Patient Information

Surgical Instructions

Before Intravenous Anesthesia

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 and remain with the patient the day of surgery.
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, please check with Dr. Miller or Dr. Sethman 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 one half hour. After this time, the gauze pad should be removed and discarded. Additional gauze may be required until substantial bleeding subsides.
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 you begin to feel discomfort. Take your prescribed pain medication as directed.
Restrict your activities the day of surgery.
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 (your mouth fills up rapidly with blood) may be controlled by placing a gauze pad over the area and biting firmly for thirty 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

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 as much as possible, for the first 24 hours. 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 heat to the sides of the face is beneficial in reducing the size of the swelling. Your doctor may also prescribe medication to reduce the severity of swelling postoperatively. This medication should be started on the day after surgery as directed by your doctor.

Pain

For severe pain, the prescribed medication should be taken as directed. While you are taking your prescription pain medication, DO NOT drive or operate any type of heavy machinery. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it. Also, you will have less discomfort if you rest with your head elevated or remain in a semi-reclining position. If pain persists, it may require attention and you should call the office.

Diet

After general anesthetic, liquids, or soft, bland food should be taken at first. Avoid dairy products at first meal. 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.

Oral Hygiene

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

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.

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. 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 soda, 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. You may have been prescribed medication for nausea. Use as directed.

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. If this occurs, call our office so we may schedule a follow-up appointment.
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 the doctor.
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 up to a week following surgery. This is a normal post-operative event which will resolve in time.

Finally

Self-dissolving sutures maybe placed in the area of surgery to minimize post-operative bleeding and to help healing. They are designed to fall out on their own within a few days. Just remove the suture from your mouth and discard it. If a permanent suture has been placed you will be given a post operative appointment for their removal.
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 the office for instructions.
There will be a cavity or hole where the tooth was removed. The cavity will gradually, over the next month, fill in with the new tissue. 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: Drs Miller or Sethman or your family dentist.
Brushing your teeth is okay - just be gentle at the surgical sites.
A dry socket occurs 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 4-7 days following surgery. Contact the office if this occurs.
If you are involved in regular exercise be aware that your normal nourishment intake is reduced and exercise may weaken you. If you get light headed stop exercising. Do not exercise if you are taking pain medication.

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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 elevate the head and avoid hot liquids and exercise. If bleeding persists call our office. 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 continuously while you are awake.
For mild discomfort use 1 or 2 Tylenol or Tylenol Extra Strength every 6 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter, comes in 200 mg tablets: 2 – 4 tablets may be taken every 6 hours as needed for pain.
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 multiple 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 the 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 multiple 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 heat will help eliminate the discoloration more quickly. The heat 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. 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. Your dentist should see you the day following your surgery and make any necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.

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After Bone and Sinus Grafting

Bleeding

A certain amount of bleeding is to be expected following the surgery and it may continue for several hours. You should place a moistened gauze roll directly on the bleeding site and apply pressure for 30 minutes. Repeat as often as necessary every 30 minutes until bleeding subsides. Slight oozing the first 24 hours is acceptable. To help control bleeding, DO NOT rinse your mouth the first day. A small, dry tea bag may be alternated with the gauze for extra clotting effect. In case of severe or heavy bleeding, inform Dr. Miller.

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 continuously, as much as possible, for the first 24 hours. 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 heat to the sides of the face is beneficial in reducing the size of the swelling. Your doctor may also prescribe medication to reduce the severity of swelling postoperatively. This medication should be started on the day after surgery as directed by your doctor.

Sinus Precautions

After a sinus graft, do not blow your nose until directed by the doctor. It is also helpful to take an over the counter decongestant like Sudafed or Actifed for 7 days as directed on the package.

Oral Hygiene

After the first 24 hours, begin rinsing your mouth twice a day with Peridex. Do not swallow. Continue using the Peridex until gone. You may resume gentle tooth brushing on the day after your surgery to all areas except the implant surgical site. Clean this area with Q-tips and Peridex only for approximately 10-14 days. Do not wear your partial, complete or temporary denture until your doctor has instructed you to do so.

Pain

Unfortunately, pain pills only help control pain and do not entirely eliminate it. It takes a pain pill 30 – 60 minutes to work; therefore, take your pain medication before the local anesthesia wears off completely. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 6 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets: 2-4 tablets may be taken every 6 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. While you are taking your prescription pain medication, DO NOT drive or operate any type of heavy machinery. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it. Also, you will have less discomfort if you rest with your head elevated or remain in a semi-reclining position.

Nausea

Post-operative nausea is usually caused by taking medication on an empty stomach. Occasionally people experience nausea from different pain medications. If nausea occurs, discontinue the pain pills. Tylenol or Ibuprofen (Advil, etc.) can be used until your prescription can be changed. Avoid milk products until the nausea subsides. If you were given a prescription medication for nausea take it as directed.

Diet

Begin with clear liquids such as Sprite or 7-Up and then advance to soft foods: soup, pudding, gelatin, oatmeal, applesauce, baked potatoes, pasta, etc. It is very important that you drink plenty of fluids. DO NOT use a straw to drink. Also, avoid tobacco products and alcoholic beverages for 5 – 7 days.

Activity

There are no set of rules because people recover at different rates. Take it easy for the first few days, then be reasonable; don’t push yourself. Remember, while you are taking your prescription pain medication, DO NOT drive or operate any heavy machinery and avoid any other activities in which you may injure yourself.

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After Placement of Dental Implants

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 up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 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

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

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 day after surgery, use the prescribed Peridex Oral Rinse 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 not a problem. Be gentle initially with brushing the surgical areas.

Activity

Wearing your Prosthesis

Partial dentures, flippers, or full dentures should be used as directed by Dr. Miller.

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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 30 minutes. If bleeding continues please call for further instructions.

Swelling

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

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 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.

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