Post-Op Instructions


Preparing for your Surgery


  • NOTHING to eat or drink for six (6) hours prior to surgery. Eat a light easily digestible meal the night before surgery.
  • Notify the office as soon as possible of the development of any cold or flu symptoms such as stuffy nose, sore throat, cough, or fever.
  • Bring someone to stay with you while you are in the office and drive you home and care for you.
  • Patients under 18 years of age MUST have a parent, guardian, or spouse accompany them.
  • DO NOT wear earrings, hairpieces, tight clothing, or contact lenses
  • Plan to remain at home with a minimal of activity on the day of surgery.
  • Wear a short sleeve shirt on the day of your surgery.
  • Because it takes some of the anesthetic medications at least 24 hours to leave your system, you should not drive a vehicle, operate any machinery, or perform any other similar tasks during that time period.
  • It is OK to brush your teeth and rinse your mouth with mouthwash prior to your surgery. No smoking at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery.
  • Have NOTHING to eat or drink (including water) for six (6) hours prior to the appointment EXCEPT for small amounts of water to take prescribed medications.
  • If under 18, a parent or legal guardian must sign a witnessed informed consent form granting permission for surgery and anesthesia to be performed.
  • A responsible adult must accompany you to the office, remain in the office during the procedure, drive you home, and remain with you for several hours after anesthesia. If under 18, this person must be a parent or other adult specifically designated by a parent.
  • Please wear loose fitting clothing with sleeves which can be rolled up past the elbow and low-heeled shoes. NO FLIP FLOPS OR LOOSE SHOES.
  • Contact lenses, jewelry, and dentures must be removed at the time of surgery. Any body piercing jewelry in the tongue, lips, cheeks, nose, ears or anywhere about the head and neck must be removed before surgery.
  • Do not wear lipstick, excessive makeup, or nail polish on the day of surgery.
  • If you develop any illness such as a cold or sore throat, please contact the office prior to surgery.
  • In most instances, unless you have been instructed to withhold medications, it is OK to you take routine oral medications. If you take medications for diabetes, your blood sugar should be checked to determine need for insulin or oral medications. It is usually better to have a slightly higher blood sugar than normal than a lower one. Please check with Dr. Johnson or the staff prior to your surgical date if you have any questions.
Caring for someone after outpatient sedation or general anesthesia is an important job, and it may be your first time in this new role. The general anesthetic we use during our surgical procedures can produce lingering effects that may cause the patient to require additional attention and assistance.

For this reason, we require patients to be accompanied by a responsible driver who will remain in the reception area the entire time the patient is being treated and is recovering. The amount of time may vary depending on the procedure, but the in office recovery period averages about 30 minutes.

Once the procedure is completed, the driver will join the patient in the recovery area to sit with and assist the patient. In recovery, the wakefulness of patients varies because the anesthesia affects each patient differently. Some patients will be very alert; some will be very sleepy or restless. Younger patients in particular could feel disoriented. Patients could also feel nausea, weakness and dizziness upon standing, but our staff will be available for assistance until the patient is comfortable and ready for discharge.

The staff will provide detailed home care instructions while you are in the recovery room.

  • To stop oozing at the surgical site, the patient should bite firmly on a gauze bandage, which might need to be changed periodically. The patient should experience no discomfort during the dressing changes and for about 8 hours after the procedure.
  • Please warn the patient not to bite their lips or tongue to test the numbness. The local anesthetic may cause dryness of the mouth, numbness of the face, lips and mouth, as well as difficulty speaking or swallowing.
  • Our staff will be available to monitor the patient’s progress but you should be available to provide assistance to the patient.
    The staff will give the driver and patient further instructions before returning home. These are very important!
  • Be sure to help the patient walk to the car and up any stairs at home.
  • Be sure to help the patient into the car and assist them with their seat belt.
  • Please be aware that while the patient may seem to understand the instructions, the medications and anesthesia may affect their memory. Once the patient is settled at home, please be sure to review the instructions with the patients.
  • If your consultation appointment is more than one week away:
    • Begin using the chlorhexidine rinse twice daily one week prior to surgery. Use it on the day of surgery immediately before coming to the office. Begin using it again twice daily for one week starting on the day following the surgery.
  • If your consultation appointment is less than one week prior to your surgery:
    • Begin using the chlorhexidine rinse on the day or your consultation appointment. Use it twice that day regardless of when you get the prescription filled. Then use it on the morning of surgery prior to coming to the office and then begin using it again on the first day after surgery. Use it twice daily until one week after surgery.
  • Vitamin C 1000 mg.
    • If your consultation appointment is more than one week away:
      • Begin using 1000 mg of vitamin C one week prior to surgery. Do not take any vitamin C on the day of surgery but start back the day after surgery for one week.
    • If your consultation appointment is less than one week prior to your surgery:
      • Begin using 1000 mg of vitamin C on the day of your consultation appointment and use it until the day before your surgery. Do not take any on the day of surgery but start back the day after surgery for one week.
  • Special Instructions
    • Depending on the presence of infection, unusual inflammation or special needs, the doctors may recommend that you follow a different set of instructions and they will tell you that specifically.

We recommend these procedures in order to help prevent dry sockets and other infections. Should you have any questions, please don’t hesitate to ask.

