DAY OF SURGERY: IMMEDIATELY AFTER SURGERY

Patients who received a general anesthetic should return home from the Center immediately upon discharge, and lie down with the head elevated until all the effects of the anesthetic have disappeared. Anesthetic 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 24 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 firmly on the gauze pack that we placed over the surgical area. This gauze may be changed every 20 - 30 minutes for the first couple of hours. This is important to allow blood clot formation on the surgery site. Gauze may be left out at this time if no bleeding is detected, or patient preference. Have gauze out by bedtime, and do not use after the first day of surgery. DO NOT rinse or brush your teeth vigorously or probe the area with the tongue, any objects or your fingers. DO NOT SMOKE for at least 48 hours, since it is detrimental to the healing process.

BLEEDING

Some bleeding is normal and should not be severe. Blood-tinged saliva may be present for 24 hours. 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 the bleeding continues, please call the Center.

SWELLING AND BRUISING

Swelling is to be expected, and usually reaches its maximum in 48 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 for 20-30 minutes then removed for 20-30 minutes during the first 24 - 48 hours after surgery. After 48 hours, it is usually best to switch to moist heat or heating pad to the same area, until swelling has receded. 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

Eat any nourishing food that can be taken with comfort. Starting with clear liquids such as Sprite, jello, broth, etc., advancing to thicker liquids such as ice cream, milk shakes, cream soups, pudding, etc. as you are able to tolerate. The next several days you should remain on a soft diet progressing to more solid foods as tolerated. Avoid foods like nuts, sunflower seeds, potato chips, popcorn, pizza crust and coconut. Proper nourishment aids in the healing process. If you are a diabetic, maintain your normal diet as much as possible and follow your physician’s instructions regarding your insulin/oral hypoglycemic agent schedule. Encourage fluids the first day of surgery, even if the patient doesn’t feel like eating. Straws are okay with clear liquids.

PAIN AND MEDICATIONS

Unfortunately, most oral surgery is accompanied by some degree of discomfort. Take the pain medication prescribed as directed. The local anesthetic administered with the general anesthetic during the surgery normally has a duration of several hours. We, therefore, advise you to take the pain medication as soon as possible after your surgery. It may be difficult to control the pain once the local anesthetic has worn off. Taking the pain medication with a sugared drink (Coke or Sprite) or soft food will lessen any side effects of nausea or stomach upset. Do not work, drive or operate any type of machinery while taking the pain medication.

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.

ORTHODONTIC APPLIANCES

If you wear orthodontic appliances, start wearing them when you are able to tolerate without too much discomfort.

INSTRUCTIONS FOR THE DAYS FOLLOWING SURGERY: ORAL HYGIENE

Keeping your mouth clean after oral surgery is essential. Start the day after surgery, and gently rinse your mouth with warm salt water (1 tsp. in a glass of warm water) 3 to 4 times a day for the next several days. Begin your normal toothbrushing routine the day after surgery, carefully avoiding the surgical site and with no aggressive swishing of water or mouthwash. Soreness and swelling may prevent brushing of all areas, but make every effort to clean your teeth within your comfort level. If you were given an irrigating syringe, start using it the fifth day after surgery to keep the sockets clean. Fill the syringe with warm salt water and gently flush the bottom sockets after every meal and snack. This helps keep food particles from being trapped in sockets until they have closed up, which takes approximately 2 weeks.

OTHER POSSIBLE POST-SURGERY EFFECTS DRY SOCKETS

The blood clot on the surgical site may be lost causing a dry socket (usually on the 3rd to 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 the Center to report these symptoms.

SKIN DISCOLORATION

This may be expected, and is usually limited to the neck and 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. Tylenol or Advil and application of heat on the area will usually correct these symptoms.

NUMBNESS

Loss of sensation of the lip, cheek, gums, chin and tongue 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 as possible. If you have any questions about your progress or any symptoms you are experiencing, please call our office at 893-3333. Due to the increased incidence of drug abuse and fraud, we ask that you call the Center before 5:00 pm if the need for additional pain medication is necessary. Failure to do so may result in refusal by the doctor “on call” to call you in a prescription or may require an emergency room visit. Your cooperation with this matter will be greatly appreciated.

PRE-ANESTHETIC INSTRUCTIONS

If you are to have a general anesthetic (to be asleep) every effort will be made to make your office visit as pleasant as possible. Please follow these very important instructions.

1. You may have nothing to eat or drink after MIDNIGHT, including water. If you do eat or drink your surgery will be cancelled.
   
   
2. A responsible adult must accompany you to the Center to take responsibility for your transportation and welfare because the medicine you will receive will diminish your thinking and reflexes. This person will be required to remain at the Center during your surgery and transport you home immediately after your recovery period. It is most important that someone watch you carefully for 6-8 hours after you get home. You should not be allowed to drive or even walk around unescorted because the anesthetic can slow down your reactions.
   
   
3. Wear loose fitting clothing. A button up shirt is recommended. Due to the coolness of the environment, please dress accordingly.
   
   
4. Do not wear contact lenses.
   
   
5. Make sure you brush your teeth before coming to the Center.
   
   
6. If you take any heart or blood pressure medication, please take your usual morning dose with a small sip of water.
   
   
7. If you are on any other medications, including insulin, DO NOT take it the morning of surgery unless you have been instructed to do so by your doctor.
   
   
8. No herbal supplements 2 weeks prior to surgery.
   
   
9. If you have asthma and are using inhalers, bring them with you on the day of surgery.
   
   
10. If you take aspirin daily, check with your doctor about stopping prior to surgery.
    
    
11. Should you have any questions regarding medications, please call 893-3333.
    
    
12. Do not drink any alcohol 24 hours before or after surgery.
    
    
13. Be sure to tell us of any previous anesthetic experiences (i.e.: post op nausea/vomiting), so we can pre-treat if necessary.
    
