Complicated Extractions / Bisphophonate Drug Exposure

Here you can find:

  • General Description
  • FAQ: Frequently Asked Questions
  • Postoperative Instructions: ENGLISH
  • Postoperative Instructions: SPANISH; las Instrucciones


There are a variety of reasons why your dentist may have recommended that be extracted: infection, gum disease, fractured teeth, failed root canals and during the course of braces. The actual extraction may be very difficult due to its proximity to vital structures like a nerve that gives you sensation in your face or the sinus. The roost may be very crooked or the tooth may be stuck to the bone. The tooth may need to be removed with limited bone removal to increase the chance of receiving a DENTAL IMPLANT or may need to be grafted with bone (SITE PRESERVATION) to preserve the jaw structure for a future bridge or implant. These conditions increase the difficulty in removing the tooth. Dr. Leslie Heffez uses special techniques to atraumatically remove the teeth.


If you are taking certain medications, it may be dangerous to have an extraction. For example, if you are receiving or EVER have received an IV form of a bisphosphonate or bone building medication, Dr. Heffez may not recommend an extraction but alternative procedures such as orthodontic extrusion of a tooth or coronectomy (the removal of the top of the tooth leaving the root in place). Patients who have been treated for metastatic breast cancer, prostate cancer, multiple myeloma or severe osteoporosis may have received these medications. If proper attention is not taken, a severe bone infection may result in the jaws resulting in loss of a portion of your jaw bone.


The tooth is sectioned using a special drill into multiple pieces and removed like a puzzle. The tooth fragments are removed via the small opening of the tooth socket to minimize pain and discomfort.

Frequently, an antibiotic is prescribed as well as an anti-inflammatory (Ibuprofen, Advil, Aleve, Lodine are examples) and strong pain (Vicodin, Norco, Tylenol with codeine are examples) medications. The anti-inflammatory is taken around the clock to keep the pain level to minimal. It is unusual for you to use the strong pain medication that is prescribed. However, all three medications may be taken at one time.

Swelling and bruising should be minimal. However, it all depends on the difficulty of your procedure. Dr. Heffez will be better able to say after the consultation.

You frequently will be able to go to work the next day. However, depending on your response to surgery you may need to take 1-3 days off.

You will be proved the patient cell number of Dr. Heffez to attend to your needs after hours.


1. Bleeding: Bite on a gauze pad for ONE HOUR then discard. EXPECT SOME OOZING FROM THE SURGICAL SITE FOR 24-48 HOURS. If bleeding continues, fold gauze tightly, place over bleeding area and maintain firm biting or finger pressure for 30 minutes. A tea bag, wet or dry, is an excellent substitute for a gauze pack. Avoid frequent pack changes, rinsing or physical exertion until bleeding has ceased.

2. Do Not Rinse your mouth today. Do Not use straws for drinking. Starting tomorrow, rinse gently every three to four hours using warm salt water. AVOID VIGOROUS RINSING – DO NOT BALLOON YOUR CHEEK WHEN RINSING. Do not brush the teeth in the area of the surgical site(s). Continue with salt water rinses until your doctor instructs otherwise.

3. Diet: No eating or drinking for one hour. STAY ON A FULL LIQUID DIET (NO CHEWING) UNTIL INSTRUCTED OTHERWISE BY YOUR DOCTOR. If you eat any solid food you will jeopardize the final result. It is important that you drink at least 2 quarts of fluid per day. Liquid supplements, (Boost, Meritene, Nutrament, etc.), available at your pharmacy, and baby foods are excellent food sources for those few days, if needed. Two weeks of uneventful healing are required for best success.

4. No smoking or alcoholic beverages for two weeks.

5. Anesthesia: Patients who have received a general anesthesia should:
A. NOT drive a vehicle or operate any machinery within the same day of surgery,
B. NOT undertake any responsible business matters within the same day of surgery,
C. NOT drink any alcohol on day of surgery,
D. NOT take any medication without approval.

6. Pain: Pain is to be expected and may be severe for the first few hours. One Must:
A. Take the prescribed medication before the anesthetic wears off, and the pain becomes evident, usually one hour following the procedure.
B. Take the medication to relieve pain. If dizziness or weakness is experienced, you should lie down.
C. Approximately 45 minutes should be allowed for you to become aware of the effect of pain medication.
Call if you have any questions concerning any reactions.

7. Swelling: Swelling is to be expected and may reach its maximum up to three days after surgery, but it is no cause for alarm.

Swelling may be reduced by:
A. Applying an ice bag or chopped ice to the operated area 15 minutes on and 15 minutes off as possible during the first 48 hours. After 48 hours substitute a hot water bottle or hot towel in the same manner until swelling has receded. CHECK THE TEMPERATURE OF THE HOT PACK ON YOUR WRIST BEFORE PLACING THE PACK ON YOUR FACE, IN ORDER NOT TO BURN YOURSELF.
B. Keep your head slightly elevated when lying down (i.e. extra pillow or two).

8. Bruising may occur, especially at the chin area. Sometimes the bruise is a deep purple. The bruise, if it occurs, can take up to 3 weeks to disappear. This should not be cause for alarm and should disappear within 10 days. You may have a slight earache or sore throat. Should this become worse after several days, call the office.

9. Occasionally following oral surgery, unrelated complications may occur (tonsillitis, flu or cold). This is due to the fact the patient’s resistance may be low prior to or following surgery. If you feel run down or have not eaten or slept for several days, it is wise to avoid crowds, drafts and get as much rest as possible. Even, if you feel well and strong, do not workout or perform aerobic exercises until your doctor allows you to.

10. Nausea rarely occurs and may be avoided by taking pain medication with a glass of milk. If nausea is severe, stop taking the prescribed medication and switch to an acetaminophen based (Tylenol) medication. If pain is severe, call the office.

11. Antibiotics (Penicillin, etc.): You must take these antibiotics aS PRESCRIBED and for the exact length of time indicated on the bottle. Antibiotic medication may decrease the effectiveness of birth control pills. Therefore, patients taking birth control pills who have been prescribed antibiotics should use an additional method of contraception during the remainder of the contraceptive cycle.


13. Stitches are removed in 7 – 14 days without pain. Usually they will work loose and fall out on their own. This is of no concern.

14. Complete and partial dentures should NOT be worn at any time following surgery. DO NOT USE THESE APPLIANCES UNTIL THE DOCTOR ALLOWS YOU TO. YOU MAY SERIOUSLY DAMAGE THE SURGICAL AREA.

15. Tightness of the jaw muscles may cause difficulty in opening the mouth. This should disappear within 3 days. Application of a warm towel may be of some benefit.

16. Your lips should be kept moist with a cream or Vaseline following surgery to avoid cracking.

17. If any unusual symptoms occur or if you have any questions concerning your progress. Please Call the office.

18. You must keep your appointment with your doctor because any opening in the tissues must be immediately closed to avoid infection.

AFTER HOURS DR. HEFFEZ TEL. # 224-707-0039
For any emergency do not try to use the web page to diagnose yourself. Go the nearest Hospital emergency room and have the doctors contact Dr. Heffez on his ER TEL #.

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