Managing and Controlling Post-Extraction Complications
Many common complications that arise after tooth extraction can be managed or prevented by giving patients clear post-operative care instructions. When these complications escalate into emergencies, patients may mistakenly believe that the dentist made an error, which could lead to threats of legal action. This article provides essential instructions to give to your patients following an extraction procedure to help avoid misunderstandings related to common treatment complications.
Patient Instructions for Post-Extraction
| Local anesthesia | Local anesthesia will have been administered to the patient. Advise your patient that the feeling of numbness will begin to wear off in 30 minutes and last up to 4 hours. Until that time, the patient should avoid all hot foods or liquids and avoid foods that will require intense chewing. This will aid in preventing accidental burning or biting of their lips, cheeks, inside of their mouth, or tongue (especially children) until normal feeling has returned. They may also have been given other sedative medications, so it is important to discuss any side effects or precautions with your patient. INSTRUCT THE PATIENT TO CALL THE OFFICE WITH ANY CONCERNS ABOUT PROLONGED NUMBNESS. |
| Gauze | Fold the gauze into a small pack and place over the extraction site. Keep firm biting pressure on the gauze pack for at least 30 minutes. Advise the patient that maintaining firm biting pressure on the gauze for one to two hours is ideal. Refresh the gauze pack every 15-30 minutes. It may aid in clotting if they dip the gauze in a strong but COOLED tea solution before biting on it. |
| Bleeding | Advise your patient that it is normal for the extraction site to bleed slightly or ooze blood for 12 to 24 hours following surgery. |
| Ice pack | Encourage the patient to apply ice packs for the first 2-8 hours after surgery to the outside of the face (protect the skin with a cloth from direct contact with ice) over the area of the extraction site. The ice pack should be held in place for 15 minutes or so and then removed for 15 minutes. This may help reduce discomfort and swelling. |
| Medications | The patient should be told to NOT TAKE ASPIRIN PRODUCTS for pain due to the possible increase in bleeding potential (especially if they are already taking Plavix or Coumadin or other blood thinning medications.) Follow label instruction on prescription medications (including pain medications and antibiotics) and over-the-counter medications. Over-the-counter medication(s) will often provide excellent pain relief. Avoiding highly addictive narcotics is always preferred. Advise them not to take more than the manufacturer or doctor recommended dosage of any over-the-counter or prescription medication(s). Advise them to discontinue use and call your office if they experience any untoward side effects from the medication(s). INSTRUCT THE PATIENT THAT FOR SERIOUS SIDE EFFECTS OR ALLERGIC REACTIONS, SEEK MEDICAL CARE IMMEDIATELY. |
| Diet | Advise the patient to adhere to a liquid or soft diet for the first 12-24 hours. Let them know that it is important for them to drink plenty of fluids for the first day or two following surgery. Advise them to avoid the use of a straw when drinking as it may dislodge the blood clot that is forming in the extraction site. |
| Oral hygiene | Instruct your patient to continue their routine oral hygiene practices – good oral hygiene after an extraction is essential. However, advise them to avoid bumping or brushing the extraction site for the first 24 hours. INSTRUCT YOUR PATIENT NOT TO VIGOROUSLY RINSE OR SWISH THEIR MOUTH for the first 24 hours following surgery. They should be told NOT TO SMOKE and to avoid alcoholic beverages for the first 24 hours following surgery as this will interfere with healing. |
| Activity | For the first 48 hours, patients should be advised to rest and relax as best they can and limit physical activity. After 48 hours, they may resume activity as tolerated. |
| Sutures/stitches | Advise the patient that stitches and sutures will resorb or fall out on their own. It is normal for a suture to come out on the day of surgery. If bleeding occurs because the sutures have fallen out, the patient should bite on gauze to apply pressure as described earlier. If non-resorbable sutures were placed, ensure a follow-up appointment has been scheduled for their removal. |
Further Complications for Patients to Beware of
Explain to the patient that complications may arise from the oral surgical procedure and provide guidance on what to do if they encounter any issues. This information should also be included in the informed consent discussion.
- Dry socket: Discuss with the patient that dry socket is sometimes a problem after surgery. The symptoms associated with dry socket are constant moderate-to-severe pain, bad taste, putrid odor, and poor clot formation at the surgical site. Tell them to call your office immediately if they think they have any of these symptoms.
- Fever: Patients should be advised to monitor their temperature for the first 24-48 hours and report any elevated temperature to the office.
- Swelling/Pain: Tell the patient to expect some swelling, bruising, and discomfort during the first 24-48 hours. Advise them that they may have difficulty opening their mouth and have associated jaw pain. Advise them to SEEK MEDICAL ATTENTION IMMEDIATLEY AND GO TO THE EMERGENCY ROOM if there are any concerns that the pain, swelling, or limited opening is excessive, or rapidly worsening and/or they are having difficulty breathing or swallowing.
Additional Discussions with Your Patients
It is important to discuss with your patient that, while we strive to cover all foreseeable complications, there are various unforeseen issues that can arise after any surgical procedure. Some of these may require additional therapy or emergency medical attention. If they have any questions or concerns about what they are experiencing following an extraction procedure, they should call the office for guidance. Always provide specific instructions on how to contact the doctor after office hours.
Emphasize that if they experience any severe swelling, difficulty breathing, prolonged bleeding, intense or prolonged pain, high fever, dizziness, allergic reactions, or anything they believe to be life-threatening, they should go to the emergency room immediately for medical attention.
And Don’t Forget to Make Copious Notes in the Patient Chart
Ensure you note in the patient’s chart that you have discussed these key points with them. Provide a written copy of your instructions and anything else you find suitable for them to reference later. Call the patient on the day of the procedure and the day after to assess their progress and address any potential complications. Verify that they have an appointment to return to your office in a week or ten days for you to examine the surgical site. Conversations with your patient, as mentioned above, will help you prevent misunderstandings regarding common treatment complications and give them a clear understanding of when to seek immediate medical attention for any life-threatening escalations of typical complications.
The information contained on the DentistCare Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. All information contained on the blog is subject to change.
