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Periodontal and Implant Dentistry

Crown Lengthening

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Periodontics St. Louis

The Procedure

The periodontal surgery is done to either assist your dentist in future placement of a crown on a tooth that either the decay/fracture is too far underneath the gum, or there is too much of a gummy smile that is unaesthetic. This surgery is done with a local anesthetic, and you should feel no discomfort whenever the surgery is being done. After the surgery is completed, a dressing may be placed around the gums and the teeth which will protect that area involved. You may remove the dressing 4-5 days following the surgery, unless otherwise instructed. We will be providing you with the prescriptions/recommendations for whatever pain relievers or other drugs are indicated for the surgery. Below are helpful tips to prepare you for the upcoming procedure and thereafter.

Periodontics St. Louis

Presurgical Instructions

Please arrive at the office at least 20 minutes prior to your surgical appointment to make any final arrangements prior to the procedure.Please don’t apply makeup and lipstick around the mouth. If a cleaning is due, it is ideal to have it done within a week prior to the procedure and brush your teeth immediately prior to the appointment is advised.
Take your medications as advised. If taking blood thinners, some aspirins, or fish oil prescriptions, we will contact your Prescribing Doctor for their recommendation on modification. We will inform you of their recommendations before surgery. If you have any questions about your prescriptions, please contact us.
If advised, begin taking pain reliever about 24 hours in advance (600-800mg of Ibuprofen or 1000 mg of Tylenol typically for an adult and 200-400mg of Ibuprofen for a child; this was discussed in your pre-surgical appointment). The over-the-counter ibuprofen comes in 200mg tablets and over the counter extra strength Tylenol comes in 500mg tablets, so please take the appropriate number as listed above for them to be effective.

For patients who require antibiotic prophylaxis for previous joint replacement, or heart conditions, please take your premed 1-hour prior to the dental surgery.
If you are having IV sedation, please take 2 hours prior to your surgery with the 2 glasses of water we advocate taking. DO NOT CONTINUE TO DRINK WATER UP UNTIL YOUR SURGERY.
If you are having IV sedation, please take the Ibuprofen and antibiotic right after the surgery.
No alcohol 24 hours prior to procedure.

It is strongly advised to abstain from smoking. Continued abstinence will assist in greater long-term success in treating your periodontal condition.

Periodontal Post-Surgical Instructions

The hand of a woman holding a purple toothbrush

Care of The Mouth

Normal brushing and flossing following the procedure should be followed throughout the mouth except in the area where surgery was performed. It is important to maintain a high level of oral hygiene care after periodontal surgery. This reduces the accumulation of bacteria (plaque), chances of infection, and minimizes unpleasant mouth odor.

A spoon with salt

Oral Hygiene at the Surgical Site

• Do not brush, floss, or otherwise disturb the surgical area during the first week or longer if instructed.
• Beginning 24 hours after surgery, rinse gently with the prescribed mouth rinse (Chlorohexidine/Peridex/ClosysTM) 2 times a day (after breakfast and before bed) for at least 30 seconds. No eating, drinking, or rinsing should be done for 30 minutes after the oral rinse isused. This rinse is continued for at least the following 10 days after the procedure.
• You may also consider using throughout the day a warm salt-water mixture (1/2 teaspoon of saltinto 6-8 oz. of warm water) 3-4 times per day for the first couple of weeks.

The hands of a woman holding two dark brown pills

Pain

It is normal for there to be varying amounts of discomfort for 1-6 days after surgery. How much pain and how long it lasts depends on the extensiveness of surgery done, how long it took, and your unique response to it. Everyone differs in his or her perception of, and response to pain; the pain medication may not eliminate all pain but should make you reasonably comfortable. It is not routine to require narcotics.
• For mild discomfort, alternate 600-800mg of Ibuprofen and 1000mg of Tylenol every 3 hours.
For severe discomfort, take 800mg of Ibuprofen and 1000mg of Tylenol at the same time, every 6 hours. If this regiment isn’t managing your pain control, please give us a call.

A young woman resting in bed

Bleeding

It is normal to have some oozing for 2-3 days. To prevent excessive bleeding follow these steps: If advised, Ceasing/modifying your blood thinner/aspirin/fish oil at the recommended time priorto surgery should have occurred. (If you have any questions concerning this, please call the office).
• Don’t spit, rinse, or use a straw for at least 24 hours after the surgery. Avoid strenuous activity for 2 days.
• It is recommended to place a towel over your pillow and keep your head slightly elevated for the first 3 days.
• If you notice continued heavy bleeding, apply biting/thumb pressure with a clean, dampened, rolled-up gauze/tea bag/paper towel directly to the area for 40 continuous minutes.
• If these attempts are unsuccessful and the bleeding is excessive, please call us.

A woman putting ice on her jaw becaushe she is in pain

Swelling

Gently apply an ice pack to the side(s) of your face over the surgical area for 10-15 minutes per hour during the first 24-48 hours after surgery.
• Keep your head elevated at night to reduce the swelling. Minimize the heat of your food for the next 24-48 hours to slightly warm.

• After 48 hours, if still swollen, a moist heated washcloth or heating pad applied to the site will then be effective.

• Swelling typically peaks on the third day and then slowly begins to reduce from there forward.
This is also why Ibuprofen/ anti-inflammatory is advised to continue to be taken for the first 4-5
days after the surgery.

A glass of mango smoothie

Diet

For the first 24 hours, restrict your diet to cool soft foods and liquids (ie. milk shakes, ice cream, instant breakfast drinks, junior baby food, Ensure, yogurt, cottage cheese, pudding, jello, applesauce, etc.) After 24 hours warm foods can be introduced.
• For the first 3-4 days, avoid Spicy foods, citrus, alcohol.

