Bay Area Smiles - Health Library

Wisdom Teeth: Removal

Wisdom teeth are often removed in a surgeon's office or in an outpatient surgical center. Your experience depends on the position of the teeth, the number of teeth being removed, and other factors. Your surgeon may advise removing all of your wisdom teeth in a single procedure, even if they are not all causing problems. Or your surgeon may advise separate procedures for each side of the mouth.

Preparing for Surgery
Your surgeon can tell you how long the surgery is likely to take. Including recovery from anesthesia, it may last between 45 minutes and 2 hours. Before surgery, be sure to:

• Arrange time off from work or school. You'll need a day or more to rest and begin to heal.
• Tell your surgeon about any medications you normally take. Your surgeon may advise some medication changes.
• Follow your surgeon's instructions on eating and drinking before surgery. You may be asked not to eat or drink anything after the midnight before surgery.
• Wear loose, comfortable clothing. Choose a shirt or blouse with short sleeves. This makes inserting an intravenous (IV) line easier.
• Arrange for a ride home. An adult family member or friend should drive you home after surgery. Don't drive yourself, and don't take public transportation! The person who drives you should wait in the reception area during surgery.

How Your Tooth May Be Removed
Methods of extraction can vary. Details of the procedure will depend on:

• The position of the tooth.
• Whether the tooth has erupted.
• How deeply the tooth is embedded in the bone.
• How close the roots of the tooth are to the sinuses or certain nerves or blood vessels.

Removing the Tooth
An incision may be made in the gum. This creates a flap of gum tissue that can be folded back to expose the bone and the tooth. In some cases, the surgeon may be able to loosen the tooth and extract it with forceps. The tooth may need to be sectioned (cut into pieces). Bone around the tooth may also need to be removed. In rare cases, only the crown of the tooth is removed (coronectomy). After the tooth has been removed, any incision that was made is closed with sutures.

Anesthesia Options
The type of anesthesia you receive depends on your surgeon's recommendation and your preference. Your insurance coverage may also be a factor. Tell your surgeon if you have had problems with anesthesia in the past. Types of anesthesia include:

• Local anesthetic. This numbs the area around the tooth to be extracted. Local anesthetic is used even if another type of anesthesia is also given to you.
• Sedative. This helps you stay relaxed but awake during surgery. Nitrous oxide ("laughing gas") is one type of sedative. Other sedatives are given in pill form or by IV.
• General anesthesia. This puts you to sleep during surgery. Your surgeon may advise using it if the extraction is likely to be difficult. Or it may be an option if you prefer to be asleep.

Dental Treatment for Temporomandibular Disorders (TMD)

You have been diagnosed with temporomandibular disorder (TMD). This term describes a group of problems related to the temporomandibular joint (TMJ) and nearby muscles. The TMJ is located where the upper and lower jaws meet and is part of a structural system that includes the teeth. Because the joint and teeth work together, a problem with your teeth and bite can be linked to TMD. If you grind your teeth or if you have a bad bite, your dentist may be able to help. If your bite needs adjustment, you may be referred to an orthodontist.

If You Grind or Clench Your Teeth
Bruxism (teeth grinding) or clenching strains the TMJ. If you have these habits during the day, doing self-checks can help you stop. But it's hard to control these habits when you're asleep. That's when splinting can often help.

How a Splint Works
A splint is an appliance that fits in the mouth. It may also be called an orthotic or night guard. There are different kinds of splints for different kinds of needs. A splint can keep the upper and lower teeth apart. This helps protect tooth surfaces from grinding. A splint can also be made to reduce strain on the area.

Wearing and Caring for Your Splint
To make a splint, your dentist or orthodontist may take impressions of your teeth. Then a splint will be made to fit your mouth. A splint:

• May be worn during the day or only at night. Be sure to ask when and how often you should wear your splint.
• Should be cleaned before you put it in and after you take it out. Ask your dentist or orthodontist how to clean the splint.
• Should be kept in a protective case, away from the reach of children and pets. This helps keep the splint from getting dirty or broken.

