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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

Smoking and Gum Disease

The systemic risks of tobacco use are well known. Tobacco use can increase the risk for cancer, lung disease, and heart disease. But whether you smoke, dip, or chew tobacco, it also affects the oral cavity in a variety of ways. It contributes to oral cancer, stains the teeth, and contributes to tartar deposits, bad breath, and a loss of taste and smell.

Tobacco use causes inflammation of the soft tissues of the mouth, ulcers, recession, and other oral lesions. Tobacco users are two times more likely to develop periodontitis, and ten times more likely to develop acute necrotizing ulcerative gingivitis (ANUG). They also are more likely to lose teeth than those who don't smoke. Smoking is the number one most significant risk factor in the development and progression of periodontal disease.

Tobacco smoking causes periodontal bone loss that is not related to the amount of gum inflammation or plaque accumulation. Although the periodontal disease may be advanced, the classical signs of gum inflammation (redness, bleeding gums, etc.) are not usually as evident in tobacco smokers. Thus, prevention and early detection are more difficult.

Tobacco smoking has a direct effect on the oral tissues and it can alter the immune response. Although smokers do benefit from periodontal treatment, the healing is often delayed and the results are less predictable. In addition, the success rates of periodontal and implant treatment are reduced in people who use tobacco products. The amount of complications is related to the amount of daily tobacco exposure, and the number of years the person has been exposed.

The use of tobacco products can increase the risk of periodontal disease:

1. It weakens the immune system: Tobacco products suppress the body's ability to fight infection. Carbon monoxide (a major byproduct of cigarette smoke) reduces oxygen concentration and inhibits the movement of white blood cells. This reduces the capacity of the white blood cells to fight bacteria (including the bacteria that cause periodontal disease), and delays healing.

2. It masks signs of infection: Tobacco reduces the ability of blood vessels to carry infection fighting cells, nutrients, and oxygen to the tissues. As a result, the typical signs of periodontal disease (redness, swelling, and bleeding of the gums) are masked. People who smoke may have periodontal disease that is harder to diagnose.

3. It increases calculus formation: Smoking can cause more calculus (tartar) accumulation that if not removed promptly can lead to more plaque build-up and periodontal disease.

4. It reduces healing: Nicotine and other chemicals can be absorbed directly by the root surfaces of the teeth and reduce the ability of cells to reattach to the root surface during healing.

Besides the obvious health benefits of discontinuing tobacco use, quitting can also reduce the risk of oral cancer and the detrimental effects of tobacco on the gums and bone that support the teeth. In addition, another incentive to stop smoking is that former smokers respond similarly to never smokers to periodontal treatment.

Because there is a physical and psychological addiction to tobacco, quitting can be very difficult. But millions of Americans quit smoking every year. There are aids available that reduce the craving for tobacco. These include the use of systemic medications, the nicotine patch, the nicotine gum, the nicotine inhaler, and the nasal spray. See your dentist or physician for aid in stopping tobacco use.

By Laura Minsk, DMD