Recover Smart: Oral Surgery Healing

Hi, everybody. I'm Dr. Sandhya Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body. As we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most natural way. Welcome to today's show when we're going to be talking all about optimum healing from oral surgery. You had a tooth removed, an implant placed, the wisdom teeth removed, gum surgery. Now what? What can you do in order to heal properly and experience less pain? Because, let's face it, nobody looks forward to having any kind of oral surgery. But if we can make the procedure easy, smooth, so you recover without pain and inflammation, that's really the goal. Let's break this topic up into topicals and basically nutrition ingestible supplements. I'm going to start with topicals. Your dentist probably will prescribe you a mouthwash. Why? Because we want to keep the area clean in the mouth. We have over 600 different species of bacteria, parasites, fungi that are living together. What can we do to keep this out of the site of healing? Most of the time, a dentist prescribes a mouthwash. Chlorhexidine, that's the name of it. Or Peridex as otherwise named. This is not something that I use because it is toxic. Yes, you heard me correctly. And you might be thinking, why in the world are dentists prescribing this mouthwash if it's toxic? Chlorhexidine studies have shown that if it's actually in contact with fibroblast, which are the cells that are in your gums aiding for repair, chlorhexidine actually kills fibroblast. Would you want such a mouthwash in contact with your own cells? Luckily, we have better options today. So there's natural mouthwashes that have shown to be effective in fighting off bacteria, such as triology. The reason why I like triology and they are not paying me for endorsing their product, I just love the product because it's aloe vera based. It has no alcohol, unlike chlorhexidine, which has a lot of alcohol and alcohol denatures cells. Triology is aloe vera based with essential oils, and they have shown in studies that it actually is more effective than chlorhexidine in reducing bacterial pathogens, even some of the most aggressive ones. So ask your dentist for an alternative. Do you do not use chlorhexidine based products? Chlorhexidine is also used as a pesticide in the field to kill bugs. So yes, it is effective to kill bacteria. However, it is also toxic to your own cells. Another option would be to rinse with ozone water. Let's say you might be, for example, allergic or you don't like, you know, minty mouthwashes. There are other options out there today that are homeopathic based mouth rinses that help with the healing. But ozone water in itself, if you have the opportunity to make ozone water at home, and Nowadays the company BioSure has a great tumbler into which you put water. Definitely not tap water, but filtered water, not reversed osmosis, and you can actually generate ozone water in about two minutes. Ozone water is great as a rinse because it's antiseptic and it is all natural and it also oxygenates the cell diet. Other topicals that you might consider is basically a homeopathic gel to in order to speed up healing, but it's really not necessarily. Try to keep the area as clean as possible, stay hydrated and also refer to my book Heal up in which I describe different modalities healing. You have to get good sleep. You have to basically breathe good air, make sure your tissues stay oxygenated and definitely relax. There is a sympathetic state of being, meaning fight or flight versus parasympathetic. The parasympathetic nervous system kicks in when we rest and digest. This is when healing happens. That's why most of our healing actually takes place at night. If you can't sleep while you're not going to heal and regenerate, please mention this to your doctor that you're having problems sleeping if you're planning on undergoing any kind of oral surgery procedure. So sympathetic versus parasympathetic. We wanna be in a relaxed state when we're healing. I remember when I was in dental school, there was a study being conducted where they actually punched a hole in the roof of our mouth. Of course you had to volunteer for this. They wouldn't do it for everyone, but they would study the closure of this wound in the roof of the mouth right at the beginning of the semester when everybody came back from vacation relaxed, how fast it would close versus at the end of the semester when you have finals and everybody's stressed out. And they would punch a little hole in the roof of the mouth and measure how fast it closes. So actually when we are stressed, we heal significantly slower than when we are relaxed. I want to encourage you, if you're planning any kind of procedure, don't plan Any major trips or moving or anything right after the procedure as it will delay your healing. Okay, wound healing. There's actually four stages of wound healing. And I want to go over this a little bit so you understand what nutrients are required at different stage. In the first 24 hours after a wound, let's say we make an incision or we extract a tooth, what happens is the platelets rush into the place. Of course, if you had PRF or platelet rich fibrin that's going to already be in the site and sped up your healing, the fibrin clot establishes and then for the next four or five days, we kind of enter the stage two of healing called the inflammation time, when blood vessels kind of dilate so you see more redness in a sight, you might get a little bit of swelling and your cells are cleaning the debris, the dead cells in the area and new blood vessels or angiogenesis is starting to