Post-Surgical Instructions
Most patients experience only mild to moderate discomfort following root canal surgery. After any invasive treatment, the body responds with inflammation – the reaction of the body’s own defence system. The tooth itself will likely be somewhat tender to biting for a few days following any dental treatment, and the corners of the mouth may be sore from being stretched during the appointment.

Pain - Generally, discomfort following root canal surgery is moderate, and can be controlled by over the counter non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin or Advil). Ibuprofen has been clinically proven to be more effective than acetaminophen (Tylenol) for post-operative dental pain because it fights inflammation, which is the body’s natural response to invasive procedures including dental treatment.

Swelling - Patients can expect localized swelling in the area of surgery. This is not generally a sign of infection, but of inflammation – the natural course of healing following invasive procedures. Pain and swelling go hand in hand, and will usually peak approximately 36 hours following surgery.

Bruising – Patients may see discolouration inside their mouth in the area of surgery, and may also experience bruising on the skin surface.

Ice pack – Patients are advised to place an ice pack on the skin of the face over the surgical area following the appointment. This may decrease the amount of swelling and bruising that occurs following the surgery. Patients should place the ice pack on the face for 10 minutes, then remove it and place it in the freezer for 10 minutes, then re-apply it to the face for 10 minutes, etc. The effect of the ice pack in reducing swelling and bruising is most effective in the first 2 – 3 hours after surgery.

Bleeding – Patients can expect to see some pink discolouration to their saliva for the first day or two following surgery. This is normal. If frank bleeding occurs, pressure with moist gauze should be applied to the surgical area. The gauze should be moistened with tap water before application to the wound area. The reason for moistening the gauze before it is applied to the surgical site is to prevent it from sticking to the sutures/stitches, which may pull out or become loose upon removal if the gauze is placed dry onto the wound area. If no more gauze is available, a moist tea bag can also be used. The tannic acid in the tea helps to control bleeding as well. Patients should avoid any strenuous work or exercise for approximately 24 hours following oral surgery to avoid an increase in blood pressure which may lead to bleeding.

Rinsing and spitting – Patients should avoid rinsing and spitting in the first 24 hours following surgery.

Sutures – The stitches placed at the end of the surgery are resorbable and will come out on their own in 3 – 5 – 7 days. However, they may be removed at your post-surgery follow-up appointment if the healing has progressed well enough.

Medications – ibuprofen (Motrin or Advil) or acetaminophen (Tylenol)
Patients are advised to take ibuprofen following their root canal surgical appointment, preferably while they are still frozen. It is advisable to take double the regular dose of ibuprofen (Motrin or Advil) for the initial dose in order to increase the concentration of the drug in one’s blood stream to speed its onset of action. This means that patients should normally take 600 – 800 mg of ibuprofen in the immediate post-surgical period.

Patients should stay on a regular schedule with ibuprofen and take it every 6 hours according to the clock for the first 24 – 48 hours following their surgery, even if this means setting one’s alarm at night to wake up to take the medication. Subsequent doses of ibuprofen after the initial double dose should be the regular dose (400 mg). Patients should not exceed 3200 mg of ibuprofen over 24 hours. For patients who experience discomfort prior to their next scheduled dose of ibuprofen, they should take acetaminophen (Tylenol) at the time of discomfort, but should continue to take ibuprofen at their next scheduled time.

For patients not able to take ibuprofen, acetaminophen (Tylenol) is a reasonable alternative medication, but it does not fight inflammation, only the symptom of pain.

Antibiotics are not generally indicated with root canal surgery.

Oral hygiene – Patients should avoid vigorous brushing and flossing in the surgical area for the first 24 hours after surgery. On the day of surgery, only the biting surfaces of the teeth should be brushed in the surgical area. Starting the day after surgery, patients should also begin gently brushing the sides of the teeth toward the tongue/roof of the mouth and the cheeks/lips, but should be sure to sweep the toothbrush from the gum level to the biting surface of the teeth, so as not to disturb the stitches. Flossing in the area of surgery should usually be avoided until the stitches are removed. Patients should brush and floss the remainder of their teeth as normal following the surgery. Patients should use the prescribed antibacterial mouth rinse (chlorhexidine) for approximately one week following surgery.

Numbness – This refers primarily to patients who undergo endodontic surgery involving lower molar or premolar teeth. Patients may experience some tingling or numbness in some of the same areas they were frozen for the surgery after the usual time when numbness normally wears off. This may be a temporary situation due to inflammation affecting the nerves in the area; however, tingling or numbness may also occur due to surgical trauma involving the nerves and may last for months or, rarely, even be permanent.