Oral Surgery Post Op Instructions

Immediately following the initial 48 hours after a surgical procedure we generally recommend a period of reduced activity and good nutrition. This reduced activity will aid greatly in minimizing immediate postoperative pain, swelling and bleeding. There are many factors that affect your recovery (extent of surgery, age, presence of infection, etc.) and recovery time will vary dramatically from patient to patient. During your recovery we urge you not to compare your progress with other friends or relatives. Follow our instructions carefully and report any unusual concerns to our office immediately. Depending on the extent of the surgery you may see an increase in symptoms through the third day post-operatively. After the third day you should begin to see your overall condition improve gradually on a daily basis. Please continue reading for detailed descriptions that pertain specifically to the surgical procedures most frequently performed.

Intravenous anesthesia is provided routinely at all office locations. In addition to Board Certification in Oral & Maxillofacial Surgery the doctors are Fellows in the American Society of Dental Anesthesiology and certified in Advanced Cardiopulmonary Resuscitation (ACLS). Outpatient office anesthesia provides our patients with an opportunity to have invasive, stressful oral surgical procedures performed in a safe, stress free and comfortable setting. All patients choosing to have intravenous anesthesia should pay particular attention to the following recommendations:

• We ask that you refrain from all food and drink (including water) for six (6) hours prior to your appointment.
• A responsible adult must accompany the patient to our office, remain in the office during the procedure, assist and drive the patient home.
• Patients undergoing anesthesia should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
• Please wear loose fitting clothing with sleeves which can be rolled up past the elbow and low-heeled shoes.
• Contact lenses, jewelry, piercings (tongue, lips etc.) 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 bowel upset, please notify the office in advance of your scheduled treatment.
• If you take routine oral medications, please follow the instructions provided by the doctor on your consultation visit.

The removal of impacted teeth is a serious surgical procedure and post-operative care is very important. Unnecessary pain, the complications of infection and swelling can be minimized if the instructions provided by our staff are followed carefully. At the conclusion of every surgical procedure you will receive personalized verbal instructions by the doctor and/or support staff and in addition you will be provided specific written instructions. The following is a general overview of instructions that we normally recommend following the removal of impacted teeth:

Immediately Following Surgery:
The gauze pad placed over the surgical area should be kept in place for up to 6 hours after leaving the office. After this time, the gauze pad should be removed and discarded.

• Vigorous mouth rinsing or touching the wound area following surgery should be avoided for 24 hours. This may initiate bleeding by causing the blood clot that has formed to become dislodged. Some oozing may continue post operatively and is to be expected. This is normal and should be no cause for concern.
• Take the prescribed pain medications as soon as you begin to feel discomfort, this will usually coincide with the diminishing effects of the local anesthetic agent.
• Restrict your activities the day of surgery and resume normal activity when you begin to feel comfortable.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for further explanation.
• Generally mouth rinsing should begin 24 hours following surgery. We recommend vigorous rinsing with a full glass of warm water, a teaspoon of salt and ½ teaspoon of baking soda every 2-3 hours and especially after each meal. This is important for proper hygiene as well as medicinal purposes (healing aid).

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 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 firmly on a moistened tea bag for thirty minutes. The tannic acid in the tea bag aids in blood clot formation by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, contact our office for further instructions.

Swelling
The swelling that is normally expected after oral surgery is proportional to the extent of the surgical procedure. 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 may not become apparent until the day following surgery and may 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 reusable ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be placed over the surgical area for 20-minute increments (20 minutes on, 20 minutes off) while you are awake. Generally after the first 36 hours, ice has very little beneficial effect. Swelling or jaw stiffness may persist for several days and this may be no cause for alarm. However if you are concerned, we encourage you to contact our office.

Pain
The amount and duration of pain may vary greatly from patient to patient. The pain medication prescribed by our office, when taken as directed, is generally adequate to control your symptoms. Medication may require 30-95 minutes to take effect and should not be taken on an empty stomach. For mild pain, over the counter medications such as Tylenol, Extra Strength Tylenol or Ibuprofen (Motrin or Advil) may be sufficient.

For more severe pain, take the prescribed medication as directed. The prescribed pain medicine may make you groggy and slow down your reflexes. While taking prescribed pain medication, do not drive an automobile, work around machinery and avoid all alcoholic beverages. Pain or discomfort following surgery generally will begin to subside after the third day and continue to decrease with each passing day. If after three days your pain persists, or more importantly if it should begin to increase, it may require our immediate attention and you should contact our office.

