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Tooth extraction refers to painless removal of tooth or tooth roots with minimum trauma to the surrounding tissues so that the extraction socket wound heals uneventfully without any post-operative complications. Whenever any surgery  or Tooth extraction takes place the first thing we want is to let it heal properly ,quickly and smoothly. As a common practice, most of the dental surgeons have standard post surgery instructions printed which are handed over to the patient. One must follow these instructions given by the dentist. Apart from those instructions there are few things which need to be taken care post tooth extraction. Following all the post-operative instructions after tooth extraction reduces the incidence of infection and chances of dry socket after tooth extraction. If aftercare instructions are not followed after tooth extraction, then it can cause dry socket which can further lead to delayed healing of the tooth extraction socket. So patient is advised to follow certain do's and don'ts after tooth extarction procedure.  

Try to take some rest after Tooth Extraction. You may feel great but don’t exercise at least for a day after tooth extraction.When taking rest,keep your head lifted on a pillow.

Let the clot be formed on the tooth extraction site , which covers it and allow it to heal. Bite on the gauze piece after tooth extraction, which the dentist has put on the extraction socket,  minimum for an hour. Don’t chew on that gauze piece but put a steady pressure. This will help in stopping the bleeding and formation of clot  which acts like a cork on the bottle. Change gauze after every half an hour depending on the amount of bleeding. If clot is dislodged,the nerve endings are exposed,nerves and capillaries spasm and constrict,limiting essential blood supply which causes delay in healing. If the bleeding doesn't stop one should try putting a wet tea bag in the site, as tannic acid present in black tea helps  stop bleeding.

Ice Packs: Apply ice pack on the side where surgery was performed. All this is done to reduce swelling. Though on simple extractions, swelling isn’t accompanied but in cases requiring severe cheek retractions, swelling can occur after operation. Though the swelling will not occur immediately but will reach maximum at 2^nd or 3^rd day. So, to minimize this swelling immediately apply ice packs. Various methods of applying ice packs are:

• Sealed plastic bags filled with ice or

• A bag of frozen peas or

• Corn wrapped in a washcloth

Application of ice pack is most effective during the day of extraction as after 24 hours there is no significant beneficial effect. Ice packs should be applied 15 minutes on and 15 minutes off for 1-2 hours.

Blowing and sneezing: Make sure not to blow or sneeze after extraction as it creates a negative pressure thereby dislodging the clot and making the conditions favorable for dry socket.

Don’t spit minimum for 24 hours after tooth extraction because it can dislodge the clot. If the clot is dislodged you can have very painful condition known as dry socket. In case of dry socket, physiologic clot is lose both in quantity and quality. Afterwards one should spit 3-4 times in a day so that no food is lodged near the area where the tooth is removed. Dentist may advice CHLOROHEXIDINE mouth rinses as they kill bacteria.

Don’t take solids immediately after Tooth Extraction till the numbness is there. When you start feeling your jaws you can start taking solids. After tooth extraction, take soft and liquid foods like soups, mashed potatoes, yogurts, milkshakes, smoothies etc.

Warm saline rinses: The main aim of rinsing is to clean the area of extraction as it is not possible to brush the socket. We mix salt to make the solution isotonic and similar to natural tissue fluid and thus it is less irritating than water. Rinsing is usually advised 12 hours after extraction. So, warm saline rinses help in cleaning and maintaining the hygiene of that area.

Take your medicines as prescribed by your dentist. Don’t skip the medicines. If antibiotics are given they should be taken regularly. Pain killers and anti-inflammatory drugs are to be taken after tooth extraction. It help in reducing the pain and swelling. If the pain continues even after two days of tooth extraction and bleeding starts then you should call your dentist.

Avoid Aspirin: Don’t ever take aspirin (Can take ibuprofen). Aspiring being a blood thinner will delay in clot formation thereby will prevent healing. Take the medications as prescribed by the physician and consult your dentist before taking any medicine.

Avoid Sucking of any type -  SMOKING, SIPPING, EATING HARD VEGETABLES are to be avoided after tooth extraction. Try taking soft and liquid food options such as soups, mashed potatoes, yogurts, milkshakes, smoothies etc. after tooth extraction. Avoid hot drinks, spicy foods, sodas, etc.

If you are daring enough to avoid these instructions, you may be a strong contender for some complications.

Don’t poke into the gap created: Though for initial few days, it will feel a bit awkward to have a gap but don’t poke that area with any toothpick or tongue as it may delay healing, may provoke bleeding and can also lead to dry socket. 

WHAT COMPLICATIONS CAN BE THERE AFTER TOOTH EXTRACTION?

1. Bleeding
2. Infection
3. Dry socket
4. Jaw fracture
5. Sinus perforation
6. Broken Bone Fragments (Sequestrii)
7. Part of the Tooth Left (Retained Roots)
8. Osteonecrosis

Bleeding After Tooth Extraction: If one follows the instructions of the dentist after Tooth extraction to take rest and to keep the gauze piece for 1 to 2 hours after extraction then the problem of bleeding is not there. The patients who are taking anticoagulants like Heparin or Coumadin or the patients who have bleeding disorders like hemophilia should give the history to the dentist. The patients who are taking aspirin or nonsteroidal analgesics have increased bleeding time.

Infection after Tooth Extraction:  Infection is the most common complication after tooth extraction. Our mouth Is full of bacteria. One cannot sterilize it. Dentist decides whether to give antibiotics after the tooth extraction or not. Normally for the simple tooth extractions antibiotics are not required but if patient has pain and swelling or pus then it is better to go for preventive antibiotics.  Bleeding continuing after 48 hours after tooth extraction, acute pain and swelling are very common signs  of infection after the tooth extraction and the patient must visit the dentist in such circumstances to avoid further complications after tooth extraction.

Dry Socket:  It is the most dreaded and painful condition which can happen after tooth extraction. For a day or two after dental extraction the patient is fine, and then he has acute pain and becomes very restless. Patient complains of bad taste in the mouth. It is more common after the dental extraction of lower teeth than the upper teeth. It can happen even after the simplest tooth extraction.

Jaw Fracture during Tooth Extraction: It can happen but very rarely and that too in lower jaw. The dentist who is doing the tooth extractions knows that how much pressure has to be put to pull out the tooth. But sometimes dentist before doing the extraction see the x-ray and tell the patient that the bone structure around the tooth has become fragile and chances of fracture are there. In such cases patient and the dentist are prepared beforehand to manage the situation.

Sinus Perforation during Tooth Extraction: The back teeth are in close proximation with the sinus. Sometimes if you see the x-ray it looks as if the roots of the back teeth are virtually in the sinus. It never happens. There is always a thin bone separating the sinus from the roots of the teeth. But sometimes during tooth extraction the piece of the bone comes along with the sinus. This normally happens when the tooth is close to the bone because of infection. In that case perforation occurs. If perforation occurs you cannot suck because in that case the air will rush from the nose to the sinus and through perforation to the mouth. If the perforation is small the patient complains of bleeding from nose. If the perforation occurs then the patient should follow certain instruction like:

1. Do not suck anything till the tooth extraction socket heals.
2. Do not do anything which will dislodge the clot. If the clot is not disturbed then no complication arises.
3. Do not smoke at least for a week after tooth extraction because the chemicals in the smoke either dissolve the clot or dislodge it.
4. Do not blow up the balloons or anything else, it will disturb the clot..
5. Avoid aerated drinks instead you can take fruit juices.
6. Don’t sneeze, it sneezing will surely dislodge the clot.