Oral Surgery Surgical Instructions Lehi, Utah

Surgical Instructions

Before Intravenous Anesthesia Sedation

You may not have anything to eat or drink (including water) for eight (8) 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 low-heeled shoes.
Contact lenses, jewelry, and dentures must be removed prior to the appointment for 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. Viehweg prior to your surgical date for instructions.

After Wisdom Tooth Removal

The removal of impacted teeth is a serious 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 place for one hour. After this time, the gauze pad should be removed and discarded.
Should an additional gauze pad be needed, it should be moistened lightly with clean water and placed for an additional hour. Do not remove the gauze pad, look at it and replace it. It should remain undisturbed for one hour to accomplish the purpose of placing the pad.
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 effects of 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 an explanation.

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four to six hours or ibuprofen (Motrin or Advil) two to four 200 mg tablets may be taken every four to six hours.

For severe pain, take the tablets prescribed by Dr. Viehweg, 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. You should not be responsible for the well being of small children while taking the prescribed pain medication. 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.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. A large amount of saliva with a small amount of blood can appear to be a large amount of blood. Excessive bleeding which results in your mouth filling rapidly with blood can frequently be controlled by biting with pressure on a moistened gauze pad placed directly on the bleeding wound for 60 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 60 minutes. The tannic acid in the tea bag helps to control bleeding by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call the office 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. Dr. Viehweg utilizes techniques and medications that have been demonstrated to reduce the amount of swelling generally encounter. This does not however, eliminate the possibility of swelling. The swelling will not become apparent until the day following surgery and will not reach its maximum until two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice, or ice packs should be applied to the areas of the face and jaws where surgery was performed. The ice packs should be left on for no longer than twenty minutes at a time, with a twenty minute break between applications. After twenty-four hours, ice has no beneficial effect, and can actually increase the incidence of swelling. 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 affected areas of the face and jaws is beneficial in reducing the swelling.

Bruising

In some cases, bruising of the skin can accompany swelling. The development of black, blue, green, or yellow discoloration is due to bruising of the tissues. This is a normal postoperative occurrence, which may appear as late as two to three days post-operatively. Moist heat applied to the area may help clear the discoloration.

Nausea & 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 cold ginger ale, Sprite, or 7-up. You should sip slowly over a 15-minute period. A cool, moist compress to the forehead may be applied. When the nausea subsides, you can begin increasing the intake of clear liquids and resume taking the prescribed medicine. If nausea and/or vomiting persists, call the office for further instructions.

Other 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 the sensation. So be careful. Try not to eat or chew until you have full sensation in your tongue and lips. Call Dr Viehweg if you have any questions.
A slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
You should be careful going from the lying down or seated position to standing. You were not able to eat or drink prior to surgery, this can make you weak and dizzy. Taking pain medications can also make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit upright for one minute and then stand slowly with assistance.
Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls, which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Viehweg.
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.
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 two to three days. Drinking a lot of ice cold water can hasten the recovery of a sore throat.
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 that will resolve in time. Ice packs for twenty-four hours and warm compresses after twenty-four hours can help alleviate the presence of stiff muscles.

Diet

Drink liquids after general anesthesia or IV sedation. Avoid extremes in temperature (cold and hot). Do not use straws when drinking 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 site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. 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 five to six 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. Many smaller meals may be substituted for the traditional three meals. Avoid sharp foods such as popcorn, tortilla or potato chips, etc.

CAUTION: If you suddenly sit up or stand from a lying or reclined position, you may become dizzy. If you are lying down following surgery, make sure you sit up straight for one minute before standing. Stand up with assistance to prevent falling.

Keep The Mouth Clean

No rinsing of any kind should be performed until twenty-four hours following surgery. You can brush your teeth the night of surgery but rinse gently. Twenty-four hours after surgery you should begin rinsing gently after each meal with a teaspoon of salt dissolved in a cup of warm water (8 ounces).

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Be certain to complete the entire course of the antibiotic prescription unless specifically instructed otherwise by Dr. Viehweg. Where it is supported by clinical scientific evidence, antibiotics may be given to help prevent infection. This may be pre-operatively or post-operatively. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

Finally

Sutures are often placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. Most sutures are designed to fall out after a week or so, eliminating the need for an additional visit to the doctor for suture removal. If sutures do need to be removed, the doctor with notify you of this and an appointment will be made for the appropriate time to remove the sutures. The sutures that do need to be removed 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 little or no discomfort associated with this procedure.

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 the office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean with salt-water rinses or a toothbrush, especially after meals.

Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Viehweg and his staff.

Brushing your teeth is okay – just be gentle at the surgical sites.

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 two to three days following surgery. Call the office if this occurs.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

After Exposure Of An Impacted Tooth (for Orthdontics)

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.

