Irvine Oral and Maxillofacial Surgery

- Irvine Oral & Maxillofacial Surgery -Dr. Jeffrey A. Elo, D.D.S., M.S., Inc. diplomate of the american board of oral & Maxillofacial surgery

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ORAL SURGERY, IRVINE CA

Oral and maxillofacial surgery is the management, diagnosis, and treatment of diseases, injuries, and defects involving both the functional and aesthetic aspect of the hard and soft tissue of the face, jaw, and mouth.

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Driving Directions Wisdom Teeth

By the age of eighteen, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth or molar teeth are used to grind food up into a consistency suitable for swallowing.The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your Third Molars, also known as "wisdom teeth."Why Should I Remove My Wisdom Teeth?Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.These poorly-positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain and illness. The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.Oral ExaminationWith an oral examination and x-rays of the mouth, Dr. Elo can evaluate the position of the wisdom teeth and predict if there may be present or future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid- teenage years by their dentist, orthodontist, or by an oral and maxillofacial surgeon.All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Dr. Elo has the training, license, and experience to provide various types of anesthesia for patients to select the best alternative.RemovalIn most cases, the removal of wisdom teeth is performed under local anesthesia or intravenous general anesthesia. These options as well, as the surgical risks (i.e. sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding, bite down on the gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your post-operative kit will include postoperative instructions, a prescription for pain medication, antibiotics, and a follow-up appointment in one week. If you have any questions, please do not hesitate to call us at 714-556-7000. Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff that are experienced in anesthesia techniques.Feel free to give us a call at 714-556-7000 if you want to know more about wisdom teeth removal in the Irvine, CA area.
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Dental Implants

Dental Implants are the most predictable and natural form of tooth replacement. Dental implants are changing the way people live. They are designed to provide a foundation for replacement teeth which look, feel, and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything, knowing that teeth appear natural and that facial contours will be preserved. Patients with dental implants can smile with confidence. They are the standard of care.What are Dental Implants?The implants themselves are small titanium posts, which are inserted into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes. They are surgically placed into the jawbone. The bone bonds with the titanium, creating a strong foundation for artificial teeth. Small posts are then attached to the implant, which protrude through the gums. These posts provide stable anchors for artificial replacement teeth.Implants also help preserve facial structure, preventing bone deterioration that occurs when teeth are missing.The Surgical ProcedureFor most patients, the placement of dental implants involves two surgical procedures. First, implants are placed within your jawbone. For the first three to six months following surgery, the implants are beneath the surface of the gums gradually bonding with the jawbone. You should be able to wear temporary dentures and eat a soft diet during this time. At the same time, your dentist is forming new replacement teeth.After the implant has bonded to the jawbone, the second phase begins. Dr. Elo will uncover the implants and attach small posts, which will act as anchors for the artificial teeth. These posts protrude through the gums. When the artificial teeth are placed, these posts will not be seen. The entire procedure usually takes six to eight months. Most patients experience minimal disruption in their daily life.Surgical AdvancesThere are situations where the implants can be placed at the same time as a tooth extraction - further minimizing the number of surgical procedures. Advances in dental implant technology have made it possible, in select cases, to extract teeth and place implants with crowns at one visit. This procedure, called immediate loading, greatly simplifies the surgical process.Who actually performs the implant placement?Implants are a team effort between an Oral and Maxillofacial Surgeon and a Restorative Dentist. While Dr. Elo performs the actual implant surgery, the initial tooth extractions, and bone grafting (if necessary), the restorative dentist (your dentist) fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the implant process.What types of prostheses are available?A single prosthesis (crown) is used to replace one missing tooth each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended. A removable prosthesis (over denture) attaches to a bar or ball-in-socket attachments, whereas a fixed prosthesis is permanent and removable only by the dentist.Dr. Elo performs in-office implant surgery. Inpatient hospital implant surgery is for patients who have special medical or anesthetic needs, or for those who need extensive bone grafting from the jaw, hip, or tibia.Why dental implants?Once you learn about dental implants, you finally realize there is a way to improve your life. When you lose several teeth whether its a new situation or something you have lived with for years chances are you have never become fully accustomed to losing such a vital part of yourself.Dental implants can be your doorway to renewed self-confidence and peace of mind.Why would you select dental implants over more traditional types of restorations?There are several reasons: Why sacrifice the structure of surrounding good teeth to bridge a space? In addition, removing a denture or a partial at night may be inconvenient, not to mention that dentures that slip can be uncomfortable and rather embarrassing.Are you a candidate for implants?If you are considering implants, your mouth must be examined thoroughly and your medical and dental history reviewed. If your mouth is not ideal for implants, ways of improving outcome, such as bone grafting, may be recommended.What type of anesthesia is used?The majority of dental implants and bone grafts can be performed in the office under local anesthesia, with or without intravenous general anesthesia.Do Implants need special care?Once the implants are in place, they will serve you well for many years if you take care of them and keep your mouth healthy. This means taking the time for good oral hygiene (brushing and flossing) and keeping regular appointments with your dental specialists.
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Facial Trauma

