Pre-operative Instructions

Preoperative Instructions for Patients Undergoing General Anesthesia or Intravenous Sedation

• Do not drink anything (including water), eat or smoke for six (6) hours prior to the appointment.
• A responsible adult must accompany the patient to the office, remain in the office during the procedure, and drive the patient home. Patients can not be dropped off.
• The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia.
• Take your pre-operative medications as directed by your doctor.

IMPORTANT: Failure to follow these above instructions may result in postponement of your surgery.

What to wear for your surgical appointment

• Please wear loose fitting clothes and low-heeled shoes. Women may prefer to wear pants. Each patient will wear a surgical gown.
• Remove contact lenses prior to appointment time. Dentures must be removed at the time of surgery.
• If you have long hair, please tie it back away from your face.
• Leave jewelry, watches, and purses with your driver.

Guidelines for children receiving Anesthesia

The surgeon's role: The surgeon and staff are concerned with many aspects of your child’s care. The task is to provide a safe and comfortable environment, making the experience as pleasant as possible. Your oral and maxillofacial surgeon is uniquely educated and trained in anesthesia to assure the optimal safety and well-being of your child.

The parent's role: Along with the efforts of your child’s professional caregivers, parents also have a key role in their child’s care. It is known that children do better with anesthesia and surgery when they are well-prepared. This can begin as soon as a decision is made regarding surgery. It is natural to have fears of the unknown. It is our desire to provide comfort and information to improve your child’s experience.

The consultation appointment is the opportunity for you and your child to learn about and grow comfortable with this experience. Once you learn what will happen you will gain confidence and be better able to talk calmly and honestly with your child. An opportunity will be provided for you to familiarize yourself with our clinic and staff and to learn about options for your child’s anesthetic. It is also important for the child to know that you may not be with them every minute, but will be waiting nearby. An informed and composed parent is essential for an optimal surgical experience for the child.

What will the Oral and Maxillofacial surgeon need to know? Your child’s medical history (including anesthetic) is obtained and an examination is done at the consultation appointment. The anesthetic and surgical procedures will be thoroughly explained. In the event of minor illnesses such as “sniffles and colds”, inform our office for an assessment. Surgery may need to be rescheduled.

How will the child be given anesthesia? Sedation, medications, and any special instructions will be discussed pre-operatively. The protocol for monitoring your child’s anesthetic is thorough and includes: EKG, listening to heart and lung sounds, blood pressure/pulse readings and blood oxygen saturation levels. Induction of anesthesia can be done several ways. In adults, commonly an intravenous injection is used and the state of anesthesia begins rapidly. For children, this method can be used or the child can breathe the anesthetic agents. Your child will be informed of these choices and their preferences respected. Once asleep the anesthetic medications will be given intravenously. The patient is breathing oxygen continuously until fully awakened.

Children and adults awaken from anesthesia at different rates and emotional levels. The surgical site will be numb from a local anesthetic. Nausea and vomiting are occasional side effects of anesthetics and surgery.

What happens following anesthesia and surgery? The parent joins the child in the recovery area. Your assistance is necessary in providing ongoing emotional comfort and support. Instructions will be given and and your child discharged when criteria are met. Arrangements for follow-up care will be made if needed. Our staff calls each surgical patient later in the day.

Instructions for Drivers of Post-Anesthetic Patients

This may be your first experience caring for someone who has experienced out-patient sedation or general anesthesia. Unlike local anesthesia, a short-duration general anesthetic for a surgical procedure produces lingering effects. Therefore, we require all patients receiving a general anesthetic to be accompanied by a driver who remains in the reception area during the procedure. The length of time a patient remains in our office varies greatly; however, an in-office recovery period of thirty minutes could be considered average.

After surgery the patient is assisted to the recovery area in our office and the driver will be asked to sit with and assist the patient. Here patients are in various stages of wakefulness because the general anesthetic affects each individual differently. Some patients may be very sleepy; some are restless; still others are quite aware of their surroundings. Occasionally some may feel disoriented; this is especially true of our younger patients. Others may feel nauseated, appear pale, and upon standing, become weak. While these are normal responses, our surgical staff and your driver will be available to assist until the patient is comfortable and ready for discharge.

