TO INSURE MAXIMUM COMFORT
FOLLOWING TOOTH EXTRACTIONS
AND OTHER ORAL SURGERY…

REMOVE – Gauze pack in ½ hour if this was not already done in the office.

ORAL HYGIENE – No vigorous rinsing the first day.  On the day following surgery you should rinse 3-4 times daily with warm salt water (1/2-1 teaspoons salt in 8ozs. of warm water) for the rest of the first post-op week.  Brush all unaffected areas starting the day after surgery.

BLEEDING – A certain amount of bleeding is expected following oral surgery, especially with the removal of infected or impacted teeth.  Direct biting pressure on gauze placed over the surgery site for 30-45 minutes stops most bleeding.  Fresh gauze may be used as needed.  Do not chew on the pack.  In the case of excessive or prolonged bleeding, pinch off any loose blood clot over the socket with gauze or tissue, then place a gauze roll or moistened tea bag directly over the bleeding area and bite down firmly and continuously for 30 minutes.  Repeat this several times as necessary to control the bleeding.  Try to avoid spitting or sucking action as this will prolong the bleeding.  Contact the office if there is uncontrollable bleeding.

PAIN – Take two Tylenol or Ibuprofen 600m every 3-4 hours if necessary for pain.  If this is not adequate, use the prescription pain medication as directed.  Do not take pain medication on an empty stomach, as this may result in nausea or dizziness.  Do not operate a car or dangerous equipment while taking prescription pain medicine.

SWELLING – To reduce ordinary immediate post-operative swelling, apply an ice pack to the face over the area of extraction.  The ice pack should be applied for about 45 minutes out of each hour for the first 8-12 hours.  DO NOT APPLY HEAT in any form to the outside of the face unless specifically instructed to do so.  Some swelling is normal and usually increases slowly until it reaches its greatest extent on the second or third post-operative day.

DIET – A liquid or soft diet is recommended for at least the first 24 hours.  Do not disturb sockets or allow food to collect in the wound.  After the first day, eat anything you are able to eat without causing pain or bleeding.  Drink plenty of liquids. Please avoid drinking through a straw for the first 24-48 hours.

IMPACTED TEETH – Surgery of the removal of impacted teeth is quite different than the extraction of erupted teeth.  The following conditions are not uncommon with removal of impacted teeth:
            Difficulty in opening your mouth as a result of swelling and stiffness. This should resolve in 3-4 days.
            If a lower impaction was removed you may have numbness of the lower lip on the side from which the tooth was removed.  This is almost always a temporary condition.  It is not disfiguring, but is annoying.  It may last from a few days to many months.
            You may have pain which becomes worse after a few days and does not respond to the medication you are taking.  This may indicate an inflammation of the bone cavity and can be treated in the office with a sedative dressing.
            You may develop a mild fever.  This is often expected.  If the temperature reaches 101 degrees, call the office.
            After removal, the adjacent teeth may realign themselves, causing some discomfort.  Sores may develop at the corners of the mouth.  These should be covered with mild ointment (Vaseline).
            If you have reason to believe that you are not recovering or healing satisfactorily from any operation, or are in doubt about anything at any time, notify us by telephone or by coming directly to the office.

IN CASE OF POST-OPERATIVE COMPLICATION,
PLEASE CALL THE OFFICE AT:

(949) 586-7000 [Mission Viejo Office]
(949) 760-1600 [Newport Beach Office]
(949) 661-0166 [San Clemente Office]

MAXILLOFACIAL-ORTHOGNATHIC
POST-SURGICAL INSTRUCTIONS

1. You will probably be hospitalized from 1-2 days.  During this time you will be cared for by nurses and auxiliary personnel who are very experienced in attending to maxillofacial surgery patients.  We will visit you at least once per day after surgery.


2. You will be up and about (with assistance at first) the first day after surgery.


3. The second day after surgery you probably will be able to shower and shampoo your hair.


4. You most likely will have an acrylic splint and elastics between your upper and lower teeth. These elastics help maintain the jaws in their new position.  Wire fixation of the lower to the upper jaw may also be temporarily necessary.  You will be on a non-chewing diet (primarily liquid) for six weeks.  Should nausea and vomiting occur, do not panic, and let the fluid pass between your teeth and through your nasal passages.


5. You will be discharged from the hospital when you are able to move about without assistance, go to the bathroom on your own, and take sufficient fluid by mouth to satisfy your body’s maintenance requirements.


