Surgical Instructions

Before and After Surgery

Before I.V Anesthesia Sedation
    • Do not have anything to eat or drink (including water) for six (6) hours prior to the appointment
    • No smoking at least twelve (12) hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery.
    • A responsible adult must accompany the patient to the office, remain in the office during the procedure and drive the patient home. All minors under the age of 18 must be accompanied by a parent or legal guardian.
    • The patient should not drive a vehicle or operate any machinery for 24 hours following anesthesia.
    • Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and low heeled shoes or sneakers.
    • Contact lenses, jewelry and dentures must be removed at the time of surgery.
    • Do not wear lipstick, excessive makeup or nail polish on the day of surgery.
    • Prior to your surgery appointment, please notify our office if you have an illness such as a cold, sore throat, stomach or bowel upset.
    • If you take routine oral medications, please call the offices of Drs. Cummings, Balasanian, Caputo and Nicholls prior to your surgery date for instructions.
After Placement of Dental Implants

Bleeding

    • Some bleeding or redness in the saliva is normal for 24 hours.
    • Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes.
    • If bleeding continues please call our office for further instructions.

 

Swelling

    • Swelling is a normal occurrence after surgery.
    • To minimize swelling, apply an ice bag, or a plastic bag, or towel filled with ice on the cheek in the area of surgery.
    • Apply the ice to the swelling 20 minutes on and 20 minutes off, for the first 36 hours. It is not necessary to apply ice while sleeping.

 

Diet

    • Drink plenty of fluids and avoid hot liquids or hot food.
    • Soft food and liquids should be eaten on the day of surgery.
    • Return to a normal diet as soon as possible unless otherwise directed.

 

Pain

    • Patients should begin taking pain medication as soon as you feel the local anesthetic wearing off.
    • For moderate pain, Tylenol or Extra Strength Tylenol may be taken every 4-6 hours as directed.
    • Do not exceed 4000mg of Tylenol in any 24 hour period. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets: 3-4 tablets may be taken every 6-8 hours as needed for pain. Do not exceed 3200mg of Ibuprofen in any 24 hours period.
    • For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic, or if you have been instructed by your doctor not to take it.

 

Antibiotics

    • Be sure to take the prescribed antibiotics as directed to help prevent infection.

 

Oral Hygiene

    • Good oral hygiene is essential to good healing.
    • On the night of surgery, use the prescribed Peridex Oral Rinse before bed.
    • The day after surgery, the Peridex should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 60 seconds then spit it out. Warm salt water rinses (teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, as well, especially after meals.
    • Brushing your teeth and the healing abutments is no problem once the surgical site is healed. Be gentle initially with brushing the surgical areas.

 

Activity

    • Patients are advised to keep physical activities to a minimum immediately following surgery.
    • If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising.
    • Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.

 

Wearing your Prosthesis

    • Partial dentures, flippers, or full dentures can be worn, but should not be used for chewing immediately after surgery and for at least 10 days as discussed during the pre-operative consultation appointment.
After Wisdom Tooth Removal

Immediately Following Surgery

    • The gauze pad placed over the surgical area should be kept in place for a half an hour. After this time, the gauze pad should be removed replaced if bleeding persists.
    • Avoid vigorous mouth rinsing or touching the wound area following surgery. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
    • Take the prescribed pain medications as soon as you begin to feel discomfort typically when the local anesthetic begins to diminish.
    • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
    • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

 

Bleeding

    • A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon.
    • Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary.
    • If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels.
    • To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call our office for further instructions.

 

Swelling

    • The swelling that is normally expected is usually proportional to the surgery involved.
    • Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair.
    • The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively.
    • Swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be rotated off and on, every 20 minutes while you are awake. After 48 hours, ice has no beneficial effect.
    • If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery.
    • Once the swelling begins to improve, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

 

Pain

    • Begin taking pain medication as soon as you feel the local anesthetic wearing off.
    • For moderate pain, Tylenol or Extra Strength Tylenol may be taken every 4-6 hours as directed on the packaging.
    • Do not exceed 4000mg of Tylenol in any 24 hour period. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets: 3-4 tablets may be taken every 6-8 hours as needed for pain. Do not exceed 3200mg of Ibuprofen in any 24 hour period.
    • For severe pain, the prescribed medication should be taken as directed.
    • Do not take any of the above medication if you are allergic, or if you have been instructed by your doctor not to take it.

