General Post-operative Instructions

• The best way to manage bleeding is with the application of direct pressure
• Create gentle pressure by keeping your mouth closed on a rolled-up gauze.
• The gauze will be most effective when it Is used to apply direct pressure over the surgical site.
  • Please note that this may be uncomfortable at first.
• Keep the gauze in place after leaving interface for one hour after leaving interface Centre.
• Do not sleep with gauze in your mouth as it may be a choking hazard.
• After one hour, remove the gauze. It is normal for there to be some blood on gauze when removed.
• Assess the surgical site in your mouth once gauze removed.
• Minor trickles of blood is normal but there should not be any active bleeding.
• If there is no bleeding from the surgical site, leave the gauze out and begin your nutrition.
• If you notice pooling of blood along the surgical site, further gauze pressure should be applied.
  • Roll up a fresh gauze (similar to rolling up a sleeping bag). Dampen the gauze slightly with tap water and form into a tight ball. Place directly over the surgical site and apply gentle pressure for 20 -30 more minutes.
  • This may be comfortable.
  • In some cases, when one piece of gauze is not big enough to provide adequate pressure, use two gauzes together to create a larger ball.
• If you have to change the gauze more than 2 times at home and are still concerned about bleeding, please call us at the Interface Centre.
• It is normal to have slightly pink tinged saliva for the first 1-2 days after surgery. You may also notice soiling of your pillow. This is normal and you may wish to cover your pillow with a towel.

• The local anesthetic (freezing) administered to your surgical site may last approximately 4-8 hours. Interface surgeons recommend taking pain medication prior to your freezing wearing off, so that the medication will already be working when your freezing is gone.
• The best management for pain relief is a preventive approach.
  • It is best to take the pain medication prior to the perception of pain.
  • Please start taking the pain medications before the freezing (local anesthesia) has worn off.
• If you have been provided 2 or more medications to manage your discomfort, please take them using an alternating schedule. This will provide you with an even pain control and improved comfort.
  • For example: If you have been provided prescriptions for ibuprofen and Tylenol #3, take the ibuprofen as soon as possible after surgery, preferably with something to eat or drink. Then in 2-3 hours, take the Tylenol #3 (again with some food). This can be followed by ibuprofen in another 3 hours, and so on.
• It is best to take the pain medications after breakfast, and before bed with the remaining doses divided for the remainder of the day.
  • If you have pain during your nighttime sleep, please fell free to take the pain medication, but by using the above regimen, you may not need to interrupt your sleep for taking medications.
• Interface surgeons advise that NSAIDs (non-steroidal anti-inflammatory drugs) such as Advil, Motrin, Naproxen, Aleve, Toradol, ibuprofen, ketorolac or aspirin should be used together with Tylenol (acetaminophen) as the basis for your pain relief strategy.
• Narcotic pain relievers (such as Tylenol 3) should only be used for breakthrough pain that cannot be managed with the above medications.
• With good management, surgical pain should resolve in the first 24-48 hours post-operatively.
  Please return any unused narcotics to the pharmacy for safe disposal.
• Ear pain, slight difficultly in swallowing and/or difficulty opening your jaw completely are symptoms which may develop. If you have had a general anesthetic, you may also experience a sore throat. These findings are usually normal within the first week and resolve with time.
• If you are having pain not managed by medications, please call us at the Interface Centre for assessment.

• Proper nutrition after surgery is very important to your overall well-being, and expeditious healing.
• Nutrition can begin after gauze is removed.
• It is not advisable to eat or drink with gauze still in your mouth.
• The local anesthetic effect (freezing) may last for 4-8 hours after surgery While frozen, we do not want you to bite, and traumatize, your cheek or tongue . Please eat and drink carefully.
• While frozen, consume drinks and smooth textured foods (pudding, apple sauce, lukewarm soups).
• Straws should be avoided as the sucking pressure can start bleeding.
• As soon as the freezing wears off and for the next 3-5 days – you may consume a modified diet. Anything you can mash with a fork is good to eat (mashed potatoes, scrambled eggs, oatmeal, pancakes, pasta, chicken, fish, are acceptable).
• Avoid crispy or crunchy foods (chips, nuts, seeds) until the surgical sites are less tender.
• Avoid hot foods and straws for the first 24 hours after surgery.
• You may resume your normal diet at any time when you are comfortable to do so.
• Avoid alcoholic beverages for 2 days following surgery
• Nausea (and vomiting) after surgery may be common, especially if there is inadequate intake of food and fluids. This should settle in the first few hours after surgery .
• If you are having persistent problems with nausea or vomiting after your surgery – please call us at Interface Centre for assessment

• Bruising of the skin along the face, jaws, neck, and at times front part of the chest may occur, sometimes a few days after surgery.
  • Please be assured that this will gradually resolve over time.
  • Once bruising is noted, moist warm compresses will hasten the resolution of bruising.

