PATIENT INSTRUCTIONS BEFORE AND AFTER SURGERY

Before Your Surgery **IMPORTANT, PLEASE READ**

If you chose to have general anesthesia or intravenous sedation, do not have anything to eat or drink, including water, for at least 6 to 8 hours before surgery. If you take medications regularly, you should take them with small sips of water at the regular time. Also, any additional medications which might be prescribed to you by our office should be taken with small sips of water as directed.

Wear comfortable, loose fitting clothing with short sleeves and baggy pants. Avoids boots or high shoes.

If you have general anesthesia or intravenous sedation, a responsible person must accompany you, remain in the reception area, and take you home. We ask that your escort accompany you to the office so that we can let him/her know when you will be ready to leave the office and give them appropriate instructions.

Do not wear jewelry, including any facial piercings, makeup, including nail polish or eye cosmetics.

Please tie long hair back.

If you wear contact lenses, please remove them prior to your appointment.

Wear loose clothing, short sleeves and low shoes.

No smoking the morning of surgery.

Your mouth and teeth should be well cleansed to help avoid infection.

Do not ignore a head or chest cold when oral surgery is to be performed. Please call the office if you have any symptoms, as an appointment change may be necessary.

If you are going to have local anesthesia (numbing shot) only, you may eat prior to your appointment and do not need somebody to accompany you to the office.

After Your Surgery ** Post-operative Instructions**

• After Dental Extractions and Third Molar (Wisdom Tooth) Removal.
• PostOperative Instructions for Socket Bone Grafting
• PostOperative Instructions for Cortical Onlay Bone Grafting
• PostOperative Instructions for Sinus Lift or Augmentation Surgery
• POSTOPERATIVE INSTRUCTIONS FOR DENTAL IMPLANT PLACEMENT (SURGERY)

POSTOPERATIVE INSTRUCTIONS FOR WISDOM TEETH AND DENTAL EXTRACTIONS

After dental extractions and third molar (wisdom tooth) removal a certain amount of bleeding, discomfort or pain, and swelling is normal.

The following instructions are provided to make your post-operative recovery as short and pleasant as possible.

The Day of Surgery

During this time, the most important care is not to disturb the surgical area.

1. Bite down with firm pressure on the gauze pack for at least 30 minutes after leaving this office. At that time, remove pack and replace with another gauze sponge as provided. Repeat as necessary. You may start taking pain pills after you have some food in your stomach. If an antibiotic is prescribed, start taking it according to directions.

2. Do not rinse or spit for 72 hours. This tends to disturb the blood clot and thus prolong bleeding. It is better to just swallow normally during this time.

3. Do not chew until the numbness has worn off. Diet should then be limited to cool, soft foods and non-carbonated liquids for at least 48 hours. A high calorie, high protein nutritional supplement such as Ensure or Boost may be helpful and is available at your pharmacy. It's essential that you eat and drink as much as your comfort will allow. Do not take pain medicines on an empty stomach.

4. Apply ice packs immediately to all areas where surgery was performed. Place ice packs on for 30, then off for 30 minutes. Continue at least 24-48 hours.

5. Avoid all excessive activity. In addition, do not drink with a straw and avoid alcoholic or carbonated beverages and smoking until healing is well established (3-5 days). Do not drive a car or operate machinery for 24 hours after sedation or general anesthesia or while taking narcotic pain medication.

To control bleeding

Some bleeding following surgery is a normal event. If excessive bleeding is still occurring 4-5 hours after surgery, place 2 sterile gauze packs firmly and directly over the area of surgery and bite down with firm, even pressure for 30 minutes. Do not chew the gauze! Do not speak! Repeat if necessary.

If this is not successful, try biting firmly on a moistened tea bag for 30 minutes. If excessive bleeding continues, call (765) 446-8808.

After Your Surgery

During this time the most important care is to keep your mouth clean.

