Surgical Instructions

I. Preoperative Instructions for Patients Undergoing Intravenous

1. The patient may not have anything to eat or drink for eight (8) hours before surgery except for prescribed medications with a few sips of water.
2. A responsible adult must accompany the patient to the office, remain in the office during the procedure, and be able to drive the patient home.
3. The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
4. Please wear loose fitting clothing with short sleeves and low-heeled shoes.
5. Please do not wear contact lenses, jewelry, or nail polish.
6. Women please note: Some antibiotics may interfere with the effectiveness of your birth control pills. Please check with your pharmacist.

II. Postoperative Instructions

Please take time to read this information, even though some of these instructions may not apply to you, depending on the type of surgery you have had. If you have any questions about these instructions or your procedure, please call our office at Raleigh Oral Surgery Office Phone Number 919-876-4746. Depending on the urgency of your problem or question, one of our assistants or nurses may need to call you back when they are able. One of our doctors is always on call after hours and on weekends follow the instructions on our telephone recording to leave your name and telephone number and the doctor on call will reach you shortly.

• Do not smoke for at least 4 to 5 days smoking is detrimental to the healing process and may worsen bleeding, pain and swelling. The longer you refrain from smoking, the more quickly you will heal.
• Do not spit this will prolong bleeding and may dislodge the blood clots that are forming at the surgical site(s).
• Do not rinse with anything on the day of surgery. The next day, begin rinsing gently with warm, dilute salt water after meals (1/8 teaspoon salt in 8 ounces warm water).
• Do not use drinking straws for several days after surgery. The suction effect in your mouth may dislodge blood clots and cause additional bleeding.
• You may begin brushing your teeth gently on the day after surgery. Be careful in the area(s) where your surgery was performed. Keeping your teeth and mouth as clean as possible will make you feel better and help promote healing.

Bleeding:

Bleeding is normal after oral surgical procedures. Bite gently but firmly on the gauze packs that have been placed over the surgical sites. Do not try to talk and do not chew on these packs if they become dislodged, they will not be effective. After one hour, remove these initial packs and replace them with fresh gauze only if steady bleeding or oozing is present. Be sure to place new packs, if needed, directly over the actual surgical sites not between your teeth where no pressure will be exerted on the surgical site. Continue to replace the gauze every 45 to 60 minutes until you no longer need it. Remember that the fresh gauze will often act as a wick, drawing more blood out of the socket(s). If bleeding persists or is heavy, a moistened teabag used instead of gauze for 45 to 60 minutes will often be effective. Call our office if bleeding persists or is heavy despite using gauze packs and/or teabags.

Pain:

Some degree of discomfort is usually unavoidable after surgery, especially after extensive procedures such as removal of wisdom teeth. If you have been given a prescription pain medication, try to take it with food to avoid stomach upset. Taking pain medication before the numbness in your mouth has worn off is helpful, but it is better to wait until you have been able to eat, or at least drink, something beforehand. The effectiveness of pain medication varies among different individuals it may be necessary in some instances to take two pain pills at once, but be sure to read the directions, and if you have any questions, call our office. Typically the most severe discomfort occurs during the first few hours after surgery and improves somewhat by the next day. Your need for pain medication should lessen gradually over the next few days. Be aware that most prescription pain medications may make you sleepy or drowsy, so it is not advisable to drive while taking such medications.

Swelling:

Swelling is to be expected after most oral surgical procedures. Swelling typically reaches its peak approximately 48 hours after surgery and then slowly resolves. Using ice packs for 24 hours and keeping your head elevated for 48 hours after surgery will help minimize your swelling. Apply ice or cold packs wrapped in a towel to your cheeks adjacent to the surgical sites for twenty minutes at a time and then remove for twenty minutes. After 24 hours of ice therapy, stop applying ice. If discomfort is still present after 24 hours, switch to warm, moist heat. Sleeping with two or three pillows for several nights after surgery will also help.

Sutures:

You may have sutures/stitches in the area of your surgery. We usually place dissolving stitches that will start to break up and dissolve during the first week after surgery. Occasionally they will dissolve or loosen earlier this is usually not a problem. Your doctor will inform you if he uses non-dissolving stitches that will need to be removed at your follow-up visit.

Nausea:

Some patients experience nausea after surgery, and most often it is caused by prescription pain medications, especially if they are taken on an empty stomach. The anesthetic medications, swallowed blood, and dairy products are less common causes. If you do experience nausea or vomiting, try to avoid taking any more of the prescription pain medication until your stomach feels better and you are able to eat. Treat the stomach upset in the same manner as a stomach virus start with clear liquids (Gatorade, Sprite, apple juice, tea, jello, water, etc.) and progress slowly as you are able. Try to maintain adequate fluid intake. You may have been given a prescription for Phenergan suppositories before you left the office use these as needed, especially if you cannot keep anything in your stomach. Call our office if your symptoms persist or if the Phenergan does not help.

Eating:

It is important that you maintain your nutritional intake as much as possible to assist with healing after surgery. For the first two to three days you will most likely be more comfortable eating soft foods that do not require heavy chewing. It is fine to progress to normal foods as you feel able, but avoid foods such as nuts, popcorn, etc., that may become lodged in tooth sockets or surgical sites.

If you are diabetic, it is particularly important for you to maintain your eating schedule and diet. If you have any questions about your diet or your insulin (or other diabetic medications), do not hesitate to call our office or your regular physician.

You may notice sharp edges in the area of your surgery these are usually the edges of the bony socket that held the tooth before it was removed. Such edges usually smooth themselves with time, and small slivers of bone will occasionally work their way out of the socket area. If such areas persist, or if you have questions, please call our office.

III. Postoperative Findings

The removal of impacted wisdom teeth and surgical extraction of teeth is quite different from the extraction of erupted teeth. The following conditions may occur, all of which are considered normal:

1. The surgical area will swell.
2. Swelling peaks on the 2nd or 3rd post-operative day.
3. Trismus (stiffness) of the muscles may cause difficulty in opening your mouth for a period of days.
4. You may have a slight earache.
5. A sore throat may develop.
6. Your other teeth may ache temporarily. This is referred pain and is a temporary condition.
7. If the corners of the mouth are stretched out they may dry and crack. Your lips should be kept moist with cream or ointment.
8. There will be a space where the tooth was removed. After 24 hours this area should be rinsed following meals with warm salt water until it is healed. This cavity will gradually fill in with new tissue.
9. There may be a slight elevation of temperature for 24 to 48 hours. If temperature continues, notify us.
10. It is not unusual to develop bruising in the area of an extraction.
11. A certain amount of bleeding is to be expected following surgery. Bleeding is controlled by applying pressure to the surgical area using small rolled gauze for 60 minutes. After that time remove the gauze and then you may eat or drink. If bleeding persists, a moist teabag should be placed in the area of bleeding and bite firmly for one hour straight. This will aid in clotting blood. Repeat if necessary. If bleeding still persists call our office.
12. Numbness of lips and/or tongue on the affected side may be experienced for a variable period of time.
13. Severity of postoperative pain will depend on the procedure and your physical condition. Take medication for pain precisely as directed.

Feel free to contact us if any doubt arises as to your progress and recovery.