POST OPERATIVE INSTRUCTIONS
CARE OF ORAL SURGERY WOUNDS - Simple oral surgery and wisdom teeth
Your cooperation with the following instructions will go a long way toward helping you have a smooth and uneventful post-operative course. Please refer to your written post surgical instructions for specific information and after hours contact
There are 3 key points to focus on in the post operative period
1) strict regular oral hygiene 2) regular simple pain relief 3) a soft diet
After surgery healing usually occurs quickly and without complication.
There is always a risk of infection in healing oral wounds. The risk of infection is increased with smoking and the placement of foreign objects into the mouth such as fingers or pencils.
The mouth should be kept clean by using a soft toothbrush to clean the teeth but avoiding the wound or extraction socket. Use the monoject syringe as instructed.
Please do not chew a numb lip or tongue as injury can result.
Most stitches in the mouth will be dissolvable and usually disappear within 10-14 days.
The most common complications are pain, swelling, bleeding and infection.
You should focus on very strict, regular oral hygiene for at least 4-6 weeks after your surgery
BLEEDING
Bleeding will be under control by the time you leave the hospital or Dr Madden’s rooms. Continued bleeding upon discharge is not normal, however, some oozing or blood-tinged saliva may persist for up to 24- 48 hours.
Should excessive bleeding occur, it may be controlled with pressure. Apply a folded gauze pad (usually supplied or purchase from the chemist) or a small, cleaned, dampened handkerchief over the area and bite firmly for 30 minutes. This may be repeated if necessary.
Sleeping with the head of bed elevated above the level of the heart for the first two post-operative nights will minimize bleeding and swelling. We recommend placing a towel on your pillow for the first 48hrs.
PAIN
Pain is best controlled by the medications prescribed. They are most effective when taken before the local anaesthesia diminishes and normal sensation returns to the area. Do not take pain pills on an empty stomach. Regular simple over the counter pain relief such as paracetamol and ibuprofen taken together and regularly are very effective for most types of simple oral surgery. Stronger opioid style medications may be prescibed. Narcotic pain medication such as codeine may cause nausea, vomiting, drowsiness, dizziness, itching or constipation. If these side effects occur, discontinue the medication. Please be aware certain types of underlying health conditions can be affected by analgesic medications, never take medications in excess of the manufacturers recommended daily maximum - If the pain worsens you should call Dr Madden or your anaesthetist.
SWELLING
Swelling may occur immediately and/or increase gradually over 24-48 hours. It is common and can cause some difficulty with mouth opening. To minimize stiffness and stimulate circulation, exercise the jaw periodically by opening and closing.
Restricted jaw opening usually requires 7-14 days to return to normal. Swelling from the surgical procedure will maximize at 48-72 hours. Ice packs applied externally to the area at 20 minutes intervals throughout the first day or two after surgery may help control swelling. Do not apply ice packs or ice directly to the skin, instead use a tea towel or washer as a buffer. After 1 week post surgery HEAT packs applied regularly 3-4 times daily may be useful to reduce residual bruising and swelling.
INFECTION
Continued pain, swelling or a raised temperature beyond the first 7 days may indicate infection. Due to infection spreading or delaying healing, you should contact Dr Madden if you are concerned. Very strict oral hygiene can help avoid infection. Rinsing after meals with savacol 3 times daily for 5-7 days (available from supermarkets or pharmacies) or a 1/2 teaspoon of salt dissolved in a glass of warm water 4-5 times daily for at least 1 minute will assist. Over the longer term, regular warmed salt water is a gentler and more effective approach than medicated mouthwashes. If food packing in the wound occurs it may require proper syringing. Please use the monoject syringe provided - Please contact our rooms for a follow up if you are concerned about this. Restriction in mouth opening, difficulty swallowing and difficulty talking (hot potato voice) are all critical signs of a more significant post operative infection that may require hospital admission.
NAUSEA
Nausea may result from a general anaesthetic or the drugs prescribed for pain. Ceasing the prescribed pain medications ( ie codeine) and drinking a small glass of a carbonated beverage will generally control mild nausea.
