RESOURCE CENTER

Scheduling + Registration
Please contact us to schedule an initial consultation with Dr. McGann.

You’ll need to fill out this form online before you come in.

On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

HIPPA Privacy Policy Form
First Visit Details
Your initial appointment will consist of a consultation explaining your diagnosis and treatment options. Occasionally, surgery can be performed the same day as the consultation. However, a complex medical history or treatment plan will require an evaluation and a second appointment to provide treatment on another day. Please assist us by providing the following information at the time of your consultation:

• Your surgical referral slip and any x-rays if applicable.

• A list of medications you are presently taking.

• A copy of your current medical or dental insurance.

IMPORTANT: All patients under the age of 18 years of age must be accompanied by a parent or guardian at the consultation visit

Out Of Town Patient
How Long Do I Need To Be In San Diego?

For years, McGann Facial Design has been serving the specific needs of patients visiting San Diego for their care. We make every attempt to make your visit to our office before, during, and after your procedure as seamless and convenient as possible. During your initial consultation with Dr. McGann, we take your full history and recommend a tailored treatment plan. In order to ensure all details are covered, we schedule a final workup or pre-op visit anywhere from 2 weeks to 4 days before your scheduled surgery. You can expect to stay in San Diego for at least 1 week after surgery for post-op visits and to make sure you are healing appropriately. Typically, Dr. McGann will not need to see you after this week and you can continue your care with your home-town dental professional.

How Much Will Surgery Cost?

How much a surgical procedure will cost is a very common question with unfortunately no simple answer. Each medical plan has different guidelines and out of pocket expenses that make each case individual. The good news is that McGann Facial Design has been navigating insurances for over a decade and while there is no secret, we help you by paying attention to all the details.

As a guideline, once a procedure is approved, the best information we can provide is that you can expect to pay your deductible and out of pocket maximum in full for this surgery. For some patients, this could be $US 250, and for others it could be $US 10,000 or anywhere in between. The plan chosen by either you or your employer will determine this amount for you. The largest cost comes from the facility or hospital since these cases are typically inpatient surgeries and care is provided to you by their skilled nursing teams. Out of pocket maximum means that no additional money will be paid by you after that number is reached, as long as the procedure status is deemed as medically necessary by their care guidelines (we help you determine this status). As an example, if the hospital charges $50,000 for the entire case but your out of pocket maximum is $US 250, then that is what you will pay. Again, we work with you closely to make sure all costs are understood before proceeding with surgery.

Insurance + Financials
At McGann Facial Design, we make every effort to provide you with the finest surgical care and the most convenient financial options. To accomplish this goal, we work hand-in-hand with you to maximize your insurance reimbursement for covered procedures. As always, if you have any questions, please ask our staff.

For your convenience, we accept Visa, MasterCard, Debit, and cash. We deliver the finest care at the most reasonable cost to our patients; therefore, insurance co-payment is due at the time of service. If you have questions regarding your account, please contact us at (858)874-8181. Many times, a simple telephone call will clear any misunderstandings. Please remember that you are fully responsible for all fees charged by this office regardless of your insurance coverage.

Referring Providers
At McGann Facial Design, the security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it. You may refer patients to our office by filling out our secure online Referral Form (link attached). After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information.
Pre- and Post-Operative Care for Hospital Surgery
Pre-Operative Care

Pre-Operative Examination

Anywhere from one week before your surgery to the day of surgery, Dr. McGann will perform a medical history and physical examination to make sure there are no potential medical problems for your surgery. These tests may include laboratory blood and urine tests, a chest x-ray, and an electrocardiogram.

Hospitalization and Surgery

Diet

To aid your recovery, you will need to do the following:

1. Acquire a Blender

Before you go into the hospital, you should purchase or borrow a blender or food juicer. Any food that you normally eat can be blended into a meal you can eat while you are recovering from your surgery. Your favorite foods may look different, but they will still taste the same.

