Your Guide To Successful Periodontal Surgery

Pre-operative and post-operative care are very important. Unnecessary pain and swelling can be minimized and the chance of complications can be diminished if the instructions are followed carefully.  Our office hours are Monday through Thursday from 8:00am to 4:00pm.  If you should have any concerns following surgery, please contact the office during regular office hours at 770-422-5220. After hours, please call our office and follow the prompts to reach the emergency number. Please leave a detailed message and the doctor will return your call as soon as possible.  

Pre-surgical Instructions

* Have all prescriptions filled and be familiar with their instructions on use.  Please Remember to eat something when taking your medications.

 * If you are being sedated, you should plan to have someone drive you and pick you up, as well as stay with you the remainder of the day. The office will also review post-operative instructions with the person staying with you.  If your driver does not stay for the surgery, he/she needs to be back 15 minutes before the scheduled end of your appointment.

 * You can eat and drink up until about two hours before your appointment time. Items should consist of light liquids or soft foods (no dairy, caffeine, juice or carbonation).

* Wear loose-fitting, comfortable clothing. Sleeves should be easily drawn above the elbows.  If you wear contact lenses and will be sedated for your surgery, please DO NOT wear them on the day of surgery.

* Aspirin should be avoided for at least 48 hours prior to your appointment, unless stated otherwise. All routine medications should be taken as normal, unless otherwise stated.

* The following are some foods that you might find helpful with your diet following surgery:

Jello, ice cream, pudding, popsicles, frozen yogurt, milkshakes (no straw), yogurt, cottage cheese, egg salad, applesauce, tuna salad, scrambled eggs, mashed potatoes, canned fruits, gatorade, macaroni & cheese, spagetti, steamed vegetables, rice, soup (no tomato), oatmeal, grits, baked fish, iced tea.

Post-Surgical Instructions:

BLEEDING:

A certain amount of bleeding, oozing or red-tinged saliva is to be expected following surgery and is not uncommon. Excessive bleeding may be controlled by first gently rinsing any blood from your mouth, placing a moistened plain tea bag over the surgical site, biting firmly for twenty to thirty minutes, and repeating as necessary. Tannic acid contained in tea helps blood to clot. To minimize further bleeding, remain calm, sit upright, and avoid activity. If bleeding still persists, call the office for further instructions.

PERIODONTAL DRESSING (If used):

The pinkish casts (if applied to the surgical area) should remain until post-operative appointment, but they may become loose or chip away.  These were applied to provide greater comfort.  Should they loosen, do not force them back into place.  If you have any questions, please call the office.  When NO PERIODONTAL DRESSING is used, the following precautions should be observed:

SUTURES:

Sutures are sometimes placed in the area of surgery to minimize post-operative bleeding and to help healing.  If sutures become loose or become dislodged, please do not pull on them.  Please call the office for instructions.  Suture removal is very easy and requires no anesthesia or needles.

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. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until 24-48 hours after surgery and will not reach its maximum until up to 3-4 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. An ice pack (dispensed with your instructions) should be applied to the sides of the face where surgery was performed. The ice packs should be placed on and off at 15-20 minute intervals, continuously while you are awake. After 24 hours, ice has little beneficial effect, so the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.  If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This can be a normal reaction to surgery for some individuals.

MEDICATIONS:

Prescriptions will vary depending on the circumstance warranting medication.  Please follow your doctor's orders for each medication as they were discussed for you and please consult your individual prescription instructions prior to taking ordered medications.

PAIN:

For mild discomfort, over-the-counter acetaminophen (Tylenol) or ibuprofen (Motrin/Advil) may be taken.  We usually recommend taking a dose immediately before and after your surgery to decrease the amount of discomfort.  The medication should be taken whether you experience pain or not, as it will also help with swelling.  Please carefully read and follow all instructions on the bottle. For moderate to severe discomfort, take the prescribed pain medication as directed. The prescribed pain medication may make you groggy and may slow down your reflexes. Do not drive an automobile, work around or operate machinery, or attempt to make important decisions while you are taking the prescription pain medication. Avoid mixing any prescribed pain medications with alcoholic beverages. Discomfort following surgery may increase on the third or fourth day following the procedure and then should improve each day thereafter. If pain persists or worsens after this timeframe, it may require attention and you should call the office.

ANTIBIOTICS:

If you are placed on an antibiotic, make sure to take the tablets or liquid as directed. Be sure to finish taking all of the antibiotics as scheduled. Antibiotics are sometimes given to help prevent or cure an infection. If a rash or other unfavorable reaction would occur, stop taking the antibiotic and contact the office immediately for further instructions.

PRESCRIPTION MOUTHWASH:

Usually, chlorhexidine gluconate (peridex) will be the mouthwash prescribed.

