Increasing Gum Around a Tooth with Soft Tissue Grafts
If an individual has gum recession as a result of periodontal disease, or has thin gums that need to be augmented before dental procedures, their dentist may recommend a soft tissue (gum) graft. The purpose of the gum graft is to cover exposed root surfaces and to increase the amount of gum around a tooth. It can be done to improve the esthetics of the gum line, prevent further recession, as preparation for other dental procedures (restorations or orthodontics), or to protect the tooth from root sensitivity and cavities.
A graft is the transplantation of living tissue from one part of the body to another. In the case of a gum graft, the tissue is usually taken from the roof of the mouth and placed on the exposed root surface. In some instances, it may be possible to move gum tissue from a site right next to the root surface or to use tissue donated from a different source. One or several teeth can be treated simultaneously.
Gum grafts have been done since the 1960's with exceptional success. The techniques have changed since then, making the procedures even more predictable, comfortable, and esthetic. Today it is possible to match the texture and color of the gum tissue with minimal scarring.
What to Expect from Periodontal Gum Grafts
Soft tissue (gum) grafts are done in the dentist's office with local anesthesia (lidocaine). After obtaining the donor tissue, it is secured on the recipient site with stitches (sutures) or tissue glue. The donor site (usually the roof of the mouth) may also require stitching, bandages, or tissue glue. Post-surgical discomfort is usually minimal and can be easily managed with commonly available over-the-counter medications such as aspirin, acetaminophen, or ibuprofen. Patients can expect to follow their normal routine the day after oral surgery. The dentist will provide special instructions related to diet, exercise, and medications.
The stitches are usually removed five to ten days after the surgery. Follow-up appointments are scheduled as necessary to evaluate healing and plaque control.
Benefits of Gum Grafts
Soft tissue (gum) grafts are beneficial to help reduce further gum recession and bone loss as well as to help protect the root surface from decay and sensitivity. In addition, a dentist should be consulted about gum grafting procedures if individuals have exposed root surfaces or long-looking teeth that create a cosmetic problem. If a general dentist does not frequently perform soft tissue grafts, he or she may refer the patient to a periodontist who specializes in this technique.
By Laura Minsk, DMD
Periodontal Disease: Preventing Tooth And Bone Loss
The best way to control periodontal disease and to help prevent tooth loss is with early detection and treatment. Three out of four people are afflicted by periodontal disease at some point in their lives, so everyone should be tested. After reviewing a patient's dental and medical history, the dental care provider or periodontist will conduct a thorough clinical intraoral exam called a periodontal charting.
This consists of taking a series of measurements around each tooth. Unless the gums are very inflamed and sensitive, the periodontal charting causes minimal discomfort.
The space between the gum and the tooth is measured using a periodontal probe. This space is called the probing or pocket depth. In a healthy mouth, this space should be between 0 and 3 millimeters.
The amount of recession or loss of gum around each tooth is measured. In healthy mouths, the gum tissue should be at the junction of where the crown of the tooth meets the root. The two measurements (pocket depth and recession) are then added to calculate the amount of attachment loss around each tooth. The greater the amount of attachment loss, the more advanced the periodontal disease.
While completing the periodontal charting, a dentist will evaluate the conditions of an individual's gums. Healthy gums are pale pink, firm, and immobile. The gums should not bleed during the probing exam. Bleeding gums during this exam are a sign of gum inflammation, gingivitis or periodontitis.
The dentist will also measure tooth mobility. Under normal functional conditions, teeth should not move. Tooth mobility is a sign that there has been bone loss around the teeth or that the biting forces are too strong. If so, the dentist may also assess a patient's occlusion, or bite. If the bite has changed or if the forces on the teeth are too strong, there may be an acceleration of bone loss around the teeth.
A full mouth series of X-rays (approximately 20 films) are also indispensable in a periodontal examination.
In addition to identifying areas with cavities, bone infection, tumors, or developmental abnormalities, X-rays help reveal if bone loss has resulted from periodontal disease. The crest of the teeth's supporting bone is normally 2 mm below where the crown of the tooth meets the root. A greater distance indicates a history of bone loss.
Although bacterial samples are not usually taken for diagnosis of periodontal disease , under certain circumstances, it may be necessary to take a bacterial culture from a plaque sample. This is especially valuable to help detect sites at high risk for disease progression or if conventional treatment is not working.
The culture is analyzed in a laboratory for the presence of certain bacteria that are known to contribute to gum disease. Actually, of the more than 300 different types of bacteria normally found in the mouth, there are only about 13 that are known to be associated with causing periodontal disease. After identifying the specific disease-causing bacteria, the laboratory can test to determine what antibiotics they are susceptible to.
Depending on the risk factors (see article " Risk Factors for Periodontal Disease") involved and a person's specific situation, other tests may also be required. Under certain circumstances, a dentist may require diagnostic casts (molds of one's teeth), medical laboratory tests, medical consultation, or genetic testing.
After completing the periodontal examination, the dentist will be able to discuss with the patient the diagnosis, treatment alternatives, potential complications, and expected results. The key to long-term periodontal health is early diagnosis and treatment. Because everyone is at risk of developing periodontitis, everyone should be routinely tested.
By Laura Minsk, DMD