Dr. Ashour's Patient Instructions

Bone Graft Post-Operative Instructions

Your bone graft is made up of many small particles of bone, like “grains of sand.” You may find some small granules of particulate bone in your mouth for the first several days after surgery. Do not be alarmed by this. It is normal to have some bone graft particles leak into the mouth.

Caring for Your Socket Bone Graft

• Firm, Moist Gauze Pressure for 2 Hours: Firm, moist gauze pressure stops bleeding. Bite down firmly and do not talk during this time. Relax sitting upright in a comfortable chair. If still bleeding after 2 hours, stack and fold 3 pieces of fresh gauze, moisten with water, and apply to the wound for 1 hour at a time until bleeding stops.
• Apply Cold Packs to Face: Apply bags of ice or frozen peas to each side of your face. Hold the bags in place with a wrap, scarf, or towel. Alternate cold packs 30 minutes on and 30 minutes off for the first 48 hours.
• Elevate Your Head for the First 7 Days: Keep your head elevated on a recliner or couch while sleeping for the first 7 days to minimize swelling.
• No Smoking: Do not smoke. Smoking slows healing and increases the risk of infection and severe dry socket pain, as well as increasing the risk of failure of the bone graft.
• No Spitting: Do not spit for 1 month. Spitting can dislodge the bone graft, causing failure of the bone graft. If you feel like you need to spit, gently rinse water in your mouth and then let the water passively fall into the sink.
• No Straws: Avoid straws for 1 month. Using a straw can dislodge the bone graft, causing failure of the bone graft. Eat smoothies and milkshakes with a spoon, or drink from a cup.
• Diet: On Day 1, eat cool, soft foods such as ice cream, yogurt, smoothies, and milkshakes. Use a spoon and no straws. During Days 2 through 31, eat soft, room-temperature foods such as pasta, scrambled eggs, red beans, rice, and mashed potatoes. Avoid hot and spicy foods and drinks. Make sure soup and coffee have cooled to room temperature.
• Medication: Take all medications with food to help prevent nausea. Use medications as directed by prescriptions. Do not drive or operate heavy machinery after IV or oral sedation, or if you are taking narcotic medications such as codeine, hydrocodone, oxycodone, or tramadol, or nausea medication such as promethazine, as they impair judgment and cause drowsiness.
• Rinsing: Begin gentle rinsing on Day 2 after each meal. Vigorous rinsing can dislodge the bone graft, causing failure of the bone graft. You may use the prescribed mouthwash, an over-the-counter alcohol-free mouthrinse, or warm salty water. Do not spit. Instead, gently rinse and then let the rinse passively fall into the sink.
• Oral Hygiene: Use a soft-bristle toothbrush and avoid an electric toothbrush. Brush teeth normally, but avoid the bone-graft surgical site. Gently rinse with an over-the-counter alcohol-free mouthrinse or water, as directed by Dr. Ashour.
• Activity: Frequent rest is important after surgery. Do not exercise for 1 week after surgery, as exercise can cause painful throbbing or bleeding at the surgical site.
• Swelling: For the first 4-5 days after surgery, it is normal to experience swelling, pain, and even bruising, which then gradually disappear.

