If gum recession is affecting your health or your appearance, a procedure called gum grafting may be recommended. Although it might sound scary, a variety of gum grafting procedures are routinely performed by periodontists. Following a gum graft, it’s more important than ever to practice good oral hygiene; this will help prevent gum problems from developing in the future. Your regimen should include proper brushing with fluoride toothpaste, daily flossing, a healthy diet and regular dental and periodontal checkups. Maintaining healthy gums is a key to keeping up your overall oral health — and preserving your smile.
candidates for gum surgery
Receding gums can impact the aesthetic appeal of your teeth, making them look longer and creating an “aged” appearance, as well as their overall health. When the gumline recedes, the exposed tooth roots lack the protection they need and may feel sensitive. They are also at an increased risk of damage, like tooth decay and mechanical abrasion from toothbrushing. Gum grafts are often performed to repair gum recession caused by periodontal (gum) disease. However, receding gums can also be the result of other factors, such as a misaligned bite, genetics, aggressive home care techniques, oral piercings, and grinding of the teeth (bruxism). A consultation with periodontal specialists can help you learn if your smile could benefit from a soft tissue graft.
Benefits of Gum Grafting
There are many benefits to gum grafting surgery. Keep reading to learn about the top five benefits of gum grafting.
Protects against further recession
Gum grafting is needed when gums have receded to a problematic point. Luckily, a top benefit of gum grafting is that it helps protect against further receding in the future.
When your tooth and roots are covered healthy gums, the gum tissue to do its job. The job of healthy gums is to protect your teeth and its roots from bacteria and infection. When you have healthy gum tissue, it can do this and prevent inflammation from infection and ultimately prevent receding.
Protects Roots from Further Decay and Prevents Tooth Loss
Over time, gum recession leaves the roots of your teeth exposed. When the roots are exposed to bacteria, viruses, and harm, they begin to decay. Over time, this decaying leads to loosing of the teeth and eventually tooth loss.
By adding new and healthy gum tissue to the areas where the recession has occurred, the tooth’s roots are protected again and will have time to strengthen. This will also protect them from further decay.
Reduces Tooth Sensitivity
When gums recede, they expose areas of the tooth that do not have enamel built up to protect it. When the teeth, as well as any exposed roots, are not protected by either enamel or gum tissue, they become highly sensitive to touch, hot, and cold.
Gum grafting will add that layer of protection and stop the bothersome sensitivity associated with gum recession and exposed roots. You’ll patients will be able to enjoy ice cream and hot beverages again!
Improves your smile
Gum grafting can greatly improve the aesthetics of your smile. If your gums are swollen, uneven, discolored, or you cannot see your gums when you smile, your smile may look less attractive. Gum recession can also lead to sensitive gums that bleed easily, making it embarrassing to smile after eating or brushing teeth.
By adding new gum tissue with grafting, gums look even, natural, and healthy. They will also be stronger. Your patients will not only have good looking gums again, but their smile will look normal and healthy, too.
Prevents Plaque Buildup
Without healthy and strong gum tissue to protect your teeth, plaque can easily get under the gums and/or onto more areas of the tooth including the roots. This means more cavities, more decay, and more dentist appointments.
With a gum grafting procedure, the new layer of gums will help prevent plaque from getting to those sensitive areas and overall keep the mouth a healthier place. This means fewer problems for your patients in the long run.
Types of Gum Grafts
There a few different types of gum grafts that are commonly performed. Dentist will work with each patient on an individual basis to assess their needs and determine the type of graft needed for your dental health.
- Connective-Tissue Grafts: A piece of tissue is removed from a flap of skin from the roof of the mouth and is stitched to the gum tissue surrounding the exposed tooth root.
- Free Gingival Grafts: A small amount of tissue is removed directly from the roof of the mouth is attached to the affected area.
