After Tooth Removal


1. Exercise Care:

  • Do not disturb the surgical area today. Do NOT rinse vigorously or probe the area with any objects or your fingers. Do NOT smoke.

2. Pain:

  • Unfortunately most oral surgery is accompanied by some degree of discomfort.
  • Take the first pill of your pain medication BEFORE the anaesthetic has worn off. You will be able to manage any discomfort better this way.
  • If you do not have a prescription for pain medication: take regular/extra strength advil (ibuprofen) or Tylenol (acetaminophen) as per the instructions listed on the medication package.
  • If you have a prescription for pain medication: start with one tablet of the Ibuprofen or one tablet of the pain medication that you were given. If you do not achieve adequate relief, you may supplement with one tablet of the second type of pain medication if given. You may also take a second tablet of medication if allowed on the medication instructions. This may add to the risk of stomach upset.
  • Do not operate any motorized vehicle or machinery while taking the stronger narcotic pain medication. Avoid alcoholic beverages while taking pain medication.
  • Remember that the most severe discomfort is usually within the first six hours after the anaesthetic wears off. After that your need for medicine should lessen.

3. Bleeding:

  • Intermittent bleeding or oozing is normal within the first 24-48 hours. It may be controlled by placing warm wet gauze over the surgical areas and biting down firmly for 30-60 minutes.
  • If bleeding increases, it usually means that the packs are being clenched between your teeth rather than exerting pressure on the surgical areas. First, wipe out old blood clots. Then try repositioning warm wet gauze. If bleeding persists you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in a moist gauze) for 30-60 minutes and sit upright.
  • If bleeding becomes uncontrolled, please call our office.
  • DO NOT SLEEP WITH GAUZE in your mouth, as this could become a choking hazard.

4. Swelling:

  • Swelling following oral surgery is expected. It typically peaks at day 2 or 3 and then gradually subsides over the next 7-14 days.
  • You can minimize this by using a cold pack or ice bag wrapped in a towel and applied firmly to face or cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 12 to 24 hours after surgery.
  • If you have been prescribed medicine to reduce swelling like Ibuprofen, be sure to take it as directed.
  • After 24 hours, it is usually best to switch from ice to moist heat (moist hot towels) to the same areas to reduce jaw stiffness.

5. Nausea and Vomiting:

  • Nausea is not an uncommon event after surgery and it is sometimes caused by stronger pain medicines. Nausea may be reduced by preceding each pill with a small amount of soft food, and then by taking the pill with a large volume of water.
  • Try to keep taking clear fluids and minimize the pain medication. Call us if you do not feel better or if repeated vomiting is a problem.
  • Sipping on Cola drinks, Ginger Ale, or Tea may help with nausea.


1. Diet:

  • Local freezing administered to the surgical area can last up to 6 or more hours after surgery depending on the procedure. Therefore, have liquids only for the rest of the day following surgery (juice, milkshakes, and lukewarm fluids, pudding, yogourt, ice cream) to avoid accidental biting of cheek, tongue or lip regions. Avoid hot liquids.
  • Do not drink through a straw for the first 24 hours
  • On the day following the surgery, eat soft foods (mashed potatoes, eggs, over-cooked pasta) if tolerated, but avoid chewing on the surgical site. Continue with a soft diet for approximately 1 week. Progress to a normal diet when comfortable.
  • Crunchy/chewy foods should be avoided until the surgical sites are less tender.
  • Avoid foods like sunflower seeds, popcorn, etc. That may get lodged in the socket areas.
  • Avoid very hard foods like raw carrots and nuts for 4 to 6 weeks following surgery.
  • It is important not to skip meals and drink 5-6 glasses of liquid daily! If you take nourishment regularly, you will feel better, gain strength, have less discomfort and heal faster. A high calorie, high protein diet is recommended.

