What can I eat and drink after jaw surgery?

Whatever diet your surgeon has specified, and nothing firmer — usually a progression from fluid, to puree, to soft, and only then back to normal food. Your treating surgeon's instructions take precedence over anything on this page. See Jaw Surgery, what is orthognathic surgery? and Oral & Maxillofacial Surgeons.

Good nutrition after facial surgery matters because it supports healing, and the difficulty is that chewing and swallowing are harder at exactly the point your body most needs the input. Swelling, pain and reduced jaw movement all get in the way.

Much of the same advice applies after other oral surgery — see Recovering from wisdom teeth surgery, I’ve just had oral surgery: what can I expect during recovery?, what does oral and maxillofacial surgery involve? and Wisdom Teeth. The scale is different, though, and it is worth saying so plainly: healthdirect's guidance after wisdom-tooth removal is that "You should be able to go home the same day", that "You may need to take up to a week off work", and that "You should be able to return to normal activities within a week." Jaw surgery is a longer road than that, and a diet measured in weeks rather than days is normal.

Follow the prescribed stage

After surgery your surgeon will advise which diet is required. Depending on the procedure, you will start on a fluid, puree or soft diet.

It is important to stay on the recommended diet until your surgeon is satisfied you can move on. Advancing early can affect your recovery — in some procedures the fixation is holding bone that has not yet united, and premature loading is exactly what it is designed to avoid.

The progression is typically fluids first, then puree, then soft, then normal — but the timing is individual, and it is set at your review appointments rather than by the calendar. What the surgery is correcting, and why the bite is planned before the bone is moved, is covered in treatment of malocclusion and what is malocclusion of the teeth?

Eating enough when you do not feel like it

Some people find it hard to eat well, particularly when appetite is poor because of pain. If you are already underweight, or have lost weight recently, eating well matters more rather than less.

The approach that works: regular meals and snacks that are high in protein and calories, spread across the day. Small and frequent beats three large meals you cannot face.

Protein is the priority — it is what tissue repair is built from. Practical high-protein options that fit these diets: milk and milk powder added to soups and drinks, Greek yoghurt, custard, smooth soups blended with legumes, eggs, and nutritional supplement drinks. Ask your surgeon or a dietitian whether a supplement drink is appropriate for you.

Monitor your weight. Continuing loss is worth reporting rather than accepting.

Fluid diet

Depending on how far you can open your mouth, you may need different feeding tools. Different shaped cups, bottles, spoon sizes, straws and syringes can all make drinking easier — it is worth trying a few rather than persisting with one that does not work.

Aim for at least eight glasses of fluid a day — around two litres.

The key point most people miss: make those fluids count. Have nourishing fluids — milk, yoghurt drinks, custard, soups and juices — rather than filling up on water, tea and coffee. On a fluid diet, everything you drink has to carry your entire nutritional intake.

The trade-off is worth naming. Frequent sweet and acidic drinks, sipped through the day, are the exact pattern that causes decay and erosion — and they are also what a fluid diet requires. The relevant principle from ADA Policy Statement 2.2.2 on diet and nutrition is not about quantity alone: "The form, frequency, timing and total amount of sugar intake are significant in the initiation of the caries process." A fluid diet maximises the frequency variable, which is the one that does the damage. The same policy adds that "Exposure to acid from the consumption of acidic or sugar-sweetened foods and beverages can lead to softening and loss of tooth structure", and that "The combination of sugar and food acid can be particularly destructive" — which describes fruit juice exactly. The ADA also singles out, as circumstances where acidic drinks should be avoided, "individuals with poor oral hygiene" and "sipping drinks, other than water, during interrupted sleep"; post-operative recovery tends to involve both.

The answer is not to avoid nourishing fluids, which would compromise your healing, but to rinse with water afterwards and to be scrupulous about the cleaning your surgeon does permit. See how does sugar affect your dental health?, what is dental erosion and how is it addressed? and how does tooth decay develop?