happen. The proliferation or stage three of healing happens up to three months from surgery. New bone cells, new gum cells actually rush into the place. They grow. Connective tissue is getting established. The blood vessels that are were starting to go in, in the first couple of days are actually starting to mature. And a lot of growth factors are needed during the stage three. In the first three months after a procedure, stage four, we call this the maturation time. And the maturation time happens anywhere from like the second month of the procedure, all the way years. Especially when we're talking about bone regeneration. Bone regeneration actually takes the longest and we know that mineralization and maturation of the bone can take up to two years. So I have some patients that are, oh my God, in six months, my bone is not healed yet in the extraction socket. That's okay. It just depends on your mineralization time. Even though you might see, let's say on a CT scan, the bone is not mature, you still have the connective tissue there and we're just waiting for mineralization. So after the second month, really taking in an uptake of minerals becomes very important, especially for bone healing. Now, what are some things that might be retarding factors when we're talking about the wound healing stages? So in the beginning, in the first 24 hours, if you're taking any kind of blood thinning supplements such as vitamin E or maybe medications like aspirin, high levels of fish oil, this is going to retard this stage. So prior to any kind of oral surgery or surgery, make sure you're not taking any blood thinning supplements. At least I would say A week prior to your procedure, but ideally 10 days to two weeks in the second stage. The inflammatory control. If you are using, let's say, ibuprofen on a regular basis because you're an athlete and guess, you know, muscle aches or you're popping in anvil like candy, this is really bad for your healing because it will really delay your healing. We want the inflammation to be there in the first four or five days. Everybody thinks, oh, inflammation is all bad. That is not necessarily the case in the first four or five days. We want that healthy, acute inflammation because that's what brings in healthy cells in a site. If you're taking too many, too much sugar, this is going to delay the healing. Sugar is actually inflammatory, so you're going to have an E increased inflammation during this time and basically more pain than normal. So definitely try to stay off the sugar about two weeks prior to any kind of procedure and substitute it with a healthier sugar during the proliferation phase. If you have a lack of oxygen in the site, it's not going to heal well. Oxygen is definitely needed, you know, for your new blood vessels that are starting to form for any kind of new cells. A deficiency in vitamin C is also problematic because it's not going to allow the collagen fibers, which are basically inside the bone, inside the tissues. It's not going to allow proper formation. So it will delay the healing. And in terms of maturation, as I mentioned earlier, having the right minerals during that time, especially sufficient protein, is very important. So oftentimes if you're vegan, you're going to heal slower if you don't have enough protein. And during the healing time, typically our body requires about 20% more proteins in our diet. So make sure you up your protein, especially if you're on a vegan diet. We do have this increased nutrient requirement during healing. So for major surgeries such as like a sinus lift or bone augmentation, make sure you up your proteins. Zinc is also very important because zinc is important in infections to decrease the amount of infections and antioxidants. Why antioxidants? Because we're creating oxidative stress. So let's say having a smoothie, especially if you can't chew very well after oral surgery, have a smoothie with fruits in it like cantaloupe, which is not very acidic, or any other kind of melon. I like cantaloupe because it has a high level of vitamin A and C, which is so important for healthy tissue formation. However, stay away from seeds like, you know, strawberries and blueberries still have little seeds and that can actually affect the gum healing and potentially get under the gum and cream issues. Peaches are also great when they're in season to have a like incorporated in your smoothies to up the level of antioxidants. And of course, you know, a lot of dark leafy greens are also important. And dark leafy greens also bring the minerals in a smoothie. So when you're having a smoothie after surgery, incorporate both fruits and dark leafy greens. And not just spinach, you can put in a kale, chard, you can put parsley, anything that's dark leafy greens. Even the, you know, the leaves from beets, celery leaves. Because of this increased energy requirement, you can also add a protein powder. The protein powder is very important. Some people think, oh my God, peas are not good. Peas are bad because they have too many lectins. Actually, pea protein isolate is completely different than pea protein itself. So for those of you that are trying to stay away from lectins, just know that pea protein isolate actually have a completely different absorption rate. It doesn't really cause the bloating or the inflammation that is associated with lectins. Besides pea protein isolate, of course you can also do you know, the whey protein or any kind of isolate is easier to digest. In terms of fats, should you be eating fats during healing? Absolutely. But again, the right kind of fats. Why? Because certain fats can cause inflammation