Post-Operative Instructions: Bone Grafting/Soft Tissue Grafting

Patients Receiving General Anesthesia: Return home from the office immediately upon discharge. You may feel drowsy for a short period of time, or for several hours. You should not operate any mechanical equipment or drive a motor vehicle for at least 12 hours.

Oral Hygiene and Care: Do not disturb the surgical area today. Place the gauze directly on the surgical site, but do not bite down. Pressure on the bone graft will displace the material. Do not change the gauze for the first 20 minutes unless the bleeding is not controlled. Do not drink with a straw and do not rinse or brush your teeth vigorously, or probe the area with the tongue, objects, or your fingers. Do not place any pressure on the grafted area.

***After the first 24 hours have occurred, you may brush your teeth gently, carefully avoiding the surgical site. Do not smoke for at least 72 hours, since it is detrimental to the healing process.

Beginning the Day After the Surgery: You may start rinsing your mouth with a warm salt-water rinse (½ teaspoon of salt with 1 cup water) 3–4 times a day for the next 2 weeks. It is imperative to keep your mouth clean, since an accumulation of food or debris may promote infection.

Steady Bleeding: Bleeding should not be severe. Placing gauze during the first hour lightly will help to stop your pattern of bleeding. If bleeding persists, this may be due to the gauze pads being clenched between the teeth, rather than on top of the surgery site. Try repositioning a new gauze and hold for 20–30 minutes. No gauze should be left in for more than 30 minutes at a time. If bleeding persists or becomes heavy, substitute a moist, caffeinated tea bag on the area for 20–30 minutes. Gauze is to be removed while eating, drinking, and sleeping, or if bleeding has stopped. If bleeding becomes severe or continues for more than 24 hours, please call our office immediately.

Swelling or Bruising: Swelling is to be expected and usually reaches its maximum peak in 48–72 hours. Buying Arnica Remedy pills can reduce swelling & bruising (buy over-the-counter from your local pharmacy). Vitamin C, an antioxidant found in citrus fruits and green vegetables, can reduce inflammation as well. Head wraps are a great way to provide convenient, hands-free heat therapy after any procedure accompanied by bone grafting. The application of moist coldness to the sides of the face is beneficial in reducing the size of the swelling. Our head wrap features one continuous jaw sleeve that wraps around the head with extra padding for your chin. The swelling that is normally expected is usually proportional to the surgery involved, and will not reach its maximum until 2–3 days postoperatively. After day 4 of the surgery, apply a warm compress to the surgical site. To create a warm gel pack, you can bring water to a boil and dip the gel pack inside for 30 seconds to a minute. Before applying, slide the reusable gel packs into the sleeve. Our head wrap features two rows of Velcro^® at the top of the head for an adjustable, universal fit and comfort. Discoloration and swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery.

Diet: Introduction of foods and pain medications should be done gradually if IV sedation was administered. Follow this protocol to minimize nausea and vomiting:

1. Sleep for 1–2 hours when arriving home.
2. Awaken and drink a glass of water. Wait 15 minutes.
3. If no upset stomach occurs, then introduce cool liquid/soft foods and wait 15 minutes again.
4. If no upset stomach occurs, then take the pain and antibiotic medication as prescribed and check if more gauze is needed.

After this introduction period, eat any nourishing food that can be taken with comfort. It is advisable to confine the first day’s food intake to cool bland liquids or pureed or soft foods. Avoid foods like nuts, sunflower seeds, or popcorn, which may get lodged in the surgical sites. Over the next several days, you may progress to more solid foods. Proper nourishment aids in the healing process. If you are a diabetic, maintain your normal diet as much as possible, and follow your physician’s instructions regarding your insulin schedule.

Pain and Medications: Inherently, most oral surgery procedures are accompanied by some degree of discomfort. Take the pain medication prescribed as directed and according to the protocol listed in the Diet section above if general anesthesia was administered. If the procedure(s) were performed without general anesthesia, take the pain medication immediately. If you do not achieve adequate pain relief, you may supplement each pill with an analgesic such as ibuprofen & Advil^®. Taking pain medication with soft foods and a large volume of water will decrease the side effects of nausea or stomach upset.

*** 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. ***

Soft Food Diet Sample Recommendations After Oral & Maxillofacial Surgery:

A soft food diet includes soft-textured foods, or those softened by cooking, mashing, or chopping, where minimal chewing is required or easy to swallow.

Breads, Cereals, Grains – Safe soft foods in the grains group include cooked cereals, such as oatmeal, grits, and cream of wheat, or easily softened cereals such as Rice Krispies^® and Corn Flakes^®. Also acceptable are soft breads, muffins, pancakes, French toast with the crusts cut off, and soft pasta.

Eggs and Dairy – All eggs are acceptable; scrambled and soft-boiled are considered the best. All dairy products, including chocolate milk, ice cream, and yogurt, are acceptable.

Fruits and Vegetables – Juices, both fruit and vegetable, are the best. Others that qualify are those that are canned or cooked without seeds or skins. Fresh vegetables include avocados, tomatoes, and potatoes without the skins. Acceptable fresh fruits include bananas, pureed berries put through a strainer to remove skins and seeds, and melons.

Meats and Entrees – Meats such as beef, veal, lamb, liver, chicken, and turkey should be chopped or prepared in a food processor. Meatloaf and ground patties are acceptable. Cooked, fresh, or frozen fish without bones such as canned tuna, salmon, or white fish are allowed. Other good protein sources include tofu and well-cooked legumes.

Desserts – Desserts can include ice cream, sherbet, sorbet, pudding, or custard.

A Sample Soft-Food Daily Menu:

• Breakfast: Scrambled eggs with grated melted cheese and a banana
• Lunch: Tuna salad made with tuna, mayonnaise, and some spices, and applesauce
• Supper: Poached salmon and mashed or baked skinless sweet potato
• Dessert: Pudding with whipped cream

Liquid Food Supplements:

• Ensure^®, Boost^®, or other similar products.