Post-Op Instructions


General Guidelines for all procedures:

Do not chew on hard, sticky or chewy foods for a least 24 hours. Never chew on ice. Avoid aggressive chewing and sticky foods such as “hard tack” candies that can loosen or damage a restoration. Carefully follow all guidelines provided by the doctor and their staff and most importantly practice good oral hygiene. Additional instructions following various types of treatment are listed below. Please click on the below topics for detailed instructions. In the event of an emergency, please call our office. If you are experiencing a serious or life threatening emergency, please call 911 or visit the nearest emergency room.

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There will be a flat metal healing abutment protruding through the gingival (gum) tissue with disolving sutures.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding can be controlled by biting with firm pressure on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues please call for further instructions.

Swelling

Swelling is an occasional occurrence after some implant surgeries. To minimize swelling, apply an ice pack, or “Zip Lock” bag filled with ice on the cheek in the area of surgery. Apply the ice 10 minutes each hour, as much as possible, for the first 36 hours if instructed to do so.

Diet

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. Popcorn and nuts may get stuck around healing implant parts.

Pain

Pain after implant placement is usually minor. If you are experiencing pain, limit your physical activity and consider the following advise.

Mild to moderate pain, two to three 200mg Ibuprofen, (Motrin or Advil) tablets may be taken every 4-6 hours if you are not allergic and stomach can tolerate these medications. It is always best to take ibuprofen with food even if not sensitive. Alternatively, Tylenol 650 – 1000mg every four hours may provide some relief.

Moderate to severe pain is best treated adding a prescribed narcotic pain medication to your routine ibuprofen dosing. This pain medicine may make you groggy and will slow down your reflexes. Do not drive an automobile, work around machinery, care for children or consume alcoholic beverages while taking narcotic pain medications. The prescription narcotic medication often has a Tylenol base so there is no need to mix with Tylenol. Patients with liver, kidney or stomach illness or allergy should consult with their physician prior to the use of any pain medications.

Antibiotics

All patients are pre-medicated for implant placement surgery. These antibiotics are available at your pharmacy prior to surgery. Certain circumstances may require you to stay on antibiotics after surgery. If instructed, please follow the prescription directions until finished.

Oral Hygiene

Good oral hygiene is essential to good healing. The night of surgery, use the prescribed Peridex Oral Rinse (chlorhexidine gluconate 0.12%) as directed. Peridex should be used twice daily, after breakfast and before bedtime. The best method uses a double Q-tip moistened in the peridex to rub the implant cap and gumline of the tooth on either side of the implant.

Electric/Vibrating tooth brushes should not be use around healing implants. Once healed and restored these power toothbrushes present no harm to the implant and are often preferred. “ Water Piks” and other pressure jet cleaning tools should never be used around the collars of implants unless you are specifically instructed.

Keep Exercise to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.

Wearing your Prosthesis

Partial dentures, flippers, or full dentures should not be used immediately after surgery and for at least 10 days. This was discussed in the pre-operative consultation. If you need to wear a removable appliance in the first two weeks after implant surgery, please make sure it is properly adjusted to avoid pressure on the implants. It is best to eat only a soft diet with removable appliances over healing implants even after proper adjustment.

After Wisdom Tooth Removal

The removal of impacted teeth is a significant surgical procedure. Post-operative care is very important. Post-operative discomfort and the complications of infection and swelling can be minimized if instructions are followed carefully.

Immediately Following Surgery

  • The gauze pad placed over the surgical area should be kept in place for one hour. After this time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take the prescribed dose of ibuprofen before discomfort begins and continue every four hours for the first day. We often will give the first dose in our office to patients who can tolerate ibuprofen.
  • Restrict your activities the day of surgery even if you feel fine and resume normal activity the following day or when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

Bleeding

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 thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid spitting. If bleeding does not subside, call for further instructions.