Diet
Immediately following all surgical procedures we recommend only liquids be taken until the effects of the local anesthesia have subsided. Do not use a straw. The sucking motion can cause more bleeding by dislodging the blood clot. After the sensation returns to the surgical site we suggest you begin with a soft diet (eggs, potatoes, or pasta) and chew away from the area. High calorie, high protein intake is very important. Good healing requires good nutrition and we recommend that you return to your normal diet as soon as possible. Be sure and prevent dehydration by taking fluids regularly (at least 5-6, 8 oz. glasses of liquid should be taken daily), as your food intake may be limited for the first few days. Remember, you will feel better, have more strength, less discomfort and heal faster, if you are able to maintain proper nutrition.

Oral Hygiene
There should be no rinsing of any kind until 24 hours following surgery. You may brush your teeth the night after surgery but rinse gently. Generally mouth rinsing should begin 24 hours after surgery. We recommend vigorous rinsing with a full glass of warm water, a teaspoon of salt and ½ teaspoon of baking soda every 2-3 hours. This is important for proper hygiene as well for healing purposes.

Discoloration (Black and Blue)
In some cases, discoloration of the skin will follow swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the facial tissues. This is a normal post-operative occurrence and may occur 2-3 days after your surgical procedure. The discoloration may persist for up to 1 week.

Antibiotics
If you have been placed on antibiotics please take them as directed. Antibiotics may be prescribed to either combat or to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reactions and contact our office at once.

Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, refrain from taking anything by mouth for one hour (including the prescribed medicine). You may then attempt a light beverage such as coke, tea or ginger ale. Sip slowly over a fifteen-minute period. When the nausea subsides you may begin taking solid foods and the prescribed medicine. If nausea persists please contact our office.

Other potential complications
Prolonged numbness of the lip, chin, or tongue may occur during the early post-operative period. This generally is no cause for immediate alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue remains numb for an extended period of time you may bite it and not feel the trauma, so please be aware. If you should have any questions we encourage you to contact our office.

Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen may be taken to reduce the fever.

You should be careful when moving from a lying down position to standing. Preoperatively you were not able to eat or drink prior to surgery and taking pain medications can make you dizzy on such sudden movement. You may become light headed when you suddenly stand up. To avoid this effect, gradual movements are recommended. Prior to standing up you, sit up for one minute then stand.

Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots of teeth but more likely they are the bony walls which supported your tooth. These projections usually will smooth out spontaneously. If not, this condition is easily treated on your scheduled post-operative visit.

If your lips are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline or A&D ointment.

A sore throat and pain when swallowing are not uncommon. The muscles in the back of your mouth often become swollen causing this problem. This will generally 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 normal post-operative event that will resolve in time.

Do not disturb the wound. Often times a surgical packing is placed and you should avoid disturbing the area. The packing will help to keep the tooth exposed and ready for your orthodontist. If the packing should become dislodged or if it falls out, do not be alarmed, contact our office

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 30 minutes. If bleeding continues please contact our office for further instructions.

Swelling
Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice pack or towel filled with ice cubes on the cheek in the area of surgery. Apply the ice to the affected area for 20 minutes at a time (20 minutes on/20 minutes off) for the first 36 hours.

Diet
After receiving local anesthesia we recommend that only liquids be taken until the effects of the local anesthesia have subsided. Do not use a straw. The sucking motion can cause more bleeding by dislodging the blood clot. After the sensation returns you may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Good healing requires good nutrition and we recommend that you return to your normal diet as soon as possible. You should prevent dehydration by taking fluids regularly (at least 5-6, 8 oz. glasses of liquid should be taken daily), as your food intake may be limited for the first few days. Remember, you will feel better, have more strength, less discomfort and heal faster, if you are able to maintain proper nutrition.

Pain
The amount and duration of pain one should expect may vary greatly from patient to patient. The pain medication prescribed by our office when taken as directed is generally adequate to control your symptoms. Medication may require 30-95 minutes to take effect and should not be taken on an empty stomach. For mild pain, over the counter medications such as Tylenol, Extra Strength Tylenol or Ibuprofen, (Motrin or Advil) may be sufficient.
For more severe pain take the prescribed medication as directed. The prescribed pain medicine may make you groggy and slow down your reflexes. Do not drive an automobile, work around machinery and avoid all alcoholic beverages. Pain or discomfort following surgery should begin to subside after the second day and continue to decrease more and more every passing day. If pain persists or more importantly increases, it may require our immediate attention and you should contact our office.

Oral Hygiene
Mouth cleanliness is essential to good healing, especially after orthodontic exposure cases. We recommend that you clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can and rinse with warm salt water (1 teaspoon of salt, ½ teaspoon of baking soda in a cup of warm water) six times a day. Continue this procedure until healing is complete. REMEMBER: A clean wound will greatly enhance healing.

Activity
Keep physical activities to a minimum immediately following surgery. If you are considering exercise, be aware that throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that immediately following surgery you generally have not maintained your normal fluid and dietary intake and your entire system is weakened.

Additional Concerns
Most orthodontic exposure cases will have some type of chain/attachment device attached. If this should come loose during healing there is no need for alarm. Contact our office for further directions.

