POST SURGICAL INSTRUCTIONS

POST-OPERATIVE INSTRUCTIONS FOLLOWING TOOTH EXTRACTION

Our goal is for your healing process after an extraction to be as comfortable as possible. The removal of
teeth is a surgical procedure, and post-operative care is imperative. Please follow all instructions
carefully to avoid any unnecessary pain and possible infection.
If you have any difficulties or concerns following your surgery, please do not hesitate to call us or
return to our office for a follow-up exam.
Immediately Following Surgery
*Keep the gauze pad placed over the surgical area with pressure applied by biting down until the
bleeding stops.
*Take your prescribed pain medication as soon as you begin to feel discomfort. This will usually
coincide with the local anesthetic becoming less effective.
* Do not suck on a straw, spit, or smoke.
*Restrict your activities the day of surgery, and resume normal activity when you feel comfortable.
*Place ice packs on the side of your face where surgery was performed. Refer to the section on swelling
for an explanation.
*For mild discomfort, use Ibuprofen (Advil, Motrin). DO NOT take more than 800mg every 4-6 hours.
*Vigorous mouth rinsing or touching the affected area following surgery should be avoided. This may
initiate bleeding caused by dislodging the blood clot that has formed. 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 after meals to flush out particles of food and debris that may lodge in the area.
*Restrict your diet to liquids and soft foods which are comfortable for you to eat.
Bleeding- A certain amount of bleeding is to be expected following a surgical procedure. Slight
bleeding, oozing, or redness in the saliva is not uncommon. Bleeding is best controlled by the use of
pressure. Excessive bleeding may be controlled by placing a gauze pad over the area and biting firmly
for thirty minutes. Repeat if necessary. If bleeding has not decreased in 3-4 hours, bite on a dampened
tea bag placed directly over the surgical site. The tannic acid in the tea helps the blood to clot.
Swelling- The amount of swelling that is normally expected after an extraction depends on the type of
surgery. Swelling around the mouth, check, eyes, and side of the face is not uncommon. The swelling
sometimes may not appear immediately, and it may occur up to 2-3 days post-surgery. You can help to
minimize the swelling by applying ice packs to the affected area. For the first 3 hours, apply the ice
packs directly to the area, alternating on for 20 minutes then off for 20 minutes. Applying ice after 24
hours has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no
cause for alarm. If the swelling is significant, you may use a moist heat compresses to help suppress it.
Pain- Post operative pain will be the most severe the first day after surgery. It is beneficial to take your
pain medication before your numbness wears off. For moderate pain, 800mg of Ibuprofen (Motrin or
Advil) may be taken every 4-6 hours. For severe pain, take the prescribed medication that was
provided. DO NOT take the pain medication on an empty stomach as nausea may result. The
prescribed medicine may make you drowsy. DO NOT drive an automobile or operate machinery, and
AVOID alcoholic beverages. Pain or discomfort following surgery should subside more and more each
day. If pain persists, it may require attention, and you should contact our office.
Antibiotics- If you have been placed on antibiotics, take the medicine as directed. Antibiotics may be
prescribed to help prevent infection. Discontinue antibiotic use in the event of a rash or other
unfavorable reaction. PLEASE NOTE: If you are currently taking birth control pills, they will be
inactivated by the antibiotic.
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 medication. You should then sip on
water, tea, or juice. Sip slowly over a fifteen-minute period. When the nausea subsides, you can begin
taking solid foods and the prescribed medication.
Sutures- If any sutures were required, they will dissolve on their own in 7-10 days. It will not be
necessary to return to the office for sutures to be removed.
Activity- Over-exertion may start or intensify your pain. AVOID excessive work or play. It is not
necessary to stay indoors following uncomplicated surgery. However, rest and minimal activity will
help to minimize pain, swelling, and bleeding. Normal activity may be resumed the following day as
tolerated.
Cleaning- Do not rinse or spit vigorously for the first 24 hours following surgery. You can brush your
teeth the night of the surgery, but rinse gently. The day after surgery, you should begin rinsing four
times a day and after eating. Do this gently as to not dislodge the blood clot. To rinse, mix a teaspoon of
salt and a cup of warm water. DO NOT use a non-prescription rinse for 24 hours after surgery. Clean
the rest of your mouth as usual.
Diet- It is advisable to eat only soft, non-spicy food for the first few days following surgery. AVOID
hot food or liquid that could agitate the already inflamed area. AVOID rice, grits, and foods that are
very small that may become lodged in the area.
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Special Considerations- Trismus (stiffness) in the face muscles may cause difficulty in opening your
mouth for a period of days. Moist heat compresses can minimize this condition. You may experience
 POST SURGICAL INSTRUCTIONS

aching from other teeth. This discomfort is caused by referred pain and is a temporary condition. It is
not unusual to develop bruising in the area of the extraction. There may be a slight elevation in
temperature for 24-48 hours. If the fever persists, please contact our office.
Dry Socket- A “dry socket” is the loss of the blood clot in the socket. This condition creates a delayed
healing at the extraction site and presents symptoms such as pain in the ear, chin, adjacent teeth, and
jaw. The discomfort usually begins about the third or fourth day after the surgery and can last for many
days. The cause of a dry socket is unknown, but it can be attributed to the difficulty of the surgery,
increased age, medications (such as birth control pills), and smoking. Treatment is for the symptoms
only.

