Fever and pain
While it is normal for the body’s temperature to be slightly elevated for 24 hours after oral surgery, individual experience of pain post-surgery can vary significantly. Regular use of anti-inflammatory / pain relief medication is recommended for the first 1 to 2 days and is best started as soon as possible after surgery and before the local anaesthetic wears off.
The most useful medications for treating fever and pain are regular Paracetamol (4-6 hourly) and an anti-inflammatory (either Nurofen 4-6 hourly, or a slow release tablet, such as Naprosyn SR once daily). In addition, you might need a stronger tablet, such as Endone, for the first day or two. This should be in addition to the simple pain-relievers, not instead of them. You must not operate machinery or drive a vehicle while taking Endone.
You should take regular pain/fever medication for the first 1 to 2 days, whether or not you are feeling pain. It is normal to need painkillers for up to a week or so.
- The number of ibuprofen-containing tablets you take should not exceed 12 in 24 hours (2400mg/24 hours).
- The number of paracetamol-containing tablets you take should not exceed 8 in 24 hours (4000mg/24 hours).
- Codeine use should be limited; this medication can have unpleasant side effects (e.g. nausea, vomiting, constipation, sedation). Endone can also have similar effects, so avoid prolonged usage.
Blood-stained saliva is common for 24 to 48 hours after oral surgery and is not a cause for concern. If you experience bleeding, bite firmly on a gauze pack for 30 minutes. You may need to repeat this several times before the bleeding stops. If bleeding is excessive despite the above measures, please contact your surgeon for further instructions.
Swelling is a very common side effect of oral surgery, especially with longer procedures, but its occurrence is variable. Ice packs applied as early as possible may slightly reduce any swelling, which can be expected to increase over the first 24 to 72 hours and then begin to subside. Skin (including skin over the neck area) may discolour as the swelling settles. Ibuprofen taken as described above will help reduce any swelling.
Nausea and Vomiting
These are common after general anaesthesia and will resolve as the anaesthetic wears off. Any nausea or vomiting that lasts for more than 24 hours is most likely caused by the post-operative medication you are taking.
All patients having surgery under general anaesthesia will receive, during the procedure, a single dose of intravenous antibiotic prophylaxis to reduce postoperative infection rates. Unless clinically indicated, there is no evidence that an additional course of oral antibiotics will further reduce post-operative infection. Therefore you will not receive post-operative antibiotics unless clinically warranted. In the event that you develop signs of an infection, such as increasing pain and swelling, and sometimes a fever (usually around day 5-10), please contact your surgeon.
Inflammation of the jaw bone after a tooth extraction (known as dry socket) is an uncommon complication. It is caused by dislodgement (or absence) of the blood clot that normally forms as part of the healing process. The signs, which present 3 to 5 days after surgery, are increasing pain, bad breath and a foul taste, with no other signs of infection. A simple dressing can usually manage the symptoms and an appointment can be made to attend to this.
Stitches are used to reposition the gum at the front of the mouth and to help stop troublesome bleeding. They are not always required at the back of the mouth (e.g. after wisdom teeth removal). If stitches are used, they will be dissolvable and will disappear within 1 to 2 weeks. When the gum is stitched you might feel as though your cheek has been tethered, but this will resolve over time..
Resume normal tooth brushing as soon as possible after surgery; it will not damage the healing sockets. The day after surgery you should start to rinse your mouth 3 to 4 times per day. A teaspoon of salt in a glass of warm water is an appropriate rinse for most patients. Patients who have undergone implant surgery or major jaw surgery should use an antiseptic mouthwash for the first two weeks. Alcohol-free 0.2% chlorhexidine mouthwash can be purchased from pharmacies without a prescription. It is generally recommended that you continue to rinse your mouth as above until your first follow-up appointment.
A relatively soft diet will be more comfortable in the period immediately following surgery. Hot and spicy foods should be avoided. Ensure that you maintain adequate fluid intake. After a few days you may wish to practise opening and closing your mouth gently to encourage restoration of normal movement. This may sometimes take a few weeks, depending on the procedure you have had.
This should be restricted to a minimum for the first 2 to 3 days because strenuous activity or exercise may promote bleeding. If you have had a general anaesthetic or sedation, we require that a responsible adult accompanies you home. Under no circumstances should you drive a motor vehicle for at least 24 hours.
Possible post-operative side effects include earache, temporary ache or sensitivity of adjacent teeth, restricted mouth opening, stretching or cracking at the corners of the mouth or discoloration of the skin. These are temporary conditions that will reduce as healing progresses.
We will make a follow-up telephone call in the days following your surgery to confirm your progress. A routine review appointment will be arranged for you around 2 to 3 weeks post-surgery unless otherwise indicated. Review appointments do not incur an additional out-of-pocket charge.
A small pack is sometimes sutured over the exposed tooth to act like a dressing. This pack will usually fall out 7 to 14 days post-operatively. For some patients an orthodontic device may be bonded to the exposed tooth to enable your orthodontist to move the tooth. You can begin circular brushing over an exposed tooth as soon as this feels comfortable.
If you have had a denture inserted it should be left in place for 24 hours, then removed twice a day for cleaning.
After an implant, you should leave out your denture (if applicable) until your practitioner advises you to resume normal daily wear. Antibiotics are prescribed if you have had a bone or gum graft. A second, very minor procedure may be required in 3 to 6 months’ time if the implant is buried at the time of surgery.