After Bone Grafting
Post-operative care for a bone graft is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.
Immediately Following Surgery
- If you received intravenous sedation or general anesthesia, you may feel drowsy for several hours. Remember do not drive a vehicle, operate any machinery, or undertake important matters for 24 hours following your anesthesia experience and plan to rest for the remainder of the day.
- Keep the gauze pad in place over the surgical site with firm biting pressure for one (1) hour. After this time, the gauze pad should be removed and discarded. A new gauze pad does not need to be placed unless bleeding continues or recurs.
- Avoid vigorous mouth rinsing, sucking on straws, smoking, chewing on, and/or touching the wound area following surgery. This may initiate bleeding by dislodging the blood clot and the bone graft material.
- Do not pull on your lips to look at the wound. This can cause damage to the incision site and tear the sutures free.
- Do not smoke. Smoking will drastically decrease the chances of a successful bone graft.
- Take the prescribed pain medications before you begin to feel discomfort. This will usually coincide with the start of the local anesthetic wearing off which typically occurs 4 to 6 hours after surgery.
- Restrict your activities the day of surgery and avoid exercise. Lie down upon returning home with your head elevated on two or three pillows or sit up in a recliner and take it easy.
- Place ice packs to the sides of your face where surgery was performed to help minimize swelling.
- Drink plenty of fluids – at least five to six glasses of water a day.
Bone Graft Particles
A bone graft is typically made up of many small particles of bone. You may occasionally discover small granules of bone in your mouth during the first several days after the surgery and as healing progresses. Do not be alarmed, as this is normal and to be expected. Things you can do to minimize the displacement of bone particles and to improve healing include:
- Avoid disturbing, chewing near, or touching the wounds. Do not apply pressure with your tongue or finger to the surgical site, as the bone graft material may move during the initial healing phase.
- Avoid vigorous rinsing or spitting to prevent destabilization of the blood clot and bone graft.
If You Had a Sinus Graft
- Do not blow your nose or plug your nose when sneezing. If necessary, just wipe or dab and sneeze with your mouth and your nose open until your return visit.
- Avoid anything that causes increased pressure in your nasal cavities, sinuses, or mouth such as playing a musical instrument, blowing up balloons, scuba diving, etc.
- Use an over-the-counter decongestant (Dimetapp/Sudafed) as needed to reduce sinus and nasal congestion.
- Do not be alarmed if you experience bloody drainage from your nose.
- Notify the office if you experience the unexpected flow of air or fluid between your mouth and your nose.
A certain amount of bleeding is to be expected following bone graft surgery. Slight oozing or blood-tinged saliva is not uncommon for the first 12-24 hours. Excessive or continued 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 an additional hour. Repeat as necessary. If bleeding continues, you may bite on a moistened black tea bag in the same manner. Tannic acid in the black tea helps blood clot by contracting bleeding vessels. To minimize further bleeding, try to remain relaxed, sit in an upright position, and avoid strenuous exercise. If bleeding does not subside, please call our office for further instructions.
Swelling is normally expected after most surgical procedures and is usually proportional to the extent of the surgery performed. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to surgery. Most swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, swelling and discomfort may be minimized by the immediate use of ice packs. Ice packs (a bag of frozen peas work great) should be applied to the side of the face where surgery was performed. These ice packs should be applied for 30 minutes on and 30 minutes off for the first 24 to 48 hours while awake. After 48 hours ice has no beneficial effect. Instead, the application of moist heat to the sides of the face may be helpful in reducing the size of the swelling more quickly. On occasion, some residual swelling may last a week or longer.
In some cases discoloration of the skin may follow swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues of the mouth and face. This is a normal post-operative occurrence that may occur 2-3 days after the procedure and will gradually fade away over the following one to two weeks. Although rare, this bruising can occasionally extend from the eyes to as far down as the clavicles.
Take the prescribed pain medications before you begin to feel discomfort. This will usually coincide with the start of the local anesthetic wearing off which typically occurs 4 to 6 hours after surgery. Taking pain medication on an empty stomach may cause nausea, so it is recommended to take the pills with food or drink. Pain medication may make you groggy and slow your reflexes. Do not drive a vehicle, operate any machinery, or undertake important matters while medicated. It is also best to avoid alcoholic beverages. If you do not achieve adequate pain relief you may supplement each pill with an over-the-counter pain medication such as ibuprofen. When appropriate you may transition from the prescribed pain medication to an over-the-counter pain medication such as acetaminophen (Tylenol) or ibuprofen (Advil/Motrin).
It is best to wait until your local anesthetic has completely worn off before beginning to eat. Start with plenty of fluids during the first 24 hours. At least five to six glasses of liquid a day will help prevent dehydration. Drink from a glass and do not use a straw as this encourages more bleeding by displacing a blood clot. Avoid hot foods and liquids the first day after surgery. Begin with soft cool foods and chew away from the surgical sites. Avoid hard, crunchy foods that may disturb the area. It is best to progress to more solid foods and return to your normal diet as soon as possible.
Good oral hygiene is essential for good healing and to reduce the risk of infection. Begin gentle, warm salt water rinses (1 teaspoon of salt in 1 cup of warm water) the morning after surgery. Rinsing with salt water at least 3-4 times a day, especially after eating, will help to reduce inflammation and will gently flush food particles away. Dr. Conquest may prescribe an antibiotic mouth rinse to use in place of salt water. Rinse gently to avoid disturbing the bone graft material. Continue to brush your teeth 2-3 times a day as best you can – being careful to avoid the surgical sites for several days.
Antibiotics may be prescribed for certain patients after a bone grafting to help prevent infection. If you have been placed on antibiotics, take the tablets or liquid as directed until gone. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. If you were prescribed an antibiotic and are currently taking oral contraceptives, you should use an alternate method of birth control for the remainder of this cycle.
You will likely have sutures in the area of your bone graft to help with healing. Dr. Conquest will tell you if your sutures will dissolve on their own or if they will require removal. Even if your sutures are dissolvable, a follow-up appointment will be required seven to ten days after your procedure to check your healing.
Wearing your Prosthesis
You should not wear your dental prosthesis (partial denture, full denture, or flipper) immediately after your bone graft procedure unless specifically instructed otherwise. Your prosthesis may need to be properly adjusted at the time of your procedure by Dr. Conquest or afterward by your dentist so that it does not cause tissue irritation and interfere with the healing of your bone graft.
What Else Should I Know?
You should be careful going from the lying down position to standing, upright position. You may get light headed standing up too quickly. Before standing up, you should sit for one minute, then get up slowly.
Slight elevation of temperature immediately following surgery is not uncommon. If an elevated temperature persists or a fever (>101.5) develops, please notify the office.
Keep your lips moist with chap stick or an ointment such as Vaseline. Due to stretching of the mouth during surgery, your lips may dry out and crack – especially at the corners.
A sore throats and pain when swallowing are not uncommon due to swelling and inflammation of the nearby muscles. This will usually subside in two to three days.
Stiffness (Trismus) of the jaw muscles may occur and cause difficulty when opening your mouth and during chewing for several days following surgery. This is a normal post-operative event which will resolve on its own after several days. Taking an anti-inflammatory medication such as ibuprofen (Advil/Motrin) may help.
If you are involved in regular exercise, please be aware that your normal nourishment intake is reduced and you may be dehydrated after surgery. Exercise may further weaken you. Please avoid strenuous exercise for 2-3 days following surgery.