Surgery Information
Anesthesia Choices
Anesthesia makes surgery beareable, for both doctor and patient. There are several types of anesthesia available. Which one is chosen depends largely upon the nature of the surgery being performed, and how nervous the patient is beforehand.
Patient Instructions
Below is some basic information on everything from wisdom tooth removal to sedation. We have attempted to address all the key points about our most common procedures we perform at our clinics. If you have any questions, we didn't cover, or you think you may be experiencing a dental emergency, please don't hesitate to call anytime!
Anesthesia and implants
Pre-Intravenous Anesthesia Sedation guidelines
Before your surgery
Please review the information below carefully
in the days leading up to your surgery:
- Nothing to eat or drink (including water) for eight hours prior to your appointment. Prescription medication may be taken with a small sip of water.
- Do not smoke for at least 12 hours prior to surgery. Better yet, cut down or quit smoking altogether well before your surgery takes place.
- All patients, regardless of age, must be accompanied by a responsible adult. They must escort the patient to the office, remain in the office while the procedure takes place, and escort the patient home.
- You should not drive a vehicle or operate any machinery for at 24 hours following anesthesia.
- Wear comfortable footwear and loose fitting clothing, preferably with a short-sleeved shirt, or sleeves that rolled up past the elbow.
- Remove your contact lenses, jewelry, and dentures before going into surgery.
- No lipstick, excessive makeup, or nail polish should be worn the day of surgery.
- If you are sick with a cold, sore throat, or upset stomach, please notify the office.
After Placement Of Dental Implants
Post-Operative Instructions
The wound must not be disturbed! Refrain from rinsing, spitting, or touching the wound immediately following the surgery. A metal healing cap will protrude through the gum tissue. Avoid running your tongue over it.
Bleeding
You will experience some bleeding or redness in the saliva for approximately 24 hours post-op. It's completely normal. If you experience excessive bleeding (where a lot of blood fills your mouth in a short time), place a gauze pad directly on the bleeding wound, then bite down on it (not too hard) for about 30 minutes. This should control the bleeding. If the bleeding continues, and is profuse, please call the office at 817-741-2200 immediately for further instructions.
Swelling
Your mouth and jaw will be swollen for a day or two, maybe more, after your procedure. This is also a normal occurrence. To minimize discomfort, keep an ice bag, plastic bag, or a towel filled with ice on the swollen area. Apply ice as frequently and continuously as possible for the first 24 hours after your surgery.
Diet
Stay hydrated. Drink plenty of fluids, and stick to soft foods and warm liquids in the days immediately following the surgery. Continue the soft food regimen (food that can easily be cut with the side of a fork) for 2 full weeks. After that, you can go back to your normal diet, but keep hard or crunchy foods like nuts, raw vegetables, crackers, chips, carrots, etc. away from the area of the dental implant.
Pain
As soon as feel your local anesthetic wearing off, you should start taking pain medication. 2-3 tablets of 200mg Ibuprofen (Advil or Motrin) may be taken every 4 hours as needed. If you are in severe pain, then take your prescription medication as directed. Naturally, you should not take any of the above medication if you have allergies, or your doctor has instructed you not to take them.
Antibiotics
Keep your surgical wound from getting infected by take the prescribed antibiotics as directed.
Oral Hygiene
Ensure your wound heals properly by practicing good oral hygiene. Use the prescribed Peridex Oral Rinse before bed the night of your surgery. Use the Peridex again twice daily, after breakfast and before bed, the day after your procedure. Keep it in your mouth for at least 30 seconds before spitting it out. Later in your recovery, warm salt water rinses (one teaspoon of salt in a cup of warm water) can be used 2–3 times a day, particularly after eating. Brush your teeth and the healing caps, but remember to be very gentle around the surgical areas.
Activity
Physical activity should be kept to a minimum immediately following surgery. Exercise may cause throbbing or bleeding. If so, discontinue your exercise routine for a few days before trying again.
Dentures and other prosthetics
Go ahead and use flippers, partial dentures, or full dentures immediately after surgery.
