Surgical Instructions

Preoperative Surgical Instructions

• Patients may not have anything to eat or drink for eight hours prior to the surgical appointment.
• Patients may not smoke at least 12 hours before surgery. Ideally, patients should stop smoking two weeks or longer prior to the day of surgery.
• Patients may not drink any alcoholic beverages 24 hours prior to their 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.
• Patients should 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. Patients should bring their eyeglasses and a contact lens case to their appointment, or wear their eyeglasses to the surgical appointment.
• Patients should not wear lipstick, excessive makeup, or nail polish on the day of surgery.
• If a patient has an illness such as a cold, the flu, bronchitis, sore throat, stomach or upset bowel, please notify our office.
• If routine oral medications are taken, please check with our office prior to the surgical date for instructions. Many medications may still be taken with a sip of water.

Immediately Following Oral Surgery

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if these instructions are followed carefully.

The gauze pad placed over the surgical area should be kept in place for 30 to 45 minutes. After this time, the gauze pad should be removed and discarded.

Mouth rinsing or touching the wound area following surgery should be avoided. This may cause bleeding by disturbing the beneficial blood clot.

Take the recommended and/or prescribed pain medications as directed before the numbness subsides.

Place ice packs to the sides of the face where surgery was performed. Refer to the section on Swelling for an explanation.

Activity

It is not necessary to go home and go to bed, but patients should go home without stopping for activities, restaurant meals, or shopping beyond picking up prescriptions. Quiet activities at home such as reading, watching television, or sitting at a computer are recommended. Minimal talking, especially while the gauze pads are in place, is recommended. We usually recommend waiting about 72 hours before resuming aerobic exercise and weight training.

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 wiping any old clots from the mouth, then placing a gauze pad over the area and biting firmly for 30 minutes while sitting upright. Repeat if necessary. If bleeding continues, sit upright and bite on a moistened dark tea bag for 30 minutes over the surgical site. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, avoid rinsing, spitting, talking, chewing on the pack, and exercising. 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 and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until three to four days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice or ice packs should be applied to the sides of the face where surgery was performed. After 48 hours, ice has no beneficial effect. 48 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

If swelling occurs that is hard, painful, and increasing after three to four days, or is accompanied by fever, please contact our office.

Pain

For moderate pain, our surgeon may recommend an over-the-counter medication.

For severe pain, take the medication prescribed as directed. Most prescription pain medications will cause grogginess and slow down reflexes. Do not drive an automobile, climb ladders, or work around machinery. Avoid alcoholic beverages. If pain persists, it may require attention please call our office if this occurs.

Diet

Drink plenty of liquids after general anesthesia or intravenous sedation to avoid dehydration. Do not use straws or suck from a sport-top drink bottle for three to four days after surgery. The sucking motion can cause more bleeding by dislodging the blood clot. We recommend a non-chew diet for the remainder of the day following surgery. Some examples include, yogurt, soup, smoothies, ice cream, and milk shakes. Ensure, Boost, or Carnation Instant Breakfast Essentials can be an excellent supplement. Adequate fluid and nutrient intake can promote optimum healing. The day after surgery soft foods may be eaten. Try not to miss a single meal. Patients who eat meals accordingly will feel better, have more strength, have less discomfort, and heal faster.

CAUTION: Sitting up or standing from a lying position may cause dizziness. Following surgery, make sure to sit for one minute before standing.

Keep The Mouth Clean

No rinsing of any kind should be performed until the day following surgery. Teeth can be brushed the morning after surgery, but rinse gently. Either a sonic toothbrush or manual toothbrush can be used. Do not use a Waterpik for at least three weeks after wisdom tooth removal or any other oral surgery.

The day after surgery begin rinsing at least three times daily for one week with a cup of warm water mixed with a half teaspoon of salt, especially after eating.

Discoloration

In some cases, discoloration 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 postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If antibiotics are prescribed, take the prescription as directed. Discontinue the antibiotic use in the event of a rash, diarrhea or other unfavorable reaction and notify our office.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take any solids by mouth for at least an hour. Small amounts of water or carbonated beverages may be sipped slowly over a 15-minute period. When the nausea subsides, solid foods may be consumed.

Other Concerns

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. This is usually temporary in nature. Be aware that numbiness in the lip or tongue could result in biting of the lip or tongue and not having the ability to feel the sensation. Call our office for any questions.
• A slight elevation of temperature immediately following surgery is not uncommon. If the elevated temperature persists, notify our office.
• Caution should be taken going from the lying down position to standing. Taking pain medications may cause dizziness. Feeling light headed could result from suddenly standing up. To prevent this from happening, before standing up, sit for one minute and then get up.
• Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls, which supported the tooth. These projections usually smooth out spontaneously. If not, they can be evaluated at a follow-up appointment.
• If the corners of the mouth are stretched, they may dry out and crack. Lips should be kept moist with an ointment such as lip balm or Vaseline.
• Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in two to three days.
• Stiffness (trismus) of the jaw muscles may cause difficulty in opening the mouth for a few days following surgery. This is a normal post-operative event that will resolve in time.
• The molars (back teeth) may feel sore when beginning to chew normal foods. A softer diet may keep patients more comfortable until this normal healing reaction subsides.

Sutures

Sutures (stitches) are placed in the area of surgery to stabilize gum tissue, minimize post-operative bleeding, and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture and discard it. Most sutures used in our office are the dissolving type.

After surgery, the peak days of pain and swelling occur on day three and four and should subside more and more each day. If post-operative pain or swelling worsens after peak days or unusual symptoms occur, call our office.

There will be an empty spot where the tooth was removed. This area will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean especially after meals with salt-water rinses or a toothbrush.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur three to six days following surgery. Call our office if this occurs.

Regular exercise, specifically a light workout, may be resumed after 72 hours.

Every patient case is individual. No two mouths are alike. Do not accept well-intended advice from others. Discuss any problems with the people best able to effectively help: our office or the patient’s family dentist.