 

Diet

    • After general anesthetic or I.V. sedation, liquids should be initially taken.
    • Do not use straws. Instead, drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot.
    • You may eat anything soft by chewing opposite the surgical sites. High calorie, high protein intake is very important. For patients who have had multiple teeth removed soft , cold, non chewing item are best.
    • Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake.
    • At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, experience less discomfort and heal faster if you continue to eat.
    • Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

 

Keep the mouth clean

    • No rinsing of any kind should be performed until the day following surgery.
    • You can brush your teeth the night of surgery but rinse gently.
    • The day after surgery you should begin rinsing 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.

 

Discoloration

    • In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively.
    • Moist heat applied to the area may speed up the removal of the discoloration.

 

Antibiotics

    • If you have been placed on antibiotics, take the tablets or liquid as directed.
    • Antibiotics will be given to help prevent infection.
    • Discontinue antibiotic use in the event of a rash or other unfavorable reaction.
    • Please call our office if you have any questions or concerns.

 

Nausea and Vomiting

    • In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine.
    • You should then sip on coke, tea or ginger ale. Sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.
    • If nausea persists call the office and anti-nausea medicine will be prescribed.

 

Additional Post-Surgery Information

    • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call our office if you have any questions.
    • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
    • You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
    • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots but rather bony walls which supported the tooth. These projections usually smooth out spontaneously however, if not, our oral surgeons can remove them.
    • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.
    • Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
    • Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.

 

Final instructions to patients

    • Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged however this is no cause for alarm. Simply remove the suture form your mouth and discard it.
    • The sutures will be removed if needed approximately one week after surgery. The removal of sutures requires no anesthesia or needles.
    • The pain and swelling should subside increasingly each day following surgery.
    • If your post-operative pain or swelling worsens or unusual symptoms occur, call our office for further instructions.
    • There will be an open area (cavity) where the tooth was removed. The cavity will gradually close over the next month and will heal with new tissue. In the meantime, the area should be kept clean especially after meals with salt water rinses or a soft toothbrush.
    • Brushing your teeth is okay – just be gentle at the surgical sites.
    • A dry socket is when the blood clot gets dislodged prematurely from the tooth socket.
    • Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. If this occurs, please call our office for further instructions.
    • If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercisin
After Exposure of an Impacted Wisdom Tooth

Do not disturb the wound. If surgical packing was placed, please leave it alone. The pack helps to keep the tooth exposed. However, if it gets dislodged or falls out do not get alarmed.

 

Bleeding

    • Some bleeding or redness in the saliva is normal for 24 hours.
    • Excessive bleeding which results in your mouth filling rapidly with blood can frequently be controlled by biting with pressure on a gauze pad placed directly on the bleeding wound for 30 minutes.
    • If bleeding continues please call our office for further instructions.

 

Swelling

    • Swelling is a normal occurrence after surgery.
    • To minimize swelling, apply an ice bag or a plastic bag or towel filled with ice cubes on the cheek in the area of surgery.
    • Apply the ice continuously as much as possible for the first 48 hours.

 

Diet

    • Drink plenty of fluids.
    • Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery.
    • Return to a normal diet as soon as possible unless otherwise directed.

 

Pain

    • You should begin taking pain medication as soon as you feel the local anesthetic wearing off.
    • For moderate pain, Tylenol or Extra Strength Tylenol may be taken every 4-6 hours as directed on the packaging. You should not exceed 4000mg of Tylenol in any 24 hour period. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets: 3-4 tablets may be taken every 6-8 hours as needed for pain. You should not exceed 3200mg of Ibuprofen in any 24 hour period.
    • For severe pain, the prescribed medication should be taken as directed.
    • Do not take any of the above medication if you are allergic, or if you have been instructed by your doctor not to take it.

 

Oral Hygiene

    • Mouth cleanliness is essential to good healing.
    • Clean your mouth thoroughly after each meal beginning the day after surgery.
    • Brush your teeth as best you can. Rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) six times a day.
    • Continue this procedure until healing is complete.

 

PLEASE NOTE: A clean wound heals better and faster.

 

Activity

    • Immediately after surgery, keep physical activities to a minimum.
    • If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising.
    • Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.
After Tooth Removal

After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. That’s why we ask you to bite on a gauze pad for 30 minutes after the appointment. If the bleeding or oozing still persists, place another gauze pad and bite firmly for another 30 minutes. You may have to do this several times.

 

After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities can dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.

 

After the tooth is extracted you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours.

 

Use the pain medication as directed. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.

 

It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean.

