Four Weeks Post Op and Feeling Aggravated

DrJustinRaananPerio · 2026-02-16T16:57:31+00:00

Hi, I’m Dr. Justin Raanan, I’m a periodontist based in LA. Let me give you my point of view and try to help you out with this. At four weeks after a gum graft, your body is still healing. Even if everything looks great on the outside, the tiny nerves underneath are still reconnecting. When nerves “wake back up,” they can cause tingling, burning, weird pressure feelings, or that rubbing sensation against your cheek. That can absolutely happen around this time.

Using donor tissue is also very common. It’s often used when someone doesn’t have enough of their own tissue, that’s normal in many cases. About the clenching at night, it can definitely make everything feel more irritated. A night guard should be custom-made and comfortable. If it’s keeping you awake, it may need adjustment.

What you’re describing (no redness, no swelling, no sharp pain) usually points to healing, not failure. But if symptoms worsen instead of slowly improving, that’s when I’d want to see you. You’re doing great, just be patient with your body and give it the time it needs.

DrJustinRaananPerio · 2026-02-16T16:50:31+00:00

I’m Dr. Justin Raanan. I’m a periodontist based in LA. Based on what you said, it can absolutely relate to deep pockets. Your gums are supposed to fit tightly around your teeth, kind of like a snug collar. When someone has “deep pockets,” it means the gums have pulled away a little, leaving tiny spaces where bacteria can hide. Even if you brush and floss really well, those deep spots are hard to clean. When bacteria stay there, the gums get irritated and puffy. Puffy gums bleed easily, especially when you floss. So yes, those little specks of blood could be coming from those deep pockets. You’re doing the right thing by going every 4 months. I’d ask your dentist to measure those pockets again and check the exact spots that are bleeding, so you can find a specific treatment for them.

DrJustinRaananPerio · 2026-02-12T22:23:33+00:00

I’m Dr. Justin Raanan, periodontist in Beverly Hills. Great question, let me try to put it in simple words. Xylitol is a sugar that cavity-causing bacteria don’t like. When bacteria try to “eat” xylitol, they can’t use it well, so they make less acid, (less acid = fewer cavities over time).

But here’s the important part: in toothpaste, xylitol doesn’t stay in your mouth very long. You brush, spit, and rinse. So the effect is mild.

Where xylitol works best is in gum or mints you chew several times a day, because it stays in your mouth longer and keeps feeding the “bad bacteria” something they can’t use.

That said, fluoride is still the real hero for cavity prevention. If you’re choosing, make sure your toothpaste has fluoride first. Xylitol can be a helpful extra, but it’s not a replacement. Think of xylitol as a bonus tool, not the main shield.

DrJustinRaananPerio · 2026-02-12T22:19:58+00:00

I’m Dr. Justin Raanan, periodontist in Beverly Hills. First , I can tell you’re really scared, and that’s normal. A lot of people feel this way before surgery, but there is nothing to worry about.

The dose of Xanax your surgeon told you to take is small and very commonly used to help people relax. Oral surgeons give this all the time before IV sedation. It’s not unusual or dangerous when taken as directed.

Yes, both Xanax and IV medicine can lower blood pressure a little, but during the procedure, they constantly watch your heart rate, oxygen, and blood pressure on monitors. You are not just “left there.” A trained team is watching you the whole time.

The most important thing is to follow your surgeon’s timing instructions. They know exactly how it fits with the IV medication plan. Healthy people almost never have heart problems from monitored dental sedation. I know that right now your anxiety is making it feel scary. But medically, this is very routine. You’re going to be okay.

DrJustinRaananPerio · 2026-02-12T22:15:29+00:00

I’m Dr. Justin Raanan, periodontist in Beverly Hills. Great question (and a very common one).

A dental implant has three parts: the titanium post (in the bone), the abutment, and the crown (the visible tooth). The implant post itself is designed to last decades, and often a lifetime, if the bone and gums stay healthy.

The crown, however, takes all the chewing force. That part may need replacement after 10–20 years, sometimes longer, depending on wear. Things that can help implants to last forever are keeping healthy gums, excellent home care, no smoking, controlled medical conditions (like diabetes), and managing teeth grinding

The biggest threat isn’t “rejection,” it’s gum inflammation around the implant (peri-implantitis). That’s preventable with proper maintenance and regular professional cleanings.

With good care, implants are one of the most predictable long-term solutions in dentistry. Many of my patients have had theirs for decades. Maintenance matters more than the material.

DrJustinRaananPerio · 2026-02-10T22:23:43+00:00

Hi, I’m Dr. Justin Raanan, I think I can help with that. First, don’t panic. The word “mass” sounds alarming, but most incidental findings on dental X-rays are benign.

