Before & After Surgery Instructions

BEFORE SURGERY INSTRUCTIONS

Instructions for Anesthesia

If your treatment procedure requires you to receive intravenous anesthesia the following must be strictly adhered to or your appointment will have to be rescheduled.
1.    DO NOT EAT OR DRINK ANYTHING FOR 8 HOURS PRIOR TO SURGERY.
Medicines that are taken on a daily basis may be taken with as little water as possible, unless told differently by the doctor or nurse.
2.    Wear loose fitting clothing—preferably short sleeves. We need access to both arms. Wear comfortable lace-up shoes. NO FLIP FLOPS.
3.    A responsible adult must accompany you (Limit 2) and remain in the office for the duration of your surgery and recovery. Usually 1—2 hours. They or someone responsible must be able to stay with you for the first 12 hours following surgery.
4.    Leave contact lenses at home the day of your surgery. If needed wear your eye glasses.
5.    Leave all jewelry at home, i.e., watches, bracelets, earrings, including tongue and lip piercing ornaments, etc. 6. After surgery you are not to drive or operate machinery or perform any activity that requires alertness or motor coordination.

AFTER SURGERY INSTRUCTIONS:

1. After Apicoectomy

Immediately following surgery:

Remove the gauze pad, that was placed directly over incision/surgical site, 20 minutes after leaving our office. Immediately began to push the cold fluids. This will help the bleeding to subside. Placing gauze over the incision repeatedly will begin to irritate the gum tissue. Remember a tooth wasn’t extracted, only incisions were made in the gum tissue.

Avoid vigorous mouth rinsing or touching the wound area following the surgery. This may initiate bleeding by causing the blood clot that has formed to become dislodged.

To minimize any swelling, place an ice pack to the side of your face where surgery was performed.

Take the prescribed pain medication as soon as you can so it is digested before the local anesthetic has worn off. (This instruction will be given to you, by the nurse, after the procedure. The local anesthetic is different for everyone and lasts only so long.) Having something of substance in the stomach to coat the stomach will help minimize nausea from the pain medication.

Restrict your activities the day of surgery and resume normal activity when you feel comfortable. If you are active, your heart will be beating harder and you can expect excessive bleeding and throbbing from the wound.

NO SMOKING UNDER ANY CIRCUMSTANCES.

Bleeding:
A certain amount of bleeding is to be expected following surgery. Since the wound is sutured closed, the bleeding is usually clotted a short time after surgery. Sight bleeding or oozing causing redness in the saliva is very common. For this reason, the gauze will always appear red when it is removed. Saliva washes over the blood clots and dyes the gauze red even after bleeding from the wound has actually stopped.

Excessive bleeding may be controlled by first GENTLY rinsing or wiping an old clots from your mouth, then placing a gauze pad over the area and biting down firmly for 20 minutes.

If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting blood vessels. This can be repeated if necessary.

To minimize further bleeding, sit upright, do not become excited, maintain constant pressure on the gauze (no talking or chewing) and avoid exercise. Call the office for further instructions.

Swelling:
The swelling that is normally expected is usually proportional to surgery involved.

If there is a fair amount of cheek retraction involved with your apico, then it would be appropriate to apply ice on the outside of your face on the affected side.

The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. The swelling may be minimized by the immediate use of ice packs. The ice packs should be applied 20 minutes on/ 20 minutes off until bedtime that night. After 24 hours, ice has no beneficial effect.

The day following surgery the application of moist heat to the side of the face may help some in reducing the size of any swelling that has formed. Use 3-4 times a day for 30 minutes each.

Bright red, rock hard, hot swelling that does not indent with finger pressure which is getting bigger by the hour would suggest infection. This usually would develop around day 3-4 after surgery when you would expect swelling to be going down, not up. If this should occur, call our office immediately.

