Patient Resources

This is a reminder that we are looking forward to seeing you on (date) for your surgical procedure.

1. If your physician has prescribed medications (i.e. blood pressure medication) continue to take them as directed the day of your surgery. You are not having IV sedation, so you may eat or drink as you normally would prior to your appointment. You do not need a designated driver.
2. If our office has prescribed a prescription, please fill, and take as directed. If you have a known allergy to aspirin or any antibiotic, have ulcers or other health concerns related to these prescriptions, please inform us at the time of scheduling.
3. If you take any Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) on a daily basis, please DO NOT take daily for 2 weeks prior to surgery or 2 weeks after surgery. Most common types of NSAIDs are: Meloxicam, Ibuprofen, Naproxen, Celecoxib, Aspirin*.
   *If the Aspirin dose exceeds 325 mg per day. If your daily dose exceeds 325 mg per day, you should decrease your dose to 325 mg per day or less, two weeks prior to surgery. If you are currently taking one baby aspirin (81mg) or one adult aspirin (325 mg) per day for the prevention of stroke or heart attack, you should continue taking this dosage for the duration of the dental implant process.
   You MUST discuss stopping these medications with your prescribing provider before stopping.
4. You must denote any medications you are taking at the time of scheduling the surgery. If there are any changes to your medications on the day of the surgery or prior to, please make sure to notify our office.
5. The day prior to surgery, take 600mg of Motrin 4 times: At breakfast, lunch, dinner and before bed. (As long as you are not allergic. Please ask for alternatives if allergic.)
6. Bring any denture, partial or flipper that you are presently wearing with you to your appointment so if we need to adapt it we can do so.
7. SMOKING IS NOT PERMITTED prior to or after the surgical procedure.

If you have any questions, please contact our office. 614-885-1215 or office@oirdental.com

This is a reminder that we are looking forward to seeing you on (date), for your surgical dental procedure. Since you will be given intravenous medication along with local anesthesia, you are required to comply with the following instructions.

1. If you are scheduled for a morning surgery, do not eat or drink anything after midnight the night before your appointment.
2. If you are scheduled for an afternoon surgery (1:00pm or after) you may have a light or liquid breakfast BEFORE 7:00am the day of your scheduled appointment. Liquids permitted: no pulp juice, black coffee, tea, clear broth. Foods permitted: toast (no butter), Jell-O, dry cereal (no milk). No sugar or dairy products.
3. If our office has prescribed a prescription, please fill, and take as directed. If you have a known allergy to aspirin or any antibiotic, have ulcers or other health concerns related to these prescriptions, please inform us at the time of scheduling.
4. The day prior to surgery, take 600mg of Motrin 4 times: At breakfast, lunch, dinner, and before bed.
5. You must denote any medications you are taking at the time of scheduling the surgery. If there are any changes to your medications on the day of the surgery or prior to, please make sure to notify our office.
6. If your physician has prescribed medications (i.e. blood pressure medication) continue to take them as directed the day of your surgery with a small sip of water. Insulin needs to be taken as directed either oral or injection. If your medication requires you to take it with food, please call our office.
7. If you take any Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) on a daily basis, please DO NOT take daily for 2 weeks prior to surgery or 2 weeks after surgery. Most common types of NSAIDs are: Meloxicam, Ibuprofen, Naproxen, Celecoxib, Aspirin*.
   *If the Aspirin dose exceeds 325 mg per day. If your daily dose exceeds 325 mg per day, you should decrease your dose to 325 mg per day or less, two weeks prior to surgery. If you are currently taking one baby aspirin (81mg) or one adult aspirin (325 mg) per day for the prevention of stroke or heart attack, you should continue taking this dosage for the duration of the dental implant process.
   You MUST discuss stopping these medications with your prescribing provider before stopping.
8. Wear loose or comfortable fitting clothing. Long sleeved items need to fit over your arms and elbows easily and loosely. Short sleeves are ideal. Flat heel shoes are required.
9. No facial makeup.
10. No jewelry on your ears, neck, or wrists.
11. No fingernail polish.
12. Male patients need to be clean-shaven; however, it is not necessary to remove beards or mustaches.
13. Bring any denture, partial or flipper that you are presently wearing with you to your appointment so if we need to adapt it we can do so.
14. SMOKING IS NOT PERMITTED prior to or after the surgical procedure.
15. Your designated driver needs to remain on the premises during your procedure.

If you have any questions, please contact our office. 614-885-1215 or office@oirdental.com.

StellaLife® is a biotech company on a mission to improve people’s lives by supporting healing and helping reduce pain, swelling, and the need for narcotic pain medications.

The homeopathic VEGA® Oral Care encompasses a broad spectrum of applications, ranging from recovery to maintenance, and from oral inflammatory conditions to pain management. Active ingredients are part of Homeopathic Pharmacopeia of the United States. In addition, the solutions promote exceptional long-term oral health care.

Patient Application Guide

Our office recommends StellaLife® be used for after surgery, cold sores, canker sores, aphthous ulcers, chemotherapy patients, erosive lichen planus, dry sockets, dry mouth, tissue grafts, angular cheilitis. The products are natural, non-staining, and sugar-free and come in a gel, rinse, or spray option.

Use for 7 DAYS after the procedure

Gel

Apply with a cotton swab to the site, 3-4 times per day, preferably after meals. Do not eat for 20 mins after application.

Rinse

Swish 1-2 minutes, 3 times per day, preferably after meals. Do not eat for 20 mins after application.

Spray

Spray under tongue, 3-4 times per day, preferably after meals. Do not eat for 20 mins after application.

Products can be ordered at:

• stellalife.com
• Amazon

If IV medication has been given, you cannot drive a car for the remainder of the day. It is advised that you have someone remain with you until your sedated condition wears off.

If you had sutures placed, two weeks after the surgery the sutures will be removed and you will be examined by the doctor.

Usually you are able to continue wearing your present partial or flipper. Sometimes it is necessary to leave it in the night of the surgery. It is important to keep the appliance as clean as possible during the healing period. Your referring dentist can make a temporary tooth replacement for you, if it is necessary. If braces are being worn, your orthodontist can place a tooth for cosmetic purposes.

Every consideration must be given to keep the surgical site clean and free of food particles. The following are instructions for your mouth care after surgery.

1. NO SMOKING: Smoking is to be avoided for the time specified by Dr. Heller or Dr. DiDonato, since it increases the heat in the surgical area and significantly lowers the body’s ability to heal.
2. Avoid Alcohol for 30 hours, commercial mouth rinses with alcohol and very hot fluids and foods for 30 hours after your surgery. Room temperature to cold is adequate. Anything that is cooked must be allowed to cool.
3. Gentle rinsing of the mouth should be started the day of surgery. Frequent gentle rinsing with lukewarm saltwater will aid the healing process and maintain cleanliness. Add ½ teaspoon of salt to a six-ounce glass of water. Avoid use of a water pik.
4. Ultra-Soft Brush: please begin using the Ultra-Soft brush 24 hours after your surgery to clean and stimulate the tissue. It will not harm the sutures. Dip the brush into the saltwater rinse and brush directly on the surgical site. Sutures should be brushed at least twice daily.
5. Antibiotics: IV sedated patients have received an appropriate antibiotic through their IV line. You may be given a follow-up antibiotic prescription. Please take as directed. Patients who have not had IV sedation should follow the directions of the prescription given to them prior to surgery. If an appropriate antibiotic has been prescribed for you today, it is very important that the prescription is filled and taken as directed. PLEASE TAKE THE TABLETS/CAPSULES UNTIL ALL ARE USED. Should you develop hives, itching, skin rash, or difficulty breathing, stop taking the medication and call the doctor immediately or proceed to your nearest hospital emergency room.
6. Probiotics: If you have been prescribed an antibiotic, please consider taking an over-the-counter probiotic supplement. The probiotic will provide more friendly bacteria present in the gut, the lower the chance of developing digestive issues like diarrhea. Three strains of probiotics in particular, Lactobacillus acidophilus, Lactobacillus rhamnosus  and Bifidobacterium lactis  have been shown to do this. They can safely be taken at exactly the same time as antibiotic medication. Yogurt is another option for probiotics. However, keep in mind that not all yogurt contains live probiotics. In some cases, the live bacteria have been killed during processing. For this reason, make sure to choose yogurt with active or live cultures. Also, always read the label on yogurt before you buy it and look for the Lactobacillus strain. The recommended dosage is as follows for either the probiotic supplement or yogurt:
   • Take one probiotic capsule daily with breakfast, with your antibiotic medication and until the antibiotic course is finished, and for one week after.
   • Eat one tablespoon of yogurt each time you take your antibiotic tablet.
7. Pain: a certain amount of pain must be expected with all types of surgery. An appropriate pain medication has been prescribed to you. Please take it according to the instructions. It is advised that you do not drive while taking the pain prescription. However, if only Motrin is needed, most people are able to drive without any problem.
8. Swelling: some swelling and possible minimal bruising is to be expected and is not unusual. In most instances, swelling can be prevented or controlled. Apply the ice pack that has been given to you for a period of 20 minutes on and 20 minutes off during the day for the next two days. The application of ice to the outside of the face over the surgical area will minimize the swelling. If after three days you still have inordinate swelling or pain, please call our office.
9. Bleeding: a small amount of bleeding following surgery should not alarm you. If the bleeding is excessive or continuous, please call us at once. Vigorous rinsing of the mouth prolongs bleeding by removing the clotting blood, so when rinsing your mouth, do it gently.
10. DO NOT spit, gargle, or suck on a straw for 24 hours following your surgery. This tends to loosen the sutures and blood clots.
11. Diet: following the surgery, it is best to restrict your diet to fluids or soft foods for the first day. A normal diet may then be resumed the following day but you will want to avoid chewing on the implant site until the tissue is completely healed. Soft foods such as Jell-O, pudding, mashed potatoes, scrambled eggs, ice cream, and soups are suggested. If you have difficulty chewing, trying putting food in a blender or diet supplements such as Carnation Instant Breakfast or Ensure.

