If advised, begin taking pain reliever about 24 hours in advance (600-800mg of Ibuprofen or 1000 mg of Tylenol typically for an adult and 200-400mg of Ibuprofen for a child; this was discussed in your pre-surgical appointment). The over the counter ibuprofen comes in 200mg tablets and over the counter Extra Strength Tylenol comes in 500mg tablets, so please take the appropriate number as listed above for them to be effective.
If you are having iv sedation, please take the ibuprofen and antibiotics right after the surgery.
No alcohol 24 hours prior to procedure.
If you have a nightguard or upper retainer, please bring with you to your surgery.
Periodontal Post-Surgical Instructions
Care of The Mouth
• Normal brushing and flossing following the procedure should be followed throughout the mouth except in the area where surgery was performed. It is important to maintain a high level of oral hygiene care after periodontal surgery. This reduces the accumulation of bacteria (plaque), chances of infection, and minimizes unpleasant mouth odor.
Oral Hygiene at the Surgical Site
• Do not brush, floss, or otherwise disturb the surgical area during the first week or longer if instructed.
• Beginning 24 hours after surgery, rinse gently with warm salt-water mixture (1/2 teaspoon of salt into 6-8 oz. of warm water) 3-4 times per day for the first couple of weeks. Please remove the BLUE palatal guard, rinse, then place the guard back in.
• If given and instructed to use Peridex/Closys, start 24 hours after surgery, and use twice a day until instructed otherwise.
Pain
It is normal for there to be varying amounts of discomfort for 1-6 days after surgery. How much pain and how long it lasts depends on the extensiveness of surgery done, how long it took, and your unique response to it. Everyone differs in his or her perception of, and response to pain; the pain medication may not eliminate all pain but should make you reasonably comfortable. It is not routine to require narcotics.
• For mild discomfort, alternate 600-800mg of Ibuprofen and 1000mg of Tylenol every 3 hours. For severe discomfort, take 800mg of Ibuprofen and 1000mg of Tylenol at the same time, every 6 hours. If this regiment isn’t managing your pain control, please give us a call.
Bleeding
It is normal to have some oozing for 2-3 days. To prevent excessive bleeding follow these steps:
• If advised, ceasing/modifying your blood thinner/aspirin/fish oil at the recommended time prior to surgery should have occurred. (If you have any questions concerning this, please call the office).
• Do not spit, rinse, or use a straw for at least 24 hours after the surgery.
• Avoid strenuous activity for 2-3 days.
• It is recommended to place a towel over your pillow and keep your head slightly elevated for the first 3 days. If you notice continued heavy bleeding, apply biting/thumb pressure with a clean, dampened, rolled-up gauze/tea bag directly to the area for 40 continuous minutes.
• If the bleeding is occurring from under the palatal guard, remove it and apply the pressure to the area. When it stops, please place the guard back in.
• If these attempts are unsuccessful and the bleeding is excessive, please call us.
Swelling
• Gently apply an ice pack to the side(s) of your face over the surgical area for 10-15 minutes per hour during the first 24-48 hours after surgery.
• Keep your head elevated at night to reduce the swelling. Minimize the heat of your food for the next 24 hours, then you can return to slightly warm foods.
• After 48 hours, if you are still swollen, a moist heated washcloth or heating pad gently applied to the site will then be effective.
• Swelling typically peaks on the third day and then slowly begins to reduce from there forward. This is also why ibuprofen/ anti-inflammatory is advised to continue to be taken for the first 4-5 days after the surgery.
Diet
• For the first 24 hours, restrict your diet to cool soft foods and liquids (i.e.. milk shakes, ice cream, instant breakfast drinks, junior baby food, Ensure, yogurt, cottage cheese, pudding, jello, applesauce, etc.).
• For the first 3-4 days, avoid Spicy foods, citrus, and alcohol.
• After 24 hours warm, soft foods can be introduced.
• Then for the 2-4 weeks, continue with warm softer foods (ie. Pastas, malts, soups, well cooked chicken, fish, omelets, mashed/baked potatoes, tuna noodle casseroles, meat loaf well cooked vegetables, etc.) and continue to avoid chewing on the surgical side.
• Avoid eating crunchy, chewy foods, along with popcorn and peanuts for at least 4 weeks after surgery.
• No tobacco products (cigarettes, chewing tobacco, snuff, etc.) for at least 3 weeks after.
By four weeks, unless otherwise advised, you are usually able to eat without any restrictions.
The guard and putty protectors
• A PINK, surgical putty dressing may be placed over the area where the soft tissue graft is placed. THIS IS NON-REMOVABLE, unless the putty becomes loose, then it needs to be removed immediately. You can do this very gently yourself. If you feel uncomfortable with this, no worries, give us a call and we can get you in ASAP. If the putty is still there at your 2-week post op, we will remove it for you.
• In some situations, a medical grade superglue may be placed over the harvested tissue site. The material will typically fully dissolve in a week to 10 days.
