The local anaesthetic from implant surgery often wears off in the evening, around the time you would normally go to bed, and that is when the site starts to make itself felt. For the first two or three nights, sleeping with your upper body raised, lying on your back or on the side away from the implant, and keeping your mouth empty of gauze, dentures and guards will help the swelling settle and protect the wound. After that, most people drift back to their usual position without thinking about it.
Written by Dr James Tran, BDent (University of Sydney), MICOI, GradDip (Oral Implants), general dentist at Lumi Dental in Melrose Park.
Raising your head works with gravity, not against it
Swelling after surgery is fluid gathering in the soft tissues of the cheek and lip. When you lie flat, that fluid has nowhere to drain, so the area feels tighter and often throbs. Propping yourself up lets it move away from the site overnight. Bedfordshire Hospitals NHS Trust's advice after tooth removal recommends keeping the head raised on several pillows to reduce swelling, and ice packs may be used over the area during the first 24 to 48 hours. Cold packs are for waking hours only; do not fall asleep with one on your face.
Swelling does not peak on the first night. In a study by González-Santana and colleagues that followed 41 patients receiving 131 implants, swelling peaked at around 48 hours after surgery in about half of patients. The same study found more swelling in older patients, when more than four implants were placed, after sinus lifts or bone grafting, and with implants towards the back of the mouth. If any of those apply to you, expect to need the extra pillows a little longer. Bruising tends to appear on a similar schedule; our article on bruising after extraction or implant surgery explains why it can track down towards the neck.
Set the bed up before you leave for surgery
You will not feel like rearranging furniture when you get home. Before the appointment, put two firm pillows or a foam wedge on the bed so your shoulders as well as your head are lifted; stacking soft pillows under the head alone just bends the neck forward. Cover the top pillow with an old pillowcase or a towel, since a little pink saliva overnight is common. Leave a glass of water on the bedside table, keep your pain relief and after-care sheet within reach, and save the practice phone number in your mobile.
If you take a blood thinner, keep taking it unless your doctor tells you otherwise. Your dentist will discuss it with your GP or specialist during planning rather than on the day.
Which way to lie
Back sleepers
Lying on your back, raised, is the simplest option and keeps pressure off both cheeks. Some people find a recliner chair more comfortable for the first night.
Side sleepers
Lie on the side opposite the implant, so the treated cheek faces up and is not pressed into the pillow. A pillow tucked lengthways behind your back makes it harder to roll over in your sleep, and a U-shaped travel pillow keeps some people from turning their head.
Implants on both sides or a full arch
When there is no "good" side, stay on your back until the swelling is clearly going down, usually after the third night.
Nothing left in your mouth overnight
Take out any gauze before you settle down; falling asleep with it in is a choking risk and it can stick to the clot. Removable dentures, night guards and sleep apnoea splints should stay in their cases until your dentist has looked at the site and confirmed they can go back in.
There are good reasons for this. A denture resting on a fresh implant can rock and put pressure on it during the early healing period, so it is usually left out at night for at least the first week. If you cannot go without it during the day, the dentist can adjust the fitting surface. A night guard may press on stitches and, once the gum changes shape, may not fit as it did. A sleep apnoea splint clips onto the teeth and moves the jaw forward, which can load a healing area. Each is reassessed at the review visit. If you grind heavily, raise it at the planning stage; our article on implants and teeth grinding explains why.
If you use CPAP
Keep using your CPAP machine; stopping it is not a safe trade-off. Tell your dentist about it when the surgery is being planned. A full-face mask sits across the upper lip and cheeks, close to where an upper implant heals, and air leaking through the mouth can dry the wound. Any change to the mask or pressure settings should come from your sleep physician, not from improvising at home. Our article on CPAP and dry mouth has more on protecting the teeth and gums while using one.
Mouth breathing, rinsing and a dry mouth
If you snore or breathe through your mouth, you may wake with a dry, sticky mouth. Sip water before bed and when you wake. Do not rinse on the day of surgery, because vigorous rinsing can dislodge the blood clot. From the following day, guidance from Guy's and St Thomas' NHS Foundation Trust suggests gentle warm salt-water rinses, four times a day for four to five days.
