Periodontal Post-Operative Instructions
The most common adverse reactions after surgery are: pain, swelling, and bleeding. Most often, these are mild and resolve after 24-72 hours. If your symptoms are exceedingly severe or persist for a long time, please contact your surgeon
Pain:
If needed, you may take over-the-counter pain tablets (normal headache remedies) as directed on the label to relieve discomfort. If severe pain is anticipated, your surgeon will prescribe a prescription pain reliever for you. Please take these tablets as directed.
IF YOU TAKE ANY OPIOID PRESCRIPTION PAIN MEDICINE, DO NOT DRIVE AN AUTOMOBILE, OPERATE HEAVY MACHINERY, MAKE LEGAL DECISIONS, OR CARE FOR MINOR CHILDREN.
To prevent traumatizing the surgical site, avoid eating in that area and/or grinding your teeth on that side. These increased pressures can cause pain or damage the surgical area.
Swelling:
When surgery is extensive, some swelling may be expected. Cold packs may be held on the external facial area nearest the surgery site during the first 24 hours after surgery to inhibit swelling. Apply the cold pack for 20 minutes and then remove it for 20 minutes. Repeat this application as often as possible. After the initial 24 hours, heat may be applied to the area, if needed for comfort, but you can also continue using the cold pack.
Bleeding:
Some oozing of blood from the surgical site is normal after any surgery. A small amount of blood mixed with saliva will appear red or pink in your sink basin. If you have significant bleeding, a piece of gauze or a tea bag may be moistened in cold water, squeezed to dampness, and applied to the surgical area with pressure for 30 minutes. This gauze should be replaced every 30 minutes. When no blood is present on the gauze, you may cease applying pressure. Details for bleeding after soft tissue surgery are given on the next page.
Medications:
In addition to pain medication, your doctor may prescribe antibiotics and/or a mouth rinse for you. Please begin the antibiotics and pain medicine immediately after surgery and take the antibiotics to completion. During the first 24 hours following surgery, do not rinse or spit vigorously.
Diet:
Maintain a well-balanced diet. Do not chew on the surgical site. Avoid hard foods that are difficult to chew and those that are very hot, very cold, or very sticky. Highly seasoned foods, fruit juice, and alcoholic beverages can also irritate the surgical site and should be avoided. If the surgery site is on front teeth, do not bite down into foods until cleared by your doctor; cut food into small pieces and chew on the back teeth. A soft diet may include items such as yogurt, protein drinks, applesauce, pudding, scrambled eggs, most breakfast foods, pastas, and soups.
Surgical Hygiene:
24 hours after the surgery, you may begin using the antimicrobial mouth rinse prescribed for you as well as warm salt water rinses. These mouth rinses will gently dislodge food particles and decrease bacteria in your mouth. Flossing or the use of a waterpik in the area should be avoided. If a dressing has been placed, do not disturb the dressing. You may use a cotton swab to clean the surgical site and may resume brushing all non-treated areas 24 hours after surgery.
Sutures:
If you have sutures that need to be removed, your doctor will schedule a follow-up visit to remove them. Normally, sutures are removed 5-14 days after surgery. Do not attempt to remove your own sutures.
Home Care:
Avoid any activity that causes suction in your mouth for 24 hours after surgery. Do not rinse, vigorously spit, suck through a straw, or smoke cigarettes/cigars/vapes. Any kind of suction in your mouth can increase bleeding and may dislodge graft material. If you have had an extraction, suction may dislodge the blood clot and cause a dry socket, which is very painful. If you wear a denture, leave it out until your sutures are removed or your surgeon tells you that you are healed enough to wear it. This will minimize pressure on the surgical site and prevent implant failure.
If you develop a fever, uncontrolled bleeding, rash, or numbness, or if you have pain in your jaw or sinuses that is unrelieved by your pain medication, please call our office or the emergency number below:
IF YOU ARE UNABLE TO REACH YOUR DOCTOR AND IT IS AN EMERGENCY, PLEASE GO TO THE NEAREST EMERGENCY ROOM.
