Tooth Extraction
This is Dr. Dulac, and I am providing post-op instructions. You can eat or drink to comfort, meaning whatever you want. However, try to avoid spicy foods and foods with sharp edges if they bother the surgical site. Brush and floss to comfort. Be gentle in the area of the operation. Over-the-counter options are Tylenol and Motrin. If you need something stronger, please call me.
You can engage in physical activity to comfort. As your blood pressure and heart rate may go up, you might feel a little sore but there's no restriction. Please don't suck through a straw or swish vigorously for a couple of days post-op. The main thing that would hinder healing is smoking. If you smoke, consider using patches as the nicotine in tobacco can constrict blood vessels and prevent healing. Smokers often get a dry socket, a painful condition. If you're worried about this, call the office and I can provide a medicated paste.
If there's any bleeding, bite on the gauze we provide. A good home remedy is a teabag, or you can apply ice on the outside of the face. You can use warm compresses after the first 72 hours if you wish. If your pain isn't managed by over-the-counter medicine, give us a call and I can prescribe something stronger.
Take any antibiotic that we prescribe to completion. Amoxicillin or penicillin are our go-tos if you don't have an allergy to them. If you need an antibiotic, I'll let you know and get you one after the procedure. After the first three to five days, the clot will be pretty stable. It'll start to scab over. In about three to four to five weeks, the gum will be fully healed in the area. The most common time for a post-op infection is about a week after the surgery. If your condition starts to get worse and not better, let us know.
Dental Implants
If we punch the tissue, meaning there are no stitches, there's almost nothing to worry about. You might experience mild spot bleeding in the area if you brush and floss, and mild pressure. Most of the healing and discomfort and post-op complications come with the extraction, not with the implant. If there are any sutures around the implant to hold the gum down around it, you should be gentle in the area, be gentle brushing, and be gentle eating. Kind of avoid it for a couple of days. We'll have you back in a week or two to take the stitches out.
With an implant, if the site's closed over or if there's a healing cap on there and there are no stitches, you can pretty much do whatever you want. You're not going to hurt it. The only thing I advise against is using a water pick on the implant. You can use a water pick everywhere else, and I do want you to brush and floss. If you can't fit your full toothbrush in there, I'll give you a little one to brush the cap with. But don't try and blast the water pick down under and into the implant.
The implant is at its weakest about three to four weeks from the time of surgery. So after the first couple of days, you shouldn't feel anything at all. If you're seeing any redness, pus, bleeding, pain, or you're worried something's moving, especially if it's about a month from the surgery, three to four weeks from surgery, give us a call. If you're going to have a problem, it's usually three to four weeks from surgery.
Immediate Dentures
What is immediate denture?
Immediate denture is when we take out your remaining teeth and put the denture in the same day. These aftercare instructions are for those without dental implants or implants that aren't attached to the denture or buried under the denture.
These are the aftercare instructions for if we're delivering immediate denture with all the teeth removed, with or without implants underneath them.
What if you have dental implants underneath the denture?
If you have implants underneath them, you're going to see a stainless steel healing cap that's going to show through the gum. After the gum heals for a little bit, you do want to gently brush this. We give you some little brushes to brush that with. That's the only real difference for when you have implants.
Also, if you have an implant, the weakest time for the implant is about a month after surgery, three or four weeks after surgery. If you're having a problem, especially if it's three or four weeks after surgery, any increased pain, bleeding, pus, swelling, anything like that, please call me. Those are the only two modifications for implants under a denture.
What should you do in the first 24 hours?
If you don't have implants under your denture, we're going to deliver it the day of surgery, and then we're going to do a 24-hour check. Normally, I want you to take your denture out at night, clean your denture, gently stimulate the gum with a very soft brush or something like the edge of a washcloth or gauze or something like that. But you do want to stimulate that tissue so that you clean it.
For the denture, the first 24 hours I do not want you to take it out. If you take the denture out in the first 24 hours, the tissue is going to swell and you probably won't be able to get the denture in for a couple days again. The first day, just leave it in at night. We'll take it out the next day and we'll adjust all the sore spots.
How many adjustments should you expect after getting dentures?
I usually tell people to expect three to five adjustments. Some people it's less, some people it's more. But three to five adjustments is average. The day after surgery, we'll do a 24-hour check. We'll check your bite because you were numb the day before, and we'll check for sore spots.
Anytime you get a new denture, there's going to be some sore spots. It's like getting a blister if you have a new shoe. The denture is new; it might rub somewhere and need to be adjusted. That's why we do the 24-hour check. Past that, it's as needed. If you're feeling a sore spot, give us a call, and we'll adjust it.
