Diplomate, American Board of Oral & Maxillofacial Surgery
GENERAL POSTOPERATIVE INSTRUCTIONS
We are committed to providing the same quality of care following procedures that began during your initial visit. To that end, please refer to some general postoperative guidelines below, and by all means, CALL at any hour of any day to report any continuing problem.
1. FLUID AND FOOD INTAKE IS IMPORTANT. Start by first taking the gauze out of your mouth then I suggest
you start with clear carbonated beverages, such as ginger ale, Seven-up, or Sprite. Once your stomach hassettled, you can have other fluids such as water, teas, cooled down broth and soups. You can also have coolor warm soft foods; pancakes, mashed potatoes, jello, scrambled eggs, omelettes, pasta, muffins. Avoid hot liquids until the numbness has worn off, and the bleeding has stopped. Avoid dairy products the first half of the day or if your stomach is upset. Dairy can cause nausea. Once youhave eaten some of the previously suggested foods and your stomach is doing fine then you can have dairy. IT'S VERY IMPORTANT TO DRINK FLUIDS AND EAT SO YOU DO NOT GET DEHYDRATED AND LIGHTHEADED. IT'S ALSO VERY IMPORTANT TO DRINK FLUIDS AND EAT IN CASE YOU NEED TO TAKE SOME OF THE STRONGER PAIN MEDS.
2. AVOID USING A STRAW FOR SEVERAL DAYS as it may cause the blood clot to dislodge and delay healing.
3. After you have eaten you can replace the gauze we have provided. You should replace the gauze packs every
30-45 minutes for the first couple of hours. THE BLEEDING MAY LAST UNTIL BEDTIME. If the bleeding later in the day does not seem to be under control biting on a moist tea bag wrapped in gauze for 30 minutes may help control persistent oozing. Tea has an ingredient that promotes blood clotting. Should active bleeding persist, please call the office. DO NOT DISTURB THE AREA OF SURGERY. Avoid vigorous chewing, excessive spitting, or rinsing as initial healing may be delayed, active bleeding restarted, or infection introduced.
4. PAIN FOLLOWING ORAL SURGERY will be most severe within the first 6-8 hours after the operation. You
were either prescribed CELEBREX or MOTRIN.
a.) If CELEBREX, you should have taken 1, one hour prior surgery, then 1 every 12-24 hours. If the pain is
not under control you can supplement the celebrex with either Tylenol (acetominaphon) or percocet(roxicet, oxycodone). MAKE SURE TO EAT BEFORE YOU TAKE THE PERCOCET! DO NOT TAKE ON AN EMPTY STOMACH!!
When the celebrex is gone after 4-5 days, if you are still having some pain and swelling, you can thenswitch to one of the following:Aleve (lasts 12 hours), Advil, Motrin, Ibuprophen. PLEASE WAIT TO TAKE THEM 12 HOURS AFTER YOUR LAST CELEBREX!!
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b.) If MOTRIN, you should take one when you get home, then take one every 6-8 hours. BOTH CELEBREX AND MOTRIN ARE FOR PAIN AND SWELLING! DO NOT TAKE CELEBREX AND MOTRIN TOGETHER!
Please, do not drink alcoholic beverages while taking prescription pain medication. Moderate to severepain usually does not last longer than 24-48 hours, and there should be no more than slight pain ordiscomfort after the third day. Persistent or increasing pain 3-4 days following oral surgery may be causedby early loss of the blood clot (dry socket) or infection. There would be pain going up towards your ear,or a bad taste in your mouth. The best thing for a dry socket is the anti-inflamatories we prescribed(celebrex or motrin). They do go away on their own, but if the pain is unmanageable, please call the officeand we can place a medicated packing, which we would need to change a few times over a course of 3-7days. You are at a higher risk for a dry socket if you take the birthcontrol pill or do not stop smoking 2weeks prior to surgery.
5. Take any ANTIBIOTICS we may have prescribed. If prescribed a week's worth you should eat 1 yogurt with
active cultures or acidophilus (which is in the vitamin section). the first day of surgery you can have the yogurt at the end of day after you have something else to eat first. The yogurt or acidophilus is to prevent diarrhea. If you do get diarrhea stop the antibiotics right away and call us. Other than that you should finish taking the antibiotics until gone. If you are given antibiotics and take the birthcontrol pill, you should be aware that the birthcontrol pill MAY BECOME INEFFECTIVE, therefore take appropriate precautions.
6. Take any regularly scheduled medication (for diabetes, high blood pressure, blood thinners etc.) on your
regular schedule unless advised to do otherwise.
7. SWELLING RELATED TO THE SURGICAL PROCEDURE usually develops during the first 12-24 hours following
surgery, often increasing up to the third day. It should start to subside on the fourth day. Swelling can beminimized a great deal by wearing the ice wrap on the side of your face for the first 24 hours, you can takea break from the ice 15 minutes every now and then, unless you receive special instructions.
