Instructions Before Anaesthesia

Please follow these instructions to prepare for IV Sedation.

Pre-Anaesthetic Instructions

• Do not take any food or drink for eight hours prior to surgery. NO WATER. Blood pressure medications can be taken with a sip of water.
• If you take an antiplatelet drug (Plavix) or an anticoagulant (Pradaxa, Coumadin, Xarelto, Eliquis), you must obtain your regular physician’s consent before you stop taking any prescription drug. It is not required to stop taking aspirin, blood pressure medications, or anti-inflammatory drugs ( non-steroidal), i.e. Advil, Naproxen, Celebrex.
• Please wear loose fitting clothing and short sleeves (e.g. T-shirt).
• Do not wear contact lenses, perfume, and nail polish.
• Arrange for a responsible adult to take you home and meet you inside the clinic. This does not include: taxi driver, Uber, Lyft, Wheel trans driver, etc. Plan to be at the clinic for about 2 hours from start to finish.
• Do not operate a motor vehicle, machinery, perform any business transactions, or drink any alcohol for 24 hours following the surgery.
• Kids will be discharged with two responsible adults, so that one can be with the patient during transport.
• Please notify our office 48 hours in advance of any coughs or colds that may develop.

Eating and Fluid Intake

• Perform your usual oral hygiene routine prior to your appointment.
• DO NOT chew gum, eat, or drink anything 8 hours prior to the appointment. This includes water. This will ensure that you come to the appointment with an empty stomach and prevent you from vomiting should nausea occur. Vomiting while being sedated is dangerous and can be prevented by following the above protocol.
• Blood pressure medications can be taken with a sip of water.
• If you take an antiplatelet drug (Plavix) or an anticoagulant (Pradaxa, Coumadin, Xarelto, Eliquis), you must obtain your regular physician’s consent before you stop taking any prescription drug. It is not required to stop taking aspirin, blood pressure medications, or anti-inflammatory drugs (non-steroidal), i.e. Advil, Naproxen, Celebrex.

Clothing and Eye wear

• Wear loose fitting clothing that does not restrict your breathing and allows a blood pressure cuff to be placed on the skin of your upper arm. Please avoid turtlenecks or dresses.
• Wear flat shoes.
• DO NOT wear contact lenses
• DO NOT wear perfume
• DO NOT wear fitted jewelry

Nail polish & Lipstick

• DO NOT wear nail polish, shellac, or acrylic nails. A probe will be placed on your finger to monitor your pulse and oxygen while you are sedated and does not work well on nail varnish or fake nails.
• Minimal makeup is best for the day of your procedure. Do not wear lipstick or heavy eye makeup.

Adult Escort & Transportation

• A responsible adult escort MUST accompany you to the office, remain in the office during your procedure, be available to help you fill your prescription, and drive you home safely.
• NO PUBLIC TRANSIT following sedation.
• Your escort should remain with you for 12 hours following your procedure.
• Arrange for a responsible adult to take you home and meet you inside the clinic. This does not include: taxi driver, Uber, Lyft, Wheel trans driver, etc. Plan to be at the clinic for about 2 hours from start to finish.

****Please note, that a taxi or Uber driver does not classify as an escort home.

Other

• All minors, 15 years old or younger, must have a parent or legal guardian present to sign the consent form.
• Kids will be discharged with two responsible adults, so that one can be with the patient during transport.
• DO NOT ignore a head or chest cold when having oral surgery. Call immediately if you have any cold symptoms. A change of appointment may be necessary. Please notify our office 48 hours in advance of any coughs or colds that may develop.
• Have a pillow, light blanket, trash can, and a box of tissues in the car.
• Have an ice pack available at home to apply post operatively.

Cancellation/Rescheduling

• A minimum of 48 business hours notice is required to cancel or reschedule any surgical
  appointments. Failure to provide sufficient notice, or if you arrive late for your appointment and it is rescheduled, or a no-show of your appointment will result in a charge of $350.00. Please contact our office if you have any questions or concerns prior to your procedure.

If you take routine oral medications, please check with Dr. Daisy Chemaly or prior to your surgical date for instructions.

Instructions following IV Sedation

The sedative agents used in your treatment will affect your coordination, memory, and judgment. Please follow these instructions for a minimum of 24 hours following your procedure with IV Sedation:

• DO NOT operate a motor vehicle,  machinery, or cook
• DO NOT perform any strenuous or hazardous activities
• DO NOT drink alcohol or take any sleeping medication
• DO NOT perform any business transactions

PRE & POST Operative Instructions Nitrous Oxide

Instructions Before Nitrous Oxide

Please follow these instructions to prepare for your procedure with Nitrous Oxide.

