Surgical Instructions

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Looking for more information on your pre and post surgery care? Use the various resources below to read up on tips or download detailed instructions regarding your oral surgical procedure.

Before IV Sedation

  • Do not eat or drink for at least eight hours before your procedure, including water.
  • Consult your doctor if you take any routine oral medications for instructions on what to do on the date of your surgery.
  • Please let our office know if you are experiencing any symptoms of illness such as a sore throat, cold symptoms, or upset stomach.
  • Do not smoke for at least twelve hours before your procedure; if you are able to cease smoking earlier, do so.
  • Make sure that a responsible adult is able to accompany you to the procedure, stay in the office for the duration of the surgery, and drive you home.
  • Keep in mind that you should not operate a motor vehicle or any machinery for at least 24 hours after anesthesia.
  • Wear loose, comfortable clothes and low-heeled shoes. Make sure your sleeve can be raised past your elbow for anesthetic administration.
  • On the day of surgery, refrain from wearing heavy makeup, in particular lipstick or nail polish.
  • Ensure that jewelry, contacts, dentures, and other items are removed before the procedure.

DENTAL IMPLANT SURGERY

Following Dental Implant Placement

Avoid touching or disturbing the area in any way, including spitting and rinsing, after your implant placement procedure. Keep in mind that a metal healing abutment will protrude through the gum tissue at the surgical site.

Bleeding

It’s normal for some redness and/or bleeding to be present in your saliva for up to a day following surgery. If you’re experiencing excessive bleeding, you may bite down on a gauze pad placed over the wound for half an hour. If this does not mitigate the problem, call our office for assistance.

Swelling

It’s also normal to experience swelling following your procedure, and this can be minimized by applying ice to the cheek around the area. You can accomplish this with an ice bag or simply a towel or plastic bag filled with ice, and keeping the ice applied as consistently as possible within the first 36 hours of surgery.

Food & Drink

It’s important to consume lots of fluids after surgery, but make sure to avoid any hot liquids or food. You should follow a soft diet on the day of the surgery, but you may return to a normal diet as soon as you are able unless instructed otherwise.

Pain Management

Pain medication may be used once the local anesthetic begins to wear off, and for moderate pain over-the-counter treatments like acetaminophen or ibuprofen may be used every few hours according to instructions. Do not take both medications at once. For patients who are minors, check with our office for the best course of action.

If your pain is more severe and over-the-counter painkillers are insufficient, take your prescribed pain medication as instructed. Do not take any medication your doctor has instructed you not to take, or that you are allergic to. While taking these medications, avoid driving or operating machinery, as well as drinking alcohol. Your pain should gradually reduce over the course of each day, but if you find that your pain is continuous, contact us.

Antibiotics

If you have been prescribed antibiotics to prevent infection of the surgical site, make sure that you take the medication as instructed.

Oral Hygiene

In order for you to heal successfully, you must maintain proper oral hygiene. Before bed on the night following your surgery, use the oral rinse you have been prescribed – after which you will use the rinse twice daily, once following breakfast and before sleep. Rinse for a minimum of thirty seconds before spitting. Combine one teaspoon of salt in one cup of warm water, and use this salt rinse four to five times daily including after eating. It’s important that you brush your teeth with any healing abutments, but ensure that you are gentle during the healing process.

Activity

Because exercise can lead to pain, swelling, or bleeding, it’s important to refrain from physical activity or exertion as much as possible after your procedure. As you start to recover, make sure to monitor your physical activity for any of these symptoms. Because your food consumption may be restricted, you may also feel weak.

Prostheses

In your pre-op consultation, you will be instructed to refrain from using any full or partial dentures, as well as dental flippers, for a minimum of ten days after surgery.

WISDOM TOOTH REMOVAL

Following Wisdom Tooth Extraction

As with the removal of any impacted tooth, wisdom tooth extraction is a serious procedure that necessitates consistent hygiene and care practices. Heeding these instructions carefully will help to ensure that additional complications and discomfort are avoided.

