Operative Instructions

Pre & Post Operative Care

Pre-operative Instructions
The following instructions may be helpful when preparing for your upcoming surgery. Please do not hesitate to call if you have any last minute questions. We can be reached telephonically on 011 486 3198 during regular business hours.

If you are taking any blood “thinning” medication, please discuss this with Dr Abram. It may be necessary to alter the dose or discontinue the medication before surgery. This will be done in conjunction with the prescribing practitioner.

If you take antibiotic premedication, please take it as directed before your surgery. You will feel better if you have eaten prior to surgery. You may bring your iPod or MP3 player with you if you would like. In order to evaluate your progress and healing, we will see you for weekly post-operative checks during the first 1 – 5 weeks. After surgery, in most cases, we will also look forward to seeing you back for a periodontal maintenance cleaning and an examination of tissue maturation about 10-12 weeks following the surgery. Antibiotics

Please alert the office to any allergies or sensitivities that you might have to antibiotics. You will be prescribed an antibiotic if our doctor determines it to be necessary. Sedatives
  • If you prefer to be sedated during the procedure, please inform Dr Abram
  • Remember to arrange for someone to drive you home after the procedure.
Food Suggestions
  • A soft but nutritious menu is recommended for the days following surgery.
    Post-operative Instructions Periodontal Surgery
    These instructions apply to the surgical procedure just completed. They are designed to help you minimize post-surgical discomfort and inform you of any situation that may require special attention.

    Pain Medications
    It is not unusual to have discomfort for at least the first week following your surgical procedure. You will be given a prescription for medication to help you tolerate the post-surgical recovery period. Please take your medications as directed. If necessary, you may take your pain medication more frequently than every 4-6 hours to stay ahead of the soreness. It is advisable to not take pain medication on an empty stomach, as nausea may result.

    Antibiotics
    An antibiotic may be prescribed following your surgical procedure. Take as directed until the entire prescription is finished. Failure to take all antibiotic pills as prescribed can increase your odds of having antibiotic resistance. It is advisable not to take these medications on an empty stomach, as nausea may result. For women taking birth control pills, be advised that antibiotics may interfere with their effectiveness.

    Swelling
    Swelling may occur following your surgical procedure and will typically increase 2-3 days after the procedure. To minimize the swelling, place an ice pack over the outside cheek area for 20 minutes on and 20 minutes off. Continue using ice for 2-3 days following the procedure as often as possible.

    Bleeding
    A small amount of bleeding is normal. If excessive or continuous bleeding occurs:
    • Do not rinse your mouth.
    • Elevate your head when lying down.
    • Apply moistened gauze to the immediate area with moderate pressure for 20 minutes, repeat if necessary.
    • Enclose a moistened tea bag in gauze square and apply pressure for 20 minutes.
    • Call the office if bleeding persists.

    Diet
    Until comfortable, avoid chewing on the side where surgery was completed. A soft diet is recommended. Foods such as cottage cheese, oatmeal, soup, eggs, yogurt, pasta, mashed potatoes, casseroles, and fruits are more easily eaten. Remember, adequate nutrition is essential for feeling better as well as for healing.

    Smoking
    Do not smoke for at least 2 weeks following your surgical procedure. It will significantly slow healing and can compromise results.

    Alcohol
    Do not drink alcohol while taking prescription pain medications.

    Rinsing
    Do not rinse for the first 24 hours. After that, you may use a mild, diluted mouthwash. Repeat as necessary to help keep the dressing clean.

    Brushing
    Do not brush the surgical site. You may resume normal brushing/flossing in other areas the following day.

    Suture Removal
    You may notice increased discomfort 3-4 days after the surgical procedure. As the tissues begin to heal, they may pull against the sutures and dressing. You may choose to take some form of pain medication one hour prior to your suture removal appointment to minimize tenderness. If you are a patient for whom Antibiotic Pre-Medication is required, take the prescribed antibiotics 1 hour prior to the appointment.
    Post-operative Instructions Implant Surgery
    Do not disturb the wound. Avoid forcefully rinsing, spitting or touching the wound on the day of surgery. There could be a metal healing cap protruding through the gingival (gum) tissue. Other times they are completely under the gum tissue.

