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After your Perio Surgery

These instructions apply to the surgical procedure just completed. They are designed to help you minimize post-surgical discomfort and inform you of any situation that may require special attention.

Post- Operative Instructions

After hour questions or concerns, please call (608) 833-1889

Activities

• If you had oral sedation, you should not drive a car, operate any machinery or undertake any responsible business matters for at least 24 hours.
• Return to exercising when you feel ready, strenuous activity may result in increased pain and bleeding.

  • Swimming - with larger surgical procedures I recommend staying out of the pool for 3 days.
  • Jogging - most people say the surgical site aches and throbs, may start to bleed while jogging. Take a few days off or walk instead.

Bleeding

  • Mild oozing of blood is to be expected after surgery. This may continue for 24-72 hours. Such oozing, combined with saliva, can appear as noticeable bleeding.
  • Most procedures that I do are 'closed up' with stitches, and bleeding is usually minimal.
  • Pressure with moistened gauze will stop most bleeding complications at home.
  • However, sometimes a 'liver clot' forms at the surgical site. This is a poorly formed clot along the edges of a wound and often on top of a wound (extraction site, incision line). It looks like a dark, gelatinous lump. Continuous bleeding often occurs with a liver clot. You can often fix this complication by wiping off the clot with moist gauze or a small towel. Then, reapply pressure until the bleeding has stopped. (This is more common with patients taking blood thinners such as Coumadin/Warfarin.)
  • If you have tried wiping off the liver clot and applied pressure and the bleeding just won’t stop, call the office. Sometimes this surgical site needs to be anesthetized, cleaned out and sutured In order to stop the bleeding.
  • Placing a moistened tea bag over the surgery area may stop persistent bleeding. The tannic acid in the tea bag helps to form a blood clot by
    contracting bleeding vessels. 
  • Rest  and sleep with your head elevated by two pillows and place an old towel over the pillows. The towel will help absorb any oozing that may seep out of your mouth.

Discomfort

  • Pain usually becomes more Intense on days 2-3 after surgical treatment.
  • Do not take pain medication on an empty stomach. This may make you feel nauseated and sick.
  • Take your pain medication as prescribed. The worst thing to do is to wait for the pain to begin and then trying to control the pain.
#1 - Take one pain pill when you begin to feel the 'Novocain' wearing off. (Examples: 600mg ibuprofen, 500mg Tylenol, one Vicodin.) This will allow the pain pill to dissolve and get into the blood stream by the time the local anesthetic has worn off. 
  • Prescribed pain medications are generally needed the first few days. I usually prescribe the narcotic pain medication Vicodin that is 5mg hydrocodone and 325mg Tylenol.
#2 - lf you can take ibuprofen, it is recommended to use this as your main pain pill.
  • This helps control pain, Inflammation and fever.
  • Maximum daily dose is 3,200mg.
  • 400 mg every 4 hours
  • 600 mg every 6 hours
  • 800mg every 8 hours
#3 -Alternate Ibuprofen with the narcotic pain pill.
  • For example, take 600mg of ibuprofen and 3 hours later; take 1-2 vicodin or plain Tylenol (325-500mg).

#4 – You can also take Ibuprofen and Tylenol at the same time or ibuprofen and vicodin at the same time.

#5 - Be careful of taking too much Tylenol, especially if you have liver problems, bleeding problems or a history of alcoholism.
  • Vicodin contains 325mg of Tylenol.
  • Tylenol #3 contains 300mg of Tylenol
  • Percocet contains 325mg of Tylenol
  • Ultracet contains 325mg of
Maximum daily doses:
  • Acetaminophen (Tylenol): 3,000mg
  • Ibuprofen (Advil): 3,200mg
• Narcotic-containing medications and cold pills containing anti-histamines can cause drowsiness.
Do not drive or operate machines while taking these medications. Alcohol can add to the sedative effect of the narcotic-containing pain medication and of the anti-histamine-containing cold pills. Never drink alcohol while taking either of these medications.