Download Bone Graft Instructions PDF

Extraction Post-Operative Instructions

• Bite on the gauze for 30 minutes. Change the gauze 30 minutes later. The gauze will be stained with blood when you remove it. That is not due to active bleeding, but to the gauze’s ability to absorb blood. If your mouth is filling with blood after removing the second gauze, place gauze on the socket site and apply more pressure. If that does not stop the bleeding, wrap a moistened tea bag in gauze and bite on it for 30 minutes.
• Do not rinse your mouth or spit today. That causes more bleeding. Instead, lean over a sink or cup and let saliva drip out of your mouth without force.
• Avoid foods or activities that create suction in the mouth, such as straws, rinsing, or spitting.
• Avoid hot foods such as coffee, tea, and soup. Let them cool before eating today. On the day of surgery, eat cool, soft foods such as ice cream or yogurt. Consider soups, yogurt, ice cream, puddings, eggs, omelets, and soft pasta.
• Avoid foods with a sharp edge, such as chips, crackers, or toast, for 4-5 days.
• Avoid smoking for a minimum of 24 hours. Smoking triples the risk of a painful, slow-healing extraction socket called a dry socket.
• Place ice on your cheek in the area of surgery. Ice is most effective if placed on the cheek for 20 minutes and then removed for 20 minutes throughout the first day.
• Start pain relievers before your anesthesia wears off, about 30-60 minutes after your appointment. Unless otherwise specified, start with ibuprofen such as Advil or Aleve, 800 milligrams every 6-8 hours. Do not use aspirin. Acetaminophen such as Tylenol, 650 mg every 6 hours, is a good alternative. Full doses of ibuprofen and acetaminophen can be taken together or alternated every 3 hours. There is no bad interaction from taking acetaminophen and ibuprofen at the same time. It is much safer than taking too much of one medicine.
• Take other medicines as prescribed. Avoid driving or drinking alcohol if given prescription pain pills.

Day After Surgery

1. Gently rinse with warm salt water (1 teaspoon of salt in 1 glass of warm water) 4 times a day for one week, or use the mouthrinse as prescribed by your dentist.
2. Brush your teeth gently with a soft-bristle brush. Be very gentle around the surgical site.

Two Days After Surgery

Place moist heat, such as a face towel in very warm but not overly hot water or a hot-water bottle, for swelling. Postoperative swelling is greatest 48-72 hours after the extraction.

Minor bruising after surgery is a normal response and no cause for alarm. It will improve in 7-14 days. If you are concerned, please call our office. Some jaw muscle stiffness is common, especially after longer procedures. This is normal and will improve in 7-14 days. Moist heat and ibuprofen will help relieve some of these symptoms.

Sutures and Stitches

Most stitches dissolve on their own and will not have to be removed. The stitches will fall out within the week; some may come out the same day. Do not worry if stitches are swallowed. Never pull at loose stitches, but you can carefully cut a loose stitch at the gum line. Some stitches may last 2 weeks, depending on the type.

Download Extraction Instructions PDF

Implant Placement Post-Operative Instructions

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery.

• Firm, Moist Gauze Pressure for 2 Hours: Bite down firmly and do not talk during this time. Relax sitting upright. If still bleeding after 2 hours, stack and fold 3 pieces of fresh gauze, moisten with water, and apply to the wound for 1 hour at a time until bleeding stops.
• Apply Cold Packs to Face: Apply bags of ice or frozen peas to each side of your face. Hold them in place with a wrap, scarf, or towel. Alternate cold packs 30 minutes on and 30 minutes off for the first 48 hours.
• Elevate Your Head for the First 7 Days: Keep your head elevated on a recliner or couch while sleeping for the first 7 days to minimize swelling. Do not lie flat on a bed for the first 7 days, as increased facial swelling will occur.
• No Smoking: Do not smoke. Smoking slows healing and increases the risk of infection, pain, and implant failure.
• No Spitting: Do not spit for the first 7 days. Spitting can dislodge a blood clot, triggering bleeding and pain. If you feel like you need to spit, gently rinse water in your mouth and let it passively fall into the sink.
• No Straws: Avoid straws for 7 days. Using a straw can dislodge a blood clot, triggering bleeding and pain. Eat smoothies and milkshakes with a spoon, or drink from a cup.
• Diet: On Day 1, eat cool, soft foods such as ice cream, yogurt, smoothies, and milkshakes. Use a spoon and no straws. During Days 2-7, eat soft, room-temperature foods such as pasta, scrambled eggs, red beans, rice, and mashed potatoes. Avoid hot and spicy foods. Make sure soup has cooled to room temperature.
• Medication: Take all medications with food to help prevent nausea. Use medications as directed by prescriptions. Do not drive or operate heavy machinery after IV sedation, or if taking narcotic or nausea medications, as they impair judgment and cause drowsiness.
• Rinsing: Begin gentle rinsing on Day 2 after each meal. You may be prescribed Peridex (chlorhexidine), or you may use an over-the-counter alcohol-free mouthrinse or water. Do not spit. Gently rinse and let the rinse passively fall into the sink.
• Oral Hygiene: Use a soft-bristle toothbrush and avoid an electric toothbrush. Brush teeth normally and delicately around the surgical site. Gently rinse with prescribed Peridex, an alcohol-free mouthrinse, or warm salty water.
• Activity: Frequent rest is important after surgery. Do not exercise for 1 week after surgery, as exercise can cause painful throbbing or bleeding.
• Swelling: For the first 4-5 days, it is normal to experience swelling, pain, and even bruising, which then gradually disappear.

