Surgical Instructions

surgical instructions

The following information applies when upper jaw bone height or width have been lost. The graft is placed to help restore your jawbone in preparation for possible implant replacement of the missing tooth or teeth.

You have had a Sinus Lift Augmentation procedure in your upper jaw. This procedure regains lost bone height in the area of your first and second molar and occasionally second premolar. It is an important procedure as it allows implant placement in an area that could not be implanted otherwise because of insufficient bone height due to an enlarged sinus.

 

The bone that has been grafted is most commonly a combination freeze-dried bone, artificial synthetic bone and your own bone. Because of this you may have two post-surgical wounds: the donor site and the recipient site.

DO NOT- UNDER ANY CIRCUMSTANCES -BLOW YOUR NOSE FOR THE NEXT FOUR (4) WEEKS.


This may be longer if indicated. You may sniff all you like but NO BLOWING.

Do not blow your nose or sneeze holding your nose. Sneeze with your mouth open. Do not drink with straws and do not spit. Scuba diving and flying in pressurized aircraft may also increase sinus pressure and should be avoided. Decongestants such as Drixoral, Dimetapp, or Sudafed will help reduce pressure in the sinuses. You may also be given a prescription for antibiotics. Please take these as directed. Anything that causes pressure in your nasal cavity must be avoided. Avoid “bearing down”—as when lifting heavy objects, blowing up balloons, playing musical instruments that require a blowing action or any other activity that increases nasal or oral pressure. Smoking must be stopped.

 

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

 

Oral Hygiene
Do not rinse or spit on the day of your oral surgery. This tends to disturb the blood clot, open the wound and can prolong bleeding and slow healing. You should not have a significant amount of blood in your mouth. Saliva can be swallowed, even if slightly blood tinged.

Keeping your mouth clean after surgery is essential to reduce the risk of infection. Start salt water rinses the day following your dental treatment. Use one-half teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least four to five times daily and always after eating for the next five days.

Do not brush the teeth in the area of surgery for 48 hours. When brushing, be very gentle. When expectorating, also be gentle.

We may prescribe an antibiotic rinse (Chlorhexadine, Periogard, Peridex) for certain dental treatments. This rinse should be used in the morning and at bedtime after routine mouth care. Do not eat or drink or rinse your mouth after using the medicated rinse. Using this rinse more than two times a day will cause staining of your teeth.

 

Smoking
Do not smoke for at least two weeks after surgery, if at all. As discussed at your consultation, smoking dramatically increases the risk of bone graft and sinus lift failure. Your oral surgeon can prescribe a Nicoderm patch if you feel you need it.

 

Wearing your Prosthesis or Nightguards
Partial dentures, flippers, or full dentures should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise. Please contact the office if there is any question. If you have questions about the fit of your flipper, partial or complete denture, do not wear it until your general dentist or our office can see you.

 

Post-Operative Problems or Complications
As with any procedure, unexpected post-operative healing can occur:

  • If you notice the unexpected flow of air or liquids between your mouth and nose, please let us know immediately
  • If you are aware of several small particles of graft material being discharged from your nose, let us know as well
  • If you experience sinus or nasal congestion on the side your surgery was performed, let us know
  • If there is an increase in swelling in your mouth, cheek or under your eye after 3 days, let us know

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call us.

The following information applies when grafting material has been placed into extraction sites to help preserve your jawbone in preparation for possible implant replacement of the extracted tooth.

Your dental bone graft is made up of many particles. You may find some small granules in your mouth for the first several days. Do not be alarmed by these. It’s normal to have some of them come out of the graft site and into your mouth. There are some things you could do to minimize the number of particles that become dislodged:

  • Do not disturb or touch the wound
  • Avoid rinsing or spitting for 2 days to allow blood clot and graft material stabilization
  • Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing
  • Do not lift or pull on the lip to look at the sutures. This can actually cause damage to the wound site and tear the sutures
  • Do not smoke

 

Following the second day, gentle rinsing would be allowed but not too vigorously as you can again disturb some of the bone graft granules. If a partial denture or a flipper was placed in your mouth, you may have to see your restorative dentist have it adjusted and learn how to remove and replace it appropriately.

