Patient Information

POSTOPERATIVE INSTRUCTIONS FOLLOWING PLACEMENT OF DENTAL IMPLANTS

Upon arrival home, you will need to change the gauze. Extra gauze has been provided in your postoperative packet. Place folded gauze directly on the surgical area. Close your mouth firmly so that pressure is applied. Replace the gauze approximately every 30 minutes until bleeding is controlled (usually after 4-5 changes). Remove gauze packs to drink and replace with clean gauze. Slight oozing from the area may last 24-48 hours. If continued bleeding persists, you may place a moist tea bag on the area for 30 minutes. If profuse bleeding occurs, call the office.

ICE/SWELLING Some degree of swelling and discomfort following surgery is to be expected. Apply ice packs to the outside of the face over the surgical site for 20 minutes, then remove for 20 minutes and repeat as necessary while awake for the first 24-36 hours. Keep your head elevated, sleeping on 2-3 pillows. Swelling will usually peak in 48-78 hours following surgery and resolve 7-10 days following surgery.

STIFFNESS OF THE JAW MUSCLES Should this occur, apply a warm, moist towel to the outside of the face over the affected area.

DIET Begin with cool liquids, fruit juice, water, broth, tea, etc. Avoid hot liquids until the numbness has worn off. It is important to keep hydrated while healing from surgery; so drink plenty of fluids. Avoid chewing food over the implant sites. Chewing forces, during the initial healing process, may decrease your body’s ability to heal around the implant, which could cause the implant to not integrate or “fuse” with your jaw bone. Food selection is a matter of choice, starting initially with soft foods such as soups, Jello, macaroni and cheese, applesauce, mashed potatoes, yogurt, rice, fish, spaghetti, etc. Avoid hard and chewy foods such as nuts, hard crusty breads, steak, popcorn, poppy seeds, sesame seeds, or seeded fruits.

NUMBNESS/DISCOMFORT Due to local anesthetic, there may be numbness in the area of surgery for 6-10 hours postoperatively. This is usually transient but may be prolonged in difficult surgical cases.

TEMPERATURE (FEVER) A slight increase in temperature for 24-48 hours is normal. Should a temperature continue, notify the office.

BRUSHING AND HYGIENE Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of the surgery. There may be a metal healing abutment protruding through the tissue (gum). Gently brush your teeth near the surgical site. Avoid the use of a water pick. The rest of your mouth may be brushed as usual. Avoid commercial mouth rinses. If You were prescribed an oral mouth rinse (chlorhexidine) by your surgeon, use as directed. Vigorous rinsing should be avoided. Keep your mouth clean during healing.

CORNERS OF THE MOUTH OR LIPS These may be dry or cracked following surgery. Keep moist with an ointment such as Vaseline.

WEARING YOUR PROSTHESIS (FLIPPER, PARTIAL DENTURES, OR FULL DENTURES) Each mouth is different and your surgeon will give you specific instructions. If You are wearing your prosthesis postoperatively, your surgeon has made initial adjustments. Leave the prosthesis in your mouth for 12-24 hours. Expect some oozing of blood around the sides of your prosthesis. When you brush your teeth remove the prosthesis, clean it, and then place the prosthesis back into your mouth. Sore spots may develop. You may call your dentist or call our office to make the necessary adjustments to relieve those areas. For some patients, the denture will not be worn for a period of time or your surgeon may want you to wear it for aesthetic purposes only (not for eating). We will inform those patients prior to surgery.

MEDICATIONS Take all prescribed medications as directed by your surgeon. Antibiotics are given to help prevent infection. (For women only: if you are using oral contraceptives, please note that antibiotics and other medications may interfere with their effectiveness, and an alternative form of birth control should be used for one complete cycle following the course of antibiotics). For moderate discomfort take two ibuprofen (Motrin or Advil) 200 mg tablets. For patients who cannot take ibuprofen or aspirin, one or two tablets of regular Tylenol may be taken. Take any prescribed pain medication as directed by your surgeon. Should the pain persist or worsen after the third postoperative day, it may require attention, please telephone our office.

SMOKING Avoid smoking during your healing process, as nicotine delays healing and aggravates bleeding.

GAUZE PACKS Remove loose gauze packs from the mouth 45 minutes after the procedure.

