Pre and Post-Op Care

Pre & Post-Op Periodontal Care

TIPS AND USEFUL INFORMATION BEFORE YOUR PERIODONTAL PROCEDURE

During your initial consultation appointment, specific recommendations, prescriptions, and post-operative instructions will be given to you for your upcoming surgery. Please ensure you follow all recommendations and take all prescribed medications as instructed.

It is essential to follow instructions because this specific information is given to you in order for treatment to heal as uneventfully as possible.

• It is extremely important to advise us of any changes in your health as soon as possible, as this may have an impact on upcoming treatment. This includes: recent illness (flu, common cold, other infections), cold sores, fever, and change in medications or new medications prescribed.
• Current medications. If you are taking medications that thin your blood (aspirin, Coumadin, Pradaxa, Plavix, Vitamin E, garlic pills, or others), you may have been instructed to stop or alter the dosage. Please make sure you have done as instructed.
• If treatment will be done with sedation, a separate sedation instruction sheet will be given to you. If you are interested in sedation and have not discussed this with us at the time of consultation, you may call for further information.  We will give you additional information regarding sedation, such as having to arrive one hour before the procedure with an escort, among other useful information if sedation is planned for you.
• Take all given prescriptions as instructed. This may include an oral rinse, Ibuprofen (Advil/Motrin), Tylenol, or antibiotics. If we have recommended you start the prescriptions from the day before your surgery, please make sure you do so, since this will help with post-operative healing. For children’s dosage of Tylenol or Advil, please follow the directions on the packaging, because the dosage for children depends on weight/age.
• It is recommended that you return home after surgery. Unless you have been sedated and have been instructed to take additional time off work, you may return to work the following day if you are feeling well enough to do so. 
• Eat well prior to surgery since we recommend that your diet be modified after the procedure. Also, since your mouth will be numb/frozen for a while following surgery, we recommend a liquid diet (without the use of straws) until the local anesthetic/freezing is gone.
• As instructed in the post-operative instruction sheet, physical activity should be modified for a few day after surgery. 
• Due to some individuals being extremely sensitive or allergic to perfumes and other strong scents, please avoid wearing them in the office.

POST-OPERATIVE INSTRUCTIONS

• Return home right after surgery. Unless you have been sedated and instructed to take additional time off work, you may return to work the next day if you are feeling well enough to do so.
• While the tongue and lips are numb/frozen, do not eat solid food because you might inadvertently bite your lips or tongue. 
• Do not push or play with any dressing or sutures, because this will irritate the area and may keep it from healing properly. 
• Do not pull on lips, put fingers in your mouth, or indulge other habits like nail biting, as this may affect healing, damage the surgical area, or cause an infection.
• Straws: Avoid straws for 24 hours after surgery, since this may increase the risk of bleeding due to suction and pressure.
• No rinsing or spitting following surgery until the next day, as this may also increase the risk of bleeding due to suction and pressure.
• Swelling is common and may peak 2 to 3 days after surgery.  Swelling can be minimized by applying ice to the face for 10 minutes on and 10 minutes off for several hours after surgery.  Moist heat can be applied intermittently during the 2nd and 3rd post-operative days to decrease any swelling.  If the face or surgical area begins to swell 3-4 days after surgery, call the office.
• Bruising occasionally occurs. This is normal and will last for about 7 to 10 days. 

Rinsing:

• If a bottle of post-operative mouth rinse is dispensed, you may start rinsing 24 hours after surgery.  Rinse 2-3 times daily until the post-operative appointment.  Rinse for at least 30 seconds before expectorating.  Do not eat or drink for 30 minutes after rinsing.  Continue for 1 to 2 weeks after surgery.

Brushing:

• After surgery, do not brush anywhere in the mouth until the following day. Beginning the day AFTER surgery (24 hours after surgery), you may brush/floss areas of the mouth that HAVE NOT been treated. Areas with sutures or dressing should not be brushed with your regular brush or flossed for at least one week (or more if instructed) until the first post-operative visit. During the first post-operative visit, additional instructions will be given to you. 
• For surgical area(s) you may be provided with an extra-soft post-surgical toothbrush to use.  This brush should only be used on the surgical area: it will not adequatedly clean the rest of the mouth. 
  For certain procedures, such as soft tissues grafts, no bushing should be done for the first week.

Pain and pain/anti-inflammatory medications:

• The most uncomfortable time is usually when the local anesthetic/freezing comes out. It is vital to take your pain/anti-inflammatory medication as prescribed to keep any pain/swelling under control. 
• If you are able to take Ibuprofen (Motrin/Advil), you will be instructed to start using 600mg every 4 to 6 hours beginning one day before your appointment. It is critical to do so in order for an adequate loading dose to be present in your body before surgery: This will better control any chance of pain or swelling after surgery. It essential to take the medication regularly every 4 to 6 hours for at least 3 to 4 days after surgery, whether you are experiencing pain or not.
• The following is a useful regimen to help reduce pain following surgery:  Take 600mg Ibuprofen and then take 500mg Tylenol 4 hours later.  Continue to alternate these medications every 4 hours.
• Never take any pain medication on an empty stomach to avoid nausea.
• Some discomfort follows most periodontal surgery.  The amount of discomfort varies with each patient and procedure, and the degree of pain is not necessarily related to the severity of the surgery.  Take the prescribed medications if needed.  If pain is not alleviated by the medication, call the office.

