POST-OPERATIVE CARE. nyimplantdentistry.com/postop

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1 POST-OPERATIVE CARE nyimplantdentistry.com/postop The Diamond Schlesinger Group 30 East 60 th Street, Suite 703 New York, NY Welcome! Please read through the information carefully and use good judgment. There are many variations on follow-up care that you may encounter either by word-of-mouth or online. What I have written below is what seems to work best based on my own observation of thousands of patients. Proper post-operative care is very important after undergoing oral, periodontal and implant surgery. Failure to follow post-op instructions can result in a delayed recovery. Below are our general post-op care instructions. You will also find specific guidelines for particular procedures. BLEEDING & BRUISING Slight bleeding is normal for several hours following surgery. Normal means when you rinse and spit, you may see some streaks of blood. If there is some oozing of blood, simply use the gauze provided by the office, moisten it first and then apply with slight pressure on the surgical site. Hold it there for minutes before removing the gauze. Alternatively, you can moisten a tea-bag in ice water and apply the teabag over the bleeding site. Tea leaves have tannic acids which are thought to help a blood clot stabilize quicker. If the bleeding persists, reapply gauze or a tea-bag several times until the bleeding stops. Please call us if the bleeding continues. Depending on the nature of the procedure, your blood chemistry, and medications you re taking, it s possible the bruising and discoloration may be visible for 3-5 days following surgery. Do not be alarmed. This reaction is normal. DISCOMFORT If we prescribe medication, take them as directed. If you re unsure of any possible interaction with existing prescription medications, please contact the prescribing doctor. General aches and throbs are

2 normal. Sometimes the throbbing sensation can be intense. Your gums will also be sore at the anesthetic injection sites. Most discomfort can be controlled by over the counter anti-inflammatory drugs. The recommended drug of choice, if no allergies are present, is ibuprofen. It is available over-the-counter and also goes by the brand names Advil or Motrin. 800mg three times daily (every 8 hours), or 600mg four times daily (every 6 hours), are the recommended doses. Please be aware that ibuprofen usually comes in 200mg or 400mg tablets so adjust the dose accordingly. Be mindful of other medications you are taking. Ibuprofen may exacerbate the anti-coagulant effect of aspirin mg acetaminophen/ Tylenol can be taken in between the ibuprofen doses as a synergistic effect. For example, if you are taking ibuprofen every 6 hours beginning at 8am, 3 hours later at 11am you can take acetaminophen, followed by the next dose of ibuprofen at 2pm, and then acetaminophen again at 5pm, and so on. Please exercise caution when mixing drugs, and drink plenty of fluids while taking the medications. Aleve/ naproxen can also be taken instead of ibuprofen. It doesn t work as quickly as ibuprofen, but it is personal preference and everyone responds differently. SWELLING You may experience some swelling, which appears to increase during the first two days. This will normally subside by the third day. Ibuprofen (Advil/ Motrin) and naproxen (Aleve) are anti-inflammatory. They can be taken at the same recommended dose as advised in the DISCOMFORT section above. The use of ice packs and heat may also help minimize swelling. Ice (cold compress or bag of frozen veggies) can be applied to the outer jaw for minutes on and off, during the first 24 hours. Heat (warm/ moist compress) can be applied to the outer jaw on the 2nd and 3rd days. EATING AND DRINKING (NUTRITION) Do not eat until the anesthetic wears off, and sensation of the lip, cheek or tongue is back to normal. This will avoid injury by accidental biting or burning. Avoid vigorous rinsing or spitting for three days, so as to not disturb the blood clot. During the first week, it may be helpful to cut your food into small pieces and eat on the side opposite the surgical site. Avoid small crunchy foods like popcorn, poppy seeds, nuts, granola,

3 chips and hard pretzels during the first week or so. Avoid gum as it may accidentally stick to any sutures or graft material. ORAL HYGIENE DO NOT BRUSH the area until directed. This is generally for 3-4 days but could be as long as 2 weeks post-surgery. Brush and floss normally in the rest of your mouth. It is generally safe to gently rinse your mouth right away with either the prescribed mouth rinse or plain water/ salt water. Rinse at least 3 times daily following the day of surgery. The best time to rinse is right after you eat something. The goal is to keep the surgical site as clean as possible, but since you cannot brush for several days it s important to cleanse the mouth with periodic rinsing to flush away pieces of food and debris. The cleaner the site, the quicker it will heal. When you re ready to spit out after rinsing, do so gently. Plain warm water is fine if you re away from home. There is no need to leave the house with special bottles or salt. If your surgery included the use of a bone graft, DO NOT RINSE WITH LISTERINE. A NON ALCOHOLIC RINSE SHOULD BE USED. Good oral hygiene is important for proper healing of the wound. NUMBNESS When surgery is performed near a nerve or nerve ending, trauma or swelling on rare occasion may disturb the nerve causing numbness of your chin, lower lip, and teeth on that side. It is impossible to determine the duration of numbness, but it is rarely permanent. Let us know if you experience any lingering numbness. ANTIBIOTICS If you are given a prescription for antibiotics, it is critical that you take them exactly as directed. If you re unsure of any possible interaction with existing prescription medications, please contact the prescribing doctor. Stopping the antibiotic early and/or skipping doses will not only reduce its effectiveness, but also increases your risk for developing a more severe infection. Some antibiotics can cause gastrointestinal upset, a normal side-effect; however, if the gastrointestinal upset progresses to a severe diarrhea, call us immediately and discontinue use.

