Gum graft from a patient’s perspective

April 28, 2021

Picture credit: Val

Sometimes, for various reasons, the gum that covers the base of your teeth start to fade away, exposing more and more of the root. This is known as gum recession.

At some point this can become somewhat concerning and that’s usually when your dentist suggest you have a gum graft.

A gum graft is a surgery where gum is removed from the palate in order to, well, graft it on the base of your teeth where you’re supposed to have gum in the first place.

I’ve had my second gum graft done a week ago, and I decided to write this post to answer all the questions that I asked for myself before, during, and after the graft, as well as some tips and tricks learnt from my experience.

This will be useful to my future self when I need to do another one, and hopefully that can help you too if you’re considering having a gum graft, or if you just had one and don’t really know what to expect.

Why did my gum go away in the first place?

I am not a dentist, but my understanding is that many things can cause gum recession. Genetics, brushing technique and smoking seem to be the most common.

As far as I’m concerned, it’s probably a mix of the first two.

All my life, I brushed my teeth pretty aggressively, thinking that it would prevent cavities, which it probably did as I’ve never had a cavity. But all those strong horizontal strokes or thorough up and down vertical strokes likely played a major role in my gum recession.

Some people really scrub their teeth during brushing. The key to effective, non-harmful brushing is low-force, hi-repetitions (or “reps”). Some people have discovered that they can get a nice clean feeling quickly (low “reps”) by brushing with heavy force. The problem with this approach is that you lose gum tissue as recession occurs over time.

— Dr. Kyle Hornby, “Can gum grafts fail?”

Properly brushing your teeth 🪥

Instead, brushing should be done more lightly, with circular movements, or angled strokes going from the gum to the tooth and not the other way around. This means doing a downwards movement for the top teeth and upwards movement for the bottom teeth.

Brush your teeth as though you are painting a portrait. Use many repetitions under light force.

Also, you may want to transition to a more circular motion with the bristles instead of side-to-side scrubbing.

— Dr. Kyle Hornby, “A rational approach to managing gum recession”

— Kathleen Davis, “Caring for teeth and gums”

I believe that this is also related to genetics, as I’m pretty sure lots of people brush like I did before without ever having gum issues, and those circular / angled brushing techniques were only ever mentioned to me after a gum graft.

How many teeth can you graft at a time?

I have like 5 teeth that could use some care as far as gum is concerned, but the surgery seems to be limited by how much gum can be taken from your palate.

If you have two teeth that need a graft that are just next to each other, it seems more likely that they can be treated in the same graft, but if you’re like me and all the concerned teeth are all around the place, it’s probably gonna need individual surgeries.

For me, by taking gum on the left side of my palate, my dentist was only able to treat one tooth.

I’ve read online experiences from people where the gum was taken from both sides of the palate in the same surgery, which I assume would allow to treat two different areas at the same time. But as you’ll see later, the palate wound was pretty painful and I was really happy to have one side that didn’t hurt to allow me to eat at least a little bit.

I can imagine how (even more) painful and annoying it would be to have wounds on both side of the palate.

Where does the gum graft comes from

Typically it’s taken from your own palate, but there are alternatives.

Gum from your own palate

In that scenario, there is two options; taking a whole chunk of gum directly from the palate, or taking a layer of gum from under the palate.

The second one yields a thinner graft but should be less painful during the recovery period.

In my case, I had a full graft, which means my recovery period was not fun at all.

Other alternatives 🐖

It seems that there’s two other options for getting the gum for the graft. Instead of taking it from your own palate, which seems to be the most common option, it can also be taken from a dead person, or from a pig (presumably dead as well).

Those options were not offered to me. I later on asked my dentist about the pig gum specifically, so here’s what you need to know about it:

It’s a collagen graft, the collagen coming from a pig. It’s not as successful as gum taken from your own palate as there’s more chances of your body rejecting the graft. Aesthetically, it’s supposed to “not make much difference”.

Other than the higher risk of the graft being rejected, there is apparently no health risk to using pig collagen for this surgery.

It would cost an extra CA$200, presumably from the pig. That seems pretty expensive to me as you could buy a whole piggy for that price at the market, and not only take the gum but also cook everything else and eat it. Maybe they have some kind of special medicinal pigs they use for this and that’s why it costs so much?