    Bleeding
    Some bleeding or redness in the saliva is normal for the first 24 hours. Keep your head elevated slightly rather than lying flat. Vigorous rinsing and forceful spitting tend to prolong or increase bleeding. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call our office during working hours or after working hours call Dr Abram’s emergency number provided to you for further instructions.

    Medications
    You will have a schedule provided by us on how to take your medications. This is an important part of your recovery process. Take medications with a full glass of water at room temperature. For most medications it is preferable to have food before taking. Let us know if any of the medications disagree with you in anyway.

    Pain
    You should begin taking your prescribed pain medication within an hour following surgery. Do not take any medication if you are allergic or if you have been instructed by your doctor not to take it.

    Antibiotics
    Be sure to take any prescribed antibiotics as directed. Do not take any medication if you are allergic or have been instructed by your doctor not to take it. If you are childbearing age and are on birth control pills, know that antibiotics may interfere with their effectiveness. Please take additional birth control precautions if this is the case.

    Oral Hygiene
    Good Oral Hygiene is essential to good healing. The night of the surgery, use the prescribed mouth rinse before bedtime. The day after surgery, the rinse should be used twice a day, after breakfast and before bed. Be sure to rinse for at least 30 seconds then expectorate. Warm salt water rinses (teaspoon of salt in a cup of warm water) can be used 4-5 times a day best after meals. This usually speeds up the healing and provides a comfortable feeling to your tissues. Brushing your teeth and the healing caps is not a problem with an ultra soft hand toothbrush. Be gentle with brushing the surgical areas. Do not use your electric toothbrush until healing has progressed enough and you are advised at our office to do so.

    Sutures
    Sutures are expected to remain in place until you return to the office for you post-op visit. It is normal for dissolvable sutures to begin to melt before your first post-op visit and we will remove the remaining sutures as soon as they are ready to come out during your post op visits. If they being to melt do not be concerned you can use a cotton swab dipped in the prescribe mouth rinse to clean them gently. Be sure to gently clean food from between the teeth after meals. Let us know if you discomfort.

    Swelling
    Swelling and Bruising is common but comes with varying degrees depending on your procedure and post-operative care. The use of ice packs (on the day of surgery) will help diminish the swelling you would otherwise experience in the next 48-72 hours. Applying ice for 15-20 minutes followed by resting the same amount of time works very well. If you have 2 surgical sites alternate between them. Bruising may occur and is not unusual.

    Diet
    Drink plenty of fluids. Start with clear fluids and advance as you can tolerate them. Products like Energade and Ensure are good for most patients. Have cold foods on the first day post-operatively. Stay away from spicy foods. Also avoid sharp and crunchy foods like tacos, chips and nuts. Having food frequently and good nutrition after surgery will help your healing process.

    Activity
    If you had sedation for your procedure do not plan on driving or using any type of machinery for at least 24 hours. Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking your usual nourishment. This may weaken you further and limit your ability to exercise

    Wearing your prosthesis
    Partial dentures, flippers, or full dentures can harm the surgical site if they are not fitting properly. Please let us know if that is the case and we will work with you for adjustments. In the interim do not wear them until they are fitting properly.

    Tobacco and Alcohol
    Tobacco and Alcohol should not be used. Smoking is an irritant and will decrease the benefits to you from surgery. It also will slow down the healing process. Alcohol should not be used in combination with pain medications and it also can inhibit the effectiveness of any antibiotics prescribed. Success rate with dental implants are diminished on patients that smoke.
    Post-operative Instructions Soft Tissue Grafts
    Do not disturb the wound. Avoid forcefully rinsing, spitting or touching the wound on the day of surgery.

    Bleeding
    Some bleeding or redness in the saliva is normal for the first 24 hours. Keep your head elevated slightly rather than lying flat. Vigorous rinsing and forceful spitting tend to prolong or increase bleeding. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call our office during working hours or after working hours call Dr Abram’s emergency number provided to you for further instructions.

