Surgical Instructions Section

The following pre-operative instructions were designed to answer many of your questions and simplify your surgical appointment.
• IF YOU ARE HAVING INTRAVENOUS SEDATION ANESTHESIA, you should have NOTHING TO EAT OR DRINK FOR SIX HOURS PRIOR to your scheduled appointment and a responsible adult, who can drive, must accompany you and REMAIN IN THE OFFICE during your surgery. Someone should be with you at home throughout the evening after surgery. Wear loose, comfortable clothing. Choose a top with sleeves that roll up easily. Do not wear high-heeled shoes or flip flop sandals.
• If you were given prescriptions at your consult, have them filled prior to your surgical appointment.
• If you are NOT being sedated and you are having a local anesthetic (“novocaine”), you may have a light breakfast or lunch before your appointment.
• If you are taking medication on a regular basis, continue to do so, unless otherwise instructed.
• It is NOT advisable to bring small children to the office during your appointment.
• You may need to take a few days off from work or school to give yourself time to recover from your surgery.
• Purchase cold soft foods such as pudding, jello, applesauce and cottage cheese to eat the first day after surgery. Have ice packs ready for your use when you arrive home from surgery.
• Please make financial arrangements in advance of your surgery date.
• If you have any questions, please feel free to call our office.

Immediately Following Surgery

• The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
• 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 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.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, 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 sides 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 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 sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

For moderate pain, one or two tablets of Extra Strength Tylenol may be taken every 6 hours or ibuprofen (Motrin or Advil) (2 to 4) 200 mg tablets may be taken every 4-6 hours. The maximum dose of Tylenol is 3000 mg per day. The maximum dose of ibuprofen is 3200 mg per day.

For severe pain, take the tablets prescribed 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. 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.

Diet

Drink liquids after general anesthesia or IV sedation. 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.

Keep the Mouth Clean

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least five to six times a day with a cup of warm water mixed with a teaspoon of salt especially after eating.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be 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

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 Coke, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.

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. Call Dr. Overbeck at Venice Office Phone Number 941-488-8788 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 position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and then get up.
• 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. Overbeck. 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.
• 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.

Finally

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. Dr. Overbeck usually uses dissolvable sutures that do not need to be removed.

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, especially after meals, with salt-water rinses or a toothbrush.

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. Overbeck or your family dentist.

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 from 3 to 5 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.

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.

Bleeding

Some bleeding is normal, and blood tinged saliva may be present for approximately 24 hours following the surgery.  Bite down gently but firmly on the gauze that have been placed over the surgical areas, making sure they remain in place for 30-60 minutes.  If active bleeding persists after 1 hour, place enough new gauze to obtain pressure over the surgical site for another 30-60 minutes.  Bleeding should not be severe.  If bleeding persists or becomes heavy, substitute a moist tea bag (first soaked in hot water, squeezed dry and wrapped in moist gauze) on the area for 20-30 minutes.  If bleeding continues, please call our office.

Swelling or Bruising

Swelling is to be expected and usually reaches its maximum in 72 hours.  To minimize swelling, ice packs wrapped in a towel should be applied to the face 20 minutes then removed 20 minutes, and repeated often during the first 12-24 hours after surgery.  Beginning the third day, discontinue ice and start moist heat compresses for as many days as needed.  Bruising may also occur, but should disappear in a couple of weeks.  Tightness of the jaw muscles may cause difficulty in opening the mouth.  This should disappear in 7-14 days. 

Diet

Eat any nourishing food that can be consumed with comfort.  It is advisable to limit the first day’s food intake to bland cold to cool liquids and pureed or soft foods (creamed soups, pudding, yogurt, ice cream, etc.).  Avoid foods like nuts, seeds or popcorn.  Over the next several days, you may progress to more solid foods.  Proper nourishment aids in the healing process.  If you are a diabetic, maintain your normal diet as much as possible and follow your  physician’s instructions regarding your insulin schedule. 

Discomfort and Medications

Medication has been prescribed according to anticipated level of discomfort.  The local anesthetic administered during your surgery normally lasts several hours.  Your tongue, lips, cheeks and back of the throat may become numb and you may feel as if it is hard to swallow.  You may take your pain medication before the anesthetic starts to wear off.  Taking the pain medication with soft food and/or a large volume of clear fluids will lessen any side effects of nausea and/or stomach upset.  If you do not achieve adequate pain relief, you may supplement each pain pill with an analgesic such as acetaminophen or ibuprofen.  Most patients will be given a prescription for antibiotics.  Please take as directed.  For additional information on alternatives to opiods, please visit https://www.floridahealth.gov/programs-and-services/non-opioid-pain-management/_documents/alternatives-facts-8.5×11-eng.pdf

Oral Hygiene and Care

• DO NOT spit on the first day.  
• DO NOT drink with a straw on the first day. 
• DO NOT rinse vigorously or probe the area with the tongue, any objects, or your fingers. 
• DO NOT brush vigorously over the surgery sites on the first day.
• DO NOT consume hot foods or beverages on the first day. 
• DO NOT smoke for at least 72 hours.  It may slow down the healing process after surgery.
• DO NOT operate any mechanical equipment or drive a motor vehicle for at least 24 hours if having IV sedation, longer if you feel any residual effects.  

Restrict physical activity for 1 week. 

After the first 24 hours, start rinsing your mouth gently with warm salt-water (1/2 teaspoon with 1 cup water) 2-3 times daily.  Continue this for 1 week.

If you were given a prescription mouth rinse, use as directed.

You may start normal tooth brushing 24 hours after surgery or after bleeding is controlled.  It is imperative to keep your mouth clean, since this is important for proper healing.  An accumulation of food or debris may promote infection.

Patients who received IV sedation (go to sleep) will be going home immediately upon discharge from our office.  You must have someone who can stay in the office throughout the surgical procedure as well as stay with you all day after your surgery.  You should lie down with your head elevated until all of the effects of the anesthetic have disappeared.  Patients who have had nitrous oxide combined with a local anesthetic may not need supervision. 

If you have soreness or swelling of your arm from the IV anesthesia used during the surgery, place hot compresses on the arm beginning the day after surgery.  Should you see redness, please call our office. 

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 area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours.

Use the pain medication as directed. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, 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 once 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 Venice Office Phone Number 941-488-8788.

Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 36 hours only. Apply ice continuously while you are awake.

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

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 every four hours and following meals to flush out particles of food and debris that may lodge in the operated area. (Use one teaspoon of salt in a 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 area operated on will swell, reaching a maximum in two days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration. The towel should be applied continuously for as long as tolerable beginning 36 hours after surgery (remember ice packs are used for the first 36 hours only).
• A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in two to three days.
• 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. If temperature continues, 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.