Surgical Instructions

What to Expect

Before you have any kind of surgical procedure performed in our office, we will require you to have a consultation with one of our surgeons. This provides the surgeon with an opportunity to evaluate your condition, take any necessary medical images (such as X-rays), and confirm that you are a good candidate for a safe and successful procedure. It also allows the surgeon a chance to talk with you about your treatment plan and answer any questions you might have.

There is a full range of topics that might be discussed during this appointment. For example, your surgeon will discuss some of the anesthesia and sedation options that are available to you, ensuring your comfort and safety during the procedure. You and your surgeon will also talk about the expected surgical results, aftercare, and recovery instructions.

It is important to us that your experience is positive and comfortable. Below, we have outlined a few of the options we offer to make that happen. If you have any questions, we recommend writing them down so that you can ask us during your consultation.

IV Sedation

Not only does sedation help keep you out of physical pain, but it can also mitigate any anxiety you are feeling about your procedure. Our team offers the option of intravenous sedation, also referred to as IV sedation or IV anesthesia. This is one of the best ways to keep you comfortable, and will help to manage pain and anxiety throughout your surgery.

Anesthesia and Surgical Experience

Our surgeons have years of experience evaluating patients for surgery and administering anesthesia. Additionally, they are skilled in recognizing the signs of surgical complications and other medical emergencies, managing and responding to them in a way that promotes patient health and optimal outcomes. We have state-of-the-art facilities and advanced surgical technologies that are designed to provide our patients with safety throughout their entire experience.

Before Intravenous Anesthesia Sedation (Pre-Op Instructions)

During your consultation, your oral surgeon will go over some basic guidelines about how to prepare for surgery, and specifically how to prepare for the administration of IV sedation. Here is a summary of the general surgical guidelines. Always ask your surgeon if you have any questions or concerns.

Some guidelines for preparing for your oral surgery include:

• Avoid having anything to eat or drink, including water, for eight (8) hours before your surgery.
• Avoid smoking for at least 12 hours before surgery. Ideally, we recommend patients cut out smoking altogether.
• You will need a responsible adult to come with you to the appointment, wait for you, listen to any important post-surgical instructions, and drive you home. We cannot discharge patients who do not have a ride lined up.
• Following the anesthesia experience, you will need to avoid driving or operating heavy machinery for at least 24 hours.
• We advise patients to wear loose-fitting clothes with short sleeves and low-heeled shoes.
• Before surgery, you will be asked to remove dentures, contact lenses, and jewelry.
• On the day of your surgery, avoid wearing lipstick, nail polish, or any kind of excessive makeup.
• Notify the office if you have any kind of illness leading up to the day of your surgery, including a sore throat, cough, upset stomach, etc.
• Ensure that you discuss any medications you take with your surgeon. Ideally, you should furnish a current list of medications at your initial consultation.

Wisdom Teeth Removal

Wisdom teeth removal is very common and safe. With that said, it is a surgery and requires care during the recovery process. Following these aftercare instructions can significantly minimize your risk of ongoing discomfort or infection.

Immediately Following Surgery

• There will be a gauze pad placed over the incision sites intraorally. Keep this gauze pad in place for half an hour after surgery, or until it becomes fully saturated, whichever happens first. It is very common to experience a small amount of blood oozing from the surgical sites for the first 12-24 hours after surgery. While this oozing will slow and eventually stop, most patients will need to replace the gauze and bite with firm pressure for several cycles before this happens. Once oozing has stopped, you may remove the gauze indefinitely.
• Avoid trauma to the wound area or any kind of vigorous mouth washing immediately following surgery. Dislodging the blood clot may prolong bleeding and impair healing.
• To help keep you comfortable during recovery, it is recommended that you start any prescribed pain medication before the numbing medicine wears off.
• Try to rest on the day of your surgery. Take it easy and restrict physical activities. Get back to your normal physical activities only when you feel able.
• Use ice packs on the side of your cheeks for 48 hours post-surgery. When possible, it is also beneficial to keep your head elevated during this time. These are important ways to minimize swelling. After 48-72 hours, it is recommended to switch to heat therapy on the cheeks with a gentle massage 3-4 times per day to facilitate the reduction of any swelling and soreness that you experienced.

