Oral Surgery
After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. We ask you to bite on a gauze pad in the tooth extraction area for 30 minutes after the appointment. If the bleeding or oozing persists, repeat the process. After the blood clot forms, it is important not to dislodge the clot. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge the clot. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.
After the tooth is extracted you may feel some pain and experience some swelling. An ice pack applied to the area 20 minutes on, 20 minutes off, will keep swelling to a minimum. Take pain medications as prescribed by John L. Sulak, DDS. The swelling will usually subside in about 48 hours.
Use the pain medication as directed. Call the office if the medication doesn't seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.
It's important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least twice a day. This will speed healing and help keep your mouth fresh and clean.
After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling after 2-3 days, or a reaction to the medication, call our office immediately at (209) 524-4000.
After the Removal of Multiple Teeth
BLEEDING. A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding continues, a moist tea bag can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.
SWELLING. Use ice packs on the same side of the face of the surgical area. Apply ice 20 minutes on, 20 minutes off, during your waking hours for a maximum of 36 hours only. Ice does not have an effect after 36 hours. Call the office for further assistance.
DISCOMFORT. For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 3-4 hours. Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 3-4 hours. For severe pain use the prescription given to you. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, finish your prescription regardless of your symptoms.
DIET. Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day. Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.
HOME HYGIENE CARE. Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt water rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One half teaspoon of salt in a glass of lukewarm water.). After you have seen your dentist for denture adjustment, take out denture and rinse 3 to 4 times a day.
WEARING DENTURES. The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:
- The area operated on will swell reaching a maximum in two days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 36 hours after surgery (remember ice packs are used for the first 36 hours only).
- A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
- If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline. There may be a slight elevation of temperature for 24-48 hours. If temperature continues, notify our office.
If immediate dentures have been inserted, sore spots may develop. In most cases, John L. Sulak, DDS will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.
Post-operative care of the removal of impacted teeth is very important. Carefully follow instructions to minimize unnecessary pain and complications of infection and/or swelling.
BLEEDING. A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or slight blood traces in the saliva is not uncommon. To help minimize bleeding site, avoid any sort of exercise or excitement. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. This action should create a blood clot and bleeding will stop; however, if bleeding does not stop repeat as necessary. As an alternative to the gauze gently bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. If bleeding does not subside, call the office at (209) 524-4000 for additional instructions.
Standard After Surgery Instructions:
- The gauze pad placed over the surgical area should be kept in place for a half hour prior to removal.
- Vigorous mouth rinsing the surgical area following surgery should be avoided. Vigorous sucking through a straw should be avoided. Touching the surgical area should be avoided. These actions may cause the blood clot to become dislodged and cause excess bleeding.
- Begin taking the prescribed pain medications as soon as you begin to feel discomfort.
- Place ice packs to the sides of your face where surgery was performed.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
SWELLING. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon as it is the body’s normal process in repairing itself. Swelling does not always appear immediately. It may take 12 to 24 hours before swelling becomes apparent. Swelling may not reach its maximum until 2-3 days post-surgery. Swelling may be minimized by the immediate use of ice packs post-surgery. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
PAIN MEDICATION. For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours. For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive or operate machinery and avoid alcoholic beverages. Pain or discomfort should subside more every day. If pain persists, it may require attention and you should call the office for assistance.
DIET. After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. Nourishment and regular fluid intake is important to your recovery. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
HOME HYGIENE CARE. There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush. No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.
ANTIBIOTICS. If John L. Sulak, DDS has prescribed antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Call the office in the event of a rash or other unfavorable reaction at (209) 524-4000.
NAUSEA. Occasionally, a prescribed pain medicine may induce nausea and/or vomiting following surgery. Do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.
Other Complications
- NUMBNESS. As discussed in your per-surgery consultation numbness of the lip, chin, or tongue can occurs, but there is no cause for alarm. This is usually a temporary condition. If you do experience numbness be careful not to bite your lip of tongue as you will not feel the action. Call John L. Sulak, DDS if you have any questions.
- TEMPERATURE. Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
- DIZZINESS. Taking pain medications can make you dizzy. You can get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
- SUTURES. Sutures may be placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. In about a week post surgery the sutures will be removed by John L. Sulak, DDS . It is a simple procedure that does not require any anesthesia or needles and only takes a few minutes.
