Post-Procedures Instructions

Surgical Instructions Section

Before General Anesthesia or Intravenous Sedation

  • You may not have anything to eat or drink (including water) for at least six (6) hours prior to the appointment.
  • No smoking at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery.
  • A responsible adult, over 18 must accompany the patient to the office, remain in the office during the procedure, and drive the patient home. No children should be present with the escort.
  • 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.
  • Do not wear lipstick, excessive makeup, or nail polish on the day of surgery.
  • If you have an illness such as a cold, sore throat, stomach or bowel upset, please notify the office.
  • If there is any chance you are PREGNANT, notify your doctor immediately.
  • If you take routine oral medications, please check with Dr. Bontempi or Paolella prior to your surgical date for instructions.

After Wisdom Tooth Removal

The removal of impacted teeth can be a serious surgical procedure. Post-operative care is very important. Unnecessary discomfort and the complications of infection and swelling can be minimized if the instructions are followed carefully. Please read these instructions carefully. Sometimes the after effects of oral surgery are quite minimal, so not all of these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call the office at any time for clarification.

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. If active bleeding persists after _ hour, place a new piece of gauze to obtain pressure over the surgical site for another 30 – 60 minutes. The gauze may be changed as necessary and may be dampened or fluffed for more comfortable positioning. For wisdom teeth, remember that the teeth are behind your last tooth and the gauze should be positioned accordingly.

Exercise Care

Do not disturb the surgical area. Vigorous mouth rinsing or touching the wound following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged. You may brush your teeth, however, avoid areas where surgery has been done. DO NOT SMOKE for at least 48 to 72 hours, since it is can slow down or prevent the wound from healing. Take it easy today. Do not do anything too strenuous.

Steady Bleeding

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 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling

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 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two 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 applied twenty minutes on and twenty minutes off during the first 12 to 24 hours. After 24 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. Thirty-six hours following surgery the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling and stiffness. Like the cold packs, heat should be applied for twenty minutes on and twenty minutes off over the tender areas. Also sleeping with your head elevated (in a reclining chair or with 2 to 3 pillows) will help to minimize the total amount of swelling.

Pain

Unfortunately most oral surgery is accompanied by some degree of discomfort. For mild to moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every 6-8 hours or Ibuprofen, (Motrin or Advil) two to four 200 mg tablets may be taken every 4-8 hours with food. Do not take Motrin/ Advil/ or other anti-inflammatories if you are pregnant. This medication should ideally be taken before the anesthetic has worn off.

For severe pain take the tablets prescribed for pain as directed. The prescribed pain medicine may make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Be careful, pain medication can cause an upset stomach and should be taken with some food and never on an empty stomach. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require extra attention and you should call the office.

Diet

After general anesthetic or I.V. sedation, liquids should be taken at first. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat soft or pureed foods (yogurts, soups, pudding, etc) by chewing away from the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. Temperature of the food does not matter, but avoid extremely hot or cold foods. Avoid food like nuts, sunflower seeds, popcorn, etc., that may get lodged in the surgical areas. It is also a good idea to avoid spicy or acidic (orange juice) foods. 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. If you are diabetic, maintain your normal eating habits as much as possible and follow instructions from us or your physician regarding your insulin schedule. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. Therefore, immediately following surgery, if you are lying down, make sure you sit for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be done until the day following surgery. You can brush your teeth the night of surgery but rinse gently. Do not brush any of the surgical areas. The day after surgery you should begin rinsing at least 4-5 times a day especially after eating with a cup of warm water mixed with some table salt. Use one-quarter teaspoon of salt dissolved in an 8 ounce glass of warm water, taking about 5 minutes to use the entire glassful. If you were given an irrigating syringe by your doctor, start using it (with the salt water) on the second day to keep the sockets clean.

Discoloration/Bruising

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. This is most common in the lower jaw. Moist heat applied to the area may speed up the removal of the discoloration.

Sharp Edges

If you feel sharp edges in the surgical areas with your tongue it is probably the bony walls which originally supported the teeth. Occasionally small sliver of bone may work themselves out during the first week or two after surgery. They are not pieces of tooth and, if necessary, Dr. Bontempi or Paolella will remove them. Please call the office if you are concerned.

Dry Sockets

If a dry socket (loss of blood clot from the tooth socket, usually noticeable on the 3rd to 5th day after surgery) occurs, there will be a noticeable, distinct, and persistent pain in the jaw like a toothache. Often the pain radiates toward the ear and forward along the jaw, causing other teeth to ache. Pain medication usually does not help. If you do not see steady improvement during the first few days after surgery, do not suffer needlessly. Call the office and report symptoms so you can be seen as soon as possible.