Before Intravenous Anesthesia Sedation
After Wisdom Tooth Removal
After-surgery care
If you've had an impacted wisdom tooth or teeth removed, you've had a surgical procedure. Self-care during this period is very important. Unnecessary pain, and complications such as infection and swelling, can result if these instructions are not followed to the letter.
Right After Surgery
- A gauze pad has been placed over the surgical area. Please keep it in place for an hour. Afterward, you can remove and discard the pad.
- Avoid vigorous mouth rinsing and/or touching the wound area immediately following surgery. This can dislodge the blood clot that has formed over the area, and cause severe bleeding.
- As the local anesthetic wears off, you will feel pain. Take your prescribed pain medications at the first sign of discomfort starts.
- Rest. Keep your activities low-key the day of surgery, and gradually increase them when you feel comfortable.
- Put ice packs on the side(s) of your face where the surgery occurred for at least one day after surgery.
Bleeding
Bleeding is a normal occurrence following surgery. Slight bleeding, oozing, or redness in the saliva is not cause for alarm. If you experience excessive bleeding, first rinse or wipe away any old clots from your mouth. Place a gauze pad over the area and bite firmly on it for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened black tea bag for thirty minutes. The tannic acid in the black tea aids clot formation by causing bleeding vessels to contract. Also, be sure to sit upright and take it easy. If bleeding won't stop, call us right away at 817-741-2200 for further instructions.
Swelling
Swelling around the mouth, cheeks, and sides of the face is not uncommon after this kind of procedure. That is a natural and normal reaction to surgery. How much swelling you get usually corresponds to the length and complexity of the surgery performed. The swelling does not typically manifest until the day after the surgery and usually peaks out 2–3 days post-operatively. To minimize swelling, use ice packs. Two baggies filled with ice, or towels filled with ice, should be applied to the areas of the face where swelling occurs. If possible, leave them on continuously while you are awake for the first 36 hours. If swelling or jaw stiffness persists after this period, you're still OK. Again, this is perfectly normal. 36 hours after surgery, applying moist heat to the sides of the face can be help bring the swelling down.
Pain
Moderate: take over-the-counter Ibuprofen (Motrin or Advil) in 200 mg tablets; take 2-3 tablets every 4 hours
Severe: take your prescription medication as directed. This medicine is much stronger than aspirin or ibuprofen, so expect it to make you sleepy and for it to slow down your reflexes. Do not drive a car, work around machinery, or drink alcohol.
If necessary, you may also take both Ibuprofen and the prescribed meds, either at the same time or alternating between the two.
Your post-operative pain and discomfort should improve daily. If pain does not subside, you should call our office at 817-741-2200.
Diet
Immediately after your surgery, only liquids should be consumed. Drink directly from a glass. Do not suck liquid through a straw. This can cause more bleeding by dislodging the blood clot. Soft foods may be introduced the day after the surgery. Eggs, potatoes, and pasta are excellent examples of soft foods.
Nourishment should be taken regularly. This is no time to go on a diet. A high calorie, high protein intake is optimal. Drink plenty of fluids to prevent dehydration, and to compensate for a decreased food intake. Try to drink at least 5 glasses of liquid every day. Do not skip meals if you can help it. By continuing to eat, you will feel better, have more strength, less discomfort and heal faster.
CAUTION: Avoid suddenly sitting up or standing up from a lying down position. You may become dizzy. When you are resting following surgery, be sure you sit up for one minute before standing.
Keep the mouth clean
Immediately following the surgery, do not rinse your mouth - at all. The day afterward, then you can start rinsing at least 3-4 times daily, particularly after meals. Mix one teaspoon of salt mixed into one cup of warm water.
Discoloration
In some cases, swelling may be accompanied by bruising 2-3 days after the procedure. This is a normal, healthy post-operative occurrence resulting from blood spreading beneath the tissues. Applying moist heat to the affected area has been shown to accelerate the removal of the discoloration.