• Then for the 2-4 weeks, continue with warm softer foods (ie. Pastas, soups, well cooked chicken, fish, omelets, mashed/baked potatoes, tuna noodle casseroles, meat loaf and well-cooked vegetables, etc.) and continue to avoid chewing on the surgical side. Avoid eating crunchy,
chewy foods, along with popcorn and peanuts for 3 weeks after surgery. No tobacco products (cigarettes, chewing tobacco, snuff, etc.) for at least 3 weeks after.

• Please refrain from biting food off if the procedure was done in the front of the mouth for 4
weeks.
By four weeks, unless otherwise advised, you are usually able to eat without any restrictions.

Periodontics St. Louis

Medications

Take your medications for blood pressure, heart, anxiety asthma/lung the day of your procedure. If you are having iv conscious sedation, then take them with enough water to get the medication down (less than 3oz.) Bring your inhalers with you. If you are diabetic and having iv sedation, do not take oral diabetic medication or insulin the morning of your procedure. If there are any issues regarding the interruption of your medication, contact your prescribing physician.

Blood thinner medications: (Our office will be consulting your cardiologist. Unless otherwise told, the following recommendations for temporarily discontinuing your blood thinner/s is listed below.)
Dabigatran (Pradaxa)- hold off 48 hours and wait to begin 48 hours after treatment.

Rivaroxaban (Xarelto)- hold off 48 hours prior to the procedure and begin 48hrs after treatment.

Apixaban (Eliquis)-hold off 48 hours prior to the procedure and begin 72 hours after treatment.

Edoxaban (Savaysa, Lixiana)- hold off 48 hours prior to the procedure and begin 48 hours after treatment.

Warfarin (Coumadin, Jantoven)-If instructed, hold off 3 days prior and begin 48 hours after treatment.

*Ticagrelor (Brilinta)- hold off 5 days prior to the procedure and begin 48 hours after treatment.
*Ticlopidine (Ticlid)- hold off 5 days prior to the procedure and begin 48 hours after treatment.
*Clopidogrel (Plavix)- If instructed, hold off 5 days prior to the surgery and begin 48 hours after
treatment.
*Prasugrel (Effient)- hold off 5 days prior to the procedure and begin 72 hours after treatment.
*Cilostazol (Pletal)- hold off 3 days prior to the procedure and begin 4 days after treatment.
*Aspirin 325mg or greater- hold off 1 week prior to the procedure and begin 48 hours after treatment.
*Dipyridamole (Aggrenox)-hold off 5 days prior to the procedure and begin 48 hours after treatment.
(*) anti-platelet meds

***Patients with mechanical artificial heart valves cannot stop their anticoagulant medications (blood thinners) without discussion with their cardiologist and the periodontist!!
Supplements are non-prescribed medications. If you are taking any of the supplements listed below, please stop 1 week prior to your surgical procedure.

▪ Dong Quai (Angelica sinensis)
▪ Feverfew (Tanacetum parthenium)
▪ Fish oil
▪ Garlic
▪ Ginkgo Biloba
▪ Ginseng (Panax quinquefolium/Panax
ginseng)
▪ Licorice Root (Giycyrrhiza glabra)
▪ Red Clover (Trifolium pretense)
▪ Vitamin E

Periodontics St. Louis

Commonly prescribed/recommended medications for this procedure:

__ Ibuprofen (ie. Motrin, Advil): This is usually over the counter. (if can be taken, 600-800mg for adult and 200-400 for a child, every 6-8 hours for at least 4-5 days after the surgery.) This is an over-the-counter medication. It is used to control mild to moderate pain. The medication also has an anti-inflammatory result at surgical sites. It works best when taken before surgery followed by consistent dosing times afterwards. The major side effect of Motrin is an upset stomach. To avoid this issue, take ibuprofen gel caplets with meals, milk, or 2 full glasses of water to lessen this complication. If you are prone to stomach ulcers, take this medication cautiously and discontinue if you have any stomach pain, nausea, or vomiting. Do not take ibuprofen if you have had any allergic type of reactions (itching, swelling, rash, difficulty breathing, etc.). Ibuprofen has been reported to make some people drowsy (1 in 100)

__ Tylenol (Acetaminophen): (Can be taken 325mg-650mg every 4-6 hours) This is an over-the-counter pain reliever that can be taken while breast-feeding. It is contraindicated to those that are allergic to acetaminophen, or those who have a known G-6PD deficiency.

__ Peridex (chlorohexidine Gluconate): This is a mouthwash used to kill the bacteria in the surgical area. Take ½ oz. of mouth rinse, swish for a full 30 seconds, or swab the teeth with a Q-tip in the area, 2 times a day, no eating or drinking for 30 minutes afterwards. If instructed, begin this medication 24 hours after the surgery is completed and continue for at least 3 weeks or longer, even if brushing and flossing has been implemented again. Staining of the teeth can occur, which can be polished off. Avoiding tannin containing food products during its use will reduce staining tendencies (ie, red wine, tea, coffee)    

___ Closys®: This is a post-surgical rinse that is initiated 24 hours after a surgery. Gently rinse for at least 30 seconds with ½ oz (2 full caps), then spit it out. It should be used 2-3 times a day. This is a non-staining, killing 99.9% germs in the external part of the surgical site. The rinse is used specifically for the surgical site, generally until all the sutures are removed. Brushing and flossing should occur throughout the rest of the mouth.

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