Pre-operative Instructions: Wisdom Teeth Removal

Before General Anesthesia

If you have been scheduled to have general anesthesia, it will be imperative that you follow these instructions. Failure to do so could be life-threatening, and your appointment will be rescheduled if these instructions are not followed. If you have questions about these instructions, please call our office.

• You may not have anything to eat or drink for at least 8 hours before surgery. The doctor may increase this time based on certain medications you are taking or your health history.

• We will attempt to schedule anesthesia for children in the early morning so that enforcement of the fasting requirement is not burdensome for parents.

• If you are taking prescription medications for other medical reasons, these may be taken at their normal times with small sips of water.

• When you have general anesthesia, a responsible adult who is over the age of 18 must accompany you to the office, remain in the office during the procedure, and drive you home. This person should also be able to stay with you for several hours once you get home and are situated after surgery. We also require a driver to bring you to your surgery appointment if you have been given pre-operative medications to take at home.

• Please do not wear lipstick, contact lenses, facial jewelry of any kind, pantyhose, or high-heeled shoes to your appointment. Please tie hair back away from your face. Please wear a short-sleeved shirt or blouse. Please remove all dark fingernail polish for our monitoring equipment.

• If you develop lung or nasal congestion, the flu, a cold, or a fever, please advise us a few days before your surgery.

• The use of alcohol or recreational drugs can have an adverse effect on the anesthesia medications that we use. Please discontinue the use of such for at least 72 hours before your procedure.

• Ideally, stop smoking 24 hours before surgery.

Prescription Opioids for Surgical Pain

Opioid medications can be addictive and anyone is at risk of developing an opioid use disorder. Keep yourself and others safe by limiting usage, disposing of all unused medications, and knowing how to recognize the signs of opioid use disorder.

Common types of opioids are oxycodone, hydrocodone, codeine, tramadol, fentanyl, morphine, and methadone. Opioid medications may be prescribed by healthcare providers to treat moderate-to-severe pain, but can have side effects and serious health risks, such as tolerance, physical dependence, opioid use disorder, and overdose.

It is important to follow medication instructions when taking opioids and always be honest with your healthcare provider regarding other medications you may be taking. You should avoid consuming alcohol or operating heavy machinery when taking opioid medications.

What to Know as a Patient

Before prescribing opioids, your healthcare provider may:

• Ask you to complete a risk assessment
• Ask more questions for your patient record
• Check the Prescription Monitoring Program to identify other medications or drugs of concern

Individual healthcare providers, practices, systems, pharmacies, and insurance companies may have more strict policies regarding opioids.

Be Informed. Be Aware. Never Share.

What Are the Risks?

• Opioid use disorder
• Physical dependence
• Falls and accidents
• Increased sensitivity to pain
• Overdose

Risks May Be Greater With:

• Pregnancy
• History of substance use
• Over the age of 65
• Mental health conditions
• Combining with other medications (example: sleep or anxiety)

Possible Side Effects

• Nausea, vomiting, and dry mouth
• Constipation
• Sleepiness and dizziness
• Confusion
• Withdrawal

Safe Storage

• Never share or sell your prescription opioids
• Keep opioid medications locked or in a safe location
• Keep out of reach of children and out of sight from others
• Leave in the original bottle with the label attached

Proper Disposal

You are not required to use all of your opioid medication. To find your nearest toke-bock location for proper disposal of unused medications, please visit:

• takebackyourmeds.org
• med-project.org

Managing Your Pain After Oral Surgery

Controlling pain after oral surgery is important for your recovery. Your doctor may use different medications to help reduce and control your pain.

EXPAREL@ (bupivacaine liposome injectable suspension) may be a great option. EXPAREL is indicated for administration into the surgical site to produce postsurgical anesthesia and is available for oral surgery when administered as local infiltration.

How EXPAREL Works 

• EXPAREL starts working before you feel the pain — your doctor injects it directly into the surgical site during your procedure. 
• EXPAREL numbs the area around the surgical site.
• EXPAREL is not a narcotic medication. 
• EXPAREL gives long-lasting pain control, meaning you may need fewer pain medications

 

Your Recovery

• When your pain is under control, you can focus more on healing.
• Follow the postsurgical orders given to you at discharge.
• Be sure to communicate any discomfort you may be feeling to your doctor.
• Talk to your pharmacist about discarding unused medications responsibly.

