MODERN SURGICAL DENTISTRY
POST OPERATIVE
INSTRUCTIONS
AFTER TOOTH REMOVAL
This page is a reference for patients who've recently had a tooth removed, or for patients who are about to have a tooth removed and want to understand how to care for their wounds after a tooth is removed.
DISCLAIMER
The advice on this page is general in nature, and is modelled on how Dr Andrew Chan at Adelaide Tooth Removals & Dental Implants manages his patients. This advice does not replace any advice given to you by your surgeon. Your surgeon should provide you with his/her own post operative instructions.
BLEEDING
AFTER TOOTH REMOVAL
Post operative bleeding after having a tooth removed usually stops within 10-15min. We will make sure your bleeding has stopped before you leave our rooms.
You will leave with a gauze pack over your wound(s). Keep this gauze pack in place for 10-15min.
If the bleeding starts again when you are at home, put some of the spare sterile gauze provided over any bleeding wounds and bite down firmly, putting pressure directly onto the wound for 30min. This will usually address any minor bleeding.
Make sure the gauze is putting pressure on the wound. You may need to mould the gauze into the right shape and carefully position it so that when you bite down the pressure applied by the gauze is on the wound (not on any surrounding teeth).
Pressure (when applied correctly) will stop 99% of bleeds. Patients often make the mistakes of:
1) not applying pressure on the correct area (i.e not on the wounds directly)
2) not applying enough pressure
3) not applying pressure for enough time
If you can’t control the bleeding with these simple measures and the bleeding is minor, please call the practice. (See ‘Emergency Situations’ below for severe bleeding advice)
CLOT FORMATION
AN IMPORTANT STEP
After a tooth is removed, the wound will initially be an empty bony 'socket', where the tooth once was.
Within 10-15min, this socket will fill with blood and clot. Forming a soft 'jelly like' clot in the socket.
This clot is easily lost, and easily damaged. But we want this clot to stay in your wound(s), as it helps promote the healing process, and helps prevent a dry socket.
Most of the points below, are about how to care and maintain this 'jelly like' clot in in your wound(s) over the first 3-5 days.
EATING &
DRINKING
You can eat & drink straight away after having your tooth removed.
Eat pureed or soft foods for the first 5 days. And chew on an area away from your wounds if possible. If you chew directly on your wounds you will damage the delicate blood clot in your wounds.
You can eat and drink 'normal' temperature food and drink. You definitely do not have to have lukewarm coffees or lukewarm meals. Just don't eat or drink very hot foods and drinks. As these can 'cook' the blood clots in your wounds.
You can have ice-cream also, but keep it off the wounds directly. Otherwise you can accidentally 'freeze' the delicate blood clot.
Avoid using a straw for the first 7 days. Using a straw can cause you to accidentally 'suck' the blood clot out of your wounds.
RINSING
& GARGLING
On the day of your procedure, if you have blood in your mouth, you can spit it out. But do not rinse or gargle on the day of your procedure.
On the day of your procedure you are allowed to drink and spit. But do not 'swish' or 'gargle' water or mouthwash around your mouth. This risks washing the delicate blood clots out of your wounds.
The day after your procedure, the blood clots will be more mature, so you can start gently rinsing the day after your procedure.
The day after your procedure start rinsing your mouth with warm salty water 4 times a day: once after every meal and once before bed. And make sure it's gentle, as vigorous rinsing can wash the blood clots out of your wounds (even after they've had a day to mature).
Keep this up for 5-7 days.
To make the warm salty water dissolve 1 teaspoon of table salt in a glass of warm water. Do no use mouthwashes, just use the warm salty water.
BRUSHING
YOUR TEETH
You can brush your teeth on the evening of your tooth extraction. But do not brush the wounded areas. Keep your tooth brush approximately 2 teeth away from any wounds for the first 5-7 days.
After you finish brushing your teeth spit only. Do not rinse your mouth out with water.
ANTIBIOTICS
OFTEN NOT REQUIRED
Most guidelines agree that antibiotics are not required after routine tooth extractions.
However, if there are concerns about an increased risk of infection, antibiotics will be prescribed after a tooth is removed.
If you started a course of antibiotics before your tooth was removed, you can stop your course of antibiotics after the offending tooth is removed, unless we've instructed you otherwise.
