Surgical Instructions

Before Intravenous Anesthesia Sedation
• You may not have anything to eat or drink (including water) for seven (7) hours prior to the appointment.
• No smoking 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.
• The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
• Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and closed toe 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 bowel upset, please notify the office.
• If you take routine oral medications, please check with Dr. Szakal prior to your surgical date for instructions.

General Surgical Instructions for Oral Surgery Procedures
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 the instructions are followed carefully.

Immediately Following Surgery:
• The gauze pad placed over the surgical area should be kept in place for 30-45 minutes as needed for bleeding. After this time, the gauze pad should be removed and discarded.
• Vigorous mouth rinsing 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 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 30-45 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 45 minutes. The tannic acid in the tea bag 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 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. After 48 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. 48 hours following surgery the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain
For adults who are experiencing moderate pain, one or two tablets of Extra Strength Tylenol may be taken every 6 hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 8 hours.
For severe pain take the tablets prescribed for pain as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. 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 and does not improve within 5 days, it may require attention and you should call the office.

Diet
After a general anesthetic or I.V. sedation, liquids should be taken at first. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. 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 a single meal. 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. Therefore, immediately following surgery, if you are lying down, make sure you sit for one minute before standing.

Keep the mouth clean
No rinsing of any kind should be done until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt.

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 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 may be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. 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 water 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. Call our office if nausea continues.

Other Complications
If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, 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 it so be careful. Call 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. As you were not able to eat or drink prior to surgery, and it is difficult to take fluids, and taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute 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 reduced as needed. If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with a moisturizing ointment.

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 2-3 days.

Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a few days to over a week following surgery. This is a normal post-operative event which will resolve in time.

Finally
Sutures are 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 form your mouth and discard it.

There will be a cavity where the tooth was removed. The cavity will gradually disappear over the next few months. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush.

Your case is individual, no two mouths are alike. Do not take seriously well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr Szakal or your family dentist.

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

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 radiating to the ear may occur 5 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.

After Exposure of an Impacted Tooth
Do not disturb the wound. If surgical packing was placed leave it alone. The pack helps to keep the tooth exposed. If it gets dislodged or falls out do not get alarmed.

Follow all General Surgical Instructions for Oral Surgery Procedures

After the Removal of Multiple Teeth
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 30-45 minutes. If bleeding continues, a moist tea bag 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.

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.

Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 48 hours only. Apply ice 30 minutes on and 30 minutes off.

Follow all General Surgical Instructions for Oral Surgery Procedures

After Placement of Dental Implants
Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There will be a metal healing abutment protruding through the gingival (gum) tissue in most cases.

Follow all General Surgical Instructions for Oral Surgery Procedures