You will be numb for a few hours, sometimes up to 24 hours following surgery. This de-pends on the type of local anesthetic used for your procedure. Please do not eat or drink anything hot until normal feeling returns so that you do not burn yourself. Similarly avoid chewing so that you do not bite yourself. Cool soft foods such as smoothies are recom-mended while numbness is present. Straws should be avoided for 72 hours as suction promotes bleeding. Once normal sensation returns your diet should consist of softer, non-spicy foods that are comfortable to eat. A list of suggested foods is included on the reverse side.
Intermittent bleeding is expected following surgery. This is normal for the first 24 hours. This is usually controlled by biting on moist gauze for 30 minutes along with keeping the head elevated and applying ice over the affected area. Do not bite on gauze while sleep-ing. Biting on a moistened green or black caffeinated tea bag for 30-45 minutes has been shown to aid in control of bleeding. Herbal and decaffeinated tea bags will not work. If you have been taking anticoagulants or blood-thinners such as Aspirin, Ibuprofen, Aleve or cer-tain prescription drugs prior to surgery minor bleeding could last longer.
Some discomfort is expected and may persist for up to one week, in rare cases longer. Dis-comfort should be controlled with over the counter analgesic medications along with rest. We recommend beginning medication before the numbness wears off. Get something in the stomach first like a smoothie. We recommend that healthy adults use 600mg Ibu-profen (Motrin, Advil) every six hours along with 1000mg Tylenol every six hours. These medications should be staggered or alternated so that you are taking a different medica-tion every three hours. In the rare cases that this regiment fails to give appropriate pain re-lief the surgeon will prescribe a narcotic pain medication to be used with the Ibuprofen. Every attempt should be made to avoid narcotic pain medications due to side effects in-cluding addiction, nausea, drowsiness and constipation.
Some swelling is expected. Maximum swelling is usually 72-96 hours after surgery. Most swelling resolves after one week but may persist longer with more complex surgeries. Normal swelling is soft and non-painful. If you have swelling that is hard, painful and red you should call the office. Swelling can be minimized with steroids, cold compresses and elevating the head. You may be prescribed a steroid. Use this as directed. Cold compresses should be used approximately 20 minutes each hour while awake for the first 72-96 hours. The head should be kept elevated 30-45 degrees at all times for the first 72-96 hours.
Bruising is not uncommon. Bruising should not be hard or painful. Warm moist compresses after day three may help dissipate bruising.
Avoid rinsing or spitting the day of surgery as this will increase bleeding. Rinsing with warm salt water should begin the day after surgery. You may make your own saline solution by mixing ½ teaspoon of salt in 8 ounces of water. Tap water is ok but distilled water is better. Rinsing every two hours and after meals is recommended for at least the first two weeks after surgery. You may also be given an irrigation syringe to use. You may be prescribed a disinfectant rinse (Peridex or Chlorhexidine Gluconate). You are encouraged to brush your teeth. Avoid the surgical sites. Consider dipping your toothbrush in the Peridex rinse in-stead of using toothpaste as this could be irritating to the wound.
Sutures are usually dissolvable. Most dissolve in 7-10 days. Some take longer, up to one month. Some sutures will need to be removed.
Exercise and strenuous activity should be avoided for the first week after surgery. This could lead to increased discomfort, swelling and bleeding. Light activity can be resumed on fourth day after surgery as tolerated.
Smoking should be avoided during the healing period. Smoking slows the healing process and increases the risk of complications.
Antibiotics should be taken to completion when prescribed. If you experience a rash, itch-ing or diarrhea you should stop taking the antibiotic and call our office for further guidance.
Your Temperature may be slightly elevated- up to 100.4° F is not uncommon for the first 48 hours after surgery. If your temperature reaches 101.0° F you should call our office for fur-ther guidance.
Chapping or cracking of the lips is not uncommon. Liberal use of a lip balm or Vaseline is encouraged.
Trismus, stiffness or inability to open your mouth is not uncommon. Most often this re-solves after approximately one week. Moist warm compresses in conjunction with stretch-ing exercises can help. If the ability to open decreases you should call the office.
Nausea is common after I.V anesthetic. Nausea is also common with the use of narcotic pain medication. You may be prescribed an anti- nausea medication. Use this as directed along with maintaining adequate hydration(small sips of water) and consuming a bland di-et.
I.V. General Anesthesia If you have had I.V. sedation or general anesthesia you may feel a little sleepy for up to 24 hours. You should have someone with you for the rest of the day. You should not drive or operate machinery for 24 hours. If your I.V. site becomes red and painful which is extremely uncommon, you should call our office.
When should I call the office?
If you have any questions or concerns.
Temperature of 101° F or higher.
Pain that is not controlled with pain medication.
Swelling that is hard, painful and red.
Swelling below the lower jaw or on the neck.
Swelling under the tongue.
Any drainage from the wound.
Inability or decreasing ability opening your mouth. Inability to get one finger between the upper and lower front teeth.
Painful swallowing.
Bleeding that is not controlled or is not slowing down by the preceding instructions.
Persistent vomiting not made better by anti-nausea medication.
Suggested Diet for After Surgery:
While numbness is present – Cold and soft; smoothies, milk shakes, ice cream, applesauce, yogurt, Jell-O, pudding. Do not use a straw for the first 72 hours after surgery.
Day 2, When feeling returns – Soups, oatmeal, eggs, mashed potatoes, bananas, macaroni and cheese, pastas.
Day 3 and beyond – Slowly resume normal diet as tolerated. If it is uncomfortable don’t push it. It is not unheard of to stay with a soft diet for up to one week.
Medications:
Narcotic pain medications: As outlined above, most post-operative discomfort can be man-aged with a combination of NSAIDS such as Ibuprofen or Naproxen and Tylenol. Sometimes a narcotic is necessary. Addiction is a risk. Most often we prescribe Hydrocodone with Tylenol (Norco or Vicodin). Nausea, drowsiness and constipation are common side effects of all narcotic pain medications. You CAN NOT drive a car on any day which you have taken a narcotic. DO NOT use alcohol or any other sedative drug or medication on the same day as this combination could be deadly.
Antibiotics: If you have been prescribed an antibiotic you should take it to completion. Not everyone will be prescribed an antibiotic as every case is different. For females on birth control antibi-otics may interfere with the effectiveness. You must use an alternative form of birth control to avoid pregnancy. Antibiotics my cause diarrhea or even Clostrium Difficile Colitis. Probiotics containing Lacto-bacillus may be helpful in preventing both. Probiotics should be taken at least two hours prior to taking your antibiotic. If you develop a rash, diarrhea or abdominal pain you should call the office for guid-ance.
Steroids: Steroids are used to reduce the swelling and discomfort associated with inflamma-tion. We typically prescribe a brief tapering dose lasting from one to five days.
Antimicrobial Rinse (Chlorhexidine Gluconate or Peridex) may be prescribed to disinfect the mouth. This should be started beginning 1-3 days prior to surgery twice daily(morning and night) for 30 seconds. Peridex can leave an unpleasant taste. Peridex can stain the teeth and tongue.