2. Antibiotics:

  • If you were prescribed antibiotics – please complete your entire course of antibiotics, even when you start feeling better.
  • Please be aware that oral contraceptives (birth control pills) may not work while on antibiotics. Avoid alcoholic beverages while taking antibiotics.
  • If you are concerned about a reaction to a medication please call the office.

3. Mouth Rinses:

  • These should only be started 24 hours AFTER surgery because no spitting is allowed over the first 24 hours.
  • Salt Water Rinses: Use one-half teaspoon of salt dissolved in a glass of warm water. Gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily for 1 week.
  • If you were prescribed an antibiotic (chlorhexidine) mouth rinse, use as directed twice per day.

4. Activity:

  • Avoid strenuous activity and exercise for 7-10 days after surgery.

5. Fever:

  • A slight elevation of temperature over the first 24-48 hours is possible. However, if your temperature continues to rise, please call the office.

6. Smoking:

  • Avoid smoking for several days following surgery. It is very detrimental to healing.


1. Brushing Your Teeth:

  • You may begin tooth brushing the day after surgery, but gently in the areas where surgery was performed. Begin your normal oral hygiene routine as soon as possible.

2. Stitches:

  • If stitches are placed, they will start breaking down in 2 to 7 days. You will notice them between your teeth. Your gums may appear loose after the stitches fall out. They will return to normal in approximately 7 days.
  • The stitches dissolve on their own, but if they are still bothersome after 1 week, you can return to the office to get them removed.

3. Hole at site of tooth removal:

  • There will be a void where the tooth was removed. This will fill in with new tissue gradually over the next month. In the meantime, the area should be kept clean, especially after meals, with salt-water rinses or a toothbrush.

4. Sharp Edges

  • If you feel sharp edges in the surgical areas with your tongue it is probably the bony walls, which originally supported the teeth. Occasionally, small slivers of bone may work themselves out during the first week or two after surgery. They are not pieces of tooth. If necessary, we will remove them. Please call the office if you are concerned.

5. Bruising:

  • Bruising of the skin may occur and is more noticeable with a fair skin complexion. It can move down one’s neck and onto the chest due to gravity, but will resolve with time. Moist heat applied to the area can speed up the removal of the discoloration.

6. Stretching/Cracking of lips:

  • The corners of the mouth may be stretched, and may dry out and crack. If so, the lips should be kept moist with Vaseline.

7. Stiffness of the jaw muscles:

  • This may cause difficulty in opening your mouth for a several days following surgery. This is a normal event after surgery and will resolve in time.


1. Monojet Syringe:

  • When do I start? When you start eating soft foods (typically between the first and third day following the procedure).
  • When do I stop? Continue until no food is removed after use (typically 2-3 weeks)
  • How do I use it? It should be used every time after eating. It must only be used on the BOTTOM surgical sites. Fill the syringe with warm salt water or regular water. Place the tip of the syringe behind the last tooth on the bottom. Irrigate VERY GENTLY for the first week. After 1 week, irrigation should be more thorough.

2. Dry Socket: Normal healing after tooth extraction should be as follows:

  • The day of surgery is usually the most uncomfortable, and there is some degree of swelling and stiffness.
  • On the second day, you will usually be far more comfortable, and although possibly more swollen, you can usually begin a more substantial diet.
  • From the third day on, GRADUAL, STEADY IMPROVEMENT should mark the remainder of your post-operative course.v
  • If a DRY SOCKET occurs (loss of the blood clot from the socket), there is a noticeable, distinct, persistent throbbing pain in the jaw, often radiating toward the ear and forward along the jaw that starts between day 3 and day 7. Call the office and report the symptoms so we can help make you more comfortable.

If you were prescribed a narcotic medication, please remember they are to be used for break-through pain only and pain uncontrolled by over-the-counter medications. Return all unused medication to your pharmacy after 10 days.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office during office hours at 416.461.0424. If there is an after hours concern please do not hesitate to call Dr. Kaplan on his personal mobile at 647.539.6565.

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