Surgical Instructions

Before Intravenous Anesthesia Sedation

  • You may not have anything to eat or drink (including water) for six (6) hours prior to the appointment.
  • Do not smoke for at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery and for 24 hours after surgery.
  • A responsible adult must accompany the patient to the office, and drive the patient home. 
  • 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 makeup, or nail polish on the day of surgery.
  • If you have an illness such as a cold, sore throat, or stomach or bowel upset, please notify the office.
  • If you take routine oral medications, please check with the doctor for instructions prior to your surgical date.

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After Wisdom Tooth Removal

The removal of impacted 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.

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 and discarded.
  • Vigorous mouth rinsing or touching the wound following surgery should be avoided. This may initiate bleeding by causing the blood clot  to become dislodged.
  • Take the prescribed pain medications before you begin to feel discomfort. The local anesthetic usually lasts for 60 to 90 minutes after the surgery.
  • Restrict your activities on 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 explanation.

Bleeding

A certain amount of bleeding is to be expected following oral surgery.  Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by constricting 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 usually proportional to the surgery involved. Swelling is often worse when surgery is performed on the lower jaw.  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 surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs and by keeping the head elevated. Two 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 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is usually no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the amount of swelling

Pain

For moderate pain, ibuprofen, (Motrin or Advil) two to four 200 mg tablets, may be taken every 3-4 hours.

For severe pain, take the tablets prescribed (e.g. Percocet) as directed. The prescribed pain medicine will make you groggy and will slow 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 oral surgery and general anesthetic or I.V. sedation, liquids should be taken initially . Do not use straws.  The sucking motion can cause more bleeding by dislodging the blood clot. Drink from a glass. You may eat anything soft by chewing away form 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. 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

Minimize mouth rinsing on the day of 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 the resolution 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.

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 the prescribed medicine. You should then sip on coke, 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 medicines.  If nausea persists contact the office at 727-894-1442.

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 bite it and not feel the sensation. So be careful. Call Dr Chuong if you have any questions.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office.
  • You should be careful going from the lying down position to standing. You were not able to eat or drink prior to 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 up, 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 usually smooth out spontaneously. If not, they can be removed by Dr. Chuong.
  • 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.
  • Sore throats and pain when swallowing are not uncommon. The muscles get swollen after oral surgery. The normal act of swallowing can then become painful. This will subside in 2-3 days.
  • Stiffness (trismus) 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. Moist heat sometimes improves the jaw movement.

Finally

  • Sutures are placed in 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 form your mouth and discard it. The sutures will dissolve approximately one week after surgery. 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 the office for instructions.
  • There will be a cavity (space or hole) where the tooth was removed. The cavity will fill in with the new tissue gradually over the next month. In the mean time, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.
  • Brushing your teeth is okay - just be gentle at the 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 2-3 days following surgery. Call the office if this occurs.
  • If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Your normal tolerance for exercise may be compromised by surgery and anesthesia for several days. If you get light headed, stop exercising.

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After Exposure of an Impacted Tooth

Do not disturb the wound. If surgical packing was placed, leave it alone. The pack helps to keep the tooth exposed. If it gets dislodged or falls out do not get alarmed.  Call the office if you are concerned.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding which results in your mouth filling rapidly with blood can frequently be controlled by biting with pressure on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call for further instructions.

Swelling

Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag or a plastic bag or towel filled with ice cubes on the cheek in the area of surgery. Apply the ice continuously as much as possible for the first 36 hours.

Diet

Drink plenty of fluids. Avoid hot liquids or hot food. Soft foods and liquids should be eaten on the day of surgery. Return to a normal diet over the next several days. 

Pain

You should begin taking pain medication before you feel the local anesthetic wearing off. For moderate pain, ibuprofen bought over the counter may be used and comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed.

Oral Hygiene

Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can. Rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete. REMEMBER: A clean wound heals better and faster.

Activity

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal food and liquid intake may be reduced. Exercise may weaken you. If you get light headed, stop exercising.

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After Tooth Extraction

After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. That’s why we ask you to bite on a gauze pad for 30 minutes after the appointment. If the bleeding or oozing still persists, place another gauze pad and bite firmly for another 30 minutes. You may have to do this several times.

After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.

After the tooth is extracted you may feel some pain and experience some swelling.  An ice pack or an unopened pack of frozen peas or corn applied to the area will keep swelling to a minimum.  Take pain medications as prescribed. The swelling usually subsides after 72 hours.

Use the pain medication as directed. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.

It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean.

After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued severe swelling beyond 3 to 4 days, or experience a reaction to the medications, call our office immediately at 727-894-1442.

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After the Removal of Multiple Teeth

  • A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding continues, a moist tea bag can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove the immediate denture unless the bleeding is severe. Expect some oozing around the sides of the denture.
  • Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 36 hours only. Apply ice continuously while you are awake.
  • For mild discomfort use Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 3-4 hours.
  • 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 your symptoms.
  • Drink plenty of fluids. If many teeth have been extracted, the blood lost 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 4 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 your dentist for denture adjustment, take out denture 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.
  • 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 upon will swell, reaching a maximum in two days. Swelling and discoloration around the eye may occur. The application of a moist warm (but not hot) towel will help eliminate the discoloration more quickly. 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 the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline. There may be a slight elevation of temperature for 24-48 hours. If fever 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 surgery 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.

