John P. Blazic, DDS - Oral and Maxillofacial Surgery

I. Preoperative Instructions for Patients Undergoing General Anesthesia

-	You may not have anything to eat or drink (including water) for eight (8) hours prior to the appointment. You may brush your teeth but do not swallow any water.

-	A responsible adult or parent/legal guardian, if the patient is a minor, must accompany the patient to the office, remain in the office during the procedure, and be able to drive the patient home.

-	The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.

-	Please wear loose fitting clothing with short sleeves and low-heeled shoes. No slip-on shoes such as sandals or clogs. Contact lenses, jewelry, and dentures must be removed at the time of surgery.

-	Remove fingernail polish or acrylic nail from the left index finger.

II. The following conditions may occur after oral surgery, all of which are considered normal:

-	The surgical area will swell.

-	Swelling peaks on the 2nd or 3rd post -operative day.

-	Infrequently a patient may find that after several weeks swelling may suddenly recur. This may be an infection. The patient should call the office and make an appointment to be seen.

-	Trismus (stiffness) of the muscles may cause difficulty in opening your mouth for a period of days.

-	You may have a slight earache and/or throbbing of the side of the jaw. This condition is probably irritation of the bone in one of the sockets and delayed bony healing.

-	A sore throat may develop.

-	A sore arm may occur for a few days or longer where intravenous anesthesia has been administered. There may be bruising from this area. You can apply warm compresses to this area if it is uncomfortable.

-	The outside of your lower jaw and your neck may be sore from the nurse holding your head during surgery.

-	Your other teeth may ache temporarily. This is referred pain and is a temporary condition.

-	If the corners of the mouth are stretched out they may dry and crack. Your lips should be kept moist with cream or ointment.

-	There will be a space where the tooth was removed. After 24 hours this area should be rinsed following meals with warm salt water until it is healed. This cavity will gradually fill in with new tissue.

-	There may be a slight elevation of temperature for 24 to 48 hours. If temperature continues, notify us.

-	It is not unusual to develop bruising in the area of an extraction.

-	If you experience nausea, try a carbonated soft drink. If this worsens, then please call the office and a prescription can be called in.

-	Lower impacted teeth often rest on the main nerve to the lower jaw. Sometimes, in spite of all precautions, this nerve is bruised. Most often, the result will be numbness of the lower lip or tongue on that side. This effect often does not last more than a few weeks, however, it could last months or even be permanent.

-	Please take all prescriptions as directed.

-	Women please note: Some antibiotics may interfere with the effectiveness of your birth control pills. Please use an additional method of contraception while taking the antibiotics until you have completed the rest of that cycle�s package of pills.

III. Postoperative Instructions Following Oral Surgery

-	DO NOT SMOKE FOR 48 HOURS! Smoking can cause dry sockets, prolonged bleeding and pain, and delay the healing.

-	Keep fingers and tongue away from socket or surgical area.

-	Immediately upon arriving home, apply ice packs on the surgical area for first 24-48 hours. If surgery was performed on both sides of your jaws, then alternate the ice pack from side to side - 10 minutes on - 10 minutes off. If surgery was performed on only once side, then leave on for 10 minutes and off for 10 minutes. If an ice bag is unavailable, simple fill a �Ziploc� bag with crushed ice and cover with a soft cloth. Use moist heat after 48 hours. We suggest elevating your head when resting and sleeping by resting in a reclining chair or by placing at least 2 pillows under the head.

-	Immediately following the procedure, begin taking the medications prescribed for you.

-	Drink plenty of fluids. (Do not use a straw)

-	Do NOT rinse your mouth or brush your teeth the first 24 hours. After that time, you may brush your teeth, being very careful around the site of the extractions. Also, we recommend you use a warm salt-water rinse following meals for the first week to flush out particles of food and debris which may lodge in the surgical area. (1/2 teaspoon of salt in a glass of warm water. Mouthwash can be added for better taste.)

-	Your diet the first twenty-four hours (24) will consist of liquids such as broth, bullion, tomato soup, soda, or juice. If having any hot foods, please be sure and have someone check the temperature before drinking. You may still be numb and not be aware the drink is too hot and burn your mouth. You may have jello or pudding six to eight hours after surgery. The following forty-eight hours (48), your diet may consist of soft foods which can be easily chewed and swallowed such as soups, scrambled eggs, mashed potatoes, baked potatoes, applesauce, oatmeal, etc. After the forty-eight hours, you may return to your regular diet if ready. No seeds, nuts, rice, popcorn, etc.

-	A certain amount of bleeding is to be expected following surgery. Immediately following the procedure, keep a steady pressure on the area by biting firmly on the gauze placed there by the surgeon. Pressure helps reduce bleeding and permits formation of a clot in the tooth socket. Gently remove the compress when you return home. Some oozing of blood may persist even after 24 hours. If necessary, the bleeding may be controlled by applying pressure to the surgical area using small rolled gauze for 90 minutes. After that time remove the gauze and then you may eat or drink. If bleeding persists, a moist teabag should be placed in the area of bleeding and bite firmly for one hour straight. This will aid in clotting blood. Repeat if necessary. If bleeding still persists call our office.

-	Pain after surgery is normal and is usually most severe for the first few hours after surgery especially when the local anesthetic has worn off. As soon as you get home, get something to eat and take your pain medication before the numbness is gone.

-	Since anesthetics and pain medication make most people unsteady or dizzy, patients should be careful when getting up and moving about.

-	The stitches are self-dissolving. They should come out on their own within 5 to 10 days following surgery.

-	When lower wisdom teeth are removed, the doctor sometimes uses a long-acting anesthetic. It is possible for the lower jaw to remain numb for as long as 8 to 10 hours.

-	You may need two to three days to recover. Sometimes longer depending on the difficulty of the surgery.

-	Feel free to contact us if any doubt arises as to your progress and recovery.

Special considerations following removal of impacted teeth:

-	Removal of teeth is a surgical procedure. Postoperative problems are not unusual, and extra care must be taken to avoid complications.

-	Severity of postoperative pain will depend on the procedure and your physical condition. Take medication for pain precisely as directed.

-	Healing of the surgical site is variable.

-	Swelling can be expected. Be certain to apply ice bags as directed above.

-	Difficulty in opening your mouth widely and discomfort upon swallowing should be anticipated.

-	Numbness of lips and/or tongue on the affected side may be experienced for a variable period of time.