Surgical Instruction

Before Your General Anesthesia for Oral Surgery

1. It is critical that you DO NOT EAT any solid food for eight (8) hours before your appointment.
2. You may have CLEAR FLUIDS ONLY until four (4) hours before anesthesia. Clear fluids are anything you can hold to the light and see light through it -- black coffee, water, plain tea, clear soda, pulpless apple juice (NOT milk or orange juice). Ask us if you have any questions before the day of surgery.
3. A responsible adult driver must be present to drive you home. An adult should be with you at home for that day. You cannot take a taxi home without an escort. It is not adequately safe by our standards.
4. A minor patient MUST come with his/her parent or the actual legal guardian who needs to stay in our facility during the procedure.
5. A sedated or anesthetized patient must have their escort’s full attention on the way home. A small child SHOULD NOT be here on surgery day unless there is a second adult to supervise the child. The escort’s focus must be on helping to safely guide a possible unsteady patient into the house and to bed or sofa.
6. Please wear a short sleeve shirt or one with sleeves that easily pull up.
7. Please remove contacts lenses, tongue rings, and protruding facial ornaments before your surgery.
8. You were asked by Dr. Levy not to have any alcohol for two (2) days prior to surgery. Marijuana must be stopped at least two (2) weeks prior to surgery. In addition, it is critical for your health and well-being that Dr. Levy be told about any use of “street drugs” such as: cocaine, heroin, Ecstasy (E), methamphetamine (meth), crystal meth, “designer drugs,” etc. or any other recreational drugs before surgery. Please understand that this is not a value judgment about your lifestyle. It is a safety concern about your well-being in surgery.
   

After Surgery Homecare Instructions

WE WOULD LIKE YOUR RECOVERY FROM SURGERY TO BE AS PLEASANT AS POSSIBLE. YOU MAY HAVE ONLY ONE OR NONE OF THESE COMMON POST-OPERATIVE PROBLEMS. PLEASE FOLLOW THESE SUGGESTIONS; WE WOULD LIKE YOU TO FEEL BETTER AS QUICKLY AS POSSIBLE.

FOR EMERGENCIES AFTER OFFICE HOURS, CALL 603.228.9050

BLEEDING – Oozing is normal for the first day or two after oral surgery, as a small amount of blood will mix with your saliva.

1. Bite firmly on the gauze that we gave you for 30-minutes. Place the gauze directly on the new surgical site and apply direct pressure to it. Do not keep taking the gauze out during that time "to see if it's working."
2. If the bleeding or oozing starts again, put a cold, moist tea bag (regular tea, not herbal tea) directly on the spot and bite firmly for half an hour.  Tea has a chemical in it which helps to tighten up your “gums."
3. Important – if you have some oozing, it is important that the gauze be placed directly on the surgical site and not just in the general area in your mouth. This is the same as when you get a cut on your hand, you have to press directly.

RINSING – Do not rinse on the day of surgery. The next morning, rinse several times a day with warm water. Rinse thoroughly in the general area of surgery to keep it clean until you can brush comfortably. Whether rinsing or brushing, please keep your mouth clean. You may use mouthwash if you wish.

SWELLING – Swelling often occurs and is usually much greater the morning after surgery than the day of surgery. This is normal.

1. Use ice packs to your jaw for the first two days.
2. On the third day, STOP USING ICE COMPLETELY. USE A HEATING PAD OR HOT WATER BOTTLE which can supply as much heat as can be comfortably tolerated. This makes the area feel better and reduces the swelling.
3. Continue to use heat for a tight jaw for up to a week. Patients do much better and recover more quickly if they use HEAT.
4. Please read #2 and #3 again! If you continue to use heat, your puffiness will decrease quicker and your jaw stiffness will improve faster!

SMOKING – Smoking during the first three days post-operatively can cause painful post-operative problems. Please do not smoke for the first three days post-operatively. A nicotine patch might help you. If you must smoke, the fewer cigarettes, the better your healing will be.

DRY SOCKETS – This occurs when the blood clot from the surgical site does not stick properly to the healing jaw. You will know that you have a dry socket if there is a MARKED INCREASE IN DISCOMFORT on about the third day postoperatively. If this occurs, it is not dangerous, but you should call the office during office hours. We will arrange to see you promptly. Smoking is a major contributor to the development of dry sockets.

STIFF JAW – It is normal for your mouth to be hard to open for several days after significant oral surgery. Using a heating pad helps you to gradually open. You do not need to try to force your jaw open. USE HEAT until you are pain-free and your jaw opens widely.

BRUISING – This can occur under the eyes if upper teeth have been removed or in the upper part of the neck or even spreading down the neck in some types of oral surgery. This is not dangerous and will pass like any other bruising.

DRUGS – If you had anesthesia or sedation, do not drive or do things requiring coordination on the day of surgery. You may be uncoordinated even though you don’t recognize it. Driving a car, riding a bicycle, sports, etc. can be dangerous due to this impairment. Any drugs, including “over the counter” ones, should be taken only as prescribed.

STITCHES – We often use self-dissolving stitches that will fall out on their own within a few days. As the swelling goes down you will feel the stitches more. This is normal. Please be assured that Dr. Levy has been a surgeon and has done suturing for more than 25 years and that the suturing was done properly. A common concern is that “my cheek is sutured to my teeth or gums." This is not true and as you heal it will be seen that the tissue is positioned just as it should be.

FOOD AND DRINK – Make sure that you drink as many fluids as you can for the first several days even if you do not feel like eating. You can eat any type of food that does not hurt you. Most sites have sutures and you will not rip those sites apart by eating. You may eat warm, but not hot, food for the first 24 hours after surgery. It is scientifically not true that you can’t use straws for liquids. Drink with a straw if you want to.

ALCOHOL – This is not to be taken in the same time interval as your narcotic pain medications. Similarly, recreational drugs cannot be used while taking narcotics. Combining them is very dangerous.

SHARP BONY EDGES – Sometimes after surgery, a patient may feel a NEW SHARP EDGE of bone. This is the jawbone reshaping itself. It is NOT an infection or piece of tooth left in the jaw. The bone chip will flake out and may look a lot like a grain of rice. TREATMENT: MASSAGE the area three times a day for 15 seconds with a clean finger. Rinse with some very warm water afterwards. The bone chip will dissolve, separate, or come out on its own. This is normal. If the edge bothers you greatly, or is still there after a week of MASSAGE, call us. Dr Levy can smooth the edge if necessary. But the jawbone usually gets rid of this unneeded chip by itself as part of the natural healing process.

POST-OPERATIVE MEDICINES – We often give you prescriptions for “pain medicine” and antibiotics. Please take them as discussed and directed. We find that a small amount of stomach-coating remedy, such as Pepto-Bismol helps to prevent nausea, since pills on an empty stomach are irritating. Take as directed 10 minutes before your medicines on the first 2 or 3 days after your surgery.

OVER THE COUNTER DRUGS – Tylenol or ibuprofen can harm you if overused. Take only as directed on product box.

SUMMARY:

1. Take medicines only as directed.
2. Use an ice pack to surgical sites for 48 hours then use a HEATING PAD, electric or microwave, for the next 5 days. This will greatly help to reduce swelling and improve the normal post-operative muscle tightness in you jaw. PLEASE DO THIS!
3. Drink lots of fluids. Begin eating soft food as soon as possible.

Please follow these instructions carefully and re-read them frequently as it is easy to forget them after surgery. This will help make for the quickest and most comfortable recovery from surgery that we can offer you.