/facial trauma

There are a number of possible causes of facial trauma such as motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work related injuries. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands). Soft Tissue Injuries of the Maxillofacial RegionWhen soft tissue injuries such as lacerations occur on the face, they are repaired by suturing. In addition to the obvious concern of providing a repair that yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands and salivary ducts (or outflow channels). Dr. Elo is a well-trained oral and maxillofacial surgeon and is proficient at diagnosing and treating all types of facial lacerations. Bone Injuries of the Maxillofacial RegionFractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, the age and general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures. One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique of treatment can often allow for healing and obviates the necessity of having the jaws wired together. This technique is called "rigid fixation" of a fracture. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly. The treatment of facial fractures should be accomplished in a thorough and predictable manner. More importantly, the patient's facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary, are designed to be small and, whenever possible, are placed so that the resultant scar is hidden. Injuries to the Teeth and Surrounding Dental Structures Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth. The proper treatment of facial injuries is now the realm of specialists who are well versed in emergency care, acute treatment, long term reconstruction and rehabilitation of the patient. Dr. Elo meets and exceeds these modern standards. He is trained, skilled and uniquely qualified to manage and treat facial trauma. He is on staff at local hospitals and deliver emergency room coverage for facial injuries.
Facial Cosmetic Surgery Bone Grafts

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Major and Minor bone grafting Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants. Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance. Major Bone GraftingBone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee.) Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patients own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.
Sinus Lift

/sinus lift

Sinus lift procedureThe maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.There is a solution and its called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patients jaw and dental implants can be inserted and stabilized in this new sinus bone.The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the Sinus Augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.
Snoring & Sleep Apnea

/snoring & sleep apnea

People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and air flow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears and the flow of air starts again, usually with a loud gasp. Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.Some patients have obstructions that are less sever called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Oral and Maxillofacial Surgeons offer consultation and treatment options.In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor individuals overnight.There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. One of the surgical options is a uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometime done with the assistance of a laser and is called a Laser Assisted uvulo-palato-plasty (LAUP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These are procedure usually performed under light intravenous sedation in the office.In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (Orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires 1 to 2 days overnight stay in the hospital.OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.
Preprosthetic Surgery

