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PATIENT INFORMATION

Surgical instructions

Preoperative Instructions


APPOINTMENT: Please arrive 15 minutes before any surgery. LOCAL ANESTHESIA (numbing only) or NITROUS OXIDE: Eat and take all medications as usual (especially diabetics). You may drive and come alone unless instructed otherwise. I.V. ANESTHESIA or ORAL SEDATION: Have no food or drink after midnight. Have an escort to remain in the car during your treatment, to drive you home, and to attend to you until fully recovered from the anesthetic. (Due to COVID, you will be asked to remain in the car after checking the patient in). This may take the entire day. Diabetics on insulin – follow specific instructions given regarding insulin use and food. If you have albuterol, bring it with you to the procedure. If you have an illness such as a cold, cough, sore throat etc. please notify the office immediately. Your procedure may need to be rescheduled. MEDICATIONS/PRE-MEDICATIONS: If directed, take antibiotic one hour prior to procedure or as directed. If directed, take Benadryl one hour prior to appointment, usually 50mg. Take ALL routine PRESCRIPTION medicines as scheduled, unless instructed otherwise. All medicines should be taken with as little water as possible, before the procedure. Please make sure you have Benadryl 25mg tabs, Ibuprofen 200mg tabs and Tylenol 500mg tabs at home. CLOTHING: Wear comfortable, loose fitting clothing with short sleeves, eg. T-shirt. Contact lenses and jewelry must be removed. Do not wear finger nail polish or acrylic nails, as it interferes with our sensors.




Dental Implant Surgery


Immediate Postoperative Instructions After Placement of Dental Implants BLEEDING No spitting or rinsing your mouth for 2 days. These can cause bleeding. Bleeding is normal for 24 hours and will increase with talking and general activity. Bite on MOIST gauze for 20 minutes at a time and change until bleeding stops. If bleeding continues or is increasing, place a moist tea bag (not herbal) directly over surgical site and bite down for 1 hour. Repeat as needed. PAIN MANAGEMENT/MEDICINE After something cold and soft to eat, like a milkshake or yogurt, take pain medicine as directed. 600mg Ibuprofen AND 500mg Tylenol every 6 hours. Start this regimen 3 hours after the procedure and take it for 2 days. After that you can take them as needed. We do NOT routinely prescribe narcotics. If nauseated, take 25 mg of Benadryl to settle the stomach. Take antibiotic if directed. If rash or itching develops, stop taking antibiotic, take 25 mg of Benadryl and call the office. ICE Apply ice pack to face (20 min. on 20 min. off) for 24 hours to control bleeding, pain and swelling. FOOD/DIET Eat cold, soft foods until numbness wears off to avoid biting your lip or tongue. No hard, crunchy foods for 2 weeks. Refer to diet sheet for food suggestions. Avoid chewing on surgical site for at least 1 week while area is healing. Avoid straws for 2 days. ORAL HYGIENE Brushing with a soft bristled, manual toothbrush may be resumed the day following surgery, being careful to avoid the surgical site. You may gently rinse with water only, but do not swish vigorously to protect the surgical site If instructed, one week after the procedure, gently rinse with warm salt water twice daily for one week. [ 1 cup warm water + 1 tsp salt] EXERCISE No exercise or heavy lifting for 3-4 days, or as directed SWELLING/BRUISING Swelling and bruising are normal following surgery and can peak on day 3 then start to dissipate Bruising is possible, especially if patient is on blood thinners SMOKING/MUSCLE SPASM If pain increases or is referred to the ear on day 4-5, you may have a muscle spasm. Apply a COLD pack to the side of the face and take Motrin to reduce discomfort Smoking delays healing, avoid for 1 week following surgical procedures IF HEALING CAP PLACED (in addition to General Instructions): Continue rinsing with Peridex twice a day for one week. Do not brush healing cap for 2 weeks until gum tissue has healed. Do not use floss or WaterPik around the implant for one week SIGNS TO WATCH FOR Fever, chills, sour taste of pus, swelling that worsens after the third day, bleeding after the second day. If you notice any of these signs, call the office.




