Before Intravenous Anesthesia Sedation
- You may not have anything to eat or drink for six (6) hours prior to the appointment. A small amount of water may be taken for pre operative medications.
- No smoking for 48 hours after 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 at the time 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. Schlimmer prior to your surgical date for instructions
Post Operative Instructions
Post Operative Instructions
Office Phone: 361-992-9500
- When you leave the office after your surgery visit, there are several things you will need to do. Sometimes the after-effects of oral surgery are minimal, so not all of the instructions may apply. Common sense will often dictate what you should do. However, when in doubt follow these guidelines or call our office for clarification. A 24-hour answering service is available to contact a doctor after hours by calling the office number. Calling during office hours will afford a faster response to your question or concern.
Day of Surgery
- GAUZE: 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 45 – 60 minutes). It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning.
- 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. Take one of the prescription pain pills as soon as you get home. 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 Tylenol (Acetaminophen) or Advil (Ibuprofen).
- ANTIOBIOTICS: If an antibiotic is prescribed, it should be taken 4 times a day (unless otherwise directed) • ANTIOBIOTICS: If an antibiotic is prescribed, it should be taken 4 times a day (unless otherwise directed) until all are taken.
- ICE: Swelling is often associated with oral surgery. It can be minimized by using a cold pack or ice bag wrapped in a towel and applied firmly to the cheek adjacent to the surgical area. This should be applied 20 minutes on and 20 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.
- PRECAUTIONS: Do not disturb the surgical area today. Do NOT rinse vigorously or probe the area with any objects. PLEASE DO NOT SMOKE, or drink alcohol for at least 72 hours. This is very detrimental to healing and may cause a dry socket. Do not use any mouthwashes because they may contain alcohol. Do not drink using a straw for at least 24 hours.
- DIET: Liquids only until the numbness wears off. (Take care not to bite lip or cheek while numb). Eat any nourishing food that can be taken with comfort. Avoid extremely hot foods. It is sometimes advisable, but not absolutely required, to confine the first day's intake to liquids or pureed foods (soups, puddings, yogurt, milk shakes, etc). It is best to avoid crispy foods like nuts, chips, popcorn, etc., which may get lodged in the socket 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 diabetic, maintain your normal eating habits or follow instructions given by your doctor.
- OOZING: Intermittent bleeding or oozing overnight is normal. Placing fresh gauze over the areas and biting on the gauze for 30-45 minutes at a time may control bleeding.
- PRESISTENT BLEEDING: Bleeding should never be severe. If so, it usually means that the packs are being clenched between the teeth only and are not exerting pressure on the surgical areas. Try to reposition the packs. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in cold water, squeezed damp-dry and wrapped in a moist gauze) for 20 – 30 minutes. If bleeding remains uncontrolled, please call our office.
- NAUSEA: Nausea is not uncommon after surgery. Sometimes pain medications are the cause. Try to keep taking clear fluids and minimize dosing of pain medications. Coca-Cola or 7-Up may help with nausea. If nausea becomes excessive or continues the next day, please call us.
- REST: Although strict bed rest is not required, excessive physical exercise, especially lifting, bending over, or straining should be avoided for the first 3-4 days after surgery. Sleeping on 2-3 pillows to avoid additional swelling is suggested.
Instructions For Second and Third Days
- RINSING: Keeping your mouth clean after surgery is essential. After 24 hours, use ¼ teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution. Repeat at least two or three times daily.
- BRUSHING: Begin oral hygiene, including brushing your teeth, as soon as comfortable after surgery, even on the first day. Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth within the bounds of comfort.
- MOIST HEAT: After 48 hours you may apply a warm, moist compress to the skin over the areas of swelling (wet wash cloth with heating pad or hot water bottle). You may do this continuously. This will also help decrease swelling and stiffness. Make sure it is warm, not hot.
- 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 our office.
- HEALING: Normal healing after tooth extraction 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. If you are given a plastic irrigation syringe, DO NOT use it for the first seven days. Then, if you are pain free, use it according to the instructions until you are certain the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket.
- BIRTH CONTROL: Recent medical studies indicate that antibiotics, and possibly analgesics, may interfere with the effectiveness of oral contraceptive.
- DRY SOCKET: Our most common post-operative nuisance is the dreaded “Dry Socket.” This is not an infection. After a tooth is removed, a “hole” or socket is left in the jawbone where the roots of the tooth used to be present. Normal healing requires the formation and continued presence of a blood clot in that hole. If this clot does not form or dissolves prematurely, then dull throbbing in the jaw or pain radiating to the ear may occur. This pain usually starts to increase the third to the tenth day after the tooth is removed. We would like for you to contact us if this occurs. (We try to be accessible to our patients. We have an answering service, carry a pager, and each of our home phone numbers is listed in the phone book.) A dry socket usually can be turned around by applying medication within the socket. No more shots! Just a short appointment to place the medication will often resolve the discomfort within a few moments.
