Special instructions and/or medication details.

Please follow the advice provided from your dentist after your visit.

Anaesthetic

The length of time you feel numb varies depending on the type of anaesthetic we have used, and the site of the injection. While your mouth is numb, be careful not to bite your cheek, lip or tongue.The numbness should subside within a few hours, but it can last up to 5-8 hours. Lower jaws usually stay numb longer than top jaws. Occasionally, the needle can cause slight injury to the tissue or a nerve and cause swelling, or limited jaw opening. If so, it usually gets worse for a day or two, then levels off for a day or two, and then gets better.

Healing

We will place a gauze pack on the extraction site to limit bleeding and confine the blood while the clotting takes place. You must have pressure on the gum to stop the blood flow, and the clotting happens a lot faster if you stop the blood flow. This gauze or tissue should be left in place for 20-30 minutes after you leave our office. Do not chew on the pack. After approximately 30 minutes, take out pack and discard. There is no need to replace it unless heavy bleeding occurs. Expect a bit of ooze.

Do not be concerned if the site takes time to fill in after a tooth is taken out. The average time for complete healing is 3-4 months.

Bleeding

There may be some bleeding or heavy oozing after the pack is removed. If so, do this -

• Fold a piece of clean gauze (or a tissue or handkerchief) into a pad thick enough to bite on so that the other teeth don't quite touch. Place it directly on the extraction site - even if it means squeezing it down between two other teeth.
• Apply moderate pressure by closing the teeth firmly over this pad. Maintain his pressure for about thirty minutes. If the pad becomes soaked, you can replace it with a clean one, but only if the taste really bothers you.
• Do not suck on the extraction site.
• Minimise smoking, exercise, and alcohol for the first week. These activities tend to increase the blood pressure and “pop” the tiny capillaries in the healing area.

If heavy bleeding continues, call your dentist. (Remember though, that a lot of saliva and a small amount of blood, can look like a lot of bleeding.)

The Blood Clot

After an extraction, a blood clot forms in the tooth socket. This clot is an important part of the normal healing process. You should therefore avoid activities that might disturb the clot.

• Do not smoke, or rinse your mouth vigorously, or drink through a straw for 24 hours. These activities create suction in the mouth, which could dislodge the clot and delay healing.
• Do not clean the teeth next to, or the healing socket, for the rest of the day. You should, however, brush and floss your other teeth.
• Gently rinse your mouth afterward. (Use DifflamC or equivalent.)
• Limit strenuous activity for 24 hours after the extraction. Heavy exercise increases the blood pressure, and this can also cause bleeding.

Stitches

If you had stitches placed, please make an appointment to have them removed approximately 7-10 days after surgery.

Swelling, pain and limited mouth opening

After a tooth is removed, you may have some discomfort and notice some swelling develop over the next few days. You can help reduce swelling and pain by applying cold compresses to the face on and off for several hours after the extraction. You can use an ice bag or cold, moist cloth 5 minutes on, 5 minutes off. A bag of frozen vegetables wrapped in a tea towel often suffices. This must be done in the immediate post operative period to be beneficial.

“Trismus” (limited ability to open the mouth) is also common in the post operative period. It can last two weeks. If you have difficulty brushing, be sure to rinse with a chlorhexidine mouth rinse (Difflam C or Savocol) as these tend to compensate.

If your extraction was very difficult and required extensive oral surgery, you can expect significant swelling and some bruising of the skin adjacent to the wound. This goes away after approximately two weeks.

Medication

We may prescribe medication to control pain and prevent infection. Use it only as directed. If you have prolonged or severe pain, swelling, bleeding or fever, call us immediately. We will give you exact instructions on how to care for your problem. (See front page for your particular medication details, if required.) If no strong medication is required, Panadol (or any paracetamol) can be taken. This is considered to be the only safe analgesic for children under twelve and pregnant or lactating women. You may be given antibiotics but do not take Amoxil or Augmentin if you are allergic to penicillin. If Amoxil or Augmentin gives you a skin rash, stop taking it, as you are probably allergic.

Antibiotics generally don't make much, if any difference to the healing of mouth wounds, and over prescription can result in development of resistant organisms. In line with this, current theory says to stop taking antibiotics when the symptoms subside, rather than taking the full course, as was previously advocated.

Diet

After the extraction, drink lots of liquids and eat soft, nutritious foods. Avoid alcohol and hot liquids as they can promote bleeding. Begin eating solid foods the next day or as soon as you can chew comfortably. For about two days, try to chew food on the side opposite the extraction site. Vitamins such as B and C may help in the healing process, and make you feel better. Therefore we recommend one “Berocca” per day during the healing period (2 weeks).

Rinsing

Four hours or so after the extraction (unless still bleeding), start gently rinsing your mouth with warm salt water (half a teaspoon of salt in 200ml glass of warm water) or Difflam C. We recommend using DifflamC dental rinse to reduce pain and lower risk of infection, because it has antibacterials plus anti inflammatories. Remember not to rinse your mouth vigorously because you may disturb the blot clot.

Dry Socket - IMPORTANT - READ THIS

Not infrequently, an extraction site may seem to be comfortable for 3-7 days after the extraction, only to become extremely painful. This is usually accompanied by a bad taste and odour but almost no pus. If you develop these symptoms, it is probably “dry socket” infection. Although painful, it is not a serious problem, and you can either:

1. Continue taking pain killers (if needed) and put up with it for a further 10-14 days (it always gets better on its own, without treatment) or
2. Come into the surgery. We will place medicaments which, whilst not curing the infection, will take away the pain in about an hour. Antibiotics do not generally cause any improvement in dry socket, but may be indicated if you have wider surgical wounds. If you would prefer to take antibiotics, we are happy to oblige, but we do not advocate them, because of the chance of developing resistance.

Oral Hygiene

It is important to continue to brush and floss your teeth thoroughly at least once a day. The tongue should also be brushed. This will help eliminate the bad breath and unpleasant taste that is common after an extraction. Ask for a Bad Breath Kit if you are concerned. It has a special tongue brush, and chlorine dioxide and zinc mouth washes that “eat up” the volatile sulphur compounds that cause the bad odour.

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