Bleeding

Following surgery, a little bit of bleeding is normal and can be anticipated. Some slight bleeding, or red saliva, is nothing to worry about and may continue off and on for 12-24 hours. If you experience excessive bleeding, you may be able to control it by first rinsing away any old blood clots in your mouth. Next, place a folded gauze pad over the wound area, and bite down on it with firm pressure for at least half an hour, or until the gauze becomes fully saturated. These steps may need to be repeated multiple times. Additionally, you may try biting down on a moist tea bag for half an hour. Finally, you can minimize bleeding by resting, head elevation, and avoiding physical exercise or excitement.

Swelling

Following wisdom teeth removal, you can expect some swelling around the mouth, cheeks, and even underneath the eyes. This is the body’s normal response to surgery. Usually, swelling does not become evident until the day after surgery and will reach its peak on day two or three. You can control swelling with the use of ice packs. Place them against the outside of the face where surgery was performed, and keep them there continuously while you are awake. Note that, after 36-48 hours, ice will no longer provide as much benefit. At this point, moist heat (e.g., a warm compress) with gentle cheek massage 3-4 times per day will help the swelling to subside over the next week.

Also, be aware that your jaw may become stiff following surgery, especially during the second and third days of your recovery. This is a normal response to surgery and is nothing to worry about. Once the swelling begins to decline, you may begin daily mouth opening exercises to regain full mouth opening. It is not uncommon to require 3-4 weeks of exercising before you begin to feel back to normal.

Pain

It is recommended to begin any prescribed pain medications prior to your numbing medicine wearing off.

If you experience mild to moderate pain, you may take 1-2 tablets of Tylenol or Extra Strength Tylenol every 6 hours. Ibuprofen (Motrin or Advil) may also be taken to help control not only pain, but also swelling and inflammation. Ibuprofen generally comes in 200mg tablets and may be taken in a 600mg dosage every 6 hours, or an 800mg dosage every 8 hours.

For more severe pain, take narcotic pain medications if prescribed by your surgeon and use them as directed. Note that narcotic pain medications can cause you to feel groggy, and they may also slow your reflexes. When taking narcotic pain medicines, avoid driving, operating machinery, and drinking alcohol. Narcotics prescribed by your doctor may also contain Tylenol, and it is important to not take any additional Tylenol if you are regularly taking this medication. In contrast, Ibuprofen (Motrin or Advil) does not contain any Tylenol and is safe to take alongside any narcotic.

Following 72 hours after surgery, pain should become less and less pronounced each day. If pain persists or intensifies, contact your surgeon.

Diet

After anesthesia or IV sedation, you will want to resume your diet with liquids first. Drink from a glass and avoid any vigorous suctioning with straws (the sucking motion from the straw may dislodge your blood clot and cause more bleeding). Once tolerating liquids, you can enjoy any soft foods that are easy to clean out of the mouth. We recommend chewing away from the surgical site when possible. 

Seek nourishment regularly, and drink lots of fluids to ensure that you avoid dehydration. Over the first couple of days, your food intake may be lower, so compensate by drinking more liquids, and protein/nutrition shakes to obtain plenty of calories and protein. Aim for a minimum of five to six glasses of liquid daily.

Exercise

It is okay to begin light cardiovascular activities 3-4 days after surgery, if you feel able. If you exercise regularly or play a sport, be aware that your normal nourishment intake will be temporarily reduced, and you may need to ease back into activities. If you become lightheaded, avoid exercising for several more days to allow additional recovery. It is beneficial to avoid heavy weightlifting and contact sports like football, basketball, wrestling, hockey, etc., for up to 7-10 days. 

