Charles B. Nissman, D.D.S.
Michael B. Salin, D.M.D.
Surgical Instructions
Frequently Asked Questions
General
I am pregnant, is it safe to have oral surgery?
If you are pregnant, only emergency oral surgery will be performed (not elective surgery) under local anesthesia. You will be required to bring with you clearance from your OB-GYN doctors or have it faxed to our office (215-322-7832).
I take Coumadin (warfarin), do I need to stop?
If you take coumadin you may not need to stop. You must call our office to determine the proper treatment. Bloodwork (INR) is often required. If you have had the test performed in the previous month, please obtain the result from the prescribing doctor before calling our office.
I take Plavix (clopidogrel) and or Aspirin do I need to stop?
Not necessarily. Most often times it is based on the procedure you will be undergoing. Therefore, please call our office to determine if stopping these medications is necessary. If you must stop, please do so 7 days prior, as this is the time required for the medication’s effects to be inactive.
I have a joint replacement, should I take antibiotics prior to my surgery?
This decision is to be left to your orthopaedic surgeon. Please contact your orthopaedic surgeon to determine if antibiotics are necessary.
I breastfeed, is it safe for my baby if I undergo general anesthesia?
The anesthetics agents used for general anesthesia are quickly metabolized and excreted from your body. Therefore, we recommend that you pump and store enough breast milk to be used for 24 hours after your anesthetic.
Extractions
Is it normal to be more swollen a few days after my tooth extractions?
Yes. After surgery, swelling peaks in 48-72 hours, after which it starts to go down. Ice has minimal effects after 36 hours except to ease the pain. Maintaining an upright position and sleeping with 3-4 pillows during the night may help to decrease the amount and duration of swelling.
How long should I expect the bleeding to continue?
Most commonly, bleeding subsides in 24 hours, though oozing may continue off and on for a few days. If bleeding continues, bite on moistened gauze for 45 minute increments (without removing) for 1-2 hours. If it continues, biting on a moistened teabag may help. Do not hesitate to call the doctors if bleeding continues.
The pain medication is not relieving my pain, what can I do?
If you are able to take ibuprofen (Motrin, Advil) you may begin alternating the narcotic (Tylenol with codeine, Vicodin, Percocet, Darvocet) and ibuprofen every 4 hours. These medications help to decrease inflammation and thereby pain. If you are unsure that you can take ibuprofen, please call the doctors before initiating this alternative pain regimen.
The teeth close to the extraction socket are sensitive, is that normal?
After a tooth is removed, the surrounding bone, soft tissue and nerve become inflamed. Therefore, other teeth in the area or distant from the area may become sensitive due to the phenomenon known as “referred pain”. This will resolve on its own. If you are concerned or symptoms continue please call the doctors.
It has been 3 to 4 days after my extraction and the pain is getting worse, what should I do?
Make an appointment to see the doctors. A very painful condition known as “dry-socket” may develop 3-4 days following tooth removal. Common symptoms are a steady increase in pain, throbbing at the extraction site, ear pain on the side the tooth was removed, and a bad taste or odor in your mouth. Treatment involves placing materials into the socket that will ease your pain until the body heals itself. Other causes of pain may be infection, a problem with a neighboring tooth, sharp edges of the tooth socket, and bone exposure through your gums.
Is it normal to have a fever after my extraction?
After oral surgery or any surgery for that matter, patients may experience a low-grade fever. Do not take your temperature in your mouth after oral surgery, as it will naturally be higher. Preferably take your temperature in your underarm. If fever continues or is elevated (>101.0°F) please call the doctors.
The stitches have fallen out and it has only been a few days after my extraction, should I worry?
Not to worry. Stitches often fall out at various time intervals due to various reasons, that is why multiple stitches are often placed. Other oral surgical procedures, besides dental extractions, require stitches to have a successful surgical result. Therefore, if you are concerned, we are concerned. Please call our office if you have a question.
Implants
Is it normal to me swollen after my dental implant?
Yes. After surgery, swelling peaks in 48-72 hours, after which it will resolve. Ice has minimal effects after 36 hours except to ease the pain. Maintaining an upright position and sleeping with 3-4 pillows during the night may help to decrease the amount and duration of swelling.
I can see a silver cap in my gums where the implant was place, it that normal?
Not to worry. Some silver caps are placed above the gums intentionally and some become uncovered during implant healing. If you see a silver cap make sure you keep the area clean rinsing with Listerine for 1 minute twice a day. Avoid any unnecessary mechanical trauma to the implant site (such as using cotton-swabs and/or a toothbrush on the silver cap) please call the doctors.
I have a “bubble” or abnormal swelling and pain in the site of my implant(s), is that normal?
NO! Successful implants heal without complications. After the initial surgical swelling and discomfort have subsided, call the doctors if you notice a "bubble", drainage, or anything out of the ordinary. Do Not Wait.
When can I eat on the side of my mouth that the implant was placed?
Six weeks! For the first six weeks please eat a softer diet on the opposite side of implant placement. If implants were placed on both sides, then your diet must be restricted to pureed-soft foods (i.e. eggs, tuna salad, egg salad, cottage cheese, soft pasta, flaky fish, etc).
The silver cap that my doctor placed is loose, what should I do?
Call for an appointment immediately. If left loose, gum tissue may grow between the implant and silver cap, necessitating an additional minor procedure under local anesthesia.
Bone Grafting
When can I eat on the side of my mouth that the bone graft was placed?
Six weeks! For the first six weeks please eat a softer diet on the opposite side of the bone graft placement. If bone grafts were placed on both sides, than your diet must be restricted to pureed-soft foods (i.e. eggs, tuna salad, egg salad, cottage cheese, soft pasta, flaky fish, etc).
I wear a denture or partial denture, can I use them after the bone graft?
Each bone graft is very different. Please always ask the doctors before ever placing a denture onto a site that a bone graft has been performed.
I had a tooth removed and bone placed in the tooth socket, now I see a hole with white material?
When bone is placed in a tooth socket after extraction (Socket Preservation), a white sheet of material is placed over it to provide protection. This initially protects the bone and then dissolves and is replaced by your native gum tissue. This event may occur 3-5 days after the extraction leaving a “crater-appearance” in the tooth socket. This is normal. Eat on the opposite side, and if you have any questions please do not hesitate to call our doctors
General Anesthesia
How long prior to my general anesthetic must I not eat or drink?
You may not eat or drink anything for 6 hours prior to your general anesthetic. If you must take medication do so with a tiny sip of water 2 hours or more prior to your procedure. If you require antibiotic prophylaxis, you may take the medication with a tiny sip of water 1 hour prior to your procedure.
What medications may I take the day of my general anesthetic?
Most of the medications you take daily can be continued the day of your general anesthetic. Any medications you normally take in the morning should be taken prior you procedure, especially blood pressure medications, GI reflux medications, seizure medications, thyroid medications, etc. If you have any questions please call our office the day before your planned procedure.
How soon after the general anesthetic can I drive?
You should not drive a motor vehicle or operate dangerous machinery for 24 hours after your procedure. This time is necessary to allow your body to metabolize the anesthetic agents.
I’m nauseous and vomiting, is that from the general anesthetic?
It may be, but most of the general anesthetic medications used today do not cause nausea and vomiting. Rather, narcotic pain relievers, swallowed blood, pain, etc, all may be culprits. Please call our office if nausea and vomiting continue, as medications can be prescribed to help.