Wisdom teeth — the third molars in the very back of your mouth — may not need to be removed if they are:

• Healthy
• Grown in completely (fully erupted)
• Positioned correctly and biting properly with their opposing teeth
• Able to be cleaned as part of daily hygiene practices

Many times, however, wisdom teeth don’t have room to grow properly and can cause problems. Erupting wisdom teeth can grow at various angles in the jaw, sometimes even horizontally. Problems can include wisdom teeth that:

• Remain completely hidden within the gums. If they aren’t able to emerge normally, wisdom teeth become trapped (impacted) within your jaw. Sometimes this can result in infection or can cause a cyst that can damage other teeth roots or bone support.
• Emerge partially through the gums. Because this area is hard to see and clean, wisdom teeth that partially emerge create a passageway that can become a magnet for bacteria that cause gum disease and oral infection.
• Crowd nearby teeth. If wisdom teeth don’t have enough room to come in properly, they may crowd or damage nearby teeth

Some dentists recommend removing wisdom teeth if they don’t fully emerge. Many dentists believe it’s better to remove wisdom teeth at a younger age, before the roots and bone are fully formed, and when recovery is generally faster after surgery. This is why some young adults have their wisdom teeth pulled before the teeth cause problems.

According to the American Dental Association, wisdom teeth removal may be necessary if you experience changes in the area of those teeth, such as:

• Pain
• Repeated infection of soft tissue behind the lower last tooth
• Fluid-filled sacs (cysts)
• Tumors
• Damage to nearby teeth
• Gum disease
• Extensive tooth decay

The decision to remove wisdom teeth isn’t always clear. Talk to your dentist or an oral surgeon about the position and health of your wisdom teeth and what’s best for your situation.

Thomas J. Salinas, D.D.S. (Mayo Clinic Online Article)

SINUS AUGMENTATION – SUMMARY INSTRUCTIONS

1. Do not blow your nose.  Avoid things that will make you sneeze or cough.  Do not blow your nose hard or vigorously inhale.  If you have to cough or sneeze, do it with your mouth open.  This will allow the pressure to go out the mouth, not the nasal sinuses.
2. Take the prescribed Motrin or ibuprofen every 8 hours, for a minimum of one day.  Take stronger pain medication as needed.  Discontinue as discomfort subsides.
3. Take antibiotics as prescribed, finishing prescribed dose.
4. Apply ice to site 20 minutes on, 20 minutes off.
5. Avoid extremely hot beverages for the first 48 hours, cold is encouraged.
6. Do not create positive pressure in mouth (for example, drinking through a straw or SMOKING).
7. Expect minor bleeding.
8. Expect a minor nose bleed.
9. Rinse with Peridex as instructed.
10. Do not exercise for the first week.
11. You may be aware of small granules in your mouth for the next few days.  This is not unusual, as your graft is mainly made of particles and some excess particles will be lost.
12. If you feel congested, you may need to use antihistamines or decongestants.  If you do, use over the counter product such as Sudafed, Tavist-D, or Dimetapp.  I would also suggest that you avoid nasal sprays unless they are saline.

SINUS AUGMENTATION – DETAILED INSTRUCTIONS

ACTIVITY:  After leaving our dental office today, we suggest you consider relaxing or at least limiting your activity as much as possible for the remainder of the day.  Avoid strenuous activity or aerobic exercise for the next 2-3 days.

DISCOMFORT:  Some discomfort may be present when the anesthesia wears off.  You may have been given a prescription for an anti-inflammatory (NSAID) analgesic.  Please take this every 4-6 hours or four times per day for at least the first day.  This drug will greatly decrease the possibility of post-surgical swelling and pain, and has shown to accelerate healing.  Should more significant discomfort occur at any time after the surgery, please take the narcotic medication (if one has been prescribed for you), as directed.  You may take both the narcotic and NSAID together.  Their analgesic effect will be synergistic.

INFECTION:  Please continue taking your antibiotic until gone.  If you notice that after a few days, pain or swelling are increasing, or that you are experiencing an elevated temperature, or after one week are seeing yellow or green discharge from your nose, please call our office.

ANTIHISTAMINE USE:  Antihistamines should be taken every 6-8 hours, or 2-3 times per day for a least the first 4-5 days, particularly if you are having any symptoms of “stuffiness” or tendency to sneeze.  Antihistamines can make you drowsy.  If this is the case, then reduce the dosage, i.e., take them twice a day instead of three times a day.  Continue to use saline nasal spray, one puff every 6-8 hours for the first three days, or longer, if symptoms of “stuffiness” and difficulty breathing through your nose are present.

SWELLING:  It is normal to experience some facial swelling after surgery.  To minimize this, apply an ice bag wrapped in a light tea towel or handkerchief to the outside of your face over the operated area.  This should be left on your face for about 20 minutes, then removed for 20 minutes, or alternated from side-to-side, between operated areas, for 2-3 hours after surgery.  The use of both ice and the NSAID analgesic as described above will reduce facial swelling.