A caution about straws: some surgeons advise against them after certain procedures, because the suction can disturb a healing site. Check before assuming.

Puree diet

Pureed food must be smooth, lump free, and require no chewing at all. It should not be hard, dry, flaky or sharp, and there should be no skins, husks, pips or strings.

Useful equipment: a blender, sieve, masher, food processor, stick blender or milkshake maker.

Tips for preparing pureed meals:

That last point is worth taking seriously. Pureed food that tastes of nothing is food that does not get eaten, and appetite is already the problem. Puree components separately where you can, so the meal still tastes like distinct things.

Two of those flavourings are worth a footnote. Honey counts as a free sugar in the World Health Organization's definition — "all sugars added to foods and beverages by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups and fruit juices" — and lemon is acidic. Neither is a reason to eat bland food while you are healing; both are a reason to rinse with water afterwards.

Soft diet

A soft diet requires little chewing and should be easily mashed or broken up with a fork. As with puree, nothing hard, dry, flaky or sharp, and no skins, husks, pips or strings.

When preparing soft food:

Looking after your mouth in the meantime

This is not in the original advice and it matters:

If you are in orthodontic treatment around the surgery — which is usual with orthognathic cases — the appliance makes cleaning harder at exactly this point: see All your conventional braces questions answered, what are the most common complaints associated with conventional braces? and Orthodontics. The orthodontic phase continues after surgery, and retainers hold the final result: how long does orthodontic treatment take? and will my teeth need retainers after I’ve had braces?

Jaw stiffness and limited opening are expected for a period, and exercises may be prescribed. Persistent joint symptoms are a separate matter to raise: TMD and teeth grinding and can TMD be fixed?

When to call

Contact your surgeon, or seek urgent care, if you have:

One point on that first item is worth stating exactly, because it changes when you should act. The Emergency Care Institute at NSW Health's Agency for Clinical Innovation lists, as the features suggesting a spreading infection in the mouth or neck, "swelling", "trismus", "inability to protrude tongue", "drooling" and "dysphagia" — and then notes that "dysphonia and dyspnoea are late signs". In plain terms: a changed voice or shortness of breath means the problem is already advanced, so the time to act is at the drooling or difficulty-swallowing stage, not when breathing is affected.

For out-of-hours dental problems that are not surgical complications, see Emergency Dentistry and what is considered a dental emergency?

Common questions

Fruit juice or a milkshake? On a fluid diet I have to drink something.

On the tooth side of the question, milk-based wins, and the reason is in the ADA's own diet policy. It states that ‘Calcium rich foods and drinks such as milk, cheese and some fish should be promoted as the preferred source of dietary calcium', and separately that ‘The combination of sugar and food acid can be particularly destructive'. Fruit juice is that combination; the World Health Organization counts ‘sugars naturally present in honey, syrups and fruit juices' as free sugars, so ‘no added sugar' on the carton does not mean what people think it means.

The ADA goes further and lists circumstances in which acidic drinks should be avoided outright, including ‘individuals with poor oral hygiene', ‘individuals with conditions which lead to a reduction in salivary flow' and ‘individuals using medication(s) which lead to a reduction in salivary flow'. Post-operative recovery tends to tick more than one of those boxes at once.

So: milk, milk-based drinks, yoghurt drinks, custard and blended soups first; juice as an occasional item rather than the thing you sip all afternoon; water to rinse after anything sweet or acidic. If juice is the only thing you can face, have it at a meal rather than spread across the day — frequency is the variable the ADA singles out.

Can I just live on nutrition shakes until this is over?

As a bridge, yes; as the whole plan for weeks, ask a dietitian rather than decide alone. The Australian Dietary Guidelines are built around eating ‘a wide variety of nutritious foods' from five groups — vegetables and legumes, fruit, grain foods, lean meats and alternatives, and milk, yoghurt and cheese or alternatives — and they warn that eating patterns which ‘restrict the recommended intake of foods from any of the Five Food Groups can be dangerous'.

