Post-operative Instructions

Post-operative instructions after Periodontal Surgery

Things to do:

REST: Avoid talking excessively or strenuous activity. Plan to have the day off work after your procedure. Return home after your surgery, in most cases patients can return to work after 48 hours.

SLEEP: For the first night, sleep with your head elevated and protect your pillow with an old towel.

ICE: Ice should be applied as soon as possible to prevent inflammation from occurring and to promote blood clotting. To manage inflammation: wrap a towel around an ice pack/frozen vegetables and apply the pack to the face near the surgical site; alternating 15 minutes on, 15 minutes off for a maximum of 24 hours after surgery.

MEDICATION: Take the medications prescribed as directed. You may have taken pain medication one hour prior to your surgical appointment. Be sure to continue this after the procedure for at least 72 hours. If the medications make you sick, give you redness of the skin or itchiness, contact Dr. Diamond/your pharmacist immediately as this may be an allergic reaction. If antibiotics are prescribed be sure to take as directed, until all of the medication is finished.

PAIN MANAGEMENT – If you have NOT been provided with a prescription, be advised of the following directions and doses for Adults: Take 600 mg of Ibuprofen (Advil) and if needed, you can alternate with 1000 mg Acetaminophen (“Tylenol”) every 6 hours for 24 hours. If after 24 hours, you are still feeling pain, you may repeat the dose for another 24-48 hours. If you followed these instructions and still have pain after 3 days, please call our office. Pain is usually the worst in the first 24 hours. Please use the prescribed medication. It is better to take the pain killers before the freezing wears out and throughout the first day. If you are having a reaction to the medication please call us.

TOOTH BRUSHING AND RINSING:   Do not spit, you may allow excess saliva to drool over the sink. Do not rinse your mouth for the remainder of the first day (24 hours). Brush and floss your other teeth normally, Do not brush the surgical site until we give you instructions at your post-operative appointment (usually at 2 weeks) to do so. Do not pull at your lip to look at the surgical site. Avoid rinsing or swishing for the first 24 hours. After 24 hours starting using the provided mouth rinse (Chlorhexidine), if prescribed, or salt water rinses. Gently swish with ½ cap of Chlorhexidine for 3 days. After 4 days, apply the mouth wash to the area of surgery with a Q-tip to avoid unwanted staining of other teeth. This should be done 3-4x per day for 2 – 3 weeks. If you should run out of the mouth rinse, use warm salt water rinse (1/2 tsp. salt to 8 ounces of water). Use the prescription mouthwash twice daily and warm salt water rinses. Do not spit, just let the liquid drool out the side. Wait at least 6 to 8 weeks for use of power brush and power flosser / irrigators.

EATING: You should stick to a soft diet of nutritious foods (such as scrambled eggs, mashed potatoes, warm soups, yogurt, smoothies, etc.) for the first week following surgery, to promote better healing. Foods to avoid: spicy/acidic foods and carbonated drinks, hard or crunchy foods (nuts, popcorn and granola), as well as hot liquids (soup/coffee/tea). Eat a soft diet such as scrambled eggs, mashed potatoes, warm soup, yogurt, etc. Avoid hot, sharp, or spicy foods.Try to chew on the opposite side of the surgical site(s). Drink lots of water. Do not use a straw when drinking, as suction may cause bleeding. Avoid spitting for one week. Add solid foods back into your diet as soon as they are comfortable to chew.

TOBACCO, ALCOHOL AND GUM: Avoid smoking, chewing tobacco, chewing gum and drinking alcohol during the healing process (approximately 14 days following surgery). The use of alcohol when taking prescription drugs such as pain medication and antibiotics can cause potentially lethal interactions.

 Things to expect:

SWELLING/BRUISING: Swelling typically occurs after surgery and peaks by 2-3 days after. Please ice the area for 15 or 20 Minutes on/off intervals on the first day. Bruising may occur and slowly progress down your cheeks, jaw and neck. Most discomfort is caused by inflammation. This is a normal part of the healing process which will cause you to experience aching or throbbing. Bruising may also occur due to the nature of the surgery and especially if you are a person that bruises easily.

DISCOMFORT: Most discomfort will occur a few hours after the sensation returns to your mouth and may increase over the next 3 days following surgery. It should subside afterwards, especially if you follow these instructions and take the prescribed medication.

