Bone Grafting After Care
The following information applies in instances in which the grafting material has been placed into extraction sites or other areas to help preserve or reconstruct your upper and or lower jaws in preparation for implant placement.
Your bone graft is typically particulate bone and its consistency is near that of course 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. However, you can do some things to mitigate this occurrence.
Following the second day, you may gently rinse, but not vigorously, so not to disturb the bone graft granules. Please follow our instructions if you are wearing a full or partial denture.
Please take all prescribed antibiotics as directed to help prevent infection.
Do not smoke for at least two weeks after surgery, if at all. Smoking dramatically increases the risk of bone graft failure. If you feel it necessary, we can prescribe a Nicoderm patch.
Do not rinse or spit on the day of surgery, as this can disturb the blood clot, open the wound, potentially dislodge the membrane, prolong bleeding and/or slow healing. You should not have a significant amount of blood in your mouth, but saliva can be swallowed, even if slightly blood tinged.
Keeping your mouth clean after surgery is essential to reduce the risk of infection. Start warm salt water rinses after the day of your procedure by combining ½ teaspoon of salt dissolved in 8 ounces of warm water and gently rinsing with small portions until the solution is gone. Repeat 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 48 hours have passed, brush and spit gently. Additionally, we may prescribe an antibiotic rinse which should be used at least in the morning and at bed time. With frequency, 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 antibiotic rinse for at least 30 minutes.
Wearing Your Prosthesis or Night Guard
Do not use partial or full dentures immediately after surgery until your post-operative appointment (unless instructed otherwise). Please contact the office with any further questions. When the prosthesis is seated, it should not heavily touch the gums in the surgical area. Heavy contact can cause ulceration of the wound edges and breakdown of the suture margins, leading to loss of the graft.
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 rinsing or wiping any old clots from your mouth and placing a gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea will help form clotting by contracting the blood vessels in the area. To further control bleeding, do not become excited, sit upright and avoid exercise.
Swelling 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 will subside on its own. However, swelling is usually not apparent until the day following surgery and will not reach its maximum until two to three days postoperatively. The swelling may be minimized by the immediate use of ice packs applied to the areas of the face where surgery was performed. The ice packs should be left on for 20 minutes and then taken off for 20 minutes for the first 12-24 hours. After the first 36 hours, ice has no beneficial effect. If swelling or jaw stiffness persists for several days there is no cause for alarm, as this is a normal reaction to surgery. 36 hours after surgery, the application of moist heat to the sides of the face is beneficial in reducing swelling.
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours. Two to four Ibuprofen (Motrin or Advil) 200mg tablets (400-800 mg) may be taken every six hours. For severe pain, take the medication prescribed as directed (typically narcotic medication). The prescribed narcotic pain medication will make you groggy and slow down your reflexes, so you should not drive a motorized vehicle or work around machinery. Additionally, avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day.
Do not use a straw for the first 24 hours – instead, drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical site. A high calorie, high protein diet is very important – nourish your body regularly. You should prevent dehydration by drinking fluids regularly. Your food intake will be limited for the first few days, and in turn you should compensate by increasing your fluid intake. Try drinking at least five to six glasses of fluid, and do your best to not miss meals. You will feel better, have more strength, feel less discomfort and heal more quickly if you continue to eat.
Discoloration and Bruising
In some cases, bruising, or 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 rare but may occur postoperatively. Applying moist heat to the area may speed up the removal of the discoloration.
Sutures are placed in the surgical area to minimize postoperative bleeding and to help healing. Dissolvable sutures typically fall out in five to seven days while non dissolvable sutures will require a return visit for removal one to two weeks post surgery. Sometimes the sutures become dislodged, but this is not a cause for alarm – simply remove the suture from your mouth and discard.
Use common sense. If you exercise regularly and get lightheaded, reduce your exertion or stop. Do not assume upside-down positions for one to two weeks.