After Sinus Floor Bone Grafts

You have had a Sinus Floor Bone Graft Augmentation procedure in your upper jaw.  This procedure is designed to regain lost bone height in the area of your first and second molar and occasionally second premolar.  It is an important procedure as it allows implant placement in an area that could not receive an implant because of insufficient bone height due to an enlarged sinus and shrinkage of the bone below the sinus.
The bone that has been grafted is most commonly a combination of different bone graft materials and growth factors. It is a very delicate graft which can be easily disturbed.

DO NOT UNDER ANY CIRCUMSTANCES. BLOW YOUR NOSE OR DRINK THROUGH A STRAW FOR THE NEXT EIGHT (8) WEEKS. This time period may be longer if indicated. Anything that causes pressure or suction in your nose or mouth must be avoided.  Avoid “bearing down” – as when lifting heavy objects, blowing up balloons, playing musical instruments that require a blowing action or any other activity that increases nasal or oral pressure.

Should you need to sneeze, sneeze with your mouth open.  Do not drink with straws and do not spit.  Scuba diving and flying in pressurized aircraft may also increase sinus pressure and should be avoided.  Decongestants such as Zyrtec D (if your physician allows these medications) will help reduce pressure in the sinuses.  Nasal saline drops are also suggested (2-3 drops per nostril, four times a day). Smoking is strictly forbidden and will ruin the result.  You should stop all smoking at least one month prior to surgery as it will absolutely ruin the result.  Seek the aid of your physician for medicines and programs to help you with this.

EARLY CARE AFTER SURGERY

  1. On the Day of surgery, patients tend to do well if they follow this sequence:
    1. Control Bleeding First.
    2. Have the patient sit up and bite hard on the gauze until the bleeding is stopped.  Do not spit.  Apply ice packs immediately.
  2. Get something in your Stomach.
    1. A milkshake is suggested.
  3. Start Medications.
    1. If you have pain, start taking your pain medicine first and wait one hour to start the antibiotics.
    2. If you have no pain, start taking your antibiotic first and wait to start the pain medicine until pain is just starting to occur.

BLEEDING

Apply a thumb size roll of moistened sterile gauze between your molar teeth and cheek on the operated area. You then place your icepack on the cheek and apply a moderate-light pressure to the cheek in a constant manner. Do not talk or move the ice pack while trying to get bleeding to stop as this will provoke bleeding. It may require 3-4 hours to stop the bleeding even when the techniques described are used properly.

It is best if someone other than the patient can check for bleeding and apply the gauze for the patient.  At the end of each hour, remove the gauze and check the wound directly for further bleeding.  Do not be afraid to look at the wound directly.  It is the best way to check bleeding.

Please ignore bloodstain on the gauze as a sign of bleeding.  Instead, it is best to have a second person look at the wound using a flashlight and a spoon handle for a retractor.  Do not be surprised if the patient cannot open very wide.  You only need partial opening to see if it is bleeding.

If you see blood clots (“jelly clots”) on the adjacent teeth, wipe them off. This may stimulate some bleeding but it is the correct thing to do.  These “jelly clots” form when the gauze does not seal off the gum opening and blood seeps outside of the gum and clots on the adjacent teeth. To determine if bleeding is still present, look into the wound for about 20-30 seconds.  If blood is directly coming out of the wound, place a new gauze and apply a light ice pack pressure again. Check the wound an hour later to see if the rate of bleeding has improved, worsened or stayed the same.

A variable amount of bleeding is to be expected following surgery from the mouth or even from the nose. You can wipe the nose but do not blow the nose. Slight bleeding, oozing, or redness in the saliva is not uncommon. To minimize further bleeding, sleep with your head elevated and avoid exercise for 10 days or more. If bleeding does not subside, call for further instructions.
It is normal to have some minimal bleeding with pink or red saliva during the first 24 hours.  Bleeding can occasionally recur during the week after surgery.  It will usually stop by itself, but pressure gauze may be used if it is persistent.
It may be useful to place a towel on your pillow the night of surgery, as minor oozing may occur from the wound at night.

