What are the recommendations for oral care and management after a tooth extraction?

Post-Extraction Oral Care Recommendations

For optimal healing and to minimize complications after tooth extraction, patients should follow a soft diet for the first 10 days, avoid sucking on pacifiers or digits, and use warm saline rinses starting 24 hours after the procedure. 1

Immediate Post-Extraction Care (First 24 Hours)

• Bite firmly on gauze for 30-60 minutes to control bleeding
• Avoid rinsing, spitting, or using straws for the first 24 hours to prevent dislodging the blood clot
• Apply ice packs to the outside of the face in 20-minute intervals to reduce swelling
• Take prescribed pain medications as directed

Care After 24 Hours

Oral Hygiene

• Begin warm saline rinses 24 hours after extraction 2
  • Mix 1 teaspoon of salt in 8 ounces of warm water
  • Rinse gently twice daily (evidence shows twice daily is as effective as six times daily) 2
  • Continue for at least 72 hours to significantly reduce risk of alveolar osteitis (dry socket) 2
• Resume gentle brushing of other teeth, avoiding the extraction site
• Keep the extraction site clean by irrigating with an antiseptic rinse such as chlorhexidine 1

Diet and Habits

• Maintain a soft diet for 10 days after extraction 1
• Avoid sucking on pacifiers or digits if possible 1
• Avoid smoking and alcohol as these delay healing 1
• Avoid hot, spicy, acidic, raw, or crusty foods that may irritate the extraction site 1
• Contrary to some beliefs, milk and dairy products do not need to be avoided after oral surgery 3

Pain and Complication Management

• Monitor for signs of complications such as:
  • Excessive bleeding
  • Severe pain after 2-3 days
  • Swelling that worsens after 2-3 days
  • Fever
  • Foul taste or odor from the extraction site
• Watch for symptoms of pulpal necrosis including gingival swelling, increased mobility, or parulis (gum boil) 1

Special Considerations

Infected Teeth

• Infected teeth should be extracted promptly rather than delaying extraction by using antibiotics first 4, 5
• Evidence shows no increase in complications when extracting acutely infected teeth compared to asymptomatic teeth 4

Antibiotic Use

• Routine use of systemic antibiotics is not indicated for most tooth extractions 1
• Antibiotics should be reserved for patients with specific medical conditions requiring coverage 1

Follow-up Care

• Return to the dentist if any concerning symptoms develop
• Complete any recommended follow-up appointments to ensure proper healing
• Consider implant placement timing if relevant - early implant placement (4-8 weeks after extraction) is often recommended when ideal conditions for immediate placement aren't present 1

By following these recommendations, patients can minimize complications and promote optimal healing after tooth extraction. The evidence strongly supports the use of warm saline rinses starting 24 hours after extraction as a simple yet effective measure to prevent complications like alveolar osteitis.