1. Preparation

WHAT IS A DENTAL EXTRACTION?

An extraction is a dental procedure where a tooth is permanently removed from its socket in the jawbone. In simple terms there are two types of extractions, routine general extractions and surgical extractions.

Extractions that are classified as routine extractions are those where the tooth is visible in the mouth and easily grasped by forceps. These extractions are routinely performed by general dentists, using local anaesthetic.

A surgical extraction is required for a tooth that has either not yet broken through the gum or a tooth that has broken off at the gum line so it is not easily removed. Surgical extractions are performed by dentists with more advanced skills in this area.

Some surgical extractions can be performed in the dental surgery while more complicated surgical extractions may have to be performed under a general anaesthetic in a day surgery or hospital. This level of surgery may be carried out by a suitably trained general dentist, oral surgeon or an oral and maxillo-facial surgeon (OMFS).

WHY IS IT DONE?

There are a number of reasons why an extraction may be required and they are:

Tooth fracture, gum disease or decay – Your dentist will attempt to repair the fractured or repaired tooth but if that is not possible, the tooth may need to be extracted.

Wisdom teeth – Wisdom teeth (third molars) come through either in your late teens or early twenties, although sometimes this can occur later in life. In some cases there is not enough room in the mouth for these molars so they crowd the molar next to it causing pain and swelling. Sometimes one or all of the wisdom teeth become impacted which means they are unable to break through the surface of the gum which can cause pain, gum infections and sometimes decay to the wisdom tooth and/or the adjacent molar.

Not only wisdom teeth but other teeth such as canine and other molars can become impacted as well, causing the same problems.

An extraction is recommended in these circumstances:

Abscessed (Infected) tooth – This is an infection of either the root of a tooth or between the gum and tooth. The most common causes of an abscess are advanced tooth decay, a severely broken down tooth or a tooth that has been affected or damaged by a sever traumatic incident. The infection may be extremely painful. Your dentist will endeavour to preserve the tooth by treating the infection but if that is not possible, the tooth may have to be extracted.

Orthodontic treatment – An Orthodontist may require the removal of permanent or deciduous teeth to free up space for the teeth that are being moved into place.

Extra teeth – In some cases there are too many teeth in the mouth due to having extra teeth. These are called supernumary teeth. In this situation the supernumary teeth sometimes block other teeth from erupting into the mouth and may require extraction to free up space.

HOW DO I CHOOSE A SPECIALIST?

Your Dentist, or the doctor you first consulted, will be able to recommend and refer you to a suitably trained and skilled dentist or OMFS. Alternatively in some circumstances your own general dentist may perform the procedure.

You may be happy to accept the advice of your dentist in regards to choosing an oral surgeon. Or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. For oral and OMFS surgeons this is the Royal Australasian College of Dental Surgeons (RACDS).

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular dentist / surgeon. Practical issues you may also like to consider are what hospital(s) a particular clinician operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going to hospital”, which is also available on the HCF website).

To access a list of Oral Surgeons who participate in HCF’s Medicover no gap arrangement:

Please note: Participation in HCF’s no gap initiatives is at the dentists/doctor’s discretion. HCF does not guarantee that every service provided by these clinicians will be a no gap service. Patients are encouraged to confirm with their dentist/doctor whether they will support Chef’s no gap initiatives for their treatment. Some clinicians who participate in the HCF Medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your particular dentist/doctor.

WHAT SHOULD I ASK MY SPECIALIST?

• Make sure you fully understand the procedure that is planned; do not be afraid to ask.
• It is your right to know all the relevant information, as this is part of informed clinical consent. Your dentist/doctor will ask you to sign a consent form.

• Apart from what the procedure is about you should also ask about:

• Preparation
• Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
• Aftercare

• Most medications should be continued as usual, but some may interfere with the examination. Your dentist/doctor will inform you of the medications you should stop. The following are examples of medications that may require special instructions:

• Aspirin (or any related products),
• Blood thinners (Warfarin, heparin.),
• Arthritis medications,
• Pain medication,
• Insulin, and iron preparations

WHERE IS IT DONE?

In most cases routine and minor surgical extractions are done while sitting in a chair at a dental surgery. In some instances general anaesthetic is required so the surgical procedure is performed in either a day surgery or hospital.

HOW LONG IS THE PROCEDURE?

The length of the procedure varies as it is dependent upon the number of teeth being extracted as well as the reason for extraction. Make sure you ask your dentist or oral surgeon prior to the procedure being performed.

WHO IS INVOLVED?