It is our desire that your recovery is as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call us. Please try to call during office hours; however, a 24-hour answering service is available for after-hours contact with a doctor.

Post-Operative Instructions for Patients Undergoing Corrective Jaw Surgery

 

PHASE I – IMMEDIATELY BEFORE AND AFTER SURGERY

Prior to your jaw surgery, you will visit your oral surgeon to have molds and records taken. This office appointment can vary between 1 to 2 hours in length. It will consist of taking x-rays, molds and photographs and is an opportunity for you to sit down with all your remaining questions. It’s also an opportune moment for any family member(s) that may be with you to also discuss with your surgeon the period following the surgery.

Prior to your jaw surgery, it is imperative that you have seen the orthodontist for placement of surgical hooks and your family dentist for a generalized cleaning since oral hygiene will be a little difficult for the first 2 weeks. Also, you should enjoy a normal routine and savor your favorite meals, since these will be curtailed for at least 1 month after surgery.

 

The day and morning before your surgery, it is important that you thoroughly brush all your teeth and appliances.

The day of your surgery, you will first meet the anesthetist who will bring you to the operating room and guide you through the process over the next few hours. Depending on the number of jaws that you will have surgery on, the length will vary between 1 to 3 hours. This is different for all patients and this will be explained to you.

When you wake up from your jaw surgery, your teeth may be held together with small elastics, just to help you guide into your new occlusion. These elastics, if present, will be changed after the first week.

You will be completely numb on the jaw that was operated on, so there is not a great amount of pain. However, the swelling starts up immediately and there is some jaw stiffness to be anticipated. There is some soreness from the breathing tube that the anesthetist places and this soreness will also subside with time.

 

Your course in hospital will usually last 1 night for 1 jaw and 2 nights for 2 or more jaws. The goal of your hospital stay is to ensure that you are drinking as best as you can. We will be coaching you to do some walking around, but drinking is of the highest necessity. Too much activity may cause a bit of nausea, so it’s best to remain as quiet as possible.

 

Immediately After Surgery

  1. All patients feel discomfort or pain after an operation, although the level of pain varies from patient to patient. Take your pain medications as directed.
  2. When you go home, it is important that a friend or relative spends the first night with you. Continue to take any previous medications before following the instructions on the bottle.
  3. You will be able to shower on the second day after surgery. You must avoid hot, prolonged showers which may cause bleeding in the upper jaw if surgery is performed there.
  4. Avoid exercises, any heavy lifting or activity that raises your blood pressure or pulse for at least one month after the surgery. The blood vessels are still healing from the surgery and any increase in activity may cause bleeding. You may begin gentle exercise after 2 weeks, but do not do any cardio for 4 weeks after the surgery.
  5. Do not drive a vehicle or perform any task that requires coordination or judgment for at least 48 hours following your anesthetic.

 

Prescriptions

You will be provided with prescriptions for the following medications:

  • Celebrex 200mg orally 2 times a day for 14 days. This is to help decrease your swelling and help control pain. This is a small white pill which you will need to swallow with some fluid.
  • Codeine Elixir 30mg will be given to you in a syrup form and you will take this every 4 or 6 hours as you need for pain. You will most likely need it the first 2-3 days.
  • Amoxicillin 500mg Elixir – you will take this 3 times a day for 7 days and this prescription is an antibiotic that must be finished. If you are penicillin allergic, you will be given another antibiotic.
  • Ativan 1mg tablet that you will place either in your cheek pouch or underneath your tongue and this is to help you sleep at night without causing any undue clenching or grinding that sometimes occurs. You will be given 14 tablets. You are encouraged to use this for at least the first 7 days and then if needed after that.

