Mountain View Oral Surgery

Before-Surgery	After Tooth Extraction(s)	After Dental Implant Surgery	After Sinus Lift Graft
After Multiple Extractions/Immed. Denture		After Sinus Communication

Before Surgery Instructions

Skin preparation: remove all make-up & cleanse your entire face on the evening before & on the morning of your appointment. Phisohex or Hibiclens antiseptic skin cleanser work very well (available at pharmacy/grocery). Otherwise an antibacterial soap will work fine. If any makeup (including base) is not removed, your appointment will be delayed.
Clothing: Collar-less shirts are preferable. Wear loose-fitting, comfortable clothing, including a short-sleeved shirt. During the cooler months of the year, wear an outer garment over your short-sleeved shirt that may be easily removed once you are seated. Please do not wear a shirt that has a turtle-neck collar.
Medications: if prescriptions were printed for you at your pre-operative/consultation visit, then have them filled no later than 24 hours before your appointment and begin using them as directed. Take your usual prescription medications on day of surgery and eat normally unless you have been directed to do otherwise (see bottom of this page). If you use an inhaler for wheezing, use it per ysour usual schedule and then bring it with you to your appointment.
Feeling well: if symptoms of a cold or other illness develop prior to the scheduled surgery, please notify our office ASAP as your appointment may need to be rescheduled. Most oral surgery is elective and it is important that you feel as healthy as possible on the day of your surgery.

Smoking: do not smoke beginning 48 hours before your surgery and do not resume smoking until at least 3 days (preferably seven) after. Smoking discourages wound healing & increases the risk of infection!

Brushing: Please brush your teeth (if applicable) thoroughly on the morning of surgery appointment.

If Intravenous / General Anesthesia (sleep) is planned, it is important that you comply with the following instructions. If you will be awake for your procedure, there is no need for you to read further.

Empty Stomach: you must not eat solid food or drink liquids after the midnight before your surgical appointment. If your surgery is scheduled in the afternoon, then do not eat or drink for at least six hours prior to your appointment time. This requirement is made for your own protection, and violation of this rule could be potentially life threatening. You may have sips of water for taking medications and brushing your teeth before surgery.
A Ride Home: bring a responsible adult with you on the day of your surgery. This individual must be prepared to wait in the office for you, drive you home after surgery, and then stay with you (unless there is another adult in your home) until you have recovered from the effects of the anesthesia (usually several hours). If you do not arrive for your appointment with an adult, your surgery must be cancelled. Sorry, but taxi rides are not acceptable!

Anesthesia History: if you have had general anesthesia in the past & have experienced any complications or side effects such as nausea and vomiting, please notify us. Furthermore, if any of your relatives have experienced anesthesia-related complications such as Malignant Hyperthermia or Pseudocholinesterase deficiency, be sure to notify Dr. Worley or an office team member.

Contact Lenses: please do not wear contact lenses!. Please bring any reading glasses to your appointment.

IF QUESTIONS ARISE, PLEASE DO NOT HESITATE TO CALL US AT 770-218-9135

After Surgery Instructions Following Removal of Teeth

The discomfort and swelling that may follow your surgery are due to a combination of factors, including the difficulty or duration of surgery and individual patient responses. However, careful surgical technique and your compliance with these instructions will enhance your rapid and uneventful recovery. Your surgeon can only optimize the environment in which healing must occur. The supply of fuel for healing (nutrition) and maintenance of the area (oral hygiene) are up to the patient.� Please do not underestimate the importance of your role in a rapid recovery!

DISCOMFORT: in most cases a NSAID (like prescription Flurbiprofen or OTC Ibuprofen or Advil 400 to 600mg every 6 hours) or even Tylenol (if your doctor has advised you to avoid NSAIDs) will relieve a significant amount of your discomfort, if not all of it. It can be helpful (but not required) to start taking the NSAID (or Tylenol) several hours before your surgery if this is possible. Then continue to take the NSAID or Tylenol on a schedule for 5 days after the procedure. This is your BASELINE pain-preventive medication. Depending upon your specific procedure, you may also receive a prescription for a narcotic analgesic (like Darvocet or Lorcet); if so, then use this only if pain persists in spite of your taking the BASELINE medication. If your BASELINE medication is Tylenol, then you should stop taking this while you are using the Prescription narcotic medication (as it contains some Tylenol). If your BASELINE is an NSAID medicine, then continue taking and use the narcotic prescription in addition for break-through discomfort.