Additional Instructions:

If you have been given a prescription for a Medrol Dose Pack , please take it as follows not in the manner in which it reads on the package Please take all the pills for the first day in one dose as early in the morning as possible and do the same with each daily dose there after until gone. If given a refill please do not get it filled unless you have been instructed too by the office.

If you have any questions, please contact our office. 614-885-1215 or office@oirdental.com

A dental implant has just been placed in your mouth.  The implant is located in the bone, under the tissue & usually cannot be seen.  The implant will remain submerged for a period of 4 to 6 months, depending upon your body’s healing properties & the type of implant placed.  NEVER USE A WATER PICK NEAR YOUR IMPLANT, EVEN AFTER WORK IS FINISHED.  IT CAN CAUSE THE IMPLANT TO FAIL.

• IF I.V. medication has been given to you, you are not allowed to drive a vehicle or operate heavy machinery for 24 hours following. It is advised to have someone with you during that time period, or until your sedation completely wears off
• 2 weeks following your surgery, you will need to have your sutures out and be examined by the doctor.
• If you wear a partial, denture, flipper or essay retainer – you may take it out to brush, eat, use the surgical red brush or use salt water rinse.  Keep the appliance as clean as possible at all times, you may soak it in Efferent cleaner, brush it lightly and rinse it regularly.  However, you will need to wear it during the night while you’re sleeping on the very first night of the day you had surgery.  After the very first night of wearing your appliance, you should take it every night after that, it will help the tissue to heal (unless you have been directed otherwise).

1. 1. No smoking at all!  You can’t be around anyone who does for 3 days. Smoke, nicotine & heat slow down your healing time and can cause the implant(s) to fail.
   2. No alcohol to drink for 30 hours after your surgery.  We also advise not to use rinses with alcohol in it, as it will dry out the tissues and prevent healing.
   3. Salt water – you will do salt water rinses 3 to 4 times daily for two weeks after surgery – 1/2 teaspoon to a 6 ounce glass of warm water (be very gentle when doing so – holdout the side of your mouth and tilt your head side to side vs. rinsing.  Lean over the sink and let the water fall out. Do not spit.
   4. Red Brush – use the red brush on the sutures within 24 hours of the surgery, 3 to 4 times a day for two weeks.  You need to keep sutures clean (no white stuff on sutures). Doing this properly will help stimulate the tissue, promoting tissue to heal.  It will not harm the sutures in any way.  You can also dip the brush into salt water.
   5. Antibiotics: I.V. sedated patients have received an antibiotic through the I.V. line.  You may be given a follow up antibiotic to take.  You will start that antibiotic the day after surgery in the morning.
   6. Antibiotics: If an antibiotic has been prescribed for you today, it is extremely important that it is taken until gone.  Should you develop hives, rash, itching or difficulty breathing, PLEASE STOP THE MEDICATION AND CALL OUR OFFICE, YOUR DOCTOR, AND GO TO THE NEAREST EMERGENCY ROOM.
   7. Probiotics: If you have been prescribed an antibiotic, please consider taking an over-the-counter probiotic supplement. The probiotic will provide more friendly bacteria present in the gut, the lower the chance of developing digestive issues like diarrhea. Three strains of probiotics in particular, Lactobacillus acidophilus, Lactobacillus rhamnosus  and Bifidobacterium lactis  have been shown to do this. They can safely be taken at exactly the same time as antibiotic medication. Yogurt is another option for probiotics. However, keep in mind that not all yogurt contains live probiotics. In some cases, the live bacteria have been killed during processing. For this reason, make sure to choose yogurt with active or live cultures. Also, always read the label on yogurt before you buy it and look for the Lactobacillus strain. The recommended dosage is as follows for either the probiotic supplement or yogurt:
      • Take one probiotic capsule daily with breakfast, with your antibiotic medication and until the antibiotic course is finished, and for one week after.
      • Eat one tablespoon of yogurt each time you take your antibiotic tablet.
   8. Please follow prescriptions given to you prior and after your surgery.
   9. Pain: A certain amount of pain is to be expected with all types of surgery.  A pain medication has been prescribed to you, take it as directed.  It is advised that you do not drive or operate heavy machinery while taking the medication.
   10. Motrin/Ibuprofen/Advil: These are all the same type of medication.  Please take 600mg every 4 to 6 hours following your surgery for 3 days. This type of medication is not only for pain but is an anti-inflammatory as well, which will help with swelling.  If you are not able to take this type of medication, take Tylenol Extra Strength 400mg every 4 to 6 hours for 3 days.
   11. Swelling:  Some swelling is to be expected and possible bruising may occur and is not unusual. In most cases swelling can be prevented or controlled.  Please use an ICE PACK – applied to the outside of your face on the side of the surgery for 20 MINUTES ON AND 20 MINUTES OFF FOLLOWING YOUR PROCEDURE.  It is best to use the ice pack for 24 to 48 hours, following your surgery.  If after 3 days you still have swelling or pain, please call our office. IF URGENT and it is after hours, call our office and a doctor will provide you with help. If not, please leave a message and we will return your call promptly.
   12. Bleeding:  You will experience a small amount of bleeding and this is normal.  If it is excessive (blood filling your entire mouth within seconds) please call our office.
   13. NO VIGOROUS RINSING, SPITTING, OR SUCKING THROUGH A STRAW FOR 24 HOURS AFTER YOUR SURGERY.  IT WILL PROLONG THE HEALING TIME.
   14. Diet: Soft cold things are ok right away such as: Jello, pudding, yogurt, milk shake, ice cream, frosty, carnation breakfast or Ensure. Nothing hot the day of surgery, but you may have warm and soft food such as, mashed potatoes, eggs, soup, broth or soft noodles.  Avoid chewing on the implant site until the doctor or staff informs you that it is ok to do so.  You may have other foods days following that are normal, although it is up to you personally can tolerate, just no chips, nuts or anything sharp or chewy lie gum or hard bread.

A bone grafting procedure(s) has just been completed for you. Sutures have been placed to hold the tissues together during healing. Two weeks after the surgery, the sutures will be removed, and you will be examined by the doctor. There may be two types of sutures utilized and some may be left in place for an additional 2 weeks.

If I.V. medication has been given, you cannot drive a car for the remainder of the day. It is advised that you have someone remain with you until your sedated condition wears off.

In most cases with an advanced bone grafting procedure if you wear a removable appliance to replace teeth in the area of the surgery, you WILL NOT be able to continue to wear it as it will put pressure on the site and will cause it to not heal properly. If you are able to wear the appliance it is important to keep the appliance as clean as possible during the healing period. You may need to use denture adhesive to hold your partial or denture in place during healing. Avoid placing adhesive directly on the suture line.

