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:
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:
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:
in the case of chronic gums infection, will gingival graft solve the problem?
the gums infection is treated with steroids, if that helps.
- ANSWER:
QUESTION:
Does anyone know what a gingival graft costs?
I need two of them done on lower molars.
- ANSWER:
  This is done by a periodontist who is a specialist. The fee would vary from state to state. For 2 molars I would think around the 0 range, but that is pretty much a guess. Gum surgery is usually in the 00 range depending on the teeth involved and this is less invasive. The price may include a splint that protects your palate tissue (the donor site).
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:
I need a gingival graft and I’m scared to death!!?
I had braces and now I’m wearing a fixed retainer. For some reason it messed with my lower gums and 3 teeth need to be repaired – gingival grafted. How bad does this hurt? I’ve watched videos on youtube and I’m scared out of my mind :”(
My dentist says I would lose the teeth if I don’t get it done soon and I’m also in pain. HELP!
- ANSWER:
  Hi! I just had a gum graft this last Tuesday (two actually), and it wasn’t as bad as I thought it’d be at all. I usually hate any sort of dental work. You will most likely get some numbing shots first (which always suck a little, but make everything much better). After that you will feel pressure being put on your gums, but no pain, and if you gain any sensitivity back, they will stop and re-numb you. They will also probably prescribe a pain medication for afterwords. It definitely gets sore, but if you just take the medicine, it’ll be fine. I’m already able to eat solid foods (you’ll be on a liquid diet for the first few days), and I’m not taking any pain meds anymore. Mostly I just got bored during the procedure, then sat around watching movies after. It’ll be alright!!!
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:
My dentist said I should have a “gingival graft” due to the amount my gums have receded and the pain. ,000?
Is this procedure really going to help or is gum recession just a natural occurance due to aging? 00 seems VERY expensive. I was told I will need to be under a general anesthetic for this surgical procedure. How risky is procudure? This next question may or may display my lack of knowledge on this subject: Is this procedure for real? Or just a way to generate revenue for my dentist?
- ANSWER:
  I have receding gums as well. My denstist never said I needed to have gum grafting. There are many other treatments out there that are usually considered before the gum grafting. For instance, there is special sealants that the dentist can put on. Also, there are special toothpastes for sensitive teeth. You need to use them for up to a month before you notice an improvement.
  
  Yes, gum grafting is a real procedure, but usually only considered as a last resort. Go to another dentist and ask them about special sealants that can be applied.
  
  My sensitive teeth only bother me in the winter. So I try to keep the temperature up in the house.
  
  I would try all your other options before you shell out 4 grand to a dentist. I would be finding myself a second opinion.
  
  Good Luck.
QUESTION:
I have to have a gingival graft done tomorrow,(where they take gum from the roof of your mouth and graft?
stitch it to where your gums are gone). Mine is from wearing a labret piercing for many years and it ended up wearing the gum down to nothing. ANYWAY, has anyone had one? Does it hurt? Do they prescribe pain meds to help?
- ANSWER:
  it depends on where you have healthy gums. Usually it is taken from the side of the area where the gum is missing & slided to cover up.
QUESTION:
Gum/Gingival graft and frenectomy?
On tuesday I’m having surgery to get a gingival graft on my lower front teeth and a frenectomy on the skin that connects from lip to gum. Basically, I’m scared to death.

Has anyone had either of these procedures done before and if so, can you tell me a little about what to expect? How badly will it hurt, what’s the recovery time, etc.