/preprosthetic surgery

Bone GraftingOver a period of time the jawbone associated with missing teeth atrophies or is resorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.Bone Graft ProceduresBone grafting can repair dental implant sites with adequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from tissue bank or your own bone is taken from jaw, hip, or tibia (below the knee). Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patients own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia) are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.Sinus Lift ProcedureThe maxillary sinuses are behind your cheeks and above the upper teeth. Some of the roots of the natural upper teeth may extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.There is a solution and it is called a sinus graft or sinus lift. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and the donor bone is inserted into the floor of the sinus. After several months of healing, the bone becomes part of the patients jaw and a dental implant can be inserted and stabilized in this new sinus bone. The sinus graft makes it possible for many patients to have dental implants when years ago there were no other option other than wearing loose dentures.If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and dental implants placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus augmentation will have to be performed first and allowed to mature for several months, depending upon the type of graft material used. Once the graft has matured, the dental implants can be placed.Ridge ExpansionIn severe cases, the ridge has been resorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge is too thin to place conventional implants. In this procedure, the boney ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and allowed to mature for a few months before placing the implant.Ridge Preservation refers to a specific application of bone grafting that attempts to prevent the resorption of bone that normally follows the removal of a tooth. At the time of tooth removal, the resulting socket is filled with bone material and covered with a protective dressing. Our doctors typically use processed cow or human donor bone for this purpose, sometimes mixing it with a small amount of bone obtained from a neighboring area of the patients own jaw. Filling the socket with bone in this manner dramatically delays the normal bone resorption process that would occur at an extraction site. It also hastens the process of bone maturation at the site, thus allowing the placement of a dental implant sooner that would be possible if the socket was left to heal without the benefit of the added bone. This procedure is very successful in preserving the ridge of the bone that is necessary for implant placement-hence the term ridge preservationPostoperative recovery following this procedure is usually no more complicated than that following removal of a tooth without ridge preservation.
Orthognathic Surgery

/orthognathic surgery

What is Orthognathic Surgery?Orthognathic surgery has been referred to as surgical orthodontics because the oral and maxillofacial surgeon uses the surgical procedure to reposition the upper and lower jaws. This can be compared to an orthodontist correctly repositioning the teeth. The overall goal for orthognathic surgery is to correct and align minor and major facial and jaw irregularities. This not only improves facial appearance but also ensures that the teeth meet correctly and function properly.Orthognathic surgery is performed using the team approach in which the patient, the orthodontist, and the oral and maxillofacial surgeon have integral roles.Who needs Orthognathic Surgery?People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and in some instances the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing, function, speech, long-term oral health, and appearance. Injury to the jaw and birth defects can also affect jaw alignment and position. Orthodontics alone can correct many bite problems if only the teeth are involved, orthognathic surgery may be required if the jaws also need repositioning.Difficulty in the following areas also need repositioning:*Chewing*Biting or swallowing*Speech problems*Open bite*Protruding jaw*Unbalanced facial appearance*Facial injury*Birth defects*Receding chin*Inability to make lips meet without effort
Oral and Facial Pathology

/oral & facial pathology

The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or cancerous growth: *Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth *A sore that fails to heal and bleeds easily *A lump or thickening on the skin lining the inside of the mouth *Chronic sore throat or hoarseness *Difficulty in chewing or swallowing Dr. Elo uses the newest of technology to visualize pathology in it's earliest stages.These changes can be detected on the lips, cheeks, palate and gum tissue around the teeth, tongue, face and/or neck. Pain does not always occur with pathology, and curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.We would recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body's most important warning systems. Do not ignore suspicious lumps or sores. Please contact us so we may help.
Meet Dr. Elo

