Free Gingival Graft

Editor-in-Chief, Judy J. Johnson, DDS

Aesthetic Considerations in Periodontics

Periodontics, also referred to as Periodontology, is the study of the structure of the teeth along with the diseases and conditions that affect them. Periodontal disease, more commonly known as gum disease, can be caused by a series of events within the mouth, all of which lead to periodontal disease.

The Problem is Gum Disease

Gum disease is typically caused by bacterial infection of the soft tissues and bone which support the teeth. Eventually, the disease will cause the bone and teeth to be destroyed. When destruction occurs, the individual will experience tooth loss.

No matter which stage of periodontal disease the patient is in, treatment will improve the individual’s gums and making them healthier. The type of treatment an individual receives varies according to the stage of gum disease they are in.

Treatment to Conquer Gum Disease

Typically, the goal of periodontal treatment is to eliminate any bacterial infections that the patient may be experiencing, which may be causing gum disease. Treatment also controls the inflammatory process destroying the tissues that anchor the teeth to the jawbone. It also creates a healthy periodontal environment, making it easy for the patient and the dentist to maintain.

Damage Done

Gingivitis is the earliest stage of gum disease and if interrupted, it can be stopped without permanent damage to the tissue or bone. A dentist with no special or additional training should be able to effectively treat gingivitis in the office. If gingivitis develops into a more advanced stage of gum disease, damage can occur. The patient’s structures, which anchor the teeth into the jawbone, are in jeopardy of becoming damaged. A very advanced stage is referred to as periodontitis. This stage requires very aggressive treatment and the patient will likely be referred to a periodontist, who is a specially trained gum specialist.

Esthetics Affected

In periodontic treatment, there are many different aesthetics to be considered. Even if there is no bacterial infection, gums may recede or shrink. Improper brushing is probably the main cause of gum recession. Individuals who use a hard or medium bristled brush may be wearing away their gums. Using too much force during brushing may also wear the gums away with time.

Receding Gums

When an individual’s gums recede, the roots of the teeth will eventually be exposed. When this happens, the outcome is that the individual’s teeth will become sensitive to hot and cold temperatures. Individuals who experience significant amounts of gum recession are at a higher risk for developing root cavities.

Gummy Smile

For patients who have what is referred to as a agummy smilea, their teeth may look very small in comparison to their gums, which will have the appearance of being too big for their mouth. Some medicines may cause overgrowth of gum tissues (such as phenytoin, cyclosporine and nifedipine). A periodontist can remove excess gum tissue with a procedure that’s called gingivectomy.

Crown Lengthening

When bone tissue or gum is removed, the procedure is referred to as crown lengthening. This procedure is necessary when a tooth needs to be fixed. Sometimes, not enough of the tooth will stick out above the gum to support a filling or a crown. This procedure is necessary when a tooth breaks off at the gum line or when a crown or filling falls out.

Grafts

Soft-tissue grafts can also be very beneficial to the aesthetic look of an individual. Periodontal disease, physical mouth trauma, such as brushing too hard or too often with a firm bristled brush. The position of the tooth or gum tissue that is too thin may benefit from a soft-tissue graft.

Some of the tooth will be exposed when gums recess severely. Again, this will cause the tooth to become extremely sensitive to hot and cold temperatures and these teeth are more prone to tooth decay. Often times, people do not like the way their mouths look when this happens.

A soft-tissue graft is used to add more tissue and can help to prevent further recession, to cover the exposed root, stop the tooth sensitivity and to improve the overall look of the teeth. For individuals who have naturally thin gums, they are more likely to have a problem with gum recession at some point in their life and may need a soft-tissue graft to remedy the situation.

There are three different types of soft-tissue grafts: free gingival grafts, connective-tissue grafts and pedicle grafts. A free gingival graft is typically used for people who naturally have too little gum tissue around their teeth and need to have their gums enlarged.

A connective-tissue graft is most commonly used for treating root exposure. A pedicle graft can be done in certain cases, but not all cases. There must be a tooth next to the tooth which is being treated, which has enough gum tissue to asharea. A pedicle graft uses the flap of tissue from the gum of one tooth to fix a tooth next to it that is experiencing recession.