Oral hygiene is important

72 hours after surgery, you may begin gently rinsing your mouth with a lukewarm salt-water solution (one-half teaspoon of table salt in a glass of warm water). Repeat this 4 or 5 times a day for one week to gently cleanse the area of surgery.

Brush teeth carefully and thoroughly, except for the immediate surgical area, with a soft toothbrush. Keeping your mouth clean helps avoid postoperative infection and speeds healing.

Often operations are performed very close to nerves. This can sometimes cause some lingering numbness or altered sensations, especially of the lower lip or tongue. This condition is usually temporary and will generally disappear when swelling recedes and the nerve heals. If this persists for two weeks, please contact the office.

Special considerations following removal of impacted teeth

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

The Day Following Surgery and Thereafter

DO NOT WORRY ABOUT STITCHES. Stitches (also known as sutures) are usually placed to control bleeding, aid healing and help prevent food from collecting in the surgical site - - especially for lower teeth. The sutures we use dissolve in 3 to 5 days and DO NOT HAVE TO BE REMOVED.

ANY SWELLING, SORENESS, OR STIFFNESS IN THE JAW MUSCLES can be relieved by applying ICE to the affected side of the face several times a day. Moist heat should not be used until after the first 48 hours. If swelling, tenderness, or pain should increase after the first few days, call the office.

MOST TIMES A SOFT DIET MAY BE NECESSARY for the first few days after surgery. Most patients are able to resume regular food intake within a short time.

BRUISING MARKS MAY APPEAR ON THE SKIN OF THE FACE during the first few days after surgery. Moist heat application will help relieve this condition once again. An antibiotic or moisturizing cream may be used on the lips to promote healing. .

We make every attempt to answer our emergency pager as promptly as possible. Occasionally, your messages do not reach our pagers. If you do not hear from the nurse or doctor on call within one-half hour, please call back and ask them to page again. Do this until the nurse or doctor on call has answered your page.

POSTOPERATIVE INSTRUCTIONS FOR SOCKET BONE GRAFTING

In addition to the general postoperative instructions, we would like to emphasize a few points.

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 by these. 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 vigorously rinse or spit for 3-5 days.
• 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.

For the first 2 days, we would suggest letting the blood clot stabilize and not even rinse your mouth. Following the second day, gentle rinsing would be 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.

POSTOPERATIVE INSTRUCTIONS FOR CORTICAL ONLAY BONE GRAFTING

A certain amount of swelling, pain and bleeding is normal.

The following instructions are provided to make your postoperative recovery period as short and pleasant as possible.

You will be having a Cortical Bone Graft if the area that you are to have an implant placed currently has insufficient bone to place the implant. This procedure will augment the deficient area. The bone that is being grafted will most commonly be coming from your ramus or chin area. Other sites may be used as previously discussed with you by your doctor Because of this you will have two post-surgical wounds: the donor site and the recipient site.

1. Bite down and maintain firm pressure on the gauze pack that was placed at the end of your surgery. There may be two areas of gauze in your mouth. Do this for at least 30 minutes. At that time remove the pack and replace it with another gauze sponge as provided. Repeat this as necessary. There should not be excessive bleeding. Bright red blood rapidly pooling in the area is not normal. If this occurs and does not decrease with pressure please call the office immediately.

2. If you were asleep for the surgery be sure to eat a soft nutritious food prior to taking any medications. This will decrease the chances of post surgical nausea. You were prescribed a antibiotic prior to surgery this should be continued until all the pills have been taken. Take your pain medications as needed in accordance with the directions. Codeine, hydrocodone or Demerol can be supplemented with Advil or ibuprofen type medications. Be sure you have no allergies that the doctor does no know about.

