Gum Recession 101

Gum Recession 101

A healthy tooth is surrounded by gum tissue, but sometimes gum tissue can breakdown in a process called recession, resulting in an exposure of the root surface.

Gums can recede away from the teeth for a number of reasons, including: improper brushing, using a brush with hard bristles, trauma, genetics, orthodontics, or a strong frenum (muscle) pull.  When the attached tissue is very thin, the area becomes even more susceptible to breakdown, ultimately leading to a destabilization of the tooth.

Some types of gum recession require treatment, others can be monitored for further changes.

What’s important is making sure the bone and gum support around the teeth is engineered to resist further deterioration and further damage.  There are several periodontal plastic surgery techniques that can be used to repair gum recession.  Every patient receives their individualized treatment plan depending on their unique dental situation.

Nearly everyone who has recession of the gums with minimally attached tissue and is in general good health is a candidate for gum grafting.  The first step in investigating if you are a good candidate involves an examination and consultation with Dr. Fritz or Dr. Schuldt.

Prior to your procedure, an impression of your upper jaw is taken to model a stent.  A stent is a thin, plastic retainer that is worn after your periodontal gum grafting surgery to protect your palate.

On the day of your procedure, the graft tissue is harvested from the palate and then overlaid on the exposure root surface and held in place to heal with sutures.

Two weeks post-operatively, you will return to have the sutures gently removed and four weeks post-operatively you will return for a final check of the area by your periodontist.  At this moment, any brushing and eating modifications will be lifted if your healing is on track and in line with the expectations of your periodontist.

It is imperative to follow all of Dr. Fritz and Dr. Schuldt’s post-operative instructions to ensure the successful healing and integration of your graft.  Our team are experts in how to care for your graft and will give you all of the instruction and guidelines that you need to provide the best care at home.

Intra/Extra-oral Examination

Intra/Extra-oral Examination

The intra-oral and extra-oral soft tissue examination is an essential part of all dental exams.  This examination is performed in a thorough and systematic nature to ensure that no parts of the head and neck region are missed or overlooked.

This examination can be broken down into sequential steps to review all tissues and to determine if they are within normal limits (WNL) or if there is an abnormality noted.

If an abnormality is noted in an intra/extra-oral examination, further detailed notes about the abnormality such as size, colour, location, surface texture, and consistency are made.  Information about the onset, location, duration, characteristics, aggravating and alleviating factors, related symptoms, and treatment are all considered by your dental hygienist and periodontist.

As part of a full intra/extra-oral examination for abnormalities in our oral pathology, a detailed medical history, family history, drug/medication history, and social history are taken.

As a patient, we can prepare for our intra/extra-oral examination by being aware of any abnormal colouration, bumps, textures, or sensations in our head and neck region. 

A full video of what to expect during a full intra/extra-oral examination by your dental hygienist or periodontist can be viewed below.

How to Care for my Stent after Gum Grafting

How to Care for my Stent after Gum Grafting

Prior to your soft tissue grafting surgery, a periodontal stent will be created based on a model of your mouth.  The periodontal stent is a hard, thin piece of plastic that functions to protect the palate (roof of the mouth) after soft tissue grafting surgery.

After your periodontist completes your soft tissue grafting, they will insert your stent and ensure its proper fit.  Do not remove your stent for the first 24 hours following you gum grafting procedure.

After 24 hours, you may remove your stent to rinse and wash it gently.  When removing your stent, expect to see a small membrane with some blood.  This membrane was placed by your periodontist to protect the surgical site.  It is OK for the membrane to be washed away and removed before re-inserting your stent.

After 24 hours, you may wear your stent as often as you feel is necessary.  Most patients report wearing their stent for 5-7 days post-operatively.  The stent effectively shields and protects the surgical site on the palate of the mouth when eating, drinking, talking, and sleeping.

Post-Operative Instructions – Care after a Soft Tissue Graft

Post-Operative Instructions – Care after a Soft Tissue Graft

After your gum grafting surgery, there are some steps to follow for quick and smooth recovery.  Healing after soft tissue periodontal surgery can be broken into periods.

