Pre-Op and Post-Op Instructions

Pre-Operative Steps for Wisdom Teeth 3rd Molar Extraction

1. 1 day or more before surgery please pick up the prescriptions sent to your pharmacy electronically by Scarsdale Dental Group.

2. Take 2X Amoxicillin or other antibiotic at or after dinner the night before the extraction.

   a. For Your Information: After the surgery you will continue with the antibiotics prescribed until complete. See Post-Operative Care for Wisdom Teeth 3rd Molar Extraction

3. If Prescribed, Take 3 Medrol dose pack tablets first thing in the morning of the surgery. This will reduce post-operative swelling.

   a. For Your Information: You will take an additional 3 Medrol dose pack tablets after the surgery.

   1. Please note the Medrol dose pack has an additional 5 days of a prescribed regimen of tablets to take after the day of surgery.

Dexamethasone (Decadron) elixer 0.5mg/5ml

1. For 3 days, rinse with 1 tablespoonful (15ml) four times a day and swallow. Then,
2. For 3 days, rinse 1 teaspoonful (5ml) four times a day and swallow. Then,
3. For 3 days, rinse with 1 teaspoonful (5ml) four times a day and swallow every other time. Then,
4. Rinse with 1 teaspoonful (5ml) four times a day and spit out. Discontinue medication when mouth becomes comfortable. When mouth discomfort recurs, begin at step #3.

• Immediately following surgery:
  • Some bleeding, swelling, and seeping are normal following oral surgery.
  • Please abstain from Cigarettes or Vaping as the healing is reduced by the nicotine chemicals in the smoke.
  • For the first 24 hours following your surgery, do not suck on a straw, brush, rinse, swish, or spit.
• Place an ICE PACK externally against the affected areas as soon as possible to minimize swelling and bruising. Apply for periods of 10 minutes on and 10 minutes off. Do this as often as possible for up to 72 hours after the surgery.
• Avoid excessive work or play, and resume normal activity the following day as tolerated. This will keep blood pressure lower and will reduce bleeding and aid healing.
• Use Q-Tips™ with Peridex™ to swab the surgical site suture any adjacent teeth after meals and at bedtime for 7-14 days as required.
  • Do not do any vigorous rinsing.
  • Abstain from any commercial mouth rinses or washes (i.e. Listerine) for 21-30 days.
• Take 2X Amoxicillin or other prescribed anti-biotic the day of surgery and 3X per day until finished.
• Take Anaprox™ (Naproxen) DS 550mg 1 tab 2X day the day of surgery (best taken with food) and the 3 days following.
  • Drink a full glass of water or glass of milk when taking pills.
• For some treatments, an Essex temporary tooth will be provided to wear until the final restoration is complete 2-6 months later.
  • For the first 48 hours after the Essex retainer(s) is placed after surgery, remove the retainer to clean the surgical area underneath with Peridex™.
  • The (Essex) retainer may be worn during the daytime, nighttime or both. You may remove the retainer while eating. A retainer is provided for storage of retainer any time it is not in your mouth.
  • This purpose of the retainer is to improve the security of the sutures, maintain control over swelling, increase the cleanliness of the surgical area.
• You may brush your teeth with a soft toothbrush gently. Brush and floss the rest of your mouth as normal.
• After 72 hours and more following your surgery the cold compress will be ineffective. An alternative at this point is the application of a warm moist heat to the sides of the face can be soothing.

If pain or swelling or throbbing continue please call us during office hours, or contact the After Hours #.

• Immediately following surgery, maintain pressure on the surgical area by biting down on the provided gauze pad or roll until the bleeding stops. A certain amount of bleeding is to be expected following a surgical procedure. Placing the gauze pad over the area and biting firmly will help prevent excessive bleeding. Replace the gauze as necessary until the bleeding stops.
• Children should be supervised after having an extraction to make sure they do not bite or chew their tongue or lips as this can cause serious injury to the soft tissue.
• For 24 hours following your surgery, do not suck on a straw, brush, rinse, spit, or smoke. Avoid hot and spicy foods as well as carbonated and alcoholic beverages.
• 24 hours following your surgery, you may rinse every four(4) hours with one teaspoon of salt dissolved in an 8-ounce glass of warm water for one day.
  