3. Do not rinse or spit for a minimum of 72 hours and longer if possible. This tends to disturb the blood clot, prolong bleeding, open the wound and slow healing. There should be no blood in your mouth. Saliva can be swallowed. Do not brush your teeth for 48 hours near the surgical site, only brush in areas away from your graft surgery. When expectorating, BE GENTLE. If you used a prescribed mouthwash prior to surgery, it should be continued starting 24 hours after your surgery. Place the mouthwash in the area of the surgery and let it sit 30-60 seconds. Do not rinse with it until after you have returned for suture removal.

4. Apply ice immediately in the areas where the surgery was done. If your graft was in the anterior upper jaw you can expect swelling and discomfort up into the nose and even under the eyes. Bruising and discoloration is not unusual. Crushed ice or equivalent should be placed in a plastic bag then in a washcloth and placed on the face. Apply for 30 minutes, then off for 20-30 minutes. This should be done on a near continuous basis (or as much as possible) for the first 48 hours and longer if possible or if this helps reduce your pain.

5. Avoid excess activity. In addition, DO NOT SMOKE. Do not drink with a straw or drink carbonated liquids (minimum 3 days). Do not consume alcoholic beverages while taking your pain medication.

6. You will notice that you cannot see any new bone in your mouth as the gums covers the area. The area of the graft placement will feel full and tight. This is normal. Do not stretch your lip daily to inspect the area. This can cause wound breakdown

7. 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. If you have questions about the fit of your flipper, do not wear it until our doctors or your referring dentist can see you.

POSTOPERATIVE INSTRUCTIONS FOR SINUS LIFT OR AUGMENTATION SURGERY

A certain amount of swelling, pain and bleeding is normal.

The following instructions are provided to make your postoperative recovery period as short and pleasant as possible.

You will be having a Sinus Lift if the area in the upper jaw that you are to have an implant(s) currently has insufficient bone because of an enlarged sinus. This procedure will augment the deficient area in the maxillary sinus. The bone that is being grafted will most commonly be coming from freeze dried bone and artificial synthetic bone. Other sites may be used for donation of your own bone as previously discussed with you by our doctors. 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 FOR THE NEXT FOUR (4) WEEKS. This may be longer if indicated. You may sniff all you like but NO BLOWING.

Bite down and maintain firm pressure on the gauze pack that was placed at the end of your surgery. There may be two areas of gauze in your mouth. Do this for at least 30 minutes. At that time remove the pack and replace it with another gauze sponge as provided. Repeat this as necessary. There should not be excessive bleeding. Bright red blood rapidly pooling in the area is not normal. If this occurs and does not decrease with pressure please call the office immediately. There may be a small amount of nasal discharge. It may be clear or lightly bloody. Excessive bleeding from the nose should be reported immediately.

If you were asleep for the surgery be sure to eat a soft nutritious food prior to taking any medications. This will decrease the chances of post surgical nausea. You were prescribed a antibiotic prior to surgery this should be continued until all the pills have been taken. You were prescribed a decongestant; take this until it is all gone. Take your pain medications as needed in accordance with the directions. Codeine, hydrocodone or Demerol can be supplemented with Advil or ibuprofen type medications. Be sure you have no allergies that the doctor does no know about.

Do not rinse or spit for a minimum of 72 hours and longer if possible. This tends to disturb the blood clot and can prolong bleeding, open the wound and slow healing. There should be no blood in your mouth. Saliva can be swallowed. Do not brush your teeth next to the surgery site for 48 hours or only brush in areas away from your graft surgery. When expectorating, BE GENTLE. If you used a prescribed mouthwash prior to surgery, it should be continued starting 24 hours after your surgery. Place the mouthwash in the area of the surgery and let it sit 30-60 seconds. Do not rinse with it until after you have returned for suture removal.

Apply ice immediately in the areas where the surgery was done. Since your graft was in the upper jaw you can expect swelling and discomfort up into the nose and even under the eyes and cheeks. Bruising and discoloration is not unusual. Crushed ice or equivalent should be placed in a plastic bag then in a washcloth and placed on the face. Apply for 30 minutes, then off for 20-30 minutes. This should be done on a near continuous basis (or as much as possible) for the first 48 hours and longer if possible or if this helps reduce your pain.

