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Post-Operative Instructions: Extraction (With Bone Grafting)

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Immediately Following Surgery

  • The gauze pad placed in the surgical area should be kept in place for 30 minutes. After this time, the gauze pad should be removed and discarded. Once you are home, please change the gauze and use firm biting pressure over the extraction site(s) until the bleeding stops.
  • Vigorous mouth rinsing and/or touching the wound area following surgery should be avoided on the day of surgery, as it may cause bleeding.
  • Take the recommended pain medication as soon as possible following the surgery, ideally before the numbness from local anesthesia has worn off.
  • Restrict your activity on the day of surgery and resume normal activity when you feel comfortable.

Bleeding

  • Bleeding is normal following surgery. Slight bleeding, oozing, or redness in the saliva or gauze pad is not uncommon and is expected. When the gauze pads have little or no blood on them, they are no longer necessary. It can take a variable amount of time for bleeding to resolve but usually resolves within a few hours, although a small amount of bleeding is common for up to 24 hours.
  • Excessive bleeding (i.e., rapidly fills up or pools in your mouth) may be first controlled by gently rinsing or wiping any old clots from your mouth, placing a fresh gauze pad over the surgical site, and applying firm biting pressure on the extraction site for 30 minutes. Repeat as necessary. If excessive bleeding continues, you may apply biting pressure on the extraction site with a moistened black tea bag for 30 minutes. Repeat as necessary. Repeatedly replacing or using gauze in the absence of excessive bleeding (i.e., rapidly fills up or pools in your mouth) will delay the clotting process and prolong bleeding. If bleeding continues excessively, please call for further instructions.

Swelling

  • Swelling is normal following surgery. Swelling may not present immediately following surgery, as it usually increases or peaks in the days following surgery. It can take a variable amount of time for swelling to resolve, but usually improves within a week or two.
  • To minimize swelling, apply an ice bag, or a plastic bag or towel filled with ice, on the cheek or jaw outside the surgical area. Apply the ice continuously (20 minutes on, 20 minutes off) for the first 24 hours, as tolerated.
  • Keeping the head elevated with a couple of pillows for the first few days following surgery can also help reduce swelling.
  • Some patients, especially those on blood thinners, may experience cheek or jaw bruising following surgery. This is not unusual and typically improves over several days.

Diet

  • In general, you may return to a normal diet as soon as possible unless otherwise directed.
  • For the first day of surgery, eat soft foods and drink liquids as this will help with discomfort and help allow blood clots to form undisturbed.
  • Avoid straws as this may cause the blood clot to dislodge.
  • Avoid hot liquids and hot food as these may cause discomfort.
  • You should be encouraged to eat regularly and drink plenty of fluids, as these will help with recovery.
  • You may advance your diet to normal foods as your comfort and tolerance allows.
  • If you had a bone graft placed at the time of your surgery, it is advisable to chew on the opposite side of the surgical site for 2 weeks following the surgery.

Pain

  • Pain and/or discomfort is normal following surgery. Pain may not present immediately following surgery as it usually increases or peaks in the days following surgery. It can take a variable amount of time for pain to resolve, but usually improves within a week or two.
  • You should take non-steroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen) as first-line pain therapy, unless otherwise stated by your doctor. The recommended maximum daily dose of ibuprofen is 3,200 mg and, typically, two to four 200 mg tablets may be taken every 6 hours.
  • If you are unable to take NSAIDs, acetaminophen (e.g., Tylenol®) is recommended as first-line pain therapy. Typically, Extra Strength Tylenol may be taken every 4–6 hours.
  • Ibuprofen and Tylenol, taken simultaneously, work as well or better than opioids in their pain management effect. Often, taking Tylenol between doses of ibuprofen provides better pain control than taking Tylenol at the same time as the ibuprofen