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After Exposure of an Impacted Tooth
Do not disturb the wound. If surgical packing was placed, leave it alone. The pack helps to keep the tooth exposed. If it gets dislodged or falls out do not get alarmed.
Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding which results in your mouth filling rapidly with blood is unlikely, but can frequently be controlled by biting with pressure on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call for further instructions.
Swelling is a normal occurrence after surgery. Many impacted teeth are canines located on the palate, in which case the swelling is generally localized to the roof of the mouth and there is no particular treatment for this. It will resolve. To minimize facial swelling, apply an ice bag or a plastic bag filled with ice cubes and wrapped in a towel on the cheek in the area of surgery. Apply the ice for 15 minute periods with short breaks as much as possible for the first 36 hours.
Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet when you are comfortable unless otherwise directed.
Many patients having this procedure are children and you should have received instructions and a prescription from you doctor at or before surgery. Healthy children may use over-the-counter analgesics as directed on the bottle and if additional pain control is required, please follow the instructions on your prescription. Be careful about using Tylenol in addition to the prescription (see below). The following information is for healthy adult size patients only with normal liver and kidney function and who are not taking other medications. Please ask your doctor about dosing for children. You may begin taking pain medication as soon as you feel the local anesthetic wearing off. For mild to moderate pain, Ibuprofen (Advil or Motrin) may be taken. Ibuprofen, bought over-the-counter comes in 200 mg tablets: 2-3 tablets may be taken every 6-8 hours as needed for pain. Taking this medication every 6-8 hours for two days or more will greatly enhance the effects of the medication. Patients who do this tend to have less pain than those who do not. Tylenol may be taken instead of Ibuprofen, but be aware that your prescription pain medication may contain Tylenol also. For severe pain, the prescribed medication should be taken as directed on the bottle, in addition to Ibuprofen or instead of regular Tylenol, unless otherwise directed. The prescribed pain medicine will make you groggy and will slow down your reflexes, alertness, and concentration. Do not drive a vehicle, work around machinery or other dangerous areas such as a hot stove, and do not be responsible for child care. DO NOT drink alcoholic beverages. For most patients, pain or discomfort following surgery will subside each day after the 3rd day. If pain persists, it may require attention and you should call the office. DO NOT take any of the above medication if you are allergic, have had a reaction to, or have been instructed by any doctor not to take it.
Maximum dose of Ibuprofen is 800 mg every six hours and 3200 mg in 24 hours.
Maximum dose of Tylenol is 1000 mg every six hours and 3000 mg in 24 hours.
Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can. Rinse with warm salt water (1/4 teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete.
REMEMBER: A clean wound heals better and faster.
Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Generally, it is best to avoid strenuous activity for one week. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.
Usually, antibiotics are not prescribed for this procedure. If you have been prescribed antibiotics, take your prescription as directed. Antibiotics may be prescribed to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions or develop multiple unformed (watery) bowel movements.
Nausea and Vomiting
Nausea and vomiting can occur due to a combination of altered diet, reaction to anesthesia, and medications (especially prescription pain medications). In the event of nausea and/or vomiting following surgery, do not take anything by mouth, if possible, for about an hour, including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking food and the prescribed medicine. Nausea due to medications is less likely if you have some food in your stomach. You may call our office if the nausea and/or vomiting persists.
Occasionally, an allergic reaction can occur to one of your medications. Allergic reactions usually consist of itching, rash, or hives. If such a reaction occurs, you should stop taking the medications and call our office. Over-the-counter Benadryl may help alleviate these symptoms, but also will cause drowsiness. If a severe reaction such as swelling of the face or neck or difficulty breathing occurs, contact your nearest hospital emergency department and/or call 911 immediately.
Sutures are often placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged soon after surgery and this is no cause for alarm. Just remove the suture form your mouth and discard it. Usually, sutures are used that will dissolve and come out on their own in 4-8 days.
Bracket and Chain
Many exposures include the bonding of a bracket and small chain to the impacted tooth. The chain will protrude through the gums and will be ligated or tied to an adjacent tooth or orthodontic bracket. Please do not disturb the chain. If you have not done so already, you should make your orthodontist aware of your surgery date and inquire as to when he or she would like to see you next. Preferences vary among dentists. Rarely, a bracket will come loose and need replacement. In this case, your orthodontist should contact us.
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