Soft Tissue Procedures/
Soft Tissue Grafting

Post-operative care is very important following soft tissue procedures or grafting. Proper care of the soft tissue wound is important to help the soft tissue heal appropriately. If you were given specific instructions as to how to avoid disturbing the soft tissue wound or graft it is very important that you follow those directions. Unnecessary pain, swelling, and infection can be minimized if the instructions are followed carefully.

EARLY CARE AFTER SURGERY

On the Day of surgery, patients tend to do well if they follow this sequence:

  1. Control Bleeding First.
    1. Follow the directions you were given in the office to control bleeding. 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

If you had an oral surgical procedure other than an extraction of a tooth, please use the techniques for bleeding control that were shown to you by our staff as the directions are specific to what procedure was performed.

Most biopsy soft tissue wounds do not need special measures to control bleeding. However should bleeding be an issue, a pressure gauze could be used with a moderate finger pressure to help control bleeding for one hour as needed.

Most soft tissue grafts do not require use of a pressure gauze to control bleeding in the area where the graft was placed. Should persistent bleeding occur from where the graft was placed, apply a steady moderate pressure to the wound as directed for one hour. Do not move the gauze as you apply pressure to the graft site as you will tend to move the soft tissue graft and this can ruin the result. Thus a pressure gauze can be used but do not move the gauze on the graft site as you apply pressure to the wound. Again, bleeding is often not a problem where the soft tissue graft was placed.

If a soft tissue graft was taken from the roof of the mouth (the donor site), the soft tissue wound on the palate could bleed requiring you to apply firm pressure to the area for one hour at a time. Bleeding in the donor site can occur if the area is irritated during the first week after surgery. Use the pressure gauze as directed above will control this bleeding. It is wise to avoid crunchy food for 7-10 days in the donor site area as these foods could make the donor site bleed.

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 an antibiotic 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.

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 by 72 hours then takes 5-6 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 wash cloth 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 72 hours, you can use warm, moist heat applications to the side of the face to help bring swelling down.

SMOKING

Smokers are advised not to smoke for the first 48 hours, and preferably the first week, after surgery.

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.
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

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 over a fifteen-minute period. 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.  Should they be needed, 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 brush your teeth for 24 hours after surgery.  After 24 hours, start to brush the teeth and use salt-water rinses as directed below.  If you were given specific directions how to clean in the surgical area, please follow those directions.

Please remember that your pain will resolve faster and your mouth will heal faster if you have very good hygiene after surgery.  If you are too “shy” to brush and rinse, your pain will often become worse and you are much more likely to develop a postoperative wound infection.

Twenty-four hours after tooth removal, you need to brush all of your teeth, even those adjacent to the surgical site.  Think of it as careful cleaning of all teeth at the gum line.  Brushing is not “scrubbing” of the teeth.  Rather, it is careful cleaning of the “nooks and crannies” where food gets stuck.
Twenty-four hours after surgery, start to use the salt-water rinses.  Add one half teaspoon of salt to a glass of warm water and “swish out” the food that gets stuck in the wounds.
REMEMBER: A clean wound heals better and faster.

ACTIVITY

Keep physical activities to a minimum immediately following surgery. Exercise should be avoided for 5-6 days.  If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake may be reduced.  Exercise may weaken you. If you get light headed, stop exercising.

DISCOLORATION

In some cases, discoloration of the skin follows surgery. You can gently apply an ice pack to the area if you are developing swelling. Do not apply pressure to the soft tissue wound when applying the ice however.

The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.