Keep Your Mouth Clean

The cleaner you keep your mouth and surgical sites, the better and faster they will heal.

On the day of your surgery, you may gently brush your teeth at night and keep your entire mouth as clean as possible. Begin rinsing with saltwater 3-4 times daily, especially after eating. Your surgeon may also prescribe a prescription-strength mouthwash that can be used in place of or in addition to saltwater rinses.

Discoloration

In addition to swelling, some patients may experience some slight discoloration or bruising of the skin. Any black, blue, green, or yellow discoloration may be caused by blood spreading beneath the tissues (bruising). This is very normal and may happen within two to three days of your procedure. A warm compress can help manage this discoloration, but it may require 1-2 weeks to fully resolve.

Antibiotics

Antibiotics can help prevent infection, so make sure you take them as directed if your surgeon prescribes them. Do not continue using antibiotics in the event of a rash or other adverse reaction. Contact the office if you have any questions.

Nausea and Vomiting

Nausea and vomiting can be caused by the medications and stress of your recent surgery. Dehydration from not drinking prior to the surgery can further worsen these symptoms. If you experience nausea or vomiting after surgery, begin fluid and food intake slowly and progress as tolerated. Try sipping on ginger ale, tea, or Coke. Sip slowly and take any anti-nausea medications prescribed by your surgeon. When nausea subsides, you can try eating solid foods and taking your medications again. Remember that any prescribed narcotic medication can worsen nausea. It may help to have some solid food in your stomach prior to taking any narcotics.

Sutures

Sutures will be used to minimize bleeding and expedite your healing. In most instances, the sutures are self-dissolving and will remain in place for 3-10 days. While they may become dislodged after surgery (even after a day or two), this is nothing to worry about. Simply remove the dislodged suture from your mouth, as necessary, and discard it.

There will be a cavity where the wisdom tooth was removed, and over the course of about a month, this cavity will fill with tissue and ultimately close over. Using salt water rinses and tooth brushing to keep this area very clean, especially following meals, is vital to facilitate healing. Additionally, you will be provided with an irrigating syringe to use daily. Allowing food to become trapped, particularly in the lower extraction sites, can lead to prolonged pain and infection during recovery.

A dry socket occurs when the blood clot gets dislodged prematurely from the tooth socket, causing pain in the mouth or even in the ear. The severe pain associated with this condition will typically not occur until 3-5 days following surgery. If this happens, reach out to our office for further guidelines.

Other Complications

• Following surgery, you may notice numbness of the lip, tongue, or chin. This is normal and should prove temporary. However, the numbness may cause you to accidentally bite your tongue or your lip, so be extra careful as you eat.
• You may have a slight uptick in temperature after surgery. This is normal and can be managed with Tylenol or Ibuprofen.
• Be careful moving from a lying down position to standing. You will likely feel weak and a bit dizzy. To avoid lightheadedness, you should sit for one minute before you stand up.
• Some patients feel hard projections in the mouth with their tongue. These are the bony walls that support the wisdom tooth. Most of the time, they smooth out on their own. If they cause an ongoing problem, our surgeons can address them to alleviate your symptoms.
• If the corners of your mouth are stretched out, it may result in dry, cracked lips. Use ointments such as Vaseline to keep your lips moist.
• It is also common to experience a sore throat, especially when swallowing. This is simply the result of swelling in the throat muscles, and should subside within a couple of days.
• Stiffness in the jaw muscles may cause difficulty in opening your mouth for a few weeks after your surgery. This stiffness is normal and will resolve on its own. You can facilitate recovery by applying a warm washcloth or heating pad to the cheeks and performing mouth opening exercises daily.

Tooth Extractions

Bleeding

Following the extraction of multiple teeth, it is normal to experience some bleeding for 12-24 hours after surgery. There will be a gauze pad placed over the incision sites intraorally. Keep this gauze pad in place for half an hour after surgery, or until it becomes fully saturated, whichever happens first. Once the gauze is removed, it can be replaced with a new piece. Make sure to bite with firm pressure while the gauze is in place. While this oozing will slow and eventually stop, most patients will need to replace the gauze multiple times before this happens. Once oozing has stopped, you may remove the gauze indefinitely.

