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Geoffrey R. Bauman, DMD, MS | Soft Tissue Graft in Newark

Geoffrey R. Bauman, DMD, MS / Board Certified,  American Board of Periodontology
Fellow, Midwest Implant Institute



Soft Tissue Graft

Considerations for the graft area:  Movement of the graft is detrimental to the graft and may cause it to be lost.  Therefore:  you should avoid talking as much as possible for the first 2 days and minimize talking for the next 8 days after the surgery.  Do not touch the surgical area with your tongue.  Do not rub your cheek or lip over the area of the graft.  Try not to sleep with pressure on the area where the graft was placed.  Do not swish mouth rinses of any other liquid in the mouth including water.  This would create movement of the graft which is detrimental.  If you find that you have to sneeze or cough, try not to hold it in as this may spike your blood pressure and increase the risk of bleeding.  If some of the stitches start to hang down and you can’t tolerate them, you may call to come in sooner  to have them removed.  You may notice that the outer portion of the graft turns white or yellow after a few days.  This is a normal development as some of the outer layers of the graft heal.  A clear dressing may be placed over the graft which sometimes comes loose.  If you feel something loose in the area of the graft, it is likely the dressing.  If it is completely loose, then allow it to come out, but otherwise just try to leave it alone.  The graft should still heal very well.

            Home care:  Do not perform any brushing or flossing until the second day after the surgery.  On the second day, you may begin brushing and flossing all the areas of the mouth not involved with the surgery.  You will be given a mouthwash (Peridex) to use in the surgical area in the morning and evening after you have brushed and flossed the non-surgical areas.  However, do not vigorously rinse with this or any other mouthwash.  Just allow it to pool over the surgical site for about 1-2 minutes and then spit out.

            Pain:  Some discomfort should be expected post-surgically; however, the dentist will have given you prescriptions or recommended non-prescription medications to control pain.  Take the medication as directed.  Even a doubling of the recommended dose can cause severe problems.  Take your first dose of ibuprofen or Tylenol before the numbness wears off.  If the Ibuprofen is not adequate, then start taking the narcotic in addition to the ibuprofen (don’t stop taking the ibuprofen).  Do not take Tylenol in addition to the narcotic as there is already Tylenol in the narcotic pill).   If a narcotic (Percocet, Synalgos, Vicodin, Tylenol #3) was prescribed and you find that you did not need to use it, The FDA recommends that outake it to a local take back facility (Google for local sites) or dispose of it in the toilet.  Do not save this medication for pain at a later date.  Narcotics can be detected by blood or urine test and you may be prosecuted for taking the drug without a current prescription.  Most pain medications have the potential to cause nausea and vomiting.  This effect is decreased by taking the medications with 8 oz of fluid. With narcotics, it helps to remain still (even walking around can be a problem) to prevent nausea.  If nausea ensues with narcotics, you must stop taking them. It will only get worse otherwise.

            Bleeding:  You may experience some slight oozing of blood around the surgical areas and it is rarely a problem.  However, if you notice faster bleeding, particularly in the roof of the mouth where the graft was taken, dampen a piece of gauze or facial tissue, fold it over for some thickness, and place pressure with this over the site where the graft was taken and the bleeding is coming from.  It will not stop the bleeding just to lay the gauze over it;  you must apply pressure.  Apply pressure for at least 20 minutes without removing the gauze pressure from the area (do not wipe the area with the gauze).  It will break the clot and continue to bleed if you remove the gauze pressure sooner than 20 minutes.  If the bleeding doesn’t stop, you may use a damp (not soaking wet) tea bag in the same manner as the gauze.  Do not create suction in your mouth to try to gather the blood to spit.  That will make the area bleed faster.  Just spit out and apply pressure as described above.  It is recommended that you change bed linens to some that you will not be concerned if they are stained because there is always a little oozing at night during sleep.

                Swelling:  There is often swelling and bruising after connective tissue grafts and sometimes it is quite significant.  This usually can be minimized by not talking or moving of the area much during the first week and avoiding sleeping on the side where the graft was done (sleeping in a recliner helps prevent turning).  The graft usually heals just fine in spite of swelling.   A cold compress can be used on the face where the swelling occurs early on but not using much pressure.

            Diet:  Your diet should include the equivalent of 8 glasses of water per day (anything except for alcohol or soft drinks during the first 4 days).  1000 mg of vitamin C may be helpful for healing.  For the first day, just liquids up to a milk shake/pudding consistency.  2nd day soups with soft vegetables, rice, short noodles, etc;  on the 3rd day, you may start some softer foods such as baked potatoes, ground beef, etc., in very small bites and always chew on the opposite side from the surgical areas.  If you  are not careful you might knock the dressings loose and cause severe pain and bleeding. Continue that softer diet through the first two weeks.  The surgical areas of your mouth should not be used for chewing for 4 weeks after the surgery.  If you notice that food is accidentally getting on the graft side of the mouth,  then you will need to stop eating the more regular diet and go back to soft diet  with mashed potato consistency.

                Stent:  The plastic stent/shield which covers and protects the roof of your mouth should be worn full time except to take out to clean a couple of times each day during the first week.   During the second week it may be discontinued unless you still have stitches in the roof of your mouth...if so, continue to use it most of the time.  Otherwise discontinue use in the second week unless you have to do a lot  of talking or for eating if desired.   After the second week it should not be worn.

            Smoking/alcohol: Smoking causes blood vessel constriction and alcohol causes dehydration which are both harmful to healing and it is best that you not smoke or drink for as long as possible after the procedure, especially during the first week.

            ActivitiesAvoid heavy physical exercise for at least 3 days after surgery.  After that play it by ear.