Swelling

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 2-3 days post-operatively. The peak swelling may be minimized by early use of ice packs in the first day before swelling is apparent. “Zip Lock” bags filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice pack should be applied at least 10 minutes each hour for the first few hours. For more difficult cases your doctor may advise additional time. After 48 hours ice has no beneficial effect. Remember the swelling peak will occur on the third day (72 hours) and begin to subside by the fifth day. After the third day, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. Daily opening exercises to keep the jaw muscles stretched out is also advised from the first post operative day until two weeks later. No harm will come from stretching the mouth open wide during the initial healing period. Stretching will often help prevent discomfort from muscle cramping and lead to more rapid healing. The best results from stretching are achieved following the application of moist heat and jaw muscle massage. Stretch to three finger widths and hold for 10 seconds 4-6 times each day.

Pain

Mild to moderate pain, two to three 200mg Ibuprofen, (Motrin or Advil) tablets may be taken every 4-6 hours if you are not allergic and stomach can tolerate these medications. It is always best to take ibuprofen with food even if not sensitive. Alternatively, Naproxen (Aleve) 275-550mg every 6-8 hours or Tylenol 650mg-1000mg may be used.

Moderate to severe pain is best treated adding the prescribed narcotic pain medication to your routine ibuprofen dosing. This pain medicine may make you groggy and will slow down your reflexes. Do not drive an automobile, work around machinery, care for children or consume alcoholic beverages while taking narcotic pain medications. The prescription narcotic medication often has a Tylenol base so there is no need to mix with Tylenol. Patients with liver, kidney or stomach illness should consult with their physician prior to the use of any pain medications.

Pain or discomfort may peak on the third day but should then progressively improve with each day. Muscle cramping is often the cause of jaw pain on day 3-5. If pain persists or worsens after the third day, it may require attention and you should call the office.

Diet

After I.V. sedation with local anesthesia, liquids should be initially taken until the local anesthetic effects are gone. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. Start with yogurt, apple sauce, jello or pudding consistency and progress to foods that easily break with a fork. High calorie, high protein intake is very important for the first week after surgery. Fluid intake is also very important to prevent dehydration. It is common your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. You will feel better, have more strength, less discomfort and heal faster if you continue to eat and drink from the first day.

Please refrain from eating popcorn or nuts for a few weeks after surgery.

Oral Hygiene

No rinsing of any kind should be performed until the day following surgery. You can begin to brush your teeth the night of surgery but rinse very gently. The first week after surgery brush first then rinse very gentle. Try not to rinse into the extraction sockets this may dislodge the protective clots and lead to a “Dry Socket”. The second week you may rinse the sockets lightly and by the third week there is no problem from rinsing. Warm water mixed with a teaspoon of salt or plain water will do fine. The best cleaning method is twice each day after brushing to mechanically wipe the top of the surgical site and adjacent tooth at the gumline with a Q-tip saturated with a 50/50 mixture of water and 3% Hydrogen Peroxide. This will mechanically and chemically remove plaque bacteria and food debris without rinsing. The cleaner the gumline on the back of the second molar tooth the faster you will heal while reducing risk of infection.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to the breakdown of blood spreading beneath the tissues. This is occasionally a normal post-operative occurrence, which may occur 3-5 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

Antibiotics are not routinely used following third molar removal unless there is a pre-existing infection or when surgical anatomy is difficult. Occasionally we will use antibiotics in a high risk patient to prevent infection. Routine antibiotics are useful in the post-operative period when a documented infection is found or early symptom first appear.

If you have been placed on antibiotics, take the tablets or liquid as directed. Get plenty of rest and maintain good fluid intake. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and call the office.

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 fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. Pepcid A/C or similar acid blocker may reduce nausea especially when taken the night before surgery. Prescription anti-nausea medication may be called to your Pharmacy if necessary.

Other Complications

  • 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 may bite it and not feel the sensation. So be careful. Call our office should you have any questions.
  • 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. Temperature elevation in the first few hours/days does not represent infection.
  • You should be careful going from the lying down position to standing. You were not able to eat or drink prior to 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 your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline, Chap-stick or Neo-sporin ointment.
  • 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. Call the office if this persists.
  • 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. To help prevent this and the pain that accompanies this, daily mouth opening stretch exercise will hasten recovery.