Wisdom Tooth Removal


BLEEDING Bleeding is normal for 24 hours and will increase with talking and general activity. Bite on MOIST gauze for 20 minutes at a time and change until bleeding stops. If bleeding continues or is increasing, place a moist tea bag (not herbal) directly over surgical site and bite down for 1 hour. Repeat as needed. PAIN MANAGEMENT/MEDICINE After something cold and soft to eat, like a milkshake or yogurt, take pain medicine as directed. 600mg Ibuprofen PLUS 500mg Tylenol every 6 hours. Start this regimen 3 hours after the procedure (before the numbness wears off) and take it for the first 3 days. After that you can use the same regimen as needed. * If nauseated, take 25 mg of Benadryl to settle the stomach. * If rash or itching develops with any medicine, stop the medicine, take 25 mg Benadryl and call the office. * If the entire side of your face hurts, including the head/neck/ears/opposite jaw, then the pain is likely to be a muscle pain. This is common for 1-2 weeks after any procedure. Use non-narcotic pain medicine as described above. In addition, use a COLD pack with gentle massage on the side of your face multiple times a day to relax the muscles. * If you have pain that goes to your ear around day 3-5 after an extraction and cold air or water worsens it, it could be a dry socket. Take Ibuprofen as above and call the office. ICE Apply ice pack to face (20 min. on 20 min off) for 1-2 days to control bleeding, pain and swelling. FOOD/DIET Eat cold, soft foods until numbness wears off to avoid biting your lip or tongue. No hard, crunchy foods for 2-3 weeks and avoid popcorn for 2 months. Refer to diet sheet for food suggestions. Avoid chewing on surgical site for at least 1 week while area is healing. Avoid straws for 1 week. ORAL HYGIENE Brushing with a soft-bristled, manual toothbrush may be resumed the day following surgery, being careful to avoid the surgical site. You may gently rinse with water only, but do not swish vigorously to protect the surgical site If instructed, one WEEK after the procedure, gently rinse with warm salt water twice daily for one week. [1 cup warm water + 1 tsp salt] EXERCISE/GENERAL No exercise or heavy lifting for 1 week Night guard/Retainer can be worn once the bleeding stops. Do not look at the surgical site. Each time you pull your cheek to look at it, you could loosen the sutures. If sutures loosen or fall out sooner than expected, it is okay. Continue to make sure not to disturb the site. For various reasons, the surgical site keeps changing color as it heals - white, red, purple, pink. All of this is normal. (See below for signs of infection to watch for) SWELLING/BRUISING Swelling and bruising are normal following surgery and can peak on day 3 then start to dissipate. Bruising is possible, especially if patient is on blood thinners. DRY SOCKET/SMOKING Avoiding straws, smoking, rinsing and exercise for 1 week following surgery Smoking delays healing, avoid for 1 week following surgical procedures. IF SINUS EXPOSURE There may be some bleeding from the nose on that side. Do not blow your nose or sneeze through your nose. If you have to sneeze, open your mouth wide Use the nasal spray and antibiotics as directed. SIGNS TO WATCH FOR Fever, chills, sour taste of pus, swelling that worsens after the third day, heavy bleeding after the second day. (Bad taste and smell of inadequate oral hygiene is expected during the first week) If you notice any of these signs, call the office.




