PATIENT SIGNATURE: DATE : ( day of surgery)

Transcription

1 WOUND CARE INSTRUCTIONS FOR 6 WEEKS 1.) NO BRUSHING OVER SURGICAL SITE(S). 2.) NO FLOSSING (Water-Pik ONLY from tongue-side or inside on low) 3.) NO TOUCHING: with finger or any other device or object. 4.) Do not lick surgical area. 5.) Do not use cotton swabs, cloth or any soft or hard object to clean area. 6.) Do not sleep with hands under the cheek where surgery was done. 7.) No facial massages for 3 weeks or massage that area of the face for any reason. 8.) NO LOOKING: Do not obsess over or question Doctor about appearance of gums for 6 weeks. You cannot look without pulling cheek. 9.) RINSE ONLY WITH LIPS APART: SLOSHING ONLY 10.) NO Chipmunk cheeks when you rinse. 11.) Do not play wind instruments for 3 weeks. 12.) Do not suck on straws. 13.) Do not blow balloons. 14.) No spitting. 15.) No mints over surgical area. 16.) No smoking, chewing tobacco, cigar, pipe or recreational marijuana. Please consult doctor if you use marijuana for medical purposes. 17.) WEAR PRESCRIBED BITE APPLIANCE 24 HOURS A DAY, if instructed. Check with Doctor about any other appliances (e.g., retainers, Invisalign, Perio-Protect, etc). 18.) No Clenching or grinding of the teeth 19.) No heavy lifting that require clenching of the teeth. 20.) No heavy aerobics or vigorous dancing or physical activity for 3 weeks. 21.) No Snorkeling for 6 months 22.) ICE OVER AREA at 10 minute intervals for the first 48 hours to minimize swelling. 23.) DO NOT BE ALARMED ABOUT SOFT SWELLING OR BRUISING FOR THE FIRST WEEK. 24.) DO NOT EAT crunchy or sticky food that can get stuck on or in between your teeth. 25.) EXPECT cold sensitivity for 6 weeks or longer. DO REPORT sensitivity during check-up appointments. 26.) PAIN CONTROL- take one each of acetaminophen (Tylenol) and NSAID (Motrin or Advil) at the same time, subject to other instructions by Doctor. 27.) CALL DOCTOR IMMEDIATELY IF YOU HAVE UNEXPECTED PAIN, CONTINUOUS BLEEDING, OR HEAT FROM SURGICAL SITE. 28.) Patient MUST return to our office 24 hours after surgery, 1 week after surgery, 3 weeks after surgery, and 6 weeks after surgery. 29.) After the 6th week you may brush surgical area with special extra soft brush dispensed or ordered by this office for 6 MONTHS. PATIENT SIGNATURE: DATE : ( day of surgery) DATE : ( next day) DATE : ( 1 week) DATE : ( 3 weeks) DATE : ( 6 weeks)

2 John Chao DDS. 100 S. 1 st St. Alhambra, CA (626) Post-Operative Instructions for PST HEMORRHAGE CONTROL: Do not suck on the wound or spit unnecessarily as it will prolong the bleeding. Do not be alarmed, it is normal to have some blood in your saliva during the next 24 to 48 hours. PAIN CONTROL: If you re not given a prescription, utilize ONE of the following recommendations as needed for pain management: 1) Take 1 Advil and 1 Tylenol together; or 2) 2 Advil and 2 Tylenol together; 3) 2 Tylenol, Aspirin, Anacin, or APC tablets every 4 hours for discomfort. If you were given a prescription, follow the prescribed directions accordingly. Avoid taking pain medication on an empty stomach. If this does not control the pain call this office right now. SWELLING CONTROL: To aid in the prevention of swelling after this extensive and difficult oral operation, the application of ice packs to the face is very effective. Ice Packs should be used 10 minutes out of each hour until bedtime, do not use ice packs for longer than 48 hours. Keep your head and shoulders elevated to a 45 degree angel until bedtime. The first day after surgery, don NOT apply heat to the face unless you specifically told to do so. DIET: You may have clear liquids when arriving home. After 2 hours, a soft diet may be resumed. No milk products until evening. Drink plenty of fluids, but DO NOT USE A STRAW. Well balanced meals are important to recovery. Don not use any alcohol for the first 24 hours. ORAL HYGIENE: After 24 hours, if the bleeding has stopped, a warm salt water mouth rinse (1/2 teaspoon salt + one glass of warm water) will aid in healing. Use PERIDEX after every meal. Do not swish the mouth rinse. The rinsing should not be excessively vigorous as this may affect healing. Use after every meal or at least 2 times a day. DO NOT WEAR ANY MOUTH APPLIANCES (PERIO-PROTECT, SPORTSGUARDS, FLUORIDE TRAYS, BLEACING TRAYS, ORTHODICS, ETC.) UNTIL INSTRUCTED TO BY DR. CHAO. REST: Avoid over fatigue. Go to bed early at night and get adequate rest during the day. Remain inactive for 24 hours. LIPS: If the corners of your mouth are cracked or sore from the retractors during surgery, keep lubricated with a little Vaseline. BLACK AND BLUE: Do not be alarmed if a yellow blue-black discoloration appears on your face after surgery. It may take a week or so to fade away. ANTIBIOTICS: It is not always necessary to take antibiotics after a surgical procedure. If you are given a prescription for an antibiotic, have it filled and take all of the medication according to the instructions on the label. SUTURE: Occasionally sutures are placed. The sutures are non-dissolvable and will need to be removed by Dr. Chao. POST-OP VISITS: You should return to the office for your post-operative visits at the suggested time. However, feel free to call if you are having any problems.

