On your initial visit to our office we will create a file for your records and have you complete a medical questionnaire. Our team will review and address relevant medical issues with you during the course of the assessment. It is helpful to remember the following items:

• A copy of your referral
• Any X-rays, models, appliances, or other documents which were given for you to bring (these are often forwarded separately by your referring doctor)
• Your OHIP card (this number or another form of government identification is needed for certain prescription medications)
• An updated list or working knowledge of any medications you are taking and of any allergies you may have
• Your Dental Benefit Insurance Information (this will allow us to submit your claims electronically)

Your first appointment will usually be for consultation only, but occasionally and in some emergency situations will be scheduled to include a same visit surgical procedure. We will begin by asking about the concern that has brought you to see us. We will review your medical questionnaire and ask further questions regarding your medical status, medications, and past medical history which will help guide our management decisions. We will perform an exam of the areas of concern and may order additional tests or diagnostic images. Treatment recommendations, alternative treatment options, and important treatment details will then be discussed. If treatment is recommended, the administrative staff will prepare a surgical fee estimate, insurance information, and help with scheduling your appointment.

Sedation and Anaesthesia

In our practice there is no reason that you should ever feel discomfort. If you are anxious or apprehensive regarding
any aspect of the procedure such as local anaesthetic injections, the vibrations or sounds of the drill, the odours of the
office, or just having someone working in your mouth, you are in good company. We have attempted to make our
office a comfortable and relaxing place for you.

Our office has been specially equipped and staffed so that you can have the option of receiving medications that will
make you feel more relaxed, make it so that you will not remember parts or all of an appointment, or are asleep for
some or all of an appointment.

When you are relaxed and unaware of the sights, sounds, and odours of the office, the oral surgeon is better able to
provide you with the highest quality of work in the most efficient manner. Although you may not be particularly
anxious about the surgery, some sedation may make the time go by more quickly and enable you to co-operate fully with
the surgical team. We will tailor this to your individual needs.

Instructions prior to intravenous sedation
or anaesthesia

Diet: If you have a morning appointment, have nothing to eat or drink after midnight before your appointment. If you have an afternoon appointment you may eat a small, light breakfast consisting of dry toast and juice at least 8 hours prior to your appointment. Nothing should pass your lips for 8 hours prior to your appointment. Medications to be taken before your appointment are an exception and can be taken with water sips.

Clothing: Loose fitting, comfortable clothes are recommended. A short-sleeved shirt is preferred. Patients who use contact lenses should wear glasses or remove their contact lenses prior to their appointment.

Transportation: Be sure to have someone with you to accompany you home after your appointment. This person does not have to wait for you in the office but should be available or arrive when you are ready for discharge.

Activities of daily living: You should plan to rest quietly at home for the remainder of the day. Do not operate an automobile or machinery for 24 hours following your anaesthetic.

Inform your surgeon before anaesthesia if:

1: You are pregnant or think that you might possibly be
pregnant

2: Are taking any kind of medication for ANYTHING.

3: You have had a hospitalization, treatment for your heart, or have taken medications such as
steroids or high blood pressure medications within the past 2 years.

4: You or your family has ever had any difficulty with an anaesthetic.

5: You have been diagnosed with sleep apnea.

6: You are apprehensive about the anaesthetic.

Nausea & Vomiting

Fortunately this problem doesn’t occur very often, but when it does, the most common cause is related to the use of narcotic medications. Patients who develop these symptoms should:

• Reduce or stop taking their prescription pain medication
• Consider taking some Gravol
• Try taking their medications with food instead of on an empty stomach
• Try to manage their pain symptoms with alternate medications

Unless there are allergies or other reasons to avoid their use, both Tylenol and Ibuprofen can be taken at the same time and because they work differently their combined effect will be better than either medication would be on their own. When in doubt or if nausea persists, please contact our office.

Bleeding

Our patients will be observed for a period of time following their procedure and prior to being discharged home. This will ensure that post-operative bleeding will not usually be a problem. A bit of blood tinge in the saliva or light bleeding after disturbing the surgical area is not uncommon over the first few days. If bleeding develops, roll up a lightly moistened gauze and place it directly over the bleeding area and bite on it with pressure for 20 minutes. If gauze is not available, a moistened tea bag can be substituted (the tannic acid in the tea will help to stabilize the clot). If the bleeding is persisting please contact our office or if necessary make your way to the nearest hospital emergency department.

Allergic Reaction

Allergies can vary in intensity, and their management will usually be determined by the severity of the reaction. All allergic reactions should be reported to our office as soon as possible. In an extreme and sudden (acute) reaction where breathing seems to be affected, Epinephrine will likely need to be administered. Call 911 and get immediate emergency assistance. Most allergic reactions will be slower in onset with the development of a rash or red spots on the chest or other areas of the body. If this develops, do not take any more of your medications until you have discussed this with our office or a physician. Most allergic reactions will be related to a prescribed antibiotic. An antihistamine such as Benadryl or Allegra may help reduce the intensity and duration of the allergy symptoms. The causative medication should be noted and alternative medication taken if needed in future.

Stitch Issues

Most of the common oral surgical procedures will include placement of dissolving (resorbing) stitches. These will usually soften and will either fall out or be swallowed within 3 to 7 days. Because the stitch material is made to break down, a stitch will occasionally unwind or fall out within the first 24 hours. This is not usually a problem since most surgical sites will have 2 or more stitches. Unless bleeding develops, replacement will not be required. Occasionally, a stitch will break, but hang down annoyingly. If required, a clean scissors can be used to trim the dangling end. If you have concerns about your stitches, please contact our office.

Infection

The majority of the infections that we treat are seen in patients prior to having their surgical procedure and are usually the reason that they have been referred for our help. It is important that if antibiotics have been prescribed that they be taken as directed and until they are finished unless a problem with them develops.

An odd taste coming from the surgical site during the initial healing phase is not uncommon and usually related to retention and breakdown of food debris. Extra rinsing of the area will help to resolve this problem.

The development of delayed swelling (swelling that is increasing later than 3 days after the surgical procedure) may be a sign of infection. Warm salt water rinsing should be initiated, and our office should be contacted if this is not improving.

Dry Socket

Dry socket (alveolar osteitis) is an inflammation of the bone that surrounded an extracted tooth. Bone is living tissue with sensitive nerve endings that occasionally become quite painful for a short period of time. Thankfully this doesn’t occur very often and can be treated when it does develop.

A dry socket will not typically develop right away, but is recognized by the development of a more significant pain or throbbing from the area 3 to 4 days after a tooth extraction. This time sequence coincides with breakdown of the blood clot in the extraction site which temporarily leaves the nerve endings of the exposed bone without enough insulation. Dry socket is almost always from a site in the lower jaw but may be felt along the entire mandibular nerve with radiation to the ear and upper neck. Risk factors that would make a dry socket more likely to occur include: a lower molar location, complicated extractions, smoking, increased age, dense bone, and a pre-existing infection.

Treatment will usually involve the temporary placement of a medicated dressing which is gently placed in the extraction socket. The dressing is usually left in place for the next week and then removed. Without treatment, alveolar osteitis will almost always resolve on its own over 1 to 2 weeks.