What shape will I be in after my mouth goes booom?

July 11, 2010 1:31 PM

I'm having a tooth extraction + bone graft + dental implant on Thursday on the lower left side molar closest to the jaw joint on the back of my mouth. Have you had something similar? Could I ask you a few questions?

Mainly my questions revolve around what kind of shape I'll be in afterward.

Can I go back to work the next day? (I'm a software developer so it's nothing that involves physical activity though I've already been approved to take Friday off if I need to.)

Will I be eating soft foods for a few days? A week? Are there some good foods I should get next week to have on hand?

Will I be able to drive after the procedure? (I opted out of the pill that makes you forget the procedure because I don't have dentistry anxiety at all.)

I've read some things online but I'm looking for anecdata.

Here's what I know: They're pulling the tooth out and putting some sort of steel post thing into my jaw. Then after it heals in 3 months they're putting an implant abutment and a porcelain crown thinger on top. I have a prescription for 16 extra strength vicodin and another for 28 Amoxicillin pills (there's a huge pocket of infection under the tooth because of a failed root canal that went through the bottom of the tooth).

You are not my dentist. And yes, I could ask my dentist these questions - but what are the odds my dentist has had this procedure? I want to hear what you have to say!

posted by kthxbi to health & fitness (23 answers total)

You will probably NOT be up to doing much of anything right afterward. (extraction plus infection is no cakewalk.) Based on my experiences, the answers to your questions are:

1. No, you're going to feel like shit.
2. A week, hope you like yogurt and Jello!
3. See number 1. (Drive? Really?)
posted by StrikeTheViol at 1:44 PM on July 11, 2010

For the extraction and setting the posts, you will not want to count on driving or doing much of anything useful for at least 24 hours. The prospectus for the next week or so will depend on how quickly it heals up, which can be highly individual. A lot depends on how much of the infected matter hangs around to cause trouble.

Count on being all numbed up at minimum and spaced out on vicodin at worst. This is also very highly individual and may depend on what happens during the procedure. It is notoriously hard for dentists to anticipate exactly what they'll find under a tooth they have not yet extracted. If all goes well you will probably be eating normal food in a day or two, but there are no guarantees.

When the posts have healed in and you go in for the crown, you'll be able to use it the same day. You won't even need painkilling medication. I had my entire mouth done -- 28 crowns on my post-sculpted natural teeth -- in order to correct a serious bruxism problem, and the evening after the crowns were installed I ate a steak.
posted by localroger at 1:56 PM on July 11, 2010

I had the same thing (huge, terrible infection under a large molar from a failed root canal that caused bone loss). I also had an extraction and bone graft but no implant (yet, too much bone was gone for them to be able to do it right away) and went right back to work afterwards and worked the rest of the week. I didn't drive myself back to work, but I could have, since I just had local anesthetic. I drove myself home from work that afternoon and so I didn't take anything but advil until then. It sucked, but I didn't have any choice. If I'd had a choice, I would have stayed home a couple of days, so if you have the option, I'd take the time off. It is definitely possible to go back to work if you just have an office job or something, but not really desirable. Vicodin makes me feel weird, so I mostly nibbled a tiny bit off the vicodin and took tons of advil. The pain wasn't the worst ever (especially since I'd been in terrible pain for months because of the infection and I'd had to put off the extraction because of school). The pain was really bad for maybe 2 days, then pretty much went away and there was just mild soreness (again, nothing compared to the pain of having the infected tooth)

Honestly, it was pretty damn painful, but the worst part was being hungry from not being able to eat solids. Before your procedure, go buy all of your favorite soft foods. Yogurt, apple sauce, those soups in the tetrapaks that are nothing but liquid, but are pretty rich and easy to pour in a bowl and microwave (you probably won't be in the mood to cook anything too involved), pudding, ice cream, popsicles, mashed potatoes, etc.

As sucky as it was, it was totally worth it not to have the evil tooth anymore.
posted by ishotjr at 2:01 PM on July 11, 2010

Oh, and my dentist specifically told me it was okay for me to go back to work and that a lot of people do. However, I don't know if getting the post installed that day would make that any different, though they did say that having the post put in would be way less painful than the extraction itself.
posted by ishotjr at 2:02 PM on July 11, 2010

Wow, you're getting all that done at once? I had to wait 2-3 months for my bone graft to heal up all the way before they put my implants in.


