Care of Your Mouth After an Extraction

Instructions for one or more teeth. These instructions apply after one or more teeth are removed. After multiple or difficult extractions, swelling, bruising, soreness, and jaw stiffness may be more noticeable and may take longer to improve.

Bite firmly on the gauze pad for 20 minutes without removing it to check the area. Remove the gauze before eating, drinking, sleeping, or taking medication. Do not sleep with gauze in your mouth.

A small amount of blood-tinged saliva is normal during the first day or two and does not require more gauze. After multiple extractions, mild oozing may be more noticeable.

If there is still active bleeding, place fresh slightly damp gauze directly over the extraction area and bite firmly for another 20 minutes. If bleeding continues, contact our office.

For the first 24 hours, do not spit forcefully, suck on the extraction area, or touch or pick at the area with your tongue or fingers.

Do not use a straw for the first 24 hours.

Do not try to remove food or other material from the extraction site, and do not flush or clean out the area unless specifically instructed.

For the first 24 hours, do not rinse your mouth.

Beginning the next day, gently rinse with warm salt water 2–4 times a day, especially after eating. Mix ½ teaspoon of salt in 8 ounces of warm water. Gently move the water around your mouth – do not swish or spit forcefully.

Continue brushing and cleaning the rest of your mouth. Beginning the next day, brush gently around the extraction area.

Do not use commercial mouthwash or other rinses unless we specifically recommend them.

Wait until the numbness has worn off before eating so that you do not bite or burn your lip, cheek, or tongue.

Choose nutritious soft foods at first and gradually return to your regular diet as it becomes comfortable to chew. After multiple extractions, softer foods may be needed longer. Drink plenty of water and other nonalcoholic fluids.

Avoid very hot food or drinks for the first 24 hours.

For the first few days, avoid hard, crunchy foods or small pieces that can become trapped in the extraction site, such as nuts, seeds, or popcorn.

Do not smoke or vape anything for at least 5 days after an extraction – longer is better. Smoking substantially increases the risk of dry socket and can interfere with healing.

Avoid oral nicotine products, including nicotine pouches, during the first several days. If you need nicotine to avoid smoking or vaping, a nicotine patch is preferable.

Avoid alcohol for the first 24 hours. Do not drink alcohol while taking opioid/narcotic pain medication or any medication that warns against alcohol.

Take it easy for the rest of the day. Normal light activity is fine. Avoid strenuous exercise and heavy lifting for at least 24 hours – 48 hours after multiple extractions or more extensive surgery, unless we tell you otherwise.

Return to normal activity gradually. If activity causes renewed bleeding or throbbing, stop and rest.

Some swelling is normal, especially after multiple extractions or more extensive surgery. Swelling may increase during the first 2–3 days before it begins to improve.

For comfort, apply an ice pack for 15–20 minutes at a time during the first 24–48 hours. Keep a cloth between the ice pack and your skin.

After 48 hours, moist warmth may be used if it helps with remaining soreness or jaw stiffness.

Begin pain medication when you are able to drink and swallow, before discomfort becomes significant.

For a typical adult who can safely take both medications, take 400 mg ibuprofen (two 200 mg tablets) together with 1,000 mg acetaminophen (Tylenol – two 500 mg tablets), up to three times a day as needed for pain.

Do not take additional acetaminophen if you are taking another medication that contains acetaminophen – such as Vicodin, Percocet, Ultracet, Tylenol #3, or Fioricet. Check the label or ask us if you are unsure.

If you cannot take ibuprofen, follow the acetaminophen instructions we gave you instead.

Vitamin C may provide additional help with postoperative pain and healing. A typical adult may take 250 mg three times a day for 10 days, beginning on the day of your extraction (avoid chewable or gummy preparations immediately after extraction). Swallow the tablet with water. Do not place it against the extraction site. Vitamin C supplements your usual pain medication; it does not replace ibuprofen, acetaminophen or treatment of an extraction complication.

Avoid vitamin C supplements if: known primary or secondary hyperoxaluria; advanced chronic kidney disease, dialysis dependence, renal transplant or markedly impaired renal function; active nephrolithiasis or a significant/recurrent history of calcium-oxalate kidney stones; hereditary hemochromatosis or another clinically important iron-overload disorder.

Medical clearance for vitamin C supplements for patients: receiving chemotherapy or radiation therapy; taking deferoxamine or being treated for iron overload; who are pregnant or breastfeeding, if supplementation beyond a prenatal regimen is contemplated.

If prescription opioid (narcotic) pain medication was provided, use it only as directed and only if non-prescription medication does not adequately control your pain. Do not drive or operate machinery after taking an opioid.

If an antibiotic was prescribed, take it exactly as directed.

If stitches were placed, we will let you know whether they will dissolve on their own or need to be removed. Dissolving stitches often begin to loosen within 5–10 days, although some last longer.

Do not pull on or pick at a loose stitch. If one comes out early, this usually does not cause a problem. Contact us if the area opens noticeably, begins bleeding again, or the stitch becomes bothersome.

Some soreness and tenderness are normal. After the first few days, discomfort should gradually improve rather than become worse.

Bruising, swelling, soreness, and jaw stiffness may be more noticeable after multiple or difficult extractions. Gently opening and closing your mouth can help restore normal movement.

You may sometimes feel a small sharp edge or tiny piece of bone as the area heals. These usually smooth out or work their way out on their own. Do not pick at them.

The opening where a tooth was removed may remain visible for several weeks while it gradually fills in and heals.

special situation: sinus communication

Removal of an upper back tooth can occasionally create a small opening between the extraction area and the sinus. If this occurs, we will give you separate Sinus Communication Instructions.

Follow those instructions wherever they differ from these general instructions.

Please contact our office if you have:

• Active bleeding that continues after two periods of firm gauze pressure.
• New or much worse throbbing pain 3–5 days after the extraction, especially if it radiates toward the ear or comes with a bad taste or odor. This may be a dry socket.
• Swelling or pain that continues to worsen after the first 3 days instead of beginning to improve.
• Fever, pus or drainage, increasing redness, or feeling unusually ill.
• Numbness of the lip, chin, or tongue that continues after the numbness from the procedure should have worn off. If we use a long-acting numbing medicine, we will let you know that numbness may last longer than usual.
• A rash, hives, significant itching, or another unexpected reaction after taking medication.
• Any concern about how you are healing.

EMERGENCY

Call 911 or seek emergency care immediately for difficulty breathing or swallowing, rapidly increasing swelling of the mouth, face, throat, or neck, or heavy bleeding that cannot be controlled with firm pressure.