Postop Patient Mgmt

Question 1

T/F: Patients have more preoperative concerns about the sequelae of surgery (pain,
swelling) than about the procedure itself

Answer 1

True

Question 2

Should you give IV sedation pt pre or post op instructions?

Answer 2

Both!

Question 3

Do you want the gauze to control bleeding to cover the occlusal surfaces?

Answer 3

No

Question 4

Do you want the gauze to control bleeding to be closed in the socket to the point where the occlusal surfaces are touching when closed?

Answer 4

No; want gap when closed

Question 5

How long do you want pressure from gauze to control bleeding?

Answer 5

30-45 mins

Question 6

Do you want the gauze to control bleeding to be moistened?

Answer 6

Yes

Question 7

T/F: Patients should be told they might expect mild continual oozing over next 24 hours

Answer 7

True

Question 8

If still oozing after removal of second gauze pack, patient can bite on _____ for another 1
hour
• Directions: boil tea bag, remove from hot water to cool, wrap in gauze, bite hard 1 hour
• Tannic acid is a local vasoconstrictor and pro-coagulant

Answer 8

tea bag

Question 9

Smoking (avoid for at least __ hours if possible)
• Nicotine interferes with wound healing
• The pull of the cigarette/pipe/cigar causes negative pressure, potentially pulling the clot
out of the socket

Answer 9

24 hours

Question 10

Should we be concerned or not in these situations?
• If bright red blood fills the mouth in matter of minutes
• If there is a large liver clot present over socket
• Most often darker in color, but can be bright red

Answer 10

Yes

Question 11

T/F: Amount of pain after extraction is highly variable, and depends in part on the patient’s
preoperative expectations

Answer 11

True

Question 12

Watch which drug if there are kidney issues and ulcers?

Answer 12

Ibuprofen

Question 13

Watch which drug if there are liver issues?

Answer 13

Tylenol

Question 14

Peak pain occurs after __ hours after procedure and diminishes rapidly after that

Answer 14

12 hours

Question 15

Significant pain rarely persists longer than __ days

Answer 15

2 days

Question 16

Instruct the patient to take a dose of medication ~__ hour after procedure was completed, even
if they are still numb

Answer 16

1 hours; before anesthetic wears off

Question 17

Medication needs to be absorbed and then distributed to CNS for effect, which takes at least __ min

Answer 17

45 mins

Question 18

What is the active metabolite of codeine?

Answer 18

Morphine

Question 19

If narcotics are needed for post op pain mgmnt, how many days should you be limited to?

Answer 19

2-3 days

Question 20

• T/F: In fact a high calorie, high volume liquid or soft diet is best for first 12-24 hours

Answer 20

True

Question 21

What are the 3 characteristics of the food that pt can eat after extraction?

Answer 21

Soft, cold, and bland (also no carbonation)

Question 22

Can you use straws post extraction?

Answer 22

No!

Question 23

Post op day __: brush gently on teeth not in surgical site

Answer 23

Post op day 0

Question 24

Post op day __: gentle rinses with warm dilute salt water

Answer 24

Post op day 1

Question 25

POD __ and on: resume normal oral hygiene

Answer 25

post op day 2 and on

Question 26

Edema and swelling reaches max at ____ hours post op (usually does not happen with simple extractions)

Answer 26

36-48 hours

Question 27

Cold compress okay for first _____ days, then switch to warm compress after

Answer 27

three days

Question 28

Swelling after ___ days not normal, see the patient, don’t just call-in antibiotics

Answer 28

4 days

Question 29

• Limited opening of the mouth likely caused inflammation of or damage to the muscles of 
mastication
• Causes:
• Extraction of teeth
• Mandibular IA block
• Multiple injections
• Penetrating medial pterygoid 
• Third molar extractions
• Usually not severe and resolves as the inflammation resolves (3-4 days)

Answer 29

Trismus

Question 30

• Blood oozing submucosally and subcutaneously
• Usually seen in elderly patients, due to
• Decreased tissue tone
• Increased capillary fragility
• Weaker cellular attachment
• Is not dangerous, does not cause pain, does not increase risk of
infection
• Unlike hematoma →large collection of fluid expanding tissue causing pain and
potentially infection

Answer 30

Ecchymosis

Question 31

_______ →large collection of fluid expanding tissue causing pain and
potentially infection

Answer 31

hematoma

Question 32

Ecchymosis onset POD ___, and subsides POD ____

Answer 32

2-4; 7-10

Question 33

Tristhmus is Usually not severe and resolves as the inflammation resolves ___ days)

Answer 33

(3-4 days

Question 34

Increase in swelling, redness, pain, warmth after POD ___ →infection until proven otherwise
• Get patient into clinic to treat ASAP!

Answer 34

3-4 days

Question 35

Postoperative pain increasing after day 5 which limits PO intake and sleep →_______ until proven otherwise
• Get patient into clinic to treat, but it is not as urgent as infection
It is not an infection

Answer 35

dry socket/ Localized osteitis