If Your Bite Is Incorrect
Malocclusion means the jaws or teeth don't fit together properly. This can result in pain and problems with jaw function. If your jaws or teeth are out of alignment, orthodontic treatment may help. If your bad bite is due to missing or damaged teeth, you may receive restorative treatment.

Restorative Treatment
A bad bite can be caused by missing or damaged teeth. A dentist can restore teeth in many ways:

• A crown is a porcelain or metal cap. It is cemented in place to repair a broken or damaged tooth.
• A bridge is a false tooth fused between two crowns.
• A dental implant is an artificial tooth root. It is attached to the jaw as a base for an artificial tooth.

Orthodontic Treatment
Sometimes the upper and lower jaws are out of alignment. Or teeth are out of line, turned, crowded, or spaced too far apart. Your orthodontist can align teeth with braces and other devices. This helps provide a more comfortable bite.

If Surgery Is Needed
Surgery is rarely needed for TMD. However, if other treatments haven't worked, you may be referred to an oral and maxillofacial surgeon. Talk to your dentist about whether surgery might be right for you.

Understanding Root Canal Therapy

Root canal therapy is a way of removing dead or dying tissue from inside a tooth. This stops infection and prevents it from spreading further. Therapy is most often completed in one or two visits. Your dentist will tell you how long each visit is likely to last. Between visits, you'll need to take special care of the tooth until the crown (the part of the tooth above the gumline) can be restored.

The First Step: Cleaning Out Your Tooth
Root canal therapy is done under a local anesthetic. (It's the same kind that's used when you have a filling.)

Cleaning and Shaping the Canal
A dental dam (a thin sheet of rubber) is placed around the tooth to protect your mouth and throat. The crown of the tooth is then opened and the pulp (soft tissue in the middle of the tooth) is removed. Using small files, the dentist cleans, enlarges, and shapes the root canal (pathway from the pulp to the jawbone). Medications may be used to stop infection.

Filling the Canal
The root canal is filled with gutta-percha, a rubber-like substance that acts as a permanent bandage. This prevents bacteria or fluid from entering the tooth through the roots. Typically, the opening in the tooth is then closed with a temporary crown or filling.

Between Visits
In most cases, the tooth will be closed with a temporary filling. In rare cases the tooth may be left open for a short time to drain an infection. In either case, pain often can be controlled with over-the-counter medications. To protect the tooth between visits:

• Avoid crunchy, chewy, and sticky foods.
• Avoid chewing on the treated side of the mouth unless told you can.
• Brush and floss as instructed.
• Take antibiotics as prescribed.

The Second Step: Restoring Your Tooth
After root canal therapy, the crown of the tooth must be restored. In most cases, an artificial crown is needed. Therapy is not complete until a permanent filling is in place-so don't delay longer than your provider advises. After restoration, the treated tooth is much like your other teeth.

• A Permanent Seal
  The dentist removes the temporary filling. A permanent filling is then used to seal the tooth. If needed, an artificial crown is placed on top of the filling and around the remaining natural tooth. Crowns can be made of porcelain, gold alloy, or porcelain fused to metal.
• If a Post Is Needed
  If little is left of the natural crown, a metal or fiber post may be used to help support the permanent filling. The artificial crown is then placed on top of the filling. Your dentist will take care to ensure that the post is not visible once the restoration is complete.

After Treatment Is Complete
Your dentist will check the tooth during a follow-up visit. With successful treatment, the tooth should function and look very much like your other teeth. You can eat whatever you want, including the hot and cold foods you may have been avoiding. Of course, you'll need to brush and floss daily to keep your mouth healthy.

When to Call Your Dentist
Call at any stage in the process if any of the following occurs:

• The temporary filling loosens or falls out.
• Your gums swell or you have a fever over 100.4º F.
• You have pain that can't be controlled by using over-the-counter medications.

Periodontal Disease: Bone Replacement Graft

Teeth are held in place by surrounding gums, bone, and other tissues. But periodontal disease can cause the bone to break down. Certain techniques called regenerative procedures can be used to stimulate growth of new bone. This growth increases the height of the bone around the tooth, giving the tooth more support. Getting back even half the lost bone height extends the life of the tooth. One type of regenerative procedure is called a bone replacement graft.

