If a bone grafting procedure has just been completed for you, sutures have been placed to hold the tissue together during healing. You will return in 10-14 days for your next follow-up exam appointment and suture removal.

You will be instructed on the wearing of your removable flipper, partial or denture. Sometimes it is necessary to leave it in the night of the surgery or you may be required to leave it out. It is important to keep it as clean as possible during the healing period if you are allowed to use it. You may need to use denture adhesive to hold your appliance in place during healing. AVOID PLACING ADHESIVE DIRECTLY ON THE SUTURE LINE.

Every consideration must be given to keep the surgical site clean and free of food particles and plaque build-up.

The following are instructions for your mouth care after surgery:

NO SMOKING!! Smokers will notice the greatest majority of discomfort regardless of pain medication. Therefore, smokers are advised to discontinue smoking during healing. This period ranges from 2-4 weeks depending on your healing capabilities.

DIET: Avoid hot fluids and foods for 24 hours after the surgery. Room temperature, warm and cold items are advised. Anything that is heated must be cooled down. Avoid chewing on the treated site while you are numb. Liquids and soft foods will be adequate.

Cold Soft Foods: Jell-O * Pudding * Yogurt * Applesauce * Ice Cream * Milk Shakes * Smoothies * Carnation Instant Breakfast * Slim Fast * Ensure * Cottage Cheese * Canned/Jarred Fruits *

Hot Foods (allow to cool down to a WARM temperature): Cooked Cereals * Eggs * Soups * Pastas * Rice * Mashed Potatoes * Boiled Chicken & Dumplings * Fish *

If your food is soft enough to smash with a fork then it should be tender and gentle enough to eat.

(DO NOT use a straw for 24 hours)

RINSING: Gentle rinsing of the mouth may begin following the surgery. Frequent gentle rinsing with warm salt water will aid the healing process and maintain cleanliness. Add ½ teaspoon salt to 6 oz. of warm water. Rinse gently.

ORAL CLEANSING: You have been given an Ultra Soft (Red) toothbrush. You may start using this brush in the surgery site 24 hours following your procedure. You may dip the brush in salt water, mouthwash or use toothpaste on it. Brushing the surgery site should be performed twice daily. This brush will not clean your teeth, it is TOO soft. Use your standard toothbrush and floss in the non-surgery areas of your mouth.

INFECTION CONTROL: An antibiotic will either have been given to you or prescribed to you. Please take it as instructed. Once your antibiotic is started you must finish it completely for it to be effective. Should you develop hives, itching, skin rash or difficulty breathing, stop the medication and call our office (216) 570-8827 or proceed to your nearest hospital emergency room!

PAIN CONTROL: An appropriate pain medication will either have been given to you or prescribed to you. Please take it as instructed. Most patients will experience the majority of their discomfort the first few days following their surgical procedure. However, some may find discomfort later on in the week. This is related to the healing of the never fibers.

SWELLING/BRUISING: Some swelling and possible minimal bruising is to be expected and is not unusual. Apply an ice pack to the outside of the face over the treated area 20 minutes on and 20 minutes off for the first 24 hours. Any swelling that occurs will usually peak in 48-72 hours. Moist heat may be applied after an initial 48 hour healing period from when the surgery was completed. Moist heat will also reduce any bruising that may have occurred.

BLEEDING CONTROL: Your bleeding will be under control when you leave the office. You may notice a tinge of pink or red to your saliva for the first 24 hours. It takes 24+ hours for your body to develop firm blood clots to prevent all bleeding from occurring. DO NOT vigorously rinse or use a straw for 24 hours. Avoid Exertion or anything that will increase your pulse or blood pressure such as exercising, running/jogging, lifting weights, yard work, house cleaning, etc. If continuous bleeding is persistent discontinue all rinsing. Moisten a gauze pad (included in your home care bag) with tepid tap water. Gently squeeze out all excess water. You want the pad moist, NOT soggy. Apply firm, steady pressure over the area of bleeding. This pressure should be applied for a steady 20 minutes. You may need to repeat this process several times. If you feel you cannot get the bleeding under control contact Dr. Matia.

QUESTIONS: If any questions occur, please call one of the following numbers:  Wooster Office (330) 264-5851 Medina Office (330) 725-6151 Dr. Matia cell (216) 570-8827

If a submergible implant was placed in your mouth, the implant is located under the tissue and usually cannot be seen. This type of implant has been selected for your particular situation because of the bone available to place an implant. The implant usually will remain submerged for a period of four to six months depending upon your body’s healing properties and the type of implant.

If intravenous medication has been given, you cannot drive a car for the remainder of the day. It is advised that you have someone remain with you until your sedated condition wears off.

One to two weeks after surgery the sutures will be removed, and you will be examined by the doctor.

Usually you are able to continue wearing your present partial or flipper. Sometimes it is necessary to leave it in the night of surgery. It is important to keep the appliance as clean as possible during the healing period. Your referring dentist can make a temporary tooth replacement for you if it is necessary. If braces are being worn, your orthodontist can place a tooth for cosmetic purposes.

Every consideration must be given to keep the surgical site clean and free of food particles. The following are instructions for your mouth care after surgery.

