Surgical Instructions

APPOINTMENT: Please arrive 15 minutes before any surgery. LOCAL ANESTHESIA (numbing only) or NITROUS OXIDE: Eat and take all medications as usual (especially diabetics). You may drive and come alone unless instructed otherwise. I.V. ANESTHESIA or ORAL SEDATION: Have NO food or drink after midnight. Have an escort to remain in the office during your treatment, to drive you home, and to attend to you until fully recovered from the anesthetic. This may take the entire day. Diabetics on insulin – follow specific instructions given regarding insulin use and food. If you have albuterol, bring it with you to the procedure. If you have an illness such as a cold, cough, sore throat etc. please notify the office immediately. Your procedure may need to be rescheduled. MEDICATIONS/PRE-MEDICATIONS: If directed, take antibiotic TWO hours prior to surgery or as directed. If directed, take Benadryl TWO hours prior to surgery (only for IV sedation) Take ALL routine PRESCRIPTION medicines least TWO hours prior to the surgery, unless instructed otherwise. Please make sure you have Benadryl 25mg tabs, Ibuprofen 200mg tabs and Tylenol 500mg tabs at home. If directed, rinse with Peridex mouth rinse two DAYS prior to the surgery. CLOTHING (for IV Anesthesia/Oral Sedation): Wear comfortable, loose fitting clothing with short sleeves, eg. T-shirt. Contact lenses and jewelry must be removed. Do not wear finger nail polish or acrylic nails, as it interferes with our sensors.

BLEEDING No spitting or rinsing your mouth for 2 days. These can cause bleeding. Bleeding is normal for 24 hours and will increase with talking and general activity. Bite on MOIST gauze for 20 minutes at a time and change until bleeding stops. If bleeding continues or is increasing, place a moist tea bag (not herbal) directly over surgical site and bite down for 1 hour. Repeat as needed. PAIN MANAGEMENT/MEDICINE After something cold and soft to eat, like a milkshake or yogurt, take pain medicine as directed. 600mg Ibuprofen AND 500mg Tylenol every 6 hours. Start this regimen 3 hours after the procedure and take it for 2 days. After that you can take them as needed. We do NOT routinely prescribe narcotics. If nauseated, take 25 mg of Benadryl to settle the stomach. Take antibiotic if directed. If rash or itching develops, stop taking antibiotic, take 25 mg of Benadryl and call the office. ICE Apply ice pack to face (20 min. on 20 min. off) for 24 hours to control bleeding, pain and swelling. FOOD/DIET Eat cold, soft foods until numbness wears off to avoid biting your lip or tongue. No hard, crunchy foods for 2 weeks. Refer to diet sheet for food suggestions. Avoid chewing on surgical site for at least 1 week while area is healing. Avoid straws for 2 days. ORAL HYGIENE Brushing with a soft bristled, manual toothbrush may be resumed the day following surgery, being careful to avoid the surgical site. You may gently rinse with water only, but do not swish vigorously to protect the surgical site If instructed, one week after the procedure, gently rinse with warm salt water twice daily for one week. [ 1 cup warm water + 1 tsp salt] EXERCISE No exercise or heavy lifting for 3-4 days, or as directed SWELLING/BRUISING Swelling and bruising are normal following surgery and can peak on day 3 then start to dissipate Bruising is possible, especially if patient is on blood thinners SMOKING/MUSCLE SPASM If pain increases or is referred to the ear on day 4-5, you may have a muscle spasm. Apply a COLD pack to the side of the face and take Motrin to reduce discomfort Smoking delays healing, avoid for 1 week following surgical procedures IF HEALING CAP PLACED (in addition to General Instructions): Continue rinsing with Peridex twice a day for one week. Do not brush healing cap for 2 weeks until gum tissue has healed. Do not use floss or WaterPik around the implant for one week SIGNS TO WATCH FOR Fever, chills, sour taste of pus, swelling that worsens after the third day, bleeding after the second day. If you notice any of these signs, call the office.

