Gum Surgery: Everything You Need to Know

A.K.A. Periodontal Surgery

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Gum surgery is primarily performed to prevent complications that occur as a result of advanced gum disease (periodontitis), such as tooth loss and bone damage. Surgery may also be performed to treat severe gum recession that is not directly caused by periodontitis—for example, trauma/injury or forceful tooth brushing.

Removing excess gum tissue in order to improve the appearance of your smile is another potential reason for surgery.

If you are a candidate for gum surgery, learning about the different types of surgeries available, as well as the overall preparatory/recovery processes involved, will hopefully help you feel more comfortable and at ease going into it.

Dentist performing oral surgery

Dimensions / Getty Images

What Is Gum Surgery?

Gum surgery is generally performed under local anesthesia by a periodontist, which is a dentist who specializes in treating gum disease.

In addition to local anesthesia, patients may be given a sedative (by mouth or intravenously) to make them deeply relaxed, if not asleep, during the procedure.

There are different types of gum surgeries, and the one chosen depends on your condition, its severity, and any aesthetic goals.

Types of gum surgery include:

  • Gingival flap surgery (a.k.a. pocket reduction): Your gums are folded back from your teeth and the doctor performs a deep cleaning to remove bacteria (called scaling and root planing). The gum tissue is then stitched back and secured firmly around your teeth. Sometimes, bone reshaping is also performed (called osseous surgery).
  • Gum regeneration: Your gums are folded back, bacteria is removed, and then a bone graft is used to stimulate regrowth of the gum tissue around your teeth. The bone graft may be made from synthetic material or come from your own jawbone, hip, or lower leg, a cadaver, or an animal. A synthetic or donor membrane is then placed over the bone to prevent any nearby tissues from growing into the bone. Sometimes, tissue-stimulating proteins are also applied to promote healthy bone growth.
  • Crown lengthening: Excess gum tissue is removed to make your teeth look longer.
  • Soft tissue grafting: Donor tissue or tissue taken from somewhere else in your mouth is attached to your receding gums.

Contraindications

Various medical circumstances/conditions may prevent you from being able to undergo gum surgery. These include:

Elective periodontal surgery should also be avoided in pregnant patients, if possible, especially during the first trimester and the second half of the third trimester.

Potential Risks

Besides the general risks of surgery including bleeding and a reaction to anesthesia, specific risks associated with gum surgery include:

  • Infection at the surgical site or in the bloodstream
  • Excessive pain, swelling, or bruising
  • Root hypersensitivity
  • Lockjaw (trismus)
  • Increased tooth mobility
  • Taste changes
  • Graft failure or displacement
  • Delayed wound healing
  • Recurrence of gum disease

Purpose of Gum Surgery

The main purpose of gum surgery is to treat periodontitis, which is a serious infection of the tissue that surrounds and supports your teeth.

With periodontitis, your gum pulls away from your teeth and creates pockets where bacteria become trapped and form a form a sticky film called plaque. Once the plaque get beneath your gumline, tissues and bones in your mouth may become damaged. This can ultimately lead to tooth loss if not treated.

Symptoms and signs of periodontitis include receding gums, persistent bad breath, loose or sensitive teeth, and poor tooth alignment.

Surgical treatment of periodontitis is warranted when the gum infection advances despite conservative therapies (e.g., cleanings to remove plaque and antibiotic mouthwashes/gels/pills) .

Specific indications for gum surgery include:

  • Deep pockets: Periodontal pocket reduction surgery may be performed if you have deep pockets (≥5 millimeters) around the roots of your teeth.
  • Irregular bony contour: Pocket reduction surgery with bone reshaping may be performed if irregular bony contours prevent your gum from laying flat.
  • Severe gum recession: Soft tissue grafting may be performed if your gums pull away from your teeth and expose your roots.

When you are referred by a periodontist for gum disease, they will measure the depth of the groove between your gums and teeth and take X-rays of your mouth to check for bone loss.

Based on the severity of your gum disease, your periodontist may recommend a particular surgical procedure.

Keep in mind that gum surgery may also be performed to treat gum recession not directly related to periodontitis (e.g., trauma, genetics, aggressive brushing). It may also be performed to treat a damaged or broken tooth located below the gum line.

Before your surgical appointment, you may need to see your primary care physician for pre-operative clearance if you are taking certain medications or have certain conditions like diabetes that can affect your surgical outcome.

How to Prepare

Prepare yourself for your gum surgery so that you can undergo the procedure without complications and have a speedy recovery at home.

Your periodontist will give you instructions on how to best to do this.

Location

Your surgery will take place in your periodontist's office.

What to Wear

Wear comfortable clothing on the day of your surgery with flat or low-heeled shoes. If you are receiving IV sedation, it's best to wear a short-sleeve shirt or blouse so that a vein can be easily accessed.

Also, avoid wearing perfume, cologne, body sprays, or makeup, and trim any facial hair.

Food and Drink

Eat a light meal one to two hours prior to your surgery. Remember to brush and floss thoroughly afterward.

Your periodontist will also probably ask that you avoid alcohol for at least 24 hours prior to your surgical appointment.

Medications

If you take aspirin or another type of blood thinner, your doctor might ask you to stop or decrease the dose before your gum surgery.

