Helping Impacted Teeth Erupt — What You Need to Know

Post-Operative Instructions

Proper care after surgery has an important effect on healing. Please read the following instructions carefully.

Procedure

An exposure is a procedure to expose a tooth that is malpositioned beneath the gum tissue and prepare it for realignment by an orthodontist. The most common scenario will call for the orthodontist to first place braces on teeth. In a simple procedure performed at Mahogany Oral & Maxillofacial, the gum on top of the impacted tooth will be lifted to expose the hidden tooth underneath. Once the tooth is exposed, your doctor will bond a bracket to the exposed tooth. The bracket will have a small gold chain attached to it. This gold chain will be temporarily attached to the orthodontic wire. If there are no braces on the teeth the chain will instead be temporarily bonded to a tooth. The gum tissue will then either be sutured so that the impacted tooth remains exposed, or the gum tissue may be sutured to re-cover the tooth.

Be sure to inform your orthodontist once the surgery has been complete. The orthodontist will likely see you within 1 to 2 weeks to have the chain engaged. This involves a rubber band being attached to the chain to put a light pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place.

Immediately After Surgery:

• Bite firmly on the gauze pads covering each extraction site to help stop the bleeding. We will change the gauze before you leave the office. You may need to change the gauze pads once more at home, leaving the gauze in for an additional 30 minutes. Remember to remove the gauze before eating or drinking
• You may have difficulty feeling your lips, cheeks, and/or tongue due to the numbness from the local anesthetic. This is a temporary feeling and it will wear off within 2-4hrs. Please take care not to bite your lips, cheeks and/or gums.
• Apply ice packs to your face to reduce swelling for the first 48h hours after surgery.
• Take the pain medication as prescribed as soon as possible.
• Do not rinse or spit the day of the surgery, as this may prolong the bleeding.
• Make sure to get lots of rest on the day of the surgery.

Bleeding

One of the most common concerns after surgery is bleeding. Surgery causes an increase in salivary flow which in addition to the normal oozing of blood may alarm you unnecessarily. Some oozing is normal for 24 to 48hrs following surgery and should not be a concern. It is common for saliva to be slightly blood tinged for several days following surgery.

• Use a piece of gauze (or a moist teabag), folded into a small wad, and place it over the surgical site. The idea is to apply gentle pressure on the surgical site. Apply pressure for at least 20-30 minutes after surgery. The gauze can be changed when it feels saturated. One may need to change the gauze and repeat the previous steps a few times to decrease bleeding. If bleeding is controlled, the gauze is no longer necessary.
• DO NOT rinse your mouth or use a straw for the next 24 hours.
• DO NOT smoke or consume alcohol for the next 24 hours.
• DO NOT perform strenuous activities for the next 3 days..

If you are bleeding excessively, apply firm pressure by folding and placing a gauze pad directly over the extraction site and bite firmly on the gauze for one hour. Excessive bleeding is defined as pooling or dripping of blood out of the extraction sites within 15-20 seconds of removing the gauze. If excess bleeding continues, apply a gauze pad for an additional 30 minutes. If excessive bleeding persists, contact the 24hr office number.

Pain management

Some amount of discomfort is to be expected following any surgery. If your doctor thinks that you will benefit from a prescription pain medication, you will receive a prescription following your surgery. Please follow the prescription instructions carefully.

• Ibuprofen (such as Advil, Motrin) works very well for many patients and can significantly reduce the amount of narcotic pain medicine (Tylenol 3, Percocet) needed. You may find that taking 400-600mg of ibuprofen every 6 hours on a regular schedule for the first 2-3 days is all the pain medicine needed. If needed, you may take both the ibuprofen and the narcotic pain medication as prescribed for maximum pain management. Continue to take the pain medication as directed and as needed for pain relief. You can wean yourself off the pain medications if the pain is controlled. You may or may not need to take all the prescribed pain medications for this reason.
• Begin taking your pain medications as directed as soon as you get home and before the local anesthetic (freezing) wears off. Your pain medication can be taken with liquids but it is important to get some soft food in your stomach as soon as possible. Take all subsequent doses along with food to minimize nausea.

Infection

If your doctor thinks that you will benefit from antibiotics to prevent infection, you may receive a prescription for one. If prescribed, take as directed. It is important to ensure you finish the full course of the antibiotic.

• If you are experiencing nausea you may TEMPORARILY stop taking the antibiotic until the nausea subsides, however you must always restart and finish the antibiotics as directed.
• If any medications cause hives or itching, discontinue them immediately and call the office (403) 235-0505.

