Periodontist in St. Louis, Missouri

The Procedure

A frenectomy is an oral surgery procedure that treats lip-tie or tongue-tie. During the procedure, your surgeon lasers or modifies a frenum, a band of connective tissue that joins two areas. In your mouth, frena (the plural of frenum) can join your lips to your gums or your tongue to the floor of your mouth.

Presurgical Instructions

Please arrive at the office at least 20 minutes prior to your surgical appointment to make any final arrangements prior to the procedure.

Please don’t apply makeup and lipstick around the mouth. If a cleaning is due, it is ideal to have it done within a week prior to the procedure and brush your teeth immediately prior to the appointment is advised.

Take your medications as advised. If taking blood thinners, some aspirins, or fish oil prescriptions, we will contact your Prescribing Doctor for their recommendation on modification. We will inform you of their recommendations before surgery. If you have any questions about your prescriptions, please contact us.

If give the prescription for it, please begin taking your Medrol Dose Pack as instructed on the package instructions the morning of your surgery—before your surgery.


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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 advised, please begin taking Arnica Montana 12C starting the DAY BEFORE surgery. You will dissolve 5 pellets under the tongue 5x per day beginning the day before surgery and continuing for 5 days after surgery. You can find this on Amazon.

If you are having iv sedation, please take the ibuprofen right after the surgery.

No alcohol 24 hours prior to procedure.

Periodontal Post-Surgical Instructions

Care of The Mouth

It is important to maintain a high level of oral hygiene care after periodontal surgery. Normal brushing and flossing following the procedure should be followed throughout the mouth. This reduces the accumulation of bacteria (plaque), chances of infection, and minimizes unpleasant mouth odor.

• A small amount of bleeding is common after treatment, especially during the first few days. Don’t let this discourage you from doing the exercises. Just be gentle.

• To help manage pain, you can use Tylenol, ibuprofen (if 6 months of age or older), Rescue Remedy, arnica, or other measures.

Starting several days after the procedure, the wound(s) will look white and/or yellow and will look very similar to pus. This is a completely normal inflammatory response. However, don’t hesitate to give us a call if you think that an infection is present.

Call our office immediately at (314) 842-6151, or the emergency line after hours, if you notice any of the following:

• Uncontrolled bleeding

• Complete refusal to eat or drink.

• Fever > 101.5

Oral Hygiene at the Surgical Site

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.


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.


It is normal to have some oozing for 2-3 days.

• Don’t spit, rinse, or use a straw for at least 24 hours after the surgery.

• Avoid strenuous activity for 1 week.

• 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/Kleenex directly to the area for 40 minutes.

• If you do have a palatal guard, and 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.


• Keep your head elevated at night to reduce the swelling.

• Sleep with your head elevated for 2 nights.

• Some Bruising may occur.

• Minimize the heat of your food for the next 24-48 hours to slightly warm.

• Swelling and bruising 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.


• For the first 24 hours, restrict your diet to cool soft foods and liquids (ie. milk shakes, ice cream, instant breakfast drinks, junior baby food, Ensure, yogurt, cottage cheese, pudding, jello, applesauce, etc.) After 24 hours warm foods can be introduced.

• For the first 3-4 days, avoid Spicy foods, citrus, alcohol.

• 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 3 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.


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 48 hours 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 the 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 (ie. Motrin, Advil): This is usually over the counter. (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 dosing times afterwards. The major side effect of Motrin is 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.

___ Closys®: This is a post-surgical rinse that is initiated 24 hours after a surgery. Gently rinse for at least 30 seconds with ½ oz (2 full caps), then spit it out. It should be used 2-3 times a day. This is a non-staining, killing 99.9% germs in the external part of the surgical site. The rinse is used specifically for the surgical site, generally until all the sutures are removed. Brushing and flossing should occur throughout the rest of the mouth.

__ 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 (ie, red wine, tea, coffee)

Office (314)842-6151

Dr. Scott Schlueter (636)492-1756

Dr. Trinity Boszko (314)221-6832

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