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.
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.
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 advised to, begin taking ibuprofen (600-800mg typically for an adult and 200-400mg for a child; this was discussed in your pre-surgical appointment). The over the counter medication come in 200mg 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 take 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 and antibiotic 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 except in the area where surgery was performed. This reduces the accumulation of bacteria (plaque), chances of infection, and minimizes unpleasant mouth odor.
Please try to avoid/minimize movement of your lips/smiling/laughing for 2 weeks.
Do not pull on your lip to look at the surgical site.
Oral Hygiene at the Surgical Site
Do not brush, floss, or otherwise disturb the surgical area during for the first 2-3 weeks 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.
Use the AO gel from Periosciences (found on Amazon) by applying it with a Q-tip to the surgical site 3 times per day.
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; 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).
• 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 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.
• Some Bruising may occur.
• Minimize the heat of your food for the next 24-48 hours to slightly warm.
• After 48 hours, if still swollen, a moist heated washcloth or heating pad 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.
• Sleep with your head elevated for 2 nights.
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.).
• For the first 3-4 days, avoid Spicy foods, citrus, alcohol, crunchy foods along with peanuts, popcorn, and chips.
• After 24 hours warm foods can be introduced.
• Then for the 2-3 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)
● Ginseng (Panax quinquefolium/Panax ginseng)
● Feverfew (Tanacetum parthenium)
● Licorice Root (Giycyrrhiza glabra)
● Fish Oil
● Red Clover (Trifolium pretense)
● Garlic
● Vitamin E
● Ginkgo Biloba
Commonly prescribed/recommended medications for this procedure (the ones that apply to you are check marked)
__ 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 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 800mg 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 of 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)
__ Medrol Dose Pack: This is a steroid that will help to limit the swelling at the surgical site. There are specific instructions in the box that will have you take 6 pills at specific times during the day on the first day followed by 5 pills the next day, then 4 pills, and so on, until you have tapered down to 1 pill per day and then you will be finished with the pack.
__ Z-pack (Azithromycin): This is an antibiotic that you will take for 10 days after surgery that will help to prevent infection at the surgical site. It is important to follow the instructions on the pack.
__ AO Gel by Periosciences: This is an antibacterial antioxidant gel that you will apply to the surgical area to help keep the surgical site clean and free of plaque accumulation while you are unable to brush or floss the area. You can find this on Amazon.
__ Arnica Montana 12C: This is a homeopathic remedy that is well known to help with healing. You will dissolve 5 pellets under the tongue 5 times per day starting the day before surgery and continuing for 5 days after. You can find this on Amazon and at Whole Foods.
Office (314) 842-6151
Dr. Scott Schlueter (636) 492-1756
Dr. Trinity Boszko (314) 221-6832
