• Do not eat anything after midnight on the night before surgery. This includes chewing on gum, candies, etc.
• On the day of surgery, you may only drink CLEAR fluids. However, you must STOP DRINKING altogether 3 HOURS before your surgery, e.g. If your surgery is at 2pm, stop drinking at 11am.
• CLEAR fluids include water, apple juice, plain coffee, or tea.
• Do not drink any pop, dairy & dairy-like products. This includes avoiding any coffee/tea with milk or cream.

**Patients with Diabetes will be given special instructions regarding fasting from Dr. Specht’s team. Typically, appointments for diabetic patients will be scheduled early in the day. Please bring your glucometer to the appointment.

Alcohol, Smoking & Recreational Drugs

• Alcohol and recreational drugs must be avoided for at least 48 hours before surgery.
• Do not smoke/vape for 12 hours before your surgery.

Why do I need to follow these instructions before surgery?

This is for your safety to prevent food or fluid from going into your lungs (aspiration). When food is in your stomach too close to your surgery time, you may vomit. The vomit could then spill into your lungs and affect your breathing as well as cause damage to your lungs. Aspiration can have fatal consequences.

• You must be accompanied by a responsible adult to the clinic as you may not drive for 24 hours following surgery. They must accompany you home and spend the remainder of the day with you. While you may take a taxi home, the taxi driver cannot be your responsible adult. You may not take public transport home.

Medications

• Take your regular medications (blood pressure, cholesterol etc.) at their regular scheduled time with just a small sip of water. If you have any questions about your medications, please ask us.

Clothing, Jewelry & Nail Polish

• Wear loose clothing for comfort and a short-sleeved shirt to allow room for the blood pressure cuff.
• Remove nail polish and acrylic nails from your pointer finger before your appointment so we can obtain an accurate reading of your oxygen levels.
• If you wear contacts, or any jewelry, especially on your lips and tongue, please remove them prior to the surgery.

Other

If you wish to listen to your own music during surgery, please feel free to bring your earbuds/headphones.

If you have an illness such as a cold, active cough, sore throat, stomach or bowel upset 48 hours before the surgery date, please notify the clinic.

After surgery, you may eat as soon as you get home.  For the first few days, eat soft foods such as yogurt, pudding, ice cream, creamy soups, mashed potatoes, scrambled eggs, overcooked pasta. Following this, you can return to a normal diet as soon as you feel you are able.

Return home immediately from the clinic. For the next 48 hours RESTING is KEY as well as avoiding any activities that will increase your heart rate.  Keep your head elevated with pillows while lying down.

Bite firmly on the gauze placed over the surgical site for 30 minutes. Avoid talking. Replace the gauze if strong bleeding continues. If bleeding is mild or has stopped, leave the gauze out.

Avoid rinsing, spitting, smoking and drinking through a straw for 48 hours following your surgery. These may cause the blood clot that has formed to become dislodged, delaying your healing and risking the development of a dry socket.

If you were sedated, you may feel drowsy for a period following surgery. Do not drive or operate hazardous equipment for 24 hours following your sedation.

Take the pain medication as soon as possible, before the local anesthetic (dental freezing) wears off. If any other medications were prescribed, please start them as soon as possible and take as directed.

Drink plenty of fluids and eat as soon as you are able. For the first few days, a soft diet is advised: scrambled eggs, mashed potatoes, creamy soups, yogurt, ice cream, pudding, smoothies (no straws). Avoid alcohol and spicy foods.  Food can be warm but not hot.

Place the ice packs on the sides of your face where the surgery was performed for 20 minutes at a time, alternating with 20 minutes off. Continue this for the first 48 hours to minimize swelling.

A certain amount of bleeding is normal & expected following surgery. Using the gauze as directed and resting are the best methods to get the bleeding under control.