4 If you develop itching, redness or swelling anywhere on your body, stop taking the antibiotics immediately and call us. You may be experiencing an allergic reaction to the antibiotic. Most antibiotics can be taken with or without food. Always drink plenty of fluids with any medication. ACTIVITIES You may immediately resume normal routine daily activities unless otherwise instructed. During the first 2-3 days following surgery, AVOID any vigorous activity that may elevate your blood pressure this includes lifting weights, heavy cardiovascular exercise, etc. The pulsating sensation from an increase in blood flow could disturb a clot, de-stabilizing it, which may cause fresh new bleeding. In particular, do not engage in contact sports or play musical wind instruments for one week following surgery. When feeling well, resume normal activity. STITCHES Some stitches dissolve on their own and at varying times, while others must be removed at a follow up visit. Stitches can unravel after about 7 days and can become a nuisance. This unraveling is usually harmless and will not affect the outcome of the surgery. HEMATOMA With any surgical procedure, there is some level of internal bleeding. Normally the body s circulatory system clears out the excess fluids but sometimes there is too much fluid for the body to handle and the blood can pool and coagulate. When this happens, a clot can develop down in the tissue where the gums meet the cheeks. The clot is firm and sits there, putting pressure on the jawbone and causing discomfort. The best remedy for this is a constant, gentle massage and a warm compress. A hematoma will go away in days. Sometimes an antibiotic is given to prevent the hematoma from becoming infected. Please let us know right away if you think you may have a hematoma. Unfortunately there s no way to prevent or predict a hematoma, but it does seem more likely to happen following an extraction than other procedures.

5 FOLLOW-UP VISIT You will likely be advised to schedule a postoperative visit with our office to check the progress of recovery. In the meantime, be sure to maintain a healthy diet and follow our guidelines for proper oral hygiene. LASER/ PERIODONTAL TREATMENT SPECIFIC GUIDELINES In general, after about 3-4 days it is safe to resume normal eating and oral hygiene. Be gentle the first few times you start to brush. It is normal for the gums to feel tender and bleed a little bit. Discomfort of the gums is very unusual with laser/ periodontal therapy. However, sometimes the teeth themselves become extra sensitive to cold and air. This can vary from person to person. It may be nonexistent, or it can last several months. The good news is that this is a sign that the inflammatory disease is quickly subsiding, leaving the teeth and roots in a sort of state of shock. SOFT TISSUE GRAFT SPECIFIC GUIDELINES Soft-tissue augmentation requires more care than other procedures. Typically, no brushing or flossing for at least 2 weeks of the treatment area. Careful eating is also mandatory for at least 2 weeks. Make sure to carefully follow any other instructions given to you. IMPLANT SPECIFIC GUIDELINES It is absolutely not normal to experience real pain following a dental implant surgery. Pain is defined as discomfort that wakes you up at night. If you experience sharp/ shooting pain of more than 2-3 days duration that is not relieved with over-the-counter painkillers, it is a sign that the implant may not be healing correctly. Let us know right away and we will do our best to manage it. EXTRACTION SPECIFIC GUIDELINES One of the worst complications following an extraction is something called a dry socket. It is uncommon, but manifests itself as sudden, severe, sharp pain which begins usually 3-5 days after an extraction. It is thought to be more common in women, smokers, the lower jaw and old root-canal treated teeth. A dry socket is a result of the blood clot not stabilizing itself correctly, leaving an exposure of the jawbone.

6 Treatment for this entails anesthetic along with intentional scraping of the area to re-initiate bleeding. A medicated dressing may also be used to soothe the pain. Like a hematoma, a dry socket is unpredictable and appears without warning. Sometimes there is a prior history or even a family history. Call us right away if you are experiencing unusual pain. CROWN LENGTHENING SPECIFIC GUIDELINES The purpose of a crown lengthening is to intentionally expose more of the tooth and at the same time guide the gums further away from the tooth. The natural consequence of this is that space will open up between the teeth and food may get caught more easily. This is normal and temporary. Eventually a new crown or restoration will fill up this space. In the meantime, do your best to keep the area clean and prevent inflammation. Refrain from brushing and flossing for about 3 days after crown lengthening, and then resume normal home care unless otherwise instructed. If the gums aren t kept clean and healthy, then your dentist may have to delay the restorative phase. We may need to strategize, on a case by case basis, how best to keep the sites clean until a permanent restoration is done. SINUS SPECIFIC GUIDELINES For about 2 weeks following sinus grafting procedures, avoid any action that creates negative pressure in the sinuses. It is best to sneeze with your mouth open, minimize heavy lifting, and blow your nose very gently, without applying pressure to your nostrils with your fingers. Avoid flying and the use of straws. Some bleeding from the nostrils is normal. We may prescribe a decongestant for you. Call us directly, anytime, if after surgery you experience any difficulty in breathing, fever, excessive bleeding or any other unusual conditions. Office Telephone Dr. Diamond s Cell Dr. Schlesinger s Cell