radically decrease the discomfort you may be experiencing. Untreated, dry sockets will usually dissipate over 3 to 5 days and pose no threat to your health.

For more information about Dry Socket, please click on this Wikipedia Link.

Swelling:

Swelling is expected after oral surgery; the amount of swelling seen is often proportional to the difficulty and extent of the surgery. Swelling increases quickly over the first 3 post operative days and then decreases over the next 3 to 5 days. Swelling after the extraction of impacted teeth is often significant. Should you become concerned about swelling that occurs after surgery it is important that you come into the office so that your surgeon may evaluate your post operative course.

Postoperative swelling can be minimized by the use of ice packs within the first 24 hours of surgery. An ice pack (a bag of frozen peas works well) should be placed on the outside of the face for 20 minute periods at a time. The use of NSAID's (nonsteroidal medication such as ibuprofen and aleve) before and after surgery may also reduce the extent of postoperative swelling. Often patients are given prescriptions for such medications and they should be taken as directed. Some of these medications are available over the counter in grocery stores and pharmacies; please direct any questions regarding the use of these medications to your surgeon.

Many patients report a temperature after surgery, especially if they have been sedated for the procedure. A low grade temperature the day after the procedure should not be alarming. If, however, you develop significant fever with swelling it is imperative that you return to the office for evaluation.

Discoloration:

Bruising in the soft tissues of the neck and face is often seen following oral surgery. This may manifest as discoloration of the skin; usually the area will appear black and blue, but as time goes on the bruise may appear greenish yellow. The bruising seen after surgery is due to the oozing of blood into the tissue planes of the face, and although unsightly, is of little consequence. Usually, all signs of bruising disappear within 10 days. Should you become concerned about this bruising a visit to our office would be in order.

Nausea:

Nausea following surgery can be caused by the medications used during anesthesia or by blood getting into the stomach. As the medications pass through your system and as the bleeding stops the nausea will go away. Nausea may also be seen in the first few days after surgery; usually it is related to the use of strong pain medications. Identifying which medication is upsetting your stomach and stopping this medication is key to feeling better. All patients respond differently to these medications; although one may make you sick, another may not. Please call the office if you are having trouble tolerating the medications you have been given.

Difficulty opening your mouth:

Limited jaw opening is not uncommon after the removal of lower wisdom teeth. This is caused by local swelling and spasms of the jaw muscles. Usually your jaw will loosen up on it's own within a week after surgery. Physical therapy in the form of jaw exercises several times a day will help a great deal. If, by the 5th day after surgery, jaw mobility does not improve you will need to present to the office for evaluation.

Numbness:

Numbness of the lower lip, teeth and tongue may be seen following the removal of an impacted lower wisdom tooth. This is almost always a temporary condition; full feeling usually returns within several weeks. If you should experience numbness that persists beyond one week you will need to present to the office for evaluation.

Sharp Bony Edges:

Occasionally patients will place their tongue near an extraction site and feel a sharp ledge that may feel like a part of a tooth. This is not part of a tooth but rather the bone that held the tooth in the jaw. Try to leave this area alone and it will heal nicely.

What To Do After Oral Surgery:

Do not use mouthwash for at least twelve hours after surgery. Starting the day after surgery rinse your mouth with a solution of 1/2 teaspoon of salt in a glass of water as needed. You may resume brushing your teeth the day after surgery; the surgical area should be brushed as well. If you are gentle with your toothbrush you will not cause any damage to the surgical site; minor bleeding after doing so should not be concerning. Optimal healing depends on excellent oral hygiene.

If you have been placed on antibiotics, take all of the medication as directed. The use of antibiotics may be associated with side affects such as allergic reactions, stomach upset and / or diarrhea; should you notice a reaction, discontinue the medication and contact the doctor on call.

Antibiotics may be indicated for some patients and not for others. Should you have any questions regarding the use of antibiotics, please ask your surgeon.

We encourage our patients to maintain an adequate diet in the postoperative period. Fluid intake is very important after surgery to avoid dehydration. It is important to avoid hot liquids in the very early postoperative period when your mouth and lips may still be numb. An increased intake of fluids may be needed to compensate for decreased solid food intake that is commonly seen after surgery. It is important to drink at least 5 or 6 glasses of liquid (such as water, orange juice, milk or ginger ale) a day.

As soon as practical, it is important to start eating after surgery. A soft diet is needed in the first few days after surgery. A high calorie, high protein diet is very important. Foods such as soft boiled eggs, soup, custard, jello and ice cream are some ideas. Dietary supplements such as Ovaltine, Boost and Ensure can be used if chewing soft foods is especially difficult. It is very important to keep your normal pattern of eating; meals should not be skipped, even if you do not feel hungry. You will feel better, have more strength, have less discomfort and heal faster if you maintain an adequate diet.

If sutures were placed during your surgery, these will dissolve on their own in 5 -8 days. As the stitches dissolve, the surgical site (tooth socket) may open. This is normal as the extraction socket heals from the bottom up.

How to keep extraction sockets clean:

Once the sutures start to disolve, the extraction sockets will open and food will tend to collect in the holes. Brushing and rinsing will help keep these areas clean, but food will continue to collect in the socket areas of lower teeth, especially wisdom teeth. Many of our patients are given plastic syringes (if you find that you need a syringe but were not given one, please come into the office and we will supply you with one) and these can be used to keep the sockets clean.

How to use the syringe: mix a teaspoon of salt with a glass of luke warm water (or you can use diluted mouth rinse). Suck the salt water into the syringe through the pointed end. Put the tip of the syringe into the socket area and gently rinse the hole with solution. Then spit the solution out and repeat. It is common to see large bits of food come free after rinsing the socket. It is also common for the area to bleed after rinsing the area; this bleeding will stop quickly. It is important to get the syringe tip into the socket, otherwise the socket will continue to collect food. Many patients complain of a foul odor in their mouth and much of this is due to food that collects and stagnates within the sockets.

To watch a video that shows this process, click here. (please wait for the video to load onto your computer)

Please feel free to come into the office if you have trouble with this procedure; we would be happy to show you how to use the syringe to keep the sockets clean. The vast majority of postoperative infections are caused by food and debris that get caught within the socket before it closes over. These infections can be avoided by thouroughly rinsing the sockets; the syringe can be thrown away once the area closes (you will not be able to get the syringe into the socket).

Reaching Dr. Rottman

Please feel free to call Dr. Rottman during regular office hours if you have any questions about the above information.  In the event that they are busy when you call, the receptionist will take a message and Dr. Rottman will return your call at his earliest convenience..

Dr. Rottman carries a cell phone. If you need to speak to Dr. Rottman about an urgent postoperative problem, please call him at 419-343-2863. . Please leave a voice message if the cell phone line is busy or unavailable; please remember to leave your name and your preferred call back number on the message. Please leave that phone line open so that your call may be returned. Dr. Rottman will return your call at his earliest convenience; please remember that Dr. Rottman may be without cell phone coverage from time to time and that an immediate call back is not always possible.

 

 
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