ROUTINE POST-OPERATIVE INSTRUCTIONS

Bleeding

Keep pressure over extraction (surgery) site with gauze for forty-five minutes. If bleeding continues, place a fresh gauze pad over extraction (surgery) site and bite hard, applying pressure to the area for forty-five minute intervals until the bleeding stops. It is not unusual for saliva to be slightly blood-tinged for several days following surgery.

Medication

Take pain medication as instructed by the doctor. The first dose should be taken with a clear liquid such as Coca-Cola, tea or Seven-up. After the initial dose, do not take pain medication with just water on an empty stomach. Take the second dose as soon as you feel discomfort after you have had something to drink (soup, milkshake, etc.).

Smoking

Avoid smoking for at least forty-eight hours following surgery.

Rinsing

Avoid all rinsing for at least six hours after surgery. Beginning the day after surgery you should rinse gently with mouth wash (Chloraseptic, Cepacol,times daily, especially after eating.)

Diet

You should have a LIQUID DIET ONLY on the day of surgery and the day following surgery. It is important that you maintain a high fluid intake (malts, juices, soup, etc.) for several days following surgery. Liquids may be taken beginning three hours after surgery. Beginning forty-eight hours after surgery you may eat soft foods. After that you may progress to anything that you feel you can eat, unless given other specific instructions by the doctor. No alcoholic beverages should be consumed for at least twenty-four hours following surgery, or as long as you are taking medications.

Ice Packs

Ice packs should be used for the first forty-eight hours following surgery. It is not unusual to have more swelling on the second post-operative day than was present on the first post-operative day. Beginning seventy-two hours after surgery (the third day), a heating pad or moist heat should be used for relief of swelling, bruising, and stiffness. Heat should be continued for thirty minute intervals, three or four times daily, until the symptoms subside.

Emergencies

If any unusual symptoms should occur you may reach the doctor twenty-four hours at (713) 783-5560. Proper care following oral surgery will hasten recovery and prevent complication. You should experience progressive improvement in symptoms three to four days after surgery, although tenderness for several days is not unusual. If severe throbbing pain or pain unrelieved by medication persists beyond the third or fourth post-operative day, please notify the office. You should also return to this office for your post-operative follow-up visit five to ten days following surgery.

DAY OF SURGERY

Bleeding

To control bleeding following surgery, firm consistent pressure should be applied to the surgical site(s) for one hour. This is accomplished by biting down on the sterile gauze sponges that were placed over the site(s) during surgery. These gauze sponges may be removed after one hour. If bleeding continues, the sterile gauze should be re-applied for one hour periods until the bleeding has been controlled. However, it is not necessary to continue using the gauze for slightly blood-tinged saliva which may continue for several days.

Medications

Antibiotics - Antibiotics should be started 4 hours after surgery following the first liquid meal and continued until the entire prescription has been taken.

Anti-inflammatory - If an anti-inflammatory medication (ie Ansaid, Motrin) has been prescribed, it should also be started 4 hours after surgery following the first liquid meal. It should be taken every 8 hours for 3 days and may be continued after the third day to control mild pain as necessary. Anti-inflammatory medications reduce swelling and pain without causing drowsiness. If adequate pain control is achieved with the anti-inflammatory medication, narcotic pain medication may not be necessary. However, the anti-inflammatory medication and the pain medication may be taken at the same time if necessary to control discomfort.

Pain - Medication for pain control may have been administered by the doctor following the surgical procedure. Therefore, narcotic pain medication should not be given unless pain is experienced. This may not occur until several hours after surgery. If necessary, the pain medication may be taken every 3 to 4 hours. These medications may cause drowsiness, so driving or use of hazardous equipment should be avoided.

Smoking

Smoking should be avoided for at least 48 hours after surgery.

Ice Packs

Ice packs should be used continuously for 36 hours following surgery.

Diet

A liquid diet may be started 3 hours after surgery and should be continued for 48 hours. It is important to maintain a high fluid intake (juice, soup, malts, etc.) for several days following surgery.

Rinsing

You may begin rinsing 6 hours after surgery with Chloraseptic,and half with water. Rinse after meals and before bedtime.