/meet dr elo

Dr. Jeffrey Elo is a Board Certified Oral and Maxillofacial Surgeon. EducationDr. Elo completed his Bachelor's degree and graduated summa cum laude from Indiana University. He then pursued a Master of Business Administration degree from Indiana University prior to entering dental school. He then attended dental school at the Indiana University School of Dentistry in Indianapolis, Indiana, graduating magna cum laude. Upon completion of dental school, Dr. Elo entered a 4-year, hospital-based oral and maxillofacial surgery residency program, pursuing his Certificate in Oral and Maxillofacial Surgery at Loma Linda University Medical Center and Loma Linda University School of Dentistry in Loma Linda, California. While in residency, Dr. Elo also obtained a Master of Science degree from Loma Linda University School of Dentistry for his thesis entitled, "Implant Success In Bone Grafted Versus Distracted Bone Sites." Faculty Appointment and Surgical InterestsDr. Elo is currently a full-time Clinical Professor of Oral and Maxillofacial Surgery at Loma Linda University Medical Center/School of Dentistry, and maintains a private practice in Irvine, California. Dr. Elo's surgical interests include a wide variety of oral and maxillofacial surgical procedures, including:In-Office Intravenous Sedation In-Office General AnesthesiaRemoval of Impacted Wisdom TeethPlacement of Dental ImplantsFacial/Oral TraumaReconstructive Jaw Surgery and Bone GraftingOrthognathic SurgeryFacial/Oral Growths/Oral Pathology Licenses and CertificationsDr. Elo is a Diplomate of the American Board of Oral and Maxillofacial Surgery (Board Certified), and currently holds a dental license and general anesthesia permit in the state of California. He possesses current certification for Basic Life Support, Advanced Cardiac Life Support, Advanced Trauma Life Support, and Pediatric Advanced Life Support. Dr. Elo has published numerous articles in both national and international journals on topics related to oral and maxillofacial surgery, and has lectured extensively locally and nationally on oral and maxillofacial surgery and anesthesia-related topics.Dr. Elo is a Fellow/Member of many professional organizations, including:American Association of Oral and Maxillofacial SurgeonsCalifornia Association of Oral and Maxillofacial SurgeonsAmerican College of Oral and Maxillofacial SurgeonsInternational Association of Oral and Maxillofacial SurgeonsAmerican Society of Dental AnesthesiologistsCalifornia Society of Dental AnesthesiologySouthern California Orofacial AcademyAmerican Dental AssociationCalifornia Dental AssociationOrange County Dental SocietyHospital AppointmentsLoma Linda University Medical Center (Loma Linda, California)Arrowhead Regional Medical Center (Colton, California)Providence Little Company of Mary Medical Center (Torrance, California)PersonalDr. Elo and his wife, Gabriela, are the proud parents of two young boys, Logan and Landon. They reside in Irvine, and they attend Harvest Orange County.
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Meet Our Team

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/office tour

/before anesthesia

/after wisdom tooth extraction(s)

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.Immediately Following Surgery: * The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded. * Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged. * Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished. * Restrict your activities the day of surgery and resume normal activity when you feel comfortable. * Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.Pain:For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours.For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.Swelling:The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body's normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 24 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Forty-eight hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.Bleeding:A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.Diet:After surgery, cold, soft foods are recommended. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.Keep the mouth clean:No rinsing of any kind should be performed until the two days following surgery. You can brush your teeth the night of surgery but rinse gently. The third day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.Further instructions regarding post-wisdom teeth removal will be discussed prior to surgery with Dr. Elo.If you have any questions or complications, please call us at 714.556.7000.© PBHS

Post Extraction(s)

/post extraction(s)

* A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding continues, a moist tea bag can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture. * Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 24 hours only. Apply ice continuously while you are awake. * For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 3-4 hours. Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 3-4 hours. * For severe pain use the prescription given to you. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, finish your prescription regardless of your symptoms. * Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day. * Do not rinse your mouth for the first and second post-operative day, or while there is bleeding. After the second day, use a warm salt water rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One half teaspoon of salt in a glass of lukewarm water.). After you have seen your dentist for denture adjustment, take out denture and rinse 3 to 4 times a day. * Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet. * The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal: o The area operated on will swell reaching a maximum in two days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 48 hours after surgery (remember ice packs are used for the first 24 hours only) o A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days. o If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline. There may be a slight elevation of temperature for 24-48 hours. If temperature continues, notify our office. o If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.© PBHS

Post Dental Implant(s)

/post dental implant(s)

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound for two days after the surgery. There will be a metal healing abutment protruding through the gingival (gum) tissue.BleedingSome bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call for further instructions.SwellingSwelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, or a plastic bag, or towel filled with ice on the cheek in the area of surgery. Apply the ice continuously, as much as possible, for the first 24 hours.PainYou should begin taking pain medication before you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.DietDrink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.Oral HygieneGood oral hygiene is essential to good healing. After 48 hours, warm salt-water rinses (teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, as well, especially after meals. After 48 hours, brushing your teeth and the healing abutments is no problem. Be gentle initially with brushing the surgical areas.

