Please Read and Follow These Instructions Carefully.

The after effects of oral surgery vary per individual, so not all of these instructions may apply to you. Dental implant surgery is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.

Instructions to be Followed Immediately after Dental Implant Surgery:

1. Do not disturb the surgical area today
2. Swelling is to be expected and usually reaches its maximum in 48 hours. To minimize swelling, cold packs or ice bag wrapped in a towel should be applied to the face adjacent to the surgical area. This should be applied 20 minutes on, then removed for 20 minutes, during the first 12-24 hours after surgery. After 24 hours, it is best to switch from using cold packs to applying moist heating pad to the area until swelling has receded.
3. Do not drink with a straw and avoid vigorous rinsing or spitting. It may elicit bleeding.
4. Do not pull on your lip to examine the surgical site or probe the area with your tongue, or any objects or your fingers. The stitches may loosen, incision may open which can jeopardize and delay the healing of the implant.
5. Do not smoke for at least 2 or 3 weeks after surgery. Smoking will delay healing or may even lead to implant failure.
6. Start rinsing your mouth with warm salt water (1/2 tsp. salt with 1 cup water) every 2-3 hours. Continue this for several days, then rinse 3-4 times a day for the next 2 weeks. You may start normal tooth brushing the day after surgery, except in the operated area. Rinse your toothbrush under hot water to soften the bristles and avoid vigorous rinsing. It is important to keep your mouth clean, since accumulation of food or debris may promote infection.
7. Limit your physical activity following surgery. You should be able to resume light activity in a day or two.
8. Increase your fluid intake (no straw) following surgery and maintain a soft diet. Avoid carbonated beverages (soda) and very hot foods or drinks. A nutritious diet throughout the healing period is important for your comfort and healing.
9. Increase your fluid intake (no straw) following surgery and maintain a soft diet. Avoid carbonated beverages (soda) and very hot foods or drinks. A nutritious diet throughout the healing period is important for your comfort and healing.

Bleeding

Slight bleeding for a number of hours following surgery is not unusual. Your saliva may be tinged with blood for up to 48 hours. If heavier bleeding is still present a few hours after surgery, place a gauze over the surgical area and bite down firmly for 30-60 minutes. If bleeding persists, this may be due to the gauze pads being clenched between the teeth rather than exerting pressure on the surgical site. Try repositioning the gauze. If bleeding persists or becomes heavy, substitute the gauze with a moist tea bag on the area for 30 minutes. First soak it in hot water, squeeze it dry and wrap it in moist gauze. If bleeding continues, please call our office.

Pain

Unfortunately, most oral surgical procedures are accompanied by some degree of discomfort. After surgery, take the pain medication prescribed as directed, even if you do not feel pain yet. The local anesthetic administered during your surgery normally has 2-3 hours duration and it may be difficult to control the pain once the anesthetic wears off. It is recommended that you take the pain medication 1 1/2 or 2 hours immediately after surgery when you arrive home, and as prescribed thereafter. Limit your activity the first few days after surgery. Trying to do too much too fast increases the swelling which increases your pain.

Swelling or Bruising

Swelling is to be expected, it usually reaches its maximum in 48 hours and may persist for several days. To minimize swelling, a cold pack should be intermittently applied to the face next to the operated area (use crushed ice in Zip-Lock bags or a bag of frozen peas wrapped in paper towel). This should be applied 20 minutes on, then removed for 20 minutes during the first 12-24 hours after surgery. After 24 hours, it is best to switch from using cold packs to applying moist heating pad to the area until swelling has receded. Bed rest immediately after surgery with the head elevated by a pillow is also recommended. By limiting your activity on the day of surgery, you will significantly limit the degree of swelling.

Those who bruise easily may anticipate some discoloration of the skin (bruising). It usually takes a week for the discoloration to completely disappear.

Occasionally after IV sedation the arm or hand near the site where the needle was placed to administer IV drugs may remain inflamed or tender. Application of heat to the area usually will correct these symptoms.

Sinus Precautions

Because of the close relationship between the roots of the upper wisdom teeth and the sinus, an opening between the sinus and the mouth sometimes results from surgery. It sometimes heals slowly and with difficulty. If you notice a unexpected flow of air or liquids between your mouth and nose, please let us know immediately. Certain precautions will assist healing, and we ask that you faithfully follow these instructions:

• Do not forcefully blow your nose for at least 2 weeks, even though your sinus may feel “stuffy” or there may be some nasal drainage.
• Try not to sneeze; it will cause undesired sinus pressure. If you must sneeze, keep your mouth open.
• Do not drink with straw and do not spit.
• Do not rinse vigorously for several days. Gentle salt water swishes may be used.
• Do not smoke for several days.
• Take prescription medications as directed.
• Eat only soft foods for several days, always trying to chew on the opposite side.

Slight bleeding from the nose is not uncommon for several days after surgery. Scuba diving and flying in pressurized aircrafts may also increase sinus pressure and should be avoided. Avoid “bearing down” – when lifting heavy objects, blowing up balloons, playing musical instruments that require a blowing action, or any other activity that increases nasal or oral pressure. Decongestants will help reduce pressure in the sinuses.

It is important that you keep all future appointments until this complication has resolved.

