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 Amherst Oral Surgery Thank you for visiting the web site of Dr. Ronald A. Chmiel, Jr. As an Oral and Maxillofacial Surgeon, Dr. Chmiel specializes in the treatment of diseases, malformations, infections and injuries of the mouth, face, jaws and teeth. Many procedures can be done in our office on an outpatient basis. For these procedures, anesthesia is performed using the most advanced anesthesia and pain management techniques. Patients can opt for local anesthesia, nitrous oxide (gas), intravenous sedation or general anesthesia. Our goal is to provide you with the highest level of patient comfort and safety.
We are conveniently located at 777 Maple Road in Williamsville. Office hours are 8:30 - 4:30 M, T, Th & F and 8:30 - 12 Noon on Wednesdays.
- Wisdom teeth and extractions
- Dental Implants for replacement of missing teeth
- Cosmetic and reconstructive jaw surgery
- Participation with most dental and medical plans
- Customized payment options
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Please feel free to contact us by phone (716) 633-8400 or fax (716) 633-8450 with any questions.
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About Dr. Chmiel
Education:
B.A., Biology, University of Rochester, 1980-83
D.D.S., Northwestern University, Chicago, Illinois, 1983-87
Oral and Maxillofacial Surgery Residency
Michael Reese Hospital and University of Illinois
Chicago, Illinois 1987-91
Chief Resident, Oral and Maxillofacial Surgery 1991
Board Certification & Licensure:
Board Certified, American Board of Oral and Maxillofacial Surgery, 1996
Advanced Cardiac Life Support 1990-2000
Northeast Regional Board Certified 1987
New York State License #041008
Teaching:
Clinical Asst. Professor, State University of New York at Buffalo, School of Dental Medicine
Staff Privileges:
Kalieda Hospitals
Erie County Medical Center
Sisters of Charity Hospital
Memberships:
American Association of Oral and Maxillofacial Surgeons - Fellow
American Board of Oral and Maxillofacial Surgery
American Dental Association
Omicron Kappa Upsilon Honor Society
Wisdom Teeth
When a wisdom tooth (or third molar) is blocked or unable to erupt into a normal position, it is termed "impacted". These teeth may grow sideways, partially erupt through the gums or remain fully covered by bone and gum tissue. Many problems can occur with these partially or fully impacted teeth as they try to erupt, but are unable to do so. Pain, infection, damage to adjacent teeth and crowding of teeth can occur. For completely impacted teeth, more serious problems can develop if the sac that surrounds the tooth enlarges to form a cyst or tumor. This enlargement can result in permanent damage to the jaw bone, adjacent teeth or nerves. Removal of the associated impacted tooth or teeth usually resolves these problems. Early intervention is recommended (mid to late teens) to avoid such future problems and decrease the surgical risks involved.
With an oral examination and appropriate x-rays, we can evaluate the development and position of the wisdom teeth and assist your dentist in determining a correct treatment plan. During this initial consultation, we will discuss your medical history, surgical risks and treatment and anesthetic options so that you can make an informed decision regarding your overall care.
PRE-OPERATIVE INSTRUCTIONS
IMPORTANT INSTRUCTIONS REGARDING YOUR ANESTHESIA
You will always be given local anesthesia for your surgery, but you may choose any of those listed below as a supplement. Each choice requires different preparation on your part, and for your safety it is important that you read and follow the instructions carefully. If you are unclear about anything, please ask your doctor. If general anesthesia or sedation is requested, pre-surgical consultation is required. Please call our office for further information.
For all surgery, please wear comfortable, loose-fitting clothing. Tops/shirts should have sleeves that are easily drawn up above the elbow.
If you are going to use:
A: ORAL PREMEDICATION
1. Take the medication at the time directed before your surgery.
2. Follow instructions for any additional anesthesia chosen.
B: LOCAL ANESTHESIA
1. Have a light meal a few hours prior to surgery.
2. For more extensive procedures you may wish to have someone drive you home.
3. Plan to rest for a few hours after surgery.
C: NITROUS OXIDE
1. You may have a light meal four (4) hours prior to surgery.
2. You must have a responsible person to drive your home after surgery.
3. Plan to rest for the remainder of the day.
D: IV ANESTHESIA OR GENERAL ANESTHESIA
1. Nothing to eat or drink (not even water) for six (6) hours prior to surgery. However, it is important that you take any regular medications (high blood pressure, antibiotics, etc.) or any pre-medication prescription that we may have provided, using only a small sip of water.
2. Please wear a short sleeve shirt, tie back long hair, and remove any nail polish.
3. You must have a responsible person who will remain in the office during the surgery, and drive you home after surgery.
