Home care instructions following wisdom teeth extractions with general anesthesia
On the day of your consultation, you will receive a prescription slip with five medications on it: ibuprofen, vicodin, antibiotic, anti-nausea medication, and an antibacterial rinse. When you arrive the day of surgery, you will receive a bag with a soft bristle toothbrush and a monoject syringe.
BLEEDING
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Bite on the gauze pack in your mouth with firm, continuous pressure after leaving the office. Bleeding usually subsides within an hour or two. When you get home, remove the gauze to eat something and take the ibuprofen, then place it back in. Make sure the gauze is behind the last molar over the extraction site, and bite down to apply pressure.
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Sit upright. While biting on the gauze, avoid any spitting or expectorating. Remove the gauze when there is a residual component of one-quarter red and the rest pink, which is a normal small amount of seepage. Dissolvable sutures are placed in the surgical site to minimize post-operative bleeding and to help with healing. Sometimes they become loose or dislodged; this is no cause for alarm. Just remove the suture and discard it.
ACTIVITIES
Reduce your physical activities today to avoid exertion that could reinitiate the bleeding or induce swelling. You should avoid exercise for 5 days; no sports or going to the gym. Cardiovascular activity within the first 5 days can cause rebound swelling and bleeding, doubling your recovery time. Do not smoke cigarettes for the first 10 days following surgery to minimize the chance of secondary infection or dry socket. It is advisable for the first 24-48 hours following surgery to have someone assist you when going from a lying to standing position. To help avoid becoming lightheaded or dizzy, rise slowly to a sitting position and sit for several minutes before standing.
SWELLING
To minimize swelling, apply ice packs over the affected areas as soon as possible for 20 minutes on and 20 minutes off the day of the surgery until you go to bed that night. This is usually a 24-hour cycle. You should also ice a little when you wake up. Please note that ice is not effective after 24 hours. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days postoperatively.
Anti-inflammatory medications, as well as elevation of the head while you sleep for the first 2-3 nights after surgery, will help minimize swelling. The application of heat can be done with the small ice packs dispensed by the office (warming them in hot water or the microwave) or blue gel hot/cold packs. Apply heat for 5-7 minutes on each side, starting 2 DAYS after surgery. When the heat is in place, it is helpful to open and close the mouth and shift the jaw from side to side. Repeat 3 times a day for 3-4 days.
PAIN
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Some discomfort or pain is normal and should be relieved by the prescription medication. Take the ibuprofen within an hour of getting home from surgery. Take all medications with food to avoid stomach upset or nausea. Use the vicodin on an as-needed basis; take 1-2 tablets every 4-6 hours, but only if you need it.
FOR IV PATIENTS (Wisdom teeth procedures)
It is recommended for the first 2 nights to keep your pain medication at your bedside and set an alarm for a DOSE IN THE MIDDLE OF THE NIGHT (4-6 hours from the last dose). This will help keep the medication uniform in your bloodstream to help with pain management.
NUMBNESS
You will be numb after surgery. Numbness in the upper jaw usually subsides before the lower jaw. For procedures on the lower jaw, our office uses a long-acting local anesthetic. Your chin and tongue may be numb for up to 8 hours following surgery. Prolonged lower jaw numbness can be perceived as having difficulty in swallowing; however, you still have the ability to swallow. Take small, slow sips of fluid while slightly tilting your head back. For upper jaw procedures, a shorter-acting anesthetic will be used, lasting 2-4 hours following surgery.
MEDICATIONS
Please have any prescriptions filled immediately. We give an IV antibiotic, but you should also begin the prescribed antibiotic the night after surgery. The antibiotics need to be taken until completely gone. Please note that antibiotics decrease the effectiveness of birth control pills. Take all medications with a minimum of a glass of water and soft foods. If any side effects or nausea occur, discontinue the medications and call the office. Avoid combining medications at the same time. Allow at least 1-2 hours before taking your next medication. If you experience difficulty swallowing pills, please contact our office.
NAUSEA
If there’s any nausea going home, proactively give our office a call and we will call in an anti-nausea medication. It is a dissolvable pill that you place under the tongue that begins working instantly Nausea may be caused by taking pain medication on an empty stomach or by swallowing blood. Avoid taking any further medications until the nausea is controlled. Antacids may be effective to relieve stomach upset, followed by bland food. If nausea persists, please contact the office.
ORAL HYGIENE
You can brush the night of surgery, but avoid vigorous rinsing or spitting. Use the soft brush provided by the office for 2 weeks around the surgical sites. You may use your regular toothbrush for all other areas in your mouth. Begin the antibacterial rinse (Peridex™) the fourth day after the procedure; surgery day is included in that 4 days. Fill the syringe with the antibacterial rinse and irrigate half of it into the lower right socket and half into the lower left socket. Hold out the cheek so you can see where you’re putting it. Make sure the tip of the syringe is down in the socket, and flush it until it’s clean. Do this twice per day. The bottle should last about 2 weeks; be sure to finish it all. Please leave out any retainer or bite guard for 3-4 days or until comfortable to begin wearing again. After you have finished the oral rinse, you may begin using warm salt water rinses.
DIET
You will be on a liquid diet the first day. You will be numb, and liquids prevent biting down on your cheek or tongue. Resume your normal diet as soon as possible on the second or third day after surgery. Do not drink fluids through a straw for 7 days; the sucking motion can cause more bleeding by dislodging the clot. High-calorie, high-protein intake is very important to feel better and heal faster. Avoid seeds, nuts, and popcorn for about 2 weeks. You should prevent dehydration by taking fluids regularly. Drink at least 5-6 glasses of liquid daily.
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For the first day of surgery:
- Milkshakes (add fruit such as a banana)
- Carnation® instant breakfast
- Creamy soups and broths
- Jamba juice (avoid seeds such as strawberry, raspberry, blackberry)
- Yogurt
- Applesauce
- Ensure®/Boost® dietary supplement drinks
- Jell-O®
For the second day following surgery:
- Soft-cooked pasta
- Mashed potatoes
- Macaroni and cheese
- Scrambled eggs
- Pancakes/waffles
- Steamed rice
- Chili with melted cheese on top
- Oatmeal/cream of wheat
- Ice cream
- Pizza
For the first 3 weeks, avoid popcorn, nuts, uncooked vegetables, such as carrots, etc.
Other instructions
- Please leave retainer out for about 4 days or until it is comfortable to begin wearing it again.
- Do not play musical instruments (e.g., trumpet, saxophone, horn instruments) for 10 days after surgery.
IF THERE ARE ANY QUESTIONS OR CONCERNS, PLEASE DO NOT HESITATE TO CALL OUR OFFICE IMMEDIATELY.
Sunnyvale: (408) 245-6010
San Jose: (408) 270-9450
Milpitas: (408) 263-2962
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