Surgical Instructions

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Before Intravenous Anesthesia Sedation

• You may not have anything to eat or drink (including water) for eight (8) hours prior to the appointment.
• 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.
• 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, stomach or bowel upset, please notify the office.
• If you take routine oral medications, please check with Dr. Nelson prior to your surgical date for instructions.

After Dental Implant Surgery

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There may be a metal healing abutment protruding through the gingival (gum) tissue.

Bleeding
Bleeding should never be severe. If it is, usually means that the packs are being clenched between your teeth rather than exerting pressure on the surgical areas. Try repositioning the packs. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in moist gauze for 20-30 minutes. If bleeding remains uncontrolled, please call our office.

Swelling
Often there is some swelling associated with oral surgery. You can minimize this by using a cold pack or ice pack wrapped in a towel and applied firmly to face or cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 12 to 36 hours after surgery. Keeping the head elevated will also minimize swelling. 3 to 4 pillows will work well to keep the patient in a restful, elevated position. This position should be maintained, even during sleep, for the first three days. If you have been prescribed medicine for the control of swelling, be sure to take it as directed. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is 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 size of the swelling.

Diet
Eat any nourishing food that can be taken with comfort. Temperature of the food doesn’t matter, but avoid extremely hot foods. It is sometimes advisable, but not required, to confine the first day’s input to bland liquids or pureed foods (creamed soups, puddings, yogurt, milk shakes, etc.). Avoid foods like nuts, sunflower seeds, popcorn, etc., that may get lodged in the socket areas. Over the next several days you can progress to solid foods at your own pace. It is important not to skip meals! If you take nourishment regularly, you will feel better, gain strength, have less discomfort and heal faster. If you are a diabetic, maintain your normal eating habits as much as possible and follow instructions from us, or your physician regarding your insulin schedule.

Pain
Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication, and if you take the first pill before the anesthetic has worn off, you will be able to manage any discomfort better. Effects of pain medications vary widely among individuals. If you do not achieve adequate relief, you may supplement each pill with an analgesic such as aspirin or acetaminophen or ibuprofen. Some people may even require two of the pain pills at one time during early stages (but that may add to the risk of upset stomach). Remember that the most severe discomfort is usually within the first six hours after the anesthetic wears off; after that your need for medicine should lessen.

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.

Oral Hygiene
Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort. Keeping your mouth clean after surgery is essential. Use one-quarter teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily for the next five days.

Activity
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising. Remember no exercise the first week, 75% of your normal routine the second week, and 100% the third week.

Wearing your Prosthesis
Partial dentures, flippers, or full dentures should not be used immediately after surgery and for at least 10 days. Unless you have a modified prosthesis which was discussed with Doctor Nelson previously.

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 30-60 minutes. After this time, the gauze pad should be removed and discarded.

Vigorous mouth rinsing or touching the wound area following 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 you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.

Restrict your 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 explanation.

Day of Surgery

Bleeding
Bleeding should never be severe. If it is, it usually means that the packs are being clenched between your teeth rather than exerting pressure on the surgical areas. Try repositioning the packs. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in moist gauze) for 20-30 minutes. If bleeding remains uncontrolled, please call our office.

Oozing
Intermittent bleeding or oozing is normal. It may be controlled by placing fresh gauze over the surgical areas and biting down firmly for 30-60 minutes.

Swelling
Often there is some swelling associated with oral surgery. You can minimize this by using a cold pack or ice pack wrapped in a towel and applied firmly to face or cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 12 to 36 hours after surgery. Keeping the head elevated will also minimize swelling. 3 to 4 pillows will work well to keep the patient in a restful, elevated position. This position should be maintained, even during sleep, for the first three days. If you have been prescribed medicine for the control of swelling, be sure to take it as directed. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is 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 size of the swelling.

Pain
Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication, and if you take the first pill before the anesthetic has worn off, you will be able to manage any discomfort better. Effects of pain medications vary widely among individuals. If you do not achieve adequate relief, you may supplement each pill with an analgesic such as aspirin or acetaminophen or ibuprofen. Some people may even require two of the pain pills at one time during early stages (but that may add to the risk of upset stomach). Remember that the most severe discomfort is usually within the first six hours after the anesthetic wears off; after that your need for medicine should lessen.