BLOWING YOUR NOSE:   Do not under any circumstances,  blow your nose for the next 4 weeks.  This may be longer if indicated.  You may sniff all you like, but NO BLOWING.
Do not blow 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 such as Drixoral, Dimetapp, or Sudafed will help reduce pressure in the sinuses.  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.

BLEEDING:  It is common to have slight bleeding for a few hours following surgery.  Most of the blood you may see in your mouth is actually a little bit of blood mixed with a lot of saliva – blood is a very strong “dye” and a little bit of blood will color your saliva dramatically.  If bleeding persists, apply a tea bag to the surgical site with gentle pressure for 15-20 minutes.  Let yourself rest for 15 minutes then repeat the application of the tea bag for a second time if you still have slight bleeding.  If excessive bleeding continues, please call our office or the doctor after normal office hours.  You may experience some blood discharge from your nose.  If so, lie down, with your head slightly elevated and apply an ice pack over your midface-nasal area.  If this bleeding does not stop within 30 minutes, telephone our office.

ORAL HYGIENE:  Brushing and oral hygiene procedures should be done as usual in all untreated areas.  The exposed operated areas will be cleansed by rinsing with Peridex (Chlorhexidine) at bedtime and again in the morning after breakfast.

EATING AND DRINKING:  High protein foods and liquids are desirable for 3-5 days following surgery.  Semi-solid foods may be eaten as long as this may be done comfortably.  Eggs, custard, yogurt, pasta, steamed vegetables, casseroles, cooked cereals are some thing that you might consider eating during the first few days following your surgery.  Avoid spicy, salty, acidic, very hot or very cold foods or liquids.  Also, avoid nuts, chips or other crunchy or fibrous foods which may become caught between your teeth.  Please refrain from drinking alcoholic beverages the day of surgery.

USE OF REMOVABLE DENTAL APPLIANCES:  If you normally wear a removable appliance which replaces missing teeth, and it rests on the operated area, it is best to minimize use of this appliance as any pressure on the surgical site could be detrimental to healing and cause discomfort.

Dr. Britten is genuinely concerned about your well being and postoperative healing.  If you experience any symptoms, which you feel are unusual, please feel free to contact us any time.
After hours, Dr. Britten can be reached at  his emergency number listed on our office voicemail message 727-586-2681.

Soft Foods to Eat After Periodontal Surgery

Applesauce

Avocado (Mashed plain or mixed with salt, lemon, or honey)

Bananas (Mashed well)

Broth (Chicken, Beef, or Vegetable)

Casseroles (Soft and well-cooked with plenty of liquid)

Cheesecake (You can enjoy yourself during recovery!)

Cheese (soft or melted)

Couscous/Semolina (Well-cooked and served sweet or savory)

Cottage cheese (Plain)

Custard (Made fresh or frozen)

Dips (Tzatziki, Lebneh (Greek yogurt), French Onion, Hummus and guacamole)

Eggs (Scrambled or poached)

Fish (baked or broiled, not fried)

Ice cream (Frozen yoghurt too, NO NUTS)

Jelly/Jell-O (any flavor)

Juice (just avoid acids; like tomato, grapefruit, and oranges)

Macaroni & Cheese (Well-cooked and soft)

Mashed Potato (Well blended with no lumps)

Meatloaf or Meatballs (Small bites)

Noodles/Pasta (Small, Flat overcooked pasta that doesn’t require much chewing or slurping)

Nut Butters (Peanut, Almond, or Cashew.  Needs to be smooth not CRUNCHY)

Oatmeal (Mixed with honey, syrup or mashed banana)

Pudding (Any flavor and Tapioca too)

Ramen (With well cooked veggies or meat)

Risotto (Well cooked)

Mousse

Mushed Beans/Peas

Rice (Cooked very soft)

Sherbert

Sloppy Joe Meat (Skip the bun)

Soup (The less chewy, the better)

Smoothies (Mix with fresh fruits (no seeds) milk, yoghurt or ice cream)

Spinach (Creamed or mashed)

Stew (Vegetables and meat need to be cooked for a long time)

Tea (Iced or warm, not hot)

Tofu (Mashed or cubed, firm or silken)

Vegetables (Cooked really soft and mashed)

Yogurt (Avoid flavors with seeds)

Instructions for Patients following Periodontal Surgery: 

DISCOMFORT: Following periodontal surgery, the discomfort level often varies from patient to patient and even from one area to another in the same mouth. You may have been given a long lasting local anesthetic and it is not uncommon for you to remain “numb” for several hours after surgery. In order to minimize the discomfort, it is best to start taking your prescription medication prior to the local anesthetic wearing off. Continue to take your medication according to the instructions placed on the label for as long as necessary. Sometimes, you may supplement your prescription medication, if necessary, by taking two non-prescription analgesic tablets, such as Tylenol or Advil, in between doses of the prescription medication. Please check with Dr. Britten for specific instructions regarding which type of analgesic you may use as a supplement.