ORAL HYGIENE Brush/floss your teeth thoroughly at least twice a day. Use a soft bristled brush so that you do not injure the tissue in your mouth. Following extraction, clean the teeth next to the healing tooth socket very gently for 2 days, carefully avoiding the surgical area.

MOUTHWASH AND/OR RINSING Do not rinse during the first 24 hours. After 24 hours, rinse very gently with warm diluted salt water or the prescribed oral rinse (if you were given a prescription by your surgeon). A syringe may have been given to you for tooth socket irrigation. Instructions are included with the syringe (do not use this until after 1 week).

ICE PACK OR BAG / HEAT You may use an ice bag over the operated area for the first 48 hours following surgery. Apply to the affected area for 20 minutes and remove for 20 minutes. Repeat This as necessary. Elevate your head with 2-3 pillows when lying down. This will help minimize your swelling, bleeding, and discomfort. After 4 days, heat can be applied for as long as needed.

PAIN Ibuprofen 600mg-800mg, every 6-8 hours (includes Motrin or Advil) may be recommended by your doctor to help control your discomfort. A stronger prescription pain medication may also be prescribed to take with the ibuprofen. If the prescribed pain medication makes you feel nauseated, discontinue it and substitute with Tylenol or Ibuprofen. While taking prescribed pain medication, do not drive a vehicle. Should the pain persist or worsen after the fifth postoperative day, it may require attention, please telephone our office.

BLEEDING Some bleeding following the extraction of teeth is to be expected. Tooth sockets may continue to ooze a little during the night and even through the next day. Should the bleeding seem to be excessive, there are several things you may do. Rinse the mouth thoroughly with cold water, removing any superficial masses of clotted blood. Then place a tightly folded piece of clean gauze over the bleeding area using enough gauze to apply firm pressure to the tissues when the jaw is closed. Maintain pressure with the gauze pack for a full 30 minutes. Remain quiet and keep your head elevated. Should this not control the bleeding, wrap a moist tea bag in gauze; place this over the socket and bite firmly. Should all of these measures fail to stop the bleeding, do not hesitate to call the office and/or doctor.

SUTURES (STITCHES) Most sutures dissolve or fall out 5-14 days following surgery. The duration depends on the type of suture used. Sometimes, no sutures are placed.

SWELLING Swelling is to be expected in cases where extensive surgery has been performed. Swelling will usually peak at approximately 48 hours and resolve 7 days following surgery. Should your swelling persist for an extended time, please call our office and speak with an assistant and/or your doctor.

NUMBNESS Numbness of the lower lip and tongue is not uncommon following surgery in the lower jaw region. This is usually transient but may be prolonged in difficult surgical cases.

MEDICATIONS Take all prescribed medications as directed by your surgeon. Antibiotics may be given to help prevent infection. (For women only: if you are using oral contraceptives, please note that antibiotics and other medications may interfere with their effectiveness, and an alternative form of birth control should be used for one complete cycle following the course of antibiotics).

REST AND NOURISHMENT

Liquids – It is important to stay well hydrated after surgery Dairy products (milkshakes, protein shakes, yogurt, cottage cheese, or Instant Breakfast) are a cool temperature and are a good food to start with after surgery. Soft foods – spaghetti, macaroni, soft vegetables, baked potatoes, etc. This gets you slowly chewing.

NAUSEA Nausea is occasionally caused by anesthesia, but may also be due to the prescribed pain medication. Discontinue medication and substitute Tylenol or Ibuprofen or call the office for another prescription. While nauseated, restrict your diet to clear liquids like tea, ginger ale, or 7-Up.

DISCOLORATION Discoloration of the skin is frequently seen in patients who “bruise” easily. It is due to bleeding from the operative site into the tissues. This will often be present 2-3 days following surgery and may take 5 days or more to fade.

LIMITED MOUTH OPENING This is normal for 2 weeks after surgery. A heating pad on the jaw may help speed this healing process.