Eating and Fluid Intake

• DO NOT eat or drink anything 2 hours prior to the appointment. This includes water.  Nitrous oxide can cause “stomach butterflies” (nausea), which may result in vomiting.

Clothing and Eyewear

• Wear loose clothing that does not restrict breathing and allows a blood pressure cuff to be placed on the skin of your upper arm. Please avoid turtlenecks and dresses.
• DO NOT wear contact lenses. Please wear your glasses instead.
• DO NOT wear fitted jewelry.

Nail polish and Lipstick

• DO NOT wear nail polish, shellac, or acrylic nails. A probe will be placed on your finger to monitor your pulse and oxygen while the nitrous oxide is being administered and does not work well on nail varnish or fake nails.
• Minimal makeup is best for the day of your procedure. Do not wear lipstick or heavy eye makeup.

Additional

• Perform your usual oral hygiene routine prior to your appointment.
• DO NOT ignore a head or chest cold when having a dental procedure completed. Nitrous oxide is administered through a nasal mask. You must be able to breathe through the nose (blocked nasal passages, colds, etc., defeat the idea of using nitrous oxide for relaxation). Call immediately if you have any cold symptoms. A change of appointment may be necessary.
• All minors, 15 years old or younger, must have a parent or legal guardian present to sign the consent form.
• On the day of your appointment, do not take any antidepressants (unless your dentist is aware of them) or other sedatives unless prescribed by your dentist.
• If you are required to take antibiotic pre-medication before any dental procedure, please take your antibiotics 60 minutes before your appointment with a small sip of water or according to the pre-operative instructions.
• Have an ice pack available at home to apply post operatively.

Instructions during Nitrous Oxide Use

• Breathe through the nose only. Notify the doctor if you are experiencing difficulty in breathing through your nose.
• No talking is allowed while nitrous oxide is being used. Talking blows nitrous oxide into the room, lessening the desired effect for you, and exposing the dental staff to the nitrous effects.
• You may feel nauseated, dizzy, drowsy or claustrophobic during and after nitrous oxide use.

Instructions following Nitrous Oxide Use

• The gas dissipates from the body within 3 to 5 minutes after administration has stopped and the effects are rapidly ceased.
• Recovery status will be assessed following the procedure. Only fully recovered individuals can be considered for discharge unaccompanied. Should any residual symptoms remain, you must be accompanied by a responsible adult.

Instructions Following Oral Surgery

Home Instructions After Oral Surgery

Oral surgery such as tooth extraction, removal impacted wisdom teeth and implant placement is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these 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 and/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 begin to feel 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 a more thorough explanation.

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 up for one minute before standing.

Bleeding

It is normal for your saliva to be lightly streaked with blood for 1 to 2 days following surgery. If moderate bleeding is present, fold gauze into a firm, thick pad and place directly on the socket or against the operative site and maintain steady pressure for 30 minutes or longer. The less frequently the gauze is changed, the better. Rest and keep your head elevated to slow down the flow of blood and stop the bleeding. Do not spit out. Do not chew the gauze. Do not fall asleep with the gauze in your mouth. In an emergency, a tea bag moistened in warm water may be substituted for the gauze pad. Do not rinse your mouth until 24 hours after the bleeding has stopped.

Swelling, Discoloration & Numbness

Swelling is to be expected in certain cases, often reaching its maximum approximately 48 hours following surgery, and then disappearing over the following 4 to 5 days. An ice bag/pack may be applied to the outside of the face next to the surgical site for 20 minutes on and 20 minutes off for the first 24 to 48 hours following surgery. If there has been considerable swelling and/or bruising, a temporary loss of sensation may occur. It is permissible to apply mild heat, using a hot water bottle or heating pad/bag, beginning 48 hours after surgery. Apply to the affected site(s) 20 minutes on and 20 minutes off.

Bruising of the skin occasionally occurs and disappears spontaneously in approximately one week. This is a normal consequence of surgery and no treatment is indicated. 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.

Partial loss of sensation of the lower lip and chin may occur, usually following removal of lower teeth or lower implant placement. This is usually temporary and disappears within a few days or weeks.

Pain & Medications

Pain or discomfort following surgery should subside more and more every day.

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3200mg daily for an adult. Consult our practice for individuals under 18. Do not take the two medications at the same time. Do not take any of the above medication if you are allergic to them or have been instructed by your doctor not to take it.