No smoking! Smoking is to be avoided for the time specified by Dr. Matia since it increases the heat in the surgical area and significantly lowers the body’s ability to heal the site.

Avoid alcohol, commercial mouth rinses and very hot fluids and foods for 24 hours after your surgery. Room temperature to cold is adequate. Anything that is cooked must be allowed to cool down.

Gentle rinsing of the mouth should be started the day after surgery. Frequent gentle rinsing with Peridex will aid the healing process and maintain cleanliness. Avoid use of a water pik.

Ultra-Soft Brush: Please begin using the red brush 24 hours after your surgery to cleanse and stimulate the tissue. It will not harm the sutures. Dip the brush into the Peridex rinse and brush directly on the surgical site. Sutures should be brushed at least twice daily.

Antibiotics:
IV sedated patients have received an appropriate antibiotic through their IV line. You have been given a follow-up antibiotic table(s) to be taken at a specific time. Please follow the direction on the envelope.

Patients who have not had IV sedation should follow the direction on the prescription given to them prior to surgery.

If an appropriate antibiotic has been prescribed for you today, it is very important that the prescription is filled and taken as directed. PLEASE TAKE THE TABLETS/CAPSULES UNTIL ALL ARE USED. Should you develop hives, itching, skin rash or difficulty breathing, stop the medication and call the doctor immediately, or proceed to your nearest hospital emergency room.

Pain: A certain amount of pain must be expected with all types of surgery. An appropriate pain medication has been prescribed for you. Please take it according to the instructions. It is advised that you do not drive while taking the pain prescription. However, if only Motrin is needed, most people are able to drive without any problem.

Swelling: Some swelling and possible, minimal bruising is to be expected and is not unusual. In most instances, swelling can be prevented or controlled. Apply the ice pak that has been given to you for a period of 20 minutes on and 20 minutes off during the day for the next two days. The application of ice to the outside of the face over the surgical area will minimize swelling. If after three days you still have inordinate swelling or pain, please call the office.

Bleeding: A small amount of bleeding following surgery should not alarm you. If the bleeding is excessive or continuous, please call us at once. Vigorous rinsing of the mouth prolongs bleeding by removing the clotting blood, so when rinsing your mouth, do it gently.

DO NOT spit, gargle or suck on a straw for 24 hours following your surgery. This tends to loosen the sutures/blood clots.

Diet: Following surgery, it is best to restrict your diet to fluids or soft foods for the first day. A normal diet may then be resumed the following day, but you will want to avoid chewing on the implant site until the tissue is completely healed. Soft food such as Jell-O, pudding, mashed potatoes, scrambled eggs, ice cream, milkshakes and soups are suggested. If you have difficulty chewing, try blenderizing foods or diet supplements such as Carnation Instant Breakfast, Slim Fast and Ensure.

Questions: If you have any questions, please call one of the following numbers: Wooster Office (330) 264-5851 Medina Office (330) 725-6151 Dr. Matia cell (216) 570-8827

Complete rest during the early healing period will permit a more comfortable post-operative course. Try to scale down your normal routine during the first week after surgery. You will be more comfortable and heal faster if you do.

COMFORT AND MEDICATIONS
Comfort will be maintained by taking your pain medication as often as every four to six hours the first day. If Motrin (Ibuprofen) has been prescribed, you should take it as directed by Dr. Matia. This will minimize the need for narcotic pain medication later in the week. If taking Motrin (Ibuprofen), do not exceed 3200 mg per day. (our doctor may advise a maximum of only 2,400 mg for certain patients.) Do not take pain medication on an empty stomach as nausea may result. Most patients will experience the majority of their discomfort the first few days after surgery, however, some may find the greatest pain later in the week. This is related to healing of the nerve fibers.

Antibiotics may be prescribed. Take them as directed on the label until all tablets are taken (usually seven to ten days). The chance of an infection occurring is very small.

DIET
It is important to follow a nutritious diet, particularly during the first seven-day healing period. Avoid eating on the treated side, if possible, so as not to disrupt the dressing.

Try to eat regular foods. If you cannot chew normally, stay on a soft and/or liquid diet, but be sure it contains enough calories and protein to keep you feeling and healing well. If you can only manage with liquids, you can supplement your diet with liquid diet supplements such as Instant Breakfast, Nutriment, Sustacal, Boost, Ensure, Ovaltine, Slimfast, etc. The following require little pressure to chew and provide necessary nutrients: eggs, cottage cheese, ground meat, bananas, cooked fish, cereals, and whole wheat bread. You should continue your vitamin supplements.

DRESSING (PINK PACKING)
The dressing used to cover the treated area is helpful in maintaining comfort. If small pieces of the dressing fall off, it is not of concern unless the operated area becomes uncomfortable or you were told to maintain the dressing the first week in your particular case. If you have a removable partial and it has been seated over the dressing, try to leave it in for twenty-four hours. You can take the partial out when you get home if you feel more comfortable without it, but usually it will fit better the first week if it can be left in place over the dressing during the first twenty-four hours. When you do remove your partial, do so carefully so the dressing does not come out with the partial. Lubricate, with Vaseline, the part of the partial that touches the dressing before reinserting it. The Vaseline will prevent the partial from sticking to the dressing.

