After Sinus Lift

You have had a Sinus lift bone graft procedure in your upper jaw. This procedure regains lost bone height in the area of your molars. It is an important procedure as it allows implant placement in an area that could not be implanted otherwise because of insufficient bone height due to an enlarged sinus. If your own bone was harvested for your graft, you may have two post-surgical wounds.

Sinus Precautions

DO NOT UNDER ANY CIRCUMSTANCES. BLOW YOUR NOSE FOR THE NEXT FOUR (4) WEEKS. This may be longer if indicated. You may sniff all you like but NO BLOWING. Do not sneeze holding your nose. 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 Drixoral, Dimetapp, or Sudafed will help reduce pressure in the sinuses. You may also be given a prescription for antibiotics. Please take these as directed. Anything that causes pressure in your nasal cavity 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. Smoking must be stopped. If necessary Dr. Bergen can prescribe Nicoderm patches.

Immediately Following Surgery

  • Do not disturb or touch the wound.
  • If a gauze pad has been placed over the surgical area, it should be kept in place for 30-45 minutes. After this time, the gauze pad should be removed and discarded. If the bleeding or oozing still persists, insert another gauze pad and bite firmly for another 30 minutes. You may have to do this several times.
  • Unless otherwise instructed, take your first dose of ibuprofen (Motrin or Advil) 400 mg (2 tablets) before the local anesthesia wears off to decrease the initial pain. If you feel it is necessary, you may take the prescribed pain medication.
  • If it is necessary to take a prescription medication for pain, you may take it in conjunction with the ibuprofen or staggered with the ibuprofen.
  • Avoid rinsing or spitting for 2 days to allow blood clot and graft material stabilization.
  • Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.
  • Do not lift or pull on the lip to look at the sutures. This can actually cause damage to the wound site and tear the sutures.
  • Do not smoke
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.

Pain

For moderate pain, ibuprofen (Motrin or Advil) 400mg (2 tablets) should be taken every three to four hours on a regular schedule. By taking this pain medication regularly and keeping the blood levels constant, the medication can work better and often less prescription narcotic pain medicine is necessary.

If you cannot take ibuprofen, you can take two, regular strength (325mg) acetaminophen (Tylenol), or one extra strength (500mg) every three to four hours, keeping in mind that no more than 4 grams may be take in 48 hours. The prescription medication may have some of this medication in it as well and should be taken into account.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. You may take the prescription medicine it in conjunction with the ibuprofen or staggered with the ibuprofen.

Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag (regular tea, not herbal) for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the bodys normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. In some cases you will be provided with ice packs. Plastic bags filled with ice, ice packs, or frozen peas should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Diet

Drink liquids after intravenous anesthesia. Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least five to six glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.

Activity

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

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

Nausea & 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, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.

Oral Hygiene

Do not rinse or spit on the day of your surgery. This tends to disturb the blood clot, open the wound and can prolong bleeding and slow healing. You should not have a significant amount of blood in your mouth. Saliva can be swallowed, even if slightly blood tinged.

Keeping your mouth clean after surgery is essential to reduce the risk of infection. Start salt water rinses the day 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 five days.

Do not brush the teeth in the area of surgery for 48 hours. When brushing, be very gentle. When expectorating, also be gentle.

We may prescribe an antibiotic rinse (Chlorhexadine, Periogard, Peridex). This rinse should be used in the morning and at bedtime after routine mouth care. Do not eat or drink or rinse your mouth after using the medicated rinse. Using this rinse more than two times a day will cause staining of your teeth.

Smoking

Do not smoke for at least two weeks after surgery, if at all. As discussed at your consultation, smoking dramatically increases the risk of bone graft and sinus augmentation failure. Dr. Bergen can prescribe a Nicoderm patch if you feel you need it.

Wearing your Prosthesis or Nightguards

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. If you have a temporary flipper to wear do not place it until the numbness in the area is gone. When it is placed it 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 your general dentist or our office can see you.

Post-Operative Problems or Complications

As with any procedure, unexpected post-operative healing 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, let us know as well.

If you experience sinus or nasal congestion on the side your surgery was performed, let us know.

If there is an increase in swelling in your mouth, cheek or under your eye after 3 days, let us know.

Finally

Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Drs. Aslanian and Bergen or your family dentist.

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. Please try to call during office hours, however a 24-hour answering service is available for after hours contact with a doctor. The afterhours telephone number is Greenwich Office Phone Number 203-661-4231.