Pain

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one or two Tylenol or Extra Strength Tylenol may be taken. Tylenol may be taken every four to six hours. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: Two to three tablets may be taken every four to six hours as needed for pain. For severe pain, the medication prescribed by Dr. Viehweg should be taken as directed.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon, and is normal for 24 hours following surgery. A large amount of saliva with a small amount of blood can appear to be a large amount of blood. Excessive bleeding may be controlled by placing a moistened gauze pad over the area, and biting firmly for 60 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 60 minutes. The tannic acid in the tea bag helps to control bleeding by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call the office for further instructions. If bleeding continues, please call the office 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. The ice packs should be left on for no longer than twenty minutes at a time, with a twenty minute break between applications. After twenty-four hours, ice has no beneficial effect, and can actually increase the incidence of swelling. Twenty-four hours following surgery, the application of moist heat to the affected areas of the face and jaws is beneficial in reducing the swelling.

Diet

Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

Oral Hygiene

Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning starting twenty-four hours after surgery. Brush your teeth as best you can. Rinse with warm salt water (one teaspoon of salt in a cup (8 ounces) of warm water) after each meal. 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 immediately. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

After Tooth Extraction

After tooth extraction, it is important for a blood clot to form within the tooth socket to stop the bleeding and begin the healing process. That is why we ask you to bite on a moist gauze pad for 60 minutes after the appointment. If the bleeding or oozing still persists, insert another moistened gauze pad and bite firmly for another 60 minutes. You may have to do this several times.

After the blood clot forms, it is important not to disturb or dislodge the clot, as it aids healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.

After the tooth is extracted you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the face in the area of surgery will help keep swelling to a minimum. Take pain medications as prescribed. The swelling usually begins to subside after 48 hours.

Use the prescribed pain medication as directed. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, take the entire course of treatment as directed, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.

It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least twice a day. This will speed healing and help keep your mouth fresh and clean.

After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for two to three days, or a reaction to the medication, call the office immediately at (801) 766-4834.

After Removal Of Multiple Teeth

A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 60 minutes. If bleeding continues, a moist tea bag can be used for 60 minutes. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.

Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 24 hours only. Apply ice for twenty minutes at a time with a twenty minute break between applications. After 24 hours, moist heat can be applied for comport.

For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every four to six hours. Ibuprofen (Advil, Motrin) 200mg can be taken two to three tablets every four to six hours.

For severe pain, use the prescription given to you. If the pain does not begin to subside in two days, or increases after two days, please call the office. If an antibiotic has been prescribed, finish your prescription as directed, regardless of your symptoms.

Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day. Avoid extremely hot or extremely cold fluids.

Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt-water rinse following each meal to flush out particles of food and debris that may lodge in the operated area. (One teaspoon of salt dissolved in an 8 ounce glass of lukewarm water.) After you have seen your dentist for denture adjustment, take out denture and rinse three to four times a day.

Restrict your diet to liquids and soft foods that are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.

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, the following conditions may occur (all of which are considered normal):

The operated area will swell, reaching a maximum in two days. Swelling and bruising around the eyes may occur. The application of a moist warm towel will help to resolve the bruising and swelling. The towel should be for twenty minute intervals with a twenty minute break between applications beginning 24 hours after surgery (remember ice packs are used for the first 24 hours only).
A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling of the throat muscles can cause pain. This is normal and should subside in two to three days. Drinking plenty of ice cold water can help resolve the soreness associated with swallowing.
If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline.
There may be a slight elevation of temperature for 24-48 hours. This can be treated safely with Tylenol or ibuprofen. If an elevated temperature persists, notify the office.

If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.

After Placement Of Dental Implants

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There maybe a metal healing abutment protruding through the gingival (gum) tissue. Avoid unnecessary contact with the metal abutment.

Pain

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one to two Tylenol or Extra Strength Tylenol may be taken every four to six hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets. Two to three tablets may be taken every four to six 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.

Bleeding

Swelling

Diet

Drink plenty of fluids. Avoid extremely hot or cold liquids or food. Soft food not requiring chewing, and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

Antibiotics

Be sure to take any 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 chlorhexidine oral rinse before bed. The day after surgery, the chorhexidine rinse should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 60 seconds before spitting it out. Warm salt-water rinses (one teaspoon of salt in an 8 ounce cup of warm water) should be used as well, especially after meals. Brushing your teeth with the healing abutments is not a problem. Be gentle when 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 immediately. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.

Wearing Your Prosthesis

Partial dentures, temporary dentures or “flippers”, or full dentures should generally not be used immediately after surgery, and for at least ten days. This was discussed in the preoperative consultation.

After Socket Bone Grafting

The following information applies when grafting material has been placed into extraction sites to help preserve your jawbone in preparation for possible implant replacement of the extracted tooth.

