Please note that the following instructions are for common children's treatments:
Stainless Steel Crowns
Your child has had stainless steel crowns placed to restore badly decayed baby teeth. The decay was removed and in some cases, if the decay was into the nerve of the tooth, the nerve was removed and a special medication placed. This procedure is called a pulpotomy.
The crowns are cemented in place. The gums around them may be tender –slightly painful- for a day or two. The child may mention that his/her “bite” feels funny at first but this will correct itself. Brush these crowns just like the other teeth. They will get wiggly and fall out with the baby tooth at the normal time when the permanent tooth wants to erupt.
Your child must avoid sticky foods like toffee, sticky candy, suckers, bubble gum, etc. as these things may pull off a crown. If a crown does come off they are easily re-cemented but this must be done as soon as possible. Keep the crown and phone your dentist’s office for an appointment to have this done.
If your child had anesthesia for the procedure, please make sure that he/she doesn’t bite his/her cheek or lips till the anesthesia wears off.
Space Maintainers
Your child has had a tooth removed and a spacer cemented. The spacer is meant to hold the space between two teeth for the adult tooth to erupt into the space and drift towards the cheeks or the tongue. When the adult tooth can be seen erupting through the gums, it is time for the spacer to be removed.
Brush the spacer to keep plaque and food from sticking to it. Your child must avoid sticky foods like toffee, sticky candy, suckers or bubble gum as these may damage or pull the spacer out of place. If this happens, the spacer can be easily re-cemented if done as soon as possible. Keep the spacer and phone your dentist’s office for an appointment.
Baby Tooth Extraction
Baby teeth are shorter than adult teeth but may be much wider. The socket will typically bleed for half an hour. Biting on gauze for 30 minutes, if possible, will help keep this under control. Any infection or abscess in the baby tooth should go away once the tooth is removed so no additional antibiotics will be necessary. Children’s Tylenol or Advil is all that may be required for the first few hours after treatment. Brushing can be started again the very next day. Choose foods for the first days that aren’t going to hurt the healing gums. Let your child enjoy a cold drink and/or ice cream after the numbness has gone.
Please make sure that your child doesn’t bite his/her cheek or lips till the anesthesia wears off.
When an anesthetic has been used, your lips and tongue may be numb for several hours after the appointment. Avoid any chewing and hot beverages until the numbness has completely worn off. It is very easy to bite or burn your tongue or lip while you are numb.
It is normal to experience some hot, cold & pressure sensitivity after your appointment. Injection sites may also be sore. If your general health permits, the use of non-steroidal anti-inflammatory medications such as (Brufen, Doloraz), Paracetamol such as (Panadol, Tylenol) or aspirin (one tablet every 3-4 hours as needed for pain) work well to alleviate the tenderness. If pressure sensitivity persists beyond a few days or if the sensitivity to hot or cold increases, contact Dr. Raed M. Abutteen Dental Center office at +962 7 9100 8087 , +962 7 8100 8087 .
You may chew with your composite fillings as soon as the anesthetic completely wears off, since they are fully set when you leave the office.
If your bite feels uneven, if you have persistent pain, or if you have any other questions or concerns, please call Dr. Raed M. Abutteen Dental Center office at
+962 7 9100 8087 , +962 7 8100 8087 .
Remember that it will take time to adjust to the feel of your new bite. When the bite is altered or the position of the teeth is changed it takes several days for the muscles and nerves to recognize the new position of your teeth or their thickness as normal. If you continue to detect any high spots or problems with your bite, please call Dr. Raed M. Abutteen Dental Center office at +962 7 9100 8087 , +962 7 8100 8087 so we can schedule an adjustment appointment.
It is normal to experience some hot and cold sensitivity. The teeth require some time to heal after removal of tooth structure and will be sensitive in the interim. Your gums may also be sore for a few days. Warm salt water rinses (a teaspoon of salt in a cup of warm water) three times a day will reduce pain and swelling. A mild pain medication (one tablet of Tylenol or Ibuprofen every 3-4 hours) should ease any residual discomfort.
