AFTER SURGERY

AFTER WISDOM TOOTH REMOVAL

Starting One Week after wisdom tooth removal:

You may now stop using the rinsing solution, peridex, if prescribed.

It is now time to begin using the irrigation syringe given to you.  Fill the syringe with either mouthwash diluted with warm water, warm salt water or plain warm water.

*** Please Note: that you will only be flushing the hole/holes in the lower jaw (top only if needed).***

Focus is placed on the lower sockets because gravity pulls food from the top and collects in the lower sockets. Any build-up of debris in the sockets may cause pressure, pain and possible infection. However this can be avoided with proper irrigation.

Step 1. Standing in front of a mirror, and starting with the side you wish to irrigate first, pull your cheek out using your finger or toothbrush. This will help open the wisdom tooth hole so you are able to get a better view and placement of the syringe.

Step 2. Gently place the tip of syringe 1mm inside the hole and flush it out with the warm water in your syringe.

You may see debris including food, dried blood and even a stitch come out at this time. This is normal. Blood may be a result of the water washing over the clot which is also normal. If you see any debris come out of the hole, repeat irrigation until you no longer see debris come out. Continue on the opposite side if both lower wisdom teeth were removed. It is important to irrigate after every meal or at least once in the morning and once in the evening. You want to ensure you are clearing all of the debris out as the tissue in the hole/holes is starting to heal from the bottom- up at this time. Ineffective clearing of food and debris may cause an infection and require more surgery.

Continue to irrigate for 3-4 weeks or until the lower hole/ holes are completely closed and you are unable to get the syringe in the socket.

If you have continued swelling beyond 4-5 days after surgery, severe pain or fever call our office immediately at 519-979-7227.

AFTER TOOTH EXPOSURE OF IMPACT 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.

• 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 519-979-7227.
• 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/lip in the area of surgery. Apply the ice intermittently for 20-30 minute intervals as much as possible for the first 48 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 before you feel the local anesthetic wearing off. For mild to moderate pain, Tylenol or Extra Strength can be taken as directed on bottle. Tylenol may be taken every 4-6 hours. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol assuming no allergies to these medications. 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 the provided irrigating syringe six times a day. This wil be given at your first appointment after surgery. 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. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

AFTER 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 30-60 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. 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 intermittently for 20-30 minute intervals while you are awake. For mild discomfort use Tylenol or any similar medication; Ibuprofen (Advil, Motrin) may also be used. For severe pain use the prescription given to you. If the pain does not begin to subside in 4 days, or increases after 5 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 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 2-3 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 48 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 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.

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.

• 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 30-60 minutes. If bleeding continues please call for further instructions 519-979-7227.
• 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/lip in the area of surgery. Apply the ice intermittently for 20-30 minute intervals as much as possible, for the first 48 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. Do not use implant as a tooth until directed.
• Pain – You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For mild to moderate pain, Tylenol or Extra Strength Tylenol may be taken as directed. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. 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 complications.
• Oral Hygiene – Good oral hygiene is essential to good healing. Warm salt water (teaspoon of salt in a cup of warm water) rinses should be used at least 4-5 times a day, especially after meals. Use the peridex script as prescribed. Brushing your teeth is no problem. Be gentle initially with brushing the surgical areas.
• 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 will need to be reduced to ensure they do not apply any pressure to the implant, or bony graft sites. These should be worn for esthetics only. They should not be used to chew or function with, as this may compromise the implant or bone graft. This may be fitted the first or second visit after your surgery.

GENERAL INSTRUCTIONS

• General Instructions after Surgery – 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 gauze pad placed directly on the bleeding wound for 30-60 minutes. If bleeding continues please call for further instructions 519- 979-7227.
• 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/lip in the area of surgery. Apply the ice intermittently for 20-30 minute intervals as much as possible, for the first 48 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 mild to moderate pain, Tylenol or extra strength Tylenol may be taken as directed. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. 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.
• Oral Hygiene – Good oral hygiene is essential to good healing. Warm salt water (teaspoon of salt in a cup of warm water) rinses should be used at least 4-5 times a day, especially after meals. Use the peridex script as prescribed, if given. Brushing your teeth is no problem. Be gentle initially with brushing the surgical areas.
• 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.

AFTER FACIAL TRAUMA

Discharge Instructions for Facial Trauma – Fractured Nasal Bone (Nose)

• Keep ice to top of nose for first day if nose is not splinted
• If nose is splinted and packed, maintain splint and packing until seen in office
• No nose blowing
• No heavy lifting or strenuous exercise
• Sleep with head elevated with pillows for first 3 to 4 days
• If nose continues to bleed, call the office

Maxillary Mandible Fractures (Upper and Lower Jaws)

• Keep ice to area of broken bone for first 2 days
• Sleep with head elevated for first 3 to 4 days
• Keep mouth clean by rinsing and brushing teeth
• Diet – soft foods & liquids only. NO CHEWING!
• If elastics or wired shut and 1 or 2 fall off, no need to worry until next office visit
• No heavy lifting or strenuous exercise
• If jaws wired shut, may use straw for delivery of soft foods and liquids
• If sutures have been placed and profuse bleeding from incision site, call the office
• If sutures have been placed and a couple dislodge, no need to worry
• If swelling increases after the 3rd or 4th day, call the office
• Although you may be able to open and close your lower jaw, you must remember it is considered still broken 4-6 weeks after the injury
• Plates and screws that have been placed will be maintained unless otherwise indicated for removal
• Remember a numb feeling to the lower lip, chin, or tongue area may be normal with the particular fracture. This may or may not resolve in time.
• If fractured jaw not repaired as of yet & sent home, still follow above applicable instructions
• Clean bars & wires on teeth as well as brushing teeth

Zygomatico-Orbital Fractures (Cheek Bone/Orbital Bone Fractures)

• Keep ice to face in area of fracture for first 1-2 days after fracture/surgery
• Sleep with head elevated with pillows for the first 3 to 4 days
• Remember that numbness to the fracture side of the face is normal for this particular fracture and may or may not resolve with time
• Do not sleep on affected side of face
• If pain or loss of vision in eye, call the office or go to the Emergency Room immediately
• Double vision may be normal for this type of fracture & may resolve with surgery or time
• No nose blowing
• No heavy lifting or strenuous exercise
• Apply antibiotic ointment to surgical incision 2 times a day

Dento-Alveolar Fracture (Tooth & Gum Injuries)

• Soft foods and liquid for diet
• Expect that hot and cold temperatures may cause sensitivity
• Expect that root canal treatment may be necessary in the near future
• Brush teeth and keep wires clean
• If increase in swelling, pain and/or associated bad taste in mouth please call the office and make an appointment

Lacerations

• Keep wounds clean and clear of scabs
• Apply antibiotic ointment to wounds after cleaning 2 times a day
• If dressing is placed over wounds, maintain dressing seen in the office
• Avoid sun exposure for first 6 months to a year by applying complete block sunscreen to wounds once healed