Every consideration must be given to keep the surgical site clean and free of food particles. The following are instructions for your mouth care after surgery:

1. NO SMOKING. Smoking is to be avoided for the time specified by Dr. Heller since it increases the heat in the surgical area and significantly lowers the body’s ability to heal the site.
2. Avoid alcohol for 30 hours after your surgery, commercial mouth rinses with alcohol for two weeks, and very hot fluids and foods for 30 hours after surgery. Lukewarm to cold is adequate. Anything that is cooked must be allowed to cool down.
3. Rinsing: Gentle rinsing of the mouth should be started the day of surgery. Frequent gentle rinsing with lukewarm saltwater will aid the healing process and maintain cleanliness. Add ½ teaspoon of salt to a 6-ounce glass of water. Avoid use of a water pik.
4. Ultra-Soft Brush: Please begin using the Ultra-Soft 24 hours after your surgery to cleanse and stimulate the tissue. It will not harm the sutures. Dip the brush into the saltwater rinse and brush directly on the surgical site. Sutures should be brushed at least twice daily.
5. Antibiotics: IV Sedated patients have received an appropriate antibiotic through their IV line. You may be given a follow-up antibiotic prescription. Please take as directed. Patients who have not had IV sedation should follow the direction on the prescription given to them prior to surgery. If an appropriate antibiotic has been prescribed for you today, it is VERY important that the prescription is filled and taken as directed PLEASE TAKE THE TABLETS/CAPSULES UNTIL ALL ARE USED. Should you develop hives, itching, skin rash, or difficulty breathing, stop the medication and call the doctor immediately or proceed to your nearest hospital emergency room.
6. Probiotics: If you have been prescribed an antibiotic, please consider taking an over-the-counter probiotic supplement. The probiotic will provide more friendly bacteria present in the gut, the lower the chance of developing digestive issues like diarrhea. Three strains of probiotics in particular, Lactobacillus acidophilus, Lactobacillus rhamnosus  and Bifidobacterium lactis  have been shown to do this. They can safely be taken at exactly the same time as antibiotic medication. Yogurt is another option for probiotics. However, keep in mind that not all yogurt contains live probiotics. In some cases, the live bacteria have been killed during processing. For this reason, make sure to choose yogurt with active or live cultures. Also, always read the label on yogurt before you buy it and look for the Lactobacillus strain. The recommended dosage is as follows for either the probiotic supplement or yogurt:
   • Take one probiotic capsule daily with breakfast, with your antibiotic medication and until the antibiotic course is finished, and for one week after.
   • Eat one tablespoon of yogurt each time you take your antibiotic tablet.
7. Pain: A certain amount of pain must be expected with all types of surgery. An appropriate pain medication has been prescribed for you. Please take it according to the instructions. It is advised that you do not drive while taking the pain prescription. However, if only Motrin is needed, most people are able to drive without any problem.
8. Swelling: Some swelling and possible minimal bruising is to be expected and is not unusual. In most instances, swelling can be prevented or controlled. Apply the ice pack that has been given to you for a period of 20 minutes on and 20 minutes off during the day for the next two days. The application of ice to the outside of the face over the surgical area will minimize swelling. If after three days you still have inordinate swelling or pain, please call the office.
9. Bleeding: A small amount of bleeding following surgery should not alarm you. If the bleeding is excessive or continuous, please call us at once. Vigorous rinsing of the mouth prolongs bleeding by removing the clotting blood, so when rinsing your mouth, do it gently. Nose bleeding for 1-2 days following the sinus elevation can be expected. Nose bleeding for longer than two days would be out of the ordinary and you should call Dr. Heller.
10. DO NOT spit, gargle, or suck on a straw for 24 hours following your surgery. This tends to loosen the sutures/blood clots.

Additional Instructions:

If you have been given a prescription for a Medrol Dose Pack , please take it as follows not in the manner in which it reads on the package Please take all the pills for the first day in one dose as early in the morning as possible and do the same with each daily dose there after until gone. If given a refill, please do not get it filled unless you have been instructed too by the office.

If you have any questions, please contact our office. 614-885-1215 or office@oirdental.com

A bone grafting procedure(s) has just been completed for you. Sutures have been placed to hold the tissues together during healing. Two weeks after surgery the sutures will be removed and you will be examined by the doctor.

If I.V. medication has been given, you cannot drive a car for the remainder of the day. It is advised that you have someone remain with you until your sedated condition wears off.

Usually you are able to continue wearing your present partial or flipper. Sometimes it is necessary to leave it in the night of surgery. It is important to keep the appliance as clean as possible during the healing period. You may need to use denture adhesive to hold your partial or denture in place during healing. Avoid placing adhesive directly on the suture line.

Every consideration must be given to keep the surgical site clean and free of food particles. The following are instructions for you mouth care after surgery:

1. NO SMOKING. Smoking is to be avoided for the time specified by our dentists since it increases the heat in the surgical area and significantly lowers the body’s ability to heal the site.
2. Avoid alcohol, commercial mouth rinses and very hot fluids and foods for 30 hours after your surgery. Room temperature to cold is adequate. Anything that is cooked must be allowed to cool down.
3. Rinsing: Gentle rinsing of the mouth should be started the day of surgery.  Frequent gentle rinsing with lukewarm saltwater will aid the healing process and maintain cleanliness. Add 1/2 teaspoon of salt to a 6 ounce glass of water. Avoid use of a Water Pik.
4. Ultra-Soft Brush: Please begin using the red brush 24 hours after your surgery to cleanse and stimulate the tissue. It will not harm the sutures. Dip the brush into the saltwater rinse and brush directly on the surgical site. Sutures should be brushed at least twice daily.
5. Antibiotics:
   • I.V. sedated patients have received an appropriate antibiotic through their I.V. line. You may be given a follow-up antibiotic prescription. Please take as directed.
   • Patients who have not had I.V. sedation should follow the directions on the prescription given to them prior to surgery.
   • If an appropriate antibiotic has been prescribed for you today, it is very important that the prescription is filed and taken as directed. PLEASE TAKE THE TABLETS/CAPSULES UNTIL ALL ARE USED. Should you develop hives, itching, skin rash or difficulty breathing, stop the medication and call the doctor immediately or proceed to your nearest hospital emergency room.
6. Probiotics: If you have been prescribed an antibiotic, please consider taking an over-the-counter probiotic supplement. The probiotic will provide more friendly bacteria present in the gut, the lower the chance of developing digestive issues like diarrhea. Three strains of probiotics in particular, Lactobacillus acidophilus, Lactobacillus rhamnosus  and Bifidobacterium lactis  have been shown to do this. They can safely be taken at exactly the same time as antibiotic medication. Yogurt is another option for probiotics. However, keep in mind that not all yogurt contains live probiotics. In some cases, the live bacteria have been killed during processing. For this reason, make sure to choose yogurt with active or live cultures. Also, always read the label on yogurt before you buy it and look for the Lactobacillus strain. The recommended dosage is as follows for either the probiotic supplement or yogurt:
   • Take one probiotic capsule daily with breakfast, with your antibiotic medication and until the antibiotic course is finished, and for one week after.
   • Eat one tablespoon of yogurt each time you take your antibiotic tablet.
7. Pain: A certain amount of pain must be expected with all types of surgery. An appropriate pain medication has been prescribed for you. Please take it according to the instructions. It is advised that you do not drive while taking the pain prescription. However, if only Motrin is needed, most people are able to drive without any problem.
8. Use the Neo-Synephrine nose spray as directed. 2-3 sprays per nostril every 12 hours for the next 4 days.
9. Swelling: Some swelling and possible minimal bruising is to be expected and is not unusual. In most instances, swelling can be prevented or controlled.  Apply the ice pack that has been given to you for a period of 20 minutes on and 20 minutes off during the day for the next two days. The application of the ice to the outside of the face over the surgical area will minimize swelling. If after three days you still have inordinate swelling or pain, please call the office.
10. Bleeding: A small amount of bleeding following surgery should not alarm you.  If the bleeding is excessive or continuous, please call us at once. Vigorous rinsing of the mouth prolongs bleeding by removing the clotting blood, so when rinsing your mouth, do it gentle. Nose bleeding for 1-2 days following sinus elevation can be expected. Nose bleeding for longer than 2 days would be out of the ordinary and you should call Dr. Heller.
11. Blowing nose: DO NOT blow your nose, just wipe. If necessary, blow very gently with both nostrils open. If you need to sneeze, do not hold it in, but sneeze with your mouth open.
12. DO NOT spit, gargle or suck on a straw for 24 hours following your surgery.  This tends to loosen the sutures/blood clots.