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 POST SURGICAL INSTRUCTIONS

POST-OP INSTRUCTIONS - TOOTH EXTRACTION

DO NOT DISTURB THE AREA: For the next few days, and especially the first 24 hours, it is very important to allow your body to form a
good clot and start the natural healing process. Swishing, sucking through a straw, and smoking can all dislodge the clot. Keep anything sharp
from entering the wound (crunchy food, toothpicks, eating utensils). Be sure to chew on the opposite side for 24 hours.
BLEEDING: When you leave the office, you might be biting on a gauze pad to control bleeding. Keep slight pressure on this gauze for at
least 30 minutes. Don't change it during this time; it needs to remain undisturbed while a clot forms in the extraction socket. After 30 minutes
you may remove it. You may bite on another gauze or a tea bag for another 30 minutes if you feel it is still bleeding. Small amounts of blood
in the saliva can make your saliva appear quite red. This is normal and may be noticed the rest of the day after the procedure.
SMOKING: Smoking should be stopped following surgery. Healing and success of the surgery will be substantially reduced by the cigarette
smoke chemicals in your body. Also the suction created when inhaling cigarettes can dislodge the clot. Smokers are at greater risk of
developing a painful Dry Socket.
PAIN: Some discomfort is normal after surgery. To minimize pain, Take two Tylenol, Nuprin, Advil, or similar non-aspirin pain reliever
every 3 to 4 hours until bedtime to maintain comfort. Take it before the anesthesia wears off. If prescription pain medication is prescribed,
take it as instructed on the label. Don't exceed the dose on the label. Taking with food or milk will help reduce upset stomach. Avoid driving
or operating heavy machinery when taking pain prescriptions. Do not drink alcohol while taking prescription pain medications.
NAUSEA: This is most often caused by taking pain medications on an empty stomach. Reduce nausea by preceding each pain pill with soft
food, and taking the pill with a large glass of water.
SWELLING: Applying an ice bag to the face over the operated area will minimize swelling. Apply for 15 minutes, then remove for 15
minutes. Continue this for the first day.
NUMBNESS: The local anesthetic will cause you to be numb for several hours after you leave the office. Be very careful not to bite, chew,
pinch, or scratch the numb area. Sometimes the extraction causes residual numbness or tingling for six weeks or longer.
BRUSHING: Do not brush your teeth for the first 8 hours after surgery. After this, you may brush your teeth gently, but avoid the area of
surgery for 3 days.
RINSING: Avoid all rinsing or swishing for 24 hours after extraction. Rinsing can disturb the formation of a healing blood clot which is
essential to proper healing. This could cause bleeding and risk of dry socket. After 24 hours you may begin gentle rinsing with a saltwater
solution (1/2 teaspoon salt + 1/2 teaspoon soda + 8 ounces warm water). Avoid commercial mouthrinses.
DIET: Eat soft foods for the first two days. Maintain a good, balanced diet. Return to normal regular meals as soon as you are able after the
first two days. Drink plenty of water. Avoid alcohol for 48 hours.
ACTIVITY: After leaving the office, rest and avoid strenuous activities for the remainder of the day. Keeping blood pressure lower will
reduce bleeding and aid healing.
ANTIBIOTICS: If you were given an antibiotic prescription, take all of them as directed until they are gone. Women: some antibiotics can
reduce the effectiveness of birth control pills. Use alternate birth control methods for two months.
SINUS: If your sinus was involved in the procedure, you should avoid blowing your nose or playing a wind musical instrument for one
week. Use of decongestant medications might be recommended.
FOLLOW-UP APPOINTMENTS: You may need to return to the office to have sutures removed, or just for a brief follow-up healing
check.
Please call your dentist if you have:
 uncontrollable pain
 excessive or severe bleeding
 marked fever
 excessive warm swelling occurring a few days after the procedure
 reactions to medications, especially rash, itching, or breathing problems

SURGICAL INSTRUCTIONS AFTER TOOTH EXTRACTION

Immediately following surgery

 Bite firmly on the gauze pads covering each extraction site to help stop the bleeding. We will change the gauze pads before you
leave the office. You may change the gauze pads once more at home, leaving gauze in 30 additional minutes. Remember to remove
gauze before eating or drinking.
 You may have difficulty feeling your lips, cheeks or tongue due to numbness. This is a temporary feeling and will wear off within 2
to 6 hours. Please take care not to bite your lips, cheeks or tongue.
Bleeding
When you get home, fold and place a gauze pad directly over the extraction site and bite firmly for 30 minutes. If excessive bleeding
continues, apply another fresh gauze pad for an additional 30 minutes. Excessive bleeding is defined as pooling or dripping blood out of the
extraction sites within 15-20 seconds of removing the gauze. Don't use the amount of blood on the gauze as a guide, because minimal
bleeding may persist for up to 24 hours. It is not unusual for saliva to be slightly blood-tinged for several days following surgery. Please call
our office if you feel bleeding is excessive.
Medication
You may receive a prescription for an antibiotic and/or a pain reliever. You may fill these prescriptions at the pharmacy of your choice. Take
all medications as instructed by your doctor.
Pain management
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 POST SURGICAL INSTRUCTIONS

Some amount of discomfort is to be expected following any surgery. If your surgeon feels you will benefit from a prescription pain medicine,
you will receive a prescription following your surgery. Please follow the instructions carefully. Ibuprofen (such as Advil, Nuprin, Motrin)
works very well for many patients following oral surgery and can reduce the amount of narcotic pain medicine needed significantly. You may
find taking 400-600mg every six hours on a regular schedule for the first 2-3 days is all the pain medicine you need. You may alternate your
prescription pain medicine with ibuprofen for maximum pain relief. Those who are allergic to aspirin or other NSAIDs cannot follow this
regimen.
Diet
If possible chew on the opposite side of your extraction site. For multiple extractions, you should have soft foods on the day of surgery and
the day following surgery. Soft foods include ice cream, pudding, jello, yogurt, soup (lukewarm), pancakes, mashed potatoes, scrambled
eggs, pasta, etc. Avoid hard, crunchy foods such as chips or nuts that may disturb the extraction site for at least one week. After the third day,
you may eat anything you wish, unless given other specific instructions by the doctor. No alcoholic beverages should be consumed for at least
twenty-four hours following general anesthesia or as long as you are taking pain medications.
Smoking
Do not smoke for at least 3 days following surgery. The longer you avoid smoking, the better your healing will progress.
Brushing/Rinsing
Avoid all brushing, rinsing or spitting the day of the surgery. The day after your surgery, you may brush your teeth, but avoid brushing near
the surgical site(s) for 3 days. Rinse with ½ cup warm water and a pinch of salt beginning 3 days after surgery.

