Surgical Instructions

AnesthesiaDental ImplantsWisdom TeethDental Extraction

Before Anesthesia

  • You may not have anything to eat or drink (including water) for 8 hours prior to the appointment.
  • No smoking for at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of 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 anesthesia.
  • 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.
  • 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 upset bowels, please notify the office.

After Dental Implants

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There may be a metal healing abutment protruding through the gingival (gum) tissue.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding can normally be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues profusely, please call for further instructions.

Swelling

To minimize swelling, apply an ice bag near the area of surgery. Apply the ice continuously, as much as possible, for the first 48 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 severe pain, the prescribed medication should be taken as directed. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. 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.

Oral Hygiene

Good oral hygiene is essential to good healing. The day after surgery, use the prescription oral rinse as directed; after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt water rinses (one teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day as well, especially after meals. Brush your teeth and the healing abutments. Be gentle initially while brushing the surgical areas.

Activity

Keep physical activities to a minimum immediately following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking in normal nourishment. This may weaken you and further limit your ability to exercise.

Wearing your Prosthesis

Partial dentures, flippers or full dentures should be worn as discussed in the pre-operative consultation.

After Wisdom Teeth Removal

Immediately Following Oral Surgery

  • The gauze pad placed over the surgical area should be kept in place for at least 1 hour. After this time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing and/or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • 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 a more thorough 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 black tea bag for thirty minutes. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels. If bleeding does not subside, call our 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. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-4 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 48 hours, ice has no beneficial effect. 2 days following the surgery, moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Dry Socket

Normal healing of a tooth socket involves formation of a blood clot which protects the site and provides elements for soft tissue and bone healing. Loss of some or the entire clot is called dry socket (alveolar osteitis). This is usually identified by increasing or persistent pain on the fourth or fifth day after surgery. Management may include gentle washing of the site with a water syringe and placing a eugenol (clove oil) dressing.

Pain

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For severe pain, the prescribed medication should be taken as directed. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. 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 IV sedation only liquids should initially be consumed. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. Our staff can provide suggested diet instructions. 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 any meals.

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 up slowly before standing.

Oral Hygiene

Good oral hygiene is essential to good healing. The day after surgery, use the mouth rinse as directed; after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Be gentle with brushing initially. The day after surgery you should begin rinsing at least 4-5 times a day, especially after eating, with a teaspoon of salt mixed into one cup of warm water.

Discoloration/Bruising

In some cases, discoloration/bruising 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 2-4 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 or resolve infection. Discontinue antibiotics use in the event of a rash or any other unfavorable reaction and contact our office immediately. Call the office if you have any questions.

Nausea/Vomiting

In the event of nausea/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. Contact our office immediately if nausea/vomiting continues.

Nerve Injuries

Due to close proximity to the mandibular nerve, lingual nerve or buccal nerve certain tooth removal may result in altered sensation to the lower lip, tongue or cheek. While rare most of these recover without surgical intervention. The timing of recovery may be days to months or longer depending on the type of injury. Short duration injuries (neuropraxia) usually involve brushing against or bruising the nerve and recovers in hours to days. Intermediate injuries (axonotmesis) involve compression or stretching of the nerve and usually recover in weeks to months. More involved injuries (neurotmesis) involve separation of some or all of the nerve fibers and may cause permanent numbness. Surgical repair may also be needed. We will monitor and advise you should any of these events occur.

Others

  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, contact our office immediately.
  • You should be careful going from the lying down position to standing. You could get light headed from medications.
  • 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.
  • Stiffness 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.
  • 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 our office for instructions.
  • There will be a void where the tooth was removed. The void will fill in with new tissue gradually over the next few months. In the meantime, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.
  • Brushing your teeth is okay – just be gentle at the surgical sites.

After Dental Extraction

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

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding can be frequently controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues, bite on a moistened black tea bag for thirty minutes. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels. If bleeding does not subside, call our office for further instructions.

Swelling

To minimize swelling, apply an ice bag near the area of surgery. Apply the ice continuously, as much as possible, for the first 48 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 severe pain, the prescribed medication should be taken as directed. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. 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.

Dry Socket

Normal healing of a tooth socket involves formation of a blood clot which protects the site and provides elements for soft tissue and bone healing. Loss of some or the entire clot is called dry socket (alveolar osteitis). This is usually identified by increasing or persistent pain on the fourth or fifth day after surgery. Management may include gentle washing of the site with a water syringe and placing a eugenol (clove oil) dressing.

Sinus Precautions

In the event that a tooth is located near the maxillary sinus is removed, an opening into the sinus may occur. While rare, it usually heals without surgical intervention. Specific measures can be taken and may be advised after surgery to help promote healing: 1. avoid smoking 2. avoid sucking on a straw 3. avoid sneezing (or sneeze with mouth open) 4. use sinus decongestants such as Sudafed or Actifed as needed 5. antibiotics may be prescribed if indicated. If you notice drainage through the nose or movement of air where your tooth was removed, please contact our office for assessment.

Oral Hygiene

Good oral hygiene is essential to good healing. The day after surgery, use the prescription oral rinse as directed; after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt water rinses (one teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day as well, especially after meals. Brush your teeth and the healing abutments. Be gentle initially while brushing the surgical areas.

Activity

Keep physical activities to a minimum immediately following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking in normal nourishment. This may weaken you and further limit your ability to exercise.

Wearing Your Prosthesis

Partial dentures, flippers or full dentures should be worn as discussed in the pre-operative consultation.

‍