Extraction Instructions

Immediately following surgery Bite firmly on the gauze pads covering each extraction site to help stop the bleeding. We will change the gauze pads before you leave the office. You may change the gauze pads once more at home, leaving gauze in 30 additional minutes. Remember to remove gauze before eating or drinking. You may have difficulty feeling your lips, cheeks or tongue due to numbness. This is a temporary feeling and will wear off within 2 to 6 hours. Please take care not to bite your lips, cheeks or tongue. Bleeding When you get home, fold and place a gauze pad directly over the extraction site and bite firmly for 30 minutes. If excessive bleeding continues, apply another fresh gauze pad for an additional 30 minutes. Excessive bleeding is defined as pooling or dripping blood out of the extraction sites within 15-20 seconds of removing the gauze. Don't use the amount of blood on the gauze as a guide, because minimal bleeding may persist for up to 24 hours. It is not unusual for saliva to be slightly blood-tinged for several days following surgery. Please call our office if you feel bleeding is excessive. Medication You may receive a prescription for an antibiotic and/or a pain reliever. Take all medications as instructed by your doctor. Pain management Some amount of discomfort is to be expected following any surgery. If your surgeon feels you will benefit from a prescription pain medicine, you will receive a prescription following your surgery. Please follow the instructions carefully. Diet If possible chew on the opposite side of your extraction site. For multiple extractions, you should have soft foods on the day of surgery and the day following surgery. Soft foods include ice cream, pudding, jelly, yogurt, soup (lukewarm), pancakes, mashed potatoes, scrambled eggs, pasta, etc. Avoid hard, crunchy foods such as chips or nuts that may disturb the extraction site for at least one week. After the third day, you may eat anything you wish, unless given other specific instructions by the doctor. Smoking Do not smoke for at least 3 days following surgery. The longer you avoid smoking, the better your healing will progress. Brushing/Rinsing Avoid all brushing, rinsing or spitting the day of the surgery. The day after your surgery, you may brush your teeth, but avoid brushing near the surgical site(s) for 3 days. Rinse with ½ cup warm water and a pinch of salt beginning 3 days after surgery. Straws Do not use a straw for 3 days following surgery. Sutures/"stitches" Your sutures dissolve on their own and may come out any time after surgery. You may notice that they are loose after the swelling of your gum tissue decreases. This is completely normal. Resuming activities Do not drive or engage in strenuous activities for at least 24 hours. You may return to work or school when you feel you are recovered. We can supply a doctor's note if necessary. If you have undergone general anesthesia, you should go home immediately and rest for the remainder of the day. Dry socket After tooth extraction, it's important for a blood clot to form to stop the bleeding and begin the healing process. A dry socket occurs when the blood clot is dislodged from the surgery site exposing the bone and fine nerve endings. This condition is more common in back teeth, particularly wisdom teeth, although it can occur in any extraction site. Dry socket occurs two or more days after an extraction and can last 5-6 days. Avoiding dry socket Do not smoke. Clean the extraction site as instructed and follow all at-home instructions. Avoid sucking action from smoking, spitting or using straws for the first 24 hours. Do not rinse mouth excessively; it interferes with blood clotting.