2. After Exposure of an Impacted Tooth

Bleeding
We try not to place any gauze where the exposure of the tooth took place.  Usually a bracket has been bonded to the tooth as well.  If gauze or a tea bag is placed, for excessive bleeding, be very careful not to get it tangled on the bracket and braces.  This may pull the bracket off of the tooth.  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 tea bag placed directly on the bleeding wound for 45 minutes.  If bleeding continues please call for further instructions.

Swelling
Swelling is a normal occurrence after surgery.  To help minimize swelling, an ice bag or a plastic bag or towel filled with ice cubes placed on the cheek in the area of surgery may be used.  Apply the ice 20 to 30 minutes on then 20 minutes off as much as possible for the first 24 hours.  If swelling is still present after the first day, you will then apply warm, moist heat to the same area, 3 times during the day for 30 minutes each.  You will only use the ice for the first 24 hours, then the heat for the next few days if needed.

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

Pain
You should begin taking pain medication before you begin to feel discomfort.  Take your medication, as directed during post op instructions or before the local anesthesia starts to wear off.   Ibuprofen (Advil, Motrin) or Tylenol may be taken instead of the prescribed pain medicine if the pain isn’t severe enough.  The prescribed medication should be taken as directed.  Note that while Ibuprofen (Advil, Motrin) may be taken along with most of the prescribed pain medications.  Tylenol should not be taken with the prescription as most prescription pain medications already include Tylenol.

Oral Hygiene
Mouth cleanliness is essential to 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.

3. After Placement of Dental Implants

Do not disturb the wound.  Avoid touching the wound on the day of surgery.  There may 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 would for 20 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 bay, or towel filled with ice on the cheek in the area of surgery.  Apply the ice 20 to 30 minutes on and 20 minutes off as much as possible for the first 24 hours.  After 24 hours you will use warm moist heat for the next few days for swelling.  Apply 30 minutes to area, 3 times a day.

Diet
Drink plenty of fluids.  Avoid hot liquids for a few hours.  Soft, cold food and cold liquids should be eaten for the first few hours.  Return to a normal diet after a few hours, unless otherwise directed or still having bleeding.

Pain
You should begin taking pain medication as soon as you feel the local anesthetic wearing off.  The prescribed medication should be taken as directed

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

Oral Hygiene
Good oral hygiene is essential to healing.  If Peridex or Periogard, which are prescription mouth rinses, have been prescribed use them before bed.  The day after surgery, the Peridex should be used twice daily, after breakfast and before bed.  Be sure to rinse for at least 60 seconds then spit it out.  Warm saltwater 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 generous when 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.

Follow Up Appointment

Be sure to keep your post op appointment.  We will take an x-ray at this appointment, if an x-ray wasn’t taken directly after surgery.

4. After the Removal of Multiple Teeth

These instructions apply with or without placement of immediate dentures.

Bleeding
Some bleeding is expected following the operation.  If bleeding occurs, place a cold wet tea bag (squeezed out) directly over the bleeding socket and apply “biting pressure” for 30 minutes.  If bleeding continues, call our office immediately.  Remember to push the cold fluids as this will also aid in clot formation. 
If an immediate denture has been placed, do not remove denture unless the bleeding is severe.  Expect some oozing around the denture.  If the denture is removed, wipe the mouth out with a cold wet rag, figure out where the bleeding is coming from, then place a gauze or tea bag in that area.  Bite down on it for 30 minutes.  Drink a cold beverage, then place denture back in.  Repeat process if necessary.  If excessive bleeding persists, call our office immediately.

Pain
For pain use the prescription given to you.  Begin the pain medicine as instructed during post op instructions.  Especially before the numb sensation wears off.  If an antibiotic has been prescribed, always finish it.  If mouth rinse is prescribed, always rinse as directed.

Hygiene
Do not rinse your mouth for the first post-operative day, or while there is bleeding.  After the first day, use a warm saltwater rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area.  (One half teaspoon of salt in a glass of lukewarm water.)  If a denture is placed, remove the denture and rinse as 3-4 times a day while also cleaning denture.