For severe pain, the prescribed medication should be taken as directed. The first tablet can
be taken before the anesthetic wears off, roughly 2 to 8 hours after the procedure. If you were prescribed opioid pain medication (ex. Tylenol #3, Percocet) do not drive or operate hazardous equipment or drink alcohol as the medication may cause dizziness and/or drowsiness. Additional information about prescribed medications can be found on the information sheets provided by the pharmacy or by contacting your pharmacist directly.

If an allergic reaction occurs and you develop a rash, hives, itching, or have severe to persistent diarrhea please contact our office. If you develop difficulty breathing, seek emergency medical treatment.

If pain persists, it may require attention and you should call the office.

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 any other unfavorable reaction and contact our office immediately. Call the office if you have any questions.

Diet

Following oral surgery, it may be difficult to eat. A soft food diet is recommended for 3 to 5 days following surgery, along with plenty of fluid consumption. Avoid small foods like rice, peas, seeds or nuts that can easily become trapped in the operative site(s). Avoid hot drinks/soup until local anesthesia, or “freezing”, has worn off approximately 2 to 8 hours following the procedure. When “frozen” it may be more difficult to swallow liquids or medication – take small sips of water. Do not use straws for a minimum of 24 hours following surgery, as this may dislodge the blood clot. A regular diet can usually be resumed after 5 to 7 days or when it can be comfortably managed.

Oral Hygiene

In general, the cleaner you keep the extraction site the better it will heal. Keep fingers and tongue away from operative site. Do not rinse your mouth for the first 24 hours as this can disturb the healing process. Begin rinsing the socket with warm salt water (1 teaspoon of salt in 250mL of warm water) 24 hours after surgery. It is recommended to rinse after meals and before bed. Do not use commercial mouth rinses for the first 2 days, as they may irritate the extraction site. Brushing and flossing can be continued, throughout the healing process, taking extra care to avoid the surgical site for the first 4 days following surgery.

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.

Bone Fragments

Sometimes small fragments of bone will come to the surface of an extraction site as the patient’s body ejects them during the healing process. Should this occur please contact our office as you may require assistance in removing them.

Exercise & Sporting Activities

It is best to rest, keeping your head slightly elevated, for 48 following surgery. Exercise and sporting activities can typically be slowly introduced 3 to 5 days after surgery (contact sports not included and should be discussed with practitioner). Should bleeding begin during or after exercise, rest for an additional 24 to 48 hours.

Smoking

Do not smoke for a minimum of 72 hours following surgery or ideally, throughout the entire recovery period. Smoking can lead to increased pain, dry socket, delayed healing and possible infection.

Oral-antral Communication

Rarely, following the removal of an upper molar, an opening can be formed between the floor of the sinus and the extraction site. Should you experience fluid going from mouth to nose when drinking, or have a sensation of air rushing through the extraction site when breathing, please stop rinsing and contact our office for an appointment.

Removable Oral Appliances

Dentures inserted by the practitioner following oral surgery should not be removed for an extended period of time (until 72 hours after surgery) due to possible swelling. Swelling may cause the denture(s) to be more difficult to remove and/or insert. 24 hours after surgery, quickly remove your denture to clean and rinse your mouth with warm salt water, immediately insert your denture following. Continue wearing your denture(s) for an additional 24 hours, removing only to clean and rinse your mouth with warm salt water following each meal. 72 hours following the procedure you can resume your normal denture routine, ensuring that your denture is cleaned following each meal and before bed.

Appliances, such as retainers and night guards, can be worn after the healing, approximately 3 to 5 days or when comfortably managed.

Additional Instructions for Surgery Involving the Sinuses

Additional precautions need to be taken when involving the sinus cavity (ex. sinus lift procedure). For the next 14 days following surgery; do not smoke or drink from a straw, as the negative suction may result in sinus problems. Your sinus may feel “stuffy” or there may be some nasal drainage. Decongestants may be taken to reduce pressure in the sinus(es). Do not blow nose or sneeze. If sneezing cannot be avoided, ensure that mouth is open when sneezing. Do not engage in strenuous activities. Do not wear dentures, unless otherwise instructed by your surgeon. Flying in pressurized aircrafts and scuba diving may increase sinus pressure and should be avoided.

Other Complications

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, 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. Call Dr. Daisy Chemaly or if you have any questions.
• Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
• You should be careful going from the lying down position to standing. You could get lightheaded from low blood sugar or medications. Before standing up, you should sit for one minute before getting 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 not, they can be removed by Dr. Daisy Chemaly or one of the associates.
• 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 (Trismus) 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.

Finally

Sutures are placed in 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 from your mouth and discard it. The sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is usually no discomfort associated with this procedure.

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 our office for instructions.

There will be a void where the tooth was removed. The void will fill in with new tissue gradually over the next month. In the meantime, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.