Read More About Dental Health from Esthetic Considerations in Periodontics Reference Links:

Inflammation: Connection the Mouth and Body
- via http://www.perio.org/consumer/inflammation.htm
  - (American Academy of Periodontology)
Periodontal Procedures
- via http://www.perio.org/consumer/procedures.htm
  - (American Academy of Periodontology)
Periodontal Gum Diseases
- via http://www.ada.org/public/topics/periodontal_diseases.asp
  - (American Dental Association)

Frequently Asked Questions

QUESTION:
In a free gingival graft, how deep do they cut into the roof of your mouth?
The thought of this is freaking me out. How big of a chunk do they take?
- ANSWER:
  a nearly paper thin sliver. Aside from the fact that you shouldn’t if you rubbed your tounge along the roof of your mouth, you’d have a hard time feeling where they did the actual graft. Relax. Ask them if you can get a valium for the night before/morning of. Most periodontists/oral surgeons can prescribe you a dose or two to calm your nerves.
  
  Good luck with your surgery ^_^
QUESTION:
Does anyone have any experience with free gingival graft surgery?
I may need to have the proceedure done and was wondering if anyone would share their experiences in term of surgery, recovery, and cost. Thanks
- ANSWER:
  I work for a dentist and my dad has had it done and it is very painful and I would only do it as a last resort. Very costly. Took my dad a month. Could not eat very very bad pain.
QUESTION:
Any help with a free gingival graft?
I am getting my hour operation on Monday the 15th of June and just nervous about it.
I know what happens and stuff but if you had it done how did you feel during and after the operation?

Any tips and suggestions to help welcome !!

Best Regards,
David
- ANSWER:
  The worst part of the procedure will be getting the area numbed especially on the roof of your mouth if that is where they will take the donor graft from. After that you should feel no pain during the procedure. Post op you will have some discomfort but it would be less than an extraction. The gum area will be raw and irritated and you will have to watch eating salty or acidic things for a few days. Healing usually is fairly quick and if instructions are followed the chance of infection is small. I wish you good luck with the graft.
QUESTION:
gum recession ( Free Gingival Graft) Any tips ?
Hi , i had my braces off now since Feburary and i have gum recession on my lower gum , i was at the gum specialist today and i have to have a gingival graft done in a few weeks . Can anyone tell me tips on how not to worry and is it painfull after ?
- ANSWER:
  Don’t worry! I’ve just had a bone graft, which is similar except for bone (well duh:) It is really easy.
  
  It doesn’t hurt at all. Your Perio will totally numb you up. The only scary thing is possibly the injection into your palate. That may smart a bit, but it really isn’t bad.
  
  If you are nervous, you may be able to get nitrous oxide to help you calm down. Ask your DDS about it. It will make you not even care what’s going on in your mouth.
  
  My most important random tip: ask your Perio or assistant to tell you and show you exactly what your mouth looks like and feels like before you leave the chair. BEcause when you get home and are healing, it can really mess up the healing process if you are messing with your site with your tongue, or pulling back your lip to look. So I have my Perio tell me and show me exactly what it looks like so I know but don’t have to mess with the site! Just a tip that not many people think about, hope it helps
  
  You will be fine after the procedure! You may be given a script for pain pills. Take one asap, as the most pain will be just after the procedure. But after that, I was fine with my bone graft, I didn’t really need pills. If your donor site is bleeding a bit, moisten a tea bag and gently apply pressure with it. Be really gentil, cause the bag will bust open if you press too hard, and tea leaves will go everywhere!
  
  You can ice for up to 12 hours after your surgery, which may help if you are in any pain. But otherwise, you should be great and will be happy with what turns out!
  
