From the Guidelines
After a tooth extraction, it is crucial to follow proper post-operative care to ensure healing and prevent complications, and according to the most recent evidence, patients can likely continue their antiplatelet therapy without significant risk of bleeding 1. When it comes to post-operative care for tooth extraction, several key steps can be taken to promote healing and minimize the risk of complications.
- For the first 24 hours, patients should bite firmly on the gauze pad placed by their dentist for about 30-45 minutes to control bleeding, changing it if it becomes soaked.
- Prescribed pain medications should be taken as directed, typically ibuprofen (400-600mg every 6 hours) or acetaminophen (500-1000mg every 6 hours) for mild to moderate pain, or prescribed narcotics for severe pain.
- Applying ice packs to the outside of the face for 20 minutes on, 20 minutes off during the first 24 hours can help reduce swelling.
- Patients should avoid rinsing, spitting, drinking through straws, smoking, or drinking alcohol for at least 24 hours as these actions can dislodge the blood clot and cause dry socket.
- After 24 hours, patients can gently rinse with warm salt water (1/2 teaspoon salt in 8 ounces of water) 4-5 times daily, especially after meals.
- Eating soft foods like yogurt, applesauce, and soup for the first few days and gradually returning to a normal diet as comfort allows is recommended.
- Maintaining good oral hygiene by brushing and flossing, but avoiding the extraction site, is important.
- If prescribed antibiotics, patients should complete the entire course.
- It is also essential to contact the dentist if severe pain not controlled by medication, excessive bleeding, fever, or worsening swelling after 2-3 days occurs, as these may indicate infection or other complications. Additionally, there is little or no indication to interrupt antiplatelet drugs for dental procedures, including tooth extraction, as the risk of bleeding can be managed with local measures during surgery 1. In terms of oral antisepsis, rinsing with chlorhexidine 0.12%–0.20% mouthwash for 3 min before surgery may be beneficial 1, but the primary focus should be on following the post-operative care instructions provided by the dentist to ensure a smooth and complication-free recovery.
From the Research
Post-Operative Care for Tooth Extraction
Pain Management
- The combination of ibuprofen and acetaminophen has been shown to be an effective and safe alternative for postoperative pain management after tooth extraction 2.
- This combination may provide greater pain relief than ibuprofen or acetaminophen alone, with fewer adverse effects than opioid-containing formulations 2.
- Ibuprofen and acetaminophen can be used together as a therapeutic strategy for managing acute postoperative dental pain 2.
Oral Hygiene
- Salt water rinse can be used as an adjunct to routine mechanical plaque control for the prevention of oral diseases 3.
- Salt water rinse has been shown to be as effective as chlorhexidine in reducing dental plaque and certain oral microbial counts 3.
- Rinsing with salt water or chlorhexidine can help reduce oral microbes and promote healing after tooth extraction 3.
Medication Use
- The combination use of nonsteroidal anti-inflammatory drugs (NSAIDs) is not recommended due to potential interactions and lack of clinical benefit 4.
- Aspirin can reduce the blood levels of many NSAIDs, and multiple drugs may be antagonistic or less than additive in animal models of inflammation 4.
- NSAIDs should be used one at a time, with supplementary analgesics added as needed 4.