Be sure to tell your doctor all of the drugs you are taking, including prescription and over-the-counter medications, herbal products, vitamins, and recreational drugs.

Patients with certain heart conditions or a history of infective endocarditis will be prescribed an antibiotic to take prior to their surgery.

In some instances, you may be asked to take a sedative before your procedure appointment.

What to Bring

On the day of your appointment, bring your driver's license and insurance card. If you are taking a sedative during surgery, you will also need to arrange for a ride home.

Pre-Op Lifestyle Changes

Your periodontist will ask you to stop smoking at least 24 hours prior to surgery. Smoking increases your risk of complications, like poor wound healing and infection.

What to Expect on the Day of Surgery

On the day of your gum surgery, you will arrive at your periodontist's office and check-in. You may need to show your ID at this time.

Before the Procedure

After checking in, you will be taken to a procedure room. A nurse will sit with you and record your vitals. If you are receiving IV sedation, an IV will also be placed in your arm.

If you are receiving oral sedation and haven't taken your pill already, you will be asked to do so now. It can take up to an hour for it to kick in.

Your periodontist will then come to greet you and review the specifics of the procedure, the expected outcome, and the potential risks. You may need to sign a consent form after this discussion.

A dental hygienist or your periodontist will clean your teeth, and the periodontist or a dental anesthesiologist will administer the IV sedation (if applicable).

The periodontist will then inject a numbing medication into your gum. You may feel a stinging sensation while this is happening.

During the Procedure

The flow of your procedure will depend on the type of gum surgery you are having.

As an example, here is a general breakdown of a gingival flap surgery, which takes around an hour or two to complete:

  • Incision: Once your gums are numb, the periodontist will use a small scalpel to make a U-shaped cut along your gum line.
  • Deep clean: Your gums will be lifted away from your teeth. Bacteria that lie beneath your gums will be cleaned out with a hand-held tool with a sharp tip (called a scaler) and/or an ultrasonic cleaning instrument with a vibrating tip.
  • Bone work: Any damaged, exposed bone will be smoothed and reshaped with a drill and a sharp dental instrument.
  • Closure: Your gums will be sewn back into place with sutures and covered with a gauze dressing to help manage any bleeding.

You will be assisted up from the chair after the procedure is over or once your sedative has worn off.

After the Procedure

After you discuss any questions that you have about your surgery, you can leave your periodontist's office. You will probably leave with a prescription for pain medication and an antibiotic.

You will initially experience numbness in your mouth and then some pain as the local anesthesia wears off. Minor bleeding and moderate swelling for two to three days after the surgery will also occur.

Make Oral Surgery More Simple
 Verywell / Brianna Gilmartin

Recovery

After gum surgery, your periodontist will give you various instructions to adhere to at home until you return for a follow-up appointment around a week after your procedure.

These instructions generally include:

  • Take your pain medication as prescribed to control any discomfort.
  • Take your antibiotic as prescribed to prevent infection.
  • Apply ice packs to the outside of your mouth (15 minutes at a time) throughout the first 24 hours after surgery.
  • Rinse your mouth with an antiseptic mouthwash or saltwater starting 24 hours after surgery.
  • Continue to gently brush your teeth and tongue while avoiding the surgical site.
  • Avoid vigorous activity and smoking.
  • Avoid driving until you are off all prescription pain medication.

Also, for a few days or more after surgery, you will be instructed to eat soft foods like yogurt, smoothies, ice cream, and protein shakes.

As your wound heals, you will be able to slowly advance to solid foods, although you will want to stay away from very crunchy, spicy, or acidic foods, which may irritate your gum tissue.

When to Call Your Doctor

Call your periodontist if you experience any of the following symptoms:

  • Fever
  • Signs of infection at the wound site (e.g., warmth, increased swelling, or redness)
  • Excessive or persistent bleeding
  • Pain not relieved with medication

Follow-Up and Long-Term Care

At your follow-up appointment, your periodontist will review your results and monitor you for complications. If non-dissolvable sutures were placed, these will be removed at this time.

Whether you underwent surgery for periodontitis or another reason, it's important to adopt lifelong, healthy dental habits that will prevent the issue from occurring/returning.

These habits include:

  • Seeing your dentist/periodontist for regularly scheduled visits and cleanings.
  • Stopping all use of tobacco products, including cigarettes and chewing tobacco.
  • Brushing and flossing regularly (use gentle movements and a soft brush)
  • Correcting or managing any new or persistent nutritional deficiencies (e.g., in iron, zinc, folate, or vitamin B12, C, or D) or health conditions that may negatively affect your gum health (e.g., diabetes).

Possible Future Surgeries/Therapies

A future surgery or therapy may be warranted if a surgical complication like infection develops.

In addition, if you underwent gum surgery for periodontitis, another surgery or a different procedure, like a tooth extraction, may be needed if your gum disease returns.

A Word From Verywell

As with any surgical procedure, it's normal to feel scared or anxious before undergoing gum surgery. To help calm your worries and optimize your final results, be sure to review any worries or questions you have with your periodontist.

It's also very helpful to prepare for your recovery at home well ahead of time. Consider stocking up on soft snacks and instant breakfasts, arranging child or pet care, and finding a good book or television series to watch as you rest.

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Article Sources
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