Antibiotics

  • If you have been placed on antibiotics, take all of the pills as directed.
  • A common side effect of antibiotics is an upset stomach. Taking a pro-biotic may help while taking the antibiotic.
  • Sometimes a fungal Infection can start with antibiotic use. An antifungal prescription can be prescribed if needed.
  • Antibiotics may interfere with the effectiveness of oral contraceptives. Therefore, you will need to use some additional form of birth control for one complete cycle of birth control pills after the course of antibiotics
    • The drugs you may be given will minimize swelling, reduce discomfort, prevent infection and promote healing. Please take the medications as recommended. 
    • Although most patients benefit from the prescribed medications, occasional side effects such as dizziness, rash, nausea, excitement, constipation,  or  diarrhea can occur. Should any of these occur, stop the drug and notify the office. 

Swelling

  • Facial swelling is normal and most noticeable within the first 2-3 days after surgery.
  • Facial swelling may take a week to disappear.
  • Localized swelling of the surgical site or the gums may take 6 or more weeks to resolve.
  • Apply ice packs during the first 24-72 hours. Continued use of the ice often feels good for many days after surgery.
  • After 48 hours, if swelling or jaw stiffness has occurred, apply heat on the outside of the face using a warm, moist compress. Do not use the heat continually, apply it for about 20 minutes then remove it for an equal interval.

Brusing

  • Bruising is very common and usually occurs 2-3 days after surgery.
  • Black and blue marks on the face are caused by seepage of blood beneath the cheeks, chin or under the eye (black eye).
  • This may appear initially as a swelling, but often by the second or third day it may discolor the face. The color may progress from black-and-blue to yellow­ and-green, and the color may progress down your face onto your neck.
  • It will gradually disappear over a week or two. Moist external heat will assist in resolving the surgically created bruise.

Sutures (Stitches)

  • Most sutures dissolve within 3-10 days.
  • Others dissolve after 1-2 months.
  • Some do not dissolve and need to be removed after healing
  • Sutures can become loose and hang down or flop around the surgical site
  • Sutures can pull though the tissues causing irritation and mild bleeding
  • It is typically OK if sutures begin to unravel and fall out after a few days after treatment.
  • Although sometimes tempting, please refrain from taking the sutures out yourself. The exception is if there is a completely loose stitch that is driving you nuts.

Diet

  • Implants -do not chew directly on the healing cap
  • Avoid rough, sharp foods, little seeds
  • Eat on the other side
  • Stay hydrated. Drink water, juice, ginger ale, Gatorade. Ice chips with Juice or ginger helps too.
  • Soft foods are best the first few days. Try pastas, soups, shakes, smoothies, Jell-o, yogurt, pudding, ice cream.
  • Avoid smoking for as long as possible.
  • Return to a normal diet as soon as possible based on how you feel, how wide you can open and how well you can chew.
  • This is not the time to start a new diet trend. You will feel better, have more strength, have less discomfort and heal faster if you continue to eat.
  • If you are diabetic, maintain your normal caloric requirements and take you medication as usual.

Sensitivity

Cold sensitivity is very normal after scaling.  The root surfaces were not only “scraped,” but in some areas, are now exposed.  There are very small tubules communicating between the “nerve” of the tooth and the root surface.  Desensitizing toothpastes will help clog these tubules. It is important that you do not rinse your mouth out with water or mouthwash after brushing with sensitivity toothpaste. This will only remove the desensitizing agents from your teeth (potassium nitrate & fluoride).

Sensitivity usually goes away or returns to a level that you had prior to scaling within 2-4 weeks.  With people who smoke, sensitivity tends to be more severe and last longer. If you have prolonged sensitivity that does not seem to be getting better, contact the office; a prescription toothpaste may be necessary to help. 

