Health

What to Know Before, During, and After Your Gum Graft

I hate to brag, but my teeth have always been excellent. A dentist once even told me I could be a mouth model (which is a thing that exists, apparently). So I took it extremely personally when another dentist told me my gums were receding—to the point where I needed a gum graft surgery, which I did end up getting about five months ago.

If that sounds intense, that's because it is. A "gum graft" might refer to a few different procedures, but all of them involve putting new gum tissue in a part of your mouth where your current gum tissue is receding or has already receded to a problematic point. When your wounds heal, the new tissue protects against or helps correct some of that recession. (It's like a skin graft, but with gum tissue.)

If your gums are receding, that might be due to long-term aggressive brushing and, in some cases, having braces. People with thinner gum tissue may also be predisposed to recession, Panos N. Papapanou, D.D.S., Ph.D., director of the division of periodontics at Columbia University College of Dental Medicine, tells SELF. But gum recession is also often a result of gum disease, which is an infection caused by bacterial buildup and ongoing inflammation in the mouth and on the teeth, or gingivitis (a milder form of gum disease that can usually still be reversed with better oral hygiene).

Over time, gum recession can continue to the point where the roots of your teeth are left open to infection, which can also cause some bothersome sensitivity in the area. So, yes, it's important to address that gum recession at some point.

As someone who has never had so much as a cavity, it was all a bit of a shock. So, if you happen to find yourself in a similar boat, here's what you'll need to know.

There are a few different types of graft procedures.

The two main types of gum graft surgeries are the gingival graft and the connective tissue graft, Paulo Camargo, D.D.S., professor and chair of the section of periodontics at the UCLA School of Dentistry, tells SELF. Both procedures involve taking tissue from a "donor" site on the roof of the mouth and attaching it to a "recipient" site where recession has occurred—but they do so in slightly different ways.

A connective tissue graft requires your periodontist to open a little flap—a "trap door" as Camargo calls it—in order to remove a piece from the layer of connective tissue underneath. A gingival graft (sometimes called a free gingival graft) doesn't require the trap door because this procedure involves taking the tissue from the top layer of the palate. You're essentially taking "gums from one place and putting it in another place," Papapanou says.

There are a few other options, such as a pedicle graft, in which donor tissue comes from a gum area closer to the recipient area. And there are grafts that make use of cadaver tissue or porcine tissue (collected from pigs), which are generally reserved for more severe cases, Papapanou says. Using the patient's own tissue is always preferable, but not always possible. If your periodontist needs to cover the gum area of five, six, or seven teeth, for instance, "one would have to harvest half your palate to cover it," he says, so the tissue may need to come from alternate sources.

Figuring out which procedure is right for you requires a thorough conversation with your provider, usually a periodontist. They'll take several factors into account, such as the severity of your recession, the extent to which your cheek might pull on the surgical site, and whether or not your gums have receded between your teeth or just on the front, Camargo says.

Preparation is usually pretty minimal, but still important.

In general, patients don't have to do too much before their surgery, although you'll likely have some sort of consultation ahead of time where your periodontist will walk you through the procedure. During that appointment, your periodontist might also collect some sort of documentation of your gum recession for insurance purposes (like a photo or two, for example), Camargo says.

You're going to have a wound in your mouth for at least a week, so it's a good idea to stock up on soft foods (more on that in a bit). And, depending on your periodontist, Camargo says you may also be fitted for a palatal stent, a retainer-like piece of plastic that protects the donor site while you're eating.

The most important thing, though, is to make sure you're addressing the root cause of the recession that necessitated your surgery in the first place, Papapanou says. If you have thin gums or had braces as a teen, there's not much you can do about that. But if you're seeing recession thanks to poor dental hygiene or incorrect (or, in my case, overzealous) brushing habits, it's crucial to address that before the procedure. This way, you'll be wary of brushing more carefully after your procedure as to not mess with the graft as it's healing and to lower the odds that you'll need another graft in the future.

