Tooth Extraction

Periodontist in St. Louis, Missouri

The Procedure

The surgery is done to remove a poor prognosis/hopeless tooth due to decay/fracture/too significant bone loss. This surgery is done with a local anesthetic, and you should feel no discomfort whenever the surgery is being done. After the surgery is completed, damped gauze is usually placed over the extraction site and instructed to continue to bite down on the gauze for 45minutes to an hour. We will be providing you with the prescriptions/recommendations for whatever pain relievers or other drugs are indicated for the surgery. Below are helpful tips to prepare you for the upcoming procedure and thereafter.

Presurgical Instructions

Please arrive at the office at least 20 minutes prior to your surgical appointment to make any final arrangements prior to the procedure.

Please don’t apply makeup and lipstick around the mouth. If a cleaning is due, it is ideal to have it done within a week prior to the procedure and brush your teeth immediately prior to the appointment is advised.

Take your medications as advised. If taking blood thinners, some aspirins, or fish oil prescriptions, we will contact your Prescribing Doctor for their recommendation on modification. We will inform you of their recommendations before surgery. If you have any questions about your prescriptions, please contact us.

Tooth Extraction

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If advised, begin taking pain reliever about 24 hours in advance (600-800mg of Ibuprofen or 1000 mg of Tylenol typically for an adult and 200-400mg of Ibuprofen for a child; this was discussed in your pre-surgical appointment). The over-the-counter ibuprofen comes in 200mg tablets and over the counter Extra Strength Tylenol comes in 500mg tablets, so please take the appropriate number as listed above for them to be effective.

For patients who require antibiotic prophylaxis for previous joint replacement, or heart conditions, please take your premed 1-hour prior to the dental surgery. If you are having IV sedation, please take 2 hours prior to your surgery with the 2 glasses of water we advocate taking.

If you are having IV sedation, please take Ibuprofen and antibiotics right after the surgery.

To avoid a dry socket pain of nocking the clot forming in the extraction site, it is strongly advised to abstain from smoking, straw usage for 72 hours, spiting and rinsing for 24 hours.

No alcohol 24 hours prior to procedure.

Periodontal Post-Surgical Instructions

Care of The Mouth

● Normal brushing and flossing following the procedure should be followed throughout the mouth except in the area where surgery was performed. It is important to maintain a high level of oral hygiene care after periodontal surgery. This reduces the accumulation of bacteria (plaque), chances of infection, and minimizes unpleasant mouth odor.

Oral Hygiene at the Surgical Site

● No need to ever brush the gum where a tooth isn’t present. Brush, floss, all other areas in your mouth except for the extraction area/s.

● Beginning 24 hours after surgery, rinse gently with warm salt-water mixture (1/2 teaspoon of salt into 6-8 oz. of warm water) 3-4 times per day for the first couple of weeks.


It is normal for there to be varying amounts of discomfort for 1-6 days after surgery. How much pain and how long it lasts depends on the extensiveness of surgery done, how long it took, and your unique response to it. Everyone differs in his or her perception of, and response to pain; the pain medication may not eliminate all pain but should make you reasonably comfortable. It is not routine to require narcotics.

● For mild discomfort, alternate 600-800mg of Ibuprofen and 1000mg of Tylenol every 3 hours. For severe discomfort, take 800mg of Ibuprofen and 1000mg of Tylenol at the same time, every 6 hours. If this regiment isn’t managing your pain control, please give us a call.


● To create a stabile clot and slow the bleeding down, we ask you to continue to bite down on the dampened gauze for an hour. After that time, you may exchange the gauze with a new set for another hour. The gauze should be placed immediately over the extraction site and not laying between the upper and lower teeth. After which, you may dispose them.

● To prevent excessive bleeding follow these steps: If advised, ceasing/modifying your blood thinner/aspirin/fish oil at the recommended time prior to surgery should have occurred. (If you have any questions concerning this, please call the office).

● Don’t spit, rinse, or use a straw for at least 24 hours after the surgery.

● Avoid strenuous activity for 2 days.

● Slow oozing of blood is expected for 2-3 days.

● It is recommended to place a towel over your pillow and keep your head slightly elevated for the first 3 days.


● If you notice continued heavy bleeding, apply biting/thumb pressure with a clean, dampened, rolled-up gauze/tea bag/paper towel directly to the area for 40 minutes.

● If these attempts are unsuccessful and the bleeding is excessive, please call us.


● Gently apply an ice pack to the side(s) of your face over the surgical area for 10-15 minutes per hour during the first 24-48 hours after surgery.

● Keep your head elevated at night to reduce the swelling.

● Minimize the heat of your food for the next 24-48 hours to slightly warm.

● After 48 hours, if still swollen, a moist heated washcloth or heating pad applied to the site will then be effective.

● Swelling and bruising typically peaks on the third day and then slowly begins to reduce from there forward. This is also why Ibuprofen/ anti-inflammatory is advised to continue to be taken for the first 4-5 days after the surgery.


● For the first 24 hours, restrict your diet to cool soft foods and liquids (ie. milk shakes, ice cream, instant breakfast drinks, junior baby food, Ensure, yogurt, cottage cheese, pudding, jello, applesauce, etc.)

● For the first 3-4 days, avoid Spicy foods, citrus, alcohol, crunchy foods along with peanuts, popcorn, and chips.

