Tooth extraction aftercare: Instructions for the first 24 hours after having your tooth pulled.

- Stopping bleeding. / Clot protection. / Smoking. / Eating. / Numbness. / Pain control. / General do's and don'ts.

Once your tooth extraction has been completed, your dentist should provide you with two sets of aftercare instructions.

  1. One will cover things to do (and not to do) during the first 24 hours after having your tooth pulled. (The subject of this page.)
  2. The other will be recovery instructions for the days that follow. (Use the link for more information about this topic.)

Related page: Extraction Healing timeline.)


Aftercare - The first 24 hours after having your tooth pulled.

This group of instructions covers topics such as:  1) Controlling bleeding.  2) Protecting the blood clot that has formed.  3) Directions for how to minimize swelling and pain.

They also address post-extraction do's-and-don'ts for issues such as:  1) Smoking.  2) What types of physical activities are appropriate.  3) Eating and drinking.  4) Issues with numbness.  5) Cleaning your teeth.  6) If indicated, the use of antibiotics.

Remember, the care you take (or don't take) during this first 24 hour period will set the stage for the healing process to come.

Get your dentist's input.

While this page contains common aftercare guidelines typically used during the first 24 hours after an extraction, your specific situation may involve special circumstances. For this reason, you should discuss these instructions with your dentist so they can amend them as is needed.

Additionally, if you feel you have developed complications you should contact your dentist. It's their obligation to address your needs.


A) Stopping tooth extraction bleeding.

Immediately after your tooth has been pulled, some amount of bleeding will occur, possibly for some time.

[For information about continued post-extraction bleeding beyond the initial 24 hour period, use this link.]

Place the gauze directly over the socket, then apply firm pressure.

Place firm pressure on the gauze for 45 minutes or longer.

a) Controlling bleeding with gauze.

In most cases, this bleeding can be controlled and ultimately stopped by performing the following steps:

  1. Place a piece of clean damp gauze over the empty tooth socket.

    (Roll or fold it up into a ball or square. It's the portion that rests directly over your wound that's important. If you don't have any gauze, a piece of clean cloth can be used instead.)

  2. Bite firmly on the gauze for 45 minutes to an hour.

Make sure the wad of gauze is large enough and positioned so that when you bite down on it it applies pressure directly onto your extraction site. (If your teeth come fully together when you close, the gauze may not be receiving much pressure.)

Applying pressure over an extended period is the key.

It's both creating firm pressure and maintaining it over a prolonged period of time (45 minutes or so) that are important factors in getting this technique to work.

Don't keep changing the gauze, and don't chew on it. Just put it in place and close down, for the full 45 minutes to an hour.

b) Controlling bleeding with a tea bag.

If your bleeding seems to persist, a dampened tea bag can be more effective than gauze.

One of the components of tea (black tea, the regular stuff you would use to make iced tea) is tannic acid. Tannic acid aids in the formation of blood clots, thus making this method a very effective technique. (Same instructions as above, just substitute the tea bag for the gauze.)

Repeat as needed.

If some bleeding still persists after the completion of a 45 minute application (gauze or tea bag), then repeat the process.

After each subsequent application, the amount of bleeding that continues should be noticeably less. If heavy bleeding persists, then contact your dentist.

Clotting aids.

In some cases your dentist may anticipate that post-operative bleeding will be a concern. If so, they may place some type of clotting aid in your extraction socket.

This might be an absorbable collagen or gelatin dressing (CollaPlug®, Gelfoam®), oxidized cellulose (Surgicel®), microfibrillar collagen (Avitene®), or similar-purposed product.

You still need to follow standard protocol.

By no means does your dentist having placed a clotting aid in your tooth's socket lessen your need to follow standard post-op instructions.

Instead you should recognize that they consider you to be at elevated risk for complications, which makes faithfully following their directions all that more important.


B) Insuring that an adequate blood clot forms (and stays) in the tooth socket.

The blood clot that forms in the tooth's empty socket is an important part of the healing process, so be careful not to do anything that will dislodge or disrupt it.

Remember, events that occur during this first-24-hours time frame will affect the healing process for days to come. For example, it's thought that the formation of a dry socket is related to the loss of the original blood clot.

Blood-clot Don'ts.