Antibiotics
After most procedures, antibiotics are usually prescribed to help prevent infection. Take all tablets or liquid as directed. If you develop a rash or other allergic reaction, stop using the antibiotics and call the office immediately at 817-741-2200 if you have any questions.
Nausea and Vomiting
If you experience nausea and/or vomiting after your surgery, do not eat or drink anything for at least an hour. Sip on a soft drink, tea, or ginger ale, slowly over a fifteen-minute period. Medication for nausea and vomiting may be prescribed for you to use if you need it. When the nausea abates, you can resume eating solid foods and take any other prescribed medicines.
Other Complications
- Temporary numbness of the lip, chin, or tongue is a common occurrence after this type of surgery. Exercise caution, as since your lip or tongue is numb, you could accidentally bite it and not feel it. Call Dr. Parmer or Dr. Macholl at 817-741-2200 if this sensation persists beyond specified timeframe.
- Running a slight fever in the hours after surgery is common. If your temperature persists, or is excessively high, notify the office. Tylenol or ibuprofen may be taken to reduce the fever.
- Take care when transitioning from the lying down position to standing. Light-headedness may occur from low blood sugar or as a side effect of your medications. Sit for one full minute and get your bearings before standing up.
- Sometimes, patients report feeling hard projections in their mouths when they run their tongue over the area where the tooth was extracted. These projections aren't roots; what they are are the bony walls which once supported the tooth, and they will smooth out over time. If not, they can be removed by Dr. Parmer or Dr. Macholl.
- If the corners of your mouth were stretched during your proecedure, you may experience chapping or cracking. Keep your lips smooth and moist with a gentle ointment such as Vaseline.
- You may have a sore throat after your surgery, which can make the normal act of swallowing quite painful. This should go away on its own in 2-3 days.
- It is normal for your jaw to be stiff a week or so following surgery. This may make it difficult to open your mouth for a time, but be assured, it will resolve itself.
Final after care notes
The area of your surgical incision will be stitched, or sutured, together in order to minimize post-operative bleeding and facilitate healing. Alliance Oral & Maxillofacial Surgery uses self-dissolving stitches, which dissipate in approximately one week. If they happen to pop or get dislodged before that, it's no cause for alarm, as long as your wound doesn't bleed excessively.
Pain and swelling are par for the course. The good news is they should subside more and more with each passing day after surgery. If they don't, or they happen to get worse, call our office at (817) 741-2200 for instructions.
Yes, there will be a hole where the tooth was removed. Over the next few weeks, new tissue will regrow where that void used to be. Regardless, keep the area clean, especially after eating, with salt water rinses.
Yes, you can brush your teeth - just take care around the surgical sites.
Extreme pain at the surgical site that radiates up to the ear is a sign of a dry socket. This occurs when you lose the blood clot from the tooth socket, and typically takes place 2–3 days following surgery. If you suspect a dry socket, call the office right away.
Regular exercise is great, just not right now. Because your your normal nourishment intake is reduced, exercise may do more harm than good at this time. If you must exercise, take it easy. If you get light headed, quit exercising.
Every case is unique, and no two mouths in the world are alike. Trained experts like Dr. Parmer or Dr. Macholl are best able to help you address your oral health or hygiene concerns. Please call us at (817) 741-2200 if you have any questions.
Regular tooth extractions
After Tooth Extraction
Post-op self care (at home)
When you get a tooth pulled, the next thing that needs to happen is for a blood clot to form. This stops the bleeding and allows the healing process to begin. After your extraction, bite down firmly on a gauze pad for 30-45 minutes. If the area still bleeds or oozes, grab a clean gauze pad and bite on it for another 30 minutes. It may take several tries with this to stop the bleeding entirely.
Once the blood clot forms, it is crucial that it not be disturbed or dislodged. That means no mouth rinsing, no drinking liquids through straws, no smoking, no alcohol, and no teeth brushing near the extraction site for 48 hours. Any and all of these activities may result in the clot getting dislodged or dissolved, which will further delay the healing process. Also, refrain from vigorous exercise for at least 24 hours, as this increases blood pressure and could also cause more bleeding.
