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Post Surgical Instructions Full Arch Dental Implant Reconstruction with General Anesthesia

Care of your mouth after surgery has an important effect on healing. Swelling, discomfort, restricted jaw function, and skin discoloration is to be expected. However, following these instructions closely will help to insure a rapid and uneventful recovery.

Pain Management Overview

Baseline Pain Control Regimen

650 mg Tylenol (Acetaminophen) 2 x 325 mg (regular strength) tablets

 OR

500 mg Tylenol (Acetaminophen) 1 x 500mg (extra strength) tablet

AND

200-600 mg Advil (Ibuprofen) 1-3 x 200mg tablets

Avoid ibuprofen if you have been told not to take this medication or if you have a history of stomach ulcers, kidney disease, or take a blood thinning medication) Take Tylenol and Ibuprofen together 4 times per day. Breakfast lunch, dinner, and right before bed.

If Additional Pain Control is Needed

  • 2.5 – 5 mg Oxycodone ½ – 1 x tablet taken up to 4 times per day if needed for additional pain control. Do not stop taking the baseline pain control regimen if you need the oxycodone.

For your safety, do not drive or operate dangerous machinery while taking the prescription pain medication, oxycodone.

  • Postoperative pain control is of paramount importance to us and our patients after surgery. We want you to be as comfortable as possible as you recover from your surgery. When you return home and the local anesthesia (numbing medicine) wears off, you will transition to oral pain medications to assist in pain control. The goal of postoperative pain management is to use oral pain medications to reduce pain to a tolerable level while the body heals and reduces pain naturally overtime. This may result in a maximal oral medication regimen which can be progressively decreased over the recovery process.
  • Modern medicine uses three common classes of medications to achieve this goal, Acetaminophen (e.g. Tylenol), Non-Steroidal Anti-Inflammatory Drugs (NSAID e.g. Ibuprofen/Advil), and opiates (e.g. Oxycodone). Each act on different pain pathways within the body which allows them to all work synergistically at the same time. Using different classes of pain medications allows us to maximize the potential benefits of any one class while minimizing their respective side effects. During the postoperative period we want to maximize your pain control while minimizing any potential side effects.
  • All pain medicine should be used in an “as needed” fashion. If you are not in pain, you do not need to take pain medicine. However, the baseline pain control regimen outlined above can be more effective if taken on a “scheduled” basis, regularly spaced time intervals, during the postoperative period where significant pain is anticipated. The baseline pain control regimen is more effective if taken on a “scheduled” basis rather than waiting for significant pain before taking the pain medicine. This “scheduled” strategy allows you to maintain a constant level of pain control in your blood which ultimately results in more effective pain control. If you would like to take the baseline pain control regimen on a “scheduled” basis to maximize its effectiveness we recommend taking these medications ~ 4 times per day, convenient times for most patients are breakfast, lunch, dinner, and right before you go to bed. The baseline pain control regimen can be taken together as instructed above for up to 1 week without concern for significant side effects in a healthy patient. However, if you find yourself continuing to need a “scheduled” baseline pain control regimen after 1 week, please let us know so we can make sure that you are healing appropriately.
  • Opiate derived pain medications, like oxycodone, have rightfully received a lot of attention in the media recently due to their addictive potential. While this class of medication can be addictive it is important to note that addiction occurs when these medications are used for prolonged durations for chronic pain, not for acute postoperative pain. As such, these medications are safe to use as prescribed for a short duration after your surgery. However, they have other side-effects as well such as nausea, constipation, and drowsiness which are undesirable. As a result, we still reserve this class of medication for as needed additional pain control if the baseline pain control regimen above is insufficient.
  • We hope all our patients recover as painlessly as possible. However, recovering from surgery is typically uncomfortable. The strategies and philosophies outlined above will not make the recovery from surgery painless, but they should serve to reduce the pain to a tolerable level while the body heals and subsequently reduces pain naturally. If you ever feel that the pain is unbearable despite these medications, please let us know so we can make sure that you are healing appropriately.

