Postoperative Instructions: Patients Who Take Blood Thinners

If you are currently taking a blood thinner, OR if you were advised to stop your blood thinner/blood thinners before surgery, follow these instructions to avoid excessive bleeding.

YOU WERE MOST LIKELY PRESCRIBED A MOUTHWASH PERIDEX/CHLORHEXIDINE GLUCONATE

• Do not rinse with it for 48 hours after oral surgery.
• Do not rinse your mouth with ANYTHING (no water, warm salt water, or Peridex) for 48 hours after oral surgery.
• Do not spit for 48 hours.
• Once 48 hours have passed and you are able to start cleaning your mouth and rinsing, start slow. Do not rinse or spit vigorously for several more days.
• When bleeding, apply pressure with clean gauze to the area inside your mouth and change the gauze every 30-minutes. If you can go an hour in between gauze changes, even better. Steady, consistent, firm, direct pressure for at least 30 minutes at a time is best. As bleeding slows, moisten the gauze slightly before placing it.
• If your gauze is becoming saturated with blood in less than 30 minutes, then you will need to change it sooner than 30-minute intervals. In this case, make sure you are placing the gauze directly on the bleeding areas and biting down against the gauze/applying firm pressure. You may need a mirror, flashlight, and some assistance with this.
• The act of rinsing and spitting can cause you to bleed more. If you are already developing a blood clot in your extraction sites and the bleeding is slowing down, rinsing TOO soon could cause you to lose these fragile blood clots, causing a re-bleed.
• If your mouth is filling up with blood, remember: do not rinse and spit it out or hang your head over the sink and allow it to drip out. This will only increase the bleeding. Simply wipe the blood out with a clean gauze or washcloth, repack the gauze to the bleeding areas, and apply firm pressure.
• Stay as inactive as possible after coming home from surgery. The more active you are, the more bleeding you will experience.
• Swelling and bruising after surgery is normal. Apply ice externally off and on for the first 24-48 hours to help limit this swelling. Most people experience their maximum swelling around the 3rd and 4th days following oral surgery.
• No heavy lifting, pushing or pulling, and no exercising for 7 days after oral surgery.
• Do not drink from a straw, smoke, or drink carbonated beverages for 3 days after surgery.
• Once the bleeding is minimal or has stopped, make sure you are staying HYDRATED. Once you no longer need the gauze in your mouth, drink lots of water, tea, Gatorade, Vitamin Water, and juice (but no straws or carbonated drinks). Yes, you can have coffee - just not too hot.
• Bleeding is normal after oral surgery. If you are following all of these guidelines and bleeding does not seem under control, you may substitute with a tea bag (soaked in warm water, squeezed damp dry, and wrapped in moist gauze). Place the wrapped tea bag over the bleeding areas and apply firm pressure for 30-minute intervals. If bleeding does not seem to be slowing down in a timely manner, or if you are concerned, please call our office at (806) 353-1055. We are available 24/7. If you call after hours, you will reach our answering service. Tell them you are having concerns, and they will connect you with one of our surgical techs.

YOU WERE MOST LIKELY PRESCRIBED A PAIN MEDICATION

• When you leave the clinic after surgery, your mouth will be numb for at least 2-3 hours.
• We recommend eating and starting your pain medication before the numbness goes away so that you are ahead of the game. Taking pain medication without food can cause nausea.
• If you were prescribed an anti-nausea medication, start taking it AS SOON AS you start to feel ANY nausea (you will only take this IF needed).
• If you were not prescribed an anti-nausea medication, and you start to have nausea, STOP eating/drinking any dairy products, and call our clinic.
• If you become nauseated and cannot get to your pharmacy, Benadryl (over-the-counter) can be helpful.
• If you were prescribed antibiotics, start them the morning after your surgery unless instructed otherwise. It is best to take antibiotics with food.

DIET: REMOVE ALL GAUZE BEFORE EATING/DRINKING

• The day OF surgery, eat "non-chewing" foods (applesauce, jello, mashed potatoes, pudding, ice cream, yogurt, broths, Boost/Ensure drinks, baby food, cream of wheat, etc).
• Beginning the day AFTER surgery, start enjoying a "soft-chew" diet (pancakes, eggs, biscuits and gravy, pasta, oatmeal, enchiladas, tamales, soups without rice, cooked veggies, etc). Continue this diet for at least 5 days.
• If you had lower extractions done, you were given an irrigating syringe to flush out the extraction sites BEGINNING 5 DAYS AFTER YOUR SURGERY. It is very important to wait a full 5 days before using this syringe. You will fill up the syringe with warm salt water and use the tip of the syringe to flush the areas, getting any food debris out. Once you are allowed to start using the flushing syringe, you can eat whatever is comfortable as long as you flush the areas out/get any food debris out every day. You can flush the areas out after every meal, or you can just do a thorough flush right before bed every night. The important thing to remember is TO WAIT 5 FULL DAYS BEFORE DOING THE FIRST FLUSHING OUT!
• If you are on a specific blood thinner called Coumadin/Warfarin you need to contact your cardiologist or Coumadin clinic IF we prescribe antibiotics for you to take. Antibiotics can affect how thin your blood is, and your Coumadin doses may need to be modified during the days that you are taking antibiotics and possibly for several days after finishing your antibiotics.

*Anytime you are prescribed antibiotics, it is important that you contact your cardiologist or coumadin clinic for instructions.