Don’t be concerned if your speech is affected for the first few days. You’ll quickly adapt and be speaking normally. You may notice increased salivation. This is because your brain is responding to the new size and shape of your teeth. This should subside to normal in about a week.
Daily brushing and flossing are a must for your new dental work. Daily plaque removal is critical for the long-term success of your new teeth, as are regular in office cleaning appointments.
Any food that can crack, chip or damage a natural tooth can do the same to your new teeth. Avoid hard foods and substances (such as nut shells, peanut brittle, ice, fingernails, or pencils) and sticky candies. Smoking will stain your new teeth. Minimize or avoid foods that stain such as coffee, red wine, tea and berries.
If you engage in sports let us know so we can make a custom mouth guard to protect your teeth while being engaged in your sport activity. If you grind your teeth at night, wear the night guard we have provided for you. Adjusting to the look and feel of your new smile will take time. If you have any problems or concerns, please let us know. We always welcome your questions.
Crowns and bridges usually take two or three appointments to complete. In the first visit, the teeth are prepared and molds of the mouth are taken. Temporary crowns or bridges are placed to protect the teeth while the final restoration is being made. Since the teeth will be anesthetized, the tongue, lips and roof of the mouth may be numb. Please refrain from eating and drinking hot beverages until the numbness is completely worn off.
Occasionally a temporary crown may come off. Call Dr. Raed M. Abutteen Dental Center office at +962 7 9100 8087 , +962 7 8100 8087 if this happens and bring the temporary crown with you so we can re-cement it. It is very important for the temporary to stay in place, as it will prevent other teeth from moving and compromising the fit of your final restoration.
To keep your temporaries in place, avoid eating sticky foods (gum), hard foods, and if possible, chew on the opposite side of your mouth. It is important to brush normally, but floss carefully and don’t pull up on the floss which may dislodge the temporary but pull the floss out from the side of the temporary crown.
It is normal to experience some temperature and pressure sensitivity after each appointment. The sensitivity should subside a few weeks after the placement of the final restoration. Mild pain medications may also be used as directed by our office.
If your bite feels uneven, if you have persistent pain, or if you have any other questions or concerns, please call our Dr. Raed M. Abutteen Dental Center office at +962 7 9100 8087 , +962 7 8100 8087 .
Medications & Prescriptions
Local anesthetic will wear off within half an hour to six hours following surgery. It is important to take your pain medication before discomfort begins.
Pain medication is to be taken as instructed on the label. It is important to eat or have a thick drink (such as mango juice, milk or yoghurt) prior to taking your pain medication; not eating can cause nausea and vomiting. If nausea and/or vomiting occur please do not hesitate to contact us or contact your physician for further instructions.
If an antibiotic is prescribed, it has to be taken until all the medication is finished.
Attention: All female patients utilizing birth control pills, please be advised that if you were prescribed an antibiotics, consult with your gynecologist the need for an alternative form of birth control to be utilized during the period of time you are taking antibiotics.
Control of Bleeding
Gauze is placed over the surgical site to serve as a pressure bandage when you bite down. We recommend leaving it in place for about 40 minutes. Do not replace the gauze with another one or use other materials such as cotton or napkins over the surgical site. This will induce further bleeding because this will keep removing the blood clot away. Pink or blood-tinged saliva may be present for 24 to 48 hours; a small amount of oozing is normal. Rest with your head elevated on two or more pillows for the first day. You may want to cover your pillows with a towel to protect your bedding sheets.
If bleeding occurs try controlling it by placing a cool, moistened tea bag over the surgical site for one hour while applying pressure. Please do not hesitate to call Dr. Raed M. Abutteen Dental Center office for any inquiry regarding your control of bleeding status.
