Recovery After Oral Surgery

Treating Pain After Oral Surgery

The two main therapies used to alleviate pain after oral surgery are ice application and pain medication.

Ice

Your surgeon will give you specific instructions about icing, which can reduce both pain and swelling. For instance, they may recommend applying ice packs to your face (on the side where the surgery was performed) for 15-minute intervals (15 minutes on and 15 minutes off).

Pain Medication

Your oral surgeon will likely recommend either Tylenol (acetaminophen), a nonsteroidal anti-inflammatory (NSAID) like Advil (ibuprofen), or a combination of the two, to ease your post-operative pain.

For optimal pain relief and to avoid the use of opioids, an "around-the-clock" pain regimen is generally recommended, instead of treating pain only when it surfaces.

Since opioids carry a risk of dependence and other undesirable side effects like respiratory depression, sedation, and constipation, they are generally avoided as first-line pain medications for oral surgery. That said, for more severe cases, your surgeon may prescribe an opioid for breakthrough pain.

The Healing Process

Postoperative instructions for oral surgery are often outlined using a day-by-day approach.

Below is the typical healing process for a surgical tooth extraction.

First 24 Hours

During the first 24 hours after surgery, your surgeon will likely advise you to rest, not engage in any physical activity, and stay home from school or work.

You also will likely be told to not drive, especially if you underwent general anesthesia or were given a sedative.

Bleeding

With a tooth extraction, slight bleeding is normal for up to 24 hours after surgery.

To help ease the bleeding, your surgeon may recommend biting down with firm pressure on a piece of damp sterile gauze for 30 minutes to one hour.

If bleeding continues, your surgeon may instruct you to bite down on a moist tea bag, as the tannic acid in teas has been shown to reduce bleeding and assist with clotting.

Swelling

Swelling is a normal response to undergoing oral surgery. To minimize any swelling, you will probably be instructed to keep your head propped up with two to three pillows when resting and sleeping.

Icing also helps reduce swelling and inflammation.

Two to Three Days

By day two or three, you may be able to resume normal activities, which may include going back to work or school. That said, for more extensive procedures, like having multiple teeth removed, it may be one full week (or more) before you are able to do this.

The two-to-three day mark is also around the time that any stitches in your mouth will dissolve or fall out on their own. Less commonly, your stitches will need to be removed by your oral surgeon.

Seven to 10 Days

By post-operative day seven to 10, swelling is usually completely gone. If this is not the case or you have any concerns, be sure to reach out to your surgeon.

Besides swelling, stiffness in the muscles of the face should also ease up at this point. That said, you may see slight bruising, especially if the surgery involved your lower wisdom teeth.

Sometimes, an antibiotic is prescribed after oral surgery to help prevent infection. Since most antibiotic regimens last around seven to 10 days, you may be at or near the end of your course at this point.

Two Weeks

Most oral surgeons will recommend a two-week follow-up appointment. During this appointment, your surgeon will evaluate your wound and look for any signs of complications, like an infection. Be sure to not skip this appointment, even if you are feeling fine.

Oral Hygiene

Usually, after oral surgery, your surgeon will advise you to brush gently with warm water (not toothpaste) and to rinse with a saline or saltwater solution. This will naturally help keep the surgical site clean and aid in the healing process. Instead of spitting out the warm salt water, allow it to simply fall out of your mouth.

By day three or four, your surgeon may give you the OK to start gently brushing with toothpaste and flossing. You should avoid vigorous rinsing or spitting, as this can increase bleeding.

Of note, about a week after you have undergone a tooth extraction, your surgeon may recommend irrigating the site of the tooth extraction a few times a day using a syringe filled with tap water. The pressure from the syringe can dislodge any food particles from the site.

Returning to Normal Activity

Generally speaking, a person may resume normal activities by postoperative day two to three, which may include going back to work or school and engaging in their typical exercise routine.

Foods to Eat

Besides staying hydrated, it's important to follow your surgeon's diet recommendations, which usually entail eating cold liquids and soft foods for the first day or two (sometimes longer, depending on your case) after oral surgery.

Examples of such cold liquids and soft foods include:

• Yogurt
• Milkshakes
• Smoothies
• Gelatin
• Sherbert
• Pudding
• Applesauce

A couple of days after surgery, you may be allowed to incorporate warm, soft foods such as mashed potatoes, broths, and soups. Be sure to avoid chewy, crunchy foods (e.g., popcorn or carrots) for the first week, as these foods can get stuck in and irritate the tooth extraction site.

Finally, in order to optimize your postoperative healing, your surgeon may also recommend that you take a vitamin C supplement or consume foods that are rich in this vitamin.

Foods and Items to Avoid

During your surgery, a local anesthetic will likely be given into your mouth to numb it. The numbness usually only lasts a few hours but can be longer for certain procedures, like a wisdom tooth extraction.

While the numbness is wearing off, it's important to avoid hot foods and drinks that may inadvertently burn your mouth (because of the loss of sensation).

Since drinking alcohol and smoking have been found to impair wound healing in the mouth, your surgeon will want you to avoid these habits for up to a week or two after the surgery.

When to Seek Medical Attention

Even if you are attentive and careful with your postoperative instructions, issues can still arise. Be sure to contact your surgeon or seek medical attention right away if you encounter one or more of the following problems:

• Bleeding that cannot be stopped with gauze
• Signs of infection like a fever that lasts more than 24 hours after surgery and/or the presence of pus (thick whitish/yellow substance) in your mouth
• Pain that is severe or persistent, despite taking medication
• Swelling that is severe or persistent, especially if it affects swallowing or breathing
• Signs of an allergic reaction (for example, a new rash)
• Persistent numbness in your mouth and lips after the local anesthetic wears off