Periodontal Surgery for Crown Lengthening: Expectations for Post-Operative Care

Recently, I had to undergo periodontal surgery for crown lengthening for my two front teeth.Crown lengthening is a surgical procedure performed by a dentist to expose a greater height of tooth structure in order to properly restore the tooth prosthetically. Dental treatment as such is scary for most of us and the word surgery does increase anxiety. However being prepared and getting right information helps to calm your nerves as much as the sedatives your dentist /periodontist would provide before performing the procedure. If you are reading this article its highly likely that you or someone you know has been advised to undergo Periodontal Surgery. I hope my first hand account will ease your anxiety and help you make a more informed decision.

Selecting the doctor: The crown lengthening is a surgical procedure and is performed by Periodontists who are specialists and have additional training than the regular dentists. Generally you would be referred to the Periodontist by your dentist but if not be careful to check the qualification.

Periodontists (USA) must complete a 4 year undergraduate college degree, then graduate from an accredited dental school (DDS or DMD degree), and then complete 3 years of additional formal training beyond dental school in an accredited periodontal residency training program.

Periodontics is offered as specialization field in dentistry program in India.This is offered at Master of Dental Surgery ( M.D.S ) course conducted by dental colleges affiliated to different universities in India.The minimum qualification required for M.D.S is Bachelor of Dental Surgery ( B.D.S ).

Insurance Coverage: Many a times dental insurance companies deny coverage for periodontal surgery or pay only a portion of the services especially if it is for you front teeth as they may categorize it as a cosmetic procedure. Do discuss it with you insurance provider before-hand as the procedure is costly and it should not come to you as a shock later.

What to Expect: Generally the procedure can be performed comfortably as an office procedure.There should be no discomfort during the procedure itself as the procedure is performed under local anesthesia. Most of the practices have earphones and video monitors for watching movies or listening to music to help you relax during the procedure. Nitrous oxide sedation( laughing gas) is also available at request. The procedure lasted for almost 2 hrs for me. The duration may vary depending on how many teeth are being affected.

Preparing for the procedure: You will be given a prescription for an anti-inflammatory medicine to begin taking a day before your surgery. It is a good idea to get the medication for post-operative discomfort before the procedure so you don't have to stop by the pharmacy after the surgery.

I was told to take the medicine one hour prior to the surgery. I was also advised to take high protein diet before the surgery. Aspirin can interfere with normal blood clotting and you should not take aspiring one week prior to the procedure unless approved by your physician.

Unless you are taking oral sedation or an IV sedation you can drive back on your own. However its nice to have someone drive you back if it makes you more comfortable.

Post Operative Care: Moderate discomfort is expected after the procedure. Most of the pain is caused by inflammation. Swelling may also occur. Its recommended to use cold application immediately following surgery to minimize swelling. You can use ice pack of any kind and apply it on the area every 15 - 20 minutes. Repeat as often as possible the first 24 hours. The prescription medicine should be taken with meal to avoid nausea which is a common side effect of pain medications.

Bleeding: Slight bleeding may be experienced for up to 24 hrs after surgery. Rinsing interferes with blood clotting and should be avoided for first 24 hours. Do not eat/ drink anything hot the day of your procedure. Do not use straw with liquids. If excessive bleeding occurs take a moistened plain tea bag and place where its bleeding. Apply gentle pressure on the tea bag with your fingers. If you are not able to stop the bleeding contact your doctor. You should not smoke 24 hrs after surgery as it may cause excessive bleeding.

Oral Hygiene and Diet : You can perform you regular oral hygiene procedures in all areas of your mouth not involved with surgery. After 24 hrs gently rinse your mouth with warm salt water ( 1/4 teaspoon salt to 4 ounces warm water). Do it 3-4 times a day until your next appointment( generally after a week). From my personal experience avoid mouthwash and continue using salt water rinses until the tissue heals. Some mouthwashes have alcohol in them which may irritate your tissue.

Eat soft food like eggs, pasta etc. and avoid food that you have to chew a lot.Try eating high protein diet. A good diet will help you heal better.Drink at-least 8 glasses of water every day. Avoid spicy food.

Activity: You may feel tired for several days after the procedure. Keeping busy helps in distracting you from discomfort but you should take it easy the first few days. Take as much rest as possible. Avoid any activity that increases your heart rate as it may interfere with blood clotting. Get some nice DVDs at least for the day of surgery and watch some movies or read books.

It takes minimum 6 weeks for the tissue to heal completely . Be patient and maintain a good oral hygiene. The procedure involves stitches in the gum tissue. The stitches generally dissolve on their own or the doctor will remove it when you meet them one week after the crown lengthening procedure. I had three stitches. One dissolved and others were taken out by my doctor.

Hope the above information was helpful and good luck for your journey towards a healthy and beautiful smile.