4. Plan to rest for the remainder of the day. Do not operate power tools, machinery, etc. for 24 hours after surgery.
OTHER SPECIAL INSTRUCTIONS
If you prefer to listen to your own music, feel free to bring a CD or tape player with small earphones.
Our goal is to provide you with a safe, pleasant and effective anesthetic. In order to do this it is imperative that we have your full cooperation. Please feel free to call us with any questions concerning your surgery or anesthetic.
POST-OPERATIVE INSTRUCTIONS
Sometimes the after-effects of oral surgery are quite minimal, so not all of these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office any time for clarification.
DAY OF SUGERY
First Hour
Bite Down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not being controlled. If active bleeding persists after one hour, place enough new gauze to obtain pressure over the surgical site for another 30-60 minutes. The gauze may be changed as necessary and may be dampened and/or fluffed for more comfortable positioning.
Exercise Care
Do not disturb the surgical area today. Do NOT rinse vigorously or probe the area with any objects or your fingers. You may brush your teeth gently. Do NOT smoke for at least 4 days since it is very detrimental to healing.
Oozing
Intermittent bleeding or oozing is normal. It may be controlled by placing fresh gauze over the surgical areas and biting down firmly for 30-60 minutes. Change gauze every 45 minutes until bleeding slows or stops. It is normal for bleeding to continue into the following day.
Steady Bleeding
Bleeding should never be severe. If it is, it usually means that the packs are being clenched between you teeth rather that exerting pressure on the surgical areas. Try repositioning fresh packs. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in a moist gauze) for 20-30 minutes. If bleeding remains uncontrolled, please call our office.
Swelling
Often there is some swelling associated with oral surgery. You can minimize this by using a cold pack or ice bag wrapped in a towel and applied firmly to face or cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 12 to 24 hours after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed. After 24 hours, it is usually best to switch from ice to moist heat to the same areas.
Pain
Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication, and if you take the first pill before the anesthetic has worn off, you will be able to manage any discomfort better. Effects of pain medicines vary widely among individuals. If you do not achieve adequate relief, you may supplement each pill with an analgesic such as aspirin or acetaminophen. Some people may even require two of the pain pills at one time during the early stages (but that may add to the risk of upset stomach). Remember that the most severe discomfort is usually within the first six hours after the anesthetic wears off; after that your need for medicine should lessen.
Nausea
Nausea is not an uncommon event after surgery and it is sometimes caused by stronger pain medicines. Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with a large volume of water. Try to keep taking clear fluids and minimize the pain medication, but call us if you do not feel better or if repeated vomiting is a problem. Cola drinks that have less carbonation may help with nausea.
Diet
Eat any nourishing food that can taken with comfort. Temperature of the food doesnt matter, but avoid extremely hot foods, It is sometimes advisable, but not required, to confine the first days intake to bland liquids or pureed foods (creamed soups, puddings, yogurt, milk shakes, etc.). Avoid foods like nuts, sunflower seeds, popcorn, etc., that may get lodged in the socket areas. Over the next several days you can progress to solid foods at your own pace. It is important not to skip meals! If you take nourishment regularly, you will feel better, gain strength, have less discomfort and heal faster. If you are diabetic, maintain your normal eating habits as much as possible and follow instructions from us or your physician regarding your insulin schedule.
Sharp Edges
If you feel sharp edges in the surgical areas with your tongue it is probably the bony walls which originally supported the teeth. Occasionally small slivers of bone may work themselves out during the first week or two after surgery. They are not pieces of tooth and, if necessary, we will remove them. Please call the office if you are concerned.
THE SECOND AND THIRD DAYS AFTER SURGERY
Mouth Rinses
Keeping your mouth clean after surgery is essential. Use one-quarter teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily for the next five days.
Brushing
Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.
Hot Applications
Apply warm compresses to the skin overlying areas of swelling (hot water bottle, moist hot towels, heating pad) for 20 minutes on and 20 minutes off to help soothe those tender areas. This will also help decrease swelling and stiffness.
Syringe
If you were given an irrigating syringe at your first office check-up visit, start using it the third day after surgery to keep sockets clean. Fill it with warn water and irrigate any open sockets gently, especially after eating.
Dry Sockets
Normal healing after tooth extraction should be as follows: The first day of surgery is usually the most uncomfortable and there is some degree of swelling and stiffness. The second day you will usually be far more comfortable and, although still swollen, you can usually begin a more substantial diet. From the third day on gradual, steady improvement should mark the remainder of your post-operative course. If a dry socket occurs (loss of blood blot from socket, usually on the 3rd to 5th day), there is a noticeable, distinct, persistent throbbing pain in the jaw, often radiating toward the ear and forward along the jaw to cause other teeth to ache. If you do not see steady improvement during the first few days after surgery, dont suffer needlessly. Call the office and report symptoms so you can be seen as soon as possible.
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