• Swelling is to be expected in certain cases. Swelling typically increases over the first 2 days post-operatively, reaching its peak on day 3, then gradually disappears over the next 2-3 days.
• The extent of the swelling does correspond to the nature of the procedure, but it is variable. It may sometimes appear dramatic but should noticeably reduce of 3-5 days post-surgery.
• To minimize swelling, an ice pack will be provided. It is recommended for the ice to be applied to the face 15 minutes on, then 15 minutes off for the first 24 hours after surgery when awake.
  • You may also use bags of frozen vegetables, if an ice pack is not available.
  • Avoid direct contact of the plastic against skin.

Steroids or non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen), Toradol (ketorolac), or Naproxen may be prescribed as well which will help minimalize swelling in addition to providing pain relief.

• Your surgeon may have placed stitches in the surgical areas. Most of the sutures used for surgery at the Interface Centre are dissolvable.
• In most cases stitches will resorb 5-10 days following surgery. If your stitches are taking longer to dissolve, do not worry. Extra rinsing will keep stitches moist and help them to go away.
• Sometimes a stitch will fall out earlier than 5 days postoperatively. This is not a problem. If there is no active bleeding from the surgical site, nothing needs to be done. Continue with hygiene practices and gentle mouthwashes as recommended.
• If a stitch is hanging down into your mouth causing a nuisance, do not pull on it. If you, or a caregiver are able, small, clean fine tipped scissors can be used to cut the stitch to a more manageable length. If unable to do so safely, please call us at the Interface Centre for further instructions.

• Do not smoke for 7 days following surgery. Smoking is associated with a higher likelihood of postoperative pain as well as delayed healing of the surgical site.
• Avoid vigorous mouth rinsing and do not brush the surgical site for 24 hours following surgery
• Gentle tooth brushing may resume the day after surgery – avoiding the surgical sites initially.
• Unless otherwise instructed, mouthwashes should start the morning after surgery. A warm salt water solution (add one half teaspoon of salt to 1 cup of warm water) after meals and before bedtime for several days (1-2 weeks) following surgery is advised. Drinking warm tea is also an acceptable alternative if rinsing with salt water is not possible.
• You may be given a prescription mouthwash. You may begin to use this the morning after surgery unless instructed otherwise by Interface staff.
• With any mouthwash, bathe the surgical site for 30 seconds by holding the rinse over the surgical area and then spitting out twice per day. Do not swallow the prescription mouthwash.
• You may be given a syringe to use after your wisdom tooth surgery. Some extraction sites will open slightly and food trapping can be managed with this irrigating syringe. On day 4 after surgery, after eating and before bedtime, draw up warm salt water into the syringe, point the curved tip directly over the extraction site and gently flush the area. This can help to displace any food debris from the surgical site.

• If your surgery was completed under sedation or general anesthesia, you should rest at home on the day of surgery. You may not operate machinery for 24 hours.
• It is possible that you may feel light-headed or weak after surgery, especially if you had sedation or general anesthesia. Resume light activities gradually, as you are able to tolerate them.
• Refrain from strenuous activity for 3-5 days post-operatively. This will keep you comfortable and will help to reduce swelling and chance of bleeding.

• Depending on your surgery, you may be prescribed antibiotic to take post operatively. It is important that you follow the instructions closely and finish the course of the antibiotics.
• Most common signs and symptoms of infection are onset of new swelling or jaw stiffness, pain, foul taste, discharge, and fever. If any of these symptoms occur, call us Interface Centre for assessment.
• If adverse symptoms develop (rash, vomiting, diarrhea, etc) please call us at Interface Centre.

• Jaw muscle tightness may occur after oral surgery. It will become more noticeable 3-5 after surgery. This is may lead to limited mouth opening and difficulty in eating. It is usually bilateral (experienced on both sides of the face).
• This tightness does resolve over time.
• To reduce muscle tightness, it is highly encouraged that you start eating a normal diet as soon as possible after surgery. Range of motion exercises will be helpful.
• Warm rinses and compresses after the 3rd post-operative day will help alleviate the muscle tightness.
• If you have a nightguard/bite splint, restart the use of it as soon as possible after the surgery.
• The discomfort associated with the muscle tightness, may sometimes be confused with “dry socket”.
• If the muscle tightness persists, please call us at Interface Centre.

• Dry socket (alveolar osteitis) is typically noticed 2-3 days post extraction with new onset pain.
• The pain is typically intense and is experienced on one side of the face, even if the surgery was bilateral.
• It is not uncommon to mistake muscle tightness/pain with “dry socket”.
• Dry socket is not an infection and will resolve on its own, given time. However, application of topical medicated dressing by our surgeons will quickly alleviate the discomfort.
• Please call us at Interface Centre if you are concerned that you may be dealing with signs and symptoms of dry socket.