Nursing someone after oral surgery: how to not screw it up edition
July 8, 2013 7:31 PM   Subscribe

A relative of mine is having the entirety of her teeth replaced by what I think is called an implant-supported bridge. I'm caring for her the day of the surgery, but 1) I'm not super-awesome, or anyway, super-intuitive at nursing people 2) I'm not at ALL familiar with this type of procedure 3) Said relative is very ashamed of the situation and thus VERY vague about the actual terms, details, and recovery situation. She...tends to be a little in denial about stuff, I tend to take her statements with a grain of salt. So I would appreciate anything you all can offer in terms of advice, or in procedure-specific tips and information.

Specific concerns:
1) Will one day of full-time help be enough? The plan is for me to stay the night after her surgery and into the next day but I have no idea what the recovery time is like for something like this.
2) I have the basics of dental recovery (soft food, saltwater, lots of DVDs) down pat (hooray genetically awful teeth!) but is there anything I should be alert for vis a vis anaesthetic, etc.?
3) Any tips for dealing with someone who is deeply embarrassed about the procedure and very self-conscious about being seen in a gross/bad state?

If I do very well at this I think I can probably convince said relative to come stay with me when I have my wisdom teeth out, so I've got high expectations for myself! ;) Thanks, MeFi!
posted by like_a_friend to Health & Fitness (22 answers total) 1 user marked this as a favorite
Response by poster: Gah sorry about all of the numbered lists, folks. Just trying to tame the whirlwind in my brain...
posted by like_a_friend at 7:32 PM on July 8, 2013

Will you be driving her home? After about 20 minutes of highway driving post wisdom teeth removal, my boyfriend told me he felt nauseous, then that he couldn't see or hear, then he just stopped responding and was covered in beads of sweat. So if she says she's nauseous, stop immediately. I have never been so scared. (I also recommend using your parking break so when you kick the car into neutral while scrambling in the backseat for your cellphone, you don't start rolling backwards down the exit ramp.) I also recently had surgery under general anesthesia and I made it home but then threw up a bunch, so a bucket might be a good idea.
posted by carolr at 7:40 PM on July 8, 2013

Do not drink through a straw-- straws create suction in the front of the mouth which can open the stitches.

Most dental surgery is done with local anaesthesia. The doctor may provide a tranquillizer to take 1 hour before the surgery. The patient should not drive. Most likely, the doctor will recommend ibuprofen, 800 mg, more unlikely that the doctor will prescribe Oxycontin or codeine.

Keep on schedule with the meds and icing-- once the pain gets a foothold, it's more difficult to vanquish. If the administration is every 4 hours, provide the pills at 3-3/4 hours.

The person will be slightly traumatized by the experience-- surgery is indignity and trauma-- and they will sleep on and off for a couple days. With simple tooth extraction, the person can go back to work the next day.

Relatively simple DVDs, nothing that takes a lot of concentration or memory, because it won't happen. I'm thinking West Wing, 30 Rock, not the Criterion Collection of Eastern European Directors of the 1920's.

Encourage foods that promote healing-- protein, lots of antioxidants, probiotics.
posted by ohshenandoah at 7:45 PM on July 8, 2013 [2 favorites]

Best answer: Both my fiancé and I completely forget whatever happens while in the "recovery area", after the procedure but before the light anesthesia completely wears off.

For this reason, I'm grateful that the oral surgeon we recently saw allowed us to audio record the post-surgery instructions. This helped avoid a lot of confusion later.

Ask permission, preferably ahead of time and then again right before you start to record. Make sure you know how to audio record (on your phone or whatever other device you use).
posted by amtho at 7:45 PM on July 8, 2013 [1 favorite]

My then-boyfriend was the "nursemaid" when I had my wisdom teeth out. He drove me home - I remember none of that trip - and just sat with me in the living room while I was passed out on the couch for the next hour. He didn't do anything but watch old movies and wait for me to wake up.

The doctor and a neighbor both told me that burying a pill in a spoonful of apple sauce makes it easier to swallow. I think I had codeine, but I couldn't keep it down for some reason and just threw it up. I decided to tough out the pain alltogether, and just icing it kept me okay for a day.