Extraction and Bone Graft


BLEEDING Bleeding is normal for 24 hours and will increase with talking and general activity. Bite on MOIST gauze for 45 minutes at a time and change until bleeding stops. If bleeding continues or is increasing, place a moist tea bag (not herbal) directly over surgical site and bite down for 1 hour. Repeat as needed. PAIN MANAGEMENT/MEDICINE After something cold and soft to eat, like a milkshake or yogurt, take pain medicine as directed. 600mg Ibuprofen PLUS 500mg Tylenol every 4-6 hours. If nauseated, take 25 mg of Benadryl to settle the stomach. Take antibiotic if directed. If rash or itching develops, stop taking antibiotic, take 25 mg of Benadryl and call the office. If a life-threatening allergic reaction occurs, call 911. ICE Apply ice pack to face (20 min. on 20 min off) for 24 hours to control bleeding, pain and swelling. FOOD/DIET Eat cold, soft foods until numbness wears off to avoid biting your lip or tongue. No hard, crunchy foods for 2-3 weeks. Refer to diet sheet for food suggestions. Avoid chewing on surgical site for at least 1-2 weeks while area is healing. If a graft was placed avoid for 3 weeks or until the gums have closed. Avoid straws for 1 week. ORAL HYGIENE Brushing with a soft bristled, manual toothbrush may be resumed the day following surgery, being careful to avoid the surgical site. You may gently rinse with water only, but do not swish vigorously to protect the surgical site If instructed, one WEEK after the procedure, gently rinse with warm salt water twice daily for one week. [ 1 cup warm water + 1 tsp salt] EXERCISE/GENERAL No exercise or heavy lifting for 3-4 days, or as directed Night guard/Retainer can be worn once the bleeding stops. Do not look at the surgical site. Each time you pull your cheek to look at it, you could loosen the sutures. If sutures loosen or fall out sooner than expected, it is okay. Continue to make sure not to disturb the site. For various reasons, the surgical site keeps changing color as it heals - white, red, purple, pink. All of this is normal. (See below for signs of infection to watch for) SWELLING/BRUISING Swelling and bruising are normal following surgery and can peak on day 3, then start to dissipate. Bruising is possible, especially in older patients and if patient is on blood thinners DRY SOCKET/SMOKING If pain increases or is referred to the ear on day 4-5, call the office to be evaluated for a possible dry socket or muscle spasm. Take Motrin to reduce discomfort. Avoiding straws, smoking, rinsing and exercise for 1 week following surgery will decrease your chances of getting a dry socket. Smoking delays healing, avoid for 1 week following surgical procedures If BONE GRAFT PLACED (in addition to General Instructions) Do not spit, swish or rinse any liquids in your mouth or chew on that area for 3 weeks until the gum has healed – the bone graft can come out. Avoid any commercial mouth rinses (eg. Listerine), electric toothbrushes and water piks for 3 weeks. There can be an altered taste due to the bone graft or membrane material No swimming for 3 weeks while graft is healing. If SINUS EXPOSURE: There may be some bleeding from the nose on that side. Do not blow your nose or sneeze through your nose. If you have to sneeze, open your mouth wide. Use the nasal spray and antibiotics as directed. SIGNS TO WATCH FOR Fever, chills, sour taste of pus, swelling that worsens after the third day, bleeding after the second day. If you notice any of the signs, call the office.




Post Anesthesia Instructions


Do not drive for 24 hours Use assistance when walking etc. Delay bathing until the following day No alcohol for 24 hours If you develop itching or rashes from any medicine, take 25 mg of Benadryl and call the office.




Diet Sheet


Postoperative Diet Recommendations

Most food should be soft enough to swallow without chewing or should be cut into small pieces to minimize the need for chewing. The following suggestions may be helpful:


SOFT FOODS:

Cereal – Cooked breakfast cereals, cream of wheat, oatmeal
Bread – pancakes, soft bread, soft inner portion of bread or roll
Cheese¬ – cream cheese, cottage cheese, yogurt
Eggs
Fruit – Applesauce, ripe banana, melon
Meats – Fish and most seafood, ground meat, pulled pork
Potatoes – baked, mashed, sweet potatoes
Pasta – noodles with any sauce, meat sauce, cheese sauce
Soups
Vegetables – well cooked vegetables
Dessert – ice cream, custard, sherbet, Jell-O, pudding
Beverages – almost any, smoothies, milkshakes


AVOID:

Sandwiches, bagels, sub sandwiches, toast, crackers, pretzels,
Burritos
Hard crusted bread
Salads, raw vegetables, crunchy fruit like apples
nuts, raisins, seeds
Popcorn
Jellybeans, hard candies, chewing gum
Grits
Rice




Post Implant Care


After your dentist restores the implant with a crown, extreme maintenance should to be done to protect your implant. The most common reasons for failure of an implant are: Improper oral hygiene. Maintain excellent oral hygiene. Brush and floss just like any other tooth. Even though the crown won’t get decayed, lack of good hygiene can cause bone loss around the implant and eventual failure of the implant. Visit your dentist every 6 months or as needed and follow oral hygiene instructions carefully. We highly encourage smoking cessation. Uncontrolled immunosuppressive diseases, eg. Diabetes etc; or Immunosuppressive medications, eg. For rheumatoid arthritis etc. Bruxism/Clenching. If you are prone to clench or grind your teeth, we highly recommend getting a bite guard (night guard) to protect your implants. Talk to your dentist about it.





