A high-quality and rapid wound healing process after tooth extraction depends not only on the professionalism of the doctor who performed the extraction (removal) of the tooth, but on the correct behavior of the patient after the procedure, who must strictly follow the recommendations given by the doctor for the period of healing of the wound surface. If you correctly and clearly follow the advice of a specialist, the recovery process occurs quickly and as painlessly as possible.
For example, patients who do not listen to the recommendations given to them make rinsing movements in the area of the healing wound; this washes out the blood clot, which performs a protective function against the entry of bacteria and microbes, as a result of which there is a high risk of wound suppuration.
In this article we want to give recommendations on what should and can be done after tooth extraction, and what should not be done.
1. A gauze swab on the hole. When can it be taken out?
As a rule, the doctor does not immediately release the patient after removal, but asks him to wait for 15-20 minutes within the clinic to then examine and make sure that everything is in order with blood clotting and the tampon can be removed without fear. In rare cases, keeping the tampon in your mouth may take 30-40 minutes, usually 10-20 minutes. There is no need to keep it longer and it is even dangerous, because bacteria accumulate on it and there is a possibility of infection. There are exceptions, when the wound continues to bleed a little, then the old tampon is replaced with a new sterile one and kept for some time.
For some time, saliva may still be pinkish due to staining with secreted ichor, this should not be alarming, this situation can be distinguished from bleeding. At this moment, saliva can be easily swallowed; there is no need to accumulate it in the mouth.
Painkillers Powder Nimesil Laboratories Menarini S.A. - review
This will probably be my shortest review????
I decided to get rid of my wisdom teeth. They started to shift all the teeth (10 years ago, but I, like a true Estonian, pulled as hard as I could????).
A week after removal
I read dozens of reviews about how THIS happens. Complete horrors and fears. Most reported terrible pain for at least a week after tooth extraction.
In the morning at the appointment, the surgeon “reassured”: “Come back after lunch, you have a difficult case, there’s work for two or three hours.”
I wrote out a prescription for antibiotics. At the pharmacy I immediately bought antibiotics, prebiotics, and painkillers. Well, I definitely did. The doctor said it was impossible because I was breastfeeding, but I’m impressionable, so I decided to play it safe and buy strong painkillers.
Assortment of medications after tooth extraction. There is also not enough cream for skin irritation under a child’s diaper caused by one of the drugs
I bought three expensive and three cheap Nimesil.
I took it individually. Imported, from Berlin Hemi, they only give 3 pieces. I don’t know how much is in the box, I initially only wanted 3 bags.
Nimesil after wisdom tooth removal
Nimesil for toothache
- And this is the Russian nimesil:
Cheap nimesil
They don't give instructions; they remain in the box at the pharmacy. I read the instructions on the Internet.
Price 27 rubles for 1 sachet.
Price for nimesil
All in all.
They pulled out one of my wisdom teeth at 3 pm. They stitched up the wound and released him in peace???? the surgeon warned that the anesthesia would last for 4 hours.
6 hours passed and there was still no pain. The tongue, lips, everything remained “frozen”.
I put the children to bed.
And so, just enchantingly quickly, instantly, in a couple of minutes, the anesthesia wore off. I started to become afraid of the pain.
Really shivered and shook, precisely from the pain.
She quickly stirred the contents of the bag and drank.
Damn. How painful. I frantically began to search for information about when it would begin to let go.
Me - about 7 minutes later. The pain began to dull slightly. The chills stopped.
After 20 minutes the pain was rated 2 out of 10.
???????????? In general, with acute pain after wisdom tooth removal, Nimesil helped me within 20 minutes . I fell asleep peacefully. In the morning the pain was not so severe, it was saved by keterol and ibuprofen, they are allowed during breastfeeding.
By the way, about this. I showed selfishness by drinking this drug. On the eve of the removal, I spoke with a guardianship consultant, who strictly did not recommend Nimesil. But I thought that enduring such pain was unbearable. But Nurofen and similar drugs are much weaker.
The price of my selfishness is irritation on the child’s bottom. Maybe from anesthesia, maybe from a.b., maybe in combination. But it was nimesil that the consultant asked not to use.
Conclusion: it relieves pain quickly and powerfully, but when breastfeeding it is better to do without it!
