Gum Recession and Grafting
Gingival recession (receding gums) refers to the progressive loss of gum tissue, which can eventually result in tooth root exposure if left untreated. Gum recession is most common in adults over the age of 40, but the process can begin in the teenage years.
Gum recession can be difficult to self-diagnose in its earlier stages because the changes often occur asymptomatically and gradually. Regular dental checkups will help to prevent gum recession and assess risk factors.
The following symptoms may be indicative of gum recession:
- Sensitive teeth – When the gums recede enough to expose the cementum, which is a layer protecting the tooth root, the dentin tubules beneath will become more susceptible to external stimuli.
- Visible roots – This is one of the main characteristics of a more severe case of gum recession.
- Longer-looking teeth – Individuals experiencing gingival recession often have a “toothy” smile. The length of the teeth is perfectly normal, but the gum tissue has been lost, making the teeth appear longer.
- Halitosis, inflammation, and bleeding – These symptoms are characteristic of gingivitis or periodontal disease. A bacterial infection causes the gums to recede from the teeth and may cause tooth loss if not treated promptly.
Causes for Gum Recession
Gum recession is an incredibly widespread problem that dentists diagnose and treat on a daily basis. It is important to thoroughly examine the affected areas and make an accurate diagnosis of the actual underlying problem. Once the cause of the gum recession has been determined, surgical and non-surgical procedures can be performed to halt the progress of the recession and prevent it from occurring in the future.The most common causes of gingival recession are:
- Overaggressive brushing – Over brushing can almost be as dangerous to the gums as too little. Brushing too hard or brushing with a hard-bristled toothbrush can erode the tooth enamel at the gum line and irritate or inflame gum tissue.
- Poor oral hygiene – When brushing and flossing are performed improperly or not at all, a plaque buildup can begin to affect the teeth. The plaque contains various bacterial toxins that can promote infection and erode the underlying jawbone.
- Chewing tobacco – Any kind of tobacco use has devastating effects on the entire oral cavity. Chewing tobacco in particular aggravates the gingival lining of the mouth and causes gum recession if used continuously.
- Periodontal disease – Periodontal disease can be a result of improper oral hygiene or caused by systemic diseases such as diabetes. The excess sugars in the mouth and narrowed blood vessels experienced by diabetics create a perfect environment for oral bacteria. The bacterium causes an infection that progresses deeper and deeper into the gum and bone tissue, eventually resulting in tooth loss.
Treatment of Gum Recession
Every case of gum recession is slightly different, and therefore many treatments are available. The nature of the problem that caused the recession to begin with needs to be addressed first.If overly aggressive brushing techniques are eroding the gums, a softer toothbrush and a gentler brushing technique should be used. If poor oral hygiene is a problem, prophylaxis (professional dental cleaning) may be recommended to rid the gum pockets of debris and bacteria. In the case of a severe calculus (tartar) buildup, scaling and root planing will be performed to heal the gingival inflammation and clean the teeth.
Once the cause of the gingival recession has been addressed, surgery of a more cosmetic or restorative nature may be recommended. Gum tissue regeneration and gum grafting are two excellent ways to restore natural symmetry to the gums and make the smile look more aesthetically pleasing
A gum graft (also known as a gingival graft or periodontal plastic surgery) is a collective name for surgical periodontal procedures that aim to cover an exposed tooth root surface with grafted oral tissue. Gum grafting is a gum treatment in Royersford, Pennsylvania, that our knowledgeable periodontist, may recommend if you suffer from gum recession.
Exposed tooth roots are usually the result of gingival recession due to periodontal disease. There are other common causes, including overly aggressive brushing and trauma.
Here are some of the most common types of gum grafting:
- Free gingival graft – This procedure is often used to thicken gum tissue. A layer of tissue is removed from the palate and relocated to the area affected by gum recession. Both sites will quickly heal without permanent damage.
- Subepithelial connective tissue graft – This procedure is commonly used to cover exposed roots. Tissue is removed fairly painlessly from the side of the palate and relocated to the site of gum recession.
- Acellular dermal matrix allograft – This procedure uses medically processed, donated human tissue as a tissue source for the graft. The advantage of this is procedure is that there is no need for a donor site from the patient’s palate (and thus, less pain).
Reasons for Gum Grafting
Gum grafting is a common periodontal procedure. Although the name might sound frightening, the procedure is commonly performed with excellent results.Here are some of the major benefits associated with gum grafting:
- Reduced sensitivity – When the tooth root becomes exposed, eating or drinking hot or cold foods can cause extreme sensitivity to the teeth. Gum grafting surgery permanently covers the exposed root, helps reduce discomfort, and restores the good health of the gums.
