Instructions to help you have  a more successful dental surgery by following these instructions for Preparation before your Implant/Bone Graft Surgery, what to do around the time of surgery as well as during the surgery and immediately after the surgery and long term

e.

Dental  Surgery 

During Surgery or dental treatment

1. Whenever possible Dr and staff will place a rubber dam.
2. The team will place a bite block to rest your jaw on. Some patients get jaw pain after extended dental surgery and bite block reduces that problem. It is especially important to place a bite block when we are extracting a lower tooth because the forces can cause jaw pain later. However some patients do not like bite blocks. This you can discuss with doctor. If you are having sedation the bite block  helps keep your mouth open and protects your jaw.
3. The rubber dam is for your protection, especially the air way, and makes an intra oral procedure extra oral and the dental team can see what they are doing better.  It keeps saliva and bacteria and soft tissue off the area we are working on and it prevents the patient from swallowing small parts that are used in implants and root canals for example.
4. We place a guard over your nose and face and eyes. It keeps you from breathing in particles or debris from dental procedures, it also protects your eyes.
5. We Like to place a sterile nasal hood over the patients nose and have them breath at least straight oxygen.  This nasal hood is important in protecting the patients airway and lungs and keeping foreign particles out of your airway. We prefer to use both the nasal hood and facial shield together  when possible for optimum protection.
6. If you are having only local anesthetic we will give you a clicker to communicate with because it is hard for you to talk with the dam on. Use it to tell us if you are having some discomfort.

Just before Surgery

1. When we do IV sedation we give our patient supplemental Oxygen to reduce stress on heart. We also provide Nitrous Oxide as an additional relaxant that dilates blood vessels and makes inserting catheter easier for every one. However if you do NOT like nitrous or it makes you nauseated please inform staff. You do not have to have that gas. 
2. We will perform a time out just before we are to start work. 
3. If you have taken oral sedatives to help you relax tell us how many. We may want you to take another one. Give any remaining tablets to your driver or put away in your pocket or purse. We cannot and will  not handle your personal pain medications and relaxants.
   
4. You can relax yourself by activating your vagus nerve. The Vagus (wondering) nerve is the 10th cranial nerve and part of the parasympathetic nervous system that calms and relaxes you. But if you are anxious you. The secret to reducing your anxiety while in the dental chair is to activate the vagus nerve. When we earlier asked you to drink a big glass of water that is not just to hydrate you but to help turn on the vagus nerve. So if you did not get your water let us know and we will get you a small bottle. Also taking ibuprofen activates vagus. Deep breathing slowly. When you take a big breath in push down on your stomach and diaphram with your stomach muscles. Hold your breath for a few seconds. Then make long exhale. Repeat this procedure a few times while you are waiting on the doctor or staff. You can do it in the reception area. It does work. Laughing, singing, icey drinks ice on your face. Splash cold water on your face when in the office RR. Light snacks, sugar, pleasant memories, flexing and relaxing your muscles, blow your nose, so many things you can do to make your visit easier on yourself.
5. Dr. does NOT use topical anesthetic on the injection sites because it has the opposite of the intended effect. It makes the patient get ready for a painful shot. It causes salivation that is messy, the topical numbs other areas of the mouth. It isn't tasty to a lot of people. It increases the anxiety time in the chair.
6. Dr. will shake your cheek or gently squeeze your cheek or put pressure on the site to be injected with a cotton swab. Of course if you are having IV sedation the shots are no problem for the patient.
7. If you are having gagging issues this is NOT a good time to find out so inform doctor early on in the visits.

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      Master, College of Conscious Sedation American Dental Society of Anesthesiology           

Peri Surgery- around the time of surgery

1. If you are having IV sedation we prefer  you not eat  four hours before visit. If you are having general anesthesia you can NOT eat after midnight.
   
2. If you are not having IV sedation Dr. recommends you have a light snack an hour before visit. Please arrive 15 minutes before surgery.
   