Pain and swelling are normal occurrences following the extraction of a tooth. To keep this to a minimum, put an ice pack on the affected area. Don't have one? An unopened bag of frozen peas or corn can fill in quite effectively. Take your pain medication as prescribed, follow your oral surgeon's orders, and your pain and swelling should subside after a few days.
Prescription pain medication should only be used as needed, and if used at all, it must be taken as directed. If the medication doesn't feel like it's working, call our office at 817-741-2200 right away. Any antibiotics prescribed should be taken until all the pills are gone, even you have no signs or symptoms of infection. Ample fluids and soft, nutritious food should be consumed on the day of the Drink lots of fluids and eat nutritious, soft food on the day of the extraction. Then, start eating normally again as soon as you are comfortable doing so.
After the initial 24 hour post-op period, you should resume your normal oral hygiene practices. Brush and floss your teeth at least once a day to facilitate healing, and keep your mouth fresh and clean.
You should feel fine after a few days and ready to get back to your normal work, school or exercise routine. Heavy bleeding, severe pain, continued swelling, or a reaction to the medication, should be followed by an immediate call to our office at 817-741-2200.
Multiple Tooth Extractions
Bleeding
Following multiple tooth extraction, you will experience a small amount of bleeding. Deal with this by placing a gauze pad right on the bleeding socket and bite down on it for 30 minutes. If bleeding keeps up, moisten a black tea bag, and bite down on it for thirty minutes. Black tea contains tannic acid, which facilitates clotting by contracting blood vessels. If you do all this and you're still bleeding, elevate your head and avoid hot liquids and exercise. If that doesn't work, call our office immediately at 817-741-2200. If you have dentures, do not remove them unless the bleeding is severe. Oozing around the side of the denture is normal.
On your first post-operative day, or while you still have some bleeding, do not rinse your mouth. On the second day, a warm salt water rinse every 4 hours and following meals is recommended for to flush out particles of food and debris that may settle in the divot where the tooth used to be. Mix ane teaspoon of salt in one cup of warm water. After your dentist has OK'd any denture adjustments, take your dentures out and rinse 3 to 4 times a day.
Additional self-care tips
- Ice packs will only be effective for the first 36 hours following surgery. Apply it continuously while awake.
- For pain - mild or moderate: take 2-3 200mg tablets of Ibuprofen (Advil or Motrin) every 4 hours.
- For pain - severe: take the pain medication prescribed to you. If the pain persists for more than a few days, please call Alliance Oral & Maxillofacial Surgery.
- Finish any antibiotic prescription you receive, unless you have an allergic reaction.
- Drink at least 6 glasses of liquid the first day after your surgery. Keep up fluid intake in the days ahead. This will help replace blood lost, especially during multiple tooth extraction.
- Adjust your diet: liquids and soft foods that are comfortable for you to eat are the key. As the wounds heal, you will be gradually be able to integrate your favorite foods back into your diet.
Extracting many teeth in one procedure is very different from getting one or two teeth pulled. The reshaping and recontouring of the bone prior to insertion of a denture can cause one of more of the following conditions, all of which are within normal post-operative expectations:
- Swelling of the area operated on, as well as swelling and discoloration around the eyes. Apply a warm, moist towel to alleviate discomfort and accelerate normalization of the discolored area. Keep the towel on the area continuously for as long as you can tolerate it, beginning 36 hours after surgery (reminder: ice should be used in the first 36 hours only). Swelling should peak 2-3 days after surgery and begin subsiding afterwards.
- Drying and cracking of the corners of your mouth may occur, especially if your mouth had to be stretched during your procedure. A gentle ointment like Vaseline will keep your lips smooth and moist.
- A slight fever 24–48 hours following surgery is common. If your fever continues, or is abnormally high, call our office.
Sore spots may develop if dentures have been inserted immediately. Your general dentist should see you within 24–48 hours after surgery to make necessary adjustments and address those areas. Failure to see your dentist in a timely fashion may result in severe denture sores, which will delay the healing process.
