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Post-Op Care-Office Surgery
The pain, swelling, jaw stiffness, and bruising which may follow your surgery are due to a combination of factors including the difficulty or duration of surgery and individual patient responses. Appropriate medications and your compliance with the following instructions will help your rapid and uneventful recovery from surgery. The vast majority of our patients will do very well. If you have any questions about your surgery or recovery, consult these instructions.
Medications: Take the medications as perscribed and as you were instructed. The goal is to keep the patient confortable. Oral pain meds need about 45 minutes to have an effect. Most patients need the strong pain meds/narcotics (demerol, hyprocodone, oxycodone) for only a few days.
All patients who have had general anesthesia should be “checked on” every couple of hours after they arrive home. Allow the patient to sleep but assess their breathing often. When they are awake assess their level of responsiveness. Change their gauze as instructed.
When you get home:
- Place your patient in a comfortable location where he or she can sleep and relax. Make sure to keep their head elevated with 2 pillows or at a 45-degree angle.
- Some patients may choose not to eat or drink for several hours following surgery. This is normal. Do not force a patient to eat, but within a few hours of arrival at home encourage the patient to drink 8 oz. of water or sprite or Gatorade. It is not urgent to start the prescription medications immediately when you get home and forcing a patient to eat or drink will trigger nausea and vomiting.
- Remove all gauze when eating and drinking. Once the patient has taken his medication or consumed food &/or drink replace the gauze by folding one piece into quarters and placing on top of the surgical site. Repeat with additional pieces of gauze if there are multiple surgical sites
- Most patients sleep the majority of the day. Do not wake a patient to administer medication.
- Remove the gauze for good between 6 and 8 pm provided the bleeding has subsided. DO NOT permit the patient to sleep for the night with the gauze in mouth.
Medications – A separate sheet of instructions will be given with your prescriptions (if necessary) as well as the instructions placed on the bottle by your pharmacist. The local anesthetic will wear off 6 to 12 hours after surgery. It is important to take the pain medication prior to discomfort. If you should develop a rash, itching, difficulty breathing, wheezing, nasal congestion or swelling around the eyes not related to the surgery, stop taking all medications and notify our office immediately.
Along with the prescription medications we strongly recommend the patient take 800 mg (4 tabs) of Motrin three times a day for the first few days. This will significantly reduce the need for the stronger medications and minimize the swelling.
No driving while taking narcotic pain medication.
If you have been prescribed an antibiotic then take it until the supply is exhausted.
All female patients utilizing birth control pills, please be advised that if the doctor prescribes the use of antibiotics, an alternative form of birth control must be utilized during that period of time.
Pain – Pain is a very personal experience and each patient’s pain threshold is different. Of course, the more extensive the surgery, the more amount of discomfort one can expect. In general, the discomfort will last up to five days with more extensive surgeries. You have been given appropriate prescription medications for your surgery. They will work if you take them appropriately. On occasion, a patient may need additional medications once the first prescription has been taken completely and as directed. If this is the case, please contact the doctor during normal business hours, as we do not call in pain medications of any type after-hours or on weekends. Expect at least 2-3 days of significant pain, facial swelling and difficulty opening your mouth.
Dry Socket – A “dry socket” may occur in about 5% of patients (but 50% in women taking birth control pills) and presents as a persistent, throbbing ache in one or both sides of the jaw (usually lower) or ears, and are typically unrelieved by prescription medications. It begins 3-7 days after surgery and will be relieved by the placement of medicated dressings at the doctor’s office. Use of tobacco products greatly increases the incidence of dry socket and the associated pain.
Nausea/Vomiting – Nausea following surgery is common and occurs in 20 % of all patients. Nausea and vomiting are best addressed by ceasing all medications and eating. Permit the patient to rest quietly for an hour, then gradually introduce cold ginger ale or sprite. Call our office if severe nausea or vomiting persists.
Bleeding – Most surgical wounds ooze blood for up to 24-hours. Gauze placed over the surgical site serves as a pressure bandage after surgery. Replace the gauze as needed to control bleeding. Remove the gauze when eating or taking medications. Do not chew on the gauze, but maintain a firm constant pressure. Do NOT rinse your mouth for 24 hours after surgery to avoid dislodging the blot clots formed in the surgical sites. Firm pressure with gauze and/or tea bag will stop 99% of all post-surgical bleeding. Drinking ice water also helps to cool the wound and decrease the flow of blood to the area. If you feel you are bleeding excessively, (gauze is filled with blood after 15 to 30 minutes of pressure) then call the doctor. Pink or blood-tinged saliva may be present for 24-48 hours. You may wish to cover your pillow with a towel to avoid staining. Elevate your head on 2 or more pillows for the first day.
Swelling/Bruising – Some swelling after surgery is normal. It takes 3 days for surgical swelling to peak before it begins to subside. Ice packs should be used during the first 48 hours. Apply for 20 minutes; leave off for 20 minutes. After 48 hours swelling can be reduced by using moist heat (hot water bottle or warm wash cloth – do not use a dry-heat heating pad). Bruising may be present to a varying degree and will subside over a period of 5-10 days. Remember, swelling is significantly reduced by using Motrin.
Oral Hygiene – NO BRUSHING THE DAY OF SURGERY. Brushing or rinsing within the first 24 hours can dislodge any blood clots formed in the surgical sites. Rinse with warm salt water beginning the day after surgery. Brushing of the immediate surgical site should be discontinued for 2-3 days after surgery to prevent disruption of the blood clot, healing tissues and/or sutures. The remainder of the mouth may be brushed normally.
Activity – Do not perform vigorous activity for 48 hours and avoid contact sports for 3-5 days. Depending on your occupation, you may return to work within 3-5 days. Following minor surgery, you will often be able to return within 24 hours.
Sutures – These are often self-dissolving sutures and typically disappear or fall out after 3-7 days. There is no reason for concern if a stitch falls out earlier than 3 days after surgery unless persistent bleeding is present.
Fever – Your temperature may rise slightly for a day or two after surgery and is usually of no concern. This is typically associated with a decrease in fluid intake, vomiting and dehydration. An oral temperature under 101° usually responds to a good fluid intake and Tylenol every 4 hours. Fever of 101.5° or greater is significant and your surgeon should be notified promptly. Some patients are prescribed an appropriate antibiotic to ward off any infection. The prescribing of an antibiotic is at the surgeon’s discretion. If one is prescribed, please take it as directed. If the surgical wound begins to emit foul smelling pus, please call the doctor.
Numbness – As we explained prior to surgery, a partial numbness of your lips or tongue may be apparent when the local anesthesia wears off. Time will usually resolve this condition. Since most surgeries in the mouth are in close approximation to the sensory nerves to the face, a day or two of post-surgical decrease in sensation is not abnormal. Sensations of “burning,” “tingling,” or “electric shocks” in the numb areas indicate that feeling is returning. There is no need to contact the doctor on call for this but please bring any numbness to our attention at your post-operative visit.
Injection Site – The point where the needle entered the vein may develop a bluish color that will change to yellow and then to normal in a matter of days. There may be a slight tenderness to the area and perhaps small lumps. These signs and symptoms are usually of no concern and are best treated with a hot, moist towel and elevation of the arm. Should the arm begin to swell or tenderness progress up toward the shoulder, please call our office.
Follow the Three S’s for 3-5 days after surgery to help increase healing and reduce the chances of dry-sockets:
- No Straws
- No Smoking
- No Spitting