DRY SOCKET: You may have heard of something called a dry socket. This is a wound-healing nuisance (not a serious complication) that occurs in a minority of patients (under 10%) and starts as an aching pain in one or both sides of the jaws (usually lower) or as an earache. It begins 3 to 7 days after surgery but can be quickly relieved in the office by placement of a medicated dressing. Do not hesitate to call, anytime (24/7) if your pain is not relieved by the prescribed medications. Even if weekend or evening, your call will be returned. Dry sockets only become significant when ignored.

SWELLING & BRUISING: This develops to a variable degree within the first 24 hours, peaks at 48 to 72 hours, rapidly resolves, and is negligible by the 7th day. You may apply an ice pack during the first 36 hours for comfort & to reduce swelling. Try and keep your head elevated for the first 48 to 72 hours. Discoloration of the face sometimes normally occurs as a result of bleeding into the tissues (bruise or hematoma) and will resolve in 5 to 7 days. Patients who have had removal of impacted teeth should expect at least 2 to 3 days of significant discomfort, facial swelling & stiffness when opening the mouth.

BLEEDING: Bite firmly on the gauze for at least 60 minutes after surgery, then remove the gauze and throw it away. The gauze will be colored red-- this is normal). Expect to see persistent oozing from the sockets for the first 24 hours; it will color your saliva pink-red and is normal. Continuing to change/replace the gauze throughout the day is not necessary but is not harmful either. No spitting or sucking through straws, as this encourages wound oozing/bleeding. Before taking a nap, consider placing an old towel over a pillow, as dilute, bloody saliva may leak from the mouth. Any stains may be removed with 3% Hydrogen peroxide solution.
Directions for replacing gauze (if desired): use ice-cold water to moisten & then twice-fold 1 or 2 of the gauze from your HomeCare Bag into a square & place over the surgical site in your mouth, maintaining constant (not chewing!) pressure for 30 minutes. If the oozing is bothersome, you may place a dry, caffeinated tea bag (NOT herbal tea) over the wound, then the gauze. Elevate your head (extra pillow) and bite firmly on the bag & gauze for one hour. In order to be effective, your upper teeth should not be touching your lower teeth while the packs are in place. If you notice that they are touching, either reposition the packs or replace them with a thicker pack. In other words, ALL of your jaw pressure should be directed on the gauze! However, if your mouth fills with large clots of blood in spite of these steps, please call the office promptly.

EATING & NUTRITION: If you were asleep during surgery, begin with clear liquids like 7-UP to avoid nausea. Then rapidly advance to milkshakes (use a spoon, not a straw), soups, and then solid food as tolerated. Be careful not to chew until the numbness has worn off. Let the severity of your discomfort guide you in the selection & placement of food. Take smaller bites & keep the food in an area remote from the wound(s) if possible. After 3 or 4 days you should be able to chew a soft or even regular consistency diet, depending on your level of discomfort. A normal intake of calories is important, as your body now has a higher than usual metabolic requirement in order to heal your wounds.

NAUSEA: This uncommonly occurs as a side effect of the prescribed narcotic medications or (rarely) from the anesthetic drugs. Try not to take your pills on an empty stomach. Antacids (Maalox, Pepto-Bismol, etc.) may help to alleviate nausea. If vomiting occurs and is persistent, call the office. A prescription will be called in for a suppository medication.

ACTIVITY: Get plenty of rest & go to bed early! Following minor surgery like removal of a non-impacted tooth, you may be able to return to normal activity immediately. Depending upon your occupation, you may return to work within 24 to 48 hours.
However, following removal of impacted teeth, do not participate in any activity that will significantly raise your blood pressure or pulse (like vigorous exercise) for 48 hours after your surgery. Avoid contact sports for 1 to 2 weeks.

WOUND CARE: This will promote rapid healing & will reduce both odor & risk of infection. Beginning 24 hours after surgery (not before), gently rinse your mouth with warm salt water (a pinch of table salt in a small glass of water) at least four times a day, and continue for seven days. Resume brushing your teeth on the day after your surgery, but avoid brushing in the area of your wounds for 3 days. If you were given a curved-tip syringe, begin to use it on the 3rd day after surgery as an aid to removing food from your wounds. DO NOT SMOKE for at least five days after surgery. Any stitches will spontaneously dissolve within 1 to 2 weeks.

After Dental Implant Surgery

The discomfort and swelling that may follow your surgery are due to a combination of factors, including the difficulty or duration of surgery and individual patient responses. However, careful surgical technique, appropriate medications, and your compliance with these instructions will enhance your rapid and uneventful recovery from surgery. Surgical skills and medications can only serve to optimize the environment in which healing must occur. The supply of fuel for healing (nutrition) and maintenance of the area (oral hygiene) are up to the patient. Please do not underestimate the importance of your role in a rapid recovery!