Download Implant Placement Instructions PDF

Oral Sedation Pre- and Post-Operative Instructions

Pre-Sedation Instructions

• Do not eat for 6 hours before your appointment. If you eat during the 6 hours before your appointment, we may need to cancel or reschedule your procedure. Drinking water or juice for up to 2 hours prior is okay.
• If you take medications by mouth in the morning, you can take these medications with sips of water the morning of the procedure.
• Do not smoke for 12 hours, at minimum, before your appointment.
• Wear loose-fitting clothing and comfortable shoes.
• An escort who is a responsible adult must come with you to the clinic, wait while you have your procedure, receive the post-operative instructions, and bring you home to waiting care providers or stay with you for four hours.
• Do not attempt to be the sole caregiver to babies or young children on the day of your sedation.
• Do not drive or use heavy or dangerous machinery on the day of your sedation.
• If you use cannabis or other recreational drugs, let the staff know. Anything disclosed will be confidential. We need to know what medications are in your body before providing sedative pills.
• If you feel sick, including fever, muscle aches, runny nose, cough, sore throat, or stomachache, please tell us.
• If there is a chance you may be pregnant, please let your provider know.

Post-Sedation Instructions

• Do not drink alcohol for 24 hours after the procedure.
• Do not drive a vehicle or do anything that requires judgment until the morning after the procedure. If you are placed on an opioid such as Percocet, Vicodin, codeine, or oxycodone after surgery, you cannot drive while taking the opioid.
• Your diet will be guided by the type of periodontal surgery you had. From the standpoint of sedation, go slowly. Keep well hydrated, but start with small amounts of food. You may feel hungry at first and then feel sick after having too large or too fast a meal. Ginger ale and ginger candies are good for nausea.
• Sleep with your head elevated in a recliner or with pillows. This helps both swelling and discomfort.
• Get plenty of rest.

Download Oral Sedation Instructions PDF

Osseous Surgery Post-Operative Instructions

• Return home and rest. No strenuous activity such as lifting or exercising should be performed for approximately 1-2 days or until the doctor says it is okay to resume. You may resume non-physical activities in approximately 24 hours.
• Some swelling and temporary loosening of teeth is expected. Apply an ice bag to the face around the surgical site for the first 24 hours, 20 minutes on and 5 minutes off. Do this for the next 3 days. After the third day, swelling should begin to calm down. If it worsens, call the office. Use the pain protocol prescribed by the doctor: 800 mg ibuprofen initially and 500 mg Tylenol 1 hour later. Continue the same protocol every 6 hours as needed for discomfort.
• Some mild bleeding is expected during the first 24-48 hours. During this period, do not suck on the wound, expectorate, or constantly rinse your mouth. If your own tissue was used for grafting, there may be bleeding from the roof of your mouth. Control it by holding gauze or a moist tea bag over the area for 20 minutes at a time. Persistent and uncontrollable bleeding must be investigated. Call the office for advice or help.
• Do not rinse your mouth today. If prescribed chlorhexidine oral rinse, start the day after surgery by gently swishing it in the mouth. If bleeding occurs, stop rinsing. Fluids are encouraged. Swallow without swishing or disturbing the surgical site. Brush normally in areas that were not surgically treated. Avoid the surgical sites until given instructions at your post-operative visit. A white film over the surgical sites is normal.
• You may have a dressing or surgical pack over the treated area. This protects the area from discomfort and irritation. If it dislodges and you have discomfort, call the office.
• Wait approximately 1-2 hours before eating, except for food needed to take medications. Drink plenty of liquids, especially water and non-acidic juices. Avoid alcohol and hot, hard, or spicy foods. Avoid straws. Adequate nutrition is essential for healing. Following surgery, your diet should be restricted to cold liquids such as yogurt, smoothies, milkshakes, and dietary supplements such as Instant Breakfast or Ensure.
• Do not wear partial dentures, flippers, or full dentures for several days after surgery unless otherwise instructed.

