After the Removal of Multiple Teeth

The removal of many teeth at one time is quite different than the extraction of one or two teeth. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:

  • The area operated on will swell reaching a maximum in 2-3 days. Swelling and discoloration around the eye may occur. 
  • A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
  • If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.

Immediately Following Surgery

  • The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing and/or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take the prescribed pain medications as soon as you have something creamy (such as a milkshake or yogurt) on your stomach. This will usually coincide with the local anesthetic becoming diminished but do not wait until you feel pain.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for a more thorough explanation.

Bleeding

A certain amount of bleeding is to be expected for up to 24 hours following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Avoid swallowing or spitting blood. If bleeding occurs and you are wearing a denture you can bite on gauze in between the upper and lower teeth or denture. Do not place the gauze under the denture. If there is no denture, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. Repeat as necessary without talking, eating/drinking or disturbing surgical area.  If bleeding continues more than oozing after repeating this multiple times, bite on a moistened black tea bag for thirty minutes (after denture is removed but immediately return the denture to your mouth when tea bag is removed. The tannic acid in the black tea helps to form a clot by contracting blood vessels. If bleeding occurs, avoid hot liquids, activity, and elevate the head. If bleeding persists, call our office immediately. Do not remove the immediate denture unless the bleeding requires firm direct pressure with gauze. Expect some oozing around the side of the denture as normal.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs, should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 24 hours, ice has no beneficial effect and actually may delay healing. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Twenty-four hours following surgery, the application of warm, moist heat to the sides of the face is beneficial in reducing the size of the swelling and promoting circulation for surgical healing. This swelling comes on quickly but is much slower to resolve.

Pain

For minor pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. For more moderate pain you may choose to take Ibuprofen (Motrin or Advil) as soon as you are able unless there is a contraindication (such as bleeding disorder, kidney disease or stomach problems). If there are no contraindications you should take one to two 200 mg tablets every 3-4 hours.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. If taking Ibuprofen is not contraindicated you can take it in between doses of the pain medicine prescribed which can enhance pain relief but also works on inflammation. Do not take any additional Tylenol (Acetaminophen) when using the prescribed pain medication because it contains Acetaminophen. Pain or discomfort following surgery should subside more and more every day. Eventually you will find that you can manage your pain with over-the-counter meds only. If pain persists, it may require attention and you should call the office.

Diet

After general anesthetic or IV sedation only liquids should initially be consumed. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft or creamy but avoid foods that require chewing close to the surgical sites. A high calorie, high protein intake is very important. Our staff can provide suggested diet instructions. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. 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 any meals. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.

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 up for one minute before standing. Staying well hydrated will help.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. The day after surgery you should begin rinsing at least 5-6 times a day, especially after eating, with a teaspoon of salt mixed into one cup of warm water. 

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.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. Take Benadryl (Diphenhydramine) according to over-the-counter directions which can help if you are experiencing an allergic reaction. Call the office if you have any questions.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour, including the prescribed medicine. You should then sip on “flat” coke, tea, or ginger ale as carbonation is to be avoided. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking soft, creamy solid foods and the prescribed medicine. If nausea or vomiting persists, do not hesitate to contact our office as staying well hydrated is a must.

Other Complications

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. Call Dr. Gliddon if you have any questions.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
  • You should be careful going from the lying down position to standing. You could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting up.
  • 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 the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment or moisturizing lip balm.
  • Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
  • Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.

Finally

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged and may cause minor bleeding that can be alleviated with biting on gauze with firm direct pressure for about 20 minutes. This is no cause for alarm. Sutures may begin to breakdown between day 1 and day 10 but most often the sutures start to dissolve around day 4. Just remove the suture from your mouth and discard it if it can be accomplished without pulling.

The pain and swelling should subside more and more usually after the 3rd day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call our office for instructions.

There will be a void where the tooth was removed. The void will fill in with new tissue gradually over the next month or so. In the meantime, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.

Your case is unique, no two mouths are alike. Discuss any problems with the trained experts best able to effectively help you: Dr. Gliddon or your family dentist.

Brushing any remaining teeth is okay – just be gentle at the surgical sites. A soft washcloth with toothpaste may be a good option for the first day or two. Avoid mouthwash that contains alcohol but okay to freshen breath with a mixture of baking soda and water beginning on the day after surgery.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain near the ear may occur 4-7 days following surgery. Call the office if this occurs. We anticipate that day 4 following surgery should be a turning point where you should start feeling better and not worse.

You should plan to rest for at least 2 days following surgery. If you are involved in regular exercise, we recommend that you minimize activity and avoid exercise in the first week following surgery. Raising your heart rate and blood pressure can interfere with your healing. Also, be aware that your normal nourishment intake is reduced. 

Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day.

Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt water rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One teaspoon of salt in one cup of warm water). After you have seen your dentist for denture adjustment, take out the denture and rinse 3 to 4 times a day.

Restrict your diet to liquids and soft foods that are comfortable for you to eat. As the wounds heal, you will be able to resume your normal diet.

The removal of many teeth at one time is quite different from the extraction of just one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:

  • The area operated on will swell, reaching a maximum in two days. Swelling and discoloration around the eyes may occur. The application of a moist warm towel will help eliminate the discoloration. The towel should be applied continuously for as long as is tolerable, beginning 36 hours after surgery. (Remember: ice packs are used for the first 24 hours only).
  • A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
  • If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline, Blistex. There may be a slight elevation of temperature for 24-48 hours. If your temperature continues to rise, notify our office.

If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery to make the necessary adjustments and relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.