APPOINTMENTS: (972) 464.2660

Procedure Instructions

• Connective Tissue Grafts
• Protective Bite Splints (Tanner Appliance)
• Patient Instructions Following Perio Therapy
• Post-Surgical Extraction Instructions
• Medications and Pain Management Instructions

Connective Tissue Grafts

• Primary Goal: To thicken the gum tissue around the tooth with recession.
• Secondary Goal: To get some gum tissue to grow back over the root.

Pre-Operative Instructions

1. Get the 2 prescriptions filled the day before your appointment. You should have a prescription for Decadron and Vicodin.
2. You will be given 2 Decadron tablets for swelling one hour before your appointment along with your oral sedation.
3. Someone you trust must drive you to our office, because you will not be able to drive yourself.
4. Bring your prescriptions for Vicodin to the office. We will give you an oral sedation, anti-anxiety medication, in the office. You will place two tablets under your tongue to dissolve. Do not swallow. We will give you the Vicodin after the appointment.We will monitor your blood pressure, pulse and oxygen saturation level on a monitor during the procedure. This is part of the conscious sedation procedure and a simple safety precaution. You can expect to feel little to no anxiety, and to be very relaxed and sleepy.

Your responsible escort should leave their phone number, so we can call them 30 minutes prior to the end of the appointment. Your appointment will be 2-3 hours long depending on how much we are doing. Your escort will be responsible for getting you home safely and into bed to rest until the sedative wears off. Please pick a responsible escort.

Post-Operative Instructions

1. Wear your clear stint over your palate for 24 hours or until the next morning. This is your bandage for the donor site on your palate.
2. On the morning after surgery, take your remaining 3 Decadron tablets. This is to minimize swelling. Take your pain medication Vicodin every 4 hours as needed, but normally this is not needed after the first day.
3. Eat a soft diet for two weeks. If you choose to chew something against recommendations, do so away from the graft site, as this may separate the graft from the recipient site. You cannot hurt the donor site on the palate.
4. Do not floss or brush the graft site for one week. After one week, brush only with visual aid to make sure you do not hit a suture until the two week mark when all sutures are removed. You can brush and floss freely after two weeks.
5. Rinse with Perioguard two times daily and swish over the graft site. This kills bacteria so the wound can heal in a clean environment.
6. The graft site will shrink over the next 6-12 months, at which time it will take it’s permanent shape. If you have any questions, call Dr. Sowell at 214-415-5446. If he does not answer, leave a message and he will call you back.

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Protective Bite Splints (Tanner Appliance)

Purpose:

• Treat Temporomandibular Disorder – TMD
• Treat Bruxism – Grinding and Clenching
• Protect smile makeover from damage of clenching and grinding. Minimize the erosion and notching of teeth at the gum line (abfraction); minimize the recession of gums from clenching and grinding.Diagnosis (Condition):
  TMD- The purpose of this therapy is to influence your lower jaw to function freely and without pain. Many situations cause the malfunction of your jaw such as accidents, trauma, surgery, developmental defect, oral habits, large fillings placed over many years, naturally occurring poor bite, orthodontics, psychological stress, clenching and grinding, etc.

This Tanner appliance, or bite splint, fits on your upper teeth, keeping your upper and lower teeth from contacting during chewing and grinding. This allows the lower jaw to return to a comfortable hinge position without interference from the teeth.

You should wear the splint at all times if you have TMD pain, unless directed otherwise. If you remove the splint to eat, your treatment will not be as effective. Overtime your bite has deteriorated to the point your jaw joint cannot tolerate it any more. The splint eliminates a tooth to full contact and allows the joint to fall back into correct position (ball in the socket concept). Your symptoms will gradually disappear while you are wearing your splint, and we will adjust your natural teeth, bridge or filling to the new bite. This procedure is called occlusal equilibration. After equilibration you wear your splint only at night. This takes a few weeks. Your symptoms will be worse when you are under stress, causing you to clench or grind; affecting your joint.