• If a BLUE retainer covering your palate is fabricated to protect the area where the tissue was harvested, please leave the guard in for 24-48 hours. After this time, IT CAN BE REMOVED and cleaned each time you rinse or if food is caught underneath then place back in.
• To avoid injury/pain of the harvested area, the guard should be worn at all other times and thought the night for the first week.
• The guard may be cleaned with a brush and COLD water (never hot water, it will melt).
• The guard can be removed after the first week and worn at mealtimes and at night if the patient feels it is necessary for comfort. If you cannot remove the guard, please call the office for us to remove it after 1 week.
Medications
Take your medications for blood pressure, heart, anxiety asthma/lung the day of your procedure. If you are having iv conscious sedation, then take them with enough water to get the medication down (less than 3oz.) Bring your inhalers with you. If you are diabetic and having iv sedation, do not take oral diabetic medication or insulin the morning of your procedure. If there are any issues regarding the interruption of your medication, contact your prescribing physician.
Blood thinner medications: (Our office will be consulting your cardiologist. Unless otherwise told, the following recommendations for temporarily discontinuing your blood thinner/s is listed below.)
Dabigatran (Pradaxa)- hold off 48 hours and wait to begin 48 hours after treatment.
Rivaroxaban (Xarelto)- hold off 48 hours prior to the procedure and begin 48hrs after treatment.
Apixaban (Eliquis)-hold off 48 hours prior to the procedure and begin 72 hours after treatment.
Edoxaban (Savaysa, Lixiana)- hold off 48 hours prior to the procedure and begin 48 hours after treatment.
Warfarin (Coumadin, Jantoven)-If instructed, hold off 3 days prior and begin 48 hours after treatment.
*Ticagrelor (Brilinta)- hold off 5 days prior to the procedure and begin 48 hours after treatment.
*Ticlopidine (Ticlid)- hold off 5 days prior to the procedure and begin 48 hours after treatment.
*Clopidogrel (Plavix)- If instructed, hold off 5 days prior to the surgery and begin 48 hours after treatment.
*Prasugrel (Effient)- hold off 5 days prior to the procedure and begin 72 hours after treatment.
*Cilostazol (Pletal)- hold off 3 days prior to the procedure and begin 4 days after treatment.
*Aspirin 325mg or greater- hold off 1 week prior to the procedure and begin 48 hours after treatment.
*Dipyridamole (Aggrenox)-hold off 5 days prior to the procedure and begin 48 hours after treatment.
(*) anti-platelet meds
***Patients with mechanical artificial heart valves cannot stop their anticoagulant medications (blood thinners) without discussion with their cardiologist and your periodontist!!
Supplements are non-prescribed medications. If you are taking any of the supplements listed below, please stop 1 week prior to your surgical procedure.
● Dong Quai (Angelica sinensis)
● Feverfew (Tanacetum parthenium)
● Fish oil Garlic
● Ginkgo Biloba
● Ginseng (Panax quinquefolium/Panax ginseng)
● Licorice Root (Giycyrrhiza glabra)
● Red Clover (Trifolium pretense)
● Vitamin E
Commonly prescribed/recommended medications for this procedure:
___ Ibuprofen (i.e. Motrin, Advil): (if can be taken, 600-800mg for adult and 200-400 for a child, every 6-8 hours for at least 4-5 days after the surgery.) This is an over the counter medication. It is used to control mild to moderate pain. The medication also has an anti-inflammatory result at surgical sites. It works best when taken before surgery followed by consistent dose times afterwards. The major side effect of Motrin an upset stomach. To avoid this issue, take ibuprofen gel caplets with meals, milk, or 2 full glasses of water to lessen this complication. If you are prone to stomach ulcers, take this medication cautiously and discontinue if you have any stomach pain, nausea, or vomiting. Do not take ibuprofen if you have had any allergic type of reactions (itching, swelling, rash, difficulty breathing, etc.). Ibuprofen has been reported to make some people drowsy (1 in 100)
___ Tylenol (Acetaminophen): (Can be taken 325mg-650mg every 4-6 hours) This is an over the counter pain reliever that can be taken while breast-feeding. It is contraindicated to those that are allergic to acetaminophen, or those who have a known G-6PD deficiency.
___ Peridex (chlorohexidine Gluconate): This is a mouthwash used to kill the bacteria in the surgical area. Take ½ oz. of mouth rinse, swish for a full 30 seconds, or swab the teeth with a Q-tip in the area, 2 times a day, no eating or drinking for 30 minutes afterwards. If instructed, begin this medication 24 hours after the surgery is completed and continue for at least 3 weeks or longer, even if brushing and flossing has been implemented again. Staining of the teeth can occur, which can be polished off. Avoiding tannin containing food products during its use will reduce staining tendencies (i.e., red wine, tea, coffee).
Office (314) 842-6151
Dr. Scott Schlueter (636) 492-1756
Dr. Trinity Boszko (314) 221-6832