Diet
For the first 24 hours, your diet will consist of soft, cold liquids and food.  Avoiding any carbonated water.  After 24 hours you will remain on a soft diet, at any temperature, increasing consistency as tolerated.

The removal of many teeth at one time is quite different than the extraction of one or two teeth.  Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal.

The area of operation will swell.  It will reach the greatest level of swelling in 2 days.  Swelling and discoloration around the eye may occur.  The application of a warm moist towel will eliminate the discoloration quicker.  The towel should be applied continuously for as long as tolerable beginning 48 hours after surgery (remember ice packs are used for the first 24 hours only.)

A sore throat may develop.  The muscles of the throat are near the extraction sites.  Swelling into the throat muscles can cause pain.  This is normal and should subside in 2-3 days.

If the corners of the mouth are stretched, they may dry out and crack.  Your lips should be kept moist with an ointment like Vaseline.  There may be a slight elevation of temperature for 24-48 hours.  If temperature continues, or is above 101 degrees, notify our office.

If immediate dentures have been inserted, sore spots may develop.  In many cases, your dentist will see you the very next day after surgery.  This appointment will be made before your surgery with us.  At that appointment, the necessary adjustments to relieve those sore spots will be made.  Failure to relieve the sore spots may result in more severe denture sores, which may prolong the healing process.

5. After Tooth Extraction

After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process.  That’s why we ask you to bite on a gauze pad for 20 minutes after the appointment.  If the bleeding or oozing still persists, place a tea bag (after you dip it in ice cold water) squeeze out and bite firmly for another 30 minutes.  You may need to repeat if necessary.  Always remember to push cold liquids to help the clot seal.

After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing.  Do not rinse vigorously, suck on straws, smoke, and drink carbonated water or brush teeth for 24 hours.  These activities will dislodge or dissolve the clot and retard the healing process.  Limit vigorous exercised for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site. 
After the tooth is extracted you may feel some pain and experience some swelling.  The Doctor may suggest you use an ice pack.  It will be applied to the area, on the outside of the cheek, which will help keep swelling to a minimum.   The ice pack will serve no purpose after 24 hours.  Warm, moist heat will be utilized the next 2-3 days. Take pain medications as prescribed.  The swelling usually begins to subside after 48 hours.

Use the pain medication as directed.  Call the office if the medication doesn’t seem to be working.  If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone.  Drink lots of cold fluids and eat soft cold food on the day of the extraction.  You can resume your normal diet and hygiene the very next day.

It is important to resume dental routine after 24 hours.  This should include brushing and flossing your teeth at least once a day.  This will speed healing and help keep your mouth fresh and clean.

After a few days you should feel fine and can resume your normal activities.  If you have heavy bleeding, severe pain, continued swelling beyond 2-3 days, or a reaction to the medication, call our office immediately.

If an immediate denture has been placed, do not remove immediate denture unless the bleeding is severe.  Expect some oozing around the side of the denture.
Use ice packs (externally) on the same side of the face as the operated area.  Apply ice for the first 24 hours only.  Apply the ice 20 to 30 minutes on and 20 minutes off as much as possible for the first 24 hours.  Note that while Ibuprofen (Advil, Motrin) may be taken along with most of the prescribed pain medications.  Tylenol should not be taken with the prescription as most prescription pain medications already include some Tylenol.

For severe pain use the prescription given to you.  If you pain does not begin to subside in 2 days, or increases after 2 days, please call our office.  If an antibiotic has been prescribed, finish your prescription regardless of your symptoms.

Drink plenty of fluids.  If many teeth have been extracted, the blood lost at this time needs to be replaced.  Drink at least six glassed of liquid the first day.
Do not rinse your mouth for the first post-operative day, or while there is bleeding.  After the first day, use, use a warm saltwater rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area.  (One half teaspoon of salt in a glass of lukewarm water.). After you have seen you dentist for denture adjustment, take out denture and rinse 3 to 4 times a day.