I was okay enough the next day to tough things out on my own much more.
posted by EmpressCallipygos at 7:53 PM on July 8, 2013

Best answer: Oral surgery can really screw with your sinuses and make the rest of recovery hell while your brain tries to distance itself from living inside your skull. It can also deplete whatever stores of nutrients you have in your system super quickly, so I would recommend two things: ice packs or even one of those gel masks you can freeze and put on her face for pain relief, and vitamin C supplements to help her body recover. The latter can be mixed into apple sauce, or smoothies, or other soft foods for easy access.

I'd also suggest that you do whatever you can to help her sleep as much as possible, because recovery goes so much faster when sleep is consistent and substantial.
posted by These Birds of a Feather at 8:00 PM on July 8, 2013

Protein drinks. I couldn't eat anything but you need protein in your diet to recover. Most soft foods are very carb heavy. (I drank Atkins shakes.)

Adequate mediation and check their temperature. They will probably be given antibiotics. I didn't take mine as they upset my stomach, but then I got a fever after getting my wisdom teeth out, so then I started them. So make sure they take their meds, but not overmedicate with pain killers. OH and after "going under" you don't have as much pain for the first few days, then it kicks in stronger so it's best to catch it first.

WATER! Plenty of water. It also helps get food down. Soups are good too, but try to get some with more protein - like broth based ones. (Food cannot be hot for the first few days. Warm is best. Have ice ready to drop into soups to cool them quickly.)

Ice packs/heat packs. This helps with swelling and pain.

Get a small/baby size toothbrush. Probably won't be able to open their mouth all the way to fit a regular size brush. (I couldn't!)

As far as making them comfortable with being "gross" around you, why not show up in sweatpants and pj's yourself? I was a total mess and got smelly because I hurt too bad to shower for like 3 or 4 days. - super gross - Just don't make it a thing. Be comfortable yourself. They probably will care less after getting the procedure anyway with pain mediation and being in pain/wanting to sleep.
posted by Crystalinne at 8:20 PM on July 8, 2013

When I had my wisdom teeth removed, instant mashed potatoes were the best food ever.
posted by Jacqueline at 8:21 PM on July 8, 2013 [1 favorite]

Response by poster: Just to address some things people have mentioned:

-Unfortunately, I won't be driving her home or be with her AT the surgeon's. I'm car-less and coming from out of town (train to cab) so her best friend will be doing the driving.

I will tell the friend to record any instructions on her iPhone--that is an outstanding idea, amtho!

-She will be under full general anaesthetic, possibly by her request rather than by medical necessity, but from what little I can find (why is there not more on The Google?) it is actually a pretty intensive procedure--something like 25 extractions are involved.
posted by like_a_friend at 8:27 PM on July 8, 2013

Best answer: Call her surgeon's office and explain that you'll be doing after-care. Even if they can't tell you anything specific about her health without her permission, they will likely be happy to give you (or the friends who's driving) printouts/email you pdfs of aftercare directions and things to watch out for.
posted by rtha at 8:36 PM on July 8, 2013 [1 favorite]

If your relative is under full GA, it will take her some time to recover from it, she can be drowsy post -op. There might be some bleeding after the extraction so she should avoid anything that could dislodge the clot and delay healing ..she should avoid smoking if she smokes, avoid loud sneezing, eat soft luke warm food lots of ice cream and soup,it is better if she takes her pain meds before her anesthesia completely wears off.... it might be uncomfortable for her for a week but the pain will subside over the course of healing...vicodine/codeine has a side effect of causing nausea.
posted by sparkle95 at 9:20 PM on July 8, 2013

As someone who's going through a few rounds of oral surgery as well, for number 3, I'd say to just treat it as a normal medical/dental thing. Your friend's mileage may vary, but I don't like being fussed over too much beyond, "Want some soup/ice cream/yogurt?" Making a big deal out of it freaks me out and embarrasses me more, whereas just being able to tell people, "oh, I'm having some difficult wisdom teeth pulled," makes everything simpler and less scary.

Also, icing right after the surgery does wonders for keeping the swelling down. I would really recommend not skipping that step, so have ice packs ready.
posted by yasaman at 9:57 PM on July 8, 2013

Oh my god, 25 teeth!! I just had seven out and that was bad enough. I'm sorry she's going to go through this.

