Before Intravenous Anesthesia Sedation
You may not have anything to eat or drink (including water) for eight hours prior to the appointment.
No smoking for 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 anesthesia.
Please wear loose-fitting clothing with sleeves which can be rolled up past the elbow. Please do not wear a dress or shoes with heels.
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 upset bowels, please notify the office.
If you take routine oral medications, please check with Dr. Skigen prior to your surgical date for instructions.
Please follow these recommendations if specifically advised by Dr. Skigen. This applies to patients who have had a sinus lift procedure or who have had a sinus exposure during an extraction.
1. Avoid Nose Blowing
2. Avoid Holding Your Nose When You Sneeze
3. Avoid Scuba Diving
4. Avoid Plane Travel
5. Take the prescribed decongestant and antibiotic
General Post Op Instructions
These instructions apply to most procedures performed in the office. Sometimes the after-effects of oral surgery are quite minimal, so not all of the instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office for clarification.
FOR 72 HOURS AVOID THE FOLLOWING:
NO SUCKING THROUGH A STRAW.
NO CARBONATED BEVERAGES SUCH AS SODA.
DAY OF SURGERY
FIRST HOUR: Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first half-hour unless the bleeding is not controlled. The packs may be gently removed after a one-half hour. If active bleeding persists, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 30-45 minutes). It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning.
DO NOT disturb the surgical area today. DO NOT rinse vigorously or probe the area with any objects. You may brush your teeth gently. PLEASE DO NOT SMOKE for at least 72 hours since this is very detrimental to healing and may cause a dry socket. Use caution when standing up quickly. This might cause light-headedness and may or may not cause you to faint.
OOZING: Intermittent bleeding or oozing overnight is normal. Bleeding may be controlled by placing fresh gauze over the areas and biting on the gauze for 30-45 minutes at a time.
PERSISTENT BLEEDING: Bleeding should never be severe. If so, it usually means that the packs are being clenched between teeth only and not exerting pressure on the surgical areas. Try repositioning the packs. If bleeding persists or becomes heavy you may substitute a tea bag for 20-30 minutes. If bleeding remains uncontrolled, please call our office.
SWELLING: Swelling is often associated with oral surgery. It can be minimized by using a cold pack, ice bag or a bag of frozen peas wrapped in a towel and applied firmly to the cheek adjacent to the surgical area. This should be applied 20 minutes on and 20 minutes off during the first 24 hours after surgery. If you have been prescribed medicine for the control of swelling (Medrol Dose Pack), be sure to take it as directed.
PAIN: Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. Take over the counter anti-inflammatories such as Ibuprofen, Advil or Motrin. We recommend for you to take 600-800mg of Ibuprofen every 6 hours for the first five days following surgery. All over the counter strengths of Ibuprofen come in 200mg tablets or capsules. You can take 3-4 tablets or capsules every 6 hours. Do not exceed 3200mg of Ibuprofen in a 24-hour period. Ibuprofen will help not only with pain but swelling as well. It will also reduce the need for prescribed narcotic pain medication. We recommend that you take your first dose of Ibuprofen before the local anesthetic or numbing medicine has worn for optimal pain control. Some patients find that stronger pain medication like narcotics cause nausea. Taking the pain medication with a small amount of food will reduce the nausea side effect. The effects of pain medication vary widely among individuals. Remember that the most severe pain is usually within the first 6 hours after the local anesthetic wears off. Your need for narcotic pain medication should lessen after that. If you find that you are taking large amounts of narcotic pain medication at frequent intervals, please call our office.
NAUSEA: Nausea is not uncommon after surgery. This can be caused by narcotic pain medications, swallowing a small amount of blood on an empty stomach or from sedation medications given during your procedure. Nausea can be reduced by preceding each pain pill with a small amount of soft food and taking the pill with a large volume of water. Try to keep taking clear fluids and minimize the dosing of narcotic pain medication. If your nausea does not resolve, please call our office.