1. BLEEDING/SWELLING/BRUISING Bleeding is normal for 1-2 days and will increase with talking and general activity. Bite on MOIST gauze for 20 minutes at a time and change until bleeding stops. Pressure stops ALL oral bleeding (unless you have a medical cause for bleeding). The key is to put pressure directly on the surgical site. Swelling and bruising are normal following surgery and can peak on day 3 then start to dissipate. Bruising is possible, especially if patient is on blood thinners. Apply ice pack to face (20 min. on 20 min off) for 1-2 days to control bleeding, pain and swelling. https://video.wixstatic.com/video/327f01_8a0ecbd2cc2c4dbd86ef44c55c644c2d/1080p/mp4/file.mp4 2. PAIN MANAGEMENT There are several different kinds of pain: (Any recommendation of drugs here is generic and should be followed only on the instruction of Dr. John.) 3. FOOD/DIET Eat cold, soft foods until numbness wears off to avoid biting your lip or tongue. No hard, crunchy foods for 2-3 weeks and avoid popcorn-like foods for 2 months. Refer to diet sheet for food suggestions. Avoid chewing on surgical site for at least 1 week while area is healing. Avoid straws for 1 week. https://video.wixstatic.com/video/327f01_f6f6fa7e362749b3b3ee1c05929ad4af/1080p/mp4/file.mp4 4. ORAL CARE ONE day after the procedure: - Start brushing with a soft-bristled, manual toothbrush being careful to avoid the surgical site. - Gentle rinses with warm salt-water twice a day for two weeks (1 cup water + 1 tsp salt) FIVE days after the procedure: - brush the teeth adjacent to the surgical site gently and well. - use the syringe with a curved tip and wash out the LOWER sites every night (with warm or cold or salt water) until the gums close (usually 2-3 weeks). Make sure that the TIP of the syringe goes INSIDE the empty socket as you are washing it out. Food debris need to be washed out and careful hygiene maintained to avoid infection. https://video.wixstatic.com/video/327f01_8a0ecbd2cc2c4dbd86ef44c55c644c2d/1080p/mp4/file.mp4 5. EXERCISE/GENERAL a. No exercise or strenous activity for 1 week b. Night guard/Retainer can be worn once the bleeding stops. c. Do not look at the surgical site. Each time you pull your cheek to look at it, you could loosen the sutures. Typically, sutures dissolve in 7 days. If sutures loosen or fall out sooner than expected, it is okay. Continue to make sure not to disturb the site. If a suture hangs loose, feel free to take a little scissor and snip the part that is hanging, or wait for it to eventually fall off. d. For various reasons, the surgical site keeps changing color as it heals - white, red, purple, pink. All of this is normal. (See below for signs of infection to watch for). e. If nauseated, take 25 mg of Benadryl to settle the stomach. f. If rash or itching develops with any medicine, stop the medicine, take 25 mg Benadryl and call the office. g. if you have been told that there is a Sinus Exposure, you may have bleeding from the nose on that side. Do not blow your nose or sneeze through your nose. If you have to sneeze, open your mouth wide Use the nasal spray and antibiotics as directed. https://video.wixstatic.com/video/327f01_3bcc281449be4311920ed1b4762c4049/1080p/mp4/file.mp4 SIGNS TO WATCH FOR Fever, chills, sour taste of pus, swelling that worsens after the third day, heavy bleeding after the second day. (Bad taste and smell of inadequate oral hygiene is expected during the first week) If you notice any of these signs, call the office. https://video.wixstatic.com/video/327f01_a205af6fb4bf4a2cba0e24436d9e35e3/1080p/mp4/file.mp4