- SORE THROAT PAIN. Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
- JAW STIFFNESS. Stiffness of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.
Decay can frequently be found below the gum line. In order to gain access to the decay, it is necessary to reduce some of the bone surrounding the area of decay so the gum tissue can be positioned either higher up or lower down on the tooth making access to repair decay feasible. In other circumstances, the tooth may fracture below the gum line. Often the tooth requires a crown (cap) to cover over the fracture line. In order for the crown to fit over the fracture line, it is necessary to raise or lower the gum and reshape the bone accordingly so that the fracture line now becomes visible above the gum. The tooth is now ready for a crown (cap). When smiling, ideally there should be a display of upper teeth and a slight amount of gum displayed as well. In many circumstances there is an excessive amount of gum displayed (this is known as a gummy smile). In order to reduce the gum display so that there can be an ideal amount of tooth and gum showing, it is necessary to move both the gum and bone higher up on the teeth. The bone is gently sculpted to create room for the gum tissue to be ideally positioned. Hence the correct proportions of the teeth and gum are now visible.
Canine teeth are some of the last teeth to emerge. Sometimes overcrowding in your mouth will prevent your canines from coming in. Other times, abnormal tissue growth will prevent them from erupting.
Early detection through the use of x-rays is the key to treating impacted canines. If necessary, extra teeth will be removed to ease the way for canine eruption. Braces can be used on the upper teeth to make room for the canines. In adults, surgery is often the best treatment for this problem.
Oral Pathology is the specialty of dentistry which deals with the diseases of the mouth. This science investigates the causes, effects and treatment of these diseases. They include autoimmune problems, trauma, oral cancer, degenerative disease, viral and bacterial issues. Your dentist will recommend the required treatment if a problem is found.
Fold a piece of clean gauze into a pad thick enough to bite on and place directly on the extraction site. Apply moderate pressure by closing the teeth firmly over the pad. Maintain this pressure for about 30 minutes. If the pad becomes soaked, replace it with a clean one as necessary. Do not suck on the extraction site (as with a straw). A slight amount of blood may leak at the extraction site until a clot forms. However, if heavy bleeding continues, call your dentist. (Remember, though, that a lot of saliva and a little blood can look like a lot of bleeding).
The Blood Clot
After an extraction, a blood clot forms in the tooth socket. This clot is an important part of the normal healing process. You should therefore avoid activities that might disturb the clot.
Here's how to protect it:
- Do not smoke, rinse your mouth vigorously or drink through a straw for 24 hours.
- Do not clean the teeth next to the healing tooth socket for the rest of the day. You should, however, brush and floss your other teeth thoroughly, gently rinse your mouth afterwards.
- Limit strenuous activity for 24 hours after the extraction. This will reduce bleeding and help the blood clot to form. Get plenty of rest.
- If you have sutures, your dentist will instruct you when to return to have them removed.
Medication
Your dentist may prescribe medication to control pain and prevent infection. Use it only as directed. If the medication prescribed does not seem to work for you, do not increase the dosage. Please call your dentist immediately if you have prolonged or severe pain, swelling, bleeding, or fever.
Swelling & Pain
After a tooth is removed, you may have some discomfort and notice some swelling. You can help reduce swelling and pain by applying cold compresses to the face. An ice bag or cold, moist cloth can be used periodically. Ice should be used only for the first day. Apply heat tomorrow if needed. Be sure to follow your doctor's instructions.
Diet
After the extraction, drink lots of liquids and eat soft, nutritious foods. Avoid alcoholic beverages and hot liquids. Begin eating solid foods the next day or as soon as you can chew comfortably. For about two days, try to chew food on the side opposite the extraction site. If you are troubled by nausea and vomiting call your dentist for advice.
Rinsing
The day after the extraction, gently rinse your mouth with warm salt water (teaspoon of salt in an 8 oz. glass of warm water). Rinsing after meals is important to keep food particles away from the extraction site. Do not rinse vigorously!
Anesthesia - The feeling of numbness will begin to wear off in 30 minutes to 4 hours. Until that time, avoid all hot foods or liquids, and do not chew. This is to prevent accidentally burning or biting the lips, cheeks, inside of your mouth or tongue until the feeling has returned
Gauze Pack - Fold the gauze into a small pack and place over the extraction site and apply firm pressure for one to two hours. Change the gauze pack every 15-30 minutes.
