General Oral Surgery Postoperative Care

Swelling

The swelling after your surgery will take three days to peak. This means that you will be the most swollen on or around the third day after surgery. Each day leading up to that day, your swelling may get bigger. 

To help with swelling during this three-day period, you will need to apply lots of ice packs to your face. You can put ice on your face for 20 minutes, then take it off for 10 minutes and repeat this process throughout the day and night. Putting ice on your face consistently for the first three days will help with swelling and provide comfort. 

On the fourth day after surgery, switch from ice to heat. Heat will help to start carrying the swelling away. You can apply heat by using a hot water bottle, using a gel pack that you can warm in the microwave, using a heating pad, using hand warmer packs, or getting a washcloth wet and warming it in the microwave. 

Taking your prescription Ibuprofen will also help significantly with swelling and should be taken consistently as directed throughout the first three days. 

Sleeping with your head elevated will also reduce swelling, such as in a recliner or with extra pillows on the bed with the goal being to keep your head at a 30-to-45-degree angle or higher. 

Most of the swelling will be gone by the 5th to 7th day after surgery. There can occasionally be some subtle swelling that hangs on a few days longer, and this is normal and not cause for concern. 

 

Bruising

Some people will have bruising of their face or cheeks after their oral surgery. This happens sometimes even with an easy surgery in people who have fair complexions, bruise easily, are over the age of 65, or are on blood thinners. This is not a cause for concern and will resolve with time. 

 

Tightness of mouth opening

The surgical term for tightness of mouth opening is called “Trismus.” This tightness is normal and expected after some oral surgery. Like the swelling, the tightness will peak on the third day after surgery. 

Some people may have more tightness than others, depending on the type of oral surgery they have. It is completely normal for many people after surgery to feel as if they can only open their mouth a very small amount before they hit a “hard stop” and cannot open any more. If this happens, this tightness of mouth opening will get better, but it is often the last thing to go back to normal. It can take 10 to 14 days or longer for you to feel like you can yawn or fully open your mouth again without any stretching or tightness at all. 

When you start applying heat to your face on the fourth day after surgery, you can start doing gentle stretches of your mouth opening to help you progress through this. 

 

Pain Control

Your doctor will give you a couple of different medications for pain control. Most people will be given a large dose of Ibuprofen with a Hydrocodone/Acetaminophen combo pill, and Oxycodone pill, Tramadol, and/or Tylenol. 

You can take your pain medications all together every 6 hours, or alternate them every three hours (Ibuprofen, 3 hrs later Hydrocodone pill, 3 hrs later Ibuprofen, etc).

Do not take your pain medications on an empty stomach or they will cause nausea. Have a small amount of soft food or milk before taking the pain medication to avoid any unnecessary stomach upset. Your pain medications are processed differently in the body, so they can and should be taken together to get the most benefit. 

 

Bleeding

It is completely normal and expected to see blood in your mouth on and off for several days after your mouth surgery. The blood you will see is actually a very small amount of blood but when it mixes with your saliva it looks like a lot of blood, when it is only a few drops. 

The first 24 hours after your mouth surgery you will see blood constantly in your saliva. After the first 24 hours, you can expect to see blood in your saliva on and off for 3 to 5 days, sometimes longer. To help with bleeding within the first 24 hours after surgery you can fold a moistened gauze and place it over the sites and bite down firmly for 20 to 30 minutes. You can also get a tea bag wet and bite firmly on it over the site for 30 minutes. 

DO NOT put dry gauze in and out and in and out over and over, this will pull out the clots and start the bleeding again. Once the bleeding slows down (which will have happened by the time you have left our clinic) you can just take out the gauze and leave them out. Just realize that you will see a small amount of blood in your mouth on and off for 3 to 5 days. Put an old towel over your pillowcase for the first few nights since you know you will have this tinge in your saliva. 

Dry Sockets 

Dry Sockets usually occur within the 3rd to 6th day after surgery. The symptoms of a dry socket are sudden, severe, worsened pain usually on one side that radiates up toward the ear and forehead and down into the jaw. Your pain medication will no longer relieve the pain, and the pain will likely keep you up at night. If this happens, call the office and we can place a medicated packing that will completely alleviate your pain. You cannot look in your mouth and see a dry socket. Dry sockets are a diagnosis based on your symptoms. 

 

How can I avoid Dry Sockets?

The most common cause of dry sockets is smoking or vaping. Smoking includes smoking cigarettes, cigars, or marijuana. If you smoke or vape, in order to avoid a dry socket, we strongly recommend avoiding smoking or vaping for 7 full days after surgery. 