I took the days after my procedures off from work. (I'm also a software developer.) I could have managed work if necessary, but that would have given me the choice between trying to focus on coding while distracted by serious pain or trying to focus on coding while doped up on pain pills. Neither option seemed optimal. You'll probably be okay to work by Monday, although you'll still be aching.

You'll definitely want at least a few days worth of soft foods.

I drove home afterwards with no problem, because I had the surgeon only use a local anesthetic. From what I was told, that is very unusual. Most patients use a general anesthetic, which would require that someone else drive you home.
posted by tdismukes at 2:08 PM on July 11, 2010

I've had the same process done, including graft, though up front rather than a molar. If you're just a bit careful, you don't have to go all Liquid Diet. But do avoid obviously jagged things like chips(duh). If you're really careful, you could probably get away with it, but you probably won't, and you definitely won't enjoy finding out.

The Vicodin will space you out some, but an extra note: for me, at least, it has not played nice with staring at a monitor for long periods of time. After maybe half an hour to an hour, my eyes sort of start refusing to focus quite properly and I get queasy, though never to the point of actually puking. (ie. it's probably due more to the eye weirdness/disorientation than something actually going on with my stomach.) Just getting away from the screen for a few minutes tends to settle things.
posted by Su at 2:15 PM on July 11, 2010

Well so they're putting the post thing in but not putting a crown or abutment on top for three months to allow it to heal. Also, I'm only having local anesthetic so I don't really see how driving home from this would be any different than driving home from a cavity fill. The only change (in my naive view) would be how I feel after that local anesthetic wears off.
posted by kthxbi at 2:17 PM on July 11, 2010

I don't really see how driving home from this would be any different than driving home from a cavity fill.

Maybe a little more directness would help. A cavity is a small hole in your tooth. You, contrastingly, will have a BLEEDING INFECTION-PRONE WOUND in your mouth. The pain will range from "noticeably uncomfortable" if the dentist is good, to "pray for death to come and end the suffering" if the dentist is less competent. I hope this helps.
posted by StrikeTheViol at 2:54 PM on July 11, 2010

I have had significant surgery in my mouth and drove home afterwards. I think the key is how long the drive is versus how much Novocaine is still working. I think you are correct in how much will it hurt after the local wears off. It is my experience that the pain is a throbbing strong aching pain, not a sharp shooting one. I can handle that. The key to Vicodin and other pain killers is to take one before the pain gets too unbearable. If I had a short enough drive, I would ask the dentist for a small boost on the local, and on the way home get my prescription filled. As soon as I walked in the door, regardless of the pain level I would pop a Vicodin. Then when the Novocaine wears off, you will be in pain, but not care so much. Then you can make a decision in the morning about work that day.
posted by JohnnyGunn at 3:08 PM on July 11, 2010

Had the post implant (without the bone graft) around 10 months ago. It was to replace the molar in the lower jaw just before my wisdom tooth, which I'd had removed years earlier due to a rather nasty infection.

It was all done under local anesthetic in my dentist's office.

Was able to walk home without issue, was a little numb and in not too much pain once the anesthetic wore off. I felt a little knocked around and swollen after all those hours with my mouth wide open and the drilling into the jaw but certainly didn't need anything remotely resembling vicodin, managed quite well with ibuprofen to take the edge off the pain (YMMV).

I could have gone to work the next day, but was glad I took the day off and sat about snuggled on the couch taking it easy.

Had the tooth put on after 5 months and everything is peachy! Was hideously expensive, but am delighted with the results.

Just do make sure you take all the antibiotics as an infection would be not a good thing at all.
posted by the.carol.baxter.experience at 3:13 PM on July 11, 2010

AFAIK it is somewhat unusual for them to do both the extraction and the post on the same day, especially if they're going to do a bone graft. I had this same procedure done on the same tooth as yours, and unfortunately the bone graft did not take on the first or second try. I eventually had to have an autologous bone graft and did not get the implanted post until almost a year later. The crown was done 3 months after that. Had they implanted the post immediately after the extraction, I imagine things would have gone most unpleasantly awry.

Obvsly YMMV. My extraction was extremely unpleasant, as it was necessitated by a 10-year-old root canal that finally failed, causing a serious bone abcess that ate away a significant portion of my jaw. The tooth itself kind of melted into the abcess, and 2 of the roots were kind of hooked and weirdly shaped. I was in no shape to do anything afterwards aside from vomit and cry a lot. I went back to work 2-3 days later, though.

