How long leave gauze after tooth extraction

POST-OPERATIVE CARE AFTER TOOTH EXTRACTION

1. 1.Continue to bite on two pieces of folded gauze at the extraction site.  Initially you have to change the gauze every 5-10 minutes. As bleeding slows down , you don’t have to change the gauze as often.  If you run out of gauze supplies, use a tea bag instead.  Place the tea bag in the hot water to sterilize it , then remove it and wait until it is cold.  Place the tea bag over the extraction site and gently bite.
   

1. 2.Keep fingers and other object away from the extraction site.
   

1. 3.Do not rinse out your mouth or spit today as that may cause more bleeding (7-8 hours).
   

1. 4.Keep ice pack, frozen gel-pack, or a frozen bag of peas on your face close to the extraction site intermittently. Place it for 20 minutes, then remove it for 20 minutes, this way the blood supply to the area will not be cut out.
   

1. 5.Avoid drinking hot beverage, and hot food (coffee, tea, soup) at least until the bleeding completely stopped. Let the beverage/food cool before eating today. On the day of surgery most people find cool soft foods (ice cream, yogurt) soothing.
   

1. 6.Cold or lukewarm liquids may be taken for the first 4-6 hours. After this any soft food is permissible. Avoid food with sharp edges such as chips, crackers, and toast for the next week.
   

1. 7.Avoid smoking for at least 12 hours.  Be aware that smoking after 12 hours also may increase the chance of infection and bleeding.
   

1. 8.Start tomorrow, rinse your mouth frequently with a solution of 1/2 teaspoon of salt in a glass of warm water. Continue to rinse for a few days. 
   

1. 9.An irrigation syringe will be given to all patients to irrigate the extraction site thoroughly.  Place the plastic tip of the syringe gently at the extraction site and press the plunger to irrigate the wound free of food debris and bacteria.
   

1. 10.Some patients will be given a prescription-strength mouth rinse.  It should be use twice a day in addition to the saltwater.
   

1. 11. It is normal for the saliva to be streaked with blood for a day.  If frank bleeding is present, fold sterile gauze into a firm wad or use a lukewarm tea bag and place it directly on the bleeding area.  Maintain firm pressure by biting for 20 minutes.  The tannic acid in tea has a clotting effect.
   

1. 12. Swelling and discolouration is to be expected in certain areas, usually reaching its maximum two days after surgery.  It will disappear gradually and is no cause for concern. Intermittent use of ice pads  can reduce the chance of swelling.
   

1. 13. If you have been given a prescription for antibiotics you will need to complete the entire course of medication that has been prescribed to minimize the chance for Infection.
   

1. 14. Start pain relievers BEFORE your anesthesia wears off. Unless otherwise specified, start with Ibuprofen 400 mg (two 200 mg tablets) every 4-6 hours for adults.  Follow the appropriate instructions, if a prescription strength pain reliever is given.
   

1. 15. Avoid drinking alcohol or driving if taking prescription pain medication.
   

1. 16. The next day after extraction begin gentle rinsing with the prescription rinse, if given two times per day (after breakfast, and before bedtime) as directed on the bottle. You also should continue to rinse with warm salt water (1/2 tsp. salt to 8oz. glass of water) between the prescription rinses for the next two weeks.
   

1. 17.Avoid vigorous exercise and excessive talking for the next 3 days.
   

1. 18. If stitches are used, most may not dissolve on their own and must be removed at your follow-up appointment. Never pull at loose stitches or attempt to remove them yourself.
   

1. 19. Most post-surgical pain is Improving by the third day. If pain or swelling is increasing on the fourth day or later after the surgery, call the office (604-985-7032) to speak with our staff or with Dr. Chehroudi.  You may have to come in for a follow up visit ASAP.
   

After Your Surgery

Post-Operative Instructions

General Anesthesia Precautions

**If general anesthesia or IV sedation was utilized, do not leave the patient unattended for the first 12 hours.

**Please closely supervise the patient when getting up or going to the bathroom.

Medications

Please refer to your medication information sheets if you were given prescriptions. If you have any reaction to medications prescribed, call the doctor immediately.

Managing Bleeding After Surgery

For the first hour after surgery:

Keep firm pressure on the surgical site with the gauze that was placed in your mouth after surgery. Remove gauze after 1 hour.

