Post-Op Instructions

General Guidelines for all procedures:

BLEEDING: Bite on gauze for 1 hour then discard. If bleeding continues, repeat with biting or finger pressure for 1 hour. A wet tea bag may substitute a gauze pack. Avoid frequent pack changes, aggressive rinsing, or physical exertion.

DO NOT rinse your mouth the same day. The next day, rinse using 1/4 teaspoon salt to a glass of warm water or 1/2 cup hydrogen peroxide with 1/2 cup of warm water, plus any other rinses, and you may resume brushing as well. Do not use straws for one week.

DIET: Soft, cold foods are recommended for the first 24 hours: Liquid diet supplement (Ensure , Boost , etc), baby food, milk shakes/smoothies, ice cream, pudding, and yogurt. Alcohol, hot, spicy, or coarse foods should be avoided. Any other

food that the patient can tolerate is permissible. It is important to drink plenty of fluids.

NO SMOKING preferably for two weeks after surgery.

GENERAL ANESTHESIA/SEDATION: Patients who have received a general anesthetic should:

NOT drive a vehicle or operate any machinery within the same day of surgery.
NOT undertake any business matters within the same day of surgery.
NOT take any other medication without an approval.

PAIN: Pain is to be expected and may be severe for the first few hours. One must:

Take the medication with food to reduce the chance of developing nausea and/or vomiting.
Take the prescribed medication before the anesthetic wears off and before the pain becomes evident, usually one hour following the procedure. If weakness is experienced, lie down.
For mild pain use Tylenol, Advil, Ibuprofen, Aleve, Excedrin, or Motrin.
If you develop any side effects or if you have any questions, stop the medication and call the office.

SWELLING: Swelling is to be expected and usually reaches its maximum three days after surgery but is no cause for alarm. Swelling results in a tightness of the jaw muscles and may cause difficulty in opening the mouth. This should disappear

within 7-14 days. Swelling may be reduced by applying an ice bag to the operated area 15 minutes on and 45 minutes off during the first 48 hours and by keeping your head slightly elevated when lying down (i.e. use an extra pillow or two; sleep in a reclining chair).

BRUISING: Bruising, headache, or sore throat may occur. These should not be a cause or alarm and should disappear within 10 days. Unrelated complications may occur (tonsillitis, flu, or mouth “cold” sores) due to the fact that the patient’s resistance to infection is low.

NAUSEA: Nausea occurs rarely. If severe, stop taking narcotic pain medications and switch to any Tylenol-type medication. If nausea persist, call the office. Ginger ale and club soda (clear carbonated drinks) are helpful in calming the stomach.

STITCHES: Stitches, if used, will either dissolve within 2 weeks or will have to be removed.

IMMEDIATE DENTURES: Immediate dentures should not be removed until you have been seen by our office or by your dentist. This is usually within three days. Sores on the gums are common and will be treated on this visit.

SMALL BONE FRAGMENTS: Small bone fragments usually work through the gums during the healing process. They are not roots and usually fall out within a few days. If annoying, contact the office for their removal.

LIPS: Lips should be kept moist with a cream to prevent cracking. There may be numb feeling on your lower lip if lower teeth were removed. This is especially true with impacted teeth. The feeling of numbness due to the anesthetic used may last between 2-12 hours after surgery. Feeling to the lip should return gradually.

Avoid strenuous exercise such as running and swimming for several days.

Instructions for Patients Planning Intravenous Sedation

It is very important that you read and understand the following instructions if you wish your sedation appointment to be as straightforward as possible! If you are uncertain about any of these instructions, please ask.

Do NOT eat or drink anything for 6 hours prior to your appointment. This includes water, juice, coffee etc. Failure to do so will result in cancellation of your procedure.

You MUST bring an escort who shall be responsible for safely driving you home after the appointment. This individual must be a responsible adult, not a minor. The escort must remain in the office for the entire duration of the time you are in the office. It is imperative that someone remain with you for the rest of the day after your sedation.

Do NOT wear jewelry. You may remove rings, watches , and earrings prior to your surgery and give them to your escort.

Do NOT wear any nail polish the day of your appointment. Nail polish can distort the accuracy of a probe placed upon the fingernail to monitor your breathing.

Men should plan to wear a light, short sleeve shirt and women should plan to wear a light, short sleeve blouse. It is important that you not wear long-sleeve shirt or long-sleeve blouses. Bulky clothes will make it difficult or impossible to place the intravenous line, and apply the necessary medical monitoring equipment.

It is CRITICAL that you tell the doctor which medications you are taking. Depending upon what medications you take, we might have to make special modifications in our sedation routine or contact your physician for medical clearance. This can delay your treatment, or in rare cases, make it impossible to perform your procedure at this facility.

It is CRITICAL that you tell the doctor about any special medical problems you might have. Especially important are those of you who might have a history of heart murmur , epilepsy, seizure disorders, asthma, . bronchitis, drug allergies. Also, do not hesitate to tell us about any surgeries you might have had.

Are you taking aspirin, warfarin, cournarin, coumadin or other medication that might affect your bleeding? Do you have a history of excessive bleeding?