Straws
Do not use a straw for 3 days following surgery.
Sutures/"stitches"
Your sutures dissolve on their own and may come out any time after surgery. You may notice that they are loose after the swelling of your
gum tissue decreases. This is completely normal.
Irrigating
If you have been provided with an irrigator (small plastic syringe), you should begin using it on the third day after surgery on the lower
extraction sites after each meal and at bedtime. Fill the irrigator with lukewarm water. You may add a small amount of salt. Make sure to get
the tip of the irrigator into the extraction site and flush out the extraction site completely. This may be uncomfortable at first, but keeping the
site clean reduces the chance of infection or improper healing.
Resuming activities
Do not drive or engage in strenuous activities for at least 24 hours. You may return to work or school when you feel you are recovered. We
can supply a doctor's note if necessary. If you have undergone general anesthesia, you should go home immediately and rest for the remainder
of the day.
Dry socket
After tooth extraction, it's important for a blood clot to form to stop the bleeding and begin the healing process. A dry socket occurs when the
blood clot is dislodged from the surgery site exposing the bone and fine nerve endings. This condition is more common in back teeth,
particularly wisdom teeth, although it can occur in any extraction site. Dry socket occurs two or more days after an extraction and can last 5-6
days.
Avoiding dry socket
 Do not smoke.
 Clean the extraction site as instructed and follow all at-home instructions.
 Avoid sucking action from smoking, spitting or using straws for the first 24 hours.
 Do not rinse mouth excessively; it interferes with blood clotting.
Follow-up appointment
You may be asked to return to our office for a post-operative follow-up visit 10 to 14 days following surgery. There is no additional charge
for this follow-up visit. Please make every effort to return to have your surgical sites examined for proper healing.

SURGICAL INSTRUCTIONS:
http://www.drdigney.com/surgical-instructions/dental-extractions.html

INSTRUCTIONS BEFORE HAVING INTRAVENOUS ANESTHESIA

Do not have anything to eat or drink after midnight on the night before your surgery
It is O.K. to brush your teeth on the morning of surgery, but don't drink any fluids.
Have an adult with you that will wait in the office while your surgery is being done, and then will be able to drive you home.
Wear loose-fitting, comfortable clothing that will allow us access to place a blood pressure cuff, place monitors, and start the IV.
If you have any usual medications that you have to take in the morning (such as blood pressure medication) it is O.K. to take them with a small sip
of water. Any non-essential medications such as vitamins or cholesterol medications, should be taken later on, after the surgery is completed and you
have returned home.

POSTOPERATIVE INSTRUCTIONS AFTER ROUTINE DENTAL EXTRACTIONS

Immediately Following Surgery
 The gauze pad placed over the surgical area should be kept in place for 20 - 30 minutes. After this time, the gauze pad should be removed
and discarded. It is not necessary to replace the gauze unless there is active bleeding.
 Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood
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clot that has formed to become dislodged.

 POST SURGICAL INSTRUCTIONS

 Over-the-counter pain medications are usually all that is necessary after routine surgical extractions. If Dr. Digney has written a
prescription, you may want to wait to see if the over-the-counter medications provide sufficient pain control. If you feel that you need the
prescription pain medications are still needed, you can then get the prescription filled at that point. You can the take the prescribed pain
medications as soon as you get home, after you have had something to eat.
 Restrict your activities the day of surgery and resume normal activity when you are off the prescription pain medication.
 Place ice packs to the sides of your face where surgery was performed.
Bleeding
Some bleeding is to be expected following removal of teeth, but this is usually minimal. Even after biting on the gauze pads, it is normal to have
slight bleeding and oozing for the next 12 - 24 hours. Excessive bleeding is characterized by mouthfuls of bright red blood, or large rubbery clots. If
this occurs, please try the following:
 Rinse the mouth (gently, not forcefully) with cool water.
 Wipe away any clots outside the socket with a clean gauze pad.
 Bite firmly on a moistened gauze pad placed directly over the extraction site for 30 minutes. If no gauze is available, you may substitute a
moistened tea bag.
 Repeat all of the above as necessary.
It is important to avoid the use of any products that contain hydrogen peroxide, as these products may dissolve the blood clots at the site, and promote
dry socket. Strenuous exercise, jogging, or sporting activities that may cause an increase in the blood pressure should be avoided for the first 48
hours.
Some bleeding when brushing the teeth may occur for the first week following the surgery. This is normal, and should not be a reason to avoid
brushing in this area.
If bleeding does not subside, call for further instructions.
Swelling
Some degree of swelling is normal after tooth removal, especially with the extraction of lower teeth. This is the body's normal inflammatory reaction
to any injury. When you get home, place ice packs on the face in the area adjacent to the surgical site.
If swelling or jaw stiffness has persisted for several days after the surgery, there is no cause for alarm. This is a normal reaction to surgery.
Pain
As with any surgical procedure, there will always be some postoperative pain and discomfort. We normally recommend that as soon as the patient
returns home from their surgery, they take the pain medication, even though they are still "numb" and not experiencing any pain. This way, the pain
medication can begin to take effect as the numbness wears off, making the transition easier than if you were to wait for the pain, and then try to take
the pain medication. With any pain medication, it is important that you have something soft and bland to eat before you take your pain medication.
This is important, because most of our prescription pain medications (and even some of the over-the-counter pain medications) can be very irritating
to the stomach. The presence of food in the stomach can help counteract this, and will usually help patients tolerate the pain medication more easily.
We recommend semisolid foods, as just liquids alone may be insufficient to counteract the irritating effects of the pain medications.
It is also important to remember that one should not drive cars or do anything that requires coordination or balance while taking the prescription pain
medication
For minimal or moderate pain, Tylenol or Ibuprofen (Motrin or Advil) may be effective. With the Ibuprofen, the maximum dose is 2400 mg per day,
which can be taken as two 200 mg tablets every 4 hours, or three 200 mg tablets (600mg) every 6 hours, or four 200 mg tablets (800mg) every 8
hours.
Diet
We recommend that you maintain a relatively soft and bland diet for the first few days after surgery. In general, most normal foods are O.K. after the
first few days, but it would be best to avoid anything with seeds or particles, such as poppy seeds or sesame seeds. You should avoid popcorn for at
least a month after the surgery. Contrary to popular belief, it is O.K. to use straws to drink liquids after surgery. The rationale was that the "suction"
created when using the straw would "pull out the blood clots" and cause dry socket, or at least stir up bleeding. There is so little suction created by
using a straw, that it is not likely that this will cause any problems at the extraction sites, or stimulate any significant bleeding. We actually prefer our
patients to drink through a straw, as this allows the liquid to pass right by the surgical sites, without the liquid washing across the surgical sites that
have just been operated on. It would be best to avoid very hot foods, as they can dilate the blood vessels in the area and create more bleeding, and
may cause the stitches to dissolve prematurely.
Hygiene
Do not forcefully rinse for the first several days. You can brush your teeth the night of surgery but, use a very soft bristle brush, and rinse gently.
Expect to see a small amount of blood in the sink when brushing your teeth. This is very normal, and does not mean that you should stop brushing.
Do not floss between the last two teeth near the surgical sites in all the extraction sites for at least 2 weeks. Remember to avoid any products that
contain Peroxide, as this can very effectively dissolve blood clots, and contribute to dry socket formation. Check your toothpaste tube to see if there
is any Peroxide present. The popular whitening toothpastes often contain Peroxide, so be sure to check the list of ingredients.
Discoloration
In some cases, discoloration of the skin follows swelling. The development of black, blue, or yellow discoloration is due to a small amount of
bleeding in the tissues just beneath the skin. This is a normal post-operative occurrence, and it may not be noticed until 2 - 3 days post-operatively.
Moist heat applied to the area may speed up the removal of the discoloration.
Infection
Infection is uncommon in routine tooth removal surgery, but on some occasions may still occur. It is usually characterized by swelling that increases
rather than decreases after the first several days. If swelling is noted to increase after the first several days, contact the office.
Nausea and Vomiting
Nausea is our most common postoperative problem that can occur after surgery. It is most often due to the pain medications that are taken after the
surgery. Swallowing a small amount of blood after surgery is normal, and this can sometimes cause nausea as well. Usually, the intake of food will
help settle the stomach, but sometimes, despite having eaten, the patient may still experience nausea. In the event of nausea and/or vomiting
following surgery, you can take medications such as Maalox or Pepto Bismol, which may help settle the stomach down. Ginger Ale may also help in
alleviating stomach irritation. When the nausea subsides you can resume taking solid foods and the prescribed pain medicine as necessary.
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Other Complications
 POST SURGICAL INSTRUCTIONS

