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Frequently Asked Questions
Question: What are my
anesthetic choices?
Answer: The different ways of having surgery are general
anesthesia, I.V. sedation, and local anesthesia.
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Question: Can I go to
sleep for my surgery?
Answer:. General Anesthesia is an option for most people.
We use what is called I.V. general anesthesia. What this means is that in order
to put you to sleep, we first start an I.V., which is similar to having a blood
test. We then give you medication through the I.V. to allow you to drift off to
sleep. The medications are given every few minutes to keep you asleep. Once we are
done with the surgery, we stop giving the medicines and you wake up in 3 or 4 minutes.
It then takes about 10 minutes more to wake up enough to walk to recovery on your
own. Modern general anesthetics are so smooth that many people never even realize
they have been asleep. A common question we get from people is, "When are we going
to get started?" Our answer: "You are already done!"
 Not everyone is a candidate for general
anesthesia. People who are very sick, who have multiple medical problems, take multiple
medications, are very old or very young, and who are badly overweight or have had
reactions to general anesthesia in the past may not be able to be put to sleep.
For these people, we offer the options of I.V. sedation, local anesthesia, or having
your surgery done at one of our fine local hospitals or surgery centers. Your doctor
will help you decide what is most appropriate for you.
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Question: How do I get
ready for a general anesthetic?
Answer: In order to get a general anesthetic, the most
important thing to remember is that you can have NOTHING to eat
OR drink for six hours prior to surgery including water.
Those people who take medications may
take their medications on their regular schedule with a bare sip of water.
You should also wear loose fitting clothing with sleeves that can be rolled up.
You
must be accompanied by a responsible adult who should say at the office during surgery,
be able to drive you home, and be able to spend a few hours home with you until
you are completely recovered. If the patient is a minor, a parent or guardian must
be present to sign health history forms and consents.
PLEASE DO NOT DROP OFF YOUR 17 YEAR OLD AND LEAVE AS THEY CANNOT CONSENT
TO SURGERY. SURGICAL PROCEDURES CANNOT BE PERFORMED WITHOUT THE WRITTEN CONSENT
OF THE ADULT PATIENT, THEIR LEGAL GUARDIAN, OR HEALTH CARE POWER OF ATTORNEY.
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Question: What if I can't
go to sleep or would rather not?
Answer: Two other options exist for those who do not want
to go to sleep for their surgery: IV sedation and Local Anesthesia.
Question: What is Sedation?
Answer: IV sedation is a technique that we often use for
people who are too sick to safely undergo a general anesthetic or who would rather
not go to sleep for one reason or another, but will be having surgery that they
feel might be too extensive for local anesthesia alone.
What IV sedation does is remove most if
not all of your memories of your surgery without actually putting you to sleep.
In fact, most people who have IV sedation have minimal to no memory of their surgery.
The preparations to have IV sedation are the same as for general anesthesia. Please
see that section.
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Question: What is local
anesthesia?
Answer:
Local anesthesia, also commonly referred to as "Novocain," is a technique to remove
your sense of pain from a surgical area. Local anesthesia can be used for just about
any surgery we do. In fact, many people prefer it for simple surgeries such as routine
extractions, simple biopsies, minor bone trims, etc.
Once the surgery progresses to surgical removal of teeth, impacted wisdom teeth,
or surgeries in two or more different areas of the mouth, most people prefer a general
anesthetic or IV sedation. Local anesthetic may not be suitable for the very young or
apprehensive.
To receive local anesthesia, an
injection is administered.
After about two minutes, you will start
to feel the effects of the local as your lip or cheek may start to feel fat. This
does not occur all of the time depending on the type of injection. Once a suitable
amount of time has past, your doctor will check to see if the local worked. Please understand
that local anesthesia removes your sense of pain, but not your sense of touch. You
will still feel pressure, which you may find uncomfortable, but it will not hurt.
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Question: What is a dry
socket?
Answer: A dry socket or alveolar osteititis occurs when
your blood clot dissolves prematurely. This leaves exposed bone within the
socket which is painful. If you loose the clot altogether, food debris can accumulate
in the socket which makes it hurt.
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Question: How long does
a dry socket take to heal?
Answer: Most dry sockets need to be treated by placing
a medicated pack in the socket. Once this is done, the pain will usually be gone
in about 30 minutes. Ninety percent of dry sockets will resolve with two packings over six to seven days. The older you are, the more difficult
the tooth was to remove, and the farther back the tooth was in the mouth increases
the likelihood of a dry
socket developing and prolongs the time it takes to heal.
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Question: My tooth was
removed and is still hurting. What is Going on?
