Gum Surgery — What Do I Need To Know?

According to the American Dental Association (ADA), there are currently twelve formally recognized dental specialties. Periodontics is the specialty that focuses on the prevention, diagnosis, and treatment of conditions and diseases that affect your gums, and a periodontist is a specialist in this field. The American Academy of Periodontology states that periodontists receive up to three years of additional training after dental school to perform non-surgical and surgical procedures that include gum surgery, dental implant placement, and cosmetic procedures.

There are different types of gum surgery depending on what you're experiencing and what exactly your periodontist is treating. Some of the most common conditions that require gum surgery include the following.

Gum recession

If your gums are receding or pulling away from your teeth and exposing your roots, you have gum recession. The roots of your teeth don't have the same hard, protective enamel as the crowns of your teeth, so an exposed root can cause tooth sensitivity and is more susceptible to tooth decay.

Some common causes of gum recession include periodontal disease, brushing too hard, trauma from an injury or accident, ill-fitting dentures, genetics, and use of tobacco products. Some of these causes can be managed with fairly simple changes or treatments. For example, you may: 

• Use a softer toothbrush and a gentler brushing technique to avoid damaging the gums. 

• Have ill-fitting dentures or appliances re-fitted. 

• Have a scaling and root planing procedure to treat periodontal disease. 

More severe cases of gum recession may require a surgical procedure called a gum graft. Your periodontist will take tissue from another part of your mouth and attach it where your gums are receding. This surgery prevents further recession, reduces tooth sensitivity, and can improve the appearance of your smile.

Gummy smile or uneven gums

If you have more gum tissue covering your teeth than you consider normal, you have what's called a gummy smile (also known as excessive gingival display). There are three surgery options available to you to remove excess tissue and show off more of your pearly-white teeth:

• Gingivectomy, where a periodontist surgically cuts away excess gum tissue.

• Gingivoplasty, where the gum line is surgically re-shaped and contoured. 

• Crown lengthening, where both gum and bone tissue are removed to reveal more of the tooth surface.

A decayed or broken tooth below the gumline

If your tooth is damaged beneath your gum line, or if you don't have enough tooth above the gumline for a restoration, your periodontist may need to utilize a crown lengthening procedure to expose more of your tooth.

Periodontal disease

According to the Journal of Dental Research, nearly half of adults over 30 in the US have some form of gum disease (periodontal disease). It’s caused by a build-up of plaque, a sticky substance that contains lots of bacteria. The bacteria produce acid that irritates the gums, causing inflammation and irritation. Left untreated, it will spread beneath the gum line and cause the gums to pull away from the teeth, forming pockets that trap bacteria. The inflammation destroys the bone and other supporting tissues, which can cause teeth to loosen and even fall out.

If you have deep pockets around your teeth from gum disease, your dental professional may refer you to a periodontist for a periodontal pocket reduction surgery. In this procedure, your gums will be folded back so they can deep-clean the bacteria from the pockets. The gums will then be sutured (stitched) back into place, giving you more chance of holding onto your natural teeth for the long run.

After your dental professional refers you to a periodontist for gum surgery, your first visit will be an initial consultation. At this appointment, the periodontist may:

• Take additional X-rays of your mouth and head.
• Review your medical history.
• Ask what medications you take, including over-the-counter products, vitamins, and supplements.

Depending on the procedure you have planned and your medical history, there are some medical conditions for which your periodontist may recommend antibiotics as a preventative measure to fend off infection (antibiotic prophylaxis). According to the ADA, there are very few circumstances in which antibiotics should be used for preventive measures before dental procedures; your periodontist will be able to advise whether you will benefit from them.

If you're undergoing general anesthesia, your periodontist will probably recommend that you avoid food and drink for a specific period of time before your procedure. Be sure to follow their recommendations for your specific needs. 

If you have a chronic condition, like diabetes or hypertension, your periodontist or an anesthetist will monitor you during the procedure for any complications relating to the anesthetic.

Gum surgery is performed under anesthetic, so you won’t feel any pain during the procedure itself. Most procedures can be done with a local anesthetic, where the surgery area is injected and numbed, but you remain awake. Your periodontist may also suggest sedation, which can make you feel more relaxed. In some circumstances, you may need to undergo general anesthetic, where you will be unconscious throughout.  

After the surgery, you may feel discomfort or pain for a few days. Your periodontist or dental professional will advise you how to manage this pain and may recommend or prescribe medications to help. 

After gum surgery, you'll be informed how to clean your teeth and gum tissue without disturbing your healing gums. It’s best to avoid touching the surgical site with your tongue or fingers, as you don’t want to disturb the wound or introduce an infection.  

You may be limited in what you can eat for a short while, as explained below, and you’ll need to be vigilant for any signs of a possible infection. These include: 

• Severe or worsening pain that doesn’t respond to medication. 

• Persistent fever. 

• Swelling of the face or jaw. 

• Heavy bleeding. 

• Pus or other discharge from the surgical site.

While you're recovering, contact your dental professional if you have any questions or concerns. Don't wait until an oral infection gets worse or complications occur. Call your dentist as soon as you notice anything out of the ordinary.

After gum surgery, it’s important to eat a nutritious diet so that your gums can heal, and avoid anything that might damage or irritate them. This can be difficult with tender gums and jaw pain, but you still have lots of healthy options to choose from! The following guidelines and ideas may help: 

• Stick to liquids and soft foods like pasta, yogurt or mashed potato. 

• Make soups and smoothies to get your fruit and veggie fix.  

• Avoid alcohol and spicy, salty or acidic foods. 

• Avoid foods with hard, crunchy or sticky textures. 

• Avoid very hot or very cold foods and drinks.

If you’ve had a gum graft, the new tissue will be stitched in place with sutures. Sometimes, dissolvable stitches will be used, so they’ll simply dissolve over time and won’t need to be removed. If non-dissolvable stitches are used, you’ll need to go back to your periodontist or dentist around one or two weeks after your surgery to have them removed. The exact time will depend on the extent of the surgery, the type of graft you’ve had, and how quickly you heal. 

Surgery never sounds like fun, but it can be vital in helping you to get your oral health back into a condition you can smile about. You can rest assured that your dental team will be behind you every step of the way, from preparation to recovery. Hopefully, with this information, you feel confident and comfortable about what to expect with your procedure. You can do this!

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.