Endodotic Surgery Instructions

Before Treatment

Continue all medications for blood pressure, diabetes, thyroid problems and any other conditions as recommended by your physician. If there is a question, please call our office prior to your appointment.

Please eat a full breakfast or lunch as applicable, unless otherwise instructed by the doctor.  If oral or intravenous conscious sedation has been arranged then it will be required that you fast for a specific period prior to treatment, these instructions will be given to you by the doctor and staff.

If you have been advised by your physician or dentist to use antibiotic premedication because of any conditions listed below under “Antibiotic Premedication Guidelines,” please make sure you take the appropriate antibiotic on the day of your appointment, one hour prior to your appointment. If there is a question, please call our office before your scheduled appointment time.

If you can take ibuprofen (Advil) or naproxen sodium (Aleve), it does help reduce inflammation when taken pre-operatively. We recommend 2 tablets of either medication 2-4 hours before endodontic therapy.

Antibiotic Premedication Guidelines

The current recommendations recommend use of preventive antibiotics prior to certain dental procedures for patients with:

  • artificial heart valves
  • a history of infective endocarditis
  • a cardiac transplant that develops a heart valve problem
  • the following congenital (present from birth) heart conditions: *
    • unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
    • a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
    • any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device

    * Patients should check with their cardiologist if there is any question as to whether they fall into one of these categories.


Patients who took prophylactic antibiotics in the past but no longer need them include those with:

  • mitral valve prolapse
  • rheumatic heart disease
  • bicuspid valve disease
  • calcified aortic stenosis
  • congenital (present from birth) heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy


The American Academy of Orthopaedic Surgeons (AAOS), and the American Dental Association (ADA) found that there is insufficient evidence to recommend the routine use of antibiotics for patients with orthopaedic implants to prevent infections prior to having dental procedures because there is no direct evidence that routine dental procedures cause prosthetic joint infections. However, please consult with the doctor that performed your joint replacment, as their recommendations will be followed explicitly.

After Treatment:

On the day of the surgery, take it easy for the rest of the day.  Avoid any heavy lifting, exercise, or strenuous activity that might increase your heart rate and circulation, rest as much as possible.  Smoking and alcohol consumption delay wound healing and should be avoided for several days after surgery.  Eat only soft foods; nothing difficult to chew, hot or spicy.  Continue to keep activity to a minimum and maintain a soft diet for the first 5 days.

Apply cold pressure alternating, ON for 15 minutes and OFF for 15 minutes, for the rest of the day.  Moist heat applications to your face are recommended on the second and third post-surgical days.

Starting the day after the surgery, you should begin rinsing twice a day for 30 seconds with the prescribed PERIDEX (chlorhexidine) mouth rinse.  Continue to rinse twice a day for at least 1 week after the completion of your surgery.

Post-surgical pain will be at its peak when the anesthetic wears off.  Prescribed medications are to be obtained and taken immediately.  If antibiotics are prescribed, they are to be taken until gone.  Prescription medications for pain are recommended for the day of surgery and to be used only as needed on the days following the surgery. Ibuprofen, which can be purchased over the counter (brand names – Adviland Motrin), is also very effective.  For patients who can take ibuprofen, we recommend taking up to 800mg every 6-8 hours for the first few days following surgery. If you develop any unusual reactions (e.g., itching, rash, breathing difficulties, nausea, etc.) please stop taking the medication and call the office immediately.

Some swelling and facial skin discoloration (bruising) may appear following surgery and will gradually disappear in a few days.  The swelling will be greatest on the second and third days after surgery.  Some oozing of blood from the surgical site is normal during the day and evening following the surgery.  If severe bleeding occurs, please call our office.

DO NOT suck through a straw, rinse your mouth, or brush your teeth for the remainder of the day following surgery.  If you were informed that bone graft material was placed as part of your procedure, do not use a straw for a full week following surgery to prevent the graft from being disrupted.

Avoid manipulation of your facial tissues as much as possible.  DO NOT raise your lip or retract your cheeks to look at the surgical site.  It is possible to tear loose the stitches accidentally, which will open the incision, cause significant pain and substantially delay the healing process.  Try to sleep on your back, or away from the side on which your surgery was performed.

The sutures (stitches) should be removed in 3-5 days to ensure proper healing.  It is important that you return at the appointed time for suture removal.  This appointment is short, relatively easy, and local anesthetic is usually not necessary.

Are There Any Potential Problems After Treatment?

  • Lower teeth and nerve injury. There is a slight possibility that nerve injury can occur during root canal surgery to the lower posterior teeth. Your endodontist is trained to assess this possibility prior to treatment and will advise you accordingly. For lower posterior teeth, the root tips may be near a nerve that supplies feeling to the lip, chin and gums. Your endodontist is trained to design your surgery to minimize the chances of damaging this nerve. Rarely, this nerve can become irritated during the process of surgery. In these cases, when the local anesthesia wears off, you may experience tingling, altered sensation or, in rare cases a complete lack of feeling in the affected tissues. Should this occur, it is usually temporary and will resolve over a period of days, weeks or months. In rare cases, these changes can be permanent and/or painful.
  • Upper teeth and sinus communication. The upper teeth are situated near your sinuses, and root canal surgery can result in a communication between your mouth and the adjacent sinus. Should this complication occur, it will usually heal spontaneously. We will give you special instructions if this is apparent at the time of surgery. We prefer that you don’t blow your nose for two to three days after surgery. If you have to sneeze, you should sneeze with an open mouth into a tissue. You should not create any pressure in the sinus area. If you sense a complication after surgery, please contact us.
  • Post-operative infections. Post-operative infections occasionally occur. This usually requires just an office visit and examination. Many times placing you on an antibiotic for one week will take care of the infection Occasionally, other follow-up procedures will be needed.

Oral Conscious Sedation Instructions

Before Treatment:

Take the prescribed medication 1 hr prior to dental treatment while fasting.

Female Patients: If you are, or think that you might be pregnant, DO NOT take this medication. Please contact our office to go over alternative options for your appointment.

You must provide for us a current list of the medications that you are taking and the reason for each medication, including natural/organic and herbal medication.

The morning of your appointment you will need to be fasting prior to treatment. Please do not eat or drink for 8 hours before your appointment. Also, please DO NOT have any grapefruit juice the day prior to treatment. If you are diabetic then specific fasting instructions may need to be tailored depending on blood sugar levels and the stability of your diabetic condition.

You MUST have someone drive you to and from your appointment.

After Treatment:

It is necessary now for you to re-hydrate your body. You should drink fluids for the remainder of the day and should try to have something as soon after the procedure as you are able.

Please understand that you are not to operate a vehicle while under this medication, this includes the remainder of the day.

You should defer any responsible or complicated tasks or any decisions requiring fine judgment for the remainder of the day.

You will need to refrain from drinking any alcoholic beverages for two days following treatment.

You will be tired for the remainder of the day and you are requested to rest.

Associates in Endodontics

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