The practical translation for someone on fluids or puree is that the texture has to change but the groups do not. Almost everything in those five groups can be blended, thinned or strained: legume and vegetable soups, well-cooked cereals, eggs, fish, stewed fruit without skins and pips, and dairy in several forms. That is a better base than shakes alone, and it tastes of more.

Use supplement drinks for the gap between what you manage and what you need, tell your surgeon you are relying on them, and ask for a dietitian referral if the gap is not closing — particularly if you were underweight beforehand or you have a condition that makes nutrition a live issue.

How long before I can go back to work?

We are not going to give you a number, because we have not found an independent published figure for orthognathic surgery specifically, and inventing one would be worse than useless when you are booking leave around it.

What exists is a figure for a much smaller operation, and it is on this page for scale rather than for transfer: healthdirect says of wisdom-tooth removal that ‘You may need to take up to a week off work' and that ‘You should be able to return to normal activities within a week.' Jaw surgery is a different procedure with a different recovery, and applying that number to it would be a mistake.

So ask your surgeon for their own estimate at the consent appointment, before you commit to dates — ask for the usual range and the earliest realistic return, ask what kind of work changes the answer, and ask what would push it out. A written estimate you can show an employer is a reasonable thing to request.

My mouth tastes and smells terrible. Does that mean it is infected?

Usually not by itself — but it is worth knowing which version of this is ordinary and which is not.

The ordinary version has a mechanical explanation. Reduced saliva changes the mouth's chemistry: a review in the International Journal of Oral Science notes that in a dry mouth ‘The lack of salivary flow leads to the disappearance of the antimicrobial activity of the saliva and the transition from Gram-positive bacteria to Gram-negative species', which is the shift that produces the smell. Add food remnants that cannot be cleaned away normally and the cause is not mysterious. Healthdirect's general list of oral causes of bad breath starts in the same place — food left in the mouth broken down by bacteria, and a dry mouth washing them away less often.

The version that needs a phone call is on the list above: a bad taste or smell with fever, or with discharge, or alongside swelling that is increasing rather than settling. That combination is different from a mouth that simply cannot be cleaned properly yet.

In the meantime, keep up whatever rinsing your surgeon has permitted, rinse with water after every drink and every meal, and raise it at your review rather than waiting to be asked.

I smoke. How much difference does it actually make, and for how long should I stop?

Enough that it is worth treating the operation as the occasion to stop rather than pause. The ADA's consumer material lists the mechanisms plainly: smoking can ‘cause sores in your mouth to heal slowly', can ‘affect how much saliva your body makes', and increases the risk of severe gum disease. On saliva specifically it says ‘Your teeth are less protected if you have a lack of saliva or saliva that is thick and frothy instead of thin and runny' — which compounds everything else going on while you are on a liquid diet.

On timing, the clearest published instruction the ADA gives is for a smaller procedure, and it is directional rather than precise: ‘Do not smoke for as long as possible after getting a tooth removed to decrease your risk of developing a dry socket.' For jaw surgery, the interval is your surgeon's to set, and it is a specific question worth asking before the day rather than after.

The encouraging part is that it is not too late to matter: ‘Quitting smoking can improve your oral health significantly even after smoking for a long time.' Vaping is not a neutral substitute here either — see the effects of vaping on your oral health.

Related reading

Practical details

This is general guidance. Your treating surgeon's specific instructions take precedence, including on diet stage, timing, rinses and the use of straws. If in doubt, call rather than guess — Contact Us.

Oral and maxillofacial surgery is a recognised dental specialty. Specialist registration can be verified on the AHPRA register, or by calling 1300 419 495; the clinicians are listed on Our Team.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Published 22 September 2018, by A/Prof. Patrishia Bordbar. General information only; it does not replace advice from your treating practitioner.

Smile Solutions trades under ABN 28 193 514 103.

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