Avoid excess activity. In addition, DO NOT SMOKE. Do not drink with a straw or drink carbonated liquids (minimum 3 days). Do not consume alcoholic beverages while taking your pain medication. SMOKING CAN CAUSE THIS PROCEDURE TO FAIL.

You will notice that you cannot see any new bone in your mouth as the gums covers the area. The area of the graft placement will feel full and tight. This is normal. Do not stretch your lip daily to inspect the area. This can cause wound breakdown.

If you have a temporary flipper or denture to wear do not place it until the numbness in the area is gone. You very likely may need to wait until the stitches are removed until your denture can be worn. 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. If you have questions about the fit of your flipper or denture, do not wear it until our doctors or your referring dentist can see you.

POSTOPERATIVE INSTRUCTIONS FOR DENTAL IMPLANT PLACEMENT (SURGERY)

A certain amount of swelling, pain and bleeding is normal.

The following instructions are provided to make your postoperative recovery period as short and pleasant as possible.

SINGLE IMPLANT, MULTIPLE IMPLANTS or IMMEDIATE IMPLANT

Bite down and maintain firm pressure on the gauze pack that was placed at the end of your surgery. Do this for at least 30 minutes. At that time remove the pack and replace it with another gauze sponge as provided. Repeat this as necessary. There should not be excessive bleeding. Bright red blood rapidly pooling in the area is not normal. If this occurs and does not decrease with pressure please call the office immediately.

If you were asleep for the surgery be sure to eat a soft nutritious food prior to taking any medications. This will decrease the chances of post surgical nausea. You were prescribed an antibiotic prior to surgery this should be continued until all the pills have been taken. Take your pain medications as needed in accordance with the directions. Codeine, hydrocodone or Demerol can be supplemented with Advil type medications. Be sure you have no allergies that the doctor does no know about.

Do not rinse or spit for a minimum of 72 hours and longer if possible. This tends to disturb the blood clot, open the wound and can prolong bleeding and slow healing. There should be no blood in your mouth. Saliva can be swallowed. Do not brush the teeth in the area of surgery for 48 hours. When brushing, be gentle. When expectorating, BE GENTLE. If you used a prescribed mouthwash prior to surgery, it should be continued starting 24 hours after your surgery. Place the mouthwash in the area of the surgery and let it sit 30-60 seconds Do not rinse with it until after you have returned for suture removal (2 weeks after implant placement).

Apply ice immediately in the area where the surgery was done. If your surgery was in the anterior upper jaw you can expect swelling and discomfort up into the nose and even under the eyes. Bruising and discoloration is not unusual. Crushed ice or equivalent should be placed in a plastic bag then in a washcloth and placed on the face. Apply for 30 minutes, then off for 20-30 minutes. This should be done on a near continuous basis (or as much as possible) for the first 48 hours and longer if possible or if this helps reduce your pain.

Avoid excess physical activity and exercise. In addition, DO NOT SMOKE. Do not drink with a straw or drink carbonated liquids (minimum 3 days). Do not consume alcoholic beverages while taking your pain medication. SMOKING INCREASES THE RISK OF IMPLANT FAILURE.

You will notice that you cannot see any implants in your mouth as the gums cover the area. This is good. Do not stretch your lip daily to inspect the area. This can cause wound breakdown. In many instances a healing cap was placed over the implant. This will look silver and will be emerging through the gums. Do not stretch your lip daily to inspect the area. This can cause wound breakdown. Be very cautious not to eat on these temporary caps as it will place undue movement on the implants below.

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. If you have questions about the fit of your flipper, do not wear it until your general dentist of this office can see you.

Most follow up appointments are scheduled for 2 weeks after surgery. If something would arise that you consider unusual please do not hesitate to contact the office immediately.