DIET
Soft foods and liquids will be required for 24-48 hours following surgery. Avoid hot, spicy foods. Do not drink through a straw or smoke (if you do) for at least 48 hours.
If you had surgery on only one side of the mouth, favour the other side while chewing for the first few days.
After dental implant surgery it is important to avoid hard foods (e.g Nuts, raw carrots, apples), crusty bread and stick to a soft chew diet trying to focus eating on the side opposite side.
After Jaw surgery follow a thickened food and puree type diet for the first 2 weeks then a very soft chew/ mashed diet from week 3-7 post surgery - food crushable by the tongue agains the hard palate Protein shakes, fruit smoothies, porridge, vegetable soups, vegetable curries - Regular small meals are often easier to manage.
ORAL HYGIENE
Oral Hygiene is critical and should not be neglected. Brush your teeth as usual and rinse with warm salt water or savacol (as above) after each meal, beginning gently the night of surgery. Mouth rinsing should be done for at least 3-4 weeks after surgery to avoid late food trapping and infections. In the early stages of healing avoid brushing directly over the extraction socket, dental implant or oral wound to minimise trauma and bleeding.If provided, please use the monoject irrigating syringe from day 6 or 7 after tooth extraction.
ACTIVITY
Activity should be restricted to a minimum for the first 2-3 days. Strenuous work or exercise may promote bleeding. Contact sports should be avoided for at least 1 week after wisdom tooth surgery. Under no circumstances are you to drive a car or operate heavy machinery for at least 24 hours after a General Anaesthetic.
SIDE EFFECTS
For example: ear ache, hiccups, temporary ache of adjacent teeth, restricted mouth opening, stretching or cracking at the corners of the mouth or discoloration of the skin may occur postoperatively. These are temporary conditions which will improve as healing progresses.
NUMBNESS OF THE LIP AND TONGUE
This occasionally follows surgery on the mouth, face and jaw. This is usually transient and no cause for alarm. Please avoid chewing a numb tongue or lip. It is important to arrange a review appointment with Dr Madden if numbness to the lip or tongue lasts longer than 2 weeks after simple oral surgery.
BONY EDGES
After teeth are extracted, you may feel hard projections in the area and think they are pieces of tooth. This is usually the hard, bony partition which surrounds the roots of the teeth. These generally work themselves out, though if they persist please arrange a review appointment.
FACIAL TRAUMA AND JAW SURGERY
Bones take a minimum of 6 weeks healing to regain a basic level of strength. During this time we suggest you avoid contact sports or heavy, physical activity at work.
If your injury involves the cheek bone and/or orbit, please avoid air travel and nose blowing for 10-14 days following surgery.
If your surgery involves the bones of the maxilla or mandible then it is important to maintain excellent oral care and follow a strict soft, non-chew diet for 6 weeks following surgery so as to ensure there is no disruption to bony healing or your bite.
You will be provided with a dietary guide as part of your post operative care pack.
EMERGENCIES
After Hours:
Please contact Dr Madden via the hospital based phone number provided in your post surgical instruction sheet regarding any unusual occurrences or questions e.g profuse bleeding, uncontrolled pain, persistent nausea and prolonged elevated temperature localised swellings.
If you have concerns about very large facial swellings, limited mouth opening, breathing difficulties or swallowing difficulties then you should attend one of the larger city hospital emergency department straight away e.g St George, Liverpool, Westmead, Concord, Prince of Wales, Nepean, Campbelltown, RPA, North Shore, Northern Beaches Hospital. You may need admission under one of the surgical teams for IV antibiotics for 24-72 hours, stronger pain relief or surgical drainage of the infection.
Please note in Sydney the major hospitals that offer 24 hour Oral and Maxillofacial Surgery on call services: Prince of Wales Public Hospital, Randwick, Westmead Hospital , Nepean Hospital.
For those treated in hospital - Post surgical pain management and repeat pain relief prescription questions may also be directly to your anaesthetist.
If Dr Madden is unavailable please attend your referring dentist or GP until a follow up with Dr Madden can be arranged - it is important that you let our rooms know of this so that ongoing review can be provided.
During Business Hours enquiries can be directed to the main rooms: 02 92641505
*There may be a fee for cancellations with less than 24hrs notice.