 

Diet

Immediately after surgery, you will need to stay on a clear liquid diet to ensure that the wounds do not get burdened with debris. A suggestion is the following:

  1. The first 5 days will be clear fluids; that is anything you can see through, from Gatorade, clear soft drinks, clear soups, Jell-O.
  2. 5 days after that, you can move onto any liquid including milk shakes, ice cream, Soya milk drinks, yogurts, soft cheeses, protein drinks and protein supplements as well as nutritional supplements (such as Ensure, Boost, Whey, protein powders, tofu);
  3. 5 days after that, you can commence a soft food diet. A recommendation is to eat anything that does not make any noise, therefore hard or crunchy foods must be avoided. Most foods will be satisfactory at this stage including pastas, rice, potatoes, etc.

There is no limit to what you should eat, as long as you don’t need to chew too vigorously. This is all that really should be taken by mouth for the first week.

 

Hygiene

The amount of swelling that will take place in your cheeks will make it very difficult to brush your teeth. In fact, you should not brush your teeth for 1 full week after surgery, otherwise the incisions can be damaged and bleeding may start. You should use warm saline rinses (1/2 teaspoon salt in a tumbler of warm water). You can rinse your mouth with salt water as often as you would like, even up to every 2 hours. You cannot do enough rinses. This will keep your mouth nice and clean and will also tend to shrink the incision lines inside the mouth. Your hygiene will change into the second phase. You may also be given a prescription for Peridex, an anti-bacterial mouth rinse. If that is given to you, use it as prescribed.

 

Swelling

The swelling is perhaps the greatest post-operative event of your jaw surgery. This will vary from patient to patient. You must anticipate a large degree of swelling over your cheek area as well as down into your neck. The swelling is maximal at Day 4 and will slowly subside after 2 weeks. There is still about 10 to 20% of swelling that can maintain up to 2 months after surgery. You should only be critical of the result about 3 months after surgery. You will have been given medications during the surgery and immediately after to help settle down some of the swelling, but once it has occurred on Day 3, there is very little that can be done to eliminate it.
You should place ice on your face while you’re awake for the first 3 to 4 days. The ice will also have a numbing effect that will reduce any post-operative sensitivity. You must be careful not to apply too much ice directly on the skin, as it may cause burns. After Day 4, a warm water bottle is then recommended to help reduce swelling.

 

Bruising

Bruising is also quite normal after jaw surgery. Depending on which jaw was operated on, you may have bruising in the area of your upper cheek and eyes as well as your lower cheeks and down into your neck. It is not unusual to have some bruising extend all the way onto your chest. The bruising is unsightly and disconcerting, but you must understand it is perfectly normal and should not be of any concern. It will go away after about 2 weeks.

 

Activity

You should maintain minimal activity within the first week. You are able to walk and move about but you should not do any exercises, jogging or weight lifting, regardless of how well you feel. You will have lost some blood during the operation and you may be feeling weak or faint. This is not the time to try to get back into shape. It will take one month before you fully recover from the amount of blood loss and strength due to your surgery.

 

Other Findings

You may have some altered sensation to your hearing due to some of the swelling extending into the area of the ear. This numbness or muffled sound is not unusual and you should expect some of it. You may also experience some joint noises on the right and left hand side. Your joints need to get accustomed to their new position.

You will need to call the office for a follow-up visit between 4 and 7 days post-op. Please make this yourself once you get home.

 

Next Phase

Your surgeon will give you a handout regarding the second phase of healing once you are ready. Until then relax, take the medications, drink as best as you can and call if there are any problems.

 

PHASE II – 1 TO 4 WEEKS AFTER SURGERY

In this phase, the majority of swelling and bruising will have peaked and are starting to subside. It is now a time to get your jaws actively working again so that you can resume normal activity. There are a few points to remember and a few changes:

  1. Continuation of Phase I liquids;
  2. Dairy products: continue with milk shakes, ice cream, soya milk drinks, yogurts, soft cheeses;
  3. Protein drinks and protein supplements as well as nutritional supplements (such as Ensure, Boost, Whey, protein powders, tofu);
  4. Egg products (scrambled, boiled, omelets, …);
  5. Pureed vegetables and meats of a similar consistency to baby food. (this would include potatoes, peas, carrots);
  6. Starches such as mashed potatoes, rice and pasta;
  7. Other proteins such as minced meat and white fish.

