Surgical Instructions

San Francisco patients undergoing surgical procedures will discuss options for anesthesia prior to their procedure. Your choice of anesthesia is the first step to a successful and comfortable dental surgery.

Intravenous sedation is administered to relax patients and help the time pass during the surgical procedure. You will be able to respond to your oral surgeon, but, typically, you will not recall anything between when your surgeon administered sedation until shortly after the procedure.

To prepare for intravenous sedation you should:

  • Not eat or drink anything (including water) for at least six hours before the appointment.
  • Not smoke at least 12 hours before surgery. The more time that elapses between smoking and your surgery, the better.
  • Bring a responsible adult who stays in the office during your surgery and then drives or accompanies you home.
  • Not drive or operate machinery for the first 24 hours after anesthesia.
  • Wear loose-fitting clothing with sleeves that can be rolled up past the elbow and shoes with little or no heel.
  • Remove dentures, jewelry, and contact lens before surgery begins.
  • Not wear makeup, including nail polish and lipstick, on the day of your surgery.
  • Notify our office if you have a cold, sore throat, upset stomach, or any other illness.
  • Check with Dr. Michael Chan, Dr. William Chan, Dr. Kirsten Rittenbach, or Dr. Brian Yang about instructions for taking your normal oral medications on the day of surgery.

Your wound will need time to heal, and you should not do anything to disturb the wound on the day of surgery. You should avoid:

  • Rinsing
  • Spitting
  • Touching the wound

You may have a healing abutment visible through your gums and your gum tissue will need to heal around it.

Bleeding

It is normal to notice some bleeding during the first 24 hours after surgery. If bleeding becomes excessive and your mouth fills with blood quickly, you should place a gauze pad over the wound and bite down for one and a half to two hours. If you continue to bleed, call SF Oral Surgery immediately for further instructions.

Swelling

Another common symptom of surgery is swelling. You can apply ice in a bag or towel on your cheek to reduce the swelling. Ice should repeatedly be applied for the first 24-36 hours after surgery. The swelling will typically peak on the third day after surgery, and then resolve quickly thereafter.

Diet

After your surgery you should maintain a diet of soft foods and liquids that are cool or room temperature. You should avoid hot foods and liquids while recovering. As you start to recover from surgery, you can return to a normal diet when chewing is comfortable.

Pain

You will begin to feel some pain when the local anesthesia starts to wear off. When you start to regain feeling, you should take your first dose of pain medication. One or two Tylenol or Tylenol extra strength are recommended to manage moderate pain. You can take this medication every 3-4 hours as needed. If you do not want to take Tylenol, you can take 2-4 tablets of 200 mg Advil or Motrin (ibuprofen) every 6-8 hours instead.

For patients who undergo more extensive surgery, Dr. Michael Chan, Dr. William Chan, Dr. Kirsten Rittenbach, or Dr. Brian Yang will prescribe pain medication. This should be taken as directed and you should inform them of any allergies.

Antibiotics

You may be prescribed antibiotics to prevent infection and speed your healing. Take this medication as instructed by your oral surgeon.

Oral Hygiene

Your oral care routine will change as you heal. Rather than brushing your teeth, you may need to rinse with Peridex Oral Rinse for at least 30 seconds the night after your surgery. The next day, rinse with Peridex in the morning following breakfast and before going to sleep.

To maintain a healthy mouth after surgery, you should rinse with warm water and salt (one teaspoon per cup of water) 4-5 times per day. You can continue brushing your teeth a few days after surgery, but remember to be gentle around the surgical site.

Physical Activity

Exercise should be kept to a minimum immediately after surgery to prevent soreness and bleeding. If you start experiencing these symptoms while exercise, stop immediately. Your lack of normal diet will inhibit exercise as well because you will be weaker than usual until you have healed.

When to Wear Your Prosthesis

You should not put your prosthetic teeth in immediately after surgery. You will have some instructions prior to surgery, but Dr. Michael Chan, Dr. William Chan, Dr. Kirsten Rittenbach, or Dr. Brian Yang will inform you when you can begin wearing your partial dentures, full dentures, or flippers.

Wisdom tooth removal is a common procedure that will take some time to heal. While the procedure is safe and effective in treating symptoms, you should take the time to rest and properly care for the surgical site.