2. Eat Healthy Foods

Eating plenty of fresh fruits and vegetables helps your body get all of the vitamins, minerals, and fluids it needs in order to recover from your surgery. To make sure all of your dietary needs are met, you will want to purchase dietary supplements such as multivitamins that include iron and calcium. In addition to eating enough fresh fruits and vegetables, make sure that you eat enough protein, carbohydrates, and calories to help your body recover. While your jaws are held in place with elastics, you will eat about six times per day, but you will consume smaller meals.

3. Do Not Eat Prior to Surgery

You will be asked not to eat or drink anything past midnight on the day prior to your surgery. This will ensure that you have an empty stomach for your procedure, which helps ensure a safe procedure.

Anesthesia

A member of the hospital anesthesia department will discuss your surgical anesthesia with you, including its benefits, risks, side effects, and potential complications. This person will be happy to answer any questions you may have about your anesthesia.

Possible Side Effects and Complications

Swelling

After your procedure, you can expect to see significant facial swelling. During the second and third weeks, swelling should reduce significantly. To minimize swelling, you will be given steroids to accompany the use of ice packs. Getting out of bed and keeping your head elevated will assist with keeping the swelling at a minimum.

Nausea, Vomiting, and Bleeding

Nausea, vomiting, and bleeding may occur. In addition, if you feel nauseous and need to vomit, remember to stay calm and turn your head to the side to ensure that any fluids clear your mouth easily. Vomiting is not a life threatening situation after your procedure, since your stomach will be empty. It is common to vomit once after surgery to clear the blood in your stomach.

It is not uncommon to experience some minor bleeding and increased salivation after surgery. If you had upper jaw surgery, you may experience some oozing of blood and mucous from your nose. If you do, nurses will have access to a suction device at your bedside that will remove any blood that accumulates.

Post-Operative Discomfort

Discomfort is not uncommon after surgery. However, in most cases it is mild. Dr. McGann will prescribe medications as needed to help you manage your discomfort. If bone is taken from your hip for a bone graft, you may experience pain after your procedure. According to many patients, the discomfort experienced after jaw surgery is no worse than the discomfort of having wisdom teeth removed. Please remember that every attempt will be made to keep you as comfortable as possible.

Nasal Congestion and/or Stuffiness

The placement of tubes in the nose and surgery on the upper jaw can sometimes lead to nasal congestion or stuffiness. This can be managed with nasal sprays and regular cleaning of the nostrils. It is suggested that you clean your nostrils with q-tips and a 3:1 solution of water (3 parts) and hydrogen peroxide (1 part).

Splint

A plastic splint has been constructed from the impressions taken during your examinations. This splint will be used during your surgery to ensure an accurate and aesthetically pleasing result. Sometimes this splint will be left attached to your upper jaw, much like a mouth guard, in order to ensure a quality result. The splint will be removed at a later time. Whether or not the splint will be used after your surgery is usually dependent upon the type of surgery that is being performed.

Jaw Wiring

While jaw wiring was once prevalent in jaw surgery, it is now a very rare occurrence. On very rare occasions, jaws will be wired shut after surgery to ensure a quality result from your procedure. The length of time that jaw wiring may be necessary is dependent upon the type of surgery performed.

Post-Surgical Care and Home Care

After your surgery, there are a few things that you can do to improve your recovery period. You will be asked to do the following:

1. Don’t Chew Hard Foods

Your jaws are held together with plates and screws. Chewing on food can cause them to get infected and need additional surgery to be removed. Chewing can also move the jaws and teeth, and can cause the need for surgery to be redone, or have extended orthodontic time to finish your case.

2. Take Your Medications

You will be prescribed medications to be taken during your hospital stay. These medications may include antibiotics, pain medications, nasal sprays, medicated cream for your lips, or Peridex oral rinse. You will likely continue these medications after you are released form the hospital. Remember to take your medications as directed.

3. Maintain Good Oral Hygiene

After your surgery, it is important that you keep your mouth clean to minimize the chance of infection and to maintain dental health. Use a soft-bristled (baby) toothbrush and Peridex. Be sure to keep the brush in contact with your teeth as you brush them. Brush 5 times a day to keep teeth clean.

4. Walk as Soon as Possible

After your surgery, you are encouraged to try to walk as soon as it is determined safe. Getting back on your feet and walking is very healthy and will aid your recovery. The better you prepare yourself mentally, physically, and nutritionally to get back to your routine, the quicker your recovery will be.