  Good Luck!
QUESTION:
Can anybody tell me how effective a gingival graft is?
I am considering a free gingival graft to add tissue to an exposed lower tooth. If you or someone you know has had this procedure done, how effective was it at covering up the exposed area? Also, how painful was the procedure and are you satisfied?
- ANSWER:
  I and many others have come to believe that gum disease comes from bacteria and imbalances in the mouth. I have been able to heal gums and tootheaches and unfilled cavities. I took a water pik(they are generrally about ) and an antibacterial solution of some sort. I like using Xylitol(you can find at most health food stores) as an antibacterial lately.
  
  I started on a mild setting and found which areas were sensitive or bleeding. I used it about once to twice a week. Even after just two uses the teeth and gums become much less sensitive and I was able to turn up the power of the jet. It might not be the same for you, but for me it is always worth trying anything that activated the body into healing itself than to force, cut, burn, or poison which is usually very temporary.
QUESTION:
Have you had a gingival gum graft before? (I am giving best answer)?
Gingival Gum Graft – A free gingival graft is a dental procedure where a layer of tissue is removed from the palate of the patient’s mouth and then relocated to the site of gum recession. It is stitched into place and will serve to protect the exposed root as living tissue.
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I went to a Periodontist because I have periodontal gum recession. She said I need to have a gingival gum graft done in the next couple of years (preferably this year). She said it needs to be done on the right and left side of my lower teeth because my gums have receeded a lot and the gum is not attached to the teeth.

Those of you that have done a gingival gum graft:

-How was the pain? Were you able to eat easily after the the gum graft?
-Do you regret it?
-What were the results of it? (Were the results good or bad?)
-What were some problems you had?
-Do you recommend I do it? If so, should I do it sooner or wait a while?
-Any tips?
Thank you for answers….

I am going to give a best answer within a day to the most thoughtful one
Another question:

Should I get a second opinion from another dentist?
- ANSWER:
  I am a dental hygienist and while I was in hygiene school I had a graft done by a periodontal student because I had sensitivity due to recession on my lower bicuspid.
  
  - It was a little tender afterward but eating was not a problem, though my palate did swell late that evening and I would not have been able to eat then but by morning it was back to normal however that is very uncommon for the palate to swell.
  
  - I don’t regret it because now I can tell my pateints about the procedure having first hand experience. I do regret that I did not comply with the home care instructions better becasue it makes ALL the differnce. When they say don’t brush that area for several days, they mean it because the graft needs time to attach before it is touched by anything!!!
  
  - My results weren’t spectacular only beacuse I brushed the area, I thought that brushing lightly wouldn’t matter, I was wrong. Don’t brush it!!
  
  -Only problem was the swelling.
  
  - I definitely recommend it, I have had many patients with excellent results. It will prevent so many problems in the future such as root decay, sensitivity and bone loss. And the sooner you do it the better.
  
  - Follow the home care instructions –don’t brush and floss that area for however long they tell you, most likely they will give you a medicated mouthrinse to aid with healing (Peridex) use it even though it tastes bad and may stain your teeth but your hygienist will be able to remove the stain at your next cleaning.
  
  - If you are unsure go ahead and get a second opinion, it can’t hurt. Either way always make oral hygiene a top priority, you onlty get one set of teeth, take care of them!!
QUESTION:
Im getting Gum Grafting done and am really scared, any advice?
Ok so this Thursday (april.21) Im told my dentist to go get a Gum Graft done. free gingival graft. Im really freaked out right now after researching it and finding the worst comments about afterwards. Heard the pain and bleeding is horrible and someone mentioned that the pain they endured during treatment after the grafting felt worse than the pain they had giving birth. This is a real scare for me. Im only fourteen. I’ll take advil for sure but does anyone know what happens once i go inside of the room? Whats the procedure like if anyones experienced it before?
- ANSWER:
  it depends on where you are getting it done. I am guessing that you are going to have it on the bottom teeth in front? thats a common area. they numb you up so you do not feel anything. Once numb they will be scraping the gum that they do not need away from the teeth. Then take tissue from somewhere else to put onto that spot and then will stitch it up. They will probably give you some pain killers just incase you need then, and they should give you a little pack to bring home of stuff to use. If it is still bleeding after a while they usually will tell people to put a tea bag on it and it will help. You should be fine. I would recommend bring something to listen, that should make you less scared.