1. BLEEDING/SWELLING/BRUISING Bleeding is normal for 1-2 days and will increase with talking and general activity. Bite on MOIST gauze for 20 minutes at a time and change until bleeding stops. Pressure stops ALL oral bleeding (unless you have a medical cause for bleeding). The key is to put pressure directly on the surgical site. Swelling and bruising are normal following surgery and can peak on day 3 then start to dissipate. Bruising is possible, especially if patient is on blood thinners. Apply ice pack to face (20 min. on 20 min off) for 1-2 days to control bleeding, pain and swelling. 2. PAIN MANAGEMENT There are several different kinds of pain: (Any recommendation of drugs here is generic and should be followed only on the instruction of Dr. John.) 3. FOOD/DIET Eat cold, soft foods until numbness wears off to avoid biting your lip or tongue. No hard, crunchy foods for 2-3 weeks and avoid popcorn-like foods for 2 months. Refer to diet sheet for food suggestions. Avoid chewing on surgical site for at least 1 week while area is healing. Avoid straws for 1 week. 4. ORAL CARE ONE day after the procedure: - Start brushing with a soft-bristled, manual toothbrush being careful to avoid the surgical site. - Gentle rinses with warm salt-water twice a day for two weeks (1 cup water + 1 tsp salt) FIVE days after the procedure: - brush the teeth adjacent to the surgical site gently and well. - Food debris need to be washed out GENTLY and careful hygiene maintained to avoid infection. 5. EXERCISE/GENERAL a. No exercise or strenuous activity for 1 week b. Night guard/Retainer can be worn once the bleeding stops. c. Do not look at the surgical site. Each time you pull your cheek to look at it, you could loosen the sutures. Typically, sutures dissolve in 7 days. If sutures loosen or fall out sooner than expected, it is okay. Continue to make sure not to disturb the site. If a suture hangs loose, feel free to take a little scissor and snip the part that is hanging, or wait for it to eventually fall off. d. For various reasons, the surgical site keeps changing color as it heals - white, red, purple, pink. All of this is normal. (See below for signs of infection to watch for). e. If nauseated, take 25 mg of Benadryl to settle the stomach. f. If rash or itching develops with any medicine, stop the medicine, take 25 mg Benadryl and call the office. g. if you have been told that there is a Sinus Exposure, you may have bleeding from the nose on that side. Do not blow your nose or sneeze through your nose. If you have to sneeze, open your mouth wide. Use the nasal spray and antibiotics as directed. If BONE GRAFT PLACED (in addition to General Instructions): There can be an altered taste due to the bone graft or membrane material. The gums usually takes 3 weeks to completely close up. UNTIL THEN: - Do not chew sticky, sharp or hard foods on that area – the bone graft can come out. - Avoid any commercial mouth rinses (eg. Listerine) - Avoid electric toothbrushes and water piks around the surgical site. - No swimming SIGNS TO WATCH FOR Fever, chills, sour taste of pus, swelling that worsens after the third day, heavy bleeding after the second day. (Bad taste and smell of inadequate oral hygiene is expected during the first week) If you notice any of these signs, call the office. OSTEONECROSIS Rarely, especially in older patients, extraction of lower back teeth can result in exposed bone below the tongue. (It will feel like sandpaper). When it occurs, it happens 4-6 weeks after the procedure. This is not directly related to the extraction site. There is no surgical treatment for it. We have to wait for the gums to naturally cover over the exposed bone, which may take a few weeks.

If you use a CPAP, you are free to use it after the bleeding stops - usually the 2nd or 3rd day post op (unless specific instructions were given not to use it). If you have a Nightguard/retainer, you are free to use it after the bleeding stops - usually the 2nd or 3rd day post op.

Do not drive for 24-48 hours For the first day, use assistance when walking, going up the stairs or to the restroom etc. Delay bathing until the following day No alcohol for 24-48 hours If you develop itching or rashes from any medicine, take 25mg of Benadryl and call the office. If you develop swelling of the face and throat, go to an emergency room immediately.

Postoperative Diet Recommendations Most food should be soft enough to swallow without chewing or should be cut into small pieces to minimize the need for chewing. The following suggestions may be helpful: SOFT FOODS: Cereal – Cooked breakfast cereals, cream of wheat, oatmeal Bread – pancakes, soft bread, soft inner portion of bread or roll Cheese¬ – cream cheese, cottage cheese, yogurt Eggs Fruit – Applesauce, ripe banana, melon Meats – Fish and most seafood, ground meat, pulled pork Potatoes – baked, mashed, sweet potatoes Pasta – noodles with any sauce, meat sauce, cheese sauce Soups Vegetables – well cooked vegetables Dessert – ice cream, custard, sherbet, Jell-O, pudding Beverages – almost any, smoothies, milkshakes AVOID: Sandwiches, bagels, sub sandwiches, toast, crackers, pretzels, Burritos Hard crusted bread Salads, raw vegetables, crunchy fruit like apples nuts, raisins, seeds Popcorn Jellybeans, hard candies, chewing gum Grits Rice

After your dentist restores the implant with a crown, extreme maintenance should to be done to protect your implant. The most common reasons for failure of an implant are: Improper oral hygiene. Maintain excellent oral hygiene. Brush and floss just like any other tooth. Even though the crown won’t get decayed, lack of good hygiene can cause bone loss around the implant and eventual failure of the implant. Visit your dentist every 6 months or as needed and follow oral hygiene instructions carefully. Smoking. We highly encourage smoking cessation. Implants are an investment and you dont want to ruin your investment by smoking. Dr. John has many patients that have permanently quit smoking at the time of implants. It is possible! Uncontrolled immunosuppressive diseases, eg. Diabetes etc; or Immunosuppressive medications, eg. For rheumatoid arthritis etc. Bruxism/Clenching. If you are prone to clench or grind your teeth, we highly recommend getting a bite guard (night guard) to protect your implants. Talk to your dentist about it.