Post-surgical Indications

Following the post-surgical indications recommended by your oral surgeon is a key factor in success of any oral surgery.

Below we give you, for reference, a general list of indications of things you can do after wisdom teeth removal or any other surgical dental procedure.

We do not pretend to be a guide of what you need, the definitive indications must always be given by the doctor who performed the treatment.

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General Dental Post-surgical Indications

The instructions that you will receive are aimed at achieving a recovery in the shortest possible time, relieving discomfort and helping the healing processes.

This applies to procedures performed in oral surgery and periodontics such as:

• Wisdom teeth extraction
• Dental implant placement
• Scaling and root planning
• Sinus lift
• Bone grafting
• Gingivectomy

In general you must:

• Keep rest
• Mitigate pain and inflammation
• Prevent infections
• Take actions that promote healing by maintaining the suture and the clot ( which is the body’s reaction to stop bleeding).

Here is the translation into English, maintaining the original structure and professional tone:

General Guidelines

1. Acute Phase
   • Biological Time: 0–60 minutes
   • Therapy: Physical pressure with gauze
   • Objective: Hemostasis (stop bleeding)
   • Protocol: Keep the gauze bitten down for at least 40 minutes. This will allow the clot to form and the healing process to begin.
   • Safety Note: If bleeding is not controlled, contact your doctor immediately.
2. Absolute Rest Phase
   • Biological Time: 0 to 72 hours
   • Therapy: General guidelines
   • Objective: Promote healing and protect the clot
   • Protocol:
   • Communication: peak only as much as strictly necessary.
     • Soft and Cold Diet: Purees, blended cold soups, natural juices, ice cream.
     • Avoid Aggressive Foods: NO grains, NO rice, NO spicy foods, NO acids, NO alcohol.
     • Mechanical Precautions: Do not use straws, do not blow, do not kiss, do not suck, do not spit.
     • Surgical Area: Do not chew on the side of the surgery or exert any force upon it.
     • Avoid Heat Exposure: Hot meals, sun exposure, cooking, hair dryers, saunas, etc.
     • Bleeding: Do not spit out blood, as you may dislodge the clot. Try not to rinse forcefully.
     • Smoking: Do not smoke.
     • Postural: Keep your head elevated. Sleep in a semi-reclined position.
     • Physical Activity: No exercise or physical exertion.
     • Sutures: Take care of the stitches; if any fall out, notify your doctor.
     • Hygiene: Maintain oral hygiene, but brush the affected area very carefully using a super-soft bristle toothbrush.
     • Rinses: You may be prescribed some clorexidine based antimicrobial rinse or a salt water ^{1 2}.
     • Medications: follow your prescribed medications
   • Safety Note: In case of any concerns, contact your doctor immediately.
3. Reactivation Phase
   • Biological Time: 3–7+ days
   • Therapy: Gradual reactivation
   • Objective: Return to normalcy
   • Protocol:
     • Gradual phase-out of the postural and mechanical measures from the Absolute Rest Phase.
     • Maintain hygiene instructions.
     • Continue cold and heat applications as instructed.
     • Do not smoke.
     • Final appointment for suture removal (unless they are resorbable).
   • Safety Note: In case of any concerns, contact your doctor immediately.

Cold and Heat Therapy Guidelines

Using a combination of cold and moist heat is key to reducing discomfort like swelling, pain, and stiffness.

Follow these steps alongside the general guidelines provided above

Steps

1. Acute Phase (Inflammatory)
   • Biological Timeframe: 0-24 hours
   • Indicated Therapy: Cold (Cryotherapy)
   • Objective: Hemostasis, vasoconstriction, edema prevention, analgesia.
   • Application protocol:
     • Intermittent: 20 min ON / 20 min OFF (ice or gel ice pack).
     • Continuous: Only If Electronic Hilotherapy is used at 15°C.
   • Safety Notes: Use cloth barrier. Do not apply heat. Monitor for cold burns/injuries.
2. Transition Phase
   • Biological Timeframe: 24 – 48 hours
   • Indicated Therapy: Intermitent Cold (Cryotherapy)
   • Objective: Maintenance of inflammatory control
   • Application protocol: Continue with intermittent ice if pain/swelling persists. Gradually reduce frequency
   • Safety Notes: The effect of cold diminishes at the end of this period. Do not apply heat yet
3. Inflection Point
   • Biological Timeframe: 48 – 72 hours
   • Indicated Therapy: Transition (Wash-out)
   • Objective: Change from vascular to cellular phase. Peak edema.
   • Application protocol: Cease active cryotherapy. Evaluate status: if no bleeding, prepare for heat.
   • Safety Notes: Observation period. Edema will reach its maximum here.
4. Resolution Phase
   • Biological Timeframe: Day 3 – 7+
   • Indicated Therapy: Moist Heat (Thermotherapy)
   • Objective: Edema reabsorption, Trismus (difficulty opening the mouth) Treatment, Muscle Relaxation.
   • Application protocol:
     • Intermittent: Warm moist compresses 20 min, 3-4 times a day.
     • Rinses: Gently warm rinses with salty water
     • Special note for Implants and Grafts: Very gentle and strictly external heat (no rinses) after 72 hours, avoiding mechanical manipulation of the grafted area.
   • Safety Notes: Safe temperature (~40-45°C). Do not use if there are signs of active infection (pus, fever).

Infographic

References

1. Stewart, M., Levey, E. & Nayyer, N. Salt water mouthwash post extraction reduced post operative complications. Evid Based Dent 16, 27–28 (2015). https://doi.org/10.1038/sj.ebd.6401084 ↩︎
2. Collins, J.R., Veras, K., Hernández, M. et al. Anti-inflammatory effect of salt water and chlorhexidine 0.12% mouthrinse after periodontal surgery: a randomized prospective clinical study. Clin Oral Invest 25, 4349–4357 (2021). https://doi.org/10.1007/s00784-020-03748-w ↩︎

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