CARE INFORMATION FOR DENTAL SURGERY

After reviewing your case with you, the surgeon has determined that you will need to undergo a surgical procedure, which will be performed in our office. Your surgery will be scheduled in the morning, so do not eat or drink anything after midnight. However, you should brush your teeth prior to your surgery appointment. Once in the office, you will be escorted to a surgical suite and prepared for your procedure.

For some surgeries, you may decide that local anesthesia would be best for you. Local anesthesia is the loss of pain sensation over a specific area. However, many people choose general anesthesia for their surgical procedures. General anesthesia allows people to go to sleep during their surgical procedure. Our experienced surgeons will help you decide which is best for you. Following your surgical procedure, you will be transferred to the recovery area where you will be closely monitored by our team of assistants. Once you are awake, you will be discharged and permitted to go home to remain quiet for the rest of the day and evening of surgery. You should relax in a semi-reclining position.

CARE GIVER INSTRUCTIONS

Because you will be groggy following your surgery, it is necessary for you to select a person to be your caregiver. This person will be responsible for bringing you to the office for surgery and taking you home once you are discharged. This person should plan on staying with you for a minimum of twelve (12) hours after receiving general anesthesia.

At the time of your arrival, both you and your caregiver will register with the receptionist. The caregiver will be given the option of waiting for you in the office or returning to pick you up after the surgery. The receptionist will be able to give your caregiver an estimated waiting time, which most commonly is slightly less than one hour.

THE RECOVERY ROOM

After surgery, you will be taken to the recovery room in our office. Each patient is affected differently by general anesthesia. Some patients may be very sleepy, restless, or quite aware of their surroundings. Younger patients may feel disoriented or tearful. A few patients may become nauseated and/or vomit. Others may feel fine while lying down, but upon standing will feel faint. Whatever your reaction is, if any, to general anesthesia, our assistants are prepared to make your stay as relaxing and pain free as possible.

In the recovery room, you will be instructed to bite down firmly on the gauze bandage to stop the oozing in the surgical area. The gauze bandages may be bloody and will require changing periodically. By this time, you will have received a local anesthetic (numbing medicine) in your mouth during the surgery so that you will not experience discomfort when the bandages are changed. Because of the local anesthetic, you may have difficulty in speaking, swallowing, dryness in your mouth, or numbness of the lips and face. This feeling will last approximately three hours; which will allow time for you to be taken home and made comfortable.

LONG-ACTING LOCAL ANESTHESIA

In some cases, your doctor may choose to utilize a long-acting local anesthetic, which is used to provide additional comfort on the day of surgery. Generally your doctor will let you know if the long-acting anesthetic is used. This may result in an extended period of numbness of the lower lip, chin, and tongue that may persist for 6 to 12 hours. Thus, if numbness persists longer than anticipated, this is to be expected.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office where you had your surgery. For immediate help, call during office hours. Should you have problems after hours, a 24-hour answering service is available.

POST-OPERATIVE INSTRUCTIONS

Please read these instructions carefully. Sometimes the after-effects of oral surgery are quite minimal, so not all of these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office any time for clarification.

DAY OF SURGERY

First Hour

Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not being controlled. If active bleeding persists after one hour, place enough new gauze to obtain pressure over the surgical site for another 30 to 60 minutes. The gauze may be changed as necessary and may be dampened and/or fluffed for more comfortable positioning. When lying down elevate your head using two pillows.

Oral Care

Do not disturb the surgical area today. Do NOT rinse vigorously or probe the area with any objects or your fingers. You may brush your teeth gently. DO NOT SMOKE for at least 48 hours, as smoking is very detrimental to healing. No sucking from a straw.

Due to the anesthesia your reactions are slower, therefore, avoid drinking alcoholic beverages, driving your car, using any drugs unless prescribed by your physician; or us.

Oozing/Steady Bleeding

Intermittent bleeding or oozing is normal. It may be controlled by placing fresh gauze over the surgical areas and biting down firmly for 30 to 60 minutes.

Bleeding should never be severe. If it is, it usually means that the packs are being clenched between your teeth rather than exerting pressure on the surgical areas. Try repositioning fresh packs. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in a moist gauze) for 20 to 30 minutes. If bleeding remains uncontrolled, please call our office.

Brushing

Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.

Swelling

Often there is some swelling associated with oral surgery. You can minimize this by using a cold pack or ice bag wrapped in a towel and applied firmly to your face or cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 24 to 48 hours after surgery. (If you have been prescribed medicine for the control of swelling, be sure to take it as directed.) After 48 hours, it is usually best to switch from ice to moist heat to the same areas.

Apply warm compresses to the skin overlying areas of swelling (hot water bottle, moist hot towels, heating pad) for 20 minutes on and 20 minutes off to help soothe those tender areas. This will also help decrease swelling and stiffness. Do not start applying hot applications for at least 48 hours after surgery or increased swelling may occur.