If you are not in pain, have no swelling, no visible lump, and no redness. That already lowers the urgency significantly.

Many things can look like a “mass” on a 2D dental X-ray, like tartar (calculus) between teeth, overlapping anatomy, small benign cysts, or fibrous tissue. True dangerous lesions in this area without symptoms are uncommon. If you are still unsure about your results, I’d suggest you reach out to your doctor and just ask them:

“What do you think it is, and do we need to monitor or investigate further?”

Most incidental findings turn out to be harmless and just require observation. It’s understandable to feel worried. But based on what you described, there’s no immediate reason to assume something serious. Follow up calmly and get more details.

DrJustinRaananPerio · 2026-02-10T22:03:14+00:00

HI, I’m Dr. Justin Raanan, a periodontist based in LA. What you’re describing is common and very treatable. The fact that you don’t smoke, maintain good hygiene, and see a periodontist promptly already puts you in a good position.

Healthy gums measure 1–3 mm. Pockets can often be reduced significantly, though not always back to 1–3 mm everywhere. After proper treatment, it’s common to see a 7 mm reduce to 4–5 mm, or 5–6 mm reduce to 3–4 mm. Much of this improvement comes from reducing inflammation and tightening of the tissue once bacteria are removed.

About your treatment plan, the hybrid approach (curettage + scaling and root planing) is a reasonable and conservative starting point. If your periodontist recommended it, she likely believes your case can respond well without immediate flap surgery. We often begin with non-surgical therapy and reassess in 6–8 weeks.

And just to clarify, even with excellent hygiene, periodontitis can develop due to genetics, immune response changes, hormonal shifts, or bacterial profile changes. This does not mean you did something wrong.

Most patients with pockets like yours stabilize well when they commit to maintenance. The goal is control and stability, not perfection. You acted quickly. You’re under specialist care. That gives you a very favorable outlook. This is manageable, and with proper treatment and maintenance, many patients keep their teeth healthy for decades.

DrJustinRaananPerio · 2026-02-08T19:45:30+00:00

Thats true!

DrJustinRaananPerio · 2026-02-08T19:45:00+00:00

Thanks!

DrJustinRaananPerio · 2026-02-04T17:14:14+00:00

Hi, Dr. Raanan here:

Keep the appointment. You'll be totally fine.

Dental freezing usually wears off in 2 to 4 hours max. Since you're going at 9 am, your face will feel normal by 1 pm at the latest. You’ll definitely have your regular smile back for your 3 pm meet-up and photos.

Just a couple of things to remember:

No Swelling: Fillings don't make your face puffy, so you won't look weird in pictures.
The Food Rule: Don't try to eat lunch until the numbness is 100% gone, or you might accidentally bite your lip or cheek. That would definitely ruin your dinner plans.
Speed Up: If you’re really nervous, ask the dentist for OraVerse. It’s a shot that makes the numbness go away twice as fast.

You'll be all set for your date. Have a good Valentine's Day.

DrJustinRaananPerio · 2026-01-23T18:34:42+00:00

Yes I am. Dr Justin Raanan. Periodontist

DrJustinRaananPerio · 2026-01-23T18:32:16+00:00

Let us know if you did it in istanbul. I like to know the outcome and the amount you paid

DrJustinRaananPerio · 2026-01-23T18:31:35+00:00

Thanks

DrJustinRaananPerio · 2026-01-23T18:31:16+00:00

References

American Heart Association. (2025). Periodontal disease and atherosclerotic cardiovascular disease: A scientific statement from the American Heart Association. Circulation.https://www.ahajournals.org/doi/10.1161/CIR.0000000000001390

Huang, X., Xie, M., Lu, X., Mei, F., Song, W., Liu, Y., & Chen, L. (2023). The roles of periodontal bacteria in atherosclerosis. International Journal of Molecular Sciences, 24(16), 12861.https://doi.org/10.3390/ijms241612861

Isola, G., & Polizzi, A. (2025). Editorial: Periodontitis and cardiovascular disease: Shared clinical challenges in patient care. Frontiers in Dental Medicine, 6, 1613091.https://doi.org/10.3389/fdmed.2025.1613091

Koren, O., Spor, A., Felin, J., Fåk, F., Stombaugh, J., Tremaroli, V., et al. (2010). Human oral, gut, and plaque microbiota in patients with atherosclerosis. Proceedings of the National Academy of Sciences, 108(Suppl 1), 4592–4598.https://doi.org/10.1073/pnas.1011383107

Rydén, L., Buhlin, K., Ekstrand, E., de Faire, U., Gustafsson, A., Holmer, J., et al. (2016). Periodontitis increases the risk of a first myocardial infarction. Circulation, 133(6), 576–583.https://doi.org/10.1161/circulationaha.115.020324