Should I wear my denture full-time?
It is easier for me to see how the denture is fitting and adjust it if you do wear it full-time. Now, if it's sore and it's over the weekend or something, and you need to take it out for comfort, go for it. But typically, it's easier for me to see and adjust the denture if you wear it. You put it in the morning, wear it during the day, take it out at night, clean it, and go to bed without it on.
Wearing it at night, some people do it for social reasons, but if you're going to do that, you really need to stimulate and brush the gums. I advise leaving it out at night. It's kind of like where I choose to bed, but if you're going to wear the denture to bed, you really need to spend a good couple of minutes stimulating and brushing and massaging the gum, and rinse and clean the denture thoroughly, and then put the denture back in. But I recommend leaving it out at night.
Should my denture be stored wet or dry?
Different opinions and thoughts on this. If you store it dry, the bacteria are going to kind of die off. If you store it wet, it kind of keeps it in a similar environment throughout. The one thing I don't recommend is leaving it in overnight in a mouth rinse that has dye in it, so over time the blue or green in the rinse will pick up into the denture. You can rinse it with mouth rinse, you can swish with mouth rinse, but I wouldn't soak it in mouth rinse for continuous periods.
Do you need denture cleaning tablets?
Denture cleaning tablets: if you're cleaning the denture every night with a denture cleaning brush or an old toothbrush, and I recommend just soap and water, liquid soap, baby soap, any type of unscented dish soap, any type of unscented soap, just clean it with that, rinse it, and then store it dry or wet.
They do make denture cleaning tablets, and since clear aligners are very popular now, they came out with something called cleaning crystals, which is basically a crushed-up denture tablet. Whatever is cheaper, the cleaning crystals or the denture tablets.
If you're cleaning them every day with soap and water, you're probably not going to need to do this, but if it gunks up, you can bring it into the office, and we can clean it for you professionally. We don't charge for that. But if you want to do it at home, you can buy small ultrasonic cleaners on Amazon, or use denture tablets. If you're cleaning it thoroughly every day with soap and water, you shouldn't need to do that.
Should you use soap and water or toothpaste on dentures?
I do recommend soap and water over toothpaste. You can use toothpaste. The abrasive content in the toothpaste will slowly wear down the denture more quickly.
What about wearing the denture at night and grinding?
Also, if you're wearing the denture at night, especially if you're opposing natural teeth, it's going to wear down a lot quicker if you don't have a night guard. Anytime I do an all-on-x case or implant overdentures, I always do a night guard.
If you're wearing your denture at night for social reasons, you may want to consider putting an extra layer of plastic, like an Invisalign retainer or something like that, over the denture so that you're not wearing your denture down as quickly. Because teeth on plastic, the plastic will wear more quickly. Teeth on teeth is still going to wear. Teeth on plastic, the plastic is going to wear more quickly. Teeth on teeth, your teeth are going to wear. Most everyone grinds their teeth at night a little bit. The people we say do it are the people we see the wear patterns on over time.
If you have a denture, you invest a lot in that, especially if it's nice. I always recommend a guard if you're wearing your dentures at night. We probably want to protect that with something just so you wear down a cheaper plastic than resetting all your teeth in the denture, making you a new denture.
What should you expect as your gums heal and shrink?
Your gums will puff a little bit, but then they're going to heal and shrink. As they're healing and shrinking, which is going to take three to six months to fully heal in the bone, it's going to start to shrink. A denture fits like a suction cup, so as the tissue is pulling away from the denture, it's going to start to have voids in it. Adhesive is a great option for a while.
At about the three-month mark, if it's a little loose, we have a soft liner, or you can come back in, and we can send it back out to the lab for a hard liner. If we do an immediate denture, it's always going to need to be relined. I recommend a soft liner at about month three if you need it, and a hard liner at about month six. It doesn't have to follow that pattern exactly, but that's kind of average.
If your denture is loose or you don't like adhesive, we can always line it with a harder soft liner, and that's for a denture of any age. If your denture is loose or ill-fitting and you'd like to get it lined, let us know.
When and how should you use denture adhesive?
Adhesive: I do like adhesive, especially for immediates, just not in the area that the surgery was done for a couple of weeks. On the upper, usually there's no surgery on the roof of the mouth, so you can put a little dot on the upper. On the lower, if you've had areas where teeth have already been out, you can put a couple of dots there. A full set of adhesive for the upper would be kind of three pea-sized dots on the outside and maybe one on the roof. On the lower, again, three or four pea-sized dots going around. You just want to put the little pea-sized dots on.
