You can generally brush your teeth before surgery, but there is an absolute limitation on swallowing anything. Medical teams encourage good oral hygiene up to the time of the procedure because a clean mouth helps reduce the bacterial load, which aids recovery. Adhering to all pre-operative instructions, including oral care, is important for patient safety and ensuring the procedure proceeds without delay.
Specific Rules for Brushing Teeth
Brushing your teeth on the morning of your surgery is typically permitted and is often recommended by the surgical team. This simple act of cleaning the mouth helps promote a sterile environment for the procedure. You should use your normal toothbrush and toothpaste, but the amount of toothpaste should be limited to a pea-sized portion.
The absolute restriction centers on the requirement not to swallow any toothpaste or water. When brushing, patients must take extreme care to spit out all residue and avoid rinsing the mouth with a large gulp of water. The small amount of water used to wet the brush or rinse the mouth must be carefully expelled to prevent any fluid from reaching the stomach.
Timing restrictions for brushing are generally flexible, allowing this hygiene task to be performed close to the time you leave for the hospital. If your surgeon or anesthesiologist provides a specific cut-off time for all oral intake, you must adhere strictly to that time. The goal is maintaining excellent oral hygiene without violating the protocol against swallowing liquids.
Restrictions on Other Oral Products
Patients frequently ask about other oral care items besides brushing. Many surgical centers advise against using mouthwash, especially those containing alcohol, due to the risk of accidental swallowing. If mouthwash is permitted, it must be used for a quick rinse and carefully spit out, similar to toothpaste residue.
The use of chewing gum or breath mints is also prohibited in the hours leading up to the operation. Chewing and sucking on these items stimulates the production of gastric juices, which increases the volume of fluid in the stomach. Increased stomach fluid elevates the risk of serious complications under anesthesia.
Patients with removable dental appliances, such as full or partial dentures, retainers, or clear aligners, must take them out before the procedure begins. These items can become dislodged during the administration of anesthesia or while the patient is unconscious. Removing them prevents a potential airway obstruction, which is a major safety concern.
Why Oral Intake is Restricted
The rules against oral intake, known medically as Nil Per Os (NPO), prevent a life-threatening complication called aspiration pneumonia. Anesthesia medications temporarily suppress the body’s protective reflexes, such as the cough and gag reflexes. This relaxation occurs during the induction of anesthesia and during recovery.
If there is food or liquid present in the stomach, the contents can passively travel up the esophagus and into the back of the throat. Without the protective reflexes functioning, this stomach material can then be inhaled into the lungs, an event known as pulmonary aspiration. Aspiration of stomach acid or particles causes severe chemical burns and inflammation within the delicate lung tissue.
Even a small amount of swallowed water or toothpaste residue can increase the volume of stomach contents, making aspiration a higher possibility. Aspiration pneumonia is a serious complication that can cause severe lung injury, oxygen deprivation, and infection. Following the NPO guidelines precisely ensures patient safety while under general anesthesia.
Comprehensive Pre-Operative Hygiene Checklist
Before arriving at the surgical facility, patients must complete a full-body preparation that extends beyond oral care. Many facilities instruct patients to shower or bathe using a specific antibacterial soap the night before and again the morning of surgery to reduce skin bacteria. This preparation lowers the potential for a surgical site infection.
All forms of jewelry and body piercings must be removed, as metal can interfere with electrosurgical equipment used during the operation. Patients should also remove all makeup, including mascara and lipstick, and any nail polish. These cosmetics can obscure the natural color of the skin and nail beds, which medical staff monitor to assess blood circulation and oxygen levels.
Contact lenses must be removed before surgery, as the eyes can become dry or irritated under anesthesia, potentially leading to corneal damage. Patients are advised to wear loose-fitting, comfortable clothing, preferably a shirt with short sleeves for easy access for monitoring equipment and intravenous lines.