Download Osseous Surgery Instructions PDF

Periodontal Medication Instructions

Please make sure you have ibuprofen (Advil) and acetaminophen (Tylenol) at home prior to your procedure. It is best to start these medications when you get home after surgery before the local anesthesia wears off. Your antibiotic and narcotic pain prescriptions will be available on the day of your procedure.

Antibiotics

• Amoxicillin 500 mg - Start after the procedure. Take 1 pill 3 times daily until gone. Take with food to avoid nausea.
• Azithromycin, if allergic to penicillin or amoxicillin - Start after the procedure. Take 1 pill once daily for 7 days.

Oral Rinse

Chlorhexidine Gluconate Mouth/Throat Solution 0.12%: Start 24 hours after the procedure. Rinse twice daily with 1 capful (15 ml). Rinse for 30 seconds in the morning and evening after brushing. Spit out after rinsing. Use only for 2 weeks. Do not swallow.

Pain Medication

• Ibuprofen (common brand name: Advil) - Start after the procedure. Take 800 mg every 6 hours for pain.
• Acetaminophen (common brand name: Extra Strength Tylenol) - Start after the procedure. Take 500 mg every 6 hours as needed for pain.
• Hydrocodone/Acetaminophen (common brand name: Norco) - Start if ibuprofen and acetaminophen are not adequately controlling your pain. Discontinue use once pain is manageable with ibuprofen and/or acetaminophen.
• Norco contains both hydrocodone, an opioid narcotic, and acetaminophen (Tylenol). Do not exceed 4,000 mg of Tylenol in 24 hours, do not operate machinery or drive, and do not mix with alcohol.
• Unused medications can be returned at any Walgreens location and most other pharmacies.

How to Take Your Pain Medications

Advil and Tylenol can each be taken every 6 hours, but they work best if staggered every 3 hours. For example, if you start Advil at 9am, take Tylenol at 12pm and Advil again at 3pm. Take Advil and Tylenol consistently for the first 3 days for best pain management and to limit swelling. After 3 days, take them as needed. It is better to stay ahead of pain than to allow it to increase. Start Advil or Tylenol as soon as you get home after surgery before the local anesthesia wears off. If Advil and Tylenol do not adequately control your pain, stop taking Tylenol and replace it with Norco until your pain is better controlled, then restart Tylenol.

Download Medication Instructions PDF

Sinus Lift Post-Operative Instructions

After undergoing sinus lift bone graft surgery, follow these sinus precautions and post-operative instructions.

Sinus Precautions

• No Smoking: Nicotine decreases blood flow to the healing surgical site, and smoke irritates the surgical site. Smoking can result in delayed healing and sinus infection.
• Do Not Blow Your Nose for 1 Week: Blowing your nose creates high pressures that can disrupt healing of the sinuses.
• Ocean Nasal Spray: If your nose feels congested, use Ocean Nasal Spray to loosen mucus and permit passive drainage. It is available over the counter.
• Sudafed: If your sinuses feel congested, use Sudafed as directed. It is available over the counter. Do not take Sudafed if you know you are allergic to it.
• Sneeze Through Your Mouth: If you feel the urge to sneeze, sneeze through your mouth instead of your nose to avoid high pressures that can disrupt healing.
• Do Not Bear Down: Avoid lifting heavy objects, blowing up balloons, playing musical instruments that require a blowing action, or any other activity that increases nasal or oral pressure.
• No Swimming for at Least 1 Month: Water entering your nose while swimming can lead to a sinus infection.
• No SCUBA Diving for at Least 2 Months: Water pressure can disrupt healing of the sinuses.

