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Periodontal Surgery -- Open Flap

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(Pocket Depth Reduction)

Definition

Periodontal disease refers to bacterial plaque and infections around the gum and tooth root. It can happen around one or several teeth. In its more advanced stages, surgery may be needed to fix damaged gums.
During flap surgery, the periodontist makes a small incision in the gum, pulls back the gum flap, cleans out the infected, plaque-filled pocket, and stitches the gums back in place.
Periodontal Disease
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Reasons for Procedure

This surgery is needed when:
  • Deep infected pockets have formed and it is too hard to keep them clean
  • Gums around the teeth are damaged and cannot be fixed with nonsurgical techniques, like deep cleaning and medicines
This surgery slows the progression of periodontal disease by reducing deep pockets and bacterial growth. Periodontal disease can cause other health problems if not treated.

Possible Complications

If you are planning to have periodontal surgery, your dentist will review a list of possible complications, which may include:
  • Tooth sensitivity
  • Changes in gum appearance
  • Bleeding
  • Reaction to the sedation medicines (eg, light-headedness, low blood pressure, wheezing)
  • Infection
  • Gum swelling
  • Nausea and vomiting
Factors that may increase the risk of complications include:

What to Expect

Prior to Procedure

  • Tell your dentist of any recent changes to your health, medicines, allergies, or supplements.
  • Take your prescription medicines, unless your dentist says otherwise.
  • Talk to your dentist about any medicines you take, including over-the-counter medicines. You may need to avoid certain medicines.
  • You may be asked to take an antibiotic before surgery.
  • Sometimes, sedative medicines are used to make you more relaxed during surgery, even though you are awake. If you are undergoing conscious sedation, you will be asked to not eat for at least six hours before surgery. Otherwise, you can follow a normal diet.
  • Arrange for a ride if you are having sedation.
On the day of the surgery:
  • Remove contact lenses.
  • Wear comfortable clothing.
  • Bring any paperwork as directed.

Anesthesia

A local anesthetic will be used near the gum disease.
Your dentist may recommend conscious sedation. You will be awake, but will have no anxiety during the surgery.

Description of Procedure

This surgery is usually done in an outpatient setting. You do not need to stay overnight. If you are undergoing sedation, you will have an IV placed in your arm to deliver medicine. Your heart rate, blood pressure, and breathing will be monitored during and after the surgery.
The periodontist or dentist will numb the affected area using a local anesthetic delivered through a needle. He will make a small cut in the gum line near the tooth root. The gum flap will be pulled back, and he will clean out and scrape the infected area. The gum flap will be repositioned to minimize the deep pocket size that formed. The gum will be stitched back into place. A dressing will be applied.

How Long Will It Take?

The time it takes to complete the procedure depends on how bad the damage is and how many gum areas are affected.

How Much Will It Hurt?

You may feel mild discomfort while the dentist numbs the affected area or places an IV in your arm. You will not feel pain during the surgery. Medicines can help control pain and anxiety before, during, and after the procedure.

Post-procedure Care

At Home
When you return home, do the following for 24 hours to help ensure a smooth recovery:
  • Rest as needed.
  • Take medicines as directed. Over-the-counter medicines for pain, like ibuprofen , may be used.
  • Apply ice to the side of your cheek for 20 minutes at a time to reduce pain and swelling. Wrap the ice in a towel. Do not place the ice directly on your skin.
  • Drink plenty of fluids.
  • Eat small amounts of soft or pureed foods.
  • Do not smoke, rinse your mouth, or use a straw.
  • Apply dressings or gauze to the area as directed to absorb blood and saliva.
  • Do not exercise for a few days as directed.
  • Do not drive if you took a sedative or narcotic pain reliever.
  • Be sure to follow your dentist’s instructions.

Call Your Dentist

After arriving home, contact your dentist if any of the following occurs:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, a lot of bleeding, or any unusual discharge from the surgical site(s)
  • Pain and swelling that is not controlled with medicine or home care
  • Dressing or stitches have come loose or are uncomfortable
  • Loose tissue
  • Continued swelling after 48 hours
  • Other new symptoms, allergic reactions, or concerns
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which last for more than two days after leaving the dentist's office
In case of an emergency, call for medical help right away.

RESOURCES

American Academy of Periodontology http://www.perio.org/

American Dental Association http://ada.org/

National Institute of Dental and Craniofacial Research (NIH) http://www.nidcr.nih.gov/

CANADIAN RESOURCES

Canadian Dental Association http://www.cda-adc.ca

The Canadian Dental Hygienists Association http://www.cdha.ca/

Health Canada http://www.hc-sc.gc.ca/

References

American Academy of Periodontology website. Available at: http://www.perio.org/ . Accessed April 19, 2010.

Carson De-Witt R. Periodontal disease. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=1034 . Published September 1, 2009. Accessed April 21, 2010.

National Institute of Dental and Craniofacial Research (NIH). Periodontal (gum) disease. National Institute of Dental and Craniofacial Research (NIH) website. Available at: http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm . Accessed April 19, 2010.

Pre and postoperative instructions for periodontal surgery. Kathie L. Davis website. Available at: http://www.kldaviesperiodontist.com/images/WEB%5FPRE%5F%5FAND%5FPOST%5FOP%5FINSTRUCTIONS.pdf . Accessed April 19, 2010.

University of Maryland Medical Center. Periodontal disease. University of Maryland Medical Center website. Available at: http://www.umm.edu/patiented/articles/what%5Fprocedures%5Ftreatment%5Fof%5Fperiodontal%5Fdisease%5F000024%5F8.htm . Accessed April 19, 2010.

6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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