 

Immediately After Surgery

  • You will have gauze over the area of your surgery. This should only be changed regularly only after a minimum of 1.5-2 hours.
  • You should avoid any irritation or activity such as rinsing your mouth repeatedly, drinking through a straw, or touching the surgical site to prevent bleeding.
  • Take time to rest after surgery. Some patients will take a few days to feel up for normal activities.
  • Apply ice packs lightly to the side of your face to reduce swelling.
  • Do not wait until the anesthesia wears off to take your pain medication. This will prevent any discomfort or pain.

Swelling

You will not have much initial swelling until the day after your surgery, and this will peak 2-3 days after surgery. To reduce this swelling, you should immediately apply ice packs to the side of your face. It is crucial to apply ice continuously for the first 24-36 hours after surgery to minimize swelling.

After 36 hours, you should switch to moist heat to reduce swelling. Your swelling may continue for several days. Jaw stiffness is also normal for the first few weeks after surgery.

Bruising

Some patients will experience bruising after swelling has gone down. This is normal and is likely to occur 2-3 days after your surgery. To improve your comfort, you can apply moist heat to the area.

Bleeding

It is normal to experience some bleeding after any oral surgery. While a little bleeding or blood mixed in the saliva is normal, you should control any excessive bleeding by rinsing or wiping blood clots from your mouth. Follow this by reapplying gauze and biting down for 1.5-2 hours. This step should be repeated until the bleeding subsides. If you continue to bleed, you can use a tea bag instead of a gauze pad.

All exercise, sitting up, and excitement should be avoided until you have begun to heal. Drinking from a straw and talking can also disrupt your surgical site. If you have followed all of these instructions and still experience bleeding, call SF Oral Surgery.

Pain

Dr. Michael Chan, Dr. William Chan, Dr. Kirsten Rittenbach, or Dr. Brian Yang normally prescribe pain medication to reduce discomfort for the first few days after surgery. This medication will relieve pain but also cause you to feel drowsy. You should not drive a vehicle or operate machinery after taking this medication. If you pain does not begin to fade after a few days you should call SF Oral Surgery.

When your pain becomes moderate, you can switch to 2-4 200 mg tablets of Ibuprofen (Advil or Motrin) or 1-2 tablets of Extra Strength Tylenol or Tylenol every 3-4 hours.

Antibiotics

It is common to receive antibiotics as a way to minimize the risk of infection. If you develop a rash or other adverse reaction, you should stop taking the antibiotic and call SF Oral immediately.

Drinking

You should start rehydrating as soon as possible after your surgery. Water is best; however any beverage will help. Do not use a straw to drink because it can cause additional bleeding. Instead, sip from a glass and make sure to drink 5-6 glasses of fluid to supplement your diet. You may supplement your oral intact with protein or meal replacement shakes.

Eating

You should not chew on the side of your surgical site until it has healed. Anything soft with a high calorie and protein content is best because your ability to eat will be limited for the first few days. Remember that eating and drinking regularly will help you regain your strength and speed healing.

Oral Hygiene

On the day of your surgery, you should not rinse your mouth at all. The day after, you can both rinse and gently brush your teeth. Rinsing your mouth with warm salt water 5-6 times per day will help keep your surgical site clean, especially after eating.

Nausea and Vomiting

Do not eat, drink or take prescribed medication if you are vomiting or nauseous after surgery. Instead, wait at least one hour for the feeling to subside. At this point, you can sip a carbonated beverage such as Coke, 7-Up, or Ginger Ale over a period of 15 minutes. You should not attempt to move and simply rest. If you are bleeding, follow the above section to prevent swallowing too much blood.

When you feel better, begin your normal routine of prescribed medication, food, and drink.

Additional Complications

  • Your tongue, cheek, chin, or lip may temporarily feel numb after surgery. Be cautious about chewing because you could inadvertently harm yourself.
  • A small increase in body temperature is normal for the first 24-48 hours after surgery. If this lasts longer, contact the office. You can take Tylenol or Ibuprofen for your fever.
  • Be careful standing up quickly, you are likely not eating or drinking as usual and can get weak. You may also experience dizziness from pain medication.
  • You may notice hard projections in your mouth after surgery. These bony walls normally smooth on their own as you heal. However, if they do not then Dr. Michael Chan, Dr. William Chan, Dr. Kirsten Rittenbach, or Dr. Brian Yang can remove them.
  • Keep your lips from cracking by applying moisturizing ointment to remain comfortable.
  • Some patients will experience sore throats and pain when swallowing. These symptoms typically take 2-3 days to resolve.
  • It may become difficult to open your mouth for a few days because of jaw stiffness. This will also correct itself a few days after surgery.