If the procedure is carried out as an in-patient in either a specialised day surgery or in a hospital, the people involved in the procedure are:

• The Oral Surgeon if multiple or difficult extractions are required
• Your dentist if a simple extraction is required
• Anaesthetist: they give you medications that make you relaxed and sleepy and look after you whilst the procedure is being carried out
• Specialised Nurses for the procedure and recovery

HOW DO I PREPARE FOR A TOOTH EXTRACTION?

In cases of abscess and infection, your dentist may require you to finish a course of antibiotics prior to your admission.

You are normally required to fast for at least 6 hours prior to oral surgery. Your dentist or oral surgeon will have his/her own specific preparation requirements and those, along with any instructions given to you by the day surgery or hospital, should be strictly followed.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

• Do not bring any valuables with you
• Leave all jewellery at home, except if you wear a wedding ring
• Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these.

2. Costs and Charges

WHAT IS IT GOING COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Dental Extraction admissions for the financial year 06/07 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 5,569 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services).
  
  
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation and hospital related services).
  
  
• There is no excess payable for same day admissions.
  
  
• The Dental surgeon's benefits are included in the ancillary portion of your cover. Please call HCF on 13 13 34 for this information.

¹ These medical services are in-patient services only.

² The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. pathology services. Therefore, the total average medical service charge ($467) differs from the sum of the individual average charges as shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all dental extraction admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive at the day surgery or hospital, the admissions clerk will attend to the associated paperwork for your stay.

On admission the nurse will ask your medical history, confirm your medications and ask you about any known allergies. In most cases the oral surgeon would have already attended to you signing the operation consent form in his/her rooms at time of booking the surgery. An anaesthetist may see you at that time or once you are in the procedure room, to explain what to expect with general anaesthetic.

Having completed the admission processes, you will then be taken to the operating theatre.

WHAT CAN I EXPECT DURING SURGERY?

Once you are in the anaesthetic bay of the operating theatre, a small plastic tube called a cannula will be placed into a vein in your arm or hand. If you are having a general anaesthetic, the cannula is used to administer intra-venous sedation, which is the first stage of your anaesthetic. You won’t remember anything more until you wake up in the recovery unit.

Once the anaesthetic has taken effect, you will be moved into the operating theatre and the extraction/s will begin.

The oral surgeon will make an incision in the gum tissue above the tooth and move the tissue aside to expose the tooth that is to be extracted. In some cases this is enough to enable the surgeon to grasp the tooth, moving it from side to side, freeing it from the bone and surrounding tissues so that it can be extracted.

Sometimes when the roots of the tooth are curved or the tooth is impacted, removing portions of the surrounding bone using a drill or osteotome (chisel like, bone cutting knife) is required to be able to free the tooth. The tooth may be split into parts and removed one piece at a time.

Once the extraction/s have been completed, your oral surgeon will close the incision with dissolving sutures and cover the area with a gauze pad (dental packs). You will then be moved to the recovery area.

1. Aftercare

WHAT HAPPENS AFTER A TOOTH EXTRACTION?

In the recovery room, nursing staff will monitor your vital signs such as blood pressure, pulse and temperature until you have recovered fully from the anaesthetic.

Sometimes the dental packs (gauze packs) will remain in your mouth for up to 30 minutes after your procedure. While you may feel some pressure or discomfort from these, they should only be removed by the recovery staff.

It is important to remember after your operation to try and minimise swallowing any blood that may be in your mouth. If you taste any blood in your mouth you should expel it into a tissue or a dish that will be provided to you by the recovery staff. It is important to remember this as blood in your stomach may result in you feeling nauseous and nausea can lead to vomiting.

Ice packs may also be applied to your face. Whilst these may be a little uncomfortable they play an important role in preventing facial swelling. Applying ice packs periodically in the first 48 hours after your surgery will help to minimise swelling which will also ease discomfort.

In most instances your surgeon will inject local anaesthetic into your mouth so when you wake up your mouth will be numb. This will wear off in 4 to 8 hours. It is advisable to take some pain relief tablets when you first begin to you feel the local anaesthetic wearing off, as most oral pain relievers take 30 – 40 minutes to take affect.

You should be able to go home the same day if there are no complications. It is essential to have someone available to take you home as you will not be allowed to drive for at least 12 hours following a general anaesthetic.

You will be given instructions and advice upon discharge to assist you with care once you are home. The instructions may include the following:

• Wound disturbance– Do not disturb the wound as it may cause irritation, infection and bleeding.

• Chewing– Chew on the opposite side for 24 hours following the extraction.