Oh, and worst part, I won’t be able to eat on Thanksgiving. :[
- ANSWER:
  This proceedure should be preformed by a Periodontist. A Dentist that specialized in treatment of the gums. You should direct these questions to the Doctor or a member of his staff.
  You will be numb and will not hurt during the procedure. Usually the area is covered with a packing material sort of like a cast for a week. Another week of good hygiene and you will be in good shape. You will be ok by turkey soup time. Good luck!
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.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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:
I am maybe going to get a Gingival graft?
Does it hurt? I no they use Novocaine. am only 9
- ANSWER:
  you batter see a doctor and take good care of your oral health, my gingivitas started when i was 10 but i never took it serious and now some of my tooth are loose.
QUESTION:
What is the recovery period from gingival grafting surgery?
also the pain level on a scale of 1-10. I watched it on you tube….doesn’t look too pleasant.
- ANSWER:
  Did nothing for me. had it done . didn’t fix anything. I think dentists listen to a tape in there sleep how to get $$$$ for nothing or a band- aid. Dentists are a scam. went to 1 that said iI needed ,000 in dental work , had it done for 00 at another. All liars looking for $$$$
QUESTION:
Gingival flap & Bone Graft ???
I have to get this procedure done and I am super scared. I did some research on it and it does not sound fun. Anybody have this done?
- ANSWER:
  I agree with the previous answer that it will be painless during the procedure because you will be numb. However, afterwards it will be sensitive.
  Manageable with some pain killers and tender when you brush. It’s worth investing in a special (ultra soft) toothbrush for patients who had a surgery.
  You will feel it for about a week. Just make sure you keep it clean as any plaque will cause more irritation.
  You can help the healing with rinsing with saline (salt – about half a tea spoon in a glass of water).
  Many people have this done and you will be ok. If you are super scared, you can always ask for a sedation. This will not help with the post operative symptoms, however, you will not remember a thing from the process.
  Goos luck!
QUESTION:
Is a (non-surface) cheek/dimple piercing a bad idea if you have a problem with gum recession?
I have had two gingival grafts in the past year and have been warned about some ‘problem areas’.

What is the likelihood of the piercing causing further recession?
I had a labret piercing three years ago and never had a problem.
- ANSWER:
  I don’t know about cheek piercings, but other piercings in or around the mouth can definitely cause gums to recede. My orthodontist highly recommended that I take my tongue piercing of two years out because he could see my gumline starting to fade.
  I think it really depends on the location. I have two lip piercings and they don’t rub my gums because they are up high, situated right below my lip line. I would ask a few piercers and see what they have to say.
QUESTION:
How long do stitches take to dissolve?
I had some dental work done, gingival flap & bone graft. This was on Wednsday morning. The dentist used the dissolving stitches. Today, about 20 min ago, I can already feel them moving around and getting lose, like part of it has broken off. I just want to make sure nothing is wrong.
So my question is how long do they normally take to disolve?
- ANSWER:
  FYI,
  this varies with each person. It can be from 3-7 days depending on how the sutures were placed. If this just happened Wednesday and today it’s Friday, they won’t last much longer
QUESTION:
What is the difference between oral surgeon and periodontist?
Are these the same people?

Which one does gingival gum grafts?
- ANSWER:
QUESTION:
I am suffering from generalized gingival recession and sensitivity. How long will my teeth last?
I want to know from experience what is the period like for tooth loss to happen if good care is given like flossing and two time brushing. I am 28 year old male and a smoker of 20 ciggs a day(i know quitting will reduce risk). Also sometimes I clench my teeth at night. I want to know exact reasons of recession – whther it is too much brushing, bruxism (clenching of teeth – nightguard needed and how to measure bruxism?), alchohal, plaque deposits or anything else? and if I reduce all risks how long will it take for tooth loss to happen? currently I have almsot 4-5 mm of recession on outer side of all teeth while no recession at all on inside of teeth except for lower front teeth (which are mis-aligned and thus gather more plaque). Dental x-rays show very minimal bone less. how you reduced risk? Whether gum grafting is successful as I am very concerned about this condition and fear immediate tooth loss if recession goes on at this rate(i have noticed recession only 6 months back).
- ANSWER:
  As a dental hygienist of six years and now a dentist, I must tell you, no one can answer this question with out seeing you. Not only can you see recession but you must do a periodontal exam to evaluate the bone levels, if you have pockets, you have lost more bone than you know (add recession+pocket depth= total loss of supporting structure). I recommend, #1 see a dentist for a comprehensive exam and voice your concerns. #2 QUIT SMOKING (it increases your risk of periodontal disease). #3 Keep up with regual dental visits (often people with gum disease need to have cleanings and maintianance every 3-4 months). In most cases, someone as young as you are who practices good home care can reverse some of the loss or at least halt the disease in which case you could keep your teeth your entire life. Recession can be caused by many of the things you mentioned, aggressive/improper bruhsing, brusxism, plaque and calculus (tartar) depostits. Seriously, go see a dentist now, before it gets beyond help.
QUESTION:
Vegan smoothie-only diet advice?
I’m gonna need to have a gingival graft.
For about a week after the surgery, I’ll only be able to eat soft foods (so I’ve heard). That means lots of smoothies! Does anyone have any advice on how to have a balanced diet during this week, any recipes, etc.?
Thanks!
Soups too!
- ANSWER:
  Vegan smoothies are the greatest snack & meal replacements.
  My fave:
  Green Smoothie (do not let the greens throw you off even the toddlers in the family love them)
  Green Smoothie
  1 cup frozen fruit (your choice Mixed tropical is one of my faves) but peaches, strawberries or Berries work great
  1 cups water or ice or Juice if you want more calories
  Fresh or Frozen Banana if you want I don’t do them but many of the family loves them.
  Hand full of Baby Spinach.. start of small & work your way to large portions as your taste buds adjust.
  Sweetener we use Raw Agave nectar
  Blend well.
  Fresh fruit can be use but then you must use ice.Here’s a good source of recipes.
  
