Pre/Post Surgical Instructions

Preoperative instructions for general oral & maxillofacial surgery with intravenous anesthesia



Postoperative Extraction Instructions



Implant Post-Op Instructions




Preoperative instructions for general oral & maxillofacial surgery with intravenous anesthesia

Food and Drink

  • It is absolutely essential that you have NOTHING TO EAT OR DRINK for a minimum of 8 hours prior to your surgery. Take all regularly prescribed medications with a small sip of water unless otherwise instructed by our doctors.
  • Eat a light, easily digested meal the night before surgery, and get plenty of rest. Do not drink any alcoholic beverages for 24 hours before surgery or for two days after surgery.
  • Avoid smoking for at least 24 hours before surgery as smoking greatly impairs the body’s ability to heal.

Medications

  • In general, continue to take all your medications with a small sip of water unless advised differently by our doctors or your personal physician.
  • However, avoid any medications that can potentially prolong bleeding for at least 1 week prior to your surgery date. These medications include aspirin, anti-inflammatory medications (Motrin, Advil, and Naproxen), vitamins C & E, and some herbal supplements/remedies. For those patients on prescribed blood thinners (Coumadin, Wafarin, Plavix, aspirin), please consult our doctors and your physician who prescribed the medications prior to discontinuing your medications.
  • If taking diabetes medications or insulin, the usual protocol is to NOT take the previous night time dose and the morning dose on the day of surgery. Please consult your physician if there are any questions regarding this matter.

Caretaker

  • A responsible adult must accompany you and remain in the office to drive you home afterward. You should not drive at all after sedation or general anesthesia for the remainder of the day. You should not subject yourself to anything that may jeopardize your safety and well being of others. Anesthetic agents can be retained in your body for up to 48 hours and can decrease both your awareness and reflexes.
  • Patients under the age of 18 must be accompanied by a parent or guardian who will be able to give legal written consent for the procedure.
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Clothing and Jewelry

  • Wear loose, comfortable clothing with sleeves that can be easily pulled up past the elbow.
  • Wear flat, stable shoes that are easily removable.
  • Patients will be asked to remove contact lenses, glasses, hearing aids and all jewelry prior to surgery. Do not wear or bring valuables to your surgery appointment.
  • Female patients should not wear eye make-up, hairpieces, wigs, lipstick, or nail polish on the day of surgery.

Admission, discharge, and payments

  • Expect to be present at least 30 minutes prior to and after the scheduled surgery time period.
  • In order to make your discharge as smooth as possible following your anesthetic, the balance of your surgical fee(s) will be collected before your surgery. Financial concerns must be discussed with our office no less than one business day prior to surgery.
  • ANY variation from the above instructions may cause your surgery to be cancelled


Postoperative Extraction Instructions

Normal healing after tooth extraction should be as follows: The first and second day of surgery is usually the most uncomfortable and there is some degree of swelling and stiffness. On the third day you will usually be more comfortable and although maximum swelling occurs on this day, you can usually begin a more substantial diet. Beginning with the fourth day gradual, steady improvement should mark the remainder of your postoperative course.


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Bleeding

  • Immediately after surgery, fold gauze into a tight roll and place over the surgical areas and bite down firmly. Do not change the packs for the first hour unless the bleeding is uncontrolled. If bright red bleeding persists after one hour, place enough new gauze to obtain pressure over the surgical site for another 30-60 minutes. Change the gauze if you need to. Dampen the gauze with water to make is easier to place in your mouth.
  • Bleeding should never be severe. If it is, it usually means that the packs are between your teeth rather than exerting pressure on the surgical areas (for wisdom teeth, it is behind the last molars). If bleeding persists or becomes heavy, you may substitute a tea bag (soaked in warm water, squeezed damp-dry, and wrapped in moist gauze) for 30-45 minutes. If bleeding still remains uncontrolled, please call our office.
  • Intermittent bleeding or oozing is normal for the first 48-72 hours. Packs should be removed prior to eating or drinking anything. If bleeding continues, repack the surgical area by placing fresh gauze over the surgical site and biting down firmly for 30-60 minutes.

Swelling

  • Often there is some swelling associated with the surgery. You can reduce this by using a cold pack or ice bag wrapped in a towel firmly to the face or cheek over the surgical site. This should be applied 20 minutes on and 20 minutes off during the first 24 hours. After 24 hours, it is best to switch from ice to moist heat placing it to the same areas. The greatest swelling occurs after the first 2-3 days. After that time it should gradually decrease.
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Pain

  • Unfortunately, some oral surgery procedures cause discomfort. The doctor may prescribe pain medication. Take the first pill before the numbness has worn off and take the medication on a scheduled basis for the first 24 hours. This will manage the discomfort better. Effects of pain medicines vary widely among individuals. If you do not achieve adequate relief, you may add ibuprofen (Advil).
  • Some people may require more pain pills during early stages (but that may add to the risk of upset stomach). Remember that the most severe discomfort usually occurs within the first 48-72 hours after the numbness wears off. Afterward, your need for pain medication should lessen.

Nausea

  • Nausea after surgery may be the result of swallowed blood, pain medications and/or the after effects of the anesthesia. Reduce nausea by swallowing each pill with a small amount of soft food, and then followed by clear fluids.

Diet

  • It is very important to have adequate food and fluid intake following surgery.
  • Do not use straws or drink carbonated beverages for 4-5 days. The first several days’ diet should consist of bland, cool liquids and soft foods (creamed soups, pudding, yogurt, milk shakes, etc.). Avoid foods like nuts, sunflower seeds, popcorn, etc., as they may get lodged in the surgical sites. Over the next several days, gradually increase the texture of your diet as tolerated.
  • If you have diabetes, maintain your normal eating habits as much as possible and follow instructions for your insulin given by your physician or by our doctor.