• Smoking– If you are a smoker, refrain from smoking for at least 24 hours as it will interfere with healing and may cause the wound to bleed.

• Spitting and straws– Do not spit or drink through a straw as this may cause bleeding and dislodge the clot in the wound which could then result in a dry socket. A dry socket is when the wound does not clot, leaving the nerves exposed.

• Swelling– A certain amount of swelling can be expected after an extraction but this can be controlled using cold packs which slow the circulation. A cold pack should be placed at the swelling site every 20 minutes for 20 minutes at a time for the first 24 hours following surgery.

• Pain control– You may be prescribed pain medication if you are experiencing severe pain but in most cases, anti-inflammatory medication can be taken to ease minor discomfort.

• Diet– It is advisable to remain on a soft diet for the first few days until both the stiffness of your jaw has lessened and your gum has healed. As you probably will not be consuming your usual diet it may be necessary to supplement your diet with protein or sports drinks to maintain your energy levels and promote healing. It is best to avoid spicy foods and very hot drinks as these can increase pain and promote bleeding. Alcohol can also increase bleeding and delay healing so should be avoided.

• Cleaning your mouth – You will be given specific instructions from your surgeon regarding how to take care of your oral hygiene needs post operatively. These may include using special mouth rinses and special instruction on how to brush your teeth. In the case of wisdom teeth extractions you may also be asked to gently syringe the socket area of where your tooth was removed with a salty solution. This is to ensure that no food particles are trapped there after eating. Once again check with your surgeon or hospital to obtain instructions that are relevant to the type of surgery you have undergone.

• Antibiotics – If you are prescribed a course of antibiotics following your dental extraction please ensure that you take the entire course of tablets. Many antiobiotics need to be taken with meals. If you find that you are not eating a full diet, eating a small amount of yoghurt prior to taking antibiotics can often help reduce any gastric symptoms you may experience. If you have any questions then check with your doctor or pharmacist.

If you experience any of the following symptoms, contact either your dentist or the hospital immediately:

• Bleeding that continues even though pressure is applied
• You experience difficulty breathing or swallowing
• Swelling of your face continues for over three days following surgery
• Fever
• Severe pain that does not ease with painkillers

1. Preparation

WHAT IS A DENTAL EXTRACTION?

An extraction is a dental procedure where a tooth is permanently removed from its socket in the jawbone. In simple terms there are two types of extractions, routine general extractions and surgical extractions.

Extractions that are classified as routine extractions are those where the tooth is visible in the mouth and easily grasped by forceps. These extractions are routinely performed by general dentists, using local anaesthetic.

A surgical extraction is required for a tooth that has either not yet broken through the gum or a tooth that has broken off at the gum line so it is not easily removed. Surgical extractions are performed by dentists with more advanced skills in this area.

Some surgical extractions can be performed in the dental surgery while more complicated surgical extractions may have to be performed under a general anaesthetic in a day surgery or hospital. This level of surgery may be carried out by a suitably trained general dentist, oral surgeon or an oral and maxillo-facial surgeon (OMFS).

WHY IS IT DONE?

There are a number of reasons why an extraction may be required and they are:

Tooth fracture, gum disease or decay – Your dentist will attempt to repair the fractured or repaired tooth but if that is not possible, the tooth may need to be extracted.

Wisdom teeth – Wisdom teeth (third molars) come through either in your late teens or early twenties, although sometimes this can occur later in life. In some cases there is not enough room in the mouth for these molars so they crowd the molar next to it causing pain and swelling. Sometimes one or all of the wisdom teeth become impacted which means they are unable to break through the surface of the gum which can cause pain, gum infections and sometimes decay to the wisdom tooth and/or the adjacent molar.

Not only wisdom teeth but other teeth such as canine and other molars can become impacted as well, causing the same problems.

An extraction is recommended in these circumstances:

Abscessed (Infected) tooth – This is an infection of either the root of a tooth or between the gum and tooth. The most common causes of an abscess are advanced tooth decay, a severely broken down tooth or a tooth that has been affected or damaged by a sever traumatic incident. The infection may be extremely painful. Your dentist will endeavour to preserve the tooth by treating the infection but if that is not possible, the tooth may have to be extracted.

Orthodontic treatment – An Orthodontist may require the removal of permanent or deciduous teeth to free up space for the teeth that are being moved into place.

Extra teeth – In some cases there are too many teeth in the mouth due to having extra teeth. These are called supernumary teeth. In this situation the supernumary teeth sometimes block other teeth from erupting into the mouth and may require extraction to free up space.