Immediately After Your Surgery

  • A gauze pad will be placed on the surgical site and should be left in place for thirty minutes. Once this thirty minutes is up, the gauze should be disposed of.
  • As the local anesthetic wears off, you will start to feel some discomfort, at which point you should begin taking any prescribed pain medication.
  • Refrain from touching or irritating the area in any way, such as through aggressive mouth rinsing. It’s essential that the blood clot that has formed at the extraction site is left undisturbed for optimal healing and minimized bleeding.
  • Hold ice packs on either side of the face at the surgical area. For more information, consult the section on swelling.
  • Refrain from physical activity or exertion on the day of your procedure. When you begin to recover, you may resume your day-to-day activities at a rate that is comfortable to you.

Bleeding

It’s normal to experience some bleeding after your procedure, as is some amount of oozing or redness in your saliva. To control excessive bleeding, you may first wipe or rinse any old clots out of your mouth, before placing a gauze pad over the site and biting down for half an hour. If needed, this process can be repeated. You may also bite down on a moistened bag of black tea for half an hour should bleeding continue, as the tannic acid in black tea aids in blood clotting. Refrain from exertion or becoming excited, and try to lie down as much as possible, to minimize additional bleeding. If bleeding continues extensively, call our office for assistance.

Swelling

Swelling is also a normal part of any extraction procedure, including wisdom tooth removal. You may experience swelling around the surgical sites, as well as the cheeks, mouth, sides of face, and even around the eyes. This is normal, and will typically arise the day after your procedure and peak within two to three days after surgery. Swelling can be managed by applying ice, be it with ice packs or with two plastic bags filled with ice, to the sides of the face at the surgical site. Apply ice as consistently as possible for the first thirty-six hours following surgery. It’s normal for stiffness and swelling to continue for several days, although after the first thirty-six hours it is more beneficial to apply moist heat to the area.

Pain

Pain medication may be used once the local anesthetic begins to wear off, and for moderate pain over-the-counter treatments like acetaminophen or ibuprofen may be used every few hours according to instructions. One to two tablets of Tylenol may be taken every three to four hours, and ibuprofen such as Motrin or Advil may be taken in doses of two to three tablets four times a day. Do not take more than 3200mg within a 24-hour period. Do not take both medications at once. For patients who are minors, check with our office for the best course of action.

If your pain is more severe and over-the-counter painkillers are insufficient, take your prescribed pain medication as instructed. Do not take any medication your doctor has instructed you not to take, or that you are allergic to. While taking these medications, avoid driving or operating machinery, as well as drinking alcohol. Your pain should gradually reduce over the course of each day, but if you find that your pain is continuous, contact us.

Food & Drink

Immediately after anesthesia, it’s important to only consume liquids. Do not use straws, as the sucking motion can dislodge the blood clot in the extraction site and exacerbate bleeding. Once you begin eating, begin with soft food and chew away from the surgical site. Ensure that you’re taking in foods regularly that are protein-rich and calorie-dense. However, because your consumption will still be limited, make sure to compensate by drinking plenty of liquids (ideally five to six glasses per day.) The more you eat, the stronger and more comfortable you will feel during the healing process.

WARNING: It’s important to note that dizziness may result from sitting or standing up quickly from a lying position– sit up slowly, and wait at least one minute before standing.

Hygiene

Do not rinse your mouth until the day after your procedure. After the first day, rinse several times a day (ideally five to six times and particularly after a meal) with one teaspoon of salt mixed with one cup of warm water.

Discoloration

It is not unusual for skin discoloration to accompany swelling. Blue, green, black, or yellow discoloration is a normal occurrence following an extraction, and typically occurs a few days after surgery. To assist in the treatment of discoloration, moist heat can be applied.

Antibiotics

If you have been prescribed antibiotics to prevent infection of the surgical site, make sure that you take the prescribed antibiotics as instructed, as this will help prevent any infection of the surgical site. If you experience any negative reactions to the antibiotic treatment, such as the appearance of a rash, call us and let us know as soon as possible. You may also call our office with any other questions you might have regarding your antibiotic regimen.

Nausea

If you experience nausea or vomiting after your procedure, avoid taking anything by mouth for one hour. After this you should sip on tea, ginger ale, or cola slowly over the course of fifteen minutes. When you are no longer feeling nauseous you may resume eating and taking your medication as needed.