Hygiene

  • Rinse the mouth out 4-6 times dally.
    • Start the day of surgery unless you were Instructed not to.
  • Use the prescribed mouthwash, Therasol, twice per day. The antibacterial properties in Therasol last for 12 hours so twice a day is adequate.
    • You can use this more often if you like.
    • In addition to Therasol and when the Therasol runs out, rinse with one of the following:
    • Listerine (alcohol free now available)
    • Crest Pro Health (alcohol free}
    • Salt water (glass of warm water with½ spoonful of salt)
    • Hydrogen peroxide (diluted equally with water)
  • Brushing - I almost always hand out a post-operative toothbrush - a very soft brush for going over the gums at the surgical site. This aids healing by massaging the gums gently.
    • It is normal to not brush surgical sites for
      about one week.
    • When comfortable, you can often brush the
      teeth gently, avoiding the gum line.
    • After 1-2 weeks, brushing the surgical site with the toothbrush dipped in Therasol Is recommended. Wipe and massage the gums with the brush. This will aid healing, reduce Inflammation and allow the edges of the gum to adapt better and faster. 
    • Best rule of thumb: if it hurts, don't brush it yet.
  • Flossing and Proxy brushes - can usually be done shortly after surgery, Just be gentle, do not go too deep with the floss.
  • Good oral hygiene is imperative for optimal wound healing. Plaque and food left in the wound slows healing, could cause infection and could Impact surgical results.

Flipper, partial denture, denture 

  • Leave the flipper out as much as possible during initial healing. Leave it out at home, wear it while at work or socially.
  • Initial swelling will occur around the gum and the flipper may not fit the same.
    • Sore spots from the flipper can easily be adjusted.
    • Sometimes a new flipper is needed.
  • Pressure from the flipper could cause:
    • Pain
    • The gum tissue to die and recede - both could permanently compromise surgical and esthetic results

Possible Side Effects 

Presence or absence of side effects vary from patient to patient and certainly vary with the difficulty of the surgical procedure. The following conditions may occur, all of which are considered normal: 

  • Swelling - the face and jaw will probably swell.
  • Black eye
  • Stiffness of the jaws, limited opening.
  • Paresthesia:
    • Altered feeling, numbness of the lower lip and chin and on the side of the tongue may occur on the side of surgery.
    • Usually a temporary condition that will correct itself.
    • It may remain anywhere from a few days to one year.
  • Dry Socket
    • Usually occurs 3-4 days after tooth extraction.
    • Prolonged, continuous pain.
    • Treated at the office with a medication placed into the socket.
  • Adjacent teeth may feel:
    • Sore
    • Loose
    • Sensitive
  • Altered bite
  • Dry, cracked corners of the mouth
  • Sore throat
  • Ear ache

Infection 

  • Signs of infection include:
    • Increased, continuous pain
    • Increased swelling
    • Puss, colored drainage
    • Redness, heat
    • Bad taste
    • Increased joint stiffness

If you have any questions or concerns, please contact us:
Weekdays: Click here to contact your preferred clinic location
Evenings/Weekends: (608) 833-1889

There is always someone on call 7 days a week, until 10:00 p.m.

Post Scaling Instructions

After hour questions or concerns, please call (608) 833-1889

Activities

If you had oral-sedation, you should not drive a car, operative any machinery or undertake any responsible business matters for at least 24 hours.  Return to working-out when you feel ready.  Strenuous activity may result in some throbbing pain and bleeding from the gums. If anesthetic was used, it is best to wait until you are no longer numb before eating. You may want to choose soft foods, and avoid ones that are hot in temperature, or spicy. Drinking through a straw may also be needed until the anesthetic wears off.

Bleeding

  • Inflamed tissue was removed during the scaling procedure and, as a result, small blood clots will form in between the teeth.
  • Light bleeding or oozing from the gums is expected for a day or two and is normal.
  • Rinsing will help stop the bleeding. You can use:
    • TheraSol
    • Listerine
    • Crest pro health
    • Salt water