Post Bone Graft

/post bone graft

/post sinus lift

A certain amount of swelling, pain and bleeding is normal.The following instructions are provided to make your postoperative recovery period as short and pleasant as possible.You will be having a Sinus Lift if the area in the upper jaw that you are to have an implant(s) currently has insufficient bone because of an enlarged sinus. This procedure will augment the deficient area in the maxillary sinus. The bone that is being grafted will most commonly be coming from freeze dried bone and artificial synthetic bone. Other sites may be used for donation of your own bone as previously discussed with you by our doctors. Because of this you may have two post-surgical wounds: The donor site and the recipient site.IF AT ALL POSSIBLE, DO NOT BLOW YOUR NOSE FOR THE NEXT FOUR (4) WEEKS. This may be longer if indicated. You may sniff all you like but NO BLOWING.Bite down and maintain firm pressure on the gauze pack that was placed at the end of your surgery. There may be two areas of gauze in your mouth. Do this for at least 30 minutes. At that time remove the pack and replace it with another gauze sponge as provided. Repeat this as necessary. There should not be excessive bleeding. Bright red blood rapidly pooling in the area is not normal. If this occurs and does not decrease with pressure please call the office immediately. There may be a small amount of nasal discharge. It may be clear or lightly bloody. Excessive bleeding from the nose should be reported immediately.If you were asleep for the surgery be sure to eat a soft nutritious food prior to taking any medications. This will decrease the chances of post surgical nausea. You were prescribed a antibiotic prior to surgery this should be continued until all the pills have been taken. You were prescribed a decongestant; take this until it is all gone. Take your pain medications as needed in accordance with the directions. Codeine or hydrocodone can be supplemented with Advil or ibuprofen type medications. Be sure you have no allergies that the doctor does not know about.Do not rinse or spit for a minimum of 72 hours and longer if possible. This tends to disturb the blood clot and can prolong bleeding, open the wound and slow healing. There should be no blood in your mouth. Saliva can be swallowed. Do not brush your teeth next to the surgery site for 48 hours or only brush in areas away from your graft surgery. When expectorating, BE GENTLE. If you used a prescribed mouthwash prior to surgery, it should be continued starting 24 hours after your surgery. Place the mouthwash in the area of the surgery and let it sit 30-60 seconds. Do not rinse with it until after you have returned for suture removal.Apply ice immediately in the areas where the surgery was done. Since your graft was in the upper jaw you can expect swelling and discomfort up into the nose and even under the eyes and cheeks. Bruising and discoloration is not unusual. Crushed ice or equivalent should be placed in a plastic bag then in a washcloth and placed on the face. Apply for 30 minutes, then off for 20-30 minutes. This should be done on a near continuous basis (or as much as possible) for the first 48 hours and longer if possible or if this helps reduce your pain.Avoid excess activity. In addition, DO NOT SMOKE. Do not drink with a straw or drink carbonated liquids (minimum 3 days). Do not consume alcoholic beverages while taking your pain medication. SMOKING CAN CAUSE THIS PROCEDURE TO FAIL.You will notice that you cannot see any new bone in your mouth as the gums covers the area. The area of the graft placement will feel full and tight. This is normal. Do not stretch your lip daily to inspect the area. This can cause wound breakdown.If you have a temporary flipper or denture to wear do not place it until the numbness in the area is gone. You very likely may need to wait until the stitches are removed until your denture can be worn. When it is placed it should not touch the gums in the area of the surgery. If it does, this can cause ulceration of the wound edges and breakdown of the suture margins. If you have questions about the fit of your flipper or denture, do not wear it until our doctors or your referring dentist can see you.© PBHS

