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
  • 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. Please ensure that you do so at least one week prior to your procedure to ensure you are a good candidate for sedation. 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 Peridex 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 use of straws) until the local anesthetic/freezing is gone.
• As instructed in the post-operative instruction sheet, physical activity should be modified for one week after surgery. 
• Due to some individuals being extremely sensitive or allergic to perfumes and other strong scents, please avoid wearing them in the office.

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Post-Operative Instructions

General 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 one week 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.
• If you are experiencing unusual pain, swelling, or bleeding, please call the office or pager number.
• Swelling is common and may peak 2 to 3 days after surgery.
• Bruising occasionally occurs. This is normal and will last for about 7 to 10 days. 

Rinsing (should resume one day — 24 hours — after surgery):

• If Peridex has been prescribed as a rinse, use it twice a day beginning the day before surgery, as directed on the bottle. Do not rinse after surgery. Rinsing should resume the following day after surgery, as directed on the bottle.
• Salt-water rinsing: Beginning the day AFTER surgery, rinse gently with ½ tsp of salt dissolved in 250ml (one cup) of water after each meal whenever possible. 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 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): instead of brushing, use a Q-tip soaked in Peridex to swab the teeth in these areas. The Q-tip/Peridex will replace the toothbrush/toothpaste. The Q-tip should be used on teeth only and away from the gums or gum line.

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 400mg 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.
• If needed, Tylenol can be taken between Ibuprofen doses.

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.
• Foods to avoid for one to two weeks: Spicy or acidic food, popcorn/chips, small seeds or grains, hard fruit/vegetables, hard/toasted bread.

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. 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 colour. If excessive bleeding occurs that cannot be controlled, please contact our office or the pager number. 
• If excessive bleeding occurs, place a moist gauze or moist teabag over the area that’s bleeding. In order for the bleeding to stop, you need to apply firm pressure to the site non-stop for at least 20 minutes. If an inadequate amount of pressure is applied, or pressure is intermittent and not sustained for at least 20 minutes, bleeding may not stop. Repeat if needed. Call the office or the pager number if bleeding does not cease.

Loss of dressing or sutures:

• Sutures/stiches 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 one week after surgery.

Dentures, flippers, nightguards, or retainers:

• Follow the specific instructions given to you, as instructions differ depending on treatment provided.
• Remember to bring any flippers, nightguards, or other prostheses to your post-operative appointment for 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.