Other things that can cause dry sockets are: straws, anything with bubbles/carbonation like soda, spitting and vigorous swishing. All of these rules for dry sockets apply for one week, because we know that is the time period a dry socket is going to occur; so for one week no straws, nothing with bubbles or carbonation, and no vigorous swishing. When you use your mouth rinses you will gently tip your head from side to side, let the mouth rinse roll around in your mouth, then lean over the sink, open your mouth and let the mouthwash fall out.  

 

How do I keep my mouth clean after surgery? Should I brush my teeth?

After your mouth surgery it is very important to keep your mouth clean to help you heal well. We do want you to brush your teeth after your surgery. You will have to take your time brushing, and be gentle around the sites where the surgery was performed. 

If you normally use an electric toothbrush at home, it may be more comfortable for the first 2-3 days after surgery to use a normal manual toothbrush. You may want to consider purchasing a child size toothbrush because the heads are much smaller and will be easier to fit in your mouth if you have a lot of swelling. 

You will use the prescription antibiotic mouthwash that we gave you morning and night. This mouthwash is actively killing germs for 12 hours with each use, so you do not need to use it more often than morning and night. 

In between the antibiotic mouthwash you will do warm salt-water rinses after meals or as frequently as you would like. You can use 1 teaspoon of salt with 8-10 ounces of water.  Keep in mind that in order to avoid dry sockets, when you do all these rinses you will simply tip your head from side to side, let the mouth rinse roll around in your mouth, then lean over the sink, open your mouth and let the mouth rinse fall out. 

 

Will I have stitches?

You might have some stitches in your mouth after your surgery. If you do, they will be dissolvable stitches and come out on their own, you will not have to have them removed. They usually take about 7-10 days to dissolve. 

Stitches are placed only for patient comfort, and they do not make you heal any faster or slower after surgery. If a stitch for some reason comes out soon after surgery, such as the day of or one or two days after, this is OK and will not affect healing, so there is no need to be worried. 

 

What can I eat?

After oral surgery we suggest keeping a soft diet for about one week. This suggestion is for your comfort and to avoid hard or crunchy things getting lodged into the sockets (holes where the teeth used to be) and causing pain. 

Examples of soft foods are yogurt, pudding, mashed potatoes, scrambled eggs, soft noodles, soups, smoothies, milkshakes, ice cream, applesauce; any foods that you can mash up with your tongue and swallow. 

You should avoid any foods that can crumble up into pieces and get down into the tooth sockets, such as peanuts, popcorn, chips or granola. Strawberries and raspberries have small seeds that can lodge into the sockets and should be avoided. Rice should also be avoided because the small grains can get down into the sites. 

 

What if food gets into the areas where the teeth used to be?

It is almost guaranteed that some soft food debris will get down into the holes while they are healing. This is nothing to be concerned about. 

Use your mouthwash or warm salt water rinses gently after you eat. The body will break down and flush away food that gets into those sites, as long as it is soft. 

 

I looked in my mouth and I see big holes where the teeth were! What should I do?

When we pull teeth, the sockets (holes) where they used to be heal from the inside out. It will usually take 10 to 14 days for the holes to fully close, but that does not mean the sockets are not healing – they are healing, but the healing starts inside first. 

It is almost guaranteed that some soft food debris will get down into the holes while they are healing. This is nothing to be concerned about. 

Use your mouthwash or warm salt water rinses gently after you eat. The body will break down and flush away food that gets into those sites, as long as it is soft. 

 

How will I know if something has gone wrong?

Your swelling, pain, and possible bruising will take 3 days to peak after your surgery. This means you will be the most swollen, tight, and sore on the THIRD DAY after your procedure. This is the normal healing course. Beyond the third day, your pain, swelling, and bruising will significantly start to improve. 

If you have stitches and they become loose or fall out, this is NOT a cause for concern. Refer to the section in this packet on stitches for more information. 

What to look out for with a dry socket: dry sockets usually occur within the 3rd to 6th day after surgery. The symptoms of a dry socket are sudden, severe, worsened pain usually on one side that radiates up toward the ear and forehead and down into the jaw. Your pain medication will no longer relieve the pain, and the pain will likely keep you up at night. If this happens, call the office and we can place a medicated packing that will completely alleviate your pain. 

Any sudden, drastic increase in swelling and/or pain after the third day is a sign of infection. Often you will feel a hard “knot” in your cheek associated with this. Fevers, chills, and foul-tasting drainage can also sometimes occur. In this situation, please call the office number as soon as possible to be seen.

*Women Only: Please be aware that some of the medications you can be prescribed can interact with your birth control, causing it not to work (short-term). If you are currently on birth control, please speak with your surgeon.*

**We have after-hours call coverage on the office number at all times to discuss any emergencies, questions or concerns during your pre- or post-operative care.**