Gum graft goes fine (relax, if you need one)

Here's another in what I hope won't be a lengthy series of "don't worry" blog posts about scary sounding health procedures. (See "Root Canal is nothing to fear.")

I had a gum graft this morning. The worst thing about it was facing the fact that I'm old enough to need one, though I realize that people of all ages get gum grafts.

My dentist referred me to a Salem periodontist because he was worried that the beautiful bridge work he'd just redone, which had cost me more than a VW bug went for new back in the '60s, could be threatened by a receding gumline.

So he cheerily said, "I'd giving you a referral for a gum graft evaluation." That sounded ominous. So naturally I fired up Google as soon as I got home from the dentist's office.

I learned that its formal name is a gingival graft.

The usual approach is to chop out borrow some tissue from the roof of your mouth. That is sutured on the gum line, where hopefully it finds a happy new home.

Now, on the Internet I've found that most stories people share about medical procedures have an overarching theme: When Things Go Wrong. So at the moment, the #3 Google search result for "gum graft" is titled "The Procedure From Hell."

The same was true when I researched root canals, and mine went fine. It seems that few patients are motivated to write about their experience when the message is, "No problems, mate."

I talked about this with the periodontist at my evaluation appointment. He said that a balance has to be struck between educating yourself online (good) and scaring yourself half to death (bad).

Speaking of death, one of my first questions to him was whether he did grafts using Alloderm, which I'd read about on the Internet. I liked the idea of not having tissue cut out of the roof of my mouth, and I thought that Alloderm was some sort of artificial material.

But I was told, "It comes from cadavers."

My instant reaction was that I didn't like the idea of having part of my gum be made from a dead person. Plus, my periodontist said that a graft is much more likely to "take" when a person's own tissue is used.

Thus at 9:30 this morning I found myself back in his office, getting ready to be injected with several shots of Novocaine.

Reassuringly, after he was done I heard, "That's the toughest part." And it was true.

I was out the door, my VISA card $840 poorer, in almost exactly an hour. I felt less pain than from a filling or crown work. Afterwards I popped some Ibuprofen that they'd given me, but haven't felt any need to fill a Vicodin prescription.

Everybody's different, of course. Your results may differ. For what it's worth, though, here's some tips and observations.

-- I kept my eyes open throughout the gum graft. Given how much it was costing me, I wanted to absorb every moment of the experience. Such as the drops of red on the gloves of the periodontist and his assistant. Be prepared to see some of your own blood, since there's cutting going on inside your mouth. No big deal -- the bleeding stopped soon.

-- Periodontists must make good fly fishermen, who tie their own lures. I was impressed with the dexterity it took to put in the sutures. Of course, I had an extreme close-up view, since the guy's hands were just a few inches away from my eyes.

-- I was fitted for a roof of the mouth retainer at my evaluation visit. Good move. It protects the site where tissue was removed. I'm barely aware of it now, after wearing it for about 11 hours. I was told that it can come off tomorrow, if I want to remove it. There hasn't been any discomfort at all from the roof of my mouth, probably partly because of this protective device.

-- Don't get home and figure that you can eat whatever you want, even if you're feeling no pain. After I took my first bite of spaghetti with semi-tangy sauce, I did feel some pain at the graft site. Bland food has been my watchword today. Tofu and rice. Macaroni and cheese. Coffee (not too hot), for a mood elevator. Mushrooms. Wine went down fine also.

-- I was given some PerioGard mouth rinse to use. Another good move, as that saved me from trying my usual Listerine mouthwash tonight. I suspect the alcohol in it would create another "ouch" moment, but I could be wrong.

-- Five hours after I had the gum graft, I was out mowing the grass. I read some gum graft stories on the Internet where people said they stayed in bed for days afterward. That may be necessary in some cases. But I wasn't told to do anything but live a normal life, which I've been doing all day (aside from trying to elicit some sympathy from my wife so I don't have to wash the dishes or empty the dishwasher).

I'll add my own comments to this post as my recovery period proceeds. If my brain falls out through the roof of my mouth, I'll let you know -- assuming I have enough gray matter left to type coherently.

For now, here's my bottom line: this was another example where my worries about what would happen turned out to be more of a problem than what actually happened.