How a Bone Replacement Graft Works
A graft helps your body replace lost bone. The graft consists of your own bone, synthetic material, or bone from a tissue bank. A gel containing growth factors may also be used to stimulate tissues to grow. This is how a graft is done:

• Placing the graft. First, a gum flap is created. Growth factors may then be applied to the root. Graft material is packed into the area where bone was lost. This material provides a platform for new bone to grow.
• Closing up. The gum is closed and sewn together. The growth factors stimulate tissue to grow.
• After the area heals. Stitches dissolve or are removed. Though the gum has healed, it takes a year or more for new bone growth to fill the space.

After a Tooth Extraction: Caring for Your Mouth

When you've had a tooth extracted (removed), you need to take care of your mouth. Doing certain things, even on the first day, may help you feel better and heal faster.

Control Bleeding
To help control bleeding, bite firmly on the gauze placed by your dentist. The pressure helps to form a blood clot in the tooth socket. If you have a lot of bleeding, bite on a regular tea bag. The tannic acid in the tea aids in forming a blood clot. Bite on the gauze or the tea bag until the bleeding stops. Slight oozing of blood on the first day is normal.

Minimize Pain
To lessen any pain, take prescribed medication as directed. Don't drive while taking any pain medication as you may feel drowsy. Ask your dentist if you may take over-the-counter medication, if needed.

Reduce Swelling
To reduce swelling, put an ice pack on your cheek near the extraction site. You can make an ice pack by putting ice in a plastic bag and wrapping it in a thin towel. Apply the ice pack to your cheek for 10 minutes. Then, remove it for 5 minutes. Repeat as needed. You may see some bruising on your face. This is normal and will go away on its own.

Get Enough Rest
Limit activities for the first 24 hours after an extraction. Rest during the day and go to bed early. When lying down, elevate your head slightly.

Do's
Below are some things to do to help your mouth heal.

Do eat a diet of soft, healthy foods and snacks. It may be easier for you to eat soft foods soon after your extraction. Also, drink plenty of liquids.

Do brush your teeth gently. Avoid brushing around the extraction. And don't use any toothpaste. Rinsing toothpaste from your mouth may dislodge the blood clot.

Do keep the extraction site clean. After 12 hours you may be able to gently rinse your mouth. Rinse 4 times a day with 1 teaspoon of salt in a glass of water. Check with your dentist first.

Don'ts
Below are some things to avoid while you're healing.

Don't drink with a straw. Sucking on a straw may dislodge the blood clot.

Don't drink hot liquids. Hot liquids may increase swelling. Limit your alcohol use. Excessive use of alcohol may slow healing.

Don't smoke. Smoking may break down the blood clot, causing a painful tooth socket.

Call Your Dentist If:

• Pain becomes more severe the day after your extraction.
• Bleeding becomes hard to control.
• Swelling around the extraction site worsens.
• Itching or rashes occur after you take medication.

CAUTION: Rinse your mouth very gently. Otherwise the blood clot may be dislodged.

Treating Sensitive Teeth

See your dentist if you have sensitive, painful teeth. Your dentist will examine your teeth, determine the cause of your tooth sensitivity, and recommend a proper treatment plan.

Your Dental Exam
Your dentist will check your teeth for sensitivity to cold, air, or heat. Let him or her know if you eat foods that are high in acid. Also, mention any stomach problems you may have that bring acid into your mouth. Your dentist will also look inside your mouth to check for decayed teeth, or teeth worn by improper brushing. If needed, x-rays are taken. You may also be checked for signs of teeth grinding or clenching. You may start out with a special oral hygiene program for home care. But your dentist may also suggest professional treatment.

Home Care
Your dentist may suggest that you follow an oral hygiene program at home. Use a toothbrush with soft bristles. If any roots are exposed, you may be asked to use a special toothpaste. This toothpaste makes teeth less sensitive. Your dentist may also suggest that you try a fluoride rinse or gel. Cleaning all parts of your teeth and mouth helps prevent tooth sensitivity and decay.