Diet

Your diet after surgery is incredibly important to ensure that your implants and teeth will heal predictably and last for many years to come. Your new teeth will look great the day after your surgery, but they are not yet ready to take chewing forces. We have built a new foundation for your teeth that needs to fully fuse to your jawbone for 3 months before they can take full chewing forces. During this initial 3-month integration period, you can eat anything that you would like that does not require you to put food between your new teeth and bite down. Of course, this includes things like all liquids, smoothies, milkshakes, ice cream, yogurt, creamy soups, and anything you would like to put in a blender. However, it also includes many soft foods of which you can take small bites and swallow without grinding them between your teeth. Examples of these soft foods that can be “chewed” on your plate by taking very small bites include soft scrambled eggs, flaky white fish, well done pasta, oatmeal, shredded chicken, and soupy enchiladas.

Antibiotics

Pills: You will also have a prescription for several days of antibiotic pills. After you pick these up at the pharmacy, take them as directed on the bottle until they are gone.

Bleeding

It is normal for you to ooze blood from your incisions over the next 72 hours. Thin red blood mixed with saliva will often cover the new teeth and look pink or light red. The best thing to do is to swallow this small amount of blood. Spitting this out will only cause the body to continue to bleed. You can place gauze in your mouth to help absorb some of the blood, but they tend to become quickly saturated with saliva and provide minimal benefit. If blood is pooling in the mouth and forming thick dark, red clots like a stewed tomato, or if the bleeding persists without slowing down for over 48 hours, then you should call the office for re-evaluation.

  • Always remove gauze when eating or sleeping. NEVER SLEEP WITH GAUZE IN YOUR MOUTH.
  • “Oozing blood” is thin, light red, saliva that may persist for up to 24 hours spontaneously or 72 hours after oral activity such as tooth brushing or eating. Oozing blood is not harmful and is likely more trouble to try to stop then to allow it to resolve naturally. This small amount of blood is not dangerous and it is best to just swallow then try to spit or wipe out. Spitting or wiping out this blood often causes the bleeding to persist or worsen. Swallowing this amount of blood will not contribute to nausea.
  • “Significant bleeding” forms dark red, thick clots which are the consistency of a stewed tomato. These clots often slowly fill the back of the mouth or area between the teeth and cheek until they are wiped away or spit out. These clots are a sign of uncontrolled bleeding which your body is having a hard time stopping on its own. This bleeding needs to be controlled by using the strategies listed below. If does not resolve you should seek urgent medical attention.
  • Pressure Stops Bleeding. Your body can form a healthy clot and stop bleeding naturally as long as the bleeding is slowed for a long enough time to allow for clot formation. Bleeding can be slowed by applying direct pressure to the area that is bleeding. Therefore, it is prolonged, targeted pressure which allows your body to form a clot and stop bleeding naturally. Once a clot is formed, and the bleeding has stopped, pressure is no longer necessary.
  • Gauze is a vehicle by which pressure can be applied. Gauze, itself, does not inherently stop or slow bleeding. Gauze allows you to easily apply focused pressure in your mouth to the area that is bleeding. In order for gauze to apply effective pressure you should fold the gauze ~ 4 times to the size of a quarter such that it is a tight wad. Place this directly over the area of bleeding and apply pressure. Pressure can be applied in two ways in your mouth. The most common and convenient is by biting on the gauze firmly. This requires a tooth opposing the area of bleeding. However, if there is not a tooth opposing the area of bleeding, biting may not be an effective way to apply pressure. If you are having a hard time applying pressure because you do not have an opposing tooth, you can use your thumb or index finger to press firmly on the gauze to create pressure. Regardless of how you apply the pressure, pressure must be applied constantly and firmly for up to 30 minutes. If you are having trouble stopping the bleeding, adhering strictly to these guidelines can help.
    • Fold the gauze tightly and placed directly over the site of bleeding
    • Hold firm, constant pressure for 30 minutes by biting or with a finger/thumb
    • Look at the clock when you start to time 30 minutes, this may feel like a long time
    • During this 30 minutes of applied pressure do not drink, spit, eat, or talk as this will break the period of constant pressure and restart the clock.

If, despite trying the above measures, significant bleeding persists please call our office at 650-342-0213 to reach the doctor on call or seek urgent medical attention at the nearest emergency department.