After Exposure Of An Impacted Tooth
Instructions for after the procedure
Surgical packing may be placed inside the wound to keep the tooth exposed and promote healing. Leave this material alone, and do not disturb the wound. If the packing gets dislodged or falls out, don't panic, but do contact our office for instructions.
Bleeding
Bleeding or redness in the saliva will likely continue for about 24 hours. Profuse bleeding, where your mouth fills rapidly with blood, can be slowed by biting down firmly on a gauze pad placed directly over the bleeding wound for 30 minutes. Repeat this process as many times as you need to. If bleeding continues, please call our Keller, TX, Office Phone Number 817-741-2200 for further instructions.
Swelling
Swelling is commonplace after any type of surgery. To minimize it, apply an ice bag or a plastic bag filled with ice cubes to the cheek near the area that was operated on. Do this as often as you wish for the first 36 hours. If the extracted tooth was on the roof of the mouth, ice packs won't help.
Diet
Soft food and liquids are all that should be consumed on the day of surgery, and maybe even for a few days afterward. Return to your normal dietary routine as your comfort level dictates.
Pain
As soon as the local anesthetic begins to wear off, start taking your pain medication. Over the counter Ibuprofen in 200 mg tablets, with 2–3 tablets taken every 4 hours, usually suffice for mild to moderate pain relief. If your pain is more severe, take the prescribed medication, as per the directions on the label.
Oral Hygiene
Good oral hygiene is essential to proper healing. After each meal, clean your mouth thoroughly, starting the day after surgery. Rinse with warm salt water (1 teaspoon of salt in a cup of warm water) three or four times daily, and continue doing so your mouth is completely healed. Brush your teeth as you normally do, just tread lightly around the surgery site.
Activity
Physical activities should be kept to a minimum following surgery so your body can devote its resources to healing. Exercise can cause throbbing or bleeding, which will only delay recovery. If this occurs, stop exercising. Your normal nourishment intake is reduced already. This isn't the time to start a fitness regimen.
After Exposure Of An Impacted Tooth
Post-surgical instructions
The surgical wound must not be disturbed. If surgical packing was inserted in the wound, don't touch it. It is there to keep the tooth exposed and promote healing. If it does get dislodged or falls out, don't stress, but please contact our office for instructions.
Bleeding
Bleeding and/or redness in the saliva will occur for the first 24 hours. If you experience excessive bleeding, where blood rapidly fills your mouth, bite with pressure on a gauze pad placed directly on the bleeding wound for half an hour. You may need to repeat this procedure several times before the bleeding stops. If bleeding doesn't want to stop, please call our office in Keller, TX, at 817-741-2200 immediately.
Swelling
Swelling is a normal post-operative occurrence. Applying an ice bag, or a plastic bag filled with ice cubes, on your cheek near the surgical site can help keep swelling at bay. Apply the ice as often as you can tolerate it, but only for the first 36 hours. If the tooth you had extracted was on the roof of your mouth, ice packs won't help. Ask your oral surgeon for suggestions on how to deal with this particular situation.
Diet
Soft foods and liquids are all you should consume on the day of surgery. Pay particular attention to getting enough protein. Then, start returning to your normal diet as your discomfort subsides.
Pain
Start taking your pain meds as soon as you become aware of the local anesthetic wearing off. For moderate pain, over-the-counter Ibuprofen is available in 200 mg tablets. You can take 2–3 tablets every 4 hours for pain relief as you need it. For more intense pain, the prescription medication you received should be taken as directed by your surgeon or pharmacist.
Oral Hygiene
Practicing good oral hygiene can only help the healing process. Starting the day after surgery, clean your mouth. Gargle with warm salt water (1 teaspoon of salt in a cup of warm water) 3-4 times a day. Keep doing this until healing is complete. You can brush your teeth normally, just exercise care around the extraction site.
Activity
Immediately following surgery isn't the best time to exercise. Since your caloric intake is reduced, exercise could weaken you. It could also cause throbbing or bleeding, which will only cause delays to the healing process. If this occurs, then stop exercising. Rest is what this doctor ordered!