PAIN

Discomfort is usually strongest during the first 12-24 hours.  For severe pain, use the prescribed medication should be taken as directed.  For moderate pain, use Ibuprofen (Advil or Motrin -200mg. tablets).  Take 1-2 Ibuprofen every 3-4 hours.  Tylenol can be use as well as listed on the package.

Most pain medications can upset the stomach, especially the prescription pain medicine and especially if the stomach is empty.  If general anesthesia was used and the stomach is empty, you can prevent an upset stomach by drinking a milkshake and taking the first dose of pain medication 30 minutes later.  What is even more effective is to eat bulky foods of some thickness (mashed potatoes, oatmeal, ground meats) at least one half hour before taking your medication.

CAUTION – Do not drive, work or operate mechanical equipment after taking the prescription pain medication.  Also, do not mix alcohol and any pain medication (or antibiotic).

Please remember to:

  • Space different medicines at least one hour apart from each other
  • Eat food of some thickness one half hour before taking any medicine
  • Follow the frequency that is prescribed on each bottle
  • Pain medicines take the edge out of strong pain; they do not eliminate all pain sensation.
  • Avoid alcohol with any pain medication or antibiotics
  • You should not drive any vehicle or work if taking narcotic medications.  This does not apply with the anti-inflammatory pain pills.

The post-operative pain can vary considerably in different patients.  It is often worst in the first 72 hours, but occasionally it can become worse after this period.  The overall pattern to one’s pain should be that it tapers off as a general trend over 5-6 days, though the pain can vary some in any one day.  Exertional activities, exercise, and a “busy” lifestyle will tend to make the wounds “throb,” so please use common sense and minimize activities that irritate the area.

ANTIBIOTIC

If you have been placed on antibiotics you may take the first dose 1 hour after taking the pain pills.  Continue to take this medication as prescribed and complete the entire dosage. Please be aware that antibiotics may decrease the effectiveness of birth control pills.  Please ask your obstetrician if and how long after stopping the antibiotic you should use alternative birth control measures.

OTHER MEDICATIONS

Zyrtec or Zyrtec D – Start to take which ever medicine Drs. Blecha and Jandali suggested on the evening of surgery and for the next 2 weeks as indicated on the package
Nasal Saline Drops- Apply 2-3 drops per nostril four times a day (after meals and at bedtime) starting 24 hours after surgery and continue with them as directed by Drs. Blecha and Jandali.

SWELLING

Drs. Blecha and Jandali tries to use surgical techniques that prevent swelling.  However, the swelling that occurs may be proportional to the surgery involved.  Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon.  This is the body’s normal reaction to surgery and is a part of normal healing.  Swelling usually peaks by 72 hours.  The swelling that develops peaks at 72 hours but then takes 7-10 days to go down.

Your swelling can be reduced with the immediate use of ice packs.   Either ice packs or a Ziploc bag filled with ice and placed in a washcloth should be applied to the sides of the face where surgery was performed.  Use the ice in one half hour intervals (one half hour on, on half hour off) on the day of surgery and up to 72 hours.  After 96 hours, you can use warm, moist heat applications to the side of the face to help bring swelling down.

SMOKING

Smoking is strictly forbidden after this surgery and during the healing period.  Smoking is also forbidden during the implant healing.  Smoking will ruin the entire result.

DIET

There is real value in re-establishing your diet after oral surgery.  If your jaw is stiff to open after your surgery, such stiffness may last for 5-6 days and chewing could be difficult.

