Don’t considering dental implants, one of the first questions people ask is, “Are dental implants painful?”
The mention of “surgery” often evokes fear in people, leading them to anticipate the worst possible outcomes. They assume there will be a lot of pain after dental implant surgery and hesitate to get implant treatment because of this fear.
While everyone’s pain tolerance varies, it might be surprising to know that the majority of our patients express astonishment at the minimal discomfort experienced during their recovery from dental implant surgery.
Post-operatively, the majority of our patients report that they only took the over-the-counter pain medications we recommended, and not the prescription ones, (or that they only took one or two prescription pain pills) because they didn’t feel they really needed it.
Rarely do patients report having experienced a level of discomfort they considered significant. They’re usually quite surprised by this.
Procedures involving extractions in addition to implants do sometimes result in more discomfort than implants only, but there are things you can do to minimize this.
It is important to mention here that following your post-operative instructions is very important in having less post-operative discomfort. So, follow the instructions we give you.
Anesthesia and Sedation
LOCAL ANESTHESIA
First, local anesthesia is administered to numb the area. This is the same local anesthesia you get when getting a crown or an extraction or other dental procedure. Only once the area being treated is completely numb, we will begin the procedure. So, although you may feel slight vibrations from the drill, you won’t feel any pain at all during the surgery. The local anesthetic provides excellent and consistent pain management during implant surgery.
IV SEDATION WITH LOCAL ANESTHESIA
Commonly referred to as twilight sedation, conscious IV sedation will sedate you enough to put you into a light state of sleep, yet still conscious enough to respond to instructions when needed. Together with local anesthesia, you will not only not feel any pain during the procedure. Instead, you’ll sleep through most of it, and largely be unaware of the procedure. If you opt for this type of sedation, you will need someone to drive you to and from your appointment.
ORAL SEDATION
For patients who are anxious but don’t want IV sedation, oral sedation is often a good compromise. It helps to “take the edge off” and let you relax. This is a pill taken about an hour before the procedure. It is designed to make you feel deeply relaxed and sleepy, although still conscious. If you opt for this type of sedation, you will need someone to drive you to and from your appointment.
During the Procedure
- Now that your mouth is completely numb, and we’ve covered the pain management during implant surgery, what can expect to feel? You may feel vibrating or slight pressure as the procedure is done. A small hole will be drilled in your jaw to screw the metal implant post into. You’ll have a small oxygen cannula (in your nostrils) to provide extra oxygen, you’ll have protective glasses on, and likely a blanket to keep you warm if you feel chilly. That’s about it.
- If we are making a temporary prosthesis and delivering it on the day of the surgery, you’ll be in the chair longer than if we are only placing implants. Dental implant surgeries very often include getting a temporary tooth or teeth on the same day. So, in these cases, there are two phases to this visit:
- Implant surgery and;
- temporization (making the temporary teeth).
- The surgical phase can be anywhere from an hour to several hours, depending on how much we’re doing at once, and the temporization part of the surgery visit can take anywhere from an hour up to several hours, as well. This time is spent fabricating and fitting the custom temporary crown or bridge.
- This part of the appointment is not painful at all, it’s just a lot of, “Open up. (prosthesis is put in the mouth and tried in), OK, now gently bite down… move your teeth from side to side… speak a little and see how these feel…are you biting your cheek? Your tongue? How do you like the shape of the teeth? How does the bite feel? OK, tap-tap…”, that kind of thing. If the numbing wears off and you begin to feel discomfort while we are working on the temporaries, we can use a little more local anesthetic to keep you comfortable.
- Some patients who are here all day may want to get up and go to the bathroom or walk around a little, as lying in a dental chair all day can be tiring and sometimes difficult for someone with, say, back problems. We take every measure to keep you comfortable and provide not only pain management during implant surgery, but throughout the entire procedure. Then once the temporary is done, it’s secured into place, you go home.
Elizabeth’s Experience Pain Levels After Multiple Implants
A few weeks ago, one of our patients, Elizabeth, after having several extractions, several implants and an immediate fixed temporary bridge, (an all-day procedure), came into the office the day after her surgery to thank everyone on the team before heading to the airport to fly home. She wanted to tell us how surprised and how pleased she was that it all went so smoothly and that she had no pain whatsoever.
Elizabeth said she never took a pain pill, only Advil, immediately following her surgery. She followed her post-operative instructions to the letter and was feeling terrific. She was so surprised. Elizabeth was a patient who, prior to the surgery, called the office many times, with 1,000 questions and was very nervous and apprehensive about what she was about to have done. After all that anxiety she suffered in the weeks leading up to her treatment, you can imagine her relief.
This happens on a weekly basis, that patients come in or call us and report how astounded they are at just how little post-operative discomfort they had. It always makes us smile.
Post-operative Pain: What to Expect
- Regarding discomfort after dental implants: As the local anesthetic wears off, you may feel some slight tenderness or discomfort. This could be in your jaw, from holding your mouth open for a long period, or it may be more in your gums, from the incision and sutures. The good news is that this is generally alleviated with either Advil/Ibuprofen, or a combination of Advil and Tylenol (Ibuprofen/Acetaminophen), or by a prescription pain pill. We recommend taking at least one of these immediately after the implant procedure.