Swelling
Swelling after surgery is normal. It may take up to three days for swelling to reach a peak before subsiding. Ice packs should be applied during the first day after surgery to reduce swelling and produce numbness. Fill a plastic bag with crushed ice and wrap it in a damp towel. You may add water to the crushed ice and tighten the seal of the bag and apply it for 2 minutes on, 2 minutes off for 20 minutes, 3-4 times at first day of surgery. Next day, switch to moist heat like a warm washcloth. Utilize the warm cloth for 15 minutes for every hour you are awake for 2 days. If swelling increases past the fourth post-surgical day or if swelling re-appears after initial healing, an infection may be present. Feeling un-well and having a fever will quite often accompany this swelling. Please contact Dr. Raed M. Abutteen Dental Center office if this should occur.
Normal jaw opening and movement may take up to one month to return after some kinds of surgery. Jaw exercises (trying to open the jaw and stretch) should commence the day after surgery. Popsicle sticks or your own hand fingers can be used to help “stretch” the jaw. Please contact Dr. Raed M. Abutteen Dental Center office if you require further guidance on jaw stretching.
Bruising
Bruising may be present to varying degrees. It will subside within five to ten days after surgery.
Suture and Dressings
Sutures and dressings may be used as part of your treatment; you may feel them with your tongue. They will either dissolve or be removed at a post-operative appointment.
Tooth Brushing
Do not brush the immediate surgery site for one week; the remainder of the mouth should be brushed normally. This will prevent the disruption of the blood clot, healing tissues and sutures. A small amount of bleeding or discomfort may occur when you resume brushing at the surgical site.
Rinsing
For the first 24 hours, avoid rinsing, forceful spitting, drinking through a straw or using an alcohol based mouthwash as it may prematurely dissolve the blood clot.
After 24 hours, gently rinse with warm salt water (1/2 teaspoon salt in a large drinking glass) after meals and at bedtime. Rinsing with warm sage or chamomile brews is also advantageous and promotes healing. After 72 hours, vigorous rinsing is encouraged after meals and at bedtime for a two-week period.
Diet and Nutrition
For the first 24 hours, eat cold soft foods like ice cream (without nuts), Jell-O, pudding, yogurt, cottage cheese and applesauce.
Have cold or warm Luke drinks for the first 24 hours.
In some types of surgery one should follow a soft diet like eggs, mashed potatoes and pasta for the next four days.
Increase your fluid intake; do not drink carbonated beverages or alcohol for four days after your surgery.
Do not drink from a straw for 24 hours; the sucking action may dislodge your blood clot and cause a dry socket.
Proper nutrition is necessary for healing.
Smoking
Note that one should refrain from smoking for few days post surgically to reduce the chances of having post-operative problems. Smoking can increase pain and lead to poor healing. Smoking can increase the risk of infection.
Physical Activity
Stop any physical exercises for the first 24 hours post surgically. Exercise increases blood circulation which may aid in bleeding and reduce bleeding control. Avoid excessive physical exertion and fatigue for 14 days following surgery; obtain adequate sleep.
When to Call Us
Noisy or difficulty breathing
Wheezing
Nasal congestion
Swelling around the eyes not related to the surgery
Excessive bleeding
Persistent pain
Itching or a rash appears
If any other matter causes you concern.
If you were unable to reach us at Dr. Raed M. Abutteen Dental Center office at+962 7 9100 8087 , +962 7 8100 8087 . and are experiencing severe bleeding or breathing problem, immediately proceed to the nearest hospital emergency room.
Do not disturb the wound. If surgical packing was placed, leave it alone. The pack helps to keep the tooth exposed. If it gets dislodged or falls out do not get alarmed.
Bleeding
Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding which results in your mouth filling rapidly with blood can frequently be controlled by biting with pressure on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call us for further instructions.
Swelling
Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag or a plastic bag or towel filled with ice cubes on the cheek in the area of surgery. Apply the ice continuously as much as possible for the first 36 hours.
Diet
Drink plenty of fluids. Avoid hot liquids or food. Soft diet and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.
Pain
You should begin taking pain medication before the local anesthetic wears off. Local anesthetic will wear off within half an hour to six hours following surgery. It is important to take your pain medication before discomfort begins.