 

Again, there is no limit as to the amount you should eat and in fact you should try to now increase your nutritional intake, since there may have been some weight loss initially and now your body is demanding extra nutrition during this healing phase. Once again, it is imperative that you do not actively chew and you should avoid anything at all that is hard, including tough meats, candies, popcorn, pretzels, peanuts and other nuts.

 

Hygiene

Now that the swelling is slowly starting to subside, you’ll be able to get into the mouth and cheek areas a little bit more easily. You should purchase a new toothbrush and, using a small amount of toothpaste, concentrate on brushing the metal braces. You should spend at least 15-20 minutes in the evening prior to going to bed to do a thorough cleaning of all the teeth and brackets. Not only will this make you feel a little better, it will also help reduce any swelling around the gums and cheeks. Continue rinsing your mouth with salt water at least twice a day, but be careful not to injure the wounds with the head of the toothbrush. If you do hit the wounds, there may be a little bleeding, but this is normal and should not cause any worry.

 

Swelling

The swelling will now begin to subside and by the second and third week, the majority of it will be gone, but remember, there’s still about 10 to 20% that can maintain up to 2 months. Ice will no longer help reduce the swelling; you may want to switch to using warm water bottles over the area. However, this will go down on its own.

 

Bruising

Bruising may still maintain into the second week, as far down as into the neck and chest areas. Although this is unsightly, it is perfectly normal and will go away.

 

Activity

You will still be feeling slightly weak due to the surgery itself and the minor blood loss. You can start a regular routine of physical exercise that you may have had prior to surgery, but you should still avoid any heavy running or activities that will produce too much motion in the head and neck areas. Simple walking and stairs and mild activity is encouraged and will help with the elimination of some swelling.

 

New Findings

The joints on the right and left-hand sides near your ears may now be functioning a little bit more, but due to the jaw surgery, will find themselves in a new position. It is not unusual to hear some noises such as clicking or popping of the joint as you start to function more and more. These joint noises and discomforts will continue up until about 6 weeks post-surgery.
If you’ve had upper jaw surgery, the numbness tends to be reduced in the upper lip and jaw area and this is first felt as an itchy or pins and needles sensation. In the lower lip area, there will still be some numbness and pins and needles at least up until 6 months after surgery.
If you’ve had upper jaw surgery, a nasal discharge of a red-brown fluid may occur. This is normal and is a product of the blood clots being dissolved just behind the upper jaw. If you should experience brisk bright red blood that is not controlled with pressure on the nose, please contact the office.

 

Physiotherapy

  1. a) Facial Reanimation
    What I would like for you to do during the initial phases and up to a month after surgery are lip and cheek exercises. This produces strengthening of the muscles in and around the area of the mouth and nose, reduces swelling in the area and will also bring the life back to that area of your face. These exercises are quite simple and they consist of grimacing, pulling your lips apart, putting a pencil between your lips and trying to squeeze the pencil, smiling and all types of movements of the lips, cheeks and chin.
  2. b) Joint Exercises
    This consists of exercises of opening and closing the jaw. For the first 2 weeks, your goal should be to open your teeth apart approximately 2 finger breadths. This consists of placing some warm packs over the right and left-hand side and gently massaging the joints on both sides and then slowly and passively opening the jaw as much as you can. By 3 to 4 weeks post-operative, your goal should be to open approximately 3 finger breadths. This is an area that will be actively encouraged during your post-op therapy.

 

Next Phase

Your appointments will now continue probably every 2 weeks. The antibiotics will have been terminated at this stage. If you need medications to help you sleep through the night, just speak to your doctor. Oftentimes, you may find yourself clenching and grinding your teeth in the middle of the night; this is not unusual, but if it is disturbing to you, we can give you something to help you through this. Your final phase will be from approximately 4 to 6 weeks after the surgery until you have your braces removed. This phase will be explained to you at the appropriate time.

