Extractions, Bone Grafts and Implants

Please read and follow these instructions carefully since post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed. The after-effects of surgery vary per individual, so not all of the information below may apply. Please feel free to contact us at any time should you have any questions or concerns. 

General Instructions 

Immediately 

❖ Anesthetic (1-4 Hrs.) –
Every patient is different in length before the anesthetic wears off. During this time be careful not to bite your lip, tongue or cheeks. Ideally, you should wait until the anesthetic effects have worn off before eating or consuming anything hot. 

❖ Medication: (Prescribed)
Take medications as directed by your dentist. Assuming no contraindications, you should take Ibuprofen as soon as you are able. Ibuprofen should be adequate for this type of oral surgery. If you take the first pill before the anesthetic has worn off, you should be able to manage the discomfort better. If you’re unable to take Ibuprofen, you should consider Tylenol. 

Please remember that PREVENTING pain is significantly easier and more predictable than RESOLVING pain. Assuming no contraindications, we recommend alternating over-the-counter pain medications every 4 hours for the first 3-4 days even if you are not experiencing pain. 

In the rare event that you’ve been prescribed narcotic medication, make sure you have some thick liquids in your stomach when taking as nausea and vomiting are a very common side effect. Taking the narcotic medication is not required, thus if you don’t need it, you don’t have to take it.

❖ Wound Care (24 Hrs.) –
Do not disturb the surgical area today. Do not rinse vigorously or probe the area with anything. You may brush your teeth gently, avoiding the surgical area. You may eat soft foods for the first day just not on the surgical side or area. 

❖ Swelling (Immediately-48 Hrs.) –
Some swelling is common, immediate and constant gauze compression on the wound and between the gum and check are the best ways to minimize swelling. It is also recommended that for the first 2 nights following surgery that you sleep with an extra pillow under your head to keep your head elevated about the heart, thus avoiding swelling. If swelling occurs, apply a cold pack, ice bag, or bag of frozen peas wrapped in a towel to the area alternating between 20-30 minutes on and off. 

1-2 Days After

❖ Brushing (Night Of - Every night) –
You should be able to brush your teeth at this point. Brush normally in areas away from the surgical site but avoid brushing directly on the wound. Good hygiene will minimize the bacteria in your mouth, decreasing your chance of an infection. Avoid the use of an electric toothbrush or waterpick for the first two weeks. 

❖  Diet: (First 24 Hrs.) –
Maintain a soft food diet for 24 hours after surgery. Attempt to eat on other side of the mouth, as much as possible, for a week. Avoid anything extremely hot or cold. Avoid hard foods, which can get lodged in the surgical areas. If you are a diabetic, maintain your normal eating habits or follow instructions given by your doctor. 

❖ Beverages (First 3 Days) –

Remember to stay hydrated and drink plenty of liquids to help with the healing process. When the bleeding has been controlled, you should attempt to drink some full liquids, such as milkshakes, smoothies, pudding or applesauce. For the first 3 days DO NOT use a straw or drink carbonated beverages. Avoid alcohol for the next 7 days. 

❖ Bleeding (24-48 Hrs.) –
A slight amount of blood may be present until a mature clot forms. If bleeding occurs, take a moistened piece of clean gauze or a tea bag, fold thick enough to bite on and place directly over the surgical site. However, if significant bleeding occurs please call the office. 

❖ Exercise (48 Hrs. Min) –
Please refrain from exercise and all strenuous activity for a minimum of 48 hours, including light running and jogging. 

❖ Bruising (48 Hrs.) –
Although not common, bruising can occur and will present itself on the outside of the face near the surgery site. This does not constitute infection or failure of the procedure. 

Day 3 & After 

❖ Mouth Rinses (3rd Day) –
Keeping your mouth clean after surgery is essential. You should use warm salt water rinses 2-3 times a day (or as often as you’d like) after eating to keep debris from accumulating at the surgical site for the next 3 days. Use 1⁄4 teaspoon of salt dissolved in an 8oz. glass of warm water and gently rinse portions of this solution (Do NOT SPIT), taking five minutes to use the entire glassful. Avoid any commercial mouth rinses, as many contain a small amount of alcohol in them.

❖ Smoking (10 Days Min.) –
DO NOT SMOKE. Smoking impairs the healing process and decreases the chances for success. The risk is highest in the first week, therefore, you should not smoke for at least 10 days. If you do smoke or have a history of smoking, the risks of implant failure are significantly increased. 

❖ Sutures (7-14 Days) –
If your sutures dissolve/fall out before 7 days, please call our office to get them possibly replaced. It is normal for sutures to dissolve on their own in 7-14 days. Typically at your scheduled post op – you will get your sutures removed. As the swelling subsides, it might feel like the stiches are loosening up. Please do NOT cut them. 

❖ Infection (1 week) – If you have continuing pain, swelling, fever, and a bad taste in your mouth, it is possible that you have an infection at the surgery site(s). If you experience these symptoms a week after the surgery, please contact our office for an appointment. 

Specifically For Implant Placement 

You may feel or notice a metal piece sticking above the gum at the site of the implant; this is called a healing abutment. This allows future access to the implant for impressions and final crown delivery without typically needing more anesthesia. Although rare, a healing abutment may fall off, which does not negatively affect the implant healing. If it does fall off, please call the office to evaluate whether to have it put back on. There is no need for concern if you do not see or the gums heal over a healing abutment. 

Specifically For Extractions and Grafting

1. A dry socket is a condition in which the blood clot that has formed in the extraction socket has either dislodged or dissolved. It is a painful condition which occurs 5-7 days following the extraction(s), often radiating toward the ear and forward along the jaw which may cause other teeth to ache. If the pain lasts more than 24 hours please call our office to schedule an appointment to relieve the pain. 
2. Keep pressure on extraction site for 1 hour by biting on gauze, making sure they remain in place. Change gauze every 15-20 minutes. Some bleeding and oozing is very common over the next 24-48 hours. If bleeding continues, then replace it with a fresh gauze for an additional 30 minutes. It is best to moisten the gauze with tap water and loosely fluff it for more comfortable positioning. If bleeding persists, you may use a moistened tea bag directly over the extraction site and apply firm biting pressure for 30 minutes. 
3. Often times a membrane will be placed over graft sites. If you feel that the membrane has started to lift or shift, please call us so that we can evaluate for re-positioning or removal if the appropriate amount of time has passed. 
4. It is normal to sometimes feel small, sand-like particles in your mouth after grafting. 

Specifically For Partials or Dentures 

1.  For the first 48 hours keep denture(s) in as much as possible, taking them out only after eating to clean, this will help prevent swelling. You may encounter swelling – See above for Swelling instructions. 

2.  New dentures always require a period of adjustment. First-time denture patients require several weeks to get use to their new dentures. Speech may be altered and may require adaptation of the tongue and lips. If your bite feels uneven after several days, we can adjust the way your teeth contact at the follow-up visit(s). 

3.  Should a sore spot develop after surgery please call us to make the necessary adjustments to relieve the pain. These are normal occurrences and should improve with time. 

4.  Proper cleaning of your denture is important to prevent stains and bacteria from accumulating on your appliance. Use a denture cleaner and soft bristle brush daily. Do not use toothpaste as it is too abrasive for the denture material.

5.  Even if you have had all of your teeth removed, it is important to return ANNUALLY for examinations, denture cleanings, and screenings.