Surgical Instructions

Surgical Instructions

We recognize that nearly all patients are worried and nervous before their surgery. Knowing what to expect and having your questions answered before the surgery can often alleviate much of the anxiety. The following material is presented to answer some of the most common questions that you may have before your surgery.

Before Anesthesia

  • You may NOT have ANYTHING to eat or drink (including water) starting at midnight the night before your 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. Do not smoke for 4-5 days after 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 the anesthesia experience.
  • Please wear a short sleeve shirt and low-heeled shoes.
  • Brush your teeth prior to surgery to reduce bacteria and prevent infection.
  • Dentures must be removed at the time of surgery.
  • Do NOT wear nail polish, lipstick, excessive makeup, contact lenses, or jewelry on the day of surgery.
  • If you have artificial nails on, please have the nails removed from the right and left index fingers prior to your appointment. This is necessary for the  oxygen-monitoring device to be placed on your finger.
  • If you have an illness such as a cold, sore throat, stomach or bowel upset, please notify the office.
  • If you take routine oral medications, please check with your surgeon prior to your surgical date for instructions.

Home Instructions for After Surgery

After surgery, it is important to follow the post-op instructions given to you.  If you need an additional copy, instructions can be downloaded from the links below.

  • You may NOT have ANYTHING to eat or drink (including water) starting at midnight the night before your 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. Do not smoke for 4-5 days after 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 the anesthesia experience.
  • Please wear a short sleeve shirt and low-heeled shoes.
  • Brush your teeth prior to surgery to reduce bacteria and prevent infection.
  • Dentures must be removed at the time of surgery.
  • Do NOT wear nail polish, lipstick, excessive makeup, contact lenses, or jewelry on the day of surgery.
  • If you have an illness such as a cold, sore throat, stomach or bowel upset, please notify the office.
  • If you take routine oral medications, please check with your surgeon prior to your surgical date for instructions.

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Care After Dental Implant Placement

Do not disturb the wound. Avoid forceful spitting or touching the wound on the day of surgery. There may be a metal healing abutment protruding through the gingival(gum) tissue. Patients that have or receive dentures on the day of surgery should not
use any form of denture adhesive until gum tissue is completely healed or otherwise instructed. If a bone graft was performed avoid straws and smoking for 2 weeks.

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 or until saturated. Restrict activity. Repeat if necessary. If bleeding continues, please call 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 face is not uncommon. The swelling will not reach its maximum until 2–3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. A baggie, filled with ice, can be applied to the side of the face where surgery was performed. 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. 24 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing amount of the swelling.

Diet

Drink plenty of fluids. Avoid hot foods and hot liquids while numb. Soft foods 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, ibuprofen (Advil or Motrin) 400mg may be taken every 4 hours.Do not take ibuprofen if you are allergic or have been instructed not to take it by another physician. For severe pain, the prescribed medication should be taken as directed. The prescribed pain medicine will make you groggy, so do not drive an automobile or operate machinery. Avoid alcoholic beverages.

Antibiotics

Be sure to take prescribed antibiotics as directed to help prevent infection. Do not discontinue antibiotics. Always finish antibiotics unless an allergic or unusual reaction occurs. Call the office if you have any questions. Some patients are instructed to take a “loading dose” of their prescribed antibiotic prior to actual surgery. Consider those antibiotics as actually one of that day’s single dosages.

Oral Hygiene

Good oral hygiene is essential to good healing. The day of surgery, use the prescribed Peridex Oral Rinse. The day after surgery, the Peridex should be used twice daily. Be sure to rinse for 30 seconds, then spit it out. Warm salt water rinses (1/2 tsp. salt, 8oz. warm water) should be used at least 4 to 5 times a day. Tilt head left and right, then part lips to allow liquid to passively flow into the sink. Brush your teeth and healing abutments if present, but be gentle when brushing close to surgical sites. If bone grafting was performed, it is imperative that all rinses are very gentle.

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Care After a Bone Grafting Procedure

Do not disturb the site. Avoid smoking, straws, spitting, or touching the site for at least two-weeks. Patients that have or received dentures on the day of surgery should not use any form of denture adhesive until gum tissue is completely healed or otherwise instructed.

Bleeding

Some bleeding or redness in the saliva is normal for 24-hours. Moderate to heavy bleeding can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30-minutes or until saturated. Restrict activity. Repeat if necessary. If bleeding continues, please call 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 face is not uncommon. The swelling will not reach its maximum until 2–3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. A bag filled with ice can be applied to the side of the face where surgery was performed. 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. 24-hours following surgery, the application of
moist heat to the sides of the face is beneficial in reducing the amount of swelling.

Diet

Drink plenty of fluids. Avoid hot foods/liquids while numb. Soft foods 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 before you feel the local anesthetic wearing off. For
moderate pain, ibuprofen (Advil or Motrin) 4 200mg tablets may be taken every 8-hours unless allergic to or instructed not to take ibuprofen by another physician. For severe pain, the prescribed medication should be taken as directed. The prescribed pain medicine will
make you groggy. Do not drive an automobile or operate machinery. Avoid alcoholic beverages while taking pain medicine.

Antibiotics

Be sure to take prescribed antibiotics as directed to help prevent infection. Do not discontinue antibiotics. Always finish antibiotics unless an allergic or unusual reaction occurs. Call the office if you have any questions. Some patients are instructed to take a “loading dose” of their prescribed antibiotics the morning of actual surgery. If you were one of those patients, consider those antibiotics as actually
one of that day’s single dosages.