The staff will instruct the driver and the patient regarding care given in the recovery area:

The patient is to bite firmly on a gauze bandage to stop the oozing in the surgical site. The gauze bandages may require changing periodically. Because a local anesthetic, in addition to the general anesthesia, is given during surgery no discomfort is experienced during the bandage changes and up to about 8 hours post-operatively.

The patient is cautioned not to bite his lips or tongue to test the numbness. Because of the local anesthetic, the patient may comment on difficulty speaking and swallowing, dryness of the mouth and numbness of the lips and face.

Be available to give assistance and encouragement as needed. The nurses will be monitoring the patient’s progress and the recovery area is fully equipped for care.

The staff will give the driver and patient further instructions before returning home. These are very important!

• Assist the patient walking to your car.
• Have the patient sit in the passenger seat, assisting them with their seat belt.
• Remember, patients may appear to understand all instructions given to them, but the medications may hinder their memory. Upon returning home, make the patient as comfortable as possible and then review the instructions.

What to Expect Following the Removal of a Tooth

The following conditions are considered normal and may occur after the removal of a tooth:

• The surgical area may swell; swelling usually peaks the second or third post-op day.
• Trismus (stiffness) of the muscles may cause difficulty in opening your mouth for a few days.
  
• You may have a slight earache.
• A sore throat may develop.
• Your other teeth may ache temporarily. This is referred pain and is a temporary condition.
• When the corners of the mouth are stretched, they may be 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 fever continues, notify us.
• It is not unusual to develop bruising.
• Please take all prescriptions as directed.
• Women please note: Some antibiotics may interfere with the effectiveness of your birth control pills. Please check with your pharmacist.

Post-Operative Instructions

Care of the Mouth Following Minor Surgical Procedures and Removals

It is natural that temporary changes will occur in the mouth following a minor surgical procedure. You should be functioning normally in just a few days. In the meantime, you should follow a few simple rules to help promote healing, prevent complications, and make yourself more comfortable.

Anesthetics

The length of time you experience numbness varies, depending on the type of anesthetic you’ve received. While your mouth is numb, you’ll want to be careful not to bite your cheek, lip or tongue. The numbness should subside within a 24-hour period.

Bleeding

The surgeon will place a gauze pack on the surgical site to limit bleeding and confine the blood while clotting takes place. This gauze pack should be left in place for 30 minutes after you leave the doctor’s office. Do not chew on the pack. There may be some bleeding or oozing after the pack is removed. If so follow this procedure:

• Fold a piece of clean gauze into a pad thick enough to bite on. Dampen the pad and place it directly on the surgical site.
  
• Apply moderate pressure by closing the teeth firmly over the pad. Maintain this pressure for about 30 minutes, replace the pad with a clean one as necessary.
  
• A slight amount of blood may leak at the surgical site until a clot forms. However, if heavy bleeding continues, please call our office.

The Blood Clot

The clot that forms in the surgical site is an important part of the normal healing process. You should therefore avoid activities that might disturb the clot. Here’s how to protect it:

• Do not smoke, rinse your mouth vigorously, spit or drink through a straw for 24 hours. These activities create suction in the mouth which could dislodge the clot and delay healing.
  
• Do not clean the teeth next to the surgical site for the rest of the day. You should however brush and floss your other teeth as tolerated. Gently rinse your mouth afterward.
  
• Limit strenuous activity for 24 hours after surgery. This will reduce bleeding and help the clot to form.
  
• If you have sutures, our staff will instruct you when to return to have them removed.

Swelling

Swelling is expected following oral surgery and is likely to peak about 48 hours post-surgery before resolving. To minimize swelling and discomfort, apply an ice bag or cold moist cloth immediately following surgery over the affected area—30 minutes on and 30 minutes off—for eight hours. When using an ice bag, cover it with a soft cloth to avoid skin irritation. After 24 hours application of cold compresses offers little benefit. However, if swelling persists after four days or a fever develops, call our office.

Medication

The surgeon may prescribe medication to control pain and infection. Be sure to take some fluids or food prior to taking pain medication. Use medication only as directed; if the pain medication does not seem to be working for you, do not increase the dosage. If you have prolonged or severe pain, swelling, bleeding, or fever, call this office for further assistance.