As a way of protecting the clot that has formed, during the first 24 hours following your extraction, you should ...

  • Avoid vigorous rinsing or spitting. - These activities may dislodge the clot.
  • Don't disturb your extraction site. - Don't touch or poke at it with your finger. Don't explore it with your tongue.
  • Don't consume hot liquids and foods. - Hot items, especially liquids like soup, tea and coffee, tend to dissolve blood clots.
  • Minimize air pressure differences. - You should also avoid creating air pressure variations in your mouth, or pressure differences between your mouth and your sinuses (in the case of an upper tooth extraction) because these events may dislodge the blood clot from its socket.

    This means you should avoid smoking or using a straw (these activities create suction). Also, don't blow your nose. And if you need to sneeze, sneeze with your mouth open. (See below for more details.)


C) Minimize activities that may make it harder to control bleeding.

During the first 24 hours after your tooth extraction, you'll want to avoid any activities that might make it difficult to control bleeding from your extraction site, or interfere with blood clot formation and retention.

While the risk of these complications is often minimal after very simple extractions, when multiple teeth have been removed or the patient's procedure has been difficult, they can become a substantial concern. Either way, it only makes sense to take precautions.

Activities.

It's best to avoid strenuous work or exercise. You should also avoid bending over or lifting heavy objects. In general, it's not a bad idea to just take it easy for the rest of the day following your surgery.

Resting.

When you sleep or lie down, position yourself so your head is above the level of your heart. Doing so tends to lower your head's blood pressure level, which when trying to control post-extraction bleeding is a favorable thing.

Toward this goal:

  • In bed, prop your head up using an extra pillow, or even 2.
  • Position yourself in a recliner with the head portion of your chair slanted up.

Be careful when transitioning from a reclined to upright position. You may find you get lightheaded. Try just sitting up for a minute before slowly getting on up.


D) Swelling may occur.

It's common and normal for some degree of swelling to occur after having a tooth pulled. The amount that ultimately forms is typically proportional to the extent of the surgery that has taken place. That means:

  • After very simple extractions you may notice very little, possibly none.
  • With more involved cases (longer, more difficult extractions or the removal of several teeth) you may notice a pronounced enlargement, possibly involving a large portion of your face.

Generally speaking, the amount of swelling that forms can be minimized via the application of ice packs on the outside of your face over the area where your surgery was performed, starting immediately upon the completion of your procedure.

This page provides in-depth details and instructions about managing this complication: Post-tooth extraction swelling.

Do not smoke after an extraction.

Don't smoke for as many days as you can.


E) Avoid smoking.

People who smoke tend to experience a higher level of complications with extraction site healing. That means if you can avoid smoking for the first 24 hours (and preferably 48 hours and longer) after having your tooth pulled, it will be to your benefit.

We explain the how's and why's of this effect in greater detail in our discussion of smoking as a risk factor for dry sockets (a common post-extraction complication).


F) Avoid blowing your nose.

As mentioned above, in the case where you've had an upper back tooth removed (molar, bicuspid) it's best form to refrain from blowing your nose.

That's because doing so can create a pressure difference between your mouth (via the recesses of your extracted tooth's socket) and your sinuses that might be great enough to disrupt what in some cases may be just a paper-thin layer of bone separating the two.

Oroantral communications.

Failing to follow these directions can result in creating what's termed an "oroantral communication" (a direct connection between your mouth and sinus). And the development of one will complicate the healing process. (The communication itself will need to be blocked off before normal healing of the socket can occur.)

Other precautions.

Actually, it's not just avoiding blowing your nose that's important. You should generally refrain from doing anything that might create a pressure difference, such as:

  • Sneezing. If you need to sneeze, do so with your mouth open.
  • Avoid sucking on items such as a straw or cigarette.
  • If you play a 'wind' musical instrument, ask your dentist when it will be OK to resume playing.


G) Controlling extraction-site pain.

The level of discomfort a patient can expect during the first 24 hours following their extraction can be quite variable. For some people, it will be a non-event. For others, it may be quite noticeable. (This page discusses managing pain that extends beyond the initial 24 hours after your procedure.)

Timing your medication.

Quiz your dentist about what to expect. If they feel it's highly likely that you'll need to take an analgesic (pain pill), a good plan can be to do so before the local anesthetic used for your procedure has worn off.