I might consider using pig gum for the next ones, especially I presume that would allow grafting many different areas at the same time without taking a huge toll on my ability to eat because of large palate wounds.

This last point is especially important to me, as nutrition is key for the graft to heal:

Success in grafting depends on gum tissue already at the graft site connecting with grafted tissue and supplying it with blood and nutrition. When this doesn’t occur, graft tissue can die off and gum grafts fail.

— Dr. Kyle Hornby, “Can gum grafts fail?”

Because of the palate wound, my eating was largely impacted (I lost 5 kg in 10 days to give you an idea). Even drinking water was hurting, despite large doses of painkillers, so I was drinking only when really thirsty. I believe that this caused my blood to be very poor in nutriments supplied to my gums and ultimately might have caused the graft to fail (it’s still too early to tell for sure).

By taking pig gum instead, I would have been able to maintain a more consistent diet which makes me think that this could have lead to a more successful result.

Also that would be a pretty fun fact.

Surgery day 💉

So you decided to have a gum graft, and it’s now surgery day. What to expect? Here’s my experience.

I showed up at the dentist for my appointment. She needed to do two local anesthesia, one on the palate and one near the tooth that was to be grafted.

Anesthesia

The anesthesia itself is supposed to be somewhat painful, which is why she rubs some kind of soothing gel on the zone a minute before the injection. That is supposed to make it less painful. She openly told me this is more of a placebo, but placebo works decently well for me even when I know they’re placebo, so that’s fine with me.

It wasn’t as painful as I expected (and as I remembered from my first gum graft around 10 years ago). No big deal here.

The following steps are my assumption of what my dentist was doing based on what it felt like, but I might be completely wrong.

Taking gum from the palate

This is the part that I dreaded the most, as in my memories from my graft when I was a teenager, this was hurting quite a bunch even with the local anesthesia.

To my good surprise, this time this operation was totally painless. It seemed pretty quick and I felt absolutely nothing.

Grafting the gum on the base of the tooth

This part was much longer, I have no precise idea of the actual timing but this probably took 30 to 45 minutes where the whole operation was 1 hour. That’s just my perception of time though and I could be well far off.

This was mildly uncomfortable the whole time but not painful whatsoever. It’s just long.

Stitches and plaster on both the palate and the graft

The palate stitches were pretty quick, but the graft ones took a bit of time and were a bit more uncomfortable.

How long did it take?

The surgery took about an hour, totaling to an hour and half from when I first passed the door until I was out in the street.

How much did it cost?

I was charged for an hour and half surgery which was around CA$700. I’m in Montreal for context.

Right after the surgery

Because of the anesthesia, I think you’re not supposed to drive right after the surgery. That said I wasn’t told anything about that so maybe it’s not always the case. If you’re planning to drive, I would recommend you ask your dentist before. As far as I’m concerned, I rode my bicycle and it was fine.

My dentist told me to take 1 Tylenol (500 mg, also known as acetaminophen and paracetamol) and 3 Advil (200 mg, also known as ibuprofen) as soon as I got home, and repeat this dose every 6 hours until it doesn’t hurt anymore.

I also got scheduled a follow up appointment 10 days later (it seems it’s usually 7 to 10 days after the surgery), where she will remove the plaster and stitches.

After 6 hours I did feel some pain and a single Advil was enough to tame it.

The week after the surgery 🤒

In this chapter, we’ll talk about all the aspects of life affected by the surgery, including pain level and management, working, talking, eating and exercising.

For the record my surgery happened on a Thursday morning.

Pain level and management 🥲

The morning following graft day, my palate was painful and I took a single Advil to tame it. I felt pretty tired the whole day but not in bad pain. I just took another Advil before bed as the pain was mildly increasing (or I could feel it more because I wasn’t focusing on anything else).

The following day (Saturday), I didn’t even need a morning painkiller and I just took one in the evening to help me sleep.

Then I was off painkillers for 3 days where I was just uncomfortable eating but the pain was low as long as food wouldn’t touch the wounded part of my palate.