Antibiotics

If you have been placed on antibiotics take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable/allergic reaction. If you are a women and taking Birth Control Pills, an alternative birth control method MUST be used for at least one month. Call the office if you have any questions.

Nausea and Vomiting

Nausea is not an uncommon event following surgery. It is usually the result of medications given during the surgery (general anesthesia) or it is sometimes caused by stronger postoperative pain medicines. This nausea may be reduced by preceding each pain pill with a small amount of soft food and then taking the pill with a large volume of water. 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, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking bland (toast/crackers/etc) foods and the prescribed medicine. Call us if you do not feel better or if repeated vomiting is a problem.

Other Complications

  • 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 it so be careful. Call Dr. Bontempi or Paolella if you have any questions about this.
  • 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.
  • As you were not able to eat or drink prior to surgery, it is difficult to take fluids, and you may be taking pain medications, you should be careful going from the lying down position to standing. You may get light headed if you stand up suddenly. Before standing up, you should sit for one minute then get up.
  • 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 get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days. Taking cold liquids (ice water) can help to reduce the symptoms.
  • Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event that will resolve in time.

Finally

  • Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. Drs. Bontempi and Paolella mainly use dissolvable sutures. Most of the time these do not need to be removed. If removal is necessary it requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.
  • 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, call the office for instructions.
  • There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with new gum tissue and bone. In the mean time, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.
  • Your case is individual, no two mouths are alike. Do not take seriously well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Bontempi or Paolella or your family dentist.
  • If you are involved in regular exercise be aware that if your normal nourishment intake is reduced, then exercise may weaken you. If you get light headed, stop exercising.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you still have questions, please call the office. Our offices are open Monday thru Friday from 9 AM to 5PM. One doctor will always be available 24 hours a day for you or to answer any questions or concern that you may encounter.

After Exposure of an Impacted Tooth

Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully. Please read these instructions carefully. Sometimes the after effects of oral surgery are quite minimal, so not all of these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call the office at any time for clarification.

Do not disturb the wound. If a 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.

Bleeding

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, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling

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 twenty minutes on and twenty minutes off for the first 24 hours. Ice after 24 hours does not affect swelling, but may help with their discomfort. In addition, sleeping with your head elevated (with 2 to 3 pillows or in a recliner) will help to minimize swelling.

Diet

Drink plenty of fluids. Avoid hot liquids or food. It is also a good idea to avoid spicy or acidic (orange juice) foods. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

Pain

You should begin taking pain medication before the local anesthetic wears off. For mild to moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 6 hours. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 3 tablets may be taken every 6 hours as needed for pain. Do not take Motrin/ Advil/ or other anti-inflammatories if you are pregnant.

For severe pain, take the tablets prescribed for pain as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Be careful, pain medication can cause an upset stomach and should be taken with some food and never on an empty stomach. 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.

Antibiotics

If you have been placed on antibiotics take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable/allergic reaction. If you are a woman and taking Birth Control Pills, an alternative birth control method MUST be used for at least one month. Call the office if you have any questions.

Oral Hygiene

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, taking care to avoid the surgical sites. Rinse with warm salt water (1/2 teaspoon of salt in an 8 ounce cup of warm water) 4 to 5 times a day. Continue this procedure until healing is complete. REMEMBER: A clean wound heals better and faster. DO NOT SMOKE for at least 48 to 72 hours since it is can slow down or prevent the wound from healing.

Activity

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 that may weaken you during excess energy expenditure.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you still have questions, please call the office. Our offices are open Monday thru Friday from 9 AM to 5PM. One doctor will always be available 24 hours a day for you or to answer any questions or concerns that you may encounter.

After the Removal of Single or Multiple Teeth

Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully. Please read these instructions carefully. Sometimes the after effects of oral surgery are quite minimal, so not all of these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call the office at any time for clarification.

Bleeding

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. If active bleeding persists after _ hour, place a new piece of gauze to obtain pressure over the surgical site for another 30 – 60 minutes. The gauze may be changed as necessary and may be dampened or fluffed for more comfortable positioning.

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 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright rather than lying flat, and avoid excessive exercise. If bleeding does not subside, call for further instructions. If immediate dentures are placed, do not remove immediate denture unless the bleeding is severe, expect some oozing around the side of the denture.