If you do experience bleeding, keep your head elevated and avoid exercise and hot liquids. If bleeding persists, reach out to our office for further instruction.

Denture wearers can expect some oozing from around the sides of their dentures. Temporarily removing the dentures can allow eating and proper cleaning of the wound sites. However, leaving the dentures in place as much as possible post-surgery can provide pressure and a “band-aid” like effect to control bleeding and pain. 

Swelling

You can expect some swelling around the mouth, cheeks, and even underneath the eyes or chin. This is the body’s normal response to surgery. Usually, swelling does not become evident until the day after surgery and will reach its peak on day two or three. You can control swelling with the use of ice packs. Place them against the outside of the face where surgery was performed, and keep them there consistently while you are awake. Note that, after 36-48 hours, ice will no longer provide as much benefit. At this point, moist heat (e.g., a warm compress) with gentle cheek massage 3-4 times per day will help the swelling to subside over the next week.

Also, be aware that your jaw may become stiff following surgery, especially during the second and third days of your recovery. This is a normal response to surgery and is nothing to worry about. Once the swelling begins to decline, you may begin daily mouth opening exercises to regain full mouth opening. It is not uncommon to require 3-4 weeks of exercising before you begin to feel back to normal.

Pain

It is recommended to begin any prescribed pain medications prior to your numbing medicine wearing off.

If you experience mild to moderate pain, you may take 1-2 tablets of Tylenol or Extra Strength Tylenol every 6 hours. Ibuprofen (Motrin or Advil) may also be taken to help control not only pain, but also swelling and inflammation. Ibuprofen generally comes in 200mg tablets and may be taken in a 600mg dosage every 6 hours, or an 800mg dosage every 8 hours.

For more severe pain, take narcotic pain medications if prescribed by your surgeon and use them as directed. Note that narcotic pain medications can cause you to feel groggy, and they may also slow your reflexes. When taking narcotic pain medicines, avoid driving, operating machinery, and drinking alcohol. Narcotics prescribed by your doctor may also contain Tylenol, and it is important to not take any additional Tylenol if you are regularly taking this medication. In contrast, Ibuprofen (Motrin or Advil) does not contain any Tylenol and is safe to take alongside any narcotic.

Antibiotics

Antibiotics can help prevent infection, so make sure you take them as directed if your surgeon prescribes them. Do not continue using antibiotics in the event of a rash or other adverse reaction. Contact the office if you have any questions.

Diet & Hygiene

Once you are able to tolerate liquids, you can advance to eating soft foods that are easy to clean out of the mouth. We recommend chewing away from the surgical site when possible. 

Seek nourishment regularly, and drink lots of fluids to ensure that you avoid dehydration. Over the first couple of days, your food intake may be lower, so compensate by drinking more liquids, and protein/nutrition shakes to obtain plenty of calories and protein. Aim for a minimum of five to six glasses of liquid daily.

Keeping Your Mouth Clean

The cleaner you keep your mouth and surgical sites, the better and faster they will heal.

On the day of your surgery, you may gently brush any teeth at night and keep your entire mouth as clean as possible. Begin rinsing with salt water 3-4 times daily, especially after eating. Your surgeon may also prescribe a prescription-strength mouthwash that can be used in place of or in addition to salt water rinses.

Having many teeth extracted at one time is quite different from having just one or two teeth removed. During the extraction of multiple teeth, the bone must be shaped and smoothed prior to the insertion of a denture. In this case, the following conditions may occur and are considered normal:

• You may experience swelling and discoloration, sometimes around the eye or under the chin. Swelling usually begins the day after surgery and reaches its peak within two or three days, then dissipates gradually. You can minimize swelling by applying a warm compress to the affected area.
• It is normal to experience a sore throat, simply due to the throat muscles swelling. This should resolve on its own over the course of two or three days.
• Also, note that your lips may become dry or cracked. Application of Vaseline or other ointments can help a great deal.