DISCOMFORT: This is usually quite minor following placement of dental implants. In most cases a NSAID (like prescription Flurbiprofen or OTC Ibuprofen or Advil) or even Tylenol (if your doctor has advised you to avoid NSAIDs) will relieve your discomfort. It can be helpful (but not required) to start taking the NSAID (or Tylenol) several hours before your surgery if this is possible. Then continue to take the NSAID or Tylenol on a schedule for 5 days after the procedure. This is your BASELINE pain-preventive medication. In some cases, you may also receive a prescription for a narcotic analgesic (like Darvocet or Lorcet); if so, then use this only if pain persists in spite of your taking the BASELINE medication. If your BASELINE medication is Tylenol, then you should stop taking this while you are using the Prescription narcotic medication (as it contains some Tylenol). If your BASELINE is an NSAID medicine, then continue taking and use the narcotic prescription in addition for break-through discomfort.

SWELLING & BRUISING: Minimal or absent; if it occurs it will peak at 48 hours, rapidly resolve, and will be negligible by the 5th day. Mild discoloration (bruising) of the facial skin may occur but is uncommon in patients under 50 years old unless a tendency to easy bruising already exists. If it occurs it is of no concern & will clear in 3 to 5 days.

BLEEDING: Bleeding is usually minimal if present at all. There may be some mild oozing for the first 24 hours. If it seems persistent and is bothersome, please call the office. Fever can occur within 48 to 72 hours, and usually is associated with a decrease in fluid intake, vomiting, or dehydration (these problems are rare). An oral temperature under 101 degrees usually responds to good fluid intake and TYLENOL every four hours.

EATING & NUTRITION: If you were asleep during surgery, begin with clear liquids like 7-UP to avoid nausea. Then rapidly advance to milkshakes, soups, and then solid food as tolerated. Be careful not to chew until the numbness has worn off. Let the severity of your discomfort guide you in the selection & placement of food. Take smaller bites & keep the food in an area remote from the wound(s) if possible. After 3 or 4 days you should be able to chew a soft or even regular consistency diet, depending on your level of discomfort. A normal (or supernormal) intake of calories and nutrients is important, as your body now has a higher than usual metabolic requirement in order to heal your wounds. High protein/high calorie nutritional supplementation is encouraged for the first week to encourage rapid & uneventful healing.

RESTRICTIONS: Get plenty of rest & go to bed early! Do not participate in any activity that will significantly raise your heart rate or blood pressure for 24 hours after your surgery. Avoid contact sports for a week. Depending on your occupation, you may return to work within 24 hours or even the same day. If your implant was placed immediately following removal of the tooth and a crown was placed on the implant, DO NOT chew on this tooth! This tooth is “for show” only and will not be ready to withstand chewing forces for several months.

ORAL HYGIENE & WOUND CARE: Beginning the evening following your surgery, gently rinse your mouth with a 50%/50% mixture of warm salt water (1/2 teaspoon per 6 oz. glass) & hydrogen peroxide at least four times a day, ideally after eating and before going to bed. Resume brushing your teeth on the evening after your surgery, but do not brush against the gums next to your implant(s) for 7 days. If you have an immediate mplant, DO NOT floss on either side of the implant crown until cleared by our office to do so. DO NOT SMOKE for at least five days after surgery. Stitches (sutures) are auto-digestible and will dissolve within 1 to 2 weeks.

After Sinus Lift Graft

These instructions may be provided as a supplement to other post-operative instructions. Be sure to read and follow all post-operative instructions. Elevation of the maxillary sinus membrane and placement of bone graft material is a delicate and sometimes tedious operation. The success rate of this surgical procedure is very high, but your cooperation in following these instructions is important. One of the purposes of the following instructions is to avoid any maneuvers that significantly change the pressure differential between your mouth and your sinuses.

PHYSICAL ACTIVITY: Do not blow your nose. Absorb any nasal drainage with a tissue. Do not suck through a straw. Do not smoke. Do not suppress sneezes. If you must sneeze, do so with your MOUTH OPEN. Do not play with the wound and stitches with your tongue, this takes commitment, as the tongue is an inquisitive organ! DO NOT, place your fingers into your mouth or retract your cheek in an effort to see the wound. If you make an effort to see the wound, you are jeopardizing the healing process. Do not engage in any activity that will significantly raise your heart rate or blood pressure for 24 hours after your surgery. You should avoid contact sports for 2 weeks minimum. Depending on your occupation, you may return to work within 24 to 48 hours.

