Pre & Post Op Instructions

Pre-Op Instructions

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You will always be given local anesthesia for your surgery, but you may choose any of those listed below as a supplement. Each choice requires different preparation on your part, and for your safety it is important that you read and follow the instructions carefully. If you are unclear about anything, please ask your doctor. For all surgery, please wear comfortable, loose-fitting clothing. Tops/shirts should have sleeves that are easily drawn up above the elbow. Females should remove nail polish before surgery, and apply as little makeup as possible.

LOCAL ANESTHESIA will produce a numb feeling in the area being operated on and a feeling of pressure during surgery. You will be awake and recall the surgery, but there should be no significant discomfort.
1. Have a light meal a few hours prior to surgery.
2. For more extensive procedures you may wish to have someone drive you home.
3. Plan to rest for a few hours after surgery.

ORAL PREMEDICATION: may be a supplement to local anesthesia and is medication taken by mouth to produce relaxation before and during your operation.
1. Take the medication at the time directed before your surgery.
2. Do not eat or drink anything (including water) for six (6) hours prior to surgery.However, it is important that you take any regular medications (high blood pressure, antibiotics, etc.) or any pre-medication prescription that we have provided, using only a small sip of water.
3. It is not safe to drive after taking sedative drugs, and you MUST have someone drive you to and from surgery.
4. Plan to rest for the remainder of the day. Do not operate power tools, machinery, etc., for 24 hours after surgery.

NITROUS OXIDE is also known as “laughing gas.” You will be relaxed and somewhat less aware of your surroundings, but will recall most of the surgical event. Nitrous oxide is generally used in conjunction with local anesthesia, but may also be used to supplement the anesthetic choices below.
1. You may have a light meal four (4) hours prior to surgery.
2. It is best to have someone drive you home.
3. Plan to rest for the remainder of the day.

Both of the anesthetics below include local anesthesia (although general anesthesia does not require its use.)

INTRAVENOUS SEDATION: Medications are given through a vein in your arm or hand, which will cause total relaxation and, although you will not actually be unconscious, there will be very little recall (if any) of the events surrounding surgery.

1. Do not eat or drink anything (including water) for six (6) hours prior to surgery.However, it is important that you take any regular medications (high blood pressure, antibiotics, etc.) or any pre-medication prescription that we have provided, using only a small sip of water.
2. For morning appointments, skip breakfast.
3. For afternoon appointments, eat a light breakfast seven (7) hours before your appointment and skip lunch.
4. Take any regular medications with only enough water to get the pill down.
5. You MUST have someone drive you home.
6. Plan to rest for the remainder of the day. Do not operate power tools, machinery, etc., for 24 hours after surgery.

GENERAL ANESTHESIA/DEEP SEDATION: Medications are given through a vein which will result in total loss of consciousness, complete lack of recall of the event and usually a longer recovery time. General anesthesia/deep sedation has an excellent safety record as an office procedure, but may, if desired, be provided in a hospital setting. (Your health insurance may not cover you unless there is a bona fide medical reason for hospitalization.)

1. The same instructions offered above for intravenous sedation apply for general anesthesia.

Our goal is to provide you with a safe, pleasant and effective anesthetic. In order to do this it is imperative that we have your full cooperation. Please feel free to ask or call about any questions concerning your surgery or anesthetic.

Post-Op Instructions

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Sometimes the after-effects of oral surgery are quite minimal, so not all of these instructions may apply to you. It is our desire that your recovery be as smooth and pleasant as possible, but if you have additional questions about your progress, please call the office location where you had your surgery. A 24-hour answering service is available to contact the doctor on call after hours. Calling during office hours will afford a faster response to your question or concern. PLEASE NOTE: ABSOLUTELY NO NARCOTICS WILL BE PHONED IN TO A PHARMACY AT ANY TIME!

PROTECTION OF THE BLOOD CLOT AND POST-OPERATIVE BLEEDING: Bite down gently but firmly on gauze that has been placed over the surgical area, making sure the gauze remains in place. Change gauze as needed every 15 to 30 minutes until bleeding is controlled. If bleeding persists, bite onto a tea bag that has been moistened and wrapped in a piece of gauze. Bleeding should never be severe. Check the positioning of the gauze and note if it is clenched between teeth rather than on the surgical site. Do not sleep unsupervised with gauze in your mouth. Intermittent bleeding or oozing overnight is normal, especially for those on blood thinners or aspirin therapy, or those with multiple extractions.