Are you diabetic? Do you take insulin to control this condition if you are so afflicted?

Be prepared to spend the rest of the day, after surgery, resting in bed or a comfortable chair. It is customary to spend about three days after surgery recuperating. Plan accordingly.

Medications for After Surgery

In our office we utilize the following medication protocol in order to optimize your results. Each medication is used for a specific purpose and does not interact with the others.

Following surgery, after eating something soft and cool, you will be asked to take your medication as follows:

Infection: If an antibiotic has been prescribed, it should be taken __ times a day (breakfast, lunch, dinner, and bedtime) for _ _ days .
Inflammation: An anti-inflammatory tablet is to be taken __ times a day (breakfast, lunch, dinner, and bedtime) for 2 days. After the initial 2 days, you may continue taking it as needed for pain.
Discomfort: Pain pills should be taken as soon as possible before the local anesthetic wears off. Continue every __ hours as necessary. This medication should be taken with food . (You do not have to finish the bottle.)
Swelling: Apply ice to face for 15 minutes on and 45 minutes off.
Hygiene: Chlorhexidine rinses should begin the morning after surgery. Swis h, but don’t swallow, one capful after breakfast and at bedtime for 5 days.

Instructions regarding other aspects of postoperative care are included on the instruction sheet, which you will receive in the recovery room.

In case of an emergency call Dr. Bialy at (847) 525-1201

Instructions Following Implant Surgery/Implant Treatment

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. 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 continuously, 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
You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one to two Tylenol or Extra Strength Tylenol may be taken every three to four hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets. Two to three tablets may be taken every three to four hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.

Antibiotics
Be sure to take the prescribed antibiotics as directed to help prevent infection.

Oral Hygiene
Good oral hygiene is essential to good healing. The night of surgery, use the prescribed Peridex Oral Rinse before bed. The day after surgery, the Peridex should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt-water rinses (one teaspoon of salt in a cup of warm water) should be used at least four to five times a day, as well, especially after meals. Brushing your teeth with the healing abutments is not a problem. Be gentle initially when brushing the surgical areas.

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. This was discussed in the preoperative consultation.

Instructions Following Wisdom Teeth (3rd Molars)

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.

Immediately Following Surgery
The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.

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 two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 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.

Pain
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or ibuprofen (Motrin, Advil, Aleeve, or Ibuprofen) two to four 200 mg tablets may be taken every three to four hours.
For severe pain, take the tablets prescribed 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. 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.

Diet
Drink liquids after general anesthesia or IV sedation. Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. 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 five to six 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.

CAUTION: If you suddenly sit up or stand from a lying position, you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

Keep The Mouth Clean
No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least five to six times a day with a cup of warm water mixed with a teaspoon of salt especially after eating.

Discoloration
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 postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

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 reaction. Call the office if you have any questions.

Nausea & Vomiting
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 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.

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 the sensation. So be careful. Call Dr. Bialy if you have any questions.
A 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.
You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and then get up.
Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls, which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Bialy.
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 two to three days.
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. The sutures will be removed approximately one week after surgery. The removal of sutures 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 fill in with new tissue over the next month. In the meantime, 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 accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Bialy or your family dentist. Brushing your teeth is okay – just be gentle at the surgical sites.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur two to three days following surgery. Call the office if this occurs.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

Instructions Following Exposure of an Impacted Tooth

Do not disturb the wound. If 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, 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 cubes on the cheek in the area of surgery. Apply the ice continuously as much 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
You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one or two Tylenol or Extra Strength Tylenol may be taken. Tylenol may be taken every three to four hours. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: Two to three tablets may be taken every three to four hours as needed for pain. For severe pain, the prescribed medication should be taken as directed.

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. Rinse with warm salt water (one teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete.
REMEMBER: A clean wound heals better and faster.

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. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

Instructions Following Tooth Extractions

After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. That’s why we ask you to bite on a gauze pad for 30-45 minutes after the appointment. If the bleeding or oozing still persists, insert another gauze pad and bite firmly for another 30 minutes. You may have to do this several times.

After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.

After the tooth is extracted you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours.

Use the pain medication as directed. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.

It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean.

After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for two to three days, or a reaction to the medication, call the office immediately at (847) 985-9322.

Instructions Following the Removal of Multiple Teeth

A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding continues, a moist tea bag can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.

Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 36 hours only. Apply ice continuously while you are awake.

For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every three to four hours. Ibuprofen (Advil, Motrin) 200mg can be taken two to three tablets every three to four hours.

For severe pain, use the prescription given to you. If the pain does not begin to subside in two days, or increases after two days, please call the office. If an antibiotic has been prescribed, finish your prescription regardless of your symptoms.

Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day.

Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt-water rinse every four hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One teaspoon of salt in a glass of lukewarm water.). After you have seen your dentist for denture adjustment, take out denture and rinse three to four times a day.

Restrict your diet to liquids and soft foods that are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.

The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur (all of which are considered normal):

The area operated on will swell, reaching a maximum in two days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration. 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.

If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.

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