- We know that tobacco, alcohol, or early physical activity after surgery can increase the chances for a dry socket. Sometimes, no matter what you do, a dry socket will develop. We would like for you to avoid one if possible, but we would like to be the second person to know if you develop a problem.
Dental Implant Surgery
After Placement of Dental Implants
Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There will be a metal healing abutment protruding through the gingival (gum) tissue.
Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding can usually be controlled by biting on a gauze pad placed directly on the bleeding wound for 30-45 minutes. Biting on a moistened tea bag often will control the oozing. If excessive bleeding continues please contact the doctors at 361-992-9500.
Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, or a plastic bag, or towel filled with ice on the cheek in the area of surgery. Apply the ice continuously, as much as possible, for the first 36 hours (on 20 minutes off 10).
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.
You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 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.
Be sure to take the prescribed antibiotics as directed to help prevent infection.
Good oral hygiene is essential to good healing. After 48 hours, warm salt water rinses (teaspoon of salt in a cup of warm water) should be used at least 3-4 times a day, especially after meals. If you have been prescribed Peridex rinse, use ½ ounce of the rinse, twice a day instead of the salt water. Brushing your teeth the day of surgery is no problem. Be very gentle initially with brushing around the surgical areas. Continue to keep the surgical area clean and began gently brushing the gum tissue after the sutures have been removed the following week after surgery.
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 and further limit your ability to exercise.
Wearing Your Prosthesis
Full or partial dentures and other prosthesis should be discussed with the doctor.
Wisdom Tooth Removal
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 30-45 minutes. After this time, the gauze pad should be removed and discarded. And a new one replaced if necessary.
- 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 within an hour of completion of the surgical procedure. This will usually allow the medication to work before the local anesthetic has worn off.
- Restrict your activities the day following 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 explanation.
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 30-45 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding sit upright, hold ice on the surgical site and avoid exercise. If bleeding does not subside, contact the doctor at 682-8431.
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 48 hours post-op. However, the swelling may be minimized by the immediate use of ice packs. Zip lock baggies 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 20 minutes off 10 minutes 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. 48 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours, unless you have been advised not to take this medication.
For severe pain, take the tablets prescribed as directed. We try to personalize the pain medication instructions appropriate for the patient for whom it is prescribed. The prescribed pain medicine may 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.
After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. The sucking motion can cause more bleeding and may dislodge the blood clot. You may eat anything soft. Attempt to chew away form the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. 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 5-6 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. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.
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, especially after eating, with a cup of warm water mixed with a teaspoon of salt.
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 post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
If you have been placed on antibiotics, take the tablets or liquid as directed until all are taken. Antibiotics are 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 and 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, 7-Up or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. If nausea persists contact the doctor at 361-992-9500.
- 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. Schlimmer if you have any questions.
- 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 stand up suddenly. Before standing up, you should sit for one minute then get up.
- Occasionally, patients may feel hard projections in the mouth with their tongue. This is often the edge of the bony walls which supported the tooth. These projections usually smooth out spontaneously. If necessary they can be treated by Dr. Schlimmer.
- 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 may get swollen. The normal act of swallowing can then become painful. This usually will subside in 2-3 days.
- Stiffness or soreness of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.
Sutures may be placed in the area of surgery to minimize post-operative bleeding and to help healing. Often they resorb, meaning they dissolve without having 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 contact the office at 361-992-9500.
There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses.
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 often in the ear may occur 3 to 10 days following surgery. Call the office if this occurs. Tobacco, alcohol and exercise should be avoided for a few days post op.
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.
Exposure of an Impacted Tooth
After Exposure of an Impacted Tooth
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.
Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding which results in your mouth filling rapidly with blood can frequently be controlled by biting with pressure on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call for further instructions.
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. Apply the ice continuously as much as possible for the first 36 hours.
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.
You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed.
Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can. Rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete.
REMEMBER: A clean wound heals better and faster.
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. 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's important for a blood clot to form to stop the bleeding and begin the healing process. That's why we ask you to bite on a gauze pad for 30-45 minutes after the appointment. If the bleeding or oozing still persists, place another gauze pad and bite firmly for another 30 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, use tobacco or alcohol or exercise for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 72 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 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. 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 after 3-4 days, or a reaction to the medication, call our office immediately at 361-992-9500.