Your dentist will prescribe the required medications and their proper use. It is important to eat or have a thick drink (such as mango juice, milk or yoghurt) prior to taking your pain medication; not eating can cause nausea and vomiting. If nausea and/or vomiting occur please do not hesitate to contact us or contact your physician for further instructions.
For mild to moderate pain, if your general health permits, the use of non-steroidal anti-inflammatory medications such as (Brufen, Doloraz), Paracetamol such as (Panadol, Tylenol) or aspirin (one tablet every 3-4 hours as needed for pain) work well to alleviate the pain. For severe uncontrolled pain, please do not hesitate to call Dr. Raed M. Abutteen Dental Center office at+962 7 9100 8087 , +962 7 8100 8087 .
Oral Hygiene
Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can. Rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) three to six times a day. Rinsing with warm sage or chamomile brews is also advantageous and promotes healing. Continue this procedure until healing is complete.
REMEMBER: A clean wound heals better and faster.
Activity
Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.
After tooth extraction (removal), it’s important for a blood clot to form to stop the bleeding and begin the healing process. That’s why we ask you to bite on a gauze pad for 30-45 minutes after the appointment.
After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.
After the tooth is extracted you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Place them 2 minutes on, 2 minutes off at the cheek side adjacent to the removed tooth for 20 minutes per hour for 3 -4 times at the day of surgery. Take pain medications as prescribed. The swelling usually subsides after 48-72 hours.
Use the pain medication as directed. Call Dr. Raed M. Abutteen Dental Center office at +962 7 9100 8087, +962 7 8100 8087if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable starting the next day after extraction.
It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean.
After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call Dr. Raed M. Abutteen Dental Center office immediately at+962 7 9100 8087 , +962 7 8100 8087 .
The removal of impacted teeth is sometimes a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.
Immediately Following Surgery
The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
Take the prescribed pain medications as soon as you can to avoid feeling discomfort. This will usually coincide with the local anesthetic becoming diminished.
Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
Bleeding
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon for the next 24 hours. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. Try using cold drinks, keep them in your mouth for some time and smoothly spit them out. If bleeding does not subside, call our office for further instructions. If you were unable to reach us at Dr. Raed M. Abutteen Dental Center office at+962 7 9100 8087 , +962 7 8100 8087 and are experiencing severe bleeding, immediately proceed to the nearest hospital emergency room.
Swelling
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
Pain
You should begin taking pain medication before the local anesthetic wears off. Local anesthetic will wear off within half an hour to six hours following surgery. It is important to take your pain medication before discomfort begins.
Your dentist will prescribe the required medications and their proper use. It is important to eat or have a thick drink (such as mango juice, milk or yoghurt) prior to taking your pain medication; not eating can cause nausea and vomiting. If nausea and/or vomiting occur please do not hesitate to contact us or contact your physician for further instructions.
For mild to moderate pain, if your general health permits, the use of non-steroidal anti-inflammatory medications such as (Brufen, Doloraz), Paracetamol such as (Panadol, Tylenol) or aspirin (one tablet every 3-4 hours as needed for pain) work well to alleviate the pain. For severe uncontrolled pain, please do not hesitate to call Dr. Raed M. Abutteen Dental Center office at+962 7 9100 8087 , +962 7 8100 8087 .
Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.
Diet
After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.
Keep the mouth clean
No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery avoiding the surgical site, but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt. Rinsing with warm sage or chamomile brews is also advantageous and promotes healing.
Discoloration
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
Antibiotics
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. You should otherwise continue using the antibiotic till the course ends.
Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.
Other Complications
If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful.
Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, please notify us.
You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously.
If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.
Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.
A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. Call Dr. Raed M. Abutteen Dental Center office if this occurs.
Finally
Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. Some sutures will dissolve on their own in approximately one week following surgery. Others will require removal with no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it's really nothing to worry about.
The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call Dr. Raed M. Abutteen Dental Center office for instructions.
There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with rinses or a toothbrush.
Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Your dentist who did the procedure.
The following information applies when grafting material has been placed into extraction sites to help preserve your jawbone in preparation for possible implant replacement of the extracted tooth.
Your bone graft is made up of many particles. You may find some small granules in your mouth for the first several days. Do not be alarmed by these. It’s normal to have some of them come out of the graft site and into your mouth.
There are some things you could do to minimize the amount of particles that become dislodged:
Do not disturb or touch the wound
Avoid rinsing or spitting for 2 days to allow blood clot and graft material stabilization
Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing
Do not lift or pull on the lip to look at the sutures. This can actually cause damage to the wound site and tear the sutures
Do not smoke
Following the second day, gentle rinsing would be allowed but not too vigorously as you can again disturb some of the bone graft granules. If a partial denture or a flipper was placed in your mouth, you may have to see your restorative dentist to have it adjusted and learn how to remove and replace it appropriately without causing pressure at the surgical site.
It is our desire that your recovery be as smooth and pleasant as possible. Following instructions such as those provided for the After Wisdom Tooth Removal will assist you, but if you have questions about your progress, please call Dr. Raed M. Abutteen Dental Center office at +962 7 9100 8087 , +962 7 8100 8087 .
You have had a Sinus Lift Augmentation procedure in your upper jaw. This procedure regains lost bone height in the area of your first and second molar and occasionally second premolar. It is an important procedure as it allows implant placement in an area that could not be implanted otherwise because of insufficient bone height due to an enlarged sinus.
The bone that has been grafted is most commonly a combination freeze-dried bone, artificial synthetic bone and your own bone. Because of this you may have two post-surgical wounds: the donor site and the recipient site.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office.
DO NOT UNDER ANY CIRCUMSTANCES BLOW YOUR NOSE FOR THE NEXT FOUR (4) WEEKS.
This may be longer if indicated. You may sniff all you like but NO BLOWING.
Do not blow your nose or sneeze holding your nose. Sneeze with your mouth open. Do not drink with straws and do not spit. Scuba diving and flying in pressurized aircraft may also increase sinus pressure and should be avoided. Decongestants that are usually prescribed following such surgeries will help reduce pressure in the sinuses. You may also be given a prescription for antibiotics. Please take these as directed. Anything that causes pressure in your nasal cavity must be avoided. Avoid “bearing down” as when lifting heavy objects, blowing up balloons, playing musical instruments that require a blowing action or any other activity that increases nasal or oral pressure. Smoking must be stopped.
Antibiotics
Be sure to take the prescribed antibiotics as directed to help prevent infection.
Oral Hygiene
Do not rinse or spit on the day of your surgery. This tends to disturb the blood clot, open the wound and can prolong bleeding and slow healing. You should not have a significant amount of blood in your mouth. Saliva can be swallowed, even if slightly blood tinged.
Keeping your mouth clean after surgery is essential to reduce the risk of infection. Start salt water rinses the day following your procedure. Use one-half teaspoon of salt dissolved in a glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least four to five times daily and always after eating for the next five days.
Do not brush the teeth in the area of surgery for 48 hours. When brushing, be very gentle. When expectorating, also be gentle.
We may prescribe an antibiotic rinse (Chlorhexidine, Perio Plus, Peridex) for certain procedures. This rinse should be used in the morning and at bedtime after routine mouth care. Do not eat or drink or rinse your mouth after using the medicated rinse. Using this rinse more than two times a day will cause staining of your teeth. Use it without any dilution and only every 12 hours.
Smoking
Do not smoke for at least two weeks after surgery, if at all. As discussed at your consultation, smoking dramatically increases the risk of bone graft and sinus augmentation failure. Your surgeon can prescribe a Nicoderm patch if you feel you need it.
Swelling
Ice packs will help reduce the swelling but should never be placed directly on exposed skin. Rather, wrap an ice pack (or a package of frozen vegetables) in a damp towel and place gently on the sides of your face, 30 minutes on, 30 minutes off.