Diet
Eat any nourishing food that can be taken with comfort. Temperature of the food doesn’t matter, but avoid extremely hot foods. It is sometimes advisable, but not required, to confine the first day’s input to bland liquids or pureed foods (creamed soups, puddings, yogurt, milk shakes, etc.). Avoid foods like nuts, sunflower seeds, popcorn, etc., that may get lodged in the socket areas. Over the next several days you can progress to solid foods at your own pace. It is important not to skip meals! If you take nourishment regularly, you will feel better, gain strength, have less discomfort and heal faster. If you are a diabetic, maintain your normal eating habits as much as possible and follow instructions from us, or your physician regarding your insulin schedule.

Second Day
- 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 the 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.

Nausea and Vomiting
Nausea and/or vomiting are not an uncommon events following surgery, and it is caused by stronger pain medicines. Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with a large volume of water. Try to keep taking clear fluids and minimizing the pain medication, but call the office (208) 342-1551, if you do not feel better or if repeated vomiting is a problem. Cola drinks that have less carbonation may help with nausea.

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 Nelson 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 the lying down position to standing, if you were not able to eat or drink prior to surgery. 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. Nelson. 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. 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 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 from your mouth and discard it. Dr. Nelson uses absorbable sutures, so this is to be expected. If the sutures persist they may be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this 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 the office for instructions. There will be a cavity where the tooth was removed. The cavity will close gradually over the next month and fill in with the 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 friends. Discuss your problem with the persons best able to effectively help you: Dr. Nelson or your family dentist.

BRUSHING your teeth is okay! Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.

MOUTH RINSES Keeping your mouth clean after surgery is essential. Use one-quarter teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily for the next five days.

SYRINGE If you were given an irrigating syringe, start using it the third day after surgery to keep sockets clean. Fill it with warm water and irrigate any open sockets gently, especially after eating.

DRY SOCKET Is loss of blood clot from the extraction site primarily from the lower teeth. You may experience a persistent throbbing pain in the jaw unrelieved by any measure. Activities that contribute to dry socket include sucking through a straw, smoking, vomiting, aggressive exercise, or any activity that may cause the clot to dislodge.

EXERCISE If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising. Remember no exercise the first week, 75% of your normal routine the second week, and 100% the third week.

DO NOT disturb the surgical area the day of your surgery.

DO NOT rinse vigorously or probe the area with any objects or your fingers.

DO NOT SMOKE for at least 72 hours (3 days) prior to or for 2 weeks after surgery, since it is very detrimental to the healing process.

DO NOT suck through a straw for the first week after surgery.

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.

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 food. Soft foods and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

Pain
Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication, and if you take the first pill before the anesthetic has worn off, you will be able to manage any discomfort better. Effects of pain medications vary widely among individuals. If you do not achieve adequate relief, you may supplement each pill with an analgesic such as aspirin or acetaminophen or ibuprofen. Some people may even require two of the pain pills at one time during early stages (but that may add to the risk of upset stomach). Remember that the most severe discomfort is usually within the first six hours after the anesthetic wears off; after that your need for medicine should lessen.

Oral Hygiene
Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort. Keeping your mouth clean after surgery is essential. Use one-quarter teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily for the next five days.

Activity
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising. Remember no exercise the first week, 75% of your normal routine the second week, and 100% the third week. Do not disturb the surgical area the day of your surgery. Do NOT rinse vigorously or probe the area with any objects or your fingers. DO NOT SMOKE for at least 72 hours (3 days) prior to or for 2 weeks after surgery, since it is very detrimental to the healing process. DO NOT suck through a straw for the first week after surgery.

After Extractions

Our apologies, this section is still under development.

After Multiple Extractions

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 30-60 minutes. If bleeding continues, a moist tea bag can be used for 20-30 minutes. 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 36 hours only. Apply ice 20 minutes on and 20 minutes off while you are awake. Sucking on ice chips also helps with swelling.

For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 3-4 hours. 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 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 20 minutes on and 20 minutes off 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 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 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.