Clenching and Grinding:

If your condition is clenching and/or grinding and you have no joint pain, you should wear your splint only at night when you are unaware of your jaw movements. If you are still damaging your teeth (chipping front teeth, gum recession, cracking back teeth), then you must wear your splint when you are concentrating or under stress during the daytime. Slowly you should try to become aware of your teeth during the day through biofeedback, and stop the daytime habits that damage your teeth and gums.

Protecting Smile Makeovers, Slowing Abfractions – Notching and Gum Recession:

All people clench and grind, more than others. Some people damage their jaw joint and have to be treated for TMD. Some shorten their front teeth, chip their teeth, break back molars, get gum recession, root notches or erosion (abfractions). A Tanner appliance or splint helps control the habits and forces that damage your joints, teeth and gums.

It does this by giving you a balanced bite when you clench (28 teeth hit evenly, distributing forces); by decreasing the muscle activity by 40% as well as eliminating tooth-to-tooth contact and puts your jaw joint in the ideal position. That way, no one tooth gets excessive force; eliminating broken, rocking teeth and decreases your recession. When we lengthen short teeth to improve your smile, your lower jaw grinds them down resulting in broken porcelain veneers and crowns.

Caring For Your Tanner Appliance – Bite Splint

Your resin splint is made of a thermoplastic material inside for comfort and a hard outer shell for durability. We recommend you brush and rinse your splint daily, and soak it twice a week in a denture cleaner for 15 minutes. We recommend the “Fixodent” denture cleaner system. Drop a tablet into a container of warm water and put the splint in. After 15 minutes, rinse splint and you are done. This is important because bacteria and other organisms can imbed in the splint causing a health hazard, if not cleaned properly.
If you see accumulation on your splint, bring it in during your preventive care appointment and we will run it through the ultrasonic. With proper maintenance and up-keep, our goal is to get 5 years of use out of your Tanner appliance. If you do not have Fixodent in an emergency, you can use a couple drops of bleach in 4-6 ounces of water, 1:10 ratio, for 20 minutes. This should not be done regularly; it can ruin the splint if done regularly. During the day, keep your splint in its container to prevent damage, and keep in a constant temp 60-80 degrees.

If you ever feel your back teeth do not touch when you bite, you may have had some damage to your joint and need to see Dr. Sowell for evaluation. A splint that does not fit the bite properly can hurt your joints, not help them.

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Periodontal Therapy

You may notice your gums and teeth will be sensitive or tender for a few days. This sensitivity is normal and will soon subside. Tylenol or Advil may be taken along with warm salt-water rinses to help reduce discomfort. It is very important no matter how tender your gums and teeth may feel you keep the bacteria level in your mouth at a minimum. (Think of having a cut on your finger, you want to keep it clean and free of bacteria to aid in healing and prevent further infection.)

1. Gently, but thoroughly brush your teeth and gums 2-3 times a day. Gently floss 1 time a day, making sure the floss goes beneath the gum line of every tooth.
2. Swish or brush with the prescription medication, Periogard, 2 times a day. Do not eat or drink anything, including water, gum or mints, for 30 minutes after using Periogard.
3. Be sure to complete the whole course of prescription antibiotic Doxycycline.

After your Perio Therapies are completed, you will be scheduled for a 4-6 week Re-Evaluation and Supportive Perio Therapy appointment. At this appointment your hygienist will check your healing progress by probing and recording your entire mouth. Your teeth will then be scaled and polished to remove any bacterial infection, plaque, tartar and stain that are present.

Your periodontal maintenance visit will initially be set at 3-month intervals. Your 3-month visits should continue until your periodontal condition is stable, and then we may try a 4-month interval. A 3-4 month interval is essential because the bacteria-causing infection in your mouth will re-colonize in 45 days, and therefore must be professionally treated to avoid infection.

