Gum graft surgery, question on meds ??

5-7 days of Motrin is unlikely to do you much harm. You could keep the dose you need  down by taking plain Tylenol at the same time.

 

I say this as someone who's been taking Celebrex for a few weeks now, but hopefully not for much longer.

You could ask for Tramadol. It's considered a less potent opiate med. my dog even took it for arthritis pain, and they prescribed for my kiddo "just in case" when she got her braces, as she has Crohn's type colitis and has to avoid NSAIDS, too.

Oh my goodness, I had gum graft surgery this year, and it was almost more painful than my colectomy. I was totally unprepared. On the advice of my GI, I did not take the antibiotic. Instead, they gave me an antiseptic mouthwash. I got by on a little oxycodone that I had leftover from my colectomy and Tylenol. 

 

Good luck--mine turned out well, and my gum recession was very deep. Maybe he won't have to cut as much on you. 

Elisa, did they gas you or give you anything during procedure? reason I ask is my cousin went to same periodontist in February and she said they gave her something that made her woosy so she could not drive after the procedure. I called them and they stated i could drive myself home after the procedure. After talking to my cousin I called back and they assured me i could drive home myself. I hope so cuz i am driving there myself and home.

Geez!  I hope you heal up quickly and get on with your pouch plans!  Best wishes.

No, they didn't give me any sedation, just Lydocaine to numb it. It didn't hurt during the procedure, just afterward. I was able to drive home. 

Elisa, what did you mostly eat and how many days till it stopped hurting? did you get the graft from upper pallet or did you get the Alloderm? im getting graft

I ate soft foods that I didn't have to chew much for a few days. I also had to chew only on one side, the side they didn't work on (obviously). They did the graft from the upper pallet. I think the pain lasted about a week, but I don't totally remember (too many surgeries to keep track of!). 

 

I don't know if this is normal, but my upper pallet still is sort of numb, I guess like any other surgical site. I had the graft about 4-5 months ago. I am starting to regain feeling in it, but it still feels sort of weird. And the lower gum, where they put the graft, felt weirdly thick for awhile, but this is going away too. But overall, I'm glad I did it. 

My colorectal surgeon said NSAIDS are okay now that I don't have a colon.  I take them but not very often and I've experienced no problem.  Tramadol works to relieve most pain for me, as well.

A blanket OK for NSAIDs really isn't true, since they can cause problems throughout the GI tract and the liver. That said, a blanket "never use" admonition isn't correct either. 

 

It should be an individual assessment on a case-by-case basis. Plus, even if you tolerate them, you need to be alert for side effects and be ready to stop them at any time. I took them for years and developed liver inflammation. I am OK now, and still take them from time to time, but not long term anymore. It is why I had to go on a biologic for my arthritis.

 

Another thing to keep in mind is that there is a high correllation between NSAID use and chronic pouchitis. So, if you are prone to pouchitis, you need to be doubly aware!

 

Jan

so Jan, If they give me 800mg Motrin after this procedure for several days I should be ok? I never take them otherwise. I was told that and antibiotics for 5-7 days as well. Amoxocillan or a Zpak. With past cdiff issue 7 years ago, I heard Zpak would be safer to take???? my pouch is not connected right now but dealt with diversion pouchitis several weeks back. But im also getting a redo/revision by Remzi in October

Gee, that is a tough question because it depends on a lot on your specific tolerances. Since you say you "never" take it, you really don't know your tolerances, so it would be presumptuous of me to tell you that you would be OK. Keep in mind that the dose you are talking about is 4 times the normal OTC recommended dose, so side effects will be more likely. So, while you *should* be OK, it is not a given.

 

That said, I personally tolerated that dose long term without side effects until years past. But, some people develop bleeding or IBD flares after a few doses, or even a single dose. 

 

I am not sure whether azithromycin Is safer than amoxicillin in regard to C. diff. Dr. Shen would be the best one to ask. 

 

My point is that there is risk with everything. You just have to pick your poison and hope for the best.

 

Jan

In my humble opinion, Z-parks have been overused to the point of being less effective (resistance).  Just an observation. 

I had just come off a round of c diff when I had my gum graft, so I didn't take the antibiotics. Since they are prophylactic, my GI and I didn't think it was worth the risk. I was fine without them. 

OK, now i have no idea what i should take..lol. more confused now. Shen said i shouldnt have to take antibiotics, but then again, hes not a periodontist. I would hate to get an infection after and ruin a $1500.00 expense, not to mention be more miserable than i will be anyways

and besides the occasional flagyl/cipro and tindamax in the past 7 years, I have never been on any other antibiotics for anything

My periodontist seemed fine with no antibiotics—he gave me an antibacterial mouthwash instead. Maybe you can ask yours about it. Couldn't you just start an antibiotic if an infection developed? Obviously not the best-case scenario, but maybe an acceptable risk? I don't know! 

Pouchomarx, how did the gum graft go? What did you decide on the antibiotics?

