Instructions after
Oral Surgery and tooth extractions.
1.. Bleeding . After
your oral surgery, you will usually be kept under observation in the
Jaw Face Clinic until the bleeding from your socket or surgical wound has stopped. You
may have some blood stained saliva for several days following surgery.
This is quite common and there is no need to worry. If, however, the
bleeding does start again, it can be stopped by placing a rolled up gauze or
clean handkerchief directly over the bleeding area and biting gently for three quarters of an
hour or more. If the bleeding does not stop after this, it is advisable to seek advice
.
For all emergencies, the nearest NHS Hospitals to our location are
Princess
Royal University Hospital
on 01689 863000 or Queen
Mary’s Hospital, Sidcup, 0208 3022678
2 Stiches
used are usually dissolvable. Occasionally they become loose and some even may
fall out the same day. Do not worry, there are usually enough of others to keep
the edges together.
3 Rinsing . You should not
rinse your mouth for six hours following surgery. This allows
a good blood clot to form in the socket or site of
surgery. If you rinse your mouth out too soon you may dislodge the clot and cause
yourself further discomfort or bleeding. If you want to eat or drink during the
six hours following surgery, it is advisable to keep the food and drink away from the
site of surgery e.g... By drinking through a straw.
4 Mouthwashes .After six hours have elapsed, you should start to
use a warm salt water mouth wash. Take an ordinary mug or tumbler, fill it with
boiling hot water and stir in a teaspoon of salt. When it has cooled down and is as
hot as a cup of tea, take a mouthful and hold it over the socket or wound. Repeat this until you
have used the whole mug up. You should do this at least four times a day for
the week following surgery.
5 Clean. It is
worth while remembering that a tooth extraction socket or
surgical wound will heal faster if the mouth and other teeth
are kept clean. You should try to clean gently with a brush as soon as
possible.
6.Pain.
You may well experience some pain or discomfort following surgery. If you have had surgery under
local anaesthetic, it may be a good idea to take a couple of painkillers before
the local anaesthetic wears off. Minor analgesics (eg Nurofen one to two tablets six
hourly - Nurofen is the brand name of Ibuprofen) are usually adequate to
control pain. If the pain persists for more than a few days or gets worse you
should contact the office on 01959533115
7.Diet. You are
advised to have a soft diet for 48 hours eg. Soft fruit, vegetables, mince, fish, pasta. No
hard fruit/vegetables or meat.
8.Sedation.
If you have had sedation, you should rest at home, supervised. You must not drive
a car, operate machinery or sign important documents for the first 24 to 48
hours
9.Biopsy
results will be posted to you when available .Usually two weeks later.
Copyright
Jaw
Face Clinic .Chelsfield Park Hospital
Bone Grafting for Dental Implants
A successful implant requires a solid foundation of bone. Once a
tooth has been removed, then the bone which supported it, will
gradually diminish in size. By the time a decision is made to replace the
tooth with an implant, the remaining bone may have become insufficient
to act as a good foundation. So strengthening it by increasing the
volume of bone is necessary. There are different techniques of bringing extra
bone to a site where is it deficient. Some surgeons use animal or
other human products. However it is generally considered that your
own bone is the best and this is the main type of bone
grafting that I offer.
The treatment is carried out under sedation and
local anaesthesia, so during the surgery patients are not stressed by
the operation.
The bone is taken either from the side of the jaw
or the front of the chin, from within the mouth. Each site has got its own
benefits and potential problems.
If the bone is taken from the front of the chin,
the adjacent teeth do often feel numb and wooden though generally speaking
these recover and improve within a few months.
When the bone is taken from the side of the jaw at
the back in the region of the wisdom teeth, there is often facial swelling and
restriction of mouth opening. Although appropriate instruments are used to
remove the blocks of bone away from the nerves there is a theoretical risk of
developing a numb lip but the chances of this is small.
The blocks of bone which have been harvested are then
placed into the deficient area. For successful fusion of the
new bone to the base, there should be no movement of the grafted bone while it
is healing. This is achieved by various means. Those which are
superficial are stabilised with bone screws. In other occasions the bone may be
slotted into a prepared gap. In another technique the graft is sandwiched
between separated bones.
Often some additional synthetic bone is used to
round off the treated sites. Occasionally a dissolvable or non dissolvable
layer (membrane) is placed over the graft which in some situations helps with
consolidation of the grafted area.
Final part of the operation involves repositioning
of the gum and use of dissolvable and non dissolvable stitches to cover the
site of the surgery and isolate the grafted area from the mouth.
Once the anaesthetic has worn off, the site of
surgery could become painful. This would be similar to having had a wisdom
tooth removed. You are therefore prescribed pain medication before
and after the procedure to keep the symptoms under control. Following the
operation it would be advisable to take a few days off work to rest at home
You are then seen for follow up about a week and
then three weeks following the surgery and some of the
stitches removed. Others are dissolvable and are left alone.
All being well, the grafted bone attains its blood
supply in about three to six months and fuses to the prepared base. Then
a dental implant can be inserted.
It should be pointed out however that bone
consolidation is unpredictable and if a significant part of the graft
dissolves, then further bone grafting is necessary. If the patient
wishes, then the procedure can be repeated but usually at no extra fee.
As
a summary
-
· If you are sedated you must have a responsible adult
at your surgery and with you until you recover. Recovery is
considered to be through the evening of the surgery.
-
· If you have very numb lip or tongue a few hours after
surgery, contact me.
-
· Rest the first day or two following surgery.
-
· Follow the post-operative instructions.
-
· Take your medications as prescribed.
-
· Eat soft food and avoid chewing in the area of
surgery when possible.
-
· If wearing a temporary or permanent denture after surgery,
make sure it is clean
-
and not putting pressure on the site of the grafted
area.
-
· Sutures will be removed two to three weeks later at
post-operative visit.
-
· Bone grafting may take three to six months to
complete.
-
Chances
of success are less if you smoke and if you do not keep your mouth and teeth
perfectly clean.
I hope this brief leaflet is informative. Should you wish any additional
information please do not hesitate to
ask. Massoud H Ardehali Oral and Maxillofacial Surgeon
Copyright
Jaw
Face Clinic .Chelsfield Park Hospital
Intravenous sedation Please note this is
not general anaesthesia. It is simply a method of relaxing you.
Some
of the surgical procedures we carry out for dental implants are time consuming.
Patients find it more pleasant if during these procedure
they are sedated.
Before the
beginning of
the operation the blood pressure is taken by one of the nurses present . Then
a monitoring device is placed on a
finger. Through a vein on the back of the hand or front of the
elbow, medication ( Midazolam ) is
given which has an effect similar to drinking spirits quickly.
When
sedation has been achieved, the area of surgery is made numb and surgery is
carried out. During this period monitoring equipment is used to assess
pulse and breathing . If
the oxygenation of
blood is reduced through slow breathing, you may be asked to take a few deep breaths .
Most
of the effect of the sedation wears off in half an hour, but patients are
unsteady on their feet and often cannot remember the surgery.
Hence most of the information and verbal instructions are given to the
accompanying adult.
Our
recommendations to patients are:
You
can have a light breakfast or lunch ( some anaesthetist will only give sedation if you are fasted).
Attend the
hospital accompanied by a
responsible adult.
Following
surgery, you will be kept in the clinic or recovery area until
the sedation has
mostly worn off.
You should
be taken
home by taxi, or private car, under the care of the accompanying adult to rest further .
Do
not take other sedating medicines or alcohol.
If
you have had intravenous sedation, you must not drive a car,
operate machinery or make
important decisions for at
least 48 hours.
If there is
anything which you do not understand please ask us.
