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  • Melbourne Dental Surgeon

Bone Graft and Sinus Lift Instructions

PLEASE FOLLOW THESE INSTRUCTIONS BEFORE SURGERY  
1. MOUTHWASH
Commence rinsing the day before surgery using chlorhexidine mouthwash (Savacol). Use this 4 times a day and hold the solution in your mouth for a full minute each time. You will continue to use this after surgery however do not use for more than one week as it may stain your teeth. This might require cleaning by your dentist.

2. FASTING
Make sure you fast for 6 hours prior to surgery. This means no food or drink including water. Please also do not chew gum prior to surgery.
      For morning surgery, fast from midnight the previous night.
      For afternoon surgery, fast after an early light breakfast before 7.00am.

3. ASPIRIN AND OTHER ANTICOAGULANTS
Anticoagulant medications and some vitamin/herbal drugs can cause increased bleeding during and after your operation. These should be avoided in the week prior to surgery. However in some cases your GP may have recommended that you remain on them.

4. SMOKING
Although it is best to permanently quit smoking well before surgery, in the very least you should not smoke for 24 hours prior to surgery to reduce respiratory problems from the anaesthetic, and for 72 hours after surgery to reduce the risk of delayed or poor healing.

5. HOSPITAL ADMISSION
After admission to the hospital you will be seen by the hospital nursing staff and then assessed by your anaesthetist. Mention any medical problems or allergies to the anaesthetist at that time. There is usually a period of waiting before your operation actually starts, and this can vary depending on circumstances. Children and patients with certain medical problems are usually operated on first. While all efforts will be made to minimise the wait, some patients may have to wait for a couple of hours so it is recommended that you bring some reading material or other entertainment with you.

6. HOSPITAL DISCHARGE
The nursing staff will discharge you approximately 2 hours after surgery when your observations are stable. Only in exceptional circumstances will you be admitted overnight (additional hospital charges would apply if you are uninsured). You will not be allowed to drive after your anaesthetic nor will you be permitted to go home alone in a taxi due to hospital policy. You will need to be accompanied home by another adult and have someone at home with you for the first night.
PLEASE FOLLOW THESE INSTRUCTIONS AFTER SURGERY  
1. SWELLING
Swelling is normal following oral surgery and is part of the healing process. This will continue to increase over the first 48 to 72 hours after surgery before gradually disappearing. Some bruising may also occur and this will discolour the face black, blue or yellow. Swelling and bruising usually affect one side more than the other. For the first few nights we suggest that you elevate your head with a couple of pillows instead of lying totally flat. An ice pack may be placed against the skin on-and-off for the first 36 hours. After this time a heat pack can be used in order to relieve symptoms. Be careful not to freeze or burn the skin.

2. PAIN AND DISCOMFORT
These symptoms are normal following oral surgery and are usually moderate but vary with the individual. It is easier to manage pain by taking the first analgesic before the numbness has worn off. We recommend the use of ibuprofen (eg Nurofen) together with paracetamol (eg Panadol) every four hours until the discomfort seems to have settled (provided you have no allergies or other side effects from these). Other analgesics can be used such as Panadeine or Nurofen Plus, and stronger analgesics will be prescribed when indicated. However only use these if necessary and try to tailor your usage to your need. If you experience nausea, it is usually due to the codeine in the analgesic. If this occurs, cease all codeine and use only Panadol and Nurofen. Only use these medications for as long as pain persists, and follow the instructions closely. Ice chips may be sucked for comfort if desired. It is also common for the adjacent teeth to be sensitive.

3. BLEEDING
A small amount of bleeding or oozing from the incision line is normal after oral surgery. Bleeding often seems to increase a few hours after surgery but will settle an hour or two later. If increased bleeding occurs, place a piece of rolled gauze directly over the area and bite firmly so as to apply pressure directly to the site. Replace every 20 minutes until bleeding stops. Lie down with your head elevated on several pillows, and apply an ice pack to the cheek on that side. Cease any ibuprofen or aspirin. Avoid spitting as this might increase bleeding. If you develop free bleeding that cannot be controlled, contact Mr Allan or attend the emergency department of a hospital. Gauze swabs may be purchased from a pharmacy, or obtained from our office during normal office hours.

4. JAW STIFFNESS
Your jaw may also feel stiff or sore when you try to move it (trismus). This is Nature’s way of splinting and resting the area that needs to be healed, and will usually relax after a week. If it is still stiff after 7 to 10 days, massage the muscles over the side of the jaw after warming your face with a heat pack, and then do some jaw opening exercises to stretch the muscles.

5. ORAL HYGIENE
Do not rinse your mouth during the first 24 hours after surgery as this might disturb the blood clots and cause bleeding. After 24 hours, commence mouthwashing with warm salty water rinses 4 times a day and continue until the incisions heal. Also use chlorhexidine (Savacol) 4 times a day for the first week only, in order to help avoid postoperative infection. Dilute this with water if the flavour is too strong. Avoid brushing the teeth next to the surgical sites for the first week, and then commence gently with a soft brush. Antibiotics may also have been prescribed to prevent infection – follow the instructions carefully and complete the entire course. Report any symptoms you feel may be an allergic reaction.

6. DIET
Avoid food and drink that is too hot during the first 24 hours as this may cause more bleeding, or it could burn your mouth. Eat only soft foods (e.g. soup, mash, pasta, eggs, fish) until the swelling and discomfort are nearly over (usually one week). Drink plenty of clear fluids. An elevated temperature on the day after surgery may mean that you need to drink more fluids. Avoid carbonated beverages or milk products in the first 24 hours if you find that they cause nausea or discomfort.

7. SUTURES
Your sutures are resorbable. Some dissolve or fall out between 3 and 7 days following your procedure. However others are long acting and last as long as 3 to 4 weeks. Early loss of sutures will not result in healing problems.

8. OTHER SYMPTOMS
Numbness may occur following oral surgery and you should report this at your postoperative visit. Numbness lasting only a few hours after surgery means that some local anaesthetic was given to reduce discomfort and this will keep you comfortable for approximately 8 hours. Discomfort around the jaw joints and possible locking may occur and usually resolves without treatment. However this may persist for a few weeks and jaw exercises as outlined above can be used to regain jaw movement.

9. DENTURE
You will be able to wear your temporary denture after the operation. For most patients this will be 1 to 2 days after surgery. The denture might have to be modified by your normal dentist if it is rubbing or applying pressure to the surgical site. This can be done within a day or two of surgery.

10. SCREWS
If you have titanium screws holding the graft in place, these will be removed at the same time the implants are placed.

11. POST OPERATIVE
It is important to attend your postoperative appointment to check the healing. This is usually two weeks after the surgery, and if this has not already been arranged, then please phone for an appointment.

If you have any questions about the treatment, please phone Mr Allan’s office on 03 9820 5333. However if you have any urgent problems following the surgery please contact Mr Allan on the following numbers:

POST-OPERATIVE CONTACT DETAILS


Office hours
After hours
03 9820 5333
Call Mr Allan’s pager service on 03 9387 1000

It is essential to leave a detailed message regarding the problem as all calls are triaged with respect to the degree of urgency.