What to Expect from Surgery
Years ago periodontal surgery was considered an ordeal.
Things have changed! Today there should be no pain involved during surgery,
and the postoperative discomfort is minimal. New and sophisticated medications
ensure you a smooth procedure. Most patients prefer light sedation for
surgical procedures. Research has shown that light sedation improves surgical
safety, improves the outcome and contributes to a more pleasant post-operative
course. Both doctors are licensed by the States of Illinois to perform
For surgeries that last an hour or longer, most patients prefer a light sedation. The medication we use is Versed, which is similar to Valium and is administered intravenously. This is not general anesthesia, which we don't do in the office, and is extremely safe. We have done thousands of sedations without incident. Your heart and blood oxygen levels are monitored during the procedure to ensure your safety. With sedation, an hour procedure seems like 5 minutes, and you are not even aware of the local anesthetic when it is given. Of all the additions to modern periodontics, this is the most significant for patient comfort. If sedation is used, you must have a driver. If your driver does not stay for the surgery, he/she must be back 15 minutes before the scheduled appointment end.
Postoperative discomfort has been dramatically reduced
with the use of NSAIDS (non-steroid anti-inflammatant drugs). These pain
prevention drugs, such as Naprosyn and Motrin, stop the formation of the
chemicals the body normally produces that cause heightened pain. NSAIDS
are not narcotics, so you can function normally when taking them. Generally,
NSAIDS are started the morning before surgery, and taken for three days.
After this time no prescription medications are normally needed. In addition
to the NSAIDS, a narcotic may be recommended for the first day.
Patients are often given antibiotics to take after
surgery. It is important to take the prescriptions as directed, to optimize
A prescription mouthwash is often prescribed after surgery, and may be used for 2-10 weeks. It is much more effective than any over-the-counter mouthwash, and kills bacteria throughout the mouth. During the first 10 days there is generally a periodontal dressing over the operated area (similar to putty or chewing gum), and using the mouthwash keeps the dressing clean.
At 10-14 days any dressing is removed, along with
sutures which may not have dissolved. The area is cleansed, and postoperative
care of the area reviewed. This appointment generally lasts 15-30 minutes,
and should not cause discomfort.
With most cases it is important to keep all bacteria
away from the surgical site for 8-10 weeks. To help ensure optimal plaque
control, polish appointments are often scheduled every 3-4 weeks. The
prescription mouthwash may also be continued during this time. We have
found that careful control of plaque during the healing phase greatly
enhances surgical results.
SURGICAL POST-OPERATIVE INSTRUCTIONS
The post-operative instructions listed below should
be followed accurately in order to speed your recovery.
- SWELLING - The first 24 hours is the most critical
phase for swelling control. Most swelling does not visibly appear until
24-48 hours after surgery. It is therefore important to apply (on and
off) ice at 20 minutes intervals. Ice application after 48 hours slows
healing and prevents swelling reduction.
- EATING - The rule of thumb is "C.S.S."
(cooler, softer, smaller). Avoid spicy or hot foods. Any food that is
cool, easy to chew, and soft is O.K. to eat (ie. Jello, yogurt, sliced
soft fruit, cereal, potato, fish, eggs, applesauce, etc.). DO NOT eat
or drink anything hot during the first 24 hours.
- EXERCISING - Aerobic activities and heavy lifting
should be avoided for the first 72 hours. Let common sense prevail.
- SMOKING - The less you smoke, the faster things
heal and few complications arise.
- CLEANING - Areas not included in the surgery can
be cleaned as normal. Warm salt rinses (1/2 tsp. salt per 8 oz. glass
of water) can be used after eating for the first week. NO brushing of
surgical site until directed to do so.
- PAIN CONTROL - Pain management begins immediately
after surgery. The medication MUST be taken whether you experience
pain or not. Proper blood levels are necessary in order to reduce pain
- MEDICATIONS - Use only the medications below
that your doctor has checked.
(Prescriptions will vary depending upon the circumstance warranting
medication. Please follow you doctor's orders for each medication as
they were discussed with you). Examples of medication regimens are listed
below. Please consult your individual prescription instructions prior
to taking ordered medications.
- Decadron 1.5 mg: one pill taken after 6 pm
the first day of surgery. Then one pill twice daily until entire
amount is used.
- Peridex: The day after surgery, begin twice
daily oral rinses until the bottle is used up (approximately 2 weeks).
A 30 second rinse in the morning and again in the evening will control
bacteria that can delay healing. In special situations, extended
use of Peridex may be suggested.
- Apply Peridex topically with a Q tip to surgical
site beginning on second day.
- Motrin 600 mg and 1000 mg Extra Strength Tylenol.
Alternate every 2 hours for the first day. Then take as needed for
- Other medications, as listed.
- BLEEDING - Normally there will be some bleeding
following surgery. The application of pressure from a damp, cool cloth
or ice in these areas will usually hasten clotting. Continued bleeding
can be controlled by firm pressure on a dampened tea bag placed directly
on the area. However, should you become concerned about excess bleeding,
please call the office for further instructions.
- WEARING YOUR DENTURE OR BRIDGE for
days. Before wearing your prosthesis, it must be modified and a medicated
soft liner applied. This soft liner must be replaced every 4-6 weeks.
Failure to do so could jeopardize healing.
- PERIODONTAL SURGERY ONLY - PERIODONTAL DRESSING:
The pinkish casts, when applied to the surgical area, should remain
until your next appointment. These were applied to provide greater comfort.
Should they loosen, do not force them back to place. Call your doctor.
When NO PERIODONTAL DRESSING is used, the following precautions
should be observed:
- No vigorous rinsing or spitting for the first 24 hours.
This tends to promote bleeding.
- Floss may be used to remove food should it collect between
- Begin twice daily rinses with Peridex until the bottle
is used up.
- Avoid cold & hot beverages since the teeth may be
sensitive to thermal stimuli.
- If sutures become loose or stringy, do not pull on them.
If you are uncertain as to what to do, please call your
doctor or our office.
Sinus Augmentation/Sinus Lift - In addition to the
general post surgical instructions that should be followed (described
in detail above), there are specific instructions that need to be followed
for those patients who have had sinus lift surgery. The following post
surgical instructions are in addition to those which should be followed
for routine periodontal surgery/dental implant related surgery and include:
- Begin antibiotic medication 48 hours prior to surgery.
- Prior to surgery, inform the office if you are having
a sinus infection.
- Continue the antibiotics until the entire prescription
- Please use a nasal decongestant for the first 72 hours
after surgery (e.g. Afrin nasal spray). Follow the pharmaceutical manufacturer
- Do not hold your sneeze or blow your nose. The
associated increase in pressure can damage the surgical site.
- Nasal bleeding after surgery is common for the first
24 hours. Excessive bleeding should be reported to our office.
- Any discharge, which smells or is discolored should be
Please note that smoking interferes with post-surgical