After Bone Graft Surgery

In case of an emergency, if you experience difficulty breathing or swallowing, immediately call 911 for assistance. Please read through the following instructions — some may be applicable, some may not be applicable to you.

• The socket is filled with bone chips, which are small bone particles, white in color and sand-like.
• A collagen membrane, which looks like white thin paper-like material, is placed over the bone graft during healing. This will look like a sponge or blood clot over the area.
• The area will have stitches on top of your gum tissue that may or may not need to be removed. Do not pull your lip or cheek to visualize the healing process, as this may cause the stitches to come loose sooner.
• You may experience a sensation of "crunching on sand." This is normal as some of the bone grafting material will work its way out.
• Local anesthesia immediately after surgery may last 6-8 hours. Be careful not to bite your lips, cheek, or tongue.

• Keep the gauze pad over the surgical area in place for a half hour. After that, remove and discard it and repack as necessary.
• **FOR 24 HRS POST SURGERY: DO NOT RINSE / NO SUCK THROUGH STRAW / NO SPITTING**
• Avoid activities that can dislodge the clot and cause bleeding, including touching the surgical site and vigorously rinsing your mouth.
• As the local anesthetic wears off, you will begin to feel discomfort. Take your prescribed pain medication right away — it is easier to control pain before it starts.
• Restrict your activities the entire day of surgery. Resume normal activity when you feel comfortable, typically after 72 hours.
• Place ice packs on the outside of your face where surgery was performed to control swelling and pain (good for 24 hrs).
• Do Not Pull (retract) your lip or cheek to visualize the surgical site — this may cause tension on sutures and lead to premature loss of sutures.
• Take all medication after surgery as directed unless modified otherwise. Diabetics: please be cautious and eat food or drink fluids before resuming diabetic medication (to prevent low blood sugar).

• Your doctor will pack pressure gauze after surgery. Change the gauze as directed.
• Diet: It is important to maintain your dietary intake. Begin with soft, cold foods. You may resume a normal diet when you feel comfortable. Drink plenty of liquids during the post-operative period, especially when taking medications.
• If Ibuprofen or narcotics are prescribed, take one pill after eating and start taking as directed.
• If antibiotics or anti-nausea medication is prescribed, take them as directed.
• Sleep with your head elevated (head above heart) for 3-4 days to help with swelling and pain.
• Avoid rinsing your mouth or spitting the day of surgery. 24 hours after surgery, you may rinse with warm salt water (1/2 teaspoon salt to 1 cup warm water) every 2-3 hours for the first couple of days.
• Do not brush or floss in the area of surgery for the first 24 hours.
• Ice applied over the surgical site during waking hours for 24-48 hours will minimize swelling. Apply for 15 minutes then rest for 15 minutes.
• No strenuous activities for the first few days following your surgery.
• Avoid tobacco products to improve the success of your implant.
• Avoid straws for 24 hours.
• Do not pull or pick on the sutures. Most sutures dissolve within 5-7 days.

Slight bleeding: After surgery, slight bleeding, oozing, or redness in your saliva is common.

Excessive bleeding: Blood-tinged saliva may create the appearance of a lot of bleeding but is no cause for concern. If you experience quantities of dark blood, this needs attention. Gently rinse or wipe any old clots from your mouth. Place a gauze pad over the area and bite firmly for 30 minutes. Repeat if necessary. If bleeding persists, bite on a moistened tea bag for 30 minutes. Tea contains tannic acid, which contracts bleeding vessels and helps form a clot. You can further minimize bleeding by sitting upright, avoiding over-excitement, and avoiding exercise. If excessive bleeding persists, call our office.

Swelling is usually proportionate to the surgery involved. It is the body's normal inflammatory response. It could be diffused around mouth, cheeks, eyes, and sides of your face. Typically swelling starts or becomes noticeable the day after surgery and reaches its maximum two to three days post-operatively.

After surgery, minimize swelling immediately using ice packs. Two plastic sandwich bags filled with ice, or ice packs, should be applied to the sides of the face where surgery was performed. Cold compress for 15 minutes on the face and 15 minutes off for 6-7 hours during the day, use ice packs continuously while you are awake. After 36 hours, ice has no benefit. If swelling or jaw stiffness persists for several days, it is a normal reaction to surgery. Instead of ice packs, start applying moist heat to the sides of the face to reduce swelling. Call the office for a follow-up appointment if you need to be seen sooner than the one scheduled.

Moderate pain: Take one or two tablets of Tylenol or Extra Strength Tylenol every three to four hours, or take two to four 200 mg tablets of ibuprofen (Motrin or Advil) every three to four hours.

Severe pain: Take the prescribed medication as directed. It will make you drowsy, so avoid driving a vehicle or operating machinery. Avoid alcoholic beverages. Pain or discomfort should improve each day. If it persists, call our office.

Dry socket: This occurs when the blood clot is prematurely dislodged from the tooth socket. Sudden severe pain at the surgical site and even in your ear may occur two to three days after surgery. Call our office if this occurs.

FOR 24 HRS POST SURGERY: DO NOT RINSE / NO SUCK THROUGH STRAW / NO SPITTING

Don't rinse your mouth until the day following surgery (24 hours after surgery). You can brush your teeth during the night of surgery. The day after surgery, mix a teaspoon of salt with a cup of warm water. Rinse at least five to six times daily, especially after eating, and use prescription Medicated mouth wash Peridex as directed by your doctor.

Take the tablets or liquid as directed to help prevent infection. Discontinue if you develop a rash or have an adverse reaction. Call our office if you have any questions. In case of emergency such as inability to swallow, difficulty breathing, or swelling of tongue, lip and cheek, report to the nearest emergency room ASAP.

If you experience nausea or vomiting after surgery, do not take anything by mouth, including your prescribed medication, for at least an hour. Slowly sip on cola, tea, or ginger ale over a 15-minute period. When nausea subsides, you can eat and take the prescribed medicine.

You have either developed a communication between the maxillary sinus and your tooth socket or are at a high risk of developing one. We want to be certain that the tissues heal and that a communication does not become permanent. For this reason, we are recommending:

• Do not smoke. Any smoking dramatically reduces wound healing.
• Avoid blowing your nose during the next four weeks and avoid any activity that increases pressure in your sinuses such as exercise or bending over/straining/sneezing. If you have to sneeze, do so with your mouth open.
• If your nose becomes very stuffy, you may use saline nasal spray twice a day for the next two weeks.
• Be sure to take the antibiotics we prescribed until they are gone.
• We strongly recommend Sudafed or Dimetapp for at least the next two weeks to reduce sinus congestion. A non-drowsy variety is recommended.
• Do not rinse your mouth too aggressively during these two weeks. Rinse gently.
• If you continue to get a feeling of water getting into your nose when you take a drink, please call our office at 570-884-8321.