3. By taking 800 mg of ibuprofen one hour before visit you will have less pain during surgery and it has a slight anti swelling property. So if you can take ibuprofen the Dr. suggests you take 800 mg of ibuprofen.
4. If you do not have bladder issues it is a good idea to drink a glass of water  say 8-12 ounces within the hour before visit. Or if you prefer other liquid. If you drink alcohol it will impede healing. Please inform Dr. 
5. Inform Dr or staff of ANY change in your medical status
6. Inform Dr. of any medication changes or lapses
7. Inform doctor if you have to take narcotic pain medications for other problems that you have taken for long periods of time or are still taking narcotics. This is important because Dr. Starkey wants to avoid IV medications or other medications that can cause a reaction  that is very unsettling to the patient. The med we some times use to manage pain  is NOT a narcotic. That makes it safer. But if patient takes narcotics over many months or years the medication that we use will cause a reversal of the narcotic affects.  If you use narcotics or drugs we are not here to judge you. We need to know so that you have a wonderful visit without complications.
8. Inform Staff what if anything you have had to eat in the last 12 hours.
9. Please stop in the rest room to relieve yourself if the appointment is going to be an hour or more or if you are having IV or General Anesthesia.
10. If diabetic we need you to do a glucose check prior to surgery.
11. If you have gagging problems be sure and inform the doctor.
12. If you have TMJ problems please inform doctor.

Before any dental implant surgery it is necessary that:

1. You understand your options and you have asked all questions and gotten advice or suggestions from loved ones and or other dentists. Do NOT proceed without understanding the risks as well as advantages. Informed consents must be signed and witnessed. Implants are wonderful options but they are NOT for everyone and for every situation.
2. That you are in good systemic health. Uncontrolled diabetes will cause implant failure.
3. Your base line dental health must be good. That is to say gum disease should be properly managed, infections eliminated from teeth, antibiotics prescribed and used as advised.
4. Excellent home care. Unless you are planning on having teeth pulled that are infected and no implants placed. Even then a cleaner mouth will reduce risk of infection spreading through the body.
5. It may be that teeth will need to be extracted and gums treated prior to any implant surgery or bone grafting. Thus it will take more time and more effort before implants can be placed.
6. Surgical Guide and three D scan may be required prior to the surgery.
7. Improved diet
8. Stop smoking. If you cannot stop smoking reduce smoking. If you are a smoker there is a higher risk of implant failure. And you will have to take responsibility for implant failure.  Use patch, us lozenge, or gum, or certain medications. Dr. Starkey can help you with this issue. Bone loss will be the result of smoking but implants can still survive sometimes.
9. You have to be an ASA I or II, that the Doctor will have discussed with you, in order to get an implant. For example your diabetes has to be in control.
10. You need to be in good psychological health.
11. Supplements can help prior to surgery, for example Fish Oil and Vitamin C in extra dosages that does not exceed what is healthy.
12. Exercise, ability to sleep well
13. If you are having full arch implants/ dentures placed after extractions and or implants then have your medications picked up ahead of the surgery so you only have to go home.
14. Have soft diet available for you for several days.
15. Have ice available. 
16. No chewing gum.
17. Night before surgery get a good nights sleep. It may be advisable to have an oral sedative prior to bed time
18. If you are to have an IV or sedation of any kind you must have a ride and some one to look in on you after the surgery.
19. If you have difficulty having catheter placed in right arm please notify doctor ahead of time.
20. Prior to any surgery and at time of evaluation base line health data is required.  While rare it is sometimes necessary to obtain a consult from your MD or specialist.
21. If you have airway problems or snore or use a CPAP or other device please inform Dr. 
22. If you grind or clench your teeth it is important that the Dr. know

Star Sedation Dentistry   

Specializing in Total Dentistry

                     With Advanced Infusion Therapy                   To Rejuvenate the Mind & Body

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