Surgical Instructions

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· NO SMOKING!   Smoking increases the chance of infection and lowers the body’s ability to heal.

· If your procedure involved sinus surgery, avoid hard sneezing or blowing your nose if possible.

· You may begin taking the pain medication prescribed by Dr. Nazari 1-2 hours following your surgery, after you have had a small amount to eat and prior to the “numbness” of the local anesthetic wearing off.

· Restrict your activities the day of surgery and resume normal activity when you feel comfortable.

· DO NOT wear your partial or complete denture prosthesis until instructed to do so by Dr. Nazari.  You may be asked to refrain from wearing it for the first 2-3 weeks following surgery.

BLEEDING:  Some bleeding or redness in the saliva is normal for 24 hours.  Active bleeding is very uncommon and can usually be controlled by biting on a gauze pad placed directly on the bleeding site for 20-30 minutes.  If you had sinus surgery or grafting, a small amount of intermittent bleeding may occur from the nose for 7-10 days following surgery.  This is normal and will diminish with time.  If heavy or persistent bleeding occurs, please 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 side 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.  Swelling may be minimized by the use of ice packs.  Two baggies filled with ice, a bag of frozen corn or peas, or commercially available 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 24-36 hours, ice has no beneficial effect.  Thirty-six hours following surgery the application of heat to the sides of the face is beneficial in reducing jaw stiffness and residual swelling.  After reaching a peak 2-3 days after surgery, facial swelling should begin to decrease.

PAIN:  For the first 24 hours following surgery, take your prescription pain medication as prescribed.  You may begin taking your prescription pain medication 1-2 hours following your surgery, after you have had something to eat.  Your pain medication will be more effective if it is taken before the local anesthetic “numbness” wears off.  If additional pain relief is needed, you may supplement your prescription by taking 400-600mg of Ibuprofen (Motrin or Advil)  every 4-6 hours.  The additive effect will work best if you stagger your prescription medication with the ibuprofen, such that you are taking one or the other (not both) every 2 hours.  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.

*DO NOT take ibuprofen or similar compounds if allergic to aspirin.

DIET:  Do not use straws.  Drink from a glass.  The sucking motion can cause more bleeding by dislodging the blood clot.  Start with liquids, such as, milk, shakes, instant breakfast, fruit juices, and Ensure.  High calorie, high protein intake is very important.  Your food intake will be limited for the first few days, however, you may eat whatever you can comfortably tolerate.  You should compensate for this and prevent dehydration by increasing your fluid intake.  At least 4-5 glasses of liquid should be taken daily.  You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.

ORAL HYGIENE:  Good oral hygiene is essential to good healing.  The night of surgery, use the prescribed Peridex (Chlorhexidine 0.12%) rinse before bedtime.  Starting the day after surgery, rinse with the Peridex twice daily, after breakfast and before bedtime, for 14 days.  In conjunction, rinse with warm salt water 4-5 times daily, especially after meals.  Gentle brushing of your teeth and the healing abutment is important.  When brushing upper surgical sites use gentle downward strokes.  When brushing lower surgical sites use gentle upward strokes.  This may cause minor bleeding which is normal.

SUTURES:  Absorbable sutures are 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.  In non-absorbable sutures were used they will be removed approximately one week after surgery.  The removal of sutures takes only a minute or so, and there is no discomfort associated with this procedure.

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, cause increased fatigue, and further limit your ability to exercise.

BRUISING & DISCOLORATION:  Significant black, blue, yellow, and/or greenish bruising frequently occurs following bone grafting procedures and sometimes occurs following implant placement.  Unfortunately, this is normal as blood pigments seep through the facial tissues.  It is not painful and will resolve in 7-10 days.  You may accelerate the resolution of bruising by applying heat to the affected areas using a heating pad on a low setting.

ANTIBIOTICS:  If you have been placed on antibiotics take the tablets or liquid as directed.  Antibiotics are sometimes given to help prevent infection.  Discontinue antibiotic use in the event of a rash or other unfavorable reaction.  Call the office if you have any questions.

NAUSEA & VOMITING:  Although uncommon, nausea is an occasional side effect of prescription medication or intravenous anesthetics.  Nausea may also be caused by swallowing a small amount of blood.  Although unpleasant, it is usually transient and is not harmful.  In the event of nausea and/or vomiting, stop taking all medication, lay down, apply a cool compress to your head, and remain inactive.  Wait at least one hour before you resume eating.  Begin with clear liquids (broth, 7-Up, Sprite, apple juice) and dry carbohydrates (toast, crackers).  Avoid caffeine and dairy products until the nausea subsides.  If nausea persists, please call for assistance.  It may be necessary to change your prescription medication and/or prescribe an anti-nausea medication.

JAW STIFFNESS:  Stiffness (Trimus) 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.  Taking 400-600mg of Ibuprofen every 4 hours and applying heat to the jaw muscles using an electric heating pad on low setting will help to resolve jaw stiffness.

*DO NOT take ibuprofen or similar compounds if allergic to aspirin.

WEARING YOUR PROSTHESIS:  Partial dentures, flipper, or full dentures should not be used immediately after surgery and for at least 10 days.  This was discussed in the pre-operative consultation.

Special Concerns & Considerations:  

· Move slowly when going from a reclining position to sitting or standing.  Reduced nutritional intake, prescription pain medication and intravenous anesthetics can cause dizziness, lightheadedness, and loss of balance.  After laying down always sit for one minute before standing up.  If upon standing you begin to feel lightheaded or dizzy, lay back down, wait 5 minutes, then try again.

· After bone grafting, it is normal to occasionally detect small amounts of a gritty substance in the saliva.  This is a harmless supplemental graft material with the consistency of fine sand or sugar granules.

· 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 is normal and is usually due to slight dehydration.  Increasing your fluid intake should resolve this problem.  If an elevated temperature persists more than 24-48 hours, please notify the office.


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