 If numbness of the lip, chin, or tongue persists after the first postoperative day, please let us know. On the rare occasions when this does occur, it
is usually temporary in nature.
 Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, or becomes higher than 101.5
degrees, notify the office. Tylenol or Ibuprofen should be taken to reduce the fever.
 You should be careful when going from the lying down position to standing. The pain medications can sometimes make you dizzy. It may be
possible that you could get light headed or faint when you stand up suddenly. Before standing up, you should sit upright for one minute before
attempting to get up.
 Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the
tooth. These projections usually smooth out spontaneously. They will sometimes become exposed over time, and as they usually occur in the
back part of the lower jaw, they can feel sharp to the tongue. If these sharp areas persist, contact the office, as they can sometimes be removed.
 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.
 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.
Sutures
There will be sutures in the surgical sites. The sutures will come out by themselves over time. These stitches usually come out after 4 - 5 days, but it
is not uncommon to lose a stitch after the first couple of days. Often, a suture will dissolve to the point where it becomes untied, and you may feel a
"string" in the mouth. If you are able to see this loose suture, you may reach in and gently remove it. It you run into a "snag", it is acceptable to
carefully cut it short with a nail scissors. The remaining portion will dissolve and come out by itself.

POST OPERATIVE INSTRUCTIONS FOR IMMEDIATE DENTURES:

• Please see Postoperative Instructions After Routine Dental Extractions for specific postoperative instructions, as these will all apply to both
single tooth and multiple extractions.
• A couple of additional factors that are unique to multiple extractions are listed below.
• If excessive bleeding is encountered, it is important to determine which site is the one that is causing the hemorrhage. A gauze pad
moistened with ice water should then be placed directly over this site, and by biting down on the gauze, the pressure should control the bleeding. A
teabag moistened with ice water can also be used.
• When multiple teeth are removed that are adjacent to one another, it is common to feel small bony projections in the area between the tooth
sockets. These are the small triangles of bone that were located between the teeth. These are normal, and will smooth out over time as the sites heal.
• If a new denture is worn over the sites and denture adhesive is used, it is important that the adhesive is not placed near the stitches. This
would result in the adhesive adhering to the stitches, which would pull on the stitches when the denture is removed.
• When an immediate denture is placed following multiple extractions, it is best to remove and clean the denture after meals. The denture
can be cleaned with warm water and a toothbrush. The mouth can then be gently rinsed with cool water, and if any blood clots are noted to be
protruding above the level of the gums, these can be "pinched off" with a moistened gauze. The denture can than be replaced.
• It is generally best to leave the denture in place while sleeping for at least the first week to two weeks following the surgery. If the denture
is left out while sleeping, or for extended periods of time shortly after the surgery, the soft tissue can swell, and you won't be able to get the denture to
fit properly back in the mouth.
• It is normal for their to be a "settling" process, as the swelling goes down over time. This results in pressure sores in areas where the
denture is rubbing excessively. Your dentist will make periodic adjustments to the denture to make it more comfortable. After these adjustments, the
denture will settle again, and new sores will develop in different areas, requiring further adjustments. This "settling" process will eventually resolve
as the extraction sites heal, and the denture will become comfortable and stable.
• With multiple extractions in patients 50 and older, considerable bruising, sometimes even in areas quite distant from the surgical sites, is
common. Like any other bruise, these will usually resolve in 7 - 10 days. The presence of bruising does not necessarily mean that there is any
impending problems with the surgical sites.
• Restrict your diet to soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.
• When the corners of the mouth are stretched, as is necessary during this type of surgery, they may dry out and crack. Your lips should be
kept moist with an ointment like Vaseline after surgery.
• There may be a slight elevation of temperature for 24 - 48 hours. If temperature continues past this time, or elevates to 101.5 or greater,
please notify our office.

