POST-OPERATIVE INSTRUCTIONS

Our phone number is (406) 727-4322

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office where you had your surgery. Calling the office can alleviate additional expenses of going to the Emergency Room or seeing another doctor. We have a doctor and assistant available 24 hours a day, every day to answer calls. Do not hesitate to call in case of an emergency, however, for routine questions please call during business hours whenever possible.

DO NOT DRIVE OR OPERATE MACHINERY FOR 24 HOURS AFTER SEDATION OR AS LONG AS YOU ARE TAKING PRESCRIPTION NARCOTIC MEDICATION.

BLEEDING
• Bite gently on original gauze packs for one hour.
• If you replace gauze packs, moisten the new packs slightly before placing them.
• Do not chew on the gauze packs or replace them frequently, each pack should be left in place for at least 30 minutes.
• Oozing from the sites to a small degree is normal during the first 24 hours. We recommend sleeping with an old towel on your pillow for the first night as it may have blood on it when you wake up.
• Persistent bleeding may be treated by applying pressure with a moist black tea bag or sipping slowly on ice water.
• Call the office if you feel the bleeding is severe, uncomfortable, or if it does not respond to the above measures.

PAIN
• Often post-operative pain can be comfortably controlled with no-prescription medications, such as:
– For sustained pain relief, alternate between Tylenol (acetaminophen) and ibuprofen (Advil, Motrin, etc.) if you are able to take these medications. (For adults, 500 mg Tylenol, 2 hours later 400 md ibuprofen, 2 hours later Tylenol, etc.)
– OR – For maximum pain relief at one time, take both Tylenol (500mg) and ibuprofen (400mg) at the same time, then wait 4 hours for the next dose.
– For children, dosing recommendations can be found on the bottle.
• If a prescription for a narcotic pain medication is provided, this is to be used for breakthrough pain as a last resort – these medications often have uncomfortable side effects and are very addictive.
• Refills for prescription pain medications will be considered on a case by case basis and will only be filled during business hours. They will not be considered over the weekend. Please plan accordingly. Office hours are Mon – Fri 8:00am to 4:00pm and Friday 7:00am to 12:00pm.

ORAL CARE
• It is OK to gently brush your teeth. Take care to avoid disturbing the surgical area with the brush.
• Do NOT vigorously rinse with water or any mouth rinse during the first 24 hours.
• Do NOT probe or otherwise disturb the surgical site.
• Beginning the day after surgery, gently rinse your mouth with mild salt water (½ tsp. salt and ½ tsp. baking soda per cup of water) several times a day and continue for two weeks following surgery.
• If prescription mouth rinse was provided, be gentle and follow the instructions given with the prescription.
• Do NOT rinse you mouth with hydrogen peroxide.
• You should begin gently rinsing extraction sites with the irrigating syringe 4 days after surgery to prevent food impaction and dry sockets (see section on dry sockets below).

SMOKING
• Do NOT smoke after oral surgery. Smoke contains damaging chemicals that will increase the risk of pain and infection and will delay the healing process leading to higher risks of complications.
• The longer you can avoid smoking after surgery, the better.

SWELLING
• Swelling will typically start to appear within 24 hours after surgery and may take 4 days to peak, then 4 days to resolve.
• Apply a cool pack to the cheeks for 20 minutes at a time, followed by a 20-minute rest throughout the day for 48 hours.
• Keep your head elevated 30 to 45* for the first 48 hours following surgery.
• After 48 hours switch to a heating pad over the cheeks, following the same 20-minute rotation schedule.
• If swelling returns after it has already resolved, please call the office for an evaluation.

GENERAL HEALTH
• Do not stand up quickly during the first 24 hours after surgery – you may become lightheaded and faint.
• You should have assistance when you go to the bathroom.
• It is not uncommon to run a low-grade fever during the first 48 ours after the surgery and anesthesia.

SLEEP APNEA
• Unless directed otherwise after your surgery, you may use your CPAP machine post-op.
• Patients who have undergone sedation or who are taking narcotic pain medication MUST use their CPAP machine at any time post-op when they might fall asleep unless specifically directed otherwise. You are more likely to have life threatening apnea initially after anesthesia and while under the influence of narcotic pain medications.

NAUSEA
• Sometimes pain medication are the cause of post-op nausea. Nausea can be reduced by preceding each pain pill with a small amount of soft food, and taking the pill with a large volume of water.
• Ginger Ale and/ or Dramamine may help with nausea.
• Be aware that almost all anti-nausea medicines cause drowsiness.

DIET
• Avoid carbonated beverages, alcohol, citrus juices, coffee and any extremely hot foods for 24 hours after the surgery.
• Start with foods that are cool and soft during the first 24 hours after surgery.
• After 24 hours you may gradually begin to eat and drink more foods based on comfort.
• For 3-4 weeks after the surgery it is best to avoid foods like nuts, sunflower seeds, popcorn, etc. which may get lodged in the surgical site.
• Do NOT use a straw for at least 3 days following surgery.
• Do NOT skip meals. This will slow the healing process.
• If you are diabetic, maintain your normal eating habits or follow instructions given be your doctor and check your blood sugar regularly. Ideally, your blood sugar should stay below 250.

DRY SOCKET
• Typically recognized by severe, aching pain developing up to 10 days after surgery.
• Following the instructions on this sheet will minimize the risk of developing dry sockets.
• Often is the result of food impaction within the socket or otherwise disturbing the healing process.
• Dry sockets will resolve on their own, however, if you have concerns with this please call the office for assistance.

HEALING
• If your stiches are the dissolving type (most common), they will typically dissolve in 2 – 10 days.
• Occasionally a sharp edge of bone can be felt at the surgical site. Bone slivers may surface occasionally for several weeks after tooth extraction. Please call if these are causing discomfort.
• It is normal to develop a hole initially at the extraction site. This will fill in over time, typically 3 – 4 weeks.