Sinus Healing

If you had surgery on your upper jaw, our goal is to limit the change in sinus pressure to allow your sinus and the bone graft time to heal undisturbed. There are several activities that should be avoided for 4 weeks after surgery. Sneezing – if you need to sneeze, let the sneeze out. Do not attempt to hold it in Nose Blowing – It is imperative that you avoid nose blowing for four weeks after the surgery. Ear Popping – If you need to pop your ears, yawn. Do not hold your nose and blow.

Swelling

Apply ice to limit accumulation of swelling. Change the ice every 60 minutes while awake. Do NOT sleep with ice on your face (e.g. ice packs and head wrap provided, frozen peas/corn). Take NSAIDs (Ibuprofen/Advil) if instructed as part of the baseline pain control regimen above.

  • Swelling is a natural part of your body’s healing process. During the early phases of recovery from surgery tiny vessels called capillaries become increasingly porous resulting in fluid escaping and accumulating in your tissues. This accumulation of fluid allows for your body’s healing machinery to access the injured area. However, this typically results in undesirable tension and a reduction in range of motion of muscles in the area. Both of these things can contribute to postoperative pain and discomfort which is why we attempt to reduce postoperative swelling, although we will never eliminate it completely.
  • Swelling is a natural part of your body’s healing process and typically begins hours after surgery ends and continues to increase over the next 48 to 72 hours. As a result, we expect the average patient to be the most swollen on ~ day 3 after surgery. During this period of increasing swelling we have two methods of reducing swelling, ice and NSAIDs (Ibuprofen/Advil). Ice causes constriction of the small vessels in the area which results in a reduction of the fluid that escapes and thereby reducing the accumulation of swelling. Ice should only be applied when a patient is awake because prolonged application of ice can result in burns. We recommend 20 minutes of ice application to the affected area and a 20 minute period to allow the tissue to recover, repeating this cycle while you are awake. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen/Advil reduce signaling pathways in your body which reduce pain mediators and the accumulation of swelling.
  • We expect swelling to peak ~ 72 hours after surgery and then slowly dissipate. Swelling typically takes much longer to dissipate than to accumulate. During this period of swelling resolution we have two methods to reduce swelling, moist heat and elevation. Moist heat promotes dilation of the small vessels in the area and allows the body to recapture accumulated fluid and remove it from the affected area more efficiently. Moist heat should be warm, but not so hot that it causes discomfort. Moist heat can be applied using warmed heating pads available at most pharmacies or with a damp towel heated in the microwave for a short duration. Elevating the surgical area allows gravity to naturally pull swelling from the surgical site. During the day most patients naturally elevate their head, however, sleeping on several pillows such that the head remains elevated at night as well can further expedite the resolution of the swelling.
  • Swelling is part of your body’s natural healing process and we cannot eliminate it entirely. Swelling typically peaks ~ 72 hours after surgery and can contribute to postoperative pain and reduced mobility while healing. We can reduce its accumulation and promote is resolution by implementing the strategies outlined above.

Sutures

The sutures in your mouth will dissolve on their own. This typically takes 3-10 days, however, if a suture comes out early it is not a problem. Leave the sutures alone if possible and they will take care of themselves. Often, they will come out when you are eating food and you will swallow them, that is not a problem.

Dental Routine

It is important to continue keeping your mouth clean while you are recovering from your surgery. Keeping your new teeth and implants clean is just as important as keeping your natural teeth clean. First two weeks: Rinsing your mouth out after you eat and using the topical antibiotic mouth rinse provided will help gently clean your mouth. If food is stuck under the denture, you can use tap water in a syringe to gently rinse and free anything that gets stuck. If you have a temporary removable denture, this should be removed every night when you sleep until the final fixed denture is fabricated. Three weeks and beyond: Now that the soft tissue has healed, you can begin more comprehensive cleaning around the implants and under your new teeth. This is best done with a combination of small interproximal toothbrushes and a Waterpik®.

Smoking

Smoking has been proven to directly decrease the rate of implant success. You have invested a lot into your implant. Not smoking during the integration period can increase the success rate of your implant.

Activity

You should avoid strenuous activity for 7 days. After that, you can begin to return to regular activities as tolerated.

Allergic Reaction

If you develop hives or a rash, discontinue all medications and immediately contact our office.

Telephone Support 24/7 – (650) 342-0213

Post-surgical follow-up is an important part of your care. We want you to have a successful and comfortable recovery. Please call the office if you have any questions or concerns about your procedure or postoperative healing.

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