Surgical Instructions

BEFORE INTRAVENOUS ANESTHESIA SEDATION

  • You may not have anything to eat or drink (including water) for eight hours prior to the appointment.
  • No smoking for 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 office, remain in the office during the procedure, and drive the patient home.
  • The patient should not drive a vehicle or operate any machinery for 24 hours following anesthesia.
  • Please wear loose-fitting clothing with sleeves which can be rolled up past the elbow, and low-heeled shoes.
  • 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, stomach, or upset bowels, please notify the office.

 

 

 

 

 AFTER PLACEMENT OF DENTAL IMPLANTS
After receiving your dental implant, do not disturb the wound. Avoid rinsing, spitting, or 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 rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 45-90 minutes. If bleeding continues profusely, 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, one or two tablets of Ketorol DT may be taken every 6-7 hours. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3200mg daily for an adult. Consult our practice for individuals under 18. Do not take the two medications at the same time.
For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. Do not drive an 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.


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


ORAL HYGIENE
Good oral hygiene is essential to good healing.  The day after surgery, warm salt water rinses (one teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day,  especially after meals. Brush your teeth and the healing abutments if you have one. Be gentle initially while brushing the surgical areas.


ACTIVITY
Keep physical activities to a minimum immediately following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising.


WEARING YOUR PROSTHESIS
Partial dentures, flippers, or full dentures, should be used as discussed in the pre-operative consultation.

 

 

 

 


AFTER WISDOM TOOTH REMOVAL
Tooth extraction is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.

 

 

 

 


IMMEDIATELY FOLLOWING SURGERY

  • The gauze pad placed over the surgical area should be kept in place for an hour. After this time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing and/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.
  • Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for a more thorough explanation.
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BLEEDING
A certain amount of bleeding is to be expected following tooth extraction surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by placing a moistened gauze pad over the area and biting firmly for 60-90 minutes. Repeat if necessary. If bleeding continues, bite on a moistened black tea bag for an hour. The tannic acid in black tea helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call our office for further instructions.


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 are 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 post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs, should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously 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 pain, one or two tablets of Ketorol DT may be taken every 6-7 hours. You may choose to take Ibuprofen in which case you should take two to three 200 mg tablets every 3-4 hours with food. For 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 an 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 general anesthetic or IV sedation, only liquids should initially be consumed. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. A high calorie, high protein intake is very important. Our staff can provide suggested diet instructions. Nourishment should be taken regularly. 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 5-6 glasses of liquid should be taken daily. Try not to miss any meals. 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 up for one minute before standing.


KEEP THE MOUTH CLEAN
No rinsing of any kind should be performed until the day following surgery. The day after surgery you should begin rinsing at least 5-6 times a day, especially after eating, with a teaspoon of salt mixed into one cup of warm water.


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. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. 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 coke, tea, or ginger ale. You should sip slowly over a fifteen-minute period. When nausea subsides you can begin taking solid foods and the prescribed medicine.


OTHER COMPLICATIONS

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, 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. 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. Tylenol or ibuprofen should be taken to reduce the fever.
  • You should be careful going from the lying down position to standing. You could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting 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 over time. If not, they can be removed by Dr. Neha Misra
  • 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 to heal. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture form your mouth and discard it. Non-dissolvable sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is usually no discomfort associated with this procedure.
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 our office for instructions.
There will be a void where the tooth was removed. The void will fill in with new tissue gradually over the next month. In the meantime, the area should be kept clean, especially after meals, with salt water rinses.
Your case is unique, no two mouths are alike. Discuss any problems with the trained experts best able to effectively help you. 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 near 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.

 

 

 

 


AFTER EXPOSURE OF AN IMPACTED TOOTH:
Do not disturb the wound. If surgical packing was placed, leave it alone. The packing helps to keep the tooth exposed. If it gets dislodged or falls out, do not get alarmed but please contact our office for instructions.


BLEEDING
Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding that rapidly fills your mouth with blood can frequently be controlled by biting with pressure on a gauze pad placed directly on the bleeding wound for 60 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 filled with ice cubes on your cheek near the area of surgery. Apply the ice as much as possible for the first 36 hours.


DIET
Drink plenty of fluids. Avoid hot liquids or hard foods. Only consume soft food and liquids 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, one or two tablets of Ketorol DT may be taken every 6-7hours. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3200mg daily for an adult. Consult our practice for individuals under 18. Do not take the two medications at the same time.
For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. Do not drive an 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.


ORAL HYGIENE
Oral cleanliness is essential to good healing. Clean your mouth thoroughly after each meal, beginning the day after surgery. Brush your teeth normally if possible. Rinse with warm salt water (1 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 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.

 

 

 

 

 

 


AFTER TOOTH EXTRACTION
After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. Bite on a gauze pad for 30-45 minutes immediately after the appointment. If the bleeding or oozing still persists, place another moistened gauze pad and bite firmly for another 60 minutes. You may have to do this several times to staunch the flow of blood.
After the blood clot forms, it is important to not disturb or dislodge the clot. Do not suck on straws, smoke, drink alcohol 72 hours. These activities may dislodge or dissolve the clot and hinder the healing process. Limit vigorous exercise for the next 72 hours, as this increases 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 72 hours.
Use pain medication as directed. Call our 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 fluids 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.
 If you have heavy bleeding, severe pain, continued swelling for 3-4 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 moistened gauze pad directly over the bleeding socket and apply biting pressure for 60 minutes. If bleeding continues, bite on a moistened black tea bag for sixty minutes. The tannic acid in black tea helps to form a clot by contracting blood vessels. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove the immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.
Use ice packs (externally) on the cheek near the surgical site. 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 after 3 days or increases after 3 days, please call our office. If an antibiotic has been prescribed, make sure to finish your prescription unless you have an allergic reaction.
Drink plenty of fluids. If many teeth have been extracted, the blood loss at this time needs to be replaced. Drink at least six glasses of liquid the first day.
Do not rinse your mouth on the day of surgery, or while there is bleeding. After the first day, use 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 teaspoon of salt in one cup of warm water). After you have seen your dentist for denture adjustment, take out the denture and rinse 3 to 4 times a day.
Restrict your diet to liquids and soft foods that are comfortable for you to eat. As the wounds heal, you will be able to resume your normal diet.
The removal of many teeth at one time is quite different from the extraction of just 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 three days. Swelling and discoloration around the eyes may occur. The application of a moist warm towel will help eliminate the discoloration. The towel should be applied continuously for as long as is 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. Slight 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 your temperature continues to rise, 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 to make the necessary adjustments and relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.

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