That’s until the plaster I had on the palate fell off on Tuesday night as I was eating. It’s indeed supposed to fall after a few days:

Do not be alarmed if the bandage falls off within 1-3 days following the surgery.

— Dr. Kurt Van Winkle, “Periodontal cosmetic procedures instructions”

A few hours after the plaster fell off, the palate wound started to hurt like a motherfucker. That pain lasted until the following Saturday.

This means that I had to go back to the amount of painkillers that I thought was just a single time post-surgery dose: 1 Tylenol and 3 Advil, repeated every 6 hours.

Chart of painkillers

I ended up adapting it to 1 Tylenol followed by 2 to 3 Advil, 2 to 3 hours later, and looping like this. The pain was waking me up at night as soon as the painkillers effect faded. This is by far the most painkillers I’ve taken in my whole life in such a short period of time.

It was still lower than the maximum recommended daily dose per day for this kind of medicine, but not by much.

While the palate plaster was off, the stitches that presumably used to hold it in place were also detaching, leaving a hanging sting in the middle of my mouth. This is also expected and you can safely cut it with small scissors.

Sutures (stitches) are resorbable and will come out within 5-10 days. They may untie, become loose and hang down from the palate. Do not attempt to pull or remove the sutures. If they are long and bothersome, you can trim them with small scissors

— Dr. Kurt Van Winkle, “Periodontal cosmetic procedures instructions”

I took my last Advil on Saturday morning when the pain woke me up at 5 AM. Finally, when I got up a couple of hours later, after 3 days of hell where I was stuck in my bed pretty much the whole time and could do absolutely nothing productive, the pain disappeared as fast as it came and I was back to living a nearly normal life again.

Note: my guess is that because I tried to eat solid foods too soon, that made the bandage fall off earlier than it should, and that’s why I was in such pain. If I managed to preserve the plaster just a few more days I probably wouldn’t have noticed any pain whatsoever.

I also noticed that it was pretty tempting to fiddle with the palate bandage with my tongue, and that likely made it fall off sooner too.

It seems that the palate bandage plays a critical role in pain management during the weeks following the surgery. My biggest advice would be to take great care of this bandage and try to keep it as long as possible. Eat only liquid or really soft foods for the first 10 days to make sure the plaster is less likely to fall, and don’t fiddle with it with your tongue either!

Working 💻

I had the graft done in the morning, and I was pretty much useless the rest of the day. Don’t expect to get a lot of work done right after a gum graft.

The next day was pretty much the same, not much pain but feeling drained and exhausted the whole time. I would spend half an hour working and then had to lay down for an hour or so. I could attend the two meetings I had that day, and I was lucky I only needed to talk for a minute or so.

I didn’t manage to do any creative work during the weekend, but I could watch online courses and read books so it wasn’t all lost.

Monday and Tuesday were solid productive days at work. Note that I don’t have many meetings and I usually don’t need to talk a lot during those.

Wednesday to Friday were the worst days since the surgery, and I could do absolutely nothing. Consuming content was fine so I used that time to watch some more online courses.

Saturday the pain was completely gone and I was back to high productivity, both for work and personal projects.

Talking 💬

I was uncomfortable talking for at least a week after surgery. Then my French started to be somewhat OK, but I still had trouble articulating in English and it was quickly tiring and a bit painful after saying more than a few sentences.

After two weeks, I was comfortable speaking again for extended periods of time.

Eating 🥕

My diet for the first 10 days was limited to soup, mashed potatoes, yogourt, apple sauce, pudding and eggnog. I managed to eat some scrambled eggs, salmon and mac and cheese too.

Bananas were the most solid thing I ate during that time (to give you an idea) and it was really inconvenient and nearly painful. Also I needed like 5 minutes to eat a whole banana. Not ideal.

If I was to give an advice to my past self, it would definitely be to buy a blender and/or juicer, to make smoothies and juices out of fruit and vegetables to keep a healthier diet.

Edit: definitely, eating whole bananas was not only long and painful but this kind of thing made my palate plaster fall off too early and resulted in high pain.