Once the bleeding is stopped we usually suggest a milk shake.  After that we recommend that our patients eat “bulky” food as they are important in preventing nausea and vomiting from out postoperative medications.  You must remember to not eat food in the surgical areas for one month after surgery.
Examples of bulky foods include mashed potatoes, oatmeal, and ground-up meats.  Be creative.  Ask a family member to take bulky foods and chop them up so that you can feed yourself these foods with a spoon and swallow them without chewing.  You can eat bulky foods without having to chew them if you cut them up very finely.  You should also have 5-6 glasses of liquids per day to supplement the “bulky” foods.

Your jaw may be sore and stiff, but you must eat bulky foods to tolerate your medications and avoid nausea and vomiting.

NAUSEA AND VOMITING

The cause of postoperative nausea and vomiting tends to occur if the patient is not eating well and is taking postoperative medications, especially pain medications.

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 coke or seven-up. You should sip slowly until you finish the entire can.  When the nausea subsides you can try to resume eating “bulky” foods.  If you can tolerate these “bulky foods,” you can slowly resume taking your medications.  It is often the narcotic pain medication that causes nausea.  Thus, you should minimize use of narcotic pain medications, especial if you are not eating bulky foods.  Should you need pain medicine, please be slow to resume taking the narcotic pain medication and you should use a low dose to try to prevent further nausea.

ORAL HYGIENE

Do not rinse or spit for 24 hours.This tends to disturb the blood clot, open the wound and can prolong bleeding and slow healing. You may have a small amount of blood seepage in your mouth or from your nose.  Saliva can be swallowed, even if slightly blood tinged. You could notice some blood draining from the nose.  You can wipe the nose, but do not blow it.
Keeping your mouth clean after surgery is essential to reduce the risk of infection.  Start Gentle salt water rinses 24 hours following your procedure. Use one-half teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful.  Repeat as often as you like, but at least four to five times daily and always after eating for the next two weeks. Do not brush the teeth in the area of surgery for 24 hours. When brushing, be very gentle. When expectorating, also be gentle.

REMEMBER: A clean wound heals better and faster.

ACTIVITY

Keep physical activities to a minimum immediately following surgery.  Exercise and active physical activity is not suggested until your swelling has gone down.  This could take several weeks.  Drs. Blecha and Jandali will tell you when exercise is appropriate for your case.   Please talk to our staff  before attempting to exercise.

DISCOLORATION

Discoloration of the skin often follows this surgery beneath the eye and in the cheek. The development of black, blue, green, or yellow discoloration is due to blood seeping beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Warm moist heat applied to the area 72 hours after surgery may speed up the removal of the discoloration.

SORE THROAT / CORNERS OF THE MOUTH

A sore throat may develop from either the procedure or IV anesthesia. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.  Gargling with salt water will help this.

The corners of the mouth can be stretched from doing surgery inside the mouth and they may dry out and crack. Please keep the corners of the mouth moist with a lip balm or an ointment such as Vaseline.

WEARING YOUR PROSTHESIS OR NIGHT GUARD

Partial dentures, flippers, or full dentures should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise. Please contact the office if there is any question.  Any type of prosthesis or night guard should not touch the gums in the area of the surgery. If it does, this can cause ulceration of the wound edges and breakdown of the suture margins. This can lead to loss of the graft.  If you have questions about the fit of your flipper, partial or complete denture, do not wear it until our office can see you.

POST-OPERATIVE PROBLEMS OR COMPLICATIONS

As with any procedure, unexpected post-operative healing problems can occur.  If you notice the unexpected flow of air or liquids between your mouth and nose, please let us know immediately.

  • If you are aware of several small particles of graft material being discharged from your nose or mouth, let us know as well.
  • If you experience severe sinus or nasal congestion on the side your surgery was performed, please let us know.
  • If there is an increase in swelling in your mouth, cheek or under your eye after 5-6 days, let us know.  Swelling usually peaks 72 hours after surgery and it takes over one week from that point for it to gradually go down.

FINALLY

It is our desire that your recovery be as smooth and pleasant as possible.  Following these instructions will assist you, but if you have questions about your progress, please call the office.