    Medications
    You will have a schedule provided by us on how to take your medications. This is an important part of your recovery process. Take medications with a full glass of water at room temperature. For most medications, it is preferable to have food before taking. Let us know if any of the medications disagree with you in any way.

    Pain
    You should begin taking your prescribed pain medication within an hour following surgery. Do not take any medication if you are allergic or if you have been instructed by your doctor not to take it. If you had sedation or your procedure, the IV site could become sore. Warm, moist heat applied to the injection area can help. If you have other problems or the condition worsens, please let us know so we can help.

    Antibiotics
    Be sure to take any prescribed antibiotics as directed. Do not take any medication if you are allergic or have been instructed by your doctor not to take it. If you are childbearing age and are on birth control pills, know that antibiotics may interfere with their effectiveness. Please take additional birth control precautions if this is the case.

    Oral Hygiene
    Good oral hygiene is essential to good healing. The night of surgery, use the prescribed mouth rinse before bedtime. The day after surgery, the rinse should be used twice a day, after breakfast and before bed. Be sure to rinse for at least 30 seconds then expectorate. Warm salt water rinses (teaspoon of salt in a cup of warm water) can be used 4-5 times a day best after meals. This usually speeds up the healing and provides a comfortable feeling to your tissues. Please ensure that when you brush your teeth, the brush does not touch the site of the soft tissue graft for at least 6 weeks. The rest of the mouth should be thoroughly brushed. Be gentle with brushing the surgical areas. Do not use your electric toothbrush until healing has progressed enough and you are advised at our office to do so.

    Sutures
    Sutures are expected to remain in place until you return to the office for you post-op visit. It is normal for dissolvable sutures to begin to melt before your first post-op visit and we will remove the remaining sutures as soon as they are ready to come out during your post op visits. If they being to melt do not be concerned you can use a cotton swab dipped in the prescribe mouth rinse to clean them gently. Be sure to gently clean food from between the teeth after meals. Let us know if you discomfort.

    Swelling
    Swelling and bruising is common but comes with varying degrees depending on your procedure and post-operative care. The use of ice packs (on the day of surgery) will help diminish the swelling you would otherwise experience in the next 48-72 hours. Applying ice for 15-20 minutes followed by resting the same amount of time works very well. If you have 2 surgical sites alternate between them. Bruising may occur and is not unusual.

    Diet
    Drink plenty of fluids. Start with clear fluids and advance as you can tolerate them. Products like Energade and Ensure are good for most patients. Have cold foods on the first day post-operatively. Stay away from spicy foods. Also avoid sharp and crunchy foods like tacos, chips and nuts. Having food frequently and good nutrition after surgery will help your healing process.

    Activity
    If you had sedation for your procedure do not plan on driving or using any type of machinery for at least 24 hours. Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking your usual nourishment. This may weaken you further and limit your ability to exercise.

    Surgical Bandage
    For a soft tissue graft Dr Abram typically uses a surgical bandage on the donor site (the palate). Sometimes it is also used in the recipient site (grafted site). If a surgical bandage was used, it is desirable for it to remain in place for 24 hours. Do not remove it; just let it come off when it is ready. If it does not come off, we will remove it during your post-operative visit. When the surgical bandage comes off, do not place it back in position. At that point begin cleaning the wound gently with a cotton swab dipped in the medicated mouth rinse prescribed.

    Tobacco and Alcohol
    Tobacco and Alcohol should not be used. Smoking is an irritant and will decrease the benefits to you from surgery. It also will slow down the healing process. Alcohol should not be used in combination with pain medications and it also can inhibit the effectiveness of any antibiotics prescribed.
    Post-operative Instructions Sinus Augmentation
    Do not disturb the wound. Avoid forcefully rinsing, spitting or touching the wound on the day of surgery. If you have had simultaneous implant placement along with the sinus augmentation procedure, there could be a metal healing cap protruding through the gingival (gum) tissue. Other times they are completely under the gum tissue.