Oral Hygiene

Good oral hygiene is essential to good healing. The night of surgery, use the prescribed Peridex Oral Rinse. The day after surgery, the Peridex should be used twice daily. Be sure to rinse for 30-seconds, then spit it out. Warm salt water rinses (1/2 tsp. salt + 8oz. warm water) should be used at least 4–5 times a day. Brush your teeth, not the bone graft. Be gentle when brushing close to surgical sites. It is imperative all rinses are very gentle. Do these gentle rinses for the next 2-weeks. Bone grafts are fragile and easily altered.

Sutures

Sutures are needed to hold the bone graft(s) in place. Do not remove sutures. The sutures
will dissolve in 3–4 weeks time.

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in saliva is not uncommon. To minimize further bleeding, sit upright and avoid exertion. If bleeding does not subside, call for further assistance.

Swelling

The swelling that is normally expected is proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery

Pain

Take pain medication as described on pain medication instruction card Steps 1–3 as needed. Stop medication if an allergic reaction occurs. The prescribed pain medication will make you groggy. Do not drive an automobile or operate machinery. Avoid alcoholic
beverages while taking pain medicine.

Diet

After general anesthetic/IV sedation, liquids should be initially taken. Do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat soft food by chewing away from the surgical site.
High calorie/high protein intake is very important. At least 5–6 glasses of liquids should be taken daily. Avoid hot foods/liquids while mouth is numb.

Keep the Mouth Clean

Brushing teeth with soft bristle, non-electric tooth brush after each meal is essential for faster healing and preventing infection. Rinse with warm salt water 5–6 times a day or after
eating (1/2 tspn salt, 8 oz. warm water). To rinse, tilt head to right then left, then part lips and allow liquid to run out of mouth into sink.

Discoloration

In some cases, dicoloration 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.

Using the Irrigation Syringe

Use the curved tip syringe beginning four days after surgery. Take the syringe and place the tip in a cup of warm salt water. While the tip is submerged, pull back on the plunger to fill the syringe. Place the tip of the syringe over the extraction site hole, and flush out the lower extraction sites only.

Sutures

Sutures are placed to minimize post-operative bleeding and to help healing. Sometimes they
become dislodged. Just remove the suture from your mouth and discard. There will be a hole
where the tooth was removed. The hole will continue to fill with new tissue and close within
the next several months.

Dry Socket

A dry socket occurs when the blood clot gets dislodged prematurely. Smoking, sucking
through a straw, and forceful spitting can cause dry socket. If a dry socket occurs, usually 5–7 days following surgery, call the office to schedule an appointment.

Other Complications

If you suddenly sit up/stand from a lying position, you may become dizzy. Make sure you
sit for one minute before standing. If numbness of the lips, chin, or tongue occurs, there is no cause for alarm. This is usually temporary. Slight elevation in temperature following surgery is not uncommon. Occasionally, patients may feel hard projections in the mouth with their tongue. These are not roots. These projections are  bony walls, which supported the tooth, and will smooth over time. 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. It is not uncommon if the throat becomes swollen and pain occurs. This will subside in 2–3 days. Stiffness (Trismus) of the jaw may cause difficulty in opening your mouth for a few days
following surgery.

The removal of impacted teeth is a 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 should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
  • You will begin the warm salt water rinses the night of your surgery along with brushing your teeth.
  • 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 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 gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 10 minutes. The tannic acid in the tea bag 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 the 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 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 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 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. 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, Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 8 hours.

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 while taking this 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 I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. 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 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

Brushing your teeth after each meal is more important after surgery to ensure faster healing and prevent infection. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with salt water- 1/2 teaspoon salt to an 8oz glass 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. 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.

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.

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. Ibuprofen should be taken to reduce the fever.
  • 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 your oral surgeon.
  • 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 (Trimus) 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 healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture 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 unusual symptoms occur call the office for instructions.

There will be a hole where the tooth was removed. The hole will gradually heal over the next month and fill in with the new tissue. In the mean time, 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 persons best able to effectively help you: your oral surgeon or your family dentist.

Brushing your teeth after each meal is more important after surgery to ensure faster healing and prevent infection.

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.

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 10 minutes. If bleeding continues please call the office 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 24 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, Ibuprofen (Advil, 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.

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.

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Soft Foods

PRODUCE & MEAT
Mashed Avocados
Bananas
Overcooked Vegetables
Mashed Potatoes
Flaky Fish (Like Salmon)
Canned Peaches/Pears
Applesauce
Baked Beans

CANNED FOOD
& DRY GOODS
Pureed Soups
Refried Beans
Well Cooked Pasta
Grits
Nut Butters
Oatmeal
Rice

FROZEN &
REFRIGERATED
Ice Cream
Frozen Yogurt
Pudding
Hummus
Milkshakes (No Straw)
Popsicles
Yogurt/Kefir
Silken Tofu

DRINKS
100% Juice
Milk
Pedia-lite
Gatorade
Coconut Water
Protein Shakes(No Straw)
Smoothies (No Straw)

AVOID
Alcoholic Beverages
Using Straws
Foods that are hard, crunchy or sharp (for example: Popcorn and Nuts)