Surgical Instructions

• Before Intravenous Anesthesia Sedation
• Before Nitrous Oxide Anesthesia
• After Wisdom Tooth Removal
• After Exposure of an Impacted Tooth
• After Removal of Multiple Teeth
• After Insertion of an Immediate Denture
• After Placement of Dental Implants

Before Intravenous Anesthesia Sedation

Sedation is a method of anesthesia that allows us to perform a procedure while you are calm, comfortable and relaxed.  Technically, you will be “conscious” during the procedure; however, you should not feel any pain and will be very relaxed.  You will probably have no memory of the procedure.

• Wear loose, comfortable clothing with short or no sleeves.  Do not wear nail polish, contact lenses, or nylons, as they interfere with our monitoring equipment.

• Do not eat or drink anything for at least eight hours before your appointment.

• Arrange to have someone wait in our office during your procedure, take you home afterward, and stay with you until you are fully recovered from the anesthesia.  We will instruct that person on how to help care for you afterwards.  Do not attempt to drive or do work of any kind for 24 hours.

• Do not drink any alcoholic beverages for 48 hours after the anesthetic.

• If you are currently taking a daily medication, take it as usual with a minimal amount of water, but please, LET US KNOW.

Before Nitrous Oxide Anesthesia

Nitrous oxide is a method of analgesia that allows us to perform a procedure while you are comfortable and relaxed.  The “laughing gas” creates a more relaxed state and to some degree, dissociation from the environment.

• Wear loose, comfortable clothing with short or no sleeves.  Do not wear nail polish, contact lenses, or nylons, as they interfere with our monitoring equipment.

• Do not eat or drink anything for at least four hours before your appointment.

• Arrange to have someone stay with you in our office during the procedure, and stay with you until you are fully recovered from the gas.  We will instruct that person on how to care for you afterwards.  You should not drive or operate machinery until fully recovered from the gas.

• If you are currently taking a daily medication, take it as usual with a minimal amount of water, but please, LET US KNOW.

“Cooler” Instructions 

It is a good idea for patients who live more than 20 minutes from the office to bring a cooler with them.
This idea was prompted by comments from other patients.

• Bring a cooler with you the day of surgery.   Inside the cooler, you should have:

• Advil (2 tablets), unless you are unable to take Advil
• Ice pack
• Bottle of juice/soda (no milk products or orange juice) NO STRAWS
• Pudding or other soft food and a spoon

• By the time you get to the car or pharmacy, it will be time to change the gauze in your mouth.
• Remove your gauze.
• Swallow some juice/soda (this may feel strange as you may still be numb).
• Take 2 Advil.
• Eat some pudding or other soft food.
• Insert new gauze and bite firmly.
• Apply ice to face.

Once you arrive home you can start the pain prescription (remember only ¼ or ½ of a tablet), and eat more substantial food (pancakes, pasta, chicken noodle soup, mashed potatoes, etc.)

After Wisdom Tooth Removal

The removal of impacted teeth is different than the extraction of most other teeth.  Proper care of your mouth will aid in the healing process and reduce the possibility of complications.

BLEEDING

Some bleeding is normal after surgery.  To control this, place a gauze pack over the surgical site and apply firm pressure in that area by biting on the gauze for 20-30 minutes.  This process should be repeated as often as necessary until the bleeding is well controlled.  However, slight oozing may occur for the first few days.  If the gauze does not adequately control the bleeding, a tea bag can be wrapped in the gauze and placed over the surgical site. 

Vigorous rinsing, drinking through a straw, spitting, and smoking all aggravate the bleeding and should be avoided for the first 24 hours. 

If excessive bleeding occurs, please notify our office.

DISCOMFORT

Some degree of discomfort often accompanies surgical procedures.  Besides discomfort at the surgical site, pain can be referred to other areas such as the ear. 

It may be helpful to take a prescribed medication for pain relief. In some cases, prescription pain medications may cause nausea, especially if taken on an empty stomach. These medications may also cause dizziness, therefore, do not consume alcohol, drive, or operate machinery.

If you can, take Advil or other similar medications in addition to or instead of prescription pain medications.  You can also take Tylenol instead of prescription pain medication, but not in conjunction with it as they both contain Tylenol.  Do not wait for the pain to become severe before taking pain medications.

SWELLING

Swelling is a normal response to surgical procedures.  It usually reaches a peak by 48-72 hours after your surgery.  On occasion, swelling may be accompanied by bruising.  To minimize the swelling, apply ice over the affected area intermittently (30 minutes on / 30 minutes off) for the first 24-48 hours. 

