1.POTENTIALLY LIFE-THREATENING MEDICAL EMERGENCIES:

a. If an individual suffers a potential life-threatening medical emergencies, you should obviously call 911 immediately and initiate appropriate basic life support such as CPR as indicated and within the limitations of your personal skills and knowledge.
b. Within the scope of this potentially life-threatening emergencies, we should include loss of consciousness, respiratory distress, chest pain and drug-related emergencies such as overdose or allergies and severe facial injuries from trauma such as a motor vehicle accident.

2. NONLIFE-THREATENING MEDICAL EMERGENCIES:

a. If an individual sustains facial injuries such as facial fractures or lacerations from a fall or altercation, the patient should be brought immediately to either Hotel Dieu Hospital or the Metropolitan Campus of Windsor Regional Hospital for immediate care.
b.The airway should be maintained and pressure applied over those areas that may be bleeding or oozing.
c. Avoid any movement, if at all possible, to those areas of injury.

3. DENTAL TRAUMATIC INJURIES:

a. If there is a fracture, mobility or tenderness to a tooth from a traumatic injury, then your dentist should be called. Your dentist will determine the extent of the fracture, cause of the mobility and tenderness and treat the tooth accordingly
b. If a tooth is loose and is displaced out of its normal position, then your dentist should be called immediately, because the tooth will have to be realign into its normal position as soon as possible.
c. If a tooth is literally knocked out of your mouth, retrieve the tooth and keep it in a clean moist handkerchief or Kleenex or even a glass of milk. Since time is of the essence, report to your dentist immediately.

4. TOOTHACHE:
a. Obviously there is nothing worse than a toothache, however, it is not necessarily a life-threatening emergency that requires immediate treatment. If you feel a toothache developing, it is best to contact your dentist during normal business hours to treat your toothache, then waiting until the evening hoping it will get better.
b. If you call after normal hours, you may find that the dentist is not available, particularly if you have not seen him for an extended period of time.
c. If your dentist is not available or you do not have a dentist, then it may be necessary for you to call the Essex County Dental Association Emergency Service. The phone number can be found in the yellow pages under “Dentist”.
d. If you cannot find a dentist, then you may have to go to the hospital for pain medication, but be aware of the fact that they will not call a dentist in to see you nor prescribe any more medication than to last you until the next morning.
e. Prevention is always the best treatment - don’ wait for that toothache to get better. It won’t. It may be too late to find your dentist or any dentist to treat you at night or on the weekends.

5. POSTOPERATIVE PROBLEMS AND COMPLICATIONS:

a. BLEEDING:
1) Some bleeding from the sockets and gums is expected from the minor dental surgery.
2) Placer a moist folded gauze pad directly over the surgical extraction site which should control the bleeding and oozing quite rapidly.
3) Do not rinse, drink through a straw, smoke, drink alcohol or hot beverages or spit out forcefully
4) Slight oozing of blood is expected the first day and night after surgery. Please note that one drop of blood mixed with your saliva may lead you to believe that your bleeding is much worst than it actually is.
5) If bleeding persists after the first day, please call our office.

b. CRACKED LIPS:
1) The corner of your mouth and lips may appear dry and a tendency to ”crack” following oral surgery.
2) Avoid opening your mouth wide and place Vaseline on them for comfort.

c. BRUISING:
1) A black and blue discoloration of the skin sometimes occurs following oral surgery near the surgical areas. We suture the gums following the surgery, but can’t suture the bone. This represents oozing from the bone and generally occurs the 2nd to 3rd day following surgery.
2) It doesn’t mean anything, although it may look bad. It changes color from black and blue to green to yellow and works its way down the chest talking about 7-10 days to disappear.

d. SWELLING:
1) Most patients swell following oral surgery, some more than others.
2) The swelling is nature’s defense mechanism whereby all the white blood cells rush in to clean and bathe the tissue to accelerate healing.
3) It generally takes about three days for the swelling to reach its peak and about three days for it to go back to normal. During this time period, you’ll find that you won’t be able to open too wide.
4) Place ice on the swollen off and on almost continuously while it is swelling to help prevent more swelling. It is best to use crushed ice cubes in a plastic sandwich bag wrapped in a kitchen towel, so that you can still feel the coldness through the towel. Frozen peas can be used in the same manner.

e. PAIN:
1) Unfortunately pain and stiffness of the jaws are generally expected following oral surgery. A good attitude and the following of these instructions will go a long way in reduction of the pain in a shorter period of time.
2) We recommend that you supplement your diet with Boost a lactose-free meal replacement following surgery. Always take a Boost prior to taking any pain medication so as to avoid nausea and vomiting.
3) Take the pain medication as directed by our office and as written on the bottle of pills. The medication may affect your judgment and reflexes and may make you sleepy or drowsy, so avoid the use of machinery or driving any vehicles until you are off the medication.
4) The discomfort will generally begin to subside as the swelling begins to go down.
5) If you smoke, even one puff of one cigarette, during the first week of healing, you will in all likelihood develop a “dry socket” which is whereby the blood clot washes out of the socket so that each and every nerve in your bone is exposed. Pain medication generally doesn’t help and you’ll have to return to the office during regular business hours for the placement of special dressings to relieve the pain. It just isn’t worth taking that chance by smoking.

