Post-operative Instructions

Introduction

This section will allow you to review instructions to prepare for surgery and anesthesia. These preoperative instructions will be reviewed at your consultation visit. The post-operative instructions will be reviewed at your surgical appointment. The following instructions are broken down into special surgical and anesthetic scenarios to help clarify the care necessary for different types of surgery and anesthesia.

To learn more about a procedure of interest please choose a link from the menu below:

• Before I.V. Anesthesia
• Conscious Sedation of "Sleep" Dentistry
• After Implant Surgery
• After Periodontal Surgery
• After Extractions
• After Bone Grafting Procedures

Before I.V. Anesthesia

• Adults may not have anything to eat or drink (including water) for eight (6) hours prior to the surgical appointment. Typically we recommend adults do not drink or eat anything after midnight the night before surgery.
• Children under the age of 14 may not have any solids after midnight the night of surgery, but may have clear liquids up to 3 hours prior to surgery.
• All patients under the age of 18 must be accompanied by a parent or guardian.
• No smoking at least 24 hours before surgery. Ideally, cut down or stop smoking 24 hours prior to the day of surgery and 24 hours after the surgery.
• A responsible adult must accompany the patient to the office and drive the patient home. You should plan to have an adult companion stay with you for the first 2 to 4 hours after surgery.
• The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
• Wear a loose fitting shirt or blouse.
• Contact lenses, jewelry, and dentures must be removed at the time of surgery.
• Do not wear lipstick, excessive makeup, or nail polish on the day of surgery.
• Please give our office a 24 hour cancellation notice. If you feel ill with a cold or respiratory problem, please contact our office as soon as possible so we may advise you about possible cancellation.
• Take all daily medication at the usual time with a sip of water unless instructed otherwise by Dr. Orth and/or staff.

If you have any questions about these instructions or other concerns, please contact our office at (972) 991-9891

Conscious Sedation or “Sleep” Dentistry

We offer conscious sedation to help make treatment more pleasant and comfortable. This important option has eased the minds of many patients and unlocked the benefits of treatment for those who might otherwise have avoided it.

Conscious sedation is a safe, drug-induced state in which the patient is conscious and pleasantly relaxed, yet free of fear and anxiety. Conscious sedation is different than general anesthesia because the patient is still able to respond to simple requests (such as “ please turn your head slightly to the left”). However, during conscious sedation, the patient experiences little or no discomfort and usually does not remember the procedure after it is finished. The use of conscious sedation by an appropriately trained periodontist such as Dr. Orth is safe and effective.

If you're not comfortable, we're not comfortable. It's important you feel relaxed when you receive dental treatment. Please ask Dr. Orth about this service for more information.

Care and Conditions After Placement of Dental Implants

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There may be a metal healing abutment protruding through the gingival (gum) tissue.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a folded gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call our office for further instructions.

Pain

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 4-6 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 6 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.

Antibiotics

Be sure to take the prescribed antibiotics as directed to help prevent infection.

Oral Hygiene

Good oral hygiene is essential to good healing. The day after surgery, is Peridex mouth rinse has been prescribed rinse twice daily, after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out or apply with a Q-Tip type applicator as directed two times daily. Saltwater rinses (teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, in addition to Peridex, especially after meals. Brushing your teeth and the healing abutments is no problem, but be careful brushing and use a small, soft tooth brush.

Activity

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.

Wearing your Prosthesis

Partial dentures, flippers, or full dentures should be worn as directed by Dr. Orth. This was discussed in the pre-operative consultation and will be discussed in the post-operative instructions.

After Periodontal Surgery

See instructions for tooth extractions below.

IMMEDIATE RECOVERY FOR PATIENTS RECEIVING SEDATION:
It usually takes several hours for the drowsiness produced by the sedation to wear off. Do not plan to do anything for the remainder of the day except rest at home. Someone is to accompany you since you will not be allowed to drive yourself home after surgery.

DISCOMFORT:
Following periodontal surgery, there is often some discomfort. Most of this usually occurs during the first 24 to 48 hours and can be alleviated with pain medication. Begin taking pain medication while the surgical site is still anesthetized (numb). Take medication with a milk shake, milk, or fruit juice to prevent nausea; avoid taking any pain medication on an empty stomach. Avoid alcohol while taking medication.