5. Practice Speaking to Others

After your surgery, speech may be difficult. However, you can improve your recovery and your ability to speak through practice. Remember, the best way to be understood is to speak slowly, concentrate on each word, and calmly try to be understood if you have to repeat what you have said.

6. Avoid Smoking

Smoking may delay healing as well as stain your teeth. Not smoking during your recover will improve the smile you have at the end of your treatment.

7. Take Care of Your Jaw

Remember that pressure changes can be painful and can compromise your results. Avoid situations like changing altitudes, blowing your nose, sneezing through your nose, and intense exercise, as these things can cause significant changes in intraoral pressure. Don’t lift heavy weights or do anything that causes you to clench your teeth together.

Extraction Post-Op Instructions
AFTER WISDOM TOOTH REMOVAL

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 provided instructions are followed carefully.

Immediately Following Surgery

• The gauze pad placed over the surgical area should be kept in place for 1 hour. After this time, the gauze pad should be removed and discarded. Remove the gauze when eating, then replace it with new gauze when finished eating.

• 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. It is best to eat something before taking pain medication.

• 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 an explanation.

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 blood clots from your mouth, then placing a gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 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 at 858-874-8181.

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. Swelling is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will reach its maximum at 2-3 days post-operatively. However, swelling may be minimized by the immediate use of ice packs. Two plastic bags 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 36 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.

Pain

For moderate pain, 1-2 tablets of Tylenol or Extra Strength Tylenol may be taken every 3-4 hours or Ibuprofen (Motrin or Advil) 2-4 200 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 but it may last for about a week. If pain persists after 1 week, it may require attention and you should call the office at 858-874-8181.

Diet

Drink liquids after general anesthesia or IV sedation. Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. 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 1 minute before standing.

Keep The Mouth Clean

No rinsing of any kind should be performed until the day after surgery. You can brush your teeth the night of surgery, but rinse gently. The day after surgery begin rinsing at least 5-6 times a day with a cup of warm water mixed with a teaspoon of salt, especially after eating. On day 4 after your surgery, begin irrigating (the lower sites only) with water using the provided syringe. It is essential to irrigate the lower sites twice daily to ensure removal of any remaining food particles until the sites have fully healed.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

Nausea & Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on Coke, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.

Other Complications

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call Dr if you have any questions.

• A slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.

• You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and then get up.

Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls, which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. McGann.

If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.

Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.

Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event that will resolve in time.

Finally

Occasionally, sutures are placed in the area of surgery. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will be absorbed, or will fall out in 7 to 10 days. If they fall out earlier than 7 days there is no need to worry about them falling out too early.

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call the office for instructions.

There is a syringe included it is best advised if you can abstain from using the syringe for at least 4-5 days after the procedure. The syringe should be filled with water and the tip placed behind the last tooth on just the lower teeth. With the pressure from the water it will clean out the socket.

There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean especially after meals with salt-water rinses or a toothbrush.

Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. McGann or your family dentist.

Brushing your teeth is okay – just be gentle at the surgical sites.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur two to three days following surgery. Call the office if this occurs.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

AFTER EXTRACTIONS

After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. That’s why we ask you to bite on a gauze pad for 30-45 minutes after the appointment. If the bleeding or oozing still persists, insert another gauze pad and bite firmly for another 30 minutes. You may have to do this several times.

After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.

After the tooth is extracted you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours.

Use the pain medication as directed. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.

It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean. After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for two to three days, or a reaction to the medication, call the office immediately at 858-874-8181.

After Sinus Lift
The graft is placed to help restore your jawbone in preparation for possible implant replacement of the missing tooth or teeth.

The primary goals of post operative care after oral surgery are: control the bleeding, good nutrition, adequate pain management, excellent oral hygiene and proper wound care. Good post-operative care is very important. The risk of infection, excessive pain and swelling can be minimized if instructions are followed carefully.

DO NOT UNDER ANY CIRCUMSTANCES. BLOW YOUR NOSE FOR THE NEXT FOUR (4) WEEKS. This may be longer if indicated. You may sniff all you like but NO BLOWING.

