Consent for Gingival Grafting Surgery

Healthy teeth are surrounded by two kinds of soft tissue. Gingiva is firm gum that is attached tightly to the tooth and bone. Mucosa is softer and movable, like the inside of your cheek. Where there is little or no firm gum, the gum line is more likely to pull back (recede), exposing the root and leading to loss of the bone that holds the tooth in place.

Your dentist has found that some of your teeth do not have enough firm gum around them. Firm gum also matters around fillings or crowns whose edges sit at or below the gum line, and it protects the roots and improves appearance.

The area is frozen with local anaesthetic. A thin layer of tissue is taken from the roof of your mouth, or donor tissue (processed human tissue or collagen) is used instead. The gum at the treatment site is prepared, the graft is stitched in place, and your own gum may be stitched over it. Stitches that do not dissolve are removed after about 2 to 3 weeks. Dissolving stitches fall out on their own in about 3 to 4 weeks.

The main goal is enough firm gum to reduce the chance of further recession. A graft can also cover some exposed root, improve the look of the gum line, and help prevent or reduce sensitivity and root decay. It may not cover all of the exposed root.

About 1 in 20 grafts does not take, usually because the graft shrinks too much, because of smoking, or because it is disturbed in the first week. The graft can then be redone once the area has healed, usually after about 3 months, and the second attempt usually succeeds. If a graft that did not take is redone within 6 months, there is no additional surgical fee.

Other possible complications include:

• infection, bleeding, swelling, pain or facial bruising;
• jaw joint pain, muscle spasm, or limited opening for days or weeks;
• cracking or bruising at the corners of the mouth;
• temporary changes in speech;
• allergic reactions, or accidentally swallowing small materials;
• teeth that feel looser, or are more sensitive to hot, cold, sweet or acidic foods; and
• numbness of the jaw, lip, tongue, chin or gums, usually temporary but rarely permanent.

How long any complication lasts cannot be predicted, and some may not be reversible.

Alternatives include no treatment, monitoring the recession over time, and changing how you brush. Without a successful graft, the gum and the bone around the affected teeth are more likely to keep receding.

Success depends partly on you: daily cleaning as instructed, taking prescribed medications, attending follow-up visits, and returning for regular professional maintenance. Smoking, heavy alcohol use and poor oral hygiene all slow gum healing and can limit the result.