Pre-Surgical Instructions

• Anesthesia & Activity: Your procedure will be performed using local anesthesia. There are typically no restrictions regarding driving yourself home or returning to work immediately after the appointment.
• Medications to Avoid: Avoid over-the-counter Aspirin or aspirin-based products for 7 days prior to your surgery. You may continue taking standard NSAIDs (like Advil, Motrin, or Ibuprofen) up until the day of your procedure unless otherwise directed.
• Prescription Medications & Blood Thinners: Please continue taking all daily medications prescribed by your physician (including blood pressure, diabetes, and thyroid medications). CRITICAL: If you take prescribed blood thinners (such as Coumadin, Plavix, Eliquis) or a daily medical aspirin regimen, do not stop taking them unless our office or your physician explicitly instructs you to do so.
• Antibiotic Pre-Medication: If you have a medical condition (such as a joint replacement or heart condition) that requires antibiotic pre-medication before dental treatment, please ensure you take the appropriate dosage prior to your appointment as directed by your doctor.
• Diet: Do not fast. Please eat a normal breakfast or lunch before your scheduled arrival time.
• 24/7 Availability: A doctor from our practice is available at all times should any questions or problems arise after your treatment.

If you have any questions regarding these instructions, please call our office prior to your appointment day.

Post-Surgical Instructions

• Activity: Rest for the remainder of the day. Avoid strenuous exercise or heavy lifting for 24 to 48 hours. Routine, non-strenuous activities are perfectly safe.
• Bleeding & Swelling: Minor oozing of blood from the surgical site is normal on the day of surgery. You may also experience slight swelling and bruising. Swelling usually peaks 48 hours after surgery and will subside on its own.
• Ice Protocol: Apply an ice bag with firm pressure to your face over the surgical site. Alternate 20 minutes on, 20 minutes off, for the first 6 to 8 hours following surgery. Do not apply ice after the first 24 hours. Do not apply heat to your face.
• Protect Your Sutures: Do not pull back your lips or cheeks to inspect the surgical site. Manipulating the tissues can pull out or dislodge your sutures (stitches).
• Diet & Hydration: Maintain a nutritious diet of soft foods and drink plenty of fluids for the first 3 days. Avoid foods that are hot, sharp, crunchy, or require heavy chewing.
• Smoking & Alcohol: Avoid or strictly minimize smoking, vaping, and alcohol consumption for at least 3 days after surgery, as they severely delay the healing process.
• Pain Management: The surgical site will be tender. To manage discomfort, follow a strict schedule using over-the-counter Ibuprofen (Advil/Motrin). Take 600mg every 6 hours or 800mg every 8 hours as needed. Do not exceed 3,200mg of Ibuprofen in a 24-hour period.
• Oral Hygiene: You must keep your mouth clean to promote healing. Brush your teeth carefully, but completely avoid the gums near the surgical site. Starting 24 hours after surgery, gently rinse your mouth with warm salt water (½ tsp salt in a warm glass of water) or your Peridex rinse. Do not spit forcefully; let the liquid drool out over the sink.
• Suture Removal & Follow-Up: It is vital to return to our office for your scheduled suture removal appointment to ensure proper healing. We will also schedule short recall visits to monitor your long-term progress.
• Signs of Infection: While infection is rare, please call our office immediately if you experience increased pain or swelling after the third day, a fever, chills, or an objectionable taste/odor in your mouth.
• EMERGENCIES: Should any urgent complications arise, please call our office immediately. If you experience a medical emergency and are unable to reach us, go directly to the closest emergency room.

Surgical Considerations & Potential Risks

While apical surgery (apicoectomy) has a very high success rate, as with any surgical procedure, there are inherent risks. Your endodontist utilizes advanced 3D imaging (CBCT) and microsurgical techniques to precisely plan your treatment and minimize these risks.

