Canterbury Oral & Maxillofacial Surgery

Pre Operative Instructions for Intravenous Anesthesia

• Do not eat or drink anything six (6) hours prior to the appointment.  
• Must have a responsible adult accompany patient to the office and remain in the office  for the duration of 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.
• Wear loose fitting clothing with sleeves that can be rolled up past the elbow.  Contact lenses, jewelry, and dentures must be removed at the time of surgery.
• Do not wear dark fingernail polish.

Post-Operative Instructions & Information Concerning Extractions and Oral Surgery

PLEASE READ THESE INSTRUCTIONS CAREFULLY.  Sometimes the after-effects of oral surgery are quite minimal, so not all of these instructions may apply.  Common sense will often dictate what you should do.  However, when in doubt, follow these guidelines or call our office any time for clarification.  (785-628-1079)

DAY OF SURGERY

FIRST HOUR
Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place.  Do not change them for the first hour unless the bleeding is not being controlled.  After the first hour remove the gauze packs and take your first dose of pain medication.  This should be taken with water only.  (The prescription may say “take with food”.  This is not advisable for the first dose since you will still be numb from the local anesthetic.)  Place a new gauze pack over the surgical sites and maintain gentle pressure for the next 5 hours.  You may place fresh packs every two hours during that time since they will become damp and uncomfortable.  DO NOT spit or remove the gauze packs frequently.  This will disrupt the blood clots in the surgical areas and promote increased bleeding.

SPECIAL CARE
Do not disturb the surgical areas today.  DO NOT rinse vigorously or probe the area with any objects or your fingers.  DO NOT smoke for at least 48 hours, since this is very detrimental to healing.  After the local anesthetic has worn off you should begin drinking clear fluids or ice chips.  If you tolerate this well you may begin taking other fluids and soft foods after 3 hours.   DO NOT use straws as the sucking motion causes more bleeding.  DO NOT blow your nose for several days following the removal of upper molar teeth.  If an immediate denture has been placed, do not remove it for the first 24 hours or until you see your general dentist.

BLEEDING
Intermittent bleeding or oozing is normal.  This should be controlled by placing fresh gauze over the surgical areas and biting down firmly for 30-60 minutes.  Bleeding should never be severe.  If it is, it usually means the packs are being clenched between your teeth rather than exerting pressure on the surgical areas.  Try repositioning fresh packs.  If bleeding persists or becomes heavy you may substitute a tea bag (soaked in hot water, squeezed damp-dry) for 20 to 30 minutes.  Activity also encourages bleeding.  It is important for you to lie down, rest and remain inactive for the first 24 hours.  If bleeding remains uncontrolled, please call our office.

PAIN
Unfortunately most oral surgery is accompanied by some degree of discomfort.  You will usually be given a prescription for pain medication, and if you take the first pill before the local anesthetic has worn off, you will be able to manage discomfort better.  Effects of pain medicines vary widely among individuals.  If you do not achieve adequate relief, you may supplement with an analgesic such as aspirin or acetaminophen (Tylenol).  Remember that the most severe discomfort is usually within the first six hours after the anesthetic wears off.  The pain medication should be taken routinely for the first two days and as needed after that.

SWELLING
Often there is some swelling associated with oral surgery.  You can minimize this by using a cold pack or ice bag wrapped in a towel and applied firmly to the face adjacent to the surgical areas.  This should be applied 20 minutes on and 20 minutes off during the first 12 to 24 hours after surgery.  After 24 hours, it is usually best to switch from ice to moist heat to the same areas.

NAUSEA
Nausea is not an uncommon event after surgery, and is sometimes caused by pain medicines.  Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with a large volume of water.  Try to keep taking clear fluids and minimize the pain medication, but call us if repeated vomiting is a problem.  Cola drinks that have less carbonation may help with nausea.

DIET
It is advisable to confine the first day’s intake to bland liquids or pureed foods (fruit juice, soups, puddings, yogurt, milk shakes, etc.).  Temperature of the food doesn’t matter, but avoid extremely hot foods.  Eat any nourishing foods that can be taken with comfort.  Over the next several days you can progress to solid foods at your own pace.  It is important not to skip meals.  If you take nourishment regularly, you will feel better, gain strength, and have less discomfort and heal faster.

Plan to rest at home for the remainder of the day.  During the next few days, don’t plan on driving, drinking alcohol, or operating any kind of machinery; you will be drowsy from the pain medication, and anesthetic drugs.
 
INSTRUCTIONS FOR THE SECOND AND THIRD DAYS

MOUTH RINSES
Keeping your mouth clean after surgery is essential.  Use an antiseptic mouth rinse (Scope or Cepacol) or warm salt water (1/2-teaspoon salt to 8-oz water).  Gently rinse with portions of the solution, taking five minutes to use the entire glassful.  Repeat as often as you like, but at least two or three times daily for the next five days.

BRUSHING
Begin your normal oral hygiene routine the day following surgery.  Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.

HOT APPLICATIONS
Apply warm compresses to the skin overlying areas of swelling (hot water bottle, moist hot towels or heating pad) for 20 minutes on and 20 minutes off to help soothe those tender areas.  This will help decrease swelling and stiffness.

SHARP EDGES
If you feel sharp edges in the surgical areas with your tongue it is probably the bony walls which originally supported the teeth.  Occasionally small slivers of bone may work themselves out during the first week or two after surgery.  They are not pieces of tooth and, if necessary, we will remove them.  Call the office if you are concerned.

PHYSICAL ACTIVITY
Generally normal physical activity can be resumed after the third day.  Rigorous and competitive sports should be avoided for up to one week.  Use common sense.  If you feel weak, have an increase in pain, swelling or bleeding give yourself an additional day or two of rest.

OTHER SYMPTOMS
Numbness:  This sometimes follows removal of lower impacted teeth and is in most cases temporary, lasting from a few days to months.

Sympathetic pain: Teeth near the one extracted may ache for several days following surgery.  Sore throat and earache are in the same category.

Sore at corner of mouth: This occurs as a result of stretching.  Clean the areas with hydrogen peroxide applied with gauze.  Apply Vaseline to keep the areas from drying out.
Discoloration: (“black & blue marks”) These are a result of bleeding beneath the skin and are of no consequence.  Generally these areas appear a day or two following surgery and last several days.

It is our desire that your recovery be as smooth and pleasant as possible.  If you do not see steady improvement during the first few days after surgery, don’t suffer needlessly.  Call the office  (785-628-1079) and report symptoms or if you have questions about your progress.  A 24-hour answering service is available after office hours to contact the doctor.

Home Care Instructions following Oral Surgery:


DO apply pressure to stop the bleeding by placing gauze directly over the extraction site.

DO apply ice packs to your face to reduce swelling the day of surgery.

DO eat soft foods, such as soups and blenderized meals, after the bleeding stops.

DO drink lots of fluid after the bleeding stops.

DO take pain medication and antibiotics as prescribed.

DON’T rinse your mouth or spit the day of surgery; it could loosen the blood clot.

DON’T drink through a straw.

DON’T brush the teeth in the area of surgery until the day after surgery.

DON’T chew hard or “crunchy” foods in the area of surgery for at least one week.

DON’T smoke for at least 48 hours.

DON’T overexert yourself.