The gauze is present to provide the required pressure necessary to stop the bleeding. Bite firmly on the gauze with constant pressure.  Avoid chewing on the gauze or talking as this will encourage the bleeding to continue.  The gauze should be kept in place for 30 minutes at a time. Place the gauze behind the last molar tooth, over the extraction area. If you place the gauze between your teeth, it will not be effective.

Stop using the gauze when, after using it for a 30-min period, the gauze comes out only partially stained. Repeated placement and removal of the gauze can encourage more bleeding. 

If you feel that the surgical area is still bleeding too much, you can place another folded pack of gauze.  If you run out of gauze, you can bite on a moistened tea bag for 30 minutes.

Slight bleeding or pink saliva is not uncommon for 24-48 hours following surgery. This does not require more gauze.

Remember to avoid any activities that will increase your heart rate, as this typically also increases your bleeding, and may cause complications. 

Do not go to sleep or eat with gauze in your mouth. This is a choking risk.

After surgery &/or sedation, you should eat and drink as soon as you get home.

• Drink 6-8 glasses of fluids daily.  Do not drink from a straw; the sucking motion can cause more bleeding by dislodging the blood clot. Drink from a glass or use a spoon for thicker fluids like smoothies.
• Do not avoid eating.  Eat healthy foods to properly nourish your body for optimal healing.
• Initially, you may feel more comfortable with a softer diet, such as soups, mashed potatoes, overcooked pasta, yogurt, etc.
• Avoid hard foods that may irritate the wound.  Avoid alcohol and spicy foods.  Avoid foods with small nuts, seeds, popcorn that may get into the sockets.
• A normal diet can be resumed as soon as you feel comfortable.

 If you are diabetic, maintain your normal diet as much as possible and follow your physician’s instructions regarding your medication schedule.

Swelling is a normal reaction to this surgery, typically located around the mouth and cheeks.  The swelling may not be apparent for 24hours and can continue to increase for up to 72 hours.

•  Apply ice packs to the outside of your cheek near the surgical area for 20 minutes at a time, alternating with 20 minutes off. Continue this for the first 48 hours whether swelling is present or not.
• After the icing period is over, the application of moist heat to the sides of the face is beneficial in reducing the amount of the swelling and relaxing sore facial muscles.
• If new swelling develops after 3-4 days, please call the clinic to ensure that an infection has not developed.

It is common for the jaw to feel stiff following wisdom tooth removal. You may feel that you cannot open your mouth as widely as before. This is a temporary and can be best managed by:

• Applying moist heat, starting 72 hours after surgery.
• Adjusting your diet to avoid food that require you to open very wide (e.g. a hamburger) or to do a lot of chewing (e.g. tough meats).

Discolouration of the skin can occur 2-3 days following tooth removal. The development of purple, green or yellow bruising may be seen along the tissues in your cheeks, jaws and neck.  Moist heat and gentle massage to the area will speed up its removal.

In the event of vomiting following surgery, do not taking anything by mouth for at least an hour including your prescribed medications.  Sip slowly on clear carbonated drinks (ginger-ale, coke) or herbal tea. If required, you may take Gravol as directed.

Resting is recommended for a minimum of 2 days.

• You may return to work as soon as you feel able, however patients with physical jobs should ask for modified duties for the first few days.
• Returning to the gym and other sports should be avoided for a minimum of five days.

If numbness of the lip, chin or tongue is still present after 12 hours please let Dr. Specht know.  The nerve supplying feeling to these areas may be bruised as the tooth is removed. The nerve may not function for a while, resulting in a “pins and needles” sensation, or as “numbness”. In most cases, this is temporary but can take several weeks or months for sensation to return to the lower lip.

A slight elevation of temperature following surgery is not uncommon. If the temperature persists you can take Tylenol to help manage it. Also drink plenty of fluids. Notify the clinic if a fever greater than 38C occurs.

Occasionally, patients may feel hard projections in the surgical sites with their tongue. They are not pieces of tooth but little bone chips. These projections usually smooth themselves out in time. If they are causing discomfort, please contact the office.

