Surgical Instructions

I. Preoperative Instructions for Patients Undergoing Intravenous Sedation

You may not have anything to eat ( solid foods ) for six hours ( 6 ) prior to the surgical appointment. You may have clear liquids up to two hours prior to your sedation ( water, apple juice, or white Grape juice ). You are encouraged to brush your teeth prior to the appointment and take your normal required medications with a small sip of water. Dr. Buche may modify some of these medications, such as diabetic medicines.

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. Low -heeled shoes are best. Contact lenses, jewelry, and dentures must be removed at the time of surgery. Please remove nail polish from one of your fingers so we may use our oximeter. We prefer the left hand if possible

Smoking will increase the risk of infection, potentially slow down healing, and cause excessive bleeding if done immediately after the surgery.

Please do not consume large quantities of alcohol the night before your surgery. Alcohol and other drugs, especially recreational drugs, do not mix well with our sedation medications.

Aspirin may affect bleeding slightly, but it is usually not a problem. If you choose to not take aspirin before your surgery, you should stop a good week in advance.

If you have any questions about your sedation or surgery, please feel free to ask our staff or Dr. Buche in advance of the procedure.

II Post-Op Instructions and Care of the Mouth

All people respond differently to intravenous sedation and surgical procedures, so your experience may be different from that of another person. Here are some guidelines that will help. Remember that you may call the office at any time if you are unsure of your progress.

IMMEDIATELY AFTER SURGERY you may just want to go home and relax for awhile. Please do not attempt to drive or opeate machinery until you have completely recovered from your anesthesia. Watch out for dizziness for some time and get up slowly, especially if you have taken narcotics. We usually use a very long acting local anesthetic (Marcaine), so you may not need pain medication for up to twelve hours. Ibuprofen is our pain medication of choice if you can take it- it is a strong anti-inflammatory drug. It is best to avoid alcohol immediately post-operatively. For your protection, you should not drive for 24 hours.

Some BLEEDING is normal, sometimes up to 24 hours. Some SWELLING is also normal, depending on the difficulty of the surgery. Reduce your activity as much as possible for several hours. Avoid heavy eating and unnecessary talking for a little while Do not heavily rinse your mouth for 24 hours. These activities may hinder formation of a blood clot which is necessary for proper healing. Bite down on your gauze ( we will give you extra gauze ) for 45 minutes at a time, and then replace as needed. When the bleeding is minimal, take the gauze out. Chewing on it can start the bleeding again. The old trick of using a tea bag to control bleedingstill works! However, heavy bleeding ( that you can’t seem to control ) should be reported to the office.

NAUSEA: Nausea is not uncommon, but most of the time it is related to swallowing blood after the procedure. So, it is best to avoid sedating narcotics. Wait until you need narcotic pain medications. With Ibuprofen, you may not need it at all! Narcotics, such as hydrocodone, can cause an upset tummy and make you sleepy. Stay with clear liquids if you feel nauseated. Ice chips and apple juice will help until you are feeling better. Only rarely will a patient need a medication to control nausea.

DIET: Ice chips or clear liquids ( such as apple juice, ginger ale, or jell-0 ) are a good start. Later in the day, soft foods, such as mashed potatoes, soups and ice cream are fine. The day after surgery, you can eat just about whatever you can tolerate! It might be best to avoid popcorn and nuts.

ORAL HYGIENE AND ORAL CARE: Try not to rinse your mouth heavily the day of surgery. You do not want to disturb the clot. Change your gauze as needed, but just don’t rinse heavily . A straw will not hurt after the first day, but it might cause some bleeding right after the surgery. Do not probe the sites with your tongue or fingers or other objects. You may brush your teeth gently the first day, but avoid the surgical sites. Smoking is not a great idea- and you do NOT want to get smokeless tobacco in the surgical sites!

SWELLING AND BRUISING: Some swelling is to be expected, and this may increase for up to 72 hours. With really difficult wisdom teeth, for example, you may have considerable swelling. Ice packs, applied immediately after the surgery, will help. Ice cubes in a zip-lock bag, applied on and off for 20 minutes at a time, seems to help- and feel good! Place a wash cloth between your skin and the bag, however. You may experience bruising over the surgical site- or even in distant areas, such as under the chin. This is not uncommon, and it will go away. You may experience tightness of the jaw muscles, too. After several days, this may respond to mild heat. Apply vasaline or lip balm if your lips tend to crack or are sore from mild stretching. A slight elevation of temperature can be seen for 24 to 48 hours.

PAIN AND MEDICATIONS: Most oral surgery is accompanied by some post-operative discomfort. Do not be afraid to take your medications as prescribed. When local anesthesia wears off ( and this may take up to twelve hours ) there is somewhat of a “rebound”. It’s good to have some medications on board to help you at that time. Take medications with clear liquids or a small amout of soft food. Don’t forget your antibiotics if they were prescribed. More and more we are finding that people do just about as well with 800 mg of ibuprofen every eight hours instead of narcotics. You might want to give that a try. Ibuprofen will usually not make you drowsy. Please remember that antibiotics might alter the effectiveness of your Birth Control Pill. You will want to use an alternative method of birth control during the remainder of your menstrual cycle.

RINSING: Warm salt water ( with just a small amount of salt1/2 tsp to a glass of warm water ) generally does make the surgical site feel better. It helps clean the area as well. You may do this several times a day after the first day. We give irrigating syringes to our patients who need thembut not until about a week after the surgery.

DRY SOCKETS: Everyone is concerned about a dry socket, and they do occur, especially after difficult wisdom tooth surgery. If the blood clot is lost after the 2nd to 4th day, you may experience pain in the site and into the ear. It does not respond too well to pain medications. PLEASE callwe can help a lot.

NUMBNESS: Loss of sensation to the lip or chin, and sometimes the tongue, may occur after difficult surgery, especially in the wisdom tooth area. This is usually temporary and will disappear within a few days or weeks. Occasionally it persists much longer. It is due to the close proximity of the roots of teeth to the nerve that supplies those teeth and also the lips and gums. The nerve to the tongue is also close to surgical sites in the back of the mouth.

It is our desire to make your surgical recovery as smooth as possible. If you have any questions about post-surgical care or complications, please call the office for some help. The number is (325) 949-1288 ). If you need Dr. Buche after hours, you may call his emergency contact number (325 374 0809 ) and he will then contact you as soon as he can. Occasionally, Dr. Buche is out of town. A fellow oral surgeon here in town will usually cover during those periods of absence.