Professional Treatment
Depending on how sensitive your teeth are, your dentist may suggest professional treatment. He or she may:

• Apply special chemicals to the sensitive areas.
• Use a coating of resin to seal the dentin.
• Fill cavities or deep grooves in any exposed root.
• Apply a fluoride varnish to the root surface.

Know that your teeth can become sensitive again. Be sure to follow your home-care treatment plan. Also schedule regular dental examinations. By working with your dentist, you can help keep your teeth pain-free.

Herbst Appliance

A Herbst appliance helps line up your top and bottom jaws. This helps improve the way your teeth fit together (your bite). The Herbst appliance moves the lower jaw forward while pushing the upper jaw backward.

How Your Appliance Works

Each rod slides up and down within a tube. If the rod and tube come apart, open your mouth wide. Then guide the rod back into the tube as you close your mouth.

It's important to know how your appliance works. Start by learning the parts that make up your Herbst appliance. This will help you talk to your doctor about any problems you may have with it.

What You Can Expect
Your Herbst appliance may take a few weeks to get used to. Your upper and lower teeth may not touch when you close your mouth. And your teeth or muscles in your jaws and cheek may feel tender. So, it may be hard for you to eat at first. But these problems will likely go away soon. Also, the rods and tubes in your appliance may come apart if you open your mouth too wide. If this happens, they can be reconnected. Your doctor will show you how to do it.

For Your Comfort
If the appliance makes your mouth tender, your doctor may suggest medicine to relieve the soreness. The appliance may rub against your cheeks or tongue. If this happens, roll a small piece of dental wax into a ball. Then press it against your appliance at the sore spots. If you get a small cut in your mouth, rinse it with a mixture of 1 teaspoon of salt and 1 cup of warm water. Don't swallow the salty water.

Foods to Avoid
Eating certain foods can break your appliance or pull it apart. Stay away from sticky, chewy, crunchy, or hard foods, such as candy, gum, ice, and popcorn. Slice raw carrots and apples into thin pieces.

Brushing and Flossing
When wearing your appliance, you may find it harder to brush and floss your teeth. But make a special effort to keep your teeth clean. Carry a toothbrush and toothpaste with you. This way, you can brush your teeth after every meal or snack.

A Better Bite
When your jaws and teeth line up right, you'll have a better bite. And you'll look better, too. By working with your doctor, you can have a good bite and a great smile.

Call Your Doctor If:

• The appliance comes apart and you can't put it back together.
• The appliance breaks or a screw comes loose. Always save any parts that break or come loose.

Treatment for Restoring Your Tooth: Crowns

Your smile is what lights up your face. But damaged teeth may make you feel too self-conscious to smile. If you have a single damaged tooth, your doctor may recommend a crown. Read on to learn more about this treatment option.

What Is a Crown?
A crown is used to restore a damaged tooth to its normal size and shape. It may be made of gold, other metal, porcelain, or porcelain fused to metal. If your crown will be visible when you smile, your dentist will try to match it to the color of nearby teeth.

What to Expect During Treatment
Your treatment experience may be as follows:

• Preparing your tooth. A crown needs to be the same size as the original tooth. Your dentist will make the damaged tooth smaller for the crown to fit over. Then an impression of the prepared tooth and the opposing tooth will be taken.
• Between visits. It will take 1-3 weeks for a lab to make your permanent crown. To protect the prepared tooth during that time, you may have a temporary crown. Keep your mouth extra clean during this time. To avoid pulling off the temporary, pull floss out sideways, not straight up or down. And avoid sticky foods. If the temporary does come off, ask your dentist whether you should secure it back in place with denture adhesive until you can visit the office.
• Fitting your crown. At your follow-up visit, your dentist removes the temporary crown and puts on the permanent crown. He or she checks the fit. After making adjustments, the dentist cements the crown into place. If you have any problems with the crown later, call your dentist.

When to Call Your Dentist

If any of these problems occur at any point, call your dentist:

The crowned tooth hurts or feels sensitive to heat, cold, or biting pressure

The crown chips, comes loose, or falls out

The gums at the base of the crowned tooth swell, bleed easily, or get red or tender

Dental Implants: The Right Prosthesis for You

If you have one or more missing teeth, your dentist may recommend dental implants. A dental implant is an artificial tooth root. Your jawbone fuses with the implant to provide a secure platform for a prosthesis (artificial tooth). A dental prosthesis is secured to one or more implants. The prosthesis you have will depend on your dental needs. Your dentist will work with you to find the right prosthesis for you.