The success of your treatment will depend on your thorough home care and maintenance during your professional treatment interval. Since periodontal disease / infection is a cyclical disease with periods of stability and flare-ups, this co-therapy approach of thorough home care and thorough professional care will help keep your infection under control and stable.
If you have any questions or concerns, please contact our office at (972) 464-2660.

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Post-Surgical Extraction Instructions

Your smooth recovery depends greatly on how well you take care of yourself, so please read carefully.

First 24 Hours

The gauze placed by Dr. Sowell is correctly positioned to control bleeding, as long as you bite down on it, keeping your teeth together. Without this pressure, bleeding will result. Talking takes pressure off the surgical site, so please refrain from speaking. You must keep the same piece of gauze Dr. Sowell placed in position for two hours. If after two hours of lying in bed with your head elevated above your heart you feel you have no more bleeding, take the gauze out. You will have pink to reddish saliva – this is normal drainage.

If you prefer having the gauze in place, wet it first, fold over twice and place over the surgical site. If you fail to place the gauze in the correct site, it will only encourage bleeding. Do not change the gauze during the first two hours, as this will also cause more bleeding. The gauze will be soaked red, but it doesn’t work until it is saturated; therefore, do not change it. Frequent gauze changing is a sure way to keep bleeding.

It takes 24 hours for the clots to completely form; therefore, you must not be active and need to rest for that period. Activity will cause bleeding and pain. Do not spit for this period; simply drool any excess saliva into a towel to prevent damaging the clots. For the first two hours, place ice wrapped in a towel over each surgical site – 20 minutes on and 20 minutes off – to help reduce swelling.

You have been given a long-acting anesthetic (Marcaine) for your post-operative comfort. This will wear off in 4 – 8 hours after you leave the office, so please get your prescription for pain medication filled immediately. Take one as directed so it will be in your system by the time the local anesthetic wears off. Your medication can cause dizziness with sudden movement.
After the first day until sutures are removed.

You survived the first day and the bleeding is controlled. Congratulations, the worst is over but you must still take it easy. Take your second dose of Decadron (3 tabs) or continue with your Medrol dose-pack, which ever you have been given. Take your pain medication as needed. Rinse with Perioguard 3 times per day. Then, 4 – 5 days after your surgery we want to see you to remove any suture and give you an irrigator to rinse with.

Your jaw may be stiff and sore, but exercise it each day. Rinse with warm salt water every two hours while awake to help healing until the sutures are removed. Brush teeth normally except at surgical site. Your mouth must be kept clean. You can expect swelling and possible bruising. Drink a lot of fluid and eat a soft diet. We do not expect any complications, but if you have any questions, the office number is (972) 464-2660.

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Medications and Pain Management Instructions

To help your surgery appointment and recovery go smoothly, please read the following instructions below.

1. One hour before your appointment, we will give you Decadron (3 tablets) to help control swelling. Bring your pain medication (Vicodin) to your appointment.

2. When you get to the office, we will administer your conscious sedation, which will make you sleepy and control any anxiety you may have.

3. At the end of the appointment, we will give you one tablet of your narcotic pain medication (Vicodin) before your gauze is placed over the surgical site in order to control bleeding. Take the pain medication the first day after surgery as prescribed and then as needed, depending on how you feel. We may also give you Advil (3-4 tablets).Pain management: The Decadron/Medrol dose pack is steroids used to control swelling, which reduces pain.

• Mild pain can be managed with Advil (3-4 tablets), every 4 hours.
• Moderate pain - Vicodin (1-2 tablets), every 4 hours.
• Severe pain – combine Advil (3-4 tablets) and Vicodin (1-2 tablets), every 4 hours. The day after surgery, start rinsing your mouth with Perioguard 3 times per day until your post-op appointment. This is an antimicrobial agent. You will be given an irrigator at your post-op appointment to clean out your lower surgery site. You need to have someone bring you, drive you home and take care of you afterwards. Please do not smoke for 5 days after surgery, as it decreases healing and increases the incidence of dry sockets.

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