My big recommendation would be to make sure the house is stocked with lots of gauze -- not the thin holey kind that comes on a roll, but the denser kind that is separated out in individual sterile packets (I believe they're called gauze sponges). The surgeon will definitely send her home with some, but it may not be enough. With just my seven teeth out I bled for almost a full 12 hours and went very quickly through everything the doctor sent me home with.

She will probably bleed a lot -- she's having a lot of work done and there's a good chance she'll bleed more than the doctor's estimate (happened to me). To stop the bleeding: place gauze in gums and bite down with firm, constant pressure. Don't bite super hard, but a good constant squeeze. Toward the end of my 12 hours of bleeding I started using tea bags as well: simply wet some tea bags with cool water and have her use them just like the gauze. The tannins in the tea help the blood clot. So make sure to have tea bags on hand! I think you need to use real, black tea. Don't think herbal will work.

In the packet of recovery info she brings home she should have an emergency number to call if anything comes up or the bleeding is really out of control. When you get to her place, make sure you locate that phone number.

The first day it's tough to get anything down because of all the bleeding. I basically just drank Gatorade when I could. The second day she can probably get onto whole milk, kefir and cooled broth. The third day she could probably manage regular yogurt, scrambled eggs and mashed potatoes. You may want to do a grocery run to get her some of these kinds of things so she won't have to go out herself (unless she's already stocked up, of course).

And yes, stay ahead of the pain with the medication! She may want to set an alarm to wake herself in the night so that she doesn't miss a dose.

Have a pad of paper and pen around so she can 'talk' to you :)

One day of help should be enough, but this is a lot of teeth and you may need to play it by ear. Once the bleeding stops she will probably be ok on her own, unless the pain is too severe.

Good luck to her (and you)!
posted by imalaowai at 10:49 PM on July 8, 2013 [1 favorite]

She is going to be in a good bit of pain. It is important to stay on top of the pain. If you wait until you hurt before taking medication, it takes a longer time for the meds to work. Do not allow her to be delicate about the meds. She must take them on schedule. Her doctor will give her ibuprophen which will help with the swelling as well as a serious drug for the pain. She will need to have food in her belly with every dose. The serious ones will make her nutty. Watch for any allergic reactions to the medication. She will need you for several days. The pain will override the embarrassment.

Frozen peas confirm to the shape that you need them too. Set up several zip lock baggies of them and changed them out every 20 minutes, re-freezing the used ones.
posted by myselfasme at 3:30 AM on July 9, 2013 [2 favorites]

My dentist emphasizes the need for protein after oral surgery, in order to heal and build tissue. So the Atkins shakes are a great idea. Chicken soup is another good idea.

You will want loads and loads of ice packs (the soft kind that can conform to the face) because icing the area is important to keep swelling and bleeding down.

If she is taking any kind of opiate pain reliever, that is going to make her crap concrete. She'll want a stool softener to use temporarily while she's taking the Vicodin or whatever.

An iPad to stream mindless videos of baby sloths or silly movies or anything that doesn't require a lot of brainpower.

Extra pajamas and clean undies to change into - even if she can't take a shower, a change of clothes does wonders for morale.
posted by Rosie M. Banks at 6:47 AM on July 9, 2013

Best answer: Finally nudged to register an account as I just went through this and want to help . :) It sounds like she is going to have the all-on-four implant procedure? I had 28 teeth pulled in May, implant posts were placed and a temporary "bridge" was attached to those posts in such a way that it puts minimal pressure on the posts while the implants "take". I return in another month to see if all is ready for the permanent "teeth". Sometimes it can take up to 6-9 months before the surgeon is confident in loading the implants. Once it is done she (and I) will be able to chew ice, eat corn on the cob, etc.

Now, until such time she needs to eat soft food (anything that can be mashed with the back of a fork). What got me through the first couple of weeks (and still is a life saver to this day is a good protein shake.

The first couple of days she will be out of it/fuzzy headed and possible quite sore and swollen. Of course this all varies. Also, no heavy labor/lifting for a few days. No straws as mentioned as well. The doctor should provide her with a super duper soft toothbrush (not available in stores) as well as a mouthguard. Make sure she wears it!