Finally

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. Most often self dissolving sutures are used. On the occasion non dissolving sutures are used they will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles.

The progressive improvement of post operative discomfort and stiffness is expected after the third day. The most common complaint is a dull ache in the cheeks and is usually due to a lack of massage and stretch exercise necessary to keep the chewing muscle relaxed. If your post-operative pain or swelling worsens despite proper exercise, or unusual symptoms occur call our office for instructions.

There will sometimes be a cavity or hole where the tooth was removed. The cavity will gradually fill in with the new tissue over the next few months. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush. The area can be rinsed vigorously only after the second week.

Your case is individual, no two mouths are exactly alike. Do not accept well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Rissolo is always available to help you.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain may develop at the surgical site or radiate down the jaw and up to the ear. Most often socket pain starts 3 -5 days following surgery and is self limiting by day fourteen. Dry sockets are not dangerous. They most often occur in patients who smoke or are on birth control. Call the office if this occurs. A simple clean out and socket dressing can help alleviate these symptoms.

If you are involved in regular exercise, be aware that your normal dietary intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

Immediately following surgery, keep the gauze pad placed over the surgical area with pressure applied by biting down until the bleeding stops. A certain amount of bleeding is to be expected following a surgical procedure. Placing the gauze pad over the area and biting firmly may control excessive bleeding. Slight bleeding, oozing, or redness in the saliva is not uncommon. Repeat as necessary within a one-hour period following surgery.

If you have been prescribed pain medication besides aspirin, Tylenol or ibuprofen (Advil or Motrin), do not drive, operate heavy equipment, work around machinery or tools or engage in any other activity that may be unsafe when groggy, as your reflexes and judgment will be affected by the medication. Do not take more than 800mg every 4-6 hours. Medication should not be taken on an empty stomach. If you have been placed on antibiotics, take the medicine as directed. Antibiotics may be prescribed to help prevent infection.

Swelling around the face, eyes and surgical site is not uncommon. This swelling may not appear until the day following the surgery and may become more noticeable two to three days following surgery. You can help to minimize the swelling by applying a cold compress on the face near the extraction site alternating on for 20 minutes then off for 20 minutes. After 36 hours the ice will have no further impact on swelling. After this period, the application of moist heat to the sides of the face can help reduce swelling.

For 24 hours following your surgery, do not suck on a straw, brush, rinse, spit, or smoke. Avoid hot and spicy foods, carbonated and alcoholic beverages. During the first few days after surgery restrict your diet to liquids and soft foods such as soups, yogurt, juice, and smoothies. Restrict your activities on the day of your surgery, avoid excessive work or play and resume normal activity the following day as tolerated.

After the first day, gently rinse with a warm salt water rinse, approximately one-half teaspoon of salt in an eight ounce glass of water, three times a day.

If any sutures were required, they will dissolve on their own in 7-10 days. It will not be necessary to return to the office for sutures to be removed.

Please call our office if you experience severe pain, excessive bleeding or swelling, or if you have any questions or concerns. In the event of an emergency, please call our office. If you are experiencing a serious or life threatening emergency, please call 911 or visit the nearest emergency room.

Immediately following surgery, keep the gauze pad placed over the surgical area with pressure applied by biting down until the bleeding stops. A certain amount of bleeding is to be expected following a surgical procedure. Placing the gauze pad over the area and biting firmly may control excessive bleeding. Slight bleeding, oozing, or redness in the saliva is not uncommon. Repeat as necessary within a one-hour period following surgery.

If you have been prescribed pain medication besides aspirin, Tylenol or ibuprofen (Advil or Motrin), do not drive, operate heavy equipment, work around machinery or tools or engage in any other activity that may be unsafe when groggy, as your reflexes and judgment will be affected by the medication. Do not take more than 800mg every 4-6 hours. Medication should not be taken on an empty stomach. If you have been placed on antibiotics, take the medicine as directed. Antibiotics may be prescribed to help prevent infection.