You want to dry the denture first, put the adhesive on, then soak it or run it underwater so it's wet, and then seat it, and then the adhesive will kind of spread out, and it provides some extra cushion retention to the denture. We don't want this in the extraction sites right after surgery, so give it a couple of weeks for the gums to heal up before you start using adhesive anywhere in the surgical site. It's not really going to get in there and really mess up the healing, but the adhesive is very sticky; it's very hard to remove. If you're trying to remove it from the healing sites, it's going to start bleeding again. It's basically going to start your healing at day one, so it's going to delay the healing. You want to avoid that as much as possible in those areas. But if there are areas that have been healed for a bit, we can put a little denture adhesive down.
The brand doesn't matter. There are lots of different brands, and they're all good. We have some samples we give people the day of surgery, so we'll give you some as a sample. It's not that I recommend that brand, they all work. Just buy whatever you like the best or whatever's on sale or whatever is cheapest for you.
What if a bone spur comes out or you have implants?
If months after surgery, you're having a little bone spur come out, give us a call, that's whenever it happens. If you have implants, it's going to be about three to four months before we can load those or put snaps on those into the denture. We can put on a little snap, kind of like the snap on this jacket, into the denture at three or four months, and that really adds extra retention into the denture if you have implants. At that point, we would add the little snaps in and reline it as well.
What should you expect long term for my dentures?
When you're in your final, that should be stable for a number of years. I've had cases set on five or six years ago that haven't been adjusted or changed since. We do recommend, if you're without teeth and no implants, once a year, come in for an oral cancer screening and just an exam, check the bone, check the denture, things like that. If you have implants, you can build tartar up around the implants, so you could need a cleaning every six months or, rarely, every three. Some people only need to come in every year. They're good at cleaning, and they don't build up tartar.
If you have implants, we'll let you know when you need to come in for the tartar around the implants.
What if you do not like the teeth or setup?
The immediate denture, if you don't like the teeth or setup, it can be switched out, so if you want to switch that out, just let us know.
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All-On-X
What is an All-on-X?
An All-on-X is when we take out your remaining teeth, if there are any, place about four to six implants per arch, and then affix a denture to those implants that day.
What should I expect on the day of surgery and at the 24-hour check after getting dental implants?
The day of surgery, you're going to be very numb, and you're going to be a little groggy from the anesthesia. We always do a 24-hour check for the bite. When you're a little more alert and awake, we'll check the bite and go over post-care instructions again. At the 24-hour check, I'll check the bite on the denture.
What can I eat with the temporary denture?
The temporary denture is usually acrylic or print resin, you don't want to eat anything that you can't cut with a cheap fork and knife. That's kind of my generic go-to, so you don't have to be on a liquid diet, but kind of a softer diet. Steak is fine if it's medium rare, and burgers are fine.
There are a lot of foods that are fine, but I wouldn't get a big old sub sandwich that's really crunchy and just try to munch on that. I'd avoid nuts, things like that. Things that are really hard and crunchy, I would avoid. If it's soft enough to cut with kind of a cheap fork and knife, a plastic fork and knife, go for it. Really hard foods you want to wait on until your final.
When will I get my final dental implants and what are they made of?
We'll do your final typically about four months after surgery. Your final will typically be out of zirconia, so you can pretty much do whatever you want with that.
Do I need a guard with my final?
With that, we do want you to have a guard with the final. Everyone clenches and grinds their teeth a little bit, and the zirconia on zirconia is going to chip the porcelain at some point. If you can't tolerate a guard, what I'll usually do is keep one arch in zirconia and one arch in acrylic so that we intentionally wear down one arch over the other. But I do recommend a guard for All-on-X cases for the final.
Will the initial prosthesis feel bulky or affect my speech?
The initial prosthesis is going to feel bulky. It's going to take time to get used to. It's going to be a phonetic adaptation. Anytime we're doing anything that changes the way air goes through the mouth, whether it's a cosmetic rehabilitation or dentures, it's going to change your speech a little bit.
If you read out loud to yourself 15 minutes every night before you go to bed, that helps you adapt more quickly. In two or three weeks, you will have adapted to the speech of it, and it'll be fine.
What is healing like for dental implants?
The first couple of weeks of healing are the worst. That's when the tissue is healing, and you kind of have to be careful around the stitches. You will have a lot of stitches in there. They will be resorbable, so we don't have to cut them out. I do use a nicer, longer resorbable suture. It's going to take a couple of weeks for it to resorb. It's usually purple; sometimes it's white. You might see little pieces coming up. That's fine.
How should I clean under the denture while healing?
You do want to clean under it gently, so I would give it a couple days before you do any vigorous swishing. Then, past day five, I would start swishing more vigorously, and then past that, as long as it's not uncomfortable, we'll give you a little irrigating syringe to start irrigating under it. At about three weeks, the tissue should be pretty healed up, and you should be able to clean thoroughly under there with a water pick.
