Periodontal Surgery—Open Flap
En Español (Spanish Version)

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 medications
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
Problems from the procedure are rare, but all procedures have some risk. Your dentist will review potential problems, like:

  • Tooth sensitivity
  • Changes in gum appearance
  • Bleeding
  • Reaction to the sedation
  • Infection
  • Gum swelling
  • Nausea and vomiting
Before your procedure, talk to your dentist about ways to manage factors that may increase your risk of complications such as:

What to Expect
Prior to Procedure
  • Tell your dentist of any recent changes to your health, medications, allergies, or supplements.
  • Take your prescription medications, unless your dentist says otherwise.
  • Talk to your dentist about any medications you take, including over-the-counter medications. You may need to avoid certain medications.
  • You may be asked to take an antibiotic before surgery.
  • Sometimes, sedative medications 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 medication. 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. They 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. Medications can help control pain and anxiety before, during, and after the procedure.

Post-procedure Care
At the Dentist Office
During your stay, the dental staff will take steps to reduce your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:

  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
When you return home, do the following for 24 hours to help ensure a smooth recovery:

  • Rest as needed.
  • Take medications as directed. Over-the-counter medications 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
Call your dentist if any of these occur:

  • 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 medication 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
  • Persistent nausea and vomiting
If you think you have an emergency, call for medical help right away.




RESOURCES:
American Academy of Periodontology

National Institute of Dental and Craniofacial Research (NIH)

CANADIAN RESOURCES:
Canadian Dental Association

The Canadian Dental Hygienists Association

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_PRE__AND_POST_OP_INSTRUCTIONS.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_procedures_treatment_of_periodontal_disease_000024_8.htm. Accessed April 19, 2010.

6/6/2011 DynaMed's Systematic Literature Surveillance Available at: http://www.ebscohost.com/dynamed: 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.

Last Reviewed September 2013



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