Your case is unique, no two mouths are alike. Discuss any problems with the trained experts best able to effectively help you: Dr. Daisy Chemaly, or your family dentist.

Instructions after Wisdom Teeth Surgery

Instructions after Wisdom Teeth Surgery

1. Remove the GAUZE SPONGES that have been placed in your mouth ONE HOUR after surgery, unless told otherwise. Place fresh ones as needed. Dip the dry sponge into cold water first, and then wring it out well.

2. Upon reaching home, place an ICE BAG or COLD TOWEL to the face for the remainder of the day following surgery. Nibble on crushed ice or hold ice water in your mouth over the area of surgery. Do this frequently to keep the area of surgery as cold as possible, as this will help reduce the amount of swelling that you are going to have. You may even place chipped ice within the gauze sponges you are biting on. Continue cold packs for at least 24 to 48 hours.

A bag of frozen peas makes a good reusable ice pack that can be molded to the cheek.

3. On the SECOND DAY following surgery (after 48 hours) and thereafter, if swelling has occurred, apply MOIST HEAT on the outside of the face in the form of a bath towel dipped in hot water wrung out, and folded several times over. DO NOT USE HEAT CONSTANTLY but apply only for 20-30 minutes in a 2-hour period.

4. For any pain or discomfort, use the PRESCRIPTION that has been given to you. Don’t be afraid to take the medication as it is designed to make those first few days after surgery more comfortable for you. When taking medications be sure to drink at least a half to a full glass of either water or milk This will ensure RAPID ASSIMILATION by the body and MINIMIZE the amount of IRRITATION to the stomach itself. CODEINE, as well as other NARCOTIC DRUGS, can cause nausea and sometimes even vomiting, so drink plenty of liquids when taking oral medications.

5. In most instances, sutures (stitches) will be placed.  They will dissolve on their own over the next several days.

6. Avoid rinsing until the following afternoon, as rinsing may dislodge the BLOOD CLOT and initiate BLEEDING. When rinsing, use the following:

RINSE GENTLY with 1/2 TEASPOON of salt in an 8-0UNCE GLASS of warm water twice a day. You may begin brushing your teeth the day after surgery.

Begin flushing with the syringe five days after surgery. Flush the lower sockets with salt water solution at least twice a day. Avoid commercial mouthwashes, as they contain alcohol, which may cause wound irritation.

7. Drink plenty of FLUIDS, such as orange or tomato juice, ginger ale, water, tea, etc. Drink at least FOUR to EIGHT GLASSES of liquids daily. DEHYDRATION must be guarded against when having oral surgery.

8. Following your own inclination as to diet but for your own comfort, stick to a SOFT LIQUIDITY DIET. A diet high in PROTEIN and COMPLEX CARBOHYDRATES is best. A homemade SHAKE, using fresh fruit blended into it, is an excellent source of both. Try not to skip a single meal. Begin by eating soft foods or liquids such as heavy soup, milkshakes, soft-boiled eggs, cereals, etc. As soon as possible, change to solid food.

If you are a DIABETIC, maintain your normal diet and take your medication as usual. Avoid popcorn for 2 months. Avoid seeds or nuts for 2 weeks.

9. Do not use STRAW and AVOID SPITTING for the first 48 hours. This will cause negative pressure over the surgical site and may dislodge the clots. This may initiate bleeding or a dry socket which will increase the amount of pain or discomfort you are having.

10. SMOKING after your surgery is DISCOURAGED. Besides the irritation to the tissues from the smoke, the sucking action will have the same effect as using a straw.

11. High doses of VITAMIN C (3 grams per day) with meals will help to promote healing. High doses of all the vitamins are helpful during the healing period.

12. If you have been given any MEDICATIONS or prescriptions for medications, take them faithfully as directed. If you have been placed on an ANTIBIOTIC, take all of the tablets as directed. The medications which you have been placed on will help to:

• MINIMIZE swelling
• REDUCE discomfort
• PREVENT infection
• PROMOTE healing
• AID in oral hygiene and wound CLEANLINESS

13. Avoid STRENUOUS PHYSICAL ACTIVITY for 24 hours. This includes bowling, swimming and other sports in which one becomes winded. Physical activity causes the blood pressure to rise – and may cause a renewal of hemorrhage.

14. Do not operate a motor vehicle or machinery nor drinking alcohol for 24 hours following anesthetic.

IN THE EVENT THAT YOU FEEL THAT YOUR POST OPERATIVE COURSE IS MARKED BY EXCESSES OF:
PAIN, SWELLING OR HEMORRHAGE,
CALL OUR OFFICE: 416.766.7616

Post-Op Instructions Oral Antral Fistula

What is an oral-antral fistula?