- Pedicle Grafts: Tissue is removed from healthy gums around or near the affected tooth. The flap is partially cut so that part of it remains attached. Then the tissue is pulled to cover the explored tooth root and stitched into place. This procedure can only be performed on patients with an adequate amount of healthy gum tissue.
- Allograft: Instead of using your own gum tissue, the gum tissue is taken from a donor patient and is used to create grafts to treat your gums.
Gum Graft Surgery aftercare
On the day of your surgery, the periodontist uses local anesthetics for patient comfort. Tissue is either harvested from the roof of your mouth or purchased from a tissue bank. The tissue will be placed in the appropriate areas and stitched into place.
Most patients find healing takes approximately two weeks or less. Read below for some tips on how to improve comfort and promote faster recovery after gum graft surgery.
Apply Ice After Surgery
Ice is very helpful after gum graft surgery. This is especially true the day of and the day after surgery.
The cold reduces inflammation, which helps reduce pain. It also decreases sensitivity to the nerve endings, which helps numb the surgical area. In addition, ice slows the metabolism of cells, so less oxygen is needed.
When applied to your face where the surgery occurred, ice provides relief and reduces swelling. For the first 24 hours, you should apply ice every couple of hours. Keep ice on the area for 20 minutes at a time, and ice frequently within the first 24-48 hours. However, keep in mind—icing too much or for too long can do more harm than good. Because the cold constricts blood vessels, it reduces blood flow to the injured area. This can slow the healing process. Therefore, it is important to allow the tissues a chance to return to normal body temperature before returning ice to the surgical site.
Post-Surgical Pain Medication
After surgery, your gums will be tender and sore. Most of the time, over-the-counter medications such as Tylenol and Motrin offer enough relief. It is best to take these around the clock through at least the day after surgery. This helps you stay on top of the pain. However, some patients require their use for longer.
Some situations require the use of narcotic pain medications. This depends on the extent of surgery and the pain tolerance of each patient. Keep in mind, most pain medications contain either Tylenol or Motrin, so if you receive a prescription that includes either of these medications, you won’t want to take the over-the-counter equivalent while taking the prescription medication.
Avoid Extreme Temperatures
After gum graft surgery, eating and drinking warm and cool things can bring relief. Think pudding, applesauce, shakes, or yogurt for cool. Maybe scrambled eggs, oatmeal, or broth for warm.
However, avoid extreme temperatures. Foods or drinks that are too cold or too hot can be a problem. Not only can extreme temperatures lead to discomfort, but they can also delay healing. So, if you want soup or broth, don’t go for boiling hot. Avoid ice cream straight from the freezer.
Stock Up For Your Post-Op Diet
A liquid diet is optimal right after oral surgery. Drinking through a straw may allow for more comfortable drinking and is safe to do after a gum graft.
When you feel you are ready to advance past liquids, soft foods are best. This prevents hard pieces of food from irritating the surgical site or getting stuck in any sutures that may be visible. Before your gum surgery, stock up on soup, low-acid juices, and ingredients for shakes. Also, be sure to have plenty of soft foods, such as yogurt, pudding, cottage cheese, eggs, and thicker soups. Introduce solid foods as comfort allows, or as your post-operative instructions recommend.
Keep Up With Oral Hygiene
While a soft toothbrush is best after oral surgery, you do want to maintain your normal brushing and flossing routine. If you want to use mouthwash, alcohol-free is best to avoid potentially burning the surgical area. If given a prescription mouthwash, be sure to use it as directed to avoid infection and promote healing.
Tobacco causes constriction of blood vessels and interferes with healing. It can also harden gum tissue and contribute to long-term damage and further gum recession, which would negate the positive effects of your gum graft procedure.
It is best to avoid tobacco altogether after surgery. Consider this an opportunity to quit altogether, which will improve your overall health and wellbeing. However, if you are unable to quit, refrain from using tobacco for at least the first week to 10 days to allow the surgical site time to heal.