In the first 24 hours:

  • Only after freezing has completely warn off, you can apply ice to the area as needed in 10 min ON/10 min OFF for 3 cycles.
  • Do not apply heat to the area as this can stimulate blood flow and increase bleeding in the area
  • Do not brush or floss the area
  • Do not remove your stent
  • Rest with your head elevated to avoid blood pooling to the area, discomfort, and swelling
  • Do not do any activity that raises your heart rate
  • When sleeping, use an old pillow case in case your bleed through the night

After 24 hours:

  • Do not apply ice
  • You may remove your stent to clean it – to clean your stent, rinse with warm water
  • When removing your stent, expect to see a small membrane
  • Re-insert your stent when eating, sleeping, and talking for as long as you feel is necessary to protect your palate.  Most patients wear their stent for 5-7 days post-operatively.
  • Brush the area and neighbouring teeth very gently with the post-surgical toothbrush that was given (this toothbrush is even softer than a ‘soft’ toothbrush and is made specifically for surgical sites)
  • When using the post-surgical toothbrush, avoid the sutures and the gum line at the surgical site
  • Pool Peridex rinse at the surgical site twice per day (morning and night) for two weeks.  Peridex mouthrinse works like a “toothbrush in a bottle” and works to keep the surgical site clean without the manual disruption by a toothbrush at the sensitive site.
  • Do not spit, gargle or swallow Peridex.  Simply let it fall from your mouth.
  • Do not eat or drink for 2 hours post-Peridex rinse.
  • Do not floss the area
  • Brush and floss all other areas of the mouth with your regular electric toothbrush

After 48 hours until your 2 week post-operative appointment:

  • Apply a warm compress to cheeks as needed
  • You may begin to exercise at 50% intensity being careful to monitor for any bleeding at the surgical site
  • Eat only soft foods on the opposite side of the mouth.  A general rule of thumb is to eat foods that require 3 chews or less.
  • Do not eat extreme temperature foods as this can damage the tissues and can increase blood flow in the area – eat room temperature foods only
  • Avoid alcohol, tobacco and cannabis during the healing phase (2 weeks)
  • Do not pull at the lip to see the healing area.  This may loosen the stitches and can disrupt the healing tissues.
  • Do not use straws, whistles, wind instruments as the force applied may damage the delicate healing tissues
  • Avoid wearing a denture or flipper as much as possible as this may rub against the healing tissues

It is important to take all medications as prescribed, especially an antibiotic.

To manage pain, Ibuprofen can be taken by the clock, as necessary.  Any antibiotics prescribed are essential to take until completion.  Use the Peridex mouthrinse twice daily for 2 weeks.

Patients report experiencing their peak discomfort immediately following surgery and experience a steady decline in discomfort through to Day 5.  However, patients report the greatest level so swelling, which can sometimes be accompanied by bruising, 3 to 5 days following surgery.

Should you experience any bleeding, swelling, bruising, or discomfort that is out of greater concern, it is important that you contact your periodontist.

What is gum recession? Causes, Symptoms, and Treatment

What is gum recession? Causes, Symptoms, and Treatment

Our gums protect our teeth and anchor them in place. But, they can be pushed back or wear away, eventually exposing the root of the tooth.  This is a concern because the tooth becomes vulnerable to infection, decay, become loose, and eventually falling out.

Gum recession can be easily seen in the mirror, but may also have some symptoms.  When the root is exposed, some people experience pain and sensitivity to hot or cold.

There are many reasons our gums can recede:

  • Hard and aggressive brushing – it is important to use a gentle touch with your toothbrush and to switch from a manual to an electric toothbrush to protect your gums
  • Genetic factors – in some people, thin gum tissues and the position of the teeth are inherited
  • Poor oral hygiene – having poor at home habits and infrequent visits to the dentist cause lead to infection of the gums and inflammation of the tissues
  • History of orthodontics – the movement of our teeth through our jaw to align a beautiful smile can stretch the gum tissue and may be a cause of gum recession
  • Piercings – lip or tongue piercing have a dramatic effect on our gum tissues, breaking them down very quickly
  • Age – with age, our tissues thin, including our gum tissues.
  • Smoking status – smoking tobacco and/or cannabis is a risk factor for gum recession

A periodontist specializes in gum recession and the treatment of thin and receding gum tissue.  If you or your dentist suspect you have gum recession, a comprehensive examination with a periodontist is a smart choice.

At this appointment, your periodontist will assess your mouth and will make recommendations to either continue to monitor the areas, or to treat them with periodontal grafting surgery.

Periodontal grafting surgery involves grafting tissue from another site of the mouth (usually the palate) and suturing it over the area of recession to allow it to heal in this new area and protect the exposed tooth root.

