Operative Instructions


Pre-Operative Instructions


Your optimal response to dental surgery is dependent on prior preparation and your confidence that this procedure is of value to you. Part of your comfort level is based on addressing your concerns or questions. It is very important to follow these instructions for your safety and comfort during the procedure:
1.  Medications: Take prescribed medications (such as blood pressure) as directed. Please let us know if anything has changed with your medical history. Blood thinner (such as Aspirin, Plavix, and Coumadin) users should discuss the use of these medications with Dr. Yu or Dr. Litizzette before your surgery to be determined by your physician if you can discontinue them. If you are diabetic then please bring your medications & monitor with you to your appointment.
2.  Smoking: Make every effort to minimize smoking for 12 hours before the start of your procedure.
3.  Prescriptions: We will call in your surgery prescriptions 5 business days prior to your surgery. Please pick them up prior to your surgery date. If you are having an implant placement we recommend that you start your antibiotics 2 days prior to your surgery date.
4.  Clothing: Wear clothing that is not restrictive to the neck, arms or stomach. Wear loose-fitting tops, so that the sleeves can be rolled up to the shoulders and please avoid dresses.

Sedated Patients

If you are having conscious IV please follow these instructions before your scheduled appointment:
•  Designated Driver: If you are having sedation you must have a responsible adult, over 18 years old, drive you to and from your appointment (you will not be able to drive for the remainder of the day). Following the procedure, the designated driver should escort you home in a vehicle and remain with you until you are fully awake. We do not allow patients to take a taxi home after they have been sedated.
•  Food: No food or opaque liquids (ie. milk, OJ, soda, etc.) for six (6) hours before the start of the procedure. (i.e. if you are not scheduled for your procedure until after 11:30am, try to eat something in the early morning, then abstain from eating until after your procedure). If you are diabetic and required to eat something in the morning then follow the guidelines that have been given to you by your physician.
•  Liquids: Clear liquids are allowed up to two (2) hours before the start of procedure (ie. water, black coffee, cranberry juice, etc.)

If you are taking oral sedation in addition to the above instructions:
•  Prescription: You will be prescribed two (2) Halcion pills at your local pharmacy. You will be taking one (1) pill one hour prior to your surgery time and bring the second pill with you to your appointment.
•  Consents: You will need to sign your consent(s) before oral sedation. Either arrive 1 hour early, or we can e-mail them to you.

If you need to reach our office please call us at 512-306-8822. In case of an afterhours dental emergency please call Dr. Yu’s personal number at (512) 769-8855 or Dr. Litizzette’s personal number at (512) 903-6630.

Periodontal Corrective Surgery, Ridge Augmentation & Implant Surgery


Optimal healing following periodontal surgery is dependent on proper post-operative care. It is very important to follow these post-operative instructions to facilitate optimal healing after periodontal surgery.

Most surgeries involve repositioning of the gum tissues and recontouring the bone around the teeth. In regenerative procedures bone materials and barrier membranes may be used to “rebuild” tissues lost to disease.

After all surgeries, the most important factor that promotes healing is stabilization of the surgical site. Thus, the surgical site must remain undisturbed for at least 10 days.

The Day of Surgery:

1.  Do not rinse with any mouthrinse until tomorrow. Take all prescription medicines as directed. (Do not take pain pills on an empty stomach, for discomfort, you should take Ibuprofen on a regular basis- 600-mg every 6 hours and supplement with the prescribed hydrocodone as needed)
2.  Do not disturb the surgical site. No Brushing around the surgical site until you are told to do so!
3.  Do not smoke for at least 3-5 days, then limit smoking to half.
4.  Apply ice packs (15 min on/15 min off) to surgical site frequently to minimize swelling.
5.  Eat very soft foods as tolerated. They should be of high protein nature (soft boiled eggs, ice cream, room temperature soups, smoothies, scrambled eggs, etc.)
6.  No sucking from a straw or excess spitting. (This may dislodge regenerative materials)
7.  Do not take aspirin products. (Aspirin increases bleeding. Use Ibuprofen instead)
8.  No heavy activity/exercise for at least 48 hours. Keep blood pressure down! Keep your head above heart level to decrease swelling.
9.  Some bleeding and oozing from the surgical site will occur. Apply direct pressure to surgical site with gauze or a moist tea bag for 30 minutes if profuse bleeding occurs. If bleeding does not stop, page Dr. Yu or Dr. Litizzette. Put a towel on your pillowcase in the evening to avoid staining linens.
10.  If you were IV sedated for your procedure, do not drive until the following day.

