Help on the road to recovery


  Posted by: Dental Design      26th December 2023

After an invasive dental procedure, proper wound care is crucial to promote healing and prevent infection

Good oral care is key to the success of any dental treatment. But when it comes to invasive dental procedures, such as periodontal surgery or dental implant placement, meticulous postoperative care is vital.

As you know, wound healing is a dynamic process consisting of continuous, overlapping and programmed phases. In adults, optimal wound healing involves the following: (1) rapid haemostasis; (2) appropriate inflammation; (3) mesenchymal cell differentiation, proliferation, and migration to the wound site; (4) suitable angiogenesis; (5) re-growth of epithelial tissue over the wound surface; and (6) proper synthesis, cross-linking and alignment of collagen to provide strength to the healing tissue.[i]

Postoperative complications of surgical tooth extractions, for example, can include swelling, pain, trismus, prolonged bleeding, dry socket, infection and sensory alterations of the inferior alveolar nerve or lingual nerve.[ii]

One of the primary goals of post-op wound care – and one of the trickiest – is to maintain oral cleanliness without causing trauma to the surgical site. Gentle plaque removal using toothbrushes with soft bristles or antimicrobial rinses can aid in preventing biofilm accumulation and postoperative complications.[iii]Additionally, careful irrigation with chlorhexidine (CHX) or saline solutions may reduce bacterial load and improve wound healing.[iv]

Mouth rinses or gels containing chlorhexidine gluconate are commonly recommended due to their antimicrobial properties.ii CHX boasts a broad-spectrum antimicrobial effect, meaning it can target a wide range of bacteria, fungi and viruses found in the mouth. It helps to reduce the overall bacterial load in the oral cavity, preventing the growth of harmful bacteria that can cause post-op complications, as well as those pathogens that can cause dental decay, gum disease and bad breath.

Alternatives such as essential oil or herbal-based rinses (including myrrh) can also be considered based on the individual patient’s needs.[v]Diet and lifestyle modifications can have a significant impact on post-op recovery.

Patients should be advised to avoid consuming hard, sticky, or crunchy foods that could compromise wound healing or dislodge sutures.

A balanced diet rich in vitamins and minerals can support tissue repair and immune function. Omega-3 fatty acids can help in the battle against gum inflammation. They can be found in fish, such as sardines, herring, salmon and mackerel and are also present in nuts and seeds, vegetable oils, soya and green leafy vegetables. Healthy greens, such as spinach and kale, also contain many vitamins, minerals and antioxidants that are essential for immune function. For example, vitamin C aids collagen maturation which helps maintain the integrity of the connective tissue in the gingiva.[vi]

Smoking cessation is crucial, as tobacco use significantly impairs oral wound healing and is associated with an increased risk of infection.[vii] Nicotine is a vasoconstrictor that reduces nutritional blood flow to the skin, resulting in tissue ischemia and impaired healing of injured tissue.[viii] In addition to the effects of nicotine, carbon monoxide in cigarette smoke causes tissue hypoxia.

Patients are, of course, provided with thorough oral hygiene instructions tailored to their specific procedure by their dental professional. In general, gentle brushing, with toothpaste containing fluoride, should be resumed after the first 24 hours, being careful not to traumatise the surgical site. Flossing may be adjusted or temporarily avoided, depending on the extent of the procedure and the dentist’s recommendation. And prescribed medications, such as analgesics and antibiotics, should be used in compliance with the dental professional’s instructions.

Perio Plus+ from Curaprox is an alcohol-free range of oral rinses which offers patients help on the way to post-op recovery together with powerful protection against a wide range of microorganisms. Perio Plus+ Forte is an extra intensive rinse, boasting CHX at 0.2%, for use before and after invasive dental procedures while Perio Plus+ Regenerate, is a rinse for supporting tissue regeneration with a 0.09% concentration of CHX, bolstered with hyaluronic acid. Both formulations also contain CITROX®, a natural bioflavonoid extracted from bitter oranges.

Proper oral care after invasive dental procedures is essential for promoting successful healing and preventing postoperative complications. A comprehensive approach, including wound care, medication management, diet modifications and oral hygiene instructions, is crucial for ensuring optimal recovery. Dental professionals should consider these steps while tailoring postoperative care plans to individual patient needs, thereby supporting their long-term oral health and well-being.

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[i] Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res. 2010 Mar;89(3):219-29. doi: 10.1177/0022034509359125. Epub 2010 Feb 5. PMID: 20139336; PMCID: PMC2903966.

[ii] Sayed N, Bakathir A, Pasha M, Al-Sudairy S. Complications of Third Molar Extraction: A retrospective study from a tertiary healthcare centre in Oman. Sultan Qaboos Univ Med J. 2019 Aug;19(3):e230-e235. doi: 10.18295/squmj.2019.19.03.009. Epub 2019 Nov 5. PMID: 31728221; PMCID: PMC6839670.

[iii] Poppolo Deus F, Ouanounou A. Chlorhexidine in Dentistry: Pharmacology, Uses, and Adverse Effects. Int Dent J. 2022 Jun;72(3):269-277. doi: 10.1016/j.identj.2022.01.005. Epub 2022 Mar 12. PMID: 35287956; PMCID: PMC9275362 [Accessed September 2023]

[iv] James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev. 2017 Mar 31;3(3):CD008676. doi: 10.1002/14651858.CD008676.pub2. PMID: 28362061; PMCID: PMC6464488. [Accessed September 2023]

[v] Eid RAA. Efficacy of Commiphora myrrh mouthwash on early wound healing after tooth extraction: A randomized controlled trial. Saudi Dent J. 2021 Jan;33(1):44-54. doi: 10.1016/j.sdentj.2019.11.011. Epub 2019 Dec 16. PMID: 33473242; PMCID: PMC7801243.

[vi] Oral Health Foundation

[vii] Silverstein P, Smoking and wound healing, 15 July 1992, American Journal of Medicine, DOI: [Accessed September 2023]

[viii] Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res. 2010 Mar;89(3):219-29. doi: 10.1177/0022034509359125. Epub 2010 Feb 5. PMID: 20139336; PMCID: PMC2903966. [Accessed September 2023]

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