SURGICAL INSTRUCTIONS

Pre-Operative Instructions for Patient Undergoing General Anesthesia

  • You may not have anything to eat or drink (including water) for 8 hours prior to the appointment. For morning surgery, no food or liquids after midnight the night before surgery.
  • No smoking at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery.
  • A responsible adult must accompany the patient to the hospital, remain in the hospital during the procedure, and drive the patient home.
  • Plan to rest for the remainder of the surgery day. The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
  • Contact lenses, jewelry, and dentures must be removed at the time of surgery.
  • Do not wear lipstick, excessive makeup, or nail polish on the day of surgery.
  • If you have an illness such as a cold, sore throat, or stomach or bowel upset, please notify the office at least 24 hours before your scheduled surgery day.
  • If you take routine oral medications, please check with your doctor prior to your surgical date for instructions. This is especially important if you take blood thinning medication.
  • The use of alcohol can have an adverse effect on the anesthesia medications that we use. Please discontinue the use of such for at least 72 hours prior to your procedure.
  • If you were prescribed medications by your doctor, please closely follow the instructions for their use.
  • Women, please note: Some antibiotics may interfere with the effectiveness of your birth control pills.

Post-Operative Instructions

(After Surgery)

 

After Wisdom Teeth Removal

The removal of impacted teeth is a serious 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.

Bleeding
  • Immediately after surgery 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 30–45 minutes after the appointment. Proper placement will help you not swallow blood, which can make you nauseated. Replace the gauze pad(s) every 20–40 minutes. It is best to moisten the gauze with warm tap water to prevent it sticking to the oral tissue .You may have to do this several times. When the gauze pads have little or no blood on them, they are no longer necessary.
  • Most of your bleeding will slow within 3–4 hours, but a small amount of bleeding or oozing is common for up to 24 hours. The amount of bleeding will vary from person to person, but should never be severe. If bleeding persists you may replace the gauze with a warm damp tea bag  (soaked in hot water and squeezed damp dry) over the bleeding area. Tannic acid in tea causes constriction of the blood vessels and the bleeding should stop. If the bleeding continues, call the practice.
  • Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.

 

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 surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days postoperatively. However, the swelling may be minimized by the immediate use of ice packs. Two ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be applied and removed in cycles of 20 minutes (20 min on and 20 min off) while you are awake. After 36 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.
  • Thirty-six 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 moderate to severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes.
  • Do not drive a vehicle or work around heavy machinery.
  • Avoid alcoholic beverages with the pain medication.
  • 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 general anesthetic or sedation, liquids should be initially taken. Do not eat for 2 hours after surgery. Start with clear liquids, such as apple juice, tea, or broth. Gradually ramp up your diet as tolerated.
  • You should prevent dehydration by taking 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 6-8 glasses of liquid should be taken daily.
  • Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot.
  • Always cool down any hot foods or liquids during the first 24 hours. You should eat only soft food for the first week: for example, soups, eggs, mashed potatoes. You may eat by chewing away from the surgical sites.
  • High calorie, high protein intake is very important. Meals can be supplemented with meal replacement shakes (e.g. Ensure) if you are struggling to eat.  Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
  • For 2 weeks (8 weeks if you had lower wisdom teeth extracted), do not eat hard, crunchy, or very chewy foods that may get lodged in the surgical site.  To help prevent a dry socket from occurring, do not use a straw for the first 5 days after surgery.

 

Oral hygiene - Keep the mouth clean
  • No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently.
  • Begin saltwater rinses the day after surgery and continue for 1 week. Rinse with warm salt water 6–8 times each day. To make the saltwater solution, dissolve a ½ teaspoon of salt in a small glass of luke warm water. You will also receive a prescribed oral rinse ( Andolex C ) that can be used from the day after the surgery. The oral rinse should be used in addition to the salt water rinse. Do not use the Andolex C for more than 5 days.
  • If you have been given an irrigating syringe, start irrigation on the fifth day following surgery. Fill the syringe with warm salt water and place the tip of the syringe into the extraction site to clean. Do this 3–4 times a day for 2 weeks and lessen as the surgical site heals.
  • It is important to resume your normal dental routine after 24 hours. This should include gently brushing and flossing your teeth at least once a day. A clean mouth will speed up the healing process.

 

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 tissues. 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 placed on antibiotics, take the tablets or liquid as directed. Antibiotics will 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.
  • Women – antibiotics may interfere with your oral contraceptive.

 

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 coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. If nausea/vomiting persists, please contact the practice.
Other Complications
  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, 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 the office if you have any questions.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office.
  • You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. White.
  • 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 a normal post-operative event which will resolve in time.
Finally
  • Sutures are placed in the area of surgery to minimize post-operative bleeding and to help with healing. Sometimes they become dislodged soon after surgery, this is no cause for alarm. Just remove the suture from your mouth and discard it.
  • The sutures will dislodge completely after 21 days.
  • The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call the office for instructions.
  • There will be a cavity or indentation where the tooth was removed. The cavity will gradually over the next few months fill in with new bone. In the meantime, the area should be kept clean especially after meals with salt water rinses or a toothbrush.
  • Your case is individual; no two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the person best able to effectively help you: Dr. White or your referring family dentist.
  • Brushing your teeth is safe – 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.
  • 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.

Post-Operative Instructions

(After Surgery)

 

After Placement of Dental 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 in some cases.

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 twenty (20) minutes on and twenty minutes off, as much as possible, for the first 36 hours.
Pain
  • You should begin taking pain medication before you feel the local anesthetic wearing off. For severe pain, the prescribed medication should be taken as directed.
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.
Antibiotics
  • Be sure to take the prescribed antibiotics as directed to help prevent infection. Antibiotics may interfere with oral contraceptives.

Oral Hygiene
  • Good oral hygiene is essential for good healing. The night of surgery, use the prescribed Andolex C Oral Rinse before bed. The day after surgery, the Andolex C should be used three times daily, after breakfast, lunch and before bed. Be sure to rinse for at least 30 seconds then spit it out. 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 is no problem. Be gentle initially with brushing and try to stay at least one to two teeth short of 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 or full dentures should be used as discussed in the pre-operative consultation.

Post-Operative Instructions

(After Surgery)

 

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 30-45 minutes after the appointment. If the bleeding or oozing still persists, place another gauze pad and bite firmly for another 30 minutes. You may have to do this several times
  • 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, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise 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. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides 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 fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.
  • It is important to resume your normal 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 will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call our office immediately.

After the Removal of Multiple Teeth

  • A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding continues, a moist tea bag can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. 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 36 hours only. Apply ice continuously while you are awake.
  • For severe pain use the prescription given to you. If the 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 glasses 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 a warm salt water 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 your 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 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 operated on will swell reaching a maximum in two days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 36 hours after surgery (remember ice packs are used for the first 36 hours only).
  • A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling in 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 a high temperature continues, notify our office.
  • If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.