MICHAEL H. KIRSCH, D.D.S.
Diplomate, American Board of Oral & Maxillofacial Surgeons
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SURGERY & ANESTHESIA PRE-OPERATIVE INSTRUCTIONS

1. Patients scheduled for surgery under general anesthesia or intravenous sedation must not eat or drink anything (except to take prescription medication) for at least 6 hours prior to their appointment, and must be accompanied by a licensed driver.

2. As directed by your surgeon or physician, you should take all prescription medications (especially for high blood pressure and thyroid) when you normally do with a small sip of water.

3. The following is a list of common medications, which may affect platelets and cause significant bleeding during and after surgery. If advised by your doctor, you should stop taking these medications at least 5 days before your surgery: Aspirin (including Baby Aspirin), Motrin, Advil, Aleve or Ibuprofen, Anti-inflammatory or arthritis medications, St. John’s Wart, all herbal supplements, and Vitamin E.

4. If you are taking a blood thinner such as Coumadin, Warfarin or Plavix and have been advised by your surgeon to stop taking these medications, you should notify the prescribing physician before stopping.

5. Wear comfortable loose fitting clothing. Make sure your sleeves can easily be rolled up above your elbow. Short sleeves are preferred.

6. Avoid wearing contact lenses if you are having general anesthesia or intravenous sedation.

7. Prepare cold packs at home by filling two sandwich size zip-lock bags with frozen peas. Keep the peas in the freezer until you get home. The peas will comfortably mold to your face and stay colder longer than ice.

8. Have soft foods available such as yogurt, ice cream, oatmeal, scrambled eggs, Jell-O, mashed potato and soups. You may begin to eat foods that are more solid when you feel ready.

9. Patients having intravenous or general anesthesia should refrain from driving a motor vehicle, physical activities and making important decisions until the following day.

10. You must notify this office at least 7 days before your appointment if there has been any change in your medical history, medications, cough, and risk of pregnancy or if you have been sick or had a cold within one week of your appointment.

11. Notify your doctor if you are taking any of the following medications: Fosamax, Boniva, Aredia, Actonel, and Zometa.

12. The doctor has reserved his time for your surgery.   Please give the office at least 48 hours advanced notice if you will not be keeping your surgical appointment.


POST-OPERATIVE INSTRUCTIONS
 
FIRST HOUR

- PAIN MEDICATION – If instructed by your surgeon, you should take over-the-counter Motrin or Advil, 2 tablets every 6 hours continuously for the first two days. Take the first dose before the local anesthesia has worn off. You may use the prescription medication on top of and in-addition-to the Motrin/Advil tablets as needed.
 
- PROTECTING THE BLOOD CLOT - DO NOT RINSE, SMOKE, OR DRINK WITH A STRAW FOR AT LEAST 48 HOURS AFTER YOUR SURGERY. If you have been prescribed an antibiotic mouthwash, you may begin to rinse gently at bedtime.
 
 
THE CHEMICALS IN CIGARETTES ARE CAUSTIC AND WILL SIGNIFICANTLY DELAY HEALING, INCREASE POST-OPERATIVE PAIN, RISK OF INFECTION, AND DRY SOCKET.
 
– GAUZE PRESSURE - Bite down firmly on the gauze packs that have been placed over the surgical areas, make sure they remain in place. Do not change them for the first 30 minutes unless the bleeding is heavy. After 30 minutes, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 20 to 30 minutes). It is best to slightly moisten the gauze with tap water and loosely fluff for more comfortable positioning.
 
- ICE PACKS - Swelling is often associated with oral surgery. Swelling can be minimized by using cold packs, or a bag of frozen peas applied firmly to the cheek nearest to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 24 hours after surgery. DO NOT USE ANY ICE AFTER THE 1ST 24 HOURS.
If you have been prescribed medicine to minimize swelling, be sure to take it as directed. You should take the first group of pills at bedtime tonight.
DAY OF SURGERY
 
- PERSISTENT BLEEDING – Mild bleeding or oozing is normal during the first 24 hours. If necessary reposition the gauze packs directly over the surgical site. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in very hot water, squeezed damp-dry and wrapped in a moist gauze) for 20 or 30 minutes. If bleeding remains uncontrolled after a full hour of using the tea bags, call our office. Remove the gauze while you eat and sleep. Place an old towel over your pillow, as one drop of blood will turn a mouth full of saliva red. It is completely normal to experience mild oozing of blood from the surgical area for a full 24 hrs.
 
- MOUTH OPENING EXCERCISES – Jaw stiffness is common following oral surgery. You can reduce this stiffness by stretching your mouth open with two fingers each hour.
 