Additional Complications

  • Some numbness of the tongue, lip, or chin is normal and temporary, although it should be noted that there may be risk of accidentally biting the tongue as a result. If you have any concerns, feel free to contact our office.
  • It’s not unusual to feel discomfort when swallowing or a general soreness of the throat. This is due to muscle swelling, and will go away within a few days.
  • You may occasionally feel the bony walls which supported the wisdom teeth, and while they can feel sharp, they will typically smooth out naturally. These can also be removed, however, if they do not.
  • Although a slight fever is common and can be reduced by taking medications such as acetaminophen or ibuprofen, call and let us know if you experience a persistent elevated temperature.
  • Make sure to sit up for one minute before standing when moving from a lying down position, as you may be more prone to lightheadedness and dizziness due to medications and reduced food intake.
  • Make sure to keep your lips moisturized during the healing process, as the corners of your mouth may be more prone to dryness and cracking when stretched.
  • You may also experience a stiffness in your jaw muscles, known as trismus. This is not unusual, and it will resolve as you heal.

Takeaways

To aid the healing process and limit bleeding, sutures will be placed on the extraction site. Sometimes these sutures may dislodge, which is normal. Simply discard the dislodged suture. About a week following surgery, the sutures will be removed. This is a quick and painless process which requires no anesthesia and is not uncomfortable.

With each day after your procedure, the pain and swelling will reduce. However, if you find that you are experiencing unusual symptoms or your swelling and discomfort becomes worse, please contact us for assistance.

Over the next month, the cavity where the tooth once resided will fill with new tissue. During this time be sure to keep the area clean by rinsing with saltwater or gently using a toothbrush, particularly after eating.

Because every case is different, be sure to let your doctors know about any problems or questions you might have, so that Drs. Ganoe, Gray, Griffeth, or Ludwig can best help you.

Be sure to brush gently while the area is healing.

In some cases, a blood clot will be prematurely dislodge from the socket. This is known as a dry socket. You may also experience pain at the site or close to your ear two to three days after your procedure. If this happens, please contact our office.

EXPOSURE OF AN IMPACTED TOOTH

Following Exposure of an Impacted Tooth

Be sure to leave the wound alone so as to avoid irritating the site. Do not touch or move any surgical packing that was placed at the site, as this helps to maintain the tooth’s exposure. If the packing dislodges make sure to call us for further assistance, although this is not cause for alarm.

Bleeding

Some redness and/or bleeding is expected to be present in your saliva for up to a day following surgery. If you’re experiencing excessive bleeding, you may bite down on a gauze pad placed over the wound for half an hour. If this does not mitigate the problem, call our office for assistance.

Swelling

You may experience swelling following your procedure, and this can be minimized by applying ice to the cheek around the area. You can accomplish this with an ice bag or simply a towel or plastic bag filled with ice, and keeping the ice applied as consistently as possible within the first 36 hours of surgery.

Food & Drink

Be sure to consume lots of fluids after surgery, but refrain from consuming any hot liquids or food. You should follow a soft diet on the day of the surgery, but you may return to a normal diet as soon as you are able unless instructed otherwise.

Pain

Pain medication may be used once the local anesthetic begins to wear off, and for moderate pain over-the-counter treatments like acetaminophen or ibuprofen may be used every few hours according to instructions. One to two tablets of Tylenol may be taken every three to four hours, and ibuprofen such as Motrin or Advil may be taken in doses of two to three tablets four times a day. Do not take more than 3200mg within a 24-hour period. Do not take both medications at once. For patients who are minors, check with our office for the best course of action.

If your pain is more severe and over-the-counter painkillers are insufficient, take your prescribed pain medication as instructed. Do not take any medication your doctor has instructed you not to take, or that you are allergic to. While taking these medications, avoid driving or operating machinery, as well as drinking alcohol. Your pain should gradually reduce over the course of each day, but if you find that your pain is continuous, contact us.

Hygiene

Starting the first day after your surgery, be sure to clean your mouth after each meal. If you are able, brush your teeth as you normally would. Mix with one teaspoon of salt mixed with one cup of warm water, and use this salt rinse six times daily until the healing process has finished. The cleaner you are able to keep the area, the faster the wound will heal.