Limit strenuous activity during the first week or so after surgery to give your body time to repair after the procedure. Remember, straining can pop stitches or lead to excess pressure, which can increase swelling and bleeding. Slowly introduce activity back in as you feel comfortable, or as doctor recommends in your post-op instructions.
What should I call doctor after surgery?
Connective tissue grafts have a very high success rate. Generally tissue reforms, and you do not need to do anything extra.
Severe swelling/loosening sutures
The survival of the graft tissue (generally obtained from the roof of the mouth) purely depends on the blood supply that comes from surrounding bone (since there are no blood vessels on tooth surfaces). The stability of the grafted tissue is very important for the newly forming and migrating vessels.
During healing, sometimes due to severe swelling and/or loosening of the sutures, the graft may move and surgery will not be successful. In such cases, it is necessary to wait until the maturation of the surrounding tissues is complete and try again. This does not happen very often. However, every case is different and some of the surgical sites are harder to deal with, depending on the severity of the exposure and what is left from soft and hard tissue support.
Tissue sloughing from upper arch
A relatively, not infrequent, “normal” complication occurs where the tissue sloughs. It has to do with the size of the graft that was taken. Every individual’s healing pattern is different, and the same is true for the pain threshold.
However, one suggested approach is to fabricate a plastic vacuum form of your upper arch. This is a clear, thin plastic that snaps press-fit onto your teeth and is trimmed to make sure that the palate is covered in its entirety. Thus, it will provide pressure to the donor site after the surgery and avoid irritation from food and the tongue. If a series of grafting surgeries is expected, this is a good option and would certainly have a positive effect.
Similar to any type of surgical procedure, infection will delay wound healing. This is especially true for oral wounds that are exposed to continuous bacterial challenge. A prescription for antibacterial/ antiseptic mouth rinses is generally given to control bacterial load for the first 10 days of healing.
Following complete wound healing, if there is an obvious problem with symmetry, it may be necessary to go back and do what is called “gingivoplasty”. This is a simple procedure performed to thin the extra soft tissue.
How long will it take for my mouth to heal?
During the healing, soft tissue shrinks a little and edema (swelling) goes down. Soft tissue binds the underlying root surface and neighboring bone surface and starts to mature. The most important aspect of this healing is the formation of new vessels that will bring the blood supply into newly grafted soft tissue (angiogenesis). Again, wound stability is very important for the newly-forming blood supply (vascularization).
Soft tissue healing generally takes 4-8 weeks to return to normal. Healing time also depends on how much tissue (thickness and area) was taken from the roof of the mouth and whether you had any bone exposure after the procedure. If you had bone exposure at the donor site, the healing may take longer. Also, if you developed bleeding into the tissue which accumulated there and caused swelling (hematoma together with hemorrhage), this may delay the wound healing.
Will the hole at the donor site in my palate close up?
Yes, the hole will close up. This is just a matter of time. The pain that is experienced has to do with underlying connective tissue being exposed to the oral cavity and getting irritated by rubbing of the tongue and food.
14 days after surgery, the superficial layer of the skin of the donor site will become thicker. The donor site will start feeling much better once this happens. Usually, it takes between 6 to 8 weeks after the surgery for the depression in the tissue to fill up completely.
When will I know if my graft has “taken”?
Treatment outcome is generally evaluated 4-6 weeks after soft tissue grafting. You need to wait up to 8 weeks or so for tissue maturation and to determine how much tissue has “taken”. If the graft tissue was thick to start with, the superficial layer will slough off but the deep parts will survive. (The most outside portion of the graft would not survive due to lack of blood supply. It becomes necrotic-white and comes out.) What is left should be reddish in color and will survive. White/pink color may change based on tissue thickness.
Your Periodontist will need to re-evaluate the area and determine how much of it has taken. Sometimes it may be necessary to do a second surgery (gingival flap surgery) to bring what has “taken” more towards the root surface (coronally).