DIET

You may begin by taking liquids immediately following your surgery.  You should progress from liquids to soft foods to a regular diet.  It is important to keep in mind that a good diet will promote healing and should allow better tolerance of medications.

Do not take any pain medication on an empty stomach. 

RINSING

Do not rinse or spit for 24 hours.  After that time, rinsing with warm water will help remove food debris and aid in cleanliness.

BRUSHING

Brushing will help to keep the surgical sites clean.  Use a soft bristle toothbrush and run it under warm water to further soften the bristles.  A little bleeding may occur when you brush; however, this is generally of no consequence.

NAUSEA

Nausea and/or vomiting may occur and is usually a result of taking pain medication on an empty stomach.  If this occurs, stop taking any prescription pain medication and let your stomach settle for several hours.  Then try to consume liquids at first, progressing to bland / soft foods until your stomach feels calm. 

You may then begin taking Advil, Tylenol, or other similar medicine if needed, taken with food or liquids.  No further prescription pain medication should be taken for 24 hours, and then only in limited amounts.  Contact our office for further instructions, as needed.

MUSCLE TIGHTNESS

Tightness may occur and is usually associated with swelling of the muscles near the extraction sites. This usually results in difficulty opening your mouth and at times headaches. Applying moist heat after 72 hours to affected areas is helpful in alleviating this problem.

OPENING AT THE EXTRACTION SITE

A hole where your tooth was removed may become apparent after surgery.  These holes will eventually fill in with new tissue. 

Rinsing the area after meals will aid in keeping these areas clean.  An irrigating syringe is generally provided at the time of your post-operative appointment and may be helpful in keeping the area clean. 

STITCHES

Stitches, if used, will dissolve by themselves unless otherwise mentioned by our office.

TEMPERATURE

A slight elevation of temperature may occur and is usually caused by local swelling and/or dehydration (not drinking enough fluids).  Rest and plenty of liquids will usually remedy this situation. 

If a temperature becomes extreme or persists, please notify our office.

CHAPPING

Keep your lips moist with a cream or ointment if chapping occurs.

ALLERGIC REACTIONS

Reactions to medications such as penicillin or codeine usually begin with itching, redness, or a rash.  Stop taking all medications and call our office immediately!

POST OPERATIVE APPOINTMENT

It is generally helpful to be seen for a healing check-up 7-10 days after the procedure.

PROBLEMS

If any problems, questions or concerns arise, please call us at anytime at (302) 477-1800.

Following surgery, it is very important to have something to eat and/or drink.  It is also helpful to take two Advil (400 mg. Ibuprofen).  If you are unable to take Advil, please let us know so we can advise you on what else you might be able to take.  These type medications give you a head start in minimizing discomfort before the numbness wears off.        

Since pain medicine can upset your stomach, it may be best to take half of the prescribed amount.  Since most tablets are scored, they can easily be broken in half.  This approach will allow you to see how the medication will affect you and minimize the chance of experiencing side effects.  Remember, you can always add to it if it doesn’t quite cover your discomfort.  Example:  one tablet every 4-6 hours would convert to ½ tablet every 2 - 3 hours.

Get up slowly after surgery and after taking any prescription pain medication.  Rising too quickly can cause your blood pressure to decrease and result in lightheadedness or actual fainting.  If you faint, the person with you should lay you down gently and raise your legs above the level of your head to allow for good circulation.  Do not bend over and put your head in your lap.  Finally, do not drive, operate machinery, drink alcoholic beverages, or do anything that requires focus or concentration while taking prescription pain medication or for 24 hours after taking it.

OTHER POSSIBLE CONCERNS

• On rare occasions, numbness of the lip, chin, or tongue may occur after surgery and is usually temporary. Be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. If numbness persists beyond the first 24 hours, call Dr. Rafetto for further evaluation.
• Occasionally, patients may feel hard projections in the mouth with their tongue. They are not likely roots, but rather the bony walls that supported the tooth. These projections usually smooth out on their own. If not, they can be trimmed by Dr. Rafetto.
• If the corners of your mouth were stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.
• Sore throats and mild discomfort with swallowing are not uncommon. This generally subsides in 2-3 days. If this problem becomes severe and/or is associated with swelling of the neck or under your tongue, call Dr. Rafetto.
• 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, which will resolve in time. Moist heat can be applied over the area after the 3rd day to help relieve muscle tightness. 
• A dry socket is when the blood clot that normally fills the extraction site dissolves or is dislodged prematurely from the socket. The primary symptom of a dry socket is intense pain at the surgical site (sometimes referred to the ear) that becomes evident 2-3 days following surgery. Call our office if this occurs.