Hey guys, I had the grafts done on friday afternoon. It was not bad at all. I decided to take the Zpak for 5 days. I dont need the Motrin though. I have not been in any real pain. It does not look pretty but its only been 3 days.

Glad it went well and you're not I too much pain!

is this a surgery electively done or a medical necessity? and what are the consquences if you dont follow through with gum graft surgery?

 

is the issue at hand usually arising from "receeded gums"? and so they need more padding in certain areas so the dentist recommends taking a graft and putting it toward the gums to make them thicker in areas they aren't?  do i understand correctly?

 

i worry about my gums. i have medicare as a primary insurance (i won permanant disability is 2004) because going to the restroom 8-12 times a day in a 24 hour period can fall under disabled/toiletry disabled. And holding a job some where would cause more stress on the b owel situation, its just easier to not work.

 

but getting back to the gum issue/receededness my doc/dentist never said anything, but im not such a regular flosser, i mouth wash twice a day after brushing AM and PM but dont floss every single day (i know, i know..). is a symptom of receeded gums easy bleeeding from them as well?

 

just wondering. dentist's scare me, but i see one very 6 months. One dentist tried to tell me i needed a deep cleaning from one end to the other on both top and bottom teeth, i went for a second opinion and the next dentist said everyone has some degree of gingavitis, its when its out of control, beyond a certain point. i did not need deep gum cleaning from end to end, that dr was trying to get 1,000 in his pocket because he has a fancy smancy prestigeous drs office.

 

so did your drs/dentist recommend the gum graft procedures (sometimes drs try to suck money out of their patients so they could get extra money to help with their bills, rent etc) or did you insurance cover some of the cost etc? or you paid out of pocket?

 

-len

my dentist has been telling me for years to keep an eye on the gum recession. In my case it was probably caused from many years of over aggressive brushing. Last year my dentist said it got to a point of seeing a periodontist. I went for 2 consults at two different ones, one of them was a little more aggresive but the other said half of them were needed more so than the rest. If the recession gets really bad it could cause tooth loss and cavities due to the tooths root being exposed. I had 4 teeth/gum areas done. All 4 were my lower fronts. They cut the graft out of roof of your mouth or they can use cadaver tissue called Alloderm. I hear the success rate is better with your own graft than Alloderm. It is very expensive, it was $2500 for just 4 teeth, insurance only pays $1000 per calendar year.

poucho,

 

thanks for the clarification.  im sorry you can't get reimbursed or couldnt get fully covered because its just not fully covered.

 

The long term steriod has me scared. I take HRT (testosterone) by way of transdermal delivery (topical/testim 1% gel -1 tube daily). I wonder if as i age and get older, with time that my gums will receed. I already have alot of crap on my plate. I have FAP for reference and will require life long surviellence for that alone.  Add diabetes, foot /muscle/leg pain to the mix and possible early stage of kidney malfunction/disease (proteinuria) and im not in such great shape.  Im only 37. heart disease, kidney stuff (dad had 2 nephrostomies, and ostomy from colorectal cancer, diabeties running in both parents, heart disease, stroke) is all i have to worry about, and diabetes effects your whole body and as the longer you have it can ruin diff organs.

 

i was asking because its one more thing to worry about, and i cant stop the testosterone/nor is their an alternative as biologically im unable to produce a sufficient amt of it)

 

i brush after eating sweets regardless if i brushed twice a day already in that given day, so i worry about over brushing, but i try to be as gentle as possible going around the gum line not too close/directly on it .

 

i do have bone loss in a missing tooth area specifically. the dentist said its a bone grafting procedure which gov't insurance does not pay for. but i can live without that, its not effect my entire mouth.

 

Thanks for answering me Best wishes w/ healing after you procedure!!

 

Len

Thanks Len, dont worry about what "can" happen, only take on whats in front of you and deal with that stuff. I used to always be like that but recently i am changing my way of thinking. You could get hit by a bus later today so try not to worry about things that havent happened yet, worry about and handle things that already have happened and deal with them

poucho,

 

very sound advice you have given me. It is the way to go/be. dont worry about future. worry about now. I should reveal im an OCD'R where by i have troubles like obsessing about things and being over analytical etc. Basically a worry wort.

 

Thank You Again, Take care.

 

-Len

I've read through this thread with interest. It's also been recommended to me that I have this procedure done at some point, although it's not urgent at this stage, and I only need to be monitored for further recession. I met with the periodontist earlier this year, and after going over the procedure, cost aside, I was shocked at how invasive it is, and I have a number of concerns. As such I am putting it off as long as possible. When I had active UC (and even afterwards, while my rectum was still in place), I had terrible gum ulcerations. I'm afraid that this procedure will trigger that again, which would mean a course of prednisone or "magic mouthwash." I'm also wary about being on antibiotics for 10 days. Any time I've needed to be on antibiotics since having the pouch, my system is thrown out of whack for weeks at a time. Not to mention, the procedure appears very painful.