● After 24 hours warm foods can be introduced.

● Then for the 2-4 weeks, continue with warm softer foods (ie. Pastas, soups, well cooked chicken, fish, omelets, mashed/baked potatoes, tuna noodle casseroles, meat loaf and well-cooked vegetables, etc.) and continue to avoid chewing on the surgical side.

● Avoid eating crunchy, chewy foods, along with popcorn and peanuts for 3 weeks after surgery.

● Please refrain from biting food off if the procedure was done in the front of the mouth for 3 weeks.

By four weeks, unless otherwise advised, you are usually able to eat without any restrictions.


Take your medications for blood pressure, heart, anxiety asthma/lung the day of your procedure. If you are having iv conscious sedation, then take them with enough water to get the medication down (less than 3oz.) Bring your inhalers with you. If you are diabetic and having iv sedation, do not take oral diabetic medication or insulin the morning of your procedure. If there are any issues regarding the interruption of your medication, contact your prescribing physician.

Blood thinner medications: (Our office will be consulting your cardiologist. Unless otherwise told, the following recommendations for temporarily discontinuing your blood thinner/s is listed below.)

Dabigatran (Pradaxa)- hold off 48 hours and wait to begin 48 hours after treatment.

Rivaroxaban (Xarelto)- hold off 48 hours prior to the procedure and begin 48 hours after treatment.

Apixaban (Eliquis)-hold off 48 hours prior to the procedure and begin 72 hours after treatment.

Edoxaban (Savaysa, Lixiana)- hold off 48 hours prior to the procedure and begin 48 hours after treatment.

Warfarin (Coumadin, Jantoven)-If instructed, hold off 3 days prior and begin 48 hours after treatment.

*Ticagrelor (Brilinta)- hold off 5 days prior to the procedure and begin 48 hours after treatment.

*Ticlopidine (Ticlid)- hold off 5 days prior to the procedure and begin 48 hours after treatment.

*Clopidogrel (Plavix)- If instructed, hold off 5 days prior to the surgery and begin 48 hours after treatment.

*Prasugrel (Effient)- hold off 5 days prior to the procedure and begin 72 hours after treatment.

*Cilostazol (Pletal)- hold off 3 days prior to the procedure and begin 4 days after treatment.

*Aspirin 325mg or greater- hold off 1 week prior to the procedure and begin 48 hours after treatment.

*Dipyridamole (Aggrenox)-hold off 5 days prior to the procedure and begin 48 hours after treatment.

(*) anti-platelet meds

***Patients with mechanical artificial heart valves cannot stop their anticoagulant medications (blood thinners) without discussion with their cardiologist and the periodontist!!

Supplements are non-prescribed medications. If you are taking any of the supplements listed below, please stop 1 week prior to your surgical procedure.

● Dong Quai (Angelica sinensis)

● Feverfew (Tanacetum parthenium)

● Fish oil, Garlic

● Ginkgo Biloba

● Ginseng (Panax quinquefolium/Panax ginseng)

● Licorice Root (Giycyrrhiza glabra)

● Red Clover (Trifolium pretense)

● Vitamin E

Commonly prescribed/recommended medications for this procedure:

___ Ibuprofen (ie. Motrin, Advil): (if can be taken, 600-800mg for adult and 200-400 for a child, every 6-8 hours for at least 4-5 days after the surgery.) This is an over-the-counter medication. It is used to control mild to moderate pain. The medication also has an anti-inflammatory result at surgical sites. It works best when taken before surgery followed by consistent doses afterwards. The major side effect of the medication is an upset stomach. To avoid this issue, take Ibuprofen gel caplets with meals, milk, or 2 full glasses of water to lessen this complication. If you are prone to stomach ulcers, take this medication cautiously and discontinue if you have any stomach pain, nausea, or vomiting. Do not take Ibuprofen if you have had any allergic type of reactions (itching, swelling, rash, difficulty breathing, etc.). Ibuprofen has been reported to make some people drowsy (1 in 100).

___ Tylenol (Acetaminophen): (Can be taken 325mg-650mg every 4-6 hours) This is an over the counter pain reliever that can be taken while breast-feeding. It is contraindicated to those that are allergic to acetaminophen, or those who have a known G-6PD deficiency.

___ Norco (Hydrocodone+Acetaminophen): This is a narcotic used to control moderate to significant pain, however this is not an anti-inflammatory, therefore, can be used in conjunction with Motrin to dissipate any inflammation. This medication contains a derivative of codeine, which is a narcotic, and has been shown to be habit forming. It can also make you drowsy, so avoid operating any machinery, making business decisions, or driving while taking the medication. Take 1 tablet every 6 hours for the pain and can also be taken in conjunction with Motrin. It is contraindicated for patients with a known G-6PD deficiency: hypersensitivity to acetaminophen, hydrocodone. Alcohol consumption while on the medication is contraindicated. The most common adverse effect is nausea. Make sure to take with food or a full 12 oz. glass of water. If it still should occur, discontinue its use and consult the doctor. Constipation may also occur, requiring you to take a laxative. Inform your dentist if you are on a MAO inhibitor, or antidepressant, before taking this medication.

Office (314) 842-6151

Dr. Scott Schlueter (636) 492-1756

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