A Few Additional Thoughts

After Exposure of an Impacted Tooth

BLEEDING

Bleeding is normal after surgery.  To control this, place a gauze pack over the surgical site and apply pressure in that area by biting on the gauze, for 20-30 minutes.  This may be difficult due to the location of the site and your braces being “in the way”.  Repeat this process until the bleeding has stopped.  Nonetheless, slight oozing may occur for the first few days. 

If the gauze does not adequately control the bleeding, a tea bag may be wrapped in the gauze and placed over the surgical site. 

Vigorous rinsing, drinking through a straw, spitting, and smoking all aggravate the bleeding and should be avoided for the first 24 hours.  If excessive bleeding occurs, please notify our office.

DISCOMFORT

Discomfort often accompanies this surgical procedure.  Besides discomfort at the surgical site, pain may be referred to other areas, such as the ear. 

It may be helpful to take a prescribed medication for pain relief.  However, in some cases pain medications may cause nausea, especially if taken on an empty stomach.  These medications may also cause dizziness.  Therefore, do not consume alcohol, drive, or operate machinery.  If you are able, take Advil or other similar medications in addition to or instead of prescription pain medications.  You can also take Tylenol instead of prescription pain medication, but not in conjunction with it as many prescription pain medications also often contain Tylenol. 

Do not wait for the pain to become severe before taking pain medications.

BRACKETS

Often a bracket is bonded or glued to the tooth with a chain extended from the bracket to a nearby orthodontic wire.  These brackets are intended to stay attached to the tooth, but sometimes loosen.  Fortunately, this is an uncommon occurrence. 

If the bracket does come loose, call our office or the orthodontist.

DIET

You may begin by taking liquids immediately following your surgery.  You may progress from liquids to soft foods to a regular diet over the first day or so.  It is important to keep in mind that a good diet will promote healing and should allow better tolerance of medications.

Remember, do not take any pain medication on an empty stomach. 

POST-OPERATIVE APPOINTMENT

It is important that we see you for a follow-up appointment approximately 7-10 days following your surgery.  Also, you should see your orthodontist for follow-up within a couple of weeks of our procedure, so the tooth can be activated to guide its eruption.   

QUESTIONS

If you should have any questions or concerns, please contact our office at (302) 477-1800.

Following surgery, it is very important to have something to eat and/or drink.  It is also helpful to take two Advil (400 mg. Ibuprofen).  If you are unable to take Advil, please let us know so we can advise you on what else you might be able to take.  These type medications give you a head start in minimizing discomfort before the numbness wears off.        

Since pain medicine can upset your stomach, it may be best to take half of the prescribed amount.  Since most tablets are scored, they can easily be broken in half.  This approach will allow you to see how the medication will affect you and minimize the chance of experiencing side effects.  Remember, you can always add to it if it doesn’t quite cover your discomfort.  Example:  one tablet every 4-6 hours would convert to ½ tablet every 2 - 3 hours.

Get up slowly after surgery and after taking any prescription pain medication.  Rising too quickly can cause your blood pressure to decrease and result in lightheadedness or actual fainting.  If you faint, the person with you should lay you down gently and raise your legs above the level of your head to allow for good circulation.  Do not bend over and put your head in your lap.  Finally, do not drive, operate machinery, drink alcoholic beverages, or do anything that requires focus or concentration while taking prescription pain medication or for 24 hours after taking it.

After Removal of Multiple Teeth

BLEEDING

Bleeding is normal after surgery.  To control this, place a gauze pack over the surgical site and apply firm pressure in that area by biting on the gauze, for 20-30 minutes.  This process should be repeated until the bleeding has stopped.  Nonetheless, slight oozing may occur for the first few days.  If the gauze does not adequately control the bleeding, a tea bag may be wrapped in the gauze and placed over the surgical site.  Vigorous rinsing, drinking through a straw, spitting, and smoking all aggravate the bleeding and should be avoided for the first 24 hours.  If excessive bleeding occurs, please notify our office.

DISCOMFORT

Discomfort often accompanies surgical procedures.  Besides discomfort at the surgical site, pain may be referred to other areas, such as the ear.  It may be helpful to take a prescribed medication for pain relief.  In some cases, prescription pain medications may cause nausea, especially if taken on an empty stomach.  These medications may also cause dizziness, therefore, do not consume alcohol, drive, or operate machinery.  If you can, take Advil or other similar medications in addition to or instead of prescription pain medications.  You can also take Tylenol instead of prescription pain medication, but not in conjunction with it as they both contain Tylenol.  Do not wait for the pain to become severe before taking pain medications.