If your surgery is done under sedation
IV sedation is available at Lumi for implant surgery, so ask about it at your planning visit if you think it may help. If you do have intravenous sedation, a responsible adult needs to take you home and look after you for the rest of the day, and sometimes overnight, because the medicines can leave you drowsy and forgetful for several hours. Do not drive until at least the following day; your dentist will tell you how long to wait. Get the pillows sorted before you lie down for a nap, and ask your companion to remind you when your next dose of pain relief is due. Our article on IV sedation for implant surgery describes the day itself, and our IV sedation page has further information.
How the first week usually unfolds
On the first night, numbness fades, the site aches mildly and there may be a little oozing. Timing a dose of pain relief, as advised by your dentist, so that it is working when you lie down makes it easier to fall asleep. Nights two and three are when the cheek usually feels tightest and bruising may appear, so keep sleeping raised. From around night four, swelling is going down and many people can return to their normal position, still avoiding the treated side if it is tender. Stitches may feel loose or scratchy towards the end of the week.
In a survey of 40 implant patients published in the journal Medicina, swelling was the most troublesome symptom and had mostly settled by day four or five, sleep was only minimally affected, and the authors concluded that most people can expect to recover within about four days. Our implant recovery timeline picks up from there.
Night-time problems and when to call
Throbbing that starts when you slide down the pillows usually eases once you sit back up. Pink-tinged saliva on the pillowcase is common for a few days after oral surgery. Fresh red bleeding is different: sit upright, fold a piece of damp gauze over the site, bite firmly for at least ten minutes, and phone the practice if it continues.
Avoid caffeine late in the day, and do not smoke or vape for at least 72 hours, as Bedfordshire Hospitals advises. Call the practice before your review if swelling increases after the third day, pain gets steadily worse instead of better, or you develop a fever or a persistent bad taste. Guy's and St Thomas' notes that infection tends to show itself as worsening pain and swelling around four to six days after surgery. Swelling that affects your breathing or swallowing needs an emergency department straight away.
Planning that happens before the surgery
At Lumi Dental, implant treatment is planned after an examination, a 3D X-ray on our Orthophos scanner and an intraoral scan. The planning visit is also when we ask how you sleep, if you use CPAP, a night guard or a sleep apnoea splint, and which medicines you take, so the after-care advice suits you. More detail is on our dental implants page.
Common questions about sleeping after an implant
Is it a problem if I roll onto the implant side in my sleep?
One brief roll is unlikely to cause harm. Repeated pressure on the cheek can add to swelling and irritate stitches, which is why a pillow behind the back is useful for the first few nights.
When can I stop sleeping propped up?
Once the swelling is clearly going down, usually after the second or third night. With several implants or grafting, it may take a little longer.
Should I take my denture out at night in the long term?
For most denture wearers, yes. Our article on sleeping with dentures in explains why.
If you are considering implant treatment and would like your own questions about recovery answered, a dentist at Lumi Dental in Melrose Park can go through them with you. Contact the practice to arrange an implant consultation, check our current offers, or read more about dental implants.
Sources
- Guy's and St Thomas' NHS Foundation Trust: Dental surgery and recovery
- Bedfordshire Hospitals NHS Trust: Removal of teeth, post-operative care advice
- PMC (Medicina): Patients' perception of recovery after dental implant placement
- PubMed (Medicina Oral, Patologia Oral y Cirugia Bucal): Pain and inflammation in 41 patients following the placement of 131 dental implants
About the author
Dr James Tran is a general dentist at Lumi Dental in Melrose Central, Melrose Park. He holds a Bachelor of Dentistry (BDent) from the University of Sydney and a Graduate Diploma in Oral Implants, and is a Master of the International Congress of Oral Implantologists (MICOI).
This article is general information only and is not a substitute for an examination and individual advice from a registered dental practitioner. Suitability for any treatment varies from person to person.
