After Orthodontic Exposure/Bonding

PAIN: Some degree of pain is normal for all patients after the procedure. Unless contraindicated, we generally recommend ibuprofen (Motrin, Advil) and  acetaminophen (Tylenol), or if necessary, a Acetaminophen-narcotic combination painkiller (Norco, Percocet, Vicodin, Tylenol#3 / codeine) to control pain.

Please attempt to control pain with ibuprofen as your first line agent. 

If additional pain control is necessary, you may use plain Tylenol OR  the narcotic containing painkiller as needed, but not both:  Do not mix  plain acetaminophen(tylenol) if you are currently taking another medication that already contains it such as one of the painkillers mentioned above. This is to avoid a acetaminophen-overdose.

Please note: Narcotics are habit forming medications, so use as little as possible.  Please be aware that narcotics cause drowsiness and sometimes nausea; do not drink or drive while on these medications, or combine with other medications that cause drowsiness without speaking to your doctor first.

Always consult a physician or your surgeon prior to using any additional medications or methods that were not discussed prior to your discharge. If you are experiencing pain that cannot be controlled with these methods, please inform your surgeon.

If your procedure was performed in the hospital under general anesthesia while completely asleep, know that a sore throat is extremely common; this is from the breathing tube that was placed down your throat, and this pain should resolve quickly, especially with consumption of cool liquids.

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BLEEDING: Slight oozing of blood from your surgical sites is normal for the first day or so after surgery. In the event of excessive bleeding that cannot be controlled; wet plain black tea bags and place it over the site and apply firm constant pressure. If it doesn’t stop, inform your doctor or report to the nearest emergency room.

Remember, slight bleeding is acceptable, and the saliva in your mouth mixed with a small amount of blood may create a more drastic appearance than is actually the case (like a drop of food coloring in a glass of water). Do NOT spit, smoke, or drink from a straw: these will dislodge the necessary and protective embedded blood clots in the surgery site. When dislodged; bleeding, pain/dry-socket, and delay in healing can result.

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SWELLING: Swelling is also quite normal after this surgery. This is in part due to surgery and also to how your body responds to the bone grafting - the result is swelling, in certain cases, profound swelling.  This swelling will peak at about day 3 after surgery and then should gradually resolve on its own. In order to lessen the amount of swelling, please use Ibuprofen unless you are unable to take it, sleep with your head elevated using many pillows, and apply ice packs to your face on/off every 20 minutes for the first 2-3 days.

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 STITCHES/SUTURES: Sutures are placed to help facilitate closure of the gums, reduce bleeding and swelling, and prevent food from seeping into the extraction sockets. Most stitches are dissolvable and supposed to unravel or fall out on their own (typically around 5 days after surgery). Some stitches are black-silk and need to be removed at your follow up visit.  However, if any of these sutures fall out or unravel before your follow up visit, it is not an issue and usually of no consequence. The only two instances where early loss of stitches is concerning is in the presence of excessive bleeding or if you had a bone grafting procedure performed in conjunction with your extraction: in either case, you should inform the doctor on call. 

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THE CHAIN:  Please avoid touching or playing with the chain, so as to minimize the chances of it falling off. Keep in mind, that this does happen from time to time, especially after the orthodontist puts it into use. If the chain/bracket falls off, it's ok. This is not an emergency, but we will need to re-cement it for you; give us a call during normal hours and we can set up a time to be seen. 

CARE OF THE NOSE AND SINUSES: If you had surgery on your upper jaw (maxilla) it is important to know that the necessary surgical treatments occurred in the area in close proximity to your nose and sinuses. You may have even had surgery directly within your sinuses.  As such, some degree of swelling and local changes in the area have occurred. This is why many patients complain of sinus congestion and difficulty breathing through their nose. This is normal, though it is important to take certain measures to ensure a good surgical outcome and optimize your own comfort.

For the next 4-6 weeks, you should avoid blowing your nose, sneezing through your nose, or bending over.

Remember, Nasal congestion may create a feeling of not being able to breathe. If this occurs, stay calm,  and take an “over the counter” decongestant, like a nasal spray or pill, (if this ok with your MD). Simply follow the instructions on the label. A humidifier and propping yourself up with pillows at night will also help. Please note, these measures may not completely eliminate the congestion right away, but they can only help.

Sometimes minor nose bleeding can occur after nose or sinus surgery; this is common and nothing to be concerned about. The bleeding should be minimal and resolve on its own with some light squeezing of your nose. If the bleeding is excessive or is not stopping, call us immediately.

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DIET:  For the next week you should only be eating food that is soft, cool, and easy to chew. Do NOT eat anything spicy, hot, crunchy, tough to chew, or anything through a straw.

  • Your jaws are fragile after surgery, so you do not want to chew hard or tough foods.
  • Sharp/Crunchy foods can poke your surgery site and break stitches causing pain and bleeding.
  • Hot temperature, carbonated,  and Spicy items cause blood vessels to open and cause bleeding.
  • Using straws will cause bleeding.

Foods that are safe to eat include yogurts, shakes/smoothies, ice cream/sorbet, pasta, mashed potatoes, scrambled eggs, etc. Almost anything you can put into a blender is acceptable as well.

Given your procedure; we would recommend avoiding chewing directly over your surgery site as much as possible for the first week or so. We know that it not entirely possible, but try your best.

** Always remember to rinse your mouth out gently with water after every meal.

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HYGIENE: Beginning tomorrow, you may gently rinse your mouth out with warm water/salt solution every meal. After one day, resume your regular brushing routine, just be gentle near the site of surgery and the chain. You may use mouthwash as long as it is alcohol-free and if you do NOT spit ( just lean over the sink and let the fluid fall out of your mouth).  Try to keep it clean by rinsing your mouth out to avoid post-op infections, bad breath, or bad taste in your mouth from retained food/debris.

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ACTIVITY: You should avoid the gym and/or any strenuous activity or exercise for the next 5-7 days. Light out-of-bed activity (walking, shopping, etc) starting the day of your surgery is mandatory to prevent blood clots and other pulmonary issues. Most patients who undergo this procedure are able to return to work/school after two days. Remember, a gradual return to your normal daily activity is the most sensible approach. Smoking is strictly prohibited; smoking will jeopardize the success of your case and can result in delayed healing, infections, implant/graft failure,  and pain.

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FOLLOW UP: Please make sure to schedule and present to your follow up appointments, in order to optimize your outcome and monitor the site.

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WARNING SIGNS OF COMPLICATIONS: Please be aware of these possible complications and inform your doctor if you encounter them. In the event of a life-threatening emergency, or if you can not reach your doctor,  please call 911  and report to the nearest hospital emergency room.

  • Prolonged numbness or tingling sensation 8+ hours after your procedure (Call ASAP).
  • Excessive bleeding not controllable by constant pressure over the site (Call ASAP).
  • Pus or foul odor/taste from surgical sites.
  • Fevers/Chills (Although can be normal up to 2 days after general anesthesia).
  • Progressive severe pain and/or swelling after the first day of surgery.
  • Nausea/diarrhea (especially while taking antibiotics)
  • Difficulty breathing or swallowing liquids (Call ASAP)

Feel well, and if you have any questions or concerns please feel free to contact us at any time.