Surgery, Extractions, and Sedation

The following sections contain detailed instructions about home care before and after your surgery. Please read this information carefully and let us know if you have any questions.

In Case of Problems

Should you encounter any problems after your surgery that is not covered in these instructions, call our office at 505-293-8011. Usually Dr. Reachi or Dr. Yarbrough will give you their cell phone numbers; it is our goal to be available when you need us. Please select on of the following for detailed instructions.

Before Surgery

• Before Intravenous Anesthesia Sedation

After Surgery

• After wisdom tooth removal
• After removal of multiple teeth

Before Intravenous Anesthesia Sedation

• You may not have anything to eat or drink, (except for small amounts of water up to 4 hours prior to) for eight (8) hours prior to the appointment. DO NOT drink grapefruit juice for one week prior to the sedation!
• 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. We must have the responsible person’s name and have them remain in the office during the sedation.
• 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 make up, 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 24 hours prior to your appointment.
• If you take routine oral medications, please check with the Doctor prior to your surgical date for instructions. Typically you will be directed to take your normal medications as you have been told, but there are exceptions to this general rule as well.
• You must visit the restroom just prior to your being seated in the treatment room.

After Wisdom Teeth Removal

The removal of impacted wisdom 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. Remember to take care of yourself.

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, discarded, and replaced with another clean one.
• Vigorous mouth rinsing or touching the wound area following the surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
• Take the prescribed pain medications as soon as directed typically before you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished. Frequently a combination of 500 mg Acetaminophen (Tylenol) and 800 mg of Ibuprofen (Advil) taken together control discomfort.
• Restrict activities the day of surgery and resume normal activity when you feel comfortable.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanations.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Placing a gauze pad over the area and biting firmly for thirty minutes may control excessive bleeding. Repeat as necessary until bleeding stops. If bleeding continues past twelve (12) hours, bite on a moistened tea bad for thirty minutes, then repeat once. The tannic acid in the teabags help 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 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 the surgery and will not reach its maximum until 203 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. 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 24 hours, ice has no beneficial effect. If swelling or jaw stiffness persists for several days, there is no cause for alarm. This is a normal reaction to surgery. Twenty-four hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

For moderate pain take 500 mg of Acetaminophen Tylenol or 800 mg Ibuprofen every 4 hours.

For severe pain, take the prescribed medication as directed. The prescribed medication 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.

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 find allowing ice cubes to dissolve in your mouth beneficial. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. 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 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. 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.

Keep the 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 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.

Discoloration

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 post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up 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. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions. Remember alcohol decreases the effectiveness of alcohol and antibiotics decrease the effectiveness of birth control. Pregnant and nursing women should consult their physician before taking any medication.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including prescribed medicine. You should then sip on spire, 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.

Other Complications

• 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 bit it and not feel the sensation. So be careful. Call the office at 505-293-8011 if you have any questions.
• 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 a lying position to standing. You were not able to eat or drink prior to the surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing, you should sit for one minute 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 smooth out spontaneously. If not, Dr. Yarbrough or Dr. Reachi can remove them.
• If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with ointment such as Vaseline.
• 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.
• Stiffness (Trimus) 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.

Finally

• Sutures are placed 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 the mouth and discard it. The sutures will be removed approximately one week after surgery. Don not be alarmed if the sutures turn white - this is normal and common. The removal of the sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with the procedure. So it’s really nothing to worry about.
• The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions.
• There will be a depression where the tooth was removed. The depression will gradually over the next month fill with new tissue. In the mean time, the area should be kept clean especially after meals with salt-water rinses or a toothbrush.
• Your case is individual no two mouths are alike. Do not accept well-intended advice from your friends. Discuss your problem with the persons best able to effectively help you: Dr Reachi and Dr Yarbrough or our well trained staff.
• Brushing your teeth is okay - just be gentle at surgical sites.
• A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 203 days following surgery. There may be a bad taste and an odor. Call the office if this occurs, the pain can be quite severe and although it will resolve itself over time, we can significantly reduce the symptoms.

After Removal of Multiple Teeth

A small amount of bleeding is to be expected following operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes - replace as necessary for twelve (12) hours. If bleeding continues, a moist tea bag can be used for 30 minutes and repeated once. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.

• Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 24 hours only. Apply ice continuously while you are awake.
• For mild discomfort, use aspirin, Tylenol, or ibuprofen (Advil, Motrin) at recommended doses.
• For severe pain, use the prescription given to you. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office.

If an antibiotic has been prescribed, finish your prescription regardless of symptoms. Remember alcohol decreases the effectiveness of antibiotics and antibiotics decrease the effectiveness of birth control. Pregnant and nursing women should consult their physician before taking any medication.

• Drink plenty of fluids. If many teeth have been extracted, the blood loss at this time needs to be replaced. Drink at least six glasses of liquid the first day.
• Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt-water rinse every four hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One half teaspoon of salt in a glass of lukewarm water.) After you have seen one of us for denture adjustment, take out dentures and rinse 3 to 4 times a day.
• Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.

What to expect

The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:

• The area operated on will swell reaching a maximum in two days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 36 hours after surgery (remember ice packs are used for the first 36 hours only.)
• A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
• 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. There may be a slight elevation in temperature for 24-48 hours. If temperature continues, notify our office.
• If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surger and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.