Post Orthognathic Surgery

/post orthognathic surgery

BrushingYou will notice that it is much harder to keep your teeth clean with braces. Food compacts in the brackets and between your teeth, and can only be removed by brushing and flossing. If plaque remains on the teeth for any length of time, it will leave a permanent white scar on the surface. Brushing after meals should become part of your daily schedule. Use a soft toothbrush with firm pressure and brush at a 45-degree angle to the tooth; brush in small circles above and below the brackets. Click here for visual instructions. Your toothbrush will wear out faster because of your appliances, so be sure to replace it whenever the bristles start to fray. A Waterpik can be a useful addition but it cannot remove the sticky plaque that adheres to the teeth. Interplak toothbrushes are great. Flossing is important and should be done every day. The floss threaders are reusable.Eating HabitsPlease do not eat hard foods: nuts, ice, crisp taco shells, whole apples and carrots (cut them into pieces first), hard French bread crust and rolls, spareribs, corn on the cob (cut the corn off the cob before eating), and popcorn! These foods risk breaking brackets and wires. Also beware of nail biting and pen or pencil chewing habits, since these can damage your braces. Do not eat sticky foods: taffy, caramels, bubble gum, or sticky candy of any sort. Use common sense about most foods.Absolutely * No Gum * Sugarless or otherwiseSticky Foods: * Caramels * Sugar Daddies * Starbursts * Caramel Apples * Sugar Babies * Licorice * Toffee * Tootsie Rolls * Now & LatersHard Foods: * Nuts * Popcorn * Bagels * Apples * Corn on the Cob * Pizza Crusts * Carrots (uncooked) * Doritos * Pretzels * Minimize Sugar Intake * Eat Much Less * Candy * Ice Cream * Cake, Cookies * Pie * Foods with Sugar * Drink Much Less * Pop * Drinks with SugarBracesCheck braces once a week for anything loose or bent. If a bracket or band comes loose or you break a wire, please call our office so that we can arrange an appointment long enough to repair it. Try to explain what has happened by using the diagram provided. Be as specific as possible with the receptionist. If you lose your rubber bands, call us so we can mail you some more or drop by the office and pick some up.Sore TeethAfter braces are placed in the mouth it is normal for the teeth to be sore for about 2 or 3 days. Tylenol or Advil will help relieve this discomfort. Some irritation to the cheeks and tongue is normal, but if you feel anything sharp is poking you or any sores are developing, please call our office at 714.556.7000.ElasticsAttached to your braces, elastics (rubber bands) exert the proper force that creates the right amount of pressure to move teeth. In order for this force to remain constant, elastics must be worn all the time and changed every day. Any time missed in wearing your elastics will only make your treatment take longer, so remember these things:You are responsible for placing the elastics on your braces between appointments. Make sure to wear them as instructed. Remove them only when brushing your teeth, gums and braces after meals. Then put them back on immediately.Always carry a few elastics with you, so if one breaks you can replace it right away. If your supply is low, call the office and we will mail you an additional supply of elastics.If you forget to insert your elastics one day, don't double up the next day - just follow your regular instructions.Elastics become worn out. When they lose their elasticity, they don't provide the proper pressure on your teeth and jaws. It is very important to change them as directed, even when they are not broken.If your elastics break frequently, a wire or band loosens, or a hook breaks off - call our office immediately. Don't wait until your next appointment. These problems need to be corrected as soon as possible!Removable AppliancesThe removable appliance is carefully designed to move or to hold your teeth. It is important that it is worn according to instructions and brought to each appointment.Wear your appliance at all times, even while you are asleep. It may be removed while eating, swimming, or playing vigorous sports activities. In two or three days your speech will return to normal with the appliance in place. Avoid flipping your appliance with your tongue. This can cause damage to