• Place an ICE PACK externally against the affected areas as soon as possible to minimize swelling.  Apply for periods of 15 minutes on and 15 minutes off. Do this as often as possible for the 36 hours after the surgery.
• Swelling around the face, eyes, and surgical site is not uncommon although it may not appear until the day following the surgery and may become more noticeable two to three days following surgery.  After 36 hours the cold compress will have no further impact on swelling. After this period, the application of moist heat to the sides of the face can help reduce swelling.
• Please fill any prescriptions you have been given and take as directed. If you have been prescribed pain medication other than aspirin, Tylenol or ibuprofen (Advil or Motrin), do not drive, operate heavy equipment, work around machinery or tools, or engage in any other activity that may be unsafe when groggy, as your reflexes and judgment will be affected by the medication. Antibiotics may be prescribed to help prevent infection. If you have been placed on antibiotics, take the medicine as directed.
• Restrict your activities on the day of your surgery. Avoid excessive work or play, and resume normal activity the following day as tolerated.
• During the first few days after surgery restrict your diet to liquids and soft foods such as soups, yogurt, juice, and smoothies.
• Sutures may have been placed. Most sutures placed by our office will dissolve on their own in 7-10 days, and it may not be necessary to return to the office for sutures to be removed. If you have sutures that do need a follow-up visit for removal, we will let you know at the time they are placed.
• Please call our office if you experience severe pain, excessive bleeding or swelling, or if you have any questions or concerns. In the event of an emergency please call our office. If you are experiencing a serious or life threatening emergency, please call 911 or visit the nearest emergency room.

1) Immediately following surgery:

• Some bleeding, swelling, and seeping are normal following oral surgery.
  • Maintain pressure on the surgical area by biting down on the provided gauze pad or roll until the excessive bleeding stops.
• Please abstain from Cigarettes or Vaping as the healing is reduced by the nicotine chemicals in the smoke.
• For the first 24 hours following your surgery, do not suck on a straw, rinse, swish, or spit.
• For the first 48 hours after surgery do not drink carbonated or alcoholic beverages. It is strongly advised you should eat a diet restricted to liquids and soft foods such as soups, yogurt, juice, and smoothies for the next 7 days.
• Place an ICE PACK externally against the affected areas as soon as possible to minimize swelling and bruising. Apply for periods of 10 minutes on and 10 minutes off. Do this as often as possible for up to 72 hours after the surgery.
• Avoid excessive work or play, and resume normal activity the following day as tolerated. This will keep blood pressure lower and will reduce bleeding and aid healing.
• Rinse gently with Peridex™ at the surgical site after meals and at bedtime for 7-14 days as required.
  • Abstain from any commercial mouth rinses or washes (i.e. Listerine) for 21-30 days.
• If prescribed, you may take Vicodin or Percocet for severe pain relief in addition to Anaprox.
  • You can expect to need Vicodin or Percocet at most up to 12 hours after surgery.
  • One tablet of Vicodin or Percocet can be taken every 4 to 6 hours as needed for pain.
  • Tylenol™ is acetaminophen. Vicodin and Percocet each have has acetaminophen in it. Do not take Tylenol when taking Vicodin or Percocet.
  • Vicodin and Percocet are narcotics and it is recommended you do not drive while taking this medicine.
• Take Anaprox™ (Naproxen) DS 550mg 1 tab 2X day the day of surgery (best taken with food) and the 3 days following.
  • Drink a full glass of water or glass of milk when taking pills.
  • Once Vicodin or Percocet have been discontinued; we expect you will only need to take Anaprox™ 2X day for pain relief. Tylenol or other acetaminophen may be taken to supplement the Anaprox™ to alleviate discomfort.
• Take 2X Amoxicillin or other prescribed anti-biotic after the surgery, and then 3X per day until finished.
• Take 3 Medrol™ dose pack tabs 2 hours or so after the surgery. For the 5 days following the surgery you will continue to take Medrol™ dose pack tabs as directed.

2) 24 hours following surgery resume brushing, avoiding surgical sites with the toothbrush.

• Swelling around the face, eyes, and surgical site is to be expected the day of the surgery. It may wait common; it may not appear until the day following the surgery and may become more noticeable 2-3 days following surgery.
• If the sutures fall out prior to the next appointment there is likely have no need for concern.

3) 72 hours after surgery the cold compress will have no further impact on swelling. The application of moist heat to the sides of the face can be soothing.

