Surgical Instructions

Surgical Instructions

Before Intravenous Anesthesia Sedation

You may not have anything to eat or drink (including water) for six (6) 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 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 bowel upset, please notify the office.
If you take routine oral medications or insulin, please check with the office prior to your surgical date for instructions.

After Wisdom Tooth Removal

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.

The following instructions will assist in making your recovery as smooth as possible. If you have any questions about your progress, please call the office at (270) 759-4063 or (731) 885-7891.

BLEEDING: Bite down firmly on the gauze packs that have been placed over the extraction site for 30 minutes after you leave the office. The gauze may be gently removed after the first 30 minutes. If bleeding persists, place a new folded gauze directly over the surgical site for another 30 minutes and bite down firmly. If bleeding continues, you may bite down on a warm, moist tea bag for another 30 minutes. Be sure that the gauze or tea bag is placed directly over the surgical site. If bleeding remains uncontrolled, please call our office. Intermittent, mild bleeding is not unusual for 12 to 24 hours after surgery.

DIET: The first day’s intake should consist of liquids and very soft foods like soup, pudding, yogurt, milkshake, mashed potatoes, and well-cooked vegetables. Advance your diet to more solid foods as you tolerate it after the first day. It is best to avoid foods like nuts, popcorn, chips, and crackers over the first three days. Avoid forceful sucking through a straw.

PAIN: If you received a prescription for pain medicine, follow the directions on the bottle. If you take the first pain pill before the numbing medication has worn off, you should be able to manage the discomfort better. It is usually best to precede each pain pill with a small amount of soft food to help prevent nausea. You may find it helpful to supplement the stronger prescription pain medicine with another analgesic such as ibuprofen (Advil) (400 to 600 mg every six hours). This may be used between doses of the stronger pain medicine. Do not take ibuprofen if you have been intolerant or allergic to it in the past. Avoid taking Tylenol (acetaminophen) along with your prescription pain medicine. If you need additional prescription pain medicine, please call our office. Most pain should decrease after the first two to three days. If your pain increases dramatically after the third day, please notify our office.

MOUTH RINSING/TOOTH BRUSHING: Do not disturb the surgical site today. You may brush your teeth gently tonight. Tomorrow, begin rinsing your mouth with warm salt water (one teaspoon table salt in an 8 ounce glass of warm water) after each meal and at bedtime. You may gently rinse the sockets with the provided syringe the day after surgery with salt water.

SWELLING: Swelling is normal for the first two to three days. Swelling can be minimized by applying a cold pack, ice bag, or bag of frozen peas wrapped in a towel and placed firmly on the cheek, 20 minutes on and 20 minutes off during the first 24 hours after surgery. Elevating your head on two pillows while sleeping over the first three days can also help control swelling. If your swelling dramatically increases after the third day, please notify our office.

STITCHES: You may or may not have stitches in your mouth. If they are black (silk) they should be removed in 7 to 10 days. Clear or tan-colored stitches will usually fall out or dissolve in 2 to 7 days.

TOBACCO: You should avoid smoking or chewing tobacco for at least 48 hours after surgery to allow proper wound healing.

DRIVING/WORK: You should not drive or operate any type of motorized vehicle or machinery the day of surgery or while taking the prescription pain medicine. You can usually return to work one to two days after surgery.

SHARP EDGES: If you feel something hard or sharp in the areas of the surgery, it is likely bone that once supported the tooth. Occasionally, small slivers of bone may work themselves out through the gum over the first couple of weeks. If the bone causes you concern or discomfort, please call the office.

PROBLEMS: We are more than happy to see you back in the office or speak with you regarding any problems or questions that you may have. Feel free to call (270) 759-4063 or (731) 885-7891. A 24-hour answering service is available to contact the doctor on call after hours as needed for emergencies.

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. The numbing medication may have effects for several hours. You should be aware that if your lip or tongue is numb you could bite it and not feel it, so be careful. Call the office if you have any questions about this or if numbness persists beyond the day of surgery.
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 removed by Dr. Bobo or Dr. Pledger.
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 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

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 my office for instructions.
There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the meantime, 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. Bobo, Dr. Pledger 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 to 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.

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. It will not need to be replaced.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding which results in your mouth filling rapidly 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 or towel filled with ice cubes on the cheek in the area of surgery. Apply the ice continuously as much as possible for the first 36 hours.

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, 1 or 2 Tylenol or Extra Strength. Tylenol may be taken every 3-4 hours. (Do not combine Tylenol with the prescription pain medicine.) Ibuprofen (Advil, Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed.

Oral Hygiene

Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can. Rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) six 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 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; that may weaken you.

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 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 my 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 48 hours only.
For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 3-4 hours. (Do not combine Tylenol with the prescription pain medicine.) Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 3-4 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 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 half teaspoon of salt in a glass of lukewarm water.). After you have seen your dentist for denture adjustment, take out 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 area operated on will swell reaching a maximum in two days. Swelling and discoloration around the eye 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 48 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 temperature continues, notify my 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.

After Placement of Dental Implants

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery.

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 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, or towel filled with ice on the cheek in the area of surgery.

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, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. (Do not combine Tylenol with the prescription pain medicine.) 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 3-4 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 any prescribed antibiotics as directed to help prevent infection.

Oral Hygiene

Good oral hygiene is essential to good healing. The day after surgery, Peridex should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt water rinses (teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, as well, especially after meals. Brushing your teeth and the healing abutments is no problem. Be gentle initially with brushing the surgical areas.

Activity

Wearing your Prosthesis

Partial dentures, flippers, or full dentures should not be used immediately after surgery and as little as possible for the first 7 days after surgery.