A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding continues, bite on a moistened black tea bag for thirty minutes. The tannic acid in the black tea helps to form a clot by contracting blood vessels. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove any immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.

Use ice packs (externally) on the cheek near the surgical site. Apply ice for the first 36 hours only. Apply ice 20 minutes on and 20 minutes off while you are awake.

 

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one or two tablets of Acetominophen (Tylenol) may be taken every 6 hours. Ibuprofen (Advil or Motrin) may be taken instead of Acetominophen. Regular strength ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3200mg daily for an adult. Consult our practice for individuals under 18.  Always follow the instructions on the bottle.

 

For severe pain, prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office. For severe pain, use the prescription given to you. If the pain does not begin to subside after 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, make sure to finish your prescription unless you have an allergic reaction.

 

Drink plenty of fluids. 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 every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One teaspoon of salt in one cup of warm water). After you have seen your dentist for denture adjustment, take out the denture and rinse 2-3 times a day.

 

Restrict your diet to liquids and soft foods that are comfortable for you to eat. As the wounds heal, you will be able to resume your normal diet.

 

The removal of many teeth at one time is quite different from the extraction of just 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 area operated on will swell, reaching a maximum in two-three days. Swelling and discoloration around the eyes may occur. The application of a moist warm towel will help eliminate the discoloration. The towel should be applied continuously for as long as is tolerable, beginning 36 hours after surgery. (Remember: ice packs are used for the first 24 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. There may be a slight elevation of temperature for 24-48 hours. If your temperature continues to rise, 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 to make the necessary adjustments and relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.

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

 

Immediately Following Surgery

  • The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and replaced as required.
  • Vigorous mouth rinsing and/or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for a more thorough explanation.

 

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 rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened black tea bag for thirty minutes. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. 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 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs, should be applied to the sides of the face where surgery was performed. The ice packs should be left on for 20 minutes on and then 20 minutes off while you are awake. Do not place the pack directly on your skin, instead, places wet paper towel or cloth between your skin and the ice pack.  After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

 

Pain

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one or two tablets of Acetominophen (Tylenol) may be taken every 6 hours. Ibuprofen (Advil or Motrin) may be taken instead of Acetominophen. Regular strength ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3200mg daily for an adult. Consult our practice for individuals under 18. For severe pain, prescribed medication should be taken as directed.  Always follow the instructions on the bottle.

Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

 

Diet

After general anesthetic or IV sedation only liquids should initially be consumed. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. A high calorie, high protein diet is very important. Our staff can provide suggested diet instructions. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss any meals. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.

 

CAUTION: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit up for one minute before standing.

 

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. The day after surgery you should begin rinsing at least 2-3 times a day, especially after eating, with a teaspoon of salt mixed into one cup of warm water. 

 

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to mild bruising. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

 

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. Call the office if you have any questions.

 

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour, including the prescribed medicine. You should then sip on coke, tea, or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.  An antiemetic may be required, such as Gravol.

 

Other Complications

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. Call Dr. Abolfazl Ghorbani if you have any questions.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
  • You should be careful going from the lying down position to standing. You could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting 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 removed by Dr. Abolfazl Ghorbani .
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as 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 typically subside in 2-3 days.
  • Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.

 

Finally

Sutures are frequently placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures usually dissolve within a few days or may be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is usually no discomfort associated with this procedure.

 

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call our office for instructions.

There will be a void where the tooth was removed. The void will fill in with new tissue gradually over the next month. In the meantime, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.  When appropriate, you will be given a syringe to aid in this regard.

Brushing your teeth is okay – just be gentle at the surgical sites.

A dry socket is when the blood clot becomes dislodged prematurely from the tooth socket. Symptoms of increasing pain at the surgical site and even pain near the ear may occur 2-3 days following surgery. Call the office if this occurs.

 

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising immediately.

Do not disturb the wound. If surgical packing was placed, leave it alone. The packing helps to keep the tooth exposed. If it becomes dislodged or falls out, do not get alarmed but please contact our office for instructions.