And, of course, since this is a surgical procedure, you want to fully treat any infections in your mouth ahead of time.

Expect to be numb and bleeding (at first).

On the day of your procedure, there are a few things to keep in mind. Because your mouth will be numb for a few hours after it's done, you'll probably want to eat ahead of time. You'll also likely receive prescriptions (for pain medication, antiseptic mouthwash, and possibly antibiotics), and you'll want to have your pharmacy all set up.

During the procedure, usually everything is done using local anesthesia, so you won't have to be sedated, Camargo explains. (For anyone like me who has never experienced this in a dental procedure, it involves getting a few sharp shots of anesthesia directly into the gums that will cause you to feel numb and swollen on that side of your face.) There is an option to have the procedure done under general anesthesia, which is something you can talk to your periodontist about.

Then your periodontist can get to work: They'll start by preparing the recipient site, which (for a connective tissue graft) requires separating a bit of the gums from the bone and exposing a bleeding area where the donor tissue will attach. Then they'll turn to the donor site on the roof of your mouth, usually on the same side of the mouth as the recipient so you only have to avoid one side while it heals. Your periodontist will harvest the graft tissue and move it over to the recipient site, suturing it in place. (If you're having a connective tissue graft, it will have to be placed under a flap of tissue at the recipient site, Papapanou explains.) The donor site will also get sutured up.

Depending on your periodontist's preferences, they may cover the sutures on both sites with a clay-like dressing for protection or just let them heal and instruct you to use the palatal stent.

After the procedure, you may have to change your eating habits for a bit.

You shouldn't feel much (if any) pain right after but you will still be numb. As the local anesthesia wears off, the pain may start to creep in. So, if you can, get your prescriptions immediately following the procedure. That way, you can take your first dose of pain medication before the anesthesia completely goes.

When it comes to pain, "those first two days are the most bothersome," Camargo says. But swelling tends to peak around day three before going down. (In my experience, the pain was very minimal the entire time, but I did have a lot of swelling that made it a little difficult to talk with the periodontal dressing for the first few days.)

You may notice some bleeding the first day through the morning after, Camargo says. But if it's anything beyond the level of pink saliva in the sink, that's not normal and worth a call to your provider's office.

And it probably comes as no surprise that you'll have to avoid brushing and flossing in the surgical areas for at least week. During that time you may be instructed to use an antiseptic mouthwash to keep the area clear of bacteria, Papapanou explains.

But the biggest issue, of course, is eating. Different periodontists have different rules, but in general, you'll have to avoid eating anything on the affected side of your mouth for at least a week or two. And you'll likely also be asked to avoid eating anything hard or potentially irritating, like hot soup. If you were given a palatal stent, this is where it comes in really handy.

Personally, I did well with a diet including yogurt, chocolate pudding, and fruit- and veggie-filled squeezable baby food pouches. Once my swelling went down and I could chew a bit more, I was fine with small pieces of roasted chicken, cooked vegetables, hard boiled eggs, and Klondike bars. It was not my favorite 10 days—and my partner still gives me shit for eating baby food—but it wasn't as bad as I thought it would be. (I did cheat and very carefully ate some Halloween candy without any ill effects.)

Complications with a gum graft are generally rare. But if you notice bleeding after the first day, extreme pain, or a fever, call your provider, as these could be signs of something serious.

It'll be at least a few weeks before you see the full benefits.

Your periodontist will want to see you for a follow-up at some point, often after a week or so, to make sure you're healing well. At that point, they may allow you to start brushing with a baby toothbrush or just brushing lightly on the affected side of your mouth again. Or, they may ask you to wait until the end of your second week. After another week or two, you should be back to brushing and flossing normally.

In terms of healing, Camargo says you'll have a pretty good idea of what the graft is going to look like after three weeks. But it won't fully be done healing for six to eight weeks after the procedure. And, as Papapanou explains, you won't see the full benefits of having the procedure until the tissue completely heals and settles into its new home, which could take up to six months.

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