Post-operative care for the surgical removal of multiple teeth will be similar to those described under impacted teeth.

Some additional concerns are as follows:

• A small amount of bleeding is to be expected following the operation. We recommend that you avoid hot liquids, exercise, and elevate your head during the first 24 hours. 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 persists contact our office immediately.
• Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 36 hours.
• The removal of multiple teeth at one time is quite different than the extraction of a single tooth. In addition to tooth removal the surrounding bone must be shaped and smoothed prior to the insertion of a denture. The following conditions may occur, all of which are considered normal:
• Swelling will occur at the surgical site and will reach a maximum in two days. Further swelling and discoloration may occur around your eyes, face and may even extend down onto your neck (remember ice packs may be beneficial for the first 36 hours after surgery).
• 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 such as Vaseline. There may be a slight elevation of temperature for 24-48 hours. If this temperature continues, notify our office.

If immediate dentures were placed at the time of surgery you should make every attempt to keep the dentures in place until you can visit your restorative dentist where they can make the appropriate adjustments. After 24 hours you may remove the prosthesis for no more than 5 minutes to begin your oral rinses every hour. It is common for moderate amounts of blood to develop around the sides of the denture during the first 48 hours. If bleeding appears excessive you may remove the prosthesis and proceed with our instructions for the control of post-operative hemorrhage.

When immediate dentures are inserted, sore spots frequently develop. In most cases we recommend that you visit your restorative dentist within 24-48 hours after surgery. Failure to do so may result in severe denture sores, which may prolong the healing process.

For immediate denture cases we suggest that after 48 hours you remove and clean your denture every 3 hours. Do not leave your prosthesis out for more than 5 minutes during the day. If your denture is left out for any extended period (greater than 5 minutes) you may be unable to replace it until after all swelling subsides (4-7 days).

During the first week of healing you must sleep with your prosthesis. After this time (first week of healing) and for the next four weeks, we suggest that you not sleep with your denture while your oral mucosa undergoes complete healing.

The placement of osseointegrated dental implants is a surgical procedure and post-operative care is very important. If the instructions provided by our office are followed carefully, unnecessary pain, the complications of infection and swelling can be minimized. At the conclusion of every surgical procedure you will receive personalized, verbal instructions by the doctor or our support staff and, in addition you will be provided specific written instructions. The following is a general overview of instructions that we normally recommend following placement of dental implants:
Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. A soft diet is recommended and if possible chewing should take place on the untreated side for the first week.

On second stage surgery (the uncovering of your implant) there will be a metal healing abutment protruding through the gingival (gum) tissue. This abutment should be secure and will be used by your restoring dentist in the coming weeks as he begins the final prosthetic phase of treatment.

Antibiotics
We generally prescribe prophylactic antibiotics for all of our dental implant cases. We ask that you take the prescribed antibiotics as directed to help prevent infection.

Oral Hygiene
Good oral hygiene is essential to good healing. We recommend that you begin the use of the prescribed Peridex Oral Rinse the night prior to and the morning of your scheduled surgery. Beginning the next day, Peridex should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 30 seconds then expectorate. Warm salt water rinses (as previously described) should be used at least 6 times a day, and, especially after meals. Brushing your teeth and the healing abutments is not a problem. Be gentle initially with brushing in and around the surgical areas.

Wearing your Prosthesis
Partial dentures, flippers, or full dentures should not be used immediately after surgery and for up to 10 days following. Specific guidelines with regards to post-operative denture wearing for your case will be reviewed in detail during your pre-operative consultation and planning.

Sutures are often placed at the time of surgery to minimize post-operative bleeding and to aid in healing. On occasion they may become dislodged, this should be no cause for alarm. Your sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles and there is no discomfort associated with this procedure.

After 48 hours the pain and swelling should begin to subside. This decrease in swelling should continue on each passing day. If your post-operative pain or swelling worsens or unusual symptoms occur, please contact our office for further instructions.

There may be a cavity or defect in the area where your surgery was performed (especially if a tooth was removed). The cavity or defect will gradually resolve over the next month and fill in with new tissue. During this time, the area should be kept clean especially after meals with salt-water rinses or a toothbrush.

Your case is individual, no two patients are alike. Do not take seriously, well-intended advice from friends. If you feel you have a problem we encourage you to contact our office immediately.

Following the removal of a tooth a dry socket may occur. This occurs when the blood clot becomes 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. Contact our office if this occurs.

If you are involved in regular exercise, be aware that your normal daily nourishment is reduced and physical exercise may further weaken you. If you continue to experience light headedness cease exercising and contact our office. Remember that our office is ready and willing to aid you during your recovery phase. If you are unsure of anything with regards to your recovery, do not hesitate to contact our office. We provide 24 hour/day, 365 day/year coverage exclusively by Board Certified Oral & Maxillofacial Surgeons.