Before any oral surgical procedure you should:
- Eat a light and easily digestible meal the night before your appointment
- If you are going to be sedated, DO NOT eat or drink anything on the day of your appointment
- Wear short sleeves and loose-fitting clothing
- Arrange for a relative or friend to stay in the office with you and be ready to drive you home
- You may NOT drive a car on the day of the surgery if you are to be sedated!
Post-Surgery Instructions for Children
Anesthesia - The feeling of numbness will begin to wear off in 30 minutes to 4 hours. Until that time, avoid all hot foods or liquids, and do not chew. This is to prevent accidentally burning or biting the lips, cheeks, inside of your mouth or tongue until the feeling has returned
Gauze Pack - Fold the gauze into a small pack and place over the extraction site and apply firm pressure for one to two hours. Change the gauze pack every 15-30 minutes.
Bleeding - It is normal for the extraction site to bleed slightly or ooze blood for 12 to 24 hours following surgery.
Ice Pack - For the first 2 to 8 hours after surgery, ice packs should be applied to the outside of the face over the area of the extraction site. The ice pack should be held in place for 15 minutes on, and then removed for 15 minutes. Doing this throughout the day will help reduce discomfort and swelling.
Medications - DO NOT TAKE ASPIRIN PRODUCTS due to the possible increase in bleeding potential. If prescription medications were prescribed please follow label instructions carefully. For most extractions, a non-aspirin over the counter pain medication will provide good pain relief. Do not take more than the recommended dosage!
Diet - A liquid or soft diet should be adhered to for the first 12 to 24 hours after surgery. It is important to drink plenty of liquids for the first day or two. Avoid the use of a straw as it may dislodge the blood clot that is forming in the extraction site.
Oral Hygiene - Clean the rest of your mouth as usual, however avoid bumping or brushing the extraction site. DO NOT RINSE OR SWISH YOUR MOUTH for the first 24 hours following surgery. DO NOT SMOKE for the first 24 hours following surgery.
Dry Socket - This is sometimes a problem after surgery. The symptoms associated with dry socket are constant moderate to severe pain, bad taste, putrid odor, and poor clot formation at the surgical site. If you think you have ANY of these symptoms call our office as soon as possible.
Fever - Monitor your temperature for the first 24 to 48 hours. Any elevated temperature should be reported to our office.
Swelling - After a tooth is removed, you may have some discomfort and notice some swelling. You can help reduce swelling and pain by applying cold compresses to the face. An ice bag or a cold, moist cloth can be used periodically. Ice should be used only for the first day. Apply heat the following day if needed. Be sure to follow your doctor's instructions.
When the extraction of a tooth is required:
1) An incision in the gums is made
2) The tooth is removed
3) The area is stitched up and is allowed to heal
During this time, it is important to think about a tooth replacement option. An extracted tooth leaves an open area in the jaw which, in time, allows the neighboring teeth to drift into the area where the tooth was extracted. This in turn, causes a chain reaction to all the surrounding teeth. Also, if you are considering placing an implant in the future, you should consider asking your dentist to place a bone graft at the time of surgery to preserve the bone width and height.
After Extraction Care
1) DO NOT RINSE MOUTH TODAY
Tomorrow rinse mouth gently every 3 to 4 hours (especially after meals) using one quarter teaspoon of salt to a glass of warm water. Continue rinses for several days.
Following extractions, some bleeding is to be expected. If persistent bleeding occurs, place gauze pads over bleeding area and bite down firmly for one-half hour. Repeat if necessary.
Ice bag or chopped ice wrapped in a towel should be applied to the operated area; one-half hour on, and one-half hour off for 4-5 hours.
For mild to average pain, use any non-aspirin type of medication you like. If the doctor prescribes a specific pain medication, follow the instructions and do not mix with other medications unless approved by your doctor.
Light diet is advisable during the first 24 hours.
6) BONY EDGES
Small sharp bone fragments may work up through the gums during healing. These are not roots; if annoying, return to our office for their simple removal.
7) If any unusual symptoms occur, call the office at once.
8) The proper care following oral surgical procedures will hasten recovery and prevent complications.
Bone grafting is commonly performed by an oral and maxillofacial surgeon to replace or augment bone in areas of tooth loss. Bone grafting to the jaws and facial structures may be necessary in a wide variety of scenarios. The most common bone grafts are facial skeleton and jaw procedures. Other common procedures include tooth extraction site graft, bone graft reconstruction and for a sinus lift. Shrinkage of bone often occurs when a tooth is lost due to trauma, severe caries, or periodontal disease. Additionally, bone loss may have already occurred due to infection or pathology around a tooth. There are many artificial biocompatible bone substitutes available; however, the best material for a bone graft is your own bone, which most likely will come from your chin, the back part of your lower jaw or your hip bone. The hip is considered to be a better source because the hip bone has a lot of marrow, which contains bone-forming cells. There are also synthetic materials that can be used for bone grafting. Most bone grafts use a person's own bone, possibly in combination with other materials.