HOW DO I CHOOSE A SPECIALIST?

Your Dentist, or the doctor you first consulted, will be able to recommend and refer you to a suitably trained and skilled dentist or oral surgeon Or OMFS Alternatively in some circumstances your own general dentist may perform the procedure.

You may be happy to accept the advice of your dentist in regards to choosing an oral surgeon. Or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. For oral and OMFS surgeons this is the Royal Australasian College of Dental Surgeons (RACDS).

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular dentist / surgeon. Practical issues you may also like to consider are what hospital(s) a particular clinician operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going to hospital”, which is also available on the HCF website).

To access a list of Oral Surgeons who participate in HCF’s Medicover no gap arrangement:

• Call HCF Member Services on 13 13 34
• Visit one of HCF’s customer service branches
• Access HCF’s website at www.hcf.com.au/members/findahealthprofessional/findadoctor

Please note: Participation in HCF’s no gap initiatives is at the dentists/doctor’s discretion. HCF does not guarantee that every service provided by these clinicians will be a no gap service. Patients are encouraged to confirm with their dentist/doctor whether they will support Chef’s no gap initiatives for their treatment. Some clinicians who participate in the HCF Medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your particular dentist/doctor.

WHAT SHOULD I ASK MY SPECIALIST?

• Make sure you fully understand the procedure that is planned; do not be afraid to ask.
• It is your right to know all the relevant information, as this is part of informed clinical consent. Your dentist/doctor will ask you to sign a consent form.

• Apart from what the procedure is about you should also ask about:

• Preparation
• Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
• Aftercare

• Most medication should be continued as usual, but some may interfere with the examination. Your dentist/doctor will inform you of the medications you should stop. The following are examples of medication that may require special instructions:

• Aspirin (or any related products),
• Blood thinners (Warfarin, heparin.),
• Arthritis medication,
• Pain medication,
• Insulin, and iron preparations.

WHERE IS IT DONE?

In most cases routine and minor surgical extractions are done while sitting in a chair at a dental surgery. In some instances general anaesthetic is required so the surgical procedure is performed in either a day surgery or hospital.

HOW LONG IS THE PROCEDURE?

The length of the procedure varies as it is dependent upon the number of teeth being extracted as well as the reason for extraction. Make sure you ask your dentist or oral surgeon prior to the procedure being performed.

WHO IS INVOLVED?

If the procedure is carried out as an in-patient in either a specialised day surgery or in a hospital, the people involved in the procedure are:

• The Oral Surgeon if multiple or difficult extractions are required
• Your dentist if a simple extraction is required
• Anaesthetist: they give you medication that make you relaxed and sleepy and look after you whilst the procedure is being carried out
• Specialised Nurses for the procedure and recovery

HOW DO I PREPARE FOR A TOOTH EXTRACTION?

In cases of abscess and infection, your dentist may require you to finish a course of antibiotics prior to your admission.

You are normally required to fast for at least 6 hours prior to oral surgery. Your dentist or oral surgeon will have his/her own specific preparation requirements and those, along with any instructions given to you by the day surgery or hospital, should be strictly followed.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

• Do not bring any valuables with you
• Leave all jewellery at home, except if you wear a wedding ring
• Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these.

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Dental Extraction admissions for the financial year 06/07 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 5,569 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services).
  
  
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation and hospital related services).
  
  
• There is no excess payable for same day admissions.
  
  
• The Dental surgeon's benefits are included in the ancillary portion of your cover. Please call HCF on 13 13 34 for this information.

¹ These medical services are in-patient services only.

² The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. pathology services. Therefore, the total average medical service charge ($467) differs from the sum of the individual average charges as shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all dental extraction admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

3. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive at the day surgery or hospital, the admissions clerk will attend to the associated paperwork for your stay.

On admission the nurse will ask your medical history, confirm your medication and ask you about any known allergies. In most cases the oral surgeon would have already attended to you signing the operation consent form in his/her rooms at time of booking the surgery. An anaesthetist may see you at that time or once you are in the procedure room, to explain what to expect with general anaesthetic.

Having completed the admission processes, you will then be taken to the operating theatre.

WHAT CAN I EXPECT DURING SURGERY?

Once you are in the anaesthetic bay of the operating theatre, a small plastic tube called a cannula will be placed into a vein in your arm or hand. If you are having a general anaesthetic, the cannula is used to administer intra-venous sedation, which is the first stage of your anaesthetic. You won’t remember anything more until you wake up in the recovery unit.