An implant has just been placed in your mouth. The implant is located in the bone, under the tissue and usually cannot be seen. The implant will remain submerged for a period of four to six months, depending upon your body’s healing properties and the type of implant placed. NEVER USE A WATER PIK NEAR YOUR IMPLANT IMMEDIATELY AFTER SURGERY. IT CAN CAUSE THE IMPLANT TO FAIL.

1. If IV medication has been given to you, you are not allowed to drive a car or operate heavy machinery for 24 hours following. It is advised to have someone with you during that time period, or until your sedation completely wears off.
2. 2 weeks following your surgery, you will need to have your sutures removed and be examined by the doctor.
3. Your provisional is screwed into place; please keep it in your mouth. Do not pull on prosthesis.
4. NO SMOKING at all. You cannot be around anyone who does smoke for three days. Smoke nicotine and heat slow down your healing time and can cause the implant(s) to fail.
5. NO ALCOHOL to drink for 30 hours after your surgery. We also advise not to use rinses with alcohol in it until the sutures are removed, as it will dry out the tissues and prevent healing.
6. Rinse with a saltwater solution 3-4 times daily for two weeks after surgery- ½ teaspoon to a 6- ounce glass of warm water. Be very gentle when doing so-hold at that side of your mouth and tilt your head side to side vs. swishing. Lean over sink and let the water fall out. Do not spit.
7. Use the ultrasoft Post-Op toothbrush on the sutures within 24 hours after surgery, 3 to 4 times a day for two weeks. You need to keep sutures clean (no white stuff on sutures) doing this properly will help stimulate the tissue, promoting tissue to heal. It will not harm the sutures in any way. You can also dip the brush into the saltwater solution.
8. Antibiotics: IV sedated patients have received an antibiotic through the IV line. You may be given a follow up antibiotic to take. You will start that antibiotic the day after surgery in the morning. If an antibiotic has been prescribed for you today, it is extremely important that it is taken until gone. Please follow prescriptions given to you prior and after your surgery. Should you develop hives, rash, itching, or difficulty breathing, PLEASE STOP THE MEDICATION AND CALL OUR OFFICE, YOUR DOCTOR, AND GO TO THE NEAREST EMERGENCY ROOM.
9. Probiotics: If you have been prescribed an antibiotic, please consider taking an over-the-counter probiotic supplement. The probiotic will provide more friendly bacteria present in the gut, the lower the chance of developing digestive issues like diarrhea. Three strains of probiotics in particular, Lactobacillus acidophilus, Lactobacillus rhamnosus  and Bifidobacterium lactis  have been shown to do this. They can safely be taken at exactly the same time as antibiotic medication. Yogurt is another option for probiotics. However, keep in mind that not all yogurt contains live probiotics. In some cases, the live bacteria have been killed during processing. For this reason, make sure to choose yogurt with active or live cultures. Also, always read the label on yogurt before you buy it and look for the Lactobacillus strain. The recommended dosage is as follows for either the probiotic supplement or yogurt:
   • Take one probiotic capsule daily with breakfast, with your antibiotic medication and until the antibiotic course is finished, and for one week after.
   • Eat one tablespoon of yogurt each time you take your antibiotic tablet.
10. A certain amount of pain is to be expected with all types of surgery. A pain medication has been prescribed for you, take as directed. It is advised that you do not drive or operate heavy machinery while taking the medications.
11. Motrin/Ibuprofen/Advil– these are all the same type of medication. Please take 600mg every 4-6 hours following your surgery for three days. This type of medication is not only for pain, but is an anti-inflammatory as well, which will help with swelling. If you are not able to take this type of medication, take Tylenol extra strength 500mg every 4-6 hours for three days.
12. Some swelling is to be expected and possible bruising may occur, and it is not unusual. In most cases, swelling can be prevented or controlled. Please use an ICE PACK-applied to the outside of your face on the side surgery was performed for 20 minutes on and 20 minutes off following your procedure. It is best to use the ice pack for 24-48 hours following your surgery. If after three days you still have swelling or pain, please call our office. If URGENT and it is after hours, call our office and a doctor will provide you with help. If not, please leave a message and we will return your call promptly.
13. You will experience a small amount of bleeding and this is normal. If it is excessive (blood filling your entire mouth within seconds) please call our office.
14. NO VIGOROUS RINSING, SPITTING, OR SUCKING THROUGH A STRAW FOR 24 HOURS AFTER YOUR SURGERY. IT WILL PROLONG HEALING TIME.
15. Diet: soft cold things are okay right away such as:
    • Jell-O, pudding, yogurt, milkshake, ice cream, frosty, Carnation breakfast or Ensure.
    • Nothing hot the day of surgery, but you may have warm and soft food such as, mashed potatoes, eggs, soup, broth, soft noodles. Avoid chewing on the implant site until the doctor or staff informs you that it is okay to do so. You may have other foods following that are more normal, although it is up to what you personally can tolerate, just no chips, nuts, or anything sharp or chewy like gum, or hard bread.

Additional Instructions:

If you have been given a prescription for a Medrol Dose Pack , please take it as follows not in the manner in which it reads on the package Please take all the pills for the first day in one dose as early in the morning as possible and do the same with each daily dose there after until gone. If given a refill please do not get it filled unless you have been instructed too by the office.

If you have any questions, please contact our office. 614-885-1215 or office@oirdental.com.

While no incisions or sutures/stitches are involved, there are still some important post-operative instructions that you should follow.

If you have any pain or excessive bleeding following your treatment, please contact our office. 

Normally, some discomfort is to be expected, and some slight bleeding is also normal, but should be minimal. Severe pain or excessive bleeding are NOT normal and should be addressed immediately.

• Do not be alarmed by any color changes or appearance of tissues following laser normal response to laser treatments.

Try to keep your mouth as clean as possible in order to help the healing process. Brush, floss and follow other home-care measures in all the areas of your mouth except for the treated areas for a couple of days. Do not apply excessive tongue or cheek pressure to the treated areas.

• NO SMOKING. Smoking is to be avoided for the time specified by our dentists since it increases the heat in the surgical area and significantly lowers the body’s ability to heal the site.
• Avoid alcohol and very hot fluids and foods for 30 hours after your surgery. Room temperature to cold is adequate. Anything that is cooked must be allowed to cool down.
• It is very important to maintain a good food and fluid intake. Try to eat soft but nutritious foods, such as eggs, yogurt, cottage cheese, malts, ice cream, etc., until you can comfortably return to a normal diet.
• Rinsing: Gentle rinsing of the mouth should be started the day of surgery.  Avoid commercial mouth rinses. Frequent gentle rinsing with lukewarm salt water will aid the healing process and maintain cleanliness. Add 1/2 teaspoon of salt to a 6 ounce glass of water.
• Do not chew on the side of your mouth that has been treated for a couple of days.

Activity: After leaving the office, avoid strenuous physical activity for the next 2-3 days.

Swelling: Some swelling may be present after the surgery for the first week. Cold liquids may help reduce swelling, discomfort, and bleeding. Sip iced drinks, milkshakes, or similar cold liquids and keep the surgical area cold for the remainder of the day after surgery. Do not use a straw, as this suction can start bleeding. Swelling may also be minimized by placing an ice pack over the operated area on the outside of the face for the first 48 hours following the surgery, alternating on and off at 15-20-minute intervals.

Oral Hygiene: No brushing, flossing, or touching surgical site(s) for 6 weeks post-surgery. Continue to brush and floss the teeth that were NOT involved in the surgery. The surgical area should NOT be disturbed for the entire 6 weeks. However, you may rinse gently, (lips apart, no chipmunk cheeks), with salt water or with a mouthwash if prescribed. Patients with Waterpik irrigation systems may use from tongue side or inside only.

Discomfort and Medications: As is the case with any surgical procedure, some discomfort can be expected following the surgery. Expect cold sensitivity for 6 weeks or longer. Please follow the instructions for any medications prescribed. If any adverse reaction to those medications should arise, such as nausea, itching, swelling, or any allergic symptoms, please contact the office immediately and discontinue all medication. Here are some our most commonly used medications, all of which may not apply to you.