and certain fats decrease inflammation. For example, cold water fish, like salmon has a nice healthy fat. EPA and DHA which is significantly anti inflammatory. But let's say beef fat from poultry or dairy actually is inflammatory. Grass fed of course is a lot better than corn fed. So this matters as well. We know that grass fed beef has a lot more omega 3 than corn. Corn fed beef, olive oil, avocados, sesame oil, these are all great fats to have during the healing process. Now let's talk about vitamin K1 and K2 in the first 24 hours. The stage one of healing, we call this wound sealing. K1 and K2 are very important for blood clotting. What do you find K1 and K2 in dark leafy greens? As I mentioned before, K2 can also be synthesized by intestinal bacteria, but you can also take it with vitamin D. Now our Orasana supplement actually is vitamin D3, K1, K2 to aid in the absorption of calcium. Also very important to have K1, K2 during the wound healing process. Antibiotics, liver disease, maybe intestinal malabsorption, such as leaky gut really stops the production of K1, K2. So supplementation typically is important in the second stage, which is the inflammatory stage of healing, we really need the nutritional support for the immune system to prevent infections. Omega 3 Again, I mentioned it earlier. What a great fat. And it's anti inflammatory. GLA gamma, linolenic acid, vitamin C. Vitamin E is a very powerful fat based antioxidant. Ala alpha lipoic acid. For that reason, I created this optimum EFA blend which has all these essential fatty acids to help decrease inflammation and help you heal neck. Also very important carotenoids are naturally found in, let's say carrots or beets, which are the precursor for vitamin A to aid in soft skin healing or soft tissue healing. Curcumin, bromelain, boswellia. These are also great supplements to take during the inflammatory stage to support that stage. In stage three, we have the tissue building. In the tissue building, we want the high quality protein and collagen. Research on collagen peptides has really exploded in terms of showing us that collagen peptides are essential for maintaining healthy bones, healthy tissue, healthy joints. And there's different peptides for different reasons. Yes, bone broth is also great if you actually make bone broth soup. But there's a special way to make sure you get the collagen out of there. For example, my mom actually loves to make bone broth soup. But how does she do it? She actually boils them twice in a pressure cooker. So first she cooks them for three hours, lets them relax, and then she does it again. And basically we get collagen and the soup is like a jelly if. Especially when it's cooled off. So if you have the time to actually do bone broth properly, then great. Unfortunately, some of the bone broth does not get absorbed as well as the peptides. When you're looking at the peptides, and especially this company called Jolita, which I've been following, they have great studies to show that their collagen peptides are actually getting absorbed to aid in skin healing. Especially they studied also for beauty, the reduction of wrinkles. But for me especially I'm interested in that those strong collagen fibers that are formed, you know, after surgery. What else is important in tissue building is bromelain, boswellia, curcumin. You see some of the same things that are important in stage two of healing, which is the inflammatory stage. So tissue building stage three. As I was saying before, this is up to three months post your procedure. So really, some patients ask me, should I take the supplements only for two weeks? No, because your body is still healing even up to a period of like not a year or two, but really essentially the first three months. I think that they're most critical months where I recommend some form of supplementation to ensure adequate healing. In stage four, matrix maturation, when we're waiting for the bone to mature, the tissue has already matured. So let's say you're having a gum graft that's already matured at three months. The collagen fibers have already basically rearranged. They're nice and strong because you've been taking lots of vitamin C. But during stage four, the matrix maturation, the bone can take up to two years to mineralize. So mineralization is important. And you might be thinking, oh, just calcium? No, there's so much more involved. For example, in bone healing. We know we need calcium, magnesium, vitamin D, K1, K2, boron, but and phosphorus. A lot of people don't have enough phosphorus in their diet and this is key to strong bone formation. As many of you know, I started a company called Orasana and I focus on healing, anything that has to do with oral healing. And we have a whole, you know, bone strengthening program in which calcium, magnesium in the right proportion, together with phosphorus can actually give us, you know, the right ingredients to form strong bones. A lot of people are afraid of calcium. You know, what is the story with calcium? It's like, oh my. There's been some literature showing that people ch taking calcium carbonate was actually just ending up in the blood vessels, calcifying the arteries. And what was the problem with that is like the people who are taking calcium carbonate without the D3K1K2, the calcium doesn't know where to go. You might be absorbing it, but what you know, it can be absorbed in the bone from the blood. So this is what is important to make sure we understand the traveling of the calcium and how do we get it in the bone. So the recommendation today is to take up to 500 milligrams of some form of calcium, but