Notice of Privacy Practices

Post-Op Instructions

DOWNLOAD POST-OP INSTRUCTIONS

Bleeding:

  • Prior to you leaving our office, your extraction sites typically will be minimally bleeding. Biting on the gauze firmly that you were provided will slowly stop this in the 1-4 hour post op period.
  • When placing the gauze, ensure that you dampen it prior to placement.
    • Don’t be alarmed if the surgical sites continue to ooze for the immediate 24-48 hours.
  • When resting, keep your head slightly elevated using two pillows. Lying on your back with no head elevation can cause more bleeding and swelling and possibly lightheadedness.

Swelling:

  • Swelling is expected with wisdom tooth removal.
  • Applying Ice packs to the area of surgery for the first 24-28 hours following surgery can help reduce this. If using a “freezer packs” (not a bag of ice), do not apply directly to skin as this could cause damage to the tissue due to extreme cold. Apply cold for increments of no more than 15 minutes.
  • MAXIMUM SWELLING TYPICALLY PEAKS AT 72 HOURS, AND WILL GRADUALLY SUBSIDE IN THE FOLLOWING DAYS.
  • On the 3rd to 5th day after surgery, as the swelling starts to subside, the use of mild heat can help facilitate increased blood flow to the surgical sites to increase the speed at which the swelling disappears.

Oral care of the surgical sites post-op

  • Wait 24 Hours to rinse your mouth with anything. You may either rinse your mouth with warm salt water rinses (1 teaspoon salt to 1 cup of water) or the prescribed peridex mouth rinse.
  • DO NOT SWISH. Fill your mouth with the water or peridex and tilt your head from side to side to allow rinse to wash over surgical sites, then gently let the water spill out into the sink. Start this AFTER 24 HOURS and continue for 7 days. It may not be comfortable.
  • If you absolutely have to rinse in the first 24 hours, do so as gently as possible.

Diet following wisdom tooth extraction

  • • A LIQUID DIET IS BEST. Focus on foods that are high in protein and can be eaten with minimal chewing. DO NOT USE A STRAW.
  • Suggestions: smoothies (no seeds), yogurt, pudding, mashed potatoes, scrambled eggs, soup, instant breakfast

Medications

  • You have been prescribed several medications to control possible post-op pain, your escort should have picked them up during your appointment, or on the way home from your appointment.
  • Take these medications with food.
  • For medication questions, reference the “Medication Instructions” sheet provided.

Sutures

  • Sutures will dissolve and fall out on their own in 3-5 days. If they fall out sooner, this is fine. If they are still in place after a week, try rinsing vigorously for a few seconds. If they still won’t come out, we can remove them, or your referring dentist can easily remove them.

Solutions for possible post-op problems

Bleeding will not stop, or the blood clot is forming outside the surgical site

  • Generally we find that strong pressure (as uncomfortable as it may be) with damp gauze for 10-15 minutes will stop almost all bleeds.
  • If needed, switch gauze out every 10-15 minutes.
  • DO NOT CHEW ON GAUZE, SIMPLY BITE AND HOLD.

Uncontrolled pain

  • Wisdom Tooth Removal is a complex surgery involving several types of tissues- gums, muscle, bone and nerves. Like any surgery, postoperative pain and discomfort are normal.
  • Your pain medication will help relieve post-operative pain. So take them as indicated and get plenty of rest.
  • It is much easier to control post op pain by staying ahead of it, than waiting until something hurts to take the post op medications.
  • We suggest using the routine on the “Instructions for Medications” handout, even if you experience minimal to no post-op pain in the immediate 24 hours after your appointment.
  • During the first three days after surgery, ice packs placed on the cheeks can help with post-op pain, do not fall asleep on it.

Post op Nausea and Vomiting

  • While rare, this can be a side effect of the surgery, anesthesia, or post-operative pain medication.
  • Vomiting will not damage your surgical sites, however it may make it bleed which may necessitate the use of gauze and pressure to get it to stop (see above). Should you vomit and the sockets start to bleed again, ensure you gently rinse your mouth before placing the gauze.

Dry Socket

  • A dry socket arises because the blood clot in the extraction site has been dislodged and a new clot has not formed (such as smoking, drinking through a straw, not following post op diet, or vigorous swishing). This leaves the socket empty and “dry” leaving the nerve endings present in the extraction socket exposed.
  • Usually starts AFTER DAY 3 of tooth extraction and is manifested as deep pain within the jaw, the ear or the temple that is NOT relieved by the use Ibuprofen and Tylenol or a narcotic pain killer.
  • This can be avoided by:
    • Following post-op instructions.
    • No smoking for 5-7 days, nearly 100% of patients we have seen that have dry sockets are smokers.
    • Liquid diet only
    • No intense physical activity for 5-7 days.

Syringe Directions (Monoject):

  • Very gently clean out food debris from the lower jaw surgical sites using warm tap water. Do not force tip into surgical sites.

Infection or Swelling after 10 days

  • Increase swelling or pain around the extraction site that begins between 10 days after surgery to 12 months after surgery is uncommon, but it does happen. Call our office immediately if swelling, pus or pain returns at any time in the next 12 months. Treatment will be completed in our office at no additional charge to you.

After Hours Assistance

  • You may call our office after hours, there is a way to leave a message for the doctor to return a call, however this is NOT an emergency number
  • If you are concerned about the immediate health of the person you are caring for, please call 911 or take them to the emergency room.
  • If you call this number and no one answers, leave a detailed message including the patient’s name, date of surgery and your question. Please be courteous and your call will be returned at the earliest convenience of the staff member or doctor responding. Do not expect calls to be returned after 9pm or before 9am. The number is: 515-686-8200, option 2.

Instructions for using post op medications

Pain Medication- Non-Narcotic Management

  • You have been given a prescription for Ibuprofen 600mg.
  • You will need to purchase extra strength Tylenol over the counter.
  • You should start taking your post op pain medication as soon as possible after surgery.
  • Using your phone, set a recurring 3 hour timer. Take 1 ibuprofen 600mg, wait three hours, then take 2 extra strength Tylenol. Again wait 3 hours and repeat the cycle.

Additional pain control medications

  • While we discourage the use of narcotic pain killers, they do have their place in post-operative pain control.
  • We understand that pain is subjective and sometimes the above combination is not enough to completely control post-op pain.
  • If you have been given a prescription for hydrocodone 5/325mg, we would encourage you to not use it or use it minimally in combination with the above Ibuprofen/Tylenol cycle.
  • Should you need to use this medication, you need to reduce your extra strength Tylenol use by 1 pill anytime you use the Hydrocodone (in the above cycle) as the Hydrocodone has Tylenol in it. (Example: 2 Tylenol OR 1 Tylenol and 1 Hydrocodone)
  • We would like to stress that this medication should not be used as your primary medication to control pain, but used in case the Ibuprofen/Tylenol combination is not enough.
  • You were given a limited number of this medication, enough for a few days and refills CANNOT be called in under any circumstances.

Antibiotic (If prescribed):

  • Begin taking the antibiotic the morning after surgery. Take your antibiotics as indicated on the bottle. Do not stop taking the pills until all of them are gone

Medrol (If prescribed):

  • Occasionally we prescribe a strong short-term steroid to prevent or lessen expected post-op swelling that may be a result of a longer than usual surgical time, or to treat an expected post-op complication that swelling may be expected to cause. The package for this has instructions on it and should be followed as directed. Consult with your pharmacist if you should reduce or stop taking ibuprofen with this medication.
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