Additional Post-Operative Instructions
Extraction with Socket Conversion or Osseous Regeneration:
- Do not irrigate or disturb your surgery site, vigorously spit, suck through a straw, or smoke cigarettes/cigars for 2 weeks. Any kind of suction in your mouth can increase your chances of bleeding and may dislodge graft material.
- During the first few days of your healing, you may notice a few bone particles from your graft floating in your mouth or on your tongue. This is normal; it will feel and appear like uncooked grits. Also, if you had a collagen plug placed on top of your extraction site, it is normal for this material to dislodge during the first 1-3 days.
Implant Placement:
- Avoid chewing on the new implant site for 2 weeks. This is the most crucial healing period for your implant, and chewing on top of the implant may result in implant failure.
- If you feel loosening of your healing abutment/implant at any point during your healing, please contact our office immediately to schedule an appointment.
- If you are still experiencing numbness at or around your surgery site after 24 hours, contact our office as soon as possible. This could be a symptom of permanent nerve damage.
- If you had a temporary crown placed on top of your implant the day of placement, do NOT chew with, bite with, or apply pressure to the crown. Doing so may result in implant failure.
Localized or Lateral Window Sinus Lift:
- Medication protocol after sinus lift:
- Claritin D or Mucinex D should be taken for 5 days post-procedure. Follow instructions as recommended on the package.
- Afrin nasal spray may be used for 3 days maximum post-procedure. Follow directions as listed on the box.
- Avoid blowing your nose for 2 weeks post-op, or until you are cleared to do so by your surgeon. Blowing your nose can cause a pressure increase, resulting in a bleed.
- Avoid bending over headfirst or standing up too quickly. This can cause a change in blood pressure, resulting in a nosebleed or bleeding at the surgery site.
- Try to avoid sneezing if possible. If you feel the urge to sneeze, try to sneeze with your mouth open.
- If you experience a nosebleed post-op, this is normal. Pinch your nose and blot blood away until bleeding subsides.
- If you develop a black eye or bruising of the eye/cheek after your procedure, do not be alarmed as it is normal.
- If you wear a CPAP, it is advised that you do not wear it for 2 weeks post-procedure unless cleared by your surgeon or primary care doctor. Use of your CPAP can increase oxygen flow in your sinuses, resulting in a nosebleed.
Free Gingival Graft or Connective Tissue Graft:
- Do NOT at any time during the first 2 weeks of healing pull your lip to look at the graft site.
- Do not lick the surgical site with your tongue.
- Use the syringe provided to rinse with the prescribed Chlorhexidine twice a day for 14 days.
- Avoid vigorous exercise or heavy lifting for at least 7 days after surgery.
- Minimize speaking and exaggerated facial expressions for the first 4 days.
- Do not press or poke the outside of your face in the areas of surgery.
- Apply ice for 20 minutes on, 20 minutes off, for the first 24 hours after surgery.
- Take the prescribed 600 mg ibuprofen every 6 hours (for patients cleared to take NSAIDs) for the first 72 hours.
- During the first 2-4 weeks of healing, your graft may appear with areas of white and red color. This is normal as your body is still healing. Do not wipe at this gum tissue.
- If you were provided with a palatal stent, wear it as much as possible for optimal comfort and protection of the grafting harvest site while healing. Do not remove the stent for the first 24 hours after surgery. Afterward, remove the stent 3-4 times per day for cleaning.
- Do not use a toothbrush or floss at surgical sites until cleared by your doctor, typically at your 2-week follow-up.
- If you experience a palatal bleed, dampen sterile gauze provided post-op and apply firm pressure for at least 5 minutes until bleeding subsides. Alternatively, use a black tea bag or moisten the gauze with Afrin nasal spray before applying pressure. Avoid repeatedly removing the gauze, as this slows clotting. Set a timer to ensure proper timing.
- Follow the separate instruction sheet provided if your doctor has recommended the use of post-surgical tape.