  http://www.rawfamily.com/
  
  I hope this is some help. Slainte (to your health)
QUESTION:
What Are Some Natural Alternatives To Gum Grafting? How Can I Naturally Reverse Periodontal Disease?
I’m using a sub-gingival applicator to probe the gums with a hydrogen peroxide based solution. It only helps the disease from progressing, but hasn’t done much to gain back lost gum tissue. What are other alternatives besides hydrogen peroxide or colloidal silver for saving my gums? Gum grafting is too expensive.
- ANSWER:
  Hi,
  Kudos to you for trying your best to save your teeth!! But using hydrogen peroxide or colloidal silver will not help the disease from progressing. If you were told you had periodontal disease, then you will need (not unless you already had) deep cleanings, that means you will get shots to numb up your mouth. Then after that, you may need to have gum surgery to reduce the pockets around your teeth. The best way to help slow down the progression of gum disease is to have your teeth cleaned at your periodontal office every 3-4 months and for you to brush and floss everyday and do whatever else they tell you at your periodontal office. As far as your gum problems….gums DO NOT GROW BACK!! Once they are gone, they are gone. Gum grafts are the best way help cover exposed roots on teeth and help strengthen areas of thin gums. Yes, I am sure its expensive. See if you can take out a loan, sell stuff on ebay or have a yard sale. Do one graft at a time. Always use a soft toothbrush and don’t scrub the crap out of your teeth and gums. People can actually scrub their gums right off their teeth! Also, there is no natural way to reverse periodontal disease. Sorry. Please try to do what your periodontist says, its the best way to save your teeth. Good luck and take care of those teeth!! ps……don’t use hydrogen peroxide or colloidal silver – not unless your periodontist told you to!
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.
QUESTION:
is a periodontal dressing necessary for one small gum graft?
mandiular central tooth 4,1
5mm root exposure
due to mandibular labial freenum pulling on gingival
- ANSWER:
  I’m a dentist.
  
  Often times we put it, but admittedly they can fall out at any time, be it within hours or days.
  
  More important than the dressing, however, is your care of the graft. Gentle gentle gentle cleaning! Warm saltwater rinses. Absolutely positively no pulling on your lower lip in order to see the graft.
QUESTION:
I have a labial frenum that shows, sorta got a “high smile line”?
I had a frenectomy done last year, but there was always still a red mark where it always was, so it didn’t really fix anything…stupid. So, I’ve gone back to a periodontist and he said I need ANOTHER frenectomy, cause there was still a little tissue way up at the top underneath my lip, it does kinda look like it’s grown back a little, but I don’t see that as the reason the lower part is red, it’s like the first one cut too deep into the gum, anyways, I asked him, “and that will get rid of the red?” and he said “yes, that will get rid of the red”, how is this gonna work”? Another denist online said I might could get it fixed with a gingival graft? What about that? Why didn’t the other guy mention that? I just want it fixed, can ANYONE help me?
- ANSWER:
  SEE A PERIODONTIST
QUESTION:
How long till I can exercise and drink coffee again after having had oral surgery?
I had gingival grafting surgery done in my mouth. I was told not to exercise or drink caffeine (as well as other things), which I am both dying for again.

I got the surgery on Monday (5 days ago), and it’s still swollen, naturally, but not bleeding anymore.

How long till I can exercise and drink coffee again?
For anyone reading this post, please DO NOT click on the link provided by the person who answered below. It’s an attack site and it will mess up your computer if you don’t have an ad-blocker.
- ANSWER:
  1 week