Difference between revisions of "Heal Gums After a Tooth Extraction"
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When a tooth is extracted, a wound is created within the gums and alveolar bone. Improper care can lead to serious and painful complications. Knowing how to take the necessary precautions before and after the extraction procedure will facilitate a smooth healing process. | When a tooth is extracted, a wound is created within the gums and alveolar bone. Improper care can lead to serious and painful complications. Knowing how to take the necessary precautions before and after the extraction procedure will facilitate a smooth healing process. | ||
| − | [[Category:Teeth and Mouth]] | + | [[Category: Teeth and Mouth]] |
== Steps == | == Steps == | ||
=== Caring for Your Gums After a Tooth Extraction === | === Caring for Your Gums After a Tooth Extraction === | ||
| − | # Bite tightly on the gauze. After a tooth extraction, your dentist will place a gauze on the wound to stop the bleeding. Make sure to bite down tightly on the gauze to apply pressure to the area to stop bleeding. If heavy bleeding continues, you may need to reposition the gauze pack to cover the wound more directly.<ref>http://www.oralfacialsurgeon.com/procedures/surgical-instructions/after-multiple-extractions/</ref> | + | # Bite tightly on the gauze. After a tooth extraction, your dentist will place a gauze on the wound to stop the bleeding. Make sure to bite down tightly on the gauze to apply pressure to the area to stop bleeding. If heavy bleeding continues, you may need to reposition the gauze pack to cover the wound more directly.<ref name="rf1">http://www.oralfacialsurgeon.com/procedures/surgical-instructions/after-multiple-extractions/</ref> |
#* Do not talk, as this may loosen the gauze and lead to further bleeding and delay the clot formation. | #* Do not talk, as this may loosen the gauze and lead to further bleeding and delay the clot formation. | ||
#* If the gauze gets too wet, you may replace it with another; however, do not change gauze more often than necessary and do not spit out saliva, as this may hinder clot formation. | #* If the gauze gets too wet, you may replace it with another; however, do not change gauze more often than necessary and do not spit out saliva, as this may hinder clot formation. | ||
#* Do not disturb the extraction area with your tongue or fingers, and avoid blowing your nose and sneezing or coughing during this time. Increased pressure may cause the wound to bleed again. Avoid holding your hand over the area of extraction to avoid warming up the area. | #* Do not disturb the extraction area with your tongue or fingers, and avoid blowing your nose and sneezing or coughing during this time. Increased pressure may cause the wound to bleed again. Avoid holding your hand over the area of extraction to avoid warming up the area. | ||
#* Remove the gauze after 30 to 45 minutes and check in the mirror to see if there is any bleeding. | #* Remove the gauze after 30 to 45 minutes and check in the mirror to see if there is any bleeding. | ||
| − | # Take medicine for the pain. Use only the medications prescribed by your dentist. If your oral surgeon has not provided you with a prescription for pain relievers, you may take an over-the-counter pain reliever. Take the antibiotics that your surgeon gives you.<ref | + | # Take medicine for the pain. Use only the medications prescribed by your dentist. If your oral surgeon has not provided you with a prescription for pain relievers, you may take an over-the-counter pain reliever. Take the antibiotics that your surgeon gives you.<ref name="rf1" /> |
#* Take the first dose of pain medication as soon as possible before the effects of the anaesthesia wear off. It’s best to complete the dosages of painkillers and antibiotics as prescribed. | #* Take the first dose of pain medication as soon as possible before the effects of the anaesthesia wear off. It’s best to complete the dosages of painkillers and antibiotics as prescribed. | ||
| − | # Use an ice pack. Place an ice pack on your face outside the area of extraction. The ice pack reduces bleeding and controls swelling by constricting blood vessels. Use an ice pack for 10 to 20 minutes, then go without it for 30 minutes. Always wrap it in a towel or a cloth. Don’t place it directly on the skin. This can be done for the first 24 to 48 hours after extraction. After 48 hours, swelling should subside and ice will no longer provide relief.<ref>http://www.iowaoralsurgery.com/surgical-instructions/extractions/</ref> | + | # Use an ice pack. Place an ice pack on your face outside the area of extraction. The ice pack reduces bleeding and controls swelling by constricting blood vessels. Use an ice pack for 10 to 20 minutes, then go without it for 30 minutes. Always wrap it in a towel or a cloth. Don’t place it directly on the skin. This can be done for the first 24 to 48 hours after extraction. After 48 hours, swelling should subside and ice will no longer provide relief.<ref name="rf2">http://www.iowaoralsurgery.com/surgical-instructions/extractions/</ref> |