An oral-antral fistula happens rarely and is an opening or communication from your mouth (oral cavity) to your sinus (antrum). If it occurs, your oral surgeon will inform you about it and will give you specific instructions.

It usually occurs along the length of a tooth, i.e. the roots of the tooth are in or close to the sinus, whereas the crown of the tooth is in the mouth. Sometimes with extractions, an opening occurs. Fortunately, most of these openings heal spontaneously, however few of them have to be closed surgically.

Sinus Precautions

For 7 – 10 days following surgery:

1. Take the antibiotics as prescribed. This is important!
2. Do NOT smoke.
3. Do NOT blow your nose.
4. Do NOT drink through a straw, and please avoid sucking (for example, a popsicle).
5. If you have to sneeze, sneeze with your mouth open into a handkerchief. Do not pinch your nose in order to stifle a sneeze.
6. Rinse your mouth gently after each meal and at bedtime with salt water. (1/2 teaspoon of salt in a cup of water).
7. It is important to maintain good oral hygiene. Gently clean your teeth and gums.
8. Avoid disturbing the area that has been surgically treated. Do not feel this area with your tongue or brush the adjacent teeth or chew food over this area.
9. If your nose becomes congested, take ‘over the counter’ nose drops as directed by the manufacturer. These drops will open your nasal passages. Nose drops should not be used for more than 5 days in a row.
10. If you wish, you may sleep on two pillows to promote drainage of the sinus.
11. It is important that you keep your post-operative appointment as requested by your doctor.

If you have other concerns, please do not hesitate to call our office at 416.766.7616.

Post Operative Instructions following an Implant Placement

In general, dental implant patients should avoid pressure to the operated sites. In some cases, this may involve not wearing a complete or partial denture until the swelling has subsided.

If your implant is in a cosmetic area and a temporary esthetic replacement is required, it will have to be adjusted prior to being worn.

Complete dentures will generally require adjustment and relining with a soft tissue conditioning liner after initial healing has taken place. This may be as long as two weeks after the surgical date.

Smoking is absolutely contraindicated. There is now statistical evidence to show that the success rate of dental implants in a smoking individual is reduced substantially. Wound healing is compromised in the short-term period as well. Any sucking action may promote bleeding and tissue movement.

Ice is good to minimize swelling and bruising on the first day. It can be applied as regularly as 20 minutes intervals off and on. Generally, swelling is not a problem for single implants but can be a problem if multiple implants are placed. There also may be additional swelling if you have had bone grafting to facilitate placement of implants.

Sutures are most likely resorbable, if not, a follow-up appointment will be scheduled for their removal. Oral hygiene is of the utmost importance ie, continue brushing your natural teeth, rinse with the chlorhexidine rinse that may be prescribed for you. These steps will improve healing.

Although discomfort is not common, an analgesic will likely be prescribed for you, and frequently antibiotics are also prescribed. Please take this medication as prescribed and contact the office if there are any problems or side effects.

Your surgeon usually uses a healing cap to cover the head of the implant. Very rarely this cap might get loose. Do not panic, this is not the implant. Call the office and bring the cap with you for the surgeon to place it.

We have a 24- hour answering service and access to a surgeon is around the clock. If you have any questions or problems, please do not hesitate to call us at: 416-766-7616

Diet Guide Following Oral Surgery

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TMJ (Temporomandibular Joint Syndrome) Instructions

Helpful hints for a stiff, sore jaw

When the muscles that move your jaw do not work together correctly, they may become tired and cramped, and your jaw may become stiff and sore, making chewing, yawning or laughing painful. If this happens, give your jaw plenty of rest, moist heat, gentle exercises and avoid stressing it. Here’s a good basic program:

Diet:

Eliminate foods that are difficult or painful to chew or require you to open your mouth wide, such as apples, carrots, nuts, hard candy and hard rolls. You may want to prepare some of these foods especially so they will not require as much work for your jaw joints and muscles. For example: applesauce or shredded carrots are easier to chew than raw apples or carrots. This diet will give your jaw muscles time to rest and repair themselves.

Changing Your Resting and Sleeping Habits:

Whenever you lie down to sleep or just to rest for a while, avoid stressing your jaw joints by lying on your back rather than on your stomach or side. This prevents your jaw from being pushed to one side, something that can aggravate your pain. You can also try using a single flat pillow instead of a few flat ones or one thick pillow. A flat pillow will curve your neck less and is easier on the muscles of your jaw, neck and upper back.