I mean, my fretting about how painful the gum graft might be caused me more pain than the procedure itself. Sure, the anxiety was psychological rather than physical, but it was pain nonetheless.

So relax, if you're told you need a gum graft. If yours goes as smoothly as mine has so far, there's no need to worry about it.

Comments

[Jennifer Zentner]

Im nearly 70. Have already had 10 tooth implants and numerous bone implants but Im due to have my first gum implant on two teeth followed later by a massive amount of bone implant and only 9 months later, presuming all goes well, the teeth implants.
My question is has anyone here experienced gum implants on an area where there are no teeth (a bridge) followed later by bone implants and if so how was the pain factor? Being self employed its important for me to get back to work asap and truly Im terrified of the pain!

[Anominous]

Hi, I'm only 13 and have to get this surgery on October 22 and I've been extremely anxious and weepy about since I found out I had to get it. To be completely honest I'm very very anxious about the needles, they have always made me extremely nervous. Can u tell me how bad it was? I doubt that you will even see this but, I would love to have some reasurence.

[Blogger Brian]

Anominous, if you mean the needles used for the novacaine or pain killer injection, for me they weren't very painful. The area of the injection is numbed, so I just felt pressure mainly, not really pain. Then the pain killer kicks in, and no pain.

All in all, I thought the gum graft procedure was easier than some other dental work I've had, like having bridges put in. The recovery period isn't a lot of fun, given the need for me to keep the gum graft site in the roof of my mouth protected.

Try not to worry too much. I suspect you'll find that your worries about the procedure are worse than the actual procedure will be. Sure, sometimes what we fear turns out to be worse than expected, but I've found that usually my fears are overblown.

[spksmom]

I've had gum graft surgery twice. The day of the procedure went fine each time. I had "conscious sedation" - I didn't remember any of it, and the anesthetic they put in lasted many hours.

BUT I had very different recovery experiences. The first time the pain peaked at 3 days, as they predicted. It was better the 4th day, and I was back to work the 5th. My only complaints were the sutures poking my cheek and fatigue that lasted a couple of weeks.

The second time, the periodontist tried a much bigger graft, without discussing it with me ahead of time. I had 3 episodes of bleeding at home that day. Then both the graft and donor sites became infected. The pain was as bad as any I have ever had and lasted for about 2 weeks. I had to have an abscess drained after 13 days. I had two courses of antibiotics and am still sore 5+ weeks later. Because my experience was so unusual, the staff at the periodontist's office didn't seem prepared to deal with it. I will not be returning there.

My advice is to make sure you know ahead of time exactly what the periodontist is planning to do, and call early and be assertive if your recovery is not going as anticipated.

[Melissa]

Thanks for your story! I was very scared when I was told I needed 2 grafts, one top toot and 3 bottom teeth. My periodontist was great and explained every little detail, and then his assistant did again. The first procedure used my own gum tissue. Good thing I read a little before hand, and I had my ipod and headphones. I was a little freaked out when I tasted the blood after he cut the roof of my mouth. The recovery was more inconvenience than pain. I never needed the painkillers, ibuprofen and aleve were fine. The only reason I didn't go to work the next day is because I woke up with a lot of swelling and bruising. I was still swollen the 3rd day but I went to work and was fine. I ate a lot of soft foods and chewed on the other side. When I went for my follow up, some stitches didn't dissolve so they had to be taken out - not the most comfortable process. I just had the 2nd procedure 3 days ago, along 3 bottom teeth with alloderm. So far recovery is the same, if not a little easier since I don't have the stitches on the roof of my mouth. There's a little swelling but no bruising (not yet anyway). This time he used some packing substance along my gumline. So far it's still there but he said not to worry if it comes off. I am not good with pain, although after having 2 kids I can tolerate a little more!The best advice I can give is make sure you have a periodontist you can trust, and relax.

[Heather Bacon]

Do NOT procrastinate!!! Get this done!!!
I have been told for the last few years that I'd eventually need gum grafts on my lower R and L jaws. I have had both done in the last month and I will say that the worst part of this was learning that the bone loss under the existing gum was worse than we expected...primarily because I waited so long to have this done. Don't delay.