To place the removed bone in the recipient site, little holes are drilled in the existing bone to cause bleeding. This is done because blood provides cells that help the bone heal. The block of bone that was removed will be anchored in place with titanium screws. A mixture of the patient's bone marrow and some other bone-graft material will then be placed around the edges of bone block. Finally, a membrane is placed over the area and the incision closed.
The bone graft will take about 6 to 12 months to heal before dental implants can be placed. At that time, the titanium screws used to anchor the bone block in place will be removed before the implant is placed.
Crown lengthening is a surgical procedure that re-contours the gum tissue and often the underlying bone of a tooth. Crown lengthening is often for a tooth to be fitted with a crown. It provides necessary space between the supporting bone and crown, which prevents the new crown from damaging bone and gum tissue.
Wisdom Tooth Development
Wisdom teeth generally begin to form in your pre-teen years. By late teen years, the crown of the wisdom teeth will begin to erupt through the gums if there is adequate room. By mid twenties, your wisdom teeth will either be able to fully erupt or will have become impacted. Early removal of wisdom teeth makes the procedure easier for the patient to tolerate and promotes faster healing after wards. By your early forties, the wisdom teeth roots have become fully anchored to the jawbone and if required to be extracted, will be much harder and will need more time to heal.
Wisdom Tooth Positions
Wisdom teeth under ideal circumstances should grow in straight like any other tooth. However, it is common for wisdom teeth to become impacted inside the jaw or just under the gums. If this occurs, your wisdom teeth should be removed.
1) Horizontal Impaction
2) Angular Impaction
3) Vertical Impaction
4) Soft Tissue Impaction
Wisdom Tooth Problems
The problems involving your wisdom teeth may be caused by the size of your jaw and/or by how crowded your teeth are. Common warning symptoms that there is an un-natural problem in the development of your wisdom teeth could be pain and swelling.
Symptoms can be caused by:
1) Infection to the gums
2) A crowded tooth displacing neighboring teeth
3) A decayed wisdom tooth
4) Poorly positioned wisdom tooth
5) A cyst that destroys bone
Wisdom Tooth Removal
Wisdom teeth can lead to problems if there isn't enough space for them to surface or they come through in the wrong position. Wisdom teeth also known as third molars are the last teeth to erupt into the mouth. Wisdom teeth typically appear around a person's mid-twenties but can erupt much later. It the wisdom teeth doesn't have enough space symptoms can occur. The wisdom teeth may only partially erupt or might not come through at all. Dentists designate wisdom teeth 'impacted' if they are wholly or partly blocked from eruption into the mouth. The tooth may lie at an angle and remain tipped against an adjacent tooth. Impacted wisdom teeth can cause problems like pain and swelling; The mouth could ache when stretched open wide or it may be difficult to open your mouth. Tenderness when chewing and biting may occur. Earaches may develop from the spread of pain in the mouth. Symptoms may be intermittent but can begin anytime without warning. If you are experiencing symptoms, it is best to get treatment 'usually removal' as soon as you can to avoid potentially expensive and painful complications.
After Wisdom Tooth Removal
Post-operative care of the removal of impacted teeth is very important. Carefully follow instructions to minimize unnecessary pain and complications of infection and/or swelling.
BLEEDING. A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or slight blood traces in the saliva is not uncommon. To help minimize bleeding, avoid any sort of exercise or excitement. 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. This action should create a blood clot and bleeding will stop; however, if bleeding does not stop repeat as necessary. As an alternative to the gauze gently 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. If bleeding does not subside, call the office at 770-980-0232 for additional instructions.
Standard After Surgery Instructions:
- The gauze pad placed over the surgical area should be kept in place for a half hour prior to removal.
- Vigorous mouth rinsing the surgical area following surgery should be avoided. Vigorous sucking through a straw should be avoided. Touching the surgical area should be avoided. These actions may cause the blood clot to become dislodged and cause excess bleeding.
- Begin taking the prescribed pain medications as soon as you begin to feel discomfort.
- Place ice packs to the sides of your face where surgery was performed.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
SWELLING. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon as it is the body's normal process in repairing itself. Swelling does not always appear immediately. It may take 12 to 24 hours before swelling becomes apparent. Swelling may not reach its maximum until 2-3 days post-surgery. Swelling may be minimized by the immediate use of ice packs post-surgery. Two baggies 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.
PAIN MEDICATION. 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 as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive or operate machinery and avoid alcoholic beverages. Pain or discomfort should subside more every day. If pain persists, it may require attention and you should call the office for assistance.
DIET. After general anesthetic or I.V. sedation, liquids should be initially taken. 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 from the surgical sites. Nourishment and regular fluid intake is important to your recovery. 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.
HOME HYGIENE CARE. There will 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. 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 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.
ANTIBIOTICS. If Robert M. McLean, DDS has prescribed antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Call the office in the event of a rash or other unfavorable reaction at 770-980-0232.
NAUSEA. Occasionally, a prescribed pain medicine may induce 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.