Bleeding - It is normal for the extraction site to bleed slightly or ooze blood for 12 to 24 hours following surgery.
Ice Pack - For the first 2 to 8 hours after surgery, ice packs should be applied to the outside of the face over the area of the extraction site. The ice pack should be held in place for 15 minutes on, and then removed for 15 minutes. Doing this throughout the day will help reduce discomfort and swelling.
Medications - DO NOT TAKE ASPIRIN PRODUCTS due to the possible increase in bleeding potential. If prescription medications were prescribed please follow label instructions carefully. For most extractions, a non-aspirin over the counter pain medication will provide good pain relief. Do not take more than the recommended dosage!
Diet - A liquid or soft diet should be adhered to for the first 12 to 24 hours after surgery. It is important to drink plenty of liquids for the first day or two. Avoid the use of a straw as it may dislodge the blood clot that is forming in the extraction site.
Oral Hygiene - Clean the rest of your mouth as usual, however avoid bumping or brushing the extraction site. DO NOT RINSE OR SWISH YOUR MOUTH for the first 24 hours following surgery.
Possible Complications:
Dry Socket - This is sometimes a problem after surgery. The symptoms associated with dry socket are constant moderate to severe pain, bad taste, putrid odor, and poor clot formation at the surgical site. If you think you have ANY of these symptoms call our office as soon as possible.
Fever - Monitor your temperature for the first 24 to 48 hours. Any elevated temperature should be reported to our office.
Swelling - After a tooth is removed, you may have some discomfort and notice some swelling. You can help reduce swelling and pain by applying cold compresses to the face. An ice bag or a cold, moist cloth can be used periodically. Ice should be used only for the first day. Apply heat the following day if needed. Be sure to follow your doctor's instructions.
Before any oral surgical procedure you should:
- Eat a light and easily digestible meal the night before your appointment
- If you are going to be sedated, DO NOT eat or drink anything on the day of your appointment
- Wear short sleeves and loose-fitting clothing
- Arrange for a relative or friend to stay in the office with you and be ready to drive you home
- You may NOT drive a car on the day of the surgery if you are to be sedated!
Pre-surgical
Q: Is there a food and drink restriction prior to surgery?
A: If treatment calls for the patient to be sedated then yes there are food and/or drink restriction. The patient must not consume anything, including water for 6-8 hours prior to surgery.
Q: Will antibiotics be prescribed prior to surgery?
A: We commonly use antibiotics to kill bacteria found in the mouth, which will also prevent infection after treatment, particularly with the placement of dental implants immediately after extracted teeth. The specific drug used depends on the medical profile and well being of the patient and the type of treatment.
Q: Do I need to avoid certain medications?
A: It is important to discuss all medication with John L. Sulak, DDS during your pre-surgical consultation. In most cases medication should be continued unless specifically instructed to withhold them. Typically Plavix, Aspirin, Coumadin and other types of blood thinners can also be continued. When necessary John L. Sulak, DDS will consult with your physician to safely manage your medications.
Q: Are the rules different for ORTHOGNATIC SURGERY different from tooth extractions of dental implant placement?
A: Yes, very different. Patients who are undergoing surgical procedures on only one jaw usually go home the same day. Patients who are having surgery on both jaws will generally stay overnight. Generally it is necessary to wire the jaws together after orthognatic surgery. In general, the jaws are immobilized securely with rubber bands for the first 1-2 weeks and then loosely for an additional 3-5 weeks. It is very important to discontinue any medication which are “blood thinners†or which may increase your tendency to bleed. Please stop taking the following medications at least 2 weeks before surgery. John L. Sulak, DDS will provide specific instructions prior to your surgery date.
Surgery
Q: Will anesthesia be used?
A: John L. Sulak, DDS will discuss your anesthesia options. Our goal is to provide minimal discomfort as possible.
Q: How is the anesthesia administered?
A: Depending upon your treatment we may administer a local anesthesia such as lidocaine or nitrous oxide. For a more involved treatment we may recommend an oral sedation or intravenous sedation.
Q: What do I need to be aware of before intravenous sedation?