Exercise Care

Do not disturb the surgical area. Vigorous mouth rinsing or touching the wound following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged. You may brush your teeth. Avoid areas where surgery has been done. DO NOT SMOKE for at least 48 to 72 hours, since it is can slow down or prevent the wound from healing. Take it easy today. Do not do anything too strenuous.

Swelling

The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two 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 applied twenty minutes on and twenty minutes off during the first 12 to 24 hours. After 24 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. Thirty-six hours following surgery the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling and stiffness. Like the cold packs, heat should be applied for twenty minutes on and twenty minutes off over the tender areas. Also sleeping with your head elevated (in a reclining chair or with 2 to 3 pillows) will help to minimize the total amount of swelling.

Pain

Unfortunately most oral surgery is accompanied by some degree of discomfort. For mild discomfort use Tylenol or any similar medication; one to two tablets every 6 hours. Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 6 hours. Do not take Motrin/ Advil/ or other anti-inflammatories if you are pregnant.

For severe pain take the tablets prescribed for pain as directed. The stronger prescribed pain medicine may make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Be careful, pain medication can cause an upset stomach and should be taken with some food and never on an empty stomach. 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.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable/allergic reaction. If you are a women and taking Birth Control Pills, and alternative birth control method MUST be used for at least one month. Call the office if you have any questions.

Nausea

Nausea is not an uncommon event following surgery. It is usually the result of medications given during the surgery (general anesthesia) or it is sometimes caused by stronger postoperative pain medicines. This nausea may be reduced by preceding each pain pill with a small amount of soft food, then taking the pill with a large volume of water. 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, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking bland (toast/crackers/etc) foods and the prescribed medicine. Call us if you do not feel better or if repeated vomiting is a problem.

Keep the mouth clean

No rinsing of any kind should be done until the day following surgery. You can brush your teeth the night of surgery but rinse gently. Do not brush any of the surgical areas. The day after surgery you should begin rinsing at least 4-5 times a day especially after eating with a cup of warm water mixed with some table salt. Use one-quarter teaspoon of salt dissolved in an 8 ounce glass of warm water, taking about 5 minutes to use the entire glassful. If you were given an irrigating syringe by your doctor, start using it (with the salt water) on the second day to keep the sockets clean.

Diet

Restrict your diet to liquids and soft foods which are comfortable for you to eat. As the wounds heal you will be able to advance your diet. Good nutrition is important to successful wound healing, and will make you fell better. Drink plenty of fluids. If many teeth have been extracted the blood lost at this time needs to be replaced. Drink at least six to eight glasses of liquid the first day.

Dry Socket

If a dry socket (loss of the blood clot from the tooth socket, usually noticeable on the 3rd to 5th day after surgery) occurs, there will be a noticeable, distinct, and persistent pain in the jaw like a toothache. Often the pain radiates toward the ear and forward along the jaw, causing other teeth to ache. Pain medication usually does not help. If you do not see steady improvement during the first few days after surgery, do not suffer needlessly. Call the office and report symptoms so you can be seen as soon as possible.

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:

  • A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days. Drinking cold liquids (ice water) can help alleviate the symptoms.
  • 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 the office.
  • If immediate dentures have been inserted, sore spots may develop. In many cases your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.
  • Immediate dentures should be left in for 24 to 48 hours. They should not been removed unless instructed by your doctor. After 48 hours, they can be removed for about 5 minutes, cleaned, and placed back into the mouth. Postoperative swelling can acutely cause a poor fitting or painful denture if it is left out of the mouth for a long period of time.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you still have questions, please call the office. Our offices are open Monday thru Friday from 9 AM to 5PM. One doctor will always be available 24 hours a day for you or to answer any questions or concern that you may encounter.

After Placement of Dental Implants

Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully. Please read these instructions carefully. Sometimes the after effects of implant surgery are quite minimal, so not all of these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call the office at any time for clarification.

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There may be a metal healing abutment protruding through the gingival (gum) tissue.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. 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. If active bleeding persists after _ hour, place a new gauze to obtain pressure over the surgical site for another 30 – 60 minutes. The gauze may be changed as necessary and may be dampened or fluffed for more comfortable positioning. 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 thirty 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, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Exercise Care

Do not disturb the surgical area. Vigorous mouth rinsing or touching the wound following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged. You may brush your teeth. Avoid areas where surgery has been done. DO NOT SMOKE for at least 48 to 72 hours, since it is can slow down or prevent the wound from healing. Take it easy today. Do not do anything too strenuous. Strenuous exercise may increase bleeding and delay wound healing.

