Oral hygiene & patient guide after orthognathic surgery

Orthognathic surgery — commonly known as jaw surgery — is a significant procedure, and how well you care for yourself in the recovery period plays a huge role in how smoothly and comfortably you heal. This guide covers everything you need to know about oral hygiene, eating, recovery, and what to expect in the days, weeks, and months after your surgery.

What is orthognathic surgery?

Orthognathic surgery is a surgical procedure performed to correct significant discrepancies in the position of the upper jaw, lower jaw, or both. It is carried out by an oral and maxillofacial surgeon, usually in close collaboration with your dentist, and is typically performed under general anaesthesia in a hospital setting.

Common procedures include:

• Le Fort I osteotomy — repositioning of the upper jaw

• Bilateral sagittal split osteotomy (BSSO) — repositioning of the lower jaw

• Genioplasty — repositioning of the chin

• Bimaxillary osteotomy — simultaneous repositioning of both jaws

The goal of orthognathic surgery is to correct the relationship between the jaws to improve function — including biting, chewing, speaking, and breathing — as well as facial balance and aesthetics.

Immediately after surgery — the first 24 hours

• You will wake up from surgery with swelling, numbness, and discomfort — this is completely expected and normal

• Your mouth may be held in position with elastics or wires — do not attempt to remove these yourself

• Bleeding and oozing from the surgical sites in the first few hours is normal — your surgical team will manage this before you are discharged

• You will be given pain relief and anti-inflammatory medication — take these as prescribed and do not wait until pain is severe before taking them

• A soft or liquid diet will begin immediately — your surgical team will advise you on what is appropriate in the first days

• Do not blow your nose for the first 2 weeks if upper jaw surgery has been performed — this can introduce air and bacteria into the surgical site. If you need to sneeze, sneeze with your mouth open

• Rest as much as possible — your body is doing an enormous amount of healing

Managing swelling

Swelling is one of the most significant aspects of orthognathic surgery recovery — and it is important to understand the timeline so you are not alarmed:

• Swelling peaks at approximately 48–72 hours after surgery before gradually improving

• Significant swelling of the face, lips, and cheeks is completely normal and expected — some patients find the degree of swelling surprising. This is normal

• Apply ice packs to the face for 10 minutes on, 10 minutes off during the first 24–48 hours to help manage swelling

• After 48 hours switch to warm compresses to help the swelling continue to resolve

• Sleep with your head elevated on two or more pillows for the first 1–2 weeks to reduce swelling

• Most visible swelling resolves over 4–6 weeks — however residual swelling can persist for several months. The final result is not fully visible until swelling has completely resolved which can take up to 12 months

Oral hygiene after orthognathic surgery

https://www.sgh.com.sg/patient-care/specialties-services/oral-and-maxillofacial-surgery/pages/post-operative-care-for-orthognathic-surgery.aspx

Keeping your mouth clean after jaw surgery is absolutely critical — but it requires a very gentle approach, especially in the early stages. The surgical sites are delicate and must not be disrupted.

Week 1

• Do not brush your teeth for the first 24–48 hours after surgery

• From day 2–3, begin gently rinsing your mouth with the chlorhexidine mouthwash prescribed by your surgeon — swish very gently and allow it to drain out without spitting forcefully

• Warm salt water rinses — gently swish after every meal from day 2 onwards. Use half a teaspoon of salt dissolved in a warm glass of water. Allow it to gently flow around the mouth and drain out — do not rinse vigorously

• Use a small, extra-soft toothbrush — a baby toothbrush is ideal in the first week — to very gently clean the surfaces of your teeth. Avoid the surgical sites entirely in the first week

• Clean the areas you can access — the biting surfaces and outer surfaces of the teeth away from the surgical sites

• Do not use an electric toothbrush in the first 2 weeks — the vibration can disturb the surgical sites

Week 2

• Continue with gentle warm salt water rinses after every meal

• Continue with chlorhexidine mouthwash as prescribed

• Begin to gradually extend the area you brush — still using an extra-soft toothbrush with very light pressure

• Avoid direct brushing over suture lines and surgical sites — brush around them gently

Week 3 onwards

• Gradually transition back to your normal toothbrush — continue using extra-soft bristles

• Extend brushing to cover all tooth surfaces as comfort allows

• Continue warm salt water rinses after meals

• Introduce flossing very gently once your surgeon confirms healing is progressing well

• If you have braces, resume normal orthodontic oral hygiene as directed — interdental brushes, floss threaders, and water flosser

Diet and eating after orthognathic surgery

Your diet will progress through stages as your jaw heals — patience here is key.

Week 1–2 — Full liquid diet

• Everything must be in liquid form — no chewing whatsoever

• Suitable foods: smoothies, protein shakes, blended soups, milk, yoghurt drinks, juice, meal replacement drinks

• Ensure adequate protein and caloric intake — healing requires significant nutritional resources and it is common to feel hungry in the first few weeks. A blender will become your best friend!

