When to Resume Tooth Brushing After Tonsillectomy/Adenoidectomy
Patients can resume gentle tooth brushing immediately after tonsillectomy/adenoidectomy, starting the evening of surgery or the next morning, while avoiding the surgical site in the back of the throat.
Immediate Postoperative Oral Hygiene
While the major clinical guidelines from the American Academy of Otolaryngology-Head and Neck Surgery do not specifically address tooth brushing timing 1, maintaining oral hygiene is important and can be safely initiated right away with appropriate precautions.
Safe Brushing Technique
Brush the front teeth, tongue, and anterior mouth gently starting the day of or day after surgery, avoiding direct contact with the tonsillar fossae (surgical sites in the back of the throat) 2
Use a soft-bristled toothbrush to minimize trauma risk and avoid aggressive brushing motions near the surgical site 2
Avoid vigorous rinsing or spitting in the first 24-48 hours, as this can disrupt clot formation and increase primary bleeding risk (which occurs in 0.2-2.2% of cases within 24 hours) 1, 2, 3
Clinical Rationale
The primary concern after tonsillectomy is hemorrhage, with secondary bleeding typically occurring between days 5-10 when the eschar sloughs 3. However, gentle tooth brushing of the anterior dentition does not pose significant risk to the tonsillar fossae if performed carefully.
Key Safety Considerations
Primary bleeding occurs within 24 hours (0.2-2.2% incidence) and is related to surgical technique rather than oral hygiene activities 1, 4
Secondary bleeding occurs after 24 hours (0.1-3% incidence), typically days 5-10, due to eschar sloughing—not from gentle tooth brushing 1, 3
Maintaining adequate hydration through oral intake is strongly emphasized for healing, and oral hygiene supports this by keeping the mouth comfortable 2
Common Pitfalls to Avoid
Do not use mouthwash containing alcohol in the immediate postoperative period, as it can cause pain and irritation to the surgical site 2
Avoid letting the toothbrush contact the tonsillar fossae directly, especially during the first week when bleeding risk is highest 2, 3
Do not use water picks or high-pressure irrigation devices near the surgical site during the healing period 2
Warning Signs Requiring Immediate Attention
Patients should seek immediate medical care if they experience 2, 3:
- Fresh bleeding from the mouth or nose (not just blood-tinged saliva)
- Respiratory distress or difficulty breathing
- Severe pain uncontrolled by prescribed medications
- Signs of dehydration (decreased urination, extreme thirst, dizziness)