Activity

Because exercise can lead to pain, swelling, or bleeding, refrain from physical activity or exertion as much as possible after your procedure. As you start to recover, make sure to monitor your physical activity for any of these symptoms. It’s important to note that you may also feel weak due to reduced food intake.

Following Tooth Extraction

In order for the healing process to begin and for bleeding to stop, a blood clot must first form in the tooth socket. To help with this process, bite on a gauze pad for about half an hour immediately following your tooth extraction procedure. If this does not stop bleeding or oozing, bite down on fresh gauze for another thirty minutes. To fully stop the bleeding, you may have to repeat this process several times.

Once this clot forms, be careful not to dislodge it. Refrain from using straws, drinking alcohol, smoking, or brushing your teeth for 72 hours, as any of these actions may interrupt the healing process by disturbing the blood clot. It’s important that you also refrain from vigorous exercise for at least a day following surgery, as this can increase bleeding.

To help reduce some of the pain and swelling that can follow a tooth extraction, apply ice (whether via an ice pack, a plastic bag filled with ice, or a bag of unopened frozen produce) to the area and take your prescribed pain medications as directed. After the first two days, swelling typically reduces.

If your pain medication does not treat your discomfort, let our office know as soon as possible. Continue to take any antibiotics for the prescribed amount of time regardless of whether you are still experiencing symptoms of infection. Drink plenty of fluids and eat a soft, nutrient-dense diet on the first day following surgery. Once you are comfortable doing so, you may resume a normal diet.

After 24 hours, resume your standard dental hygiene routine, including brushing and flossing at least once per day. Maintaining good oral hygiene will ensure that the healing process occurs as quickly as possible.

Within a few days’ time, you should begin to feel well again and may go about your typical day-to-day activities again. If your discomfort or symptoms such as bleeding and swelling continue or worsen after two to three days, please contact us as soon as possible.

MULTIPLE EXTRACTIONS

Following the Extraction of Multiple Teeth

Following the Extraction of Multiple Teeth

Some bleeding is normal after an extraction procedure. Should you experience bleeding, bite down on a gauze pad for half an hour. If this does not staunch the bleeding, you may bite down on a moist black tea bag, as the tannic acid contained in the tea helps to promote clot formation. Refrain from exercise, elevation of the head, and hot liquids in the event of bleeding. Should the bleeding continue, contact us as soon as possible. Unless you are experiencing severe bleeding, do not remove the immediate denture. It’s normal for some oozing to occur around the side of the denture, as well.

Apply ice packs to the area on the outside of your cheek continuously while you are awake for the first 36 hours following your surgery.

Over-the-counter pain medications such as acetaminophen or ibuprofen may be taken to treat discomfort. Tylenol may be taken in doses of two tablets every three to four hours, whereas two to three tablets of ibuprofen medications like Motrin or Advil may be taken every three to four hours. For more severe pain, take the pain medication that has been prescribed to you. If your pain is not reduced after two days or increases after this time, please contact us. Unless you experience an allergic reaction, be sure to finish your antibiotic prescription completely.

Especially if you have had many teeth removed, it’s important to drink lots of fluid to recover from blood loss. You should drink a minimum of six glasses of liquid on the first day following your procedure.

On the first day following surgery, do not rinse your mouth. Once this time period has passed, begin rinsing your mouth using a warm salt water rinse every four hours and after eating. This rinse can be made with one cup of warm water and one teaspoon of salt. After your dentist has conducted a denture adjustment, remove the denture and rinse three to four times a day.

Immediately following surgery, stick to a diet of soft foods and liquids. Once healing is underway, you can return to your normal diet as soon as you are comfortable.