3 2014 Wasserman Medical Publishers, LTD. All Rights Reserved. (Code 4270) Sample of what Doctors receive under code 4270 soft pedicle graph in various cities Example: 80% of Doctors receive $1,023 or less in Los Angeles % 50% 60% 70% 80% 90% 95% Los Angeles, CA $874 $895 $923 $972 $1,023 $1,103 $1,240 New York City, NY $1,037 $1,062 $1,092 $1,154 $1,214 $1,308 $1,472 Chicago, IL $907 $929 $958 $1,009 $1,062 $1,144 $1,287 Seattle, WA $806 $825 $851 $897 $943 $1,017 $1,144 Panama City, FL $778 $796 $822 $866 $910 $981 $1,104 Salt Lake City, UT $713 $754 $790 $794 $835 $900 $1,013 San Diego, CA $836 $856 $883 $931 $975 $1,055 $1,187 San Francisco, CA $891 $912 $941 $992 $1,043 $1,124 $1,265 Las Vegas, NV $821 $841 $868 $914 $961 $1,036 $1,166 Houston, Tx $865 $886 $914 $963 $1,013 $1,092 $1,228 Pheonix, AZ $813 $833 $859 $905 $952 $1,026 $1,154 New Orleans, LA $796 $815 $840 $885 $931 $1,004 $1,129 Santa Barbara, CA $829 $848 $875 $922 $970 $1,045 $1,176 Cheyanne, WY $718 $735 $758 $798 $840 $905 $1,019 Louisville, KY $741 $759 $783 $825 $867 $935 $1,052 Spokane, WA $766 $784 $809 $853 $897 $967 $1,088 Denver, CO $744 $793 $818 $862 $906 $977 $1,099 Austin, TX $749 $767 $791 $833 $877 $945 $1,063

4 D4270: Pedicle Soft Tissue Graft Procedure A pedicle graft of gingiva can be raised from an edentulous ridge, adjacent teeth, or from the existing gingiva on the tooth and moved laterally or coronally to replace alveolar mucosa as marginal tissue. The procedure can be used to cover an exposed root or to eliminate a gingival defect if the root is not too prominent in the arch.

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6 Pedicle Soft Tissue Graft Patient Name: Date: This procedure is performed for tooth # 6 for the following reasons: 1). Gingival recession 6 mm (CEJ to Gingival Margin) 2). Keratinized attached gingival 1 mm 3). Unattached keratinized gingival 2 mm 4). Root Sensitivity: mild _X, moderate, severe 5). Root Caries: Yes, No _ X 6). Gingival Inflammation: Mild_ X, Moderate, Severe 7). Thickness _1_mm 8). Mobility 0 Procedure: this procedure is performed to create and augment gingiva, to obtain root coverage, to eliminate sensitivity and prevent root caries. The recipient site utilizes minimal incision from which is raised a full thickness flap that retains the overlying flap of gingival and mucosa. The flap is raised from the existing gingival and mucosa and moved coronally. Bioresorbable collagen is placed at the site under the overlying flap.