- MANAGING POST-OPERATIVE PAIN - Unfortunately, most oral surgery is accompanied by some degree of discomfort and you may be given a prescription for pain medication. To best manage your discomfort, you should take the first pill before the numbness has worn off. If you find you are taking large amounts of pain medicine at frequent intervals, please call our office. You must call for a refill during normal weekday business hours, if you anticipate needing more pain medication for the weekend.
 
- NAUSEA - Nausea is not uncommon after anesthesia or surgery. It generally improves within 4-6 hours. Nausea following anesthesia is best managed by avoiding all foods until you are feeling hungry. Try sipping small amounts of clear liquids to prevent dehydration.
If the pain medication is the cause, try taking Maalox immediately before the medication and drink plenty of water. Try to keep taking clear fluids and minimize dosing of pain medications, but call us if you do not feel better. Classic Coca Cola may also help with nausea.

- PAIN MEDICATION PRECAUTIONS - The prescription pain medication given to you by the doctor may cause drowsiness, decreased reaction time, blurred vision and change in mental status. Do not drive, operate dangerous machinery, make important decisions or perform strenuous exercises while taking these medications. Failure to follow these instructions increases your risk of causing injury to yourself and others.


POST-OP DAY #2 AND BEYOND

- ORAL HYGIENE - Keeping your mouth clean after surgery is essential. In addition to any prescription mouth washes you may have been given, use 1/4 teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least twice a day. Avoid commercial mouthwashes, the alcohol they contain may irritate the surgical site. Avoid brushing the surgical area for at least two weeks. However, we do encourage you to brush and floss all other areas.
 
- HEALING - Normal healing after tooth extraction should be as follows: The first three days after surgery are generally the most uncomfortable and there is usually some swelling. On the 4th day you should be more comfortable and, although still swollen, can usually begin a more normal diet. The remainder of the post-operative course should be a gradual, steady improvement. If you do not see continued improvement, please call our office.
 
- DRY SOCKET - A dry socket is a painful condition that results from premature loss of the blood clot. Risk factors for developing a dry socket are extracting painful or infected teeth, wisdom tooth surgery, females, smokers, and oral contraceptives. Symptoms of a dry socket typically occur on the 3rd or 4th post-operative day. Severe throbbing pain, which is not responsive to pain medications and bad breath, are the usual complaints. This condition requires an office visit where your surgeon will gently place a medicated dressing into the tooth socket. Pain relief is often immediate once the site is treated. A few visits are often necessary.

- SHARP EDGES - If you feel something hard or sharp edges around the surgical areas, it is likely you are feeling the bony walls, which once supported the extracted teeth or the ends of the sutures. Occasionally small slivers of bone may work themselves out during the following weeks. This is normal but if they cause concern or discomfort, please call the office.
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. Calling during office hours will result in a faster response to your question or concern. A 24-hour live operator answering service is available to contact the doctor in cases of true after-hour emergencies. PLEASE NOTE: Telephone calls for renewing narcotic (pain killer) prescriptions should be made during regular office hours.



POST-OPERATIVE SINUS PRECAUTIONS


Because of the close distance between your upper jaw and your maxillary sinus, a hole between the sinus and mouth can sometimes occur. This hole may have been present before your surgery and can result from the removal of teeth, infections, cysts, tumors and dental implant placement.

Certain precautions will help your healing and you are instructed to carefully following these directions.

1. Take all prescription medications as directed.
2. Take over-the-counter Afrin or Neosynephyrine nose drops as directed for no more than 7 days.
3. Take over-the-counter Sudafed tablets (you must now ask for the original formula which is kept behind the counter or in the pharmacy) for 5 days if directed by your surgeon.
4. Do not forcefully spit for seven days.
5. Do not smoke for at least seven days.
6. Do not use a straw for at least seven days.
7. Do not blow your nose for at least two weeks, even if your sinus feels “stuffy” or there is some drainage from your nose.
8. Try not to sneeze. If you must sneeze, then sneeze with your mouth wide open. Sneezing thru your nose will cause a rapid build-up of pressure in your sinus which can effect healing.
9. Eat only soft foods on the opposite side of your mouth until your surgeon has told you it is OK to resume a normal diet.
10. Do not rinse hard. If you have been prescribed any mouth rinses be very gentle.

Slight intermittent bleeding from the nose is common for several days after the surgery.

Make sure to keep the office advised of any changes in your condition, especially if drainage or pain increases. It is important that you keep all future appointments until you have been cleared by your surgeon.

Call the office 973.226.8444 if you have any questions.