Having many teeth removed in one surgery is a much different process than having only one or two teeth extracted. The bone must be smoothed and shaped before a denture can be inserted, and as a result you may experience the following symptoms:

  • The area(s) of the extractions will swell. This swelling will reach its peak in about two days following surgery. You may also experience swelling in the eye area, as well as some discoloration. To reduce the discoloration, apply a warm, moist towel to the area. This should be applied after the first 36 hours following surgery, as ice packs are only useful prior to that time frame.
  • Swelling may also cause a sore throat, as the throat muscles are close to the surgical site. After two to three days, the pain should reduce.
  • Dryness and cracking of the lips may occur. To prevent this, use an ointment such as Vaseline to keep your lips moist.
  • You might find that your temperature is elevated during the first day or two following surgery. This is normal, but if the temperature persists, please let us know.

You may develop sore spots if immediate dentures have been inserted. Your dentist will typically make any needed adjustments 24 to 48 hours after your procedure and relieve any discomfort. It’s important to see your dentist in this time period, as these sores can become more severe and delay healing.

JAW SURGERY

Following Jaw Surgery

Following Jaw Surgery

What you may need at home:

  • Saline (Dissolve 1 teaspoon of salt in 8 ounces of water)
  • Child size toothbrush/Waterpik
  • Scissors/wire cutter (for cutting elastics or wires depending on what is holding the jaw closed)
  • Vaseline or lip balm
  • Blender

 

Medications: 

You will be prescribed a pain medication and antibiotic upon discharge. These medications may be in liquid or pill form. If given a liquid medication then use the syringe provided by the pharmacy to measure and administer. If given a pill then you may crush the pill and mix it with a small amount of water or juice. Please take medications as prescribed by the doctor. We recommend that you take an over the counter non-steroidal anti-inflammatory such as Ibuprofen, Motrin or Advil. Take 600 mg every 6 hours for the first week to help reduce pain and swelling. Please remember that most narcotic pain medication already have Tylenol in it, so do not take any extra Tylenol as this may cause serious issues. For patients that have had an upper jaw surgery nasal decongestants, expectorants or nasal sprays may be used to help with any difficulty breathing through your nostrils. A humidifier or frequent warm showers may also help aid in congestion.

 

Swelling: 

Expect significant swelling. Swelling will maximize during the first week then should start to diminish. It is beneficial to use ice/ice packs/frozen peas wrapped in a towel and applied to the cheeks for a period of 20-30 minutes at a time. Ice should be used for the first 48-72 hours. It takes approximately two weeks for the majority of swelling to disappear. If any there is an increase in swelling and pain after 10-14 days then that could indicate an infection, which may require treatment. Should this happen, please contact the doctor. Bruising may also occur with swelling. The bruising should dissipate as swelling subsides. The bruising may travel in the skin and change in color. This is normal and will resolve in 2 weeks.

 

Bleeding: 

Minor oozing from the incisions made inside the mouth should be expected for the first 72 hours. Upper jaw surgeries usually experience some minor trickling of blood through the nose. Nasal sprays and decongestants will help with this. Dark blood clots may be coughed up or expressed through the nose toward the end of the first week for upper jaw surgeries. If in any case there is a gush of bright red blood from any incisions or the nose then contact the doctor.

 

Numbness: 

Numbness to the face and jaw depending on the surgery that was done is normal. This may persist for weeks, sometimes months. This will be monitored by your doctor during your office visits.

 

Oral Hygiene: 

It is very important to keep your mouth and teeth clean following surgery. Gentle rinsing and spiting with salt water or prescribed Peridex oral rinse should be done the first week. Then a Waterpik can be used to aid in cleaning. Use a child toothbrush to brush the outsides of your teeth. If you are wired or have elastics then you will not be able to brush the tongue side of your teeth.

 

Nausea: 

Avoid any foods that may cause your stomach to become upset. If you do that you are going to vomit then you should:

  • Bend forward
  • Put your finger inside your cheek alongside the teeth and gently pull your cheek outward.
  • Remember that everything that you are ingesting is liquid, therefore if anything comes out it will also be liquid. Vomit can escape around the teeth and out the side of the cheek. Try not to cut the wires or elastics if at all possible.
  • Anti-nausea medication can be prescribed if necessary.

 

Diet: 

It is essential that your body receives adequate fluids and nourishment in order to promote healing. You will be limited to a liquid diet for 4-6 weeks. Suggestions for a full liquid diet include: milk shakes, smoothies, Jell-O, blended foods, ensure and protein shakes. The doctor will instruct you as to when you can resume a soft diet. Avoid alcohol, sugary and carbonated drinks.