If discomfort does become an issue, in terms of types of analgesics there are two general classes of medications that are typically used.

a) OTC medications.

For just minor to mild pain, your dentist will probably advise the use of an over-the-counter (non-prescription) analgesic.

Commonly used products include acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®). You'll need to read and follow the directions and warnings that accompany the one that's been recommended for you.

b) Prescription medications.

If a higher level of pain relief is needed, your dentist will likely turn to the use of prescription analgesics.

Pain relievers.
Narcotic medications.

The formulation of many prescription pain relievers includes the narcotic codeine (or similar compounds).

  • These products will tend to upset your stomach, so it's usually best to take them with food or milk.
  • Taking a narcotic may make you dizzy, drowsy or groggy. It may also slow down your reflexes or cause you to act strangely. So if you're taking one, you should let those around you know. You should also limit your activities (driving, operating machinery, etc...).
  • Additional common side effects include nausea, vomiting and constipation.
  • You should abstain from drinking alcoholic beverages when taking a narcotic.
Other precautions.

Make sure that you read and follow all directions and precautions associated with your medication's use. If you have any questions, you should discuss them with your dentist or pharmacist.

Remember that your product has been prescribed to you for the short-term use of controlling the pain associated with your extraction. Since some products can become habit forming, their use should be discontinued at the earliest point where pain control is no longer needed.


H) Continue on with prescribed antibiotics.

Any antibiotics prescribed by your dentist should be taken as directed, to completion. This includes continuing on with them even after your tooth has been removed.


I) Eating.

After a difficult extraction, a soft (nothing hard or crunchy) or even liquid diet (supplemental nutrition drinks, milk shakes) might be indicated for the first 24 hours or so after your surgery.

For simpler extractions, just making sure that you do your chewing somewhere else should be precaution enough.

Whichever approach is indicated, maintaining proper nutrition is important for keeping up your strength and providing the nutrients needed for your socket's healing process, so try not to skip any meals. Although, it's best to wait until the local anesthetic used for your procedure has worn off.

Types of foods.

As a general rule, it makes good sense to avoid relatively hard or crunchy foods. That's because no matter how careful you are they often wind up in the wrong place, thus poking at your extraction site and even causing it to bleed.

Consuming hot liquids (like soup or coffee), and even hot foods, will tend to dissolve the blood clot that has formed in your tooth's socket, so they should be avoided. Also, you should avoid consuming alcoholic beverages.

Drink plenty of water.

It's important to stay well hydrated. That's because you've lost some bodily fluids during your extraction procedure. You'll also want to maintain optimal body chemistry for your socket's healing process.

Especially after more involved extractions (difficult procedures, the removal of multiple teeth), drinking 6 to 8 glasses of water per day makes a good idea.


J) Precautions with numbness.

A dentist giving a dental injection.

After your tooth has been pulled, some portion of your mouth will still be numb, possibly for some hours. Besides just the area immediately surrounding your extraction site, this will likely include some aspect of your lips, cheeks or tongue too.

This sensory loss can result in accidents. As examples ...

  • You might unknowingly bite your lip or tongue while chewing, possibly even repeatedly.
  • You might not be able to test hot (temperature) foods and beverages adequately, which could result in burns.
  • Some patients, especially children, may find their numbness a novelty and will bite on, or chew, numbed tissues (lips, cheeks or tongue). This may result in significant damage.

In regard to this issue, children must always be monitored during periods of numbness.


Avoid using mouthwash after an extraction.

Avoid using mouthwash.

K) Cleaning your teeth.

It's important for you to maintain good oral hygiene over the days and weeks while your extraction site is healing.

  • On the day your tooth has been pulled, it's best to avoid brushing those teeth that directly border your extraction site. Wherever access isn't a problem, it's OK to clean your other teeth.
  • During the first day after your extraction, it's OK to let water or saline solution (1/2 teaspoon of table salt in 1 cup of warm water) roll around in your mouth but rinsing vigorously must be avoided. Doing so might dislodge the blood clot that's formed in your tooth's socket.
  • Avoid the use of commercial mouthwash or mouth rinse. These products may irritate your extraction site.

Our next page discusses recovery & care for the days and weeks after your surgery. ▶

 

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