After Your Surgery
Post-Operative InstructionsSome discomfort is normal after oral surgery. You should begin taking pain medication prior to the local anesthetic wearing off. You may begin taking pain medication when you get home, along with some food. We recommend starting with ibuprofen (Advil® or Motrin®) 600 mg. Ibuprofen bought over the counter comes in 200 mg tablets; 3 tablets may be taken 4 times daily, not to exceed 3200 mg daily for an adult. An excellent over-the-counter option is to alternate between ibuprofen and acetaminophen (Tylenol®) every 3–4 hours, which is ideal for managing most types of pain after oral surgery. In addition to ibuprofen, 1 or 2 tablets of acetaminophen (Tylenol 325 mg or Tylenol Extra Strength 500 mg) may be taken every 4 hours, not to exceed 3000 mg a day.
If you have been prescribed a narcotic (opioid) pain medication (e.g., Tylenol #3, Norco®, Vicodin®, Ultram®), please use only as directed. We recommend only using opioid pain medication if the above regimen is not adequately managing your pain. You may alternate the opioid with ibuprofen if instructed to do so. The opioid you have been prescribed also has acetaminophen, so be mindful of the 3000 mg maximum daily dose. Opioids do have some unpleasant side effects. Nausea and sometimes vomiting are common. Drowsiness, which can impair your reflexes and judgment, is also common. Therefore, if you take this medication, do not drive, operate machinery, go to work or school, or make important decisions. This medication can also cause constipation. Opioids can be habit-forming. Avoid alcoholic beverages or other sedative medications while on opioid pain medication.
If you have reduced kidney function, please consult with your physician, as you may need to alter the dosing of ibuprofen.
We recommend that you familiarize yourself with these medications by reading the package insert and/or information provided by your pharmacist. If you have any questions about these medications, please call (815) 459-7400.
If you’ve just gotten a root canal or had your wisdom teeth extracted, chances are you’re in pain. Now that the numbness has worn off, you might want to know what can help ease the pain. Did you know that the best relief you can get after a tooth extraction is found in your medicine cabinet? That’s right, a study conducted by the School of Dental Medicine at Case Western Reserve University has shown that ibuprofen taken in combination with acetaminophen is the most effective way to ease dental pain. In fact, in most cases, the combination of the two is more effective than opioids.
What Are the Benefits of Ibuprofen and Acetaminophen after Tooth Extraction?
A study published in Clinical Therapeutics shows that when acetaminophen and ibuprofen are co-administered, they provide more effective pain relief than when taken by themselves.
What makes the combination of ibuprofen and acetaminophen so effective? Why should you not only take ibuprofen after a tooth extraction? The American Dental Association explains, ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), which means it helps with the pain you’re experiencing by reducing inflammation at the site where it’s occurring, in this case, your mouth. Meanwhile, acetaminophen acts centrally and blocks the transmission of pain signals within your central nervous system. Their mechanisms of actions complement each other, resulting in effective pain relief.
Should I Take Opioids after a Tooth Extraction?
The Pharmacy Times explains that opioids change pain messages in the brain and can cause dizziness, drowsiness, constipation, hallucinations, muscle rigidity, nausea, and vomiting. They can cause opioid addiction, even when used as prescribed.
That said, when it comes to pain relief, your dentist is the right person to ask for advice. If your dentist prescribes you an opioid, there's a good reason behind this. But if you feel uncomfortable with taking an opioid, don’t hesitate to ask questions about the dosage or inquire about alternative options. And of course, following your dentist and the manufacturer’s instructions is critical.
It’s no fun having your life disrupted by the pain a tooth extraction can cause. While you want things to get back to normal as soon as possible, it’s important to consider all the information while taking pain medications. Don’t forget to consult with your doctor, and you’ll be pain-free in no time!
What to do after wisdom tooth removal
Medications
All medications should be taken as directed on the bottle. If you were given ibuprofen for pain, take your first dose as soon as you get home, before the numbness wears off. Continue to take the ibuprofen every 6 hours for 3 days following surgery. If that does not satisfactorily relieve the pain in 1 hour, then take two Tylenol up to every 6 hours. If the ibuprofen + Tylenol combination are ineffective, then take the narcotic as prescribed. Do not take any pain medication on an empty stomach, as this can cause nausea. After taking medication, drink 8 oz of water and sit up for at least 20 minutes. Do not drive while taking the narcotic pain medication. If you were prescribed an antibiotic, take the medication exactly as described on the bottle until the prescription is gone.
NOTE: IF YOU EXPERIENCE ANY OF THE FOLLOWING, STOP TAKING ALL MEDICATIONS IMMEDIATELY AND CALL THE OFFICE OR GO TO THE NEAREST EMERGENCY DEPARTMENT: rash, itching, breathing difficulties, wheezing, multiple episodes of vomiting, diarrhea, or swelling of the lips throat, eyes, hands, or feet.
