Surgical Instructions

Before Surgery:

• Please wear a loose-fitting shirt or blouse with short sleeves that can be rolled up. This will make it easier for us to take your blood pressure before, during, and after surgery.
• If you will be receiving IV sedation or general anesthesia for your surgery:
• Do not eat or drink anything for 6 hours before your surgery.
• You must have a responsible adult who can drive come with you on the day of your surgery. This person will need to wait for you during your surgery and drive you home afterward. You should arrange to have responsible adult supervision at home overnight after your surgery.
• Do not wear contact lenses the day of your surgery and remove any nail polish.
• Continue to take your regular prescription medications prior to your surgery unless instructed otherwise by our office. These medications may be taken with a small sip of water the morning of your surgery.

After Surgery:

• While riding home, wear a seat belt. When you get home, lie down and rest until the effects of the sedation wear off. Do not try to get up and walk, even to the bathroom, without help until you are absolutely sure the sedative effects have worn off.
• Do not drive, operate machinery, or sign important documents for 24 hours following IV sedation.
• Do not drink any alcoholic beverages the day of your surgery, or at any time while you are taking narcotic medications.
• Be sure to follow the post-operative instructions that we have given you.

If you have any questions or concerns
please do not hesitate to call us at 404-378-2331.
Thank you for giving us the opportunity to serve you.

MEDICATIONS:

Antibiotics (Penicillin, Amoxicillin, Erythromycin, Clindamycin)

Antibiotics are used to treat infections, or to prevent infections from occurring. Not all oral surgery procedures require antibiotics. If you have been prescribed an antibiotic, be sure to follow the directions on the label. Antibiotics can alter the effectiveness of oral contraceptives.

Anti-Inflammatory Medications (Motrin, Advil, Tylenol)

These medications help prevent inflammation and relieve mild to moderate discomfort. These medications are very effective in helping patients recover from oral surgery. They can be taken in conjunction with narcotic medications, since they relieve pain from a separate pathway. They are most effective when taken on a regular basis for several days, rather than “every now and then”.

Narcotic Medications (Darvocet, LorTab, Percocet)

These are strong medications prescribed for the relief of moderate to severe pain and are frequently needed following more extensive oral surgery procedures, such as the removal of difficult teeth, grafting procedures, and wisdom tooth extraction. Narcotic medications are design to be taken in conjunction with anti-inflammatory medications, not as a replacement. In other words, anti-inflammatory medications and narcotics can be taken together. The need for narcotics typically subsides after a few days, depending on the type of procedure preformed, and then any anti-inflammatory medications can be stopped a few days later. Narcotic medications do have side effects, such as drowsiness, decreased appetite and nausea. You should not drive while taking narcotic medications, nor should they be combined with alcohol.

Anti-emetic Medications (Phenergan, Tigan, Zofran)

Nausea and vomiting is uncommon following oral surgery. We frequently give these medications during IV sedation as a prophylactic measure and prescribe them post-operatively if needed.

BLEEDING:

A small amount of bleeding (oozing) is to be expected following oral surgery procedures. Post-operative oozing may continue for 24 to 48 hours after surgery. Oral gauze packs typically need to be changed every 30 to 45 minutes the first few hours following surgery. Gauze packs should be removed while drinking and then replaced as needed. If you experience persistent oozing, place 3 pieces of folded gauze over the area and bite down firmly on the gauze for 20 minutes. Be certain the gauze pack is thick enough to provide firm pressure when biting down. Constant pressure is important. Talking, or chewing on the gauze, will only promote more bleeding. Moisten tea bags may also be effective in stopping prolonged oozing. Wrap a tea bag in gauze, place this over the surgical site and bite down with firm pressure for 20 minutes. Be sure to avoid hot liquids, keep your head elevated and be as still as possible. If bleeding persists despite your best efforts, please do not hesitate to call us.

SWELLING:

Swelling and bruising are to be expected following most oral surgery procedures. Swelling typically increases for the first three days following surgery, and then gradually resolves over the next 7 to 10 days. So, swelling increases rapidly and resolves slowly. Bruising of the face over the surgical site usually follows the swelling. Depending on the procedure, as well as the patient’s complexion and age, bruising can be quite extensive. Both the swelling and the bruising are typically gone after 10 to 14 days. If we think you will experience some swelling we will give you a specialized “head wrap” with ice packs to be placed over the surgical area. The more ice the better during the first 48 hours following surgery. If your skin becomes cold, remove the ice from the pouch, but continue to wear the head wrap. The pressure alone from the head wrap will help limit the swelling. After your face “warms up” replace the ice packs. The Velcro head wrap makes it easier to sleep with ice on your face, both during the day and at night. Keeping your head elevated (2 to 3 pillows) during the first week following surgery will help limit the swelling and will help resolve the swelling that does occur. On the third day, begin using warm, moist heat over the surgical site until the swelling and soreness are gone.

