After Surgery Care

Post-operative Instructions: Oral Surgery

Day of Surgery:

    • Bite on gauze and change it every 20-30 minutes for 3-4 hours. You can moisten the gauze with tap water and loosely fluff it to make it more comfortable.
    • Do not spit or rinse your mouth vigorously. 
    • Do not smoke for at least a week after the procedure.
    • Do not probe the area with any objects.
    • Avoid any vigorous or strenuous activities.
    • Use cold packs on cheeks for 2 days (today and tomorrow), 20 minutes ON, 20 minutes OFF, to minimize swelling.
    • A light diet is advisable during the first 24 hours. Do not eat anything extremely hot or cold; avoid chewing directly on the extraction site.
    • For mild to average pain, use any non-aspirin type medication you would like. We recommend Ibuprofen because of its anti-inflammatory properties.
    • Dry Sockets? If this develops, you will wake up on the 5th - 7th morning with an earache and throbbing. This usually occurs when the clot dissolves or doesn't form properly. Please call the office if not tolerable. 

What to expect:

    • Oozing: Intermittent bleeding overnight and into the next morning is normal. If this persists, you may substitute a tea bag, soaked in cool water, and place it directly over the site or wrapped in a moist gauze, for 45 minutes. If the bleeding is uncontrollable, please call our office.
    • Swelling: Very common and peaks on days 2-3, following the surgery. Cold packs or bags of frozen peas wrapped in a towel and applied to the cheek next to the surgical area will help. Take an anti-inflammatory medicine like Ibuprofen if prescribed, directly with food.
    • Nausea/Discomfort: Discomfort usually peaks on the 2nd and 3rd days following the surgery. Try to be ahead of any major pain. Sometimes medications can make you nauseous, especially if there is no food in your belly. Preceding pain pills with a small amount of food can help the nausea.
    • Sharp Edges? If you feel something hard or sharp, it is likely you are feeling the sutures which will soften with time. It could also be bony walls which once supported the extracted teeth. If bothersome, return to our office for simple removal. 
    • Mouth Rinsing/Brushing: Do not brush directly on the extraction site. Brush all other areas of the mouth well. Do not rinse as it can cause the clot that is forming to be rinsed out. 
    • Diet: Avoid hot foods, and any foods like nuts, poppy seeds, popcorn, etc. Stick to soft foods. 
    *If taking narcotics like VICODIN/PERCOCET: NO alcohol, NO driving, NO heavy lifting, and NO operating heavy machinery*

Post-operative Instructions: Composite Fillings

You have received a composite filling for one or more of the following reasons: Decay, Fracture/chipping/wear, Food trapping between your teeth, Damaged or failing existing filling, Cosmetic reasons  

After the procedure, you will be numb for approximately 1 to 3 hours.  Avoid eating when you are numb so as not to injure your LIP, CHEEK or TONGUE.  

You may have some sensitivity to hot, cold and even pressure at first; we expect this sensitivity to diminish over the next few weeks.  Your gums or jaw may be tender or bruised due to the injection or instrumentation during the procedure as well.  Your body takes time to get used to the new filling and bite.  Over-the-counter pain relievers (Ibuprofen or Tylenol) may be taken to alleviate the discomfort if necessary.  Take as instructed on the bottle.  

Sensitivity can be prolonged in some instances when: It was sore to begin with.  It had a large/deep filling to begin with.  The decay/preparation was very deep.  You have minor fracture lines in your tooth. You clench and grind. Your bite is “off” (it is difficult to bite normally when you are numb and therefore difficult to adjust your filling accurately).  For no apparent reason- We understand that it may be frustrating when the tooth did not hurt to begin with and you feel discomfort after placing the new filling. Approximately 3-5% of filled teeth require root canal therapy to alleviate the sensitivity; some we expect, some we don’t.   

If the sensitivity does not begin to improve within 3 to 5 days, please contact the office.  We will need a 10 minute appointment to check and/or adjust the bite on your new filling (even if the bite feels ok).   

We are committed not only to quality esthetic dentistry, but your comfort as well.