 

After a few days you will feel fine and can resume your normal activities. However, if you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, please call our office immediately at:

 

Lake Forest (949) 859-3822

 

Mission Viejo (949) 586-7000

 

Newport Beach (949) 760-1600

 

San Clemente (949) 661-0166

After The Removal of Multiple Teeth

After removal you can expect the following:

 

    • A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes.
    • If bleeding continues, a moist tea bag can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise and elevate the head higher than the body will help. If bleeding persists, call our office immediately.
    • Do not remove the immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.
    • Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 36 hours only. Apply ice 20 minutes on and 20 minutes off while you are awake.
    • For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 3-4 hours. Do not take more than 4000mg of Tylenol in any 24 hour period. Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 3-4 hours. Do not take more than 3200mg of Ibuprofen in any 24 hour period.
    • For severe pain use the prescription given to you. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, finish your prescription regardless of your symptoms.
    • Drink plenty of fluids. If many teeth have been removed, the blood volume lost during surgery needs to be replaced. Drink at least six glasses of liquid the first day.
    • Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt water rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One half teaspoon of salt in a glass of lukewarm water.). After you have seen your dentist for denture adjustment, take out denture and rinse 3 to 4 times a day.
    • Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.

 

The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:

 

    • The area treated may swell, reaching a maximum in two days. Swelling and discoloration around the eyes may occur.
    • The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 48 hours after surgery (remember ice packs are used for the first 48 hours only).
    • A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
    • If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline.
    • There may be a slight elevation of temperature for 24-48 hours. If temperature elevation continues, notify our office.

 

If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.

After The Removal of Multiple Teeth

After removal you can expect the following:

 

    • A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes.
    • If bleeding continues, a moist tea bag can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise and elevate the head higher than the body will help. If bleeding persists, call our office immediately.
    • Do not remove the immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.
    • Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 36 hours only. Apply ice 20 minutes on and 20 minutes off while you are awake.
    • For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 3-4 hours. Do not take more than 4000mg of Tylenol in any 24 hour period. Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 3-4 hours. Do not take more than 3200mg of Ibuprofen in any 24 hour period.
    • For severe pain use the prescription given to you. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, finish your prescription regardless of your symptoms.
    • Drink plenty of fluids. If many teeth have been removed, the blood volume lost during surgery needs to be replaced. Drink at least six glasses of liquid the first day.
    • Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt water rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One half teaspoon of salt in a glass of lukewarm water.). After you have seen your dentist for denture adjustment, take out denture and rinse 3 to 4 times a day.
    • Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.

 

The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:

 

    • The area treated may swell, reaching a maximum in two days. Swelling and discoloration around the eyes may occur.
    • The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 48 hours after surgery (remember ice packs are used for the first 48 hours only).
    • A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
    • If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline.
    • There may be a slight elevation of temperature for 24-48 hours. If temperature elevation continues, notify our office.

 

If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.

After Orthognathic Surgery

Recovering from Orthognathic (jaw) surgery will be a lengthy process that will be greatly influenced by the way the patient follows the post-operative instructions provided by our surgical team. Following these important guidelines will keep you comfortable, speed healing and will help to achieve successful results.

 

Pain Management and Swelling

If you received prescriptions for anti-inflammatory medications, narcotics and/or antibiotics, please follow the written instructions without skipping or altering the prescribed regimen. These medications will keep you comfortable and they also play an important role in reducing post-operative swelling.

 

Swelling can also be managed by applying a cold compress to the face during the first 48 hours after surgery. This may be facilitated by the “Jaw Bra” and cold water pump if you have been given one. After 2 days, a moist heat compress is recommended. Keeping the head slightly elevated and using a head wrap during the first 72 hours will also help to decrease swelling.

 

Bleeding

Mild, occasional bleeding is to be expected after surgery. If the bleeding becomes heavy or uncontrollable, please contact our office immediately. Strenuous activity can trigger bleeding and should be minimized during the healing period. However, patients are encouraged to move around and avoid lying in bed for extended periods of time in order to reduce the risk of blood clot formation in the legs or respiratory illness, such as pneumonia.

 

Smoking, spitting and drinking through straws should be avoided until bleeding has subsided.

 

Sutures and Rubber Bands

If re-absorbable sutures are used, they should begin to fall out after a few days, otherwise, the stiches will be removed during a scheduled post-operative appointment.

 

If rubber bands are used to hold the teeth together after surgery, you will to limit your diet to liquids and smoothly blended foods.

 

Oral Hygiene

It will be important to keep the mouth clean after surgery by gently brushing the teeth that can be reached at least twice each day. A mild saltwater solution or an antimicrobial mouth rinse might also be recommended several times daily after surgery.

 

Post-Operative Follow-Up Care

The Orange County Centers for Oral Surgery and Dental Implants wants to ensure that all patients have a positive experience with a healthy recovery. Patients are scheduled for a post-op checkup between 7-10 days after the day of surgery to evaluate the progress. However, prior to your follow up appointment, if you experience any complications or simply have additional questions, please do not hesitate to contact our office for immediate assistance.