If immediate dentures have been placed, you may notice the development of some sore spots. In most cases, your regular dentist will see you within several days after surgery and make the necessary adjustments to relieve sore spots. Failure to make this appointment may result in severe denture sores, which can, in turn, extend your healing process.

Dental Implant Surgery

Following dental implant surgery, it is important to avoid disturbing the wound. On the day of your procedure, avoid over-aggressive manipulation of the tissues.

Bleeding

It is very normal to experience some minor bleeding or red saliva for the first 24 hours following your surgery. If you have excessive bleeding, bite down on a piece of gauze for half an hour. Ensure that the gauze pad is placed directly over the incision site. If bleeding persists or cannot be controlled, contact our office.

Swelling

Swelling is a normal occurrence after any kind of surgery. The best way to control swelling is by applying ice to the side of the face where the implants have been placed. For the first 36 hours after surgery, use ice consistently while you are awake and keep your head elevated when possible. Swelling will peak in 2-3 days and then begin to subside gradually. After 72 hours, discontinue the icing and apply a heat pack or warm washcloth with gentle massage 3-4 times daily to help facilitate swelling reduction.

Diet

Following the placement of dental implants, you will want to get plenty of fluid intake. On the day of surgery, stick to soft foods and liquids, then advance to a normal diet as soon as you feel comfortable doing so. After surgery, you may have a small visible metal healing cap connected to your implant(s) that protrudes slightly through the gum tissue. If present, it is very important not to chew directly on this healing cap for several months. We do recommend that you gently brush and clean this cap daily to keep it and the surrounding tissues clean.

Pain

It is recommended to begin any prescribed pain medications prior to your numbing medicine wearing off.

If you experience mild to moderate pain, you may take 1-2 tablets of Tylenol or Extra Strength Tylenol every 6 hours. Ibuprofen (Motrin or Advil) may also be taken to help control not only pain, but also swelling and inflammation. Ibuprofen generally comes in 200mg tablets and may be taken in a 600mg dosage every 6 hours, or an 800mg dosage every 8 hours.

For more severe pain, take narcotic pain medications if prescribed by your surgeon and use them as directed. Note that narcotic pain medications can cause you to feel groggy, and they may also slow your reflexes. When taking narcotic pain medicines, avoid driving, operating machinery, and drinking alcohol. Narcotics prescribed by your doctor may also contain Tylenol, and it is important to not take any additional Tylenol if you are regularly taking this medication. In contrast, Ibuprofen (Motrin or Advil) does not contain any Tylenol and is safe to take alongside any narcotic.

Sutures

Oftentimes, sutures around dental implants will be self-dissolving. If non-dissolving sutures are used, your surgeon will discuss this with you prior to discharge and arrange a follow-up visit for removal. This is generally done 7-14 days following surgery. This process takes just a few minutes, does not require anesthesia, and does not cause any pain or discomfort.

Antibiotics

Antibiotics can help prevent infection around your implant(s) and will likely be prescribed following surgery. Please take them as directed. Do not continue using antibiotics in the event of a rash or other adverse reaction. Contact the office if you have any questions.

Oral Hygiene

Good oral hygiene is an important part of the healing process. On the night of your surgery, use the Peridex Oral Rinse before bed, if prescribed. The day after surgery, use Peridex twice daily, after breakfast and before bed. Rinse for at least 30 seconds, then spit it out. Warm salt water rinses (teaspoon of salt in a cup of warm water) can also be used 2-3 times a day, especially after meals. 

Brush your teeth and the healing caps like normal. Be gentle when brushing the surgical areas.

Activity

The day after your surgery, we advise keeping physical activity to a minimum. Physical activity may result in bleeding or throbbing. Following surgery, you may not have your normal level of nourishment, and exertion may weaken you or cause lightheadedness.