POST-OPERATVIE COURSE: Do not rinse or use mouthwash for at least 24 hours. You may brush your teeth gently if you desire. After 24 hours, warm salt water soaks (1/2 teaspoon in 8 oz. of warm water) are recommended every 1-2 hours, especially after eating. Day Two, start warm salt water soaks. Use ½ teaspoon of salt in 8oz of warm water. Rinse several times a day for the first week particularly after eating. Resume regular brushing of teeth, taking care around the surgical sites. Do not spit for 5 to 7 days. If you smoke, do not smoke for 5 to 7 days, since this is very detrimental to healing and may cause dry sockets. Do not use a soda straw for 5 to 7 days. If you have had bone grafting or implants please refrain from wearing partials and dentures for the first week or until you are told by the Doctor or our staff you can wear them.

SWELLING: Swelling can be minimized by applying an ice pack to the outside of the surgical area for 20 minutes on and 10 minutes off for the first 48 hours. If you have been prescribed medication for the control of swelling, please take as directed. Swelling will peak on 2nd to 3rd surgical day. Stiffness of the jaw which leads to difficulty in opening and closing the mouth can occur during this time. When swelling subsides, full range of motion of your jaw should return.

ACTIVITY: Rest for the first two post-operative days to minimize bleeding and swelling. Elevate head on a couple of pillows to further minimize swelling. If you had impacted teeth removed or full mouth extractions, you should avoid all strenuous activities for one week. For routine extractions, two days of limited activity is usually adequate.

EATING AND DIET: A soft, liquid diet is recommended for the first 48 hours such as soups, puddings, yogurts, and milkshakes. Avoid extremely hot and spicy foods. Avoid foods like nuts, seeds, popcorn and chips for a week as they may get lodged in the socket areas. Over the next several days you may gradually add solid foods to your diet. It is important that you do not skip meals. Eating regularly will make you feel better, gain strength, and heal faster.

PAIN: Unfortunately most oral surgery is accompanied with some degree of discomfort. You will usually have a prescription for pain medication. If you take the first pill before the anesthetic has worn off, you should be able to manage the discomfort better.Some patients find that stronger pain medicine causes nausea, but if you take the medication with food, chances for nausea will be reduced. The effects of pain medications vary among individuals. If you do not achieve adequate relief at first, you may supplement each narcotic pain pill with over the counter medication such as ibuprofen (Motrin) or acetaminophen (Tylenol). If you develop severe throbbing pain down deep in the jaw near the ear 3 or 4 days after the tooth is removed, contact our office as you may be developing a dry socket. If numbness of the lip, chin or tongue persists, it will most likely be temporary and will go away on its own in a few days although the numbness can last for several weeks.

MEDICATIONS AND ANESTHETICS: Patients receiving intravenous sedation must be accompanied home by a responsible adult who will drive them home after surgery. Medications, drugs, prescriptions and anesthetics may cause drowsiness and lack of awareness and coordination, thus we advise that you do not operate any vehicle or hazardous device for at least 24 hours after your release from surgery. Beer, wine or other alcoholic beverages can magnify the effect of the drugs to dangerous levels and could cause a fatal overdose. Recreational drugs are never to be used along with the medication prescribed by our office.

SUTURES: If they were used, they will dissolve and come out on their own, usually in a week to ten days.

ALLERGIC REACTIONS: For generalized rash, itching, hives, call our office immediately. If you experience severe hives, wheezing, difficulty in breathing go directly to the nearest hospital emergency room.

We are sending an irrigating syringe home with you; DO NOT USE SYRINGE FOR FIRST SEVEN DAYS!! Begin flushing the extraction sites with warm water on day seven to remove impacted food from the sockets. Do this every time you eat until the sockets are closed, usually for 10-14 days. Take all medication exactly according to the directions on the bottle.

ANSWERING SERVICE AND ER RECOMMENDTIONS: If you develop a significant problem after surgery and/or after regular business hours, we are always available for phone consultation and recommendations through our 24/7 answering service. Occasionally, if you cannot contact one of the doctors and you feel you have a serious or emergency situation, ALWAYS seek out medical attention at your local hospital emergency room. Never delay treatment for incidents such as severe post op bleeding, severe allergic reactions, or airway obstruction from severe swelling as these could be life threatening and treatment time is critical to successfully reverse the problem.