WOUND CARE & HYGIENE: Wait until 24 hours have passed since your surgery then rinse your mouth with a mixture of 50% warm salt water (1/2 teaspoon per 6 oz. glass) and 50% Hydrogen Peroxide at least four times a day, ideally after eating and before going to bed. If you were given a prescription antibacterial rinse, use this twice a day in addition to the salt water. Beginning on the evening of your surgery day, you may gently brush your front teeth and the top of your tongue. However, do NOT allow your toothbrush to venture past your canines (Eye teeth) towards the back of your mouth. You may resume brushing your back teeth (top only) after one week has passed since your surgery. Treat your wounds delicately.

MEDICATIONS: Take an over-the-counter decongestant like Pseudoephedrine (Sudafed) as directed on the package until your next appointment. The adult dose will be two 30 milligram pills (60 mg) every six hours. In most cases a NSAID (like prescription Flurbiprofen or OTC Ibuprofen or Advil) or even Tylenol (if your doctor has advised you to avoid NSAIDs) will relieve a significant amount of your discomfort, if not all of it. It can be helpful (but not required) to start taking the NSAID (or Tylenol) several hours before your surgery if this is possible. Then continue to take the NSAID or Tylenol on a schedule for 5 days after the procedure. This is your BASELINE pain-preventive medication. Depending upon your specific procedure, you may also receive a prescription for a narcotic analgesic (like Darvocet or Lorcet); if so, then use this only if pain persists in spite of your taking the BASELINE medication. If your BASELINE medication is Tylenol, then you should stop taking this while you are using the Prescription narcotic medication (as it contains some Tylenol). If your BASELINE is an NSAID medicine, then continue taking and use the narcotic prescription in addition for break-through discomfort.

SWELLING & BRUISING: This develops within the first 24 hours, peaks at 48 to 72 hours, rapidly resolves, and is negligible by the seventh day. You may use an ice pack during the first 24 hours (no heat) for comfort and to reduce swelling. Keep your head elevated at 45 to 60 degrees from the horizontal for the first 48 to 72 hours. Discoloration of the face sometimes normally occurs as a result of bleeding into the tissues (bruise or hematoma) and will resolve in 5 to 7 days.

BLEEDING/FEVER: Bleeding is usually minimal if present at all, since the gums have been sutured together. You may experience some mild oozing from the suture line for the first 24 hours. If it seems persistent and is bothersome, please call the office. Fever can occur within 48 to 72 hours, and usually is associated with a decrease in fluid intake, vomiting, or dehydration. An oral temperature under 101 degrees usually responds to good fluid intake and TYLENOL every four hours. If you note a fever of 103 degrees or greater, please call the office.

EATING & NUTRITION: If you were asleep during surgery, begin with clear liquids like 7-UP to avoid nausea. Then rapidly advance to milkshakes, soups, and then solid food as tolerated. Be careful not to chew until the numbness has worn off. Let the severity of your discomfort guide you in the selection & placement of food. Take smaller bites & keep the food in an area remote from the wound(s) if possible. After 3 or 4 days you should be able to chew a soft or even regular consistency diet, depending on your level of discomfort. A normal intake of calories is important, as your body now has a higher than usual metabolic requirement in order to heal your wounds.

NAUSEA: This may occur as a side effect of the prescribed medications or (rarely) from the anesthetic drugs. If you received intravenous anesthesia, a dose of nausea-preventive medicine was given. Try not to take your pills on an empty stomach. Antacids (Maalox, Pepto-Bismol, etc.) may help to alleviate nausea. If vomiting occurs and is persistent, call the office. A prescription will be called in for a suppository medication.

After Surgery Instructions following Multiple Tooth Extractions & Immediate Denture(s)

DISCOMFORT: Adults should take 400 to 600mg (2 to 3 pills of 200mg each) of Ibuprofen (Advil or Motrin) as soon as possible (before the numbness wears off), and continue taking them every 6 hours for at least 5 days. However, do NOT take Ibuprofen if your medical doctor has instructed you to avoid NSAIDs. If pain persists in spite of taking the Ibuprofen, take your prescription pain medication as directed on the bottle. Please note: it is O.K. to take the Ibuprofen & the prescription drug at the same time. Patients who have undergone removal of impacted teeth should expect at least 2 to 3 days of significant pain, facial swelling & stiffness when opening the mouth. A dry socket occurs in about 10% of patients & starts as a persistent ache in one or both sides of the jaws or ear. It begins 3 to 7 days after surgery and is relieved in the office by placement of a medicated dressing.

