That bit of the distortion over my maxillary left lateral incisor seems to be here to stay for now. Hopefully in a few months, the Emdogain will regenerate that part. We’ll see. It is probably not the only chunk of my gums the stitches cut off, but it’s in the front. You can understand why I’m upset about the lack of information being given to periodontists about the possibilities.
Because the usual professional attitude towards pain in dentistry is near apathy, this is one of those things that will probably just need to be information dark skinned people keep in the pocket for ourselves in the west. In countries and communities with darker skinned majorities though, this should be standard at least for dental assistants and nurses.
Preparation
Whether or not someone has keloid skin is relevant for both flapped and flapless Emdogain implants. Both cause trauma to a sensitive area of the body that, while not exposed to much sunlight (which is one of the main triggers of hypertrophic scarring) gets a lot of air and friction from mastication of food. Without proper preparation, it will lead to a chain reaction, that will create more wounds in the mouth and therefore more scar tissue. More open sores in the mouth will also, of course, increase the risk of infection. In a diabetic person, this could lead to necrotizing of skin from some areas possibly being strangled or cut off during the inflammation. The stitches could form a kind of tourniquet.
So the preparation for Emdogain should start days or weeks before the implantation.
Vitamin D3
Many dark skinned people in the west have D3 deficiency. You should check, and if you are low, you need to supplement.
Garlic and Onions
You should eat plenty of garlic and onions. These help the skin by regulating immune response. People call it an immune booster, but it’s more of a balancer.
Imagine a worst case scenario, and stock up on medicines and comforts just in case.
Don’t wait until the last minute to get stuff like yeast infection treatment (or fungal chafing stuff if you have testicles). Get some hydrocortisone creams, aspirin ointment, or whatever you might think you might maybe probably need if things go wrong.
You want to make sure you’re ready for whatever, and can keep yourself calm and comfortable. Even your mood can affect your healing, so do what you have to do. If you are allowed marijuana legally, go with edibles over smokeables, and make sure they will not require too much sucking or chewing. In the Czech Republic, they have a kind of infused butter tea.
Unfortunately, I don’t have this option, but trust I would use it if I did.
Speaking of herbs though, good ones to help with pain and fight the keloid response are tumeric, cloves, cinnamon, and hot peppers. With the latter, I don’t recommend the chili candies many use for mouth sores in the case of Emdogain surgery pain. First, it’s a hard object, and second, it takes too long before the burning subsides and the relief happens. You would do better to take it in capsule form. It is worth taking though, for general healing and if regardless of your best efforts, you still have bleeding.
Soft Foods
I have seen a lot of soft foods recommendations that are not really soft enough. Plan to be on liquids for a week, and soft mush for another week at least. You will really not be able to chew anything for awhile because Emdogain is injected around the roots of your teeth. Any slight bump of your teeth will make you suffer. If you’re like I was, even drinking water will hurt.
You will want to avoid anything overly salty or spicy.
Informing Folks
Inform your periodontist. If they are working in a place with a lot of brown people, they have seen your type of skin before and know how to handle it generally. What they won’t know, at least until after these articles propagate, is what to do about Emdogain specifically.
Because it is made of proteins that should fuse somewhat seamlessly with your own tissues, and nobody is saying otherwise, it’s unthinkable that someone’s skin would try to push it out. Right? Your skin, my beautiful brown person, will immediately try to push it out. You want the periodontist to cut and stitch things in a way that your skin is unlikely to succeed in its efforts. So they need to know that despite all the assurances in the literature, these should not be mistaken for lack of any danger of rejection, migrating, or violent immune response.
Dark skinned people sometimes even have a bad reaction to things grafted from parts of our own bodies.
Household Chores
Get help for the first week, and take it easy. You should get up and walk around a bit, but plan to not have to do more than dusting. You should also go outside if you can, but just don’t overdo anything.
The Day Of
If your doctor gave you Lorazepam or Ativan for the procedure, you will need to take whichever dosage it takes to have you very well sedated. Again, your mood and thoughts will have an effect on your healing. The more traumatic the surgery, the more violent your immune response will be.
Some suggest taking a small dose the night before, and building gradually so that by the time the surgery happens, you are nicely smoothed out. If you are one of those people for whom other drugs take a long time or higher doses to hit, this is a good strategy. It is not a good idea for you to take a high dose an hour before with no preparation. For all you know, this might be your limit or an overdose. Start with the minimum, let that sink in, and only take a little more at a time if you really need it.
One of the reasons for this is that you will need to take an NSAID right after the surgery. I mean as soon as you get home, some kind of ibuprofen, naproxen, or whatever you were prescribed. Do not wait for the local anesthesia to wear off. This is not just about the pain, but the inflammatory response.
So you want the surgery to happen while the happy drugs are peaking, and have your wits about you by the time you get home after. It will also help to tell a friend or family to make sure that you do not forget to take the NSAID.
