pillows when resting or sleeping during the first 24 hours since lowering the head increases blood pressure and can promote continued bleeding.

Figure 5-58. - Placing a pressure pack.

Instruct the patient not to smoke or use a straw for at least 24 hours. Frequent spitting, sucking on the wound, and using mouthwashes should be avoided during this time to secure an adequate blood clot.

Inform the patient to take the prescribed medications for pain, and the antibiotics to prevent infection (if prescribed). It is best if the patient takes the first dose of pain medication after the removal of the initial gauze pack. This allows the pain medication to enter the blood stream before the effects of the local anesthesia wears off. swelling.

Instruct oral surgery patients to place an ice bag or chemical cold pack- on the external area of the treatment site for the first 24 hours only, to minimize swelling. Apply the ice for at least 30 minutes on and then 30 minutes off after the surgery. Any amount of time less than this will not permit the cold to penetrate the tissues adequately. Cold is effective in decreasing edema by constricting the blood vessels. Heat may be placed on the jaw after the first 24 hours to minimize

You should recommend a soft diet and sipping of water and fruit juices for a few days following dental surgery. Make sure the patient has an appointment to return for a post-surgical check in 3 to 5 days.

You should always remain with your surgical patients until they recover enough to be dismissed. Dismiss your patients as cordially as you received them. Closely observe the patients as they leave to make sure that they are steady and show no signs of distress. If patients exhibit any signs of dizziness, detain them until the dentist can evaluate their condition.

SUTURE REMOVAL

Sutures can be removed 3 to 7 days following surgery, depending on the material and procedure. For example, nylon or silk sutures are removed from 3 to 5 days after surgery if adequate healing has taken place. After the extraction site is examined by the dentist, suture removal can be delegated to the assistant.

Irrigate or swab the suture site with an antiseptic solution to remove any debris. Locate and account for all the sutures placed during the surgical treatment. Use a hemostat or cotton forceps to gently lift the suture away from the tissue to expose the attachment of the knot. With the scissors in the other hand, slip one blade of the scissors under the suture and one blade over the suture. Cut the suture material as close to the tissue as possible so that a minimum of material is pulled through the tissue. Grasp the knot and gently slide the suture out of the tissue. Take care not to pull the knot through the tissue, since this causes unnecessary discomfort to the patient. Continue lifting and snipping the suture material until all sutures are removed. Count and compare the number of sutures removed with the number placed as indicated in the patient's record. Irrigate the surgical area with antiseptic solution if there is any bleeding.

COMMON POST-SURGICAL COMPLICATIONS

Just as with any surgical procedure, there can be complications. In oral surgery, the common post-surgical complications are alveolar osteitis, swelling, and bleeding. These complications have been discussed in Dental Technician, Volume 1, chapter 6, "Emergency Treatment of Oral Diseases and Injuries," and under the Post-Surgical Instructions section in this chapter.