Pre- and Post-Operative
4-Hour Smile Instructions

Before Your Surgery

Pre-Operative Instructions

EVERY PATIENT MUST ARRIVE AT LEAST 10 MINUTES BEFORE SURGERY TO AVOID RESCHEDULING.

1. DO NOT EAT OR DRINK ANYTHING FOR 8 HOURS PRIOR TO YOUR SURGERY. (Appointment will be rescheduled and a possible charge may occur.)
2. Take prescribed medication the morning of surgery with a small amount of water (sips only).
3. NO SMOKING 12 hours before surgery.
4. No drinking alcohol for at least 24 hours before surgery.
5. Brush your teeth thoroughly before surgery.
6. A RESPONSIBLE ADULT MUST ACCOMPANY THE PATIENT TO THE OFFICE AND MUST REMAIN IN THE OFFICE DURING THE ENTIRE SURGERY, DRIVE THE PATIENT HOME, AND SUPERVISE THE PATIENT FOR 24 HOURS FOLLOWING SURGERY.
7. Wear loose, comfortable clothing and a SHORT-SLEEVED shirt.
8. Remove all makeup before surgery.
9. NAIL POLISH must be removed before surgery.
10. Flu-like, head or chest cold symptoms MUST be reported to the office before surgery.
11. Schedule 48-72 hours off work and/or school.
12. Do not operate a vehicle, machinery, or engage in any job or school-related activity for 24 hours following surgery or your last dose of pain medication.
13. CANCELLATIONS MUST BE MADE AT LEAST 24 HOURS BEFORE YOUR APPOINTMENT OR THERE WILL BE A $30 NO-SHOW/CANCELATION FEE.
14. Please be advised on the day of surgery the surgeon performing your surgery could be Dr. William Graves, Dr. Paul Wilkinson, or Dr. Luis Gonzalez Aguilar.

After Your Surgery

Post-Operative Instructions

Sometimes the after-effects of oral surgery are quite minimal, so not all of the instructions may apply. Common sense will often dictate what you should do. HOWEVER, WHEN IN DOUBT FOLLOW THESE GUIDELINES OR CALL OUR OFFICE FOR CLARIFICATION (806) 353-1055.

Day of Surgery

FIRST HOUR: Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not controlled. The packs may be gently removed after 1 hour. If active bleeding persists, 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 30-45 minutes). It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning.

EXERCISE CARE: Do not disturb the surgical area today. Do NOT rinse vigorously or probe the area with any objects. You may brush your teeth gently. Please do NOT smoke for at least 72 hours—this is very detrimental to healing and may cause a dry socket.

OOZING: Intermittent bleeding or oozing overnight is normal. Bleeding may be controlled by placing fresh gauze over the areas and biting on the gauze for 30-45 minutes at a time.

PERSISTENT BLEEDING: Bleeding should never be severe. If so, it usually means that the packs are being clenched between the teeth only and not exerting pressure on the surgical areas. Try repositioning the packs. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in very hot water, squeezed damp-dry, and wrapped in moist gauze) for 20-30 minutes. If bleeding remains uncontrolled, please call our office.

SWELLING: Swelling is often associated with oral surgery. It can be minimized by using a cold pack, ice bag, or frozen peas wrapped in a towel and applied firmly to the cheek adjacent to the surgical area. This should be applied 20 minutes on and 20 minutes off during the first 24 hours after surgery. Staying in an elevated position (for example, in a recliner) for the first 24 hours could help with swelling as well. If you have been prescribed medicine for the control of swelling, be sure to take it as directed.

PAIN: Unfortunately, most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first pill before the anesthetic has worn off, you should be able to manage any discomfort better. Some patients find that stronger pain medicine causes nausea, but if you precede each pain pill with a small amount of food, chances for nausea will be reduced. The effects of pain medications vary widely among individuals. If you do not achieve adequate relief at first, you may supplement each pain pill with an analgesic, such as aspirin or ibuprofen. Some patients may even require two of the pain pills at one time. Remember that the most severe pain is usually within 6 hours after the local anesthetic wears off; after that, your need for medicine should lessen. If you find you are taking large amounts of pain medicine at frequent intervals, please call our office. If you anticipate needing more prescription medication for the weekend, you must call for a refill during a weekday business hours.

Nausea/Vomiting

NAUSEA: Nausea is not uncommon after surgery. Sometimes pain medications are the cause. Nausea can be reduced by preceding each pain pill with a small amount of soft food and taking the pill with a large volume of water. Try to keep taking clear fluids and minimize dosing pain medications, but call us if you do not feel better.

DIET: Eat any nourishing food that can be taken with comfort. Avoid extremely hot foods. Do NOT use a straw or drink carbonated beverages for the first few days after surgery. It is sometimes advisable, but not absolutely required, to confine the first day's intake to liquid or pureed foods (soup, pudding, yogurt, milk shakes, etc.). It is best to avoid foods like nuts, sunflower seeds, popcorn, etc., which may get lodged in the socket areas. Over the next several days, you may gradually progress to solid foods. It is important not to skip meals. You will feel better, gain strength, have less discomfort, and heal faster if you take nourishment regularly. If you are a diabetic, maintain your normal eating habits or follow instructions given by your doctor.

SHARP EDGES: If you feel something hard or sharp edges in the surgical areas, it is likely you are feeling the bony walls which once supported the extracted teeth. Occasionally, small slivers of bone may work themselves out during the following week or so. If they concern or discomfort you, please call the office.

Instructions for the Second and Third Days

MOUTH RINSES: Keeping your mouth clean after surgery is essential. Use 1⁄4 teaspoon of salt dissolved in an 8-ounce glass of warm water and gently rinse with portions of the solution, taking 5 minutes to use the entire glassful. Repeat as often as you like, but at least 2 or 3 times daily.

BRUSHING: Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth within the bounds of comfort.

HOT APPLICATIONS: You may apply warm compresses to the skin over the areas of swelling (hot water bottle, hot moist towel, and heating pad) for 20 minutes on and 20 minutes off to help soothe tender areas. This will also decrease swelling and stiffness.

HEALING: Normal healing after tooth extraction should be as follows: the first 2 days after surgery are generally the most uncomfortable, and there is usually some swelling. On the third day you should be more comfortable and, although still swollen, can usually begin a more substantial diet. The remainder of the post-operative course should be gradual, steady improvement. If you don't see continued improvement, please call our office. If you are given a plastic irrigating syringe, do NOT use it for the first 5 days. Then use it daily according to the instructions until you are certain the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket.

EAT:

• Chicken noodle soup
• Chicken with rice or chicken broth
• Dry cereal (no milk for 24 hours after surgery)
• Cream of Wheat^®/oatmeal
• JELL-O^®
• Crackers
• Boiled rice (plain)
• Colored popsicles (no chocolate)
• Cooked vegetables
• Boiled/mashed potatoes
• Scrambled/boiled eggs

DRINK:

• Water
• Sprite^® or 7-Up^®
• Iced tea with lemon
• Gatorade^®, Powerade^®, vitaminwater^®
• Ginger ale
• Do NOT drink through a straw

AVOID:

• Fatty foods
• Lunch meats
• Hot dogs
• Spicy foods
• "Cream of" soups
• Orange juice or orange drinks
• Cabbage
• Pork
• Pizza
• Barbecue
• Greens
• Milk, ice cream, cheese
• Red drinks
• Beans (of any kind)
• Popcorn
• Jerky