Diet

After oral surgery, begin taking clear liquids – slowly – then progress to soft nutritious foods as tolerated. Avoid alcoholic beverages and hot liquids. Do not use straws; do not skip meals. Take any prescribed food supplements as directed. If you are a diabetic, maintain your diet and take medication as usual. If you are troubled by nausea and vomiting, call this office for advice. Food suggestions:

Oral Hygiene

The day following surgery, rinse your mouth gently with a solution of one half teaspoon of salt dissolved in a glass of lukewarm water. Repeat this after each meal for several days in order to remove food debris from the surgical site. It is important to brush and floss after surgery; however, be careful not to disturb the clot forming in the surgical site. Brushing the tongue with a soft bristled brush will help to eliminate the bad breath and unpleasant taste that is common after oral surgery.

Irrigating Syringe Instructions

This syringe is to aid you in cleaning your surgical wound, thereby assisting nature's healing process. You may start this care on the fifth day after your surgery. To begin, place the curved tip in a glass of plain water and draw back on the plunger until syringe is full. Insert into wound and empty the warm water from the syringe.

Do this exercise at least twice a day. You may wish to do it more often. There is no set number of days this must be done. You will begin to notice when food and debris no longer collect in the wound. This will guide you in knowing when to stop.

Rest

Keep your head elevated by using pillows or a reclining chair for 24 hours post-operatively. It is also important to get 8 – 10 hours of sleep a night to promote healing and well-being.

Remember….

• Severity of post-operative pain will depend on the procedure and your physical condition. Take medication for pain precisely as directed by our staff.
• Healing is slower for the removal of impacted teeth.
• Swelling can be expected. Be sure to apply ice/cold compress as directed.
• Difficulty in opening your mouth widely and discomfort upon swallowing can be anticipated.
• Numbness of the lips and/or tongue on the affected side may be experienced for a variable period of time.

Complications

If any of the following complications occur, please notify our office:

• Uncontrolled pain or if discomfort persists after 36 hours
• Severe bleeding
• Marked temperature rise
• Continued inability to open mouth
• Swelling that persists after the fourth day or excessive swelling that begins several days after surgery
• Any irritation at the area of the IV
• Persistant nausea or vomiting

Localized Osteitis (Dry Socket)

What is it? Dry socket is an occasional unpleasant complication following the removal of a tooth. It occurs when the blood clot fails to organize and disintegrates from the wound, producing increasing pain and a foul odor with drainage. Bone will be exposed in the wound. Dry socket is an inflammatory process and is most often not infectious. It typically develops two to five days post-operatively , most commonly after the removal of lower molar teeth and impacted teeth.

Who gets it? Even after following the home care instructions, dry socket can develop. The causes of this condition are not completely known. Increased frequency is associated with:

• Use of tobacco products
  
• Presence of gum disease or infections
  
• Use of oral contraceptives

If your surgeon feels you may be at risk, a medicated surgical dressing will be placed at the time of surgery.

How is it treated? The surgeon inserts a medicated surgical dressing into the affected area to promote both pain relief and healing. This dressing will be changed and/or removed when appropriate. Healing of the wound usually begins three to five days following onset of symptoms. It is uncommon for dry sockets to persist longer than five days. Antibiotics will be prescribed if an infection occurs.

Outcome? When dry socket occurs it’s important to know that the wound will ultimately heal properly.

POST OPERATIVE CARE FOLLOWING ORAL-SINUS COMMUNICATION

Wound Care

• Avoid blowing your nose, but instead, wipe gently.
• Refrain from smoking as smoking interferes with healing.
• Using a straw may reopen the wound.
• Rinse mouth or surgical site gently and brush remaining teeth.
• If you need to sneeze or cough, do so with mouth open.

Medications

• Take medications, prescribed for you, as directed.

Diet

• Avoid chewing on the side surgery was performed.
• Avoid abrasive and coarse foods; a soft diet is preferred

Complications

• If you experience unexplained drainage, increased swelling or pain, air or fluids passing from the mouth to the sinus, contact this office immediately.

FOLLOW UP VISITS

Post surgery appointments will be arranged, as necessary. Healing is likely to improve each day if you follow the instructions and suggestions as outlined. If unusual discomfort, bleeding, fever or other problems persist, please call this office; the phone is answered 24 hours a day.