2. After what time can you eat and drink?
After removal, you can drink water. After two hours you can eat. The limiting condition is not to chew rough food on the side of the extracted tooth in the first few days. Hard food can damage the blood clot, which is located in the socket and is needed for wound healing. If the patient experiences an acute feeling of hunger, then no one forbids eating cool yogurt or kefir. In the first days of healing of the hole, it is better to completely avoid eating rough, hard, solid foods, so as not to make strong chewing movements, as well as spicy, salty foods, so as not to irritate the oral mucosa. It is also important to monitor the temperature of food and drinks; they should not be too hot.
Consequences
Without adequate treatment, the dental cyst continues to grow and develop; in advanced stages, large neoplasms destroy the bone tissue of the skull, as a result it is replaced by connective tissue formations, which leads to the development of the following complications:
- dissolution of the jaw bone, which depends on the growth of the cyst;
- the formation of pus in the cyst, further purulent inflammation can lead to the development of an abscess;
- inflammatory process of lymph nodes located near the source of infection;
- development of osteomyelitis or periostitis;
- development of chronic sinusitis when the cyst grows in the maxillary sinus;
- pathological fracture of the jaw bones when the cyst reaches a large size;
- development of phlegmon due to a long-term purulent inflammatory process in the cyst;
- sepsis – blood poisoning;
- degeneration of a cyst into a malignant tumor without timely treatment.
Many patients are interested in why a dental cyst appears in the maxillary sinus, how dangerous it is and its symptoms. The formation of a cyst of this type occurs as a result of untreated inflammation of the tooth root in the upper jaw. A granuloma forms at the root of the tooth, which increases in size and becomes a peri-radicular cyst, then takes a position in the maxillary sinus. The volume of such a cyst can reach 9-12 cubic centimeters.
The symptomatic picture includes painful sensations, the nature of which is similar to trigeminal neuralgia, pain in the occipital, temporal and parietal regions of the head. Externally, a dental cyst can be identified by the asymmetry of the face. Tooth cyst - photo shows a cyst in the maxillary sinus.
3.Applying ice.
After tooth extraction in our Center, a specialist will give you ice specially prepared for such procedures to apply in the first hours after extraction. Ice is applied for a certain time, at certain intervals, which the doctor will instruct you about. At home, this procedure will need to be continued for some time (the first few hours after removal). This is done in order to minimize or completely eliminate tissue swelling.
Under no circumstances should you heat the area in the area of the extracted tooth; in this case, suppuration will develop.
6. Medications after removal.
After the procedure, the doctor prescribes a number of medications to take. Under no circumstances should you take any medications on your own, without consulting a doctor.
Painkillers should be taken in case of pain, at intervals and in the amount recommended by the doctor. Each case is individual; it happens that the patient does without taking painkillers.
Antibiotics. In some cases, after removal, antibiotics are prescribed for 5-7 days. As a rule, these are situations when the doctor removes a tooth in the stage of inflammation, complex extraction or removal of several units of teeth. Only a specialist surgeon decides whether to take antibiotics or not.
Antihistamines. Reduces the likelihood of swelling.
Antiseptics. Used as a rinse. BUT, remembering that rinsing movements are prohibited in the first days. A small amount of solution is taken into the mouth and simply held in the mouth, then calmly spit out. Such baths must be done if the tooth was removed during the inflammation phase, if the flux was exposed, if there are teeth affected by caries in the oral cavity.
In the head and neck area, due to the peculiarities of the anatomical structure of the nerve plexuses, pain often occurs instantly. According to the definition from Collier's Encyclopedia, pain is an unpleasant sensation or suffering caused by irritation of specific nerve endings in damaged or already damaged tissues of the body. The biological significance of pain is that it serves as a warning signal and forces people to reduce physical activity during injury or illness, which facilitates the healing process.
All human inflammatory diseases, one way or another, are accompanied by pain. Among the main diseases of the oral cavity, periodontal diseases have held a leading position for many years. The main percentage of periodontal tissue pathology is due to inflammatory-destructive diseases, a smaller part is due to destructive periodontal pathology, such as recession. It is known that the cause of the development of periodontitis is the introduction of a number of pathogenic bacteria, which results in an inflammatory process that leads to the destruction of the supporting-retaining apparatus of the tooth. While the cause of recession is often a traumatic factor against the background of anatomical predispositions - a thin biotype of the gum and bone substrate. Incorrect movements of the brush when brushing teeth, bad habits and structural features of the soft tissues of the vestibule of the oral cavity can act as a traumatic factor [1, 2].
