Teeth Extractions: What You Need to Know

Pre-Operative Instructions (Sedation/General Anesthesia)

Extraction (removal) of teeth may be necessary if broken, damaged, decayed, or loose teeth cannot be saved. If a tooth is broken or damaged beyond repair, a filling, crown or treatment may not be enough to save the tooth. Sometimes, baby teeth or overcrowding teeth may need to be extracted to make space for proper dental care.

Infected teeth of patients receiving cancer drugs may have a weakened immune system, that requires extraction of teeth. Also, patients may be at high risk of infections that may develop from organ transplant surgeries, as a result from medications that could suppress the immune system. In these cases, certain teeth might be a source of infection that need to be removed for preventative care.

Your doctor will determine if teeth extraction is necessary and discuss why this option would be needed for proper treatment for your oral health.

All patients undergoing a general anesthetic or intravenous sedation, please read the following information carefully.

Before Surgery

1. DO NOT eat any food after midnight on the night before your surgery.
2. DO NOT drink any fluids, including water, after midnight the night before surgery.
3. DO NOT smoke or consume alcohol for 24 hours before surgery.
4. Patients taking birth control medications please be advised that its effectiveness may be reduced when taking antibiotics.

Failure to comply with these instructions can jeopardize your well-being prior to surgery and your surgery MAY BE CANCELLED.

Surgery Day Instructions

1. Any medications provided by the clinic or taken on a routine basis that have been approved by your doctor can be taken with a SMALL SIP of water only prior to surgery.
2. A responsible adult must accompany you to the office, be prepared to stay and take you home and remain with you until you have recovered from the effects of the anesthetic. You are considered legally impaired and CAN NOT drive for 24hrs after receiving anesthesia. PLEASE NOTE: IF YOU DO NOT HAVE A RIDE ON SURGERY DAY, YOUR SURGERY MAY BE CANCELLED.
3. Shower, brush your teeth and put on comfortable clean clothing (preferably dark colours) which should include a short sleeved shirt.
4. DO NOT wear makeup, nail polish, contact lenses. Remove any tongue, nose or lip jewellery.
5. Asthmatic patients: please bring your inhalers.
6. Diabetic patients: please bring your insulin and glucometer if available. Please check your blood glucose prior to the procedure.

Please note that we do our best to stay on schedule. Due to the unpredictable nature of surgery, your appointment time is an approximation and you may be waiting 1-2 hours. If we are running late, it is because the patient ahead of you has been given additional time and attention to ensure a successful surgery. The same consideration will be given to you in a similar situation. Your patience and understanding is greatly appreciated.

Post-Operative Instructions for Extractions for Dentures

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

Immediately Following Surgery

• After your surgery, your doctor will check to see if the dentures fit. If they fit well, they will be left in your mouth to provide pressure on the extraction sites in order to help stop the bleeding. Often times, the dentures aren’t a perfect fit and will be left out of your mouth. If that is the case, gauze will be placed in your mouth to provide pressure instead.
• You may have difficulty feeling your lips, cheeks or tongue due to numbness. This is a temporary feeling and will wear off within 2-4hrs. Please take care not to bite your lips, cheeks or gums.
• Apply ice packs to your face to reduce swelling for the first 24 hours after surgery.
• Take pain medication as prescribed as soon as possible.
• Do not rinse or spit the day of surgery, as this may prolong the bleeding.
• Make sure to get lots of rest today.

