How long should gauze stay in after tooth extraction

The Do’s and Don’ts after a Tooth Extraction

What is a tooth extraction?

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The Do’s and Don’ts after a Tooth Extraction
Does gauze prevent dry socket?
When can I stop using gauze after wisdom tooth extraction?
Can gauze pull out blood clot?
Should I keep gauze in my mouth overnight after tooth extraction?

The term refers to the painless removal of a tooth or tooth roots with minimum trauma to the surrounding tissues so that the extraction socket wound heals uneventfully and without any post-operative complications. Whenever any surgery takes place the first thing we want is to let it heal properly, quickly and smoothly. As a common practice, most of the dental surgeons have standard post-surgery instructions printed which are handed over to the patient. One must follow these instructions given by the dentist. Following all the post-operative instructions after tooth extraction reduces the incidence of infection and chances of dry socket. If aftercare instructions are not followed then it can cause complications, which can further lead to delayed healing. Here are some of the do’s and don’ts after a tooth extraction.

Do’s:

Rest: Try to get some rest after Tooth Extraction. You may feel great but don’t exercise or do too much activity for at least 24 hours. When resting, keep your head in a slightly upright position on the pillow.
Let it clot:Let the clot be formed on the tooth extraction site, which covers it and allows it to heal. After the procedure your dentist will give you a piece of gauze to bite on near the extraction site. Try to bite down and keep it in place for at least an hour afterwards. This will put pressure over the wound and help it to stop bleeding. However, make sure you don’t chew on gauze piece. If you can keep it in place longer that’s best, but make sure to change the gauze after roughly every half hour, depending on the amount of bleeding. If once the clot forms it becomes dislodge the nerve endings then become exposed. The nerves and capillaries spasm and constrict, limiting essential blood supply, which causes delay in healing. If the bleeding persists for a few hours after the procedure then try putting a wet tea bag on the site. The tannic acid present in black tea helps to aide in the clotting process.
Ice Packs: Apply an ice pack on the side of your face where surgery was performed. This is done to reduce swelling. While on simple extractions swelling isn’t accompanied, in cases requiring severe cheek retractions swelling can occur after operation. The swelling after an extraction may not occur immediately, but can continue to swell for a few days, reaching a maximum at the 2nd or 3rd day. Application of the ice pack is most effective during the day of extraction as after 24 hours there is no significant beneficial effect. Ice packs should be applied 15 minutes on and 15 minutes off for 1-2 hour time periods.

Don’ts:

Don’t smoke:For at least 48 hours after tooth extraction do not smoke. The chemicals in the smoke can affect the clot and hence the chances of developing dry socket 3-4 days after tooth extraction increases.
Don’t eat solids immediately after: While you still have numbness it’s best not to eat solids. When you start feeling your jaws you can start taking solids. After tooth extraction, take soft and liquid foods like soups, mashed potatoes, yogurts, milkshakes, smoothies etc.
Warm saline rinses: The main aim of rinsing is to clean the area of extraction as it is not possible to brush the socket. We mix salt to make the solution isotonic and similar to natural tissue fluid and thus it is less irritating than water. Rinsing is usually advised 12 hours after extraction. So, warm saline rinses help in cleaning and maintaining the hygiene of that area.
Take your medicines as prescribed by your dentist: Don’t skip the medicines. If antibiotics are given they should be taken regularly. Pain killers and anti-inflammatory drugs are to be taken after tooth extraction. It help in reducing the pain and swelling. If the pain continues even after two days of tooth extraction and bleeding starts then you should call your dentist.
Avoid Aspirin: Don’t ever take aspirin (Can take ibuprofen). Aspiring being a blood thinner will delay in clot formation thereby will prevent healing. Take the medications as prescribed by the physician and consult your dentist before taking any medicine.
Avoid Sucking of any type: SMOKING, SIPPING, EATING HARD VEGETABLES are to be avoided after tooth extraction. Try taking soft and liquid food options such as soups, mashed potatoes, yogurts, milkshakes, smoothies etc. after tooth extraction. Avoid hot drinks, spicy foods, sodas, etc.
Don’t poke into the gap created: Though for initial few days, it will feel a bit awkward to have a gap but don’t poke that area with any toothpick or tongue as it may delay healing, may provoke bleeding and can also lead to dry socket.

After Your Surgery

Post-Operative Instructions

General Anesthesia Precautions

**If general anesthesia or IV sedation was utilized, do not leave the patient unattended for the first 12 hours.

**Please closely supervise the patient when getting up or going to the bathroom.

Medications

Please refer to your medication information sheets if you were given prescriptions. If you have any reaction to medications prescribed, call the doctor immediately.

Managing Bleeding After Surgery

For the first hour after surgery:

Keep firm pressure on the surgical site with the gauze that was placed in your mouth after surgery. Remove gauze after 1 hour.

If Bleeding Continues

Take 1 piece of gauze and fold it in quarters, creating a firm pad. Place the pad over the surgical site. Use firm biting pressure where possible (extraction site), or direct finger pressure by holding the gauze (biopsy site). You may have to repeat this procedure several times. The bleeding should stop within 2-3 hours, but you can expect to see blood-tinged saliva for up to 24-48 hours following surgery. If bleeding is heavy, or continues after 2 hours, moisten a tea bag, place on surgical site, and apply pressure or bite firmly for 30 minutes. This usually stops the bleeding. Please remember, most bleeding is controlled and stopped with a well-positioned gauze or tea bag with direct pressure. If bleeding is heavy or continues after 24 hours, call the doctor. Do not rinse, spit, or use a straw the day of surgery, as this can cause bleeding to resume.

