Extraction with Bone Grafting
- Blood clotting: After an extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. Bite on a gauze pad for 30 minutes after the extraction. If bleeding or oozing continues after you remove the gauze pad, place another gauze pad and bite firmly for another 30 minutes. After a blood clot forms you should place ice chips in your mouth (not necessarily on the wound site) for the next three to four hours. The ice chips will help bring down the temperature in you mouth and thereby help reduce the swelling. Avoid spitting, and it is recommended that you swallow instead.
- Protecting the blood clot: After the blood clot forms, it is important to protect it, especially for the next 24 hours. Do not: smoke, suck through a straw, rinse your mouth vigorously, or clean the teeth next to the extraction site. These activities will dislodge the clot and slow down healing. Limit yourself to calm activities for the first 24 hours: this keeps your blood pressure lower, reduces bleeding and helps the healing process.
- Antibiotics: If an antibiotic has been prescribed, start taking it the first day (unless directed otherwise) and use to completion. You can reduce stomach upset by taking it with food and/or plenty of liquid.
- Ibuprofen: If we prescribed ibuprofen, start taking it the day of the bone graft surgery and continue for two days. After that you can still take it as needed for pain. Do not use ibuprofen for more than one week.
- Pain medication: Take one pain pill as soon as you can after surgery. It will usually work better if taken before the numbness wears off. After that, take only as needed. Take any narcotic pain pills with food and/or plenty of liquid. Do not drive after taking any narcotic pain pill and do not take them with sleeping pills or alcohol.
- Ice: Use a cold pack (a plastic bag of frozen peas works well) to the face over the area where the procedure was done for 10 minutes at a time, twice an hour, for the first six hours. You can periodically use an ice bag the rest of the day of surgery and the next day. If you use the ice bag as directed, you should have less swelling than you would have otherwise. Less swelling = less pain. Do not use hot packs or a hot water bottle.
- Sleep somewhat inclined: For the first two nights after the procedure, sleep in a recliner chair or with your head propped up with some pillows. A recliner is better. If you keep your head above your heart level for the first two days, it will significantly cut down on post-op swelling. Less swelling = less pain.
- Swelling: Most people get some swelling and, if they do, it usually happens about 48-72 hours after the surgery. Using the ice bag and sleeping inclined as directed above will help a great deal with keeping it to a minimum.
- Liquid in the brown jar: (if necessary) is chlorhexidine (Peridex), a topical antiseptic available by prescription. Use a Q-tip cotton swab to apply it. The ear cleaning Q-tips work best, as they are very absorbent and hold a good size drop of liquid. Apply about three times/day for four weeks to the surgical site by dabbing the chlorhexidine soaked Q-tip to the surgical area. Do not scrub it in. During the first four weeks, whenever you do start any tooth brushing at the surgical site, dip the toothbrush in the chlorhexidine, as well. Once this liquid is applied, do not eat, drink or rinse out for 30 minutes.
- Oral hygiene: Do not use a Waterpik or an electric toothbrush around the surgical area for six weeks after the procedure. Do not floss around the tooth/teeth worked on for one week, to avoid accidentally taking out any of the stitches. After four weeks, there should be no oral hygiene restrictions, except for Waterpiks and electric toothbrushes as noted above.
- Stitches and “Barrier membrane”: The stitches and barrier membrane over the extraction site are usually non-dissolvable and will need to be removed about three to four weeks later.
- Salt water rinses: Rinse your mouth out (don’t swish) with a warm salt water solution (one teaspoon of salt dissolved in eight ounces of warm water). Hold this in the mouth for 30 seconds and spit out. Repeat. Do this four to five times per day for seven days. Start the day after the procedure.
- Exercise: Avoid strenuous exercise for the first seven days. Strenuous physical activity may increase post-operative pain or cause post-operative bleeding and swelling. Less activity = less pain.
- Touching the surgical site: It is important that the surgical site remains untouched during the initial stages of healing. We recommend that you avoid stretching your mouth to look at the site and avoid playing with your tongue on the surgical sites.
- Bleeding: “Pink” saliva is normal for a few days. If you have bleeding, wipe the area clean of any “blood clots” first. It has to be thoroughly cleaned. Then apply gentle pressure to the extraction site for 10 straight minutes with a soaking wet tea bag (black tea works the best), or a soaking wet gauze pad, or a clean washcloth. Be sure it is soaking wet. If it is not, the clot will stick to it and start bleeding again when you pull it away. If it won’t stop, call our office immediately.
- Food: Stay on a soft diet, chew away from the extracted tooth/teeth and avoid any foods that would be more likely to get stuck in the extraction site, such as corn, popcorn, nuts, and seeds (fruit like strawberries have seeds). Do this for at least five weeks (if we used a non-resorbable barrier we removed, then for one week after the barrier is removed). Citric juices, carbonated beverages or acidic foods, like tomatoes, may make it hurt, but won’t damage the graft healing. For the first seven days, avoid really hot foods or drinks. Consider a nutritional food supplement (Carnation Instant Breakfast drink, Ensure, Slim-Fast, Glucerna for diabetics.) After five weeks, there should be no eating restrictions. Don’t use straws for the first week. No milkshakes with a straw for four weeks.
- Smoking: Avoid smoking during the healing process. Smokers have a much higher incidence of dry sockets. If you do smoke, keep it to five cigarettes or fewer per day and only smoke half the cigarette. No cigars or pipes. Do this for at least six weeks.
- Aspirin: Unless you have a special medical reason for taking aspirin (tell us at least a week ahead of time if this is the case), do not take aspirin products for seven days prior to through two days after the extraction procedure. Aspirin can cause bleeding.