These instructions apply to most surgical procedures performed in our office. We will go over specific recommendations for your case during the appointment. In addition to the general postoperative instructions, we have included specific guidelines for Gum Grafting and for Sinus Grafting procedures.
Most surgical procedures performed in our office only lead to mild discomfort. The pain is typically worse the day after surgery, and quickly begins to get better.
Try to prevent pain; do not wait until you have pain to take your medication. Our recommended pain management protocol may vary based on the specific procedure performed and your medical history.
In most cases, taking Ibuprofen 600 mg (i.e., three 200 mg pills) every six hours provides a good level of comfort.
Multiple studies have shown that the combination of ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) is as effective, or more effective, than opioids for the management of dental pain. Alternating these medications with each other allows you to maximize your pain control. You would take a dose of pain medication every three hours in the following schedule:
- Start by taking Ibuprofen 600 mg (3 x 200 mg pills) right after the procedure.
- Three hours later take 500 mg of Tylenol (one Extra-Strength Tylenol)
- Three hours later take 600 mg of Ibuprofen.
- Three hours later take 500 mg of Tylenol.
Important: Do not take more than 4000 mg of Tylenol or 3200 mg of Motrin in a 24-hour period.
If necessary, you may be given a prescription for a small amount of an opioid pain medication such as Norco, Tramadol, or Tylenol with Codeine. These medications can sometimes be taken together with ibuprofen. When taking a prescribed medication that contains acetaminophen you should avoid taking any additional Tylenol.
Ibuprofen an all non-steroidal anti-inflammatories (NSAIDs) are also blood thinners; avoid taking these medications prior to surgical procedures. If you are having postoperative bleeding, you may need to stop taking ibuprofen or NSAIDs.
Avoid strenuous physical activity for a minimum of three days after surgery. Light walking is OK. Rest time may vary depending on the specific procedure performed.
Swelling may occur following your surgical procedure and will typically increase for 2-3 days after the procedure. To minimize swelling, place an ice pack over the cheek area for 20 minutes on and 10 minutes off. Continue using ice for 2-3 days following the procedure as often as possible.
You may notice slight bleeding during the first 24-48 hours. Minor bleeding is not unusual. Should bleeding occur, place moistened gauze or tea bag over the area and apply pressure for 15-20 minutes non-stop. Call the office or communicate directly with Dr. Ronderos if the bleeding persists.
Avoid spitting or rinsing your mouth profusely after the procedure. This can lead to dislodging blood clots needed to stop the bleeding. Dislodging the blood clots can also led to delayed healing and, after tooth extractions, may lead to a complication called dry socket.
Avoid sucking through a straw or actions that create suction in the mouth.
If a large blood clot develops over the surgical site, you may carefully wipe it off with moistened gauze. The site is likely to start bleeding after the clot is removed. If this is the case, apply pressure for 15-20 minutes non-stop.
When lying down for the first night, maintain your head elevated above the level of your heart.
A dressing (which acts as a bandage) is sometimes used to protect the surgical site and to help reduce discomfort. The use of a dressing is common after periodontal (gum) surgery and after crown lengthening procedures. Try to avoid dislodging the dressing. Part or the entire dressing may come off in the days after the procedure. If this happens, the dressing does not need to be replaced. If the dressing is still present, it will be removed during your postoperative visit.
Smoking can significantly slow the healing process, increases risk for postoperative infection and complications, and can lead to compromised results. Avoid for at least two weeks following your surgical procedure. If this is not possible, consider reducing smoking as much as possible; using a nicotine patch may help you.
Avoid alcohol consumption during the recovery period after surgery. It may irritate the wound or interact with medications prescribed.
Avoid rinsing your mouth for the first 24 hours. You may then start using any prescribed mouthwash as directed, or rinse with saltwater. Heavy rinsing should be avoided.
Do NOT brush or floss the surgical site until it is healed. You may resume normal brushing and flossing for all other areas the day after the procedure.