Do not blow your nose or sneeze holding your nose. Sneeze with your mouth open. Do not drink with straws and do not spit. Scuba diving and flying in pressurized aircraft may also increase sinus pressure and should be avoided. Decongestants such as Drixoral, Dimetapp, or Sudafed will help reduce pressure in the sinuses. You may also be given a prescription for antibiotics. Please take these as directed. Anything that causes pressure in your nasal cavity must be avoided. Avoid “bearing down”—as when lifting heavy objects, blowing up balloons, playing musical instruments that require a blowing action or any other activity that increases nasal or oral pressure. Smoking must be stopped. If necessary Dr.McGann can prescribe Nicoderm patches.

Antibiotics

Be sure to take the prescribed antibiotics as directed to help prevent infection

Oral Hygiene

Do not rinse or spit on the day of your surgery. This tends to disturb the blood clot, open the wound and can prolong bleeding and slow healing. You should not have a significant amount of blood in your mouth. Saliva can be swallowed, even if slightly blood tinged.

Keeping your mouth clean after surgery is essential to reduce the risk of infection. Start salt water rinses the day following your procedure. Use one-half 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 four to five times daily and always after eating for the next five days.

Do not brush the teeth in the area of surgery for 48 hours. When brushing, be very gentle. When expectorating, also be gentle.

We may prescribe an antibiotic rinse (Chlorhexadine, Periogard, Peridex) for certain procedures. This rinse should be used in the morning and at bedtime after routine mouth care. Do not eat or drink or rinse your mouth after using the medicated rinse. Using this rinse more than two times a day will cause staining of your teeth.

Smoking

Do not smoke for at least two weeks after surgery, if at all. As discussed at your consultation, smoking dramatically increases the risk of bone graft and sinus augmentation failure.

Wearing your Prosthesis or Nightguards

Partial dentures, flippers, or full dentures should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise. Please contact the office if there is any question. If you have a temporary “flipper” to wear do not place it until the numbness in the area is gone. 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. This can lead to loss of the graft. If you have questions about the fit of your flipper, partial or complete denture, do not wear it until your general dentist or our office can see you.

Post-Operative Problems or Complications

As with any procedure, unexpected post-operative healing can occur. If you notice the unexpected flow of air or liquids between your mouth and nose, please let us know immediately.

If you are aware of several small particles of graft material being discharged from your nose, let us know as well.

If you experience sinus or nasal congestion on the side your surgery was performed, let us know.

If there is an increase in swelling in your mouth, cheek or under your eye after 3 days, let us know.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office. Please try to call during office hours; however a 24-hour answering service is available for after hours.

After Dental Implant Surgery
Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There might be a metal healing abutment protruding through the gingival (gum) tissue.

Bleeding

Some 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.

Swelling

Swelling 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 for 20 minutes at a time, as often as possible, for the first 24 hours.

Diet

Drink 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.

Pain

You should begin taking pain medication before you feel the local anesthetic wearing off. This should be done after eating or drinking something. If you are able to take Ibuprofen (Motrin, Advil), please take it for pain. Ibuprofen, bought over the counter comes in 200 mg tablets. Two to three tablets should be taken every four to six hours for pain. This should be taken on a regular basis the night before surgery, and then after surgery. For severe pain, the prescribed medication should be taken as directed in addition to the Ibuprofen. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.

Antibiotics

If antibiotics were prescribed be sure to take them as directed.

Oral Hygiene

Good oral hygiene is essential to good healing. Warm salt-water rinses (one teaspoon of salt in a cup of warm water) should be used at least four to five times a day, as well, especially after meals. Brushing your teeth with the healing abutments is not a problem. Be gentle initially when brushing the surgical areas. Occasionally an antibiotic mouth rinse will be prescribed. Please use as directed twice a day.

Activity

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.

Wearing Your Prosthesis

Partial dentures, flippers, or full dentures should not be used immediately after surgery and as little as possible for at least seven days. If the prosthesis does not fit over the implant please have it adjusted by your dentist before wearing it.

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