Diet:

• It is worthwhile to maintain good nutrition during healing. While the area is still frozen, do not eat solid food; you may liquefy your food or drink liquid nutritional supplements such as ENSURE or smoothies without a straw. Once the freezing is gone, you may eat most soft-textured food safely, like well-cooked vegetables, soft fruit, fish, well-cooked pasta, well-cooked soft meats, oatmeal, yogurt, and scrambled eggs. Avoid hot-temperature food for at least 48 hours. Warm soups and beverages are fine.
• Only chew on the non-treated side of your mouth until the sutures are removed.
• Foods to avoid for one to two weeks: Spicy or acidic food, popcorn/chips, small seeds or grains, hard fruit/vegetables, hard/toasted bread.
• DO NOT DRINK WITH A STRAW FOR THE FIRST 24 HOURS.

Antibiotics:

• If antibiotics are prescribed, it is extremely important to take them as directed and until finished. Contact our office immediately if rash, itching, hives, upset stomach, or diarrhea develops.
• While on antibiotics, probiotics like yogurt or acidophilus capsules may be taken to help minimize the chances of upset stomach or intestines.

Smoking:

• Smoking significantly delays healing and may increase bleeding. Avoid smoking for the first week, ideally, or decrease as much as possible.

Bleeding:

• It is normal to experience some bleeding or oozing for the first one to two days after surgery. When mixed with saliva, even the slightest amount of bleeding may seem a lot, because it changes the saliva to a light-pink color. Avoid rinsing or spitting for the first 24 hours.  Keep your head slightly elevated when resting or sleeping.
• If excessive bleeding occurs, place a moist gauze or moist tea bag over the area that’s bleeding. DO NOT USE AN HERBAL TEA.  In order for the bleeding to stop, you need to apply firm pressure to the site non-stop for at least 30 minutes. If an inadequate amount of pressure is applied, or pressure is intermittent and not sustained for at least 30 minutes, bleeding may not stop. Repeat if needed. Call the office or doctor's mobile number if bleeding does not cease.

Loss of dressing or sutures:

• Sutures/stitches are generally dissolvable within 7 to 10 days. It is normal for them to loosen or fall out before your next follow-up visit.
• Protective dressing is not always used. If it is, it may fall out before your follow-up visit. This is normal and should be of no concern. Do not try to replace the dressing. The dressing is non-toxic if it is swallowed.  
• If dental glue is used, especially over gum grafts, it will appear as white/grey in the mouth. The dental glue will loosen over the week and may come off before your next appointment. This is normal and should be of no concern.

Exercise:

• Avoid excessive or strenuous exercise for 48 hours after surgery.

Following Surgery

• You should expect to experience sensitivity to hot and cold foods and beverages for the next several weeks.  The cleaner these newly exposed tooth and root areas are kept, the quicker the sensitivity will disappear.
• You are now aware of the significance of plaque and the importance of plaque control in the success of periodontal therapy.  You should continue oral hygiene procedures after suture removal, proceed very lightly with brushing and flossing strokes, gently increasing the pressure as healing improves.  We will introduce you to other cleaning aids as healing progresses.
• If bleeding occurs during oral hygiene procedures, do not be alarmed.  Continue these procedures, since minimal bleeding is not unusual during the early stages of wound healing.
• As healing progresses, you should be able to chew more forcefully and vigorously.
• You may experience an increase in tooth mobility during the first stages of healing.  This is normal.  The mobility should decrease and return to pre-surgical levels as healing progresses.
• It is not uncommon to feel a change in your occlusion (bite).  This will improve with healing.
• Several post-operative appointments will be scheduled to monitor healing.

Dentures, flippers, nightguards, or retainers:

• Follow the specific instructions given to you, as instructions differ depending on the treatment provided.
• Remember to bring any flippers, nightguards, or other prostheses to your post-operative appointment for an evaluation to ensure that they fit well and do not exert unwanted pressure over the healing surgical site.  Pressure over the healing site may adversely affect healing and outcome.

SOFT TISSUE GRAFTS

After tissue graft surgery. talking should be kept to a minimum for the first day.  Cold liquids are recommended, but do not use a straw or do anything that creates suction in the mouth.  This can cause bleeding.  The plastic stent that was placed to protect the palate should be left in place for 24 hours.  After that it can be removed, cleaned and worn as needed for comfort.  If uncontrolled bleeding occurs, the stent should be removed and a wet tea bag applied with pressure for at least 30 minutes.  Use black or green tea.  DO NOT USE HERBAL TEA.  If the bleeding seems to be controlled, replace the stent and leave it in place for an additional 24 hours before removing it.  No oral hygiene (toothbrushing, flossing, etc.) should be done in any area involved in the surgery.  Any area not involved in surgery can be cleaned the day after surgery.