Do not disturb the sutures. If non-dissolvable sutures were placed, you will return so that they can be removed once sufficient healing has occurred; typically 1-2 weeks. The suture removal process is generally a very simple and painless procedure.
A nutritious and balanced diet is important for proper healing. Eat light soft food and drink plenty of liquids. Food items that can be easily broken-down with the back of a fork are considered to be soft enough. Favor cold foods for the first day or two after surgery. Cold tends to prevent postoperative bleeding and swelling.
Examples of soft foods you may consider:
Ensure / Slim Fast, smoothies and milk shakes (NO straws), ice cream, yogurt, blended soups, broth, pudding, rice, applesauce, Jell-O, bananas, oatmeal, macaroni & cheese, mashed potatoes, pasta, eggs, casseroles, fish, cottage cheese, avocado, hummus (NO crunchy chips), mashed / soft veggies, etc.
Foods to Avoid:
- Spicy foods: May cause pain and irritation.
- Crunchy, hard and chewy foods: Can traumatize the site disrupting healing.
- Popcorn and nuts: Hulls can get trapped under the gum and cause infection.
- Most grains and seeds: Can also get lodged in the wound and disrupt healing.
PostOperative Instructions – Soft tissue (Gum) Grafting
These are supplemental instructions that specifically relate to soft tissue grafting. Soft tissue grafting procedures (gum grafts) are delicate procedures. It is very important to avoid any trauma to the grafted area for the first weeks after the procedure.
In cases where we transplant soft tissue from the roof of the mouth to other areas, a custom-made thin clear guard will be fabricated to protect the donor site during the healing period.
- Avoid removing the guard for the first 24 hours.
- After the first 24 hours you may carefully remove the appliance, clean it with a soft brush and water, lightly rinse your mouth with the prescribed mouthwash, brush your teeth in the areas that were not operated, and place the guard back.
- The appliance should be worn 24/7 for the first two weeks and is only removed after meals to clean your teeth. You should eat with the appliance in place to avoid trauma to the surgical site on the palate.
- Avoid touching the surgical site with your fingers our tongue.
- Avoid applying firm pressure over the grafted site. When applying cold packs, do so with a light touch.
- Avoid pulling the lip or cheek close to the grafted site. This can lead to separation of the wound compromising the blood supply.
- Avoid the surgical site(s) when eating. Chew on the opposite side. If the graft was done in the front of the mouth, cut your food in small pieces and place it towards the back of the mouth.
- Avoid sleeping or laying on the operated side.
- 24 hours after the procedure you may start lightly rinsing with the prescribed mouthwash twice a day (morning and night) for 30 seconds. Remember: light Continue this until directed otherwise.
- Do NOT brush or floss around the surgical site. You may perform normal oral hygiene for the rest of the mouth as long as the operated areas are not disturbed.
PostOperative Instructions – Sinus GraftING
These are general guidelines provided in addition to the standard postoperative instructions. Depending on the specific sinus procedure that was performed the instructions may change. Drink plenty of liquids and take the full course of antibiotics as prescribed.
- Avoid strenuous physical activity, heavy lifting (> 20 lbs), or swimming for a minimum of one week after surgery. You can resume 50% of your regular exercise regimen at one week after surgery and your normal routine 2 weeks after surgery.
- Avoid diving for a minimum of one month after surgery.
- Light walking is OK during the first week.
- Rest time may vary depending on the specific procedure performed.
What to Avoid
- For two weeks avoid blowing your nose. Nose blowing may cause bleeding and may tear the thin membrane that contains the bone graft.
- Try to avoid sneezing and, if you must, do so with your mouth open.
- Avoid forceful sucking or drinking through a straw.
- Avoid talking and be at rest for the hours following surgery.
- Some nose and mouth bleeding may occur for the first 24 hours. Slight oozing may persist for two days after that.
Should you have any questions or concerns during regular office hours, please do not hesitate to contact us at (650) 595-5083 or via email at [email protected]. If you cannot reach the office contact Dr. Ronderos directly (his cell phone will be given to you after the procedure).