POSTOPERATIVE CARE AFTER DENTOALVEOLAR SURGERY

Good aftercare to prevent complications and unnecessary suffering, with loss of valuable time, is as important as a good operation.

The main purpose of aftercare is to expedite healing and prevent or relieve pain and swelling.

Rest is necessary for the prompt healing of wounds. Ambulatory patients should be directed to go home & remain quiet for several hours, preferably sitting in a comfortable chair or, if lying down, keeping the head elevated on several pillows.

  • Only liquids and soft solids should be eaten the first day. They may be warm or cold but not extremely hot.
  • Food intake should not begin until several hours after surgery to avoid disturbing the blood clot.
  • If the extractions were limited to one side, chewing can be done on the unoperated side, but when local anesthesia has been used, chewing should be avoided until sensation has returned.
  • Fluids should be taken in greater amounts than usual to prevent dehydration from limited food intake.
  • A normal diet should be resumed as soon as possible, since this facilitates healing.
  • The teeth should be brushed as usual, and on the day after surgery rinsing of the mouth should begin.
  • A saline solution (1/2 teaspoon of salt in a glass of warm water) is best for this purpose.
  • Commercial mouthwashes if used should be diluted with water due to the high alcohol content that can irritate the wound.
  • Hydrogen peroxide rinses should not be used initially as this agent can remove the blood clot.❌
  • Some degree of postoperative pain accompanies many exodontic procedures and begins after the effects of anesthetic have left. This is considered a normal response to the unavoidable trauma of surgery.
  • In most cases, such pain lasts no more than 12 to 24 hours, although a traumatic periostitis may persist for several days.
  • Ordinarily this type of pain can be controlled by the use of cold packs (30 minutes per hour) during the first 24 hours & the proper administration of analgesic drugs.
  • For mild pain, as after a routine extraction, one of the antipyretic analgesics is usually adequate.
  • For moderate pain, such as after removal of an impacted tooth, a drug such as codeine or meperidine (Domerol) should be used.
  • Narcotics are needed only in rare instances.
  • The combination of a sedative drug with an analgesic agent can also be used but barbiturate alone should never be used to relieve pain as it can result in mental disorientation in a patient suffering from extreme pain.
  • The degree of swelling that occurs is generally in direct proportion to the degree of surgical trauma.
  • The application of cold to the operated site helps diminish postoperative swelling. If a rubber ice bag is not available, the ice can be placed in a plastic bag.
  • Cold can be applied intraorally by holding an ice cube in the mouth.
  • Pressure dressings can also be beneficial in limiting postoperative swelling.
  • Once swelling has reached the maximum (usually after 24 to 48 hours), cold is no longer effective, and heat, in the form of moist compresses, should be applied. It too should be used only 30 minutes per hour. The area should be lubricated with petroleum jelly to avoid burning the skin.
  • Intraoral heat is achieved by the use of hot isotonic saline rinses.
  • Cigarette smoking should be avoided after tooth extraction because it has been shown to increase the incidence of alveolar osteitis

Dr. Mehnaz Memon🖊


References: Textbook of Oral Surgery – Daniel M Laskin

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