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Post Operative Instructions

Postoperative Instructions Following Periodontal Surgery

The following information has been prepared to help answer the many questions you may have regarding the surgical procedure which has just been performed.

1. DISCOMFORT: It is not unusual to have a certain amount of discomfort for a day or two following your surgery. In many instances, two Tylenol or Advil tablets taken every 4 hours, but not more than 10 tablets daily, will be sufficient to relieve discomfort. It is best not to take aspirin, as it can interfere with blood clotting. If necessary, you will be given a prescription for a more potent medication to allow for a mild postsurgical recovery period. Take as directed on the label. If significant discomfort persists, please contact Dr. Bissell.

2. SWELLING: Minor swelling may follow your surgical procedure. This swelling usually peaks at 48 hours post-operatively. To prevent or minimize swelling, it is advisable to place an ice pack over the area for the next two hours after the appointment. Crushed ice in a zip-lock plastic bag works well. Place on the cheek near the surgical site for 20 minutes, then off for 15 minutes, then on again, and so on. Call this office if swelling around your jaws increases greatly.

3. BLEEDING: A small amount of bleeding is all that is necessary to discolor the saliva and give the appearance of excessive bleeding. DO NOT BE ALARMED as this is not unusual. If excessive or continuous bleeding does occur: a) discontinue all rinsing, b) sit up in an erect (do not lie down) position, and c) apply a moistened tea bag to the immediate area for 20 minutes. (Repeat if necessary.) If continued bleeding is of concern to you, do not hesitate to call this office.

4. DRESSING: A periodontal dressing ("packing") may have been placed on the surgical site and is used to protect the area and help reduce discomfort. Do not be concerned if a small piece falls off. If large portions of the dressing fall off within three days of the surgery, and you are uncomfortable, then please call the office.

5. DIET: Do not eat hard or firm foods on the side receiving surgical care. If possible, chew on the other side. If both sides received surgical care, then you should eat a soft diet. Avoid very hot foods and very hot liquids for the first day following surgery. Although a liquid or semisolid diet may be used at first, keep in mind that adequate nutrition and fluid intake is essential for proper healing. Avoid popcorn, poppyseeds, or other seeds that can get stuck and cause infection. Needless to say, smoking is highly detrimental to proper healing and can jeopardize the likelihood for long term success.

6. RINSING/ ORAL HYGIENE: You may have been given a prescription for Peridex or PerioGard - an antimicrobial mouthwash. If prescribed, rinse twice a day as directed. If you have not been given a prescription, then rinsing is not an important part of the treatment, however, it may give you a sense of better oral hygiene. You are now aware of the significance of plaque and the importance of plaque control in the success of your periodontal therapy. You should use your toothbrush and floss on the nonsurgical sites as you usually do. Very gentle brushing is possible on the surgical site, but usually only on the biting surfaces of the teeth. A moistened cotton swab also works well to gently clean the teeth of the surgical site. It is acceptable, however, during this first week to completely avoid the surgical area. Do not use a Water Pik for at least 8 weeks.

Postoperative Instructions Following Periodontal Surgery - After the First Week

The following information has been prepared to help answer the many questions you may have regarding daily care of the surgical site in the ensuing days and weeks.

The most important point to remember is that for proper healing to take place, the surgical area must be kept plaque free. Complete healing requires a minimum of six weeks, and the cleaner the area is kept, the better the final result. Now that the sutures have been removed, you should expect the area to heal rapidly, feeling better and better every day. In addition, any post-operative sensitivity of the teeth (to hot and cold) that you might encounter will be lessened by meticulous plaque control. Needless to say, smoking is highly detrimental to proper healing and can jeopardize the likelihood for long term success.

The specific type of toothpaste that you use is not so important, although a toothpaste containing fluoride is preferred. What is more important that any toothpaste or mouthwash, is the actual mechanical removal of plaque which is accomplished by a cleaning aid physically rubbing against the tooth surface. The following are the more common ways to accomplish this:

1. TOOTHBRUSH: You should gently begin to brush the teeth involved in the surgical site. Use a soft brush. You can soften your toothbrush even more by holding it under hot water for a few minutes. Use a gentle circular vibrating motion where the tooth meets the gum. Do not be alarmed if the area bleeds a little bit for the first few days. This is expected.

2. RUBBER TIP SIMULATOR: This device is very important for the first few weeks. It serves two purposes: to help contour the gum closer to the underlying bone, and to remove plaque from between the teeth. This should be used (as demonstrated) at least four times per day for at least two weeks.

