2. A STITCH may come LOOSE and pull out during the first week after surgery. This is no concern unless excessive bleeding follows.

3. SWELLING may occur and is part of the body’s healing mechanism. To help minimize swelling, apply ice immediately. Use the ice 20 minutes “ON” and 20 minutes “OFF”, for the first 24 hours during waking hours. Keep your head elevated on at least 2 pillows when sleeping or resting. Should swelling persist after 24 hours, apply moist heat to the area by using a wet washcloth or hot water bottle. Be careful not to burn the skin.

4. Your PAIN MEDICINE is prescribed to be taken on an as needed basis. However, throughout the first day and night, it should be taken regularly. The first dose should be taken shortly after you arrive home. Do not drive or drink alcohol while taking pain medicine. If an antibiotic is prescribed to treat or prevent infection, be sure to take the entire prescription. Notify the office immediately if you have any problems with your medication.

5. Following general anesthesia; A) No driving or operating machinery for the remainder of that day. B) We recommend not going home and spending the day in bed or sleeping, as this will increase swelling and bruising. Limit naps to 1 hour periods and eat, drink, use ice, read, watch TV etc. C) You may experience a sore dry throat which will be relieved with cold fluids.

6. Good ORAL HYGIENE will keep the mouth clean, help prevent infection and promote healing. Beginning tomorrow, rinse the area GENTLY with warm salt water ( _ teaspoon in 8-10 oz. of water). You may use a toothbrush (run it under warm water to soften the bristle) to keep the area clean. If a little bleeding occurs, do not be alarmed, this should stop after a few minutes.

7. Start chewing gum the next day, continuing for 3 days. This helps control soreness, stiffness and swelling.

8. A good DIET will help promote healing. Allow hot liquids and food to cool to room temperature for the first 6 hours. You are encouraged to drink a lot of fluids, in addition to your meals, the day of surgery and the day after. Start your diet with soft foods. Advance to a regular diet as tolerated.

9. SPECIAL INSTRUCTIONS: The removal of impacted wisdom teeth is quite different than the extraction of erupted teeth. The following conditions may occur, all of which are considered normal:

1. THE AREA OPERATED ON WILL SWELL. This may take a day or two to develop.
2. TRISMUS (TIGHTNESS) OF THE MUSCLES may cause difficulty in opening the mouth.
3. A SORE THROAT MAY DEVELOP.
4. YOUR OTHER TEETH POSSIBLY WILL ACHE TEMPORARILY. We refer to this as sympathetic pain. It is a temporary condition.
5. IF CORNERS OF THE MOUTH are stretched, they may dry out and crack. Your lips should be kept moist with a cream or ointment.
6. THERE MAY BE A CAVITY where the tooth was removed. This area should be cleaned gently, but thoroughly, with warm salt water. Avoid vigorous rinsing so the blood clot is not dislodged causing a dry socket. This cavity will gradually fill in with new tissue.
7. THERE MAY BE A SLIGHT ELEVATION OF TEMPERATURE for 24 to 48 hours. If temperature continues, notify us.
8. If after the third or fourth post-operative day, you develop a bad taste in your mouth, as well as an aching pain, you may have a dry socket. Call our office during the day for an appointment to treat this condition.

POST-OPERATIVE INSTRUCTIONS: TOP TEN MOST FREQUENTLY ASKED QUESTIONS

Q: When can I take the gauze out?
A: Please leave the gauze in for one hour after you leave our office. If the bleeding has stopped, there is no need to have gauze placed over the surgical area.

Q: When can I eat?
A: Two hours following your appointment.

Q: What can I eat?
A: Please begin with soft foods such as pasta, macaroni and cheese, eggs, soft breads, soups (not hot), potatoes (baked, boiled or whipped), peas, lima beans, cottage cheese, yogurt, fresh vegetable juices, Jell-O, custard and pudding. Slowly advance as tolerated. Do not use a straw for drinking as this may dislodge the blood clot.

Q: What can I expect with regard to swelling?
A: Everybody is different but swelling can develop up to 2-3 days following surgery. Please use ice off and on for thirty minutes for the first 24 hours. If swelling persists after 24 hours, please use a heating pad. Discontinue ice completely.

Q: What if a stitch comes out?
A: A stitch may come loose and pull out during the first few days after surgery. This is
of no concern unless brisk bleeding follows. The first thing to do if bleeding occurs would be to use the gauze with firm pressure for 45 minutes.

Q: I still have bleeding, what can I do?
A: Some bleeding is normal up to 24 hours following surgery. Please bite firmly on a gauze pack over the surgical site for 45 minutes at a time. Keep your head elevated in an upright position without much movement to keep your blood pressure down to aide in stopping the bleeding. If excessive bleeding persists, wipe your mouth clean and place a damp tea bag over the surgery area and apply pressure for one hour. Avoid vigorous rinsing or spitting. Do not use a straw and also avoid smoking and strenuous activity which can aggravate bleeding.

Q: Do I need an antibiotic?
A: The doctors evaluate each case individually and all cases do not require antibiotics. However, if you have been prescribed an antibiotic, please take it until it is all gone.

Q: What about pain medication?
A: If you have been prescribed a pain medication, please take it within an hour or two following surgery to allow it time to get into your system before the Novocaine wears off. If you prefer to take an over-the-counter pain reliever such as Tylenol or Advil, please take it within two hours following surgery. Remember no drinking alcohol or driving while taking any narcotic medication such as Vicodin, Tylenol with Codeine or Percocet, etc.

Q: Is it okay that there is a big hole where my surgery was?
A: Often times the body wants to heal extraction wounds from the bottom to the top and a hole will form. Over the next 1-2 months the hole will usually heal completely. Do not be alarmed.

Q: When can I resume my normal sports activities?
A: Please allow 3-4 days before resuming strenuous activity. Exertion can increase your blood pressure which will lead to bleeding. Also you need to rest to aide in your healing. Please refrain from vigorous activity while taking a prescription pain reliever.

If you have a routine question, please contact our office Monday-Thursday 8 am to 4:30 pm and Friday 8 am to 12 pm at 717-544-3551. If you have an emergency after normal business hours, please call our office at 717-544-3551 and the Medical Bureau will page the doctor on call. You will hear a click as the call is being forwarded. Your call has not been disconnected. In a few seconds, the phone will ring and an operator will answer.

ORAL AND MAXILLOFACIAL SURGERY POST-OPERATIVE SINUS PRECAUTION INSTRUCTIONS

Because of the close relationship between upper back teeth and the sinus, a communication between the sinus and mouth sometimes results from surgery. If that complication has occurred in your case, certain precautions will assist healing and we ask that you faithfully follow these instructions:

1. Take prescriptions as directed.
2. Do not forcefully spit for several days.
3. Do not smoke for two weeks.
4. Do not use a straw for two weeks.
5. Do not forcefully blow you nose for at least two weeks, even though your sinus may feel “stuffy” or there may be some nasal drainage.
6. Try not to sneeze; it will cause undesired sinus pressure. If you must sneeze, keep you mouth open.
7. Eat only soft foods for several days, always trying to chew on the opposite side of your mouth.
8. Do not rinse vigorously for several days. Gentle swishing with salt water may be done.

Slight bleeding from the nose is not uncommon for several days after surgery.

Please keep our office advised of any changes in your condition, especially if drainage or pain increases. It is important that you keep all future appointments until this condition has resolved.