A: You may not have anything to eat or drink (including water) for eight (8) hours prior to the appointment. No smoking at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery. A responsible adult must accompany the patient to the office, remain in the office during the procedure, and drive the patient home. The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience. Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and low-heeled shoes. Contact lenses, jewelry, and dentures must be removed at the time of surgery. Do not wear lipstick, excessive makeup, or nail polish on the day of surgery. If you have an illness such as a cold, sore throat, stomach or bowel upset, please notify the office. If you take routine oral medications, please check with John L. Sulak, DDS prior to your surgical date for instructions.
Q: Will my vital signs be monitored during and after treatment?
A: John L. Sulak, DDS and/or one of their highly trained surgical assistants will continuously monitor your vital signs.
Q: How long will the surgery take?
A: The length of surgery depends on your treatment. Some surgery's are less than 30 minutes, while other procedures may take considerably longer. John L. Sulak, DDS will provide you with the estimated time of surgery at your pre-surgical consultation.
Q: Will there be a lot of bleeding with a tooth extraction?
A: It's important for a blood clot to form to stop the bleeding after a tooth extraction. You will be asked to bite on a gauze pad for 30-45 minutes immediately after the extraction. If the bleeding or oozing still persists, place another gauze pad and bite firmly for another 30 minutes. You may have to do this several times. After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.
Post Surgery
Q: How long is the on-site recovery before I can leave the office?
A: Plan to stay in our recovery room for at least 20 minutes if sedation was involved, or until John L. Sulak, DDS is satisfied that you are recovered sufficiently to go home. If your procedure required sedation you must be completely alert before leaving the office for home. You must have a ride home. You may not drive yourself. It is recommend that you do not drive for a minimum 24 hours after surgery.
Q: Will you prescribe antibiotics and pain medication?
A: Procedure and patient health are determining factors of what antibiotic and/or medication will be prescribed. Call the office if the medication does not seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable. Dr. Sulak will discuss what, when, how long and dosage with you in both the pre-surgery and post surgery interviews.
Recovery
Q: How long will I be off of work/out of school?
A: Depending on the extent of the procedure and type of sedation you may resume work and a normal life style anywhere from a few hours to a few days. It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean. After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call our office immediately.
Q: Will there be swelling or facial bruising?
A: After the tooth is extracted, you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours. In some treatments there may be some minor bruising; however, in procedures such as dental implant placement ordinarily there is no bruising seen. For teeth removal or jaw procedures, women and/or very light skinned patients may experience slight bruising. Taking blood thinner will help reduce bruising. It is, however, not uncommon to have a black eye or discolored cheek or neck following extensive procedures. John L. Sulak, DDS will discuss what bruising if any would be related to your procedure treatment.
Dr. Sulak is an experienced tooth extraction dentist in Modesto. When the extraction of a tooth is required:
1) An incision in the gums is made
2) The tooth is removed
3) The area is stitched up and is allowed to heal
During this time, it is important to think about a tooth replacement option. An extracted tooth leaves an open area in the jaw which, in time, allows the neighboring teeth to drift into the area where the tooth was extracted. This in turn, causes a chain reaction to all the surrounding teeth. Also, if you are considering placing an implant in the future, you should consider asking your dentist to place a bone graft at the time of surgery to preserve the bone width and height.
Wisdom teeth generally begin to form in your pre-teen years. By late teen years, the crown of the wisdom teeth will begin to erupt through the gums if there is adequate room. By mid twenties, your wisdom teeth will either be able to fully erupt or will have become impacted. Early removal of wisdom teeth makes the procedure easier for the patient to tolerate and promotes faster healing after wards.By your early forties, the wisdom teeth roots have become fully anchored to the jawbone and if required to be extracted, will be much harder and will need more time to heal.
Wisdom teeth under ideal circumstances should grow in straight like any other tooth. However, it is common for wisdom teeth to become impacted inside the jaw or just under the gums. If this occurs, your wisdom teeth should be removed.
Common Impactions:
1) Horizontal Impaction
2) Angular Impaction
3) Vertical Impaction
4) Soft Tissue Impaction
The problems involving your wisdom teeth may be caused by the size of your jaw and/or by how crowded your teeth are. Common warning symptoms that there is an un-natural problem in the development of your wisdom teeth could be pain and swelling.
Symptoms can be caused by:
1) Infection to the gums
2) A crowded tooth displacing neighboring teeth
3) A decayed wisdom tooth
4) Poorly positioned wisdom tooth
5) A cyst that destroys bone
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