Swelling around the face, eyes and surgical site is not uncommon. This swelling may not appear until the day following the surgery and may become more noticeable two to three days following surgery. You can help to minimize the swelling by applying a cold compress on the face near the extraction site alternating on for 20 minutes then off for 20 minutes. After 36 hours the ice will have no further impact on swelling. After this period, the application of moist heat to the sides of the face can help reduce swelling.

For 24 hours following your surgery, do not suck on a straw, brush, rinse, spit, or smoke. Avoid hot and spicy foods, carbonated and alcoholic beverages. During the first few days after surgery restrict your diet to liquids and soft foods such as soups, yogurt, juice, and smoothies. Restrict your activities on the day of your surgery, avoid excessive work or play and resume normal activity the following day as tolerated.

After the first day, gently rinse with a warm salt water rinse, approximately one-half teaspoon of salt in an eight ounce glass of water, three times a day.

If any sutures were required, they will dissolve on their own in 7-10 days. It will not be necessary to return to the office for sutures to be removed.

Children should be supervised after having an extraction to make sure they do not bite or their tongue or lips as it can cause serious injury to their soft tissue.

Please call our office if you experience severe pain, excessive bleeding or swelling, or if you have any questions or concerns. In the event of an emergency, please call our office. If you are experiencing a serious or life threatening emergency, please call 911 or visit the nearest emergency room.

After your procedure please do not disturb the area. Avoid forcefully rinsing or spitting. Do not drink through a straw.

Some bleeding is normal for the first 24 hours. Biting on a gauze pad placed directly on the wound for 30 minutes will help reduce bleeding. If bleeding continues please call our office. Please take all medications, included mouth rinses, as prescribed.

After 24 hours, warm salt water rinses (one-half teaspoon of salt in a cup of warm water) can be used 4-5 times a day after meals. After 24 hours, brush your teeth with a soft manual toothbrush. Be gentle with brushing the surgical areas.

Sutures may be placed after the surgery and most sutures dissolve on their own.

Swelling and bruising may occur. The use of ice packs following your surgery will help diminish the swelling you may experience in the next 48-72 hours. Applying ice for 15-20 minutes followed by resting the same amount of time works very well. After 24 hours if swelling is till present, a warm pack can be applied to aid in comfort and reduce swelling and bruising. Alternate the warm pack on and off in 15 minute intervals, as needed.

Drink plenty of fluids. Stay away from spicy foods. Also avoid sharp and crunchy foods like tacos, chips and nuts. Tobacco and alcohol should not be used 24 hours following surgery. Alcohol should not be used in combination with pain medications nor antibiotics.

Keep physical activities to a minimum immediately following surgery.

During office hours, immediate attention will be given to your situation, and you will be seen as soon as possible. After office hours, please give the office call and follow the instructions provided. Your call will be returned as soon as possible. If you are experiencing a serious or life threatening emergency, please call 911 or visit the nearest emergency room.

Immediately following surgery, keep the gauze pad placed over the surgical areas with pressure applied by biting down until the bleeding stops. A certain amount of bleeding is to be expected following a surgical procedure. Placing the gauze pad over the areas and biting firmly may control excessive bleeding. Slight bleeding, oozing, or redness in the saliva is not uncommon. Repeat as necessary within a one-hour period following surgery.

If you have been prescribed pain medication besides aspirin, Tylenol or ibuprofen (Advil or Motrin), do not drive, operate heavy equipment, work around machinery or tools or engage in any other activity that may be unsafe when groggy, as your reflexes and judgment will be affected by the medication. Do not take more than 800mg every 4-6 hours. Medication should not be taken on an empty stomach. If you have been placed on antibiotics, take the medicine as directed. Antibiotics may be prescribed to help prevent infection.

Swelling around the face, eyes and surgical sites is not uncommon. This swelling may not appear until the day following the surgery and may become more noticeable two to three days following surgery. You can help to minimize the swelling by applying a cold compress on the face near the extraction sites alternating on for 20 minutes then off for 20 minutes. After 36 hours the ice will have no further impact on swelling. After this period, the application of moist heat to the sides of the face can help reduce swelling.