The American Dental Association (ADA) and the American Association of Orthopaedic Surgeons (AAOS) completed a systemic review of the literature in December 2012. As evidenced by the title of the report: “Evidence Insufficient to Recommend Routine Antibiotics for Joint Replacement Patients Who Undergo Dental Procedures”. The answer is somewhat confusing for patients and doctors alike. Here’s why:

For many years, patients with hip and joint replacements have been told by their orthopedic surgeons that they should take antibiotics prior to dental procedures to try and prevent infections of those prostheses. There was concern that, during dental procedures, bacteria in the mouth could be forced into the bloodstream and infect the artificial joints, and might require replacement of the joints. Some patients were advised to pre-medicate with antibiotics before dental visits for two years after their joint surgery. Others were told they must do it for the rest of their lives.

If having dental procedures performed could, in fact, lead to prosthetic joint infections, then it makes sense to protect against this occurring by taking antibiotics before dental visits. But there has been disagreement that this does really happen, and there have been a lack of studies to strongly support joint infections occurring as a result of dental procedures.

In Summary, here’s what is they say:

  1. Orthopedic surgeons and dentist should discontinue the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures.”
  2. The Evaluating Committee was unable to recommend for or against the use of topical oral antimicrobials, such as antibacterial mouth rinses, in patients with prosthetic joint implants or other orthopaedic implants undergoing dental procedures.”
  3. While the Evaluating Committee could not find reliable evidence linking poor oral health to prosthetic joint infection, it was still considered important for ALL patients, including those with prosthetic joint implants or other orthopedic implants to maintain good and appropriate oral hygiene.”

What does this mean for you?

  1. While there is no evidence that dental treatment causes joint infections, the Evaluating Committee felt that the evidence that was available was not enough to conclusively prove this one way or the other, and would like to see more studies done before before making hard and fast conclusions. But, doctors might not want to give patients antibiotics before dental work unless/until they hear otherwise.
    • (According to the report, there is only one good study which explored the “association between dental procedures and orthopedic implant infection.” It concluded, “dental procedures are not risk factors for subsequent implant infection and furthermore that antibiotic prophylaxis does not reduce the risk of subsequent infection.” They also reiterate that it is known that dental treatment causes bacteria to get into your bloodstream, but there are no studies at this time that show that bacteria infects prosthetic joints.)
  2. It’s not certain that rinsing with antibacterial mouth rinses right before dental work would be helpful, since there’s not much evidence either way and it doesn’t look like dental work causes joint infections anyway, but it wouldn’t hurt so if you want to keep doing it.
  3. The two organizations did agree that it was always a good idea to practice good oral hygiene care, flossing and brushing, and dental visits.

The evaluating committee also stated that “Patient preference should have a substantial influencing role.” So do you need to take antibiotics before dental treatment if you have an artificial hip or knee? Many surgeons will probably continue to recommend it. Here’s what we recommend:

  1. For routine dental procedures, such as fillings, crowns, etc., use of antibiotics probably are not necessary. For some tooth cleaning procedures, your dentist may recommend antibiotics and antibacterial rinses.
  2. For routine non-infected dental extractions, antibiotics may not be necessary, but still their use might be prudent, especially for those who have had recent (less than 2 years), or are still have post-surgical issues with their joints. For more extensive oral surgery, including multiple extractions, surgical extractions, bone surgery, implants, bone grafts, and other procedures, antibiotics would be considered useful for the oral surgery itself, and if recommended, would be a type of antibiotic that would simultaneously protect your joint replacements.
  3. If you have an artificial joint, make sure and inform us of this at the time you make your appointment, and at your consultation, so we can discuss your options.
  4. If you are planning oral surgery, discuss this with your orthopedic surgeon, and follow those recommendations.
Are you taking Oral Contraceptives/Birth Control Pills? If so, please read the following carefully: Birth control pill package inserts warn that oral contraceptives may be rendered ineffective when taken concurrently with antibiotics, especially penicillins and tetracyclines, BUT other medications have also been implicated. Breakthrough bleeding during the menstrual cycle may indicate these interactions have occurred.

THE RESULT OF THIS INTERACTION COULD RESULT IN UNPLANNED PREGNANCY! Therefore, it is strongly recommended that, if your are prescribed medicines including antibiotics of any kind and are taking birth control pills, you should use an additional method of contraception for the rest of your cycle of your current package of birth control pills. If you have any questions, please talk with us or consult your prescribing physician.

If you are taking oral contraceptives, you will be asked to sign an acknowledgement on your Health History Questionnaire that you have read this warning and understand it’s implications.

Current List of Bisphosphonates:

  • Fosamax – generic name: alendronate – for osteoporosis Fosamax Plus D – generic name: alendronate/cholecalciferol – for osteoporosis
  • Zometa – generic name: zoledronic acid – Prescribed mostly to cancer patients
  • Didronel – generic name: etidronate – commonly used to treat Paget’s disease and other bone conditions.
  • Reclast – generic name: zoledronic acid – This medication is used to treat a number of bone conditions including osteoporosis, Paget’s disease, and for preventing the onset of osteoporosis.
  • Boniva – generic name: ibandronate –This drug is prescribed to women who have, or at risk of developing, osteoporosis.
  • Actonel – generic name: risedronate –This is another multi-purpose bisphosphonate used for bone conditions.
  • Aclasta – generic name: zoledronic acid –This is a more all-purpose form of Zometa, which is used primarily for cancer patients. It is administered with an injection into a vein, or slowly via an IV.
  • Aredia – generic name: pamidronate –Another bisphosphonate drug administered iv form, mostly for cancer patients
  • Atelvia – generic name: risedronate –delayed-release form of Actonel used to treat postmenopausal osteoporosis.
  • Skelid – generic name: tiludronate –Paget’s disease.
  • Prolia – osteoporosis, by injection every 6 months
  • Xgeva – osteoporosis, by injection every 4 weeks

IF YOU ARE TAKING ANY OF THE ABOVE MEDICATIONS, PLEASE READ BELOW. MAKE SURE YOU DISCUSS THEM WITH DR. JOHNSON, SO SPECIAL PRECAUTIONS MAY BE TAKEN BEFORE YOUR SURGERY.