During your procedure an IV was started in your hand or arm. If the vein used for the IV gets red, lumpy or sore following the surgery, this simply means the medicine has reacted with a small vein. Large veins usually do not cause these symptoms. Use hot packs to relieve the symptoms. Moist heat applied 15 to 20 minutes at a time is best. Do this several times a day until the soreness is gone.

Black and blue discoloration may occur on the outside of your face near the area of the surgery. This occurrence is not unusual and will resolve within several days.

Pain

Unfortunately most oral surgery is accompanied by some degree of discomfort. Because your mouth was open for an extended period of time, some of your facial muscles may be temporarily stiff. Other symptoms could include a sore throat, cracked lips (from having the corners of your mouth stretched), and even some numbness about the corners of your mouth. All of these conditions are normal following surgery and will subside.

You will usually have a prescription for pain medication, and if you take the first pill before the anesthetic has worn off, you will be able to manage any discomfort better. Effects of pain medicines vary widely among individuals. If you do not achieve adequate relief, you may supplement each pill with an analgesic such as Ibuprofen or acetaminophen. Remember that the most severe discomfort is usually within the first six hours after the anesthetic wears off; after that your need for medicine should lessen.

Nausea

Nausea is not an uncommon event after surgery, and it is sometimes caused by stronger pain medicines. Preceding each pill with a small amount of soft food, then taking the pill with a large volume of water may reduce nausea. Try to keep taking clear fluids and minimize the pain medication, but call us if you do not feel better or if repeated vomiting is a problem. Drinks, such as 7-up or Sprite may help with nausea.

Diet

Eat any nourishing food that can be taken with comfort. Temperature of the food doesn’t matter, but avoid extremely hot foods. It is sometimes advisable, but not required, to confine the first day’s intake to bland liquids or pureed foods (creamed soups, puddings, yogurt, milk shakes, etc.). Avoid foods like nuts, sunflower seeds, popcorn, etc., that may get lodged in the area around the extraction site where the tooth was removed, also called the socket. Over the next several days you can progress to solid foods at your own pace. It is important not to skip meals. If you take nourishment regularly, you will feel better, gain strength, have less discomfort, and heal faster. If you are diabetic, maintain your normal eating habits as much as possible and follow instructions from us or your physician regarding your insulin schedule.

Sharp Edges

If you feel sharp edges in the surgical areas with your tongue it is probably the bony walls, which originally supported the teeth. Occasionally small slivers of bone may work themselves out during the first week or two after surgery.

Mouth Rinses

Keeping your mouth clean after surgery is essential. The day following your surgery rinse with warm water or salt water following meals. To make a salt water solution dissolve one-quarter teaspoon of salt in an eight-ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least four to five times daily for the next 10 to 14 days. If you were given an irrigating syringe, gently irrigate the socket with the warm water or salt water in addition to any prescribed mouth rinses. Use the prescribed mouth rinses as directed on the bottle. If your mouth is too sore to rinse, call the office, and we will suggest a treatment that will permit you to rinse as directed.

If you experience post-operative bad breath or taste, increase your water rinses to every hour. The condition should subside as healing progresses across the surface of the wound.

Dry Sockets

The most commonly occurring complication following an extraction is called a “dry socket.” What exactly is a dry socket? Upon removal of a tooth, a blood clot should form in the socket (the hole left from the tooth). This blood clot will provide coverage for the bone of the jaw and it initiates the healing process. However, if the whole clot or any part of it is lost or does not fully form then a delayed healing ensues. This delayed healing will result in persistent pain in the area. Normally, discomfort from an extraction should be only for the first 48-72 hours, then definite improvement should be noted. If after the fourth or fifth day the pain does not subside with your recommended oral rinses then you may be developing a dry socket. Most commonly a dry socket will occur in the lower jaw, especially the molars. The symptoms of a dry socket are a noticeable, distinct, persistent throbbing pain in the jaw, often radiating toward the ear and forward along the jaw to cause other teeth to ache. In addition, you may notice a foul odor and bad taste emanating from the socket area.

To treat this problem the socket area will be examined and irrigated to remove any debris, such as food particles, that may still be in the socket. A special medicated gauze packing will be placed in the socket to provide pain relief to the area until healing has progressed to a comfortable level. The medicated packing is left in place for two to five days, then replaced for any additional time needed to bring about relief. It is common that two or three dressings will be necessary.

BIODEGRADABLE SURGICAL DRESSING MATERIAL

For your convenience, our office is using a biodegradable surgical dressing to aid in the healing process of your dental surgery. This dressing is used primarily for lower wisdom teeth. The surgical assistants will advise you as to whether this dressing was used in your case. As the healing process progresses, the material is replaced by permanent healing tissues.

Many times the surface of the extraction site is exposed and you may see or feel the dressing material. The material will feel rough and granular to the tongue’s touch. It may appear grayish-white or light brown. Please do not be afraid and mistake the dressing material for tooth debris.

If at any time you observe any of the dressing material wash out, repeat the rinse a second time. If you should happen to swallow this material, do not be concerned. This biodegradable dressing is a “natural food” and will be digested as such.