Important Safety Information

Tell your doctor if you are pregnant, think you may be pregnant, or are considering breastfeeding; there are certain obstetrical and gynecological procedures where EXPAREL should not be used. EXPAREL has not been studied for use in patients younger than 18 years. Rarely, patients who receive bupivacaine (the active ingredient in EXPAREL) have experienced numbness and tingling in their mouth or lips, lightheadedness, anxiety, or abnormal heart rate. Speak with your doctor right away if you think you may be experiencing any of these sensations, or if you have other questions regarding possible side effects. Tell your doctor if you have severe liver or kidney disease. Products that contain bupivacaine, like EXPAREL, may cause temporary numbness in the area where bupivacaine was injected. Some patients who receive EXPAREL experience nausea, vomiting, and/or constipation. Talk to your doctor to see if EXPAREL is right for you.

For more information about EXPAREL please visit www.exparel.com/patient or call 1-855-RX-EXPAREL (793-9727).

Soft and Non-Chewed Food Options

After your surgery, begin with a clear liquid diet and progress toward soft foods. Soft foods are generally considered foods that can be swallowed without being chewed. You must begin eating and drinking immediately following surgery. Strive for a minimum of 8–10 (8-ounce) glasses of water or non-caffeinated beverages per day. This will help regulate bowel patterns, which can change when going from a solid to liquid diet. We also recommend a multivitamin supplement to assure adequate intake of vitamins and minerals.

Clear Soft Foods

A clear soft diet contains any items you can see through, but do not have to chew.

• Water 

• Gelatin

• Broths 

• Clear Juices

These items are easily digested and passed, causing no unnecessary post-surgical discomfort. They are low in fat content, minimizing excess gas production that could otherwise trigger nausea. You may use a straw 3-4 days after surgery to achieve adequate fluid intake. Be careful with hot liquids. If your doctor allows, you may continue to a mechanical soft diet.

Mechanical Soft Foods

Foods on this diet DO NOT require chewing. Foods need to be cooked long enough (such as vegetables, pastas, meats, fruits, etc.) so that they can be mashed against the roof of your mouth and swallowed without chewing. You should blend soups, stews, casseroles, and smoothies. It can be challenging to meet caloric and protein requirements on a long-term mechanical soft diet; therefore, it is suggested that you eat more frequently throughout the day (three meals with snacks in between). This will also ensure that you stay well hydrated. Protein requirements begin to increase after the age of 60, so obtaining protein in every meal and snack is important. As meats are limited (except for those that do not require chewing), you will need to add protein in other forms, such as Carnation^® Instant Breakfast mix, powdered milk, yogurt, cottage cheese, soft tofu, pudding, eggs, peanut butter powder, protein powders, or even nutritional supplements such as Ensure^® or Sustacal^®.

Multivitamin

Taking a multivitamin can help add essential nutrients to your diet, but it's recommended to eat a variety of foods from each basic food group throughout the day. Not all vitamins are equal. Getting your vitamins from a reputable source is important. Two places to get good multivitamins are:

• Cardiotabs: www.cardiotabs.com

• Pure Products: www.pureencapsulations.com

Dairy

Aim for 4-6 servings from this group daily (depending on meat intake). Milk and milk products will be the primary protein foods as you follow this post-surgery diet. Low fat, 2%, or whole milk products will depend on your preference. Keep in mind, the higher the fat content, the higher the calories, which you may need at this time.

• 1 cup milk (skim, 2%, whole, chocolate, buttermilk, eggnog)

• 1 cup yogurt

• 1 cup Instant Breakfast mix with milk

• 1 cup custard or pudding

• 1 ½ cup cottage cheese

• ½ cup ice cream

• 1 cup milk-based soup

• 1 cup milkshake or smoothie

• 1 cup LACTAID^®, soy, almond, or coconut milk

• ½ cup Ensure^®, Ensure Plus^®, Sustacal^®, or Sustacal HC^®

Carnation Instant Breakfast is tasty, convenient, and economical. To further increase protein and calorie intake, you can add powdered milk to milk and use it in all of your cooking and drinking. If you have a lactose intolerance, there are low lactose or no lactose milk products available, such as acidophilus milk, LACTAID^®, soy milk, almond milk, or coconut milk. Ensure^® and Sustacal^® are also lactose-free.

Meat and Protein

Aim for at least one serving per meal. You may find it difficult to include foods from this group. If so, incorporate more servings from the milk group. Baby meats and home-cooked, puréed, strained meats may be blended with soups or broth to add protein to your diet. Cooking a casserole, soup, or stew to a very soft point or utilizing your crockpot all day and then blending it can be tasty and nutritious.

• 1 scrambled egg or ½ cup egg substitute

• 3 oz soft baked fish or canned fish

• 3 oz ground beef, pork, chicken, or turkey (cooked soft, minced, or puréed and added to foods); canned meat is acceptable, but watch the amount of sodium.

• 1 Tbsp peanut butter or powder (blended into smoothies or puddings)

• ¾ cup soft tofu

• ½ cup cooked soft beans or lentils (can also purée into soups and stews)

• Hummus

Fruits and Vegetables

Aim for 3–4 servings of each per day. One serving is ½ cup cooked or canned.