Answer: The most common cause for continued pain following
the removal of a tooth is what is called a dry socket. If you lose a blood clot,
the socket will start to hurt. This is particularly common with lower back teeth
especially ones that have been surgically removed. Treatment is very simple. We
have you come into the office, we rinse the socket out and place a medicated gauze
in which will usually take away the pain within 30 minutes. Local anesthesia
is not even necessary. The pack is generally left in for two to three days. Usually one or two
packs are necessary to treat the problem. You will need to return to have the pack
removed. Failure to do so will cause an infection. If the socket is deep, your doctor
may give you a home irrigator to help you keep the socket clean so it heals.
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Question: How do I keep
my tooth socket clean?
Answer: We advise against rinsing and spitting for 24 hours
to avoid loosing the blood clot and causing bleeding. In most cases, this socket
will be filled with a blood clot, which looks dark brown or gray. This is normal.
If you notice a hole, normal rinsing is usually enough to keep all upper sockets
and most lower sockets clear. Occasionally a lower socket is deep and hard to clean
by normal rinsing. If you are getting food in the socket and cannot rinse it out,
please come into the office and we will give you a home irrigator, which makes
cleaning the socket easy. We do not recommend a waterpik for this is too powerful.
If you have had a lower wisdom tooth removed, it may take a month for the socket
to fill. Other teeth take less time. We advise you to rinse and use your irrigator
after every meal and at the minimum once a day. As healing progresses, the socket
will slowly fill in like pouring water into a bucket. It is important to put the
irrigator gently in the socket to keep the gum open on top so that it doesn't "purse
string" shut and trap food. If it would heal over a piece of food an infection called
a sub-periosteal abscess could develop.
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Question: What is a sub-periosteal
abscess?
Answer: A sub-periosteal abscess is a localized infection
seen usually after lower wisdom tooth removal. If you fail to keep the socket clear
enough and tissue closes over a piece of food or debris, swelling will develop on
the jaw or in your cheek adjacent to the socket. You should call the office for
instructions. Treatment is simple and usually immediately stops the pain that accompanies
the abscess. A pack is placed in the socket, which lets the infection
and food debris out. Local anesthesia (Novocain) is usually not even necessary.
The pack is left in place for one day to one week depending on the circumstances.
Sometimes an antibiotic and/or a pain medication are prescribed. You will need to
return to have the pack removed. Failure to do so will cause another infection.
Question: What is a pack?
Answer: A pack is a medicated gauze that is placed in a
painful socket. They are usually left in for 2 or 3 days, but may be changed more
often if necessary. Once a pack is placed, you must come back in to the office to
have it removed. Some people feel that they have lost the pack and do not need to
return. You should always come to the office to check to see if the pack has really
been lost. If you do not have a piece of gauze about an inch long in your hand,
do not assume that the pack is out. If the pack is not removed, a severe infection
could develop.
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Question: I had my wisdom
teeth out and was given a home irrigator. How and when do I use it?
Answer: If instructed you should begin to use your irrigator in your lower sockets one week
after surgery to keep them clean. You should rinse them ideally after every meal,
but at least once a day. To do this you put the irrigator in a cup of warm water
and pull back on the plunger, then go to a mirror and you will see a small opening
to the side and behind your lower 2nd molar. Gently introduce the tip of the irrigator
into the socket (it will go in about 1/2 inch) and flush it out. Do not use force.
Failure to keep the socket clean will cause bad breath, pain, and if you wait long
enough, infection. It usually takes about a month for the socket to fill with tissue.
We want the socket to fill from the bottom up, so it is important that you keep
putting the irrigator in the socket. If you do not, it will close at the top first,
which could trap food and cause an infection.
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Question:After my surgery,
I became sick to my stomach. What should I do?
Answer: Post op nausea may be due to the anesthetic, pain
medications, dehydration, or stress. If from the anesthetic, it will usually pass in 5 to 10
minutes. If it lasts longer than this and you are still in the office, it is best
to ask for medication to help with this. It is available as tablets, suppositories
or by injection. The injection works the best and in most cases will quiet your
stomach in about 20 minutes.
If you are at home the nausea is most
likely due to your pain medication, dehydration, or from swallowing blood. If you notice that
it occurs after taking the pain medication and are not in too much discomfort you
should stop your pain medication and switch to Motrin or Tylenol. If your surgical
site is still oozing you must not swallow the blood. Please see the section on post
op bleeding. To sooth your stomach we would recommend avoiding
solids and drink only bland liquids such as broth. Avoid acidic liquids such
as fruit juices. Should nausea persist please call the office for instructions
and medications if necessary.
Question:Can I suggest a new question or clarification?
Answer: Yes, you can. Suggest a question by clicking here. Please note that we cannot respond to your questions, so do not suggest a question expecting a response. Occasionally we will review suggested questions, and if there is a question whose answer would be helpful to a sufficiently large group of people, then we will add it. Thanks!
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© Chris Hlady 2001-2009
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