Post-Op Instructions

After Oral Surgery- General Instructions

Immediately Following Surgery:

• The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
• 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 as soon as you begin to feel discomfort this will usually coincide with the local anesthetic becoming diminished.
• 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 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

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. Re-usable ice bags are available for sale for your convenience at the time of your procedure. The ice packs should be left on continuously while you are awake. After 36 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. Thirty-six hours following surgery the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours.

For severe pain take the tablets prescribed for pain as directed. The prescribed pain medicine 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. 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.

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. Rinse gently without force. Gently let the solution roll out of your mouth. Do not spit forcefully. REMEMBER: A clean wound heals better and faster.

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 are not routinely prescribed for routine oral surgery. 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 coke, 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. If your nausea and/or vomiting persist and is intolerable contact the office.

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 Tye if you have any questions about this, or if the numbness persist for longer than one week.
• If you notice air or fluid leak from your mouth to your nose, you may have a communication from your mouth to your sinus. Start taking decongestants and notify our office to be seen. Also do not drink from a straw or forcefully sneeze.
• 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 Dr. Tye .
• 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 a 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. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures are often resorbable.
• 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 my office for instructions.
• There may be a cavity 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: Dr. Tye or your family dentist.
• Brushing your teeth is okay - just be gentle at the surgical sites.
• 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.

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. In addition to the General Oral Surgery

• Post-operative instructions:
• Take your medications as prescribed.
• Keep your head elevated and use ice packs for 24 hours to minimize swelling.
• Begin rinsing gently the day after your surgery. Do not forcefully spit. Brush your teeth also, but be gentle with the surgical sites.
• Do not use a straw or drink carbonated beverages or drink alcoholic beverages for five days after your procedure.
• Do not smoke for five days after your procedure.
• Begin using the irrigation syringe in the lower sites only five days after your procedure. Use either warm salt water or dilute mouth wash (dilute _ with water). Do this two to three times daily for two to three weeks while the sites heal from the bottom up.

Possible complications

• Pain is normal after your procedure. Pain medications are often necessary for two to three days. After this the discomfort is often subsided with Advil. You may take two to three Advil every six hours.
• A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of throbbing pain at the surgical site and even pain radiated to the ear may occur 2-3 days following surgery. Call the office if this occurs.
• 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 Tye if you have any questions about this, or if the numbness persist for longer than one week.

After Exposure of an Impacted Tooth

In addition to the General Oral Surgery Post-operative instructions:

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.

If an attachment was placed, it is tied to your orthodontic arch wire. Do not pull on this wire.

Schedule to see your orthodontist two weeks after the procedure.

After the Removal of Multiple Teeth

In addition to the General Oral Surgery Post-operative instructions:

• 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 avoid hot liquids, exercise, and elevate the head. If bleeding persists call my 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 36 hours only. Apply ice continuously while you are awake.
• For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 3-4 hours. Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 3-4 hours.
• 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 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.
  
• Dentures: 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 two 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 36 hours after surgery (remember ice packs are used for the first 36 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 my office.
  • In the weeks that follow: You will need to make an appointment with your general dentist to have an adjustment done on your denture. 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

In addition to the General Oral Surgery Post-operative instructions:

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. This is normal.

Medications

Be sure to take the prescribed antibiotics as directed to help prevent infection. Take them until they are all gone. If implants were placed in the upper jaw, you may have been instructed to take decongestants for five days.

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 and for a period of two weeks, 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. Do not eat or drink for one hour afterwards. After two weeks, topically apply the Peridex to the implant site only with the use of a cotton tip applicator. 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 gentle brushing of the healing abutments is no problem. Do not use an electric toothbrush. 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. Afterwards, they may be worn. Be sure there is no pressure on the implant site. Your prosthesis may need to be adjusted. This was discussed in the pre-operative consultation.

Excessive pain or bleeding
Itching, or rash around the stitches
Temperature above 100 degrees orally.
Excessive: Swelling/bruising, Fatigue/depression

The head dressing, if used, will be removed at the first postoperative visit.
The small surgical clips used to close the incision will be removed in the office
4 to 5 days after surgery.
Clean suture lines with hydrogen peroxide and water (1/2 to _ mixture) using a Q-Tip 4 times daily. Apply Bacitracin or Neosporin antibiotic ointment ONLY to the sutures following cleaning for the first 3 days. Do not apply an antibiotic ointment to any other areas unless instructed by the doctor.
After sutures are removed, fine paper tape may be used on the incision. Please be sure to keep these dry.
Forehead swelling may prevent the upper eyelids from closing completely for several days. Lubricating eye ointment such as Duratears or Lacri-lube may be used before going to sleep to prevent dryness. Eyedrops such as Liquifilm Forte or Refresh can be used during the day if your eyes feel dry.
Numbness and tingling sensations in the forehead may last for several weeks. You may also experience some tenderness in this region.
As the small nerves grow back, bizarre symptoms of itching are often experienced; these will eventually disappear.
Makeup can be used within several days. Although your appearance will be presentable within several weeks, final healing may require several months.