your teeth or breakage of your appliance.Your new appliance may make your teeth sore for a day or two, especially after an adjustment. If you have a sore spot on your gums call our office so that we can adjust the appliance.Clean your appliance by brushing it daily with toothpaste. Denture cleaner can also be used for a more thorough cleaning. If you are wearing a bonded wire retainer behind your front teeth, be extra careful to clean the wire and the area around it. Flossing should be done every day.Never wrap your appliance in a paper napkin or tissue and set it down on the table. You or someone else may throw it away. Don't put it in your pocket when playing or you may break or lose it. Whenever it is not in your mouth it should be in its plastic appliance case.Keep your appliance away from dogs or cats as they love to chew on them. Avoid storing them near any source of heat. Do not boil your retainer to sterilize it! If needed, bring it to the office and we will be happy to disinfect it for you.An additional charge will be incurred for lost or broken appliances.Orthodontic Brushing and FlossingBrush after every meal.(pictures are displayed on website corresponding to the instructions)Use a toothbrush with a small amount of toothpaste.Use circular, vibrating motions around the gumline for about 10 seconds on each tooth.Brush every tooth slowly.Brush the lower teeth up and the upper teeth down. Also brush your tongue and the roof of your mouth.Floss nightly after brushing to remove the plaque missed by brushing.Carefully pull waxed floss between wire and braces.Floss carefully around the braces.Floss carefully around the gum area.Floss around each tooth.ResultsProper Oral HygieneImproper Brushing and FlossingFirst AidIf a wire causes irritation, push the wire away from the area using the eraser end of a pencil or a Q-Tip. If the wire cannot be tucked away, cover the end of the wire with a small piece of wax, a cotton ball, or a piece of sugarless gum until you can see Dr. Elo for an adjustment.If the main wire has come out of the tube or pipe on your back molar tooth, attempt to reinsert the wire with a pair of needle-nosed pliers or tweezers. If the wire is not sticking you, place a piece of wax over the area. If the wire is sticking you and wax does not help, the wire can be cut with a small wire cutter or toenail clipper close to the back of the last brace. This is a last resort if professional help is unavailable.In case a rubber spacer falls out, take two pieces of dental floss and insert them through the spacer. Pull on both pieces of floss to stretch the spacer, then slide the spacer back and forth between the two teeth where it belongs. Once the bottom half of the spacer slips under the tight spot between the teeth, release and remove the floss and the spacer will fit back properly.If a bracket becomes loose, it usually remains connected to the main wire by a little rubber colored ring. Eyebrow tweezers can be used to reposition the brace if it flips around the wire and becomes a source of irritation. Call our office and inform us of your situation.If a piece of your braces breaks, save the piece and call our office to schedule a repair visit.Remain calm if you swallow a piece of your appliance. This will usually go into the stomach, passing out of the body in a bowel movement. However, should difficulty breathing be experienced you should seek immediate medical attention. X-rays will be taken to determine the location of the swallowed piece.If a retainer cracks, remove the retainer from your mouth and bring all the pieces to our office for professional repair.Take Aspirin, Tylenol or Ibuprofen (unless allergic) if your teeth are sore after a monthly visit.Rinsing your mouth with a cup of warm water and teaspoon of salt can also be soothing. If you teeth get sore suddenly in the middle of the month, give us a call. It is unusual for the teeth to get sore several weeks after your last office visit.If food becomes stuck between your teeth, use dental floss or a proxy brush to dislodge the food.If you cut your gums, tongue or the inside of your cheek, apply finger pressure to the bleeding site for several minutes. If the bleeding does not clot, call your orthodontist or family dentist.© PBHS

Woodbridge Medical Center 4950 Barranca Pkwy Ste. #202 Irvine, CA 92604p: (949) 679-3470 (714) 556-7000 f: (714) 556-6828