Swelling

Swelling is a normal occurrence after surgery. 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 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two 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 applied twenty minutes on and twenty minutes off during the first 12 to 24 hours. After 24 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. Thirty-six hours following surgery the application of moist heat to the side of the face is beneficial in reducing the size of the swelling and stiffness. Like the cold packs, heat should be applied for twenty minutes on and twenty minutes off over the tender areas. Also sleeping with your head elevated (in a reclining chair or with 2 to 3 pillows) will help to minimize the total amount of swelling.

Diet

Liquids should be taken at first. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat soft or pureed foods (yogurts, soups, pudding, etc) by chewing away from the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. Temperature of the food does not matter, but avoid extremely hot or cold foods. Avoid food like nuts, sunflower seeds, popcorn, etc., that may get lodged in the surgical areas. It is also a good idea to avoid spicy or acidic (orange juice) foods. 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. If you are diabetic, maintain your normal eating habits as much as possible and follow instructions from us or your physician regarding your insulin schedule.

Pain

Unfortunately most oral surgery is accompanied by some degree of discomfort. For mild to moderate pain, 1 or 2 tablets of Tylenol or Extra Strength Tylenol may be taken every 6-8 hours or Ibuprofen (Motrin or Advil) two to four 200 mg tablets taken every 6-8 hours. Do not take Motrin/ Advil/ or other anti-inflammatories if you are pregnant. This medication should be taken before the anesthetic has worn off.

For severe pain, take the tablets prescribed for pain as directed. The prescribed pain medicine may make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Be careful, pain medication can cause an upset stomach and should be taken with some food and never on an empty stomach. 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. Do not take any of the medication if you are allergic, or have been instructed by your doctor not to take it.

Nausea

Nausea is not an uncommon event following surgery. It is usually the result of medications given during the surgery (general anesthesia) or it is sometimes caused by stronger postoperative pain medicines. This nausea may be reduced by preceding each pain pill with a small amount of soft food, then taking the pill with a large volume of water. 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, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking bland (toast/crackers/etc) foods and the prescribed medicine. Call Dr. Bontempi or Paolella if you do not feel better or if repeated vomiting is a problem.

Antibiotics

If you have been placed on antibiotics take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable/allergic reaction. If you are a women and taking Birth Control Pills, an alternative birth control method MUST be used for at least one month. Call the office if you have any questions.

Oral Hygiene

Good oral hygiene is essential to good healing, especially with implants. The day after surgery, the Peridex Oral Rinse should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. This should be done for about three weeks or until the doctor tells you otherwise. Warm saltwater rinses (one quarter teaspoon of salt in an 8 ounce cup of warm water) should be used at least 4-5 times a day, as well, especially after meals. Brushing your teeth is no problem. Do not brush the implant or the surgical site for 2 weeks, unless instructed by your doctor. Always be gentle initially with brushing the surgical areas and use an extra soft toothbrush.

Implant Maintenance

Implants need time to integrate with the surrounding bone. A major cause of implant failure is implant mobility. After 2 weeks the implants or their healing caps can be gently brushed, but absolutely no eating or pressure should be applied to the implant during the healing process. This can take anywhere from 6 weeks to 6 months. Your doctor will tell you how long this process will take. If you have an oral hygiene appointment (dental cleaning) with your dentist before the implant has been completely restored, please advise the hygienist not to clean the healing cap/implant with anything other than a toothbrush.

Activity

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

Partial dentures, flippers, or full dentures should not be used immediately after surgery unless instructed by your doctor. If these devices are to be worn, no pressure or forces should be placed on the implants. This may require minor adjustments to the dentures. If there is any pain associated with wearing the dentures post operatively or they are clearly hitting on the implant healing cap, they should be removed immediately and the doctor should be called.

Immediate Temporization

If your doctor has placed an immediate temporary on your implant, care must be applied to the crown of the tooth. It is present only for cosmetic reasons. NO CHEWING must be done on the tooth. This can cause micro movement and prevent the implant from integrating with your bone. If you have any concerns, call the office with any questions.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you still have any questions, please call the office. Our offices are open Monday thru Friday from 9 AM to 5PM. One doctor will always be available 24 hours a day for you or to answer any questions or concern that you may encounter.