Post-operative Instructions: Crown/Bridge & Temporaries

Crowns and Bridges: Your tooth/teeth have been prepared for a crown or bridge for one or more of the following reasons: Poor color, fit, contour or decay around an existing crown or bridge. Advanced decay (leaving inadequate tooth structure to support a filling or resist fracture). Cracks, fracture lines, advanced wear. Pain from incomplete/ internal fractures. Large damaged or failing fillings that cover over 65% of the biting surface (predisposing the tooth to fracture). Root canal therapy (all back teeth and some front teeth that have had root canal therapy will require a crown or onlay to prevent fracture). Missing teeth. Cosmetic reasons

Build-ups: Often after all the decay and old filling material has been removed there is inadequate tooth remaining to support and retain the crown. If this is the case we build a core using filling material and support the remaining tooth and new crown. Unfortunately, we can’t always predict which teeth need build-ups until after the decay and filling/crown are removed.

Temporaries: You will go home with a temporary crown or bridge while your permanent crown or bridge is being made. This temporary is made out of plastic and is therefore not very strong. It is also being kept on your tooth with cement that is designed to only last a few weeks. The purpose of the temporary is to keep the teeth and gums from shifting. IF the temporary becomes dislodged it is important to have it re-cemented SOON. The permanent restoration may not fit and a new crown may need to be remade if the temporary has been out for too long; this is obviously a costly and time intensive problem.

Here are a few instructions to prevent the dislodging or breaking of your temporary: 1. Do NOT eat sticky or Hard/Chewy foods on the side of your temporary. (i.e. French bread, caramel, toffee, gum, jolly ranchers, ice, granola, nuts, etc.). If it is a front tooth, then avoid biting into anything. You may cut up the food and eat it using the back teeth. But avoid biting into anything using the front teeth. 2. Flossing is ENCOURAGED! However, slide the floss out the side and do not snap it out. 3. Brushing is ENCOURAGED! However, do not have an electric toothbrush on the temporary; vibrations can weaken the cement. 4. Night Guards: Please do not wear it while there is a temporary in your mouth. But, be sure to bring it when we cement your permanent crown or bridge so we can adjust it to fit the new crown. 5. If your temporary comes out or breaks please call us as soon as possible to arrange a time to re-cement it. If unable to get to the office or are out of town, try to replace the crown using fingers first then tap gently. If still loose, a small amount of Fixodent may be used until you get back to the office. We will make all efforts to accommodate you. Shifting of teeth can happen quickly so it is recommended you come in as soon as possible. If shifting occurs, we may have to take new impressions and fabricate a new crown. This is both costly and timely on your part.

Numbness: After the procedure you will be numb 1 to 3 hours, avoid eating when you are numb so as not to injure your LIP, CHEEK, or TONGUE. Once the anesthesia has worn off, if you feel as though any of the teeth we worked on are hitting first, please give the office a call. We will need to adjust the temporary. It can cause your tooth to be sore if this is not adjusted. It is common to experience some sensitivity to hot or cold. Your gum may also be tender. As long as the sensitivity does not worsen, this is normal. Typically, warm saltwater rinses and over the counter pain reliever can be used. We look forward to seeing you in approximately two weeks for your new restoration. Keep in mind the final restoration must fit and meet our expectations for us to seat (cement) it permanently!

Post-operative Instructions: Bone Grafting & Tissue Regeneration

Your bone graft is made up of many particles.  You may find some small granules in your mouth for the first several days.  Do not be alarmed by these.  The area is over packed to allow for the loss of a small amount of particles.  It is normal to have some of them come out of the graft site and into your mouth. There  are  some  things  that  can  be  done  to  minimize  the  amount  of  particles  that  become dislodged.

Bleeding:  When you leave the office, you will be biting on a gauze pad to control bleeding.  Keep slight pressure on this gauze for at least 30 minutes. Do not change the gauze during this time as it needs to remain undisturbed while a clot forms in the extraction site.  After 30 minutes you may remove the  gauze;  however,  if  bleeding  continues,  replace the  gauze  for  an  additional  30  minutes. Small amounts of blood in the saliva is normal for the rest of the day after the procedure.

Smoking:  Smoking should be stopped prior to and following surgery.  Healing and success of the graft will be substantially reduced by the cigarette smoke.

