Surgical Instructions

Before Anesthesia

All appointments for oral surgery under general anesthesia are made under the following conditions:

• Your appointment will be scheduled in the morning; you must have no solid food or liquids after midnight before your procedure.
• Take your medications as directed with small sips of water at any time prior to your procedures.
• You must be free from cold or congestion.
• A responsible adult (18 years or older) who can drive, must come with you to the office, remain in the office through the surgery and drive you home. A parent or a legal guardian must accompany a minor child.
• You should wear comfortable clothing, i.e., short sleeve shirt and low flat shoes.
• Do not wear contact lenses, watches, earrings, bracelets, nail polish, etc.
• Please leave small children at home on the day of the surgery.

After Oral Surgery

Care of mouth after oral surgery:

• Do not rinse or spit for 24 hours after surgery.
• Keep fingers and tongue away from socket or surgical area.
• Use ice packs on surgical area (side of face) for first 48 hours, apply ice 20 minutes on — 20 minutes off. Bags of frozen peas and corn work well.
• For mild discomfort take Tylenol or Ibuprofen every three to four hours.
• For severe pain use the medication prescribed to you.
• Drink plenty of fluids. (Do not use a straw)
• If the muscles of the jaw become stiff, chewing gum at intervals will help relax the muscles, as well as the use of warm, moist heat to the outside of your face over these muscles.
• After the first post-operative day, use a warm salt-water rinse following meals for the first week to flush out particles of food and debris which may lodge in the surgical area. (1/2 teaspoon of salt in a glass of warm water; mouthwash can be added for better taste.)
• Diet may consist of soft foods which can be easily chewed and swallowed.
• No seeds, nuts, rice, popcorn, etc.
• A certain amount of bleeding is to be expected following surgery. Bleeding is controlled by applying pressure to the surgical area using small rolled gauze for 90 minutes. After that time remove the gauze and then you may eat or drink. If bleeding persists, a moist tea bag should be placed in the area of bleeding and bite firmly for one hour straight. This will aid in clotting blood. Repeat if necessary. If bleeding still persists call our office.
• We suggest that you do not smoke for at least 5 days after surgery. Nicotine may break down the blood clot and cause a "dry-socket".

After Implants

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There will be a metal healing abutment protruding through the gingival (gum) tissue.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call for further instructions.

Swelling

Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, or a plastic bag, or towel filled with ice on the cheek in the area of surgery. Apply the ice continuously, as much as possible, for the first 36 hours.

Diet

Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

Pain

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets: 2 tablets every 4 hours or 3 tablets every 6 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.

Antibiotics

Be sure to take the prescribed antibiotics as directed to help prevent infection.

Oral Hygiene

Good oral hygiene is essential to good healing. Warm salt water rinses (teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, as well, especially after meals. Brushing your teeth and the healing abutments is no problem. Be gentle initially with brushing the surgical areas.

Activity

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.

Wearing your Prosthesis

Partial dentures, flippers, or full dentures may be used, immediately after surgery on a selected basis. This will be discussed with you on the pre-operative visit.

After Extraction

The after-effects of oral surgery vary per individual, so not all of these instructions may apply. Please feel free to call our office any time should you have any questions, or are experiencing any unusual symptoms following your treatment.

IMMEDIATELY AFTER SURGERY

Patients who received a general anesthetic should return home from our office immediately upon discharge and lie down with the head elevated until all the effects of the anesthetic have disappeared. Anesthetics effects vary by individual and you may feel drowsy for a short period of time or for several hours. You should not operate any mechanical equipment or drive a motor vehicle for at least 12 hours or longer if you feel any residual effect from the anesthetic.

Oral Hygiene and Care

Do not disturb the surgical area today. Bite down gently but firmly on the gauze pack that we have initially placed over the surgical area, making sure that they remain in place. Do not change them for the first 20-30 minutes unless the bleeding is not being controlled. This is important to allow blood clot formation on the surgery site. The gauze may be changed when necessary and/or repositioned for comfort. DO NOT drink with a straw and DO NOT rinse or brush your teeth vigorously or probe the area with the tongue, any objects, or your fingers. You may brush your teeth gently, carefully avoiding the surgical site. DO NOT SMOKE for at least five days, since it is detrimental to the healing process. You may start normal tooth brushing the day after the surgery or after bleeding is controlled. It is imperative to keep your mouth clean, since an accumulation of food or debris may promote infection.

Bleeding

Some bleeding is normal, and blood-tinged saliva may be present for 3 to 4 days. This may be controlled by placing fresh gauze over the surgical area and biting down firmly for 30-60 minutes.
Steady Bleeding

Bleeding should not be severe. If bleeding persists, this may be due to the gauze pads being clenched between the teeth rather than exerting pressure on the surgery site. Try repositioning the gauze. If bleeding persists or becomes heavy, substitute a moist tea bag (first soaked in hot water and squeezed dry) on the area for 20-30 minutes. If bleeding continues, please call our office.