Restrict your diet to liquids and soft foods, which are comfortable for you to eat.  As the wounds heal, you will be able to advance your diet.
The removal of many teeth at one time is quite different than the extraction one or two teeth.  Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:

The area of the operation will swell.  If will reach the greatest ever of swelling in 2 days.  Swelling and discoloration around the eye may occur.  The application of the moist warm towel will help eliminate the discoloration 48 hours after surgery (remember ice packs are used for the first 24 hours only)

A sore throat may develop.  The muscles of the throat are near the extraction sites.  Swelling into the throat muscles can cause pain.  This is normal and should subside in 2-3 days.

If the corners of the mouth are stretched, they may dry out and crack.  Your lips should be kept moist with and ointments like Vaseline.  There may be a slight elevation of temperature for 24-48 hours.  If temperature continues, or is above 101 degrees, notify our office.

If immediate dentures have been inserted sore spots may develop.  In most cases, your dentist will want to see you the next day after surgery and make the necessary adjustments to relieve those sore spots.  Failure to relieve the sore spots may result in more severe denture sores, which may prolong the healing process.

6. After Wisdom Tooth Removal

The removal of impacted teeth is an invasive surgical procedure.  Post- operative care is very important.  Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.
Immediately Following Surgery:

The gauze pad placed over the surgical area is designed to enable you to keep pressure on the surgical site to prevent bleeding.  If you are not actively bleeding the gauze is not necessary.  Once you leave the office, if bleeding is still present, the gauze should be kept in place for 20 minutes with biting pressure on the extraction sites.  If you are sleeping, while the gauze will still absorb oozing, the lack of pressure will likely not assist much with oozing control.  After use, the gauze pad should be removed and discarded.  We ask that after the gauze is removed to immediately start cold fluids to stop the bleeding.

No mouth rinsing or touching the wound area following surgery.  This may initiate bleeding by causing the blood clot that has formed to become dislodged.
Take the prescribed pain medication before you begin to feel discomfort.  This will usually coincide with the return of sensation in your mouth, as the local anesthetic wears off.   In the lower jaw, the return of sensation may not occur until that evening.

Restrict your activities the day of surgery regardless of how you feel and resume normal activity when you feel comfortable.  You may have been instructed to place ice packs to the sides of your face where surgery was performed.  Refer to section on swelling for explanation.
Bleeding

A certain amount of bleeding is to be expected following surgery.  Slight bleeding, oozing, or redness in the saliva is not uncommon.  Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a tea bag over the area and biting for 30 minutes.  The tannic acid in the tea bag may help to form a clot by contracting bleeding vessels.  To minimize further bleeding, do not become excited, sit upright, and avoid exercise. Remember, pushing very cold fluids will also help the clot to seal and the bleeding to subside. If bleeding does not subside, please call to discuss how to proceed. 

Swelling
The swelling that is normally expected is usually proportional to the surgery involved.  Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon.  This is the body’s normal reaction to inflammation and eventual repair.  The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days after the surgery.  Therefore it is normal and expected to be more swollen the second postoperative day than the first.  You may have been instructed to use ice packs following your surgery.  The ice packs should be placed 20 – 30 minutes on and 20 minutes off for the first 24 hours following your surgery.  After 24 hours, ice has no beneficial effect.  If swelling or jaw stiffness has persisted for several days, there is no cause for alarm.  This is a normal reaction to surgery.  48 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain
For severe pain, take the tablets prescribed as directed.  If you have been prescribed a narcotic pain medication, it likely also contains Tylenol and thus should not be mixed with additional Tylenol doses.  With rare exceptions, Advil may be taken along with your prescribed medication.  If you have been prescribed an anti-inflammatory medication along with your narcotic, you should not add further such medication (i.e. Motrin, Ibuprofen, etc.)  The prescribed pain medicine will make you groggy and will slow down your reflexes.  Do not drive and automobile or work around machinery.   Avoid alcoholic beverages.  Pain or discomfort following surgery should subside more and more every day.  If pain persists, it may require attention and you should call the office.

