All on 4
The following information applies when you have had multiple extractions and placement of implants utilizing the All-On-Four technique
Sometimes the after-effect of oral surgery is quite minimal. Not all of these instructions will apply to you. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or contact us for clarification.
There are two stages of healing. The first stage of healing consists of the first 2 to 4 weeks after your procedure. It will consist of varying degrees of tenderness, sensitivity, discomfort and possibly some bruising around the face. You may have swelling and pain in the ears, under the lower jaw, on the side of the head, under the eyes, or along the side of the nose.
The second stage of healing will take approximately 2- 4 months. This period of time will allow for a decrease of the swelling, tenderness, discomfort and bruising. All of these time periods are approximate and will vary depending on the patient, complexity of the procedure, pre-existing medical problems, and medications being taken on a daily basis. Even though you may feel well 4 weeks after surgery, you will need to continue a soft diet.
Any unusual condition occurring after being dismissed should not be neglected and should be brought to the doctor’s attention. It is our desire that your recovery be as smooth and pleasant as possible and following these instructions will assist you during this process.
Important Considerations after I.V. Sedation
If your procedure was completed with I.V. sedation, someone needs to stay with you for the first 24 hours. Do not do anything that requires your judgment during the 24 hours following I.V. sedation. You cannot work, drive, operating heavy machinery, be responsible for making any major decision, or be responsible for watching and/or holding children for the first 24 hours after surgery or while taking the pain medicine. It is also suggested to have someone stay with you when going to the restroom. The medication given in the IV and the prescribed pain medication can make you feel dizzy and impair your judgment.
1st-5th Days of Care
DO NOT rinse vigorously, probe the area with any objects and/or fingers, or pull your cheek away from you mouth. You may brush your teeth very gently avoiding the surgical site. DO NOT SMOKE. Smoking is very detrimental to a surgical site and can cause complications during your healing process. No drinking through a straw or causing any type of suction or spitting for 1 week.
Intermittent bleeding or oozing for 24-48 hours after surgery is normal. The day of surgery gently bite down on the gauze packs that have been placed over the surgical areas, making sure they remain in place and changing them out once saturated (usually every 30-40 minutes). If you have a fixed denture (not removable), it will help apply pressure but you will still need to tuck gauze in the corners of the mouth for additional pressure. While your lip, tongue, and cheek are numb, you will need to be careful not to bite these areas when biting down on gauze, or when eating and talking. You will need to change the gauze until the bleeding stops. You will only use the gauze for the first day. On the second and third day it is normal to have a slight amount of bloody saliva, which usually does not require biting down on additional gauze. Do not eat or sleep with the gauze in your mouth.
Bleeding should never be severe. If it is, it usually means that the packs are being clenched between your teeth rather than exerting pressure on the surgical areas. Try re-positioning fresh packs onto the surgical areas. If bleeding persists or becomes heavy, you may bite on 1-2 black tea bags (soaked in cold water, squeezed and damp-dried). Do not take them out to check until after you have been biting down on them for 1 hour. If the bleeding remains uncontrolled, please call the office.
There is often some swelling associated with this procedure. You can minimize this by using an ice pack applied firmly to your face or cheek adjacent to the surgical area. This should be applied 20 minutes on and 20 minutes off during the first 24 hours after surgery. After 24 hours, switch from using ice packs to warm moist heat compresses 3 times per day (morning, noon & night). You can use a hot water bottle wrapped in a warm moist towel, or just a warm, moist towel. Usually swelling and discomfort will peak on the 3rd-4th day after surgery.
Nausea is not an uncommon event after surgery with I.V. sedation, and it is sometimes caused by stronger pain medicines. Nausea may be reduced be preceding each pill with a small amount of soft food. Call us if you do not feel better or if repeated vomiting is a problem.
Unfortunately, most oral surgery is accompanied by some degree of discomfort. Your discomfort will be better controlled if you take the first pain pill before the anesthetic wears off after your surgery. Effects of pain medication varies widely among individuals i.e. upset stomach, nausea, dizziness, drowsiness, or need to take 2 pain pills instead of 1 during the early stages of healing etc. Do not take pain medication on an empty stomach.
Remember that most discomfort is usually on the 3rd -5th day after surgery. After this period the need to take pain medication should be lessened.
- For mild pain: 1 – 2 Tylenol or Extra Strength Tylenol may be taken ever 4-6 hours. Ibuprofen (Advil or Motrin) may be taken instead, bought over the counter it comes in 200mg tablets and 2-3 tablets may be taken every 6 hours as needed for pain.
- For moderate pain: 1-2 Tylenol and 3 Ibuprofen (Advil or Motrin) may be taken together every 6 hours.
- For severe pain: the prescribed medication should be taken as directed (if taking prescribed medication, discontinue taking Tylenol or any other acetaminophen product.) It is okay to continue Ibuprofen (Advil or Motrin.)
*****Unless otherwise instructed, DO NOT stop taking Ibuprofen for the first 4-5 days. This helps with pain and swelling.
Antibiotics are prescribed to treat and/ or prevent an infection.