Ibuprofen – Healthy adults can take up to 800mg of Ibuprofen every 8 hours if needed. This may help with pain, swelling and inflammation.

Mouthwash – If you are prescribed a mouthwash, you should begin to use it the day after the surgery. Gently rinse with about a tablespoon for 30 seconds and then spit it out. Use twice daily. Do not rinse vigorously. Try not to eat or drink for one hour following use.

Antibiotics – If antibiotics are prescribed; take them as directed until ALL ARE GONE, as long as there are no adverse reactions or discomfort. Women, please be aware the antibiotics can interfere with the effectiveness of oral contraceptives. If taking oral contraceptives, an alternative form of birth control is recommended for at least 4 weeks following the completion of the antibiotics.

Probiotics: If you have been prescribed an antibiotic, please consider taking an over-the-counter probiotic supplement. The probiotic will provide more friendly bacteria present in the gut, the lower the chance of developing digestive issues like diarrhea. Three strains of probiotics in particular, Lactobacillus acidophilus, Lactobacillus rhamnosus  and Bifidobacterium lactis  have been shown to do this. They can safely be taken at exactly the same time as antibiotic medication. Yogurt is another option for probiotics. However, keep in mind that not all yogurt contains live probiotics. In some cases, the live bacteria have been killed during processing. For this reason, make sure to choose yogurt with active or live cultures. Also, always read the label on yogurt before you buy it and look for the Lactobacillus strain. The recommended dosage is as follows for either the probiotic supplement or yogurt:

• Take one probiotic capsule daily with breakfast, with your antibiotic medication and until the antibiotic course is finished, and for one week after.
• Eat one tablespoon of yogurt each time you take your antibiotic tablet.

Eating and Drinking: It is necessary to maintain a relatively normal diet throughout the course of healing. Drink plenty of fluids. For the first few days, softer foods can be eaten. Hot foods and hot drinks should be avoided. Also, avoid using a straw. If possible, chewing should be done predominately on the side opposite the surgical site. It may be necessary to stick to liquids for the first day if chewing is uncomfortable. Avoid foods that are hard, sticky, or crunchy or difficult to cleanse from the surgical site (popcorn, caramel candies, chips, etc.)

Smoking: Please refrain from smoking during the post-surgical period as tobacco use interferes with the healing process.

DO NOT DISTURB GRAFTING: Do not look at or disturb the graft. Try to avoid touching the graft or pulling on the lips in the treated area. Graft stability is critical for success.

Sutures: They are usually not needed, but in some cases may be placed if deemed necessary. These are the stitches which may get loose over time and fall out on their own. Most will dissolve, but continued follow-up care is still necessary.

Follow-Up: Additional follow-up care and maintenance is critical for the long-term success of your surgery. Please continue to follow-up as recommended.

Problems or Questions? Call the doctor immediately, if you have unexpected pain, continuous bleeding, or heat from the surgical site.

If you have been given a prescription for a Medrol Dose Pack , please take it as follows not in the manner in which it reads on the package Please take all the pills for the first day in one dose as early in the morning as possible and do the same with each daily dose there after until gone. If given a refill, please do not get it filled unless you have been instructed too by the office.

If you have any questions, please contact our office. 614-885-1215 or office@oirdental.com.

If IV medication has been given, you cannot drive a car for the remainder of the day. It is advised that you have someone remain with you until your sedated condition wears off.

If you had sutures placed, two weeks after the surgery the sutures will be removed and you will be examined by the doctor.

In some cases, you are able to continue wearing your present provisional prosthesis. Sometimes it is necessary to leave the prosthesis out after surgery to allow proper healing. It is important to keep the
appliance as clean as possible during the healing period.

Every consideration must be given to keep the surgical site clean and free of food particles. The following are instructions for your mouth care after surgery.

1. NO SMOKING: Smoking is to be avoided for the time specified by Dr. Heller or Dr. DiDonato, since it increases the heat in the surgical area and significantly lowers the body’s ability to heal.
2. Avoid Alcohol for 30 hours, commercial mouth rinses with alcohol and very hot fluids and foods for 30 hours after your surgery. Room temperature to cold is adequate. Anything that is cooked must be allowed to cool.
3. Gentle rinsing of the mouth should be started the day of surgery. Frequent gentle rinsing with lukewarm saltwater will aid the healing process and maintain cleanliness. Add ½ teaspoon of salt to a six-ounce glass of water. Avoid use of a water pik.
4. Ultra-Soft Brush: please begin using the Ultra-Soft brush 24 hours after your surgery to clean and stimulate the tissue. It will not harm the sutures. Dip the brush into the saltwater rinse and brush directly on the surgical site. Sutures should be brushed at least twice daily.
5. Antibiotics: IV sedated patients have received an appropriate antibiotic through their IV line. You may be given a follow-up antibiotic prescription. Please take as directed. Patients who have not had IV sedation should follow the directions of the prescription given to them prior to surgery. If an appropriate antibiotic has been prescribed for you today, it is very important that the prescription is filled and taken as directed. PLEASE TAKE THE TABLETS/CAPSULES UNTIL ALL ARE USED. Should you develop hives, itching, skin rash, or difficulty breathing, stop taking the medication and call the doctor immediately or proceed to your nearest hospital emergency room.
6. Probiotics: If you have been prescribed an antibiotic, please consider taking an over-the-counter probiotic supplement. The probiotic will provide more friendly bacteria present in the gut, the lower the chance of developing digestive issues like diarrhea. Three strains of probiotics in particular, Lactobacillus acidophilus, Lactobacillus rhamnosus  and Bifidobacterium lactis  have been shown to do this. They can safely be taken at exactly the same time as antibiotic medication. Yogurt is another option for probiotics. However, keep in mind that not all yogurt contains live probiotics. In some cases, the live bacteria have been killed during processing. For this reason, make sure to choose yogurt with active or live cultures. Also, always read the label on yogurt before you buy it and look for the Lactobacillus strain. The recommended dosage is as follows for either the probiotic supplement or yogurt:
   • Take one probiotic capsule daily with breakfast, with your antibiotic medication and until the antibiotic course is finished, and for one week after.
   • Eat one tablespoon of yogurt each time you take your antibiotic tablet.
7. Pain: a certain amount of pain must be expected with all types of surgery. An appropriate pain medication has been prescribed to you. Please take it according to the instructions. It is advised that you do not drive while taking the pain prescription. However, if only Motrin is needed, most people are able to drive without any problem.
8. Swelling: some swelling and possible minimal bruising is to be expected and is not unusual. In most instances, swelling can be prevented or controlled. Apply the ice pack that has been given to you for a period of 20 minutes on and 20 minutes off during the day for the next two days. The application of ice to the outside of the face over the surgical area will minimize the swelling. If after three days you still have inordinate swelling or pain, please call our office. You may be given a post-operative medication for swelling PLEASE TAKE IT AS DIRECTED.
9. Bleeding: a small amount of bleeding following surgery should not alarm you. If the bleeding is excessive or continuous, please call us at once. Vigorous rinsing of the mouth prolongs bleeding by removing the clotting blood, so when rinsing your mouth, do it gently.
10. DO NOT spit, gargle, or suck on a straw for 24 hours following your surgery. This tends to loosen the sutures and blood clots.
11. Diet: following the surgery, it is best to restrict your diet to fluids or soft foods for the first day. A normal diet may then be resumed the following day but you will want to avoid chewing on the implant site until the tissue is completely healed. Soft foods such as Jell-O, pudding, mashed potatoes, scrambled eggs, ice cream, and soups are suggested. If you have difficulty chewing, trying putting food in a blender or diet supplements such as Carnation Instant Breakfast or Ensure.
12. Please do not pull on your cheeks or lips to look at the surgery site.
13. Limit spicy and acidic foods for the first 2 weeks and we will re evaluate at the time of the suture removal.

Additional Instructions:

If you have been given a prescription for a Medrol Dose Pack , please take it as follows not in the manner in which it reads on the package Please take all the pills for the first day in one dose as early in the morning as possible and do the same with each daily dose there after until gone. If given a refill, please do not get it filled unless you have been instructed too by the office.

If you have any questions, please contact our office. 614-885-1215 or office@oirdental.com

Avoid eating/drinking anything hot until the numbness goes away.

You may experience some discomfort on the tooth that has been treated. This may last anywhere between 7-10 days. Swelling in the affected area may also occur. These are not unusual post-operative events.

