Preoperative Instructions

General Anesthesia or IV Sedation

• AM appointment: No food or liquid after midnight the night before surgery (including water).
  

• PM appointment: No food or drink for 6 hours prior to surgery.
  

• No smoking for 12 hours before surgery.
  

• You must have a responsible adult with you to bring you and take you home.
  

• Do not disturb the wound. Avoid rinsing spitting or touching the wound on the day of surgery.
  

• BLEEDING: Some bleeding or redness in 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 the bleeding continues, please call the office for further instructions.
  

• SWELLING: Swelling is a normal occurrence after surgery. To minimize swelling apply an ice pack or plastic bag or towel filled with ice on the cheek in the area of the surgery. Apply the ice continuously as much as possible in the first 24 hours.
  

• DIET: Drink plenty of fluids and avoid hot liquids. Soft foods and fluids shall be eaten on the day of surgery. Return to a normal diet as soon as possible.
  

• PAIN: You should begin taking the pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra-Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen over-the –counter comes in 200mg tablets; 2-3 tablets may be taken every 3-4 hours as needed for pain. For severe pain, the prescribed medications should be taken as directed.
  

• ORAL HYGIENE: Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal. The day after surgery, brush your teeth as best that you can. Rinse with warm salted water (1/2 teaspoon of salt in a full glass of warm water) six times a day. Continue this procedure until healing is complete. A clean wound heals better and faster.
  

• ACTIVITY: Keep physical activity to a minimum immediately following surgery. If you are continuing exercise, throbbing and bleeding can occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking in normal nourishment, which may weaken you.

Local Anesthesia

Take routine maintenance medications unless told to do otherwise (you may be
asked to hold taking coumadine, aspirin, or other blood thinners)

I. Preoperative Instructions for Patients Undergoing Intravenous Anesthesia

• You may not have anything to eat or drink (including water) for eight (8) hours prior to the appointment.
  

• 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 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.
  

The removal of impacted wisdom teeth and surgical extraction of teeth is quite different from the extraction of erupted teeth. The following conditions may occur, all of which are considered normal:

• The surgical area will swell.
  

• Swelling peaks on the 2nd or 3rd post-operative day
  

• Trismus (stiffness) of the muscles may cause difficulty in opening your mouth for a few days.
  

• You may have a slight earache.
  

• A sore throat may develop.
  

• Your other teeth may ache temporarily. This is referred pain and is a temporary condition.
  

• If the corners of the mouth are stretched out they may dry and crack. Your lips should be kept moist with cream or ointment.
  

• There will be a space where the tooth was removed. After 24 hours this area should be rinsed following meals with warm salt water until it is healed. This cavity will gradually fill in with new tissue.
  

• There may be a slight elevation of temperature for 24 to 48 hours. If temperature continues, notify us.
  

• It is not unusual to develop bruising in the area of an extraction.
  
  Please take all prescriptions as directed.
  
  Women please note: Some antibiotics may interfere with the effectiveness of your birth control pills. Please check with your pharmacist.
  
  

II. Care of Mouth After Oral Surgery

• Do not rinse or spit for 24 hours after surgery.
  

• Keep fingers and tongue away from socket or surgical area.
  

• Use ice packs on surgical area (side of face) for first 48 hours, apply ice 20 minutes on — 10 minutes off. Bags of frozen peas and corn work well.
  

• For mild discomfort take Tylenol or Ibuprofen every three to four hours.
  

• For severe pain use the medication prescribed to you.
  

• Drink plenty of fluids. (Do not use a straw)
  

• If the muscles of the jaw become stiff, chewing gum at intervals will help relax the muscles, as well as the use of warm, moist heat to the outside of your face over these muscles.
  

• After the first post-operative day, use a warm salt-water rinse following meals for the first week to flush out particles of food and debris which may lodge in the surgical area. (1/2 teaspoon of salt in a glass of warm water. Mouthwash can be added for better taste.)
  

• Diet may consist of soft foods which can be easily chewed and swallowed. No seeds, nuts, rice, popcorn, etc.
  

