Pre- and Post-Treatment Guidelines for Pediatrics and Adolescents – Dr. Colin Richman

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Pre- and Post-Treatment Guidelines for Pediatrics and Adolescents

Pediatric + Adolescent Pre Treatment Guidelines for patients scheduled for
periodontal or dental implant treatment.

The following guidelines are intended to facilitate the treatment process. Please follow these guidelines closely if you need additional help.


  1. Advise the office of any changes in medical and medication history.
  2. If not scheduled for an IV sedation, start all prescribed medications 1 hour before your scheduled dental appointment at our office.
  3. Prior to arrival:
  4. Clothing: Wear a short-sleeve shirt to enable blood pressure monitoring as needed.
  5. Make-up: Do not apply any makeup, including facial or eye makeup, as this will contaminate the surgical site and result in potential infections.
  6. Hair: If you wear your hair long, please tie it into a ponytail in order to avoid contamination of the sterile working area.
  7. Shaving: Men shave to skin – NO stubble. Stubble may contaminate the surgical field and result in potential infections.
  8. Smoking: If you are a smoker, try to cut back on the amount of smoking (if possible). This would include taking a lesser number of puffs on each cigarette.
  9. Driver and Companionship: You CANNOT drive a motor vehicle either to and from the office if taking an oral sedative (Halcion). You must have a driver who is known to you and not a public transportation service (e.g. Taxi/Lyft/Uber). It is necessary to have someone with you for the next 12 hours after your surgical procedure.
  10. Appliances: Bring all appliances (e.g. bite guard, sleep appliance, orthodontic retainer, etc.) to every visit, especially treatment visits.

Following your procedure:

11. Bruising/swelling: Anticipate bruising and swelling. This is normal and routine following oral surgery. It will be controlled both by your medications, as well as ice packs on the outside of your face following treatment, and sucking on ice cubes, all at the same time.

13. Consume one or two natural, non-flavored yogurts with a live culture every day while completing antibiotic therapy. Examples include: Chobani or Activia.

Pediatric + Adolescent Post treatment guidelines

  • DO NOT deviate from guidelines. Please take all your prescribed tablets until gone (approximately 4 days).
  • Use the mouthrinse until gone (approximately 2-3 weeks). Finish all medications.
  • If prescribed, Motrin/Ibuprofen 600mg, is a prescription item that is time released. 3 x200mg OTC Motrin/Ibuprofen/Advil/NSAIDs are NOT equivalent to 1x600mg time released Motrin/Ibuprofen.
  • DO NOT Explore or Rub the surgical area with your tongue and/or fingers.
  • DO NOT pull your lip or cheeks back to view the procedure. This will cause stitches to detach…please don’t do it!
  • DO NOT be concerned if the surgical area appears gray, red, swollen or abnormal – surgical areas will only start to take on a normal anatomical shape + appearance 4-6 weeks after the procedure.
  • Some patients are anxious and worry prematurely about surgical success. Almost all oral surgical procedures are successful and predictable, but do not resemble normal tissue for at least 6 weeks post treatment.
  • Swelling and bruising are NOT a problem. Do not be alarmed if this should happen. If present, swelling will subside between 4-7 days after treatment.
  • ABSTAIN from aerobic exercise that may raise your blood pressure for at least four full days, starting the day of the surgery

Immediately on arriving home:

  1. Start all medications.
  2.  The guidelines on each medication container override any verbal or written instructions from our office.
  3. Always take all medications with a full glass of room temperature water or any liquid.
  4. Always have some food just prior to taking medications.
  5.  Apply a cold compress over the surgical site.
  6.  Read this instruction sheet daily

Arnica Montana

  • Some patients describe value to the use of topical Arnica Montana. Dr. Richman has no positive or negative thoughts regarding topical use. However, do not use oral Arnica Montana tablets as these may interfere with the conventional medications you are taking.


  • If provided, wear the palatal shield 23.5 hours per day until the suture removal appointment. Remove it only for eating and brushing/flossing and immediately place the shield back into your mouth.

Brushing, Flossing, Rinsing and Eating

  • Do not brush the treated gum tissue area, until stitches are removed.
  • This may include areas covered with a dressing, if we placed a dressing.
  • Do not use a water pick or electric toothbrush until after suture removal 2-3 weeks after treatment.
  • Do not floss or use a toothpick in the treated area for one week.
  • The rest of the mouth must be brushed and flossed thoroughly.
  • Do not eat or drink anything hot until you get the feeling back in your lips and tongue.
  • No chewing until the next day. Liquids/fluids only on the surgical day.
  • Do NOT use straws for the next 7 days.
  • Drink orange juice for the Vitamin C content, and be sure to eat a normal well balanced, soft diet for a few days.

Swelling, bleeding and bruising/Icepacks

  • Place icepacks over the surgical site for 30 minutes, 3 times a day, for 3 days. Also, suck on ice cubes adjacent to the surgical area, at the same time as applying the icepacks.
  • However, if the swelling and bruising is worsening substantially, please contact your doctor.
  • Expect some bleeding or oozing during the first 12 hours.
  • Certain surgical procedures have a dressing over the area. If you have a dressing, it might be lost within the first 12 hours. This is normal.

Pain and discomfort.

  • Expect some pain and discomfort during the first week. In most instances the medication prescribed should be adequate. Pain will start subsiding after the 4th day.
  • ALL medications must be taken consistently and finished, even if you don’t think you need it (minimum of 4 days).
  • If prescribed Ibuprofen (Motrin) and Extra Strength Tylenol, these should be taken every 6th hour – alternate these two medications. Take Ibuprofen (Motrin) 600mg first then 3 hours later Extra Strength Tylenol then 3 hours later Ibuprofen (Motrin) 600mg, etc.
  • In the unlikely event you need a narcotic, take 1 Norco tablet every 4 – 6 hours in addition to the Ibuprofen (Motrin) 600mg. If taking Norco, stop Tylenol .
  • Any pain medication requiring a prescription, such as Lorcet , Norco or Tylenol III will make you sleepy. Do not drive a motor car or operate machinery. This does not apply to Motrin/Ibuprofen.
  • Certain medications especially antibiotics (e.g. Penicillin, Tetracycline, Doxycycline and others) are birth control inhibitors. If relevant, please take appropriate precautions if you are on birth control medication.
  • Patients taking Doxycycline (Tetracycline) should not be exposed to the sun or tanning lamps.
  • If you experience severe nausea, diarrhea, vomiting or dehydration, contact your doctor

Essix Retainer, if provided.

  • An Essix retainer is for cosmetic purposes only. It is okay to keep it out of your mouth as needed.


  • We suggest sleeping with your head elevated on a 2nd pillow. This tends to reduce the blood pressure to the mouth, which should keep you more comfortable.

Diet Instructions, If laser periodontal therapy (LANAP) was provided

  • For the first three days following (LANAP), consume a soft diet. Anything that can be put into a blender is ideal. The purpose is to protect the blood clot that serves as a “band-aid” between the gums and the teeth.
  • Do not drink through a straw. This creates a vacuum in your mouth that can disturb the “band-aid”.
  • Consume foods with a soft consistency – anything that can be cut with a fork or a spoon. Examples include pasta, fish, chicken or steamed vegetables.
  • For the first 2 weeks post laser (LANAP) surgery, do not chew gum, candy, cookies, chips, nuts, or anything hard or crunchy. This also includes anything that has seeds or hard pieces,meat that shreds and can lodge under the gum and between teeth, raw vegetables/salad.

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