Sever cheek swelling is normal following this procedure. If your eyes swell shut, please call our office.
Nosebleeds
Nosebleeds are normal and may occur for several days following surgery. Treat by leaning your head back; apply an ice pack and direct pressure. Don’t be alarmed by the presence of bone granules; drainage is normal from both the nose and mouth – wipe gently away.
Wearing your Prosthesis or Nightguards
Partial dentures, flippers, or full dentures should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise. Please contact the office if there is any question. If you have questions about the fit of your flipper, partial or complete denture, do not wear it until your general dentist or our office can see you.
Post-Operative Problems or Complications
As with any procedure, unexpected post-operative healing can occur:
If you notice the unexpected flow of air or liquids between your mouth and nose, please let us know immediately
If you are aware of several small particles of graft material being discharged from your nose, let us know as well
If you experience sinus or nasal congestion on the side your surgery was performed, let us know
If there is an increase in swelling in your mouth, cheek or under your eye after 3 days, let us know
Immediately Before And After Surgery
Prior to your jaw surgery, you will visit your surgeon to have molds and records taken. This office appointment can vary between 1 to 2 hours in length. It will consist of taking x-rays, molds and photographs and is an opportunity for you to sit down with all your remaining questions. It’s also an opportune moment for any family member(s) that may be with you to also discuss with your surgeon the period following the surgery.
Prior to your surgery, it is imperative that you have seen the orthodontist for placement of surgical hooks and your family dentist for a generalized cleaning since oral hygiene will be a little difficult for the first 2 weeks. Also, you should enjoy a normal routine and savor your favorite meals, since these will be interrupted for at least 1 month after surgery.
The day and morning before your surgery, it is important that you thoroughly brush all your teeth and appliances.
The day of your surgery, you will first meet the anesthetist who will bring you to the operating room and guide you through the process over the next few hours. Depending on the number of jaws that you will have surgery on, the length will vary between 1 to 3 hours. This is different for all patients and this will be explained to you.
When you wake up from your surgery, your teeth may be held together with small elastics, just to help you guide into your new occlusion. These elastics, if present, will be changed after the first week.
You will be completely numb on the jaw that was operated on, so there is not a great amount of pain. However, the swelling starts up immediately and there is some jaw stiffness to be anticipated. There is some soreness from the breathing tube that the anesthetist places and this soreness will also subside with time.
Your course in hospital will usually last 1 night for 1 jaw and 2 nights for 2 or more jaws. The goal of your hospital stay is to ensure that you are drinking as best as you can. We will be coaching you to do some walking around, but drinking is of the highest necessity. Too much activity may cause a bit of nausea, so it’s best to remain as quiet as possible.
Immediately After Surgery
All patients feel discomfort or pain after an operation, although the level of pain varies from patient to patient. Take your pain medications as directed.
When you go home, it is important that a friend or relative spends the first night with you.
You will be able to shower on the second day after surgery. You must avoid hot, prolonged showers, which may cause bleeding in the upper jaw if surgery is performed there.
Avoid exercises, any heavy lifting or activity that raises your blood pressure or pulse for at least one month after the surgery. The blood vessels are still healing from the surgery and any increase in activity may cause bleeding. You may begin gentle exercise after 2 weeks, but do not do any cardio for 4 weeks after the surgery.
Do not drive a vehicle or perform any task that requires coordination or judgment for at least 48 hours following your anesthetic.
Prescriptions
You will be provided with prescriptions that will provide medications for pain management, prevention of infection and all that may help your recovery be as smooth and pleasant as possible. Please follow the instructions and commit to the timing of each medication.
Diet
Immediately after surgery, you will need to stay on a clear liquid diet to ensure that the wounds do not get burdened with debris. A suggestion is the following:
The first 5 days will be clear fluids; that is anything you can see through, from clear soft drinks, clear fruit drinks, clear soups, Jell-O.
