Dr. Massimo Mazza
www.massimomazza.it
office: +3902317634
Link to Italian traslation
Preoperative Guidelines
1. no aspirine or any similar anti-inflammatory drug intake in the 2 weeks foregoing the operation: they increase bleeding risk!
2. no alchool intake (wine or alchoolic drinks) in the weeks foregoing the operation: they increase bleeding risk!
3. avoid smoking for minimum 1 week before and after surgery;
4. abstain from food and fluid intake after midnight the day before surgery;
5. no finger nail laque;
6. male patients: please come to surgery shaved in order to get a more clean operating field!
7. avoid any makeup: no lipstick, no lip gloss etc.;
8. don’t wear any rings, earrings, bracelets or watches on the operation day;
9. on the operation day,in the morning, carefully wash teeth, oral cavity and visage;
10. only for iliac crest autogenous bone grafting: possibly take a shower, thoroughly wash your hair ( hair can carry bacteria to the head and neck disctrict) as well as the skin area of the eventual extra-oral bone graft (hip);
11. go to bed early the night before operation and take – if required – a mild sedative to have a quiet sleep ( ask for surgeon’s authorization);
12. remember to plan someone pick you up after discharging from office (you will not be able to drive);
13. inform the physicians of any ongoing therapy (that is antihypertensive, antidiabetic, antiarythmic drugs, beta blockers etc.): do not interrupt the morning drug intake without previous surgeon’s or anesthesiologist’s approval!
Suggestions and Guidelines for postoperative care after oral surgery
(wisdom tooth, implantology, apicoectomy, complex dental extractions, sinus lift, bone grafting procedures, periodontal surgery, connective grafts from palatal gum)
Strictly avoid hot food in the postoperative period, such as:
- hot coffee
– hot tea or camomile
– homemade bouillon … deadly hot!
Lower jaw surgery
1. Pain
a last dose of local anesthetic is commonly injected at the end af the operation in order to let the patient’s anesthesia last for the first 2-3 hours in the postoperative period, wich is when painful symptoms might be worst. It is therefore advisable to take the analgesic anti-inflammatory medications recommended by the doctor before the local anesthesia diminishes and normal sensation returns to the area;
2. Gauzes:
within the first 12 hours we recommend to use a folded gauze pad soaked with cold tap water, the size suitable to the oral cavity, pressing on the surgical wound. This will help in a better and quicker approximation of the wound edges, prevents bleeding and helps in controlling swelling in the first post-operative days;
3. Ice packs:
the application of ice packs externally to the area has to be limited because the cold feeling stops blood supply to the affected area, thus preventing patient’s antibodies and antibiotics to reach the surgical wound;
4. Bleeding: some oozing or little bleeding is common in the first postoperative hours. Sometimes blood-tinged saliva may cause patient’s alert. Anyway, should excessive bleeding occur, inform the surgeon and behave as follows:
a) strictly avoid mouth rinsing that could remove the developing clot thus worsening bleeding,
b) use a soaked gauze swab, carefully pressing upon the exact wound area when you close your mouth (an oversized swab would prevent teeth clenching thus hindering compression),
c) get some Tranex (or Ugurol) ampules, break the ampule, mix with some water or some other cold drink and swallow. The effect usually begins after 20-30 minutes. Should bleeding continue, you can repeat the procedure up to 3 ampules. Before starting the procedure always ask the surgeon for any possible contraindication.
5. Diet: the patient is allowed to eat liquid or semi-solid foods, cold or at room temperature (shakes, smoothies, mashed potatoes etc.), as long as prescriptions of surgeon.
6. Oral Hygiene: brush your teeth as usual except for the surgical area that will be cleaned with the prescribed mouthrinse: gently hold the diluted mouthrinse in your mouth over the surgical area for about 1-2 minutes. Do not rinse. Repeat the procedure after each meal until the removal of surgical stitches.
7. Rest: anesthesia and administered drugs prevent you from realizing how demanding surgery was!: you could misjudge the deceitful well-being feeling. A prudent behaviour is advisable:
no stressful work, no physical exercise or sport, no smoking, no alcohol or hot drinks (hot camomile is responsible for severe burns of the recently operated and still anesthetized oral mucosa!).
8. Anesthesia: it is quite normal to experience numbness or a tingling sensation of the lip or chin following posterior lower jaw operations (wisdom tooth extraction, implantology, cysts, etc.): this is a temporary and reversible symptom. Brief the surgeon.
9. Swelling: swelling lasts usually a maximum of 2 days following surgery, while the local anaesthetics wear off, and it takes 3 to 5 days to gradually subside.
10. Ecchymosis (hematoma): black and blue marks of the cheek (becoming green and yellow after a couple of days) may go down along the neck, as a common following healing process. Color turning from blue to yellow reflects the normal healing process of hematoma.
11. Vomiting and nausea: it is not uncommon for the patient to swallow a lot of water coming from bone drilling instrument cooling during the operation (specially under anesthesia), as well as blood coming from the surgical wounds; in both cases the patient may feel nauseous.
Moreover, a side effect of all narcotic drugs (morphine-like) used by the anesthesiologist is nausea. Don’t worry. Once the drug wears off, nausea disappears!
12. Therapy: follow the surgeon’s prescription as directed. If you have any concern please contact your surgeon.
Upper jaw surgery
Same guidelines except for the following steps:
1. step 8 (anesthesia) doesan’t apply to upper jaw surgery,
2. resting: keep head raised, prop your head up with two pillows when in bed, possibly lie down on the site opposite to surgical area while sleeping,
3. blue eye: hematoma is closer to eye,
4. avoid blowing your nose roughly or sneezing keeping your mouth shut: this could produce a sinus opening and a connection with the mouth – the patient feels water in his nose while drinking, and is a sign of sinusitis!
5. do not bend your head
6. avoid hopping or any strenuous physical activity,
7. don’t finger tapping on your cheek or cheekbone (expecially in case of sinus lift or sinus augmentation),
8. it is important to keep your nose clean and to use the prescribed nasal spray (Biorinil spray)
Special Guidelines in case of Implantology
- refrain from chewing on the implant area for up to 6 weeks
- avoid hard or spicy foods,
- avoid hot foods,
- carefully keep a good oral hygiene,
- avoid seeds or any tiny food that could slip inside the surgical wound: they can be hardly removed and increase the risk of infection of gums and underliying bone,
- should the prosthesis on implants break, please immediately contact the office: loss in prosthetic stability may damage the endosteal implant.
dr. Massimo Mazza
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