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Sarosh F. Dastoor, D.M.D., M.S Precision Periodontics and Implant Dentistry, P.C.
Post Operative Instructions After Extractions
If an antibiotic has been prescribed, start taking it the day of the surgery. It is very important
that you finish all of the pills, as prescribed, because they will give you the best chance to prevent infection.
You can reduce stomach upset by taking them with food and plenty of liquid. Ibuprofen (such as Advil, Motrin, or Generic Brand):
Unless you have a reason that you
cannot take ibuprofen (such as an allergy to ibuprofen or aspirin or a stomach ulcer), take 600 mg of
ibuprofen (3 pills) at a time, every 6 hours. Start taking this dose the day of the surgery, and take it for the
next 2 days, whether you have pain or not. Ibuprofen is a very good anti-inflammatory medication that will
help decrease swelling, which will help reduce pain and discomfort. After 2 days, you can still take
ibuprofen, as needed, for pain. Tylenol is not effective against swelling but you can take 1 tablet every 6
hours if you cannot take Ibuprofen or Asprin. Prescribed Narcotic Pain Pills (Percocet, Vicodin ES, Tylenol #3, Darvocet, etc):
Take one of these pain pills along with your Ibuprofen dose as soon as you can after surgery because it
usually works better if it is taken before the numbness wears off. After that, take these pain pills only as
needed for pain. Do not take more than 1of these pain pills every 6 hours. Take these pain pills with food and
plenty of water to prevent stomach upset. Do not drive a motor vehicle, drink alcohol, or use additional
sleeping pills while taking these medications.
If any, the worst pain or discomfort after periodontal surgery is usually around 48-72 hours after surgery.
Please do not be alarmed if pain and/or swelling increases up to 48-72 hours after surgery. After this time,
your discomfort should gradually decline daily. Swelling:
Most people will get some swelling and, and if they do, it usually happens about 24-48 hours
after surgery. Slight discoloration (black and blue) of the face is also normal during this time. Using the
ibuprofen (Advil, Motrin, Generic Ibuprofen), ice bag, and sleeping in an inclined position, as directed above,
will help a great deal with keeping swelling to a minimum. Ice bag:
To keep swelling to a minimum, use a cold pack (wrapped in a soft cloth) to the skin on the face
over the area where the procedure was performed for 20 minutes on and 20 minutes off. Do this for the first
24 hours after your surgery. Doing this may allow you to have less swelling and therefore much less pain.
Remember, Less Swelling = Less Pain. If swelling continues after the first 24 hour period, switch to a warm
heating pad every 20 minutes for another day. Sleep:
For the first 2 nights after the procedure, try to sleep in a somewhat inclined position, with your head
propped up with some pillows. By keeping your head above your heart level, you may significantly cut down
on post-operative swelling. Remember, Less Swelling = Less Pain. Prescription Antibacterial Mouth Rinse (Periogard):
You may be asked to use a special
prescription antibacterial mouth rinse which you will need to pick up from the pharmacy. Please gently rinse
with this mouth rinse about ½ hour after brushing your teeth. The lingering effects of the fluoride in
toothpaste may deactivate the good effects of the mouthwash if you rinse with it any earlier than that. Rinse
with this mouthwash for 1 minute
, in the morning and at night
, taking care not to spit out the mouthwash
forcefully. Also, soak a Q-tip in a cup of the mouthwash and apply this Q-tip gently to the gums and teeth of
the surgical area 3 times/day for 2 weeks. Do not scrub it in.
Starting the day of the extraction, rinse your mouth (don’t swish) with warm salt water
(1/2-teaspoon of salt in an 8-ounce glass of warm water). Hold this in your mouth for 30 seconds and then
dribble out very gently. Repeat. Do this 3-4 times per day for 7 days. Oral hygiene:
Make sure that you properly brush and floss all the teeth in your mouth because this
greatly helps healing. As soon as you can tolerate it, you may resume your normal oral hygiene procedures
(brushing twice a day and flossing once a day) in the surgical area. To minimize traumatizing the surgical
area, always use an extra-soft bristled toothbrush and be very gentle when flossing.
Avoid strenuous exercise for the first 7 days after surgery. Strenuous physical activity may
increase post-operative pain or cause post-operative bleeding and swelling. Touching the surgical site:
Do not touch the surgical area during the first 2 weeks, in order to
prevent contamination. Avoid stretching your mouth to look at the site or to show it to friends or family. Use
caution when washing your face, and avoid playing with your tongue on the surgical sites. Stitches:
If the stitches are disolvable, they should fall out between 7 to 10 days. If the stitches are not
disolvable, they will be removed by me in about 2 weeks. Bleeding:
“Pink” saliva is normal for a few days. If bleeding is excessive, apply gentle pressure by biting
for 20 minutes on a soaking wet gauze pad placed on top of the extraction site. If this doesn’t stop the
bleeding, apply pressure by biting on a wet black tea bag wrapped in a gauze for 30 min. If the bleeding just
won’t stop, contact the office. Food:
For the first few days after the extraction:
• DO NOT drink through a straw
as this will cause bleeding and could lead to dry socket.
• DO NOT spit
as this will cause bleeding and could lead to dry socket.
• Stay on a soft diet until pain subsides (pudding, milkshakes, scrambled eggs, pasta, mashed
potatoes, luke-warm soup, oatmeal, jell-o, etc.).
• Chew away from the surgical area (on the other side of your mouth).
• Avoid foods that are likely to get stuck in the surgical area (popcorn, nuts, seeds, etc).
• Avoid acidic foods, like tomatoes, and hot or spicy foods because these may cause pain. For the
same reason, avoid citric, hot, or acidic beverages.
• It is helpful to drink a few servings of a nutritional food supplement (Carnation Instant Breakfast
drink, Ensure shake, Slim-Fast shake, etc.) to make sure you are getting enough nutrients and protein to promote good healing.
• Drink at least eight 10-ounce glasses of water per day.
Smoking: Do not smoke
because it will result in more pain and slower healing. Smoking after an
extraction is the leading cause of “dry socket” which is very painful and difficult to treat. Pipes, cigars, and
smokeless tobacco should also be avoided.
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The combative multitrauma patient: a protocol for prehospitalmanagementEitan Melamed, Yahav Oron, Ron Ben-Avraham, Amir Blumenfeld and Guy LinObjective To describe the management of the combativemore agitated after administration. No adverse effectstrauma patient in the prehospital setting, and to suggest awere recorded by the prehospital caregivers. Conclusions In this article, an algorithmi
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