• A certain amount of bleeding is to be expected following surgery. Bleeding is controlled by applying pressure to the surgical area using small rolled gauze for 90 minutes. After that time remove the gauze and then you may eat or drink. If bleeding persists, a moist tea bag should be placed in the area of bleeding and bite firmly for one hour straight. This will aid in clotting blood. Repeat if necessary. If bleeding still persists call our office.
  

• We suggest that you do not smoke for at least 5 days after surgery. Nicotine may break down the blood clot and cause a "dry-socket".
  
  

• Feel free to contact us if any doubt arises as to your progress and recovery.
   

III. Post-Op Instructions

• What you should do following extractions and other oral surgery procedures?
  
  

• A certain amount of bleeding, pain, and swelling is normal. Reduce your activity as much as possible for several hours.

• Avoid eating, drinking and unnecessary talking. Do not rinse your mouth or brush your teeth for 24 hours. These activities may hinder formation of a blood clot which is necessary for proper healing.
  
  

• Do not be alarmed if your vision is blurred for a time following anesthesia or if a "black and blue" bruise should appear at the site of an injection. The arm also may be bruised, swollen and tender to touch due to the IV.
  
  

Follow the simple instructions below to minimize complications and help ensure prompt recovery.

To control bleeding

• Immediately following procedure. . .keep a steady pressure on the bleeding area by biting firmly on the gauze placed there by your doctor. Pressure helps reduce bleeding and permits formation of a clot in the tooth socket. Gently remove the compress after the local anesthesia has worn off and normal feeling has returned.
  
  

• After 24 hours... some oozing of blood may persist. If necessary, resume use of moist tea bags. After bleeding has stopped, cautiously resume oral hygiene.

To relieve pain

• Immediately following the procedure... begin taking medication as directed by your doctor to minimize discomfort when the anesthesia wears off and feeling is back to normal. Application of an ice bag can also help relieve discomfort.
  
  

• After 24 hours, continue to take your medication if pain persists, and use an ice bag if needed.

To minimize swelling

• Immediately following procedure. . .apply an ice bag over the affected area. Use 20 minutes on and 20 minutes off for 24 hours to help prevent excessive swelling and discomfort. If an ice bag is unavailable, simply fill a heavy plastic bag with crushed ice. Tie end securely and cover with a soft cloth to avoid skin irritation.
  
  

• After 24 hours. . . it should not be necessary to continue with cold applications. You may expect swelling for 10 days to two weeks and a fever of 99 to 100 degrees Fahrenheit.
   
  

Special considerations following removal of impacted teeth:

• Removal of impacted teeth is a surgical procedure. Postoperative problems are not unusual, and extra care must be taken to avoid complications.
  

• Severity of postoperative pain will depend on the procedure and your physical condition. Take medication for pain precisely as directed.
  

• Healing of the surgical site is variable.
  

• Swelling can be expected. Be certain to apply ice bags as directed above.
  

• Difficulty in opening your mouth widely and discomfort upon swallowing should be anticipated.
  

• Numbness of lips and/or tongue on the affected side may be experienced for a variable period of time.

Oral hygiene is important

• Twenty-four hours after surgery, rinse mouth gently with a solution of one-half teaspoonful of salt dissolved in a glass of water. Repeat after every meal or snack for seven days. Rinsing is important because it removes food particles and debris from the socket area and thus helps prevent infection and promote healing. Brush tongue with a dry toothbrush to keep bacteria growth down, but be careful not to touch the extraction site.
  
  

• Resume your regular tooth brushing, but avoid disturbing the surgical site so as not to loosen or remove the blood clot.

Maintain a proper diet

Have your meals at the usual time. Eat soft, nutritious foods and drink plenty of liquids with meals and in between. Have what you wish, but be careful not to disturb the blood clot. Add solid foods to your diet as soon as they are comfortable to chew.

In case of problems

You should experience no trouble if you follow the instructions and suggestions as outlined. But if you should have any problems such as excessive bleeding, pain or difficulty in opening your mouth, call our office immediately for further instructions or additional treatment.

Remember your follow-up visit

It is often advisable to return for a postoperative visit to make certain healing is progressing satisfactorily. A follow-up visit will be scheduled. In the meantime, maintain a healthful diet, observe rules for proper oral hygiene and visit your dentist for regular checkups.