It is EXTREMELY important to take antibiotics as directed and to finish the entire prescription. Even if you start feeling better, it is still extremely important to finish the antibiotics completely. It is very ineffective, and in some cases dangerous, to take half the pills, and stop, and then start again.
NOTE: If you develop a RASH, HIVES, ITCHING, DIARRHEA, EXCESSIVE VOMITING or DIFFICULTY BREATHING when taking the antibiotics STOP taking them and call the office immediately.
(IMPORTANT NOTE FOR FEMALES): Antibiotics have been shown to decrease the effectiveness of Birth Control. Therefore, to avoid an unwanted pregnancy, it is highly recommended that you continue taking your Birth Control pills AND use an additional form of birth control until after you have completed your antibiotics and started your next menstrual cycle.
Mouth Rinse & Hygiene
If prescribed, 24 hours after surgery gently rinse with the medicated mouth rinse two times a day for 1 week unless instructed differently by the doctor.
Otherwise gentle rinsing with WARM SALT WATER (1/2 teaspoon salt + one cup water) should be started the second day after surgery and should be done at least 6 times per day. This rinsing should be continued for approximately 1-2 weeks. Proper rinsing can speed healing and keep your mouth feeling fresh and clean. After the 2 week check you will receive a monoject syringe and will start using that along with warm salt water to flush under the denture. The syringe will be used until 4 weeks and then a water pick is highly recommended.
Be sure to drink plenty of fluids and eat plenty of soft nourishing foods the first several days after surgery.For the first day, it is sometimes advisable, but not required, to confine your diet to bland liquids or pureed foods and avoid foods that are hot (temperature wise), spicy, acidic, small, or sharp (i.e. seeds, ice, tomatoes, chips, etc.). It is important not to skip meals! Staying hydrated and nourished will make you feel better, gain strength, have less discomfort and heal faster. Restrict your diet to liquids and soft food only (nothing harder than pasta) until otherwise directed by your doctor (this can be for several months).
If you are diabetic, check your blood glucose frequently after surgery. It is important to follow your physician’s insulin schedule and dosing to properly maintain your glucose levels to help prevent infection, promote proper healing, and avoid diabetic related complications.
During the first 1-3 days after surgery, these foods are examples of what you may eat in addition to other similarly textured food (soft cold foods you do not have to chew) such as shakes, Ensure, smoothies, ice-cream, pudding, JELLO, seedless yogurt ETC.
After the initial 3 days after surgery, and until the four to six month final checkup visit, these foods are examples of what you may eat in addition to other similarly textured food (foods that require a minimal amount of chewing) such as steamed rice, very small pieces of soft chicken, fish, meatloaf, chicken noodle soup, cooked vegetables, pasta (overcooked noodles), eggs, mashed potatoes, ETC.
Sinus Precautions (Only if you were instructed)
Surgeries performed on the upper jaw in and around your Maxillary sinus cavities will require special precautions. To give your sinuses the best chance of healing you must adhere to the following instructions:
- No Nose Blowing, and No Closed Mouth Sneezes for 2 weeks. The purpose of this is to avoid any increase in oral, nasal or sinus pressure that may create an opening or prevent an already existing opening in your sinus from being able to properly heal or close.
- No Smoking for 4 Weeks. Smoking even in small amounts will dramatically reduce the chances of proper healing of your sinus and implants. This can lead to infection, complications with the sinus and a need for additional surgery. It is imperative that you follow this rule.
- ONLY IF INSTRUCTED – Nasal Decongestant for 2 Weeks. It is critical that you take the suggested over the counter nasal decongestant for 2 weeks as directed on the box to ensure that your sinuses remain open and clear during the healing process. Recommended nasal decongestants are over the counter ZYRTEC “D” OR over the counter SUDAFED.
Please DO NOT use a water pick or electric toothbrush directly on the implant site during the first 3-4 months of healing. The constant vibration directly on the implant site could lead to your implant being unsuccessful. You can brush your teeth with an electric tooth brush but you will need to turn it off when brushing the implant site.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you. If you have questions or concerns about your progress please contact us.
____ Norco (Acetaminophen/Hydrocodone)
This is pain medication. Take 1-2 every 4-6 hours as needed for pain after surgery.
____Percocet 5/325mg (Acetaminophen/Oxycodone)
This is pain medication. Take 1 tab every 3-4 hours as needed for pain after surgery.
____ Tylenol #3 with Codeine (Acetaminophen/Codeine)
This is pain medication. Take 1-2 every 4-6 hours as needed for pain.
____ Amoxicillin 500mg
This is an antibiotic. Take 1 tab three times a day (breakfast, lunch and dinner) until gone.
____ Augmentin 875 mg
This is an antibiotic. Take 1 tab two times a day (breakfast and dinner) until gone
____Clindamycin 150mg or 300mg
This is an antibiotic. Take 1 tablet three times a day (breakfast, lunch and dinner) until gone.
____Medrol Dose Pack (Methylprednisolone dose pack)
This is a steroid to help reduce swelling. Take as directed on package insert.
____Peridex (Chlorhexidine Gluconate)
This is an antibiotic mouth rinse. Swish ½ capful for 1 ½ minutes then gently spit. Use after breakfast and after dinner time. (Do not eat or drink for 30 minutes following use)