Bisphosphonates are a class of drugs that prevent osteoporosis in oral and IV form. High-potency intravenous forms have been shown to modify the progression of malignant bone disease in several forms of cancer, especially breast and frequently prostate cancer. Oral bisphosphonates are used to treat other conditions such as multiple myeloma.

After they are taken orally or intravenously, bisphosphonates help prevent bone loss, by improving bone density reducing the risk of fractures. Bisphosphonates also help in treating malignant bone disease. In these cases, bisphosphonates have helped reduce skeletal complications in patients with bone cancers.

The drugs have specifically shown to effective inpatients with or at risk for osteoporosis when taken orally or by injection. Treatment in these cases increases the density of the patient’s bones and reduces the risk of fracture. The benefits of bisphosphonate therapy for osteoporosis sufferers are still evident several years after cessation of treatment. The FDA has recently approved a new class of drugs called monoclonal antibodies (Denosumab®) for the treatment of osteoporosis in postmenopausal women at high risk for fractures, and to reduce bone weakening or loss in cancer patients. Denosumab has been identified as just as high a risk factor for osteonecrosis as bisphosphonates.

BRONJ

Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ) can be described as an area of bone in the jaw that has died and been exposed into the mouth for more than 8 weeks in a person taking any bisphosphonate. Although the exact cause is unknown, BRONJ is considered to be a side effect of bisphosphonate therapy. Symptoms of BRONJ include exposed bone, localized pain, swelling and redness of gums, development of loose teeth at the site.

Can You Get BRONJ?

While the majority of patients on intravenous (IV) and oral bisphosphonates will not develop BRONJ, patients on these drugs appear to have an increased chance of developing this condition. The dosage and length of therapy that are the determining factors. IV bisphosphonates used in cancer treatment are much more potent than the oral bisphosphonates used to manage osteoporosis, thus increasing the risk for BRONJ in these patients.The risk of developing BRONJ with IV forms of bisphosphonates appears to increase in relation to the number of treatments with an bisphosphonate, and, also, with the increase in number of years on oral forms.

About 60% of BRONJ cases occur in patients undergoing routine dental surgical procedures, including tooth extraction, periodontal surgery or dental implant placementThree Stages of BRONJ. Other cases can occur due to seemingly minor injuries to the soft tissues and gums covering the jawbones. Once BRONJ had developed, it is treated according to what stage of severity has occurred. It is classified into three stages. Treatment may range for discontinuation of bisphosphonates and local measures to major surgery and reconstruction

Preventing BRONJ?

If you are taking oral or IV bisphosphonates, you should have a pre-surgical consultation with your surgeon. A request may be made to your physician that you take a holiday from therapy before and if any surgery is performed. Emergency dental situations

If you are about to begin monthly IV bisphosphonate therapy for the treatment of bone cancer, visit your family dentist for a thorough check up. Take care of all necessary procedures, including oral surgical procedures, before treatment starts. If you have removable dentures, make sure they fit well and are comfortable.

While on bisphosphonates, oral hygiene is particularly important. It is also crucial that you schedule regular examinations with your family dentist so that any infections or problems can be identified and addressed early. Perform a regular self-examination of your mouth for signs and symptoms of BRONJ, such as pain, swelling and exposed bone. Early detection allows your oral and maxillofacial surgeon to diagnose and treat the condition as quickly as possible.Conclusion

Bisphosphonates are excellent medications for bone diseases and osteoporosis that help relieve bone pain and prevent fractures. However, long-term use of bisphosphonates, particularly IV bisphosphonates for metastatic bone disease, may be associated with a small but real risk of developing osteonecrosis of the jaw. While BRONJ is a potentially serious condition, it is important to know that your oral and maxillofacial surgeon is experienced and knowledgeable in the prevention and treatment of this disease.

It may be necessary to delay oral surgery for a period of time to allow you discontinue your bisphosphonate regimen. This drug “holiday” may decrease you chance of developing BRONJ after extractions or other oral surgery procedures of the jaws.

The information provided here is not intended as a substitute for professional medical advice, diagnosis, or treatment. It is provided to help you communicate effectively with your oral and maxillofacial surgeon. Always seek the advice of your oral and maxillofacial surgeon regarding an oral health concern.

**Ref: American Association of Oral & Maxillofacial Surgeons

Instructions Following your Surgery


  • DON’T RINSE YOUR MOUTH FOR 24 HOURS!
  • Keep your fingers and tongue away from the socket.
  • BLEEDING:  Some bleeding following a tooth extraction is to be expected. If unusual, place a sterile gauze pad firmly over the place of extraction and bite down or hold in place with pressure for thirty minutes. Repeat if necessary. Avoid hot liquids. A moistened tea bag may be used in place of the gauze.
  • SWELLING: Swelling may start after the tooth has been removed but is no cause for alarm. Use ice bag, or place ice in a zip lock bag and wrap it with a moistened cloth, or moisten a towel in iced water, place against cheek for thirty minutes. Remove. Repeat half an hour later.
  • ARM INJECTION:  If you were given an injection in the arm, the skin may turn black and blue and remain sore for three or four days.
  • FOOD:   A light and/or soft diet is best during the first 24 hours following surgery. Avoid hot foods and hot liquids. Do NOT use a straw to drink with!
  • RINSE: Rinse mouth with ½ teaspoon salt in glass of warm water three times a day.
  • BONY EDGES:  After teeth are extracted you may feel hard projections in the mouth and think they are roots. This is usually the hard, bony partition that surrounded the roots of the teeth extracted. Theses generally break away or work themselves out.
  • PAIN:  If nothing has been prescribed, over the counter painkillers may be used. Be sure to follow directions exactly.
  • STITCHES:  If placed, will dissolve or be removed if given another appointment.
  • A responsible adult must have accompanied you to your procedure, drive you home, and remain with you for several hours after anesthesia. If under 18, this person must be a parent or other adult designated by your parents. See information for escorts/drivers.
  • During the first 24 hours after intravenous anesthesia, you will be like a drunk and seem more alert and awake than you really are. You MUST have someone near you at all times.
  • Remain at home, at rest. Stay in bed, on a sofa or in a recliner. Absolutely no activities the first 24 hours.
  • No bathroom, stairs, walking around without assistance. Dizziness and even fainting and falling can occur. No Driving, operating equipment, or any other activity where medications remaining in your system might hinder your ability to perform well.
  • A responsible adult must have accompanied you to your procedure, drive you home, and remain with you for the first 24 hours after anesthesia. If under 18, this person must be a parent or other adult designated by your parents.
  • Because it takes some of the anesthetic medications at least 24 hours to leave your system, you should not drive a vehicle, operate any machinery, or perform any other similar tasks during that time period.
  • No smoking. Ideally, cut down or stop smoking as long as possible after surgery.
  • Resume any of your normal medications as soon as feasible. If you take insulin or other diabetic medications, check your blood sugar levels to determined your dosages.
  • If you have any concerns or questions, call the office at 770-461-2101.
In the event of a serious emergency such as severe allergy, or any condition you feel could be life threatening, you should call 911 or go directly to an Emergency room

IF YOU WANT TO RECEIVE A RETURN CALL FROM THE ON-CALL YOU MUST TURN OFF ALL “CALL BLOCKING” AND “CALLER ID REQUIRED” OPTIONS.

An answering service is available for current patients of record. Answering Service Number is 404-487-2301.

Dr. Johnson shares an on-call schedule with other oral surgeons, so, should you have post-surgical concerns, the surgeon answering your call may not have personal knowledge of your condition or treatment. To allow for providing for your needs as efficiently as possible, you should have the following information available when you speak with Dr. Johnson or the on-call surgeon:

  • The date that your surgery was performed.
  • The procedure that was performed and the date your surgery was performed
  • A brief description of the issue that concerns you, and any other treatment you have already received for this.
  • Then names of all prescriptions provided to you, prescription numbers, the dates they were written.
  • The name and phone number of the pharmacy where the prescriptions were filled
  • Your date of birth and home address.
    List of any allergies or medical conditions you may have.
  • A telephone number where we can reach you if we have additional questions or instructions.

PLEASE NOTE:

  • Please turn off any call blocking devices. WE WILL BE UNABLE TO RETURN YOUR CALL IF THESE ARE ACTIVE.
  • Some prescriptions, by law, can not be called in by telephone, and require written prescriptions available only during regular office hours.
  • If you are under 18 years of age, a parent should contact us on your behalf.
  • We will not able to refill any prescriptions that can not be validated by the original issuing pharmacy by date and prescription number.
  • Patients under care of Pain Management Specialists must have narcotics prescriptions filled by those doctors.
  • Out of date prescriptions can not be refilled. You will need to be seen in the office for evaluation.
  • Diagnosis, treatment, or prescriptions will not be provided to persons who are not Patients of Record. If you are not a patient of record, but having an issue that you feel needs urgent attention, you should contact your regular dentist, an urgent care center or an emergency room.
  • Scheduling of new appointments, cancellation of appointments, insurance or billing issues can not be processed after hours. If necessary, you may leave a message at 770-461-2101, and a qualified staff member will contact you during the next regular workday.
  • Answering Service Number: 404-487-2301
Good care is important to proper healing after surgery. Recovery may be delayed if this is neglected. Try to maintain good nutrition and try not to miss meals.

After Intravenous Anesthesia:

You will be like a drunk and seem more alert and awake than you really are. You MUST have someone near you at all times. Remain at home, at rest. Stay in bed, on a sofa or in a recliner. Absolutely, no activities the first 24 hours. No bathroom, stairs, walking around without assistance. Dizziness and even fainting and falling can occur. No Driving.

DAY OF SURGERY

  • BLEEDING: Keep head elevated and rest quietly. Avoid rinsing or spitting for 24 hours. Avoid using a straw.
    • Remove gauze bandages which were placed before you left our office. They will probably have some blood staining. Examine the site to see if active bleeding is present. If so, roll a piece of gauze, moisten in very warm water, squeeze out. Remove any blood you see with a gauze and place the roll over the bleeding site, and bite down for 15 minutes. Repeat as necessary until bleeding is controlled.
    • If, after several attempts, bleeding persists, uplace a regular tea bag moistened in warm water over the site, then the guaze bandage, and bite for 15 minutes, and repeat up to 3 times. If active bleeding persists, call the office, day or night.
    • Please note that some seepage of blood is normal for several days after surgery. This small amount of blood may mix with saliva, making bleeding appear worse than it is.
  • SWELLING: Some swelling is normal and expected, and some patients swell more than others, and may be worse on one side than the other. Swelling is generally worse 3 – 5 days after surgery, then begins to decrease over several more days Swelling may persist for 7-10 days or longer.
    • Apply an ice pack to the face during the first 24 hours. Apply for 15 minutes on, then 15 minutes off, during normal awake times. After 24 hours, used moist heat applied to face opposite the surgery site.
  • PAIN: If prescriptions are given for pain, take them according to the bottle label instructions. It may be recommended that you take over-the-counter medications along with your prescriptions. If so, separate instructions will provided.
  • DIET: Try not to skip meal. First 24 hours: Cold or luke-warm, easy to swallow foods, like ice cream, milk or protein shakes, smoothes, luke-warm broths, etc. After 24 hours, eat foods the you like that are easy to chew. If you tolerate these, slowly return to a normal diet as tolerated. Rule of Thumb: If it hurts to chew something, back off and don’t do it.

AFTER THE FIRST DAY AFTER SURGERY

  • Progress with eating as previously described.
  • Begin to brush teeth as normal. Use a Q-tip to gently clean tooth surfaces adjacent to the surgical sites.
  • Use moist heat as previously described
  • Continue medications as prescribed or instructed.
  • Saline rinses: Place enough salt into a glass of warm water so that you think it’s salty. If it tastes salty, it’s too strong and can irritate the tissues. Hold the salt water in your mouth until it cools, but don’t swish too hard. Repeat 3 – 4 times a day for 7 days.
  • Chlorhexidine Rinse: If prescribed for you, use as directed on the bottle label.

FOLLOW-UP APPOINTMENT:

  • Packings inside sockets: If you had lower teeth extracted, and occasionally uppers, small medicated dressings may have been placed inside the sockets to help reduce pain and decrease infection. It is imperative that these been removed. If left too long they can cause increased pain and infections.
  • Syringe: If you were given an irrigation syringe after your surgery, don’t use it until the dressings have been removed. Then, fill the syringe with luke-warm tap water, and place the tip into the lower tooth sockets as far as possible and gently irrigate to remove food debris. Repeat each time until all the food debris is removed. Repeat at least twice a day.
  • Dry Sockets: A dry socket is pain caused by loss of the blood clot protecting the socket. It generally occurs 3 – 7 days after surgery, and usually on lower extraction sites. You would experience throbbing pain not relieved by the pain medicines. Patients taking birth control pills and smokers have a greater chance of developing dry sockets, but any one can have one.
    • Treatment of dry socket requires being seen in the office for placement or replacement of socket dressings.
Generic Name: Methylprednisolone
Brand Names: Medrol, Medrol Dosepak, MethylPREDNISolone Dose Pack

  • 1st day: Take 2 tablets before breakfast (or after surgery), 1 tablet after lunch, 1 tablet after supper, and 2 tablets at bedtime.
  • 2nd day: Take 1 tablet before breakfast, 1 tablet after lunch, 1 tablet after supper, and 2 tablets at bedtime.
  • 3rd day: Take 1 tablet before breakfast, 1 tablet after lunch, 1 tablet after supper, and 1 tablet at bedtime.
  • 4th day: Take 1 tablet before breakfast, 1 tablet after lunch, and 1 tablet at bedtime.
  • 5th day: Take 1 tablet before breakfast and 1 tablet at bedtime.
  • 6th day: Take 1 tablet before breakfast.

**Unless otherwise directed by your physician, all six (6) tablets in the row labeled “1st day” should be taken the day you receive your prescription, even though you may not receive it until late in the day. All six (6) tablets may be taken immediately as a single dose, or may be divided as needed to have all 6 taken in the 1st day.

After oral surgery, most patients will receive a prescription for an oral analgesic for pain control. Most of these will contain a narcotic pain reliever that also contains Tylenol or acetaminophen. For this reason, you should not take any medications containing additional acetaminophen.

We recommend the following:

  • Take three (3) 200 mg Ibuprofen (Advil, Motrin IB etc.) 4 TIMES A DAY during waking times for 4-5 days, or as instructed by Dr. Johnson. (TOTAL – NO MORE THAN 12 A DAY)
  • Then, take your prescription pain medication according to the instructions on the bottle, as you need it for additional pain control.
  • Ibuprofen will have an anti-inflammatory effect, help swelling, and help block pain making the prescription medication work more effectively.

WARNING:

• DO NOT take Ibuprofen if you are taking any other type of non-steroidal anti-inflammatory drugs, such as Aspirin, Aleve, Anaprox, Naprosyn, Relefen, Vioxx, and others.

• DO NOT take Ibuprofen if you are using any type of blood thinner, such as Coumadin, Aspirin, Plavix or others.

• DO NOT take Ibuprofen if your physician has instructed you not to do so.Then, take your prescription pain medication according to the instructions on the bottle, as you need it for additional pain control.

Ibuprofen will have an anti-inflammatory effect, help swelling, and help block pain making the prescription medication work more effectively.

 

Good care is important to proper healing after surgery. Recovery may be delayed if this is neglected. Try to maintain good nutrition and try not to miss meals.

After Intravenous Anesthesia:

You will be like a drunk and seem more alert and awake than you really are. You MUST have someone near you at all times. Remain at home, at rest. Stay in bed, on a sofa or in a recliner. Absolutely, no activities the first 24 hours. No bathroom, stairs, walking around without assistance. Dizziness and even fainting and falling can occur. No Driving.

DAY OF SURGERY

  • BLEEDING: Keep head elevated and rest quietly. Avoid rinsing or spitting for 24 hours. Avoid using a straw.
    • Remove gauze bandages which were placed before you left our office. They will probably have some blood staining. Examine the site to see if active bleeding is present. If so, roll a piece of gauze, moisten in very warm water, squeeze out. Remove any blood you see with a gauze and place the roll over the bleeding site, and bite down for 15 minutes. Repeat as necessary until bleeding is controlled.
    • If, after several attempts, bleeding persists, uplace a regular tea bag moistened in warm water over the site, then the guaze bandage, and bite for 15 minutes, and repeat up to 3 times. If active bleeding persists, call the office, day or night.
    • Please note that some seepage of blood is normal for several days after surgery. This small amount of blood may mix with saliva, making bleeding appear worse than it is.
  • SWELLING: Some swelling is normal and expected, and some patients swell more than others, and may be worse on one side than the other. Swelling is generally worse 3 – 5 days after surgery, then begins to decrease over several more days Swelling may persist for 7-10 days or longer.
    • Apply an ice pack to the face during the first 24 hours. Apply for 15 minutes on, then 15 minutes off, during normal awake times. After 24 hours, used moist heat applied to face opposite the surgery site.
  • PAIN: If prescriptions are given for pain, take them according to the bottle label instructions. It may be recommended that you take over-the-counter medications along with your prescriptions. If so, separate instructions will provided.
  • DIET: Try not to skip meal. First 24 hours: Cold or luke-warm, easy to swallow foods, like ice cream, milk or protein shakes, smoothes, luke-warm broths, etc. After 24 hours, eat foods the you like that are easy to chew. If you tolerate these, slowly return to a normal diet as tolerated. Rule of Thumb: If it hurts to chew something, back off and don’t do it.

AFTER THE FIRST DAY AFTER SURGERY

  • Progress with eating as previously described.
  • Begin to brush teeth as normal. Use a Q-tip to gently clean tooth surfaces adjacent to the surgical sites.
  • Use moist heat as previously described
  • Continue medications as prescribed or instructed.
  • Saline rinses: Place enough salt into a glass of warm water so that you think it’s salty. If it tastes salty, it’s too strong and can irritate the tissues. Hold the salt water in your mouth until it cools, but don’t swish too hard. Repeat 3 – 4 times a day for 7 days.
  • Chlorhexidine Rinse: If prescribed for you, use as directed on the bottle label.

FOLLOW-UP APPOINTMENT:

  • Packings inside sockets: If you had lower teeth extracted, and occasionally uppers, small medicated dressings may have been placed inside the sockets to help reduce pain and decrease infection. It is imperative that these been removed. If left too long they can cause increased pain and infections.
  • Syringe: If you were given an irrigation syringe after your surgery, don’t use it until the dressings have been removed. Then, fill the syringe with luke-warm tap water, and place the tip into the lower tooth sockets as far as possible and gently irrigate to remove food debris. Repeat each time until all the food debris is removed. Repeat at least twice a day.
  • Dry Sockets: A dry socket is pain caused by loss of the blood clot protecting the socket. It generally occurs 3 – 7 days after surgery, and usually on lower extraction sites. You would experience throbbing pain not relieved by the pain medicines. Patients taking birth control pills and smokers have a greater chance of developing dry sockets, but any one can have one.
    • Treatment of dry socket requires being seen in the office for placement or replacement of socket dressings.
Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. In many instances, there will be a metal healing abutment protruding through the gingival (gum) tissue.

  • Bleeding
    • Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues, please 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 on the cheek in the area of surgery. Apply the ice for 30 minutes on then 30 minutes off, as often as possible, for the first 36 hours.
  • Diet
    • Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.
  • Pain
    • Prescriptions for discomfort have been provided to you. Please follow additional instructions provided on taking ibuprofen and warning about Tylenol/acetaminophen. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.
  • Antibiotics
    • If given, be sure to take the prescribed antibiotics as directed to help prevent infection.
  • Oral Hygiene
    • Good oral hygiene is essential to good healing. If Chlorhexidine rinse was prescribed, begin using the day after surgery according the the instructions on the bottle. Use a q-tip soaked in Chlorhexidine to cleanse the exposed healing screw least twice daily.
    • Warm salt-water rinses can be used. Place enough salt into a glass of warm water so that you think it’s salty. If it tastes salty, it’s too strong and can irritate the tissues. Hold the salt water in your mouth until it cools, but don’t swish too hard. Repeat 3 – 4 times a day for 7 days.
  • 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 and for at least ten days unless otherwise discussed. These may need to be adjusted by the surgeon or your dentist before wearing to avoid their placing excessive pressure on the implant and interfering with healing.
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 surgical site 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. 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).

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 two to three days.

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.

DAY OF SURGERY

  • BLEEDING: A small amount of bleeding is to be expected following the operation. Some seepage of blood is normal for several days after surgery. This small amount of blood may mix with saliva, making bleeding appear worse than it is.
    • Avoid hot liquids, exercise, and elevate the head. Keep head elevated and rest quietly. Avoid rinsing or spitting for 24 hours. Avoid using a straw.
    • Remove gauze bandages which were placed before you left our office. They will probably have some blood staining. Examine the site to see if active bleeding is present. If so, roll a piece of gauze, moisten in very warm water, squeeze out. Remove any blood you see with a gauze and place the roll over the bleeding site, and bite down for 15 minutes. Repeat as necessary until bleeding is controlled.
    • If, after several attempts, bleeding persists, place a regular tea bag moistened in warm water over the site, then the gauze bandage, and bite for 15 minutes, and repeat up to 3 times. If active bleeding persists, call the office, day or night.
    • If an immediate denture was placed, do not remove it unless the bleeding is severe. Expect some oozing around the side of the denture.
  • SWELLING: Some swelling is normal and expected, and some patients swell more than others, and may be worse on one side than the other. Swelling is generally worse 3 – 5 days after surgery, then begins to decrease over several more days Swelling may persist for 7-10 days or longer.
    • Apply an ice pack to the face during the first 24 hours. Apply for 15 minutes on, then 15 minutes off, during normal awake times. After 24 hours, used moist heat applied to face opposite the surgery site.
  • PAIN: If prescriptions are given for pain, take them according to the bottle label instructions. It may be recommended that you take over-the-counter medications along with your prescriptions. If so, separate instructions will provided.
  • DIET: Try not to skip meals. First 24 hours: Cold or luke-warm, easy to swallow foods, like ice cream, milk or protein shakes, smoothes, luke-warm broths, etc. After 24 hours, eat foods the you like that are easy to chew. If you tolerate these, slowly return to a normal diet as tolerated. Rule of Thumb: If it hurts to chew something, back off and don’t do it.
    • Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Try to drink at least six glasses of liquid a day.

FIRST DAY AFTER SURGERY

  • Progress with eating as previously described.
  • Begin to brush teeth as normal. Use a Q-tip to gently clean tooth surfaces adjacent to the surgical sites.
  • Use moist heat as previously described
  • Continue medications as prescribed or instructed.
  • Saline rinses: Place enough salt into a glass of warm water so that you think it’s salty. If it tastes salty, it’s too strong and can irritate the tissues. Hold the salt water in your mouth until it cools, but don’t swish too hard. Repeat 3 – 4 times a day for 7 days.
  • Chlorhexidine Rinse: Use as directed on the bottle label.

FOLLOW-UP APPOINTMENT:

  • In many cases, a follow-up appointment time will be established for you after your surgery has been completed so that we may check the progress of your healing and deal with any healing issue that you may have, including:
  • Packings inside sockets: If you had lower teeth extracted, and occasionally uppers, small medicated dressings may have been placed inside the sockets to help reduce pain and decrease infection. It is imperative that these been removed. If left too long they can cause increased pain and infections.
  • Syringe: If you were given an irrigation syringe after your surgery, don’t use it until the dressings have been removed. Then, fill the syringe with luke-warm tap water, and place the tip into the lower tooth sockets as far as possible and gently irrigate to remove food debris. Repeat each time until all the food debris is removed. Repeat at least twice a day.
  • Dry Sockets: A dry socket is pain caused by loss of the blood clot protecting the socket. It generally occurs 3 – 7 days after surgery, and usually on lower extraction sites. You would experience throbbing pain not relieved by the pain medicines. Patients taking birth control pills and smokers have a greater chance of developing dry sockets, but any one can have one.
Generally, most bone grafts are placed in one of 3 ways to prepare for future implant placement:

  1. Socket Graft: Into an extraction site to maintain bone width and height and to speed of the time of implant placement;
  2. Augmentation Graft: Along the side of your jaw where teeth have been missing and the bone is thinned to make the ridge wider to allow for an implant;
  3. Sinus Lift Graft: Bone placed into your sinus cavity to increase the bone height to allow for a longer implant to be placed.

In all cases, a Barrier Membrane may have been place to help protect the graft from premature growth of scar or “gum” tissue into the spaces between the granules of bone. This barrier may be resorbable (dissolving) or non-resorbable (non-dissolving, requiring a minor surgery to remove them).

Your bone graft is made up of many particles mixed with a component of your own blood. You may find some small granules in your mouth for the first several days. Do not be alarmed by this. It’s normal to have some particles come out of the graft site and into your mouth. These may feel like sand or grit between your teeth. There are some things you could do to minimize the amount of particles that become dislodged:

  • Do not disturb or touch the wound.
  • Avoid hard rinsing or spitting for several days to allow blood clot and graft material stabilization. You may hold the chlorhexidine rinse in your mouth without swishing.
  • Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.
  • Do not lift or pull on the lip to look at the sutures. This can actually cause damage to the wound site and tear the sutures.
  • Do not smoke.
  • Following the first post-operative day, gentle rinsing should be performed but not too vigorously as you can again disturb some of the bone graft granules. If a partial denture or a flipper was placed in your mouth, you may have to see your restorative dentist to have it adjusted and learn how to remove and replace it appropriately.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office at 770-461-2101

  • Bleeding
    • Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues, please call for further instructions. Patients having sinus grafts may experience some blood drainage from their nostril on the side of the surgery.
  • Swelling
    • Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, or a plastic bag, or towel filled with ice on the cheek in the area of surgery. Apply the ice for 30 minutes on then 30 minutes off, as often as possible, for the first 36 hours.
  • Diet
    • Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.
  • Pain
    • Prescriptions for discomfort have been provided to you. Please follow additional instructions provided on taking ibuprofen and warning about Tylenol/acetaminophen. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.
  • Antibiotics
    • If given, be sure to take the prescribed antibiotics as directed to help prevent infection.
  • Oral Hygiene
    • Good oral hygiene is essential to good healing. If chlorhexidine rinse was prescribed, begin using the day after surgery according the the instructions on the bottle. Use a q-tip soaked in chlorhexidine to cleanse the exposed healing screw least twice daily.
    • Warm salt-water rinses can be used. Place enough salt into a glass of warm water so that you think it’s salty. If it tastes salty, it’s too strong and can irritate the tissues. Hold the salt water in your mouth until it cools, but don’t swish too hard. Repeat 3 – 4 times a day for 7 days.
  • 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 and for at least ten days unless otherwise discussed.