DIET: Eat any nourishing food that can be taken with comfort. Avoid extremely hot foods. Do not use a straw for the first few days after surgery. It is sometimes advisable, but not absolutely required, to confine the first day’s intake to liquids or pureed foods (soups, puddings, yogurt, milk shakes, etc). It is best to avoid foods like nuts, sunflower seeds, popcorn, etc., which may get lodged in the socket or surgical site areas. Over the next several days you may gradually progress to solid foods. It is important not to skip meals. If you take nourishment regularly you will feel better, gain strength, have less discomfort and heal faster. If you are a diabetic, maintain you normal eating habits or follow instructions given by your doctor.
FEVER: Slight elevation in body temperature immediately following surgery is not uncommon. Tylenol should be taken to bring the fever down. If your fever persists after the second day, please notify the office.
INSTRUCTIONS FOR SECOND AND THIRD DAYS
MOUTH RINSES: Keeping your mouth clean after surgery is essential. Use 1/4 teaspoon of salt dissolved in an 8-ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Lean over the sink, open your mouth and allow the rinse to fall into the sink. Do not rinse or spit forcefully. Repeat at least twice a day or as often as you like.
BRUSHING: Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth within the bounds of comfort.
DRY SOCKET: After a tooth is removed, the tooth socket normally fills with a blood clot. This blood clot serves as a protective bandage and helps with proper bone healing of the socket. To reduce the risk of a dry socket, please AVOID SMOKING, SPITTING, SUCKING THROUGH A STRAW OR VIGOROUS MOUTH RINSING. Behaviors such as these will cause the blood clot to break up or dissolve prematurely and will leave the bony socket open or “dry.” This dry socket results in increasing pain around the fourth or fifth day following a tooth extraction.
SHARP EDGES: If you feel something hard or sharp edges in the surgical areas, it is likely you are feeling bony walls which once supported the extracted teeth. Occasionally small slivers of bone may work themselves out during the following week or so. If they cause concern or discomfort, please call our office.
NUMBNESS: If numbness of the lip, chin or tongue occurs there is no cause for alarm. As reviewed in your consultation, this is usually temporary in nature, sometimes lasting weeks to months. You should be aware if your lip or tongue is numb, you could bite it and not feel the sensation. If your numbness persists after one week, call the office to schedule a follow-up appointment.
DRY, CRACKED LIPS: If the corners of your mouth or lips are cracked or dry, this is likely from stretching your lips during surgery. Your lips should be kept moist with an ointment such as vaseline.
DECREASED MOUTH OPENING: Normal swelling that occurs after oral surgery procedures causes stiffness of the jaw muscles and a decreased ability to open your mouth for a few days after surgery. Sometimes this can last up to one week. Eating soft food and taking Ibuprofen will ease this tightness and swelling.
HEALING: Normal healing after tooth extraction should be as follows. The first two days after surgery are generally the most uncomfortable and there is usually some swelling. On the third day you should be more comfortable and, although still swollen, can usually begin a more substantial diet. The remainder of the post-operative course should be a gradual, steady improvement. If you don’t see continued improvement, please call our office. If you are given a plastic irrigating syringe, DO NOT use it for the first five days. Then use it daily according to the instructions until you are certain the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call our office.
Implants and Bone Grafts
Home Instructions After Dental Implant Surgery
After dental implant surgery, 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 rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues profusely, 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 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, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. 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 four times daily, not to exceed 3200mg daily for an adult. Consult our practice for individuals under 18. Do not take the two medications at the same time.
For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. 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.
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 (one teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day as well, especially after meals. Brush your teeth and the healing abutments. Be gentle initially while brushing the surgical areas.
Activity | Keep physical activities to a minimum immediately following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking in 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 for at least 10 days, as discussed in the pre-operative consultation
Exposure of a Tooth for Orthodontics
After an impacted tooth is uncovered and an orthodontic bracket placed, there will be a chain that is attached to your orthodontic wire. Do not disturb this area until you follow up with your orthodontist. If the chain becomes unattached to the wire before you follow up with your orthodontist, call our office and we can easily re-attach it to your wire.
If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery to make the necessary adjustments and relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process