The Days After Surgery

1.  Continue all prescribed medications as directed, be sure to read precautions and warnings.
2.  If PerioSciences gel is advised, gently apply 5 times each day for the first 3 days, then 3 times a day for the next 5 days.
3.  Do not disturb the surgical site.
•  No toothbrushing or pulling on tissues around surgical site until otherwise directed.
•  If a periodontal dressing is used, do not remove it intentionally. It may fall off throughout the following week, but try to leave it undisturbed.
•  Never remove sutures or barrier membranes. (This may dislodge regenerative materials)
•  Avoid chewing on surgical site for 10 days or until comfortable.
•  If swelling is still present, do not use ice packs; instead use warm, moist compresses.

If excessive bleeding, pain, swelling or infection occurs following periodontal surgery please contact the office, 512-306-8822, or Dr. Yu’s (512) 769-8855 or Dr. Litizzette’s (512) 903-6630 personal numbers.

Soft Tissue Grafting & Soft Tissue Augmentation


Optimal healing following periodontal surgery is dependent on proper post-operative care. It is very important to follow these post-operative instructions to facilitate optimal healing after periodontal surgery.

After all surgeries, the most important factor that promotes healing is stabilization of the surgical site. Thus, the surgical site must remain undisturbed for at least 10 days, this includes NOT pulling your lip out to see it.

Discomfort

Keep ice on your face (15 min on/15 min off) to prevent discomfort and future swelling. Take regular dosages of Ibuprofen (600mg every 6 hours) with the prescribed hydrocodone to supplement if needed.

Stent

If donor tissue was taken from the palate, a Stent may be placed to cover the roof of the mouth. Please be sure to wear this stent as much as possible for the first 24 hours (including bedtime). It will help with sensitivity and prevent oozing. After the first day, wear it whenever you need the comfort and security (eg: eating). The donor site will be tender and feel quite rough to your tongue. This is normal. Do not be disturbed by a dark coloration of the donor site.

Bleeding

Occasionally, bleeding may occur from the donor site in the palate, especially during the first two days. Wearing the stent during the first day will help. Repeated rinsing will make the problem worse. Usually bleeding can be controlled by applying direct pressure on the palate with some moistened gauze or a moistened tea bag. If bleeding persists, call me.

Eating

For 2 weeks, you should avoid foods that require you to bite off or bite into food with the front teeth (hamburgers, com on the cob, hard bread, etc.). Cut meat and vegetables into small bites (as for a young child) and place the food carefully in the mouth with a fork or spoon. Cold liquid type foods are the best for the first couple of days after surgery (malt or shake, pudding desert, jello, etc.) DO NOT USE A STRAW. Avoid hard and crunchy foods, chips, popcorn, and snack foods. Avoid carbonated drinks and alcohol for one week. Avoid spicy foods.

Smoking

DO NOT SMOKE FOR AT LEAST 5 DAYS AFTER SURGERY. Thereafter, limit smoking as much as possible until your postoperative visit. Remember, the more smoking, the more likelihood for failure of the graft to take.

Activity

Exercise such as jogging, swimming, and tennis should be discontinued for 48 hours after surgery. This is to reduce the risk of postoperative bleeding that might interfere with proper healing of the graft tissue. Pressure and movement on the lips and cheeks should be avoided during the first 7 to 10 days after surgery (blowing up balloons, playing wind instruments, etc.)

Problems and Questions

Don’t hesitate to call me if you have a question or think you may be having a problem. Please contact the office, (512) 306-8822, or Dr. Yu’s (512) 769-8855 or Dr. Litizzette’s (512) 903-6630 personal numbers.

Extraction


Optimal healing following surgery is dependent on proper post-operative care. It is very important to follow these post-operative instructions to facilitate optimal healing after teeth removal.

Most teeth extractions involve a gum incision and removal of the bone. Thus, pain is dependent on your capacity to heal and the care of yourself at home. After an extraction, the most important factor that promotes healing is stabilization of the surgical site. A clot needs to form within the extraction site, which will protect the exposed bone and will eventually become new bone. Thus, the surgical site must remain undisturbed for at least 4-6 days.

