Post –operative instructions for: General oral or dental surgery
(Surgical Extractions, Apicectomies, Crown Lengthening, Soft Tissue and Biopsy Surgery)

 

1.     General information: The site where surgery has been will normally be sutured so that there is minimal space left for much bleeding to occur. However, a clot will still need to develop under the gum and trouble-free healing is dependent on this initially fragile clot remaining undisturbed as much as possible. Most surgery sites heal with minimal trouble. Please keep turbulence in your mouth to a minimum for 24 hours after the surgery. For at least 8 hours after the surgery, do not rinse, eat, gargle or touch the wound with your fingers or tongue. You may brush your other teeth normally that evening keeping away from any sutured wounds but be aware that some bleeding may follow.

 

2.     Painkillers: You will benefit from taking an anti-inflammatory painkiller (such as Nurofen 400mg 6 hourly or Voltarol Retard 100mg 12-18 hourly) for the first 48 hours. If you are unable to take such non-steroidal anti-inflammatory drugs for medical reasons (e.g. stomach or oesophageal ulcer or moderate to severe asthma), please take 1g of Paracetamol every 6 hours for 48 hours. This can be supplemented with dihydrocodeine 20mg if required (the combination of paracetamol and dihydrocodeine is available as Co-dydramol over the counter). Paracetamol or Co-dydramol can be used in addition to the anti-inflammatory painkillers if necessary for up to three days. You should not need to take this medication for more than 4-5 days. Please inform me if pain increases after 4 days as it may indicate that an infection has occurred and requires attention.

 

3.    The effect of the local anaesthetic will normally wear off after 2-6 hours depending on the site anaesthetised and the amount used. Occasionally it may persist for longer. Take great care not to bite or otherwise traumatise the numb site during this time. Do not attempt to drink hot fluids for at least 8 hours. The application of heat on the day of extraction or surgery will both encourage further bleeding and swelling and can locally scald the site without your being aware of it.

 

4.     Please let me know the same evening if numbness persists for over 8 hours without diminishing.

 

5.     Bleeding: We will check that any bleeding has stopped before you leave the surgery. Be aware that movement, exertion, eating or drinking may re-start bleeding. (A small volume of blood will be present in your saliva as natural washout from the surgical site). You will be provided with sterile gauze when you leave the surgery. Please roll this into a tight bundle to use as a compress, moisten under a cold tap, wring out any excess water then place over the surgery site and press or bite down on the gauze firmly for at least 10 minutes by the clock. Ensure that the gauze is applying pressure to the wound and is not merely trapped between your teeth. If there is further bleeding, repeat with a new pack. (If a temporary bridge exists over your surgery site, apply firm pressure from the sides by pinching the gum between forefinger and thumb for 10 minutes). If you feel that the wound is bleeding beyond your control, or persisting into the night, please call or text me on my mobile on 07747 798 083. I would be grateful if this number is reserved for emergencies only.

 

6.     Swelling: There will be a variable amount of swelling depending on how much the soft tissues have needed to be manipulated during the procedure. Moderate swelling and skin bruising are normal and relatively common. Swelling can be minimised by applying a cold pack which we will supply for you and keeping the head elevated during the night on an extra pillow or two. Please inform me on the surgery number during surgery hours or on the above mobile number outside surgery hours if the swelling is particularly painful, or has not started to subside by the end of the fourth day following surgery. This may indicate that there is an infection that requires attention.

 

7.     Aftercare: I recommend that you do not plan any strenuous activity or swimming for at least 4-7 days after the surgery or extraction depending on the size of the wound. The following day (or at least 6 hours after bleeding has stopped), start to carry out gentle hot salt-water mouth rinses every 3-4 hours. An antiseptic mouthwash such as Corsodyl will also be of help in limiting any infection and should be used at least twice a day in the morning and last thing at night. Antibiotics are not normally required after routine surgery, though a covering antibiotic will normally have been given to you prior to surgery. Additional antibiotics may be given if any kind of additional bone graft has been carried out or a particularly extensive infection was present. Usually, these would be one or two of the following:

·          Amoxicillin 500mg three times a day (every 8 hours) for 7 days

·          Clindamycin 150mg four times a day (every 6 hours) for 7 days if you are allergic to penicillin.

·          Metronidazole 400mg three times a day (every 8 hours) for 7 days

It is important that you take and complete the antibiotic course(s) as prescribed. I would recommend daily supplements of “ friendly bacteria” by having a pot of bio yoghurt or one of the proprietary probiotic drinks available on the market.

 

8.     Please inform me immediately if you have any kind of skin rash or swelling, persistent abdominal pain, vomiting, or bloody stools with any of these antibiotics on the surgery number during surgery hours or on the above mobile number outside surgery hours.

 

9.     Please also remember that a course of antibiotics will reduce the efficacy of the contraceptive pill. Please use an additional form of contraception during and for 3 days after the course of antibiotics.

 

10.   Do not drink alcohol during your course of antibiotics.

 

11.  If sutures have been placed, they will usually need to be removed after 7-12 days even if they are dissolvable. An appointment will be arranged for you before you leave the surgery. If sutures are left in for too long then they themselves may become a focus for future infection.

 

 

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