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Patient Instructions


Post-Operative Instructions

General Guidelines for all procedures:


Carefully follow all guidelines provided by our office, and, most importantly, practice good oral hygiene. Additional instructions following various types of treatment are listed below. Please click on the below topics for detailed instructions. In the event of an emergency, please call our office. If you are experiencing a serious or life threatening emergency, please call 911 or visit the nearest emergency room.


Before Anesthesia

  • Nothing to eat for 8 hours before surgery
  • You may drink water up to 4 hours before surgery
  • Do not wear contact lenses
  • No recreational drugs within 48 hours of surgery
  • You must be accompanied by an adult to safely assist you home
  • Wear loose fitting, comfortable clothing
  • If you regularly take prescription medications or our office has prescribed medication for you, please take them as directed with a small amount of water.
  • Smoking delays healing and increase your risk of a “dry socket” or post-operative infection. Please refrain from smoking for 24 hours before surgery and after surgery.

After Anesthesia

  • After general sedation, patients should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
  • Phlebitis, or irritation of the vein, can occur on the injection site. Use moist heat and take Ibuprofen to alleviate any discomfort. Should you have persistent pain, please contact us.
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.

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 replaced if there is any bleeding.
  • There will be a hole where the tooth was removed. The hole will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean especially after meals with salt-water rinses or a toothbrush.
  • 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.
  • Before the local anesthetic subsides (about 90 minutes) you may take two 200 mg tablets of Ibuprofen (Motrin or Advil) every three to four hours. If you are unable to take Ibuprofen then take one or two tablets of Tylenol or Extra Strength Tylenol every three to four hours.
  • For severe pain, take the tablets prescribed as directed along with Ibuprofen (They work well together). 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.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.
  • CAUTION: If you suddenly sit up or stand from a lying position, you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

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 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 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 two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. 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. . If your post-operative swelling worsens or unusual symptoms occur, call the office for instructions.

Diet

  • Drink cold liquids after general anesthesia or IV sedation. Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. 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 five to six 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. Avoid eating hot temperature, acidic, and spicy foods.

Keep Your Mouth Clean

  • No rinsing of any kind should be performed 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 five to six times a day with a cup of warm water mixed with a teaspoon of salt especially after eating.

Discoloration/Bruising

  • 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 postoperative occurrence, which may occur two to three 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 will be given to help prevent infection, but are not routinely necessary after surgery. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Call the office if you have any questions.

Nausea & 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 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.

Activity

  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable. If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you become light headed, stop exercising.

Smoking

  • Do not smoke for at least twenty four hours after surgery, if at all. As discussed at your consultation, smoking dramatically increases the risk of bone graft and sinus augmentation failure. Our surgeons can prescribe a Nicoderm patch if you feel you need it.

Pain

  • For moderate pain, you may take two 200 mg tablets of Ibuprofen (Motrin or Advil) every three to four hours. If you are unable to take Ibuprofen then take one or two tablets of Tylenol or Extra Strength Tylenol every three to four hours.
  • For severe pain, take the tablets prescribed as directed along with Ibuprofen (They work well together.). 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.

Other Concerns

  • 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 the sensation. Be careful. Call our office if you have any questions.
  • A 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. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and 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 your surgeon.
  • 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. This will subside in two to three days.
  • Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event that will resolve in time.
  • 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 from your mouth and discard it. The sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.
  • Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the people best able to effectively help you:  your surgeons, Dr. Calat and Dr. Carunchio, or your dentist.
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 up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues, 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 often as possible, for the first 36 hours.

Diet

  • Drink plenty of fluids. Avoid hot liquids/foods and spicy 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 before you feel the local anesthetic wearing off. For moderate pain, Ibuprofen (Advil or Motrin) may be taken. Ibuprofen, bought over the counter, comes in 200 mg tablets. Two tablets may be taken every three to four hours as needed for pain. If you cannot take Ibuprofen, one to two Tylenol or Extra Strength Tylenol may be taken every three to four hours .For severe pain, prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.
    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 four to five times a day, as well, especially after meals. Brushing your teeth with the healing abutments is not a problem. Be gentle initially when 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.

Smoking

  • Do not smoke for at least two weeks after surgery, if at all. As discussed at your consultation, smoking dramatically increases the risk of bone graft and sinus augmentation failure. Your surgeon can prescribe a Nicoderm patch if you feel you need it.

Wearing Your Prosthesis

  • Partial dentures, flippers, or full dentures should not be used immediately after surgery and for at least ten days. Often they will need to be adjusted by your dentist.
  • After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. That’s why we ask you to bite on a gauze pad for 45 minutes after the appointment. If the bleeding or oozing still persists, insert another gauze pad and bite firmly for another 30 minutes. You may have to do this several times.
  • After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.
  • After the tooth is extracted you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. The swelling usually begins to subside after 48 hours.
  • For moderate pain, you may take two 200 mg tablets of Ibuprofen (Motrin or Advil) every three to four hours. If you are unable to take Ibuprofen then take one or two tablets of Tylenol or Extra Strength Tylenol every three to four hours.
  • For severe pain, take the tablets prescribed as directed along with Ibuprofen (They work well together.). 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.
  • If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.
  • It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. Avoid flossing the surgical site and brush very gently. This will speed healing and help keep your mouth fresh and clean.
  • Do not smoke for at least two weeks after surgery, if at all. As discussed at your consultation, smoking dramatically increases the risk of bone graft and sinus augmentation failure. Your surgeon can prescribe a Nicoderm patch if you feel you need it.
  • After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for two to three days, or a reaction to the medication, call the office immediately at 212-696-2677.
Diet

  • Drink plenty of fluids. Avoid spicy food and foods that have citric acid. 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/Soreness

  • You should begin taking pain medication before you feel the local anesthetic wearing off. For moderate pain, you may take two to four 200 mg tablets of Ibuprofen (Motrin or Advil) every three to four hours. If you are unable to take Ibuprofen then take one or two tablets of Tylenol or Extra Strength Tylenol every three to four hours. For severe pain, the prescribed medication should be taken as directed.

