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Dental Implant Surgery
Exposure of Impacted Teeth
Before AnesthesiaAnesthesia/Surgical Pre-Operative Instructions
Thank you again for selecting Spokane Oral Surgery to provide your clinical and surgical care. To help us provide the absolute best treatment, we ask that you follow these essential pre-operative and post-operative instructions.
Please feel free to contact us if you have any questions regarding your planned anesthesia/surgery or overall treatment, at (509) 242-3336.
Tooth RemovalThe removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if you follow instructions carefully.
Immediately Following Surgery:
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary.
If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag will help to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair.
The swelling will not become apparent until the day following surgery and will not reach its maximum until two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake.
After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial for reducing the size of the swelling.
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours, or Ibuprofen (Motrin or Advil) in the amount of two to four 200 mg tablets may be taken every three to four hours.
For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages.
Pain or discomfort following surgery should subside more every day. If it persists, it may require attention and you should call our office.
Liquids should be initially taken after general anesthetic or IV sedation. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot.
You may eat anything soft by chewing away from the surgical sites. High-calorie, high-protein intake is very important. Refer to the section on suggested diet instructions. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly.
Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least five to six glasses of liquid should be taken daily. Try not to miss a single meal.
You will feel better, have more strength and less discomfort, and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position, you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.
Keep the Mouth Clean
No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery, you should begin rinsing at least five to six times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt.
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence that may occur two to three days post-operatively. Moist heat applied to the area may speed up the dissipation of the discoloration.
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.
Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour, including the prescribed medicine. You should then sip on Coke, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.
Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, but this is no cause for alarm.
Just remove the suture from your mouth and discard it. The rest of the sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.
The pain and swelling should subside more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call our office for instructions.
There will be a cavity where the tooth was removed. Over the next month, the cavity will gradually fill in with new tissue. In the mean time, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.
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 help you effectively: Dr. Paxton, a member of our team, or your family dentist.
Brushing your teeth is okay, just be gentle at the surgical sites.
A dry socket occurs when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur two to three days following surgery. Call the office if this happens.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light-headed, stop exercising.
Dental Implant SurgeryPost-Operative Instructions for Osseointegrated Implant Placement
It is essential for the early healing process that the following directions are observed during the first two weeks after the operation:
If possible, an elevated head rest (an extra pillow) should be used during the first two nights post-operatively to reduce swelling in the operated areas.
Apply an ice pack to the outside of the face over the surgical site to reduce swelling. Leave the pack on for 20 minutes, then off for ten minutes. This can be repeated up to 24 hours to help reduce swelling, pain, and bleeding.
First six days: A soft diet only. This is to avoid inadvertent food particles contaminating the wound.
Smoking and consumption of alcoholic beverages should be avoided during this time period.
Should any oozing of blood occur in the operated jaw, it may usually be stopped by softly biting down for one hour on a roll of gauze dressing soaked in salt-water solution. If the bleeding does not stop by doing this, you should contact us immediately.
After 24 hours, the mouth should be gently rinsed after each meal with a salt-water solution. Dissolve 1/2 teaspoon of salt in an eight-ounce glass of warm water. Specific mouth rinses or other disinfectants should not be used, unless prescribed by Dr. Paxton.
Old dentures may not be worn until refitting adjustments (relining) have been made. Insertion of dentures too early may jeopardize a successful healing process.
Avoid any activity or sport that might expose you to a blow to the mouth or jaw.
Pain medication (Vicodin, Lortabs, etc.): Take one when you arrive home. Avoid taking aspirin or aspirin-containing compounds one week prior to and one week after surgery.
CAUTION: Do not drive or operate dangerous machinery while on pain medication.
PLEASE REPORT ANY OF THE FOLLOWING TO THE OFFICE
If you are in doubt or there is any sign whatsoever of a disorder related to the healing of the implant areas, you are kindly requested to contact us.
Bone GraftsAlso called regenerative surgery, a bone graft is used to recreate bone and soft supporting tissues lost due to periodontitis. If you have periodontitis, you may be losing bone support around your teeth. In order to avoid extractions, your periodontist may recommend regrowing the lost bone with a graft.
The goal of bone grafting is to encourage the body to rebuild the bone and other structures that attach a tooth to the jaw. First, your periodontist will separate the gums from your teeth in order to gain access to the roots and bone. The roots will be thoroughly cleaned, and the holes in the bone will be filled with a graft material that usually consists of your own bone.
After this process is completed, the periodontist will put the gums back in place and stitch them together. Over the next few months, the grafted material will be encouraged to grow, which will fill in for lost bone and soft tissue.
A common use of bone grafting is for ridge augmentation. Ridge augmentation can recapture the natural contour of your gums and jaw after the loss of a tooth as a result of trauma, congenital anomalies, infection, or periodontal disease.
Achieving an ideal amount of gum and bone as a support to surrounding restorations or implants may require hard and soft tissue reconstruction. After the loss of one or more teeth, your gums and jawbone may become indented where the tooth or teeth used to be. This occurs because the jawbone recedes when it no longer is holding a tooth in place.
Not only is this indentation unnatural looking, it also causes the replacement tooth to look too long compared to the adjacent teeth, and this can create an area that is difficult to keep clean.
Ridge augmentation uses bone and tissue-grafting procedures to fill in the indented area of the jaw and gums, which should leave you with a smooth gum line that coexists with your restoration or dental implant.
