Oral Hygiene

Oral Hygiene

Recently we have been experiencing an increasing number of patients returning to our office at their post-op appointment with sockets packed with un-rinsed food. This is largely a preventable problem.

The sockets have, in most cases, been carefully sutured closed. If the clot is allowed to form underneath without disturbing this tissue closure it can heal very rapidly. If the closure is violated by aggressive chewing or by food forcing itself in, then the clot will shrink and a food trap can occur. Sometimes the clot will contract and the tissues will fall in leaving an unavoidable food trap. Dry sockets leave the largest openings and are the most difficult to keep clean.

The pamphlet given to you immediately after surgery has a section on oral hygiene suggesting no rinsing for 24 hours. It is then recommended to rinse with warm salt water after meals and before you go to bed. This is at least four times a day. If the salt is disagreeable then warm water will do. After the third post-operative day then Listerine can be substituted.

I would recommend that the diet remain soft and cold the first day: Ice cream, yogurt and pudding. Avoid any with nuts or seeds. “Cold helps you clot, Hot helps you bleed”. Hot soups or drinks are to be avoided the first day. Cold soup is fine. The next day, I suggest: pancakes, scrambled eggs and mashed potatoes; soft, yet more nutritious foods. Avoid chewing directly on the sockets if at all possible.

You have to think: “Eat then rinse”. Whether it is one french fry or the whole “happy meal”, you must rinse afterwards. If one piece of food enters the socket, it can lead to a delayed infection. Usually at 3 weeks after surgery. You cannot wait until dinner to rinse breakfast out. Antibiotics will not cure a “carrot infection”. If a piece of carrot remains in the socket, we will have to go back and get it.

Swishing with warm water over the sink, after meals is ideal. If you are out and about, then milk or tea will do. Use whatever you are drinking at meals to swish and swallow if you have to. It is more important to rinse it clean than what you rinse with.

It is also not a gargle. In your mind’s eye you are trying to rinse any particles out of the back sockets. Rinse until no particles are felt or seen coming out. If there is an opening it will gradually close from the “inside out”. This may take several weeks.

At your post op appointment, you may be told that there is a large collection of food in the back sockets. This is usually a surprise to the patient. We will need to rinse this food out for you, but relax, as it can be done painlessly. We may need to see you for several visits of rinsings until you are able to keep them clean. Post ops are usually free and we would rather see you for a rinsing appointment than treat a post operative infection.

You may be given an irrigating syringe and a prescription for an antibiotic oral rinse. The syringe can be difficult to use, but essentially you pull back some warm water, point it into the back socket and give it a blast. Do this over sink as it can be messy. The antibiotic rinse will speed the healing within the socket and help with most discomfort. This is used when you get up and before you go to bed as a rinse then spit protocol.

Working in the mouth can be humbling. Every bacterium known to mankind can be found in the mouth. Patients also obviously eat and possibly smoke with the mouth. Infections are rare but do occur. Most are related to food getting in the socket. If you do your best to keep it clean, then you can expect a quicker recovery with little discomfort. We realize that a prolonged healing is frustrating for the patient and you have our sympathy. Remember that we are a team trying to speed your recovery. We are here for you and want you to get well as soon as possible.

Please avoid any peanuts or other nuts and popcorn for around a month.