POSTOPERATIVE INSTRUCTIONS AFTER SOCKET GRAFTING

The following information applies when bone grafting material has been placed into extraction sites to help preserve the thickness of your jawbone in
preparation for possible implant replacement of the extracted tooth.
Your bone graft is made up of many small particles. You may notice that some of the small bone graft particles may work themselves free from the
graft site, and may be lost into the mouth for the first several days. It is normal to lose a few particles over the first several days, and this does not
mean that you are losing the graft, or are having a serious problem. There are some things you can do to minimize the amount of particles that
become dislodged:
 Do not disturb or touch the wound.
 Avoid rinsing forcefully for 2 days to allow blood clot and graft material stabilization.
 Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.
 Do not lift or pull on the lip to look at the sutures. This can actually cause damage to the wound site and tear the sutures.
 Do not smoke.
 Avoid the use of products that contain peroxide, such as certain toothpaste or mouthwashes, as these can dissolve blood clots.
 Avoid foods with small seed or particles such as poppy seeds, that may accidently be pushed down into the graft site.
 Brush the teeth adjacent to the site with a very soft bristle toothbrush.
If a partial denture or a flipper was placed in your mouth after the graft, be careful that this denture is not placing excessive pressure on the graft site.
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If this is the case, you may have to see your restorative dentist to have the denture adjusted.
 POST SURGICAL INSTRUCTIONS
INSTRUCTIONS AFTER DENTAL IMPLANT SURGERY
Do not disturb the wound. Avoid forceful rinsing, spitting, or touching the wound for the first few days after surgery. There may be a metal healing
abutment protruding through the gum tissue.
Bleeding
Some bleeding or redness in the saliva is normal for the first several days. Excessive bleeding (your mouth fills up rapidly with blood) can usually be
controlled by biting on a gauze pad placed directly on the bleeding wound for 10 - 15 minutes. If significant bleeding continues please call the office
for further instructions.
Swelling
Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice pack, on the cheek in the area of surgery. Apply the ice
continuously, as much as possible, for the first 12 - 24 hours.
Diet
Drink plenty of fluids. Avoid very hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as
possible, but try to avoid biting food directly over the the surgical site. It is also best to avoid food items with small seeds or particles, as these can
sometimes work themselves under the gum tissue at the surgical site.
Pain
You should begin taking pain medication before the local anesthetic begins to wear off. For moderate pain, either Tylenol or Ibuprofen (Advil or
Motrin) may be taken every 4 hours. For more significant pain, the prescribed medication should be taken as directed. As these medicines are often
irritating to the stomach, it is usually best to have eaten solid food prior to taking the medications in order to minimize the irritating effect of the
medications.
Antibiotics
Be sure to take any prescribed antibiotics as directed to help prevent infection.
Oral Hygiene
Good oral hygiene is essential to good healing. The night of surgery, use the prescribed Peridex Oral Rinse before bed. The day after surgery, the
Peridex should be used three times daily; after breakfast, after lunch, and before bed. Be sure to rinse for at least 30 seconds, and then spit it out.
Brushing the teeth adjacent to the surgical site is very important, but a soft bristle brush should be used. If after implant surgery there are metal
healing abutments visible in the mouth, these should be cleaned with a cotton swab dipped in the Peridex for the first week, then with the toothbrush
after that time. Be very gentle initially with brushing the surgical areas. Some bleeding after brushing is to be expected, and is perfectly normal, so
don't avoid brushing if any minor bleeding is encountered.
Activity
Keep physical activities to a minimum immediately following surgery. If you have been sedated, you should avoid any activities that require
coordination or balance, and you may not drive a car the day of surgery. On the day after the surgery, you may resume normal activities, and it is
permissible to drive as long as you have been off the prescription pain medications for at least 8 hours. It would be best to avoid any strenuous
exercise for the first 48 hours after surgery as this may produce excessive bleeding.
Wearing a Prosthesis
Every situation is different, and Dr. Digney will give you instructions regarding the wearing of partial dentures, flippers, retainers, or full dentures
after the procedure. This will be discussed in the pre-operative consultation.