BLEEDING: You can expect a small amount of bleeding for the first 24-48 hours. Small amounts of blood on a gauze are normal. On the first night you may want to place a towel on your pillow in case you drool some saliva mixed with blood. Blood completely soaking gauze is a concern and you should follow the instructions below.

• Take 2-3 pieces of gauze and lightly moisten with water.
• Fold the gauze on its self several times
• Place the moistened folded gauze on the area bleeding and either bite or press firmly on the area for 20 minutes. Do not spit or rinse or touch the area with your tongue or fingers. Sitting upright position in a chair can be helpful. Avoid hot foods and liquis in the first 24 hours as this can increase the risk of bleeding. 
• If the bleeding does not stop, moisten a tea bag and place on the area firmly for 20 minutes.
• If the bleeding persists, please call us at any time.

SUTURES: In most cases, sutures are dissolvable and will dissolve after 7 to 10 days following your surgery. If non-dissolvable sutures are placed, they will be removed about 2 or 3 weeks after surgery. At times a periodontal dressing (bandage) may be placed to protect the surgical site during the healing phase. Dental glue or a dressing can be placed in the surgical area; this will disintegrate/flake off after a few days.  This is not of any concern. Some sutures may become loose or come out on their own, and some may be removed at the post-op appointment.

SENSITIVE TEETH: Sensitivity is normal and usually resolves gradually over 6 weeks. Please use a toothpaste for sensitivity such as Colgate Pro-Relief for sensitive teeth twice daily. The key is to keep the area clean and allow time for the fluorided or desensitizing tooth pastes to work. If necessary, sometimes our clinic can apply a stronger desensitizing chemical to assist.

For patients having Gingival “GUM” Grafts :

SURGICAL DRESSING:  It should stay about 5 days then can fall out. If it falls out sooner and there is discomfort, call our office for re-application. You can start rinsing your mouth with the provided mouth rinse [See Tooth Brushing and Rinsing Instructions above]. If the palatal gum graft donor site is painful and there is no relief from pain medications, please contact our clinic and we will prescribe a special rinse to help reduce discomfort and promote healing.

Soft tissue – Gingival graft (FGG) and Connective tissue graft (CTG):  Absorbable sutures are used in the palate. Do not force the removal of stitches. A dental adhesive and/or dressing might be placed in the surgical area and it will fall off after a few days. If it becomes uncomfortable, please call the office for instructions. Non-dissolvable sutures are utilized and will have to be removed about 2 weeks after the surgery. If a bone graft was placed around teeth or implants – do not use a Waterpik irrigator. We will provide you instructions regarding how to care for your mouth after specific procedures. Wait at least 6 to 8 weeks for use of power brush and power flosser / irrigators.

For patients having Dental Implants:

There is a possibility that the metallic healing cap over the implant comes off during the healing phase. Simply save this healing cap and call our office to have it replaced, it is not an emergency. 

 Following appointments:

• About 2 weeks post-operative appointment is necessary to evaluate primary healing.
• Diamond & Associates may also advise subsequent evaluations for final healing. If necessary, it will be scheduled at your first post-operative appointment; it is vital that our office continues to monitor your periodontal health during this period.

Additional Recommendations after a Sinus Lift

You may notice some sinus congestion or mild bleeding from the nose. No blowing your nose for 1 week. You may wipe your nose gently. If you need to sneeze, do so from your mouth and not your nose. Avoid activities which cause pressure changes such as flying, swimming, scuba diving for at least 2 weeks.

Post-Operative Instructions:  Wisdom Teeth Removal

What to expect after having your wisdom teeth removed.

Initial recovery after wisdom teeth removal takes 3 to 7 days, while typical full healing may take up to 2 weeks. Here are a few points to consider for your recovery. 

Swelling
-Swelling is normal after surgery. It tends to peak on the third day after surgery. Ice to the face
or a bag of frozen peas etc to the area is helpful to reduce swelling. Ideally this should be done
for 15 minutes on and 15 minutes off while awake for up to two to three days after surgery. Swelling and inflammation normally peaks at about day 3 and then starts to decrease after this time.

Bruising
-Bruising on the face can occur after surgery and can look bluish initially and then yellow. In some
cases, it can last for almost 10 days. Bruising can travel along the face. Do not be alarmed if
your upper tooth was extracted and the bruising reaches the lower jaw area.
Bruising will all go away in time.

