Post-Operative Instructions for Extractions and Bone Grafting

Gauze Packs: Change the gauze and bite  gently on it for thirty minutes at a time and then change it.  Do this until the bleeding has stopped.

Upon your arrival home, you will need to change the gauze that you are biting on.  Extra gauze has been provided in your post-operative surgery packet.  Take a single piece, fold it in half and then fold again into a small, tight pad.  Place pack directly over the surgery site and bite down against the gauze firmly.  This firm, biting pressure is the key to controlling the capillary bleeding from the incision or surgical site.  Keep the gauze packs in place for approximately 2 to 3 hours following surgery, changing every 30 minute to 1 hour.  Moist tea bags may be used in place of gauze to control bleeding.  Remove packs when drinking or eating and replace them with clean packs.  Do NOT sleep with gauze in your mouth. The length of time that you will have bleeding varies from patient to patient, but could persist until the day following surgery.  If profuse bleeding or any other problems occur, please contact Dr. Gocke.

Ice Packs: For the first 24 hours, apply an ice pack or cold compress to the skin over where the surgical site. 

Some degree of swelling and discomfort following surgery is to be expected.  Maximum swelling occurs within 2-3 days following surgery and then typically starts to decrease.  Most swelling resolves by the fifth day after surgery.

Discomfort: After you have eaten or had something to drink, you may begin your medications. For pain and inflammation, take the prescribed 600mg -800mg of ibuprofen (Advil or Motrin) every 6 hours as your main pain relief medication.  In between these doses of ibuprofen you may take one over-the-counter (OTC)  325 – 500mg of acetaminophen (Tylenol). If this regimen is not working for you switch out the OTC acetaminophen for the prescribed narcotic medication.  (See the  chart below for tracking your medication and other additional information). Narcotics may have acetaminophen (noted as: APAP) mixed into them so DO NOT take OTC acetaminophen in conjunction with the prescribed narcotic as you could consume too much acetaminophen.  

Antibiotics: Do take all prescribed medications as directed on the bottle.  The antibiotic (if prescribed) must be taken until it is completely finished.

Antiseptic Mouth Rinse: Start the prescribed mouth rinse the day after surgery.  It is used two times daily for 7 days only. Do not eat or drink for thirty minutes after its use.  If using salt water rinses (8oz. of warm water, mix in 1 teaspoon of table salt) gently rinse for 30 seconds and spit.  

Nausea: Anti-nausea medication was given via your IV during the anesthesia.  If needed, your doctor can prescribe an anti-nausea medication for your postoperative recovery.    For recurring nausea, call your doctor office for recommendations.    

Arnica Montana:  If this was given to you, continue to dissolve 5 pellets under the tongue 3 times a day for 5 more days.

Due to local anesthetic used, there will be “numbness” in the area of surgery that may last at least 4-8 hours.  This may cause you to drool or complain of a “funny feeling”.  Take special care that you do not attempt to chew foods until after this numbness has subsided so that you do not inadvertently bite your lip, tongue or cheek.

For the first several hours following surgery, you will need to stay on a cool, soft diet.  Foods such as Jell-O, pudding, applesauce, popsicles, Gatorade, and fruit juices are recommended. If you had IV Anesthesia – It is recommended that you do not eat dairy products such as yogurt, milk or ice cream until you have eaten a non-dairy food first, as dairy products have been known to cause nausea after anesthesia.  You may progress to mashed potatoes, scrambled eggs, cooked cereals, or soups the evening of surgery, but allow these foods to cool down significantly first.  Hot foods could aggravate the bleeding if begun too quickly.  You should refrain from slurping up noodles, sucking through straws, vigorous swishing, vigorous spitting and smoking as this may interfere with healing and may cause the blood clots (necessary for healing) to dislodge from the surgical site. Advance your diet as you feel comfortable. Avoid: Seeds, Nuts, Rice and Popcorn for a period of 2 weeks.  

DO NOT CHEW ON THE HEALING ABUTMENT.

Brushing: Brush your teeth as usual and keep your mouth as clean as possible throughout recovery. Avoid the areas of surgery with the bristles of the toothbrush for the first 7 days. After 7 days start to gently brush the surgical site.  After one week increase the brushing to a gentle pressure on the gum tissue.  After two weeks you should be able to brush this area just like the rest of your mouth. 

Rinsing: In addition to any prescribed mouth rinses, warm salt water rinses (8 oz. water mixed with 1 teaspoon of salt) may be started the day following surgery and utilized 3 to 4 times per day to help keep the surgical site clean and free from food particles.  Remember, gentle rinsing is fine, but avoid vigorous rinsing.

If you had IV Anesthesia – most people will sleep for an extended period of time following surgery.  Keep your head elevated while resting and sleeping.  This will help to minimize swelling.  Rest and sleep in recliner or with several pillows under your head.  DO NOT sleep flat on your back or flat on your stomach the first 24 hours after surgery.  If you had IV anesthesia – When you first awaken, you may require assistance with your meals, taking all medication, and navigating to the restroom.  Please have someone attend to you for the first 4-6 hours after surgery. While you are resting, place an old towel or pillowcase over your pillow, as some drainage is common while you sleep or turn on your side

2-3 days after surgery, you may experience tightening of the lower jaw in the area of the surgery. Use warm compresses or a heating pad. Then, massage outside the surgery sites, gently use your fingers to stretch your mouth open to your maximum opening, hold for 10 seconds, and relax.  Do 4 sets of 10 stretches each day until opening normal again.  This will reduce prolonged discomfort and return you to a normal state more quickly.   

The stitches (if required) are designed to dissolve within 1 week to 10 days following surgery.  It is not unusual for small pieces of the sutures to come out prior to this time, however.  If the sutures need to be removed, you will be notified and an appointment will be made for you.

If you have any Questions, please call the Office at (703) 388-2805. You may reach your Doctor after hours using the App or via the main Office Number.