• Medications. Take your medications as instructed.
• Swelling. To help reduce swelling, keep your head elevated and apply an ice pack or unopened bag of frozen peas or frozen corn to the area.
• Diet. To avoid dehydration, take in as much fluid as you can. It’s recommended that you consume 64 ounces of water per day (eight 8-ounce glasses of water). At first, you will be placed on a clear liquid diet (water, light juice, broth, etc.).
• Bleeding. It’s normal to notice minor bleeding or oozing of blood from the surgery wounds during the first 24 hours. It’s also normal to experience limited jaw mobility and some numbness of your lower lip, chin, cheeks, tongue, and teeth (for lower jaw surgery); and your upper lip, cheeks, nose, and teeth (for upper jaw surgery).
• Oral hygiene. Twice a day rinse with Peridex mouth rinse (an antibacterial mouth rinse) and brush your teeth at the same time. Carefully use a baby toothbrush to keep your teeth clean, taking extra precautions around the incision sites.
• Other precautions. For upper jaw surgery, do not blow your nose or sneeze through your nose for the first two to three weeks.

• Medications. Take 600 mg of ibuprofen (Advil^® or Motrin^®) every six to eight hours to help reduce pain and swelling. If you don’t receive adequate pain relief from these medications alone, add the prescription pain relief at least one hour after taking ibuprofen. Avoid alcohol while taking these medications. Take any other prescribed medications as directed by your surgeon.
• Swelling. Expect swelling to be worse in the first week (it generally peaks from the third to fifth day after surgery), and gradually lessen. To help reduce swelling during the first 48 hours after surgery, place crushed ice in a plastic bag, wrap the bag in a towel, and place it on your face. Use the ice pack for 15 to 20 minutes at a time, giving your skin adequate breaks from the cold. Do NOT apply heat to the area, which will worsen swelling.
• Diet. During the first week after surgery, stick to a full liquid diet (milkshakes, smoothies, non-acidic juices, Jell-O, and blenderized foods.) Avoid alcohol, carbonated drinks, and very sugary fluids, which may promote dehydration.
• Oral hygiene. You may remove the elastics for hygiene, but replace them as instructed by your surgeon. Follow this oral hygiene routine at least two to three times per day: Gently rinse your mouth with Peridex mouth rinse and use a baby-sized soft-bristled toothbrush to clean your teeth, nearby gums, and ancillary hardware, carefully avoiding the sutures and wounds. For comfort, you may use warm salt water rinses, but avoid mouth rinses with alcohol (the majority of commercial over-the-counter brands) that may burn and irritate the healing wounds.
• Smoking. Do not smoke, which may slow or prevent healing and may result in an infection.
• Activity. It’s important to not over-exert yourself during the first week after surgery, but you may resume light housework and other non-strenuous daily activities. By slowly resuming your activities you will help speed your recovery.
• Follow-up. Be sure to return to our office for a follow-up post-operative visit with your surgeon one week after your surgery. During this visit, your surgeon will evaluate your healing progress and answer any questions you might have. Be sure to follow your new set of post-operative instructions for the next five weeks. By the sixth week, you will be able to resume a regular diet as instructed by your surgeon.

SOCKET GRAFTING AND BONE PRESERVATION

Procedures to repair and grow new bone, unheard of just a few years ago, are now part of routine dental surgical care. Bone grafts are needed when a part of your jaw is missing. Examples of bone loss are: loss surrounding roots of teeth (periodontal defects) or loss which occurs following tooth extraction or trauma. Dental alveolar bone (jaw bone) is the bone that holds teeth in place. Following tooth extraction this bone begins to reshape or melt away, causing a deformity in the jaw. No matter if you choose to replace your missing tooth/teeth with dental implants, fixed bridges, removable partial or dentures, such bone loss may create major problems in restoring your smile or chewing ability. Jaw defects can be prevented or repaired by a procedure called socket grafting or bone preservation. Socket grafting or bone preservation can greatly improve your success for dental implants, fixed bridges, removable partial or dentures. This procedure may be in conjunction with tooth extraction or by itself to repair an existing jaw deformity. The procedure is performed by filling in the socket with bone or a bone-like material. This material stimulates new bone growth. Over time your bone will grow around and through this material. A barrier/membrane may be placed over the grafting material. The membrane works similarly to a band-aid as it helps hold the grafting material in the area and allows soft tissue growth over the graft material. This allows your bone height and width to be as close to the original as possible. After a period of healing, usually 4-6 months, a dental implant may be placed in the area. A dental implant will stimulate the bone to help prevent bone loss and preserve function. You may choose to have other dental restorative options, but bone/socket grafting will assist in preserving your jaw bone for a period of time. Healthy bone is necessary for healthy teeth.