Changing Harmful Oral Habits:

1) Do you chew pencils or your fingernails?

2) Do you bite your lips?

3) Do you clench or grind your teeth or tighten your jaw muscles when you drive in traffic or are in other stressful situations?

Habits like these in which a person expresses anxiety or tension by tightening up muscles are common although most people are unaware of them. Furthermore, once someone does become aware of a habit, it may be difficult to break because it has evolved over a long time.

The first step in breaking oral habits is to recognize what they are and when and how they occur. Some physicians have their patients remind themselves, “lips together, teeth apart”, which is the normal resting position of the jaw, with the teeth not quite touching. The idea is to relax your jaw muscles as soon as you’re aware that they are tight or that you are grinding or clenching your teeth. When you become accustomed to noticing when you are tense, you can begin to break the habits and help alleviate the pain and discomfort that go with them.

Moist Warm Heat:

Heat a towel by holding it under running hot water and wring it out until it is damp. If you have a microwave oven, try using it to heat a damp towel. Set the timer for 15 seconds. If that does not get the towel hot enough, increase the setting gradually until the towel is hot, but not too hot to handle. When the towel has cooled enough so that you can handle it comfortably, apply it to the painful side of your face for about 15 minutes. For best results, do this four times a day; morning, before lunch, before supper and before going to bed. This may decrease the pain and stiffness.

Exercises:

Certain exercises can help you relieve the pain that comes from tired, cramped muscles. They can also help if you have difficulty opening your mouth. The more often you do these exercises, the more you will relax the muscles that are painfully tense. Try these exercises in front of a mirror on rising, before meals, and on going to bed.

1) Open your mouth as wide as possible and then close it. Try to open your mouth far enough to allow you to fit the knuckles of your index and middle fingers between your upper and lower front teeth. Do 20 repetitions for 3 cycles (Total 60)

2) Place your thumb under your chin and your forefinger over your chin, below your lower lip. Push upward with your thumb using moderate force and slowly open your mouth wide against this resistance. Close your jaw. Do 20 repetitions for 3 cycles (Total 60)

3) With your thumb and forefinger in the same position, push against your lower jaw as you slide it forward. Avoid grinding your teeth and slide your jaw only as far as you can without producing pain. Do 20 repetitions for 3 cycles (Total 60). If you find that your fingers exert too much pressure on your chin, push your chin against the palm of your hand instead.

4) Next, place your palm on the side of your jaw and open your mouth diagonally against resistance of your hand. Do 20 repetitions for 3 cycles (Total 60) on each side. If these exercises increase your discomfort or make it harder for you to open your mouth, stop the exercises and consult your doctor.

Orthognathic Surgery Guide

This information has been developed to help you achieve a greater degree of understanding about Orthognathic surgery and to prepare you for the surgery itself. It describes a typical hospital course for surgery. It is anticipated that you will have questions after reading this information, therefore, you are encouraged to ask us about any areas of concern. We believe strongly that a well-informed patient will experience fewer surprises and will do much better both physically and emotionally when faced with major surgery.

Prior to your Hospitalization

We encourage and ask our patients undergoing this type of surgery to begin the following program four weeks prior to surgery:

1. Begin a daily program of exercise. It can be jogging, swimming, hiking, running or walking, but do so at a level corresponding to your degree of fitness. Being physically fit will play a major role in how quickly you recover from the surgery.
2. Take one standard dose multi-vitamin daily along with a balanced nutritional intake.
3. Cigarette smoking may adversely affect your anaesthetic and your recovery period. It can also delay healing and increase the risk of infection. Smokers should make every effort to reduce or stop their tobacco consumption to help avoid these potential problems.

Day of Admission to the Hospital

On the day of admission or as an outpatient within a week of planned surgery, a history and physical exam will be completed by your surgeon or one of the hospital physicians. The primary intent of this examination is to screen patients for any potentially complicating systemic diseases. Should questions arise as a result of this examination, appropriate consultation with other physicians will be made. Laboratory examinations such as blood tests and urinalysis may be done. Also, a chest x-ray and electrocardiogram may be necessary. A sample of blood may be taken for testing so that proper blood may be reserved should a transfusion be required during the procedure. This is an extremely infrequent occurrence. Please inform us if a blood transfusion is contrary to your religious beliefs.

Diet

A diet booklet will be provided and you are expected to familiarize yourself with it. Any food that you normally eat can be blenderized or thinned in order to be eaten during the early stages of healing. The juices of fresh fruits and vegetables are good sources of fresh vitamins, minerals and fluids, and can be a major source of these nutrients once you are home.