I doubt you will want to drive, much less feel capable of it. It's not so much the lingering painkillers making you woozy, it's the intense throbbing pain in your jaw, radiating throughout your entire head which will be the problem.
posted by elizardbits at 3:37 PM on July 11, 2010

Heed the advice from others that you will feel pretty lousy. Surgery is surgery.

Arrange to have someone else drive you home. Stock up on soft foods. (Buy frozen berries, bananas, milk and soy/whey protein powder so you can make big smoothies. Very filling. Don't have a blender? Buy one.) Consider pasta and sauces, if you can keep them away from the left side of your mouth.

Follow the post-op directions the dentist gives you to the letter. You want the wound to heal as quickly as possible.

Much depends on the ease, or lack thereof, of the extraction. I've had dental surgeons extract a tooth with ease and no problems. I've also had an extraction that was a very real problem.
posted by justcorbly at 4:00 PM on July 11, 2010

I had an implant, no bone graft, and the day that they put the post in I stayed home from work. I probably could've made it in if I'd really had to, but I was uncomfortable enough afterward to take a vicodin. The most painful part was paying the bill. :-(
posted by cottonswab at 4:16 PM on July 11, 2010

I was the driver for a boyfriend who got that procedure done and boy I would not drive unless you had no other option. For a short drive, you won't be in much pain but you'll likely be a little out of it. In a longer drive, you'd start hurting. He ate soft foods for maybe three or four days, literally living on protein shakes [you can also do yogurt and protein powder but those Ensure things were great for the first day] for a while and then he could start chewing on the other side of his mouth. Extra note, if they're doing the bone graft, they're likely filling the hole in your mouth with little bone pellets. Some of them may come loose and show up in your mouth. This is normal, don't flip out.
posted by jessamyn at 5:03 PM on July 11, 2010

I had a horrible dental implant saga that spanned 3 years of constant surgeries and have nerve damage and scars all over my gum. Have you had a second dentist look at the tooth to determine that pulling it is actually necessary? Since this is not a front tooth like mine was, I would really suggest you get a bridge instead.

Also, my first dentist tried to pull and bone graft and post the first day. This is probably one of the reasons the surgery was a failure. Generally, they're supposed to wait for the bone graft to heal and then drill into your new bone. Also, the second dentist who took a graft from my back jawbone had much more success with his surgery. The first dentist had used a "fake bone" graft product rather than my natural bone. This fake bone graft was rejected by my body.
posted by globotomy at 5:18 PM on July 11, 2010

my bone graft was a ... slice, i guess ... of bone, no pellets. extraction + bone graft one day; titanium posts inserted 3 months after; implants 3 months after that.

pain for me was very manageable, but i did have a script. had a friend pick me up after, but could have driven home myself no problem (and did, the 2nd time). i did not, however, follow the 'put ice on it for 10 minutes, do that every 30 minutes' (or whatever the time frame was). i looked like i'd be in a car wreck. my jaw was literally swollen down to my shoulder. so ... my best advice there is rinse the area with warm salt water on a regular basis (3x/day, maybe), and KEEP ICE ON IT. the ice pack was unwieldy for me for some reason, so i used a frozen pack of peas. worked like a charm after the 2nd go-round.

i had the extraction/graft on a saturday, and didn't have to go back to work until monday. i was glad for the day off between. at least take the rest of the day you have have the procedure, gauge it on the following day.

best of luck, memail if you have any more questions. (i have two implants & will have the 3rd done when we get around to the lower left jaw--already had the extraction so it's just a gaping hole for the time being. just started a very expensive sextet of crowns & am in the temporary phase; will get the permanent ones in a month. so yeah ... i have some experience in this area.)
posted by msconduct at 5:52 PM on July 11, 2010

I have had this done and am surprised how fast they are moving with your procedure. I had the tooth pulled and the area was some how prepped for a post. I had to wait a minimum of three months for the post and then another minimum three months for the porcelain tooth. My dentist said that research is showing that the more time the area is given to heal the better the chance is of success.

The tooth extraction sucked big time, but I was fine to go work and didn't take any prescription meds for it. It was tender for a long time and tooth shards actually worked their way out of my gum for the 4 weeks after.

Having the post put in and the tooth were super easy and no pain whatsoever. I love my implant. Crazy expensive, but totally worth it.
posted by sadtomato at 10:34 PM on July 11, 2010

Had a lower front tooth extracted, bone (pellets) graft and a titanium post implanted in one day of December 2007.