Since “treatment” is a system of measures aimed at restoring health, preventing complications of the disease and eliminating manifestations of the disease that are painful for the patient, the surgical stage is often the main one in an integrated approach to periodontal diseases.
Pain, tissue swelling, increased temperature of the damaged area - all this can occur at various stages of the course of inflammatory-destructive periodontal diseases. Often the above symptoms occur during an exacerbation of the disease, i.e. abscess formation. Then the inclusion of non-steroidal anti-inflammatory drugs (NSAIDs) in complex therapy is beyond doubt, while in the chronic course of the disease patients often do not present such complaints.
As mentioned above, the cause of recession often lies in the anatomical features of the structure of the soft tissues of the vestibule. Then, to prevent progression of gum loss and root exposure, laxative operations are recommended. Elimination of the traumatic effect of cords, for example frenulectomy or vestibuloplasty, is a fairly common operation. Direct surgical treatment of recessions themselves is also becoming increasingly popular, although it does not yet allow achieving lasting results, including aesthetic ones.
When performing any surgical intervention on the tissues of the maxillofacial area, and periodontal tissue in particular, the postoperative period is almost always accompanied by “side effects,” including pain. This is one of the indications for prescribing NSAIDs as symptomatic therapy in order to facilitate the processes of tissue repair and regeneration [3].
NSAIDs were discovered about 150 years ago and have since become widespread in medicine. The mechanism of action of NSAIDs is based on inhibition of cyclooxygenase (COX) synthesis. When tissue is damaged, be it mechanical impact or microbial invasion, a cascade of reactions develops in the body, as a result of which COX is activated, an enzyme that regulates the formation of prostaglandins (PG), mediators of edema, inflammation and pain. However, along with the positive properties of NSAIDs, side effects were soon discovered, such as reactions from the mucous membrane of the gastrointestinal tract, cardiovascular system, and kidneys.
Only after the discovery in the early 90s of the twentieth century of two isoforms of COX—structural (COX-1) and inducible enzyme (COX-2)—it became possible to explain the side effects on the body [5, 6].
The mechanism of nonselective COX inhibition is key to understanding the adverse effects that occur. It is the effect on both isoforms (COX-1 and COX-2) that is the risk of side effects, since COX-1, being a structural enzyme, regulates the production of PGs involved in ensuring the normal (physiological) functional activity of cells.
From the point of view of practical medicine, the most interesting among NSAIDs are modern drugs that can suppress predominantly COX-2, an enzyme involved in the synthesis of PG in the area of inflammation [4].
Such a drug is nimesil, a non-steroidal anti-inflammatory drug of the sulfonanilide class, presented on the Russian market. The main active ingredient, nimesulide, was first registered in 1980, and already in 1985 it was approved for use in Italy and since then has been one of the most frequently prescribed NSAIDs [7].
The advantage of the drug nimesil is its ability to inhibit COX-2 to a greater extent, thereby exhibiting analgesic and anti-inflammatory effects, while the effect on COX-1 occurs to a minor extent. This explains the minimal side effects when taking nimesulide compared to NSAID analogues [8, 9]. Of no less importance is the antioxidant property of the main active ingredient, nimesulide, as well as the ability to inhibit metalloproteases, which has an indirect effect on the processes of regeneration and repair of cartilage and bone tissue [6].
The dosage form of the drug nimesil is presented in the form of granules (Fig. 1)
Figure 1. Release form of the drug nimesil. for the preparation of a suspension for oral administration, is well absorbed, the maximum concentration in the blood plasma is achieved on average after 2-3 hours.
Having strong anti-inflammatory and analgesic properties, the drug nimesil is widely used in many countries around the world [10].
The purpose of our clinical observation was to determine the effectiveness and feasibility of using the drug nimesil in the postoperative period during various surgical interventions on periodontal tissues.
Clinical observation was carried out in the department of periodontology of the Federal State Budgetary Institution "Central Research Institute of Dentistry and Maxillofacial Surgery" of the Ministry of Health and Social Development of the Russian Federation. 23 patients of both sexes aged from 18 to 55 years without severe somatic pathologies and a history of allergic reactions were selected to participate in the study.
Depending on the type of surgical intervention, all patients were divided into groups (Fig. 2):
Figure 2. Distribution of patients into groups depending on surgical interventions.
— patients after flap operations (operation in the area of no more than 4 teeth) — 10 people (Fig. 3);
Figure 3. Flap surgery. Stage of detachment of the mucoperiosteal flap.