Discomfort

  • After a deep cleaning, gums usually ache and are sore.
  • Take your pain medication as prescribed. The worst thing to do is to wait for the pain to begin and then try to control the pain.If you were given ibuprofen from the office, take one pill up to every 6 hours as needed.  If you cannot take ibuprofen, use Tylenol every 4-6 hours.
  • Take one pain pill when you begin to feel the ‘novocaine’ wearing off.  (Examples: 600mg ibuprofen, 325mg Tylenol, 500mg Extra Strength Tylenol, Vicodin.) This will allow the pain pill to dissolve and get into the blood stream by the time the local anesthetic has worn off.  Everyone metabolizes anesthetic differently, you may be numb for 2-4 hours after leaving your appointment.
  • If you were given a prescription for pain medication, take these pills only as directed. It may be recommended to alternate over the counter pain medication, such as ibuprofen, with the prescribed pain medication. This will help control pain better than waiting to take the medication “when it hurts”.  Often, the prescription pain medication you were given contains Tylenol. Do not combine the prescription pain pill with Tylenol.  This could result in an overdose of Tylenol. 
  • If you can take ibuprofen, it is recommended to use this as your main pain medication, as it is a pain reliever, anti inflammatory, and fever reducer.
    • Maximum Ibuprofen daily dose is 3,200mg.
    • 400 mg every 4 hours
    • 600 mg every 6 hours
    • 800mg every 8 hours
  • You can take ibuprofen and Tylenol at the same time, or alternately.
  • Be careful of taking too much Tylenol, especially if you have liver problems, bleeding problems or a history of alcoholism.
    • Maximum Acetaminophen (Tylenol) daily dose is 3,000mg
    • 2 - 325 mg tablets every 4-6 hours
    • 2 - 500 mg tablets every 6 hours

Although most patients benefit from the prescribed medications, occasional side effects such as dizziness, rash, nausea, excitement, constipation, or diarrhea can occur.  Should any of these occur, stop the drug immediately and notify the office. 

Narcotic-containing medications and cold pills containing anti-histamines can cause drowsiness.   Do not drive or operate machines while taking these medications.  Alcohol can add to the sedative effect of the narcotic-containing pain medication and of the anti-histamine-containing cold pills. Never drink alcohol while taking either of these medications.

Antibiotics

  • If you have been placed on antibiotics, take all of the pills as directed.
  • A common side effect of antibiotics is an upset stomach. Taking a pro-biotic may help while taking the antibiotic.
  • Sometimes a fungal infection can start with antibiotic use. An anti fungal can be prescribed if needed.
  • Antibiotics may interfere with the effectiveness of oral contraceptives. Therefore, you will need to use some additional form of birth control for one complete cycle of birth control pills after the course of antibiotics

Sensitivity

Cold sensitivity is very normal after scaling.  The root surfaces were not only “scraped,” but in some areas, are now exposed.  There are very small tubules communicating between the “nerve” of the tooth and the root surface.  Desensitizing toothpastes will help clog these tubules. It is important that you do not rinse your mouth out with water or mouthwash after brushing with sensitivity toothpaste. This will only remove the desensitizing agents from your teeth (potassium nitrate & fluoride).

Sensitivity usually goes away or returns to a level that you had prior to scaling within 2-4 weeks.  With people who smoke, sensitivity tends to be more severe and last longer. If you have prolonged sensitivity that does not seem to be getting better, contact the office; a prescription toothpaste may be necessary to help. 

Bigger Spaces

After scaling, the spaces in between your teeth are often larger.  This is because the inflamed tissue or “pocket” has been somewhat removed.  It is important that you keep these spaces clean with regular use of the proxy-brush, and other home care aids given to you.  Flossing does not clean these areas adequately.  Only a proxy-brush will effectively remove plaque from the root surfaces in these bigger spaces or “holes”. 

Hygiene

Return to normal brushing (twice per day for at least 2 minutes, massaging the gum tissue), flossing and now, proxy-brush use, today. Do not be intimidated by the presence of some blood.  This is normal until the tissues have had enough time to heal.  You will heal faster, have less discomfort and less sensitivity with good home care.  Plaque left on roots will lead to inflammation, sore gums and increased sensitivity.  It is very important to keep your mouth as clean as possible so the tissue can heal well. An electric brush, such as a Phillips Sonicare, is highly recommended. We sell Sonicare brushes here at the office, or you could purchase one in stores or online in places such as Amazon, Target, Walgreens, Walmart, etc.   It is also very important to keep up with returning visits to monitor your condition closely.

If you have any questions concerning your post-operative care or the information provided here, please contact us:
Weekdays: Click here to contact your preferred clinic location
Evenings/Weekends: (608) 833-1889

There is always someone on call 7 days a week, until 10:00 p.m.

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