Surgical Instructions

Before General Anesthesia or IV Sedation

• You may not have anything to eat or drink (including water) for eight (8) hours prior to surgery.
• A responsible adult must drive you away from the office.
• The patient should not drive a motor vehicle or operate machinery for 24 hours following anesthesia.
• Please wear comfortable loose fitting clothing with short sleeves.
• Do not wear contact lenses, jewelry, or makeup. Dark nail polish or acrylic nails may interfere with our monitors and may be removed before surgery.
• If you have an illness such as a cold, sore throat, stomach or bowel upset, please notify the office.
• If you are taking any medications, please check with Dr. Leighty before surgery for instructions.
• Asthmatics should bring their inhaler; Diabetic patients bring blood glucose tester

After Removal of Teeth

The removal of impacted teeth is a surgical procedure. Post-operative care is very important for proper healing. Swelling, soreness, stiffness, restricted jaw movement, and oozing are expected after oral surgery. Most complications can be minimized if these instructions are followed carefully. Dr. Leighty carefully designed these instructions to help you understand how to help yourself heal following surgery. Our interest and concern for you as a patient does not end with the surgery. If you have any questions, please call our office (530.272.8871). We want you to recover as quickly and easily as possible. If you are unable to breathe or swallow, contact a Hospital Emergency Room or call 9-1-1.

Do Not Disturb the Wound

Bleeding, irritation, and infection may worsen if you disturb the surgical wound. Leave the gauze packs in place for one hour before removing them. If the socket or wound is still bleeding, put new gauze packs in place with firm pressure directly on the bleeding area. No smoking, spitting, and sucking for 24 hours.

Bleeding

Some bleeding or oozing is normal after an extraction. Your saliva will likely be red while there is active bleeding and also when the mature blood clot breaks down in the following days. If you are bleeding a lot, rinse your mouth with cold water once quickly to see where the bleeding is coming from, and place a new gauze pack firmly on that spot for one hour. Repeat if necessary. Alternatively, try placing a moist tea bag directly on the socket. The tannic acid in the tea helps to seal the tiny blood vessels. Use ice packs near the area, rest and avoid exercise. It is best to keep your head elevated with pillows or to sit in a reclining chair. Call the office for advice if bleeding continues to be a problem.

Bruising

Due to the nature of oral surgery, it is common for patients to have some bruising in the face, neck and/or mouth from the surgery. The discoloration may be blue, black, green, or yellow. Your arm may be bruised near the IV site. The bruising is caused simply by blood seeping into the skin around the surgery and usually fades within a week or so.

Diet

Immediately following IV anesthesia, you should eat cold, wet, sloppy foods like smoothies, yogurt, pudding, applesauce, or ice cream. Avoid straws because they may cause bleeding to resume by dislodging the clot. To avoid dehydration, it is important to increase your fluid intake for the first few days after surgery, which also helps to make up for a decreased food intake. You may start eating soft foods as soon as you feel able, and try to chew away from the surgical area. Bleeding may be increased if you drink alcohol or coffee soon after surgery. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat, especially high calorie, high protein nourishment.

Dizziness

Patients prone to motion sickness may have prolonged periods of dizziness following IV anesthesia. If dizziness lasts longer than 24 hours, please call the office. If you are dehydrated or recovering from a long surgery, you may get dizzy if you suddenly sit up or stand up from a reclining or lying position. Therefore, get up from a lying or sitting position slowly and deliberately.

Drowsiness

Drugs used during IV anesthesia usually wear off within 12-24 hours. If you are dizzy or weak longer than a day, that is probably due to side effects of the narcotic pain medicine or a lack of food or water intake. It is very important not to drive, operate machinery, or be responsible for minors when you are impaired.

Smoking

Smoking increases your risk of bleeding, dry socket, and pain following surgery. Smoking also slows the healing process. If you must smoke, keep it to a minimum, and do not cause a suction in your mouth.

Swelling

Ice packs should be applied to the face closest to the surgery area 20 minutes ON and 20 minutes OFF for the remainder of the day of surgery. Swelling is normal and expected with surgery. Swelling normally increases for 2-3 days following the surgery. Ice during the 1st day helps to minimize this swelling on later days, so use the ice even if swelling is not noticeable yet. On the 2nd or 3rd day, most patients get relief from applying moist heat to the same areas.

Pain

Unfortunately, some pain is unavoidable following surgery or infections. Remember that pain medicine is supposed to make the pain tolerable, NOT to take away all pain completely. Dr. Leighty has prescribed what he thinks is appropriate for each individual patient. Take the first pain tablet just as the numbness starts to wear off. Common side effects of pain medicines are nausea and vomiting, so be sure and coat your stomach with some food or drink 15 minutes before taking the medicine. Do not put your pain medicine, aspirin, or hydrogen peroxide on your gums. Do not take someone else’s pain medicine. If your medicine is making you sick or causing a rash, call the office for advice.

Pain Medicine Warning

If you are taking a narcotic prescription pain medicine like codeine or Vicodin (hydrocodone), consider yourself with impaired judgment. DO NOT drive, operate machinery, or supervise children until the effects have worn off. These medicines cause your breathing to be depressed, so please take as directed and do not use alcohol.