Diet
After I.V. sedation, cold liquids should be initially taken.  Do not use straws.  Do drink from a glass.  The sucking motion of a straw can cause more bleeding by dislodging the blood clot.  You may eat anything soft and cold by chewing away from the surgical sites, but will need to wait 2 hours before doing so to see how you are handling the fluids.  High calorie, high protein intake is very important. No carbonated water, i.e. Sodas for 24 hours (may resume next day). Nourishment should be taken regularly.  You should prevent dehydration by drinking cold fluids regularly.  Your food intake will be limited for the first few days.  You should compensate for this by increasing your fluid intake.  At least 5-6 glasses of liquid should be taken daily. A soft and cold diet is required for the first 24 hours; you may eat/drink warm/hot food the next day. Try not to miss a single meal.  You will feel better, have more strength, less discomfort and heal faster if you continue to eat.  Caution: If you suddenly sit up or stand from a lying position you may become dizzy.  If you are lying down following surgery, make sure you sit for one minute before standing.

Keep the mouth clean
No rinsing or brushing of any kind should be performed until the day following surgery.  You can brush your teeth the morning of surgery prior to coming in.  The day after surgery you should begin rinsing at least 3 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt.  If Peridex, a prescription mouth rinse is prescribed, start it the next day for 5 more days.

Discoloration
In some cases, discoloration of the skin follows swelling.  The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissue.  This is a normal post-operative occurrence, which may occur 2-3 days post-operatively.  Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics
If you have been prescribed antibiotics, take the tablets or liquid as directed.  Antibiotics may be given to help prevent infection.  Discontinue antibiotic use in the event of a rash or other unfavorable reaction.  Call the office if you have any questions.

Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine.  You should then sip on Sprite, tea, or Ginger ale.  You should sip slowly over a fifteen-minute period.  Stay lying down.   Avoid excessive movement and NO MILK PRODUCTS.   When the nausea subsides you can begin taking solid foods and the prescribed medicine.  If this is not successful please call the office for assistance.

Other Complications
If numbness of the lip, chin, or tongue occurs there is no cause for alarm.  This is usually temporary in nature.  You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation.  So be careful.  Call your Doctor if you have any questions.  Slight elevation of temperature immediately following surgery is not uncommon.  If the temperature and numbness persist, notify the office.

Occasionally, patients may feel hard projections in the mouth with their tongue and mistake them as being roots.  They are actually the bony walls that supported the tooth.  These projections usually smooth out spontaneously, with the help of brushing over the area and doing the salt water rinses.  If they do not, they can be smoothed by your Doctor.

If the corners of your mouth are stretched, they may dry out and crack.  Your lips should be kept moist with an ointment such as Vaseline.
Sore throats and pain when swallowing are not uncommon.  The muscles get swollen.  The normal act of swallowing can then become painful.  This will subside in 2-3 days.

Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery.  This is normal post-operative event that will resolve in time.
Further General Considerations

Sutures are sometimes placed in the area of surgery to minimize post-operative bleeding and to help healing.  They are restorable and will become dislodged; this is no cause for alarm.  Just remove the sutures from your mouth and discard it.

The pain and swelling should subside more and more each day following surgery.  If your post-operative pain or swelling worsens or any unusual symptoms occur call our office for instructions.

There will be a space where the tooth was removed.  The space will gradually, over the next few months, fill in with the new tissue.  In the mean time, the area should be kept clean especially after meals with saltwater rinses or a toothbrush.

Every case is individual and no two mouths are alike.  Therefore, do not accept advice from friends.  Discuss your problem with your doctor or your family dentist.
Brushing your teeth is okay – just be gentle at the surgical sites.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket.  Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery.  Call the office if this occurs.  We can help.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced.  Exercise may weaken you.  If you get light headed, stop exercising.