The procedure itself took about 90 minutes, and I was on 1.5mg of Xanax plus the local anesthetic. Bring a portable mp3 player to drown out the sound, if that might make you more comfortable. I was definitely not in shape to drive afterward, and found myself to be surprisingly emotional the next day.

I remember taking the Vicodin for 3-4 days after, and the pain was pretty manageable. Little shards of bone/tooth did work themselves out of my gum for a week or two afterward. There were some stitches, too, if I remember correctly, and those worked themselves loose after about a week.

I had a temporary crown situated above the implant for several months. (Long story, but had more to do with finances than anything medical.)

Good luck -- hope it all goes smoothly.
posted by Work to Live at 7:42 AM on July 12, 2010

Ok based on all of your feedback my SO is going to drive me to and from the procedure and I'm strongly leaning towards taking Friday off (unless I wake up and feel amazing and ready to carpe diem). I'll post a post-operation update with details as to how it went etc. I'm also planning to ask if it's normal for him to do all that in one visit ...
posted by kthxbi at 9:29 AM on July 12, 2010

Good plan. When I had an extraction and bone graft and two implants last summer, I was wrecked for days. It is a major surgical procedure. You will feel as if you have been punched in the face. You'll be swollen for days.

Start taking your antibiotics a day or so before the procedure. It'll give them a head start. And take a pain killer an hour or so beforehand, as well.

Have ice packs at your house, waiting. You'll need them.

Soft food advice:

- Applesauce
- Yogurt
- Soup, but not heated
- Bananas
- Ice cream

Drink lots and lots of water. Sleep as much as you can. Good luck.
posted by sdn at 6:28 PM on July 12, 2010

And now the only question is how I'm going to get through that softball double-header on Saturday afternoon while torqued up on vicodin... my team will have to forfeit without me. Any girls in Seattle willing to play 1st base for two games on Saturday? ...no? ... damn
posted by kthxbi at 8:59 PM on July 12, 2010

An update! So I went in on Thursday and had everything completed. The dentist was able to numb me up really well (actually I was numb like 4 inches into my hairline and halfway down my neck!) and pulled the tooth with no issues in about 20 minutes. Then the oral surgeon came in to place the implant. I asked him about the whole "why are you putting in an implant right now that seems a bit early" thing and here's what he told me. It used to be that they would pull the tooth, then fill the hole in with bone graft pellets and wait for all this bone to heal. Then a few months later they would come back and drill a hole in the new bone perfectly suited for the implant. Instead, what they do now is use the hole your tooth left to place a bigger cylindrical implant so that there is a drastically reduced healing time and the pain is much less. Also he said one of the downsides of filling the hole with bone graft and waiting for it to heal is that the jaw bone kind of melts down a bit into a puddle and you lose some of the bone mass around the hole.

Long story short - I had this big cylindrical implant with screw threadings drilled down into my tooth hole and it was such a tight fit the didn't even need to do a bone graft (and it's a damn good thing I was coherent enough to realize they didn't do the bone graft since I asked about it afterward and made them refund the $400 they pre-charged me for it). Since the hole is obviously not perfectly cylindrical the bone is going to have to grow up to grab it completely before they put on the abutment and porcelain crown.

I totally could have drove myself home afterward since like I predicted I felt totally fine and just numb. I will admit it was nice to have my SO drive me home but not necessary. I took vicadin Thursday night and all day Friday but I'm thinking I'm allergic to it since it made me itch all over like crazy. Today (Saturday) I've only taken advil and I'm fine. I even had a doughnut for breakfast. The dentist said I didn't really need to worry about holding off on solid foods after the first day or so just to allow the soft tissue to heal up.

Looks like I'll be able to play that double header today just fine!
posted by kthxbi at 10:42 AM on July 17, 2010

congrats on the relative ease of your procedure & thanks for the update. i will definitely ask my dentist about the way you had your procedure done--and hope that it won't be necessary for me to get any more implants to find out if they've changed their m.o.

also mega kudos on catching the $400 add-in for the bone graft they didn't do!

re the itching all over because of the vicadin: might not be an allergy but more of a side effect. vicadin is a narcotic & opiates lots of time make people itch--my face itches a LOT when i take codeine, oxy, etc.

again, congrats on getting that over with!
posted by msconduct at 10:54 AM on July 20, 2010