Discomfort may be alleviated by taking ibuprofen (Advil), aspirin, or acetaminophen (Tylenol) as directed.

Your doctor may also prescribe medications such as narcotic analgesics, prednisone (steroids), and/or antibiotics for pain management and/or facial swelling. Please follow written instructions and precautions with their use.

NOTE: Alcohol intake is not advised while taking any of these medications. Should you experience discomfort that cannot be controlled with the above listed medications, or should swelling develop, please
contact the office immediately.

If your tooth has been left open to drain

In order to alleviate your distress, your tooth has been left open for drainage. Follow these instructions until your next appointment:

1. Irrigate your tooth as instructed with warm salt water for five minutes after every meal or snack (one teaspoon of salt in a glass of warm water). Place the warm water in the affected area, hold it there until it cools, then rinse out. A small piece of cotton may have been placed in your tooth. If it falls out, it may
   be replaced with a fresh piece provided for you.
2. Avoid blocking the open tooth with food by cautiously eating on the opposite side of your mouth. Avoid eating foods that may contain small seeds in it that may get caught in the tooth. To prevent any
   accidental food blockage, continuously and gently rinse after meals or snacks with warm salt water.
3. Avoid using objects (such as toothpicks) to remove debris within the tooth. Gentle and continuous warm saltwater rinses are often all that are needed for removal of debris.
4. If medication(s) have been prescribed, use according to directions. Notify this office in the event of any significant swelling, pain, or problems from the prescribed medication. Remember that even though
   your tooth may be comfortable, follow-up treatment is necessary!

If you have any questions, please contact our office. 614-885-1215 or office@oirdental.com

The next 72 hours are important in enhancing and maximizing your whitening results for a long-lasting, bright, and healthy smile.

Everyone’s teeth have a protective layer called the acquired pellicle. This layer contains the surface dental stains and is removed during a regular dental cleaning or the whitening process. It takes twelve to twenty-four hours for the barrier to fully develop again.

To maximize the whitening, we ask that for the next 72 hours, you DO NOT consume dark or yellow staining substances such as:

• Tobacco Products
• Coffee / Tea
• Red Wine
• Dark Colored Sodas

In addition, do not use any colored mouthwash or home fluoride treatments.

Minimizing Pain

While extreme discomfort after treatment is uncommon, a small number of patients do report experiencing heightened sensitivity from Zoom! Whitening. This discomfort presents itself as a bothersome tingling sensation, often referred to as ‘zingers,’ on your teeth.

If post-operative sensitivity occurs, to ease your symptoms we recommend taking anti-inflammatory medication such as what you would normally use for a headache.

You can also purchase over-the-counter toothpastes, such as Sensodyne, that aid in treating sensitivity to use until your teeth return to their normal sensitivity levels.

OUR TIP: Teeth whitening is a safe, painless procedure for most. However, excessive treatment and overuse of whitening gel can be highly damaging to the health of your teeth and gums. Whether you choose Zoom! Whitening or another treatment for your smile, be sure to follow the instructions carefully.

The long-term success of your implant is fundamentally dependent upon both your effective home care routine and on the dental team’s administration of professional procedures in the dental office. You are considered a co-therapist in maintenance therapy and your contribution is indispensable.

As soon as your implants are placed and restored, the immediate care you will be responsible for is:

Thorough at-home oral hygiene

Your first checkup at no more than 6 months

Reports of any discomfort 

Report any:

Tissue Soreness

After the implant supported prosthesis is placed, it takes a little time for the tissues to adapt to the new situation. Therefore, slight pain and light bleeding in the tissues may occur.

Most often, the symptoms gradually disappear after a period of time or after simple adjustments performed by the doctor.

Discomfort When Chewing

Pain or discomfort when biting down on something, most often concludes that the bite needs to be adjusted. The same is true when a part of the restoration is “too high”.  It is important to consult the doctor. It is essential that the restoration/prosthesis fits perfectly in the bite so all chewing forces are evenly distributed on the implants.

It is important to know that adjustments are normal after receiving your dentures, overdentures or prosthesis. It can take a while for your tissues to become used to the new prosthesis. Therefore, it is not uncommon to require a few adjustments within the first couple of weeks. As time goes on, the underlying bone structure will change as well. Because of this, you may require an adjustment every couple of years for maximum fit and comfort.

Adjust Your Diet Accordingly

Once you have your new dentures, overdentures or prosthesis , there are certain foods you will want to avoid, such as hard nuts or corn on the cob. Most patients do quite well with softer foods in the beginning, such as eggs, yogurt, cooked vegetables, fish, potatoes, ice cream, and more. However, it is important to maintain proper nutrition as well, so be sure you are eating well-balanced meals and healthy snacks.

Clean Regularly

You will accumulate plaque and tartar just like your natural teeth. They can also stain. Therefore, it is important to brush your removable prosthesis using a toothbrush or denture brush. You should also use a denture cleanser soak daily to eliminate debris, food particles, and bacteria. Be sure to rinse them well before reinserting them. It is also crucial that you keep brushing your gums, tongue, and cheeks with a soft toothbrush and toothpaste twice a day. This will not only eliminate the bacteria that causes bad breath, it will also prevent fungal infections.

Speak More

Typically, there is a slight learning curve when it comes to speaking with dentures or overdentures. While some patients become used to them right away, others may require a few weeks before talking feels natural. We encourage you to speak as much as possible during the first couple of weeks. Even reading out loud helps. The more you can practice, the faster your tongue and soft tissues will become accustomed to your new teeth.

Stay Hydrated

Drinking lots of water is a good idea for anyone. However, if you suffer from dry mouth, it is even more important to stay hydrated. Certain medications can lead to dry mouth. If you think this could be the underlying cause of your condition, speak to your medical doctor about the possibility of adjusting your prescriptions or dosages.

Give Your Tissues a Rest

We always recommend sleeping without your dentures. This will give you plenty of time to soak them, and it will also give your gums a break and allow them to heal from any soreness or irritation.

Generally, it takes time to get used to any new restoration. However, after a period of time, the implant-supported prosthesis should look, function, and feel like regular teeth.

Periodic Monitoring

Implants should be professionally evaluated at least twice a year during regular checkups. Criteria for the success are the absence of pain, stability, mobility, bone integration around implants, the lack of infection or bleeding in the soft tissues, adequate function, and aesthetics in the prosthetic. X Rays are taken annually, the oral mucosa is checked and a cleaning is performed. The patients should report any pain, discomfort or unusual signs. Necessary adjustments will be made. 

Maintenance of Removable Dentures and Overdentures

Removable dentures and overdentures require continuous maintenance. 

Replacement of Worn Attachments

The attachments that are housed in the denture need to be changed or refreshed every one to two years because they wear. The operation is extremely simple and quick.

Relining

Relining is indicated when a removable denture fit has worsened due to the manufacturing material (normally acrylic) from the base of the denture wearing and/or the bone beneath the denture has diminished in height. This results in an unstable denture causing tissue trauma. A denture reline involves the replacing and refitting of the tissue side of the denture to custom fit to the mouth. This is done at the dental lab and the procedure typically takes 2 appointments. It is not very expensive.

Oral Hygiene

At-Home Implant Care

Proper and thorough oral hygiene is a prerequisite for a successful dental implant. Poor oral hygiene greatly increases the risk of failure.

Patients with dental implants generally have a history of less-than-ideal home care, resulting in the partially or edentulous state. These patients may moreover have improper oral hygiene practice due to postsurgical fear of causing damage, on the one hand, or overzealous home care trying to stay absolutely plaque free, on the other hand. Either of these situations can lead to detrimental consequences. Therefore, oral hygiene instructions should include detailed verbal guidance and visual demonstration for the long-term success of the implant and its restoration. Also, the oral hygiene techniques and aids used by patients should be reevaluated during every hygiene visit. 

Removable dentures, overdentures, fixed prostheses and implant crowns and bridges will accumulate plaque and tartar just like your natural teeth. They can also stain. Therefore, it is important to brush using a toothbrush.  On a removable denture, use a denture brush. You should also use a denture cleanser soak daily to eliminate debris, food particles, and bacteria. Be sure to rinse them well before reinserting them.

