Care After Bone Grafting

Your bone graft is typically particulate bone and is much the consistency of coarse sand. As a result, you may find some small granules in your mouth for the first several days. Do not be alarmed. It is normal to have some of these granules periodically come out of the graft site and into your mouth. You can do some things to minimize the number of particles that become dislodged.

• Do not disturb or touch the wound
• Avoid rinsing or spitting for 2 days to allow blood clot and graft material stabilization
• Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing
• Do not constantly lift or pull on the lip to look at the sutures. This can actually cause damage to the wound, dislodge the membrane, or tear the sutures
• Do not smoke if possible, for at least 2 weeks

Following the second day, gentle rinsing would be allowed but not too vigorously as you can again disturb some of the bone graft granules. If a partial or full denture was placed in your mouth, you may have to see your restorative dentist to have it adjusted and learn how to remove and replace it appropriately. It is our desire that your recovery is as smooth and pleasant as possible. Following these instructions will assist you, but if you have any questions about your progress, please call the office. Antibiotics: Be sure to take the prescribed antibiotics as directed to help prevent infection. Oral hygiene: Do not rinse or spit on the day of your surgery. This tends to disturb the blood clot, open the wound, possibly dislodge the membrane, and can prolong bleeding and slow healing. You should not have a significant amount of blood in your mouth. Saliva wan be swallowed, even if slightly blood-tinged. Keeping your mouth clean after surgery is essential to reduce the risk of infection. Start warm saltwater rinses the day following your procedure. Use one-half teaspoon of salt dissolved in an 8oz glass of warm water and gently rinse with portions of the solution, taking a few minutes to use the entire glassful. Repeat as often as you like, but at least four to five times daily and always after eating for the next five days. Do not brush the teeth in the area of surgery for 48 hours. When brushing, be very gentle. When expectorating, also be gentle. We may prescribe an antibiotic rinse (Chlorhexidine, Perioguard, Peridex) for certain procedures. This rinse should be used at least in the morning and at bedtime after routine mouthcare. Frequently, you can use this medication on a cotton-tipped applicator, gently wiping the membrane and surrounding area, to minimize staining of your teeth. Do not eat, drink or rinse your mouth after using the medicated rinse for at least 30 minutes. Using this rinse as an oral rinse more than 2 times a day will cause staining of your teeth. REMEMBER: Clean wounds heal faster. Smoking: Do not smoke for at least 2 weeks after surgery, if at all. As discussed at your consultation, smoking dramatically increases risk of bone graft and sinus augmentation failure. Wearing your prosthesis or night guard: Partial dentures or full dentures should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise. Please contact the office if there is any question. When it is placed it should not heavily 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 the loss of the graft. If you have questions about the fit of your partial or complete denture, do not wear it until your general dentist can see you. Bleeding: A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon for 24 hours or more. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting blood 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, inflammation, and eventual repair. The swelling will not become apparent until the day following the surgery and will not reach its maximum until 2-3 days postoperatively. The swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on for 20 minutes, then off for 20 minutes for the first 12-24 hours. 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. 36 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. Pain: For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every 3-4 hours or Ibuprofen (Advil) two-four 200mg tablets (600-800mgs) may be taken every 6 hours. For severe pain, take the medication prescribed as directed (typically narcotic medication). The prescribed narcotic medication will make you groggy and will slow down your reflexes. Do not drive an automobile or operate machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office. Diet: After general anesthesia or I.V. sedation, liquids should be taken. Do not use straws for the first 24 hours. Drink from a glass. The sucking motion can cause more bleeding by dislodging the clot. You may eat anything soft by chewing away from the surgical site(s). High calorie, high protein intake is very important. Please refer to the section on suggested diet instructions at the end of this section. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss meals. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat. CAUTION: If you suddenly sit up or stand from a laying position, you may become dizzy. If you are laying down following surgery, make sure you sit for several moments before standing. Discolouration and bruising: In some cases, discolouration of the skin follows swelling. The development of black, blue, green or yellow discolouration is due to blood spreading beneath the tissues. This is a rare but normal post-operative occurrence, which may occur 2-3 days postoperatively. Moist heat applied to the area may speed up the removal of discolouration. Nausea and vomiting: In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on clear liquids such as flavored waters, tea, or ginger ale. You should sip slowly over a 15-minute period. When nausea subsides you can begin taking soft foods and the prescribed medicine. If your nausea continues for more than 6 hours, please contact our office. Other complications:

• 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 the sensation. So be careful. Call our office if you have any questions.
• A slight elevation of temperature immediately following surgery is not uncommon. If your fever persists, notify our office. Tylenol or Ibuprofen should be taken to reduce fever.
• You should be careful going from laying down position to standing. You were not able to eat or drink during surgery. It was also difficult to take fluids after surgery. Taking pain medications can make you dizzy. You could get lightheaded when you stand up suddenly. Before standing up, you should sit for a few moments and then get up.
• If the corners of your mouth are stretched, they may dry out and crack. Your lips are kept moist with an ointment such as Vaseline or other lip balms.
• Sore throats and pain when swallowing is not uncommon. The muscles adjacent to the surgical sites can become inflamed and subsequently give some discomfort during swallowing. This will subside in 2-3 days.
• Stiffness (trimus) of the jaw muscles may cause some difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event, which will resolve typically in several days.

Sutures: Sutures are placed in the area of surgery to minimize post-operative bleeding and to help to heal. These sutures are frequently dissolving sutures, which will typically fall out in 5-7 days. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. Exercise: If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get lightheaded, stop exercising or reduce your exertion. Do not assume upside-down positions for 1-2 weeks. Finally: The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions. In the meantime, the area should be kept clean, especially after meals with salt water rinses or a toothbrush.