SWELLING

Swelling is a normal response to surgical procedures.  It usually reaches a peak by 48-72 hours after your surgery.  On occasion, swelling may be accompanied by bruising.  To minimize the swelling, apply ice for the first 24-48 hours. 

DIET

You may begin by taking liquids immediately following your surgery.  You should progress from liquids to soft foods to a regular diet.  It is important to keep in mind that a good diet will promote healing and should allow better tolerance of medications. Do not take any pain medication on an empty stomach. 

RINSING

Do not rinse or spit for 24 hours.  After that time, rinsing with warm water will help remove food debris and aid in cleanliness.

BRUSHING

Brushing will help to keep the surgical sites clean.  Use a soft bristle toothbrush and run it under warm water to further soften the bristles.  A little bleeding may occur when you brush; however, this is generally of no consequence.

STITCHES

Stitches, if used, will dissolve by themselves, unless otherwise mentioned by our office.

ALLERGIC REACTIONS

Reactions to medications (such as penicillin or codeine) usually begin with itching, redness, or a rash.  Stop taking all medications and call our office immediately.

PROBLEMS

If any problems, questions or concerns arise, please call us at anytime at (302) 477-1800.

Following surgery, it is very important to have something to eat and/or drink.  It is also helpful to take two Advil (400 mg. Ibuprofen).  If you are unable to take Advil, please let us know so we can advise you on what else you might be able to take.  These type medications give you a head start in minimizing discomfort before the numbness wears off.        

Since pain medicine can upset your stomach, it may be best to take half of the prescribed amount.  Since most tablets are scored, they can easily be broken in half.  This approach will allow you to see how the medication will affect you and minimize the chance of experiencing side effects.  Remember, you can always add to it if it doesn’t quite cover your discomfort.  Example:  one tablet every 4-6 hours would convert to ½ tablet every 2 - 3 hours.

Get up slowly after surgery and after taking any prescription pain medication.  Rising too quickly can cause your blood pressure to decrease and result in lightheadedness or actual fainting.  If you faint, the person with you should lay you down gently and raise your legs above the level of your head to allow for good circulation.  Do not bend over and put your head in your lap. Finally, do not drive, operate machinery, drink alcoholic beverages, or do anything that requires focus or concentration while taking prescription pain medication or for 24 hours after taking it.

Insertion of an Immediate Denture

KEEP THE DENTURE IN PLACE …

You should leave your new denture in place for 24-48 hours, if possible.  This allows the underlying tissues to better heal into the shape of your denture allowing for better stability.  If this becomes too uncomfortable, or if bleeding is a continued problem, the denture can be removed for short periods of time, but should be reinserted as soon as tolerable.  After 2-3 days, the denture should be worn during the daytime only and left out at night.

BLEEDING

“Biting” with your denture in place should control the bleeding adequately.  However, if a significant bleeding persists, despite this, the denture can be removed to enable you to bite on a gauze pad placed directly over the extraction sites for 20-30 minutes.  At the end of that time, remove the gauze.  If the bleeding is well controlled replace your denture.  If the bleeding continues, repeat with the gauze for an additional 20-30 minutes.  If the bleeding continues to be excessive, please call our office.

RINSING

You may rinse gently with cold water when the denture is in place during the first 24 hours.  After that, rinsing with warm water several times a day (with or without the denture in place) will help keep the area clean.  You may want to remove the denture briefly during the first 24-48 hours and rinse gently with a mouthwash solution to provide a fresher taste.

RETENTION

Your new denture may not fit as tightly as you would like.  Remember, healing must occur before any judgment can be made about its long-term stability or fit.  Your general dentist may have to adjust the denture for the next several visits.  In the meantime, if retention becomes a significant problem, a soft lining material may be placed to help improve the stability.

BITE RELATIONSHIP

It will probably be necessary to have adjustments in the bite of your denture.  This should be done by your regular dentist, as he/she is most familiar with your proper jaw and tooth relationships.

SORE SPOTS

It is normal for sore spots to develop during the first two weeks or so.  This can generally be managed by adjustment of the denture (done by your general dentist).  However, it a bone spicule or sharp area of tissue is causing the problem, this can be easily treated in our office.

DIET

You may begin taking liquids or soft foods almost immediately.  Most people progress slowly to a regular diet.  This will generally take 10 days to several weeks depending upon your ability to tolerate the new denture, as well as the discomfort that you may experience when chewing with your new teeth.

STITCHES

If stitches were placed, they will generally dissolve by themselves; however, if these stitches are either black or purple in color, we will remove them approximately 7-10 days after the surgical procedure.