definitely not carbonate because that's the least absorbed. Could be citrate, could be lactate together with magnesium. D3K 1K2. In order to maintain strong bones, especially for those of you that don't have enough dark leafy greens or dairy based calcium in the matrix maturation phase, the stage four of healing, we need blood flow stimulation, movement. So having some form of microcurrent is important. Oxygenation, exercise, bring the brings the oxygenation, blood flow stimulation, having high quality protein is still important. Collagen peptides, vitamin C also helps with those collagen inside the bone. And the same curcumin, bromelain and boswellia, which are anti inflammatory msm, especially if you've had an injury. Studies have shown that msm, which is basically a sulfur based supplement, really aids in connective tissue repair. Now when we're looking at bone and tissue or gums, they do have different requirements. So having a nice well balanced diet that's anti inflammatory, low in sugar, good in healthy fats such as avocado and salmon is highly important for both. I wanna take a little time to talk about vitamin D. Because vitamin D is so important during the healing process. Vitamin D helps to decrease infection, also increase the healing and also making sure that we have the right minerals going to the bone. Vitamin D also has been shown to increase implant success rate. So make sure that you have adequate vitamin D prior to any oral surgery. How do you know for sure you can actually do a blood spot test? It's basically a finger prick. You put like a couple of drops of blood on a blotting paper and we send it to the mail. It's very accurate and that way we could really target your supplementation. And what is normal really is the vitamin D. We want it to be between 60 and 80, 80 nanograms per milliliter. Is that too high? Not at all. There's been some studies done with tribes in the Amazon where the level of vitamin D was up to 140 nanograms per milliliter. Because we're spending all this time outside and you might say, oh yeah, I spend a lot of time outside. Yes, but you don't live outdoors. So typically still vitamin D is necessary to take as a supplement. But the best way again is to test. Test. Don't guess. Let's talk about pain management. So how do we manage pain after oral surgery? Definitely some of the curcumin that I mentioned to you before helps with decreasing pain and inflammation. Also the essential fatty acids, such as, you know, epa, dha, fish oil, gla, vitamin E, these all help in decreasing inflammation and managing pain. You can actually tackle take up to 4 to 5 grams a day. There were some studies done in the pain management department for the treatment especially of chronic pain. You could up your fish oil, APA, DHA, GLA to about 4 to 5 grams a day. Now anti inflammatory enzymes are great for pain control. Some of you might say, oh, you know, I don't want to take Advil or ibuprofen. Bromelain and proteolytic enzymes are great at controlling pain. We actually have had some studies done on proteolytic enzymes that come from pineapple stem in wisdom tooth extractions and they have shown to control inflammation just as well as ibuprofen. So definitely taking enzymes, you do have to take em on an empty stomach in order for them to take effect. And the nice thing about the enzymes, especially bromelain, it inhibits prostaglandin. It breaks up hematomas, those bruises in the site. So it helps you to recover faster, it decreases swelling and you can take up to 1500 milligrams a day. Quercetin is also a nice flavonoid to to have there. It's also anti inflammatory antioxidant and can be taken together with with the bromelain outside of enzymes for pain control. Homeopathics also help a lot for bruising and swelling. Arnica Montana, especially in 30x higher concentration the better it is. Um, so 30x is what I recommend for my patients. What are homeopathics is really a therapeutic method consisting of administering a small dose of any substance to an ill patient which after you take it by the person when healthy, would produce the symptoms observed in his or her illness. So it's based on the principle of the law of similars. And homeopathics have been around since the 1700s. I started in France and we have over 1100 different formulations of homeopathics for all kinds of different reasons, but for healing. The recommendation is Arnica Montana. And if you have nerve pain, definitely Hypericum perforatum is another great one to help in nerve regeneration and to really calm down the nerve for the stinging. APIs mellifica is great for any kind of stinging and burning. The important thing with homeopathics, you know, you can find them in forms of pellets. It has a little sugar component to aid in absorption. Or you can find them in an alcohol based. If it's an alcohol based liquid, it might put 20 drops. If you're worried about the alcohol content, you can put it in a little bit of warm water and just let it evaporate for 10 minutes and then you can take it. Belladonna is also a great homeopathic for cellulitis. Cellulitis is when you have that hard swelling or fever. It helps to bring down the fever. If you have nausea, let's say from maybe you had IV sedation. Nux vomica is great homeopathic you put it under your tongue and it helps to bring down the nausea. So that's it in a nutshell. I hope I've given you some great tips to heal. Always prepare your body and your mind to ensure that your healing grows perfectly. Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram doctorsanda this is Dr. Sanda. And remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.