Exposure of an Impacted Tooth

Following surgery, try not to disturb the wound. You may have surgical packing in place to keep the tooth exposed. Do not bother the packing, but also do not worry if it falls out on its own.

Bleeding

You may experience some minor bleeding or red saliva for the first 24 hours following your surgery. If you have excessive bleeding, bite down on a piece of gauze for half an hour. Ensure that the gauze pad is placed directly over the incision site. While bleeding will eventually slow and ultimately stop, it may require multiple gauze changes before reaching that point. Once bleeding has ceased, the gauze may be removed indefinitely. If bleeding persists or cannot be controlled, contact our office.

Swelling

Swelling is a normal occurrence after surgery. The best way to control swelling is by applying ice to the side of the face where the procedure took place. For the first 36-48 hours after surgery, use ice continuously, as much as possible, while you are awake. On the third day post surgery, discontinue the icing and begin a warm compress or washcloth with a gentle massage to promote swelling reduction.

Diet

Drink plenty of fluids and avoid hot foods and beverages. On the day of surgery, stick to soft foods and liquids, then advance to a normal diet as soon as you feel comfortable doing so. If a gold chain or other hardware was connected to your impacted tooth, clean and rinse the area daily to promote healing and avoid infection.

Pain

It is recommended to begin any prescribed pain medications prior to your numbing medicine wearing off.

If you experience mild to moderate pain, you may take 1-2 tablets of Tylenol or Extra Strength Tylenol every 6 hours. Ibuprofen (Motrin or Advil) may also be taken to help control not only pain, but also swelling and inflammation. Ibuprofen generally comes in 200mg tablets and may be taken in a 600mg dosage every 6 hours, or an 800mg dosage every 8 hours.

For more severe pain, take narcotic pain medications if prescribed by your surgeon and use them as directed. Note that narcotic pain medications can cause you to feel groggy, and they may also slow your reflexes. When taking narcotic pain medicines, avoid driving, operating machinery, and drinking alcohol. Narcotics prescribed by your doctor may also contain Tylenol, and it is important to not take any additional Tylenol if you are regularly taking this medication. In contrast, Ibuprofen (Motrin or Advil) does not contain any Tylenol and is safe to take alongside any narcotic.

Antibiotics

Antibiotics can help prevent infection, so make sure you take them as directed. Do not continue using antibiotics in the event of a rash or other adverse reaction. Contact the office if you have any questions.

Oral Hygiene

Keeping your mouth clean is an important part of the healing process. Beginning the day after surgery, clean your mouth after every meal. Brush your teeth as best you can, and wash your mouth with a warm salt water mix. Use this mix 3 times a day until your mouth is fully healed.  If your impacted tooth has a gold chain or other hardware, be sure to clean and rinse the area daily to promote healing and avoid infection.

Activity

The day after your surgery, we advise keeping physical activity to a minimum. Physical activity may result in bleeding or throbbing. Advance to light, and then normal activity as tolerated.

After Tooth Extraction

Following the extraction of a tooth, we will ask you to bite down on a gauze pad for 30 to 45 minutes, which helps a blood clot form. If bleeding persists, discard the gauze pad, replace it with a clean gauze pad, and repeat this process. You may need to do this multiple times in order to get a clot to form.

Following the formation of a blood clot, it is important not to disturb it. Avoid vigorous spitting or forceful straw usage for at least 72 hours. Also, be very gentle when brushing near the extraction site. Limit exercise or strenuous physical activity for at least 24 hours.

Pain and swelling can be expected for the first 48-72 hours. You can manage these symptoms with ice packs and pain medications, as recommended or prescribed by your surgeon.

On the day of the extraction, drink plenty of fluids and stick to soft foods. Advance to a more normal diet as soon as you feel able to do so.

Within 24 hours, resume your normal oral hygiene habits, including brushing and flossing.