Numbness

Partial loss of sensation of the lower lip and chin may occur, usually following lower wisdom teeth removal or sometimes after lower implant placement. This is usually temporary and disappears within a few days or weeks. Occasionally, some numbness may persist for months due to the close association of the roots of the teeth or the implant to the nerve that supplies sensation to the areas described.

Medications

Take all of the medications given or prescribed for you as directed. They have been given to you for very important reasons. The only medicine that you do not have to take all is the pain medication. Take medications with food unless otherwise stated.

If an allergic reaction occurs and you develop a rash, hives, or itching, discontinue the medication and call our office. If you develop severe or persistent diarrhea, please also call us. If you develop difficulty breathing, seek emergency medical treatment.

If you regularly take medications (such as high blood pressure medicine) prescribed by your physician, you should take them as prescribed, unless you are told otherwise. During your consultation visit, your current medications will be reviewed by Dr. Agrawal.

If you are taking a narcotic pain medication, do not drive a motor vehicle, operate any machinery (such as kitchen appliances, lawn mower, power tools, etc.), or drink alcoholic beverages. You may develop constipation from the narcotic medication and may need an over the counter laxative, if necessary. You may also develop nausea or vomiting from narcotic pain medications. If you are only heaving minimal discomfort, you may switch to over the counter pain relievers (Tylenol, Advil).

You may be prescribed an antibiotic after surgery. Please take the medication as instructed. Failure to take them as directed may increase your risk of infection. If you were prescribed an antibiotic and currently taking an oral contraceptive you should also use an alternate method of birth control for the remainder of your current cycle.

Diet Following Implant Placement

After surgery, especially after general anesthesia or IV sedation, liquids should be initially taken. Drink plenty of cool fluids. Do not use straws, drink from a glass. Using a straw with sucking motion can cause more bleeding. Avoid carbonated beverages or very hot foods or drinks.

A soft, non-chewing diet is recommended for 10 days to 2 weeks after surgery to allow the gum tissue to heal. Chop food in small pieces or use a blender to puree. Eat any nourishing food that can be taken with comfort. Patients who maintain a good diet of soft foods, generally feel better, have less discomfort and heal faster. Avoid foods that may cause trauma to the gums, such as chips, popcorn, nuts or shells. Over the next several days you may progress to more solid foods.

Recommended food and drinks:

• Juice, water, milk, coffee, tea.
• Cooked cereals, such as oatmeal or cream of wheat, yogurt.
• Scrambled eggs, cottage cheese, apple sauce.
• Home cooked broth, bouillon, soups.
• Ground beef, baked or broiled fish, broiled or stewed chicken (finely chopped).
• Macaroni and cheese, soft bread, baked or mashed potatoes.
• Jell-O, puddings, pound cake, milkshakes, ice cream.

Oral Hygiene

Keeping your mouth clean after surgery is essential to reduce the risk of infection. Start rinsing your mouth with warm salt water (1/2 tsp. salt with 1 cup water) every 2-3 hours. Continue this for several days, then rinse 3-4 times a day for the next 2 weeks. You may start normal tooth brushing the day after surgery, except in the operated area. Rinse your toothbrush under hot water to soften the bristles and avoid vigorous rinsing. It is important to keep your mouth clean, since accumulation of food or debris may promote infection.

Temporary Teeth

Temporary removable dentures, flippers, or fixed teeth are often used after dental implant insertion. The proper fit of these temporaries after implant insertion is crucial. After surgery, the surgical site is swollen, so the temporary may not fit properly. Do not wear a temporary flipper until the numbness in the area is gone. It is very important when temporary teeth are placed that they do not touch the gums in the area of the surgery, nor do they put pressure on the implant. They may need to be adjusted and re-adjusted again after the swelling has subsided. Until your post-operative appointment, do not eat with your removable temporary teeth. If you are in a social situation that you will want to wear your dentures and need to eat a meal, choose a diet that is soft and does not require chewing.

In certain cases, immediate temporary loading (immediate temporary fixed teeth insertion over the implants) of the implants is possible. These cases will be discussed by Dr. Agrawal.

Commonly Happen after Surgery

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite them without feeling it. So be careful when chewing.
• Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
• In the event of nausea or vomiting following surgery, do not take anything by mouth for at least one hour, including the prescribed medication. You should then sip on tea or ginger ale (no straw), slowly over a 15 minutes period. When the nausea subsides, you can begin taking liquids and the prescribed medication.
• Reabsorbable sutures are often placed to the area of surgery to minimize post-operative bleeding and to help healing. Since they are resaborbable, they do not need to be removed. Sometimes they become dislodged, or they may slide out of the gum as they dissolve. This may cause a little bleeding, but it is no cause for alarm. Just remove the sutures from your mouth and discard them.
• You should be careful going from the lying down position to standing. If you were sedated, you were not able to eat or drink prior to surgery. After surgery it was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute, then get up.
• If the corners of the mouth are stretched, they may dry out and crack. Lips should be kept moist with an ointment such as Vaseline.
• Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
• Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.

Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your questions with Dr. Agrawal or with his surgical staff. They will effectively help you.

Don’t live with missing teeth any longer! Schedule online or call (352) 674-9077 for a no-obligation implant consultation today to determine your suitability for dental implants.