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After Placement of Dental Implants

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. Your doctor may also advise you to avoid nose blowing in some cases.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call for further instructions.  A moistened tea bag applied to the site for 30 minutes may also help to stop bleeding. 

Swelling

Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, or a plastic bag filled with ice, on the cheek or on the jaw in the area of surgery. Apply the ice continuously, as much as possible, for the first 36 hours.

Diet

Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

Pain

You should begin taking pain medication before the local anesthetic wears off. For moderate pain, ibuprofen, bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medications if you are allergic, or have been instructed by your doctor not to take it.

Antibiotics

Be sure to take the prescribed antibiotics as directed to help prevent infection. Antibiotics are usually started an hour or two prior to implant surgery and then continued for several days after surgery.

Oral Hygiene

Good oral hygiene is essential to good healing. Warm salt water rinses (teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, especially after meals. Gentle brushing of your teeth and of the implant healing attachments is no problem. 

Activity

Keep physical activities to a minimum immediately following surgery. If you engage in vigorous exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.

Wearing your Prosthesis

Partial dentures, flippers, or full dentures should not be used immediately after surgery and for at least 10 days, unless allowed by your doctor.

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After TMJ Surgery

PATIENT CHECKLIST FOR TEMPOROMANDIBULAR JOINT SURGERY

  • Do not eat or drink anything for at least eight (8) hours before your scheduled surgery time. That restriction includes water and coffee. You may, however, brush your teeth.
  • Do not wear makeup or jewelry.
  • Have your prescriptions filled within three (3) days of your preoperative visit so that they will be conveniently available to you after surgery.
  • Leave valuables at home, including your TMJ splint.
  • Arrange your appointment for physical therapy before your surgery. Check with your insurance company to see if you need authorization for physical therapy. If authorization is needed contact your primary care physician. The therapy should begin within 48 hours of your surgery date.
  • Before the surgery, please arrange an appointment for adjustment of your TMJ splint if another doctor has provided the splint. This appointment should be at approximately two (2) weeks after the surgery.
  • You are not allowed to chew for between two (2) to four (4) weeks after the surgery in most cases. Dr. Chuong will specify the period of restriction.
  • Your face and hair may be washed approximately twenty-four (24) hours after the surgery. The incisions may get wet but there should be no scrubbing or excessive pressure applied to them.
  • In most cases a preoperative visit to the hospital or surgery center must be done no sooner than one (1) week before surgery and no later than one (1) day before the surgery.
  • Your surgery is scheduled at: Edward White Hospital / Bayfront Medical Center, on (Date) _________________________ At: _______________ A.M. / P.M.
  • Please call 727-894-1442 should you have any questions or problems.

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After Corrective Jaw Surgery (Orthognathic)

INSTRUCTIONS FOR PATIENTS HAVING ORTHOGNATHIC SURGERY

  • Fill your prescriptions prior to surgery.
  • Do not eat or drink any fluids, not even water, for 8 hours before surgery.
  • Do not wear makeup or jewelry.
  • A blender may help you to prepare foods after surgery. Nutritional supplements such as Ensure or Boost may be helpful for the first week or two after surgery.
  • A Water Pik device may help with oral hygiene. It must be used carefully so as not to damage the incisions in the mouth. A small toothbrush may work better than an adult sized brush for the first few weeks.
  • Showering and washing of the face and hair can be done as soon as you return home.
  • Vaseline for the lips or any similar lubricant or lip balm will make you more comfortable.
  • If your jaws are wired together, a wire cutter will be dispensed by the hospital for release of the wires in case of an emergency. Similarly, if rubber bands are used to restrict your mouth opening, a small set of scissors will be dispensed. Whether wire cutters or scissors, these instruments must be carried with you at all times.
  • You should rinse your mouth with salt water after each meal and more frequently if possible. Mouth wash can be used as well.
  • The sutures (stitches) used in the mouth or around the face will dissolve and do not have to be removed.
  • If you undergo surgery on the upper jaw, do not blow your nose for at least 2 weeks after the surgery. Some minor bleeding from the nose is expected for several days. Saline nasal spray can be purchased from a drug store and may be used as necessary to moisturize the inside of your nose and to loosen secretions and/or dried blood.
  • Over-the-counter Sudafed in liquid form should be purchased if you are undergoing upper jaw surgery. It should be used at a dose of 30 mgs three times per day for about one week.
  • Iron supplements are sometimes prescribed. They will make your stools dark.
  • Constipation can occur after surgery for a variety of reasons. A laxative or enema may be necessary, which you should discuss with your surgeon.
  • Generally sleep with your head elevated to limit the amount of facial swelling. Apply ice to the face as tolerated for the first 48 hours or so. The greatest swelling is often evident by 48 hours after surgery.
  • You will be advised as to when to see your orthodontist. This visit is commonly 2 to 4 weeks after surgery. Your first visit back to this office will be one week after surgery.
  • If you have questions or concerns after you are discharged from the hospital, please call 727-894-1442. The answering service will respond during the hours of 5 PM to 8 AM.

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