#*You can use a zipped plastic bag with crushed ice or ice cubes inside if you don’t have an ice pack. | #*You can use a zipped plastic bag with crushed ice or ice cubes inside if you don’t have an ice pack. | ||
#*Avoid keeping your hand in the area of extraction as you will generate heat. | #*Avoid keeping your hand in the area of extraction as you will generate heat. | ||
| − | # Use tea bags. Tea contains tannic acid, which helps blood clots form by contracting your blood vessels. Using a tea bag may help reduce bleeding. If you notice a small amount of bleeding an hour after extraction, place a moist tea bag on the extraction site and bite down tightly to apply pressure to the area. Do so for about 20 to 30 minutes. Drinking cold tea may also be helpful, but applying a tea bag directly to the area gives better results.<ref>http://www.uofmmedicalcenter.org/healthlibrary/Article/84678</ref> | + | # Use tea bags. Tea contains tannic acid, which helps blood clots form by contracting your blood vessels. Using a tea bag may help reduce bleeding. If you notice a small amount of bleeding an hour after extraction, place a moist tea bag on the extraction site and bite down tightly to apply pressure to the area. Do so for about 20 to 30 minutes. Drinking cold tea may also be helpful, but applying a tea bag directly to the area gives better results.<ref name="rf3">http://www.uofmmedicalcenter.org/healthlibrary/Article/84678</ref> |
| − | # Gargle with a warm saline rinse. Wait until the morning after extraction to rinse your mouth. You can prepare a warm saline rinse by mixing one teaspoon of salt into one 8-ounce glass of water. Gargle slowly and gently without creating any pressure. Just move your tongue from one cheek to another several times, and then spit out the solution smoothly to avoid damaging the clot.<ref | + | # Gargle with a warm saline rinse. Wait until the morning after extraction to rinse your mouth. You can prepare a warm saline rinse by mixing one teaspoon of salt into one 8-ounce glass of water. Gargle slowly and gently without creating any pressure. Just move your tongue from one cheek to another several times, and then spit out the solution smoothly to avoid damaging the clot.<ref name="rf2" /> |
#*Repeat rinsing with this solution four to five times a day for several days after the extraction, especially after meals and before bed. | #*Repeat rinsing with this solution four to five times a day for several days after the extraction, especially after meals and before bed. | ||
| − | # Get plenty of rest. Proper rest ensures steady blood pressure, which helps facilitate blood clotting and healing of the gums. Do not engage in any physical activity for at least 24 hours after the extraction, and elevate the head slightly while resting to ensure that blood and/or saliva does not cause a choking hazard.<ref | + | # Get plenty of rest. Proper rest ensures steady blood pressure, which helps facilitate blood clotting and healing of the gums. Do not engage in any physical activity for at least 24 hours after the extraction, and elevate the head slightly while resting to ensure that blood and/or saliva does not cause a choking hazard.<ref name="rf3" /> |
#*Try sleeping propped up on two pillows and avoid sleeping on the extraction side so the blood doesn't stagnate under increased heat. | #*Try sleeping propped up on two pillows and avoid sleeping on the extraction side so the blood doesn't stagnate under increased heat. | ||
#* Do not bend downwards nor do any heavy lifting. | #* Do not bend downwards nor do any heavy lifting. | ||
#* Always sit in an upright position. | #* Always sit in an upright position. | ||
| − | # Brush your teeth. After 24 hours, brush your teeth and tongue gently, but '''do not use the toothbrush near your extraction site'''. Instead, rinse gently using the saline solution described above to avoid damaging the clot. Follow this procedure for the next three to four days.<ref | + | # Brush your teeth. After 24 hours, brush your teeth and tongue gently, but '''do not use the toothbrush near your extraction site'''. Instead, rinse gently using the saline solution described above to avoid damaging the clot. Follow this procedure for the next three to four days.<ref name="rf2" /> |
#*Flossing and using mouthwash can be kept in your regular routine. Just be sure not to use the floss near extraction site. Use an antiseptic mouthwash or a rinse prescribed by your dentist to help kill bacteria and prevent any infection. | #*Flossing and using mouthwash can be kept in your regular routine. Just be sure not to use the floss near extraction site. Use an antiseptic mouthwash or a rinse prescribed by your dentist to help kill bacteria and prevent any infection. | ||
| − | #Use Chlorhexidine gel. This can be applied to the extraction area starting the next day after extraction for faster healing. It can also prevent bacteria from forming near the extraction site. This also helps reduce pain and discomfort.<ref>http://www.thedentalelf.net/2012/12/13/moderate-evidence-that-chlorhexidine-rinse-or-gel-provides-a-benefit-in-preventing-dry-socket/</ref> | + | #Use Chlorhexidine gel. This can be applied to the extraction area starting the next day after extraction for faster healing. It can also prevent bacteria from forming near the extraction site. This also helps reduce pain and discomfort.<ref name="rf4">http://www.thedentalelf.net/2012/12/13/moderate-evidence-that-chlorhexidine-rinse-or-gel-provides-a-benefit-in-preventing-dry-socket/</ref> |
