After Exposure of an Impacted Tooth
Do not touch or play with the wound or sutures with your tongue or fingers for two weeks after surgery. There may be a metal or white colored material (healing abutment) protruding through the gingival (gum) tissue. This is not the implant. It is a post that attaches to the implant. The healing abutment helps to form the opening in the gum for your future tooth. Do not eat on the gum in this area as it will ruin the implant healing.
Placement of a dental implant is a surgical procedure. Post-operative care is very important. Unnecessary pain and swelling and the complications of infection can be minimized if the instructions are followed carefully.
Please read these instructions carefully. They will help you understand the normal reactions following your surgery and help to keep you as comfortable as possible
EARLY CARE AFTER SURGERY
On the Day of surgery, patients tend to do well if they follow this sequence:
- Control Bleeding First.
- Have the patient sit up and bite hard on the gauze until the bleeding is stopped. Do not spit. Apply ice packs immediately.
- Get something in your Stomach.
- A milkshake is initially suggested.
- Start Medications.
- If you have pain, start taking your pain medicine first and wait one hour to start the antibiotics.
- If you have no pain, start taking your antibiotic first and wait to start the pain medicine until pain is just starting to occur.
Some bleeding can occur after surgery and can be controlled by biting on a gauze pad placed directly to the bleeding wound for one hour. Apply a thumb size roll of moistened sterile gauze or a teabag over the wound and bite with 80% of your maximum jaw pressure on a constant basis for one hour. It may require 3-4 hours to stop the bleeding. If you were shown a different technique for applying pressure to the wound to stop bleeding please use the technique that you were shown.
At the end of each hour remove the gauze and check the wound directly for further bleeding. Please ignore a blood stain on the gauze as it will often stain a gauze all day and is a poor indicator of bleeding. Do not be afraid to look at the wound directly, as it is the best way to check bleeding. A flashlight may be useful, and a spoon may be used as a cheek retractor. If bleeding is still present, apply a new pressure gauze in the area using the technique that we taught you for another hour. Repeat as necessary. If bleeding still continues, please call for further instructions. Most reports of bleeding result from a poorly placed gauze, the use of intermittent pressure, or talking when one is supposed to be biting on the gauze.
It is normal to have some minimal bleeding with pink or red saliva during the first 24 hours. Bleeding can occasionally recur during the week after surgery. It will usually stop by itself, but a pressure gauze may be used if it is persistent.
It may be useful to place a towel on your pillow the night of surgery as minor oozing may occur from the wound at night.
Discomfort is usually strongest during the first 12-24 hours. For severe pain, use the prescribed medication should be taken as directed. For moderate pain, use Ibuprofen (Advil or Motrin -200mg. tablets). Take 1-2 Ibuprofen every 3-4 hours. Tylenol can be use as well as listed on the package.
Most pain medications can upset the stomach, especially the prescription pain medicine and especially if the stomach is empty. If general anesthesia was used and the stomach is empty, you can prevent an upset stomach by drinking a milkshake and taking the first dose of pain medication 30 minutes later. What is even more effective is to eat bulky foods of some thickness (mashed potatoes, oatmeal, ground meats) at least one half hour before taking your medication
CAUTION – Do not drive, work or operate mechanical equipment after taking the prescription pain medication. Also, do not mix alcohol and any pain medication (or antibiotic).
Take this medication as prescribed and complete the entire dosage. Please be aware that antibiotics may decrease the effectiveness of birth control pills. Please ask your obstetrician if and how long after stopping the antibiotic you should use alternative birth control measures.
Swelling is a normal occurrence after surgery. To minimize swelling, apply ice packs to the surgical site for thirty minute intervals (thirty minutes on, thirty minutes off) continuously during the day of surgery. Reapply the ice packs the next morning after surgery if swelling increases during the night. After 72 hours, warm, moist heat every 2-3 hours, may be applied to the face to help bring the swelling down as necessary.
Smokers are advised not to smoke after implant surgery until the implants have healed. The implant is much more likely to fail if you smoke.