6. You will be given prescriptions for liquid pain medication and a liquid antibiotic on the day of discharge.  Use the pain medication as required.  Please take the antibiotic as directed until all is gone.  There will be ointment for your lips and Afrin nose spray to help decrease the swelling in your nose (if any) at your bedside in the hospital.  Take whatever is remaining with you and use it as required.  Vaseline or Chapstick is sufficient for your lips once you get home.


7. ACTIVITY:  Increase your activity as your strength increases.  Most patients are able to resume normal work (unless heavy labor) or school 2-3 weeks after the surgery.  If your jaws are wired shut, you may have difficulty breathing during physical exertion.  You must avoid any situation which could result in being hit on the head (such as hard hat areas and contact sports). Other than those situations, moderate activity is definitely encouraged.


8. SMOKING AND ALCOHOL: None or very minimal.  Good time to break the habit.


9. ORAL HYGIENE:
• Mouthwash: Either warm saline or the commercial mouthwash of your choice, 3-4 times per day.
• Toothbrushing: Use toothpaste and brush twice daily as soon as it is comfortable.


10. PERSONAL HYGIENE: Shower and bathe every day.


11. POST HOSPITAL COURSE: We will see you in the office the week following your surgery.  More x-rays will be taken at this appointment.  Depending on how well you get along you will see us every week for a while then every two or three weeks.  We will be available anytime you think you might be having a problem.
    

    One problem you may encounter is muscle spasm of your jaw and temple muscles.  This occurrence is normal.  Another problem that can be experienced is ear discomfort.  This discomfort is usually short-lived and is helped by taking liquid pain medication.  If this pain is persistent, notify us of this situation at your next appointment.  If it is unbearable, notify us immediately.  Additionally, your jaw movement will be limited for several weeks as healing continues.

    Gentle jaw exercise and external heat packs will help improve jaw mobility post operatively.  You will be instructed on how to utilize these techniques.

12. INTERNAL HARDWARE USED AT SURGERY: There will be wire, metal screws or other bone fixation devices placed in the area of surgery that will remain.  You will usually not realize these devices are present except as demonstrated by taking an x-ray of the area.  These fixation devices can be removed if they become problematic after surgery.


13. NUTRITION:  Proper liquid nutrition is very important to the post maxillofacial surgery patient.  We will cover some basic points and offer some hints, but basically your oral intake will be left up to you.  Different people have different tastes, so experiment. Smoothies with commercial powdered protein are another option. Protein intake should approximate 100 grams per day.

• At least 8 oz. (250cc) of liquid supplement should be taken 3-4 times per day. Examples of these liquids are: Carnation Instant Breakfast, Sustacal, Nutrament, Ensure, Ensure Plus, and Meritene.  These liquids all have different tastes.  This supplement plus your other diet will provide all of the vitamins you require, so supplemental vitamins are not required.  These supplements may be obtained in most grocery stores or pharmacies.
• Until the intra-oral swelling has decreased, you should try to take only thin liquids.  Although some of the liquid enters between your teeth, most enters along the cheek and behind the last teeth.  This situation requires that most of the swelling be gone before thick liquids are taken.  Most patients can progress to foods mixed in a blender after 1-2 weeks.  You may find the syringe/catheter system demonstrated at the hospital helpful.
• You will lose weight.  Do not be concerned.  How much you will lose will be up to you. If you wish to lose weight, cut down on your regular diet, not on the supplements which are providing most of the vitamins and minerals.  A 10% loss of body weight is not unusual.
• Solid bowel movements may not be as frequent on a liquid diet as before surgery.  Diarrhea requires a change in diet.  Experiment.
• You will be provided with more information concerning your diet by our office personnel.

OPEN SINUS INSTRUCTIONS

1. The roots of your upper teeth have grown through the bone into your sinus.  Following their removal an opening into the sinus was visible.  This opening will close without complications if you help by following these instructions.
2. Please take prescribed antibiotics as directed.  These are essential to prevent infection.
3. Use decongestants as directed on the prescription.
4. Refrain from any vigorous mouth rinsing.
5. Do not smoke.
6. Do not blow your nose.  If necessary just wipe or blot with a tissue.  Some discharge (perhaps containing blood) may be expected for the first few days.
7. Do not suppress a sneeze.  Heavy pressure with a finger against the upper lip will sometimes break the sneeze reflex.  Failing this, if you must sneeze, open the mouth widely during the sneeze to avoid pressure in the nasal and sinus area.
8. Do not engage in sports such as scuba diving or snorkel swimming.
9. Strict adherence to these instructions may prevent the necessity of surgical closure at some later time.
10. Please call the office if you have any questions.  (24 hour answering service)