 

Bleeding

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

 

Swelling

Swelling is a normal occurrence after surgery. To minimize swelling apply an ice bag or a plastic bag filled with ice cubes on your cheek near the area of surgery. Apply the ice as much as possible for the first 24 hours.

 

Diet

Drink plenty of fluids. Avoid hot liquids or hard foods. Only consume soft food and liquids on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

 

Pain

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one or two tablets of Acetominophen (Tylenol) may be taken every 6 hours. Ibuprofen (Advil or Motrin) may be taken instead of Acetominophen. Regular strength ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3200mg daily for an adult. Consult our practice for individuals under 18. For severe pain, prescribed medication should be taken as directed. Always follow the instructions on the bottle.

Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

 

Oral Hygiene

Oral cleanliness is essential to good healing. Clean your mouth thoroughly after each meal, beginning the day after surgery. Brush your teeth normally if possible. Rinse with warm salt water (1 teaspoon of salt in a cup of warm water) 2-3 times a day. Continue this procedure until healing is complete.

 

REMEMBER: A clean wound heals better and faster.

 

Activity

Keep physical activities to a minimum immediately following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

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 rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues profusely, please call for further instructions.

 

Swelling

Swelling is a normal occurrence after surgery. To minimize swelling apply an ice bag, or a plastic bag or towel filled with ice, on the cheek on the area of surgery. Apply the ice, 20 minutes on, and 20 minutes off, as much as possible, for the first 24 hours. Do not place the pack directly on your skin, instead, places wet paper towel or cloth between your skin and the ice pack.

 

Diet

Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

 

Pain

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one or two tablets of Acetominophen (Tylenol) may be taken every 6 hours. Ibuprofen (Advil or Motrin) may be taken instead of Acetominophen. Regular strength ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3200mg daily for an adult. Consult our practice for individuals under 18. Always follow the instructions on the bottle. For severe pain, prescribed medication should be taken as directed.

Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

 

Antibiotics

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

 

Oral Hygiene

Good oral hygiene is essential to good healing. Warm salt water rinses (one teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, starting the day after surgery. Brush your teeth and the healing abutments. Be gentle initially while brushing the surgical areas. Do not use an electric toothbrush until cleared by your doctor to do so.

 

Activity

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

 

Wearing your Prosthesis

Partial dentures, flippers, or full dentures, should not be used immediately after surgery for at least 10 days, as discussed in the pre-operative consultation, unless specifically instructed otherwise.

After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. Bite on a gauze pad for 30-45 minutes immediately after the appointment. If the bleeding or oozing persists, place another gauze pad and bite firmly for another 30 minutes. You may have to do this several times to decrease the flow of blood.

 

After the blood clot forms it is important to not disturb or dislodge the clot. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities may dislodge or dissolve the clot and hinder the healing process. Limit vigorous exercise for the next 24 hours, as this increases blood pressure and may cause more bleeding from the extraction site.

 

After the tooth is extracted you may feel some discomfort and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours.

 

Use pain medication as directed. Call our office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time even if signs and symptoms of infection are gone. Drink lots of fluids and eat nutritious, soft food on the day of the extraction. You can eat normally as soon as you are comfortable.

 

It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean.

 

After a few days you should feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call our office immediately at: 

(905) 737-5151.

  • You may not have anything to eat or drink (including water) for eight hours prior to the appointment.
  • No smoking for at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery.
  • A responsible adult must accompany the patient to the office, remain in the office during the procedure, and drive the patient home.
  • A responsible adult should stay with the patient for the remainder of the day.
  • The patient should not drive a vehicle or operate any machinery for 24 hours following anesthesia.
  • Please 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.
  • Do not wear lipstick, excessive makeup, or nail polish on the day of surgery.
  • If you have an illness such as a cold, sore throat, stomach or upset bowels, please notify the office.

 

If you take routine oral medications, please check with Dr. Abolfazl Ghorbani  prior to your surgical date for instructions.

Need More Information?

We will be more than happy to answer your questions