After you have undergone a surgical procedure to correct the position of your upper jaw, lower jaw, or both, attention must be given to several aspects of postoperative care in order to help make the recovery as quick and easy as possible. Since surgery produces soreness in the muscles and bones of the jaw as well as the lips, nose and other areas of the face, some difficulty is encountered in performing such tasks as eating, drinking and cleaning your teeth. However, each of these things must be done continuously and carefully to avoid postoperative problems. This is a list of instructions which should help you in your postoperative recovery.
For now, it is important you maintain a STRICT LIQUID DIET ONLY. The plates and screws used to secure the jaw(s) in their new position take 6 weeks to stabilize, and thus your diet will need to progress slowly. Do not use a straw for the first 48 hours after surgery as it can create more bleeding. Avoid cold milk products for 48 hours after surgery as it can adhere to the incision sites and may promote infections. Attempt to drink from a cup as soon as possible, as this is the most effective way to take in liquids. Sometimes the use of a toddler “sippy cup” can help. If drinking from a cup seems to be impossible, another alternative is to obtain a squeeze bottle to squirt fluid into your mouth. This type of device can be obtained at most department stores, sporting goods stores, or bicycle shops. Examples of nutrition that is safe to consume are:
Baseline Pain Control Regimen
If Additional Pain Control is Needed
Postoperative pain control is of paramount importance to us and our patients after surgery. We want you to be as comfortable as possible as you recover from your surgery. When you return home and the local anesthesia (numbing medicine) wears off, you will transition to oral pain medications to assist in pain control. The goal of postoperative pain management is to use oral pain medications to reduce pain to a tolerable level while the body heals and reduces pain naturally overtime. This may result in a maximal oral medication regimen which can be progressively decreased over the recovery process. Modern medicine uses three common classes of medications to achieve this goal, Acetaminophen (e.g. Tylenol), Non-Steroidal Anti-Inflammatory Drugs (NSAID e.g. Ibuprofen/Advil), and opiates (e.g. Oxycodone). Each act on different pain pathways within the body which allows them to all work synergistically at the same time. Using different classes of pain medications allows us to maximize the potential benefits of any one class while minimizing their respective side effects. During the postoperative period we want to maximize your pain control while minimizing any potential side effects. All pain medicine should be used in an “as needed” fashion. If you are not in pain, you do not need to take pain medicine. However, the baseline pain control regimen outlined above can be more effective if taken on a “scheduled” basis, regularly spaced time intervals, during the postoperative period where significant pain is anticipated. The baseline pain control regimen is more effective if taken on a “scheduled” basis rather than waiting for significant pain before taking the pain medicine. This “scheduled” strategy allows you to maintain a constant level of pain control in your blood which ultimately results in more effective pain control. If you would like to take the baseline pain control regimen on a “scheduled” basis to maximize its effectiveness we recommend taking these medications ~ 4 times per day, convenient times for most patients are breakfast, lunch, dinner, and right before you go to bed. The baseline pain control regimen can be taken together as instructed above for up to 1 week without concern for significant side effects in a healthy patient. However, if you find yourself continuing to need a “scheduled” baseline pain control regimen after 1 week, please let us know so we can make sure that you are healing appropriately. Opiate derived pain medications, like oxycodone, have rightfully received a lot of attention in the media recently due to their addictive potential. While this class of medication can be addictive it is important to note that addiction occurs when these medications are used for prolonged durations for chronic pain, not for acute postoperative pain. As such, these medications are safe to use as prescribed for a short duration after your surgery. However, they have other side-effects as well such as nausea, constipation, and drowsiness which are undesirable. As a result, we still reserve this class of medication for as needed additional pain control if the baseline pain control regimen above is insufficient. We hope all our patients recover as painlessly as possible. However, recovering from surgery is typically uncomfortable. The strategies and philosophies outlined above will not make the recovery from surgery painless, but they should serve to reduce the pain to a tolerable level while the body heals and subsequently reduces pain naturally. If you ever feel that the pain is unbearable despite these medications, please let us know so we can make sure that you are healing appropriately.
In addition to the prescription for oxycodone you will be given several other prescription medications to aid in your recovery.
Below are some medications available over the counter at any local pharmacy that may be helpful to aid in your recovery.
Maintaining proper oral hygiene can be extremely difficult post-operatively, but it is incredibly important to help prevent an infection from developing. We recommend purchasing a baby toothbrush as the smaller size and soft bristles will make it easier to keep your braces and teeth clean. It is important you brush your teeth at least twice a day, taking care to clean the front of your teeth and braces only (do not clean the gums because your surgical incisions are in that area). You may also be prescribed an antibacterial mouth rinse (e.g. Chlorhexidine) that can be used twice a day to help clean and prevent infection. Do not use a water pik or electric toothbrush for the first 7 days after surgery.
Post-operative elastics are crucial to help establish and stabilize your new bite. Depending on your surgical movements, we will show you the location and quantity of elastics that you will be using in the post-operative period. These will change over time, so at each follow-up appointment we will review your elastic use and location as well as provide you with a diagram. You will also be provided with extra elastics and an “attacher” to use should an elastic fall off or break. Please be sure to secure this “attacher” in a safe location. It is normal that the elastics will limit your jaw movement; this is intentional.
Following surgery, you will find that your energy level is much lower. This will take some time to return to normal. when you attempt to return to normal physical activity start slowly and work up to your normal level. Physical exercise such as walking can begin immediately after surgery once you feel able. Other than a light walk, there should be no cardio or weight lifting exercises at this time. Jogging can begin 3 weeks after surgery, light weights 4 weeks after surgery, and heavy lifting or contact sports 6 weeks after surgery. Begin by going shorter distances and at a slower pace than usual to be sure you feel up to the exercise. As your endurance and confidence improve, gradually increase the level of exercise within a level of comfort.