Your bone graft is made up of many particles. You may find some small granules in your mouth for the first several days. Do not be alarmed by these. It is normal to have some of them come out of the graft site and into your mouth. There are some things you can do to minimize the amount of particles that become dislodged:

Do not disturb or touch the wound.
Avoid rinsing or spitting for 2 days to allow proper blood clot and graft material stabilization.
Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.
Do not lift or pull on the lip to look at the sutures. This can actually cause damage to the wound site and tear the sutures.
Do not smoke.

Following the second day, gentle, but not vigorous rinsing can be initiated. Vigorous rinsing should be avoided, as you can again disturb some of the bone graft granules. If a partial denture or a temporary “flipper” was placed in your mouth, you may have to see your restorative dentist to have it adjusted and learn how to remove and replace it appropriately.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office. Please try to call during office hours; however a 24-hour answering service is available for after hours contact with a doctor. The after-hours telephone number is (801) 766-4834

After Sinus Lift

The following information applies when upper jaw bone height or width have been lost. The graft is placed to help restore your jawbone in preparation for possible implant replacement of the missing tooth or teeth.

You have had a sinus lift/bony augmentation procedure in your upper jaw. This procedure regains lost bone height in the area of your first and second molar and occasionally second premolar. It is an important procedure as it allows implant placement in an area that could not be implanted otherwise because of insufficient bone height due to an enlarged sinus.

The bone that has been grafted is most commonly your own bone, a freeze-dried donor bone, artificial synthetic bone, or a combination of two or more. Because of this you may have two post-surgical wounds: the donor site and the recipient site.

Increasing pressure in the sinuses can jeopardize the integrity of the sinus and bone graft, and can result in the loss the graft. Therefore:

DO NOT UNDER ANY CIRCUMSTANCES. BLOW YOUR NOSE FOR THE NEXT FOUR (6) WEEKS. This may be longer if indicated. You may sniff and wipe all you like, but NO BLOWING.

Do not blow your nose or sneeze holding your nose. Do not try to stifle sneezes. Sneeze with your mouth open. Do not drink with straws and do not spit. Scuba diving and flying in pressurized aircraft may also increase sinus pressure and should be avoided. Decongestants such as may be prescribed to help reduce pressure in the sinuses. You may also be given a prescription for antibiotics. Please take these as directed. Anything that causes pressure in your nasal cavity must be avoided. Avoid “bearing down”—as when lifting heavy objects, blowing up balloons, playing musical instruments that require a blowing action or any other activity that increases nasal or oral pressure. Smoking must be stopped. If necessary Dr Viehweg can prescribe nicotine patches.

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

Oral Hygiene

Do not rinse or spit on the day of your surgery. This tends to disturb the blood clot, open the wound and can prolong bleeding and slow healing. You should not have a significant amount of blood in your mouth. Saliva can be swallowed, even if slightly blood tinged.

Keeping your mouth clean after surgery is essential to reduce the risk of infection. Start salt water rinses the day following your procedure. Use one teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking three minutes to use the entire glassful. Repeat at least three times daily and always after eating for the next five days.

Do not brush the teeth in the area of surgery for 48 hours. When brushing, be very gentle. When expectorating, also be gentle.

Dr. Viehweg may prescribe an antibiotic rinse chlorhexidine for certain procedures. This rinse should be used in the morning and at bedtime after routine brushing and flossing. Do not eat or drink, or rinse your mouth after using the medicated rinse. Using this rinse more than two times a day can cause staining of your teeth.

Do not smoke for at least two weeks prior to surgery and for at least two weeks after surgery, if at all. As discussed at your consultation, smoking dramatically increases the risk of bone graft and sinus augmentation failure. Dr. Viehweg can prescribe a nicotine patch if you feel you need it.

Wearing your Prosthesis or Nightguards

Partial dentures, flippers, or full dentures should not be used immediately after surgery until after your first post-operative appointment, unless specifically instructed otherwise. Please contact the office if there are any questions. If you have a temporary “flipper” to wear, do not place it until the numbness in the area is gone. When it is placed, it should not touch the gums in the area of the surgery. If it does, this can cause ulceration of the wound edges and breakdown of the suture margins. This can lead to loss of the bone graft. If you have questions about the fit of your flipper, partial or complete denture, do not wear it until Dr. Viehweg or your general dentist can see you.

Post-Operative Problems or Complications

As with any procedure, unexpected post-operative problems or complications can occur. If you notice the unexpected flow of air or liquids between your mouth and nose, please let us know immediately.

If you are aware of several small particles of graft material being discharged from your nose, let us know as well.

If you experience sinus or nasal congestion on the side your surgery was performed, let us know.

If there is an increase in swelling in your mouth, your cheek, or under your eye after 3 days, let us know.

It is our desire that your surgery and recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office. Please try to call during office hours; however a 24-hour answering service is available for after hours contact with a doctor. The after hours telephone number is (801) 766-4834.