SWELLING & BRUISING: This may develop within the first 24 hours, peaks at 48 to 72 hours, rapidly resolves, and is negligible by the 7th day. You may apply an ice pack during the first 36 hours (20 minutes on then 20 minutes off) for comfort & to reduce swelling. Keep your head elevated for the first 48 to 72 hours. Discoloration of the face sometimes normally occurs as a result of bleeding into the tissues (bruise or hematoma) and will resolve in 5 to 7 days.

BLEEDING: If gauze were left in your mouth, bite firmly on them for at least 60 minutes after surgery, then remove (gauze will be colored red-- this is normal). Expect to see persistent oozing from the sockets for the first 24 hours; it will color your saliva pink-red and is normal. If needed, moisten & then twice-fold 1 or 2 of the gauze from your Postop Bag into a square and place over the surgical site in your mouth, maintaining constant (not chewing!) pressure for 30 minutes. If the oozing is bothersome, you may place a dry, caffeinated tea bag (NOT herbal tea) over the wound, elevate your head (extra pillow) and bite firmly on the bag for one hour. Your upper teeth should not be touching your lower teeth while the packs are in place. If you notice that they are touching, either reposition the packs or replace them with a thicker pack. In other words, ALL of your jaw pressure should be directed on the gauze! However, if your mouth fills with large clots of blood, please call the office promptly. Before taking a nap, consider placing an old towel over a pillow, as pink-red (serous oozing) saliva may leak from the mouth. Stains may be removed with 3% Hydrogen peroxide.

EATING & NUTRITION: If you were asleep during surgery, begin with clear liquids like 7-UP to avoid nausea. Then rapidly advance to milkshakes, soups, and then soft, solid food as tolerated. Be careful not to chew until the numbness has worn off. Let the severity of your discomfort guide you in the selection & placement of food. Take smaller bites & keep the food in an area remote from the wound(s) if possible. After 3 or 4 days you should be able to chew a soft or even regular consistency diet, depending on your level of discomfort. If teeth were removed, a straw should not be used for drinking for 48 hours following your surgery so as to avoid dislodging the blood clots from the wounds.
A normal (or supernormal) intake of calories and nutrients is important, as your body now has a higher than usual metabolic requirement in order to heal your wounds. High protein/high calorie nutritional supplementation is encouraged for the first week to encourage rapid & uneventful healing.

NAUSEA: This uncommonly occurs as a side effect of the prescribed medications or (rarely) from the anesthetic drugs. Try not to take your pills on an empty stomach. Antacids (Maalox, Pepto-Bismol, etc.) may help to alleviate nausea. If vomiting occurs and is persistent, call the office. A prescription will be called in for a suppository medication.

ACTIVITY: Get plenty of rest & go to bed early! Do not participate in any activity that will significantly raise your heart rate or blood pressure for 24 hours after your surgery. Avoid contact sports for 1 to 2 weeks. Depending on your occupation, you may return to work within 24 to 48 hours. Following minor surgery, you may be able to return to normal activity immediately.

WOUND & DENTURE CARE: Try and leave your dentures in place until the second evening following your surgery. At that time, remove your dentures and soak them in a mixture of 50 % salt water (1/2 teaspoon per 6 oz. glass) and 50% hydrogen peroxide. Now gently rinse your mouth with warm salty water and then immediately replace the dentures. If you leave your dentures out for more than 5 or 10 minutes, it may be difficult to replace them due to the swelling that persists for several days. You should resume brushing any remaining teeth on the day after your surgery. Beginning the fourth day after surgery you should begin leaving your denture out of your mouth at night while sleeping. Stitches (sutures) are auto-digestible and will dissolve within 1 to 2 weeks.

After Sinus Communication

Because of the close relationship between the upper back teeth and the sinus cavity, a communication between the sinus and the mouth sometimes results from surgery. If you have been told that you may have a communication from the sinus, certain precautions will assist healing this area. We ask that you faithfully follow these instructions.

Take prescription medications as directed
Do not forcefully spit for several days
Do not smoke for at least 7 days
Do not use a straw for several days
Do not forcefully blow your nose for at least 2 weeks, even though your sinus may feel "stuffy" or there may be some nasal drainage.
If you must sneeze, keep your mouth open and don't try to hold it in
Do not vigorously rinse for several days. Gentle salt water rinses may be used
You may use a nasal decongestant such as Sudafed or a nasal spray such as Afrin to help avoid blowing your nose
Slight bleeding from the nose is not uncommon for several days after surgery.

Please keep our office advised of any changes in your condition, especially if drainage or pain increases. It is important that you keep all future appointments until this complication has resolved