- NUMBNESS. As discussed in your pre-surgery consultation numbness of the lip, chin, or tongue can occur, but there is no cause for alarm. This is usually a temporary condition. If you do experience numbness be careful not to bite your lip of tongue as you will not feel the action. Call Robert M. McLean, DDS if you have any questions.
- TEMPERATURE. 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.
- DIZZINESS. Taking pain medications can make you dizzy. You can get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
- SUTURES. 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. In about a week post surgery the sutures will be removed by Dr. Robert McLean. It is a simple procedure that does not require any anesthesia or needles and only takes a few minutes.
- SORE THROAT PAIN. 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.
- JAW STIFFNESS. Stiffness 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.
Q: Is there a food and drink restriction prior to surgery?
A: If treatment calls for the patient to be sedated then yes there are food and/or drink restriction. The patient must not consume anything, including water for 6-8 hours prior to surgery.
Q: Will antibiotics be prescribed prior to surgery?
A: We commonly use antibiotics to kill bacteria found in the mouth, which will also prevent infection after treatment, particularly with the placement of dental implants immediately after extracted teeth. The specific drug used depends on the medical profile and well being of the patient and the type of treatment.
Q: Do I need to avoid certain medications?
A: It is important to discuss all medication with Robert M. McLean, DDS during your pre-surgical consultation. In most cases medication should be continued unless specifically instructed to withhold them. Typically Plavix, Aspirin, Coumadin and other types of blood thinners can also be continued. When necessary Robert M. McLean, DDS will consult with your physician to safely manage your medications.
Q: Are the rules different for ORTHOGNATIC SURGERY different from tooth extractions of dental implant placement?
A: Yes, very different. Patients who are undergoing surgical procedures on only one jaw usually go home the same day. Patients who are having surgery on both jaws will generally stay overnight. Generally it is necessary to wire the jaws together after orthognatic surgery. In general, the jaws are immobilized securely with rubber bands for the first 1-2 weeks and then loosely for an additional 3-5 weeks. It is very important to discontinue any medication which are â€œblood thinnersâ€ or which may increase your tendency to bleed. Please stop taking the following medications at least 2 weeks before surgery. Robert M. McLean, DDS will provide specific instructions prior to your surgery date.
Q: Will anesthesia be used?
A: Robert M. McLean, DDS will discuss your anesthesia options. Our goal is to provide minimal discomfort as possible.
Q: How is the anesthesia administered?
A: Depending upon your treatment we may administer a local anesthesia such as lidocaine or nitrous oxide. For a more involved treatment we may recommend an oral sedation or intravenous sedation.
Q: What do I need to be aware of before intravenous sedation?
A: You may not have anything to eat or drink (including water) for eight (8) hours prior to the appointment. No smoking 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 the anesthesia experience. Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and low-heeled shoes. 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 bowel upset, please notify the office. If you take routine oral medications, please check with Robert M. McLean, DDS prior to your surgical date for instructions.
Q: Will my vital signs be monitored during and after treatment?
A: Robert M. McLean, DDS and/or one of their highly trained surgical assistants will continuously monitor your vital signs.
Q: How long will the surgery take?
A: The length of surgery depends on your treatment. Some surgery's are less than 30 minutes, while other procedures may take considerably longer. Robert M. McLean, DDS will provide you with the estimated time of surgery at your pre-surgical consultation.
Q: Will there be a lot of bleeding with a tooth extraction?
A: It's important for a blood clot to form to stop the bleeding after a tooth extraction. You will be asked to bite on a gauze pad for 30-45 minutes immediately after the extraction. If the bleeding or oozing still persists, place 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.
Q: How long is the on-site recovery before I can leave the office?
A: Plan to stay in our recovery room for at least 20 minutes if sedation was involved, or until Robert M. McLean, DDS is satisfied that you are recovered sufficiently to go home. If your procedure required sedation you must be completely alert before leaving the office for home. You must have a ride home. You may not drive yourself. It is recommend that you do not drive for a minimum 24 hours after surgery.
Q: Will you prescribe antibiotics and pain medication?
A: Procedure and patient health are determining factors of what antibiotic and/or medication will be prescribed. Call the office if the medication does not seem to be working. 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. Dr. McLean will discuss what, when, how long and dosage with you in both the pre-surgery and post surgery interviews.
Q: How long will I be off of work/out of school?
A: Depending on the extent of the procedure and type of sedation you may resume work and a normal life style anywhere from a few hours to a few days. 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. This will speed healing and help keep your mouth fresh and clean. After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call our office immediately.
Q: Will there be swelling or facial bruising?
A: 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. Take pain medications as prescribed. The swelling usually subsides after 48 hours. In some treatments there may be some minor bruising; however, in procedures such as dental implant placement ordinarily there is no bruising seen. For teeth removal or jaw procedures, women and/or very light skinned patients may experience slight bruising. Taking blood thinner will help reduce bruising. It is, however, not uncommon to have a black eye or discolored cheek or neck following extensive procedures. Robert M. McLean, DDS will discuss what bruising if any would be related to your procedure treatment.
Robert M. McLean, DDS would love to meet you and your family and provide you with the dental care you need to give each of you the smile you deserve!