All medications should be taken strictly as prescribed. The interval between taking the medications and the total length of time that you are to remain on your medications has been carefully determined to give you the maximum benefit with the minimum use of drugs. Variation from the prescribed regimen can affect healing and the success of your procedure.

BLEEDING:
You may notice slight bleeding from the surgical site. This type of minor bleeding for one or two days is not unusual and is not a major concern. If at any time you notice the formation of large blood clots or an obvious flow of blood which is more than a slight ooze, notify our office.

SWELLING:
Some slight swelling of the operated area is not unusual and may begin after the surgery. An ice pack may be used to minimize swelling. Ice should be placed in a plastic bag and then wrapped in a towel and applied directly over the surgical area. You should maintain the towel wrapped ice pack in contact with the skin as much as possible for the first 24 hours after surgery. You should also keep your head elevated above the level of your heart during the first 24 hours after surgery. This may necessitate the use of several pillows to support your head and upper body while sleeping. If swelling occurs, it usually disappears after several days. Applying moist heat to the swollen area will help the swelling resolve, however, heat should not be applied until at least 1-2 days after surgery. Any unusual or large swelling should be reported at once.

ORAL HYGIENE:
Continue to brush and floss the teeth which were not involved in the surgery. The surgical area should not be disturbed for the first week post operatively. However, you may rinse gently with salt water. If you were prescribed a mouthwash (Peridex or PerioGuard) delay rinsing for 48 hours after the surgery. After your sutures have dissolved, generally after 1 week, you should lightly clean the teeth using a soft toothbrush or as instructed by the doctor. Do not use a water-pik for at least 2 weeks following surgery.

DIET:
For your comfort and to protect the surgical area, a soft diet is recommended. During the first 24 hours, restrict your food to a cold liquid diet. Avoid chewing in the area of surgery. Avoid hard, fibrous, or “sharp” foods (such as corn chips) as these may be uncomfortable and can disrupt healing. Drink plenty of liquids. It is important to maintain a diet with a normal calorie level that is high in protein, minerals and vitamins to support post-operative healing. Dietary supplements such as Instant Breakfast, Nutrament, Ensure, or Metracal are recommended. Eat as normal a diet as possible. POST SURGICALLY IS NOT THE TIME TO START A DIET, since this can have detrimental effects on healing and lessen the chances of success of the surgical therapy. Do not take medication on an empty stomach. Nausea is sometimes an undesirable side-effect of taking medication. If nausea persists, call the office for a change in medication or a prescription for relief.

SUTURES:
Sutures (stitches) are placed to hold the gum tissues in the proper position for ideal healing. The sutures (stitches) will dissolve usually in 5-10 days, with the exception of the sutures used for implant surgery. Do not disturb the sutures with your tongue, toothbrush, or in any other manner since displacement will impair healing. If you notice that a suture has come out or come loose, notify our office during regular office hours. For patients having gingival graft or ridge augmentation surgery, avoid removing the plastic appliance for at least 5-7 days. It is preferable to leave the appliance in place until you return. If a periodontal dressing is used, it should also remain in place until your return.

PHYSICAL ACTIVITY:
Avoid strenuous physical activity during your immediate recovery period, usually 3-5 days.

SMOKING:
All smoking should be stopped until after your sutures have dissolved or have been removed to insure the best healing and success of your surgical procedure. Healing results are significantly worse in smoker than in non-smoker.

ALCOHOL:
All intake of alcohol should be stopped until after your sutures have dissolved or have been removed and minimized for the next several weeks to enhance healing. The combination of alcohol and certain pain medi- cations is not recommended.

DO NOT:
For the next several days do NOT smoke, spit, rinse hard, drink through a straw, create a “sucking” action in your mouth, use a commercial mouthwash or peroxide rinses, drink carbonated soda, or use an oral irrigating device.

MISCELLANEOUS:
Some looseness of the teeth is normal after surgery. Do not be alarmed. Also, it is normal to experience sensitivity to cold liquids and sweets.

It is our sincere desire to have you as comfortable as possible during your healing period. If you have any questions or problems, call the office anytime. Office and after-hours answering service – 972-991-9891

Tooth Extraction Postoperative Instructions

At The Dentist’s Office:_Anesthetics

The length of time you experience numbness varies depending on the type of anesthetic you’ve received. While your mouth is numb, you will want to be careful not to bite your cheek, lip, or tongue. The numb- ness should subside within a few hours.