INSTRUCTIONS AFTER WISDOM TOOTH REMOVAL

Immediately Following Surgery
 The gauze pads placed over the surgical sites should be kept in place for 20 - 30 minutes. After this time, the gauze pads should be removed
and discarded. It is not necessary to replace the gauze unless there is active bleeding.
 Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot
that has formed to become dislodged.
 Take the prescribed pain medications as soon as you get home, after you have had something to eat. Do not wait until you begin to feel
discomfort.
 Restrict your activities the day of surgery and resume normal activity when you are off the prescription pain medication.
 Place ice packs on the sides of your face where surgery was performed. Refer to the section on swelling for further information.
Bleeding
Some bleeding is to be expected following removal of the wisdom teeth, but this is usually minimal. Even after biting on the gauze pads, it is normal
to have slight bleeding and oozing for the next 12 - 24 hours. Excessive bleeding is characterized by mouthfuls of bright red blood, or large rubbery
clots. If this occurs, please try the following:
 Rinse the mouth (gently, not forcefully) with cool water.
 Wipe away any clots outside the socket with a clean gauze pad.
 Bite firmly on a moistened gauze pad placed directly over the extraction site for 30 minutes. If no gauze is available, you may substitute a
moistened tea bag.
 Repeat all of the above as necessary.
It is important to avoid the use of any products that contain hydrogen peroxide, as these products may dissolve the blood clots at the site, and promote
dry socket. Strenuous exercise, jogging, or sporting activities that may cause an increase in the blood pressure should be avoided for the first 48
hours.
Some bleeding when brushing the teeth may occur for the first week following the surgery. This is completely normal, and should not be a reason to
avoid brushing in this area.
If bleeding does not subside, call for further instructions.
Swelling
 Some degree of swelling around the mouth, cheeks, eyes and sides of the face is normal after this type of surgery. This is the body's normal
inflammatory reaction to any injury. Similar to expectations about postoperative pain, we usually find our patients anticipate much greater
swelling than they normally actually experience. When you get home, place ice packs on the back portion of the lower jaw, as this is where the
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majority of swelling is seen. Despite these factors noted above, it is still normal for patients to be a little swollen for a couple of days, so
 POST SURGICAL INSTRUCTIONS
anticipate that there will still be some puffiness of the cheeks near the surgical sites. The swelling usually peaks around 24 - 48 hours after the
procedure
 Ice has been shown to be beneficial for the first 12 - 24 hours, but after that time it has very little effect on reducing the swelling. If you are
more comfortable applying ice, and want to use the ice pack the next day, it is perfectly acceptable to do this, but it will not make the existing
swelling resolve any faster.
 There are several things that can be done to minimize the swelling:
 Keep the head elevated at a 30 - 45 degree angle. Lying flat will increase the blood flow to the head, and cause more bleeding and swelling.
 Place ice packs on the sides of the face. Keep the ice packs on as much as possible for the first afternoon and evening following surgery. It is
O.K. to take occasional breaks from the ice packs, but try to leave the packs in place as much as possible. Ice has been shown to be beneficial
for the first 12 - 24 hours, but after that time it has very little effect on reducing any existing swelling. If you are more comfortable applying ice,
and want to use the ice pack the next day, it is perfectly acceptable to do this, but it will not make the existing swelling resolve any faster.
 On many occasions we may prescribe steroid medications for control of the swelling. These are not always necessary, but are often used when
bony impacted lower teeth need to be removed. See below for more information about steroids.
 If swelling or jaw stiffness has persisted for several days after the surgery, there is no cause for alarm. This is a normal reaction to surgery.
Steroid Medications:
On many occasions, we will prescribe steroid medications that are intended to significantly reduce the body's inflammatory response (which is
responsible for swelling in an injured area). These are not the same kind of steroids that most people associate with athletics or body building, but
are similar to medications like Cortisone, which most people are familiar with as a medicine to reduce inflammation. We normally use a medication
called SoluMedrol, which comes in a (6) day dosage packet called a Medrol Dosepak. We generally recommend that our patients start taking this
medication on the day prior to surgery. There are (6) pills on the first day, (5) on the second, etc. We prefer that our patients begin taking this
medication starting the day before the surgery.
The day prior to surgery: Take (2) pills in the morning, (2) in the afternoon, and (2) at night before bed.
The morning of the surgery: Do not take any food or liquid by mouth prior to surgery, so wait until you return home after the surgery to start taking
the swelling medication. There should be (5) pills in the pack, and it will say "Day 2". After you have returned home, had something to eat, and
taken your pain medication, you should take (1) swelling pill, then (2) more around mid-afternoon, and then the last (2) at night.
The remaining days: Follow the directions on the pack beginning with day 3.
Pain
As with any surgical procedure, there will always be some postoperative pain and discomfort. We normally recommend that as soon as the patient
returns home from their surgery, they take the pain medication, even though they are still "numb" and not experiencing any pain. This way, the pain
medication can begin to take effect as the numbness wears off, making the transition easier than if you were to wait for the pain, and then try to take
the pain medication. As you will be on an empty stomach from your surgery visit, it is important that you have something soft and bland to eat as
soon as you return home from the office before you take your pain medication. This is important, because most of our prescription pain medications
can be very irritating to the stomach. The presence of solid food in the stomach can help counteract this, and will usually help patients tolerate the
pain medication more easily. We recommend semi-solid foods, as just liquids alone may be insufficient to counteract the irritating effects of the pain
medications. Examples would be foods such as macaroni & cheese, pancakes, scrambled eggs, oatmeal, etc.
Most people will require the prescription pain medication for the first 24 hours following surgery, and are then usually able to switch to the over-the-
counter pain medications the following day. It is also important to remember that one should not drive cars or do anything that requires coordination
or balance while taking the prescription pain medication
For minimal or moderate pain, Tylenol or Ibuprofen (Motrin or Advil) may be effective. With the Ibuprofen, the maximum dose is 2400 mg per day,
which can be taken as two 200 mg tablets every 4 hours, or three 200 mg tablets (600mg) every 6 hours, or four 200 mg tablets (800mg) every 8
hours.
Diet
We recommend that you maintain a relatively soft and bland diet for the first few days after surgery. In general, most normal foods are O.K. after the
first few days, but it would be best to avoid anything with seeds or particles, such as poppy seeds or sesame seeds. You should avoid popcorn for at
least a month after the surgery. Contrary to popular belief, it is O.K. to use straws to drink liquids after surgery. The rationale was that the "suction"
created when using the straw would "pull out the blood clots" and cause dry socket, or at least stir up bleeding. There is so little suction created by
using a straw, that it is not likely that this will cause any problems at the extraction sites, or stimulate any significant bleeding. We actually prefer our
patients to drink through a straw, as this allows the liquid to pass right by the surgical sites, without the liquid washing across the surgical sites that
have just been operated on. High calorie, high protein intake is very important. It would be best to avoid very hot foods, as they can dilate the blood
vessels in the area and create more bleeding, and may cause the stitches to dissolve prematurely. You should prevent dehydration by taking fluids
regularly. Although it is normal to have a decreased appetite after surgery, you will feel better, have more strength, and heal faster if you continue to
eat.
Hygiene
Do not forcefully rinse for the first several days. You can brush your teeth the night of surgery but, use a very soft bristle brush, and rinse gently.
Expect to see a small amount of blood in the sink when brushing your teeth. This is very normal, and does not mean that you should stop brushing.
Do not floss between the last two teeth near the surgical sites in all the extraction sites for at least 2 weeks. Remember to avoid any products that
contain Peroxide, as this can very effectively dissolve blood clots, and contribute to dry socket formation. Check your toothpaste tube to see if there
is any Peroxide present. The popular whitening toothpastes often contain Peroxide, so be sure to check the list of ingredients.
Discoloration
In some cases, discoloration of the skin follows swelling. The development of black, blue, or yellowish discoloration is due to a small amount of
bleeding in the tissues just beneath the skin. This is a normal post-operative occurrence, and it may not be noticed until 2-3 days post-operatively.
Moist heat applied to the area may speed up the removal of the discoloration.
Infection
Infection is uncommon in routine wisdom tooth surgery, but on some occasions may still occur. It is usually characterized by swelling that increases
rather than decreases after the first several days. If swelling is noted to increase after the first several days, contact the office. Sometimes, late
infections can occur that may not be seen until several weeks after the surgery. These normally respond quickly to antibiotic treatment, and usually
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do not require any further surgery.