POSTOPERATIVE APPOINTMENTS

It is helpful that you see your regular dentist within the first few days after insertion of your denture.  At that time, the progress of the healing process will be evaluated and necessary adjustments made.  You will need to be followed closely for the first couple of weeks after the denture is inserted to ensure optimal healing.  You will also be seen in our office about 7-10 days after your surgery.

If you have any questions or concerns, please contact our office at (302) 477-1800.

• 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 quicker. 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)
• 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 our 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 and /or to adjust you bite relationship.

After Placement of Dental Implants

You have just completed the first step of your implant treatment.  Proper care of your mouth will aid in the healing process and reduce the possibility of complications.  The following instructions will assist you with this healing phase.

DISCOMFORT

Discomfort often accompanies surgical procedures.  Besides discomfort at the surgical site, pain may be referred to other areas, such as the ear.  It may be helpful to take a prescribed medication for pain relief.  In some cases, prescription pain medications may cause nausea, especially if taken on an empty stomach.  These medications may also cause dizziness, therefore, do not consume alcohol, drive, or operate machinery.  If you can, take Advil or other similar medications in addition to or instead of prescription pain medications.  You can also take Tylenol instead of prescription pain medication, but not in conjunction with it as they both contain Tylenol.  Do not wait for the pain to become severe before taking pain medications.

BLEEDING

Bleeding is normal after surgery.  To control this, place a gauze pack over the surgical site and apply firm pressure in that area by biting on the gauze, for 20-30 minutes.  This process should be repeated until the bleeding has stopped.  Nonetheless, slight oozing may occur for the first few days.  If the gauze does not adequately control the bleeding, a tea bag may be wrapped in the gauze and placed over the surgical site.  Vigorous rinsing, drinking through a straw, spitting, and smoking all aggravate the bleeding and should be avoided for the first 24 hours.  If excessive bleeding occurs, please notify our office.

SWELLING

Swelling is a normal response to surgical procedures.  It usually reaches a peak by 48-72 hours after your surgery.  On occasion, swelling may be accompanied by bruising.  To minimize the swelling, apply ice for the first 24-48 hours. 

DIET

We would like you to eat soft nutritious foods.  Care should be taken to avoid hard or crunchy foods that may cause trauma to the implant area.  The day after your surgery, gently rinse with warm water after every meal to keep your mouth clean.  Do not attempt to floss, brush or Water-pik in the area of surgery until after your stitches are removed.  This will be approximately 7-10 days after your surgery.  Once they are removed, run your toothbrush under warm water to soften the bristles.  Then gently massage your gums in the area of the surgery.  The rest of your mouth can be cleaned as usual.  Review further cleaning techniques with your dental hygienist.

ANTIBIOTICS

We may prescribe an antibiotic course for you following your surgery.  It is important that you finish this medication unless otherwise directed. 

ALLERGIC REACTIONS

Reactions to medications (such as penicillin or codeine) usually begin with itching, redness, or a rash.  Stop taking all medications and call our office immediately.

APPLIANCE

Your dental appliance (denture, retainer, nightguard) may be able to be worn after your surgery, if it fits without causing pain.  Remember no undue pressure should be applied over the implant surgical site, as it could affect the success of your implant.   

ACTIVITIES

Following your procedure, you may find it advisable to take it easy for a day or two afterward.  Jogging and vigorous activities should be avoided for a few days.

SMOKING

Smoking has been shown to negatively affect the healing process in several ways.  Therefore, it should be avoided for at least two weeks following your surgery

PROBLEMS

Should you notice any swelling, redness, or discomfort in the area of the implant, please notify the office.  If any problems, questions or concerns arise, please call us at anytime at (302) 477-1800.

Following surgery, it is very important to have something to eat and/or drink.  It is also helpful to take two Advil (400 mg. Ibuprofen).  If you are unable to take Advil, please let us know so we can advise you on what else you might be able to take.  These type medications give you a head start in minimizing discomfort before the numbness wears off.        

Since pain medicine can upset your stomach, it may be best to take half of the prescribed amount.  Since most tablets are scored, they can easily be broken in half.  This approach will allow you to see how the medication will affect you and minimize the chance of experiencing side effects.  Remember, you can always add to it if it doesn’t quite cover your discomfort.  Example:  one tablet every 4-6 hours would convert to ½ tablet every 2 - 3 hours.

Get up slowly after surgery and after taking any prescription pain medication.  Rising too quickly can cause your blood pressure to decrease and result in lightheadedness or actual fainting.  If you faint, the person with you should lay you down gently and raise your legs above the level of your head to allow for good circulation.  Do not bend over and put your head in your lap. Finally, do not drive, operate machinery, drink alcoholic beverages, or do anything that requires focus or concentration while taking prescription pain medication or for 24 hours after taking it.