Surgical Instructions for Periodontal Patients
Instructions for Before Gum Surgery
- DO limit your fluid intake for 5 hours prior to your appointment if your appointment is scheduled to exceed 2 hours.
- If you are receiving oral or IV conscious sedation, those instructions supersede these instructions. Follow Instructions for a Sedation Patient regarding restrictions on food and liquid.
- DO wear loose fitting clothing. To maintain an ultra-clean environment, protocol requires that you be draped over your clothing from the neck down. Please wear something comfortable with this in mind.
- DO continue taking aspirin if you are on a once-a-day aspirin regimen.
- DO NOT take any additional (beyond a once-a-day regime) aspirin or aspirin-like products for 5 days prior to the surgery.
- DO alert your treating surgical team if you are taking Coumadin (warfarin) or Plavix.
- Patients may continue taking Coumadin (warfarin) during dental surgery if their INR blood levels are 2.5 or below.
- Patients taking Plavix should specifically discuss this circumstance with their Perico doctor.
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POST-OPERATIVE SURGICAL INSTRUCTIONS
- DO all that you can to PROTECT SURGICAL SITE. The most important factor affecting healing is STABILIZATION following the procedure, so AVOID DISTURBING THE SURGICAL SITE.
- DO take all normal prescription medications, including antibiotics, and medications associated with the procedure as prescribed. If you are prescribed an antibiotic, the antibiotic works by suppressing bacteria that cause infections at the surgical site. The antibiotic can sometimes suppress the “good” bacteria in your gut and can cause discomfort and diarrhea. To avoid this or minimize this, you can eat or drink something with “active or live” bacterial cultures in it such as a probiotic yogurt (such as Activia.)
- DO apply ice packs to the surgical site frequently to minimize swelling. Alternate applying the ice pack with 20 minutes on and 20 minutes off for the first 48 hours. After 48 hours, warm compresses should be applied to the area to increase blood circulation and to promote healing.
- DO begin your Peridex rinse the night of the surgery. Gently swish for at least 60 seconds. DO NOT rinse after spitting out the mouthwash as this will remove the active mouthwash from the surgical site and decrease its antimicrobial activity. DO NOT brush your teeth within 30 minutes of using mouthwash as it will inactivate the anti-microbial properties of the Peridex rinse.
- DO control any intolerable discomfort. The best way to control intolerable discomfort is with the use of a Non-Steroidal Anti-Inflammatory (NSAID) medication (like ibuprofen.) You may also attempt to control the discomfort by alternating doses of ibuprofen (Advil/Motrin) and acetaminophen (Tylenol.) If you were prescribed a pain reliever, follow the instructions on the prescription only until you can tolerate the discomfort. If you were prescribed Flurbiprofen (a long-lasting NSAID), you should avoid taking any other NSAIDs.
- DO enjoy soft foods. DO NOT chew on the surgical site.
- DO NOT blow your nose or sneeze if your surgery involved a SINUS ELEVATION. If you absolutely must sneeze, hold your nose closed to avoid sudden, excess pressure.
- DO NOT take aspirin products for pain control unless you are instructed to do so by your physician. If taking aspirin as part of a daily regimen, you may continue to do so on the day of surgery and during healing unless specifically instructed not to do so.
- DO NOT smoke within a minimum of 1 week from the time of surgery. Smoking can dramatically adversely affect the results of treatment and is the number one controllable reason for surgical failure and extreme post-operative pain.
- DO NOT exercise or participate in heavy activity for 48 hours. Excessive exertion can increase your blood pressure which can cause excess swelling, bleeding, and bruising. DO take it easy!
- DO NOT use a straw or spit for 1 week following surgery. Avoid any activity that will cause your lips to purse or create suction, such as drinking from a water bottle, sucking on a popsicle, etc. If blood gathers in your mouth, DO NOT spit it out as this will dislodge the protective blood clot and cause bleeding to be worse. Try to gently wipe the blood from your mouth with a paper towel rather than spit it out. Some bleeding and oozing from the surgical site will occur and is completely normal. Occasional blood stains in the saliva may be expected. You may wake up for a few days following surgery with a crust of blood on your lips or some blood on your pillow. That is normal. Put a towel on your pillowcase in the evening to avoid staining linens.
- If bleeding is actively coming from the surgical site, rinse with ice water and apply direct pressure to surgical site with gauze for 15 minutes. If you do not have gauze at home, a cold, wet tea bag works very well. DO NOT REMOVE THE PRESSURE WITH GAUZE EVEN ONCE DURING THIS 15 MINUTE PERIOD. 15 minutes of constant pressure will stop 99.9% of bleeds. If bleeding does not stop, please call the office telephone to have the issue addressed.
- DO NOT disturb the surgical site by touching, brushing, or flossing the surgical area.
- Do not remove any sutures under any circumstances. Some sutures may fall out on their own and some may need to be removed at the 1 week follow-up visit. If a suture is dangling or is loose, do not cut it. Often, a single or several very long sutures are used to close a surgical site and one part of that can become loose. This is ok because the rest of the long suture is still doing its job. If that small loose area is cut, the entire suture will come out and surgical failure often results. If your sutures become loose and are bothering you, you can call the office and we can fix the problem.
- Do not brush the surgical site after surgery until you are specifically instructed to do so. Even though you will want to brush the area because it often builds up lots of deposits such as food and plaque, especially when sutures are present, but you must avoid the urge to brush. You must keep the surgical site stable during healing by not brushing. The Peridex rinse is killing the bacteria in the area so that you don’t have to brush. Brush other areas of your mouth as usual.
- Do not remove any portion of the dressing, or the healing membrane, if one was placed during your surgery. This may or may not fall off by itself before you return for your follow-up visit. Even if it does fall off, continue to avoid the surgical site.
- DO prepare for your suture removal if you typically pre-medicate for your dental procedures. On the day of your suture removal, please pause your prescribed antibiotics for that day and take your separately prescribed premedication dose 1 hour prior to your suture removal. The following day, resume your prescribed antibiotic.
- DO care for any tooth sensitivity. Tooth sensitivity, especially to cold, is a common side effect of surgery and can last several weeks. To decrease sensitivity, you can brush with an anti-sensitivity toothpaste such as Sensodyne or rinse with a Fluoride mouthwash such as ACT.
If additional questions or problems arise, please call the office. The telephone is covered 24 hours a day, 7 days a week.