REGULAR
MEDICATIONS
It is important to continue all of your regular medications as per normal. Unless otherwise instructed.
This includes any mediations that 'thin your blood' or promote bleeding. Unless otherwise instructed.
THINGS
TO AVOID
Avoid alcohol, strenuous exercise, and smoking/vaping for at least 48 hours. Ideally avoid smoking/vaping for 1 month.
Smoking
Smoking and vaping (including marijuana and other THC / CBD containing formulas) is the biggest risk factor for a dry socket.
If you are a regular smoker, you may want to consider nicotine chewing gum, sprays or patches to reduce any cravings. If you are able to not smoke (or even reduce) after your tooth extraction, we strongly encourage you to kick the habit permanently!
Exercise
Vigorous exercise can promote bleeding and dislodgement of the delicate clots in your wounds.
Alchohol
Alcohol is an irritant and will damage any blood clots it comes into contact with.
POST OPERATIVE
SWELLING
Many 'simple' tooth extractions result in no post operative swelling.
Surgical extractions (typically lower wisdom teeth) often cause post operative swelling. Patients will often first notice post operative swelling the morning after their procedure.
Any swelling in the first 24-48 hours is likely 'normal' post operative swelling. Post operative swelling will start to come down after 48 hours.
Swelling that increases after 48 hours potentially represents an infection. If you experience this please contact our practice, as Dr Andrew Chan or Dr Ryan Cornish will want to reassess you and will potentially start you on antibiotics.
If you are concerned you have an abnormal or severe swelling, see Emergency Situations below.
PAIN CONTROL
Pain and discomfort after a tooth is removed is often only moderate, and often very manageable with the right pain medication.
Many 'simple' tooth extractions are often surprisingly not very painful. After a 'simple' tooth extraction we recommend just 'simple' analgesia, such as a combination of paracetamol and ibuprofen. Which are readily available from all supermarkets without a script.
Surgical extractions require stronger pain killers. We often recommend a combination of paracetamol, ibuprofen and a strong opioid, such as Tapentadol or Oxycodone after surgical tooth extractions.
Strong opioid pain killers such as Tapentadol and Oxycodone often cause nausea and constipation. We prescribe anti-nausea medication and recommend the use of laxatives whilst strong opioid pain killers are being used.
We give all of our patients a customised and written pain management plans with appropriate scripts and written instructions.
EMERGENCY SITUATIONS
AIRWAY COMPRIMISE & SEVERE BLEEDING
Emergency situations are very rare. However they can occur. And to increase the safety for our patients we offer some general advice below.
Airway compromise
In rare circumstances patients can get post operative infections/swelling that can endanger their airways. This is a medical emergency. However if this were to ever happen, it would usually happen slowly and patients have plenty of time get to a hospital if needed. If hospital doctors are worried about an airway being compromised, they may deem it necessary to intubate to protect their airway.
None of our patients have ever needed intubating after having a tooth removed.
Severe Bleeding
A minor post operative bleed is not uncommon (see above). Severe post operative bleeding is rare. Post operative bleeding that is life threatening and needs emergency secondary surgery or a blood transfusion is very rare.
None of our patients have ever had post operative bleeding so severe that it needed emergency surgery or a blood transfusion.
Many times patients feel they are bleeding more than they really are. Often a small amount of blood is mixed with a lot of saliva, which can make the severity of the bleed appear worse than it really is. Knowing when a bleed is so severe that you need to go to hospital is impossible to describe here. The only advice we can give is: if you are worried you are experiencing severe post operative bleeding and need emergency care, go directly to an emergency department or call an ambulance.
When to seek emergency care
If you experience any of the following signs or symptoms, go directly to an Emergency Department or call an ambulance: Severe bleeding. Difficulty breathing. Noisy breathing. Difficulty swallowing. Severe swelling. Swelling that starts spreading down your neck and/or under your chin. Swelling under your tongue or on the floor of your mouth. A swollen or elevated tongue. Altered levels of consciousness, collapse or mental confusion. Feeling generally severely unwell.
Or if you are just simply worried that you need emergency hospital care then go directly to a hospital Emergency Department or call an ambulance.