Pain:  Some discomfort is normal after surgery.  To minimize pain, take Tylenol, Advil or similar non-aspirin pain reliever every 4 to 6 hours until bedtime to maintain comfort.  Begin taking it before the anesthesia wears off.  If prescription pain medicine is prescribed, take it as instructed.  Do not exceed the dose on the label.  Taking with food or milk will help reduce upset stomach.  Avoid driving or operating  heavy  machinery  when  taking  pain  prescriptions.    Do  not  drink  alcohol  while  taking prescription pain medications.

Nausea:  This is most often caused by taking pain medications on an empty stomach.  You can reduce nausea by eating soft food prior to taking the medication, as well as drinking a large glass of water with the medication.  If nausea medications are given, take them as instructed, being sure to not exceed the dose on the label.

Swelling:  Apply an ice bag covered in a thin towel to the face over the operated area will minimize swelling.  Apply for 15 minutes, then remove for 15 minutes for the remainder of the first day.

Numbness:  The local anesthetic will cause numbness for several hours after leaving the office.  Be very careful not to bite, chew, pinch or scratch the numb area. 

Brushing:  Do not brush your teeth for the first 8 hours after surgery.  You may then brush your teeth gently, being careful to avoid the surgical area.

Rinsing:  Avoid all rinsing or swishing for 24 hours after your procedure.  After 24 hours you may begin gentle rinsing with a saltwater solution (1/2 teaspoon salt + 1/2 teaspoon soda + 8 ounces warm water).  Do not use over the counter mouth rinse!  You may also be instructed to use a prescription antimicrobial mouth rinse.

Diet:  Eat soft foods (see list below) for the first two days.  Return to normal balanced meals as soon as you feel comfortable doing so.  Be sure to drink plenty of water and avoid alcohol for 48 hours.

Foods to Drink and Eat While Numb: AVOID carbonated beverages and hot liquids for 48 hours. Drink / Eat: Water, Applesauce, Juice Jell-O, Ice Chips, Pudding, Popsicles, Yogurt, Milkshake (no straw) Add Soft Foods When Numbness is Gone Mashed Potatoes, Pasta, Eggs, Pancakes, Creamed Cereals, Soups (be careful-not too hot) Increase Diet as Tolerated

Activity:  Following your procedure, rest and avoid strenuous activities for the remainder of the day.

Antibiotics:  If you were given an antibiotic prescription, take all of them as directed until they are gone.

Post-operative Instructions: Immediate Dentures

For the first 24 hours your immediate denture is not to be removed from your mouth. If the denture is removed, swelling may occur that will make it difficult or impossible to replace the denture.

Wear your dentures over night for the first 2-3 nights. After that, it is advised that the dentures be removed every night and placed in a cup of water. After the first 2-3 days, you should clean your new dentures daily with liquid soap and water.

Your immediate dentures not only replace your missing teeth, but it is acting to protect the surgical site, control swelling, and control bleeding. The denture needs to be in place to be effective.

After 24-72 hours, you will see your dentist for a check-up. You will continue to see your dentist regularly for check-ups throughout the healing process.

After extractions, do not rinse, spit, smoke or suck on a straw. Do not rinse your mouth vigorously. Do not drink any hot beverages or carbonated beverages.

You may rinse your mouth with warm salt water (1 cup warm water to 1 teaspoon salt)

Ice packs (or bags of frozen peas or corn) can be applied to the side of the face for 20 minutes on and 20 minutes off to help with swelling and pain.

The fit of your immediate dentures will change as your mouth heals from the extractions of your teeth. As healing occurs, the dental ridges may change shape – and they generally shrink in size. An immediate denture is often only a temporary denture which will require a permanent reline after the final healing of the mouth.

The immediate denture will need to be adjusted regularly. A temporary soft liner may be placed to help compensate for changes that will take place in your mouth as gums heal. (Do Not soak dentures with soft liner in a denture cleaner, just plain water) You will be instructed by your dentist to return for periodic appointments to monitor your mouth for changes that require denture adjustments.

Dental extraction sockets take at least 6 months to heal and fill in with new bone. At that time, your dentist will speak to you about adding a permanent hard reline to your dentures.