 

In the meantime, I'm being careful when I brush, flossing and using mouthwash regularly. However, I was told that the recession is usually genetic and so there isn't a lot that can be done to prevent it. I'm going to meet with the periodontist again, probably in January. Hopefully there has been no further recession and we can just continue on the status quo.

Poucho, glad your surgery went well!  I just had implant to replace front tooth that was discinigrating the root due to autoimmune disorder. Had a bone graft from cadaver. Used prescription mouthwash for weeks, starting before surgery and had short dose of amoxicillin . Did great-no  c-diff (always my big worry), no infection, and bone graft looks good. Do take VSL#3. Waiting for crown now. This was not related to lack of dental care, home care or with my dentist, but since it was not at all covered by my dental insurance and very expensive ($7000!) I will never skip my daily flossing or frequent brushing! Dental work is soooo expensive and mostly out of pocket. Possible this dental problem related to meds I've taken for UC and pouch problems. Hoping it's only one tooth!

Shen told me antibiotics are not needed for gum surgery, although he is a great pouch doctor, he is not a periodontist. My peridontist said he highly recommends the antibiotics after this procedure so even though i had cdiff in 2008 after takedown, i took his recommendation. I didnt want to pay all that money to have procedure and end up getting infection and ruin the whole procedure. I was put on 250mg Zpak for 5 days and took last pill yesterday. I feel pretty good, and barely any pain still. I was expecting to be in alot of pain, just from reading on the internet. I go back to periodontist on Tuesday morning for my followup. It still does not look very pretty and gum line is still pretty swollen.

Spooky, my dentist had recommended the gum graft surgery for at least a year, but it didn't become urgent until my last (and final) UC flare, when it seemed like the gum recession on a couple of my teeth suddenly got very bad--it looked like my entire tooth root was exposed. I don't know if it was because of the prednisone I was on (thin skin?), or whether it was disease related at all. I think it's worth waiting if you can. 

 

I had two teeth done, and I think I paid around $500 out of pocket. 

 

Pouchomarx, I'm glad your procedure went well and you're not in much pain!

 

now might have a problem.. eating today at lunch and i noticed the resin putty they put over the incision in roof of my mouth is no longer there.. It must have come off while eating and didnt even realize it. They told me if it started to come off i could just remove it but if not they would remove on my followup. I am freaking out now that i swallowed it and might get an obstruction now. I have ileostomy right now. Nothing I can do, just sit and wait. god help me..always something. it was size of a half stick of chewing gum roughly. very thin. SOMEONE PUT ME AT EASE, PLEASE

Maybe you also chewed it without realizing, or maybe it came off in parts, so it won't be one big chunk trying to pass through. Hope it all passes!

I would think after being exposed to gastric acids it would be pretty broken up by the time it gets to the end of the line if you find things are not passing then you can start to worry. 

had a few very hard chips come out of bag this morning so hopefully the rest will be passing soon as well

The reason for taking antibiotics for some dental procedures is precautionary for your heart.  I think the antibiotic was okay, it may depend on what kind of antibiotic it was? I had c.diff several times with my colon and the first time it was caused by Cipro. Before I had chronic pouchitis I had to get 2 stitches in my lip.  The Urgent Care doctor prescribed a heavy duty dose of the same antibiotic given Pouchomarx.  I contacted my Internist and she said NOT to take it as I would notice right away if there was a problem. It's harder to tell if it's your heart. Some people with certain heart conditions need to take antibiotics for dental procedures.  

 

SO I can't take Cipro for pouchitis and I can't take Flagyl any more.  I did take it for c.diff in my pouch that took 4-5 rounds of flagyl to get rid of.  Flagyl started making my peripheral neuropathy in my feet worse.

 

Someone mentioned diabetes and you probably should talk with your doctor about the affects Flagyl before taking it. It might contribute to diabetic foot pain. I'm not diabetic but swear my feet must not know that.  End result is I can't take the 2 preferred antibiotics for pouchitis.  Augmentin and Xifixan are what I'm rotating until my diversion to a permanent ileostomy in around 9 days.....

 

I have had a lot of little cavities due to 3-4 of the medications I had to take for medical reasons.  My gums receded and I had 18 small cavities in one year when that happened!  My dentist has Crohns and he said I was taking 3-4 meds that cause dry mouth which leads to receding gums. My dental insurance refused to pay for the cavities in teeth that had crowns because they say you can't get cavities in teeth that are crowned.  They didn't even pay for the full cost of the crowns to begin with..... He has me using prescription toothpaste that has 5 times the fluoride of regular tooth paste.  He instructed me to brush around my crowns as if I was brushing the gums under them.  I'd only had 6 cavities in my entire life before this happened. My dentist appealed the denial of coverage saying that the problem that caused the cavities was due to medications I needed for ulcerative colitis. They didn't care. The cavities were very small so he did 6 at a time and I paid for nitrous oxide the 3 times.  I highly suggest it and wish I'd requested it for my root canals.  I took a xanex before that as well.  (It was causing me anxiety.)