Post-Dental Surgery Meal Planning

Post-Dental Surgery Meal Planning

Proper care after your periodontal surgery will help your mouth to heal quickly.  This includes a healthy, soft food diet.

At first, your temporary soft food diet may seem challenging, but with some planning you can ensure that you have all of the nutrients you’ll need for your body to heal quickly.

As soon as you are able (after your local anesthetic has worn off), start drinking nutritious fluids such as real fruit juices, milk, milkshakes, and fruit and vegetable smoothies.

REMEMBER: Do not drink from a straw for at least two weeks.  The suction and force created when using a straw will be disruptive to the sutures and the delicate healing tissues.

A general rule of thumb for the first two weeks following periodontal surgery is to avoid any foods that take more than 3 chews to swallow.

Avoid hot food or drink for the first two weeks.  The heat of your food can increase the flow of blood to the area and can cause your surgical site to bleed.

Just because your diet is of a soft consistency, it is still important to eat a variety of nutritious foods.  Below are some general guidelines according to Health Canada’s Food Guide and some examples of food choices.

Fruit & Vegetables

Consume at least 7 servings of soft fruit and well-cooked vegetables per day:

  • apple sauce
  • stewed or canned fruit
  • peas
  • smoothies
  • soups
  • well cooked or pureed vegetables (potatoes, broccoli, cauliflower, carrots, turnip, other root vegetables)

Protein

Two servings of tender protein:

  • tuna
  • salmon
  • flakey fish served without a crispy coating
  • well-cooked poultry cut into small, bite-sized pieces
  • eggs
  • baked beans
  • lentils
  • Greek yogurt

Milk & Dairy

Two servings of milk or dairy products:

  • milk
  • calcium-fortified soy or almond milk
  • ice cream/frozen yogurt
  • yogurt
  • fruit sorbet
  • puddings
  • soft cheeses such as cottage cheese

Whole Grains

Chose whole grain foods over processed, simple carbohydrates:

  • porridge
  • oatmeal
  • cream of wheat
  • cereals without nuts or dried fruit
  • whole-grain pastas or noodles
  • soft bread without hard crust

Beverages

Make water your drink of choice.  It is important to stay hydrated.

Avoid alcohol and tobacco as much as possible during the healing period.

How much is my dental surgery going to hurt?

How much is my dental surgery going to hurt?

Many of our patients experience fear and extreme anxiety at the dentist and while we do our best to create a calm and tranquil environment, the fear of pain associated with periodontal treatment may still be a deterrent for some.

Therefore, to answer one of the most commonly asked questions “Is this going to hurt?”, we conducted a study that was published in the Journal of Clinical Periodontology.

Over a period of two years, we enrolled 213 patients requiring either dental implant or grafting surgery.  The average age of the patients that were recruited was 51 years, but ranged from 19-80 years.  Prior to their surgery, patients were asked to rate the amount of pain that they anticipated feeling from No Pain to Worst Pain Imaginable.  For 7 days following their surgery, patients were asked to rate the amount of pain they experienced on the same scale.

When all of the data was analyzed, we found that the actual pain that patients experienced after periodontal surgery was lower than the pain they anticipated feeling.

With these findings, we are now able to provide our patients with an evidence-based answer when they ask us “Is this going to hurt?”  Happily, we are able to put them at ease by sharing with them that in fact, periodontal surgery hurts less than they expect!

Some factors that we found did predict the amount of pain a patient would feel are:

  1. Anticipated Pain – if you expect it to hurt, you’ll report it hurting more
  2. Age – older individuals reported it hurting less
  3. Sedation – those who had their periodontal surgery under sedation with one of our Registered Nurses reported experiencing less pain

Some factors that we found did not predict the amount of pain a patient would feel are:

  1. Nervousness
  2. Gender
  3. Surgery Type (dental implant vs. soft tissue grafting)
  4. Smoking Status

Also collected as part of the study, we found that patients needed only 600mg of Ibuprofen for relief of their post-operative pain and discomfort.  This reinforces Dr. Fritz’s mandate of never prescribing narcotics to any of this patients.

This study was conducted by Jennifer Beaudette as part of her Master’s of Science research through the Faculty of Applied Health Sciences at Brock University.  Jen has since completed her M.Sc. and is currently pursuing a Ph.D at Brock University.