No dressings are applied to the eyes following surgery. It is important to be sure to keep moist compresses on your eyes. There is no need to put antibiotic ointment on the incision lines.
When you arrive home, get a small basin with ice cubes and water and apply cold, moist compresses to your eyes. A bag of frozen peas with a damp washcloth works the best. This is to keep the swelling down and to keep the wounds clean of all crusting. Continue cold compresses over the eyelids for 3 days, then switch to warm moist heat.
Sleep with your head elevated for one week.
Continue to take prescribed medications and antibiotics as directed.
Apply sterile saline eye drops to your eyes if they feel dry or irritated. If an upper lid procedure was preformed, you may want to use Duratears ointment at bedtime and artificial tears several times a day.
Occasionally, a small area of swelling or reddish bumps are seen on or around incision lines; these disappear as healing progresses.
Swelling, bruising, and redness of the eyelids of varying degrees may occur. It last for approximately 2 weeks.
Wash hair following surgery, if desired.
Avoid bending over or lifting heavy objects for one week. No strenuous exercise for at least 6 weeks.
Do not apply any makeup for the first 10 days following surgery.
Do not wear contact lenses for 10 days. Wear glasses, if necessary, beingsure they do not pull on the incision line.
Do not pluck eyebrows for 2 weeks following surgery.
Report any eye pain or change in your vision to the office immediately.

Swelling: Swelling is the body’s normal response to surgery and the beginning of the healing process. Swelling and discoloration will vary among individuals and according to different procedures. Swelling will increase over the first 48 hours, and subside over the next 5 to 7 days, although swelling in the tip of the nose can persist for several months. Apply cold packs (15 minutes on, 15 minutes off) for the first 36 hours while awake. Keep the head elevated for the first 72 hours using pillows under the back and head while sleeping.
Bleeding: Minor bleeding or blood-tinged mucous may occur for the first 24 to 48 hours. Do not blow your nose for at least one week after surgery. A “mustache” drip pad of gauze may be used and changed as often as needed. If bleeding persist over 2 days or is heavier than normal, call the office.
Pain: Medication has been prescribed according to your anticipated level of discomfort. Take pain medication before numbness from the local anesthesia is gone. Repeat every 4 to 6 hours as needed unless otherwise instructed by your doctor. Take the medication with a milk shake or other food or beverage to avoid nausea. Do not drive, operate hazardous machinery or drink alcohol while taking pain medications.
Packing: At the doctor’s discretion, you may have packing placed in your nose at the time of surgery. This is done to minimize swelling inside your nose and to improve breathing. These soft plastic packs are sutured into place and will be removed by the doctor about one week after the surgery. There removal by the doctor is not painful.
Splint: The nasal splint with tape will remain in place for five to seven days. Avoid getting it wet. Wash your hair in a beaty salon fashion. After the splint is removed, do not allow glasses or mask to rest on the bridge of your nose for 6 weeks. Glasses should be taped to the forehead if needed
Wound Care: You can use Afrin nasal spray for the first 2 days following surgery, provided splints are not inside your nostrils, but you cannot use it longer than this or it will actually cause nasal congestion and impair healing. You can, however, use over-the-counter salt water nasal sprays such as Ocean spray or Fresh Ayre, warmed gently in the microwave, as often as desired. This will help clean the nose and decrease intranasal swelling. You may clean the edges of your nostrils with a Q-tip dipped in hydrogen peroxide to remove crust. However, do not advance the Q-Tip into the nose at all.
Diet: If your surgery is to be performed under an IV sedation or general anesthesia, you should not eat or drink anything for at least 6 hours prior to the procedure. After your surgery, start with a soft or liquid diet, and advance slowly to a normal diet to avoid post-operative nausea.
Sutures: The sutures placed inside the nose will dissolve by themselves. Sutures holding in the nasal packing and on the outside of the nose will be removed by your doctor about one week after your surgery.
Medications: In addition to medication for pain, you have also been given a prescription for an antibiotic on the day prior to the procedure.
Activity: Do not engage in any strenuous activity (bending, heavy lifting, etc.) for at least 2 weeks following surgery. Protect your nose from excessive sun exposure for 8 weeks after surgery.
Be assured that our interest in you well being does not end with your surgery. If you have any questions or problems, please call the office number. Help will always be available. A post-operative appointment has been scheduled, but we would be happy to see you sooner should the need arise.
Report any excessive pain, nasal drainage, rise in temperature above 100.5, or injury to the nose.

Apply ice packs to treated areas for the first few days to decrease swelling.
DO NOT PICK OR RUB TO REMOVE DEAD SKIN OR SCABS, as this may increase the risk of scarring. Any scabs should be gently soaked off, if possible. You may trim the ends of any flaking skin with clean scissors.
Apply a moisturizer such as Aquaphor or Catrix whenever the skin feels dry.
Sleep on your back with your head elevated on a few pillows for 3 - 4 days. You may experience increased swelling each morning upon awakening.
If the skin around the mouth is swollen or tight, drink using a straw.
Avoid strenuous exercise for 2 weeks to avoid irritating the skin.
Avoid drafts, fans, or air conditioners, etc., as air blowing on treated areas may cause stinging and will also dry out the skin.
Do not expose the skin to the sun for 2 weeks. It is very important to keep the area protected from the sun for the next several months to avoid changes in skin pigmentation and to minimize redness. For 2 - 4 weeks after surgery, a Titanium Dioxide containing sunscreen should be applied daily.
Most laser peels are supplemented by the use of rejuvenating creams. These may be started after 4-6 weeks.
The physician will instruct you when it is okay to start wearing make-up. This is usually day 7-10. A green or yellow undercover make-up applied under your foundation will help hide redness. We strongly recommend a consultation with our aesthetician prior to and one week after surgery for skin care and make-up directions and tips.