Teeth in Day Surgery – All on 4

POST OP INSTRUCTIONS – All on 4

The placement of dental implants is a true surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling may be minimized if these instructions are followed carefully. Sometimes the after effects of surgery are quite minimal, so not all of these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office at any time for clarification.

Immediately Following Surgery:

The gauze placed over the surgical area should be kept in place for 30 minutes and changed at regular intervals until the bleeding subsides. Usually within 45 minutes to an hour, the bleeding will subside to a trickle. After the bleeding slows significantly you can quit using the gauze.
Vigorous mouth rinsing or touching the wound area immediately following surgery should be avoided. This may initiate bleeding. Gentle rinsing is encouraged BEGINNING THE NIGHT OF SURGERY. Use the Peridex (chlorhexidine) that was prescribed. For further oral hygiene instructions, please review the section below entitled: Keep The Mouth Clean.
Take the prescribed pain medications as soon as you begin to feel discomfort. This will happen when the local anesthetic wears off.
Restrict your activities the day of surgery and resume normal activity when you feel comfortable. Allow yourself 7-10 days to resume normal eating patterns, to engage in regular or strenuous physical activity and to feel back to your normal self.
Place ice packs to both sides of your face where surgery was performed. Refer to the section below entitled: Swelling for further explanation.
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. Stand up slowly to provide time to steady yourself. If you feel dizzy when you sit or stand, you should lie back down immediately to minimize the possibility of fainting.
DO NOT SMOKE. Smoking decreases the success rate of dental implants and voids the warranty.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing or redness in the saliva is not uncommon for up to 72 hours after surgery. Excessive bleeding may be controlled by first wiping any old clots from your mouth if present, then placing gauze pad over the area and biting firmly for 30 minutes. When changing gauze, the new gauze should be moistened with cold water. Squeeze out excess water until gauze is damp then place in mouth. Dry gauze will absorb any forming clot and will stimulate bleeding. Each change of the gauze should be whiter and less red as the bleeding subsides. 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 exercise. Avoid bending over and lifting anything greater than three pounds. Smoking, forceful spitting and use of a straw can cause the bleeding to start again. Do not hesitate to call our office if you have any concerns about bleeding.

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. However, the swelling may be minimized by the immediate use of ice packs. Ice packs or small bags of frozen corn or peas should be applied to the sides of the face where surgery was performed. The ice packs should be used for 20 minutes on and 20 minutes off for the first 48 hours following surgery while awake. Moist heat is permitted after 48 hours. Drinking plenty of cold fluids with crushed ice is also advantageous. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Three days following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling and jaw stiffness. Please note that it is important to keep your head elevated for 2-3 days following surgery to minimize swelling. A reclining chair works well to keep your head elevated.

Pain

For mild to moderate pain, take the Ibuprofen. As a substitution for the prescription ibuprofen, you can use over the counter ibuprofen (Motrin or Advil) by taking two to four 200 mg tablets every 3-4 hours. You should not take more than 3200 mg of ibuprofen in any one 24-hour period which equates to four 800 mg tablets every 6 hours or three 200 mg tablets every 4 hours. For severe pain, take the narcotic pain medication as directed. This prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages as this is a dangerous combination, enhancing the effect of the narcotic. Read the precaution sheet from the pharmacist. Pain or discomfort following surgery should begin to subside after the first three or four days. If pain persists, it may require attention and you should call the office. DO NOT routinely take Tylenol with prescription pain medications, as many prescription pain medications already contain Tylenol.

Diet

After general anesthesia or I.V. sedation, clear liquids should be initially taken to keep you hydrated. DO NOT USE STRAWS when drinking. The sucking motion can cause more bleeding. You may eat anything soft but try to avoid too much chewing for the next 8 weeks. High-calorie and high-protein intake is very important. Nourishment should be taken regularly. Your food intake will be limited for the first few days; however you should compensate for this by increasing your fluid intake. At least 5-6 tall glasses of liquid should be taken daily. Keeping well hydrated also prevents nausea and vomiting We recommend caloric supplements such as Ensure or an equivalent product. Two to three cans per day will help keep your strength and promote healing. Blending the Ensure type products with ice usually makes it more palatable and the ice will soothe the tissues. Remember to remove the gauze before eating. It is also advisable to avoid very hot foods for the first 24 hours. . Once you resume eating, try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. For the first 30 days foods such as: soups, scrambled/soft boiled eggs, Cream of Wheat/oatmeal, cottage cheese, yogurt, Jell-O/pudding, mashed potatoes, pasta, applesauce, fish, ice cream, pancakes, canned potted meat, smoothies/protein drinks are recommended. Over the next 4 months foods such as: chicken, fish, rice, pasta, very tender meats, green salads, steamed vegetables, mashed potatoes, yogurt, Jell-O/pudding, cottage cheese, scrambled/soft boiled eggs, smoothies/protein drinks, soups, applesauce, Cream of Wheat, and oatmeal. Basically, anything you easily cut with a plastic fork you can eat. For 6 months, avoid foods such as nuts, popcorn, sunflower seeds, pretzels, chips and any other food that can get lodged underneath the tissue within the surgical site. Stay away from: Crunchy protein bars, hard candy, bagels, anything crunchy, anything chewy, ANY NUTS. Once you have your definitive (final) bridge, you may eat anything you want WITHIN REASON.

