Pre- and Post-Op Instructions

 Pre- and Post-Operative Instructions for Extractions and Oral Surgery  

These guidelines have been formulated to help you during the healing period following an oral surgery procedure. The mouth is a very delicate environment, and all these guidelines are very important to a successful outcome.

Pre-Operative: Each medication is very important. Start the following medications at the times listed. If you haven’t been prescribed one of these medications or rinses, please confirm with us the need or lack thereof: 

• If you are taking a sedative or will have IV sedation, do not eat 8-10 hours prior. Failure to do so can result in a major health crisis. This does not apply to nitrous oxide gas. 

• One-Two Days Prior: antibiotics (amoxicillin, augmentin or Z-pack usually) , stellalife twice a day

• Day of: sedatives if given (i.e. triazolam pre-op 45 minutes before procedure)

• After surgery: pain medication as directed below for 5 days on a schedule; stellalife twice a day until gone; continue antibiotics until gone

• Ice packs: at least five days after surgery as often as possible will decrease swelling significantly

Habits to Avoid:

• Seven Days: No heavy exercise or lifting (can harm clots); no spitting; no sucking through a straw; no scalding hot soups or drinks; absolutely no smoking for one week. Exercise should not be more than walking until swelling is down to almost pre-op levels.

 

The goal is to keep the blood clot in the socket to prevent a painful complication called a dry socket.

Bleeding:  Bleeding after surgery may continue for 12-24 hours. The best way to stop bleeding is to fold a piece of damp gauze and place it over the extraction site. If stitches have been placed do not use gauze; stitches will control most of the bleeding. Rest with your head elevated. If you experience excessive bleeding, apply firm pressure with 1-2 damp gauze or a moist tea bag to the extraction site, keeping your head elevated. You may have pink saliva for a few days afterwards. Call the clinic if bleeding doesn’t subside or gets worse after it gets better, especially if on blood thinners.

Bruising: May occur up to a week post op; this is your body’s natural response from surgical trauma. It may occur at either jaw, regardless of where the surgical site is. This is only worrisome if there is major swelling that occurs with the bruising that impedes swallowing or breathing, in which case it is a medical emergency. Bruising is especially common in the elderly and in patients on blood thinners, even with a drug holiday. 

Swelling: Swelling is the body’s normal reaction to surgery and healing, and usually peaks at three days post op. Apply a cold pack to the outside of the face for 20 minutes on and 20 minutes off while awake for the first 24 hours. After 48 hours, you can use a warm compress to the cheek but continue with the ice pack for at least three days for as much as possible. 

Pain: Dental Surgery may be accompanied by some discomfort. The use of the Pain Pack Protocol has greatly diminished the need for narcotics in dentistry, and is comprised of alternating the following:  

• Ibuprofen 800 mg taken every 6-8 hours

• Tylenol 1000 mg taken every 6-8 hour

• Optional: Take a dual action (acetaminophen/ibuprofen) over the counter pain pill as directed on the bottle, instead of taking both independently.

Diet: First week, liquid to extremely soft foods; after one week slowly increase to soft foods (nothing harder than soft tender chicken). Return to normal foods after two weeks with the exception of small indigestible foods like peppercorns. After sutures have been removed, slowly increase back to normal diet unless something hurts when eating…this is a sign that food is too hard for the time being. The following are some dietary ideas for immediate post op:

• Liquids: milkshakes (no straw), yogurt or yogurt drinks, broth without hard food, protein shakes, smoothies without seeds, juices, blended soups without meats or hard bits. 

• Soft Foods: oatmeal, soft chicken, steamed/boiled/pureed vegetables, soft fruit like bananas, scrambled eggs, macaroni and cheese, avocados, over boiled pasta.

• All on X Procedure: Until you receive your final prosthetics, you must not eat anything that cannot be cut by a plastic knife. 

Stitches: If you have received sutures, avoid playing with them. Most commonly they are dissolvable; however, you will be informed if this is not the case . If they are not dissolvable, they will need to be removed at one of your follow up appointments, typically at 2-3 weeks post-op.

Prescriptions: If you have been prescribed antibiotics, take them as directed until they are all gone.  Again, any pain medication prescribed should only be taken as directed. All prescriptions are important to take as directed, with the exception of pain prescriptions like tramadol; this should be taken optionally in addition to the pain pack protocol. Some examples of when to start medications are below (not all medications may apply to you)

• Amoxicillin, Augmentin or Zpack: start one day before procedure, or two if an infection is present, and take until gone

• Halcion: take as directed on the bottle for sedation, 30 minutes to 1 hour before the procedure.

• Stellalife: use starting two days prior to procedure until the bottle is gone. 

• Tramadol: If prescribed, take one after procedure when convenient, then after as needed not exceeding one every 6-8 hours. 

• Methyprednisolone (Medrol dose pack): Optionally prescribed in some cases, start one day prior and take as directed on the packaging.

Oral hygiene: Brush gently, avoiding any sutures and one tooth on either side of each wound site. Do not spit out mouthrinse; rather, let it drool out while leaning over the sink. Skip brushing one tooth on either side of the procedure site until stitches are gone. Mouth rinses should be ‘rolled’ but not swished vigorously as to not disturb stitches and wound sites.

 

Summary

• The mouth is a very harsh environment due to constant motion, high levels of bacteria, and social visibility. However, the body is very adept at healing this area, but will need your help.

• Liquids for three days, soft foods (plastic fork rule) for 7 after, all on X patients with temporaries- soft foods for entire treatment

• No straws, smoking, or strenuous activity (more than walking) until swelling is down.

• Ice pack as much as possible for at least five days

• Alternating ibuprofen and Tylenol on a schedule for at least three days (or take new combo formula) 

• All prescriptions are important and should be followed, especially antibiotics and pain protocol

• Brushing should be limited around ‘next door’ teeth and prohibited around wound site

• I’ve put this together from many years of experience with helping these surgical sites heal faster. If you have any questions contact us, and if you have an emergency where you think the wound is getting infected, please call immediately.