Tooth Extractions – Greater Steele Creek and Fort Mill Communities

You and Dr. McWatters may determine that you need a tooth extraction for a variety of reasons including extensive decay, fracture, malalignment, or advanced periodontal disease. Extraction is usually recommended if the tooth is not savable with a restoration.

Removal of a compromised tooth will help alleviate pain and infection, but there are consequences that should be considered. Extraction of a tooth can possibly lead to shifting of adjacent teeth and chewing difficulty. Dr. McWatters will spend time with you to discuss treatment options for tooth replacement following extraction.

Tooth Extraction Procedure:

As most teeth that are planned for extraction have significant loss of structure due to decay or malalignment, the removal can be difficult and require invasive surgical manipulation to handle the buried tooth structure. In order to eliminate the painful numbing needles, uncomfortable pressure sensation and sounds, Dr. McWatters recommends IV sedation to decrease anxiety and pain associated with the procedure. He will discuss the full procedure, anesthesia details, as well as pre and post-operative instructions at the consultation appointment.

Post Operative Care:

• Gauze placed over the surgical area should be removed in 30 minutes, replace as necessary
• Take the prescribed pain medications as outlined on the regimen card
• Advance your diet to normal as soon as local anesthesia dissipates
• Gentle brushing of area with care around sutures is recommended

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. If bleeding does not subside, call for further instructions.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to inflammation/surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days postoperatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be used in a 20 minutes on, 20 minutes off continuous cycle while you are awake. After 24 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. 24 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

The pain following dental extractions is inflammatory in nature. The anti-inflammatory regimen provided by Dr. McWatters targets this process and should be followed consistently for the first several days. This consists of 600-800mg of Ibuprofen every six hours alternating with 500-650mg of Tylenol every six hours. A narcotic pain medication may be prescribed as a backup analgesic for refractory pain if multiple impacted teeth are removed or invasive surgery is performed. The narcotic pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken while your mouth is numb. Do not use straws. Drink from a glass or use a spoon. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing twice a day with the prescribed antibacterial mouthwash or warm salt water.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given 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.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least 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 solid foods and the prescribed medicine.

Other Complications:

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call Dr. McWatters if you have any questions.
• A slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the Tylenol or ibuprofen should be taken to reduce the fever.
• You should be careful going from the lying down position to You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light-headed when you stand up suddenly. Before standing up, you should sit for one minute and then get up.
• Occasionally, patients may feel hard projections in the mouth with their They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously.
• If the corners of your mouth are stretched, they may dry out and Your lips should be kept moist with an ointment such as Vaseline.
• Sore throats and pain when swallowing are not The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
• Stiffness of the jaw muscles may cause difficulty in opening your mouth for a few days following This is a normal post-operative event that will resolve with increased jaw movement and time.

Finally

Sutures are placed in the area of surgery to minimize postoperative bleeding and to help healing by re-approximating the tissue. The sutures will dissolve by themselves in 7-10 days. Sometimes they become dislodged; this is no cause for alarm. Just remove the suture from your mouth and discard it.

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call my office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the meantime, the area should be kept clean, especially after meals with salt water rinses or a toothbrush.

Brushing your teeth is okay – just be gentle at the surgical sites.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain in the ear may occur 2-3 days following surgery. Call the office if this occurs.