Patient Information

Surgical Instructions Section

Before Intravenous Anesthesia Sedation

• You may not have anything to eat or drink (including water) for eight (8) hours prior to the appointment.
• No smoking at least 36 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 and as long as narcotic pain medication is being taken.
• Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and low-heeled shoes.
• Contact lenses, jewelry, tongue rings 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. Keyhani 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.

Immediately Following Surgery:

• The gauze pad placed over the surgical area should be kept in place for forty five minutes with pressure. After this time, the gauze pad should be removed and discarded. Remember, it is the pressure that stops the bleeding not the guaze.
• 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 before the local anesthesia wears off in order to minimize the discomfort.
• 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 forty five minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty 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. The ice packs should be alternated twenty minutes on and twenty minutes off. A bag of frozen peas works well. Do not contact the ice bag directly to your skin. Try wrapping it in a towel. After 24 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. Twenty four hours following surgery the application of moist heat to the sides of the face is beneficial in reducing the discomfort.

Pain

For patients who are completely healthy(i.e. No Asthma, etc.) and are not taking any medication or are not allergic to any medication, we recommend the following regimen: Motrin or Advil (Ibuprofen) 800 mg as the initial dose followed by a narcotic such as Vicodin or Percocet about three hours after the initial dose of Ibuprofen. This regimen of alternating Ibuprofen 800 mg with a narcotic every three hours could be continued for one week. Remember, the maximum dose of Ibuprofen in twenty four hours is 3200 mg and maximum dose of Tylenol or acetamenophen (contained in the narcotic) in twenty four hours is 4000 mg.

Also please note that there could be side effects associated with your narcotic pain medication such as nausea and vomiting. In case of nausea and vomiting, stop the narcotic and substitute it with Tylenol 1000 mg alternating with Ibuprofen 800 mg every three hours.

The prescribed narcotics 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, it may require attention and you should call the office.

Diet

After 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. Refer to the section on suggested diet instructions in the section entitled “Food Suggestion”. 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 laying down, make sure you sit for one minute before standing.

Food Suggestion

You may eat whatever you want as long as it is comfortable for you to eat.

Some examples:

Make sure to get plenty of fluid intake, including water.

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. The doctor may also prescribe a medicated mouth wash that is to be started the day after surgery.

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 will 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 Sprite, 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. Call the office if you have difficulty keeping anythin down after more than a couple of hours.

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 Dr. Keyhani if you have any questions about this.

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. Keyhani.

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

Finally

Sutures may be placed in the area of surgery to minimize post-operative bleeding and to help healing. Usually disolvable sutures are used that fall out on their own and don’t require removal. However if they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. If disolvable sutures are not used they will 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 no discomfort associated with this procedure. So it’s really nothing to worry about.

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 Dr. Keyhani’s office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually fill in with tissue over the next six weeks to three months. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush. The doctor will furnish you with a curved syringe at your one week follow up visit and show you how to use it. This will aid in the removal of food from the socket.

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. Keyhani.

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.

Remember, the human body takes 14 days to heal. It is normal to have pain and muscle soreness for at least 14 days. Dr. Keyhani will examine you a week after surgery and discuss your progress with you.

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.

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 45 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 bag of frozen peas or towel filled with ice cubes on the cheek in the  area of surgery. Apply the ice for 20 minutes on and 20 minutes off as much as possible for the first 24 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 the local anesthetic wears off.

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 45 minutes. If bleeding continues, a moist tea bag can be used for 45 minutes. If bleeding occurs avoid hot liquids, exercise, and elevate the head. If bleeding persists call Dr. Keyhani’s 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 24 hours only. Apply ice 20 minutes on and 20 minutes off.

For people who have no drug allergies and are completely healthy (no Asthma): in case of mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 6  hours.

Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 6 hours. Remember, the maximum dose of Ibuprofen in twenty four hours is 3200 mg and maximum dose of Tylenol or acetamenophen in twenty four hours is 4000 mg.

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, please take it as instructed.

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 which may lodge in the operated area. (One half teaspoon of salt in a glass of warm water.). After you have seen your dentist for denture adjust ment, 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 three days. Swelling and discolor ation 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 24 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. Swell ing 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.

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 45 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. Apply the ice 20 minutes on and 20 minutes off, as long as possible, for the first 24 hours

Diet

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

Food Suggestion

You may eat whatever you want as long as it is comfortable for you to eat.

Some examples:

Make sure to get plenty of fluid intake, including water.

Pain

You should begin taking pain medication before the local anesthetic wears off. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 6 hours. For patients with no allergies, and who are completely healthy, 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 6 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 have been instructed by your doctor not to take it. Remember, the maximum dose of Ibuprofen in twenty four hours is 3200 mg and maximum dose of Tylenol or acetamenophen in twenty four hours is 4000 mg.

Antibiotics

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

Oral Hygiene

Good oral hygiene is essential to good healing. The night of surgery, use the prescribed Peridex Oral Rinse before bed. The day after surgery, the 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

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 should not be used immediately after surgery and for at least 10 days. This was discussed in the pre-operative consultation.