Information for Patients General information: The site where an implant has been placed will normally be sutured to reduce the amount of bleeding and begin the healing process. However, a clot will still need to develop under the gum and trouble-free healing is dependent on this initially fragile clot rejoining undisturbed as much as possible. Most implant sites heal with minimal trouble. For at least eight hours after the surgery, do not rinse, gargle or touch the wound with your fingers or tongue. You may brush your other teeth normally that evening keeping away from the sutured wounds around the implants, but be aware that some bleeding may follow. Painkillers: You will benefit from taking an anti-inflammatory painkiller (such as Nurofen 400mg 5 hourly or Voltorol Retard 100mg 12-18 hourly) for the first 48 hours. If you are unable to take such non-steroidal anti-inflammatory drugs for medical reasons (e.g. stomach or oesophageal ulcer or moderate to severe asthma), Please take 1g of Paracetamol every five hours for 48 hours. This can be supplemented with Dihydrocodeine 20mg if required (the combination of Paracetamol and Dihydrocodeine is available as Co-dydramol over the counter). Paracetamol or Co-dydramol can be used in addition to the anti-inflammatory painkillers if necessary for up to three days. You should not need to take this medication for more than four to five days. Please inform us if pain increases after four days as it may indicate that an infection has occurred and requires attention. 3. Local anaesthetic: The effect of this will normally wear off after two to six hours depending on
the site anaesthetised and the amount used (see 4). Occasionally it may persist for longer. Take greatcare not to bite or otherwise traumatise the numb site during this time. Do not attempt to drinkhot fluids for at least eight hours. The application of heat on the day of implant will both encouragefurther bleeding and swelling and can locally scold the site without you being aware of it. 4. If implants have been placed in the lower jaw, Please inform us the same day evening if lip
numbness persists for more than six hours after you hove left the practice. 5. Bleeding: We will check that any bleeding has stopped before you leave the practice. Be aware
that movement, exertion, eating or drinking may re-start the bleeding. You will be provided with sterile gauze packs for when you leave the practice. Please use these as a pressure pack over the implant site and bite down firmly for at least 10 minutes. Ensure that the gauze pack is applying pressure to the wound and is not merely trapped between your other teeth. If there is further bleeding, repeat with a new pack. (If a temporary bridge exists over your implant, apply firm pressure from the sides by pinching the gum between a clean forefinger and thumb for 10 minutes) If you feel that the wound is bleeding beyond your control, or persisting into the night, please call us on 07522 216809. (We would be grateful if this number is reserved for emergencies only.) Swelling: There will be a variable amount of swelling depending on how much the soft tissues have needed to be manipulated during the procedure. Moderate swelling and skin bruising are normal and relatively common. Swelling can be minimised by applying a cool pack, keep your head elevated during the night on an extra pillow or two. Please inform us on the practice number during practice hours or on the emergency number (07522216809) outside of practice hours if the swelling is particularly painful or has not started to subside by the end of the fourth day following surgery. This may indicate that there is an infection that requires attention. Aftercare: It is recommended that you do not plan any strenuous activity or swimming for at least four days after the implant. The following day (or at least eight hours after bleeding has stopped), start to carry out warm salt-water mouth rinses every three to four hours. An antiseptic mouthwash such as Corsodyl will also be of help in limiting any infection. Antibiotics are not normally required after routine implant placement, though a covering antibiotic will normally have been given to you prior to surgery. Additional antibiotics may be given if any kind of additional bone augmentation has been carried out or a particularly extensive infection was present before. Usually these would be one or two of the following.
Amoxycillin 500mg three times a day (every eight hours) for seven days
Clindamycin 150mg four times a day (every six hours) for seven days if you are allergicto penicillin
• Metronidazole 400mg three times a day (every eight hours) for seven days
Please inform me immediately if you have and kind of skin rash or swelling, persistent abdominal pain, vomiting, or bloody stools with any of these antibiotics on the practice number during practice hours or on the emergency number outside practice hours (07522 216809)
Please also remember that a course of antibiotics will reduce the efficacy of the contraceptive pill. Please use an additional form of contraception during and for three days after the course ofantibiotics. 10. Do not drink alcohol during your course of antibiotics. 11. If sutures have been placed, they will usually need to be removed after 10 days even if they are
dissolvable. An appointment will be arranged for you before you leave the practice. If sutures areleft in for too long then they themselves may become a focus for future infection.
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Harvey a. K. WHitney Lecture Pharmacy practice model The evolution and metamorphosis of the pharmacy practice model Paul W. abramoWitz Am J Health-Syst Pharm. 2009; 66:1437-46 E volution is generally defined as a Alvin Toffler,1 in his landmark and what I hope we may achieve in book Future Shock , observed that the future. ring over a prolonged period of “What joins [everyda