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There are two types of skin in the mouth. The first is the thin reddish lining of most of the mouth called mucosa. Mucosa contains minor salivary glands which keep the mouth moist, and because it is thin, allows easy movement of the lips, tongue and cheek. The second type of skin in the mouth is called “gingiva”. Gingiva is thicker, light pink in color and forms a narrow band around existing teeth and the roof of the mouth. Gingiva is important because it is stronger and can resist the forces resulting from chewing food. It also resists infection by limiting the ability of bacteria to enter between the tooth and the “skin”.
When teeth are lost, gingiva (like bone) shrinks away. If insufficient gingiva is present, gingival or “keratinzed” grafting is necessary to insure that there is an adequate band of attached gingiva around the implants like there is around teeth. If there is inadequate gingiva around the implants, there is increased risk of pain, infection and loss of implants over time.
The most frequent source of graft material is the roof of the mouth (hard palate). A superficial portion of the skin is removed from the hard palate, prepared and then sutured to the area around the implant (or tooth). Initial healing takes place within 10-14 days after which the sutures are removed. This procedure is performed in our office under IV sedation.
Before Surgery
Preoperative instructions for patients undergoing intravenous (IV) anesthesia
- You may not have anything to eat or drink (including water) for six (6) hours prior to the appointment except to take your normal medication or medication prescribed by our office.
- A responsible adult must accompany the patient to the office, remain in the office during the procedure, and drive the patient home after the procedure.
- The patient should not drive a vehicle for 24 hours following anesthesia or for 4 hours after taking narcotic pain medication.
- Wear loose fitting clothing with short-sleeved shirts or sleeves which can be rolled up past the elbow. Contact lenses, jewelry and dentures should be removed before the time of surgery.
After Dental Implant and Bone Grafting Surgery
- Following placement of dental implants or bone grafting, bite firmly on the gauze until normal feeling returns. This will allow for proper clot formation and prevent accidental biting of the cheek or tongue. Once the gauze has been removed, and normal feeling has returned, we recommend that you drink or eat something light and then take the recommended pain medication and antibiotic (if prescribed). Remember, do not drive for 4 hours after taking prescription pain medication.
- It is not necessary to replace the gauze packs unless you have abundant bright red persistent bleeding. Slight “oozing” is normal and can continue throughout the day and possibly the night. Placing a moistened tea bag or moistened gauze on the wound and biting with firm pressure with your head elevated for approximately 90 minutes without changing can stop persistent active bleeding. Please call our office if there are further questions or if you have tried these measures and they are unsuccessful.
- After the first 24 hours, begin saltwater rinses 3-4 times a day (1/2 tsp salt/8 oz water) for 7-10 days to aid healing. The night of surgery, brush your teeth gently. If the implant(s) are exposed, use a Q-tip dipped in the saltwater solution to gently swab around the top of the implants 2-3 times per day until they are shiny and clean.
- Swelling is the normal body response to surgery. Cold packs (bags of frozen peas, or crushed ice) should be used for the first 24-36 hours, (20 minutes on/20 minutes off), when you are awake to minimize swelling. Swelling usually peaks the second or third day, then subsides over the next several days
- Adequate nutrition is a very important part of the healing process. Even though it may be difficult to eat normal food, normal and increased protein and caloric intake is recommended. Blenderized food and instant breakfast drinks (Ensure, Ensure Plus, or Sustical, found at the grocery store or pharmacy) can supplement your diet and help the healing process.
- Activity: Light exercise, such as evening walks, can begin the day following your surgery but do not lift heavy objects, bend over or return to strenuous activity for at least one week.
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