13.  Patient management

First appointment

Patient interview

In addition to the medical questionnaire that is systematically completed by the patient, the surgeon should ask the following questions:

• Do you receive regular medical checkups?

• Do you take medications on a regular basis?

• Do you take aspirin?

• Do you have allergic reactions?

• Have you experienced spasms?

Before deciding on the presurgical prescription, the patient’s medical history must be assessed for pericoronitis.

Clinical examination

After extraoral and intraoral examination, the clinician will be able to provide all relevant information pertaining to the surgical phase. It is essential to inform the patient of the possible risks if treatment is not carried out, as well as the risks inherent in the surgical treatment. It is strongly advised to give the patient an informed consent form, which clearly explains the possible incidents and accidents that may occur during and after surgery. This informed consent does not disengage the clinician’s responsibility in any case. However, in case of litigation, it will prove that the patient had been fully informed of the risks; this is a (legal) forensic obligation.

Specific instructions prior to oral surgery

The clinician should give an instruction form to the patient. This form summarizes the presurgical precautions previously mentioned, as well as the postsurgical recommendations to limit inflammatory reactions and avoid complications. Following is an example of the information to be provided.

Before surgery

In order that your surgery—carried out under local anesthesia—can be performed under optimal conditions, you should observe the following recommendations:

• Do not take any salicylic acid (aspirin and derivatives) during the 10 days preceding surgery.

• Take the prescribed medications.

• Avoid smoking and alcoholic drinks during the 12 hours preceding surgery.

• Eat normally during the hours preceding surgery.

After surgery

In order to ensure rapid healing and to avoid complications, you must observe the following recommendations.

During the first 24 hours following surgery:

• Immediately after surgery, keep biting on the gauze placed between your teeth at the site of the operation. (Replace the gauze three times.)

• Apply an ice pack as soon as possible to the surgical site for 15 minutes every half hour during the first 4 hours following surgery. This simple precaution will limit edema and bleeding.

• Take the prescribed medication, even if you feel no pain and observe no edema during the first few hours.

• Avoid hot food and drinks.

• Do not smoke.

• Avoid mouthrinses. In the case of slight bleeding, you may rinse with cold water if necessary and then bite on one or two folded gauze pads placed on the wound.

• If you lie down, keep your head in a raised position.

During the first week following surgery:

• If bleeding continues, rinse with cold water then bite on a gauze pad placed on the wound; the gauze pad should be renewed every 10 minutes. Inform the surgeon.

• Brush your teeth using cold water but avoid the area of surgery.

• Take all medication for the exact period of time specified on the prescription.

Radiographic examination

A standard presurgical radiograph is obtained routinely, but may be complemented with a CT scan where necessary.

Presurgical medication


A salicylate-free analgesic is given to the patient 30 minutes prior to surgery.


Antibiotics are prescribed in all cases where there is:

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Jan 20, 2015 | Posted by in Oral and Maxillofacial Surgery | Comments Off on 13.  Patient management
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