Additional Information

  • Your oral surgeon may have closed the area using sutures. They are typically dissolvable and it is best to leave them alone.
  • It will take you a few months to completely heal. Continue warm water salt rinses and brushing your teeth after meals to keep the area clean.
  • If you experience any problems, call SF Oral Surgery for advice or information about what to do next.

Surgery to expose an impacted tooth will result in a surgical wound that will be covered in gauze and possibly surgical packing. Do not touch either because it will help in the healing process. If the surgical gauze falls out on its own, it is completely normal, and you should not panic.

Pain

Start taking your pain medication when you begin to feel the effects of the anesthesia wear off. You will likely be given a prescription pain medication to manage the first few days of pain. Take this medication as instructed and be sure not to drive or operate heavy machinery after taking it.

If you experience mild or moderate pain, take 1-2 tablets of Tylenol or Extra Strength Tylenol every 3-4 hours as needed. If you prefer ibuprofen, you can take 2-4 tablets every 6-8 hours.

Bleeding

Blood in saliva and the mouth is completely normal for the first 24 hours after surgery. Apply a gauze pad to your surgical site and bite down for one and a half to two hours if you are bleeding more. Call SF Oral Surgery if these symptoms persist.

Swelling

All patients will experience some degree of swelling after their surgery. To better manage this side effect, apply ice to your cheek often in the first 24-36 hours after surgery. This will reduce the pain and swelling.

Physical Activity

Do not overexert yourself in the first few days after surgery. You should limit exercise and other strenuous physical activities to avoid bleeding, pain, or discomfort. Because you are taking pain medication and eating less food, you can get dizzy during any activity. Consult Dr. Michael Chan, Dr. William Chan, Dr. Kirsten Rittenbach, or Dr. Brian Yang for more information about when to get back to your normal routine.

Oral Care

You will need to continue cleaning your mouth to maintain good oral hygiene. You can begin by gently brushing your teeth after meals the day after surgery. Brush gently to avoid disturbing your surgical site and rinse your mouth with warm salt water (1 teaspoon with a cup of warm water) six times per day.

Eating and Drinking

You should switch to a diet of soft foods until you begin to feel better. Stay hydrated and drink 5-6 glasses of fluid each day. Discontinue hot food and beverages until your surgical site heals.

Tooth extraction is a serious surgical procedure that will require time to heal from the surgical wound. You should limit your activity after surgery, resting and continuing to bite down on the gauze pad for 1.5-2 hours after surgery. If the bleeding has not subsided, replace the gauze pad with a clean gauze pad or tea bag for an additional 1.5-2 hours. The bleeding may take several hours to subside, but this is fine as long as it is not excessive.

Clotting

Once the bleeding has stopped, a blood clot will form over your surgical site. This is a normal part of healing, and you should avoid touching the blood clot with your tongue. To keep the blood clot intact you should avoid eating or drinking hot food or liquid, drinking through a straw, rinsing your mouth or brushing your teeth for 24 hours after surgery. If you drink alcohol or smoke, these activities should be avoided for 72 hours. Exercise should be limited for a few days after surgery and only continued when you begin to improve.

Symptoms After Surgery

Pain, swelling, and possibly bruising will occur within the first few days. To avoid swelling and bruising, apply ice to your cheek until 24-36 hours after surgery. You will have a prescription for pain medication, which you should take as directed by Dr. Michael Chan, Dr. William Chan, Dr. Kirsten Rittenbach, or Dr. Brian Yang.

After Removing Multiple Teeth

As you heal you may experience:

  • Swelling for 2-3 days. This can be reduced with the application of ice to your cheek for the first 24-36 hours after surgery. You may also notice bruising around the eye, which can be alleviated by applying moist heat after 36 hours.
  • Sore throat from irritation from surgery. This should only last 2-3 days.
  • Cracked, dry lips. This is the result of stretching your mouth for the procedure. Apply a moisturizing lip ointment to correct this problem.
  • Low fever for the initial 24-48 hours. If you temperature persists after two days, call SF Oral Surgery for additional information.

Patients who have immediate dentures can develop sore areas. These will be corrected during your dentist visit 24-48 hours after surgery.

Getting Back to Normal

Keeping good oral hygiene habits important for healing. You should continue brushing and flossing at least once a day 24 hours after surgery. This will remove all bacteria, speed healing, and lower the risk of infection. You will be able to return to your normal routine a few days after surgery.