- Improved appearance – Periodontal disease is characterized by gum recession and inflammation. Gum recession and root exposure can make the teeth look longer than normal and cause the smile to appear “toothy.” Gum grafting can make the teeth look shorter, more symmetrical, and generally more pleasing to look at. In addition, adjacent tissue can be enhanced and augmented during the procedure for aesthetic purposes.
- Improved gum health – Periodontal disease can progress and destroy gum tissue very rapidly. If left untreated, a large amount of gum tissue can be lost in a short period of time. Gum grafting can help halt tissue and bone loss, preventing further problems and protecting exposed roots from further decay.
What does gum grafting involve?
Once the need for gum grafting surgery has been determined, there are several treatments the dentist will want to perform before gum grafting takes place. First, the teeth must be thoroughly cleaned supra and subgingivally to remove calculus (tartar) and bacteria. The dentist can also provide literature, advice, and educational tools to increase the effectiveness of homecare and help reduce the susceptibility of periodontal disease in the future.The gum grafting procedure is usually performed under local anesthetic. The exact procedure will depend much on whether tissue is coming from the patient’s palate or a tissue bank.
Initially, small incisions will be made at the recipient site to create a small pocket to accommodate the graft. Then a split thickness incision is made and the connective tissue graft is inserted into the space between the two sections of tissue. The graft is usually slightly larger than the recession area, so some excess will be apparent.
Sutures are often placed to further stabilize the graft and to prevent any shifting from the designated site. Surgical material is used to protect the surgical area during the first week of healing. Uniformity and healing of the gums will be achieved in approximately six weeks.
Pocket Reduction “Osseous Surgery”
Pocket reduction surgery (also known as gingivectomy, osseous surgery, and flap surgery) is a collective term for a series of several different surgeries aimed at gaining access to the roots of the teeth in order to remove bacteria and tartar (calculus).
The human mouth contains dozens of different bacteria at any given time. The bacteria found in plaque (the sticky substance on teeth) produce acids that lead to demineralization of the tooth surface and ultimately contribute to periodontal disease.
Periodontal infections cause a chronic inflammatory response in the body that literally destroys bone and gum tissues once they invade the subgingival area (below the gum line). Gum pockets form and deepen between the gums and teeth as the tissue continues to be destroyed.
Periodontal disease is a progressive condition which, if left untreated, causes massive bacteria colonization in gum pockets and can eventually lead to teeth falling out. Pocket reduction surgery is an attempt to alleviate this destructive cycle and reduce the depth of the bacteria-harboring pockets.
Reasons for the Pocket Reduction Surgery
Pocket reduction surgery is a common periodontal procedure that has been proven effective at eliminating bacteria, reducing inflammation, and saving teeth. The goals of pocket reduction surgery are:
- Reducing bacterial spread – Oral bacteria has been connected to many other serious conditions such as diabetes, heart disease, and stroke. Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize. It is important to decrease bacteria in the mouth in order to reduce the risk of secondary infection.
- Halting bone loss – The chronic inflammatory response induced by oral bacteria leads the body to destroy bone tissue. As the jawbone becomes affected by periodontal disease, the teeth lose their rigid anchor. When the teeth become too loose, they may require extraction.
- Facilitate home care – As the gum pockets become progressively deeper, they become incredibly difficult to clean by the patient. The toothbrush and dental floss cannot reach to the bottom of the pockets, increasing the risk of further periodontal infections.
- Enhancing the smile – An oral cavity that is affected by periodontal disease is not attractive to the eye. In fact, smiles may be marred by brown gums, rotting teeth, and ridge indentations. Pocket reduction surgery halts the progression of gum disease and improves the aesthetics of the smile.
What does pocket reduction surgery involve?
Before recommending treatment or performing any procedure, the dentist will perform thorough visual and X-ray examinations in order to assess the condition of the teeth, gums, and underlying bone. Pocket reduction surgery may be performed under local or general anesthetic depending on the preferences of the patient.The gums will be gently pulled back from the teeth and bacteria and calculus (tartar) will be eliminated. Scaling and root planing will generally be required to fully remove the ossification (tartar) from the surface of the tooth root. If the root is not completely smooth, a planing procedure will be performed to ensure that when the gums do heal, they will not reattach to rough or uneven surfaces.
The final part of the surgery is usually the administration of an antimicrobial liquid to eliminate any remaining bacteria and promote healing. The gum is then sutured with tiny stitches that are left in place for 5-10 days.
Although the gums will be more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums.