Surgical Instructions

I. Preoperative Instructions for Patients Undergoing Intravenous Sedation

1. Do not to eat or drink (including water) six hours prior to your surgery. If ignored, this could lead to life threatening consequences. We do not want anything going from your stomach, into your mouth, and down your lungs. For your safety, be on an empty stomach.
2. Arrange transportation with a responsible adult to bring you to and from the office on the day of surgery. This person must remain in the reception room during the surgery or special arrangements may be made at the time of consultation. Do not drive or operate hazardous machinery the same day after surgery.
3. You may be instructed to take 2 antibiotic pills prescribed by our office the night of your surgery (before midnight).
4. If you are currently taking Birth Control Pills for contraception, be aware that taking antibiotics will decrease the effectiveness of the Birth Control Pill and that alternative methods should be utilized. Please consult your physician with any questions.
5. Arrange a responsible person to care for you at least six hours after leaving the office.
6. Wear loose fitting, comfortable clothing the day of surgery, preferably with short sleeves or sleeves that can roll up past the elbow.
7. Do not wear heavy make up, jewelry, lipstick, or contact lenses the day of surgery. If wearing nail polish or non-translucent artificial nails, please remove either from one nail on each hand(so our anesthesia monitoring equipment may be placed on either hands).
8. The patient is requested to use the restroom to empty their bladder (urinate) one hour before surgery.
9. Patients under the age of 18 years must be accompanied by an adult.
10. Brush your teeth really well the morning of your surgery, especially in the back. Spit out all of the water.
11. Parents of children scheduled for surgery will be allowed only at the beginning and recovery phase of surgery.
12. No smoking or alcohol 24 hours prior to surgery. It improves healing and surgical outcome.
13. You will have the opportunity to talk with the doctor prior to going to surgery.
14. Please leave all valuables or jewelry at home as we are not responsible for loss of any of those items.

If you have any questions about your surgery or the above recommendations, please ask the surgical staff or the doctor. We are committed to making your surgical experience a comfortable one.

–Dr. Casey K. Shimane and Staff

II. Post-Op Instructions

What you SHOULD NOT do following extractions and other oral surgery procedures?

1. DO NOT rinse, spit, or brush teeth for 24 hours after surgery (may dislodge blood clot)
2. DO NOT drink through a straw for 24 hours after surgery (may dislodge blood clot)
3. DO NOT smoke for 48 hours after surgery (nicotine breaks down blood clot)
4. DO NOT drink alcohol for 48 hours after surgery (delays blood clot formation)
5. DO NOT eat or drink spicy or acidic foods for seven days after surgery (irritates site)
6. DO NOT exercise vigorously for three days after surgery (increases blood pressure causing more bleeding)
7. DO NOT probe the surgical site with your tongue, any objects, or your fingers (may cause infection)

What you SHOULD do following extractions and other oral surgery procedures?

To control bleeding

Immediately following the procedure keep a steady pressure on the bleeding area by biting firmly on the gauze placed there by your doctor. Pressure helps reduce bleeding and permits formation of a clot in the tooth socket. After two hours, remove the gauze and then you may eat or drink. Replace the gauze and bite down for two hrs. Repeat as necessary. Bleeding is common and very normal after surgery. Saturation of the gauze usually slows down 6-8 hrs after surgery. It is best to remove the gauze before going to bed. Some slight pink coloration on the gauze may persist for up to 24 hrs and the gauze may be left out at this point. If bleeding persists, a moist teabag should be placed in the area of bleeding and bite firmly for one hour straight. This will aid in clotting blood. Repeat as necessary. If bleeding still persists call our office.

To relieve discomfort

1. Take the prescribed medication as soon as tolerated after surgery. Taking the medication with soft food and a large volume of water will lessen any side effects of nausea. The local anesthesia (numbing medicine) administered with the general anesthetic during your surgery normally has a 1-2 hour duration on the upper jaw and 5-7 hours on the lower jaw, and it, Motrin/Advil, may be difficult to control the discomfort once the anesthetic wears off. Therefore supplemental medication for relief of discomfort is usually necessary. We advise that you start by taking a non-steroidal anti-inflammatory such as motrin/advil after surgery. If discomfort is not controlled sufficiently, then take a narcotic analgesic such as Vicodin or Tylenol #3. We try to avoid taking the narcotic analgesics if possible to avoid the side effects of 1) nausea and 2) constipation. The Motrin/Advil should not be taken at the same time as Vicodin. If both medications are needed, alternate using each type of medication. Continue to take your medication if discomfort persists.
2. A slight temporary earache is common after wisdom teeth removal due to the complex network of nerves of the face.
3. A sore throat may develop and disappears in a few days.
4. Your other teeth may ache temporarily. This is also referred pain also due to the complex network of nerves of the face and is a temporary condition.

To minimize swelling

1. Extremely important to apply ice packs immediately after surgery 30 minutes on and 30 minutes off to the side of the jaws/cheeks for 24 hours consistently to decrease the inflammation and minimize the swelling. We recommend the ice packs provided at our office or a ziplock bag of crushed ice or a bag of frozen peas. Cover the crushed ice bag or frozen peas with a thin cloth to avoid skin irritation.
2. After 48 hours, it is usually best to switch from using ice packs to moist heat pack 30 minutes on and 30 minutes off the cheek to obtain more circulation in the area and decrease swelling.
3. Sleep with your head elevated with pillows for three days following surgery
4. Remember, swelling is very common after surgery. It will reach its maximum at day 2 and will gradually resolve (70%) after two weeks. Different people react to surgery in various ways… some will swell more or less than others. Rest assured, it will get better.
5. Keep lips moist with cream or vaseline to prevent cracking or chapping.

To maintain oral hygiene

Twenty-four hours after surgery, rinse mouth gently with a solution of one teaspoonful of salt dissolved in a quart of water. Repeat after every meal or snack for seven days. Rinsing is important because it removes food particles and debris from the socket area and thus helps prevent infection and promote healing. You may brush your teeth and tongue gently, carefully avoiding the surgical sites, beginning the 2nd day after surgery.

To maintain a proper diet

1. We recommend liquids (such as 7-up, water, apple juice,) and soft foods (such as mash potato, gravy, ice cream, jello, pudding, soup broths) for the next 7 days. For seven days, do not eat anything with pieces of food as they may become lodged into the extraction socket. Maintain this soft diet for seven days or until you see Dr. Shimane for a Post-op (follow-up) appointment. Dr. Shimane will then increase your diet on a case-by-case basis gradually progressing your diet to solid foods as tolerated.
2. Especially avoid food like popcorn, nuts, sunflower seeds, or rice, which may get lodged in the extraction socket.
3. If you are a diabetic, maintain your normal diet as much as possible and follow your doctor’s instructions regarding your insulin or diabetic pill schedule.

In case of problems

You should experience no trouble if you follow the instructions and suggestions as outlined. But if you should have any problems such as excessive bleeding, uncontrolled pain, or extreme difficulty in opening your mouth, call our office immediately for further instructions or additional treatment. In the extreme rare case of a life threatening problem, call 911 immediately before calling our office for instructions.

Remember your follow-up visit

It is often advisable to return for a postoperative visit to make certain healing is progressing satisfactorily. A follow-up visit will be scheduled. In the meantime, maintain a healthful diet, observe rules for proper oral hygiene, and visit your dentist for continued dental care or regular checkups.

Other Possible Post-Surgery Effects:

DRY SOCKETS:

• When a tooth is removed, a “hole” or “socket” is left in the jaw bone where the roots of the tooth used to be present. Normal healing requires the formation and continued presence of a blood clot in that “socket.”
• When the clot is lost or does not form properly, you begin to have pain of varying degrees and intensity. The pain usually starts to increase the third to the fifth day after the tooth was removed. The pain often radiates to the ear or to other teeth. The pain is usually caused by exposed bone due to the absence of a proper clot. One will notice a bad taste and odor. Women on birth control pills and smokers are the most likely to have dry socket although any patient may potentially have these symptoms. Premature spitting within the first few days after surgery may also lead to dry socket. A dry socket is not a true infection but rather an inflammatory condition. If you experience the following symptoms and your discomfort is not alleviated with medications, please contact our office for instructions or follow-up care.
• Most dry socket or dry socket-like symptoms may be treated temporarily with adequate pain medications. If there is a complete resistance to the effect of pain medications, then the treatment is to pack is place a eugenol based medication into the extraction site. Our office has dissolvable medication that we may place into the extraction site and a notable improvement in comfort is usually felt within 30 min. It is sometimes necessary to place another set of this dissolvable medication 1-3 days later if necessary. One or two placements is common and three or more placements is extremely rare.

BRUISING:

• May occur around the cheeks, inside the mouth, on the side of the jaw, or down the neck but will soon disappear.
• May occur around the arm or hand near the site of intravenous access (site where IV medications entered patient). It is very common to have minor bruising. If your arm is inflamed or tender for first day, apply moist heat pack 30 minutes on and 30 minutes off. If inflammation or tenderness does not resolve the second day, please contact our office for an evaluation.

NUMBNESS:

• Loss of sensation of the lip and chin may occur, usually following lower wisdom teeth removal. This is usually temporary and disappears within a few days or weeks. Occasionally, some numbness may persist for months, due to the close association of the roots of the teeth to the nerve that supplies sensation to these areas. Inform Dr. Shimane so that he may continue to follow-up and monitor your progress throughout the healing process.

STIFF JAWS/MUSCLES:

• Stiffness of the muscles after surgery is to be expected due to the swelling. It should disappear within seven days.
• The four days following surgery, you may begin light stretching of your mouth to exercise your jaw muscles. In three to four weeks you should be able to open to your original distance.

NAUSEA:

• The medications used during surgery and the medication prescribed after surgery may cause nausea in some people. Also, nausea may be common from the swallowing of some blood from excessive bleeding of the surgery sites. If nauseated, avoid milk and other dairy products. After surgery, do not take medications on an empty stomach. If it continues for one day or more, please contact our office and an anti-nausea medication may be prescribed. Most anti-nausea medications have very common side effects such as repetitive movements of the arms, legs, or head.  Rest assured, these side effects should stop shortly after discontinuing the medication.

SUTURES:

• Do not be alarmed if they come out on the night after surgery, as they are made to dissolve on their own. They are designed to dissolve and come out anytime from one day to three weeks.

If you have any questions about your recovery or the above recommendations, please call our office at 510-885-8720 anytime during the business hours or 510-885-8724 anytime during the night and our answering service will contact the doctor immediately. We are committed to making your surgical experience a comfortable one.

–Dr. Casey K. Shimane and Staff

Instructions for care after your post-op appointment:

It is now approximately four to seven days after your surgery and you are probably wondering...

1. What you can eat now?
2. How to keep the surgical area clean?

Answer to question #1:

You can now advance your diet to foods like soft pasta and bread softened in soup. Stay on this diet for another week. Then you can eat more and more regular foods as tolerated.

Answer to question #2:

You may be given a plastic "Monoject" irrigating syringe to help rinse out the surgery site. It is most commonly used for washing out food caught in the lower jaw third molar extraction sites. (You do not have to rinse upper third molar sites).

If you are not given a syringe, then Dr. Shimane has determined that you do not need it and you should just swish and gargle with salt water as you feel necessary.

How to use the plastic "Monoject" irrigating syringe:

The best irrigating solution is salt water: Add a teaspoon of salt to a quart of water. You may also use plain water. Mouthwash is not recommended as an irrigating solution.

• Load the syringe with the salt water by pulling on the plunger with the tip in the solution.
• Go to a mirror, place the syringe tip behind the last lower tooth. Do not worry, you cannot damage the surgery site with the syringe tip. Push the plunger on the syringe to wash out any food trapped in the lower third molar extraction site.
• Brown foul-smelling fluid or some bleeding is very normal after rinsing with the syringe. Do not worry, the bleeding is temporary and will stop again.
• Rinse the lower third molar sites after every meal for one week, then use it as you feel necessary.

We hope that these instructions have been informative.

– Dr. Casey K. Shimane and Staff