FIRST DAY AFTER SURGERY

Medications

Antibiotics and anti-inflammatory medications should be continued as directed and pain medication taken as needed.

Ice Packs

Ice packs should be continued throughout the day and may be discontinued at bedtime. It is not unusual to have increased swelling the first day after surgery.

Diet

A full liquid diet should be continued throughout the day.

Brushing

You may begin brushing your teeth in front the first day after surgery, avoiding the surgical sites until after your post-operative check-up.

SECOND DAY AFTER SURGERY

Medications

Antibiotics and anti-inflammatory medications should be continued as directed and pain medication taken as needed.

Ice Packs

Ice packs should not be used the second day after surgery.

Diet

A soft food diet may be started including scrambled eggs, mashed potatoes, and items of similar consistency.

THIRD DAY AFTER SURGERY

Medications

Antibiotics should be continued until the entire prescription has been taken. Anti- inflammatory medication may be discontinued unless needed for relief of discomfort. Pain medication should be taken only if full relief of discomfort is not achieved with the anti-inflammatory medication.

Heat

If symptoms of swelling, bruising, or stiffness are present, apply a heating pad or moist heat to the affected area 3 or 4 times daily for approximately 20 to 30 minutes each time. Heat should be continued until the symptoms subside, which may take several days.

Diet

A regular diet may be resumed although sharp or chewy items should be avoided for a few more days.

EMERGENCIES

If any usual symptoms occur, you may reach the doctor 24 hours a day by calling (713) 783-5560.

Proper care following oral surgery will hasten recovery and prevent complication. Although tenderness is not unusual for several days, the patient should feel progressively better every day starting 3 to 4 days after surgery. If severe throbbing pain or pain unrelieved by medication persists, please notify the office.

Regular post-operative visits are scheduled 5 to 10 days following surgical procedures. This is an important part of comprehensive care. If you are unable to keep this appointment, please contact our office to reschedule as soon as possible.

1. Just as a cast immobilizes other bones for healing, immobilization of the jaw bones is necessary when broken or surgically repositioned. Wiring of the teeth and immobilization with splints and rubber band traction may be used to position the jawbones for healing. If internal rigid fixation with screws and plates are utilized, movement of the jaw is allowed.
2. The usual healing time is 6-8 weeks. Appliances are removed shortly thereafter.
3. Initially you may have pain. Take prescribed medicine as needed. The pain will gradually diminish. Do not attempt to move or open your jaws. This action only increases the pain, may delay healing, and may cause muscle spasms in your jaw muscles.
4. Adequate nourishment is important during this period. Your diet will consist of milkshakes, soups, and juices. Many liquid food supplements are also available such as Sego, Metrecal, Sustagen, Boost, and others. A blender or food processor is useful to puree solid food for intake. Five or six small feedings each day are usually easier than three larger ones. Your oral intake should be at least 8-10 cups of fluid each day. A general rule is to maintain a minimum of 2,000 calories per day to avoid losing weight. It is important to keep well hydrated as well.
5. Oral cleanliness is of the utmost importance while the teeth are wired together. Rinsing the mouth 4-5 times each day, especially after eating, is a necessity. A small child's toothbrush is also handy for cleaning. An oral irrigation device (Water Pic) is extremely useful following meals. The following mouthwashes should be used separately at each cleansing period:
   1. Hydrogen peroxide, 3% - 1/2 strength
   2. Chloraseptic, Listerine or Cepacol mouthwash
   3. Peridex oral rinses
6. If severe nausea or vomiting occurs, cut the rubber bands or wires between the upper and lower teeth. If your jaws are fixed together, have pair of scissors or wire cutters on your person at all times. Call the office for replacement immediately.
7. Frequent office visits and periodic post-operative x-rays are necessary.
8. Following initial recovery (1-2 weeks), a moderate schedule may be resumed. No swimming or contact sports are allowed. You may bathe and wash your hair.
9. If wires begin to irritate cheeks or lips, wax can be placed over these sharp areas temporarily. Vaseline or other lip lubricants will aid in comfort. If any problem arises such as a shifting of your bite, fever, excessive swelling or bleeding, call the office at once - (713) 783-5560.

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