8. LIMIT PHYSICAL ACTIVITY during the first 24-48 hours after surgery. Over exertion may lead to
postoperative bleeding and discomfort. When you lay down, keep your head elevated on a pillow. When youhave been laying down for a while, get up slowly. Sit up for a few minutes then you can get up. If you get uptoo fast, you could become lightheaded and faint. FOR THE FIRST 24 HOURS YOU SHOULD HAVE SOMEONE WITH YOU WHEN ATTEMPTING TO GET UP AND GO SOMEWHERE!!!
9. DO NOT DRIVE AN AUTOMOBILE for 24 hours following surgery if you have had intravenous sedation, or if
you are taking prescription severe pain medication.
10. IF YOU WERE INFORMED THAT SINUS COMMUNICATION OCCURRED DURING SURGERY, as a close
relationship between the roots of your upper teeth and your sinuses, or if you have had some surgery thatinvolved work near your sinuses or in your sinuses ,please follow these instructions:
DO NOT BLOW YOUR NOSE. DO NOT SNEEZE THROUGH YOUR NOSE. IF THE URGE TO SNEEZE ARISES, SNEEZE WITH YOUR MOUTH OPEN. DO NOT SMOKE OR USE A STRAW. AVOID SWIMMING AND STRENUOUS EXERCISE FOR AT LEAST A WEEK. IT IS NOT UNCOMMON TO HAVE A SLIGHT AMOUNT OF BLEEDING FROM THE NOSE FOR SEVERAL DAYS. PLEASE REMEMBER THAT OCCASIONALLY A SECOND PROCEDURE MAY BE REQUIRED IF THERE IS A PERSISTENT COMMUNICATION. THE DAY FOLLOWING SURGERY AND THEREAFTER
1. The day after surgery, start rinsing your mouth carefully with solution made by adding 1/2 teaspoon of salt
to a large glass of warm water. Repeat three times a day until remaining soreness subsides. Resume brushing any remaining teeth and your regular oral hygiene as soon as possible. Make sure to brush GENTLY the area of the extraction to avoid inflammation in the area. Please do not use a syringe or Water Pik to aggressively rinse for the first week. This may dislodge the blood clot.
2. Do not worry about stitches. sutures were placed to control bleeding and aid healing. Generally, they dissolve
on their own 3 to 7 days later. If they fall out they do not have to be replaced.
3. SWELLING, SORENESS, OR STIFFNESS OF THE JAW MUSCLES can be relieved by applying a warm, moist towel
to the affected side of the face several times a day. Moist heat should be used AFTER the first 24 hours. If swelling, tenderness or pain should increase after the first few days, call the office.
4. Sometimes a soft diet may be necessary for the first few days following surgery. Most patients are able to
resume regular food intake within a short time.
5. Bruising marks may appear on the skin of the face during the first few days after surgery. Moist heat
application will help relieve this condition once again.
6. Some discomfort may be a canker sore, which can be quite painful. These usually occur 3-4 days after surgery
and can last 7-10 days. You can get some over-the-counter products that may help with discomfort until theygo away. PEROXYL- WHICH YOU SWISH AROUND YOUR MOUTH FOR 1 MINUTE AND THEN SPIT OUT ZILACTIN - PLACE A LITTLE ON A Q-TIP AND PLACE ON THE CANKER SORE. GLYOXIDE - PLACE 3 DROPS ON THE CANKER SORE AS DIRECTED. AT THE ONE WEEK POINT WE WILL GIVE YOU AN IRRIGATING SYRINGE TO HELP GET OUT ANY FOOD PARTICLES, DO NOT USE ANYTHING LIKE THAT SOONER TO AVOID DISRUPTING THE CLOT. WE WILL ALSO GIVE YOU A SOFT TOOTHBRUSH.
If you need assistance over the weekend, please call around 9:00 am , so we may answer any questions you mayhave. We appreciate your patience as we do our best to keep you comfortable during the healing process. FAITHFUL COMPLIANCE WITH THESE INSTRUCTIONS WILL ADD TO YOUR COMFORT AND HASTEN YOUR RECOVER. Be sure to follow these instructions carefully. Only in this way will you avoid the complications which lead to unnecessary discomfort and delayed recovery. Should any undue reaction or complication arise, notify the office immediately.
If you need to contact us after office hours, please call the office at 603-436-8222 or 603-749-2522.
I make every attempt to answer my emergency pager as promptly as possible. Occasionally, our messages donot reach my pager. If you do not hear from the office on call within one-half hour, please call back and ask themto page the office again. Do this until your page has been answered by the office.
Pretreatment for Nerve Agent Exposure Chapter 6 PRETREATMENT FOR NERVE AGENT EXPOSURE MICHAEL A. DUNN, M.D., FACP*; BRENNIE E. HACKLEY, JR., PH.D.†; AND FREDERICK R. SIDELL, M.D.‡ INTRODUCTION AGING OF NERVE AGENT–BOUND ACETYLCHOLINESTERASE PYRIDOSTIGMINE, A PERIPHERALLY ACTING CARBAMATE COMPOUND Efficacy Safety Wartime Use Improved Delivery CENTRALLY ACTING NERVE AGENT
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