POSTOPERATIVE INSTRUCTIONS FOR GRAFTED SOCKET / BONE PRESERVATION PROCEDURES

You may notice a white material inside the socket. This is the membrane. We plan on this membrane to remain in place for approximately 1 month (your surgeon may have a specific amount of time that he wants your membrane to remain; he will inform you of any specifics in your case). However, depending on the speed of healing, a membrane can stay in a minimum of 2 weeks to as long as 6 weeks. Should your membrane come out sooner than explained to you, please call our office: your surgeon may want to evaluate the area. You may notice small particles (size of sand) in your mouth. It is normal to have a small amount of escape. These loose particles will not harm you if swallowed. Should a large amount come out, please call our office to determine if you need a postoperative appointment. You may have sutures (stitches) in the area. These will usually dissolve in 7-14 days.

BRUSHING AND HYGIENE

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of the surgery. Do not use a water pick in the area. The rest of your mouth may be brushed as usual. If you were prescribed an oral mouth rinse (chlorhexidine), use as directed. Avoid commercial mouth rinses. Vigorous rinsing should be avoided. Keep your mouth clean during healing.

MEDICATION

If you have been placed on medications, take all prescribed medications as directed. Antibiotics are given to help prevent infection. (For women only: if you’re using oral contraceptives, please note that antibiotics and other medications may interfere with their effectiveness, and an alternative form of birth control should be used for one complete cycle after the course of antibiotics). If you have been prescribed pain medication, take as directed. Alternatively, take Tylenol or Ibuprofen as directed on the bottle. For moderate discomfort take 3-4 Ibuprofen, (Motrin or Advil) 200 mg tablets every 6 hours. For patients who cannot take Ibuprofen, extra-strength Tylenol may be taken as directed on the bottle.

SMOKING

Avoid smoking during your healing process as nicotine delays healing and aggravates bleeding. Smoking may hinder the healing process and the success of the procedure.

DIET

Avoid undue pressure to the area. Try to chew on the opposite side of the mouth until the area is healed. Begin with cool liquids, fruit juice, water, broth, tea, etc. Avoid hot liquids until the numbness has worn off. It is important to keep hydrated while healing from surgery, so drink plenty of fluids.

CORNERS OF THE MOUTH OR LIPS

These may be dry or cracked due to retraction during surgery. Keep moist with an ointment such as Vaseline.

ICE / SWELLING

Varying degrees of swelling and discomfort following surgery is to be expected. Apply ice packs on the outside of the face over the surgical site for 20 minutes, then remove for 20 minutes and repeat as necessary while awake for the first 24 hours. Keep your head elevated, sleeping on 2 or 3 pillows. Swelling will usually peak in 48-72 hours following surgery and resolve 7-10 days following surgery.

NUMBNESS / DISCOMFORT

Due to local anesthetic, there may be numbness in the surgical area for 6-10 hours postoperatively. This is usually transient but may be prolonged in difficult surgical cases. Discomfort usually peaks at 3-5 days but can persist 10-14 days longer than one might expect.

GAUZE PACKS / BLEEDING

Upon arrival home, you may need to change the gauze. Extra gauze has been provided in your postoperative packet. Place folded gauze directly on the surgical area. Close your mouth firmly so that pressure is applied. Replace the gauze approximately every 30 minutes until bleeding is controlled (usually after 4 to 5 changes). Remove gauze packs to drink and replace with clean gauze. Slight oozing from the area may last 24-48 hours. If continued bleeding persists, you may place a moist tea bag on the area for 30 minutes. If profuse bleeding occurs, call the office.

WEARING YOUR PROSTHESES

Each mouth is individual and your surgeon will give you specific instructions on stay plates, partial dentures, or full dentures.

TEMPERATURE (FEVER)

A slight temperature (101.5f) for 48-72 hours is normal. If the temperature continues, notify the office.

STIFFNESS OF THE JAW MUSCLES

If this occurs, apply a warm, moist towel to the outside of the face over the affected side.