A Prosthesis to Fit Your Needs
Depending on how many teeth you're missing, you may have a single, partial, or complete prosthesis. The more teeth to be replaced, the more implants you will need. For most people, a permanent prosthesis won't be made until the jawbone has fused to the implants. Until then, a temporary prosthesis may be used.

• A single prosthesis is used to replace a missing tooth. One implant is all that's needed for support.
• A partial prosthesis replaces two or more teeth. Two or three implants are used for support.
• A complete denture prosthesis replaces all the teeth in an upper or lower jaw, or both. The number of implants needed depends on whether a fixed or removable prosthesis is used.

If You Need a Complete Prosthesis
There are two types of complete denture prostheses: removable and fixed. Both can be used to replace a complete set of teeth. Removable means you'll be able to take it out of your mouth. Fixed means it can only be taken out by a dentist. You and your restorative dentist can discuss which type is best for you.

• Removable prosthesis: With a removable prosthesis, the new teeth are joined to the implants by a connecting device, such as a clip and bar. This allows you to take the prosthesis out for cleaning. For support, this type often uses 4 to 6 implants per jaw.
• Fixed prosthesis: With a fixed prosthesis, the new teeth are fitted to a frame that is secured to the implants. Five or more implants are placed along the contour of the jaw. In some cases, a fixed prosthesis offers more stability for chewing.

Flossing Crowns, Bridges, and Implants

Bacteria collects in every nook and cranny of your mouth. It can cause disease in teeth, gums, and bone. It can even decay teeth beneath restorations (dental treatments such as crowns, bridges, and implants). Brushing cleans bacteria from surfaces that are easy to reach. But to clean where a toothbrush can't reach, you need to floss.

Daily Flossing

Scrape the floss against the side of each tooth several times.

Flossing daily removes bacteria from between teeth and from pockets between teeth and gums. A water jet product can help.

• Clean all surfaces under and around a restoration just as well as you would clean your natural teeth. The technique is also pretty much the same.
• Flossing is easiest with a floss holder or disposable floss tool. These let you floss with one hand. That way you can floss while doing other tasks, such as working at your desk.
• To floss:
  • Take about 18 inches of floss and wrap the ends around your middle fingers.
  • Gently slide the floss between your teeth. Scrape it against the side of each tooth several times.

A floss threader helps you get floss under a bridge.

Cleaning Aids
Special cleaning aids can make it easier to clean all surfaces of your teeth.

• Denture cleansers reach denture surfaces that brushing misses.
• Floss holders help you floss in hard-to-reach places.
• Interdental brushes clean inside spaces, such as under a bridge.
• Electric toothbrushes help you clean teeth with less effort.

Understanding Orthognathic Surgery

A jaw that's too small, too large, or crooked can cause problems with chewing, speaking, breathing, and even sleeping. The shape of your jaws also affects the way your face looks. Orthognathic surgery is treatment that reshapes the jaws to improve their form and function.

How Orthognathic Surgery Can Help
Some people are born with poorly aligned jaws. Others develop problems as the bones grow or as a result of an injury. Orthognathic surgery realigns facial bones, making jaws work together better. Surgery is only one part of the treatment process. In most cases, treatment to move and straighten the teeth (orthodontics) is needed before and after surgery. This combination of treatments can relieve problems caused by teeth and jaws that are out of alignment.

Your Treatment Plan
Orthognathic surgery and related treatments can take time, often over a year. Starting treatment and not completing it could leave you with more problems than you have now. So you need to commit to the process before treatment begins. Your plan will likely include a time frame for each stage of treatment. Typical stages and time frames are shown here:

If You Have Questions
Be sure you understand what each step involves, and what you can and can't expect from treatment. Keep in mind that treatment plans can differ depending on your jaw problem and factors such as your age and oral health. Your healthcare provider can answer your questions and address your concerns.