5 days after that, you can move onto any liquid including milk shakes, ice cream, Soya milk drinks, yogurts, soft cheeses, protein drinks and protein supplements as well as nutritional supplements (such as Ensure, Boost, Whey, protein powders, tofu);
5 days after that, you can commence a soft food diet. A recommendation is to eat anything that does not make any noise, therefore hard or crunchy foods must be avoided. Most foods will be satisfactory at this stage including pastas, rice, potatoes, etc.
There is no limit to what you should eat, as long as you don’t need to chew too vigorously. This is all that really should be taken by mouth for the first week.
Hygiene
The amount of swelling that will take place in your cheeks will make it very difficult to brush your teeth. In fact, you should not brush your teeth for 1 full week after surgery, otherwise the incisions can be damaged and bleeding may start. You should use warm saline rinses (1/2 teaspoon salt in a glass of warm water). You can rinse your mouth with salt water as often as you would like, even up to every 2 hours. You cannot do enough rinses. This will keep your mouth nice and clean and will also tend to shrink the incision lines inside the mouth. Your hygiene will change into the second phase. You may also be given a prescription for chlorhexidine or Peridex, an anti-bacterial mouth rinse. If that is given to you, use it as prescribed.
Swelling
The swelling is perhaps the greatest post-operative event of your jaw surgery. This will vary from patient to patient. You must anticipate a large degree of swelling over your cheek area as well as down into your neck. The swelling is maximal at day 4 and will slowly subside after 2 weeks. There is still about 10 to 20% of swelling that can maintain up to 2 months after surgery. You should only be critical of the result about 3 months after surgery. You will have been given medications during the surgery and immediately after to help settle down some of the swelling, but once it has occurred on day 3, there is very little that can be done to eliminate it.
You should place ice on your face while you’re awake for the first 3 to 4 days. The ice will also have a numbing effect that will reduce any post-operative sensitivity. You must be careful not to apply too much ice directly on the skin, as it may cause burns. After day 4, a warm water bottle is then recommended to help reduce swelling.
Bruising
Bruising is also quite normal after jaw surgery. Depending on which jaw was operated on, you may have bruising in the area of your upper cheek and eyes as well as your lower cheeks and down into your neck. It is not unusual to have some bruising extend all the way onto your chest. The bruising is unsightly and disconcerting, but you must understand it is perfectly normal and should not be of any concern. It will go away after about 2 weeks.
Activity
You should maintain minimal activity within the first week. You are able to walk and move about but you should not do any exercises, jogging or weight lifting, regardless of how well you feel. You will have lost some blood during the operation and you may be feeling weak or faint. This is not the time to try to get back into shape. It will take one month before you fully recover from the amount of blood loss and strength due to your surgery.
Other Findings
You may have some altered sensation to your hearing due to some of the swelling extending into the area of the ear. This numbness or muffled sound is not unusual and you should expect some of it. You may also experience some joint noises on the right and left hand side. Your joints need to get accustomed to their new position.
You will need to call the office for a follow-up visit between 4 and 7 days post-op. Please make this yourself once you get home.
Next Phase
Your surgeon will give you a handout regarding the second phase of healing once you are ready. Until then relax, take the medications, drink as best as you can and call Dr. Raed M. Abutteen Dental Center office at +962 7 9100 8087 , +962 7 8100 8087 . if there are any problems.
Phase II -1 to 4 Weeks After Surgery
In this phase, the majority of swelling and bruising will have peaked and are starting to subside. It is now a time to get your jaws actively working again so that you can resume normal activity. There are a few points to remember and a few changes:
Diet
Depending on the amount of mouth opening you have and also the amount of elastics that may be placed, your diet will be still restricted to your mouth opening. However, you can now start moving up to a more substantial diet. A shopping list for the second to fourth week would include the following:
Protein drinks and protein supplements as well as nutritional supplements (such as Ensure, Boost, Whey, protein powders, tofu);
Egg products (scrambled, boiled, omelettes, );
Pureed vegetables and meats of a similar consistency to baby food. (This would include potatoes, peas, carrots);
Starches such as mashed potatoes, rice and pasta;
Other proteins such as minced meat and white fish.