From then on, take your doses on time every time.
Do not skip one.
Do not be late.
Set an alarm if you need to.
As to how much you can take, ask your doctor. You may need to start with the maximum safe dose, and start reducing little by little after a week. If this isn’t enough, you may need to combine it with another drug, but don’t just decide this on your own. Ask your doctor which ones will be more efficient and not conflict with each other.
Get lots of rest. If you can, take a week or two off from work.
Signs of Things Going Wrong (or Uncomfortable but Right)
Because our skin is considered special (though it is actually the normal for humans but just fell out of the gene pool in some places), there isn’t much information about what right and wrong looks or feels like for anything. With Emdogain, there is less than nothing.
A good time with Emdogain is going to involve a fair bit of pain, and things that feel wrong but are not. It should swell a bit. You should have some mild “strain” against the sutures (stitches). You should feel something like little lumpy spot under the skin of your gums. As long as you aren’t bleeding profusely, leaking tissue or gel, or nothing bursts open, you are probably alright.
The mild strain of the stitches is so common that later, some of them may sag a bit or maybe even unravel after the 7th or 8th day. By the time you go to have the stitches removed, you should have some loops. If they hang too much you may need them clipped. Have this done by the periodontist or assistant if possible. If not then though I can’t officially recommend clipping your own, just make sure to do it safely. If you haven’t done it before, you are not going to do it right.
Though some pain and grossness is to be expected, things are going badly if you feel the lumps migrating. It is normal for them to kind of shift a bit, but if you notice your skin pushing stuff towards the incisions, and have a leaking of the gel, go back to the periodontist. One tiny little bit the size of a breadcrumb may not be bad news, but anything bigger is a problem because that is probably the entire injection around one of the roots. It means that one might not have held enough to get the regenerative benefits. If more than one leaks, you are in real trouble.
As I said before, a bit of strain against the stitches is to be expected. However, if the stitches are cutting into your skin, or you see your skin is puffed up around them like the ropes of a blimp, this is wrong. Best case, you aren’t taking enough NSAID. You may need to ask your doctor about increasing your dose even if you don’t need it for pain. Again, this is not just about the pain, but preventing damage.
Don’t just assume this is the issue though. There could be other things going wrong. You may have an infection. You may have “princess and the pea” level keloid skin that can’t take any kind of trauma without blowing up like a balloon. You may be having an allergic reaction to some material used in the procedure. It is extremely unlikely due to the fact that Emdogain is made from basically “blank slate” animal proteins, that it would cause an allergic reaction. There is maybe one guy in the world for whom this may have been the case.
What is more likely is that you could be allergic to the local anesthesia, something in the rinse, or something used to sterilize their equipment. If they are using maybe not the best quality tools, and you have a nickel allergy, this may cause an allergic reaction as well. Either way it’s going to take something more than over the counter medicines to deal with. So go to the periodontist or maybe the emergency if you start getting hives or other signs of allergic reaction.
If you feel any of the flaps are flappy or turned outward, a suture may have unraveled too soon.
If you feel any really open wounds or circular sores, there could be an infection. If you’re taking antibiotics, you might have also caught a fungal infection that needs to be treated. Especially if you have cats, tinea is a constant battle. So be watchful especially if the pain is kind of itchy.
If some parts of your mouth feel super dry and hurt, you probably have some dry spots. Consult your periodontist about this, but generally, it just takes some petroleum jelly or maybe olive oil to fix. If any of these areas crack open and bleed, this is bad enough to go to the doctor.
If any part of your mouth turns blue, your circulation is cut off somewhere. You may need your sutures adjusted or redone. If you are diabetic or prediabetic this could lead to serious problems. Of course, if anything is black, you need to go to the emergency clinic immediately.
Other things to be on the lookout for is bad odor that is not just like the taste of fresh blood, oozing pus, constant bleeding, or pain that makes you question whether you want to keep breathing.
Some pain is normal for this, but there is a limit. If you normally have a high tolerance for pain, but you are questioning life, that is too much. The stress by itself is unhealthy and bonus, causes a higher inflammatory response.
Do not take your pain for granted. Just because most periodontists and dentists don’t seem to care about your pain doesn’t mean you shouldn’t care. They are humans. They are usually very caring humans who have committed a good deal of their lives to helping people keep their smiles. This level of caring person must at some point steel themselves to be able to survive in their careers or else they would weep all the time. They have to be hard. This does not mean your pain is not important, even to them. It just can’t be their focus while they are operating. This has to be you and your family doctor’s issue.
I hope this article has been helpful for those who will be getting Emdogain implants. May you have successful operations and outcomes, and keep your beautiful smiles. When you can’t smile, may you have an especially bright set of teeth to bare in your ferocity.
Blessings and Ashe!