 

Biopsies are surgical procedures performed by removing a portion of an abnormal appearing growth or the entire growth for the purpose of obtaining a microscopic diagnosis of the lesion. In some cases, a special surgical laser is used in performing all or part of the surgery.

Sutures may be placed that either dissolve or must be removed later.

After your biopsy, expect some swelling that will usually be worse 3-5 days after your surgery. The amount of discomfort you experience will vary from person to person and will depend on the location of the site of the surgery. Biopsies of the tongue often cause pain out of proportion to the surgery performed.

On the day after surgery, allow mildly salty warm water to bathe the surgical site 4-6 times a day for about one week.

Avoid rubbing the surgical site with your tongue or fingers.

If surgery was performed on the inside of your lips or cheeks, do not pull on these areas, as this may aggravate the site.

Sutures or stitches may be placed. In some cases, they may not be necessary. If placed, they will be resorbable, or dissolving, or may require removal by the doctor. Because it is not possible to keep the cheeks or tongue from moving and the constant moisture of the mouth, sutures may loosen and come out prematurely. Don’t be alarmed. While this may slightly slow the healing process, it will not usually affect the long term results. If you are concerned, please call and we will be glad to check this for you.

In most cases, Dr. Johnson will see you for post-surgical follow-up about 2 – 3 weeks after surgery. Your biopsy results should be available and will be presented and discussed with you at that time. We will send a copy of that report to your referring doctor and make a copy available to you.

The bone of the floor of the maxillary sinuses, bone cavities in the upper jaws, will sometimes surround a portion of the roots of upper back teeth. Also, where teeth have been previously extracted, the sinuses can enlarge and expand into the areas of the jaw where the teeth had been, all the way down to the ridge of the jaw.

If this is the case in your jaw, then an opening from the end the tooth socket into the sinus may occur after extractions or other surgery to the upper jaw.

This can result in seepage of blood from the tooth socket into the sinus and drainage from your nose. Also, fluids which you drink may enter into your sinus and drain from your nose, or you may feel like air enters your mouth from your sinus cavity. Very small openings (perforations) may heal spontaneously. Larger openings may require immediate treatment or surgery later.

To treat this, we may place a collagen plug into the socket. This stimulates new bone and gum tissue to form and decreases the chance of this opening becoming a fistula that requires additional surgery to repair. If an obvious sinus opening occurs and a collagen plug is placed, we will inform of this.

If you are advised to take sinus precautions, please follow these instructions:

  • Avoid blowing your nose for 14 days. Instead use a tissue to wipe away fluids.
  • Refrain from smoking as this interferes with healing.
  • To reduce nasal pressure, sneeze and cough with your mouth open and do not block or pinch your nostrils.
  • Avoid using a straw for 2 weeks, as this may reopen the wound.
  • Depending on your situation, you may be prescribed antibiotics, antihistamines, nasal sprays or decongestants, or other medications. Use these products as directed.
  • If you experience unexplained drainage, increased swelling or pain, air or fluids passing from the mouth to the sinus, or have any other concerns, contact us at 770-461-2101.
If you have received prescriptions for pain control from this office, you will have probably been prescribed a medication containing a narcotic or non-narcotic such as hydrocodone (Vicodin, Lorcet, Lortab and others), oxycodone (Percocet, Percodan, Tylox and others) or Darvocet N, or other medications. All of these medications also contain acetaminophen or Tylenol in doses equal to one or more regular strength tablets. Recent reports by the Food and Drug Administration have expressed concern that excessive doses of acetaminophen may cause liver failure. This possibly is markedly increased by alcohol use.

Do not take acetaminophen or Tylenol with these medications. Acetaminophen toxicity has occurred in patients taking the above mentioned prescription medications and simultaneously taking additional acetaminophen or Tylenol, and by taking other over the counter medications, such as cold medications (Nyquil, Theraflu, and others) which contain acetaminophen. In doing so you could be unknowingly receiving excessive levels of acetaminophen.

We may also recommend that you take a non-steroidal anti-inflammatory drug (NSAID), such as Ibuprofen, Advil and Motrin. NSAID’s do not contain acetaminophen, and can usually be taken with the pain control prescriptions we prescribe. All they act on a different pain site in the brain, so give an extra level of pain control.

WE URGE YOU TO CHECK ALL MEDICATIONS THAT YOU MAY BE TAKING, AND IF YOU ARE RECEIVING PAIN CONTROL PRESCRIPTIONS FROM THIS OFFICE, OR ANY OTHER DOCTOR, DO NOT TAKE OTHERS CONTAINING ACETAMINOPHEN. DO NOT DRINK ANY ALCOHOLIC BEVERAGES IF YOU ARE TAKING PAIN CONTROL PRESCRIPTIONS OR ACETAMINOPHEN.

If you have any questions or concerns regarding this matter, please discuss your concerns with a member of our staff or with Dr. Johnson.