Rinsing
– Rinsing with warm salt water can begin the day after surgery. Do not rinse or spit on the day of
surgery. If you must brush your teeth that day, avoid spitting afterward. Otherwise, resume
brushing your teeth the next day, however, avoid the area of surgery for a week.
– Rinsing: use 1 cup of water and 1 tbsp of salt. Rinse 3-4x/day each time rinsing 3 times.
Rinsing for 1 week is adequate. If needed, a syringe will be supplied to flush the sockets out
directly, however, this is only started 1 week after surgery. Using the syringe for 2 weeks is
typically adequate. Dr. Diamond & Associates will inform you if you need to use a syringe.

Pain
– Pain after surgery is normal. The first 3 post-operative days are usually the toughest. Start
taking the pain medication before the local anesthesia wears off. Typically, you can start taking
it when you arrive home. It is best to take medications after eating (even a little something) if
possible.
– If you have been instructed to take Extra Strength (ES) Tylenol, you may take 2 at a time
(maximum 8 tabs/day). ES Tylenol may be taken at the same time as ibuprofen/motrin/advil/toradol if
needed.
– We may also prescribe pain medication depending on the nature of your surgery. If the pain
medication is not relieving your pain, contact us. There is no need to suffer!
Sometimes we may prescribe a pain narcotic and Toradol. They may be taken together and even with
Tylenol as well. Please note, that Toradol cannot be taken with Advil/Motrin/Ibuprofen which are
all anti-inflammatory medications.

Nausea
– Nausea may occur after surgery if you have had sedation or general anesthesia. It may also occur
with some pain medications. Gravol may be helpful to reduce nausea.

Eating/Drinking
– You may drink and eat soft foods after your surgery such as fish, pasta, jello, eggs, smoothies,
pudding, juices, soups, mashed potatoes etc.
– Avoid anything hard or crunchy such as nuts, popcorn, crusty breads, crackers, and seeds.
– Stick to soft foods for 1 week after surgery. After 1 week, you may progress to a normal diet
(whatever is comfortable to eat) except for nuts, seeds and popcorn which should be avoided for 3
weeks after surgery
– If you have had general anesthesia or sedation, avoid eating dairy for 24 hours after surgery.

Bleeding
– It is normal to have some bleeding after surgery. If this occurs, use gauze to put pressure
DIRECTLY over the bleeding extraction site. Take 2-3 pieces of gauze on top of each other: fold in
half, then in a quarter and put it directly over the site (vertically) and bite down. Bite down for
15 minutes without talking. Direct pressure over the site is required to stop the bleeding. If the
gauze (when removed) is red just over the site where pressure was applied that is normal. If the
gauze is completely soaked with blood, apply fresh gauze again. A black tea bag soaked in warm
water can also be used. Remember, the key is to apply direct pressure to the site for 15 minutes.
If bleeding is persistent despite proper application of biting pressure, contact our office.
– Do not exercise for 3 days after surgery as this will increase your blood pressure and may cause
bleeding

Mouth Opening
– It is normal for your mouth opening to have stiffness or limited opening after surgery, usually peaking at day 3 to 4 after wisdom tooth removal. It then slowly improves. It can take up to 10-14 days for your mouth opening to return back to normal. If you cannot open as wide as you did before surgery do not worry as it will return back to normal in time. If your mouth opening does not return to normal within 2 weeks, please contact our office. We regularly will see you for a post-operative appointment about 7 days after your surgery.

Smoking
-Do not smoke for 7 days after surgery. Smoking after surgery can increase the risk of infection and
cause significant pain. 

Sutures (stitches)
-Stitches typically do not have to be removed and will resorb on their own. Stitches are not always
required. If they fall out within a couple of days after surgery it is not a concern.

 Socket Healing
– It will take approximately 4-6 weeks for the gum tissue to fill in the holes (extraction
sockets). Do not be alarmed if you see “black holes” where the teeth were extracted until the gum
fills in. This is normal. The sockets heal from inside toward the outside.

 Numbness and local anesthesia

-In the lower jaw, long acting local anesthesia is often used. This means that you may
feel numbness in you lower lip, chin, gums, and tongue until you go to sleep. If you continue to
feel numbness the next day, please contact our office.

AFTER HOURS EMERGENCIES:

Finally, if you have any questions or concerns AFTER business hours / over the weekend, you may
contact Dr. Diamond & Associates directly via text or phone:  705 923-7575.

 705-670-8005 (Clinic / Office Administrative Hours, Day time: Mon-Thurs 7:30 am – 4:30 pm)   

705-923-7575 (After Hours Emergency Cellular Evenings/Weekends)