3. PROXABRUSH: This oral hygiene aid may eventually become your greatest ally in the battle against plaque! The proxabrush is an excellent device to clean between the teeth. The gum tissue that used to fill the spaces between your teeth (and formed the periodontal pockets) has been placed closer to the bone so that you can now effectively clean that area. You should start to gently use the proxabrush (as demonstrated) in about four days (or 11 days after the surgery.) You should use it whenever you brush your teeth, at least twice per day. Once again, do not be alarmed if the area initially bleeds a little.

4. FLOSS: Do not use floss for the next two weeks (or for three weeks after the surgery.) We want the gum to heal tightly around the teeth, and vigorous flossing can initially delay that result. After these three weeks following the surgery, you may resume flossing of the surgical site.

Care of the Mouth Following a Soft Tissue Graft

The important point is to leave the graft site (recipient site) undisturbed. This is especially important if we are striving for root coverage. Be careful not to dislodge the periodontal dressing over the graft if there is one. Use caution when eating. Begin brushing the rest of the mouth the day after surgery, but try to avoid brushing the graft site.

Depending upon the specific type of surgical procedure performed, the area where the graft was taken (the roof of the mouth or hard palate) may cause you the most problems. Since you do not form a scab in the mouth, the area on the palate could become ulcerated. Do not become concerned - this is normal healing.

In some cases, a "plastic" bandage covered with a white periodontal dressing may be placed over the donor site. This dressing is easily disturbed. It is, however, only there for your comfort; it does not specifically help with the healing. The most common problem, other than discomfort, associated with the palate is bleeding. The slightest trauma during eating, playing with the tongue, etc. may initiate oozing or even profuse bleeding. Do not panic. Simply apply pressure with a wet gauze to the area for a minimum of five minutes. Always remove all large clots before applying pressure.

This type of bleeding may occasionally occur for up to a week following surgery, especially if you have not been on a high protein diet. Poor healing will also result if you do not maintain proper nutrition. Tuna is an excellent source of protein, and has been shown to have a profound effect on healing. It is recommended that you eat a can of tuna a day. Another good idea is to take a vitamin supplement, one that is high in vitamin C and zinc. If the vitamin supplement is taken in the middle of a meal, you maximize absorption. The palate will be more comfortable and heal more rapidly if you avoid excessive sugar, salt, spicy, and acidic foods.

Smoking has been shown to have a strong detrimental effect on healing and success of the graft. Smoking appears to affect the circulation of the graft and may cause the graft to slough, resulting in recession. It is very important, therefore, to stop smoking during the healing phase, or at the very least, to cut down considerably. Please call Dr. Bissell if you have any questions.

Care of the Mouth Following Sinus Grafting

The following information has been prepared to help answer the many questions you may have regarding the surgical procedure which has just been performed.

  • Do not blow your nose. 
  • If you must sneeze, do so with your mouth open to avoid any unnecessary pressure. 
  • Avoid taking in liquids through a straw to avoid any unnecessary pressure. 
  • Minor transient bleeding from the nose is common. 
  • The presence of small bone particles in the mouth is common and not of concern. 
  • Minor swelling may follow your procedure. This swelling usually peaks at 48 hours post-operatively. To prevent or minimize swelling, it is advisable to place an ice pack over the area for the next two hours after the appointment. Crushed ice in a zip-loc plastic bag works well. Place on the cheek near the surgical site for 20 minutes, then off for 15 minutes, then on again, and so on. Call this office if swelling around your jaws increases greatly. 
  • It is not unusual to have a certain amount of discomfort for a day or two following your surgery. In many instances, two Tylenol or Advil tablets taken every 4 hours, but not more than 10 tablets daily, will be sufficient to relieve discomfort. It is best not to take aspirin, as it can interfere with blood clotting. If necessary, you will be given a prescription for a more potent medication to allow for a mild postsurgical recovery period. Take as directed on the label. If significant discomfort persists, please contact Dr. Bissell. 
  • Make sure you faithfully take your entire antibiotic prescription as directed. 
  • If you feel congested, you may use antihistamines or decongestants. Over the counter products such as Sudafed, Tavist-D, or Dimetapp work well. Avoid any non-saline nasal sprays. 
  • Avoid pulling on the lips to peer at the wound site, as this can tear delicate sutures. 
  • Please do not smoke – this greatly inhibits proper healing.