Also, the pain meds can really stop one up. Have some Senokot some other type of stool softener available.

The first week was really rough for me. Then it was sort of an up and down trajectory. Now I'm rather comfortable but cannot WAIT until my permanents are so that I can return to a normal diet. Missing pizza and bread a lot!

I hope some of this helps. Tell her good luck, no shame(!) and it will all be worth it in the end!
posted by WalkingHorse at 7:49 AM on July 9, 2013 [2 favorites]

Give her a pass if she acts like an unappreciative jerk.

Some of my family members do not make good patients, so I have learned to just ignore it. Being incapacitated and in pain is really frustrating, there will be times when your friend will probably just be fed up with it.
posted by inertia at 8:02 AM on July 9, 2013 [1 favorite]

Seconding imalaowai's tea bag suggestion for bleeding. I know it sounds kind of nuts, but I was having a lot of trouble with bleeding after my 3 extractions, and the tea bags helped a lot. My mom, who's a nurse, suggested it.

Also yes to keeping on top of the pain. Hopefully the oral surgeon will prescribe something for her to take (I had hydrocodone for mine), and she needs to take it on time, whether she thinks she needs it or not.

You're awesome for helping her out. Be sure to take care of yourself too!
posted by ashirys at 8:03 AM on July 9, 2013

Response by poster: Yes, WalkingHorse, that is exactly the one! Thank you so much for registering to chime in! Her oral surgeon has been emphasizing an easy recovery and I have been fairly skeptical, so it's good to hear that the "couple days of fuzzy & sore, no heavy lifting, liquid diet then soft food" is pretty accurate.

So it is a little different from standard extractions, in that she isn't going to have just a bunch of exposed sockets apparently? She said she will come back from the surgery with what look like regular teeth in her mouth, though she must be on an all-liquid diet for a week.
posted by like_a_friend at 8:51 AM on July 9, 2013

All the extractions will be covered tightly with her temporary teeth. It will be very sore and tight for quite some time. The stitches will dissolve over time and she will be finding herself spitting out bits of stitching at various times. :)

The doctor will hand her post op instructions. Make sure she doesn't lose them (or her mouthguard like I did for a few hours haha!).

Another thing I thought of is frozen/slushy drinks are a godsend! If she's like me her teeth have been very sensitive to cold for a long time. That is all gone once the teeth are removed and cold feels wonderful as the healing process moves along.

My doctor had me come back two weeks post op as he does all his patients. Apparently the bone/implant area is at its softest at this time and he wants to be sure that patients are following the strict diet.

She is going to be so happy when all is said and done. I wont was about 6 weeks until I felt happy/out of pain but I stopped the pain Rx after 5 days. Motrin was my best friend.

My face is thinner (long term low-grade infection/swelling gone) and I've been told by many people that I look ten years younger. At 50 that is a nice thing to hear! haha So very happy but will be over the moon happy when the permanents are in.

If she wants to email with someone or through you to me with a person that's gone through it....or has questions or anything feel free to email me (Kimberly) at siberia @ gmail . com. It's a very scary thing to stare down in the weeks leading up to the procedure. Wishing her (and you!) the best! :)
posted by WalkingHorse at 12:11 PM on July 9, 2013 [1 favorite]

There are many steps to the implanting of dental appliances. There should have been maxillo-facial x-rays to judge if she has enough bone to support the implants.
Is she having the extractions or the actual implanting? AFAIK, it is necessary to have something like ferrules implanted into the jaw. After these are accepted, and tissue grows around them, then the actual teeth are screwed into them. In processes by ethical dental surgeons, these steps are completed over a period of time. The teeth/bridges are not removable by the patient, only by a dentist.
Be sure to retain any home care handouts the assistant gives her. If she is actually having the ferrules implanted, it might be good to have the dentist call in her pain pill Rx so you can pick it up on the way home. When she feels the anesthesia leaving, she should pop a pill and never let pain establish.
The real pain is the bill.
posted by Cranberry at 2:19 PM on July 9, 2013

The pain killers can be a bit constipating, so having OTC stool softener on hand could save you or your relative a trip out to the drug store. It's cheap enough that if it isn't used it will be no big deal. Definitely remember no straws.
posted by nobeagle at 4:20 PM on July 9, 2013

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