PREOPERATIVE INSTRUCTIONS FOR ORAL SURGERY (BEFORE SURGERY)

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Expect the Best... Plan for the Worst...Prepare to be Surprised 

The removal of teeth, in particular impacted teeth can often be a significant surgical procedure.  Preoperative planning and post operative care is very important!  Unnecessary pain as well as complications from surgery can be minimized and/or avoided all together if the instructions given by your surgeon beforehand and afterwards are followed carefully.  The following is a guide to aid you in preparing for your upcoming surgery.

When having Impacted Wisdom Teeth removal, it is generally required to have a consultation prior to surgery with an Oral Surgeon.  If somehow this consult was not performed and you are scheduled for surgery do not be too surprised if the procedure can not be done that day or if all of them are not removed at the first visit.  

The above shows a forming wisdom tooth, without any root formation yet.  It is advisable to removed third molars when the roots are short, before full growth. This reduces the risk of nerve injury during surgery which could lead to numbness to the lower lip/chin/tongue/gums and teeth. Typically if numbness occurs from the roots of the tooth tugging on the nerve as it is removed it it most commonly isolated to the lip and chin region of the side affected and is most of the time a temporary situation.  Most patients have return of full sensation to the areas.  Although rare, the deficit may not return fully and loss of sensation may be permanent. 

Root formation "Nerve and tooth roots in closer approximation"

This is the most common angulation of lower impacted wisdom teeth.  When left in place due to this angulation the wisdom tooth will eventually cause damage to the tooth/root in front of it which often leads to needing both teeth extracted instead of just the wisdom tooth.  Often prior to this damage occurring you will have already noted shifting of your lower teeth, which is from the wisdom teeth trying to make room to erupt.  

Prior to surgery you may view this video demonstration as to how impacted third molars are removed. Just copy and paste the link into your web browser.

http://vimeo.com/63748309



Preoperative Instructions:

• You should EAT something prior to surgery.  If you or your child is having nitrous oxide analgesia just have a light meal but it is still advised to eat beforehand.  Typically, some form of pain medication is prescribed which should never be taken on an empty stomach.  It is even recommended to have some food immediately after your surgery such as yogurt or ice cream prior to taking these medications.

• Take all regularly prescribed medications on the day of 
• your scheduled surgery unless specifically instructed 
• otherwise by your Oral Surgeon and/or Physician.  
• Most commonly blood thinners will be stopped a few days prior to dental extractions.  However, not all blood thinners need to be stopped, these decisions should be made prior to surgery.  NEVER STOP MEDICATIONS WITHOUT PERMISSION FROM YOUR PRESCRIBING DOCTOR

• You can drive yourself to and from your surgery appointment.  Your surgery will be performed under local anesthesia (Novocaine) or local anesthesia with Nitrous Oxide analgesia.  Currently we do NOT offer General Anesthesia so you are capable of driving home from your appointment.  Nitrous oxide wears off within minutes of removing the gas therefore allowing you the ability to drive. However, if you are having a large procedure done such as difficult third molar extractions or full mouth extractions you may not want to drive after the surgery so having a friend or family member bring you to your appointment may be advisable.

• DIET PREPARATION:  Make sure to have plenty of soft food prepared for after your surgery.  You are not going to want to have to prepare/cook or shop for food afterwards. Also make sure to have water and other clear liquids available in case of nausea, such as ginger ale etc.   It is very important to eat after any surgery.  Your body needs nutrition to heal. 

• Stay well Hydrated.  Clear liquids are a good place to start immediately after surgery.  Once you know you are okay with clear liquids you can start to advance your diet to soft foods. 

Water, Ginger Ale, 7-up, Sprite, Gatorade, Jello, Clear broth, tea

• Not to worry there are plenty of foods you will be able to eat after surgery. Remember prepare ahead of time.  Do not wait to go food shopping until after your surgery.  
• Here are some "Soft Food" examples for after surgery. 

1. Almost anything you can put in a Blender or puree; Cauliflower, carrots, fruits, 
2. Yogurt
3. Ice Cream (Most soft dairy products are okay)
4. Hearty Soups/Cream soups (no small particles) 
5. Proteins shakes blended with or without ice cream
6. Eggs (Scrambled, soft boiled, egg salad, poached, omelettes)
7. Pancakes/crepes
8. French toast
9. Oatmeal/Cream of wheat
10. Soft cereals
11. Mashed Potatoes
12. Macaroni and Cheese
13. Meatballs
14. Pudding/Custard/Jello
15. Apple Sauce/Baked apples
16. Cottage/Ricotta Cheese
17. Banana's
18. Smoothies avoid strawberry & raspberry due to seeds
19. Milkshakes (avoid straws with all drinks)
20. Boost or Ensure; also you can add ice cream to these
21. Hummus with soft pita
22. Fresh cooked vegetables (soft)
23. Baked beans
24. Avocado/guacamole
25. Tofu
26. Pasta
27. Baked potatoes, 
28. Butternut squash 
29. Pierogies with butter or sour cream
30. Fish (soft and cut into small pieces)
31. Thanksgiving Dinner (Turkey cut small, mashed potatoes, cranberry sauce, stuffing, cream spinach)

• Foods and other Things to AVOID

1. Popcorn, Pretzels, Chips, Nuts
2. Rice
3. Spicy Foods
4. Foods with seeds, everything, poppy, sesame seed bagels 
5. Difficult foods to chew (steak, chicken, ribs,)
6. Hot Food; Initially stick to colder foods or food that is close to room temperature 
7. Foods that involved opening wide, Burgers, larger sandwiches, apples, etc
8. Avoid Alcohol and SMOKING!!

•  PREVENTION OF SWELLING AND BRUISING
• ICE:  The standard treatment to reduce post operative swelling is to apply ice packs the first 24 hours after surgery to the cheek of the affected side.  Make sure prior to surgery you freeze a few ice packs.  The soft/gel/bead type are most comfortable in the facial region but any kind will work. Have at least 3 or 4 packs frozen ahead of time.  You will apply ice to the outside of your cheek for the first 24 hours in 10-15 minute intervals.  The more you ice the area the first day the less you will swell over the next few days. 

STEROIDS:  I may have given you a prescription at yourconsult appointment for a Medrol Dose Pack.  

• These are tapering dose of a steroid which will significantly prevent  excessive swelling after surgery. 
•  Do not be concerned if you did not receive this medication.  It's not that I forgot, it means I don't anticipate you will have severe swelling post operatively.  
• This in no way imply's that you will have no swelling, you may have some mild swelling which can be minimized with ice pack therapy.  However, on occasion teeth are more difficult to remove than anticipated, in the event that this occurs I will then prescribe the steroid for you to start after the surgery.  

• If  you have an early appointment you will only take your breakfast dose prior to surgery.  If your appointment is in the afternoon you will take 2 doses beforehand, a breakfast and a lunch. 
• Below is the packaging of the Medrol dose pack and the instructions for each day.

START TAKING THE MORNING OF YOUR SURGERY APPOINTMENT!!

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