Commercial dietary supplements (such as Carnation Instant Breakfast, EnRich, Boost, EnSure, Sustical, etc.) may also be of assistance to those individuals who find normal blenderized food difficult to consume. It is recommended, however, that a concerted effort be made to become accustomed to normal diets rather than to have to rely on commercial dietary supplements. It is important for you to consume a sufficient amount of calories and protein while you are convalescing to assist with healing. Post-operatively, you will eat more frequently (six times per day) while consuming lesser amounts.

It is NOT likely that your jaws will be wired because rigid internal fixation has been applied. Please keep in mind that your jaw initially will not have the normal strength of your unoperated jaw. It is, therefore, important that, although you may be able to open your mouth, you should not attempt to generate significant chewing force. You could damage the fixation if chewing forces are generated. We would, therefore, strongly recommend that for the first few days, your diet consist of liquids and very soft foods, but you will find that you can progress quickly into a diet of foods that can be mashed with a fork and consumed without chewing. This will include pasta, well-cooked or ground meats, fish, puddings, eggs and mashed or well-cooked vegetables. At around the fourth week, soft sandwiches made with Wonder Bread or its equivalent are acceptable. At around eight weeks, most patients can resume their normal diet.

Diet Protocol

1. Post-Op (first 1-5 days) Liquids, puree
2. Post-Op (first 4 weeks) Mashed foods
3. Post-Op (4-8 weeks) Soft sandwiches, light chewing
4. Post-Op (8 weeks+) Resume regular diet

Anaesthesia

An anaesthesiologist will discuss with you the form of anaesthesia that he/she will use as well as the side effects. Please direct any questions regarding the anaesthesia to this member of the anaesthetic team. After midnight of the day prior to the procedure, you will be required to not have anything to eat or drink. This will assure an empty stomach at the time of surgery.

Day of Surgery

You may receive pre-operative medications approximately one hour prior to your surgery. These medications, in addition to being an important preparation for the anaesthesia, will reduce normal presurgical nervousness. You will be taken to the operating room. There, an intravenous catheter (I.V.) will be inserted into the back of your hand or arm. This is to provide a means of delivering both intravenous fluids and medications including the induction of your anaesthesia. An I.V. eliminates the need for repeated injections. Because general anaesthesia is required and because surgery will be done in the mouth, it is usually necessary to pass a breathing tube (endotracheal) from the nose into the trachea (windpipe). This will be done while you are asleep. A second tube may be passed from the nose into the stomach and will be used to keep your stomach empty (NG tube). Finally, a catheter may also be placed in an artery located in your wrist or foot to facilitate continuous monitoring of your blood pressure.

In some situations, if your surgery is later in the day, you will have the intravenous started at bedside by a member of the nursing staff. This is to allow for salt and sugar fluid to be administered intravenously as you are not taking any fluid by mouth pre-operatively. If this is the case, there may be anti-swelling medication or antibiotic medication given to you pre-operatively on the ward. If this is not given to you at bedside, it will be given to you in the operating room.

Following the surgery, when you are in the post-anaesthetic recovery phase, the endotracheal tube will be removed as soon as possible. However, the I.V., and in some cases, NG tube will remain in place a little longer. Patients have a varying degree of recall of the day of surgery. Some remember from the moment that they awake, while others have no recall of post-operative events until the following morning. Frequently, patients will be given sedative medications if they are having any of the tubes left indwelling for several hours. This helps to improve comfort and eliminates virtually any recall of events of the immediate post-operative period.

Diet Guide Following Orthognatic Surgery

This diet has b­een designed to provide you with the best possible nutrition while you are recovering from facial surgery or while you are having difficulty in chewing and/or swallowing.

General Guidelines

1. All food in this diet is in a liquid or blended form which is easy to consume.
2. You may find that smaller and more frequent feedings are better tolerated than the usual three meals a day.
3. It is important for you to consume a variety of foods from each of the four food groups in Canada’s Food Guide so that your diet will be nutritionally adequate.
4. Since it will be more difficult for you to keep your teeth clean while your jaw is wired shut, avoid food high in sugar such as soda pop, syrup and sticky foods such as jelly and caramel. Do brush your teeth and oral rinse after each meal or snack.
5. The food preparation tips and recipe ideas which follow are only a guide. Any food item, which you can blenderize or which is easy to consume, may be taken. Do experiment and vary the flavor and colour of your foods to make the diet more interesting and enjoyable.

Food Preparation

A) If you own or can borrow a blender:
Most soft foods can be successfully blended. Extra fluid in the form of milk, cream, gravy, broth, fruit juice or water may be required to achieve the desired consistency. Extra portions of blended foods can be prepared and frozen in meal size amounts for future use.

