Pre and Post-Op Instructions

Postoperative Pain Regimen

• Ibuprofen (Motrin, Advil) - 600 mg every 6 hours

AND

• Acetaminophen (Tylenol) - 500 mg every 6 hours
• *Options: Take both together every 6 hours or alternate each every 3 hours

• If your pain is NOT controlled, other options can be called in including Tylenol #3 or Hydrocodone
• *Please call 972-231-6661 or 214-675-1944, if needed*

FOLLOWING ORAL SURGERY EXPLANATION OF EVENTS THAT MAY OCCUR

There are several events that occur post-operatively about which our patients should be aware.

1. Swelling can be anticipated, and the patient may have some difficulty in opening and closing the mouth due to muscle tightness. There is a normal amount of pain and discomfort, which will be helped with medication and time. Swelling does not usually reach its peak until 48 hours after surgery.
2. Following an extraction, a most unpleasant problem known as "dry socket" (alveolitis) may occur. This condition occurs in about 10% of patients and, unfortunately, cannot be predicted or prevented. A "dry socket" indicates that the blood clot that was in the extraction site is no longer there. This can cause pain in the jaw, ear, and neck. Alveolitis is an uncomfortable situation that usually occurs on the fourth to sixth day following surgery. Recovery from a "dry socket" generally takes from a week and a half to two weeks. During this period, a medicated dressing can be placed in the socket to help control the pain.
3. During oral surgical procedures, the nerve supply to structures within the oral cavity can, on occasion, be interrupted. Should this rare event occur, patients could experience numbness of the jaws, teeth, gum tissues, lips, and possibly the tongue. This is most often a temporary situation, but it can take several weeks or months before the feeling returns. However, the potential for permanent numbness exists. As stated previously, this situation does not often occur.
4. Sinus involvement is not unusual following the removal of upper teeth. The roots of upper premolar and molar teeth are very close to each other and often protrude into the sinus, so tooth removal can expose the sinus. This normally presents no problems, but if it does, it is usually a sinus infection or an opening between the mouth and the sinus (oral antral opening). This opening will usually close on its own within six weeks; surgical closure is delayed for at least this period.
5. If a patient is fair-skinned or very light-complexioned, there are often areas of ecchymosis (bleeding into the tissues), which can result in bruises. This is often a problem for our more mature patients.
6. Oral wounds can become infected due to the high bacterial population of the mouth. Antibiotics are given for infection and for prevention of infection.
7. There can be bad taste and unpleasant odor due to the blood clots that form in the extraction site. Following surgery, the extraction site may form a depression or hollow area which may trap food particles. The odor and food particles may be removed with warm saltwater rinses.
8. Bone spicules sometimes work their way through the gum tissue and feel sharp to the tongue. In most instances, they work out on their own, but it may be necessary for the doctor to help with the removal.
9. An extremely rare problem, but one that might possibly occur, is a separation (or fracture) of the jaw. If the teeth are very deep and the bone is thin, this may occur, although it is very unlikely. If it does occur, the fracture will be properly treated.
10. Inflammation is necessary for wound healing; inflammation produces temperature elevation. A temperature elevation of 1 to 2 degrees is expected with the healing of oral wounds.
11. Following intravenous sedation, an inflammation of the vein (phlebitis) can occur on occasion. This will produce a firmness and sometimes tenderness of the vein. This condition usually clears up without treatment. If this condition persists without improvement, call for an appointment for an examination of the area.

INSTRUCTIONS FOR POST-SURGICAL PATIENTS

Please follow the instructions as written. They will add to your comfort and hasten your recovery.

Please Read the front and back thoroughly.

1. CONTROL OF BLEEDING: Bite on the gauze pressure pads consistently for 20-30 minutes; swallow frequently. Remove the gauze pressure pads. Take your first medications with water. Do not replace the gauze pressure pads unless you have excessive bleeding.
2. SIX THINGS NOT TO DO FOR THE FIRST 72 HOURS:
   • No smoking.
   • No use of soda straws or carbonated beverages.
   • No hot liquids (lukewarm coffee, tea, or soup is fine).
   • No vigorous rinsing with mouthwash or water (mild swishing is okay).
   • No spitting; wipe thesaliva from your lips with a tissue.
   • No milk or dairy products if you tend to have an easily upset stomach.
3. Any of the above can cause increased bleeding after surgery. Some bleeding following oral surgery is to be expected. You will notice an oozing for 12 to 24 hours following the surgery. Pressure applied over the surgical areas by biting on gauze pads or moistened tea bags will decrease the bleeding.
4. DIET: Maintain an adequate diet by eating soft but chewable foods and cold liquids. Chewing soft foods will help prevent muscular stiffness, and you will feel better if you are well-nourished. Examples of a soft but chewable diet are spaghetti, macaroni, casserole, scrambled eggs, pancakes, custards, jello, baked potatoes, tender cooked vegetables, and vegetables or noodles in soups. Avoid hard, crisp foods such as raw vegetables and corn chips.
5. POSTURE AND POSITION: From the time you arrive home following surgery until bedtime, remain in a sitting, semi-reclined, well-supported position.
6. PHYSICAL ACTIVITY: Avoid physical exertion or exercise on the day of surgery.
7. SWELLING: Swelling of the face following difficult oral surgery is to be expected, is normal, and does not usually peak for 48 hours. You may help prevent and decrease the swelling by the proper use of ice bags for 24 to 48 hours (no longer than 48 hours, please). Apply an ice bag to the face for 10-15 minutes at a time. Repeat this sequence over and over again. Swelling may last for five to seven days. DO NOT AT ANY TIME USE HEATING PAD OR HOT PACKS.
8. ORAL HYGIENE: You may resume brushing and flossing your teeth the morning following surgery. Rinse your mouth four times daily with warm salt water for several days (1/2 teaspoon salt in an 8-ounce glass of water).
9. PRESCRIPTIONS: The prescriptions given to you are for a specific purpose. Take them according to the instructions. Do not let anyone else take your drugs. Take all the antibiotics (if prescribed) until they are gone. Remember, no driving while taking pain medications.
10. STITCHES (SUTURES): If sutures were placed, it was for control of bleeding and to hasten healing. These will dissolve on the 4th to 6th day following surgery. If non-dissolving sutures were used, you will be given an appointment for their removal.
11. TELEPHONE AND CALL POLICY: Our oral surgeon in Richardson, TX, is available for night and weekend emergency calls. Emergency calls are shared with other oral and maxillofacial surgeons in this area. Please limit your after-hours and weekend calls to those of a true emergency nature, such as prolonged bleeding, severe allergic reactions, and temperature elevation of 101° that persists for 24 hours or prolonged periods of repeated nausea with vomiting. The doctors may be reached by calling the office telephone number 972-231-6661.