POST OPERATIVE INSTRUCTIONS

Post Operative Instructions

Proper post-op care is essential to a speedy and successful recovery. It’s normal to experience stiffness, swelling, and some bleeding and pain following your procedure. It is advised that you have a responsible adult to assist you for the first day after surgery. Below are the instructions to follow after the operation, as well as information on symptoms and phenomena you may experience.

1. Bleeding

A gauze pad will be placed over the site to protect the wound and reduce bleeding by aiding the formation of a blood clot. While some oozing of blood is normal, you can mitigate this by gently applying pressure to the gauze. Do not change out the gauze until roughly twenty to thirty minutes have passed, and bleeding can be controlled by ensuring that pressure is applied for two to three hours. Rest and refraining from talking and physical exertion will also help to control bleeding. If you find that you are experiencing excessive or persistent bleeding, contact us as soon as possible.

2. Pain

You will be given a prescription for appropriate pain medication if needed, which can be filled at any drugstore. Use this medication only as directed. It’s recommended that you begin taking this medication within the first hour following the procedure, preferably with a carbonated beverage such as 7-Up to limit the risk of nausea.

3. Nausea

Because pain medication can sometimes increase nausea, it’s important to only take your medication with something in your stomach. To relieve nausea following your procedure, drink one ounce of a carbonated drink such as 7-Up or ginger ale every five to six hours. You can follow this with mild tea, broths, or soft foods before you are able to eat a normal diet.

4. Swelling

Stiffness and swelling are normal, and will increase within the first three days before beginning to subside. To mitigate swelling, you can elevate your head with a few pillows while resting in bed or a reclining chair. You may also treat swelling using both ice and heat:

  • ICE: For the first day or two following surgery, apply ice to the cheeks for twenty minutes at a time. Remove the ice for twenty minutes and repeat.
  • HEAT: Beginning on the third day after your procedure, apply warm, moist heat to treat stiffness and swelling. You may also chew gum and engage in light stretching beginning the day after surgery to deal with stiffness.

5. Food & Drink

On the first day after surgery, a liquid diet is best, but refrain from using a straw during the first 24 hours so as not to disturb the blood clot. After the first day, you may begin returning to a normal diet as soon as you are able with the help of soft foods.

6. Hygiene

Do not brush your teeth, rinse, or spit on the day of surgery. Refrain from using a Waterpik device. After the first day, warm salt water rinses are recommended, as is careful brushing.

7. Activities

Avoid physical exertion as much as possible during the first 24 hours after surgery. Make sure to rest with your head elevated for two to three days. Do not smoke for at least three days after your surgery, and do not engage in any vigorous physical activity until swelling has resolved and pain has subsided. Contact sports should be avoided for roughly one week. Do not play any musical wind instruments within the first week to ten days.

8. Bruising

It is normal for some bruising to occur on the face for a few days following surgery.

9. Numbness

Do not be alarmed if you experience some numbness in the chin, lower lip, or lower teeth on the side of your surgical site. Tooth extraction can sometimes affect the nerve, but this is usually temporary. If the numbness continues for more than one week, however, please call us for assistance.

10. Odor and Taste

If you experience a bad odor or taste following surgery, this is typically a result of improper cleaning. In addition to brushing and rinsing, you may also use mouthwash.

11. Additional Complications

While dry sockets are not common, be sure to contact our office if you are experiencing persistent pain that is unresponsive to medication, as this may be a symptom. You may also face some difficulty moving your jaws or swallowing, which is usually not cause for concern. If you experience an increase in swelling after five to seven days, please give us a call.

If you are using oral contraceptives, you should be aware that antibiotic use can reduce the effectiveness of birth control pills. Be sure to utilize a secondary means of contraception during your antibiotic regimen, and for the rest of the menstrual cycle affected by this antibiotic use.

12. Emergencies

Contact our office immediately if you have any trouble breathing, excessive bleeding, fever, or any other unusual symptoms after your procedure We have a 24-hour answering service for any after hour emergency communication.

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