A milkshake is usually suggested as the first food to be taken following surgery. If nausea is present avoid the milkshake initially and substitute seven-up or coke until the nausea clears. Then try the milkshake. Please drink lots of liquids on the day of surgery.
Our office staff has given you the diet you should eat after implant surgery. If one or several implants were placed, you can eat normal foods the day of surgery but you cannot eat these foods in the implant area. Often you take one half of a normal bite size in order to keep the food away from any implant area.
If all of your teeth were removed and immediate temporary teeth placed (all on four) , your diet is restricted to what you can cut up with a plastic fork (not a plastic knife or spoon).
Please remember that the success of your implants is highly related to you following these dietary restrictions for the entire implant healing period.
NAUSEA AND VOMITING
Most instances of nausea or vomiting occur when the patient is not eating well and is taking pain or other medications. In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicines. You should then sip on coke or seven-up. You should sip slowly over time until you can finish an entire can. When the nausea subsides you can try to resume eating “bulky” foods. If you can tolerate these “bulky foods,” you can slowly resume taking your medications. It is often the narcotic pain medication that causes nausea. Thus, you should minimize use of narcotic pain medications if you are not eating or if you have nausea. Should they be needed, please be slow to resume taking the narcotic pain medication and you should use a low dose to try to prevent further nausea.
Cleanliness after surgery is important for rapid and uncomplicated healing. Do not rinse or brush your teeth the day of surgery. The day after surgery, you may begin your oral hygiene measures. You can begin to brush your teeth, even the teeth adjacent to the surgical area. Brush the adjacent teeth carefully with toothpaste and a soft bristle brush at the gum line. You should not brush a temporary abutment post but you can brush the teeth adjacent to the temporary abutment post. If a temporary tooth was placed on your implant, you can carefully brush this temporary tooth carefully at the gum line as well. You should also begin to rinse food out of the wound by rinsing with a warm salt water solution every 3-4 hours (1/2 teaspoon of salt in a glass of warm water).
You must continue both the brushing and salt water rinses each day until you return to my office for your postoperative appointment.
If general anesthesia was used, the patient should stay on the couch for 6 hours until the sedative effects of the anesthesia diminish. After 6 hours the patient may gradually move about, but should not drive, operate machinery, drink alcohol or work for 12-24 hours until all sedative effects of the anesthesia have resolved. Use of prescription pain medication involves these same restrictions for a period of 6-8 hours after the last dose of pain medication. You are best to avoid physical exertion for 5-6 days.
In some cases, discoloration of the skin follows surgery. The development of black, blue, green, or yellow discoloration is due to blood seeping beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. After 72 hours, moist heat applied to the area may speed up the removal of the discoloration.
SORE THROAT / CORNERS OF THE MOUTH
A sore throat may develop from either the procedure or IV anesthesia. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days. Gargling with salt water will help this.
The corners of the mouth can be stretched from doing surgery inside the mouth, especially if they are chapped before surgery. Please keep the corners of the mouth moist with a lip balm or an ointment such as Vaseline.
WEARING YOUR PROSTHESIS
Use of temporary teeth (Partial dentures, flippers, or full dentures) will be reviewed with Drs. Blecha and Jandali on a case-by-case basis. This was discussed in the pre-operative consultation and postoperatively.
You May Experience:
- Swelling around the surgical site.
- Stiffness of the muscles which may cause difficulty when opening the mouth or when moving your lips or cheek in a certain manner.
- A slight earache.
- Pain in other teeth.
- Dryness or cracking of the lips.
- A slight elevation of the body temperature for the first 24-48 hours.
- Black or blue discoloration on the outside of the face or neck. This will resolve within several days and can be aided by warm, moist heat applications to the area.
Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Please do not play with them. Sometimes they become dislodged; this is no cause for alarm. Just remove the suture from your mouth and discard it. Your sutures may or may not be dissolvable depending on your case.
Finally – Your case is individual; no two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Drs. Blecha and Jandali or his staff
Drs. Blecha and Jandali and his staff are interested in your speedy and comfortable recovery. If any problems should arise during your treatment, please feel free to contact our office.