 

Postoperative Instructions Following Implant Placement

The following information has been prepared to help answer the many questions you may have regarding the surgical procedure which has just been performed.

1. DISCOMFORT: It is not unusual to have a certain amount of discomfort for a day or two following your surgery. In many instances, two Tylenol or Advil tablets taken every 4 hours, but not more than 10 tablets daily, will be sufficient to relieve discomfort. It is best not to take aspirin, as it can interfere with blood clotting. Most patients report a "tightening" sensation in the jaw bone for a day or so following the surgery. This will dissipate over time. If necessary, you will be given a prescription for a more potent medication to allow for a mild post surgical recovery period. Take as directed on the label. If significant discomfort persists, please contact Dr. Bissell.

2. SWELLING: Minor swelling may follow your surgical procedure. This swelling usually peaks at 48 hours post-operatively. To prevent or minimize swelling, it is advisable to place an ice pack over the area for the next two hours after the appointment. Crushed ice in a zip-lock plastic bag works well. Place on the cheek near the surgical site for 20 minutes, then off for 15 minutes, then on again, and so on. Call this office if swelling around your jaws increases greatly.

3. BLEEDING: A small amount of bleeding is all that is necessary to discolor the saliva and give the appearance of excessive bleeding. DO NOT BE ALARMED as this is not unusual. If excessive or continuous bleeding does occur: a) discontinue all rinsing, b) sit up in an erect (do not lie down) position, and c) very gently bite on gauze over the implant site. If continued bleeding is of concern to you, do not hesitate to call this office.

4. APPEARANCE: It is possible and perfectly normal during healing for the implant(s) to sometimes show itself through the gum. This is nothing to worry about. (If a Teflon membrane was placed over the implant during the surgery, then you may see white material exposed under the gum tissue.) We will periodically review the healing of the site.

5. DIET: Do not eat hard or firm foods on the side receiving surgical care. The key point to remember is to avoid putting any biting forces on top of the implant(s). If both sides received surgical care, then you should eat a soft diet. Avoid very hot foods and very hot liquids for the first day following surgery. Although a liquid or semisolid diet may be used at first, keep in mind that adequate nutrition and fluid intake is essential for proper healing. Needless to say, smoking is highly detrimental to proper healing. Avoid popcorn, poppyseeds, or other seeds that can get stuck and cause infection.

6. ANTIBIOTIC: In all likelihood, you will be given a prescription for an antibiotic. Although infection is an extremely remote possibility, the antibiotic is an additional measure of security that will help insure a successful implant placement. Take as directed on the label. Call the office if you develop a fever.

7. RINSING/ ORAL HYGIENE: You may have been given a prescription for Peridex or PerioGard - an antimicrobial mouthwash. Rinse twice a day as directed. You should use your toothbrush and floss on the nonsurgical sites as you usually do. Try not to get the toothbrush tangled with the sutures. A cotton swab can be used on the sutures if you feel that you would like to keep that area clean. Do not use a Water Pik near the surgical site for at least 8 weeks.

8. DENTURES: If applicable, Dr. Bissell will discuss with you the use of your dentures.

Instructions Following Tooth Removal

1. Bite down on gauze for 45 minutes. This will prevent bleeding. If bleeding persists, then bite down for another 45 minutes on new gauze.

2 Do not rinse, smoke, or use a straw for 24 hours. Any of these actions will dislodge the blood clot. The blood clot prevents bleeding and is the first step in regenerating the bone in the socket.

3. Avoid hot liquids for 24 hours.

4. You can eat when the anesthesia wears off; avoid chewing directly on the extraction site.

5. If swelling occurs, or to prevent swelling, place ice on the area of extraction within the first 24 hours for about an hour or so: 20 minutes on, 10 minutes off. (Place the ice outside the mouth - use crushed ice in a baggy covered with a dish towel.)

6.If swelling appears after the first 24 hours, do not use ice. Begin applying warm, moist heat to the area.

7. At this time of day tomorrow, start rinsing your mouth with 6 oz. of warm water containing 1/4 teaspoon of salt. Rinse after meals and before bedtime. Rinsing helps keep food particles from collecting in the socket.

8. Take medications (if any) as prescribed by Dr. Bissell.

9. If sutures are used, they may or may not dissolve on their own. Check with Dr. Bissell to know when you should return to the office.

10. If you have any questions or complications, please contact Dr. Bissell at his office phone number, and if after office hours, follow the directions to reach him.


 
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