MOUTH RINSES:

Vigorous rinsing may stimulate bleeding following oral surgery. Therefore, do not begin rinsing your mouth for at least 24 hours following your surgery. Beginning on the second day, start rinsing with warm salt water (1/2 teaspoon salt in a glass of warm water) 4 to 5 times a day for several days. If bleeding should occur, stop the warm rinses and follow the instructions in the second paragraph above. Listerine, Scope and other over the counter rinses may be used in conjunction with saline rinses and will leave a more pleasant taste in your mouth. Do not spit vigorously. Do not use a straw the first few days following your surgery.

FLUIDS:

Fluid intake is important following your surgery. It is best to start with clear beverages such as Ginger Ale, 7-Up, or Sprite. Gatorade, tea, broth, or juices also work well. Avoid drinking a lot of water at first. Once your stomach has settled, you can advance to other fluids such as milkshakes, but remember to avoid a lot of dairy products until your stomach has settled, especially after IV sedation. Avoid hot liquids until the numbness has worn off and the oozing has stopped. It is very important to stay well hydrated while healing from surgery, so be sure to drink plenty of fluids.

DIET:

Chewing a normal diet, especially during the first few days following your surgery, will be difficult, but maintaining a good level of nutrition throughout your recovery is very important. Food selection is largely a matter of choice. Be patient and start initially with soft, easily digested foods such as soups, Jell-O, milkshakes, and mashed potatoes. Coarser foods can be added as your healing progresses.

TEMPERATURE:

It is not uncommon to have a slight elevation in temperature following even minor oral surgery procedures. Rest, medications (Tylenol or Motrin), and plenty of fluids will hasten a return to a normal temperature.

SUTURES:

Sutures may have been placed in the surgical area to help reposition the tissue, promote healing, and decrease post-operative bleeding. These sutures are dissolvable and will typically disappear 3 to 10 days following your surgery. Sutures may also cause a “drawing” or tight feeling in the area. This tight feeling is normal and will be relieved when the sutures release and dissolve.

PHYSICAL ACTIVITY:

Limited physical activity during the first 24 to 72 hours following oral surgery is usually best. Trying to do “too much too soon” may lead to persistent oozing, increased discomfort, and a prolonged recovery.

SMOKING:

Don’t. Nicotine decreases blood vessel diameter and thus impairs blood flow to the surgical area, which delays healing. The heat from smoking destroys immature tissue, dissolves blood clots (dry socket), prolongs post-operative pain, and prolongs your recovery.

Please remember that we are at your service and are here to help.
Please do not hesitate to call us at 404-378-2331 if you have any questions.
Thank you for giving us the opportunity to serve you.

The Day Following Surgery and Thereafter

On the morning of the day following your surgery, rinse your mouth with warm salt water as described above. Begin brushing your teeth normally as best as you can, taking care not to disturb the surgical or extraction sites. Please do not use a syringe or Water Pik during the first week since this could dislodge blood clots.

Gradually return to our normal diet. Be patient and do your best to stay well hydrated. The stiffness and soreness of your jaws will slowly resolve. It usually takes a full 2 weeks before you can open your mouth as widely as you could before surgery.

Pain and discomfort should gradually decrease after a few days. If your pain increases after the third day, especially if the pain is felt as an earache and is not controlled with pain medications, you may be developing a “dry socket”. Please call us if you think you are developing a dry socket so that we can relieve your discomfort and get you back on the road to feeling better.

Swelling, soreness, and stiffness of the jaw muscles is normal and will slowly resolve. Apply a warm moist towel to the affected side of your face several times a day. This will help the soreness to resolve. Moist heat, rather than ice packs, should be used after the first 24 hours. If swelling, tenderness, or pain should increase after the first few days, please call us.

As the extraction site heals you will probably notice a “hole” which you can feel with your tongue. This is normal. Rinse after eating to prevent food from being trapped in this area. The hole will gradually heal from the inside out and is not permanent. We will rinse these areas out for you at your follow up appointment and give you a plastic syringe at that time to keep the area clean while it continues to heal.