New Patients

Consultation Appointment/Patient Registration


Please BRING with you the following information at the time of your consultation: 1. Your surgical referral slip and any X-rays if applicable 2. A list of medications you are presently taking Also, to save time during your appointment, please fill out the following forms ONLINE: 1. Patient Information Form 2. Medical/Dental History 3. HIPAA Privacy Policy and Release of Information [Here is the HIPAA Policy for your review.] 4. Please Email us a FRONT AND BACK copy of your dental insurance card. Your first appointment at our office will be to review your condition and medical history. Please alert the office if you have a medical condition that may be of concern prior to surgery (e.g.diabetes, high blood pressure, artificial heart valves, rheumatic fever, etc.) or if you are currently taking any medication (e.g. heart medications, aspirin, anticoagulant therapy, Fosamax, Actonel, etc.). Based on your physical condition, treatment options and anesthesia options will be presented. Your surgical appointment and necessary prescriptions as well as preoperative and postoperative instructions will be given at that time. Only occasionally will actual surgery be performed on the day of consultation. Please allow 30-60 minutes for your consultation. Important: All patients under the age of 18 years of age must be accompanied by a parent or legal guardian at the consultation visit.




Scheduling


Schedule your consultation appointment online or call us at 410-337-7755 to schedule. Our practice is open Monday through Friday, 8am to 4pm. We will schedule your appointment as promptly as possible. If you have pain or an emergency situation, every attempt will be made to see you that day. Generally surgical appointments are made in the morning. The afternoon appointments are for consultations, post-operative visits and emergencies. Consultation visits require approximately half to one hour. We try our best to stay on schedule to minimize your waiting. Due to the fact that our practice provides surgical services, various circumstances may lengthen the time allocated for a procedure. Emergency cases can also arise and cause delays. We appreciate your understanding and patience.




X-Rays


If your dentist or physician has taken x-rays, you may request that they forward them to our office. If there is not enough time, please pick them up and bring them to our office. If additional films are necessary, they can be taken at our facility.




Anesthesia Preparation


A preoperative consultation and physical examination is mandatory for patients undergoing IV anesthesia for surgery.





Payment options

What insurances do we work with?


Here is the full list of Insurance Companies we Participate with :

Aetna EXTEND

Alwayscare/UNUM

Ameritas

Careington DISCOUNT plans ONLY. No PPO

Cigna

Delta Dental

Dominion National

GEHA

Guardian

Unicare

United Concordia

Since there are numerous individual plans, Please CONFIRM with your insurance company if Dr. John is in network with your plan prior to an appointment.




Insurance & Fees


Our business office staff is experienced with insurance procedures and can answer most questions regarding billing or insurance coverage. We will give you a fee-for-services Treatment Plan during the initial consultation. 1. Out of Network and Uninsured patients: We collect 100% of fees prior to any procedure. 2. We do not accept any Medical Insurance. Patients will have to file medical claims on their own. We will provide you with the necessary codes etc so that you can file it. 3. In-Network patients: We require a 50% down payment prior to services. If the PreAuthorization (Pre-determination) is available, you will be asked to pay whatever that amount is. Insurance will be billed after the procedure and any reimbursement will be determined and provided over the next several weeks. Insurance generally pays a portion of your bill. For your convenience, our staff will prepare and send your insurance claim. Fees for services are based on the complexity of the treatment, not on what insurance companies allow. Most communication is via email due to expediency and convenience. Please remember that you are fully responsible for all fees charged by this office regardless of your insurance coverage. We accept VISA, Mastercard and Discover credit cards. We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect payments made by your insurance company during that time period. Any remaining balance after your insurance has paid its portion is your responsibility. Your prompt remittance is appreciated. We can make arrangements for a monthly payment plan, but that must be implemented prior to any actual procedures.




Healthcare financing information


If you are interested in obtaining financial help for procedures, please visit the Care Credit website.





Existing Patients

If you are an existing patient:


Existing patients can login to our Patient Portal where they can view scheduled appointments, treatment plan and account balance. If you are interested in this service, please email the office and we will send you the user id and a temporary password.