After Bone Grafting

Your bone graft is made up of many particles.  You may find some small granules in your mouth for the first several days.  Do not be alarmed by these.  The socket is over packed to allow for the loss of a small amount of particles.  It is normal to have some of them come out of the graft site and into your mouth.  There are some things that can be done to minimize the amount of particles that become dislodged.  Following the instructions below will help in keeping your graft in place and allow for successful healing.

Sometimes the after-effects of oral surgery are quite minimal, so not all of the following instructions will apply.  In such cases, use your best judgment.  When in doubt, however, please follow the guidelines below or call our office for further clarification at Bowie Office Phone Number 301-262-4500.  After business hours, please contact our answering service at the same number and they will put you in contact with Dr. Menendez.

Bleeding

Typically, you can expect to have some bleeding after your surgery.  Most patients should only need to change the gauze periodically for several hours after surgery.  Minor “oozing” is normal up to 48 hours after surgery, and is not a cause for concern.  Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth. Your “Care of the Mouth” card has specific instructions for rinsing with hydrogen peroxide after surgery.  Place a cold moist gauze over the area and bite firmly for thirty minutes.  Repeat if necessary.  If bleeding continues, bite on a moistened tea bag for thirty minutes.  The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels.  To minimize further bleeding, do not become excited, sit upright, and avoid exercise.  If bleeding does not subside, call for further instructions. 

Swelling

The swelling that is normally expected is usually proportional to the surgery involved.  Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon.  This is the body’s normal reaction to surgery and eventual repair.  The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 day post-operatively.  However, the swelling may be minimized by the immediate use of ice packs which should be applied to the sides of the face where surgery was performed.  Keep the ice packs on for 30 minutes, then remove them for 30 minutes.  Continue to repeat this cycle to help control pain and swelling.  After 36 hours, ice has no beneficial effect.  If swelling or jaw stiffness has persisted for several days, there is no cause for alarm.  This is a normal reaction to surgery.  Thirty-six hours following surgery the application of moist heat to the sides of the face may help to reduce swelling.

Bruising

Swelling after any surgical procedure is normal and usually occurs 24 to 48 hours after surgery.  In some cases, discoloration of the skin follows swelling.  The development of black, blue green or yellow discoloration is due to blood spreading beneath the tissues.  This is a normal post-operative occurrence, which may occur 2-3 days after the procedure.  Moist heat applied to the area may speed up the removal of the discoloration.

Pain

Have all prescriptions filled and take your medications as directed on each prescription bottle.  For the most effective pain relief, take your first dose of pain medicine after you get home, before the numbness wears off.  Do not operate machinery or drive a car for 24 hours after your surgery if you had intravenous anesthesia or after taking prescription pain medication.  The prescribed pain medicine will make you groggy and will slow down your reflexes.  Avoid alcoholic beverages.  For break-through pain (pain that persists after taking prescription pain medication) you can alternate with ibuprofen (i.e. Motrin, Advil).  Do not exceed 600mg of ibuprofen in six (6) hours.  Do not take acetaminophen, (Tylenol), or aspirin. Nausea with pain medication may occur but can reduced by eating food 30 minutes before taking your pain medication.  If you do become nauseated, you can also take one-half of your prescribed dose more frequently.  If you continue to experience nausea or vomiting, please contact our office.  Pain or discomfort following surgery should subside more and more every day.  If pain persists, you may require attention and should call the office.

Antibiotics

Antibiotics will be given to help prevent infection.  Be sure to take the prescribed antibiotics as directed.  It is important to completely finish all of the medication; however, discontinue antibiotic use in the event of a rash or other unfavorable reaction and call our office.  If you are taking birth control pills, please note that antibiotics may make your birth control pills less effective.

Diet

After intravenous sedation, liquids should be taken at first.  Do not use a straw, drink from a glass.  The sucking motion can dislodge the bone graft.  Drink lots of liquids after the surgery to prevent dehydration.  Drink at least 5-6 glasses of liquid a day.  Avoid hot foods until all bleeding stops.  Cold foods often can soothe an uncomfortable area.  Milk shakes, yogurt, pudding, Jell-O, and applesauce usually work well.  You may advance to normal food as you feel able, but avoid crunchy foods like popcorn and potato chips until gum tissue has healed.  Your food intake will be limited for the first few days.  You should compensate for this by increasing your fluid intake.  You may eat anything soft by chewing away from the surgical site(s).  High calorie, high protein intake is very important.  Try not to miss a single meal.  You will feel better, have more strength, less discomfort, and heal faster if you continue to eat. 

Oral Hygiene

Oral hygiene is very important following a bone grafting surgery.  Do not rinse your mouth or brush your teeth in the area of your surgery until the day after surgery.  The next day you may rinse your mouth with the prescription mouthwash, Peridex, twice a day, in the morning and the evening before bedtime.  In addition, rinse your mouth with one-half teaspoon of salt in a glass of lukewarm water and rinse four to five times each day for 10 days.  Minor bleeding may occur when you brush or rinse during the first week.  Do not be alarmed by this. 

Activity

Reduce physical activity for 2-3 days.  Avoid lifting, bending, running, etc. to help minimize swelling.  Rest and sleep with your head elevated.  After 2-3 days, you may resume normal activity as you feel able.

Dentures and Prostheses

Partial dentures, flippers, or full dentures should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise.  If you have a temporary “flipper” to wear do not place it until the numbness in the area is gone, unless specifically instructed otherwise.  When it is placed it should not touch the gums in the area of the surgery.  If it does, this can cause ulceration of the wound edges and breakdown of the suture margins.  This can lead to loss of the graft.  If you have questions about the fit of your flipper, partial or complete denture, do not wear it until your general dentist or our office can see you.

Other Possible Complications After Bone Graft Surgery

Numbness:  If numbness of the lip, chin or tongue occurs there is no cause for alarm.  As stated before surgery, this is usually temporary in nature.  You should be aware that if your lip or tongue is numb you could bite it and not feel it, so be careful.  Should the numbness persist overnight, call our office the next day to make arrangements for a follow up appointment and we can answer any questions about this.

Fever:  Slight elevation of temperature immediately following surgery is not uncommon.  If the temperature persists, notify the office.  Tylenol or ibuprofen should be taken to reduce the fever.

Dizziness:  You should be careful going from the lying down position to standing.  If you stand up suddenly, you could get light headed.  To prevent this, sit for one minute then get up.

Dry/cracked lips:  If the corners of your mouth are stretched after surgery, they may dry out and crack.  Your lips should be kept moist with a lip balm or Vaseline.

Earache/ sore throat:  It is normal to experience a slight earache and or pain when swallowing after surgery.  As the muscles near the extraction site get swollen, the normal act of swallowing can then become painful.  This will subside in 2-3 days.

Muscle stiffness:  The jaw muscles may be stiff making it difficult to open your mouth for a few days following surgery.  Eating solid foods or chewing gum may help to relileve muscle tightness.  This is a normal post -operative event which will resolve in time.

Smoking:  Smoking or chewing tobacco is not healthy for your mouth, so it is best to avoid smoking or chewing tobacco after your bone grafting surgery.  The chemicals and tar slow or inhibit the healing process in your mouth, and also tend to restrict blood flow to the area of your mouth that needs it most to begin the healing process.