The Day of Surgery:

•  Place cold towels or an ice bag to your face during the first day. Leave it on for 15 minutes, then off for 15 minutes.
•  Do not rinse with any mouthrinse (even if Chlorhexidine was prescribed) rinse until tomorrow. Take all prescription medicines as directed but take hydrocodone as an adjunct to Ibuprofen (2-3 pills every 4-6 hours with 12 pills/day max). (Do not take pain pills on an empty stomach)
•  Do not disturb the surgical site.
•  No sucking from a straw or excess spitting. (This may dislodge the clot)
•  Do not smoke for at least 3-5 days, then limit smoking to half.
•  Diet of liquid (cold shakes) or soft foods and avoid chewing on surgical site.
•  Do not take aspirin products. (Aspirin increases bleeding. Use Ibuprofen, Advil/Motrin, instead)
•  No heavy activity/exercise for at least 48 hours. Keep blood pressure down!
•  Some bleeding and oozing from the surgical site will occur. Apply direct pressure to surgical site with gauze or a moistened tea bag for 30-45 minutes if profuse bleeding occurs. If bleeding does not stop, call Dr. Yu or Dr. Litizzette. Put a towel on your pillowcase in the evening to avoid staining linens.

The Days After Surgery:

1.  Swelling and stiffness is normal. Continue all prescribed medications as directed.
2.  If Chlorhexidine mouth rinse is prescribed, gently swish for at least 30 seconds and expectorate, do this 2-times/day beginning on the second day.
3.  Do not disturb the surgical site.
•  No toothbrushing or pulling on tissues around surgical site until otherwise directed.
•  Never remove sutures or materials within the socket. (This may dislodge the clot)
4.  Avoid chewing on surgical site for 10 days or until comfortable. Eat soft foods. Drink plenty of liquids.
5.  If swelling is still present, do not use ice packs; instead use warm, moist compresses.

If excessive bleeding, pain, swelling or infection occurs please contact the office, (512) 306-8822, or Dr. Yu’s (512) 769-8855 or Dr. Litizzette’s (512) 903-6630 personal numbers.

Sinus Lift for Implants


The key to a successful sinus grafting procedure is your comfort and the care of the area during the next few days: this means that you must keep the area stable and take the prescribed medications as directed to prevent infection.

Here Are Some Tips That Should Help You Out:

1.  DO NOT blow your nose
2.  Try not to sneeze, it may place additional pressure on the sinus membrane and introduce bacteria into the graft. Therefore if sneezing occurs, it should be done with the mouth open to relieve pressure within the sinus, as a cough.
3.  For Discomfort:
•  Apply ice pack or in a cloth to your face 10 minutes on, 20 minutes off for 24 hours to reduce pain and swelling.
•  Eat very soft foods as tolerated. They should be of a high protein nature (Soft boiled eggs, milk, ice cream, malts, boiled chicken, soup, etc.)
•  For the first 24 post-operative hours drink plenty of fluids: juice, water, milk.
•  Expect a good amount of swelling and some discoloration. These findings are common and do not indicate infection or other problems. Sleep with your head well elevated. By doing so, you may experience decreased swelling, but may still be marked the next morning.
•  Don’t exert yourself for at least the next couple of days. The surgical site needs to be stable for optimum results.
•  Follow the instruction(s) given to you by Dr. Yu or Dr. Litizzette and take your prescribed medications as directed:
•  ANTIBIOTICS: Use as directed.
•  DECONGESTANT: Afrin Nasal Spray-instill 3 times daily for 3-4 days. While on your back, place your head over the edge of the bed so that your nostrils are facing upward. Instill the nose drops without inhaling and remain in position for 2 minutes, to allow the solution to reach the sinus cavity. If you taste the nose drops, they have not entered the antral cavity, and that will be ineffective. TRY AGAIN. DO NOT use for more that 4 days.
•  DECONGESTANT: Sudafed
•  PAIN MEDICATION: Acetaminophen/Hydrocodone take one or two tablets by mouth every 4-6 hours as necessary for pain.

Do not hesitate to telephone me if any question or problem regarding your condition arises. In an emergency, you should call the office, 512-306-8822, or Dr. Yu’s (512) 769-8855 or Dr. Litizzette’s (512) 903-6630 personal numbers.
512-306-8822
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Dr. Yu and Associates

Dr. David Yu
Dr. Nicole Litizzette

4201 Bee Caves Road Suite C-211
Austin, TX 78746

Fax: (512) 306-8848


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