The dressing will be removed after one week. It may be replaced, depending on the rate of healing, but usually it is not.

ORAL HYGIENE
Your usual plaque-control procedures should be continued in the non-treated areas of your mouth. Brushing and/or flossing should be completely avoided in the surgery area for the next eight weeks. It is helpful to brush your tongue. Vigorous and/or frequent rinsing should be avoided. Vigorous rinsing or use of an oral irrigator should be avoided in the surgical area for eight weeks. Your prescribed mouth rinse will keep the areas clean until you are able to brush in that area.

SWELLING
Apply an ice bag to the outside of your face, over the treated area, 15 minutes on and 15 minutes off for the first 24 to 28 hours. A Baggie filled with ice and wrapped in a towel works nicely if you cannot get the cold pack provided cold enough. Swelling usually peaks at 48 to 72 hours. Gentle cold water rinses every one-half hour in the first six to twelve hours will keep your mouth clear of blood and provide cold to the operated area. Moist heat may be used to help diminish swelling after the first 48 hours if you feel the swelling is excessive. Moist heat will also reduce any bruising that occurs following surgery.

BLEEDING
Some blood will stain your saliva. This minor “oozing” of blood is normal. Oozing will be diminished by gently rinsing with cold water for a few minutes every one-half hour.

If continuous bleeding occurs, discontinue rinsing, avoid exertion, and do the following: Thoroughly rinse all blood and blood clots from your mouth. Moisten a gauze pad, or wash cloth. Place one of these moistened pads on the tongue side of the dressing and a second one on the cheek side in the area of bleeding. Hold pressure against the dressing with your thumb and forefinger. Apply CONTINUOUS, FIRM pressure to both sides of the dressing for 20 minutes, WITHOUT removing for inspection. You may need to use pressure for an additional 20 minutes if bleeding continues.

If bleeding persists, call the doctor. Dr. Matia cell (216) 570-8827.

FEVER
A slight fever or chill can occur; it is of no consequence unless it persists more than 48 hours. A persistent low-grade temperature or one above 102 degrees should be reported to the office.

FUTURE APPOINTMENTS
You will be given an appointment to remove the dressing and monitor healing. Appointments should be kept as scheduled. Delay in removing any dressing or stitches may delay healing.

LONG TERM HEALING
Over the next six months the normal gum contour will begin to reappear as healing occurs. Long term, the gum growth will continue for about three years after surgery.

QUESTIONS
If any questions occur, please call on of the following numbers: Wooster Office (330) 264-5851 Medina Office (330) 725-6151 Dr. Matia cell (216)570-8827

1. Do not be alarmed with any color changes or appearance of tissues following laser therapy. Tissues can be gray, yellow, red, blue, purple, “stringy” and reflect normal response to laser treatments.

2. Reduce activity for several hours following the surgery.

3. Try to keep your mouth as clean as possible in order to help the healing process. It is ok to spit, rinse, and wash your mouth today. Rinse as directed with Peridex morning and night. In between it is OK to rinse gently every three (3) hours with warm salt water (1/2 teaspoon of salt dissolved in an 8 oz. glass of warm water). You will not brush the treated area(s) for ten days. After ten days you may begin to use your soft toothbrush. After 30 days you may begin to floss and use your electric toothbrush.

4. Do not eat spicy or excessively hot foods.

5. Do not apply excessive tongue or cheek pressure to the surgerized area.

6. Do not be alarmed if one of the following occurs:
a. Light bleeding
b. Slight swelling
c. Some soreness, tenderness, or tooth sensitivity
d. Medicinal taste from Peridex

7. Swelling may possibly occur. To keep this at a minimum, gently place an ice pack on the outside of the face for 20 minutes each hour until you retire for sleep that night. Do not continue using the ice bag beyond the day of the periodontal surgery. You may be prescribed ibuprofen, anti-inflammatory medication, to keep swelling to a minimum.

8. Some oozing of blood may occur and will appear to be greatly exaggerated when it dissolves in saliva. If excessive bleeding occurs, please call the office.

9. It is very important to maintain a good food and fluid intake. Try to eat soft but nutritious food such as eggs, yogurt, cottage cheese, malts, ice cream, etc., until you can comfortably return to a normal diet. Please refer to our “Post LANAP Diet Instructions” for diet regimen.

10. If medication has been prescribed, please take exactly as directed.

11. Please call the office so that we may render further treatment if any of the following occurs:
a. Prolonged or severe pain
b. Prolonged or excessive bleeding
c. Considerably elevated or persistent temperature

12.The teeth may become sore, tender, or sensitive as the bone and ligaments around the teeth regenerate and become more firm. This is a sign of healing, but may indicate the presence of a bite imbalance that needs to be adjusted.

13. One of the contributing factors of periodontal disease is trauma from tooth to tooth contact. Therefore, we will require you to sleep with a night guard. You will wear this indefinitely.

Please contact our office with other concerns or questions. Wooster (330) 264-5851 Medina (330) 725-6151 Dr. Matia cell (216)570-8827