• A dry socket can develop when a blood clot gets dislodged prematurely from the walls of the tooth socket. Symptoms of a dry socket include throbbing pain at the surgical site, the ear, chin, adjacent teeth, and/or jaw. These symptoms indicate a dry socket when they occur three to four days following surgery and do not respond to pain medication.

In case of pain, or bleeding, or a fever or other unusual symptoms please call us during office hours.

1) Immediately following surgery:

• Some discomfort, a little blood in the saliva, swelling, and seeping is to be expected throughout the day of the surgery.
• For the first 24 hours following your surgery, do not suck on a straw, brush, rinse, swish, or spit.
  • For the first 48 hours after surgery do not drink carbonated or alcoholic beverages.
  • Avoid sharp and crunchy foods like tacos, chips and nuts; and hot, spicy or acidic foods.
• Apply an ICE PACK externally against the affected areas as soon as possible to minimize swelling.
  • Apply for periods of 10 minutes on and 10 minutes off. Do this as often as possible for up to 72 hours after the surgery.
• Use Q-Tips™ dripping wet with Peridex™ to swab the site and adjacent teeth after meals and at bedtime for 7-14 days as required.
  • Abstain from any commercial mouth rinses or washes (i.e. Listerine) for 21-30 days as these can inhibit gum growth.
• Take 2X Amoxicillin or other prescribed anti-biotic the day of surgery and 3X per day until finished.
• Take Anaprox™ (Naproxen) DS 550mg 1 tab 2X day the day of surgery (best taken with food) and the 3 days following.
  • Drink a full glass of water or glass of milk when taking pills.
  • Tylenol or other acetaminophen may be taken to supplement the Anaprox™ for pain relief.

2) 8 Hours after Surgery: You may brush your teeth gently, but avoid the area of surgery and adjacent teeth for 7-14 days. Brush and floss the rest of your mouth as normal.

• If the sutures fall out prior to the next appointment there is likely have no need for concern.

3) 72 hours after surgery the cold compress will have no further impact on swelling. The application of moist heat to the sides of the face can be soothing.

If pain or swelling or throbbing occur please call us during office hours.

1) Immediately following surgery:

• Some discomfort, bleeding, swelling, and seeping are normal following oral surgery.
• Please Abstain from Cigarettes or Vaping as the healing is reduced by the nicotine chemicals in the smoke.
• For the first 24 hours following your surgery, do not suck on a straw, brush, rinse, swish, or spit.
• For the first 48 hours after surgery
  • Do not drink carbonated or alcoholic beverages.
  • Avoid sharp and crunchy foods like tacos, chips and nuts; and hot, spicy or acidic foods.
  • If your dental surgery involved both the left and right side of your mouth, it is advised you should eat a diet restricted to liquids and soft foods such as soups, yogurt, juice, and smoothies for the next 7 days.
• Place an ICE PACK externally against the affected areas as soon as possible to minimize swelling and bruising. Apply for periods of 10 minutes on and 10 minutes off. Do this as often as possible for up to 72 hours after the surgery.
• Avoid excessive work or play, and resume normal activity the following day as tolerated. This will keep blood pressure lower and will reduce bleeding and aid healing.
• Use Q-Tips™ dripping wet with Peridex™ (Chlorhexidine) to swab the surgical site suture and any adjacent teeth after meals and at bedtime for 7-14 days as required.
  • Abstain from any commercial mouth rinses or washes (i.e. Listerine) for 21-30 days.
  • For 7-14 days following your gum surgery brush and floss the rest of your mouth as normal.
• Take Anaprox™ (Naproxen) DS 550mg 1 tab 2X day the day of surgery and the 3 days following.
  • Take with pills with a full glass of water or milk.
  • To prevent upset stomach take with food and avoid acidic drinks like citrus juice.
  • Do not lie down for at least 10 minutes after taking this medicine.
  • Tylenol or another acetaminophen may be taken to supplement the Anaprox™ for pain relief.

2) 72 hours after surgery the cold compress will have no further impact on swelling. The application of warm moist heat to the sides of the face can be soothing.

If concerns post-surgery please call us at the office or use the after hours #.

