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 IV sedation.

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 healing.

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.

1. 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.
2. 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.
3. EXERCISING - Aerobic activities and heavy lifting should be avoided for the first 72 hours. Let common sense prevail.
4. SMOKING - The less you smoke, the faster things heal and few complications arise.
5. 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.
6. 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 and swelling.
7. 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 discomfort.

   • Other medications, as listed.
     
   
   
8. 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.
9. 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.
10. 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:

1. No vigorous rinsing or spitting for the first 24 hours. This tends to promote bleeding.
2. Floss may be used to remove food should it collect between teeth.
3. Begin twice daily rinses with Peridex until the bottle is used up.
4. Avoid cold & hot beverages since the teeth may be sensitive to thermal stimuli.
5. 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:

PRE-OPERATIVE PHASE:

1. Begin antibiotic medication 48 hours prior to surgery.
2. Prior to surgery, inform the office if you are having a sinus infection.

POST-OPERATIVE PHASE:

1. Continue the antibiotics until the entire prescription is completed.
2. Please use a nasal decongestant for the first 72 hours after surgery (e.g. Afrin nasal spray). Follow the pharmaceutical manufacturer instructions.
3. Do not hold your sneeze or blow your nose. The associated increase in pressure can damage the surgical site.
4. Nasal bleeding after surgery is common for the first 24 hours. Excessive bleeding should be reported to our office.
5. Any discharge, which smells or is discolored should be reported promptly.

Please note that smoking interferes with post-surgical healing.