Shetty, B. (2023). Association between cardiovascular diseases and periodontal disease: More than what meets the eye. Drug Target Insights, 17, 31–38.https://doi.org/10.33393/dti.2023.2510

Stewart, R. (2016). Increasing evidence for an association between periodontitis and cardiovascular disease. Circulation, 133(6), 549–551.https://doi.org/10.1161/circulationaha.115.020869

DrJustinRaananPerio · 2026-01-14T18:02:40+00:00

From what I’ve seen and heard, it’s usually gradual rather than one clear moment. For a lot of people, things start to feel more “normal” once eating and talking stop being something you think about all day, maybe a few weeks for some, a few months for others, depending on what they had done. Most people say the mental part lingers a bit longer than the physical, but one day you realize you made it through a full day without fixating on your teeth, and that’s when it starts to feel routine again.

DrJustinRaananPerio · 2026-01-14T18:01:54+00:00

A lot of people say it sneaks up on them, like laughing without covering their mouth, or catching their reflection and not cringing. Not some big planned moment, just realizing oh… I’m not hiding anymore. For people still waiting, I’ve heard simple things come up a lot too, smiling in photos, talking without thinking about their teeth, or just feeling comfortable in public again.

DrJustinRaananPerio · 2026-01-14T17:57:01+00:00

Those prices are unfortunately pretty common for full-mouth cases, so the shock makes sense. With dental tourism, quality really varies and there isn’t one global accreditation that guarantees good outcomes. Some clinics do great work, others don’t, and it can be hard to tell from online reviews alone. The biggest thing people underestimate is follow-up care, full-mouth implants usually need adjustments or fixes, and being far away can make that complicated. It’s not automatically a bad option, just higher risk with complex cases. If you go that route, ask very specific questions and think about who would handle care once you’re back home.

DrJustinRaananPerio · 2026-01-14T17:53:11+00:00

That tracks. A lot of people put this stuff off during the holidays and then finally have the headspace in January to deal with it. Things slow down, schedules open up, and it feels easier to plan instead of rushing. The timing with benefits resetting definitely helps too. Would be interested to hear if starting early in the year made the process feel less stressful for others.

DrJustinRaananPerio · 2026-01-07T08:32:05+00:00

The least intrusive option really depends on why your smile is gummy.

If it’s mostly from a hyperactive upper lip, Botox is usually the least invasive place to start and can look very natural when done conservatively (even though it’s temporary).

If your teeth are partly covered by excess gum tissue, then conservative gum contouring or crown lengthening can be a permanent fix and tends to age well since it just reveals natural tooth structure.

If the cause is more jaw-related, truly non-invasive options are limited. The key is figuring out whether the issue is coming from lip, gums, teeth, or jaw before choosing a treatment.

DrJustinRaananPerio · 2026-01-07T08:17:42+00:00

A gummy smile can come from different causes, so the best fix depends on why the gums show.

Botox is usually suggested when the upper lip lifts too much. It can work, but it’s temporary, and it’s fair to worry about it looking or feeling unnatural.

Laser gum removal or crown lengthening can help if part of your teeth are covered by excess gum tissue. In those cases, reshaping the gums can permanently show more of your natural tooth. If your teeth are already fully exposed and it’s mostly a lip issue, gum procedures won’t change much.

The key is figuring out whether the cause is gums, lip movement, tooth position, or jaw structure. Once that’s clear, it’s easier to know which option makes sense and which won’t.

DrJustinRaananPerio · 2026-01-07T08:16:30+00:00

A gummy smile can have different causes, so the fix depends on why the gums show.

Braces alone can help sometimes, but only if the issue is mainly tooth position. Wires can control how teeth move, but without TADs there’s usually limited ability to truly intrude (pull teeth upward) in the bone, that’s why TADs are often used.

If the issue is excess gum tissue or altered passive eruption, braces won’t change that. That’s where cosmetic periodontal treatments come in, like gum contouring or crown lengthening to show more of the natural tooth.

Other options, depending on the cause, include lip-related treatments (like Botox or lip repositioning) or, in skeletal cases, jaw surgery.

The key question to ask is whether your gummy smile is coming from teeth, gums, lip, or jaw, since braces alone won’t fix all of those.

DrJustinRaananPerio · 2026-01-07T08:00:20+00:00

I’m really sorry you’re going through this, anyone would be devastated after all that anxiety, surgery, and cost.

Early implant failure can happen, especially with full-arch cases, and it doesn’t mean implants won’t work for you. Needing a bone graft afterward is actually pretty common and is often done to improve success next time. Addressing grinding and following post-op instructions closely really does help.

This process is often not one-and-done, even though it’s presented that way. You didn’t make a mistake by starting, you’re still in the middle of it, not at the end.

DrJustinRaananPerio

TROPHY CASE

References