Please take the pain medications as prescribed within the hour following your surgery. This ensures that the medication is acting before the local anesthetic wears off, when it may be more difficult to control the pain.

Most patients will be prescribed an anti-inflammatory pain medication, such as Ketorolac/Toradol as the first line of pain management.

• Take the anti-inflammatory pain medication as prescribed, starting immediately following surgery and continue for 2-3 days following surgery whether there is discomfort or not. The anti-inflammatory medication will help to manage both your swelling and discomfort.
• If you feel that the anti-inflammatory medication is not providing enough relief, you can also take Acetaminophen (e.g. Tylenol). Acetaminophen controls pain in a different way than anti-inflammatories do, and as such is a good and safe supplement to the anti-inflammatory medication. Do not take more than 4000mg of Acetaminophen in a 24-hour period. This is equivalent to 8 tablets of Extra Strength Tylenol (500mg).
• Only supplement your prescribed anti-inflammatory with Acetaminophen. Do NOT supplement the Ketorolac with other anti-inflammatory medications such as Advil, Motrin, Ibuprofen, Aleve or Naproxen.
• While the anti-inflammatory and the acetaminophen can be taken together, alternating between the two different types of medications every three hours can optimize your pain control.  An example of this pain management schedule is:
  • • • • At 9am: take the prescribed anti-inflammatory.
        • At 12pm: take 1-2 Tablets of Extra Strength Tylenol.
        • At 3pm: take the anti-inflammatory.
        • At 6pm: take 1-2 Tablets of Extra Strength Tylenol

        It is not uncommon to have a second phase of discomfort 3-4 days following surgery that lasts for 24-48 hours. If this discomfort continues to worsen following this time please call us for further instructions.

Keeping your mouth clean after surgery is essential to reduce pain and lessen the incidence of infection.

For the first 48 hours, do not rinse your mouth out. Instead, put water in your mouth and gentle swirl it around by moving your head from side to side.  Do not forcibly spit this out. Rather, just let the water fall out of your mouth as you hold your head over the sink.

Brushing can resume the night of surgery with a small amount of toothpaste or warm, salt water.  Be gentle around the surgical area and don’t be alarmed if a small amount of bleeding starts again.

It is important to keep the extraction socket clean by using the irrigation syringe provided. Place the tip of the syringe into the socket and gently irrigate with warm salt water. Start doing this 48 hours after your surgery and continue for a minimum of 7-10 days.

Avoid using mouth rinses that contain alcohol as alcohol can cause complications in healing.

Retainers can be worn again after 24 hours.

Sutures/stitches are placed to minimize bleeding and to help with healing. They will dissolve on their own within 7-10 days.

Sometimes they become dislodged early. This is no cause for alarm. Unless significant bleeding begins you do not need to have them replaced.

The holes remaining where the teeth were removed are normal. They will gradually fill in with new tissue over the next several weeks. Until then, keep the holes clean using the syringe provided, filled with salt water.

A small percentage of patients can experience an increase in jaw discomfort 5 to 6 days after surgery. The blood clot at the surgical site may be prematurely lost leading to exposure of bone – this is a dry socket.  A dry socket is not an infection. 

• Cigarette smoking and poor oral hygiene, in addition to using a straw, rinsing or spitting in the first 48 hours increase the risk of dry socket.
• There will be a noticeable, localized persistent pain in the jaw, which may radiate to other areas. You may also experience increased bad breath or a bad taste in the mouth.
• This discomfort will pass and can often be managed with the pain medications prescribed. If you do not see an improvement after the first few days or if the pain is too severe, please call the office for care.

*** Please be advised that if you have any unscheduled hospital visits within 10 days of your procedure, the office & Dr. Specht must be notified at your earliest convenience. ***

It is our desire that your recovery be as smooth as possible. If you have any questions about your progress or any symptoms you are experiencing, please contact the clinic or a member of Dr. Specht’s team to obtain advice and, if indicated, organize an additional appointment.