Discoloration/Bruising

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. For some patients, this is a normal occurrence which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration. In younger patients, bruising is rare and sometimes is represented as a slight yellow discoloration. In older patients, especially the elderly, bruising can be quite significant and is represented as black and blue discoloration. Bruising can cover a larger area sometimes even involving the neck and upper part of the chest. Bruising of this degree can take approximately two weeks to resolve.

Keep The Mouth Clean

AFTER YOUR SURGERY, it is imperative to keep your mouth clean to promote healing and prevent infection. Please follow the schedule of instructions below:

Rinse 2-3 times a day with warm water or salt water. (1/2 teaspoon of salt in 8 oz of warm water) DO NOT SPIT as this may dislodge the blood clot — Place the water in your mouth and gently swirl it around; release water by letting it fall out of your mouth. DO NOT SPIT as this may dislodge the blood clot.

In addition, rinse with the prescribed Peridex (chlorhexidine) mouth rinse twice a day. This should be used in the morning when you wake up and at night before you go to bed. Gently swish with Peridex for 60 seconds and then let it fall out of your mouth. DO NOT SPIT as this may dislodge the blood clot. Peridex should be used for at least 10 days. After 10 days do not use peridex.

AFTER ONE WEEK
Please use a soft bristle brush. DO NOT USE TOOTHPASTE. Please use a soft circulator brushing technique at the junction of the hybrid acrylic implant supported bridge and your natural gum tissue. Be gentle initially when you are brushing these areas. The important thing is to keep the surgical areas as clean as possible. DO NOT FLOSS. Flossing may disturb the biological seal created around the titanium implant abutment which connects the hybrid acrylic bridge to the implant.

AFTER 3 WEEKS
Use a WaterPik on lowest setting daily to flush out debris from underneath the bridge. If you choose to use a mouth rinse use one that does not irritate your gum tissue such as CloSys, Crest ProHealth or Oxyfresh. These mouth rinses do not contain alcohol. Products containing alcohol could irritate your natural gum tissues or could stain your hybrid acrylic bridge.

Antibiotics
Please take the antibiotics as directed. Be sure to finish the entire prescription even if you feel that it is not necessary. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Immediately notify the office of the reaction. Sometimes taking the antibiotics with yogurt can help prevent diarrhea.

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 flat Coke, Sprite, tea, or ginger ale. You can also purchase Coke syrup over the counter which can have a soothing effect on the stomach. You should sip slowly over a fifteen-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. Please call if the nausea does not subside within 3 hours. There are medications we can call in to your pharmacy that work very well to control nausea and vomiting.

Additional Information:

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.
If the corners of your mouth are stretched, they may dry and crack. Your lips should be kept moist with an ointment such as Vaseline.
Sore throats and pain when swallowing is not uncommon. The muscles get swollen, and 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. In some patients, this is a normal post-operative event. Do not force your mouth open. Massage the muscles and apply moist heat, and usually this will resolve in time.
In an upper implant placement, especially in the back of the mouth, there is a possibility of the sinus communication. If this occurs, you may develop bleeding from the nose. This is usually a temporary finding and will not persist past 2 or 3 days. If this occurs, try to avoid blowing your nose for several days.
Sutures are usually placed in surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will dissolve on their own approximately one week after surgery.
The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions.
Your case is individual as no two mouths are alike. Do not accept well intended advice from friends. Discuss your questions and concerns with Dr. Parekh, Dr. Martinez or Dr. Rios or a member of their staff.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. We recommend that you take at least a week off from any vigorous physical activity. When you do resume your exercise regimen, start with a light to moderate workout, and gradually increase your regimen over several sessions. Stop exercising if you get lightheaded.
You will need to make an appointment with your general dentist within a few days of surgery to make any needed adjustments to your bridge and the way it bites together.
An appointment will be made at the front desk for 1 week to check the implants. If you did not receive an appointment, please call our office so we can make that appointment. Dr. Parekh, Dr. Rios or Dr. Martinez will also see you 3 to 6 months after the initial surgery to check the implant to be sure it is well integrated with the bone. The doctor will then release you to your restorative dentist for the final restoration.
If you have any questions regarding your condition, it is best to call the office during our regular office hours. Dr. Parekh, Dr. Rios and Martinez or the assistant can be reached 24 hours a day 7 days a week (469-698-9800) in the event of a true emergency. During the day, call the office number. At night, call the doctor’s cell phone. If there is no answer, leave a message and the doctor will call you back as soon as possible