After Bone Grafting
Bone grafting prior to the placement of dental implants is a true surgical procedure. Post-operative care is extremely important. Unnecessary pain and the complications of infection and swelling may be reduced if the instructions are followed. Sometimes the after-effects of surgery are quite minimal, so not all these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office anytime for clarification.
Immediately Following Surgery
The gauze placed over the surgical area should be kept in place for 30 minutes and changed at regular intervals until the bleeding subsides. Usually, within 60 minutes, the bleeding will subside to a trickle. After reduction in bleeding, you can stop using the gauze. Mouth rinsing or touching the wound area immediately following surgery should be avoided. This may initiate bleeding. Gentle rinsing is encouraged prior to bedtime. Use the Peridex (chlorhexidine) that Dr. Hilmi prescribed. Take the prescribed pain medications as directed by the doctor. This will happen when the local anesthetic wears off.
Restrict your activities the day of surgery and resume normal activity when you feel comfortable. It is not unusual to require one week to ten days before you are feeling back to normal, and before you can resume exercise and normal eating patterns. Place ice packs to the sides of your face where surgery was performed. Do not smoke, as this will compromise the success rate of the bone graft that was placed.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon up to three days following surgery. Excessive bleeding may be controlled by first wiping any old clots from your mouth if present, then placing a moistened gauze pad over the area and biting firmly for 30 minutes. As the bleeding subsides, each change of the gauze should be whiter and less red. 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 sit upright and avoid exercise. Avoid bending over and lifting anything greater than three pounds. Smoking, forceful spitting, and use of a straw can cause the bleeding to start. Do not hesitate to call us if you have any concerns about bleeding.
The swelling is to be expected. Swelling around the mouth, cheeks, eyes, and sides of the face is quite common. 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 two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two Ziplock bags filled with ice, ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be used for 20 minutes on, 20 minutes off for the following surgery while awake. Drink plenty of cold fluids. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Please note that it is important to keep your head elevated for two to three days following surgery to minimize swelling. A reclining chair or extra pillows work well to keep your head elevated.
For mild pain, one or two tablets of Tylenol may be taken every four hours. You can use over the counter ibuprofen (Motrin or Advil) by taking two to four 200 mg tablets every three to four hours if preferred. You should not take more than 2400 mg of ibuprofen in any one 24-hour period. For severe pain, take the narcotic pain medication as directed by our surgeon.
After general anesthesia or I.V. sedation, clear liquids should be initially taken. DO NOT USE STRAWS. Drink from a glass. You may eat anything soft but try to avoid too much chewing for the next eight weeks. High calorie, high protein intake isespecially important. 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 your fluid intake. At least eight glasses of liquid should be taken daily. Keeping well hydrated also prevents nausea and vomiting. Try not to miss meals. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat. We recommend caloric supplements such as Ensure or an equivalent product. Two to three cans per day will help keep your strength and promote healing. Remove the gauze before eating. It is also advisable to avoid extremely hot foods for the first 72 hours. Avoid foods such as nuts, popcorn, sunflower seeds, and any other food where particles can get lodged underneath the tissue within the surgical site for three months.
Gently place the water in your mouth and let it swirl around and drip out into the sink. Do not spit as this may dislodge the blood clot. Warm water rinses are fine or ½ teaspoon of salt in eight oz. of warm water should be used two to three times a day, especially after you eat something. In addition to this, Peridex (Chlorhexidine Gluconate 0.12%) mouth rinse will also be prescribed. This should be used in the morning when you wake up and at night before you go to bed. Rinse with Peridex for 60 seconds and then let it fall out of your mouth. Peridex should be used for at least ten days.
Use of a WaterPik for oral irrigation can be done after two weeks. After two weeks, try to stay away from the site or use lower settings around the site. Please use a soft bristle brush and low abrasion toothpaste such as the Original Crest. Be gentle initially when you are brushing around the surgical sites. The important thing is to keep the surgical areas as clean as possible. If you choose to use a mouth rinse, please use one that does not irritate your gum tissue such as Crest Pro-Health. This mouth rinse does not contain alcohol which could irritate your natural gum tissues. You will use the Peridex mouth rinse for the first ten days.
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. In some patients, this is a normal occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration. In younger patients, bruising is rare and sometimes is represented as a slight yellow discoloration. In older patients, especially the elderly, bruising can be quite significant and is represented as black and blue discoloration. This can cover a larger area sometimes even involving the neck and upper part of the chest. Bruising of this degree can take approximately two weeks to resolve.
Please take the antibiotics as directed by Dr. Hilmi. Be sure to finish the entire prescription even if you feel that you are fine. Discontinue antibiotic use in the event of a rash or other reaction and notify us 845-340-1962. Take a probiotic while taking the prescribed antibiotic. If you take birth control pills the birth control may become ineffective; use back up form of birth control.
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 cold tea. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. Please call if the nausea does not subside within three hours.
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.
If the corners of your mouth are stretched, they may dry and crack. Your lips should be kept moist with an ointment such as Vaseline.
Sore throat and pain when swallowing is not uncommon. The muscles get swollen, and the normal act of swallowing can then become painful. This will subside in 48-72 hours.
Stiffness of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. In some patients, this is a normal post-operative event. Massage the muscles and apply moist heat, and usually, this will resolve in time.
In an upper jawbone(maxillary) grafting, especially in the back of the mouth, there is a possibility of the sinus communication. If this occurs, you may develop bleeding from the nose. This is usually temporary and will not persist past a few days. Try to avoid blowing your nose for several days.
Sutures are usually placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. Do not be alarmed. Just remove the suture from your mouth and discard it. The sutures will dissolve on their own seven to ten days following surgery.
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. Your case is individual as no two mouths are alike.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. or surgeon strongly recommends that you take at least a week off from any vigorous physical activity. When you do resume your exercise regimen, start lightly and gradually increase your routine over several days.
An appointment will be made with our staff for one week to check the surgical sites. If you did not receive an appointment, please call our office so we can make you one. Dr. Matthew Hilmi will also see you three months after the initial surgery to check the graft site to be sure it is well healed and ready for implant placement. He will then discuss the implant surgery with you.
If you have any questions regarding your condition, it is best to call the office during our regular office hours. A follow-up visit is provided as a courtesy at no charge. If you have an emergency, our surgical staff can be reached 24 hours a day, seven days a week.