Brushing and rinsing

  • Do not disturb the surgical area for 24 hrs. Do not rinse vigorously or probe the area with any objects or your fingers.
  • Start brushing your teeth gently after 24 hrs. 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.
  • Please start the prescribed antibiotic oral rinse (Peridex) 24 hrs after surgery. Avoid eating or drinking at least 2 hrs after using the rinse.
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Sharp edges

  • Sharp edges felt with your tongue are probably the bony walls of your jaw, which originally supported the teeth. Occasionally small slivers of bone may come out during the first week or two after surgery. They are not pieces of tooth and, if necessary, we will remove them. Please call the office if you are concerned.

Dry socket

  • A “dry socket” occurs when there is a loss of the blood clot from the extraction socket, usually in the 4th to 5th day. There is usually noticeable, increased, distinct, persistent throbbing pain in the jaw, often radiating toward the ear and possibly causing other teeth to ache. You may also have a foul taste in your mouth and bad breath. If this occurs please contact our office so we can help you.
  • DO NOT SMOKE for at least 4-5 days, since it is very detrimental to healing.

It is our desire that your recovery be as smooth and pleasant as possible. If you do not note steady improvement during the first few days after surgery, do not suffer needlessly. Call the office and report symptoms during working office hours. A 24-hour option to contact the on-call doctor is available during non-business hours.

IMPORTANT EMERGENCY INFORMATION: If you need to contact the on-call doctor dial 214.572.8633; choose option 2 to leave a message. Please do not leave a message on the main voicemail, as we will not get that message until the next business day. When you leave a message for the on-call doctor, please allow up to 2 hours for the doctor to retrieve your message and return your call.



Implant Post-Op Instructions

Congratulations on completing the first step of your dental implant treatment. If you look inside your mouth, you may be able to see the healing abutment portion of the implant. If you do not see this portion your implant, do not be concerned. Some dental implant treatments require the implant to be completely covered by your gum tissues.

Dental implants require a clean and gentle environment in order to heal properly. In that regard, much of the success of this implant will depend on your care. In order to achieve optimal healing and thereby success of the implant treatment, correct post-operative care is required. The following instructions will assist you in this healing phase.


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Activity

  • Immediately following IV sedation you should rest the remainder of the day in a recliner or comfortable chair. It is advisable to have whoever is taking care of you to remain with you until you are sure the effects of the anesthesia is completely gone. It is best to take it easy for a day or two. Vigorous activities and manual labor should be avoided for a few days.

Discomfort and swelling

  • You may experience some swelling after the procedure which will peak at 72hrs. Ice packs will keep swelling and/or bruising to a minimum. Apply ice to your face on a “20 minute on and 20 minute off” cycle for the next 24hrs if possible. If swelling persists after 72 hours, apply a warm moist towel.
  • You may have some discomfort after the procedure. The discomfort could also be from the adjacent teeth next to the implant. Over the counter anti-inflammatory medicines (Advil, Aleve or Ibuprofen) are often helpful in controlling this type of discomfort. Your doctor may also prescribe a “stronger” pain medication. You may supplement the anti-inflammatory medication with this prescription medication if needed. You do not have to take or finish the pain medication.

Antibiotics

  • Your doctor may prescribe an antibiotic for you. Unlike the pain medication, it is important that you finish this medication unless otherwise directed. If you have an antibiotic prescribed prior to the procedure, continue taking it unless advised by a doctor to stop.

Bleeding

  • There is usually a minimal amount of bleeding following the procedure. We suggest that you bite on the gauze packing in your mouth for at least 20-30 minutes. If you notice bleeding from the area after the first 30 minutes, place another gauze pad over the area. Some oozing may occur for a day or two after the surgery. If implants are placed in the upper jaw, you may experience a nosebleed within the first few days after surgery.

Hygiene

  • Do not attempt to floss, brush or water-pik in the area of surgery until your first follow-up appointment. However, the rest of your mouth should continue to be brushed and flossed as usual. Your doctor will instruct you on further cleaning techniques
  • Rinsing is very helpful in keeping your mouth clean. The prescribed Peridex oral rinse can be started the day after surgery. Rinse gently several times a day after every meal and continue to do so for ten to fourteen days.
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Diet

  • Diet is very important in the postoperative period. You should eat soft nutritious foods. Care should be taken to avoid hard or crunchy foods that might cause trauma to the implant area. You must avoid chewing in the area of implant placement. Exerting chewing pressure on a newly placed implant will cause it to not heal properly and may lead to failure of the implant.
  • Smoking and nicotine gums should be avoided for at least two weeks following surgery. This has been shown to negatively affect the healing process.
  • Your doctor will decide when dentures or partial dentures may be worn after surgery, but they must be worn only with caution. Remember, no undue pressure should be applied over the new implant site. This may lead to failure of the implant.

Sutures (stitches)

  • We usually place stitches that are absorbed over several days to weeks. You may feel bits of the sutures in your mouth as they fall apart. If there are stitches that need to be removed, we usually remove them at your follow-up appointment.

Bone graft

  • If you had a particulate bone graft with your implant, you may feel some of the granules in your mouth over the next several days. This is normal. We make every attempt to get the excess particles out at time of surgery but occasionally a few particles remain.

Increasing discomfort, redness, or swelling after the initial healing period should be reported to our office. Your patience and self care will help make your dental implant successful. If you have any questions or unusual problems, please call us.

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