Post-operative Instructions: Implant Dentistry

Immediate Postoperative Care Care should be taken in the immediate postoperative period to minimize contact with the implant. Aside from normal hygiene, it is best to completely leave the implant alone for the first 2 weeks after placement. You may want to limit foods to softer items and chew in an area away from the implant during the 10 to 12 week integration stage.

Bleeding Minimal bleeding is expected after implant surgery. Bleeding after surgery may continue for several hours. The best way to stop bleeding is to fold 2 pieces of damp gauze over the extraction site and gently bite for 30-60 minutes making sure pressure is being applied to the extraction site. Rest quietly with your head elevated. If bleeding continues, use gauze for an additional 30 minutes. Bleeding should always be evaluated by looking directly at the surgical site. Pink or blood-tinged saliva may be seen for 2-3 days following the surgery and does not indicate a problem. Suture material may last 2 to 3 days and should be left alone. You will be asked to return to the office for a 2 week follow-up appointment. Any sutures remaining at that time may be removed at the surgeon’s discretion. Do not pull or cut the sutures yourself.

Swelling Swelling is the body’s normal reaction to surgery and healing. The swelling will not become apparent until 24 hours after surgery and will not reach its peak for 2-3 days. After this time, the swelling should decrease but may persist for 7-10 days. Swelling may be minimized by the immediate use of ice packs. Apply the ice packs to the outside of the face 20 minutes on and then 20 minutes off while awake for the first 24 hours. After 48 hours, begin use of a warm, moist compress to the cheek.

Medication / Pain Unfortunately, most oral surgery is accompanied by some degree of discomfort. If you do not have an allergy to non-steroidal anti-inflammatory medications (Ibuprofen, Motrin, Advil) we recommend taking this prior to the local anesthetic wearing off. More severe pain may require a narcotic pain medication. Narcotic pain medication will make you drowsy, do not drive or operate mechanical machinery while taking the prescription. Once you feel like you can stop the narcotic, use Ibuprofen or Tylenol. You may also be prescribed an antibacterial mouth rinse which should be used twice daily in the first two weeks following implant surgery. All medications should not exceed the recommended dosage. *NOTE: If you are taking PLAVIX or COUMADIN, do NOT take Ibuprofen or Aspirin products.

Diet After general anesthetic or I.V. sedation, start with liquids. While numb, patients should avoid hot liquids or foods. Patients may have applesauce, pudding, or jello. Once numbness wears off patients can progress to solid foods, chewing away from the surgical sites.

Oral Hygiene The best way to prevent infection and ensure healing is to keep your mouth clean. Clean your mouth thoroughly after each meal beginning the day after surgery. Use a soft bristle toothbrush and toothpaste after meals and at bedtime. Should bleeding resume after brushing, repeat the use of gauze as described above. Do not rinse your mouth the day of surgery.

Activity For the first 48 hours you should rest and relax with no physical activity. After 48 hours, you may resume activity as tolerated.

Healing Bad breath is common and will disappear as healing occurs. Two to three days following surgery, white, possible hard tissue may be seen in the surgical site. This signifies normal, healing tissue. It’s not unusual to see the silver healing cap appear through gum tissue following procedure.

Antibiotics If an antibiotic is prescribed, take the tablets or liquid as directed. Take the entire prescription until gone. Antibiotics can be given to help prevent infection. Make sure to call the office if a rash or other unfavorable reaction occurs.

Foods to Drink and Eat While Numb AVOID carbonated beverages and hot liquids for 48 hours. Drink / Eat: Water, Applesauce, Juice Jell-O, Ice Chips, Pudding, Popsicles, Yogurt, Milkshake (no straw) Add Soft Foods When Numbness is Gone Mashed Potatoes, Pasta, Eggs, Pancakes, Creamed Cereals, Soups (be careful-not too hot) Increase Diet as Tolerated