Do not attempt to specifically stretch your jaw at this time, passive opening is ok for eating and hygiene. It is normal to have a restricted motion and for your muscles and bones to be stiff and sore. Jaw exercises will be introduced later in your recovery period.
You can continue to progress your diet but maintain a soft, non-chew diet. You can eat anything you would like that does not require you to place food between your teeth and bite. Remember, the plates and screws used to secure the jaw(s) in their new position take 6 weeks to stabilize, and thus your diet will need to progress slowly. Using a baby spoon can be helpful as it will still be difficult to open your mouth. Examples of food that is safe to consume are:
At this stage most patients are no longer using any oxycodone, but may still be tapering off from the Tylenol and Ibuprofen. Once you are no longer taking oxycodone you can slowly decrease the amount of Tylenol and Ibuprofen, by progressively taking one less pill at each 6-hour dosing interval. It is normal for patients to need some Tylenol and Ibuprofen for up to 3-4 weeks after surgery. As long as you are staying hydrated, continuing to use the Tylenol and Ibuprofen 4 times per day is completely safe. If you still needing the maximum dose of Tylenol and Ibuprofen 4 weeks after surgery, please let your surgeon know.
Maintaining proper oral hygiene can be extremely difficult post-operatively, but it is incredibly important to help prevent an infection from developing. We recommend purchasing a baby toothbrush as the smaller size and soft bristles will make it easier to keep your braces and teeth clean. Once you are able to open your mouth and adequately brush your teeth to keep your mouth clean you can stop using the antibacterial mouth since (Chlorhexidine). Continue to refrain from brushing where the incisions were made, just brush the teeth. It is now safe to use a water pik or electric toothbrush if desired.
At this stage ~ 50% of the swelling should have resolved. The remainder of the swelling will continue to dissipate slowly but can take up to 6 months before it is completely gone. Continuing to elevate your head while sleeping and beginning the jaw stretching exercises will continue to encourage the swelling to resolve.
Post-operative elastics are crucial to help establish and stabilize your new bite. It is normal that the elastics will limit your jaw movement; this is intentional. We will evaluate your bite and advise on the quantity of elastics to use and length of time and provide you with an elastic diagram.
It is now safe to begin light cardio activity. Stationary bike, brisk walking, or jogging can begin. However, heavy lifting or contact sports need to wait until at least 6 weeks after surgery. Begin by going shorter distances and at a slower pace than usual to be sure you feel up to the exercise. As your endurance and confidence improve, gradually increase the level of exercise within a level of comfort.
It is now safe to begin passive jaw exercises. Attempt to gradually increase the amount you can open your mouth by simply using normal jaw muscles. Some mild discomfort might be experienced but keep this within a level that is easily tolerated for a short period of time. About 5 minutes of concentrated jaw movement in the morning, during the middle of the day, and again at night should be sufficient. By the fourth week after surgery you should be able to easily get one finger between your front teeth (10-15mm opening). By the fifth week you should be able to get two fingers between your teeth (20-25mm). If you do not achieve this goal, begin “Hold and Relax” exercises. This involves opening your mouth about one half the amount you comfortably can. Fold your hand into a fist and place your fist under your lower jaw. Using gentle pressure with your hand try to push your mouth closed, use your jaw muscles to resist the pressure from your hand. Hold this pressure for five seconds. Release and spend 30-60 seconds moving your jaw side to side and try to passively stretch and open your mouth without resistance. Then repeat the hold and relax exercise. Do five repetitions of this exercise three times per day.
You can begin to progress your diet back to normal. However, you should be careful and ease yourself back into the foods you enjoy. Tougher foods like apples, carrots, and tougher meats still may be several weeks away. Imagine you have been on crutches for 6 weeks and your doctor just told you that you can walk. If you went for a long run that first day (ate steak), your body just is not ready for that yet. Common sense dictates that food still be somewhat soft and cut into small pieces, as you slowly progress back to your regular diet.
You can now resume your normal, pre-operative oral hygiene routine. As always, it is important to continue to keep your mouth and braces clean to avoid dental decay.
Post-operative elastics are crucial to help establish and stabilize your new bite. We will evaluate your bite and advise on the quantity of elastics to use and length of time and provide you with an elastic diagram. At this stage your orthodontist will likely take over the instructions on your elastic use.
It is now safe to progress to more strenuous activity. Let your body be your guide as you progress into more normal activities. It is now safe to begin progression back to sports. As always avoiding being hit in the head and face is recommended.
It is now safe to begin active jaw exercises. Begin with two or three repetitions of the Hold and Relax exercises you have done previously. Then, place your middle finger on your lower teeth and your thumb on your upper teeth. Apply pressure that creates a feeling that you are stretching muscles with some feeling of tightness or mild discomfort. Hold this for five seconds then release and move your jaw side to side and open and close using just your jaw muscles for 30 seconds. Repeat the finger stretching, placing your fingers on the opposite side. Do three repetitions on each side, and repeat this cycle three times per day. Each time try to slightly increase the finger pressure to produce more opening. (Do this to produce only mild discomfort, do not push enough to create significant pain.) It is normal to be sore after each session, but your soreness should recover by the next morning. If you are waking up with soreness in your jaw muscles you are likely pushing yourself too hard. Reduce your intensity or frequency such that your body can recover overnight.
As you can see, recovery from surgery requires a lot of effort on your part. We will be happy to answer any questions regarding diet, hygiene, elastics, exercise, or any other problem which may be of concern to you. Remember, postsurgical progress is sometimes uncomfortable and may occur slowly. However, with some determination and attention to these instructions, you can maximize your healing process. If you have any questions regarding your postoperative recovery, please do not hesitate to call us anytime at (650) 342 – 0213.