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.
Tips for Post-Surgery Exercises
• Stretches are NOT meant to be forceful or prolonged. It’s best to be quick and precise with your movements.
• 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.
• For your child, post-op exercises are best done with your baby placed on a bed or in your lap, with their feet facing away from you.
• Using an affordable LED headlight (like a camping headlight) will help you see during exercises.
• To help manage pain, you can use Tylenol, ibuprofen (if 6 months of age or older), Rescue Remedy, arnica, or other measures.
An Ideal Exercise Routine
• Wash your hands well with soap and water before your exercises (gloves aren’t necessary) and apply a small amount of coconut oil to your finger.
• Your first post-op exercise should be done the evening of the surgery.
• Starting the day after your surgery, stretches should be done 5 times per day for three weeks.
• During the fourth week, taper exercises each day until quitting completely at the end of the fourth week. (Day 1 of the fourth week, you will do 6 post-op exercises. Day 2 you will do 5 exercises. Day 4 you will do 4, and so on)
• We’ve found that the best time to perform post-op exercises on your child is immediately before or after a diaper change. We also suggest that parents refrain from these exercises immediately before or after a feeding.
Exercise Technique for the Tongue
Coming from behind, insert both index fingers into the mouth (insert one in the mouth and go towards the cheek to stretch out the mouth, making room for your other index finger). Then use both index fingers to dive under the tongue, placed at the base of the fold, and pull straight back.
The tongue needs three separate stretching motions:
1) Once you are under the tongue, try to pick the tongue up as high as it will go (towards the roof of the mouth). Hold it there for 1-2 seconds and then relax. The goal is to completely unfold the diamond so that it’s almost flat in orientation.
*Remember, the fold of the diamond across the middle is the first place it will reattach.
The key to the success of this stretch is that your fingers are placed deep enough prior to lifting the tongue up.
Picture how a forklift works: If you don’t get the forklift tines completely under the pallet, lifting it up will just cause the pallet to tip backwards. If you get the tines completely under the pallet, you can lift the pallet straight up.
We recommend pushing your index fingers together to prevent them from separating, then pushing at the top of the diamond into the tongue (in the direction of the tonsils). Once you are under the tongue, lift so that the middle of the tongue comes up with you. If your fingers separate and go on either side of the diamond, your lifting pressure will be directed at the sides of the tongue and not at the diamond itself.
2) With one finger propping up the tongue, place your other finger in the middle of the diamond, turn your finger sideways and use a lifting motion from low-to-high to try and keep the diamond as deep as possible. Use a lifting motion when you sweep through the diamond, trying to separate the horizontal fold across that diamond. Make sure your finger starts within the diamond when doing this stretch. This stretch should not be forceful or rough within the wound.
3) Massage outside of the diamond on either side to loosen up the remainder of the musculature on the floor of mouth. You can use more pressure when doing these stretches because you aren’t touching the wound itself, only the areas surrounding it.
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.
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.
• 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.
Swelling
• 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.
Diet
• 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.
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 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
