pillows when resting or sleeping during the first 24
hours since lowering the head increases blood pressure
and can promote continued bleeding.
Figure 5-58.Placing a pressure pack.
Instruct the patient not to smoke or use a straw for
at least 24 hours. Frequent spitting, sucking on the
wound, and using mouthwashes should be avoided
during this time to secure an adequate blood clot.
Inform the patient to take the prescribed
medications for pain, and the antibiotics to prevent
infection (if prescribed). It is best if the patient takes
the first dose of pain medication after the removal of
the initial gauze pack. This allows the pain medication
to enter the blood stream before the effects of the local
anesthesia wears off.
Instruct oral surgery patients to place an ice bag or
chemical cold pack- on the external area of the
treatment site for the first 24 hours only, to minimize
swelling. Apply the ice for at least 30 minutes on and
then 30 minutes off after the surgery. Any amount of
time less than this will not permit the cold to penetrate
the tissues adequately. Cold is effective in decreasing
edema by constricting the blood vessels. Heat may be
placed on the jaw after the first 24 hours to minimize
You should recommend a soft diet and sipping of
water and fruit juices for a few days following dental
surgery. Make sure the patient has an appointment to
return for a post-surgical check in 3 to 5 days.
You should always remain with your surgical
patients until they recover enough to be dismissed.
Dismiss your patients as cordially as you received
them. Closely observe the patients as they leave to
make sure that they are steady and show no signs of
distress. If patients exhibit any signs of dizziness,
detain them until the dentist can evaluate their
Sutures can be removed 3 to 7 days following
surgery, depending on the material and procedure. For
example, nylon or silk sutures are removed from 3 to 5
days after surgery if adequate healing has taken place.
After the extraction site is examined by the dentist,
suture removal can be delegated to the assistant.
Irrigate or swab the suture site with an antiseptic
solution to remove any debris. Locate and account for
all the sutures placed during the surgical treatment.
Use a hemostat or cotton forceps to gently lift the
suture away from the tissue to expose the attachment of
the knot. With the scissors in the other hand, slip one
blade of the scissors under the suture and one blade
over the suture. Cut the suture material as close to the
tissue as possible so that a minimum of material is
pulled through the tissue. Grasp the knot and gently
slide the suture out of the tissue. Take care not to pull
the knot through the tissue, since this causes
unnecessary discomfort to the patient. Continue lifting
and snipping the suture material until all sutures are
removed. Count and compare the number of sutures
removed with the number placed as indicated in the
Irrigate the surgical area with
antiseptic solution if there is any bleeding.
Just as with any surgical procedure, there can be
complications. In oral surgery, the common
post-surgical complications are alveolar osteitis,
swelling, and bleeding. These complications have
been discussed in Dental Technician, Volume 1,
chapter 6, "Emergency Treatment of Oral Diseases
and Injuries," and under the Post-Surgical Instructions
section in this chapter.