BLEEDING: Blood stained saliva is not at all unusual during the first few hours after surgery and it does not take very much blood to cause the saliva to be “pink” in appearance. In order to prevent potential bleeding problems, it is advisable to avoid rinsing, vigorous swishing, or the use of a straw for the first 24 hours. Should significant bleeding occur, rinse your mouth with strong, cold tea or water to determine the exact location. If bleeding persists in one area, dip a regular tea bag in cold
water, squeeze out the excess water, place the tea bag in the area of the bleeding and apply gentle pressure for ten minutes. Repeat this if the bleeding has not stopped completely. When bleeding occurs, it is always best to keep the head elevated. If it continues, contact the office.

NAUSEA: Should nausea occur, it is most likely the result of swallowing small amounts of blood or as a side effect from your medication. To minimize this possibility, avoid taking medications on an empty stomach. Take all medications, if possible, with a small amount of food. If it persists and
results in vomiting, stop taking all medications and contact the office.

SWELLING: This is a normal sign of healing, unless it exists in the presence of temperature and pain. If severe swelling is present, or you have a temperature of 101 or greater, please contact our office. To minimize swelling, place an ice pack on your face over the area as soon as possible after the surgery. Hold this in place for 20 minutes and then remove the ice pack for 20 minutes. Repeat this as often as possible, for the first 24 to 48 hours after surgery. If swelling persists after the first
48 hours, utilize moist heat packs 20 minutes on and off as above. Place gel pack in microwave for 10-15 seconds.

BRUISING: Bruising is not unusual and can occur in varying degrees. To minimize bruising utilize ice packs as described above. A homeopathic medication called ARNICA can be purchased at health food stores. This topical gel and/or tablets that dissolve beneath the tongue can minimize or shorten the extent and duration of any bruising.

TO AID HEALING: If you were given a prescription for an antibiotic, be sure to take all of it as directed. Ladies, please be aware that antibiotic medications can reduce the effectiveness of birth control pills. Routine oral hygiene should continue, but avoid the area of surgery until otherwise directed. If you were given a prescription for Peridex rinse or instructed to use Listerine, rinse gently twice a day after cleansing the rest of your mouth. DO NOT begin rinsing with the Peridex until the day after your surgery.

SURGICAL DRESSING: A “bandage” or dressing material may have been placed in order to protect the surgical area. This is a pink, putty-like material that is placed around the teeth in the area of the surgery. It should be in place until your first post-operative visit. However at times, small pieces of it
may break off, but this is of no concern unless the area becomes uncomfortable. If a portion of the dressing or the entire dressing comes off, please contact the office.

TISSUE GRAFT (gum graft): If you have had a tissue graft, try to keep the area as immobile as possible for the first 72 hours. To help keep the dressing in place, DO NOT pull on your lip. When needing to cough, yawn or sneeze, cup your hand over the area of surgery to help prevent the dressing from becoming loosened. Should the dressing come loose or come off
in the area that the tissue was placed, please call the office for direction. If the tissue graft was “borrowed” from the roof of the mouth and there is significant bleeding coming from that area, refer to the “BLEEDING” section on this instruction sheet for directions in use of a tea bag. If the dressing should come off of the roof of the mouth, and it is not uncomfortable to you, it is OK to leave it off.

BONE GRAFT: If a bone graft was done, you will likely have additional prescriptions to aid in the healing and there may not be any dressing (bandage material) placed in the area where the bone graft was placed. You will be given a prescription for an antibiotic and for a special mouthwash to help cleanse the area for a number of weeks. The antibiotic will give the bone graft the best possible chance of success. Please be sure to take ALL of the medication as directed.

AVOID SMOKING: As long as you can refrain from smoking and as much as you can reduce the frequency, the more quickly you will heal. Smoking greatly impairs the healing process and can compromise the final results of your procedure and may cause additional discomfort.

DIET: Eat and drink as much as you can! If possible, do not chew in the area(s) where surgery was performed for a period of 2 hours or longer. Avoid hot foods and liquids for 2 hours. Adequate nutrition is essential for healing. Diets rich in quality protein, Vitamin C and Vitamin B Complex are especially desirable. Eat softer foods such as eggs, potatoes, ground chicken, fish, soups, pastas and cooked vegetables. Avoid foods with small seeds such as tomatoes, strawberries and seeded breads for at least the first week following surgery. Return to your regular diet as soon as you feel
comfortable. Avoid alcoholic beverages for a minimum of 24 hours after surgery and possibly longer depending on the type of medication you are taking. Should you have questions regarding this, please call the office. Drink plenty of water and other clear liquids.

If you received conscious IV sedation: Do not operate motor vehicles or heavy equipment for 24 hours. Please take care when walking, you might be drowsy from your procedure.
If you were advised to stop taking aspirin, Coumadin, Plavix or other type of blood thinners, resume taking your medication the day following your surgery unless instructed otherwise.
If you should have ANY questions or problems, please feel free to call the office at 727-586-2681.

After hours, Dr. Britten can be reached at his emergency number provided on our office voicemail.