1) Immediately following surgery:

• Some discomfort, a little blood in the saliva, swelling, and seeping is to be expected throughout the day of the surgery.
• Please be gentle in blowing your nose for up to four weeks following your surgery.
• Do not hold or tightly cover your nose when sneezing. If you must sneeze try to sneeze with mouth open.
• Please abstain from Cigarettes or Vaping as the healing is reduced by the nicotine and other chemicals in the smoke.
• Place an ice pack externally against the affected areas as soon as possible to minimize swelling and bruising. Apply for 10 minutes on and 10 minutes off as often as possible for up to 72 hours after the surgery.
• Use Q-Tips™ dripping wet with Peridex™ (Chlorhexidine) to swab the surgical site suture and any adjacent teeth after meals and at bedtime for 7-14 days.
  • Abstain from any commercial mouth rinses or washes (i.e. Listerine) for 21-30 days.
• Avoid blowing up balloons, playing musical instruments that require a blowing action, scuba diving or any other activity that increases nasal or oral pressure for at least four weeks after surgery.
• Avoid excessive work or play, and resume normal activity in the following days as tolerated.
• Take Anaprox™ (Naproxen) DS 550mg 1X approximately 2 hours after the surgery and one at bedtime. For the 3 days following the surgery take 2X per day.
  • Always take with a full glass of water or milk.
  • To prevent upset stomach take this medication with food. Avoid acidic drinks like citrus juice.
  • Do not lie down for at least 10 minutes after taking this drug.
  • Tylenol or another acetaminophen may be taken to supplement the Anaprox™ for pain relief.
• Take other medications as prescribed.

2) 8 hours or more after surgery brush your teeth gently with a soft manual toothbrush on the evening of your surgery or the first day following your procedure and continue brushing at least twice a day. Avoid the area of surgery and adjacent teeth with Peridex™ as directed.

• If nasal congestion is occurring you may take a prescribed or over the counter decongestant.

3) 72 hours following your surgery the cold compress will have no further impact on swelling. The application of moist heat to the sides of the face can be soothing.

If pain or swelling or congestion is occurring please call us during office hours.

1) Immediately following surgery:

• Place an ICE PACK externally against the affected areas as soon as possible to minimize swelling. Apply for 10 minutes on and 10 minutes off. Do this for up to 72 hours after the surgery.
• No eating or drinking for the first 30-90 minutes following your treatment.
• Avoid feeling around your tooth with your tongue for up to 2 hours after surgery. This should allow the temporary filling sufficient time to harden.
• If post-op prescriptions were sent to a pharmacy for you, please pick them up promptly.
• Restrict your activities on the day of your procedure and resume normal activity the following day as tolerated.
• You may choose to take NSAID medications such as Motrin, Tylenol or Advil for alleviation of discomfort.

2) Regular oral hygiene should be maintained, so please keep the treated area clean by gently brushing and flossing regularly.

3) Some discomfort is normal for 2 to 4 days following root canal therapy. In some cases the tooth and surrounding tissue may be sore for a few weeks following treatment.

4) The temporary filling is vulnerable :

• Until the permanent restoration is put in place, avoid chewing on hard substances such as peanuts, pretzels, hard candy, ice cubes, etc.
• You may experience increased sensitivity until the final restoration. Using a toothpaste made for sensitive teeth may reduce unpleasantness.
• As you resume eating, try to avoid chewing or biting on the treatment area until your permanent restoration is placed.

If you are unable to achieve adequate pain control OR a temporary filling falls out please our office during business hours or use the after hour # to get in touch with us.

1) Following Tooth Preparation:

• Sensitivity and tenderness of the tooth and surrounding gums is common for the first day or two after a tooth has been prepared for a restoration. If the tenderness or sensitivity lasts longer than this, please contact our office.
• If anesthesia is used, avoid chewing, biting, and eating until the numbness wears off.
• Warm salt water rinses, after numbness wears off, may be soothing to gum tissues.

2) With Temporary Restorations:

• Eat softer foods, and avoid foods that are particularly crunchy, chewy, or hard.
• Carefully clean around the restoration, brushing and flossing daily. Be gentle when flossing, taking extra care not to loosen the temporary restoration. Slowly pulling the floss out by one end can help avoid putting too much pressure on the temporary.
• Please do not chew gum, or sticky foods as it may become attached to the temporary crown.
• If the temporary restoration becomes loose or breaks, please contact us during business hours, or use the emergency contact during off hours.