• 1 cup raw (must be soft, such as banana or avocado) or ½ cup juice

Remember to add a variety. The more color, the more nutrients.

• Avocado, banana, softly cooked or canned fruits, applesauce, apricots, peaches, pears, all juices, puréed melon, strawberries, and berries. Purée fruits into smoothies to add nutrients.

• All vegetable juices, V8^® juice, all vegetables cooked tender, mashed, steamed, puréed, canned, or stewed, tomato paste, and sauce. Fruit and vegetable toddler pouches can be VERY nutritious and packed full of omega-3s, fiber, and vitamin C. Happy Tot^® and Gerber^® sell fruit and vegetable pouches at stores and on Amazon. Look for pouches with the addition of chia, quinoa, and kale for higher protein.

Grains

Bread is not allowed on the diet, as it requires too much chewing. You will need to add 4 servings of grains per day through other foods.

• ½ cup cooked cereal (oatmeal, grits, Cream of Rice^™, Cream of Wheat^®, Malt-O-Meal^®)

• ½ cup pasta (overcooked until very soft, beyond al dente)

• 1 pancake

• ½ cup soft bread stuffing

• ½ cup rice (overcooked to a very soft point or into soups)

Other Foods

To add calories and variety, make use of foods such as butter, margarine, oils, salad dressings, gravies, sauces, melted cheeses, jellies, syrups, baby foods, and canned soups. Soft desserts, gelatins, puddings, ice cream, milkshakes, sherbet, and smoothies can also easily be incorporated.

DO NOT EAT: breads, hard candies, apples or raw hard fruits and vegetables, ice, any foods with bones, or foods that require chewing and cannot be mashed against the roof of your mouth before swallowing.

Sample Menu

(Eaten as 3 Meals and 3 Snacks)

• 3 Tbsp Cream of Wheat with 2% milk — 162 kcal

• 1 Tbsp brown sugar — 52 kcal

• 6 oz orange juice — 34 kcal

• 1 cup Instant Breakfast in 2% milk — 250 kcal

• Scrambled egg with 1 Tbsp margarine — 102 kcal

• ½ cup macaroni and cheese (blenderized) — 200 kcal

• ½ cup puréed broccoli and cheese — 45 kcal

• 6 oz V8 juice — 162 kcal

• 8 oz peanut butter banana smoothie — 52 kcal

• 1 ½ cup mashed tuna noodle casserole — 34 kcal

• 2% chocolate milk, 8 oz — 250 kcal

• ½ cup ice cream — 102 kcal

• 1 Tbsp chocolate sauce — 200 kcal

• DAILY TOTAL — 1,971 kcal

Nutritional needs vary depending on age, weight, gender, etc.

Sample Recipes

High Protein Milk

(Use in all recipes and cooking if extra protein is needed)

• 1 cup whole milk

• ¼ cup nonfat dry milk powder

Instructions: Mix milk powder with whole milk until dissolved, and refrigerate. 

(240 kcals and 16g protein)

Peanut Butter Banana Smoothie

• 1 medium banana or 1 jar banana baby food

• 1 cup whole milk

• 1 Tbsp creamy peanut butter

• ¼ cup vanilla bean ice cream

Instructions: Blend ingredients until smooth.

(430 kcals and 12g protein)

Orange Dreamsicle Smoothie

(2 servings)

•1 cup 2% fat Greek yogurt

•⅔ cup crushed ice

•¼ cup chopped, peeled ripe mango

•½ cup orange juice

•1 medium orange, peeled and segmented

•1 tsp vanilla extract

Instructions: Place all ingredients in a blender and process for 1 minute until completely smooth.

(164 kcals and 11g protein)

Creamy Broccoli Soup

4 servings (2 cups)

•1 Tbsp olive oil

•1 cup chopped onion

• ¾ cup chopped leek

• 2 garlic cloves, minced

• 3 cups chicken or vegetable broth

• 2 cups water

• 1 ½ cups cubed, peeled potato

• ¼ tsp salt and ½ tsp pepper

• 1 (12 oz) bag frozen broccoli florets, thawed

and coarsely chopped

• 15 oz cannellini beans, rinsed and drained

• 6 Tbsp grated parmesan cheese

Instructions: 

-Cook onion, leek, and garlic in oil over medium heat about 5 minutes until tender.

-Stir in broth, water, potato, salt, and pepper and bring to a boil.

-Simmer for 10 minutes or until potatoes are tender.

-Stir in broccoli and beans.

-Cook for 8 minutes until broccoli is tender.

-Purée in batches, taking care with the blender as steam escapes.

-Blend until smooth.

-Add more salt and pepper as desired.

-Serve warm, sprinkled with cheese.

(231 kcals and 10.5g protein)