You may experience some sensitivity to hot and cold liquids with the teeth adjacent to the extraction sites, and the adjacent teeth may ache. This is normal and will resolve as the area continues to heal.

What is a Dry Socket?

Dry sockets continue to be the most common problem people experience following dental surgery. When a tooth is extracted a blood clot forms and lines the empty tooth socket, serving as a “blanket” which covers the bony walls of the socket. If the blood clot is lost prematurely, the bony walls of the socket are exposed or “dry”. The exposed bone within the socket causes a deep, dull, continuous aching pain on the affected side. The pain may mimic an earache. Dry socket pain will even persist after taking your pain medication.

Both jaws can be affected, but dry sockets typically occur in the lower jaw and normally arise on the third to fifth day after your surgery. Although we do not know exactly what causes a dry socket, they occur more frequently in people who smoke. Dry sockets are also seen more frequently in patients on birth control pills.

Fortunately, we can treat dry sockets when they occur by placing a medicated dressing in the extraction socket. The medicated dressing does not stimulate the formation of a new blood clot, but it will greatly decrease the pain and discomfort. Depending on the severity of the dry socket, we may need to treat the area by replacing the medicated dressing 2 to 3 times over the course of a week.

If you think you have developed a dry socket please call us. We can make you feel better by cleansing the area and placing a medicated dressing.

Sinus Precautions

If you were informed that a sinus communication occurred during your surgery as a result of the close relationship between the roots of an upper tooth and your sinus, or if you have had some surgery that involved work near or in your sinus, please follow these additional instructions:

• Do not blow your nose.
• Do not sneeze through your nose. If a sneeze happens, sneeze with your mouth open.
• Do not smoke.
• Do not use a straw.
• Avoid swimming and strenuous exercise for at least one week.
• A decongestant may be prescribed if sinus congestion occurs.
• Afrin Nasal Spray may also be prescribed to help prevent nasal congestion and keep your sinuses clear while healing.

It is not uncommon to have a slight amount of bleeding from your nostril on the affected side for several days. Please remember that occasionally a second procedure may be required if there is a persistent sinus communication.

Post-Operative Instructions for Socket Grafting (Preservation)

In addition to the above instructions, it is important to remember a few additional points if you have received a graft within the socket site after we removed your tooth.

The bone graft is made up of many fine particles. You may find some small granules in your mouth for the first several days. Do not be alarmed by the presence of these small granules. It is completely normal for some granules to become dislodged from the graft site, but there are some things you can do to minimize the amount of granules which become dislodged:

• Do not rinse vigorously or spit for the first 3 to 5 days
• Do not apply pressure with your tongue or fingers to the grafted area. The material is movable during the initial phases of healing and it is best to leave the area undisturbed as much as possible.
• Do not lift or pull your lip back to look at the sutures. This pulling or stretching can damage the wound, tear sutures and decrease the success of the graft.

On the first day it is best to let the area settled and allow the blood clot to stabilize the graft material. Therefore, do not even rinse your mouth the first day. After the first day you may begin gentle rinsing with warm salt water, but avoid rinsing vigorously and avoid forced spitting.

If you have had a sinus grafting performed, either separately or in conjunction with implant placement, it is important to remember the following important points:

• Do not blow your nose
• If you must sneeze, do so with your mouth open to avoid any unnecessary pressure within the sinus
• Do not smoke. Smoking tremendously impairs wound healing, especially within the sinus
• Do not drink liquids through a straw
• Do not lift or pull your lip up to look at the stitches. Pulling around the area may actually damage and tear the stitches.
• Please take all the antibiotics prescribed.
• You may experience a slight nose bleed. This is not uncommon and should pass quickly.
• If you feel congested, you may need to use antihistamines or decongestants. Most of the time these medications are not necessary, but please call if you feel congested so we can recommend appropriate medications if needed.

If you have had implants placed, please remember the following important points in addition to the general instructions described above:

• If a one-stage implant was placed so that you can actually see the metal part of the implant protruding through the gum tissue, it is very important to keep this area clean. Please gently cleanse the area with a Q-tip dipped in Listerine or warm salt water. Just clean the metal part protruding through the tissue. After the soreness subsides, begin cleaning the implant top with a soft toothbrush.
• Avoid chewing food over the implant sites. Chewing forces during the healing process can decrease your body’s ability to heal around the implant, which could cause the implant not to “fuse”, or integrate, to your jaw bone.