3) After Final Restoration Placement:

• Avoid chewing on hard, crunchy, or sticky foods for 24 hours in order to give time for the cement to fully bond.
• Mild sensitivity to hot foods should dissipate after 6 weeks or less. Sensitivity to cold may take up to 90 days.

At any time you are unable to achieve adequate pain control please our office during business hours or use the after hour # to get in touch with us.

1) Generally we suggest TMJ patients wear the splint a minimum of 3 hours per day and all night.

• Splint therapy is a reversible treatment modality.
• If the splint is not worn its therapeutic potential will cease and the gains will be lost.

2) In some cases it will prescribed that the splint be worn 24 hours a day.

• Worn 24 hours a day would limit removing a splint for brushing your teeth and at mealtime.

3) You will receive a container to keep your splint in, when it is out of your mouth.

4) We would recommend cleaning the splint on a daily basis with your toothbrush and gentle soap.

• Gentle soap does not have abrasives common in toothpaste, The toothpaste abrasives may scratch the acrylic of the splint.
• You can also utilize denture cleansers (Efferdent, Polident, etc.).
• For freshness consider occasionally soaking your splint in mouthwash.

5) It is expected that the splint feel solid and comfortable in your mouth at all times.

• Please do call us during office hours if:
  • You are experiencing any discomfort with the splint in place.
  • You notice any sores or other pain in your mouth.
  • You find that your bite relationship does not feel solid on the splint.

We will be happy to adjust the splint if it is no longer providing muscle relaxation and jaw comfort.

• Do not eat or chew until any numbness from anesthesia has worn off.
• If you are supervising a child who has had treatment, make certain that they are not eating or chewing while numb. Please make sure they do not bite their lips or tongue as doing so can cause serious injury to their soft tissue.
• Avoid sticky, crunchy, or hard foods for 24 hours.
• Sensitivity to cold and heat, as well as any soreness, should not last more than a few days.
• Please call our office if you experience pain or discomfort for more than a few days.

• Teeth are more susceptible to staining for the first 48 hours following bleaching treatments. For the first 48 hours after whitening, it is best to avoid dark-colored foods or beverages that can stain your teeth. Any item that can stain your clothes can also stain your teeth.
• Avoid berries, cola or other dark sodas, red wine, coffee and tea, tobacco, and ketchup, soy or other dark sauces.

Using Your Custom Trays:

• Follow the instructions given by our office, placing the bleaching gel in the center of each tooth position on the tray so that the gel will rest against the anterior surface of the teeth once it is placed in your mouth.
• Wear trays for the recommended time.
• Rinse the mouth, and gently remove any gel remaining on your teeth with a soft bristle toothbrush.
• Clean the trays.

Do

• Keep aligners in except when flossing, brushing, eating, chewing gum, sucking candy or when drinking warm beverages such as coffee, tea or hot chocolate.
• Use your fingers to put your aligners in place. First, place the aligners over your front teeth, and then use your fingers to push the aligner down gently over your molars. When aligners are correctly inserted, they will fit all the way down on the teeth, with no space between the top of the aligners and the top of the teeth.
• Remove the aligner by pulling it off both sides of your back teeth simultaneously then lifting it off of your front teeth.
• Place your aligners in the case provided any time they are not being worn.
• Clean aligners with a toothbrush and toothpaste.
• Wear each set of aligners for two weeks unless our office directs you to vary from this schedule.
• Wear aligners in the correct numerical order.

Don’t

• Don’t use your teeth to “bite” your aligners into place.
• Do not use Denture cleaner, alcohol, or bleach to clean your aligners.
• Don’t chew gum with your aligners in.

Physical Damage to Aligner

• If physical damage occurs to an aligner please contact us.  There are a number of variables we (you and us) will consider in determining next steps.

• Expect for up to 24 hours to experience some cold and heat sensitivity.  Using toothpaste specifically formulated for sensitive teeth has shown to reduce discomfort.
• Do not smoke or vape, consume alcoholic or other social drugs for at least 48 hours after Treatment
• Some bleeding following a deep cleaning is normal, but if you experience excessive bleeding, please contact us.
• You can take ibuprofen, acetaminophen or aspirin to relieve discomfort.
• A warm salt water rinse, approximately 1/2  teaspoon in 8 ounces of water can be helpful.
• Brush and floss gently following a deep cleaning, resuming normal brushing and flossing when the soreness is gone.