    Bleeding
    Some bleeding or redness in the saliva is normal for the first 24 hours. Keep your head elevated slightly rather than lying flat. Vigorous rinsing and forceful spitting tend to prolong or increase bleeding. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call our office during working hours or after working hour call Dr Abram’s emergency number provided to you for further instructions.

    Medications
    You will have a schedule provided by us on how to take your medications. This is an important part of your recovery process. Take medications with a full glass of water at room temperature. For most medications it is preferable to have food before taking. Let us know if any of the medications disagree with you in anyway.

    Pain
    You should begin taking your prescribed pain medication within an hour following surgery. Do not take any medication if you are allergic or if you have been instructed by your doctor not to take it.

    Antibiotics
    Be sure to take any prescribed antibiotics as directed. Do not take any medication if you are allergic or have been instructed by your doctor not to take it. If you are childbearing age and are on birth control pills, know that antibiotics may interfere with their effectiveness. Please take additional birth control precautions if this is the case.

    Oral Hygiene
    Good Oral Hygiene is essential to good healing. The night of the surgery, use the prescribed mouth rinse before bedtime. The day after surgery, the rinse should be used twice a day, after breakfast and before bed. Be sure to rinse for at least 30 seconds then expectorate. Warm salt water rinses (teaspoon of salt in a cup of warm water) can be used 4-5 times a day best after meals. This usually speeds up the healing and provides a comfortable feeling to your tissues. Brushing your teeth and the healing caps is not a problem with an ultra soft hand toothbrush. Be gentle with brushing the surgical areas. Do not use your electric toothbrush until healing has progressed enough and you are advised at our office to do so.

    Sutures
    Sutures are expected to remain in place until you return to the office for you post-op visit. It is normal for dissolvable sutures to begin to melt before your first post-op visit and we will remove the remaining sutures as soon as they are ready to come out during your post op visits. If they being to melt do not be concerned you can use a cotton swab dipped in the prescribe mouth rinse to clean them gently. Be sure to gently clean food from between the teeth after meals. Let us know if you discomfort.

    Swelling
    Swelling and Bruising is common but comes with varying degrees depending on your procedure and post-operative care. The use of ice packs (on the day of surgery) will help diminish the swelling you would otherwise experience in the next 48-72 hours. Applying ice for 15-20 minutes followed by resting the same amount of time works very well. If you have 2 surgical sites alternate between them. Bruising may occur and is not unusual.

    Diet
    Drink plenty of fluids. Start with clear fluids and advance as you can tolerate them. Products like Energade and Ensure are good for most patients. Have cold foods on the first day post-operatively. Stay away from spicy foods. Also avoid sharp and crunchy foods like tacos, chips and nuts. Having food frequently and good nutrition after surgery will help your healing process.

    Activity
    If you had sedation for your procedure do not plan on driving or using any type of machinery for at least 24 hours. Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking your usual nourishment. This may weaken you further and limit your ability to exercise.

    Wearing your prosthesis
    Partial dentures, flippers, or full dentures can harm the surgical site if they are not fitting properly. Please let us know if that is the case and we will work with you for adjustments. In the interim do not wear them until they are fitting properly.

    Tobacco and Alcohol
    Tobacco and Alcohol should not be used. Smoking is an irritant and will decrease the benefits to you from surgery. It also will slow down the healing process. Alcohol should not be used in combination with pain medications and it also can inhibit the effectiveness of any antibiotics prescribed. Success rate with dental implants are diminished on patients that smoke.

    Sneezing and Blowing of nose
    DO NOT blow your nose for at least 10 days. The new fragile sinus environment will be disturbed and healing will be compromised. A nasal spray will be prescribed for you that will help to keep the sinuses and nose clean. If you have to sneeze, do so with your mouth open. Do not try to suppress a sneeze, as this will cause an increase in the pressure within the maxillary sinuses that could disturb the augmentation. If you play a wind musical instrument, please refrain from using it for about one month following sinus augmentation surgery.