    
14. Have liquids and soft foods available at home (ex: Reg. Coke, Sprite, Jello (made the evening before), ginger ale, Gatorade, fruit juices without pulp, ice cream, etc.)

IF YOUR SURGERY IS SCHEDULED TO BE PERFORMED AFTER 12 NOON:

1. You may have a light breakfast (i.e.: toast and a drink such as water, soft drink, black coffee) before 6 am on the morning of surgery.
   
   
2. Do not eat or drink after 6 am.
   
   
3. If you are on prescription medications, you should take them with a small sip of water the morning of surgery.
   
   

Instructions for patients who have undergone sinus surgery or who have had a tooth removed with sinus communication

Please follow the instructions below to prevent complications and to promote healing after surgery:

1. Do not blow your nose vigorously.
   
   
2. Do not smoke cigarettes or use other tobacco.
   
   
3. Do not use straws or other device that might create negative pressure on the sinus.
   
   
4. Take your prescriptions as instructed.
   
   
5. When rinsing, do not rinse vigorously as to force fluids into the surgical site.
   
   
6. Please call our office at 893-3333 should you develop intense swelling or temperature above 100.5.
   

Postoperative Information – L A U P

You have just undergone a surgical procedure with a carbon dioxide laser. The laser has a number of advantages over conventional surgery. It allows us to perform surgery in a more precise fashion through increased accuracy. Tissue injury in the area of surgery is diminished, thus decreasing scar formation bleeding, swelling and post-operative pain. However, you will experience a sour throat once the numbing medication wears off. Generally this will be most uncomfortable from day three to day ten. Following the instructions below will minimize your discomfort.

General Information:

1. Do not disturb the area of surgery except for wound care as directed below.
   
   
2. Do not over-exert as this may cause bleeding and throbbing pain.
   
   
3. Take foods as tolerated. Start off with clear liquids, then progress to full liquids, maintaining a liquid diet for the first 24 hours after surgery.
   
   
4. Take all medications as directed.
   
   
5. Smokers are advised to refrain for at least 48 hours.
   
   
6. Do not be alarmed regarding swelling or discoloration as it is a natural reaction of the body to surgery and does not necessarily indicate infection.

Specific Instructions:

1. Use mouthwash as directed.
   
   
2. No aspirin or aspirin containing drugs.
   
   
3. Use Lozenges as directed for pain relief. Do not use sprays.
   
   
4. If you have sleep apnea and have been using CPAP, please continue with your usual regimen.
   
   
5. If your throat becomes dry while you sleep, sleep with a humidifier at bedside.
   
   
6. If you experience mild bleeding, gargle with half strength hydrogen peroxide with water. Call us if bleeding continues.
   
   
7. Use antibiotics as directed.
   

Post-operative Instructions after jaw surgery

1. Take the medications that we have prescribed to you, a directed on the label. You can supplement pain medication with Tylenol or Advil (Ibuprofen) between doses for more complete relief.
   
   
2. Do not plan on returning to work or school for at least one week after your surgery.
   
   
3. If you are in fixation (mouth wired shut or elastics), do not try to open your mouth. Also, do not remove any elastics, unless instructed otherwise by your doctor. If elastics break, call the office (893-3333) to make an appointment to have them replaced, unless instructed otherwise by your doctor.
   
   
4. Using a vaporizer may make breathing easier, especially for upper jaw surgery patients.
   
   
5. Drink small amounts of liquids frequently. Increase your diet only as your doctor allows.
   
   
6. You may brush your teeth using a small, soft children’s toothbrush, starting the day after surgery. Soften the bristles by running under warm water. You may use a waterpik set at the lowest setting, direct the water at your teeth, not the incision line. Start the day after surgery.
   
   
7. Rinse your mouth at least 6-8 times a day with warm salt water. Start this the day after surgery. Do this for at least 7 days.
   
   
8. Use ice for 48 hours, then you may go to heat if desired.
   
   
9. Do not blow your nose for 1-2 weeks after surgery, (if surgery was done on your top jaw).
   
   
10. Do not smoke for at least 3 week after surgery.
    
    
11. Keep your lips moist with Vaseline. This will prevent cracking.
    
    
12. You may do anything you like as your energy level permits. Avoid activities that may injure your jaws. Avoid bending for at least 72 hours after surgery to prevent pressure to the head.
    
    
13. There are no restrictions on showers or baths.
    
    
14. Sleep with your head elevated, this will help minimize swelling.
    
    
15. If you have any questions, please call the office at 893-3333.
    

Dental Implant Post-op Instructions

1. Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There may or may not be a metal healing abutment protruding through the gingival (gum) tissue.
   
   
2. 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 – 893-3333.
   
   
3. 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.
   
   
4. 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.
   
   
5. You should begin taking pain medication as soon 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: 2-3 tablets may be taken every 3-4 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.
   
   
6. Be sure to take the prescribed antibiotics as directed to help prevent infection.
   
   
7. Good oral hygiene is essential to good healing. If your doctor has prescribed Peridex Oral Rinse, use it 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 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 and the healing abutments is no problem. Be gentle initially with brushing the surgical area.
   
   
8. 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.
   
   
9. Partial dentures, flippers, or full dentures should not be used immediately after surgery and for at least 10 days. This was discussed in the pre-operative consultation.
   
   
10. Do not smoke for 3-4 weeks after receiving your implant.