Antibiotics

  • If antibiotics have been prescribed, be sure to take the prescribed antibiotics as directed to help prevent infection.

Oral Hygiene

  • Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can. Keeping your mouth clean after surgery is essential to reduce the risk of infection.

Smoking

  • Do not smoke for at least two weeks after surgery, if at all. As discussed at your consultation, smoking dramatically increases the risk of bone graft and sinus augmentation failure. Your surgeon can prescribe a Nicoderm patch if you feel it’s necessary.
The following information applies when grafting material has been placed into extraction sites to help preserve your jawbone in preparation for possible implant replacement of the extracted tooth.

  • Your bone graft is made up of many particles. You may find some small granules in your mouth for the first several days. Do not be alarmed, it’s normal to have some of them come out of the graft site and into your mouth. There are some things you could do to minimize the amount of particles that become dislodged:
  • Do not disturb or touch the wound.
  • Avoid rinsing or spitting for 2 days to allow blood clot and graft material stabilization.
  • Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.
  • Do not lift or pull on the lip to look at the sutures. This can actually cause damage to the wound site and tear the sutures.
  • Do not smoke.
  • Following the second day, gentle rinsing is allowed but not too vigorously as you can again disturb some of the bone graft granules. If a partial denture or a flipper was placed in your mouth, you may have to see your restorative dentist to have it adjusted and learn how to remove and replace it appropriately.

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 the office. Please try to call during office hours; however a 24-hour answering service is available for after hours contact with a doctor. The after hours number is on our voicemail.

The following information applies when upper jawbone height or width have been lost. The graft is placed to help restore your jawbone in preparation for possible implant replacement of the missing tooth or teeth.

  • This procedure regains lost bone height in the back portion of your upper jaw. It is an important procedure as it allows implant placement in an area that could not be implanted otherwise because of insufficient bone height due to an enlarged sinus.
  • The bone that has been grafted is most commonly a combination freeze-dried bone, artificial synthetic bone and your own bone. Because of this you may have two post-surgical wounds: the donor site and the recipient site.
  • DO NOT UNDER ANY CIRCUMSTANCES BLOW YOUR NOSE OR SNEEZE HOLDING YOUR NOSE FOR THE NEXT FOUR (4) WEEKS. This may be longer if indicated. You may sniff all you like but NO BLOWING.
  • Do not blow your nose or sneeze holding your nose. Sneeze with your mouth open. Do not drink with straws and do not spit. Scuba diving and flying in pressurized aircraft may also increase sinus pressure and should be avoided. Decongestants such as Drixoral, Dimetapp, or Sudafed will help reduce pressure in the sinuses. You will also be given a prescription for antibiotics. Please take these as directed. Anything that causes pressure in your nasal cavity must be avoided. Avoid “bearing down”—as when lifting heavy objects, blowing up balloons, playing musical instruments that require a blowing action or any other activity that increases nasal or oral pressure. Smoking must be stopped. If necessary, your surgeon can prescribe Nicoderm patches.

Oral Hygiene

  • Do not rinse or spit on the day of your surgery. This tends to disturb the blood clot, open the wound and can prolong bleeding and slow healing. You should not have a significant amount of blood in your mouth. Saliva can be swallowed, even if slightly blood tinged.
  • Keeping your mouth clean after surgery is essential to reduce the risk of infection. Start salt water rinses the day following your procedure. Use one-half 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. Repeat as often as you like, but at least four to five times daily and always after eating for the next five days.
  • Do not brush the teeth in the area of surgery for 48 hours. When brushing, be very gentle. When expectorating, also be gentle.
  • We may prescribe an antibiotic rinse (Chlorhexadine, Periogard, Peridex) for certain procedures. This rinse should be used in the morning and at bedtime after routine mouth care. Do not eat or drink or rinse your mouth after using the medicated rinse. Using this rinse more than two times a day will cause staining of your teeth.

Smoking

  • Do not smoke for at least two weeks after surgery, if at all. As discussed at your consultation, smoking dramatically increases the risk of bone graft and sinus augmentation failure. Your surgeon can prescribe a Nicoderm patch if you feel you need it.

Wearing your Prosthesis or Night Guards

  • Partial dentures, flippers, or full dentures should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise. Please contact the office if there is any question. If you have a temporary “flipper” to wear do not place it until the numbness in the area is gone. When it is placed it should not touch the gums in the area of the surgery. If it does, this can cause ulceration of the wound edges and breakdown of the suture margins. This can lead to loss of the graft. If you have questions about the fit of your flipper, partial or complete denture, do not wear it until your general dentist or our office can see you.

Post-Operative Problems or Complications

  • As with any procedure, unexpected post-operative healing can occur. Please let us know if:
    • You notice the unexpected flow of air or liquids between your mouth and nose.
    • You are aware of several small particles of graft material being discharged from your nose.
    • You experience sinus or nasal congestion on the side your surgery was performed.
    • There is an increase in swelling in your mouth, cheek or under your eye after 3 days.
    • 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 the office. Please try to call during office hours; however a 24-hour answering service is available for after hours contact with a doctor.