What to Bring for Your First Appointment
On your initial visit to our office we will create a file for your records and have you complete a medical questionnaire. Dr. Johnson will review and address relevant medical issues with you during the course of his assessment. It is helpful to remember the following items:
Your first appointment will usually be for consultation only, but occasionally and in some emergency situations will be scheduled to include a same visit surgical procedure. Dr. Johnson will begin by asking about the concern that has brought you to see him. He will review your medical questionnaire and ask further questions regarding your medical status, medications, and past medical history which will help guide his management decisions. Dr. Johnson will perform an exam of the areas of concern and may order additional tests or diagnostic images. Treatment recommendations, alternative treatment options, and important treatment details will then be discussed. If treatment is recommended, the administrative staff will prepare a surgical fee estimate, insurance information, and help with scheduling your appointment.
Pre-Operative Instructions for Patients Receiving Sedation & Anaesthesia
Diet & Medications
Patients should fast (have nothing to eat or drink) from midnight or at least 8 hours before their procedure. Water only (in small quantities) may be consumed up to and no closer than 3 hours before the procedure.
Regular prescribed medications should be taken with water sips or as modified by Dr. Johnson. Diabetic medications will usually be held or reduced on the morning of the procedure to avoid lowering blood sugar levels in a fasting patient. Patients who use inhalers or have emergency medications such as epi-pens or nitro spray should bring their medications to their appointment.
Loose fitting, comfortable clothing should be worn. Ideally, the top will have short sleeves or be loose enough so that the sleeves can be rolled up. Patients who use contact lenses should wear their glasses or remove their contacts prior to their procedure.
A responsible adult will be required to accompany the patient home. Patients will not be legally fit to drive and should not operate any machinery for 18 hours following their anesthetic.
Post-Operative Instructions Following Oral Surgery
Avoid vigorous activities which could encourage additional bleeding from the surgical site. Patients who have had an anesthetic should rest and should not operate a motor vehicle or other machinery for the rest of the day. Smokers should refrain or at least minimize their smoking for the next week.
Full fluids and a soft diet can be started as soon as you are able. Depending on the area(s) involved with your surgery, most patients will progress to their normal diet within the first week. Milk and protein shakes, soup, apple sauce, yogurt, soft eggs, mashed potatoes, and pasta are some of the better foods to start with. Avoid alcohol for the first 24 hours and while you are taking prescription pain medications.
Gentle rinsing with a dilute solution of salt water is recommended. This can be converted to clean tap water over the next few days. The teeth should be brushed as best as possible without disturbing the surgical site(s).
Avoid vigorous spitting and rinsing for the first 24 hours.
Avoid drinking fluids by straw for the first 3 days.
A curved tip water syringe will be provided to many of our patients and can be used after the fourth post-operative day to help rinse debris from the extraction sites until they have closed over.
Anti-inflammatory medication will usually be provided to help control post-operative swelling. A cold compress or ice pack may also help and should be placed on the skin beside the surgical site for 20 minutes at a time over the rest of the first day. We have found that a frozen bag of peas will conform to the curve of the cheek quite nicely. Swelling will usually peak over the second day and start to diminish after that.
Pain medication will usually be prescribed. In order to minimize unwanted side effects such as nausea and drowsiness we encourage a laddered approach to pain management.
For most patients, the use of NSAIDs (non- steroidal anti-inflammatory drugs) such as Ibuprofen (Advil or Motrin) will be recommended due to their pain relieving and anti-swelling properties and because they have relatively few side effects. The exception to this is for patients who are allergic or who are already taking prescription NSAIDs (such as Celebrex and Naprosyn), or who are on other anticoagulant (blood thinning) medications.
Common prescription medications will often contain acetaminophen (Tylenol) with a narcotic (such as codeine or oxycodone). These work differently than the NSAIDs and can be taken as an addition to ibuprofen when needed. This pain management strategy will be more effective and help to reduce medication related problems.
Blood mixed with saliva for the first 24 to 48 hours is normal. A light bleed coming from the surgical site will usually stop quite quickly and can be managed by placing a folded, lightly moistened gauze against the area and biting on it for 20 minutes. Light bruising of the cheek or upper neck may occur in some patients. This will be temporary and typically presents as a pale yellow area a few days after the surgery.