#*Do not apply the gel directly into the socket. Just apply the gel to the area around the extraction site. | #*Do not apply the gel directly into the socket. Just apply the gel to the area around the extraction site. | ||
| − | # Apply a warm compress after 24 to 48 hours. This helps increase blood circulation, which promotes healing, and reduces swelling and discomfort. 36 hours after extraction, apply a warm, wet towel externally to the affected side of the face in a 20 minutes on, twenty minutes off rotation.<ref>http://www.dentistglendaleca.com/patient-center/post-op-instructions</ref> | + | # Apply a warm compress after 24 to 48 hours. This helps increase blood circulation, which promotes healing, and reduces swelling and discomfort. 36 hours after extraction, apply a warm, wet towel externally to the affected side of the face in a 20 minutes on, twenty minutes off rotation.<ref name="rf5">http://www.dentistglendaleca.com/patient-center/post-op-instructions</ref> |
| − | # Watch your diet. You'll want to wait until the anesthesia has completely worn off before attempting to ingest food. Start with soft foods, chewing on the opposite side of your mouth as the extraction site. You may want to eat something cold and soft, like ice cream, to soothe the pain and provide you with some nourishment. Avoid anything hard, crunchy, crumbly, or hot, and do not use a straw, as this may dislodge a blood clot from your gums.<ref | + | # Watch your diet. You'll want to wait until the anesthesia has completely worn off before attempting to ingest food. Start with soft foods, chewing on the opposite side of your mouth as the extraction site. You may want to eat something cold and soft, like ice cream, to soothe the pain and provide you with some nourishment. Avoid anything hard, crunchy, crumbly, or hot, and do not use a straw, as this may dislodge a blood clot from your gums.<ref name="rf2" /> |
#* Eat regularly and don’t skip meals. | #* Eat regularly and don’t skip meals. | ||
#* Eat food that is at room temperature or cold, but never warm or hot. | #* Eat food that is at room temperature or cold, but never warm or hot. | ||
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#* Avoid tobacco/alcohol for at least 24 hours after extraction. | #* Avoid tobacco/alcohol for at least 24 hours after extraction. | ||
===Understanding the Healing Process After a Tooth Extraction=== | ===Understanding the Healing Process After a Tooth Extraction=== | ||
| − | # Expect swelling. Your gums and your mouth will swell as a response to the surgery, and you will probably be in pain. This is normal, and usually begins to subside after about two or three days. During that time, use an ice pack held against the affected cheek to soothe pain and reduce swelling and inflammation.<ref | + | # Expect swelling. Your gums and your mouth will swell as a response to the surgery, and you will probably be in pain. This is normal, and usually begins to subside after about two or three days. During that time, use an ice pack held against the affected cheek to soothe pain and reduce swelling and inflammation.<ref name="rf1" /> |
| − | # Expect bleeding. After a tooth extraction, there is a lot of bleeding from the tiny blood vessels within the gums and bone. Bleeding should never be extreme or excessive, however, in some cases your dentist may place sutures to help with the healing process. If this happens, it may mean that post-surgical packs are being placed between the teeth and not directly on the wound. Consult your surgeon and reposition packs as necessary.<ref | + | # Expect bleeding. After a tooth extraction, there is a lot of bleeding from the tiny blood vessels within the gums and bone. Bleeding should never be extreme or excessive, however, in some cases your dentist may place sutures to help with the healing process. If this happens, it may mean that post-surgical packs are being placed between the teeth and not directly on the wound. Consult your surgeon and reposition packs as necessary.<ref name="rf1" /> |
| − | # Don't disturb the clot. A clot will form within the first day or two, and it's extremely important not to disturb or remove it. Clotting is a necessary first step toward healing, and removing or disturbing the clot may prolong the healing process and lead to infection or pain.<ref>http://www.maxillocare.com/surgical-instructions/after-extractions.html</ref> | + | # Don't disturb the clot. A clot will form within the first day or two, and it's extremely important not to disturb or remove it. Clotting is a necessary first step toward healing, and removing or disturbing the clot may prolong the healing process and lead to infection or pain.<ref name="rf6">http://www.maxillocare.com/surgical-instructions/after-extractions.html</ref> |