After TMJ Procedcures

TMJ medication or biologic concentrate injection

The purpose of medication or biologic concentrate injection into the temporo-mandibular joint is to reduce pain, assist healing and improve function. Whether the injection consists of a steroid, hyaluronic acid, or platelet rich plasma, the after care is the same.

 

    1. Rest the affected joint. This means a diet that is non-chewing for the first few days (3-5) and then progressing to a diet that is mechanically soft, e.g.: scrambled eggs, well cooked vegetables and fish or soft chicken. To be avoided are foods like bagels, beef jerky, nuts, and tougher meats. Chewing Ice is to be avoided as well.
    2. It is normal for the upper and lower teeth on the side of the injected joint not to touch for few days. This occurs because the fluid in the joint pushes the lower jaw downward and opens the bite. The fluid in the joint must be absorbed by the body before the teeth touch again. Do not try to force the teeth to touch, but let this happen naturally.
    3. It is normal to have increased discomfort in the joint area for a few days after the injection. Continue to take the anti-inflammatory you have been prescribed (usually Meloxicam) and use the narcotic pain reliever as needed for the first couple of days.
    4. It is normal to have limited movement for a few days after the injection. If you have been advised to do range of motion exercises, start these as instructed a week after the injection.The exercises should be done to the point of mild discomfort that resolves after the exercise. If the pain increases during the exercise, or afterward, reduce or discontinue the exercise until the pain resolves.
    5. Application of ice to the affected joint, 20 minutes on and 20 minutes off, for the first 24-48 hours will help with discomfort and swelling.
    6. You may remove the Band-Aid after 24 hours and allow water from a bath or shower over the joint after 48 hours.
    7. Bruising of the skin around the injection site happens occasionally and will resolve on its own.
    8. Range of motion exercises, if specified, consist of mouth opening to maximum movement, chin protrusion to maximum movement, and right and left lateral jaw movements, 10 times each per exercise session, three times a day
    9. You may have temporary loss of movement in the muscles that elevate your eyebrow and close your eye tightly, on the side of the treated TMJ. This is because the local anesthetic solution injected to numb the joint also can temporarily block the nerve that moves these muscles. Usually the loss of muscle movement will wear off as the local anesthetic is metabolized.

 

TMJ Arthrocentesis (Jaw Joint Irrigation)

The purpose of TMJ arthrocentesis, or jaw joint irrigation, is to reduce the inflammatory, pain causing chemicals that accumulate in the joint after injury or prolonged inflammation and immobility. An arthrocentesis can also help to re-mobilize a joint that has temporarily lost movement due to an injury. All of the above after care instructions apply, with the addition of the following:

 

    1. Swelling is normal after arthrocentesis as a side effect of the fluid used to rinse out the joint diffusing into the surrounding tissues. The swelling will resolve on its own and can be helped by applying ice as discussed above, for the first 24-48 hours. Thereafter, a daily application of heat for 20 minutes, at the end of the day will be helpful in swelling resolution as well.

 

TMJ Arthroscopy

The purpose of TMJ arthroscopy is to reduce pain and re-establish normal range of motion in a temporo-mandibular joint that demonstrates long-standing loss of movement and pain, where injection and /or arthrocentesis has failed, or would not be effective in restoring normal joint function. The TMJ arthroscopy is performed in an out-patient surgery facility under general anesthesia. If intra-operative photographs are taken, you will be given copies. All of the above after care instructions apply, with the addition of the following:

 

    1. You will have a small (about 1/4inch) incision in front of your ear canal that will be sutured. Please keep the incision covered for 48 hours with a Band-Aid and antibiotic ointment (Bacitracin or Neosporin). After 48 hours, you may shower and dress the incision with a small dab of the antibiotic ointment 3 times daily. This will minimize the chance of infection and scar formation. The sutures will be removed about 1 week post-operatively.
    2. You may have decreased hearing in the ear on the side of the treated TMJ, for a few days. This occurs because biologic fluid from the procedure congests the middle ear and dampens the transmission of sound, until the fluid clears. This may take a few days, but your hearing will return to its pre-treatment state.
    3. As mentioned above in #9, the nerve that animates the forehead and eye-closing muscles can be blocked by the local anesthetic used to numb the joint. Usually this side- effect resolves as the local anesthetic wears off, but with arthroscopy, can persist longer because of pressure put on the nerve by the fluid in the tissues around the joint. It is extremely unusual to have this temporary loss of nerve function not resolve completely.
    4. TMJ remobilization exercises are always given 1 week post-operatively and should continue until full jaw range of motion is achieved.