Preparing for Orthognathic Surgery

You have been scheduled for orthognathic surgery. This is treatment that reshapes the jaws to improve their form and function. During the months leading up to surgery, you'll work with your orthodontist. Your orthodontist will keep your surgeon updated on when your teeth are likely to be in the right positions for surgery. You'll be given plenty of time to get ready for surgery and plan your recovery.

Seeing Your Orthodontist
During this period, you'll see your orthodontist often. At these visits, he or she will check your progress. Your braces may be adjusted. More records may be taken. These are pictures, x-rays, and models that document the positions of the teeth and jaws. Your orthodontist will tell you if the timeline for your surgery needs to be revised, and will update your surgeon. Discuss any concerns about your bite with your orthodontist.

Meeting with Your Surgeon
Shortly before surgery you'll meet with your surgeon. He or she will evaluate your progress and finalize the surgical plan. You'll discuss factors that could affect surgery, such as medications and allergies. You'll also have an exam and blood tests to make sure you're healthy enough for surgery. Depending on various factors, you may also need other tests, such as a chest x-ray.

Before Surgery
Surgery takes place in a hospital or surgery center. A day or two before your surgery:

• Stock up on liquid foods you can eat without chewing. These include total-nutrition drinks, soup, and milk. Foods that are easy to liquify, such as bananas, are good, too.
• If you don't already have a blender, buy or borrow one.
• Arrange for an adult family member or friend to give you a ride home and stay with you after surgery.
• Don't eat or drink for at least 8 hours before surgery. Ask the surgeon whether you should take your regular medications during this period. If so, take them with small sips of water.

What You Can Do to Prepare
During the months before surgery, there's a lot you can do to make your treatment and recovery easier. For example:

• If you smoke, quit. Smoking increases the risk of complications during surgery. It slows healing after surgery. It can also cause or worsen gum disease. The sooner you quit, the better. Ask your primary healthcare provider to help you make a plan to quit smoking.
• Arrange for time off to recover. Planning in advance helps make your absence from school or work go smoothly. Ask your surgeon how long your home recovery is likely to take.
• Learn about your recovery. After surgery, you won't be able to chew at first. In some cases the jaw is held shut (immobilized) for about 2 weeks. So you'll need to learn what to eat, how to eat, and how to stay comfortable.
• Make medication changes as directed. Be sure your surgeon knows about any medications, herbs, or supplements you take. You may be advised to stop taking certain ones a few weeks before surgery.

Orthognathic Surgery: Presurgical Orthodontics

You have been scheduled for orthognathic surgery. This is treatment that reshapes the jaws to improve their form and function. Before surgery, most people need to have orthodontic treatment to move and straighten the teeth. This allows the surgeon to place the jaws in the proper position. Dental work is also needed throughout the process. This presurgical phase is often the longest part of treatment.

Impressions (molds) of your teeth are taken to help plan for your braces.

Preparing Your Mouth for Braces
To support the teeth, the gums and underlying bone need to be healthy. So you'll need to keep up with routine dental care throughout the treatment process. All cavities should be filled before surgery. If you have periodontal (gum) disease, you'll see a periodontist or general dentist for treatment. Other dental problems may also need work. For example, if you have wisdom teeth, they will most likely need to be removed before you get braces. When your teeth and gums are ready, you'll go on to the next step.

Getting Your Braces
Braces help ensure that the placement of your teeth will work well with the position of your jaws after surgery. The braces use gentle pressure to slowly shift teeth into their new positions. Modern orthodontic treatment uses very mild pressure to reduce the discomfort. Also, modern braces are less noticeable than old-fashioned braces. While you have braces, you'll need to avoid certain hard or sticky foods. You'll also need to be extra careful about brushing and flossing your teeth. Your orthodontist will tell you more about taking care of your braces and your teeth.

Orthognathic Surgery: Recovering at Home

You just had orthognathic surgery. This is treatment that reshapes the jaws to improve their form and function. Your job now is to keep yourself comfortable and help your body heal quickly. Make sure to get plenty of calories and protein. Get up and move around, but avoid strenuous activity. Be sure to get lots of rest. Keep your mouth and teeth clean to help the incisions heal.