Put the damn banana in a blender, add any kind of vegetables, other fruits, milk or plant milk, and a sweetener like honey or maple syrup if you want. Tweak it with basil, ginger, cocoa powder or whatever else you feel like! Don’t be afraid to add water to the mix if you want to make it more liquid so that it’s even easier to drink.

I got into making smoothies/juices later on and here’s a list of what I liked to put (not all at the same time obviously, but mix and match as you please):

I lost 4 to 5 kg over this period, and I’m pretty skinny in the first place so that’s no good. I normally weigh around 68 or 69 kg and I’m 185 cm tall. I got down to 64 kg.

This put me close to a BMI that starts to be concerning form a health perspective, and I surely felt really week, low energy, and empty.

For the first 4 days my palate wound was covered which made it easier to eat, I just had to avoid the graft zone which was covered by a thick white plaster anyways, and to some extent the palate wound zone, but it wouldn’t be a huge deal if some food touched it since it was covered.

When the palate plaster fell off, eating was always painful, even soft or liquid food. I could only eat lukewarm soup, especially ones without chunks in it like onions or mushrooms and such. Eggnog was the thing that hurt the less during that time. Even water was painful to drink. And all that even with the high dose of painkillers I was on.

When my palate stopped hurting, so nearly 10 days after surgery, I introduced sushi, sausages, ground beef, vegetables like lentils and beans, or anything of that kind. I still had to eat it only on the opposite side of my palate wound but it was getting better overtime.

Eating was taking me 5 to 10 times longer than it normally would, which was extremely frustrating, especially I love to just stuff my face with lots of food in a record amount of time.

After two weeks, the main limitation is that I can’t bite into things since my grafted tooth is in the front and I need not use it. This means I can’t have sandwiches or burgers, and I basically need to cut everything I eat in small pieces that I chew only with my back teeth on only one side. Sad.

Edit: after a month I was eating pizza happily without needing a fork and knife 😋 and after 2 or 3 months I was back to biting in fat nasty burgers. 💪

Burger

Drinking 🍺

I read online that it was discouraged to have fizzy drinks and alcohol before the first follow up appointment, so I didn’t have any of that (sad). I tried a sip of kombucha after 3 days and it was stinging on my palate, I wouldn’t have been able to drink it even if I wanted to.

On my follow up appointment 10 days after surgery, I asked my dentist about it and she told me it was fine to have fizzy drinks and alcohol again. I had a beer that night, and it tasted good and didn’t hurt. Great.

Exercising 🏋️

Apparently you shouldn’t do any kind of activity that raises your heart rate for the first two weeks after surgery.

On the other hand my dentist told me I could exercise since day 0 as long as it wasn’t intense like running a marathon (but she probably knew that I would not feel like exercising at all after such a surgery, especially not a marathon).

I went on a short low intensity bike ride 3 days after surgery. I felt fine but I might have increased my heart rate at points.

I went on an easy hike the weekend after that.

The evening after my 10 days follow up appointment I went on a high intensity bike ride. Might have been a bit too soon? Cardio was definitely way up. It felt good to exercise again, that said I definitely didn’t have as much in me as I used to, after losing nearly 5 kg since the surgery.

Kissing 😘

After the surgery I asked my dentist how I should go about kissing my girlfriend. She told me I could do it as soon as I felt like it, which made a lot of sense later when I realized I really did not want to be kissing anyone with the amount of pain and discomfort I had in my mouth!

That also applies to anything else you would want to do with your mouth, really. 😏

Follow up appointment

After 10 days, I had my follow up appointment. It was extremely fast.

My dentist removed the plaster and stitches from my grafted tooth. She made sure the palate stitches had all resorbed.

I was then scheduled another appointment for 6 weeks later which I have yet to attend. I will update this article then if I find out anything else worth writing.

Update: that appointment went very quick, my dentist just looked at my graft and confirmed that it wasn’t very successful and I’ll likely have to do another one next year.

I hope that your graft has a better result than mine!

Wrapping up

I wish that your graft doesn’t get too painful, and that you have successful results!

If something I wrote on this page is wrong or inaccurate, or you see something worthwhile adding here, please contact me to let me know. Cheers!

Want to leave a comment?

Start a conversation on Twitter or send me an email! 💌
This post helped you? Buy me a coffee! 🍻