Following tooth extractions:
Our staff will provide both written and verbal instructions on how to care for the mouth following extraction but summarised below are the precautions and special care recommended:
- Continue to bite down on the gauze placed over your extraction socket for a further 20 minutes after leaving the surgery. A small amount of bleeding may occur intermittently for up to 24 hours after the extraction. If blood seems to be oozing from the socket then place another gauze pad dampened in clean water over the socket so that when you bite down the gauze presses firmly against all the gum around the socket. Hold this gauze in place for a further 30 minutes and try not to move it or your jaw for the 30 minutes. If bleeding still seems to be coming from the socket after this, call our surgery for advice. You may need additional treatment to control the bleeding.
- Bear in mind that a tiny amount of blood can mix with a lot of saliva and look like a lot of blood. It is best to judge if a socket is bleeding by directly observing the socket for several minutes. If a steady ooze is seen, then more gauze pressure or other management is needed. More minor amounts of blood can be gently spit out and should eventually stop.
- Patients taking Warfarin, Aspirin or other anticoagulants (blood thinners) may bleed for longer and may still have some ooze up to 24 hours later. If bleeding still persists beyond this time, call our surgery for advice.
- Do not smoke, eat hot or hard/sharp food or consume hot drinks for at least 24 hours after the extraction. These activities may loosen the blood clot and start an infection, making the healing process much more painful.
- Refrain from vigorous activity for 24 hours. Increased blood pressure caused by vigorous activity may start the bleeding again.
- Manage pain with analgesics as directed by the dentist. Most simple extractions are easily managed with either Panadol or Nurofen Panadiene Extra or Nurofen Plus includes a moderate amount of codeine to provide increased pain control if needed. These are over the counter pharmacy supplied drugs. In extreme cases, the dentist may prescribe Panadiene Forte or Tramadol for severe pain where there has been extensive bone surgery to get to the tooth or if there is severe pain from infection.
- Ice packs may be recommended for the first couple of hours after some extractions known to cause major bruising eg. wisdom teeth removal. After 24 hours regular warm pack application eg. wheat bag can speed recovery.
- For adults, Taking 2 moderately strong analgesics, eg. Panadiene Extra before the local anaesthetic wears off is a good strategy as it prevents a strong ramping up of pain when the local anaesthetic wears off. We often recommend 2 Panadiene Extra as soon as you get home from surgery, 2 Nurofen Plus 4 hours after that and 2 Panadiene Extra again 4 hours after that, then to see if the pain can be controlled at a lesser dose or ordinary Panadol or Nurofen. Note that it is not safe for an adult to consume more than 8 Panadol or Nurofen in 24 hours. We recommend alternating paracetamol based drugs eg Panadol with ibuprofen based drugs on a 4 hourly basis to prevent the maximum dosage being exceeded with either drug. Ig take 2 Panadol first then in 4 hours 2 Nurofen, then 4 hours later 2 Panadol etc. When possible ease back from how much and how frequently analgesics are taken as pain reduces.
Ongoing pain and swelling following extraction:
Around 5% of extractions result in a socket infection known in lay terms as a dry socket. Any socket which seems to be getting more painful after 4-5 days should be investigated by a dentist. If a dry socket has occurred, we would usually treat this by gently irrigating the socket with saline, and by placing a soothing dressing in the socket to cover the bone. Often antibiotics may be prescribed if other evidence of infection is present. It can take several days to a week for the pain of socket infection to subside. Following the advice for socket care after extraction will minimise the chance of this occurring.
Swelling increasing for up to 3 days after surgery is normal with many extractions, provided it is reducing by day 4. Likewise some bruising often accompanies some extractions, particularly lower wisdom teeth and any lower tooth in an older individual. This bruising will fade after 4-5 days. Ice pack applications within 3-4 hours of the extraction minimise this bruising.
Following root canal treatment:
Some level of pain following each stage of root canal treatment is normal and does not indicate a problem. This pain is usually mild and easily controlled with Nurofen/Panadol. If you experience more severe pain or pain increasing in intensity after 3 days, you should call our surgery for advice, since this can indicate infection.