— patients after directed tissue regeneration (NTR, no more than 2 teeth) — 5 people (Fig. 4);
Figure 4. Stage of guided tissue regeneration.
- patients after opening periodontal abscesses (if there is no more than one abscess) - 8 people (Fig. 5).
Figure 5. Periodontal abscess.
We deliberately did not include in the observation patients after laxative operations on soft tissues: vestibuloplasty, frenulectomy, as well as operations to eliminate gum recession, since this should be the topic of a separate clinical observation or study due to the anatomical features of the operated areas and their high degree of vascularization .
All patients after surgery were prescribed nimesil in the dosage recommended by the manufacturer, 1 sachet (100 mg) 2 times a day after meals for 4 days.
Our recommendations for the duration of taking the drug nimesil were based on the fact that, due to the characteristics of the reactions occurring in the body against the background of inflammation, the peak of patient complaints about swelling and especially pain occurs, as a rule, on the 3rd day after the intervention. To minimize the severity of pain, we recommended starting the drug immediately after surgery to avoid the accumulation of products of COX-2 activation, namely PG, mediators of edema and pain [4].
We used a Numeric Rating Scale (NRS) to determine pain intensity. It is designed to determine only one property of pain - its intensity and consists of 11 points - from 0 (“no pain”) to 10 (“worst pain imaginable”). It should be noted that although all index assessments of pain intensity are approximate and subjective, a more accurate method of determination has not yet been established. The advantages of the NRS method are that it does not require the patient to have clear vision, does not require a pen and paper, and does not require the patient to be able to use them. The scale can be used even when communicating with a patient by telephone.
However, determining the intensity of the pain symptom alone would not allow us to evaluate the full spectrum of action of the drug nimesil, so in our study we also paid attention to swelling of the soft tissues in the surgical area as one of the informative indicators of the degree of inflammation.
Since we did not find a suitable index to determine the degree of tissue swelling, we developed a digital scale similar to the NRS. Unfortunately, this scale also does not make it possible to obtain objective data, but it allows, albeit roughly, to describe the degree of tissue swelling. The measurement range was selected from 0 to 2. In the absence of edema, the value was defined as 0; with swelling of soft tissues only in the area of the intervention - 1; with significantly pronounced edema, as well as its spread to other anatomical structures - 2.
results
Clinical examination and questioning of patients was carried out on the 1st, 3rd and 7th days after surgery.
When examined on the 1st day, complaints of pain in patients after flap operations and after opening single abscesses ranged from “weak” to “moderate”, while in patients after NTR the pain intensity was slightly higher ( Fig. 6).
Figure 6. Pain intensity on the 1st, 3rd and 7th days after surgery when taking the drug nimesil.
However, upon examination on the 3rd day, there was a significant decrease in the intensity of pain symptoms in patients with abscesses and in the group of patients after flap surgery; the average for both groups remained in the range of “mild” pain, despite the expected peak of pain. In the group of patients after NTR, the decrease in the intensity of the pain reaction occurred a little slower, and the average value was at the level of “moderate” sensations.
When examining and interviewing patients on the 7th day after the intervention, pain was completely absent in all 3 groups, despite stopping taking the drug nimesil on the 4th day after surgery.
As for determining the degree of soft tissue swelling, we obtained the following indicators.
Maximum soft tissue swelling was recorded on the 1st day after the intervention in all groups of patients (Fig. 7).
Figure 7. The degree of swelling of soft tissues on the 1st, 3rd and 7th days when taking the drug nimesil. But, as in the case of determining the pain symptom in the group of patients after NTR, the degree of tissue swelling was slightly higher. Most likely, such data are associated with the traumatic nature of the intervention and once again indicate the absolute need to prescribe NSAIDs in the postoperative period.
By the 3rd day, in all groups there was a stable decrease in soft tissue swelling and in some cases (8 patients) its almost complete absence.
When surveyed, the majority of study participants - 20 people - noted the rapid onset of the analgesic effect, approximately 15-20 minutes after taking the drug; the remaining 3 participants could not accurately determine the time of onset of the effect, but, according to them, it did not exceed 30 minutes. The strength and duration of action of the drug nimesil were sufficient, which allowed patients not to increase the recommended dose and frequency of administration.
It should be noted that no side effects were observed in any of the patients.
Thus, in the course of our clinical observation, it was found that nimesil has proven itself well as an analgesic and anti-inflammatory drug for the management of the postoperative period during surgical interventions on periodontal tissues. The use of the drug nimesil allows patients to comfortably endure the period after surgery.
