|This instruction sheet has been developed for those
patients who have undergone periodontal surgical procedures. Please read these
instructions carefully. if you have any further questions or if you are not sure what you
are experiencing is normal, please don't hesitate to call the office.
It is not unusual to have a certain amount of discomfort following any surgical procedure. In most situations one or two extra strength Tylenol or up to four Advil (Ibuprofin or Motrin) can be taken every 4 hours or as needed for pain. It’s best to take them immediately before pain sets in; it’s easier to prevent pain than to stop it. Regardless, at least take the medication before bedtime.
In many cases, Dr. Mao will prescribe a stronger medication (narcotic). He will prescribe one of the following narcotics:
1. Tylenol with Codeine #3 2. Vicodin 3. Vicodin ES (twice the strength of Vicodin or Tylenol #3)
4. Norco (3 times stronger than Tylenol #3)-no generic for this
5. Darvocette for those who can’t take codeine.
The use of the above medications should be taken seriously. Do not take them with alcoholic beverages. It could also potentiate any current medications you are taken, so consult either or both the pharmacist or your M.D.
Of course one of the best non-medications for discomfort is ICE. You can use ice in two ways:
1. Suck on cubes of ice or crushed ice. Ice cream may be the way to go, but fattening!
2. Take a zip lock bag and place ice into it. Then place it on the outside of your face adjacent to the surgical area. If the surgical procedure is on the lower jaw, be sure the ice is wrapped under or around the jaw bone.
Minor swelling may follow your surgical procedure. This most likely is just a healing reaction from your body. To minimize swelling the ICE is imperative immediately after the surgery. It should be used on and off every 10 minutes for
1-2 hours (depending on the extent of the surgery).
Do not use it constantly or it may impede the blood supply to the area all together.
After the first 1-2 hrs of ice, use it on and off for the rest of the day.
It is also helpful if you do not lie down with your head flat. If you must do so, prop your head up on several pillows; this prevents blood from pooling in your head while you are resting or asleep. Regardless, it is not unusual to see some slight increase in swelling when you wake up.
Most of the time this slight swelling goes down as you get up and move around.
If swelling seems excessive or starts increasing during the next day, please call Dr. Mao as soon as possible. Although this may be part of the healing reaction, it is still better to consult with Dr. Mao. In many cases he will prescribe an antibiotic to prevent an infection.
Of particular concern is swelling beneath the jaw (neck) or under the
STARTING ANTIBIOTICS: When antibiotics are given, it is advisable to use heat in the area (warm salt water inside or a heat pack outside). To be most effective, the heat should be used about 30-45 minutes after the antibiotic is ingested; this maximizes the antibiotics to the area for fighting a possible infection.
As Dr. Mao will not have your file after hours, please be sure to let him know if you are allergic to any drug before he prescribes anything, esp. an antibiotic.
The antibiotic of choice is usually Penicillin (Amoxicillin), but many people are allergic to it. As an option he will use one of three other antibiotics: Clindamycin (Cleocin),
Erythromycin (EES) or sometimes Tetracycline (or Doxycycline).
A small amount of bleeding is possible, esp. immediately after surgery; it may discolor your saliva slightly, so don’t be alarmed. If, however, continuous bleeding occurs (even if it is a small amount), call Dr. Mao immediately.
If a large amount of bleeding starts, stay calm; most of the time a little pressure with your finger over the surgical site will stop it. Then call Dr. Mao.
Procedures to follow:
1. Look in your mouth to see where the bleeding is coming from. If it is on the outside (cheek side) it is very easy to stop, as you can simply place your fore-finger against your cheek or lips opposite the area.
2. If the bleeding is inside your mouth (tongue side), it is more difficult to stop for obvious reasons. In this case, you can place your fingers on the periodontal dressing and place pressure for several minutes. If this works, fine. If it doesn’t , remove the packing (peal it off with your fingers) and place a gauze or wet tea bag over the area and apply pressure. The tea bag helps in that it contains tannic acid which can chemically stop bleeding.
HOW TO MAKE THE TEA MIX: Take at least 5 tea bags (not spicey tea) and place them in a tall glass of hot water. Let the tea strengthen for 15 minutes. Then place the whole glass and tea bags into the refrigerator. Two options: 1. Place the tea bags in the area of bleeding or 2. Place the tea solution into the area and hold it for 30 secs. Use this method until the bleeding stops.
A periodontal dressing (or packing) is usually placed over the surgical site. The purpose for this dressing is to protect the site from trauma (brushing and food impaction). If it comes loose, just take it off or you may swallow it. It’s important to know that the dressing does not promote healing; infact, healing may occur faster without the packing.
Quite often, small pieces fall off as the week goes by. If the pack is uncomfortable, you may take it off; simply rinse with warm water to soften the pack ; then peal it off with your fingers. The only problem you may have is if a suture (stitch) gets caught in the pack; in this case use warmer water to soften the dressing and try pulling again. Eventually, it will come off.
You will probably not want to eat on the side where the surgery was performed, although it will not hurt it, as long as the dressing is present. Do NOT eat anything seedy or popcorn. Salt may make it “twinge”, but won’t hurt it. It is also suggested not to eat anything chewy during the first week.
The first night, eat something soft, as rice or noodles. Cottage cheese and fruits will also be a good idea. Cold drinks or even milk shakes are useful. Mostly, use common sense. Hot foods or drinks are not advisable, as it could promote bleeding. discomfort is to be expected. The amount will vary
depending on the extent of surgery.
For the first week it is not really necessary to worry about flossing or brushing, esp. in the surgical area. In fact, it is really not important to brush even the other areas of the mouth as long as you rinse well. If there is dressing present, you obviously cannot brush the dressing. If the dressing comes off, you must be ) not to brush the area by accident (habit) or you may “see stars”.
For It is helpful to use rinses for at least the first week after the surgery. There are several rinses or mouth washes available: 1. Listerine 2. Chloraseptic (also numbs the area if it is sore); the disadvantage is that it is costly. 3. Periogard mouth rinse
(antibiotic rinse); a prescription is necessary and is not usually recommended unless there is severe soreness or if Dr. Mao performs a bone graft or an implant. 4. The old standby: warm salt water.