Pre-operative and Post-operative Care for Odontectomy in Healthy Adults
For an adult patient with no significant medical history undergoing routine tooth extraction, pre-operative assessment should focus on medical history screening for bleeding disorders and medication review, while post-operative care centers on pain management with regular analgesics and meticulous oral hygiene without routine antibiotic use.
Pre-operative Assessment
Medical History Screening
- Screen specifically for bleeding disorders, anticoagulant use, and any history of prolonged bleeding after dental procedures or minor trauma 1, 2
- Verify absence of cardiac conditions requiring endocarditis prophylaxis: prosthetic heart valves, prior infective endocarditis, unrepaired cyanotic congenital heart disease, or repaired congenital heart disease with residual defects 3
- Document any allergies to local anesthetics or antibiotics 2
Physical Examination
- Assess the extraction site for signs of acute infection (swelling, erythema, purulent discharge) 2
- Evaluate oral hygiene status and gingival health 3
Pre-operative Instructions
- No routine laboratory testing is required for healthy patients undergoing simple extraction 1, 4
- Standard fasting is not necessary for procedures under local anesthesia 1
- Patients should continue routine medications unless specifically contraindicated 2
Antibiotic Considerations
Routine Extractions in Healthy Patients
- Prophylactic antibiotics are NOT recommended for routine tooth extractions in healthy patients without risk factors 5, 6
- Antibiotics are indicated only when systemic involvement is present: fever, lymphadenopathy, cellulitis, diffuse swelling, or in medically compromised patients 6
Endocarditis Prophylaxis (High-Risk Cardiac Patients Only)
- If the patient has high-risk cardiac conditions, administer amoxicillin 2g orally as a single dose 1 hour before the procedure 3, 5
- For penicillin-allergic patients with high-risk cardiac conditions, use clindamycin 600mg orally 1 hour before the procedure 5
Post-operative Care Instructions
Pain Management
- Prescribe regular analgesics for the first week post-extraction, as over 50% of patients experience pain requiring medication, with peak intensity on the evening of extraction 7
- Female patients and those with chronically inflamed teeth may experience higher pain intensity and should be counseled accordingly 7
- Advise patients that mild to moderate pain is expected and typically resolves within 7 days 7
Oral Hygiene
- Instruct patients to maintain meticulous oral hygiene with gentle brushing, avoiding the extraction site for the first 24 hours 3
- Recommend warm saline rinses (1 teaspoon salt in 8 oz warm water) starting 24 hours post-extraction, performed 3-4 times daily 8
- Advise soft diet for 2-3 days post-extraction 8
Wound Care
- Instruct patients to bite on gauze for 30-45 minutes immediately post-extraction to achieve hemostasis 2
- Advise against smoking, using straws, or vigorous rinsing for 48-72 hours to prevent dislodging the clot 2
- Patients should avoid hot liquids and strenuous activity for 24 hours 8
Follow-up
- Schedule follow-up only if complications arise (persistent bleeding, severe pain, signs of infection, or dry socket) 8
- Instruct patients to contact the office if they develop fever, increasing swelling, or pain that worsens after day 3 6
Common Pitfalls to Avoid
Antibiotic Overuse
- Do not prescribe routine post-operative antibiotics for simple extractions in healthy patients—this is the most common error in dental practice 5, 6
- Remember that antibiotics alone are insufficient for treating dental infections; surgical intervention (drainage, extraction, or root canal) is mandatory 5, 6
Inadequate Pain Control
- Do not underestimate post-extraction pain—proactively prescribe analgesics rather than waiting for patients to request them 7
- Female patients are statistically more likely to experience higher pain intensity and should receive specific counseling about pain expectations 7