 POST SURGICAL INSTRUCTIONS
Nausea and Vomiting
Nausea is our most common postoperative problem that can occur after surgery. It is most often due to the pain medications that are taken after the
surgery, but can sometimes can occur after the anesthetic. Swallowing a small amount of blood after surgery is normal, and this can sometimes cause
nausea as well. Usually, the intake of food will help settle the stomach, but sometimes, despite having eaten, the patient may still experience nausea.
In the event of nausea and/or vomiting following surgery, you can take medications such as Maalox or Pepto Bismol, which may help settle the
stomach down. Ginger Ale may also help in alleviating stomach irritation. When the nausea subsides you can resume taking solid foods and the
prescribed pain medicine. In some cases of persistent nausea and vomiting, anti-nausea medications can be phoned in.
Other Complications
 If numbness of the lip, chin, or tongue persists after the first postoperative day, please let us know. As stated before surgery, this is usually
temporary in nature.
 Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, or becomes higher than 101.5
degrees, notify the office. Tylenol or Ibuprofen should be taken to reduce the fever.
 You should be careful when going from the lying down position to standing. You were not able to eat or drink prior to surgery, so you may be
slightly dehydrated. The pain medications can also make you dizzy. It may be possible that you could get light headed or faint when you stand
up suddenly. Before standing up, you should sit upright for one minute before attempting to get up.
 Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the
tooth. These projections usually smooth out spontaneously. They will sometimes become exposed over time, and as they usually occur in the
back part of the lower jaw, they can feel sharp to the tongue. If these sharp areas persist, contact the office, as they can sometimes be removed.
 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.
 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.
Sutures
There will be multiple sutures in all of the surgical sites. Most commonly after wisdom tooth surgery, there is also normally a stitch between the last
two teeth in the back of the jaw. Remember that there is a stitch in this area between the teeth so that you do not think it is a piece of food stuck
between the teeth, and attempt to remove it. These sutures will come out by themselves over time. These stitches usually come out after 4 - 5 days,
but it is not uncommon to lose a stitch after the first couple of days. Often, a suture will dissolve to the point where it becomes untied, and you may
feel a "string" in the mouth. If you are able to see this loose suture, you may reach in and gently remove it. It you run into a "snag", it is acceptable
to carefully cut it short with a nail scissors. The remaining portion will dissolve and come out by itself.
Dry Socket
The most common postoperative complication following Wisdom Tooth surgery is known as "dry socket". This is where the blood clot that normally
forms in the socket left by the tooth may dissolve away, leaving an empty socket with bare bone exposed to the mouth. This exposure of the bare
bone in the socket is not a serious problem, but causes a dull aching pain, and when it does occur, nearly always occurs in the lower extraction sites.
It usually takes at least 48 hours or longer for the clot to dissolve, so the usual scenario with a dry socket is that the patient does well for the first
couple of days following the surgery, and then notices steadily increasing pain in one or both of the lower sites. Once a dry socket is recognized, it is
usually easily treated by placing a small medicated dressing in the socket, which in most cases provides almost complete relief of the pain.

POSTOPERATIVE INSTRUCTIONS AFTER SINUS GRAFTING

DO NOT UNDER ANY CIRCUMSTANCES, BLOW YOUR NOSE FOR THE NEXT FOUR (4) WEEKS
Do not attempt to avoid a sneeze holding your nose. By doing so this creates a "stopper", which will create tremendous pressure within the sinus, and
may damage the graft site. If you feel a sneeze coming on, allow the air to be expelled through your open mouth. Do not pinch your nostrils together
while doing this. This will prevent the buildup of air pressure in the sinus. Scuba diving or the playing of any woodwind instruments may also
increase sinus pressure and should be avoided for at least two months. Flying in an airplane is acceptable during this time, but it is important that you
do not attempt to equalize the pressure in your ears by blowing against a pinched nose. Over the counter sinus decongestants and/or nasal sprays can
also help reduce pressure in the sinuses. It would be best to also avoid other activities that cause positive or negative pressure in your nasal cavity or
sinuses, such as lifting very heavy objects, blowing up balloons, forceful sniffing, or anything else that require a blowing or sniffing action and may
affect nasal or sinus pressure.
Smoking
Smoking is the single worst thing that can be done after a sinus graft procedure. The contaminants in the smoke, the tars and nicotine in the
bloodstream, and the changes in the blood flow in smokers, can all contribute to poor healing or infection in the graft site. If a sinus graft is to be
considered in a patient who smokes, they must be willing to discontinue smoking for at least 3 months prior to the procedure, and then throughout the
entire healing period.
Antibiotics
Be sure to take the prescribed antibiotics as directed to help prevent infection
Oral Hygiene
 Do not rinse forcefully or spit on the day of your surgery. This can disturb the wound, and promote bleeding. tends to disturb the blood clot, open
the wound and can prolong bleeding and slow healing.
 Keeping your mouth clean after surgery is essential to reduce the risk of infection. The teeth should be brushed with a very soft bristle brush. Do
not brush the incision line where the stitches are located. It would be best to avoid any toothpastes or mouthwashes with Hydrogen Peroxide, as
this will dissolve blood clots, and may contributing to opening of the wound.
 We may prescribe a Chlorhexidine antibiotic rinse (Periogard, Peridex) for a period of time after the surgery. This rinse should be used after
brushing the teeth, at least 2 - 3 times per day. Do not eat, drink, or rinse your mouth after using the medicated rinse.