• Avoid very hot liquids — sensitivity and numbness means you may not feel heat accurately and could burn yourself

• Drink through a cup or spoon — avoid straws in the first 2 weeks as the suction can disturb blood clots and healing tissue

• Stay well hydrated — drink plenty of water throughout the day

Week 3–6 — Soft food diet

• Progress to soft foods that require minimal chewing — mashed potato, soft tofu, scrambled eggs, soft fish, congee, well-cooked pasta, and soft fruits

• Avoid anything that requires significant biting force

• Cut all foods into very small pieces

• Chew gently and evenly on both sides

Week 6 onwards — Gradual return to normal diet

• Your surgeon will advise when you can begin to gradually introduce firmer foods

• Progress slowly — do not rush back to hard or chewy foods

• Avoid very hard foods such as nuts, raw carrots, hard candy, and crusty bread until fully cleared by your surgeon

• Full return to a normal diet typically takes 3–6 months depending on the extent of surgery and healing

Numbness and altered sensation

Numbness of the lips, cheeks, chin, and gums after jaw surgery is extremely common — and for many patients, one of the most concerning aspects of recovery.

• Numbness occurs because the nerves in the jaw are stretched, compressed, or repositioned during surgery — this is expected and anticipated

• For most patients, sensation gradually returns over a period of weeks to months

• In some cases, altered sensation such as tingling, pins and needles, or hypersensitivity may be experienced as the nerves recover — this is a positive sign that sensation is returning

• Complete return of sensation can take up to 12–18 months in some patients

• In rare cases, some degree of altered sensation may be permanent — your surgeon will discuss this risk with you before surgery

• Be careful with hot food and drinks during the period of numbness — you may not be able to accurately sense heat and could burn yourself

Jaw exercises and physiotherapy

• Your surgeon or braces dentist may recommend specific jaw opening exercises after surgery — follow these precisely as they help prevent stiffness and scar tissue formation

• Limited mouth opening is common in the early weeks — do not force the jaw open

• Gentle jaw exercises as directed help to gradually restore full range of motion

• Some patients benefit from formal physiotherapy for the jaw — ask your surgeon if this is appropriate for your recovery

Medications

• Take all prescribed medications as directed — including pain relief, anti-inflammatories, and antibiotics if prescribed

• Complete the full course of any antibiotics — do not stop early

• Do not take aspirin or aspirin-containing products unless specifically prescribed — aspirin affects blood clotting

• Inform your surgeon of all medications and supplements you are taking

Activity and lifestyle during recovery

• Rest for the first 1–2 weeks — avoid strenuous activity

• Gradually return to light activity from week 2–3 as comfort allows

• Avoid strenuous exercise, heavy lifting, and contact sports for a minimum of 6 weeks after surgery — or until cleared by your surgeon

• Avoid smoking throughout the recovery period — smoking significantly impairs healing and increases the risk of infection and complications

• Avoid alcohol while taking medications and during the early recovery period

Follow-up appointments

Recovery from orthognathic surgery requires close monitoring — please attend all scheduled appointments:

• Your surgeon will check healing, remove any sutures, and adjust elastics or fixation as needed

• Your braces dentist will resume active orthodontic treatment — usually within 4–8 weeks after surgery once initial healing is confirmed

• Regular orthodontic appointments will continue until your bite is fully refined and finalised

• Retention with retainers follows the completion of post-surgical orthodontic treatment

The emotional side of recovery

This is something that is not often talked about — but is very real and very common:

• Orthognathic surgery is a significant life event and the recovery period can feel long, isolating, and emotionally challenging at times — particularly in the first 2 weeks when swelling is at its most significant

• It is completely normal to feel overwhelmed, emotional, or anxious during recovery — please do not suffer in silence. Talk to your family, your surgeon about how you are feeling

• The swelling can make it difficult to recognise yourself in the mirror in the early weeks — remember that this is temporary. The final result takes many months to fully emerge

• Surround yourself with a good support system and be patient and kind to yourself throughout the process

Signs to watch out for

Contact your surgeon immediately if you experience:

• Significant bleeding that does not stop

• Fever above 38°C — may indicate infection

• Severe or worsening pain not relieved by prescribed medication

• Pus or foul-smelling discharge from the surgical sites

• Difficulty breathing or swallowing — seek emergency medical attention immediately

• Fixation or elastics becoming loose — contact your surgeon promptly

• Any concerns that feel out of the ordinary — always better to call than to wait

💡 Dr Watt's tip: Orthognathic surgery is one of the most transformative treatments in dentistry — but the recovery requires real patience. The results are not instant and the healing journey is a long one. Please be gentle with yourself, follow your surgeon's and dentist's instructions carefully, and trust the process. The final result — a corrected bite, improved function, and a balanced facial profile 😊