7 Pedicle Soft Tissue Graft Patient Name: Date: This procedure is performed for tooth # 7 for the following reasons: 1). Gingival recession 4 mm (CEJ to Gingival Margin) 2). Keratinized attached gingival 2 mm 3). Unattached keratinized gingival 2 mm 4). Root Sensitivity: mild _X, moderate, severe 5). Root Caries: Yes, No _ X 6). Gingival Inflammation: Mild_ X, Moderate, Severe 7). Thickness _1_mm 8). Mobility 0 Procedure: this procedure is performed to create and augment gingiva, to obtain root coverage, to eliminate sensitivity and prevent root caries. The recipient site utilizes minimal incision from which is raised a full thickness flap that retains the overlying flap of gingival and mucosa. The flap is raised from the existing gingival and mucosa and moved coronally. Bioresorbable collagen is placed at the site under the overlying flap.

8 Pedicle Soft Tissue Graft Patient Name: Date: This procedure is performed for tooth # 8 for the following reasons: 1). Gingival recession 4 mm (CEJ to Gingival Margin) 2). Keratinized attached gingival 3 mm 3). Unattached keratinized gingival 2 mm 4). Root Sensitivity: mild _X, moderate, severe 5). Root Caries: Yes X, No 6). Gingival Inflammation: Mild_ X, Moderate, Severe 7). Thickness _0.5_mm 8). Mobility 0 Procedure: this procedure is performed to create and augment gingiva, to obtain root coverage, to eliminate sensitivity and prevent root caries. The recipient site utilizes minimal incision from which is raised a full thickness flap that retains the overlying flap of gingival and mucosa. The flap is raised from the existing gingival and mucosa and moved coronally. Bioresorbable collagen is placed at the site under the overlying flap.

9 Pedicle Soft Tissue Graft Patient Name: Date: This procedure is performed for tooth # 9 for the following reasons: 1). Gingival recession 4 mm (CEJ to Gingival Margin) 2). Keratinized attached gingival 2 mm 3). Unattached keratinized gingival 2 mm 4). Root Sensitivity: mild _X, moderate, severe 5). Root Caries: Yes, No _ X 6). Gingival Inflammation: Mild_ X, Moderate, Severe 7). Thickness _0.5_mm 8). Mobility 0 Procedure: this procedure is performed to create and augment gingiva, to obtain root coverage, to eliminate sensitivity and prevent root caries. The recipient site utilizes minimal incision from which is raised a full thickness flap that retains the overlying flap of gingival and mucosa. The flap is raised from the existing gingival and mucosa and moved coronally. Bioresorbable collagen is placed at the site under the overlying flap.

10 Pedicle Soft Tissue Graft Patient Name: Date: This procedure is performed for tooth # 10 for the following reasons: 1). Gingival recession 5 mm (CEJ to Gingival Margin) 2). Keratinized attached gingival 2 mm 3). Unattached keratinized gingival 2 mm 4). Root Sensitivity: mild _X, moderate, severe 5). Root Caries: Yes X, No 6). Gingival Inflammation: Mild_ X, Moderate, Severe 7). Thickness _0.5_mm 8). Mobility 0 Procedure: this procedure is performed to create and augment gingiva, to obtain root coverage, to eliminate sensitivity and prevent root caries. The recipient site utilizes minimal incision from which is raised a full thickness flap that retains the overlying flap of gingival and mucosa. The flap is raised from the existing gingival and mucosa and moved coronally. Bioresorbable collagen is placed at the site under the overlying flap.

11 Pedicle Soft Tissue Graft Patient Name: Date: This procedure is performed for tooth # 11 for the following reasons: 1). Gingival recession 6 mm (CEJ to Gingival Margin) 2). Keratinized attached gingival 2 mm 3). Unattached keratinized gingival 2 mm 4). Root Sensitivity: mild _X, moderate, severe 5). Root Caries: Yes _X, No 6). Gingival Inflammation: Mild_ X, Moderate, Severe 7). Thickness _1_mm 8). Mobility 0 Procedure: this procedure is performed to create and augment gingiva, to obtain root coverage, to eliminate sensitivity and prevent root caries. The recipient site utilizes minimal incision from which is raised a full thickness flap that retains the overlying flap of gingival and mucosa. The flap is raised from the existing gingival and mucosa and moved coronally. Bioresorbable collagen is placed at the site under the overlying flap.

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