Now for the procedure. First procedure was tough because I failed to take the steriod medication the day before which made the swelling and bleeding worse during the surgery. First surgery I had nitrous oxide only and panicked during the donor portion (extracting the tissue from the top of my mouth). I was too aware of the goings on and it was something of a "sawing" that I didn't enjoy.

Second time around I requested a valium (or two!) before the surgery and this made quite a difference. The pain isn't bad. Both time I have had hydrocodone which I supplemented with Tylenol. Sure the soft foods/soups are a bit of an effort but trust me.... keep with the room temperature liquid, soft foods without fail. You don't want to disrupt the sutures!

In summary, get it done early, don't be too conservative on relaxation drugs (iv drugs or heavy duty drugs are NOT necessary), and follow the post-op directions to a "T". I must say that a month after my first gum surgery, the tooth/gum line looks beautiful and now I know my roots are well protected and healthy. Procrastination is your WORST enemy. Be courageous friends...it's all over quickly!

[Bridget]

Just read this post 24 hours after I had the procedure done on my bottom 4 front teeth. Everything went smoothly and I only had novocain--lots of it. When I sat down in the chair, I asked if I could use by ear buds to listen to podcasts on my phone. This worked really well as a distraction. My eyes were covered to protect them from the bright light used so I had the phone in my lap with my hand on the side volume button so that I could lower the volume if instructions were given to me. If you're the nervous type, I strongly recommend this. I was listening to the Moth Story Hour [a great podcast from NPR] and at one point, I had to restrain myself from laughing. Never had that happen in a dentist's chair before. Only regret was that the podcast was only an hour long and I couldn't play another podcast because I couldn't see so had to sit there for the remaining 30 minutes of the procedure without a pleasant distraction. I should have put the settings so that it would have automatically played the next selection.

The only thing they did not prepare me for was the facial bruising. It started after 24 hours. I woke up the next morning and commented that I looked like I had been in a fight and my husband's response was "You sure do and you lost!" So my entire chin is swollen and very discolored. Thank God I don't have any major social events for the next couple of weeks. And judging from other comments, at least I don't have bruising near my eyes.

Baked potatoes mashed up with a little salt and pepper and cold baked fish mashed up with avocado really isn't bad. And the chocolate pie scooped off the crust makes a good dessert. Those and scrambled egg will work nicely for the next few days.

[Lucy]

Thanks for this!! Getting surgery in 3 weeks on the whole front, bottom part of my mouth. 5-6 teeth?

Phew. This was much needed.

[Karen]

I do appreciate this blog, I have to get gum grafting done and was hoping someone could help, I suffer from discoid lupus uv rays will cause lesions, I am wondering about the dental overhead lighting does it emit uv rays, this could be a setback for me. What happens if if don't fix my receding gums. Thank you in advance any advice is appreciated.

[Lori]

I had 16 teeth grafted. Took an hour for each set of 8. Four top and four bottom. I was back to work afterwards. The procedure is not bad and if you read others comments, the way they do it is all about the same. Took ibuprofen but no Tylenol or Vicodin. Mouthwash and a z pack to ward off infection. That's it!

[Elin Cook]

Thanks for your positive encouragement. I need to have a graft day after tomorrow for two lower teeth and they'll take donor tissue from the roof of my mouth. They're encouraging me to take Halcion beforehand, and I'm hesitating about that because I've never taken it and I don't like the idea of being "out of it". But I was really nervous before an extraction and implant a few years ago, so maybe I will. Actually, the nervousness was worse than the extraction/implant itself!
I've read all the comments here, and it puts my mind at ease. I do need to have this done, and I know I can deal with the discomfort afterwards: it's just that I had gotten very scared, not only doing research online, but also, my periodontist's office has told me that this is pretty painful. :( I guess I'll be glad when this is over with!

[Anonymous]

I think i made the most stupidest mistake to not take an advil right before bed. Just woke up 2 hours later in really bad pain on the area they did the graft. Just had my surgery yesterday morning. Can't wait for this torture to be over. For now I'm icing the area and just popped another advil.

[Rebekah]

How many gum grafts did you have done? I just found out I need 8 in a row (bottom front) and am not sure how many I should get done at once or if I should try to get the majority over with at once.