To Reduce Swelling

Ice for the initial 24 hours. Use ice packs applied to the face for 20-minute intervals (20 minutes on, 20 minutes off). If oral surgery was performed on both the right and left sides, it is recommended to use one ice pack and alternate sides every 20 minutes. This is the most effective way to reduce swelling. Do not exceed 20 minutes in one area as this can cause tissue injury. Swelling usually reaches its maximum 2 days following surgery. To help reduce swelling, sit semi-reclined in a reclining chair; if lying down, keep your head elevated with 2-3 pillows. Icing should be discontinued after 24 hours. While icing your face may feel good, it will act to increase swelling. Again, DO NOT ice beyond 24 hours.

Orthodontic Retainers

If you have orthodontic retainers, please do not use them immediately after surgery. Use of your retainers can resume 1-3 days after the procedure or as comfort allows.

Diet

Resume your diet immediately following surgery. When you get home, start with a milkshake, smoothie, or other thick liquid using a spoon, NOT a straw. Your diet should be limited to cool and soft foods for the first day. Sometimes numbness from local anesthesia may last for hours; therefore, hot foods and liquids should be avoided, as they can cause a burn. A normal diet can be resumed as tolerated. Most foods can be eaten as long as care is taken to avoid the surgical sites. The following are some suggested softer foods: pancakes with syrup, eggs, and pastas like macaroni and cheese or spaghetti.

Oral Hygiene

Rinse with warm salt water or tap water beginning 3 days after surgery. To make a salt water rinse, add 1 teaspoon of salt to 4-5 oz of warm water. Rinse at least 3 times per day: in the morning, after meals, and before bed. Do not gargle. With extractions, you may have been given a plastic irrigating syringe. Begin using this syringe 3 days after your extraction. Using tap water or salt water, gently irrigate only the lower extraction site(s) once a day to remove any food debris that may persist after rinsing. Continue until all debris is removed. Do not use over-the-counter mouthwash, such as Scope® or Listerine®, as these can irritate the surgery site and slow healing. Resume brushing your teeth the day after surgery, being careful to avoid the surgical sites. It is not unusual to see traces of blood on your toothbrush.

Activity and Smoking/Vaping

Physical activity should be limited after oral surgery procedures. Vigorous exercise or organized sports should not be resumed until 3-5 days after surgery or as your condition allows. Please contact our office if a written excuse is needed for organized sports or gym class. The nicotine from smoking and vaping can significantly delay healing and cause an increase in post-operative pain. Therefore, you should refrain from smoking as long as possible.

Stitches

Stitches that have been placed are usually dissolvable and will fall out on their own within the first 4 days, possibly longer. It is not unusual for one or more to loosen and fall out before dissolving, especially in moving areas of your mouth, such as the tongue or cheek areas. If the stitches come out and the wound opens and creates a hole, it is typically not of concern unless there is excessive bleeding. Fortunately, incisions in the mouth do heal very quickly, and any wound that does open will close naturally.

Follow-Up Visits

If a follow-up visit is necessary, an appointment would have been scheduled for you. Post-operative appointments are always available. Please call the office during business hours if you would like to be seen.

When You Get Home

Remove gauze packing.
Drink at least ¼ of your milkshake (or smoothie, or other cool, thick liquid) using a spoon—NOT a straw.
Take pain reliever immediately, as explained in the “Pain Management” instruction sheet, unless you were already given ibuprofen in recovery.
Take the antibiotic (if prescribed) as directed.
Replace the gauze packing, if necessary.
Begin ice packs to the outside of your face, as explained previously, no longer than 20 minutes on one side.
Increase your fluid intake throughout the day.

Typical Recovery

With most oral surgery procedures, post-operative discomfort can actually worsen between the third and sixth days. This discomfort is considered normal and should be managed with your pain medication. If you have significant discomfort, even with pain medication, or you cannot tolerate the pain medication, please call the office.

When to Call the Doctor

If there is a drug reaction, significant swelling, persistent pain or bleeding, or any other unusual reactions, call the office immediately. Additionally, if you have any questions during the post-operative period, do not hesitate to call. There is an answering service to respond to emergencies at all times when the office is closed

Does gauze prevent dry socket?

The American Dental Association recommends you keep gauze over your extraction site for 30 to 45 minutes after surgery. This encourages a blood clot to form and can help prevent dry socket.

When can I stop using gauze after wisdom tooth extraction?

Keep firm pressure on the surgical site with the gauze that was placed in your mouth after surgery. Remove gauze after 1 hour.

Can gauze pull out blood clot?

Gauze placed against the wound will draw blood from the clot and this, likewise, is not a sign of bleeding. Place an old towel over your pillow for the first night to reduce risk of staining. If the bleeding persists, contact the office.

Should I keep gauze in my mouth overnight after tooth extraction?

It is not unusual to have residual bleeding after tooth extraction for up to 24 hours. It is advisable to use an old pillow case as not to damage your favorite ones. Please remove the gauze when you eat or drink. Do not sleep with the gauze in your mouth.