Care After Periodontal Pack/ Dental Root Canal Surgery
The following information on your gum operation has been prepared to answer questions you may have about how to take care of your mouth. Please read the instructions carefully you have found them very helpful.
When the anesthesia wears off, you may have slight discomfort, not pain. Two acetaminophen (Tylenol) tablets will usually keep you comfortable. You may repeat every 4 hours if necessary. A periodontal pack placed over your gums to protect them from irritation. The pack prevents pain, aids healing, and enables you to carry on most of your usual activities in comfort. The pack will harden in a few hours, after which it can withstand most of the forces of chewing without breaking off; it may take a little while to become accustomed to it.
The pack should remain in place as long as possible. Do not remove it. If particles of the pack chip off during the week, do not be concerned as long as you do not have pain. If a piece of the pack breaks off and you are in pain, or if a rough edge irritates your tongue or cheek, please contact with your dentist. The problem can be easily remedied by replacing the pack. The pack will be removed at your next appointment.
For the first 3 hours after the operation avoid hot foods in order to permit the pack to harden. After this, eat anything you can manage without chipping the pack, eggs, gelatin (Jell-O), cereals, soups, milk, fish, hamburger, or any semisolid or finely minced foods are suggested. Avoid citrus fruits or fruit Juices, highly spiced foods and alcoholic beverages. They will cause pain. Food supplements and or vitamins are generally not necessary if not prescribe.
Do not smoke. The heat and smoke will irritate your gums and delayed healing. If at all possible, use this opportunity to give up smoking. Smokers have more gum disease than non smokers.
Do not brush over the pack. Brush and floss normally the areas of the mouth not covered by the pack. Use chlorhexidin mouth rinses after brushing (the prescription for this mouth rinse has been given to you). You may experience a slight feeling of weakness or chills during the first 24 hours. This should not be cause for alarm but should be reported at the next visit. Follow your regular daily activities, but avoid excessive exertion of any type. Golf, tennis, skinning bowling, swimming or sunbathing should be postponed for a few days after the operation.
Swelling is not unusual:
The swelling is generally subsides in 3 or 4 days. If the swelling is painful or appears to become worse, call on your dentist. There may be occasional blood stains in the saliva first 4 or 5 hours after the operation.
Mechanism of Periodontal pain:
The transmission of stimuli from the surface of the dentine to the nerve endings located in the dental pulp or in the pulpal region of the dentine could occur through the odontoblastic process or owing to a hydrodynamic mechanism by means of displacement of dentinal fluid.
This is not unusual and will correct itself. It there is considerable bleeding beyond this , take a piece of gauze, form it into the shape of a U, hold it in the thumb and index finger, apply it to both sides of the pack, and hold it there under pressure for 20 minutes . Do not remove it during this period to examine it. If the bleeding does not stop at the end of 20 minutes, contact the office. Do not try to stop bleeding by rinsing.
After the pack is removed the gums most likely will bleed more than they did before the operation. This is perfectly normal in the early stage of healing and will gradually subside. Do not stop cleaning because of it. It any other problems arise, please call the office.
The 1st post operative week:
Properly performed periodontal surgery presents no serious problems. Unfavorable squeal are the exception rather than the rule. The following may arise in the post operative week.
- Persistent bleeding after surgery: If so, the pack is removed, the bleeding points are localized, and the bleeding is stopped with pressure, electrosurgery or electrocautery. After the bleeding is stopped the pack is replaced.
- Sensitivity to percussion: This is caused by the extension of inflammation into the periodontal ligament. Gradually diminishing severity is a favorable sign. This may also caused by excess pack, removal of the excess pack usually corrects the condition.
- Swelling: Within the first two post operative days there may be a soft, painless swelling of the cheek, lymph nodes and slight elevation of temperature. This may result from a localized inflammatory reaction to the operative procedure. It generally subsides by the 4th postoperative day without removal of pack.
- Feeling of weakness: Patient may experience a" washed out" weakened feeling for 24 hours after the operation. This represents a systemic reaction to a transient bacterium induced by the operation procedure. It is prevented by antibiotics coverage, beginning 24 hours before the next operation and continuing for a 5 days postoperative period.
Removal of the Periodontal Pack and Return Visit care:
- After 1 week the pack is taken off by inserting a surgical hoe along the margin and exerting gentle lateral pressure.
- Pieces of pad retained interproximally removed with sealers.
- The entire area is rinsed with warm water via syringe to remove superficial debris. Each tooth surface should re-check to be certain no calculus (mineralized plaque) is present.
After the pack is removed, it is usually not necessary to repeat it. However in some condition it is advisable to repack for additional 1 week. The conditions are-
- A low pain threshold who are partiularly uncomfortable when the pack is removed.
- Unusual extensive periodontal involvement,
- Slow healing.
Care of the mouth between periodontal surgery procedures:
A) Maintenance of oral hygiene:
- Vigorous brushing should be avoided, but plaque and food debris must be removed by the gentle use of interdental cleansers and dental floss and light water irrigation.
- Chlorhexidine mouth wash as its topical application with cotton tipped applicators is indicated for the first few postoperative week.
- Brushing is started when healing of tissues permit it.
B) Management of post operative pain:
The patient should be informed about the possibility of root hypersensitivity before treatment is undertaken. The following information on how to cope with the problem should also be given to the patient.
- Hypersensitivity appears due to the exposure of dentine which is inevitable if calculus and plaque and their products, buried in the root, are to be removed.
- Hypersensitivity slowly disappears over a few weeks.
- Desensitizing agents do not produce immediate relief. They have to be used for several days or even weeks to produce results.
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