The removal of teeth, in particular impacted teeth is a significant surgical procedure.
Pre-operative planning and post-operative care is very important. Unnecessary pain
and complications from surgery can be minimized and/or avoided if the instructions are
followed carefully.
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Pre-Operative Instructions:
1. Remember as discussed at consultation the extractions will be performed under local
anesthesia or local anesthesia with nitrous oxide. NOT General Anesthesia, so it is
recommended that you eat something prior to surgery. If you are having nitrous oxide it's
recommended that you have only a light meal before surgery. Nitrous Oxide analgesia can
occasionally result in nausea during surgery especially if a very heavy meal was eaten beforehand.
2. Take all regularly prescribed medications unless specifically instructed by your Oral Surgeon
or your medical doctor on the day of surgery. Most commonly you may be instructed to
stop taking blood thinners a few days before surgery, however not all blood thinners need to be
stopped before dental extractions. Medication should NEVER be stopped without permission
from you physician. If you take a blood thinner and are unsure whether or not to stop them
or for how long please call the office and ask and/or schedule a consult with your oral surgeon
and speak to your physician prior to your surgery appointment. It is best to discuss this with both
your oral surgeon and your physician so they can determine the best course of action for your
specific case. Your physician may not realize the extent of your planned oral surgery procedure
so to prevent any delays in dental treatment or complications to your overall heath, it is best
to allow the decision "to stop or not stop" any medication be made by both the doctors involved
in your care. If your blood thinner needed to be stopped for a few days before surgery and it
wasn't your surgery will not be performed that day and have to be rescheduled this could result
in a delay in the rest of your dental treatment as well as the need take more time off from work
3. You may drive yourself to and from the office even if having local anesthesia with nitrous oxide.
However, if you are having multiple extractions it might be a good idea to have someone drive
you to and from your appointment so you can relax and concentrate on proper post
operative instructions such as applying pressure to the surgical sites in order to stop bleeding.
4. DIET PREPARATION:
Make sure to have plenty of soft food prepared at home prior to surgery as well as liquids.
Soft diet recommendations:
Ice cream, yogurt, scrambled eggs, pudding, mashed potatoes, macaroni & cheese etc.
Foods to avoid: Nuts, rice, seeds, pop corn, chips etc. Anything small or hard should be
avoided. If food gets trapped in extraction site it can lead to infection. Therefore, it is very
important to keep surgical sites clean. Starting the day AFTER surgery rinsing with warm salt
water after every meal and before bed greatly reduces the risk of infection.
5. Swelling Prevention:
Steroids: If you were given a prescription for a Medrol dose pack at your consultation
appointment this medication should be started the morning of your surgery before coming
to the office. You will either take one dose; before breakfast if your surgery is scheduled in the
morning or two doses; one before breakfast and the second after lunch if your surgery is scheduled
in the afternoon. Be sure to follow the instructions on your prescription. Moderate to severe
swelling is anticipated so in order to prevent excessive swelling it is important to take this
medication exactly as it's prescribed. It will be less effective if not taken properly. If you were not
prescribed this medication it is expected your swelling will not be as significant, however this does
not imply that there will be no swelling at all and again as stated above something in surgery things
may turn out to be more or less difficult than expected.
The standard treatment to reduce post-operative swelling after dental extractions is to
apply an ice pack to the affected side for the first 24 hours. After 24 hours ice has no effect to
reduce swelling, you may apply it for a numbing effect if makes you feel better but it will not have
any therapeutic effect in swelling reduction at that point. Ice packs should be placed gently against
The side of the face in which the surgery was performed
Have ice packs frozen ahead of time. Preferably refreezable gel packs
with beads (beads are not essential). If you don't have gel packs you can use frozen peas or ice
in a zip lock back (crushed) wrapped in a thin towel.
7. Recovery Time: Recovery time from third molar removal will vary with every patient. We are all
unique individuals and there are many factors that play a role in determining how long it will take
for you to recuperate from surgery. Some of the key factors that make this determination are:
A. Age: Younger patients for many reason tend to heal faster but the main reason is; when we
are young our bone is softer and more forgiving allowing for smaller incisions to
remove the teeth with less bone removal (or non at all).
B. Root Anatomy: Longer roots with curves (hooks) at the end as well as multiple rooted teeth
(Molars and bicuspids) as opposed to single rooted (incisors & canines)
teeth may require more invasive surgical techniques to remove.
C. Thickness of surrounding bone plays a major role in determining ease of extraction. Patients
with thinner bone will most likely require less invasive surgery to extract a tooth. Therefore,
will have less post surgery discomfort and less swelling. Sometimes even though teeth have
all the indicators for a simple extraction they can still turn out to be more difficult so these are
only guideline not absolutes. "There's a reason the saying "It's like pulling teeth exists".
All teeth are not easy to remove. This is why it's best to have most extractions done by an Oral
& Maxillofacial Surgeon. It's not uncommon that a general dentist (no matter how good their
intentions are) is unable to complete an extraction requiring referal to an Oral Surgeon.
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