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                                                        DR. DAN PETERSON

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EXTRACTION POST-OP INSTRUCTIONS

REMEMBER THAT YOU HAVE JUST HAD YOUR TOOTH/TEETH EXTRACTED
WHICH IS SURGERY!
BE KIND TO YOURSELF

     The initial healing period typically takes from one to two weeks, gum tissue takes about 3-4 weeks to heal and complete healing of the bone can take about 6-8 months depending on your care of this area. 

     Some discomfort, bleeding and swelling should be expected in the next 24 hours as your mouth heals. Following these simple instructions will normally be all that is needed

As your mouth heals, you can promote faster healing and avoid complications by simply following these instructions.

bulletDO NOT DISTURB THE WOUND: In doing so you may invite irritation, infection and/or bleeding. The healing process begins immediately after surgery as your body sends blood to nourish the tooth socket.  Complete healing will take one to two weeks and swelling may last 48 hours. Simple pressure from a piece of gauze is usually all that is needed to control the bleeding and to help a blood clot to form in the socket. Sutures may need to be removed in 3-5 days. Keep your fingers and tongue away from this area. No positive or negative pressure like blowing up balloons.  Blowing your nose or sneezing violently can dislodge the blood clot and impair healing, so if you have an upper respiratory infection or allergies be sure to take the appropriate medications to treat these conditions.

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bulletDO NOT SMOKE OR USE TOBACCO PRODUCTS or ALCOHOL FOR 72 HOURS AFTER THE TOOTH/TEETH Have BEEN EXTRACTED: because smoke can interfere with the healing process, promote bleeding and can cause a very painful situation know as "dry socket". Continuing to smoke during these first few days will slow healing and soft tissue will not be able to begin to fill in the socket to form the blood clot needed for healthy healing. Smoking can also interfere with the bone grow that surrounds the socket resulting in slowing its process of filling in the socket

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bullet BRUSHING: For several days after the extraction, it is important to keep the area as clean as possible to prevent infection and promote healing. Do not directly brush the extraction site for the first 3-4 days after surgery to prevent dislodging of the blood clot from the socket. Don't use any toothpaste. Rinsing toothpaste from your mouth could remove the blood clot. Instead this area can be gently and carefully wiped with a clean, wet gauze pad or cloth. After this time you may carefully brush your teeth around this area and floss gently.
bullet MOUTHWASH: Avoid all rinsing for 24 hours after extraction. This is to insure the formation of a blood clot. Disturbance of this clot can lead to increased bleeding or the loss of the blood clot. After the first 24 hours you should VERY GENTLY RINSE  this area 4 times a day using warm salt water (1 tablespoon salt in 8oz of warm water) or mild antiseptic rinses like Breath RX. Rinse very gently after every meal and snack, making sure that the water reaches the extraction site. Rinsing removes food particles and debris from the socket to help promote healing. Chlorhexadine mouth rinse BID for 10 days.
bullet DO NOT SPIT OR SUCK THROUGH A STRAW: This will promote bleeding and may dislodge the blood clot.

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bullet BLEEDING: When you leave the office, you will be given verbal instructions regarding the control of postoperative bleeding. A gauze pad will be placed on the extraction site that you are asked to keep firm pressure on.  You will also be asked to change this dressing every 30 to 40 minutes or so depending on the amount of bleeding that is occurring. The gauze should be dampened before placing them over the surgical site. Change gauze only 3-4 times so as not to remove the blood clot. Do not chew on the pack. Don not such on the extraction site. It is normal for some blood to ooze from the area of surgery for 12 hours. We will also give you a package of gauze to take with you to use at home if the bleeding should continue. Should you need to use the gauze at home, remember fold the clean gauze into a pad, thick enough to bite on.  Than moisten it and place it directly on the extraction site. Hold it firmly in place, by biting down on the gauze pad or use finger pressure, for about 30-60 minutes. This pressure helps reduce bleeding and permits a clot to form in the tooth socket. If bleeding still continues, moisten a tea bag with water and wrap it in gauze and fold it in half and bite down on it for 30 minutes. Tea contains Tannic Acid which may help to reduce the bleeding. Keep your head elevated with pillows to control bleeding.   Use a towel on the pillow the first night,

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bullet MEDICATIONS: Some discomfort is normal after surgery. Analgesic tablets i.e. Tylenol or Motrin or non-aspirin can be taken (2) every four hours as needed or as directed by Dr. Peterson. Refer to pain control article. Prescription medication, which may have been given to you, should also be taken for 2-3 days after surgery or as directed. Don't drive while taking any pain medication due to drowsiness.  If antibiotics are prescribed you should carefully follow the instructions and finish the antibiotics until they are completely gone. Avoid aspirin as it may increase bleeding. A side effect of aspirin is it can increase bleeding by inhibiting blood clotting making it unsuitable following extractions.  To avoid nausea do not take pain medications on an empty stomach.
bullet SWELLING: To prevent swelling, apply an ice pack or a cold towel to the outside of your face in the area of the extraction during the first 12 to 24 hours. Apply alternately, 10-20 minutes on then 10-20 minutes off, for an  6 hour or longer if necessary. Ice is the best restriction to excessive swelling. The more ice, the less swelling. After 24 hours, ice will not stop swellingSalt water rinses after 24 hours. 
bulletSORE JAW JOINT: Your jaw may be sore from holding your mouth open during surgery. This may last 4-5 days.  Massage the jaw muscles gently/  Apply moist heat for 10 minutes on/10 minutes off.  Eat soft foods. Do not over extend opening your mouth, it can further aggravate this area. There may be some semi-permanent numbing in the area of the extraction.  It will decrease in size within the first 6 to 8 weeks and may continue until 6 months after surgery.