Special Precautions/ Denture Care

• Dentures can be kept in the mouth until the next day or may be removed earlier if discomfort becomes a problem.
• DO NOT persist on trying to wear uncomfortable dentures. Discomfort indicates that there are pressure points on the denture that may cause breakdown and ulceration of the sensitive gum tissue. Leave the denture out of the mouth until an appointment can be made with your dentist or denturist to have an adjustment done.
• If leaving dentures in, ensure you remove the dentures each morning and evening and clean them with an appropriate denture brush and cleanser. While the dentures are out, rinse your mouth gently with warm salt water (1/2tsp in 1 cup water) or the Chlorhexidine mouth rinse and immediately replace the dentures. Do this 2-3 times a day to ensure gum tissue stays clean while they heal.
• If your dentures are being left out, use the syringe to irrigate the extraction sites 3-4 times a day (after each meal) with the warm salt water solution (see wound care section below)
• If you are not having pain while wearing the dentures, they should be left in overnight for the first 3 nights after surgery to reduce swelling. If you leave the denture out for any long period of time, swelling will take place, making it very difficult or impossible to reinsert your dentures. If this happens, it is not a problem. Simply leave the denture out for 48 hours or until the swelling is reduced enough for you to reinsert your denture. After the first 3 nights, swelling will no longer be a concern and dentures should be left out of the mouth while you sleep, as well as for a few hours throughout the day. This will allow for a faster and more comfortable healing.
• After healing has taken place, the dentures should NEVER be worn at night while you sleep. This will prevent premature bone loss and early loosening of the denture.
• Make an appointment to have the fit of your denture checked and corrected by your dentist or denturist as per his/her recommended protocol.
• As healing progresses, the gum and bone will alter their shape and the dentures will gradually loosen. Periodically, your denturist will have to reline the dentures in order to keep them fitting properly. Between the relines, the use of a denture adhesive can be helpful.

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 15-20seconds 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.

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 frostbite.
  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.
  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, and 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 anesthetic 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. Take as prescribed on the box. Discontinue your medications TEMPORARILY until the nausea subsides but always restart and finish them as directed.

Wound Care & Irrigation

If you have been provided with an irrigator (small plastic syringe), you should begin using it the day after surgery on the extraction sites and after each meal and at bedtime. Fill the irrigator with lukewarm salt water (1/2 tsp in 8 oz water) or the Chlorhexidine mouth rinse. Make sure to direct the tip of the irrigator into the extraction site and flush out the extraction site completely. This may be uncomfortable at first, but keeping the site clean reduces the chance of infection or dry socket. Continue irrigating the sockets until the extraction site has closed. Normally this takes about 2-3 weeks.

If your doctor feels you will benefit from it you may have been prescribed a CHLORHEXIDINE mouth rinse as well. Use this mouth rinse as directed along with salt water rinses throughout the day.

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.

Dry Socket

After a tooth extraction, it is important for a blood clot to form to stop the bleeding and begin the healing process. A dry socket occurs when the blood clot is dislodged from the surgery site exposing the bone and the fine nerve endings. A small percentage of patients may experience a dry socket. Signs of a dry socket generally consist of an increase in jaw discomfort 3-6 days after surgery that is not relieved by pain medication. If this happens, please call the office (403) 235-0505. Follow these precautions to avoid a dry socket:

• Do not smoke
• Avoid sucking action from smoking, spitting or using straws for first 24hrs
• Clean the extraction site as described in the wound care section
• Do not rinse your mouth excessively for first 24 hours as it interferes with blood clotting

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 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 for routine extractions 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 charge for follow-up visits.

Questions

Your well-being is our primary concern. It is our sincere desire that you have the most comfortable and least anxiety provoking experience. 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.

Post-Operative Instructions for Surgical Extractions

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

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 15-20seconds 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.

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.

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 & Irrigation

If you have been provided with an irrigator (small plastic syringe), you should begin using it the day after surgery on the extraction sites and after each meal and at bedtime. Fill the irrigator with lukewarm salt water (1/2 tsp in 8 oz water) or the Chlorhexidine mouth rinse. Make sure to direct the tip of the irrigator into the extraction site and flush out the extraction site completely. This may be uncomfortable at first, but keeping the site clean reduces the chance of infection or dry socket. Continue irrigating the sockets until the extraction site has closed. Normally this takes about 2-3 weeks.

• If your doctor feels you will benefit from it you may have been prescribed a CHLORHEXIDINE mouth rinse as well. Use this mouth rinse as directed along with salt water rinses throughout the day.

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.

Dry Socket

After a tooth extraction it is important for a blood clot to form to stop the bleeding and begin the healing process. A dry socket occurs when the blood clot is dislodged from the surgery site exposing the bone and the fine nerve endings. A small percentage of patients may experience dry socket. Signs of dry socket generally consist of an increase in jaw discomfort 3-6 days after surgery that is not relieved by pain medication. If this happens please call the office. To avoid a dry socket follow these precautions:

• Do not smoke
• Avoid sucking action from smoking, spitting or using straws for first 24hrs.
• Clean the extraction site as described in the wound care section
• Do not rinse your mouth excessively for first 24 hours as it interferes with blood clotting

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 (403) 235-0505 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 for routine extractions 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.