Many convenience foods, such as canned stews, spaghetti and chunky soups as well as frozen dinners, such as lasagna and salisbury steak, can all be heated and blended for a quick tasty meal.

B) If you do not have a blender:
Commercial strained baby foods are very useful in this case. Plain, strained meats and separate strained vegetables are preferable to combination dinners which are often not high enough in protein for an adult. Since baby foods are usually too bland for adult taste, broth or well-seasoned gravies or sauces may be used to thin the meats and vegetables and to add flavor.
Strained fruits can be diluted with fruit juice or may be added to milkshakes and eggnogs.

Supplemental Foods

High energy, high nutrient supplements such as ENSURE, MERITENE, SUSTACAL and SUSTACAL PUDDING, and BOOST can be used to help prevent weight loss if this becomes a problem. Maintaining your normal weight is important. Even if you are overweight this is not a good time to diet since you require extra nutrients in order to recover as quickly as possible.

RECIPE IDEAS

Basic Eggnog
200ml whole milk, 1 egg, 5ml vanilla. Blend until smooth. Recipe can be varied by adding 125ml ice cream and/or 125ml sliced fruit. Liquid honey or sugar may be used to taste.

Wake-Up Shake (2 servings)
250ml whole milk, 125ml vanilla ice cream, 2 eggs, 125ml sliced canned peaches, 75ml frozen lemonade concentrate, thawed; blend together.

Instant Breakfast
125ml dry unsweetened cereal, 125ml whole milk, 125ml orange juice, 1 egg, vanilla or honey to taste; blend together. Strain if necessary.

High Protein Drink (2 servings)

250ml whole milk, 125ml ice cream, 2 eggs, 75ml skim milk powder, 5ml vanilla or other flavouring; blend together.

Chocolate Peanut Shake (2 servings)

375ml chocolate milk, 75ml skim milk powder, 250ml chocolate or vanilla ice cream, 50ml smooth peanut butter; blend until smooth. Optional – small ripe banana can be added.

Tiger’s Milk

200ml plain or flavoured yogurt, 1 egg, I small ripe banana sliced, 125ml pineapple juice, 15ml honey; blend together. Buttermilk can be used in place of the yogurt.

Cucumber Smoothie

250ml yogurt, 2 eggs, I small cucumber seeded and chopped, honey to taste, blend together; strain if necessary.

Quick Vegetable Soup

125ml mixed vegetables, cooked, I beef bouillon cube, 125ml boiling water, 125ml whole milk or cream, seasoning to taste. Dissolve bouillon cube in boiling water. Puree vegetable with the milk or cream. Blend both together and add seasonings. Strain and reheat in a saucepan.

Vegetable Rarebit

10ml butter, 10ml flour, 125ml milk, 50ml grated cheese, 75ml strained vegetable or meat and vegetable dinner, 1 slice bread. Soak bread in the milk for one minute. Blend in the blender and strain. Melt butter in a saucepan, add the flour and stir until blended. Stir in the strained bread and milk. Add cheese and cook, stirring constantly until thickened. Stir in strained vegetable, heat and season to taste. Add more milk if mixture is too thick.

Fruity Vegetables

125ml strained squash or sweet potato, 125ml strained applesauce and apricots, 5ml butter, dash salt and nutmeg. Combine in a saucepan and heat until bubbly.

Beefy Meatloaf

75gm serving of meatloaf, 1 small potato cooked, 1 small carrot cooked, 30ml meat gravy, 250ml beef bouillon. Blend meatloaf, potato and carrot. Add gravy and bouillon and blend until smooth. Strain if necessary.

Hot Chicken Dinner

200ml whole milk, 125ml cubed chicken or chicken baby food, 75ml cooked rice, 75ml cooked vegetables, I sl bread, 250ml whole milk, 5ml butter.

Blend milk with chicken for 2 minutes. Add rice, vegetables and bread with the remaining milk and blend for 1 minute. Strain. Melt butter in the top of a double boiler, add strained mixture and heat. Season to taste.

Seven Seas Dinner

50ml canned salmon or tuna, 75ml cooked macaroni or noodles, 50ml cooked peas, 175ml milk, I 5ml mayonnaise, seasoning to taste. Combine all ingredients and blend until smooth. Add more milk if needed for a thinner consistency. Heat and serve.

Metric and Imperial Equivalents

250ml= 1 cup 125ml=1/2 cup 15ml= 1 tablespoon

200ml=3/4 cup 25ml = 1/3 cup 5ml= 1 teaspoon

175ml= 2/3 cup 50ml= 1/4 cup 25gm= 1 ounce