There are various types of grafting procedures, and the extent of post-operative pain and swelling will depend on the type of grafting that was done. If you had a tooth extraction with grafting into the tooth socket, there will be sutures in place. Avoid chewing directly in this area. It is normal for some very small pieces of the graft to dislodge. It will feel like small granules. Do not be concerned; most of the graft material will stay in place.
In certain cases, a dissolvable suture will be used while in other cases the suture will be removed by the doctor within a few weeks. You may also have a membrane placed which may be visible as a white plastic-appearing material. Try not to disturb this, and keep it clean with gentle mouth rinsing.
Take care to minimize any sort of trauma to the area. Rinse very gently and brush very carefully on the adjacent teeth starting the of the procedure. If you are wearing a temporary prosthesis over the grafted site, try to avoid any contact between the temporary and the grafted site. If you feel it is putting excessive force on the grafted site, please call us, and we will provide further instructions.
Immediately Following Bone Grafting
The gauze pack should be kept in place with firm pressure over the area. Remove the pack after 30 minutes. If there is continued excessive bleeding, replace with new gauze and bite firmly again. Vigorous mouth rinsing or chewing in the areas of the bone grafting should be avoided. This may cause increased bleeding or damage to the bone graft.
A liquid or soft diet is recommended for the first 24 hours. After 24 hours, you may advance your diet, but take care to avoid any chewing directly on the surgical site. Avoid sucking through straws and eating hard or crunchy foods and spicy foods. Take the prescribed pain medication before the numbness from the local anesthesia wears off.
Restrict your activities on the day of surgery and return to normal activities slowly. Place ice packs on the outside of the face where the bone grafting was performed. Use ice for the first 48 hours to decrease swelling by applying it as continuously as possible.
Slight bleeding and redness in the saliva are common after surgery. If there is excess bleeding, gently wipe any old clots from the mouth and then place clean new gauze over the area and bite firmly for 30–40 minutes. Repeat every 30–40 minutes with new gauze. If excessive bleeding continues, bite on a cold-water-moistened tea bag firmly for 30–40 minutes. Slowly remove the tea bag and leave the area alone. If there is continued excessive bleeding, call our office for further instructions. Also, avoid excessive talking, drinking from a straw, or excessive chewing if there is continued bleeding.
Swelling is normal after any surgical procedure. The extent of swelling varies and depends on the extent of the surgery and each individual patient. Swelling around the mouth, jaws, cheeks, and below the eyes is not uncommon. The swelling will usually reach its maximum 2–3 days after the surgical procedure. The swelling can be decreased by the immediate use of ice packs in the first 48 hours. Ice packs should be applied to the outside next to where the surgery was performed. Keep the ice on as continuously as possible. Also, sitting upright and not lying flat on the first day will help to decrease the amount of swelling. You may have been prescribed other anti-inflammatory medications, such as dexamethasone (Decadron®). If you were prescribed these medications, follow the instructions written on the bottle.
Pain medications are normally required after bone graft surgery. If you can take ibuprofen (Motrin® or Advil®), take 400–800 mg every 6–8 hours or as prescribed by your doctor. Ibuprofen will help with pain relief and swelling reduction as an anti-inflammatory. If you cannot take ibuprofen, then 1–2 tablets of acetaminophen (regular Tylenol®, 325–650 mg) should be taken every 4–6 hours. If you were prescribed a stronger pain medication such as Norco® (hydrocodone with acetaminophen), Tylenol® with codeine, or Percocet® (oxycodone with acetaminophen), you can take that in addition to your ibuprofen if the pain is severe, but do not combine Norco®, Tylenol® with codeine, or Percocet® with any medication containing acetaminophen (Tylenol®). Follow the directions written on your prescription bottle. If you do take any of these medications, do not drive or work around machinery. Also, avoid alcohol while taking these medications.
If you are uncertain how much pain medicine to take or how often, please call us.
If the pain is severe, not controlled with your medications, or persists, please call us.
Proper oral hygiene is important because it helps reduce chances of an infection. Very gentle rinsing should begin the day of bone graft surgery. If you were given a prescription for mouth rinse, follow the instructions on the prescription. If you were not given one, rinse gently with warm salt water twice daily. You can brush your teeth the day of your bone graft surgery, but be careful not to traumatize the area where the bone graft was placed.
If you had IV sedation or general anesthesia for a bone graft, liquids should be initially taken. Your diet can then progress to more solids as tolerated; however, take special care to not chew directly on the bone graft site until directed otherwise. Ensure adequate fluids and nutrition to prevent dehydration.
Nausea and Vomiting
After IV sedation or general anesthesia, some patients may feel nauseated and vomit. To help avoid this problem, do not take your medications on an empty stomach. Take sips of clear carbonated liquids such as ginger ale or 7Up®. Hold off on your medications, if possible, until the nausea subsides. Try to stay hydrated with liquids. Sometimes patients feel nauseated from the prescribed pain medications, particularly the stronger pain medications such as hydrocodone or oxycodone (Norco® or Percocet®). Try stopping the pain medications and see if nausea subsides. If you have continued nausea and vomiting, call our office for further instructions.
Bruising and Discoloration
After surgery, some patients may notice bruising or discoloration around the areas of surgery. This is normal postoperatively and can take several days to subside.
Jaw Tightness or Limited Mouth Opening
This is normal following surgery and will improve and resolve over time. On occasion, you may be shown jaw exercises to help increase your jaw opening.
Dizziness or Lightheadedness
After IV sedation or general anesthesia, some patients may feel dizzy when standing up. Always have someone watching you the first 24 hours after sedation. Do not get up quickly from a sitting or lying position and make sure to remain hydrated with fluids.
Smoking can inhibit the healing process and can cause more pain after surgery. To ensure the best post-operative recovery, refrain from smoking for as long as possible after surgery.
If you have any questions or concerns following your bone grafting procedure, please don’t hesitate to call our office. We are on call 24 hours a day.