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INSTRUCTIONS FOR SEDATION AND ANESTHESIA

Many of the more complicated oral surgery procedures can now be performed in the office with the aid of I.V. sedation. Commonly referred to as “twilight sleep”, sedation differs from general anesthesia in that you will always be responsive to your environment, even though the chances are you won’t remember much about the procedure.  A local anesthetic is administered to further increase the comfort and safety of the procedure.

For further safety we require:

  • That you have nothing to eat or drink for six hours before the procedure.  If your surgery is to be in the morning, eat or drink nothing upon arising.  If your surgery is planned for the afternoon, you may have clear liquids (soup broth, black coffee, water, apple juice, etc.) for breakfast, then nothing.  If you have had any drug reactions or sensitivities, you must tell your doctor about these, for they may influence the choice of medications.
  •  PLEASE REMOVE ANY FINGER NAIL POLISH OFF OF ONE OF YOUR INDEX FINGERS BEFORE YOUR SURGERY.
  •  A responsible adult must accompany you to the office, remain here while you are having surgery, and drive you home.
  •  Because you will have received sedation medications, your reflexes and level of consciousness will be depressed for several hours after the procedure.  You are not to drive, operate machinery, or be walking by yourself for the remainder of the day.

By following this protocol,  you can confidently approach your surgery knowing that it will be a safe and comfortable procedure.

ORAL SURGERY POST-OPERATIVE INSTRUCTIONS

Sometimes the after-effects of oral surgery are quite minimal, so not all of these instructions may apply.  Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office any time for clarification.

  • FIRST HOUR:  Bite down gently, but firmly on the gauze packs that have been placed over the surgical area, making sure they remain in place.  Do not change them for the first 30 minutes unless the bleeding is not being controlled.  If active bleeding persists after one hour, place enough new gauze to obtain pressure over the surgical site for another 30-60 minutes.  The gauze may be changed as necessary and must be moistened before placing over the surgical area.
  • EXERCISE CARE:  Do not disturb the surgical area today.  DO NOT rinse vigorously or probe the area with any objects or fingers.  You may brush your teeth gently.  DO NOT SMOKE for at least 72 hours, since it is very detrimental to healing.
  • OOZING:  Intermittent bleeding or oozing is normal.  It may be controlled by placing fresh moist gauze over the surgical area and biting down firmly for 30-60 minutes.
  • STEADY 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 fresh packs.  If bleeding persists or becomes heavy you may substitute a tea bag (soaked in hot water, squeezed, damp-dry and wrapped in a most 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 (you may purchase from our office pre-surgery- has cold gel packs and warm gel packs) or ice bag wrapped in a towel applied firmly to the face and cheek adjacent to the surgical area.  This should be applied 20minutes on and 20 minutes off during the first 24 hours after surgery.  After 24 hours, it is usually best to switch from ice to moist heat.
  • 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 medicines vary widely among individuals.    Remember the most severe discomfort is usually within the first 6 hours after the anesthetic wears off. After that your need for medicine should lessen.
  • NAUSEA:  Nausea is not an uncommon event after surgery and it is sometimes 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 minimize the pain medication, but call us if you do not feel better or if repeated vomiting is a problem.  Cola drinks that have less carbonation may help with nausea.
  • 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 intake 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 diabetic, maintain your normal eating habits as much as possible and follow instructions from us or your physician regarding insulin schedule.
  • SHARP EDGES:  If you feel sharp edges in the surgical area with your tongue it is probably the bony walls which originally supported the teeth.  Occasionally small slivers of bone may work themselves out during the first week or two after surgery.  They are not pieces of tooth and, if necessary we will remove them.  Please call our office if you are concerned.
  • MOUTH RINSES:  Keeping your mouth clean after surgery is essential.  Use one-quarter teaspoon of salt dissolved in an eight ounce glass of warm water and gently rinse with portions of solution, taking five minutes to use the entire glassful (Do not “swish” hard – just let it gently roll around in your mouth so you do not disturb the clots in the extraction sites).  Repeat as often as you like, but at least two or three times daily for the next five days.  If you have had dentures placed, remove them twice daily and rinse them with warm saline.
  • BRUSHING:  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.
  • HOT APPLICATIONS:      Apply warm compresses to the skin overlying areas of swelling (gel packs – hot or cold –  purchased from our office, hot water bottle, moist hot towels, heating pad) for 20 minutes on and 20 minutes off to help soothe those tender areas. This will also help decrease swelling and stiffness.
  • DRY SOCKETS:  Normal healing after tooth extraction should be as follows:  The first day of surgery is usually the most uncomfortable and there is some degree of swelling and stiffness. From the third day on GRADUAL, STEADY IMPROVEMENT should mark the remainder of your post-operative course.  If a DRY SOCKET occurs (loss of blood clot from socket, usually on the 3rd to 5th day), there is noticeable, distinct, persistent throbbing pain in the jaw, often radiating toward the ear and forward along the jaw to cause other teeth to ache.  If you do not see steady improvement during the first few days after surgery, don’t suffer needlessly.  Call the office and report symptoms so you can be seen as soon as possible.

It is our desire that your recovery be as smooth and pleasant as possible.  Following these instructions will assist you, but if you have any questions about your progress, please call the office where you had your surgery.  Please try to call during the office hours, however a 24-hour answering service is available for after-hours contact with a doctor.  Calling during office hours will afford a faster response.

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