Pain Medicine Dosing Suggestions

Most patients are prescribed a nonsteroidal (NSAID) pain medicine such as ibuprofen (Advil, Motrin) which should be taken three times a day. In between those doses, you may take a narcotic medication (Darvocet, codeine, Vicodin) you were prescribed as directed. Your medicine combination is designed to give you reasonable and steady pain control over time. You should wean yourself from the narcotic as soon as possible while continuing to use the other nonsteroidal pain medicine. Remember to take food 15 minutes before to help avoid irritating the stomach lining. If you are also taking an antibiotic (amoxicillin, clindamycin), you should stagger those doses so you aren’t taking more than one medicine at any one time. Call the office if you are confused about your dosing.

Other Aches and Discomfort

Earaches and sore throats are often associated with oral surgery. Other teeth may have temporary sympathetic pain. Partial numbness of teeth or skin is not unusual and is almost always temporary. Corners of the mouth may be swollen or dry and become cracked. Vaseline, creams, or an antibiotic ointment may help. It is common to have a slight fever for a couple of days following surgery.

Laxatives

Narcotic pain medicines often cause temporary constipation. Milk of Magnesia or other over-the-counter laxatives may be used as needed to re-establish regular elimination.

Antibiotics

You may have been given a prescription to help avoid or control an infection. Women are warned that some antibiotics have been suspected of interfering with birth control pills. You may wish to discuss this matter with your physician. You may wish to use an additional form of contraception for several weeks following antibiotic use. Antibiotics should be taken until they are all gone. Ask Dr. Leighty before ordering a refill of antibiotics. Take all meds as directed due to the possible reactions with other medications. If you think you are having a reaction to your medicine, stop taking it and call the office for advice.

Nausea and Vomiting

A few drops of blood can irritate your stomach and cause nausea or vomiting. So can stress or other medicines. Coating your stomach with food or fluids 15 minutes before taking your medication may help. If nausea continues, limit your food intake to clear liquids and bland foods. If you are still bothered by significant nausea, call the office for advice.

Mouth Rinses

Warm salt water rinses help to clean the surgical wound, reduce swelling, and speed healing and comfort. Starting the day after surgery, you may rinse every 2 or 3 hours. To make salt water, add _ teaspoon of salt to half a glass of very warm water. You should rinse after each meal, and at bedtime. It is OK to use your usual mouthrinse after the salt water rinse.

Dressings

You may have had a surgical dressing placed to protect the surgical area and to aid in healing. Small pieces of the dressing may flake off and is no cause for alarm. If the entire dressing comes loose or if you have increased pain, please call the office for advice.

Sutures (Stitches)

Unless otherwise told, your sutures will come loose and dissolve by themselves. If the sutures fall out early, they are usually NOT replaced – call the office if you are concerned. If the sutures are irritating, they can usually be removed during your checkup visit.

Oral Hygiene

Perform regular flossing and brushing in the areas of your mouth not affected by surgery. Salt water rinses will assist you to clean the areas you are unable to brush temporarily. Always use a soft toothbrush and don’t neglect braces and wires. You may have a large hole where the tooth used to be, and it may take several weeks or longer to heal. A clean wound heals better and faster.

Support and Recovery Following IV Anesthesia

Medicines used during anesthesia are likely to affect your judgment, emotions, and mental sharpness. Dr. Leighty strongly suggests that a responsible person stay with the patient for 12-24 hours following surgery. Tasks like eating, taking medicines on the proper schedule, and taking care of your mouth are often difficult for patients to do all by themselves after surgery.

Numbness

Localized numbness around the surgical area is common and usually temporary. Be especially careful not to bite your lip until the numbness from the local anesthetic injection has worn off.

Jaw Stiffness

Swelling of the jaw muscles or soft tissues in the face can cause stiffness (trismus) and is common following oral surgery. As the swelling resolves, your jaw stiffness will also go away.

Tooth Socket Roughness

You may feel something hard or unusual in the area of the tooth extraction. Most often you are feeling the edge of the bony jaw or socket which may have been drilled in order to remove the tooth completely. This normally smoothens out by itself. Do not use your fingernail or a toothpick because you might damage the area or cause an infection. One purpose of your followup visit is to examine your surgery site and answer any questions you might have about how the area feels or looks.

Dry Socket

A dry socket occurs when the blood clot is taken away from the socket too soon. Smoking, rinsing or spitting too soon after surgery can increase your chances of a dry socket. Dry sockets can occur about 2-4 days after surgery and can be painful. It is not the same as an infection and usually heals with or without treatment.

Physical Exercise

In general, Dr. Leighty encourages your early return to your usual physical activities. However, you should be very careful not to overdo your activity – start slowly with frequent breaks and shorter periods and gradually build up. If you start bleeding or have throbbing pain, you should rest until another day.

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, call the office for advice. Sutures and a small gold chain may be visible around the surgery area – please leave these alone. You should rinse the surgery area until you are able to gently massage with a soft toothbrush.

Removal of Multiple Teeth

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, you should expect more swelling, bruising, or bleeding than for a smaller surgery. If immediate dentures have been placed, sore spots may develop which can be adjusted later by your dentist. Try to leave the denture in place until you see your dentist. If you must remove the denture, try and re-insert it within a few minutes or the swelling may not allow you to put it back in.

Dental Implant Placement

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. You may notice the shiny metal showing through or near the gum tissue. Be sure to take the prescribed antibiotics as directed to help prevent infection. Good oral hygiene is essential to good healing. Use warm salt water rinses several times a day to help with cleaning the area until you are able to gently brush.