Even if you are missing all of your natural teeth, it doesn’t mean you should stop brushing. On the contrary, it is crucial that you keep brushing your gums, tongue, and cheeks with a soft toothbrush and toothpaste twice a day. This will not only eliminate the bacteria that causes bad breath, it will also prevent fungal infections.

Brushing

Twice daily cleaning of implants to remove bacterial plaque accumulations should be accomplished using a soft toothbrush or a power brush. A tapered brush to access the undersurface of connector bars or to aid with interdental cleansing is also recommended. 

Several powered toothbrushes have been shown to not cause hard or soft tissue damage and to effectively reduce plaque and inflammation around the adjacent periodontal tissues. These brushes are considered superior to a manual toothbrush in removing plaque and they contribute to the improved interproximal cleaning due to bristle shapes. A patient with limited dexterity should use a power toothbrush.

In difficult-to-access areas smaller-diameter toothbrush heads such as end-tufted brushes or tapered  brushes may be of benefit. An end-tufted brush can accommodate the shape of the prosthesis and is especially useful in posterior regions where a conventional toothbrush might not reach. You can use the interdental brush heads to clean under hybrids

Interproximal Cleaning

There are many flosses, interproximal cleaners, and water irrigation systems commercially available and safe for use around implants.

Floss choice should be based on the clinical indication. The following types of floss may be used to remove interproximal plaque.

Braided flossing cord, such as PostCare is more rigid than conventional floss and suitable for open areas and places where a floss threader may be too fragile to remove denser plaque, debris, and calculus.

Satin Floss or Glide is particularly appropriate for a single tooth implant with tight tissue adaptation.

Woven, such as Thornton Bridge & Implant Cleaners or GUM Expanding Floss is indicated where there are large interproximal spaces or long expanses of a bar retained prosthesis.

Yarns can be used to access and cleanse larger embrasure spaces and under connector bars, but these should not be considered if there is the possibility of the fibers being retained on rough surfaces or around the restorations.

Dental Tapes are available in different “widths” and are used to clean the exposed abutment.

Other types include tufted, coated, and gauze thicker dental floss. All of these can be used in a “shoe-shine rag” fashion to facilitate optimal home care procedures around the abutment post. Threader floss may also be needed to access bridgework or around connector bars.

Interproximal brushes, aka “proxabrushes” can be selected and recommended considering the size and shape of the space, when patients are unable to use floss.  Whereas larger spaces can be properly cleaned with a proxabrush, smaller proxabrushes, such as Go-Betweens Cleaners are helpful in narrower interproximal spaces. However, caution must be used with interproximal brushes that have an exposed tip of metal wire or if enough pressure is exerted, as that can easily scratch the abutment’s titanium surface. 

Rubber tip stimulators and disposable picks are among the many auxiliary devices that can assist in plaque removal.

Water Irrigation 

A water flosser is a must for implant maintenance. However, care must be taken to direct the stream interproximally and horizontally between implants, as improper positioning can cause inadvertent damage to the peri-implant seal. Keep the unit at a low to medium setting and spend 3 seconds per implant site. 

Tablets that contain Xylitol that can be added to the water flosser. Xylitol starves the Streptococcus Mutans bacteria that are the source of plaque and acid.  

Locally Applied Chemotherapeutics

For implant patients especially those prone to occasional tissue inflammation, an at-home regimen of daily cleansing with chemotherapeutic agents in the form of rinses, gels, or solutions is extremely essential. CrestPro Health or StellaLIfe is typically what our office recommends for healing or sore tissues. Another option is rinsing with a salt water solution. Dissolve ½ to one teaspoon of salt in a glass of warm water. This solution helps to soothe irritated tissues as well as draw out infection, allowing your gums to heal.

Professional Hygiene Care

Routine maintenance, professional evaluations, cleanings and radiographs are necessary to insure the long life of these restorations. These procedures are performed at selected intervals to assist you in maintaining oral implant health.  Typically, every 6 months. 

During your hygiene appointment, our hygienists and doctor will evaluate these 8 items:

1. Assessment of peri-implant and gingival tissues=color and consistency
2. Palpate for presence of exudate/suppuration=signs of infection
3. Probe depths are taken=bone loss or peri-implantitis
4. Oral hygiene evaluation=presence of plaque and calculus
5. Mobility of the implant or prosthetic components=loose abutments or screws
6. Radiographic evaluation=bone levels around the implant(s)
7. Occlusal evaluation=correct bite
8. Prosthetic assessment=retention of attachments, missing or worn attachments 

Implants necessitate intensive care that goes far beyond mere brushing of teeth. Natural teeth are anchored to the socket via periodontal ligament, which has an inherent protective defense mechanism, and hence are better protected against outside attacks than the implant. Despite the long-term predictability of implants, complications do occur in a percentage of cases and can ultimately result in loss of implants and failure of prostheses. Regular professional hygiene care for patients with dental implants as well as treating peri-implantitis in a timely manner can minimize and prevent implant loss/failure due to such complications.

The dental hygienist has an important role to play in keeping dental implants infection-free, and there are many factors to be considered in selecting the right instruments for a professional cleaning. They include: the nature of the debris, meaning whether soft (biofilm, foods) or hard (calculus or tartar); the location of the deposits; the type of surface on which they accumulate; and the stubbornness with which they adhere.

Your hygienist will select instruments for cleaning that will not damage the crown, abutment, or the implant itself. Maintaining the highly polished, smooth surface of the abutment and crown are critical. If they are scratched they can attract and harbor bacteria. That’s why the instruments used in our office, called scalers and curettes, are made of solid titanium. Medical grade titanium instruments are biocompatible and soft enough to avoid scratching implants. Natural teeth don’t scratch in the same way, and therefore metal instruments can be used to clean them.

Another method we use to clean around implants is with an ultrasonic scaler.  The ultrasonic instruments have plastic tips to minimize implant damage. They clean by using high-frequency vibration, which may be necessary if large quantities of debris have accumulated. They are used on a low power setting with a lot of water irrigation, and sometimes antibacterial solutions, to clean and flush debris.

If any part of the implant body itself is visible, this may mean there is infection that has resulted in tissue and/or bone loss. The implant surface becomes exposed following loss of its fusion to the bone. Implant surfaces are generally microscopically “roughened” to increase surface area for bone attachment. But this surface roughness makes implants difficult if not impossible to clean and disinfect. Additionally, some implants are screw-shaped and their threads just add to the cleaning dilemma.

Brushes are used to clean biofilm from exposed areas of an implant wherever possible. If calculus or dental cement (used to secure the crowns) is present on an implant surface, the hygienist needs to use instruments that are effective in removing these contaminants. In such cases the clinician must ensure no scratching or damage is caused by completing the task.

Risks and Complications

Within the First 6 Months

These complications occur in the first 6 months after implant placement. The most common complication is the failure to integrate. However, the risk of complications is considered to be very low – less than 5 percent, according to current statistics. Problems are rare and when they do occur, they are usually minor and easily treated. Please, contact us if you are experiencing any pain or tenderness. 

Long Term Complications

Long-term implant failures may be caused by an improper design of the prosthetic restoration or by inappropriate care and maintenance. Regardless of the cause, implants fail due to either loss of bone around them or a mechanical failure of the implant.

There are also risks associated with the prosthetic components which over time can wear off, chip, break or cause a lack of satisfaction on the part of the patient.

The good news is that about 95% of implants today are successful. Moreover, a well-integrated implant with appropriate biomechanical loads can have long-term success rates for the fixture and close to 15 years lifespan for the prosthetic teeth.

The professional implant maintenance you will receive at our office, coupled with your diligent home care are critical factors that will ensure the long-term success of your implants.  We pride our practice on providing an exceptional dental experience and we give our patients the compassion we would offer our own family members. You deserve to be proud of your smile and confident in life. Thank you for choosing our office to provide you with your dental implants. We look forward to many more years together as we maintain your optimal dental health.

Our office recommends brushing teeth for a minimum of two minutes, twice a day, with a soft-bristled toothbrush.

The right toothbrush is a matter of personal preference and financial considerations.

A classic, manual brush costs a few dollars. An electric toothbrush can cost close to $100. According to the American Dental Association (ADA), both works equally well to clean your teeth if used properly.

There are certain important characteristics that are common to either good manual or powered toothbrushes.

