Minor Oral Surgery Wisdom Tooth Surgery
DISCHARGE INFORMATION: MINOR ORAL SURGERY
The following information is to assist those patients who have undergone minor oral surgery, either under general anaesthesia or intravenous sedation. Procedures may include the removal of wisdom teeth, surgical extractions, apicectomies, exposure and bonding of buried teeth, closure of oro-antral communications and other miscellaneous minor intraoral surgical procedures.
The information below is a guide for patients to follow on discharge from hospital:
HYGIENE/CARE OF WOUNDS
It is ESSENTIAL to maintain a very high standard of oral hygiene using a combination of Savacol (0.2% Chlorhexidine Gluconate) mouthwash diluted 1 in 10 with warm to hot water and regular toothbrushing. You should commence your mouthwashes and toothbrushing the day OF surgery and you should aim to use at least 5-6 mouthwashes per day for approximately 10 days. Where indicated, a Broxojet may be supplied to assist with oral hygiene. Gentle toothbrushing around the wounds may initially cause a small amount of bleeding, particularly around apicectomy sites, but it is important to remove food debris and plaque from the area of the wounds.
Usually no dressings are required with intraoral surgery. Occasionally a “Whitehead’s Varnish” gauze pack may be inserted for a special purpose. This will normally be removed at the time of suture removal and it is essential the pack be kept clean as part of your normal oral hygiene (see above).
Spare mouth packs are generally supplied by the hospital to assist with control of oozing and bleeding from surgical sites.
SWELLING AND BRUISING
Some swelling and bruising can occur with intraoral surgery. Generally, swelling takes up to three days to reach its maximum then this will slowly subside over about ten days. Bruising can be unpredictable and may vary from some minor facial bruising to more extensive bruising that may extend to the orbits or down the neck. The bruises slowly discolour with time and may take 10-14 days to disappear. Ice packs should be applied regularly to the face over the first 48 hours. The hospital will normally supply you with several ice packs to take home. These can be re-frozen and re-used.
When you recover from your surgery you may notice parts of your face are quite numb. You are given local anaesthetic injections at the time of your surgery; this is done deliberately as a pain control measure. The numbness generally takes 6-8 hours to wear off and during this time you should avoid contact with hot liquids etc. On occasions, some of the sensory nerves in the jaw bones can be disturbed by the surgical procedure (particularly with the removal of very difficult impacted lower teeth) and this may cause some prolonged numbness lasting a few weeks, or in severe cases some months. On very rare occasions there may even be some permanently altered sensation in and around the jaws.
From time to time some oozing may occur from third molar and extraction sites. This can usually be controlled by the use of pressure packs. These should be placed over the wounds and pressure applied by biting down firmly on the packs for at least 15 minutes. YOU SHOULD REST QUIETLY WITH YOUR HEAD ELEVATED. The hospital will supply you with spare pressure packs to take home and if the oozing or bleeding does not stop within 30 minutes please contact the hospital in which you were treated.
A very soft diet is necessary for the first three days and foods should be of a “scrambled egg” consistency. It is important to avoid hot foods within 24 hours of the surgical procedure. It should be possible to recommence a fairly normal diet by 5-7 days post-operatively. If you are unsure as to a suitable diet, further information can be obtained from the hospital dietitian.
Smoking can negatively affect the outcome of any surgical procedure. Patients who smoke can expect inflammation of their intraoral wounds and delayed healing. IT IS STRONGLY ADVISED THAT PATIENTS AVOID SMOKING ALTOGETHER for at least two weeks following an intraoral surgical procedure.
Patients who have had surgical procedures carried out in the maxilla (top jaw), particularly where the surgery is close to the maxillary sinus may be instructed to not blow their nose for ten days post-operatively. This is to avoid the formation of an oro-antral communication which is a persisting hole between the sinus and the mouth through which oral fluids can pass into the sinus and nose. This particularly applies to difficult upper third molars and procedures where an established oro-antral communication has been closed surgically often with a local fat and soft tissue flap. Such patients may note a small amount of bleeding from the nose as surgery in the sinus drains into the nose. On occasions, patients may have a nasal pack placed in theatre; this would normally be removed 24 hours post-operatively on the ward before discharge.
Most patients treated under general anaesthesia are anaesthetised using a “nasal tube”. This can produce some soreness of the nose and there may be some crusted blood within the nose which should be left alone to heal and not “picked at”.
POST-OPERATIVE MEDICATIONS AND SUPPLIES ETC
You will be provided with the following on discharge:
a) A course of antibiotics.
You will have been given intravenous antibiotics in the operating theatre and sometimes on the ward post-operatively. A prescription for your oral antibiotics will be available for you to take home or alternatively the ward may have the prescription filled for you before discharge. IT IS ESSENTIAL YOU COMPLETE ALL OF THE ANTIBIOTICS as indicated on the label.
These are also prescribed and the prescription will be available for you to take home or, as with the antibiotics, the ward may have the prescription filled for you before discharge. Generally “middle of the range” analgesics are satisfactory for pain control following minor oral surgery.
c) Savacol mouthwash.
A bottle of Savacol mouthwash will be supplied for you to take home. Please use this diluted 1 capful in a glass of warm to hot water (i.e. 1 in 10) and the mouthwash should be used 5-6 times per day, particularly at night before bed. You should start your mouthwashes the day OF surgery. You may need to purchase additional bottles of mouthwash, depending on the progress of your wounds.
d) Steroid ointment (Sigmacort – large tube).
A tube of steroid ointment will be provided for you to take home. A THIN SMEAR of ointment should be placed on the lips once or twice per day, particularly in the corners of the lips where these may have been stretched. This can be continued for approximately a week post-operatively. The steroid ointment will assist with healing of the lips.
e) Ice packs.
As indicated earlier you will be supplied with ice packs to keep on your face constantly for 24-48 hours post-operatively to help reduce your swelling. The ice packs can be re-frozen and re-used and should make your face feel more comfortable.
f) Mouth packs.
Spare mouth packs/gauze squares are usually supplied by the hospital to assist with the control of oozing and bleeding from surgical sites.
It is important that all patients are seen for follow-up and usually an appointment will have been made for you to attend Dr. Bowler’s rooms around a week post-op. Frequently the sutures used for minor oral surgery need to be removed. This is a painless procedure as the sutures stay wet in the mouth and are easy to remove. It is not uncommon for sutures to fall out and this is not a matter for concern. If you do not have an appointment please telephone the practice on 4942 1211 to make a post-operative appointment.
If you have any concerns following your surgery please do not hesitate to contact the hospital in which you were treated. Dr. Bowler can be reached through the hospital and is available most times. If for some reason this is not possible, there is a 24 hour service available through Lake Macquarie Private Hospital Emergency Department Tel 02 4947 5700