Swelling or Bruising

Swelling is to be expected and usually reaches its maximum in 72 hours. To minimize swelling, cold packs or ice bag wrapped in a towel should be applied to the face adjacent to the surgical area. This should be applied 20 minutes on then removed for 20 minutes during the first 48 hours after surgery. If you were prescribed medicine for the control of swelling, be sure to take it as directed. After 72 hours, you may want to try using moist heat to the same area until swelling has receded. Apply moist heat for 30-45 minutes,4-5 times a day. Bruising may also occur, but should disappear soon. Tightness of the jaw muscles may cause difficulty in opening the mouth. This should disappear within 7 days. Keep lips moist with cream or Vaseline to prevent cracking or chapping.

Diet

It is advisable to confine the first day's food intake to COOL liquids or pureed or soft cool foods. Avoid foods like nuts, sunflower seeds or popcorn, which may get lodged in the socket areas. Over the next several days, you may progress to more solid foods. Proper nourishment aids in the healing process. If you are a diabetic, maintain your normal diet as much as possible and follow you physician's instructions regarding your insulin schedule.

Pain and Medications

Unfortunately, most oral surgery is accompanied by some degree of discomfort. Take the pain medication prescribed as directed. It may be difficult to control the pain once the local anesthetic wears off. We therefore advise you to take the pain medication as soon as you start to feel the local anesthetic wearing off. If you don't achieve adequate pain relief, you may supplement each pill with an analgesic such as aspirin or ibuprofen. Taking the pain medication with soft food and a large volume of water will lessen any side effects of nausea or stomach upset. If you were prescribed an antibiotic and are currently taking oral contraceptives, you should use an alternate method of birth control for the remainder of this cycle. If you are anticipating the need for a refill of your medication for the weekend, please call the office before noon on Friday.

INSTRUCTIONS FOR THE FOLLOWING DAYS

Oral Hygiene

Keeping your mouth clean after oral surgery is essential. Start rinsing your mouth with a warm salt water rinse (1/2 tsp. salt with 1 cup water) after meals and at bedtime. Continue this for several days, then rinse 3-4 times a day one week. Begin your normal tooth brushing routine as soon as possible after surgery. Soreness and swelling may prevent rigorous brushing of all areas, but make every effort to clean your teeth within your comfort level.

Care of Surgical Area

Apply warm compresses to the skin overlying areas of swelling for 20 minutes on and 20 minutes off to help soothe these tender areas. This will also aid in reducing swelling and stiffness. If you were given an irrigating syringe, start using it a week following surgery to keep the sockets clean. Fill it with warm salt water and irrigate any open sockets gently, especially after eating.

OTHER POSSIBLE POST-SURGERY EFFECTS

Dry Sockets

The blood clot on the surgical site may be lost causing a dry socket (usually around the 5th day). There will be a noticeable, distinct, persistent pain in the jaw area, often radiating toward the ear and forward along the jaw which may cause other teeth to ache. If you do not see steady improvement during the first few days after surgery or if severe pain persists, please call our office to report these symptoms.

Skin Discoloration

This may be expected and is usually limited to the neck or cheek area near the surgical site. This is caused by bleeding through the mucous membranes of the mouth beneath the skin and appears as a bruise. If discoloration occurs, it often takes a week for this to completely disappear. Occasionally, the arm or hand near the site where the needle was placed to administer IV drugs may remain inflamed and tender. This is caused by chemical irritation in the vein. Aspirin and application of heat on the area will usually correct these symptoms.

Numbness

Loss of sensation of the lip and chin may occur, usually following lower wisdom teeth removal. This is usually temporary and disappears within a few days or weeks. Occasionally, some numbness may persist for months, due to the close association of the roots of the teeth to the nerve that supplies sensation to these areas described.

It is our desire that your recovery be as smooth and pleasant as possible. If you have any questions about your progress or any symptoms you are experiencing, please call our office 24 hours a day. After office hours, you will reach our answering service and our doctor will contact you as soon as possible.

After Exposure of an Impacted Tooth

Do not disturb the wound. If surgical packing was placed, leave it alone. The pack helps to keep the tooth exposed. If it gets dislodged or falls out do not get alarmed.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding which results in your mouth filling rapidly with blood can frequently be controlled by biting with pressure on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call for further instructions.

Swelling

Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag or a plastic bag or towel filled with ice cubes on the cheek in the area of surgery. Apply the ice continuously as much as possible for the first 36 hours.

Diet

Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

Pain

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength. Tylenol may be taken every 3-4 hours. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2 tablets every 4 hours or 3 tablets every 6 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed.

Oral Hygiene

Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can. Rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete.

REMEMBER:  A clean wound heals better and faster.

Activity

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.