Wearing your Prosthesis or Nightguard

Partial dentures, "flippers", or full dentures should not be used immediately after surgery until your post-operative appointment unless Dr. has
specifically instructed otherwise. Please contact the office if there is any question. When the denture is placed, it should not touch the incision line,
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or the gums in the area of the surgery. If it does, this can cause a breakdown of the incision line and opening of the wound. This can lead to loss of the
 POST SURGICAL INSTRUCTIONS
graft. If you have questions about the fit of your flipper, partial or complete denture, do not wear it until Dr. can examine you. It may be necessary
for Dr. to have you seen by your general dentist for further adjustment of the denture.
Post-Operative Problems or Complications
As with any procedure, unexpected post-operative complications can occur. Please contact us if any of the following occur:
If you notice the unexpected flow of air or liquids between your mouth and nose or sinus.
If you are aware of several small particles of graft material being from your nose or in the mouth.
If you experience unusual sinus or nasal congestion on the side your surgery was performed.
If there is an increase in swelling in your mouth, cheek or under your eye after 3 days.

POSTOPERATIVE INSTRUCTIONS AFTER EXPOSURE OF AN IMPACTED CANINE

Bleeding
Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding which results in your mouth filling rapidly with blood can
frequently be controlled by biting with light pressure on a gauze pad placed directly on the bleeding wound for 30 minutes. Care must be taken
however to avoid excessive pressure on the gold chain attached to the arch wire, as this could dislodge the bracket from the impacted tooth. If
bleeding continues please call for further instructions.
Swelling
Swelling is a normal occurrence after surgery. If the impacted tooth was on the palate, no visible facial swelling may occur, so ice packs may not be
necessary. If the impacted canine tooth was located on the lip side of the jaw, there may be some swelling of the upper lip postoperatively. To
minimize swelling, apply an ice bag or a plastic bag filled with crushed ice on the cheek and lips in the area of surgery. Apply the ice continuously as
much as possible for the first 12 hours after surgery.
Diet
Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as
possible unless otherwise directed, but remember, you should avoid biting hard or crunchy food items, as these could dislodge the bracket from the
impacted tooth.
Pain
For minimal or moderate pain, Tylenol or Ibuprofen (Motrin or Advil) may be effective. With the Ibuprofen, the maximum dose is 2400 mg per day,
which can be taken as two 200 mg tablets every 4 hours, or three 200 mg tablets (600mg) every 6 hours, or four 200 mg tablets (800mg) every 8
hours.
Oral Hygiene
You can brush your teeth the night of surgery but, use a very soft bristle brush, and rinse gently. Expect to see a small amount of blood in the sink
when brushing your teeth. This is very normal, and does not mean that you should stop brushing the area. Be very careful to avoid trauma to the
gold chain, as this could dislodge the bracket from the impacted tooth.
Activity
Keep physical activities to a minimum immediately following surgery. Strenuous exercise, jogging, or sporting activities that may cause an increase
in the blood pressure should be avoided for the first 48 hours.

POST-OP INSTRUCTIONS FOR PATIENTS ON MEDICATIONS AFFECTING BLOOD CLOTTING

 look after the initial clot at the operation site by resting
Pre-Operative Management while the local anæsthetic wears off & the clot fully
forms (2 - 3 hours)
Patients taking low-dose Aspirin (75mg - 300mg daily),  avoid rinsing the mouth for 24 hours
Clopidogrel (Plavix), Dipyridamole (Persantin, Persantin
Retard, Asasantin Retard) or are taking Warfarin are at
 not to suck hard or disturb the operation site with the
tongue or any foreign object
greater risk of bleeding after teeth have been removed or
after a biopsy has been performed.  avoid hot liquids and hard foods for the rest of the day
 avoid chewing on the affected side until it is clear that a
Patients taking low-dose Aspirin, Clopidogrel, Dipyridamole stable clot has formed. Care should then be taken to
or are taking Warfarin should not have their medications avoid dislodging the clot
stopped or altered prior to dental surgical procedures  bleeding continue or restarts, to apply pressure over
unless advised otherwise. the socket using a folded clean handkerchief or gauze
pad. Place the pad over the socket and bite down
If the patient is on Warfarin, the INR is checked on the day of extraction firmly for 15 - 20 minutes. If bleeding does not stop,
or biopsy. If the INR is below 3.5 – 4.0, then the extraction / biopsy can the Oral Surgeon should be contacted; repacking and
be done. re-stitching of the socket may be required

Peri-Operative Management How Should Post-Operative Pain Be Managed?

To minimise bleeding after the extraction / biopsy:
 the socket can be stuffed with various materials that Patients should follow the advice of their Anticoagulant
assist clotting Clinic with regard to the choice of painkillers for short-term
 the socket is stitched up tightly & mild to moderate pain.
 a mouth rinse containing Tranexamic Acid (this
Generally, Paracetamol is considered the safest simple
prevents the breakdown of blood clots) can be
painkiller for patients taking Warfarin and it may be taken in
prescribed.
normal doses if pain control is needed and no contra-
indication exists.
Post-Operative Management
Patients should:
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Patients should not to take Aspirin, Aspirin-containing

 POST SURGICAL INSTRUCTIONS
compound preparations or Non-Steroidal Anti-Inflammatory
Drugs e.g. Ibuprofen, which are considered less safe than Patients requiring a course of antibiotics post-operatively
Paracetamol in patients taking Warfarin. should be vigilant for any signs of increased bleeding.

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