Controlling Swelling and Pain
For the first few days, swelling will likely increase. It should then start to ease. To reduce swelling and pain:

• Sit or lie with your head and shoulders higher than your heart.
• Apply an ice pack to your face for 10 minutes at a time, with breaks of at least 5 minutes in between. Keep a thin cloth between the cold source and your skin.
• Use pain medications as directed.

Nutrition and Fluids
You will need to get enough nutrition, which may be harder while you're not able to chew. You also need fluids to help prevent dehydration and nausea. For calories, protein, and fluids, try total-nutrition drinks, protein powders, soups, milk shakes, and other blended foods. Don't use a straw, since the suction can stress the incisions in your mouth. Instead, use a glass or a "sippy cup" designed for young children. Once you can chew again, eat soft foods that can be cut with a spoon or fork. As you heal, you'll gradually return to your normal eating habits.

Keeping Your Mouth and Teeth Clean
To keep your teeth as clean as possible:

• If you can't open your jaws, brush the front surfaces of your teeth with a baby toothbrush.
• If a fluoride toothpaste or mouth rinse is prescribed, use it as directed.
• If your surgeon advises it, start using an oral irrigator about 10 days after surgery.
• Aim to get back to brushing and flossing normally as soon as you can.

When to Call Your Surgeon
If you have any of the following problems, call your surgeon:

• Severe bleeding
• Pain that can't be controlled
• Nausea or vomiting that can't be controlled
• Swelling that continues to worsen after 3-4 days
• A fever of 100.4°F or higher

Go to the emergency department if your doctor's office is closed.

Orthognathic Surgery: Your Surgical Experience

You have been scheduled for orthognathic surgery. This is treatment that reshapes the jaws to improve their form and function. Surgery takes place in a hospital or surgery center. The procedure lasts several hours. You will likely stay in the hospital for 1-2 days. In some cases it may be possible to leave the same day. In either case, hospital staff will keep you comfortable and help you recover until you're ready to go home.

The Day of Surgery

• When you arrive at the hospital, you'll change into a hospital gown. Staff will then prepare you for surgery.
• An IV line will be started to provide you with fluids and medications.
• You'll meet with an anesthesiologist or nurse anesthetist. This is to discuss the medication (general anesthesia) used to keep you asleep and free of pain during surgery.
• Once you're under anesthesia, the surgery will be performed.
• To help stabilize the bite, a plastic splint may be placed between the chewing surfaces of your teeth. In some cases, elastic bands or wires are attached to the braces to hold the jaws firmly shut. In other cases, looser elastic bands called "guiding elastics" are used. Sometimes, no wires or bands are needed.

Right After Surgery

• After surgery you'll awake in a recovery room.
• Your IV will remain in place.
• You'll most likely have a device to give you oxygen.
• Ice packs will be applied to your face to control swelling.
• Your face will most likely be numb, but you'll be given medication if you feel any pain.
• Nurses will monitor you to make sure you're recovering well from anesthesia.
• You'll then be taken to a regular hospital room.

Recovering in the Hospital

• You'll be urged to get up and walk as soon as possible after surgery. This helps you recover from anesthesia. It also helps prevent complications.
• Sometime late in the day, you'll likely be started on liquids.
• Using facial muscles helps reduce swelling, so try to talk if you can.
• It's common to have some nausea the first day. Vomiting when you can't open your jaws can be scary, but don't panic. Since you fasted before surgery and you're now taking only liquids, the vomit will be liquid. Just lean over and spit it out. If you have any concerns about how nausea may affect you, talk to your surgeon ahead of time.

Going Home

• You will most likely stay in the hospital overnight, or for up to 2 days. You can go home when you're up and around, you have no signs of complications, and any nausea is under control.
• Before you leave you'll be told how to reduce pain, swelling, and nausea at home.
• You'll also be given prescriptions for medications to help control these problems.

Risks and Complications
Risks and possible complications of surgery include:

• Temporary pain and swelling
• Bleeding
• Numbness (in most cases temporary)
• Infection
• Loss of teeth or bone
• Relapse (bones move back toward original positions)
• Risks of anesthesia