1. Lower Teeth & Temporary Nensation Changes (Paresthesia)

• The Anatomy: The roots of lower back teeth often lie close to a main nerve that supplies feeling to your lower lip, chin, and gums. This nerve does not control movement, only sensation.
• The Risk: During surgery, this nerve can occasionally become bruised or irritated. If this occurs, you may experience tingling, numbness, or an altered sensation in your lip or chin after the local anesthesia wears off.
• The Outcome: In the vast majority of cases, this alteration is temporary and fully resolves on its own over a period of weeks or months. In exceptionally rare instances, a permanent change in sensation can occur.

2. Upper Teeth & Sinus Communication

• The Anatomy: The roots of your upper back teeth are located directly beneath or within the floor of your maxillary sinus cavity.
• The Risk: Removing an infection at the root tip can occasionally create a tiny, temporary opening between your mouth and your sinus.
• The Outcome: If this occurs during your procedure, your endodontist will inform you immediately. These openings typically heal spontaneously on their own if you follow these strict Sinus Precautions for 7 days post-surgery:

1. Do not blow your nose. Gently wipe it if necessary.
2. Do not hold back a sneeze. If you must sneeze, do so with your mouth wide open to prevent pressure buildup.
3. Avoid restrictions. Do not drink through a straw, smoke, or play wind instruments.

3. Post-Operative Infections

• The Risk: Because surgery is performed to eliminate an existing bacterial infection, a temporary flare-up or secondary infection can occasionally occur during the healing phase.
• The Management: This is easily managed. If you develop signs of infection (increased swelling, throbbing pain, or a fever after day 3), call our office. Most cases are quickly resolved with a brief clinical evaluation and a short course of targeted antibiotics.

Pre-Sedation Instructions: Appointment Checklist

• In-Office Medication: You will receive Triazolam (Halcion) for your oral sedation. Our team will administer it and monitor you in the office.
• Arrival Time: Please arrive exactly one (1) hour prior to your scheduled appointment to allow the sedation to take effect safely.
• Mandatory Escort: You must bring a responsible adult driver. They must speak with our team before dropping you off, and they are welcome to wait in our lobby. We cannot proceed with your treatment if you drive yourself or plan to use rideshares alone.
• Pregnancy: You cannot undergo oral sedation if you are or may be pregnant.
  No Nicotine: Refrain from smoking, vaping, or using any nicotine products for 12 hours before your appointment, as nicotine severely limits the effectiveness of sedation.
• No Caffeine or Grapefruit: Do not consume caffeine or grapefruit juice for 12 hours before or after your appointment. Caffeine counteracts the sedative, and grapefruit dangerously alters medication absorption.
• No Alcohol or Narcotics: Do not consume alcohol, recreational drugs, or narcotic pain medications (including Hydrocodone/Vicodin) for 24 hours before your visit.
• Fasting Rules: No solid food or dairy products for 6 hours before your appointment. You may drink plain water up to 2 hours before arrival.
• Clothing: Wear loose, comfortable clothing with short sleeves so we can comfortably place a blood pressure cuff and monitoring sensors. Wear flat, comfortable shoes.

Post-Sedation Instructions: For Companion & Patient

• No Driving or Machinery: The patient must not drive, operate heavy machinery, or sign legal documents for 24 hours after the appointment.
• Continuous Supervision: A responsible adult must stay with the patient until the medication completely wears off. Do not leave them alone, even if they appear alert.
• Fall Prevention: Avoid stairs. The patient should stay on the ground floor and be assisted by the arm when walking.
• Child Safety: The patient must not be left alone with or be solely responsible for caring for young children for 24 hours.
• Diet & Hydration: Encourage plenty of fluids (water or clear juice). The patient should eat soft foods as soon as they feel ready.
• Dental Restrictions: Avoid hot foods or drinks until the freezing completely wears off to prevent burns. Avoid sticky or intensely chewy foods until your general dentist places the final restoration.
• Pain Management: Take the recommended non-narcotic regimen (Ibuprofen and Acetaminophen) as directed.
• Emergency Contact: Call our office immediately with any questions. If you feel that your symptoms warrant a physician and you are unable to reach us, contact emergency services or go to the nearest emergency room.