For 24 hours following your surgery, do not suck on a straw, brush, rinse, spit, or smoke. Avoid hot and spicy foods, carbonated and alcoholic beverages. During the first few days after surgery restrict your diet to liquids and soft foods such as soups, yogurt, juice, and smoothies. Restrict your activities on the day of your surgery, avoid excessive work or play and resume normal activity the following day as tolerated.

After the first day, gently rinse with a warm salt water rinse, approximately one-half teaspoon of salt in an eight ounce glass of water, three times a day.

If any sutures were required, they will dissolve on their own in 7-10 days. It will not be necessary to return to the office for sutures to be removed.

Children should be supervised after having an extraction to make sure they do not bite or their tongue or lips as it can cause serious injury to their soft tissue.

Please call our office if you experience severe pain, excessive bleeding or swelling, or if you have any questions or concerns. In the event of an emergency, please call our office. If you are experiencing a serious or life threatening emergency, please call 911 or visit the nearest emergency room.

Please refrain from blowing your nose for up to four (4) weeks following your surgery. Do not hold your nose when sneezing. Please take all medications as prescribed, included decongestants as necessary. Avoid flying in pressured aircraft, scuba diving, 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 for at least four weeks after surgery.

It is important to keep your mouth clean after surgery to reduce the risk of infection and promote rapid healing. Start salt water rinses (one-half teaspoon of salt dissolved in an 8 ounce glass of water) the evening of surgery or the day following your procedure after each meal or four to five times daily.

Brush your teeth gently with a soft manual toothbrush on the evening of your surgery or the first post-operative day and continue at least twice a day.

Drink plenty of liquids. Eat soft foods for the first several days after surgery. Advance to a regular diet as you become more comfortable. Please avoid chewing or creating pressure on the bone graft site. Please avoid drinking alcoholic beverages or smoking during the first one to two weeks following your surgery.

All removable appliances including partial dentures, flippers and full dentures must be checked for proper fit before they can be worn.

Swelling and bruising may occur. The use of ice packs following your surgery will help diminish the swelling you may experience in the next 48-72 hours. Applying ice for 15-20 minutes followed by resting the same amount of time works very well.

If you experience severe or persistent sinus or nasal congestion please let us know.

During office hours, immediate attention will be given to your situation, and you will be seen as soon as possible. After office hours, please give the office call and follow the instructions provided. Your call will be returned as soon as possible. If you are experiencing a serious or life threatening emergency, please call 911 or visit the nearest emergency room.

A socket preservation graft is a common procedure following extraction when a future implant is anticipated. The goal of the socket preservation graft is to help reduce bone shrinkage during the healing process of a tooth socket. The bone mineral placed into your tooth socket will help maintain the gum and bone dimensions of your tooth extraction socket as it goes through natural remodeling. This graft is often covered with several medicated sponge layers and dissolvable sutures. The blood clot that forms inside the socket under the sponge is the “glue” that holds it all together. It is your job to encourage a healthy clot to form in the first 24 hours and then protect it for 2-4 weeks until the gums grow over the dissolving sponges.

First Day: Bite on gauze and refrain from any activity for 30 minutes after leaving the office. Replace gauze or use a tea bag and bite with gentle but steady pressure 5 minutes every 2 hours during the first day. This will compress the sponge / clot / graft and assist the formation of a compact and stable clot. Remain on your antibiotic as directed.

Next 2-4 Weeks: Oral hygiene should be limited to Q-Tip swabbing one time each day with a 50/50 mixture water and hydrogen peroxide to mechanically and chemically remove plaque on the adjacent teeth at the gum line. Do not rinse the area to clean until the gums have healed over the exposed socket. Rinsing may prematurely dislodge your cover sponge. It takes 2-4 weeks for the gum to grow across and cover the graft as the sponges dissolve. The time of healing may vary depending on the size of the tooth. If a few graft particles are dislodged from the socket do not be alarmed. It is common to lose some of the most superficial particles during healing. If your protective sponge or a large number of particles come out in the first week, please call our office for instructions. Typical healing is 3 months after the gum closes over the graft. Call our office to schedule your implant placement on average 4 months after extraction.