Again, there is no limit as to the amount you should eat and in fact you should try to now increase your nutritional intake, since there may have been some weight loss initially and now your body is demanding extra nutrition during this healing phase. Once again, it is imperative that you do not actively chew and you should avoid anything at all that is hard, including tough meats, candies, popcorn, pretzels, peanuts and other nuts.
Hygiene
Now that the swelling is slowly starting to subside, you’ll be able to get into the mouth and cheek areas a little bit more easily. You should purchase a new toothbrush and, using a small amount of toothpaste, concentrate on brushing the metal braces. You should spend at least 15-20 minutes in the evening prior to going to bed to do a thorough cleaning of all the teeth and brackets. Not only will this make you feel a little better, it will also help reduce any swelling around the gums and cheeks. Continue rinsing your mouth with salt water at least twice a day, but be careful not to injure the wounds with the head of the toothbrush. If you do hit the wounds, there may be a little bleeding, but this is normal and should not cause any worry.
Swelling
The swelling will now begin to subside and by the second and third week, the majority of it will be gone, but remember, there’s still about 10 to 20% that can maintain up to 2 months. Ice will no longer help reduce the swelling; you may want to switch to using warm water bottles over the area. However, this will go down on its own.
Bruising
Bruising may still maintain into the second week, as far down as into the neck and chest areas. Although this is unsightly, it is perfectly normal and will go away.
Activity
You will still be feeling slightly weak due to the surgery itself and the minor blood loss. You can start a regular routine of physical exercise that you may have had prior to surgery, but you should still avoid any heavy running or activities that will produce too much motion in the head and neck areas. Simple walking and stairs and mild activity is encouraged and will help with the elimination of some swelling.
New Findings
The joints on the right and left-hand sides near your ears may now be functioning a little bit more, but due to the jaw surgery, will find themselves in a new position. It is not unusual to hear some noises such as clicking or popping of the joint as you start to function more and more. These joint noises and discomforts will continue up until about 6 weeks post-surgery.
If you’ve had upper jaw surgery, the numbness tends to be reduced in the upper lip and jaw area and this is first felt as an itchy or pins and needles sensation. In the lower lip area, there will still be some numbness and pins and needles at least up until 6 months after surgery.
If you’ve had upper jaw surgery, a nasal discharge of a red-brown fluid may occur. This is normal and is a product of the blood clots being dissolved just behind the upper jaw. If you should experience brisk Dr. Raed M. Abutteen Dental Center red blood that is not controlled with pressure on the nose, please contact the Dr. Raed M. Abutteen Dental Center office.
Physiotherapy
Facial Reanimation --- What I would like for you to do during the initial phases and up to a month after surgery are lip and cheek exercises. This produces strengthening of the muscles in and around the area of the mouth and nose, reduces swelling in the area and will also bring the life back to that area of your face. These exercises are quite simple and they consist of grimacing, pulling your lips apart, putting a pencil between your lips and trying to squeeze the pencil, smiling and all types of movements of the lips, cheeks and chin.
Joint Exercises --- This consists of exercises of opening and closing the jaw. For the first 2 weeks, your goal should be to open your teeth apart approximately 2 fingerbreadths. This consists of placing some warm packs over the right and left-hand side and gently massaging the joints on both sides and then slowly and passively opening the jaw as much as you can. By 3 to 4 weeks post-operative, your goal should be to open approximately 3 fingerbreadths. This is an area that will be actively encouraged during your post-op therapy.
Next Phase
Your appointments will now continue probably every 2 weeks. The antibiotics will have been terminated at this stage. If you need medications to help you sleep through the night, just speak to your doctor. Oftentimes, you may find yourself clenching and grinding your teeth in the middle of the night; this is not unusual, but if it is disturbing to you, we can give you something to help you through this. Your final phase will be from approximately 4 to 6 weeks after the surgery until you have your braces removed. This phase will be explained to you at the appropriate time.