Call our office if you notice any signs of infection including:

• Increased swelling after 5 days
• Swelling that is painful, hard or hot
• A foul taste or odour in your mouth
• A temperature above 38°C

Swelling

Swelling around the mouth, eyes, and cheeks is a normal reaction to the surgery and usually takes 2-3 days to fully develop. To help prevent swelling:

• Apply ice packs to the cheeks for 20 minutes on and 20 minutes off. Keep your head elevated for first 48 hours after surgery. Ice serves no purpose after 48 hours and may contribute to jaw stiffness.
• Use crushed ice in a ziplock bag or a bag of frozen peas bag wrapped in a moist cloth to prevent frost bites.
• After the first 5 days, you can begin using a heating pad or moist heat for relief of swelling, bruising, and stiffness of the jaw.
• Apply heat 4 times/day for 30 minutes time intervals.
• If your doctor thinks that you will benefit from it, you may have receive a prescription for a medication (Dexamethasone) to help with swelling. Take the medication as directed. Occasionally, this medication will cause some people to experience tingling in their hands and feet. If this happens, stop the medication and contact the office (403) 235-0505.

Diet

Try to resume a normal diet after the first 3 days. Initially you may feel more comfortable with a softer diet. Suggested foods are soups, noodles, scrambled eggs, pasta, pudding, yogurt, ice cream, juices, milkshakes, pancakes, anything soft that you can tolerate. Drink lots of fluids to rehydrate. Avoid hard, crunchy foods such as chips that may disturb the extraction site for at least 3 days. No alcoholic beverages should be consumed for at least 24hrs post anaesthetic or as long as you are taking narcotic pain medications and antibiotics.

Nausea

You may experience some nausea which is common following a general anaesthetic/sedation. Frequent sips of carbonated drinks such as ginger ale, will usually help stop the nausea. Follow this with a clear diet, apple juice, clear tea, broths, and jello. If this is not effective you may use Gravol an over the counter medication and take it as prescribed. Discontinue your medications TEMPORARILY until the nausea subsides but always restart and finish them as directed.

Wound Care

If prescribed to you, use the Peridex (Chlorohexidine 0.12%) mouth rinse three times a day after brushing. Swish in your mouth for thirty seconds then spit it out. You may also rinse your mouth with a salt-water solution (1/2tsp salt in 1 cup of water) several times daily.

Sutures (Stitches)

Your sutures will dissolve on their own 3-6 days after surgery but they may come out at any time after surgery. You may notice that they loosen after the swelling of your gum tissue decrease. This is completely normal.

Resuming Activities

If you have undergone a general anesthetic, you should go home and rest for the remainder of the day. Do not drive or engage in strenuous activities (sports) for at least 48hrs. On average most patients will take 1-2 days off from normal activity. You may return to work/school when you feel you are recovered.

Smoking

Do not smoke for at least 3 days following surgery.

Brushing & Rinsing

The day of surgery you may brush your teeth, but try to avoid the surgical site for at least 3 days. Avoid rinsing, or spitting the day of surgery. If you wear a retainer, you may continue to wear it if is comfortable for you to do so.

Straws

Do not use a straw for first 24hrs after surgery.

Temperature

A slight rise in temperature can occur for 24-48hrs after surgery and this is normal. If it continues beyond this time, please call the office (403) 235-0505.

Bone Chips

Occasionally small chips of bone may appear in the surgical site. This can happen anywhere from a few days to several weeks following the surgery. Usually they will eventually fall of by themselves . If they are causing you significant discomfort you can contact our office for an appointment.

Numb Lip and Chin

Lip numbness of the side in which the tooth was extracted may develop. This is known as “paresthesia” . It is most often a temporary condition that will correct itself. It can last a variable length of time. If it lasts greater than 3 weeks please notify the office.

Follow Up Appointments

Generally no follow up is needed unless otherwise specified by the surgeon. The nurse will let you know if a follow up appointment is necessary and it will be scheduled for you. There is no additional charges for follow up visits.

Questions

Your well-being is our primary concern. It is our sincere desire that you experience be the least uncomfortable or anxiety provoking. Should you have any questions regarding your recovery, please do not hesitate to contact our office at (403) 235-0505.

Emergencies

If any unusual symptoms should occur please call our office at (403) 235-0505. If you are calling after our office hours or on the weekend, the answering machine will direct you to the oral surgeon on call. In the event of an unexpected admission to a hospital related to a treatment done at our facility, please make sure you notify us.