f. DIET:
1) As soon as you get home from surgery, you should take the Boost as mentioned above following by a pain pill that we prescribed before the freezing wears off. Try to stay ahead of the pain and discomfort if you can.
2) The Boost coats your stomach so that the pain medication won’t cause nausea, but also provides needed nutrition.
3) Eat whatever you want to eat, but “if it hurts, don’t eat it”. Use common sense since in all likelihood, you’ll be on a soft non-chewable diet for several days.
4) Attempt to have 3-4 cans of Boost a day as well as whatever else you can eat such as soup, jello, pudding, pasta, mashed potatoes, etc. Actually anything that you can place on a spoon and swallow.
5) Consume 2-3 liters of fluid a day also consisting of juice, ginger ale and water.

g. DISCOMFORT FROM SUTURES.
1) Dissolvable sutures were placed in most cases. They may irritate the inside of your mouth, but will fall out on their own in several days.
2) If you find that they are hanging down and bothering you, that means that they are ready to come out. Just give them a slight tug and they’ll come out.

h. ORAL HYGIENE:
1) It is very difficult to maintain proper hygiene following any form of oral surgery. Generally don’t practice any oral hygiene in the surgical site on the day of surgery. However, you may brush your other teeth.
2) You may start to rinse your mouth about 24 hours following surgery gently with warm salt water. This can be made by placing one teaspoon of table salt in an 8 oz glass of warm water. Do so very gently.
3) In most cases, about the third day following surgery, you may place a little toothpaste on your fingertip and gently massage the surgical area. This will help keep it clean as well stimulate healing to the tissue.
4) Don’t use commercial mouthwash such as Scope or Listerine because they are only alcohol, water, flavoring and food coloring and don’t stimulate healing.

i. DENTURE IRRITATION:
1) When dentures are placed at the time of surgery, they are placed only to make you look good, not for esthetics. They are “looking” teeth, not “chewing” teeth.
2) If you can eat with them, it is a bonus. Don’t expect to
do so for several days or even a week.
3) If the dentures are too loose or too tight or they hurt, leave them out. The first rule is “if it hurts, don’t do it”. Adjustments can always be made by your dentist a few days later. Just don’t allow the dentures to cause any damage to your healing tissue.

j. SPECIAL PROBLEMS:
1) If a patient does not consume 3-4 Boost a day, plus whatever else they can eat, and 2-3 litres a fluid a day, they will get sick. The body needs so much energy to exist. Therefore if you don’t eat and drink, then the body steals the glucose and fluid from the cells for its needs.
2) The patient develops flu-like symptoms within the first 3-4 days with very dry skin with cracked and dry lips. The skin feels and looks pale and the patient is glassy-eyed. If this develops than it is extremely important that the patient be dehydrated, that is , given plenty of fluids, as well as multiple cans of Boost plus whatever else they can eat. If the patient is uncooperative, then at times, an intravenous must be started to administer sugar water to the patient. Don’t let this happen.

k. BONE CHIPS:
1) Infrequently bone chips do develop following oral surgery. Generally they may work themselves out within a few days.
2) Sometimes the “bone chip” is actually the contour of your bone following surgery. If so, nature will smooth it out over a period of time.

l. NAUSEA AND VOMITING:
1) infrequently, nausea following by vomiting may occur
following surgery or the administration of certain types of medication, particularly narcotic pain medication.
2) To prevent nausea, always take the pain medication on a full stomach such as a Boost milkshake.
3) If nausea does occur, stop all medication and take a Gravol pill. Do not take any more pain medication until the nausea subsides. If it doesn’t within several hours, then you may have to repeat the Gravol pill.
4) If vomiting occurs, then stop all medication by mouth and administer a Gravol Suppository following the instructions on the box. Do not take anything by mouth until the nausea and vomiting ceases. You may have to repeat the suppository if relief is no obtained with 3-4 hours.
5) Once vomiting stops, avoid the pain medication, if you can and switch to Motrin or Advil taking 200mg every three-four hours. If you don’t get pain relief, then take another Boost, then take the narcotic pain medication.

m. ASYMPTOMATIC SWELLING 3-8 WEEKS AFTER SURGERY:

1) Infrequently, about 3-8 weeks following surgery of extractions, you may wake up one morning with a firm swelling in the cheek, usually of the lower jaw. It doesn’t hurt, yet is very noticeable.
2) At the time of the extraction, food dropped in the socket. The hole over the socket closed up and the food was trapped. About 3-8 weeks later, nature comes along and dissolves the food turning it into liquid. The liquid can’t get out, so it swells.
3) The treatment is very simple. I’m not going to treat you. You’re going to treat you. Place a hot water bottle or heating pad over the area protecting it with a cloth or towel so you don’t burn yourself. Leave this in place for only 5 minutes by the clock. This will make the blood vessels open up and the tissue over the area soft and mushy.
4) Follow the heat for 5 minutes with massage for 5 minutes almost as if you're squeezing a pimple. This will dissipate the fluid generally within 2-3 days. If it is tender, we may want to place you on antibiotics to prevent an infection from occurring.

The above information is being presented only as a guide to you in the treatment of medical and dental emergencies. Obviously prevention is the best treatment. Don’t let problems develop. Follow the above instructions and call us if any further problems or questions develop.