Do not take any ibuprofen if you are allergic to aspirin, ibuprofen, or NSAIDS (non-steroidal anti-inflammatory drugs); in this case, just take Tylenol or the prescribed narcotic as directed on the label.
Bleeding
A small amount of bleeding is expected and normally is not a cause for concern. A fresh gauze will be placed in the area of the surgery prior to leaving the office. Keep the jaws tightly closed to provide pressure on the surgical sites. Remove this gauze in approximately one hour and replace it with a fresh, tightly-folded gauze. Again apply pressure and leave it in place for 60 minutes. This should stop most bleeding. Do not replace the gauze more often than every 60 minutes. When the gauze is removed, it is normal for the surgical site(s) to slightly ooze for up to 24 hours. It is not normal if the oozing causes large, thick clots to form in your mouth. If bleeding continues, run a tea bag under warm water, wrap it in gauze, and bite on it for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. If the oozing continues at a brisk pace, call Dr. Matton or report to the local hospital Emergency Department after hours for instructions.
Swelling
Some swelling is expected and may persist for several days. Peak swelling and discomfort usually occur 2-3 days after surgery. It may be minimized by the application of ice packs. Cold therapy can be helpful if swelling is expected. If you were given a Cool Jaw, place the ice packs on for 20 minutes on then 10 minutes off during the first 24 hours, except for eating and hygiene. When you lie down, elevate your head using a pillow. This allows gravity to work for you and helps reduce swelling.
Oral Hygiene
Avoid tooth brushing or rinsing until the next day after surgery. You should also begin gentle warm salt water rinses the day after surgery. To do this, add 1/2 teaspoon salt to an 8 oz glass of warm (not hot) water. Gently rinse for about 30 seconds and then let the water fall out of your mouth without spitting. The day after surgery, brush and floss but avoid the surgical sites. Remember to rinse after every meal and maintain excellent oral hygiene to promote healing. If a mouthwash was prescribed, use it as directed. Avoid ALL tobacco products INDEFINITELY. You will likely get a “dry socket” at the site of a lower extraction if you smoke after surgery. If you have an irrigating syringe or a Water Pic, do not start using it any sooner than 1 week after surgery.
Eating
Fluids should be taken as soon as possible after surgery. Avoid using a straw for the first few days. Do not drink carbonated drinks or alcoholic beverages. You may have beverages such as: water, apple juice, broth, milkshakes, etc. High fluid intake is recommend for the first 48 hours to help prevent nausea and insure adequate hydration. Only eat soft foods (pasta, eggs, yogurt, soups, instant breakfast drinks, puddings, etc.). Do not consume any hard, chewy, or crunchy foods. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
Activity
A responsible adult needs to accompany you home on the day of your surgery. You are to go directly home and rest quietly with your head elevated the remainder of the day. The residual effects of the medication used during your procedure may alter your judgment and physical abilities. Do not attempt to drive or operate dangerous equipment (e.g. power tools, motor boats, etc.), for 24 hours or while taking the narcotic pain medication, and do not exercise (jogging, sports, weight lifting) for 1 week. Restrict your activities the day of surgery and resume normal activity when you feel comfortable. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.
Sutures
If you have sutures, they will be absorbed. If the sutures are bothersome, we can remove them 2 weeks after your surgery.
Discoloration
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
Intravenous Catheter
You may notice a bruise and some soreness at site of your IV. The day after surgery you may apply moist heat to the area to relieve discomfort. If pain increases or does not improve within a few days please call Dr. Matton .
Stiffness in the Jaw
Stiffness (trismus) and soreness around the jaw area can be anticipated for several days. After 24 hours, you may start to apply moist heat packs (applied to the stiff areas for 20 minutes 4-5 times a day) to speed recovery.
For Patients Taking Birth Control Pills
Antibiotics can sometimes render birth control pills less effective. It is advisable to use an alternative method of contraception for the remainder of that cycle’s package of pills when an antibiotic is taken.
Special Precautions
You may feel light-headed or dizzy due to the combined effects of the IV and pain medications. Be careful when you get up and ask for assistance when needed. Please feel free to contact us if any doubt arises as to your progress or recovery, especially if any of the following occur:
| • | Increasing or persistent pain after the first 3-4 days |
| • | Continued increase in facial swelling after the first 72 hours |
| • | Persistent bleeding, despite following the above instructions |
| • | The presence of persistent nausea or vomiting |
Finally
There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with warm salt water rinses.
Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Matton or his staff.
If you are involved in regular exercise, refrain from exercising for 1 week after surgery. Be aware that your normal nourishment intake is reduced and exercise may weaken you. If you get light headed, stop exercising.
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. If not, they can be removed by Dr. Matton .
We will tell you at the time of discharge when your appointment is scheduled. If there is a problem keeping this appointment, please call as soon as possible to reschedule. Do not hesitate to call us at (860) 739-3133 if you have ANY questions!