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bulletDIET: For the first 24-48 hours, you should maintain a diet of soft foods, such as Jell-O, pudding, yogurt, cream of wheat, mashed potatoes, clear soups, etc. Food that crumbles such as potato chips, popcorn, crackers, cookies, etc. should be avoided. Hot spicy foods should also be avoided to prevent irritation and burns of the extraction site. Also avoid carbonated and hot beverages for 3-4 days. Avoid sticky foods like taffy.  Eating immediately following the procedure is not recommended. When the numbness has worn off you may eat yet be sure to chew on the opposite side for the first 24 hours in order to keep food away from the extraction site. Also, keep anything sharp from entering the wound (i.e. eating utensils, fingers and other objects etc.) It is also important to drink 8 glasses of fluids in between meals and with meals. Try vegetable and or fruit juices or high-protein drinks.  Cut food into small pieces to ease chewing.  Return to a normal diet as tolerated

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bulletACTIVITY: For the first 24 hours, your activity should be limited because increased activity can lead to increased bleeding. No bending over or heavy lifting for 2-3 days. Do not play any wind instruments or blow up balloons for a period of 10-14 days. When lying down elevate your head slightly. Please be aware that you may get quite severe bleeds intra-orally following extractions and endo, from flying and recreational diving.  This condition can be caused  barotrauma for up to a month after the surgery*
bulletDO NOT DRINK ALCOHOL for 48 hours after surgery.
bulletPAIN-that lasts for up to a week or so but is gradually improving should be considered typical.  Pain that seems to be getting worse after two days should be considered abnormal and may require an evaluation by us. After 24 hours, applications of heat over the surgical area may help.

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bulletFor Women ONLY: It is crucial that you follow these instructions and especially DO NOT SMOKE.  If you are taking birth control or are in the first 22 days of your menstrual cycle your are twice as likely to develop a dry socket, which is a very painful condition, after an extraction.
bulletANESTHESIA WARNING: When a local anesthetic is used your lip, tongue and cheek will be numb for several hours after the procedure. While it is numb, it will feel "funny". During this period you must be careful not to bite, chew, pinch and/or scratch this area which can lead to serious soft tissue trauma.
bulletLONG TERM PROBLEMS: You may have a numb, tingling feeling in the area for 4-6 weeks or longer.  Having a missing tooth can lead to several problems such as shifting teeth, difficulty chewing and malocclusion which could lead to TMJ problems. This area will need to be restored with a fixed bridge, implant, a removable partial or a denture to insure good long-term dental health.

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bulletFOLLOW-UP APPOINTMENT: You are required to make a post-op appointment in one week to check on the healing of this area.  If sutures were placed they will be removed at this time.

REPORT ANY UNUSUAL OCCURRENCES IMMEDIATELY !
If you have any questions regarding these directions or need any future clarification or if you experience excessive bleeding or swelling, persistent and severe pain, fever, or any reaction to medications you should call Dr. Peterson 308 436-3491

Visit A.G.D. if you are a woman and are considering having a tooth extractions: Check menstrual calendar for tooth extraction
*
British Journal of Oral Health and Maxillofacial Dentistry

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'Phantom' Tooth Pain

Phantom limb pain after an amputation isn't the only type of mysterious pain that puzzles doctors and worries patients. Dental patients who have a tooth extracted can have pain at the site of the extraction for months afterwards. It's the toothache that won't go away, but there's no tooth there. It's not common, it affects perhaps less than one percent of dental patients. But phantom tooth pain can last for months, and can also spread beyond the extraction site to other areas of the mouth. Such phantom tooth pain may be related to changes in a person's pain threshold.  Phantom tooth pain is caused by changes in surrounding nerves that can occur after some extractions.  No one knows what causes these changes. Patients who suspect they may have phantom tooth pain should consult a specialist in orofacial pain to obtain a diagnosis. Often, when the pain spreads, dentists who don't think about the possibility of phantom tooth pain will suggest more procedures, such as extracting another tooth. "Don't keep having procedures done," he advised, until a diagnosis of phantom tooth pain is ruled out. Aug. 27, 2002 Post-extraction 'phantom' tooth can haunt patients By Kathleen Doheny San Diego (Reuters Health) 2002 Reuters Limited.

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Please carefully follow these instructions because you have just had minor surgery .  These suggestions will promote healing and make you more comfortable 

February 06, 2008   

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          If you have any questions please e-mail me at: drdpeterson@scottsbluff.net
                                                                                 308-436-3491 Office number

PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
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