Welcome :: Surgical Instructions

Anesthesia Options

Local Anesthesia

Injection of local anesthetic to numb the tooth.

Local Anesthesia with Nitrous Oxide (laughing gas)

Breathing Nitrous Oxide through a nose mask in addition to the local anesthetic injection. The Nitrous Oxide makes you feel relaxed.

I.V. Sedation

Drugs are administered through an I.V. This will make you feel relaxed but you are still conscious. Local anesthetic is still administered. You cannot eat or drink six hours prior to surgery.

General Anesthesia

Drugs are administered through an I.V. You will not be conscious or aware of your surroundings. Local anesthetic is still administered. You cannot eat or drink six hours prior to surgery.

During sedations, our highly trained staff closely monitors you.

Restrictions for I.V. Sedation and General: No food or water six hours prior to surgery. You must have a responsible adult accompany you home. Wear comfortable clothes, flat walking shoes, no make up or jewelry.

For Local Anesthesia, you may bring headphones to listen to music during the procedure.

Before Intravenous Or General Anesthesia Sedation

• You may not have anything to eat or drink (including water) for eight (6) 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 flat walking shoes (ex. gym shoes). Do not wear flip flops, sandals or high-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. Zager prior to your surgical date for instructions on how to take your medications.

After Wisdom Tooth Removal

The removal of impacted teeth can be an involved 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 position for 30 to 45 minutes. After this time, the gauze pad should be removed and discarded. Replace the pad if bleeding persists. Do not go to sleep with the pads. They can block your airway!
• 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.

Bleeding

A certain amount of bleeding is to be expected following 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 contracting blood 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 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. 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 24 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. 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, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin, Advil or Aleve) two-four 200 mg tablets may be taken every 3-4 hours.

For severe pain take the tablets prescribed for pain as directed. The prescribed pain medicine 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. Please make sure small children cannot obtain your medication!

Diet

After general anesthetic or I.V. sedation, liquids should be taken at first. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. 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. Therefore, immediately following surgery, if you are lying down, make sure you sit for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be done 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 response following surgery, which may occur 2-3 days post-operatively. Moist heat applied to the area for 20-30 minutues per day several times over a 24 hour period will 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, itching, rapid swelling 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 medicine. For uncontrolled or persistent vomiting…please call or page Dr. Zager.

Other Possible 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 it, so be careful. Call the office if you have any questions about this.
• Slight elevation of temperature immediately following surgery is not uncommon especially when you are behind in oral fluid intake. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever. Immersion into a luke-warm bathtub may be helpful too!
• You should be careful going from the lying down position to standing. As you were not able to eat or drink prior to surgery, and it is difficult to take fluids, and 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. This can be true when going to the bathroom.
• Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots or teeth remnants. They are the bony walls which supported the tooth. These projections usually smooth out spontaneously after a few weeks of recovery. If not, they can be removed by Dr. Zager.
• 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 or lip gloss.
• 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. Chewing on small ice chips can help.
• 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.

Finally

• Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they can become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will 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. At times, resorbable sutures may be used and they will dissolve a few days later.
• 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 cavity where the tooth was removed. The cavity will gradually over the next month 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. A monoject or small syringe can be given to remove this debris at your post-op appointment.
• Your case is individual, no two mouths are alike. Do not take seriously well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Zager or your dentist.
• Brushing your teeth is okay - just be gentle at the surgical sites. Use common sense.
• 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. For some people taking Motrin, Advil, Alleve or Tylenol may reduce the temporary discomfort.
• If you are involved in regular exercise be aware that your normal nourishment intake is reduced and exercise may weaken you. If you get light headed stop exercising. Avoid jogging and weight-lifting one week after surgery. This activity can pull your sutures apart. Walking, yoga and swimming are okay to do.

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, then 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. Be sure to wrap the ice bag with a towel to protect your skin. Apply the ice on and off for 20 to 30 minutes at a time as much as possible for the first 24 hours.

Diet

Drink plenty of fluids. Avoid hot liquids or hard foods. Soft food (soup, pasta, yogurt, ice cream, scrambled eggs, milk shakes, apple sauce, cottage cheese, Jello, pancakes, etc.) and liquids (Gatorade, lemonade, Java Juice, Ensure, Sustacal, any fruit juices or protein shakes) should be ingested following your surgery. Return to a normal diet as soon as possible unless otherwise directed.

Pain

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil, Motrin or Alleve) may be taken instead of Tylenol. 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. For children or small adults, be careful with overdosing with these types of medications. If in doubt or if there are any questions regarding the medications, please call the office or contact your local pharmacist.

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. Remember that you are probably not taking normal nourishment or under the influence of a narcotic analgesic, which can weaken your balance. So take it easy and use common sense!

After the Removal of Multiple Teeth

Use ice packs (externally) on the same side of the face as the operated area. Be sure to cover the ice pack with a towel to protect your skin. Apply ice for the first 24 hours only. Apply ice continuously while you are awake.

For mild discomfort use Tylenol or any similar medication; two tablets every 3-4 hours. Ibuprofen (Advil, Aleve, Motrin) 200mg can be taken 2-3 tablets every 3-4 hours. Medications containing aspirin should be avoided.

Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, or a plastic bag, or towel filled with ice on the cheek in the area of surgery. Apply the ice continuously, as much as possible, for the first 24 hours

Diet

Drink plenty of fluids. Avoid hot liquids or hard foods. 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 as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil, Alleve or Motrin) may be taken instead of Tylenol. 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 medication if you are allergic, or have been instructed by your doctor not to take it. Remember to keep medications out of the reach of small children and not to over- medicate kids and small adults.

Antibiotics

Be sure to take the prescribed antibiotics as directed to help prevent infection.

Oral Hygiene

Good oral hygiene is essential to good healing. The night of surgery, use the prescribed Peridex Oral Rinse before bed. The day after surgery, the Peridex should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt water rinses (a teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, as well, especially after meals. Brushing your teeth and the healing abutments are not a problem. Be gentle initially with brushing the surgical areas.

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. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise. Use good common sense before you go back to your regular exercise routine.

After Placement of Dental Implants

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There will be a metal healing abutment or small cover screw protruding through the gingival (gum) tissue. This should not be a problem for most people.

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. You can purchase more gauze from the pharmacy or use moist tea bags if needed.

Swelling

Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, or a plastic bag, or towel filled with ice on the cheek in the area of surgery. Apply the ice continuously, as much as possible, for the first 24 hours.

Diet

Drink plenty of fluids. Avoid hot liquids or hard foods. 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 as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil, Alleve or Motrin) may be taken instead of Tylenol. 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 medication if you are allergic, or have been instructed by your doctor not to take it. Remember to keep medications out of the reach of small children and not to over- medicate kids and small adults.

Antibiotics

Be sure to take the prescribed antibiotics as directed to help prevent infection.

Oral Hygiene

Good oral hygiene is essential to good healing. The night of surgery, use the prescribed Peridex- Oral Rinse before bed. The day after surgery, the Peridex should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt water rinses (a teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, as well, especially after meals. Brushing your teeth and the healing abutments are not a problem. Be gentle initially with brushing the surgical areas.

Activity

Keep physical activities to a minimum immediately following surgery. Aerobic exercise should be avoided for 5-7 days following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Remember that you are probably not taking normal nourishment or under the influence of a narcotic analgesic, which can weaken your balance. So take it easy and use common sense!

Wearing your Prosthesis

Partial dentures, flippers, or full dentures can be used immediately after surgery to provide pressure over the surgical extraction sockets and help promote clotting. Sometimes due to a poor fit or old prosthesis, the patient needs to go without wearing anything while healing takes place for the next several days.