| − | # Expect epithelial cell layer formation. For the next 10 days, the cells of the gums will proliferate to form a layer of epithelium that will bridge the gap produced by a tooth extraction. It is important not to disrupt this process while the wound is healing.<ref>http://doctorspiller.com/Extractions/extractions.htm</ref> | + | # Expect epithelial cell layer formation. For the next 10 days, the cells of the gums will proliferate to form a layer of epithelium that will bridge the gap produced by a tooth extraction. It is important not to disrupt this process while the wound is healing.<ref name="rf7">http://doctorspiller.com/Extractions/extractions.htm</ref> |
| − | # Expect bone deposition. After epithelial layer formation, the bone-forming cells in your bone marrow are activated. The process usually begins along the side (lateral) walls of the socket and continues toward the center.<ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3220149/</ref> This will completely close the space created due to tooth loss. The complete closure of the socket created by bone deposition will take up to a year, but gum will cover the socket after just two weeks so there is nothing to worry about, as it will appear completely healed. | + | # Expect bone deposition. After epithelial layer formation, the bone-forming cells in your bone marrow are activated. The process usually begins along the side (lateral) walls of the socket and continues toward the center.<ref name="rf8">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3220149/</ref> This will completely close the space created due to tooth loss. The complete closure of the socket created by bone deposition will take up to a year, but gum will cover the socket after just two weeks so there is nothing to worry about, as it will appear completely healed. |
===Caring for Your Gums Before Going In for a Tooth Extraction=== | ===Caring for Your Gums Before Going In for a Tooth Extraction=== | ||
# Inform your oral surgeon about any pre-existing conditions you may have. You should also inform your surgeon about any medications you are currently taking. These may complicate the surgical procedure and cause problems during or after surgery. | # Inform your oral surgeon about any pre-existing conditions you may have. You should also inform your surgeon about any medications you are currently taking. These may complicate the surgical procedure and cause problems during or after surgery. | ||
| − | #* Patients with diabetes generally take a longer time to heal after any dental treatment because bleeding also takes longer. Maintain a blood-sugar level close to normal to ensure faster healing after an extraction, and inform your dentist about your diabetic condition and your recent glucose test results. Your dentist will decide whether or not your blood sugar level is adequately under control for an extraction procedure.<ref>http://my.clevelandclinic.org/health/diseases_conditions/hic_Diabetes_Basics/hic_Diabetes_and_Alcohol/hic_Oral_Health_Problems_and_Diabetes</ref> | + | #* Patients with diabetes generally take a longer time to heal after any dental treatment because bleeding also takes longer. Maintain a blood-sugar level close to normal to ensure faster healing after an extraction, and inform your dentist about your diabetic condition and your recent glucose test results. Your dentist will decide whether or not your blood sugar level is adequately under control for an extraction procedure.<ref name="rf9">http://my.clevelandclinic.org/health/diseases_conditions/hic_Diabetes_Basics/hic_Diabetes_and_Alcohol/hic_Oral_Health_Problems_and_Diabetes</ref> |
| − | #* Patients with high blood pressure should be aware that certain blood pressure medications may cause bleeding from the gums. This could cause complications if the medication is not ceased prior to a tooth extraction surgery. Inform your surgeon about any medications you are currently taking or have recently taken.<ref>http://www.drweil.com/drw/u/id/QAA337888</ref> | + | #* Patients with high blood pressure should be aware that certain blood pressure medications may cause bleeding from the gums. This could cause complications if the medication is not ceased prior to a tooth extraction surgery. Inform your surgeon about any medications you are currently taking or have recently taken.<ref name="rf10">http://www.drweil.com/drw/u/id/QAA337888</ref> |
| − | #* Patients taking anticoagulants or blood-thinning drugs like warfarin and heparin should inform their surgeon about those medications before dental extractions, as this class of medication will hinder blood clotting.<ref>http://www.ncbi.nlm.nih.gov/pubmed/15530128</ref> | + | #* Patients taking anticoagulants or blood-thinning drugs like warfarin and heparin should inform their surgeon about those medications before dental extractions, as this class of medication will hinder blood clotting.<ref name="rf11">http://www.ncbi.nlm.nih.gov/pubmed/15530128</ref> |
| − | #* Patients taking oral contraceptives containing estrogen may have complications with blood clotting. Consult with your surgeon if you are currently taking an oral contraceptive.<ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1436047/</ref> | + | #* Patients taking oral contraceptives containing estrogen may have complications with blood clotting. Consult with your surgeon if you are currently taking an oral contraceptive.<ref name="rf12">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1436047/</ref> |