Exposure of Impacted TeethDo not disturb the wound. If surgical packing was placed, leave it alone. The pack helps to keep the tooth exposed. If it gets dislodged or falls out, do not be alarmed.
Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding which results in your mouth filling rapidly with blood can frequently be controlled by biting with pressure on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues, please call for further instructions.
Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, a plastic bag, or a towel filled with ice cubes on the cheek in the area of surgery. Apply the ice continuously as much as possible for the first 36 hours.
Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.
You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one or two Tylenol or Extra Strength Tylenol may be taken every three to four hours. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets; two to three tablets may be taken every three to four hours as needed for pain. For severe pain, the prescribed medication should be taken as directed.
Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can. Rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete.
REMEMBER: A clean wound heals better and faster.
Keep physical activities to a minimum immediately following surgery. If you attempt exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light-headed, stop exercising.
If you are presently using birth control pills and taking antibiotics, it is advisable to use an additional method of birth control because antibiotics will lessen the effectiveness of the oral contraceptives.
Take the remainder of your medications as per normal instructions. Typically, patients are given pain medications to help with any pain or discomfort. Follow the directions for these pain medications and take medication as needed for pain or discomfort.
Take the first dose of pain medication as soon as convenient and before the local anesthesia begins to wear off. If you experience any problems with your medication, discontinue its use immediately and call our office at (509) 242-3336.
Following oral surgery, bleeding is normal for up to 24 hours. Gauze will be placed at the surgery site before you leave our office and should be changed every 30 minutes as needed.
If bleeding persists, soak gauze in a glass of ice water. Place the cold gauze over the surgery site and bite firmly. The pressure and coldness of the gauze should aid in clotting the blood. Notify our office if bleeding continues and cannot be easily controlled.
Do not spit, rinse, smoke, or use straws. They increase bleeding. If the above measures fail to slow or stop the bleeding, please notify our office at (509) 242-3336.
Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, to make sure they remain in place. Do not change them for the first hour unless the bleeding is not being controlled.
If active bleeding persists after one hour, place enough new gauze to obtain pressure over the surgical site for another 30–60 minutes. The gauze may be changed as necessary and may be dampened and/or fluffed for more comfortable positioning.
Do not disturb the surgical area today. DO NOT rinse vigorously or probe the area with any objects or your fingers. You may brush your teeth gently, but DO NOT SMOKE for at least 48 hours, since that is very detrimental to healing.
Following the removal of impacted wisdom teeth or other extensive surgery, it is expected that patients will swell. Swelling is worse the first day after surgery and typically increases until the third post-operative day. Sometimes swelling lasts 7–14 days.
To minimize swelling, it is recommended that you place ice packs (cubes in a washcloth) over the area of the surgery for 20 minutes, with 10-minute rest intervals. This can be done for up to 12–36 hours.
For patients receiving general anesthesia or undergoing extensive surgical procedures, the stomach may be upset for one to two days post-operatively. Nausea and vomiting are not uncommon problems.
Patients are encouraged to eat as soon as possible after surgery. Clear liquids and broth are excellent to start. As you’re able to tolerate more food, cooked cereal, mashed potatoes, gelatin desserts, puddings, and similar foods may be added. You should only eat soft and cold foods the first day following surgery.
For patients having had local anesthetics, or after the initial period of stomach upset passes, it is suggested that a regular diet be eaten. All patients should avoid food with small particles, such as chips, nuts, seeds, etc., which can become trapped in open sockets and surgical wounds.
It is normal to experience pain following most oral surgery. The amount of discomfort and its duration will relate to the nature of your surgery and your ability to tolerate pain. Do not ingest pain medication on an empty stomach. This may cause nausea.
Sutures are often placed following surgery. Resorbable sutures will become loose and fall out after several days. Do not let this concern you.
Patients who have had oral surgery should not rinse their mouths for the first twelve hours. After that, it is important to rinse the surgical area very gently with warm salt water (1/2 teaspoon salt in eight ounces of water). This needs to be done three times a day for two to four weeks.
The use of a soft toothbrush and toothpaste in the area is desirable starting the second postoperative day. Small amounts of bleeding at this time are normal. If commercial mouthwashes are used to rinse, they should be mixed with equal amounts of water before using.
In most cases, patients are given appointments for post-operative visits. The purpose of these visits is to check the progress of healing, remove stitches if necessary, look for signs of infection, and treat as needed, etc.
Some patients will be given a monoject syringe for post-operative cleaning. It is essential that these appointments be kept in order to provide the absolute best care to our patients.
If you feel sharp edges in the surgical areas with your tongue, those are probably the bony walls that originally supported the teeth.
Occasionally small slivers of bone may work themselves out during the first week or two after surgery. They are not pieces of tooth and, if necessary, we will remove them. Please call the office if you are concerned.
Nausea is not an uncommon experience after surgery, and it is sometimes caused by stronger pain medications. Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with a large volume of water.
Try to keep taking clear fluids and minimize the pain medication, but call us if you do not feel better or if repeated vomiting is a problem. Cola drinks that have less carbonation may help with nausea.
Instructions for the Second and Third DaysMouth Rinses
Keeping your mouth clean after surgery is essential. Use 1/4 teaspoon of salt dissolved in an eight-ounce glass of warm water and gently rinse with portions of the solution. Take five minutes to use the entire glassful. Repeat as often as you like, but at least two to three times daily for the next five days.
Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.