After Your Perio Surgery

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. Strenuous activity may result in increased pain and bleeding. Return to exercising when you feel ready.

• Swimming –with larger surgical procedures it is recommended to stay out of the pool for 3 days.
• Jogging –most people say the surgical site aches/throbs and may start to bleed while jogging. Take a few days off or walk instead.

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 are “closed up” with stitches and bleeding is usually minimal. If you experience bleeding:

• Apply pressure with moistened gauze. This will typically stop most bleeding complications at home.
• Place a moistened tea bag over the surgery area. The tannic acid in the tea bag helps to form a blood clot by contracting bleeding vessels and may stop persistent bleeding.
• 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.

Occasionally 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. If this happens:

• Wipe 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.

Pain usually becomes more intense on days 2-3 after surgical treatment.

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. Do not take pain medication on an empty stomach. This may make you feel nauseated and sick.

Prescribed pain medications are generally needed the first few days. We typically prescribe the narcotic pain medication Vicodin, which is 5mg hydrocodone and 325mg Tylenol.

• 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. 
• If 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)
• 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).
• You can also take ibuprofen and Tylenol at the same time or ibuprofen and Vicodin at the same time.
• 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 Tylenol

Maximum Daily Doses

• Acetaminophen (Tylenol): 3,000mg
• Ibuprofen (Advil): 3,200mg

WARNINGS

• Narcotic-containing medications and cold pills containing antihistamines 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 antihistamine-containing cold pills. Never drink alcohol while taking either of these medications

If you have been placed on antibiotics, take all of the pills as directed. The prescriptions you may be given will minimize swelling, reduce discomfort, prevent infection and promote healing. Although most patients benefit from the prescribed medications, occasional side effects can include:

• Upset stomach. Taking a pro-biotic may help while taking the antibiotic.
• Fungal infection. An antifungal prescription can be prescribed if needed.
• Interference 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.
• Dizziness, rash, nausea, excitement, constipation, and/or diarrhea. Should any of these occur, stop the drug and notify the office.

Facial swelling is normal and most noticeable within the first 2-3 days after surgery. It may take a week or so to disappear.

Localized swelling of the surgical site or the gums may take 6 or more weeks to resolve.

To help with swelling and discomfort:

• 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.

Bruising is very common and usually occurs 2-3 days after surgery. This may appear initially as 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. Black and blue marks on the face are caused by seepage of blood beneath the cheeks, chin or under the eye (black eye). It will gradually disappear over a week or two. Moist external heat will assist in resolving the surgically created bruise.

Most sutures dissolve within 3-10 days, some may take 1-2 months, and others may need to be removed after healing. Sutures can become loose and hang down or flop around the surgical site and may pull through the tissues causing irritation and mild bleeding.

Although it may be tempting, please refrain from taking the sutures out yourself.

After having a periodontal procedure, it’s best to stay hydrated (water, juice, ginger ale, Gatorade, ice chips with juice) and eat soft foods for the first few days (pasta, soup, shakes/smoothies, Jell-O, yogurt, pudding, ice cream).

Avoid smoking for as long as possible and avoid rough, sharp foods or foods with little seeds.

Use the side opposite the procedure for chewing and if you had an implant, do not chew directly on the healing cap.

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 your medication as usual.

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.

Rinse

Rinse your mouth 4-6 times daily starting the day of the 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, but you may use it more often if you would like. In addition to Therasol, and when Therasol runs out, rinse with one of the following:

• Listerine (alcohol free)
• Crest Pro Health (alcohol free)
• Salt water (glass of warm water with ½ a spoon of salt)
• Hydrogen peroxide (diluted equally with water)

Brush

It is normal to not brush surgical sites for about one week. When it feels comfortable, you can brush the teeth gently, avoiding the gum line. If you experience pain, it may not be time to start brushing.

Most times, we will provide you with a post-operative toothbrush. It is a very soft brush for going over the gums at the surgical site. This aids in healing by massaging the gums gently.

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. 

Floss

Dental floss and proxy brushes can typically be used shortly after surgery. It’s important to be gentle and not go too deep with the floss.

Leave the flipper out as much as possible during the healing process. It’s best to leave it out at home, but you may wear it while at work or socially. Wearing the flipper too much can create pressure on the surgery site. This can cause pain and even the gum tissue to die and recede (compromising the surgical and aesthetic results).

Initial swelling will occur around the gum and the flipper may not fit the same. Sore spots from the flipper can easily be adjusted and sometimes a new flipper is needed.

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
• Black eye / Bruising
• 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

Signs of infection include:

• Increased, continuous pain
• Increased swelling
• Puss, colored drainage
• Redness, heat
• Bad taste
• Increased joint stiffness

If you experience any of these, please call our office.