After Cosmetic Surgery

Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully. Please read these instructions carefully. Sometimes the after effects of cosmetic surgery are quite minimal, so not all of these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call the office at any time for clarification.

Guidelines

In the first few hours following surgery, the surgical site will usually feel “tight” more than painful. If you have a bandage or dressing over the site leave the dressing in place for 24 hours unless otherwise instructed by your doctor.

Exercise Care

Be very careful of the operative site in the first few days after surgery and avoid any direct pressure or contact with the area. Take it easy for the first 24 hours and limit any strenuous activity.

Oozing

You may notice some oozing from the surgical site and this may cause some staining of the gauze bandage. This is expected following surgery. If necessary, you may place an additional gauze pad over the dressing and secure it with some tape or a Band-Aid. Bleeding should not be severe. If you notice steady bleeding or persistent oozing, remove the surgical dressing and place a fresh gauze pad over the operative site. Use direct pressure on the suture line without letting up for twenty minutes. If the bleeding persists or if you notice significant swelling under the suture line, call the office immediately.

Swelling

Swelling is a normal occurrence after soft tissue surgery. To minimize swelling, apply an ice bag or a plastic bag or towel filled with ice cubes on the area of surgery. Apply the ice twenty minutes on and twenty minutes off for the first 24 hours. Always use a cloth placed between the skin and the ice to prevent skin freezing. The swelling should be diffuse and soft, with very little pain elicited when the area is touched. If the swelling is tense or painful, call your doctor immediately.

Pain

Unfortunately most surgery is accompanied by some degree of discomfort. For mild to moderate pain, 1 or 2 tablets of Tylenol or Extra Strength Tylenol may be taken every 6-8 hours or Ibuprofen (Motrin or Advil) two to four 200 mg tablets may be taken every 6-8 hours. Do not take Motrin/ Advil/ or other anti-inflammatories if you are pregnant. This medication should be taken before the anesthetic has worn off.

For severe pain take the tablets prescribed for pain as directed. The prescribed pain medicine may make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Be careful, pain medication can cause an upset stomach and should be taken with some food and never on an empty stomach. 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.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable/allergic reaction. If you are a woman and taking Birth Control Pills, an alternative birth control method MUST be used for at least one month. Call the office if you have any questions.

Nausea

Nausea is not an uncommon event following surgery. It is usually the result of medications given during the surgery (general anesthesia) or it is sometimes caused by stronger postoperative pain medicines. Nausea may be reduced by preceding each pain pill with a small amount of food and then taking the pill with a large volume of water. 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, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking bland (toast/crackers/etc) foods and the prescribed medicine. Call us if you do not feel better or if repeated vomiting is a problem.

Diet

Try to keep up your food intake in the early postoperative period. Eat whatever foods you are comfortable with and be sure to maintain your fluid intake. Good nutrition is essential to optimum wound healing.

Wound Care

After 24 hours, you may remove the surgical dressing and leave the area exposed. To avoid excessive scarring, you will want to clean the wound thoroughly. Mix equal parts of hydrogen peroxide and water in a small cup. Using a cotton swab, gently clean the wound in the direction of the incision line (not across it) of all dried blood and scabs so that only skin and sutures are visible. After cleaning the suture line, apply a small amount of Bacitracin or Neosporin to the wound. This should be done three times a day until you see the doctor.

Showering

You may shower after 24 hours. The wound may get wet, but do not place the wound in direct contact or totally submerged in water. Afterward, use care in drying the skin around the wound and gently pat the incision dry.

Sunlight

For the next 6 to 12 months you should avoid direct sunlight to the operative site. Tanning pigments will become trapped in the healing wound leaving a darkened scar as the surrounding skin tan fades. This can be accomplished by keeping the area covered or liberally applying sunscreen to the area (at least SPF30).

Keloids

If you are prone to forming keloids (abnormal scar tissue), or have a history of getting keloids after cuts and surgery, please notify your doctor ahead of time. There are techniques Dr. Bontempi and Paolella a can do to cut down on keloid formation.

Follow-Up

You will normally be seen in 5 to 7 days after the surgery for suture removal. If you do not have an appointment please call the office as soon as possible to schedule a postoperative visit. Once the sutures are removed, it will take another two to three weeks for the wound to reach an optimum level of strength. During this early healing period, it is essential to exercise care and avoid too much stress on the immature wound.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you still have any questions, please call the office. Our offices are open Monday thru Friday from 9 AM to 5PM. One doctor will always be available 24 hours a day for you or to answer any questions or concern that you may encounter.