Once the anaesthetic has taken effect, you will be moved into the operating theatre and the extraction/s will begin.

The oral surgeon will make an incision in the gum tissue above the tooth and move the tissue aside to expose the tooth that is to be extracted. In some cases this is enough to enable the surgeon to grasp the tooth, moving it from side to side, freeing it from the bone and surrounding tissues so that it can be extracted.

Sometimes when the roots of the tooth are curved or the tooth is impacted, removing portions of the surrounding bone using a drill or osteotome (chisel like, bone cutting knife) is required to be able to free the tooth. The tooth may be split into parts and removed one piece at a time.

Once the extraction/s have been completed, your oral surgeon will close the incision with dissolving sutures and cover the area with a gauze pad (dental packs). You will then be moved to the recovery area.

4. Aftercare

WHAT HAPPENS AFTER A TOOTH EXTRACTION?

In the recovery room, nursing staff will monitor your vital signs such as blood pressure, pulse and temperature until you have recovered fully from the anaesthetic.

Sometimes the dental packs (gauze packs) will remain in your mouth for up to 30 minutes after your procedure. While you may feel some pressure or discomfort from these, they should only be removed by the recovery staff.

It is important to remember after your operation to try and minimise swallowing any blood that may be in your mouth. If you taste any blood in your mouth you should expel it into a tissue or a dish that will be provided to you by the recovery staff. It is important to remember this as blood in your stomach may result in you feeling nauseous and nausea can lead to vomiting.

Ice packs may also be applied to your face. Whilst these may be a little uncomfortable they play an important role in preventing facial swelling. Applying ice packs periodically in the first 48 hours after your surgery will help to minimise swelling which will also ease discomfort.

In most instances your surgeon will inject local anaesthetic into your mouth so when you wake up your mouth will be numb. This will wear off in 4 to 8 hours. It is advisable to take some pain relief tablets when you first begin to you feel the local anaesthetic wearing off, as most oral pain relievers take 30 – 40 minutes to take affect.

You should be able to go home the same day if there are no complications. It is essential to have someone available to take you home as you will not be allowed to drive for at least 12 hours following a general anaesthetic.

You will be given instructions and advice upon discharge to assist you with care once you are home. The instructions may include the following:

• Wound disturbance– Do not disturb the wound as it may cause irritation, infection and bleeding.

• Chewing– Chew on the opposite side for 24 hours following the extraction.

• Smoking– If you are a smoker, refrain from smoking for at least 24 hours as it will interfere with healing and may cause the wound to bleed.

• Spitting and straws– Do not spit or drink through a straw as this may cause bleeding and dislodge the clot in the wound which could then result in a dry socket. A dry socket is when the wound does not clot, leaving the nerves exposed.

• Swelling– A certain amount of swelling can be expected after an extraction but this can be controlled using cold packs which slow the circulation. A cold pack should be placed at the swelling site every 20 minutes for 20 minutes at a time for the first 24 hours following surgery.

• Pain control– You may be prescribed pain medication if you are experiencing severe pain but in most cases, anti-inflammatory medication can be taken to ease minor discomfort.

• Diet– It is advisable to remain on a soft diet for the first few days until both the stiffness of your jaw has lessened and your gum has healed. As you probably will not be consuming your usual diet it may be necessary to supplement your diet with protein or sports drinks to maintain your energy levels and promote healing. It is best to avoid spicy foods and very hot drinks as these can increase pain and promote bleeding. Alcohol can also increase bleeding and delay healing so should be avoided.

• Cleaning your mouth – You will be given specific instructions from your surgeon regarding how to take care of your oral hygiene needs post operatively. These may include using special mouth rinses and special instruction on how to brush your teeth. In the case of wisdom teeth extractions you may also be asked to gently syringe the socket area of where your tooth was removed with a salty solution. This is to ensure that no food particles are trapped there after eating. Once again check with your surgeon or hospital to obtain instructions that are relevant to the type of surgery you have undergone.

• Antibiotics – If you are prescribed a course of antibiotics following your dental extraction please ensure that you take the entire course of tablets. Many antiobiotics need to be taken with meals. If you find that you are not eating a full diet, eating a small amount of yoghurt prior to taking antibiotics can often help reduce any gastric symptoms you may experience. If you have any questions then check with your doctor or pharmacist.

If you experience any of the following symptoms, contact either your dentist or the hospital immediately:

• Bleeding that continues even though pressure is applied
• You experience difficulty breathing or swallowing
• Swelling of your face continues for over three days following surgery
• Fever
• Severe pain that does not ease with painkillers