- Patients experience a range of pain after dental implant surgery. For most people, the pain recovery from dental implant surgery is not nearly as painful as they expected it to be. Some patients never take a single Advil. Some need the over-the-counter pain relief options for a few days. Others take prescription pain medication for a few days to get past any post-surgical discomfort. It depends on a few factors: The patient’s overall pain threshold, their overall health, whether they had extractions AND implants or implants only, whether or not they had bone grafting done as part of the procedure, and whether they’ve adhered to all of the post-operative instructions or not. For the occasional patients who do experience more discomfort than average, we recommend using pain relievers for the first 3 days, whether that be over the counter ones or prescription ones.
- For those who do experience discomfort, just know that the worst of it typically begins to ease up by the 3rd day after surgery. For patients who have additionally had bone grafting as part of their procedure, they may experience more discomfort than those who did not; for up to about 7 days or so. Again, following the post-operative instructions very carefully is of paramount importance in maintaining control over any potential pain after dental implant surgery
- Symptoms considered “normal” post-operative discomfort: Minor bleeding, mild to moderate discomfort and possibly some swelling (not extreme swelling) and (occasionally) bruising.
- Symptoms considered “signs of concern”: Fever, extreme swelling, prolonged tingling or numbness, or extreme pain. With any of these, it is important to be seen right away, as it might be a sign of infection.
Post Op Treatment Advice
For prolonged bleeding: Apply gentle pressure by biting gently on a piece of sterile gauze for 15 minutes or so. Do not take it in and out; leave it in for 15-30 minutes. (Taking it in and out will discourage the clotting needed to begin healing). Then remove it and do not suck on anything or continually spit. This vacuum/pressure of pulling all the saliva together in your mouth and spitting it out, only makes it bleed more. As do straws- so stay away from them also.) If bleeding persists, you can wet a tea bag and bite gently on it for 30 minutes, with slight pressure.
For discomfort: Take either over the counter or prescription pain medication to alleviate discomfort.
For swelling: Apply ice on and off as much as you can stand to. (After 48 hours, if swelling persists, switch to warm compresses).
For bruising: Some very fair-skinned patients or some patients who take blood-thinners might experience slight bruising. This only happens in a small percentage of patients and isn’t painful at all. And the bruising goes away on its own.
To prevent infection: Maintain good oral hygiene practices and keep everything clean. Don’t NOT brush just because things may be a little tender. We will go over instructions with you prior to your surgery. We will instruct you on the best way to keep your mouth and prosthesis clean during the healing phase. (These instructions are different for different procedures).
Pain Management Strategies
- Follow the prescribed dosage instructions for any medications provided.
- If prescribed antibiotics, take them until they are all gone.
- Only take pain medication if you have pain. Many patients don’t need it at all. If you do need pain medication:
- Over the counter option 1 (Advil/Ibuprofen only): Ibuprofen (800mgs every 4-6 hours) as it helps dental pain the best since it is an anti-inflammatory.
- Over the counter option 2: (Advil/Ibuprofen and Tylenol combination): Take 600mgs of Ibuprofen with 500 mgs of Tylenol every 4-6 hours.
- Over the counter option 3 (Advil/Ibuprofen and Tylenol combination for severe pain): Take 800 mgs of Ibuprofen and 1000 mgs of Tylenol every 4-6 hours.
- Using ice packs the first 24 hours can help alleviate any inflammation
- If we prescribed a prescription oral rinse for you, be sure and take that as directed.
- Saltwater rinses are good for the soft tissues. (1 tsp in 8 oz. of room temperature or mildly lukewarm water.)
- As far as what you should be eating and drinking with your new dental implants, stick to soft foods at first, especially if you’ve had more than just an implant or two.
- To help ensure a smooth recovery from dental implant surgery, avoid strenuous physical activity the first few days after surgery, especially if you’ve had a significant amount of treatment done. If you’ve only had a single implant with no bone grafting or extraction, you can resume normal physical (working out, etc.) activity after 2-3 days. If you’ve had your full mouth worked on, you should wait more like 7 days.
Healing Process
The first 1-3 days
Recovery from dental implant surgery, symptoms like mild discomfort and swelling will typically peak and begin to fade.
3-7 days
You can begin eating slightly firmer foods like rice and pasta, etc. You should still avoid hard or crunchy foods. Don’t brush the implant site directly for at least a week. You can get back to exercising but keep it mild until at least a week after surgery.
1-2 weeks
This is when we will typically see you for a brief follow-up visit. Now things are beginning to really heal. The sutures will be resorbing and you should be adjusting to the changes and feeling more like normal. It’s important to remember that under the surface, there’s still quite a bit of healing yet to take place. Osseointegration of the implant in the bone takes a few months. So even if you feel normal, don’t be biting and pulling on foods just because it doesn’t hurt to do so.
For patients who clench or grind their teeth, we will make a night guard for you to wear to during this healing process. This will protect your implants while they integrate with the bone.
Psychological Aspect of Pain
- Anticipation and anxiety possess the uncanny ability to amplify the perception of pain. When we anticipate pain, our mind tends to hyper-focus on the impending discomfort, intensifying its potential impact. Anxiety, with its ability to magnify sensations, can heighten the body’s sensitivity to pain. This can make it feel more severe than it might actually be.
- Discuss your fears and concerns openly with us. Let us help alleviate your anxiety by explaining anything you don’t understand fully and clearly. We want to address any misconceptions and offer reassurance, which can alleviate your anxiety.
- Stay busy. Direct your thoughts to other matters, rather than solely dwelling on what has occurred in your mouth.
- Remember, dental anxiety is a common thing many people experience. Let us help you manage it through open communication and education. When you fully understand something, it’s less scary!