Healing

Your dentist will place a gauze pack on the extraction site to limit bleeding and confine the blood while clotting takes place. This gauze pack should be left in place for 30 to 45 minutes after you leave the dentist’s office. Do not chew on the pack.

Tooth extraction is a minor surgical procedure. Therefore, it is natural that temporary changes will occur in the mouth afterward. You will be functioning normally in just a few days. In the meantime, you should follow a few simple rules to help promote healing, prevent complications, and make yourself more comfort- able.

At Home:_Bleeding There may be some bleeding or oozing after the pack is removed. If so, follow this procedure:

*Fold a piece of clean gauze into a pad thick enough to bite on. Dampen the pad and place it directly on the extraction site. *Apply moderate pressure by closing the teeth firmly over this pad. Maintain this pressure for about 30 minutes. If the pad becomes soaked, replace it with a clean one as needed. *Do not suck on the extraction site. *A slight amount of blood may leak at the extraction site until a clot forms. However, if heavy bleeding continues, call our office. (Remember though, that a lot of saliva and a little blood can look like a lot of bleeding).

The Blood Clot After an extraction, a blood clot forms in the tooth socket. This clot is an important part of the normal healing process. You should therefore avoid activities that might disturb the clot. Here is how to protect it:

• Do not smoke, rinse your mouth vigorously, or drink through a straw for 24 hours. These activities create suction in the mouth which could dislodge the clot and delay healing.
• Do not clean the teeth next to the healing tooth socket for the rest of the day. You should however, brush and floss your other teeth thoroughly. Gently rinse your mouth afterward.
• Limit strenuous activity for 24 hours after the extraction. This will reduce bleeding and help the blood clot to form.

Swelling and Pain: After a tooth is removed, you may have some discomfort and notice some swelling. You can help reduce swelling and pain by applying cold compresses to the face. An ice bag or cold, moist cloth can be used periodically.

Medication: Medication has been prescribed to control pain and prevent infection. Use it only as directed. If the medication prescribed does not seem to work for you, do not increase the dosage. If you have prolonged or severe pain, swelling, bleeding or fever, call immediately. Exact instructions will be given on how to care for your problem.

Diet: After the extraction, drink lots of liquids and eat soft, nutritious foods. Avoid alcoholic beverages and hot liquid. Begin eating solid foods the next day or as soon as you can chew comfortably. For about 2 days, try to chew on the side opposite the extraction site. If you are troubled by nausea and vomiting, call for advice.

Rinsing: The day after the extraction, gently rinse your mouth with warm salt water (half a teaspoon of salt in an 8 oz. glass of warm water). Rinsing after meals is important to keep food particles out of the extraction site, but remember not to rinse your mouth vigorously. Avoid using a mouth rinse or mouthwash during this early healing period.

Oral Hygiene: It is important to continue to floss your teeth and brush thoroughly at least twice a day using a fluoride toothpaste. The tongue should also be brushed. This will help eliminate the bad breath and unpleasant taste that is common after an extraction. Always use a soft-bristled brush so that you do not injure the tissues in your mouth. On the day of the extraction, avoid the cleaning the teeth next to the healing socket.

Remember that you have just had minor surgery. Be kind to yourself

After Bone Grafting Procedures

• A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding site and apply biting pressure for 30 to 45 minutes. If bleeding continues, a moist gauze soaked in tea can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.
• Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 36 hours only. Apply ice, twenty minutes on and twenty minutes off, continuously while you are awake.
• For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 3-4 hours. Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 4-6 hours.
• For severe pain use the prescription given to you. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, finish your prescription regardless of your symptoms.
• Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day.
• Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt water rinse or prescribed rinse every 4 hours and following meals, to flush out particles of food and debris that may lodge in the operated area. (One half teaspoon of salt in a glass of lukewarm water.). After you have seen your dentist for a denture adjustment, take out the denture and rinse 3 to 4 times a day.
• Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.
• The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:
• The surgical site will swell reaching a maximum in two to three days. Swelling and discoloration around the eyes may occur. The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 36 hours after surgery (remember ice packs are used for the first 36 hours only)
• A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
• If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline or Chapstick. There may be a slight elevation of temperature for 24-48 hours. If your temperature continues to be elevated after 24 to 48 hours, notify our office. If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.