Management of Post-Operative Complications
Nausea & Vomiting
Fortunately this problem doesn’t occur very often, but when it does, the most common cause is related to the use of narcotic medications. Patients who develop these symptoms should:
Unless there are allergies or other reasons to avoid their use, both Tylenol and Ibuprofen can be taken at the same time and because they work differently their combined effect will be better than either medication would be on their own. When in doubt or if nausea persists, please contact our office.
Our patients will be observed for a period of time following their procedure and prior to being discharged home. This will ensure that post-operative bleeding will not usually be a problem. A bit of blood tinge in the saliva or light bleeding after disturbing the surgical area is not uncommon over the first few days. If bleeding develops, roll up a lightly moistened gauze and place it directly over the bleeding area and bite on it with pressure for 20 minutes. If gauze is not available, a moistened tea bag can be substituted (the tannic acid in the tea will help to stabilize the clot). If the bleeding is persisting please contact our office or if necessary make your way to the nearest hospital emergency department.
Allergies can vary in intensity, and their management will usually be determined by the severity of the reaction. All allergic reactions should be reported to our office as soon as possible. In an extreme and sudden (acute) reaction where breathing seems to be affected, Epinephrine will likely need to be administered. Call 911 and get immediate emergency assistance. Most allergic reactions will be slower in onset with the development of a rash or red spots on the chest or other areas of the body. If this develops, do not take any more of your medications until you have discussed this with our office or a physician. Most allergic reactions will be related to a prescribed antibiotic. An antihistamine such as Benadryl or Allegra may help reduce the intensity and duration of the allergy symptoms. The causative medication should be noted and alternative medication taken if needed in future.
Most of the common oral surgical procedures will include placement of dissolving (resorbing) stitches. These will usually soften and will either fall out or be swallowed within 3 to 7 days. Because the stitch material is made to break down, a stitch will occasionally unwind or fall out within the first 24 hours. This is not usually a problem since most surgical sites will have 2 or more stitches. Unless bleeding develops, replacement will not be required. Occasionally, a stitch will break, but hang down annoyingly. If required, a clean scissors can be used to trim the dangling end. If you have concerns about your stitches, please contact our office.
The majority of the infections that we treat are seen in patients prior to having their surgical procedure and are usually the reason that they have been referred for our help. It is important that if antibiotics have been prescribed that they be taken as directed and until they are finished unless a problem with them develops.
An odd taste coming from the surgical site during the initial healing phase is not uncommon and usually related to retention and breakdown of food debris. Extra rinsing of the area will help to resolve this problem.
The development of delayed swelling (swelling that is increasing later than 3 days after the surgical procedure) may be a sign of infection. Warm salt water rinsing should be initiated, and our office should be contacted if this is not improving.
Dry socket (alveolar osteitis) is an inflammation of the bone that surrounded an extracted tooth. Bone is living tissue with sensitive nerve endings that occasionally become quite painful for a short period of time. Thankfully this doesn’t occur very often and can be treated when it does develop.
A dry socket will not typically develop right away, but is recognized by the development of a more significant pain or throbbing from the area 3 to 4 days after a tooth extraction. This time sequence coincides with breakdown of the blood clot in the extraction site which temporarily leaves the nerve endings of the exposed bone without enough insulation. Dry socket is almost always from a site in the lower jaw but may be felt along the entire mandibular nerve with radiation to the ear and upper neck. Risk factors that would make a dry socket more likely to occur include: a lower molar location, complicated extractions, smoking, increased age, dense bone, and a pre-existing infection.
Treatment will usually involve the temporary placement of a medicated dressing which is gently placed in the extraction socket. The dressing is usually left in place for the next week and then removed. Without treatment, alveolar osteitis will almost always resolve on its own over 1 to 2 weeks.
We bill and require payment for patient care on the day it is performed. The exception to this is for our personal paying hospital patients for which we require 75% of the payment one week prior to the surgical date.
We are happy to accept payment by Visa, MasterCard, Debit, or Cash. We regret that we are no longer able to accept personal cheques.
Our administrative staff will prepare third party insurance information and submit this information electronically whenever possible. Most patients are seen in consultation prior to their surgical date, and we will provide a fee estimate and insurance predetermination at this time. In keeping with ODA recommendations and because we are a specialist office, we do not accept assignment of benefits and expect that our patients’ insurance providers will reimburse them directly.
Dr. Johnson bases his fees at or below that of the present year’s Ontario Dental Association Specialist Fee Guide for oral and maxillofacial surgeons.
We will be happy to answer any questions you may have regarding your treatment and financial obligations.