Post-operative Instructions: Root Canal Therapy

  • No eating or drinking for the first 30 minutes following your treatment. Also avoid feeling around your tooth with your tongue. This is to allow the temporary filling sufficient time to harden.
  • If you were given any prescriptions, please have them filled promptly and take as directed. If no prescriptions were given, you may choose to take ibuprofen medications such as Motrin or Advil (as long as you do not have any allergies to these medications) for alleviation of discomfort and swelling.  Alternatively, you may use Tylenol.  Do not exceed the guidelines printed on the label for any medication.  If you are unable to achieve adequate pain control, please call our office.
  • Applying a cold compress to the face near the treatment area will help minimize swelling. If using an ice pack, please do not apply ice directly to your skin but place a cloth between the ice and your skin at all times. You may apply the cold compress for up to 20 minutes on and at least 20 minutes off for the next 6-8 hours as needed.
  • Once you resume eating and drinking, avoid chewing or biting on the treatment area until your permanent restoration is placed. The temporary filling or crown placed immediately following root canal treatment is usually a soft composite that is vulnerable to fracturing (cracking).  For this reason, it is important to avoid chewing on hard substances such as peanuts, pretzels, hard candy, ice cubes, etc.. You may experience increased sensitivity prior to the placement of the final restoration.  You will need to within a month to have a permanent crown or filling placed. 
  • Please keep the treated area clean by gently brushing and flossing regularly.
  • It is rare for a temporary filling to fall out although it may divot while in use.  If the temporary falls out, please contact your general dentist as soon as possible.  If your temporary falls out after office hours, you may purchase some temporary filling material from a pharmacy and follow the included instructions to cover the area until you can be seen in our office.
  • Some discomfort is normal for 2 to 4 days following root canal therapy.  In some cases the tooth and surrounding tissue may be sore for a few weeks following treatment.
  • Please brush and floss as usual unless otherwise instructed by our office. Follow any other instructions provided by our office during your visit. Please take all medications as prescribed.

While flare-ups are rare, they occur in about 5% of cases and may cause significant pain.  They generally only occur with teeth that are extremely irritated and/or infected or with teeth that have a history of prior treatment.  These sometimes occur randomly, even on patients that have had root canals done in the past without problems.  If you have a flare-up, you may experience moderate to severe pain, swelling, throbbing, or general discomfort; please contact our office right away.  You may be prescribed additional medication such as antibiotics, and/or you may be asked to come to the office for further treatment.

Post-operative Instructions: Scaling and Root Planing (Deep Cleaning)

You have had a procedure to help decrease the effects and progression of Periodontal Disease. Periodontal Disease is an on-going, progressive disease in which bacteria, tartar and your own immune system destroy the bone and gum attachment around your teeth.  This treatment has removed bacteria and tartar from the pockets below your gum line to help limit further bone loss.   Healing is usually quick and uneventful depending on severity of disease.  The following instructions can help recovery.  

Numbness: You will be numb 1-3 hours after the procedure; please avoid eating while numb to prevent biting your lip, cheek and tongue.  

Discomfort:  Mild discomfort can occur due to inflammation and instrumentation.  Over-the-counter pain relievers (Ibuprofen, Aleve, or Tylenol) will minimize discomfort and swelling. If needed, please take as instructed on the bottle.    

Home Care:  Gentle brushing at the gum line inside and out for 2 minutes after meals and at bedtime is recommended.  Flossing is of the utmost importance after a deep cleaning has taken place.  It is possible to have a recurrent infection and allow further progression of gum disease if the pockets are not kept clean.  Prescription mouth rinse may be advised to aid in healing although some transient staining can occur.      

Temperature sensitivity: Temperature sensitivity and slight tooth mobility are common while you are healing.  As the gums heal you may see more root structure exposed as well as spacing between the teeth at the gum line.  This is normal; the tartar and plaque have been removed from these areas and the gums are getting healthy.  Most tooth sensitivity is mild and short lived; if persistent an anti-sensitivity toothpaste (Sensodyne) may be used.  If symptoms do not improve, please call our office.  

Re-evaluation:  It is important to evaluate your probing after healing to see if additional therapy or referral is necessary.  An appointment will be made for you, typically in 3-4 weeks.   

Monitoring: Periodontal Disease is never cured.  The Gold Standard of Prevention is the 3 month periodontal cleaning with probing.  It is easy to forget that your bone can continue to deteriorate because bacteria become more virulent over time.  With mutual commitment to your oral hygiene, we can help you keep your teeth by minimizing the effects of gum disease.