Do I need to brush the denture?
You do need to brush the denture. You don't need to have toothpaste on your toothbrush; you can if you want, but you do need to brush all of the denture because plaque is going to build up on the denture, and it's going to affect the healing of the implants.
As the tissue heals under the denture, it's going to shrink, and as it shrinks, there's going to be a bigger void under there, and food's going to get caught in there. You definitely want to get a water pick, both for the temporary and the final. You just don't want to blast under there super hard right after surgery.
At about three weeks, the tissue is going to be nice and healed. It's going to be pretty safe to blast under there fairly aggressively with a water pick. You do want to water pick out all the food.
Will food get caught under the final and will it need to be removed for cleaning?
When we do your final, we're going to line it back down to the height of the tissue, so you won't really have stuff getting caught as much in there anymore. We try to make it so it's easy to clean underneath, and if that's the case, then we don't really need to take it out to clean it. If we can't do that and there's kind of a saddle over the arch, we might occasionally take it out to clean it. We try to avoid that to make it easier for you and for us, so we're not having to take it in and out all the time.
How often do I need maintenance cleanings with dental implants?
You do want to get your implants and your permanent denture cleaned the same way as you would your teeth. They can't get cavities because there are no teeth in there to get a cavity anymore, but they can get gum disease. If you've had an issue with gum disease before, we might have you on a three- or four-month maintenance schedule.
If you haven't, or you don't build tartar quickly, it might be six, or maybe even nine or twelve. We'll let you know what we need to see you on, but we'll start you on the shorter maintenance and extend it over time because we don't want tartar to get on the implant and get down under the gum and negatively impact the bone around the implant.
How do you make the final prosthesis and can I change anything?
I typically do a digital workflow, or something called the triple jig. It saves us time from converting your temporary to your final. About four months after all the implants have healed, if there are any changes, of course, if you want to change the teeth, change the color, change anything in any way, we can certainly do that, but we'll transition from your temporary to your final.
As you're getting closer to the four-month part, be critical about what you want changed. Other than that food gap, of course, we're going to fix that, but if you want the color changed, or the size or shape of the teeth changed, now is the time to do that. We'll take it out, test all the implants, and scan. There's something cool called photogrammetry, an extraoral scanner. There are a lot of cool techniques we use to scan the mouth. We are mostly digital now. We'll scan that, or we'll use the model from surgery to convert your temporary into your final, so you'll never be without something that's screwed in.
What happens if an implant fails or the denture can't be immediately loaded?
The only exception to that would be if implants fail or if we can't immediately load the denture. We always try to immediately load the denture. I can't guarantee it. Everyone's bone is different. Different people have different infections around certain teeth, different anatomical structures. I need at least four implants to go into a certain level of tightness to be able to immediately load your denture, so that's always our goal.
If you lose an implant while you're healing, we might need to convert you to a regular denture. Again, it's rare. It happens. The number one cause of failure in implants is diabetes, so if you're a diabetic, I would expect at least one of your implants to fail, and we can replace it, and that may or may not affect your timeline or the final prosthesis, depending on where and when you lose the implant.
Sometimes we'll bury additional implants the day of surgery and uncover them later. Sometimes the same implants you have at the beginning are the ones you have at the end. Sometimes we have to take one out or add one, or things like that, so these are all options.
It's not going to impact your long-term outcome. It might add separate steps in the interim. Don't worry about it. Your final is going to be just as good if we have to add separate additional steps. We try and avoid that, but if we need to, we will. We'll get it taken care of for you. We'll get you a nice final. That's the ultimate goal, to get you a nice final.
What should I do if I have pain, swelling, discomfort, or infection after getting dental imlants?
If you have any pain, swelling, discomfort, infection, or anything like that around the prosthesis while it's healing, let us know. But the important thing for you is to be gentle with it the first little bit after surgery, but after that, really aggressively clean that thing. You can't over-clean it. We need that thing clean so the tissue can heal, the implants can heal, and we can get you to your final.
What if I chip or break a tooth on the temporary denture?
If you chip or break a tooth off the plastic, let me know. We'll fix it, but your main job is just to keep it clean and work with home care, and then I'll worry about all the technical stuff and the implants and the integration and the final and all that.
What about clenching and grinding on the temporary denture?
Pretty much everyone clenches and grinds their teeth at night a little bit. We will definitely get you a guard in the final. I've had patients who have chipped or broken a provisional because they aggressively grind in their temporary, so we might, on occasion, need to do that in your temporary as well.
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