Periodontal Surgery (Gum Graft) - The Procedure

The first time I had this procedure done, it was a completely different procedure. It was a much more invasive operation that involved more tissue being removed, more stitches and a much bigger wound – or donor site. As such, I had a major complication: post-operative bleeding caused by either an unsutured blood vessel or artery in the roof of my mouth – I don’t recall exactly what was the cause. It wasn’t just your ordinary few drops of blood – it was a blood bath. My bathroom looked like the scene from a horror movie.


I had the procedure done late in the day and by the evening, I was bleeding so much, there was a clot forming in my mouth. As hard as I could, I could not get the bleeding to stop, even after a phone call to the dentist. I tried to relax, but that didn’t help. Early the next morning, a friend drove me to the clinic (I couldn’t talk – the clot was too big in my mouth). They cleared the clot and re-sutured the stitches. That was my first ever experience with gum grafting. So now do you understand that every time I hear that I have to have gum surgery, I immediately tense up?


10 years later, I managed to summon the courage to have the procedure done again. I was a bundle of nerves and I believe they gave me something to settle me, which is why I had to have someone drive me home. This time however, the procedure changed dramatically. Instead of a patch of tissue being removed from the roof of my mouth, a small incision was made and tissue was taken from the inside of the incision and sutured – much less invasive. The after-effects: minor to no bleeding.
5 years after the second procedure, I had another. This time went even better: no bleeding. Even though I’m becoming more and more confident with the procedure, that first time when I almost bled out still causes a deep, deep mental block. No amount of calming talk from the dentist and visual calming by me will ever get me over that first time. That said, the last few times I’ve had it done were all positive experiences.


The type of gum grafting you have done will depend on your situation. There is a right way and a wrong way to take care of yourself after gum grafting is done. This minimizes complications and promotes faster healing. Here is a basic overview of the procedure and post-operative care based on my situation:


There are 3 types of periodontal surgery:


Connective-tissue grafts. This is what I’ve had the last few times. An incision is made in the roof of your mouth and tissue from under the incision is removed and stitched to the gum tissue surrounding the exposed root. The incision is then sutured closed.


Free gingival grafts. This is the procedure I had the first time where I had bleeding issues afterward. Tissue is removed from the roof of the mouth and then attached to the gum tissue. This method takes much more tissue to cover a larger area.


Pedicle grafts. Instead of taking tissue from the palate, it is grafted from gum around or near the tooth needing repair. The flap, called a pedicle, is only partially cut away so that one edge remains attached. The gum is then pulled over or down to cover the exposed root and sewn into place.
If all this sounds nasty, it’s best not to think too much about it. On the other hand, it may help to talk to your periodontist and have him/her describe exactly what they will be doing during the procedure.


There are a lot of reasons why gums recede. In my case, I have congentially weak (thin) gum tissue and my improper bite was causing the gum tissue to separate from the tooth, causing stress to the bone. Over (and improper) brushing may also be a cause.


Pain: There should be no pain during the procedure. If the dentist freezes you in all the areas he/she will be working, you won’t even know there is work being done. Tylenol 3 works great for when the freezing comes out. The worst pain is from the initial needles of novocaine, then when the freezing comes out. After, there is mild pain from the procedure, but nothing that can’t be managed with simple ibuprofen.


Drugs: Unless you’re a nervous patient anyway, you shouldn’t need anything except the Tylenol 3 for after the procedure. The last resort is an completely knock-you-out sedation. I think this is totally unnecessary. Some may choose something to calm themselves down. You will not be able to drive if you take anything more than the novocaine to freeze your mouth.


Plan Ahead: I prefer to have the procedure done in the morning – just in case there is a complication, you can go back to the dentist that day. Having a complication at night is highly inconvenient and can be scary. Make sure you have the dentist’s home/cell number. I take at least 2 days off work to just recuperate – and not move – at all. No walking, no running, no working out. Just vegetate and let the healing promote itself – you’ll heal faster. Stock up on yogurt, ice cream, soup, apple sauce, pudding, smoothie ingredients, V8, protein powder. Liquid only for the first 3 or 4 days. Try mush after that until your stitches come out, then more mush, then softer foods.


Options: If the procedure is long, you’re more than likely having two or three sites done. If this is the case, bring some music to listen to. I haven’t done this in the past, but will this time. My periodontist is going to give me a retainer to “hold” everything in place – the area on the roof of my mouth and the areas where the grafts are being done. With this, there is less chance of me disturbing everything until the stitches come out, will promote faster healing and provide a better opportunity for a successful graft “to take”. I haven’t had this before, but will this time.


The After: If possible, have someone drive you home, even if you don’t require it – you’ll feel better. Immediately lie down (prop yourself up on pillows) when you get home and don’t move. Rest. The first 6-12 hours are crucial. If you make it through these hours with no complications, you’re home free – that’s what I tell myself. Do as little as possible. The painkillers you take will make you feel loopy the next day. Take it easy. Read a book. Watch some movies. You’ll be low energy by not eating normally. Be sure to down as much protein as you can via smoothies and other high protein/calorie rich liquids. Don’t drink through a straw – your mouth muscles damage the work done. Don’t spit when you rinse your mouth – let it fall out of your mouth. It sounds completely disgusting, but this won’t disturb your stitches. As for swelling and bruising – it all depends on if you are prone to both and how much work you are having done. I had minor swelling, no bruising. It went away after a day.


Stitches Out: After the surgery and after the stitches come out, you will more than likely be given a prescription for a highly concentrated antibacterial mouth wash (Chlorhexidine) to cleanse the area instead of brushing. Unfortunately, this stuff can cause staining on your teeth. I recommend getting a cleaning by your hygienist after the graft sites have completely healed if the staining is bad. It will be a great feeling on day 7 or 8 when your stitches come out and the retainer/packing the periodontist put over the wound/grafts is removed. The packing they put in may fall out on its own – don’t panic. This is normal. Just let it fall out. By this time, you should have moved on to mushy foods. This may continue for a few more days after the stitches come out. DO NOT brush your teeth as normal. You’ll disturb the work done. You should have a second post-op appointment 2 weeks after your stitches come out. It is at this point that your periodontist will give you the all clear – to be careful cleaning around the grafts and careful eating hard foods.


Above all else, do not get stressed out by this procedure – it’s not worth it. By thinking that everything is going to go well, it often does – and this procedure has been around (and been done many times) for many years. This will be the fourth time I’ve had this procedure done. Excepting the first time (when the procedure was in its infancy), all have been a breeze. Let the periodontist do their work and do yours by promoting the healing process. Combined, both will result in a positive experience.


Wish me luck on gum graft #4.