Peridex:  If prescribed, you will be directed to apply it locally at the site of surgery with a Q-tip.  If you also use a fluoride rinse or gel, use the following protocol:  Use the Peridex after breakfast and after dinner and use the fluoride before bedtime. 

DIET:

You can prevent dehydration by drinking plenty of fluids.  After sedation, start with clear liquids first.  At first, avoid very cold or very hot beverages since the teeth may be sensitive to thermal stimuli.  Drink from a glass and do not use straws.  The sucking motion and pressure of using a straw can cause more bleeding by dislodging the blood clot.  Once the numbness has worn off, you can begin eating soft foods, avoiding the surgical sites (if possible) when chewing.  Be careful trying to eat before the numbness has worn off as you could unknowingly bite your lips, tongue or cheeks.  Since your solid food intake may be limited for the first few days, 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. 

EXERCISE:

If you suddenly sit up or stand from a lying position you may become dizzy. Therefore, immediately following surgery, if you are lying down, make sure you sit for one minute before standing.

Restrict your activities the day of surgery and resume normal activity when you feel comfortable.  It is best to avoid aerobic activities and heavy lifting for 2-3 days following surgery.  If you are involved in regular exercise, be aware that your normal caloric intake is reduced after surgery and exercise may further weaken you.  Let common sense prevail.

SMOKING:

Please do not smoke or consume alcoholic beverages during the first week following surgery.   If you smoke, the less you smoke, the faster your mouth will heal and you should experience fewer complications.  A better result will also be obtained.  

ORAL HYGIENE:

Vigorous mouth rinsing or touching the surgical site following surgery should be avoided. This may initiate bleeding by dislodging the blood clot that has formed.  In general, no rinsing of any kind should be done until the day following surgery. You can brush the chewing surfaces of the teeth in the areas of surgery but rinse gently afterwards. The day after surgery you should begin rinsing 4-6 times a day especially after eating with a cup of plain water or water mixed with a teaspoon of salt.  Areas not included in the surgery can be cleaned as normal. 

NAUSEA AND VOMITING:

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including any prescribed medication. Sitting still in a dark room and placing a cold compress on one’s forehead may also help. After an hour, one should try sipping on bland liquids such as water, tea, or Sprite over a fifteen-minute period. When the nausea subsides begin taking solid foods and the prescribed medication again. Anti-nausea medication can easily be prescribed if nausea or vomiting would persist despite these efforts.

DISCOLORATION:

In some cases, discoloration or bruising of the skin may follow swelling. The development of black, blue, green, or yellow discoloration is due to bleeding or oozing below the surface of the tissues during and after surgery. This can be a normal post-operative occurrence, which may not be noticeable until two or three days following the procedure. Moist heat applied to the affected areas may speed up the resolution of the discoloration.

Other Good Things to Know:

If numbness of the lip, chin, or tongue occurs this is usually temporarily due to the local anesthesia and no cause for alarm. Be very cautious while attempting to eat if your lip or tongue is numb so that you don’t accidentally bite or hurt yourself.  Should any numbness or tingling persist after 24 hours, please notify the office.

Slight elevation of temperature immediately following surgery is not uncommon. If a temperature or fever persists, please notify the office. The use of tylenol or ibuprofen will help to reduce it.

You should be careful going suddenly from a lying down position to a standing, upright position. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up slowly.

During surgery, it is necessary to retract the lips and cheeks which may sometimes cause the corners of the mouth and lips to dry out and crack. Your lips should be kept moist with an ointment such as Vaseline to help prevent this.

Stiffness (trismus) of the jaw muscles may cause difficulty in opening one’s mouth or limited opening for a few days following surgery. This is a normal post-operative event which will resolve over the first week after surgery. Taking an anti-inflammatory medication such as ibuprofen (Advil/Motrin) can be helpful.

Please attempt to avoid all tobacco products and alcohol during the first week after surgery.  

SINUS AUGMENTATION/SINUS LIFT:    

In addition to the general post surgical instructions that should be followed (described in detail above), there are specific instructions that need to be followed for those patients who have had sinus lift surgery. The following post surgical instructions are in addition to those which should be followed for routine periodontal surgery/dental implant related surgery and include:

*Continue the antibiotics until the entire prescription is completed.

*Please use a nasal decongestant for the first 72 hours after surgery (e.g. Afrin nasal spray). Follow the pharmaceutical manufacturer instructions.

*Do not hold your sneeze or blow your nose. The associated increase in pressure can damage the surgical site.

*Nasal bleeding after surgery is common for the first 24 hours. Excessive bleeding should be reported to our office.

*Any discharge, which smells or is discolored should be reported promptly.

*Please note that smoking interferes with post-surgical healing.