[Blogger Brian]

Rebekah, I believe I had two grafts, but it may have been just one. I'm not sure which is best for you. Your oral surgeon must have had experience with people needing multiple grafts, so I'd be inclined to take his/her advice. You could also Google this question and see what others have done.

[maria]

Hello,

Has anyone had any experience with Platelet Rich Fibrin (PRF) technique for grafting? I can't seem to find anyone on the internet posting about it besides the doctors that do the procedure.

[Carlos Galvan]

Thanks, I'm getting mine in 2 days.

[Sheree]

Thank you so much for this blog post! I am having a single lower tooth done on July 3 (next Tuesday) to repair a hole on the inside of my gum that I somehow got from wearing my retainer at night (I have worn a retainer to at bedtime for 30 years). The tiny hole has exposed a bit of my tooth root and the periodontist is afraid bacteria will accumulate in there over time and I could destroy the tooth.

I was petrified until I read every single one of these comments (thanks, folks!). I am opting to just have Novocaine as the IV sedation was going to cost another $550 and it wouldn't be covered by my insurance. Plus, I don't want to have to trouble someone to pick me up and take me home. I am hoping it's okay to not take the antibiotics (just don't want to do it) and use a salt-water rinse instead to keep bacteria at bay. If anyone else didn't take the antibiotics and still had great results, please let me know. I read some medical studies that showed the antibiotics didn't help either way.

I will report back with how it goes once it's over! Thanks again!

[Ellen]

I’m having one tooth done next month and deciding between Alloderm and my own tissue. My perio recommends Alloderm since it’s similar results and much less pain. I’ve also heard of people having continued sensitivity and numbness at the donor site. Anyone have any experiences with this or their decision? Thanks so much for this post/chain Brian!

[Julia Lechliter]

I had a gum graft at 23. Going to get it done again because it didn't take...not to mention I have root resorption and bone loss from extensive orthodontics.

[Kel]

I am 5 days post-op from a gum graft.
I have to agree with his story.
I had myself so worked up before the procedure about how awful & painful it would be, I had a migraine for days before.
But. I have been fine.
The roof of my mouth, which is actually what I worried about the most beforehand..given that they slice in to it, actually has been pain free. They covered it and that felt a little weird in my mouth for days but it fell out on it's own. No pain what so ever!
The graft site which was my lower tooth line was tender for the first few days but the pain is manageable. I did fill my prescription for pain because I was so afraid of feeling it but haven't needed it. I have been on an antibiotic, Motrin and a mouthwash.
I did feel weak and chills the night of my procedure but that passed.
All in all.....I would say a root canal is worse!

[Charlie]

It is Sunday and I had a graft on my bottom 2 front teeth on Monday. I had braces when I was younger and was told I would likely need gum grafts on my lower jaw afterward. True enough I was sent to the perio for consult. I put the surgery off for 5 years because I was nervous. By the grace of God I did not lose any bone although my gums had completely receded. Cost was $1100 per tooth. IV sedation was extra $700 so I declined. My insurance covered almost half of the total cost including rx drugs. I had a retainer made to cover the donor site. I was given vicodin, halcion, rx mouthwash, and a 10 day course of antibiotics. I bulked up and gained as much weight as possible before surgery. I took the halcion and got a ride to the office for my surgery. One .25mg Halcion barely made a dent, but was enough to take the edge off. I should have taken 2. I am 160lb. The actual surgery was pain free (after the numbing shots) and very fast. I was in and out in less than an hour. I got a ride home and took the next 6 days off work to relax and heal. I urge everyone to take at least a few days off. Pain was managed the first 3 days with Vicodin and after that I did not need any pain medicine. If anything, my teeth are a little tender from the deep cleaning/root scraping. I did bleed a lot the first day and kept a bloody spit cup by my side. I had huge clots form that dissolved the next day. The retainer was out for good on day 5. My donor site was stitched. No issues there. I was a little swollen the first 3 days in my lower jaw but no bruising. The antibiotic and rx mouthwash dry me out a little but it is manageable. I have been surviving on Ensure Plus and bone broth. Bone broth, gelatin, and collagen supplements are supposedly great for healing so stock up. I have not lost any weight due to drinking 2000+ liquid calories everyday while laying in bed for a week. I have a 2 week follow up and I can post more here then. For anyone that is scared or nervous, don't be and don't put it off.