• Brush Head Size: The brush head should allow easy access to all surfaces. A ½” wide and 1” high head most comfortable and effective. The handle should be long enough to reach everywhere and feel comfortable.
• Bristles: Toothbrush bristles come in soft, medium, or hard varieties. Generally, soft-bristled, round-tipped toothbrushes are easiest and safest. Medium and hard-bristled brushes, if used incorrectly or too vigorously damage gums, root surfaces, and tooth enamel.

Dentists recommend products that have passed rigorous quality control tests. The ADA seal of acceptance is a reliable endorsement, signifying the toothbrush is safe and efficacious for plaque removal and gingivitis reduction.

Manual or Electric?

If you prefer a manual toothbrush, the choices of brush head designs are myriad. Multilevel or angled bristles with rounded tips perform better than conventional, flat-trimmed bristles in removing plaque and biofilm. Soft bristles minimize the risk of gingival abrasion.

If you prefer a powered toothbrush, you may find that it is easier to use, cleans in a shorter time, and is more efficient at hitting hidden crevices, nooks, and crannies. Additional benefits include built-in timers to ensure you brush for long enough, and to remind you when to change direction, or “quadrant’” to ensure equal attention to all areas; and pressure sensors to prevent over-brushing.

Despite so many choices, it is not the brush but how you use it that is critical. With proper brushing techniques, plaque buildup can be reduced, and gums kept healthy with either manual or electric toothbrushes.

Some differences to consider before choosing between a manual/disposable toothbrush or an electric brush:

• Cost: Electric toothbrushes cost much more. The toothbrush head will need to be replaced as often as a manual toothbrush – every 3-4 months, especially if bristles become matted or frayed or if you have been ill.
• Personal choice: Some do not like or cannot tolerate the vibration of a powered toothbrush. Others find it easier to clean all tooth surfaces. Your preference will determine what type of brush you use for the recommended 2 minutes. Some powered varieties include a built-in timer.
• Effectiveness: Studies find that overall, electric toothbrushes are more effective in removing plaque and preventing gum disease than manual toothbrushes.

Toothbrushes for Children

The best toothbrush is the one your child will regularly use. Disposable and electric-powered toothbrushes are available for kids. A variety of colors and children’s favorite characters from classic stories and cartoons make them more fun. Some even play music for the brushing-time needed.

More importantly, a child’s toothbrush should be child-sized with soft bristles, ADA-approved, and chosen by your child to give them a sense of ownership, enjoyment, and excitement.

We highly recommend the use of a water flosser to help clean around your implants.

What is a Water Flosser?

A water flosser is an oral health appliance designed for dental care at home around your teeth and implants.

The targeted stream of water removes plaque, food particles, and bacteria in a way that’s more effective, more comfortable, and easier than traditional floss. The pulsating action also stimulates gum tissue for added health benefits.

Why Choose a Water Flosser?

If you do not like floss, do not floss often, or find floss hard to use, a water flosser can be the answer.

• Many people find water flossing easier and more pleasant than using string floss, and they may floss more often as a result.
• Gum disease prevention and treatment is another reason to use a water flosser. Waterpik® Water Flossers are clinically proven to reduce gingivitis, remove plaque, and improve gum health.
• Water flossers are especially useful for cleaning bridges, crowns, and dental implants.
• Water flossers are helpful for people with dexterity issues, such as arthritis, who find traditional flossing difficult.

Water Flossing Guide

The correct technique is the key. You do not need to look in the mirror or hold your mouth open wide. To use a water flosser:

1. place the flosser tip in your mouth,
2. close your lips most of the way,
3. lean over the sink,
4. with the power on low to medium setting,
5. hold the tip at a 90-degree angle as you floss along the gumline and between your teeth and implants,
6. spend 3 seconds per implant site,
7. allow the water to empty from your mouth into the sink

Listed below are our recommendations for Countertop and Cordless Waterpik Water Flossers:

The Waterpik Water Flossers come with specialized tips that are especially effective for use with dental implants.

Our Favorite Tips

***These tips can be used on the above-recommended water piks.

Waterpik® Plaque Seeker™ Tip (PS-100E)

The Plaque Seeker™ Tip is designed to provide the benefits of pulsating water using three thin tufts of bristles to access stubborn plaque around implants, crowns, bridges, veneers, and other areas that are especially susceptible to plaque accumulation.

Waterpik® Implant Denture Tip (DT-100E)

The Implant Denture Tip is specifically designed to access areas that are unreachable with other tips to clean fixed implant bridges and dentures.

Vitamin D deficiency is a worldwide public health problem that spans all age groups from children to adults. The major source of vitamin D comes directly from sunlight exposure and certain foods. Studies have now shown that roughly 70% of society is deficient.

Vitamin D deficiency is most known for its association in osteoporotic and menopausal women however it plays a substantial role in various other diseases as well. These include depression, dementia, Alzheimer’s disease, asthma, cancer, cardiovascular disease, diabetes among others.

More recently, vitamin D deficiency has also been associated with up to a 300% increase in dental implant failure and other dental-related complications such as gingivitis and chronic periodontitis, as it has been shown to have antibacterial, anti-inflammatory, and wound-healing effects.

In addition, vitamin D is important for bone metabolism, alveolar bone resorption, preventing tooth loss, and promoting bone formation around dental implants. Patients who demonstrate a poor wound healing response after dental treatment—including healing after oral, periodontal, and implant surgery—should have vitamin D serum levels evaluated and treated if necessary.

Adding vitamin D to your daily vitamin line-up is a start but that won’t fix the problem entirely. Vitamin D needs help from vitamins and minerals and antioxidants for absorption. Unfortunately, a large percentage of the population today also suffers from these vitamin and mineral deficiencies directly linked to antioxidant levels. See below for the FDA rec daily requirements:

References

Richard J. Miron, Michael A. Pikos, Mark Bishara. Vitamin D Deficiency and Early Implant Failure. Dentistry Today. Vol. 39 No. 4. April 2020.

Most of the time, the inside of the mouth is moist. If that moisture is chronically absent, this condition is called xerostomia or dry mouth which happens when the salivary glands don’t produce enough saliva.

What little saliva is made becomes thick and the mouth feels sticky or dry. Chewing, swallowing, or speaking may become difficult and things may not taste the same. The tongue can become dry and grooved, and bad breath may develop. The throat also can be affected, turning dry or sore resulting in hoarseness.

If you are experiencing a variety of these symptoms, you probably have dry mouth:

• Dry feeling in your mouth
• Trouble swallowing, chewing, speaking
• A sore tongue or burning sensation
• Cracked lips
• Dry feeling in your throat
• Trouble tasting/ metallic taste in your mouth
• Mouth sores
• Bad breath
• Allergies

Health effects

In addition to these annoying symptoms, overall health can suffer. Dry mouth may cause more plaque than usual to form in the mouth, causing cavities and gum disease. An oral yeast infection, called thrush, also can develop, as can sores, both inside the mouth and at the corners of the lips. In severe cases, difficulty chewing and swallowing can interfere with good nutrition.
Possible causes can include:

• Certain medications to treat high blood pressure, pain, or asthma
• Snoring
• Mouth breathing
• Tobacco, alcohol, or recreational drug use
• Cancer therapies
• Head and neck injuries
• Aging

A dry mouth also may stem from health conditions, such as stroke, salivary gland disorders, diabetes, thrush, dementia, autoimmune diseases.

Self-help for dry mouth

Help for dry mouth is available. The answer may be as simple as asking your physician to adjust your medications or try a different one or using an over-the-counter rinse, mouth moisturizer or artificial saliva. Typically these come in a spray, rinse or gel, which can help moisten your mouth whenever it feels dry.

Below are some steps you can take to reduce symptoms of dry mouth.

• Sip water or sugar-free beverages frequently while avoiding drinks with caffeine. Drinking more water or sugarless drinks during meals will also make chewing and swallowing easier on you.
• Sucking on sugar-free candies or chewing sugar-free gum help stimulate saliva flow.
• Rethink your diet. Know that spicy or salty food may cause more pain and dryness, while juicy fruits can have the opposite effect.
• Breathe through your nose whenever possible.
• Seek treatment for snoring.
• While you’re sleeping, use a room humidifier throughout the night.
• Avoid tobacco, caffeine, and alcohol as they dry out the mouth.
• Don’t use over-the-counter decongestants and antihistamines, which can dry out the mouth.

To rule out an underlying health condition and monitor plaque and cavities, it’s important to seek dental care for dry mouth. With proper treatment, the mouth will become moist and functional again.