Implants Instructions

Day of Surgery FIRST HOUR: Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not controlled. The packs may be gently removed after one hour. If active bleeding persists, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 30 to 45 minutes). It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning. EXERCISE CARE: Do not disturb the surgical area today. Do NOT rinse vigorously or probe the area with any objects. You may brush your teeth gently. Smoking will retard healing, causing increased discomfort and increased chance of dry sockets. We strongly discourage smoking during the healing phase. ORAL HYGIENE: It is important to keep the mouth clean. You should brush your teeth the night of surgery, but be gentle around the surgical sites. If there is minimal bleeding, saltwater rinses may begin 24 hours after surgery (mix 1 tablespoon of salt with 1/2 cup of water.) Swish gently and allow the water to drip into the sink. Rinses should be done 2-3 times a day, especially after eating. ACTIVITIES: Activities after surgery should be couch or bed rest for the first day. Bending, lifting, or strenuous activity will result in increased bleeding, swelling and pain. You should be careful going from the lying down position to standing. You could get light headed when you stand up suddenly. If you exercise regularly, be aware that your normal fluid and caloric intake is reduced. Exercise in the post-operative period may also result in increased bleeding, swelling and discomfort. Exercise should be avoided for 3-4 days following surgery. OOZING: Bleeding will occur after surgery, and it is not uncommon to ooze blood for 24-48 hours after surgery. Keep in mind that oral bleeding represents a little blood and a lot of saliva. Placing a gauze pack over the area and biting firmly will control bleeding. If oozing is still active, replace gauze as needed every 30-45 minutes. PERSISTENT BLEEDING: Bleeding should never be severe. If so, it usually means that the packs are being clenched between teeth only and are not exerting pressure on the surgical areas. Try re-positioning the packs. If bleeding persists or begins again sit upright or in a recliner, avoid physical activity, use ice packs and bite on gauze for 1 hour or on a moistened tea bag for 30 minutes. The tannic acid in the tea leaves helps to promote blood clotting. If bleeding remains uncontrolled, please call our office. SWELLING: Swelling is a normal occurrence after surgery and will not reach its maximum until 2-3 days after surgery. It can be minimized by using a cold pack, ice bag or a bag of frozen peas wrapped in a towel and applied firmly to the cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 24 hours after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed. PAIN: Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first pill before the anesthetic has worn off, you should be able to manage any discomfort better. Some patients find that stronger pain medicine causes nausea, but if you precede each pain pill with a small amount of food, chances for nausea will be reduced. The effects of pain medications vary widely among individuals. If you do not achieve adequate relief at first, you may supplement each pain pill with an analgesic such as aspirin or ibuprofen. Some patients may even require two of the pain pills at one time. Remember that the most severe pain is usually within six hours after the local anesthetic wears off; after that your need for medicine should lessen. If you find you are taking large amounts of pain medicine at frequent intervals, please call our office. DIET: Eat any nourishing food that can be taken with comfort. Avoid extremely hot foods. Do not use a straw for the first few days after surgery. It is sometimes advisable, but not absolutely required, to confine the first days intake to liquids or pureed foods (soups, puddings, yogurt, milk shakes, etc.) Avoid chewing food until tongue sensation has returned. It is best to avoid foods like rice, nuts, sunflower seeds, popcorn, etc., which may get lodged in the surgical areas. Over the next several days you may gradually progress to solid foods. 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 a diabetic, maintain your normal eating habits or follow instructions given by your doctor. NAUSEA: Nausea and vomiting can occur as a result of swallowed blood, discomfort, anesthesia or pain medicines. Post-operative nausea is usually self-limiting. If nausea persists, stop taking the pain medicine and substitute an over the counter pain medicine for the next dose. If nausea persists call our office. Instructions for the Second and Third Days MOUTH RINSES: Keeping your mouth clean after surgery is essential. Use 1/4 teaspoon of salt dissolved in a 1/2 glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily. BRUSHING: Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing, but it is extremely important to clean your teeth within the bounds of comfort. Maintaining a clean environment adjacent to the healing surgical wounds is required for optimum and speedy healing. HEALING: Normal healing after placement of dental implants should be as follows: The first two days after surgery are generally the most uncomfortable and there is usually some swelling. On the third day you should be more comfortable and, although still swollen, can usually begin a more substantial diet. The remainder of the post-operative course should be gradual, steady improvement. If you don’t see continued improvement, please call our office. DISCOLORATION OR BRUISING: The development of black, blue, green or yellow discoloration is due to bruising beneath the tissues. This is a normal post-operative occurrence that might appear 2-3 days after surgery. Beginning 36 hours after the surgery, moist heat applied to the area may speed up resolution of the discoloration. SHARP EDGES: If you feel something hard or sharp edges in the surgical areas, it is likely you are feeling the bony walls which once supported the extracted teeth. Occasionally small slivers of bone may work themselves out during the following week or so. If they cause concern or discomfort, please call the office. DRY LIPS: If the corners of your mouth are stretched they may dry out and crack. Keep your lips moist with an ointment such as Vaseline.

Orthodontic Instructions

DIET In general, avoid anything very hard or sticky! These foods may loosen bands or break off brackets from the teeth causing damage and delay in your treatment. Cut your foods into small pieces and chew slowly and carefully to avoid breaking, bending or loosening your appliances (braces). Almost anything can be eaten as long as it is cut into small pieces and eaten slowly with care. • Specifically, avoid eating the following: Chewing gum, candy, apples, taffy, peanut brittle, caramels, tootsie rolls, hard candies, gummy bears. • Also avoid biting: Hard cookies, hard rolls, nuts, pretzels, ribs, and pizza crust. • Don’t even think about chewing on: ice, pens or pencils. There are still many foods you may enjoy, if you are just careful: apples, pears, raw carrots, celery, corn on the cob, crusty bread sandwiches, bagels and meat on a bone can be cut up in small pieces or strips and eaten on your back teeth. Pizza is okay. Just use your knife and fork instead of your front teeth! ORAL HYGIENE Careful tooth brushing is of critical importance. Braces trap food, bacteria and plaque that can cause tooth decay, gum disease, and leave permanent marks (decalcification), which will never come off the teeth! Brush after every meal and before bedtime. Pay special attention to the gum line and the area between the braces and gums. Keep your braces and teeth sparkling clean! A fluoride mouth rinse is highly recommended (i.e. Act, Fluoriguard). WAX If the bands scratch your lips, gums, cheeks or tongue, place a small piece of wax over the sharp spot after drying off the area with a tissue. Usually such irritations disappear after a few days. You can also use a small piece of wet tissue instead of wax. DISCOMFORT In general, rinsing with warm salt water can relieve soreness of the mouth: (one teaspoon of salt in a half glass of very warm water). Rinse for 60 seconds, then spit out. Rinse every ten or twenty minutes for best results. If pain persists, use an over the counter pain reliever or anti-inflammatory such as Panadol. (Children, please ask your parents first!) CHECK FOR LOOSE BRACES DAILY Loose braces allow decay to proceed under them rapidly. If any braces or wires break or come loose call the office. Place wax over any sharp areas, and save any loose pieces and bring them in with you. Loose or broken braces prolong treatment. REGULARITY IN KEEPING APPOINTMENTS IS ESSENTIAL Failed or broken appointments increase treatment time.

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