7.High blood pressure.
In patients with high blood pressure, there is a risk that the wound may bleed longer than usual. In this case, you need to regulate the pressure by taking appropriate medications to reduce it. In our SDent dental medical center, even before the start of manipulations, the doctor always finds out the main points about the general health of the patient. If the patient has hypertension, the specialist knows about this problem in advance and then gives the necessary recommendations appropriate to the case.
Contraindications
In what situations is it not recommended to use Nimesil for toothache? The contraindications are as follows:
- children under 12 years of age;
- for alcohol/drug addiction;
- for diseases of an allergic nature;
- with pathology of blood clotting;
- pregnant/nursing mothers;
- for liver/kidney chronic diseases;
- for peptic ulcer of the intestines/stomach;
- in case of intolerance to the composition of the drug.
In some countries (for example, the USA), Nimesil is considered toxic and is not sold in pharmacies. However, side effects appear only if the instructions for using the medicine are violated. These include:
- nausea, vomiting and stomach pain;
- stomach bleeding (rare);
- exacerbation of kidney disease;
- labored breathing;
- increased blood pressure;
- drowsiness and apathy;
- allergic reactions;
- coma.
Disturbances in the functioning of the hematopoietic system may also be observed: thrombocytopenia, anemia, hemorrhagic syndrome. Disturbances in the functionality of the central nervous system include feelings of anxiety, fears, nightmares, headaches and drowsiness.
Heartbeat disturbances may occur - tachycardia, hot flashes. Disorders of the respiratory system include the appearance of shortness of breath, bronchospasm and attacks of bronchial asthma. There is a violation of visual function - a lack of sharpness in the perception of objects.
The effect on the renal system manifests itself in the form of urinary retention, dysuria, exacerbation of nephritis and renal failure. If the functionality of the gastrointestinal tract is impaired, exacerbations of gastritis, the appearance of jaundice, and stool disorders may occur.
However, if the dosage is observed, no toxic effects on the systems and tissues of the body have been identified. If side effects occur, you should consult a doctor. In case of overdose, symptomatic (local) treatment is prescribed. If the dosage was exceeded no later than four hours ago, induce a gag reflex and rinse the stomach. After washing, drink activated carbon (1 tablet/10 kg of weight) or take a laxative.
Side effects also appear when the medication is combined with other drugs, so it is better to notify your physician before use. Some medications may enhance or reduce the effect of the active substance of the drug.
8.What happens to the sutures after removal.
After the tooth is removed, the surgeon places sutures on the wound surface. This promotes faster healing, reduced pain, less risk of inflammation, minimizes the risk of bleeding, and protects the blood clot from falling out.
At the SDent clinic we use the most modern and safe materials. The thread with which the surgeon sews the edges of the hole is self-absorbing. But during the process, the ends of the thread can cause discomfort to the patient and interfere with the oral cavity. Therefore, for the comfort and safety of the patient, the doctor always sets an appointment date for examination and removal of sutures in approximately 10 days.
For what diseases do you need to take nimesil?
The drug is used as prescribed by a doctor as a “second-line” medication and is added to therapy additionally when other drugs fail to relieve an attack of pain and relieve symptoms of inflammation that are caused by:
- toothache;
- painful menstruation and inflammation of the genital organs in women and men;
- damage to joints and ligaments that occur due to injuries, dislocations, fractures, sprains;
- pain in the spine and back;
- degenerative changes in joints with osteoarthritis.
After tooth extraction, you should not do the following.
- In the first couple of days, taking a hot bath is excluded, only a warm shower.
- During sleep, you need to be careful not to lie on the side where the tooth was removed, this provokes the appearance of swelling.
- Visiting the gym and active physical activity should be postponed in the first days.
- Do not touch the wound with your tongue or foreign object.
- Do not open your mouth very wide, do not use active chewing and facial movements to avoid the sutures coming apart.
- Aspirin is not suitable as an anesthetic due to the fact that it has a thinning effect on the blood and may cause bleeding and hematoma.
- Do not rinse during the first few days. This can negatively affect the loss of a blood clot from the socket and the occurrence of inflammation.
For more information and to make an appointment with a specialist, call:
+7,
Note!
The description of the drug Nimesil on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.
Before purchasing or using the drug, you should consult your doctor and read the manufacturer's original instructions (attached to each package of the drug). Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.