If Bleeding Continues

Take 1 piece of gauze and fold it in quarters, creating a firm pad. Place the pad over the surgical site. Use firm biting pressure where possible (extraction site), or direct finger pressure by holding the gauze (biopsy site). You may have to repeat this procedure several times. The bleeding should stop within 2-3 hours, but you can expect to see blood-tinged saliva for up to 24-48 hours following surgery. If bleeding is heavy, or continues after 2 hours, moisten a tea bag, place on surgical site, and apply pressure or bite firmly for 30 minutes. This usually stops the bleeding. Please remember, most bleeding is controlled and stopped with a well-positioned gauze or tea bag with direct pressure. If bleeding is heavy or continues after 24 hours, call the doctor. Do not rinse, spit, or use a straw the day of surgery, as this can cause bleeding to resume.

To Reduce Swelling

Ice for the initial 24 hours. Use ice packs applied to the face for 20-minute intervals (20 minutes on, 20 minutes off). If oral surgery was performed on both the right and left sides, it is recommended to use one ice pack and alternate sides every 20 minutes. This is the most effective way to reduce swelling. Do not exceed 20 minutes in one area as this can cause tissue injury. Swelling usually reaches its maximum 2 days following surgery. To help reduce swelling, sit semi-reclined in a reclining chair; if lying down, keep your head elevated with 2-3 pillows. Icing should be discontinued after 24 hours. While icing your face may feel good, it will act to increase swelling. Again, DO NOT ice beyond 24 hours.

Orthodontic Retainers

If you have orthodontic retainers, please do not use them immediately after surgery. Use of your retainers can resume 1-3 days after the procedure or as comfort allows.

Diet

Resume your diet immediately following surgery. When you get home, start with a milkshake, smoothie, or other thick liquid using a spoon, NOT a straw. Your diet should be limited to cool and soft foods for the first day. Sometimes numbness from local anesthesia may last for hours; therefore, hot foods and liquids should be avoided, as they can cause a burn. A normal diet can be resumed as tolerated. Most foods can be eaten as long as care is taken to avoid the surgical sites. The following are some suggested softer foods: pancakes with syrup, eggs, and pastas like macaroni and cheese or spaghetti.

Oral Hygiene

Rinse with warm salt water or tap water beginning 3 days after surgery. To make a salt water rinse, add 1 teaspoon of salt to 4-5 oz of warm water. Rinse at least 3 times per day: in the morning, after meals, and before bed. Do not gargle. With extractions, you may have been given a plastic irrigating syringe. Begin using this syringe 3 days after your extraction. Using tap water or salt water, gently irrigate only the lower extraction site(s) once a day to remove any food debris that may persist after rinsing. Continue until all debris is removed. Do not use over-the-counter mouthwash, such as Scope® or Listerine®, as these can irritate the surgery site and slow healing. Resume brushing your teeth the day after surgery, being careful to avoid the surgical sites. It is not unusual to see traces of blood on your toothbrush.

Activity and Smoking/Vaping

Physical activity should be limited after oral surgery procedures. Vigorous exercise or organized sports should not be resumed until 3-5 days after surgery or as your condition allows. Please contact our office if a written excuse is needed for organized sports or gym class. The nicotine from smoking and vaping can significantly delay healing and cause an increase in post-operative pain. Therefore, you should refrain from smoking as long as possible.

Stitches

Stitches that have been placed are usually dissolvable and will fall out on their own within the first 4 days, possibly longer. It is not unusual for one or more to loosen and fall out before dissolving, especially in moving areas of your mouth, such as the tongue or cheek areas. If the stitches come out and the wound opens and creates a hole, it is typically not of concern unless there is excessive bleeding. Fortunately, incisions in the mouth do heal very quickly, and any wound that does open will close naturally.

Follow-Up Visits

If a follow-up visit is necessary, an appointment would have been scheduled for you. Post-operative appointments are always available. Please call the office during business hours if you would like to be seen.

When You Get Home

1. Remove gauze packing.
2. Drink at least ¼ of your milkshake (or smoothie, or other cool, thick liquid) using a spoon—NOT a straw.
3. Take pain reliever immediately, as explained in the “Pain Management” instruction sheet, unless you were already given ibuprofen in recovery.
4. Take the antibiotic (if prescribed) as directed.
5. Replace the gauze packing, if necessary.
6. Begin ice packs to the outside of your face, as explained previously, no longer than 20 minutes on one side.
7. Increase your fluid intake throughout the day.

Typical Recovery

With most oral surgery procedures, post-operative discomfort can actually worsen between the third and sixth days. This discomfort is considered normal and should be managed with your pain medication. If you have significant discomfort, even with pain medication, or you cannot tolerate the pain medication, please call the office.

When to Call the Doctor

If there is a drug reaction, significant swelling, persistent pain or bleeding, or any other unusual reactions, call the office immediately. Additionally, if you have any questions during the post-operative period, do not hesitate to call. There is an answering service to respond to emergencies at all times when the office is closed

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