Post-Operative Care

• Firm, Moist Gauze Pressure for 2 Hours: Bite down firmly and do not talk. If still bleeding after 2 hours, stack and fold 3 pieces of fresh gauze, moisten them with water, and apply to the wound for 1 hour at a time until bleeding stops.
• Apply Cold Packs to Face: Alternate cold packs 30 minutes on and 30 minutes off for the first 48 hours.
• Elevate Your Head for the First 7 Days: Keep your head elevated on a recliner or couch while sleeping. Do not lie flat on a bed, as increased facial swelling will occur.
• No Smoking: Smoking slows healing and increases the risk of sinus infection, severe pain, and failure of the bone graft.
• No Spitting: Do not spit for 1 month. If you feel like you need to spit, gently rinse with water and let it passively fall into the sink.
• No Straws: Avoid straws for 1 month. Eat smoothies and milkshakes with a spoon, or drink from a cup.
• Diet: On Day 1, eat cool, soft foods. During Days 2-31, eat soft, room-temperature foods. Avoid hot and spicy foods and drinks. Cool soup and coffee to room temperature.
• Medication: Take all medications with food. Do not drive or operate heavy machinery after IV or oral sedation, or while taking narcotic or nausea medication.
• Rinsing: Begin gentle rinsing on Day 2 after each meal. Use an alcohol-free mouthrinse or water. Do not spit; let the rinse passively fall into the sink.
• Oral Hygiene: Use a soft-bristle toothbrush and avoid an electric toothbrush. Brush normally, but avoid the bone-graft surgical site. Gently rinse with an alcohol-free mouthrinse or warm salty water.
• Activity: Do not exercise for 1 week after surgery.
• Swelling: Swelling, pain, and bruising are normal for the first 4-5 days and then gradually disappear.

Download Sinus Lift Instructions PDF

Tissue Grafting Post-Operative Instructions

Postoperative care is important following a connective tissue graft procedure, and results are greatly dependent on your care of the grafted site. Some swelling and discomfort are expected after surgery. Inflammation peaks between 48 and 72 hours after treatment. After the third day, swelling and discomfort should decrease. If swelling increases after day three, call us.

The Day of the Procedure

• Keep your head elevated and rest quietly. Eat only cold, soft foods or liquid meal replacements while numb, and drink plenty of liquids.
• Do not use a straw. Gradually add harder foods to your diet. Place an ice pack on the cheek of the treated area for 20 minutes followed by a 10-minute break. Repeat several times during the first 4 hours. Do not place ice directly on the skin.
• Take pain medication as prescribed. Some oozing of blood from the palate is expected. If bleeding seems excessive, apply firm pressure with moist gauze or a tea bag for 40 minutes.
• Avoid sucking, rinsing your mouth, frequent spitting, smoking, or exercising for 12 hours. Strenuous exercise and heavy lifting should be avoided for 10 days.
• Surgical Stent: If a stent was provided to cover the roof of your mouth, wear it for the remainder of the treatment day and while eating and sleeping for the next 4-5 days. Remove and rinse the stent after eating.
• Pain Medication: Follow package instructions for dose and timing. If given both acetaminophen and ibuprofen, alternate doses every 3 hours.
• Some sutures dissolve on their own while others need to be removed. If ends become loose and dangle in the mouth, you may cut the dangling ends with scissors. Do not pull on them.

For the Next 4 Weeks

• Absolutely avoid chewing food, gum, or other items with the tooth or teeth where the graft was placed. Trauma or movement may cause failure of the graft to attach. Do not disturb the area during healing.
• Avoid brushing the graft area for the entire 4 weeks. Other areas may be cleaned and brushed normally. Thirty minutes after brushing your other teeth in the morning and at night, swish the prescribed mouthrinse for 1 minute and then spit.
• A somewhat soft diet is recommended. Avoid sharp foods such as peanuts, popcorn, nachos, and tacos. Continue pain medication as needed.

Download Tissue Grafting Instructions PDF