#* Some long term medications will cause mouth dryness, which may lead to infection after a tooth extraction. Consult with your surgeon before any procedure. You should also consult with your doctor before changing any medications or dosages that you are taking. | #* Some long term medications will cause mouth dryness, which may lead to infection after a tooth extraction. Consult with your surgeon before any procedure. You should also consult with your doctor before changing any medications or dosages that you are taking. | ||
| − | # Understand that smoking may cause problems. Smoking is a known factor in the development of gum disease.<ref>http://www.medicinenet.com/gum_problems/page2.htm</ref> In addition, the physical act of smoking may cause the dislodgement of blood clots, which are necessary for healing to take place in the gums. Tobacco may also irritate the sensitive wound and complicate the healing process.<ref>http://www.mayoclinic.org/diseases-conditions/dry-socket/basics/risk-factors/con-20025990</ref> | + | # Understand that smoking may cause problems. Smoking is a known factor in the development of gum disease.<ref name="rf13">http://www.medicinenet.com/gum_problems/page2.htm</ref> In addition, the physical act of smoking may cause the dislodgement of blood clots, which are necessary for healing to take place in the gums. Tobacco may also irritate the sensitive wound and complicate the healing process.<ref name="rf14">http://www.mayoclinic.org/diseases-conditions/dry-socket/basics/risk-factors/con-20025990</ref> |
#* If you are currently a smoker, consider quitting before your tooth extraction. | #* If you are currently a smoker, consider quitting before your tooth extraction. | ||
| − | #* If you do not intend to quit smoking, be aware that patients should not smoke a cigarette for at least 48 hours after surgery. Patients who chew tobacco or "dip" should not use tobacco for at least seven days.<ref>http://www.mayoclinic.org/diseases-conditions/dry-socket/basics/prevention/con-20025990</ref> | + | #* If you do not intend to quit smoking, be aware that patients should not smoke a cigarette for at least 48 hours after surgery. Patients who chew tobacco or "dip" should not use tobacco for at least seven days.<ref name="rf15">http://www.mayoclinic.org/diseases-conditions/dry-socket/basics/prevention/con-20025990</ref> |
# Consult with your primary physician. Letting your primary doctor know about the surgery before undergoing a tooth-extraction procedure may help avoid potential problems caused by medications you are taking or conditions you may have. | # Consult with your primary physician. Letting your primary doctor know about the surgery before undergoing a tooth-extraction procedure may help avoid potential problems caused by medications you are taking or conditions you may have. | ||
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*Do not drink coffee within at least six hours before the extraction is done, as it may interfere with the anesthetic effect and anesthesia may not install. | *Do not drink coffee within at least six hours before the extraction is done, as it may interfere with the anesthetic effect and anesthesia may not install. | ||
*If the pain gets worse after two days, visit your dentist immediately. The pain may indicate dry socket. | *If the pain gets worse after two days, visit your dentist immediately. The pain may indicate dry socket. | ||
| − | *Light bleeding and discolored saliva will be present during the first 12 to 24 hours. If heavy bleeding has not stopped three to four hours after the procedure, visit your dentist immediately.<ref | + | *Light bleeding and discolored saliva will be present during the first 12 to 24 hours. If heavy bleeding has not stopped three to four hours after the procedure, visit your dentist immediately.<ref name="rf2" /> |
| − | *If you feel sharp, bony fragments, called bone sequestra, left behind after the surgery, inform your dentist. Gradual bone reformation is normal, but shards of dead bone left behind by the surgery may be painful, and you may need to have them removed. Consult with your dentist or oral surgeon if you believe there may be painful dead bone fragments left behind following an extraction.<ref>http://www.northernstardentalgroup.com/oral-surgery-/surgical-instructions/after-tooth-extractions/</ref> | + | *If you feel sharp, bony fragments, called bone sequestra, left behind after the surgery, inform your dentist. Gradual bone reformation is normal, but shards of dead bone left behind by the surgery may be painful, and you may need to have them removed. Consult with your dentist or oral surgeon if you believe there may be painful dead bone fragments left behind following an extraction.<ref name="rf16">http://www.northernstardentalgroup.com/oral-surgery-/surgical-instructions/after-tooth-extractions/</ref> |
== Sources and Citations == | == Sources and Citations == | ||
