Gingival Gum Graft Surgery Necessary!

[bbsadmin]

Hi, everybody.

Well, I knew this day would be coming, and it seems to have arrived. Ten years ago, when I got my braces, my lower front gums began to recede slightly. For years I kept an on it, with the help of my dentist and a consultation with a periodontist. It was really stable for a long time and didn't seem to be progressing at all. But recently for some unknown reason I've lost 1 mm of gum tissue there and now it's starting to get critical. I saw my dentist today for a routine cleaning, and he agreed that I should see the periodontist again. I go in to see him on Oct. 10th. I plan to get the gum graft done before the end of the year -- probably in late Oct/early Nov. I will definitely need the two lower front teeth done, but may also need an additional two lower teeth on each side (pre-molars, I think).

Why are my gums receding? Well, like I said, it all started when I got braces (from the pressure). But now that I'm over 50, age might have something to do with it. Or my auto-immune thyroid disease. Or perhaps the fact that I just found out recently that I'm deficient in vitamin B-12. No matter the reason, the fact remains that I need to get this done soon.

My big concern is whether to do it under sedation. I'm really sensitive to medications, and they stay in my system a really long time. For example, if I took a whole Benedryl, it would knock me out for 8 hours and I would still be groggy for most of the next day. I can't stand taking narcotics; they make me so loopy and nauseated that I wind up getting an anxiety attack. The periodontist's office told me that they usually give their patients Halcyon. I've never taken that drug before and I'm not sure that I want my first exposure to it to be in the surgery chair. I can't believe this: they said that a patient should take Valium the night before to ensure a good night's sleep, then Halcyon before the surgery the next morning. I don't think I'd be able to pick myself off the floor with a combination like that so close together.

Is it really horrible to do it without total sedation -- just take something like Lorazapam to relax me, instead? Have any of you had this done without sedation?

I would also like to know what your recovery was like. I assume it will be several awful days followed by several so-so days, with a total recovery time of about 10 days. I understand the procedure -- taking tissue from the palate and grafting it to the gums. I would just like to know more about what to expect.

I would appreciate hearing from you.

Thanks,
Lynn

[Katvo]

In our office we use nitrous oxide and valium when doing gingival grafts. My guess is that you are right- if you have such a strong reaction to benadryl, anything too strong will have you a puddle on the floor. A dose of valium on a good empty stomach the morning of treatment will probably do the trick to relieve any anxiety that you may have. The nice thing about valium is that it just takes that edge off without being too much in the way of a sedative. (Think drunk, not comatose.)

Have you decided on using cadaver tissue vs using your own? That will be a factor in how much pain you experience afterward. I haven't personally had a graft done, but my choice would be to go with cadaver skin.

As far as pain goes- naturally, your biggest concern will be a few hours post op when the local wears off. Your periodontist will make sure you're comfortable while you're in the chair. You'll have pain for about a week, most of which can be managed with tylenol, but the first few days, you might want to take that narcotic. My boss/doctor compares the pain level to that of a bad pizza burn- so manageable with meds, but irritating.

Hope this information helps!
-Kat

[bbsadmin]

Cadaver tissue? Are you serious?! I haven't heard of that!

I'm pretty sure that my periodontist will take the graft from my palate. But I'll find out for sure when I see him on the 10th.

The office told me that they usually don't prescribe narcotics, but even if they did I wouldn't take them. I had sinus surgery 3 years ago and couldn't tolerate narcotics afterwards. They just did not agree with me at all. It was rather hellish recovering from that with just Tylenol, but I got through it.


BTW, FYI, nitrous oxide depletes a person's store of B-12. Which probably wouldn't matter to someone with a normal B-12 level, but would be pretty bad for someone like me, who is deficient, and whose body may have lost the ability to absorb B-12 from food due to auto-immune disease.

[orangeracer]

Many handy products are made these days out of cadaver tissue, such as bone screws, pins, and fascia grafts. There are processes to remove the factors from the tissue so there is no immune/transplant reaction. The tissue becomes incorporated into the patient's body as opposed to something made out of metal or teflon. It is not always the best choice for a repair, but it can be an excellent option. It's great to find out that docs are using it for gum grafts as I may be in that situation post braces, (ex snuff user, was a very stupid habit to get into).

The valium/halcyon combo should not be a big deal even if you are sensitive, katvo summed it up pretty well. It's not a long term sedative, just something for that morning to take the edge off. You could also take some extra vitamins in the days leading up to the surgery so that your system will not get as depleted, which is not a bad idea in any case.

[stepher7]

I just thought I'd throw in my opinion, since you haven't had one yet from someone who's actually had the surgery. I had 4 grafts done, all at the same time, so opted for sedation. I don't react to narcotics/sedation/drugs the way that you describe, so I can't really be a help there, but I can tell you what my recovery was like. The first few days after were pretty miserable, I won't lie. I decided to use my own tissue (taken from the palate) since I got freaked out reading the info on cadaver tissue...they said that they won't guarantee that you may not contract something from the tissue, so I thought better to be on the safe side. Yes, you'll be in more pain using your own tissue, but the possible chance of contracting hepatitis or the likes scared me too much! It was pretty difficult to eat anything solid for the first week or so probably (pretty much like the first couple of weeks with braces!), and about another week before my mouth felt pretty much back to normal. The most irritating thing for me was the stitches...they were in the roof of my mouth, and all around the 4 graft sites (all 4 canines). They came out 2 weeks after the surgery, so it could have been worse I guess. You can't brush the graft sites for a month (gross, I know) so that was really frustrating, but you get a chlorehexidine rinse to keep those areas clean. All in all, it definitely wasn't a fun process, but it was necessary and once the swelling went down and things had healed, you can't even tell where the "old" tissue is versus the "new"! Good luck with it, whatever you decide to do drug wise. Coming from someone who's been through it, I understand any anxiety over the procedure. Having a friendly, reassuring periodontist helped me tremendously, so I hope you have the same!

[BaliGirl]

Hi Lynn,

I had a connective tissue graft done last year on my lower 4 incisors. Like you, I am very sensitive to sedation and narcotics, so I elected to do the procedure using local anesthetic (in the novocaine family but longer lasting) only. It was fine, no problem at all. The entire procedure lasted about 2 hours and the recovery was a piece of cake compared to some of the horror stories I read ahead of time. I'm one of those weird people who wants to know every little thing there is to know ahead of time, which helps me to mentally prepare for the worst and be pleasantly surprised when my experience isn't that bad. For me, the worst part of the procedure was sitting in the periodontist's chair for 2 hours reclined with my head below my feet.

Here's a rundown of my procedure:

• Perio anesthetized the area using shots of a long lasting local anesthetic.
• Perio cut the gums around my lower incisors to open the area up, then he cleaned the roots extremely well. He scraped the roots until they were smooth and treated them with an antibiotic.
• Perio cut the graft from my upper left palate - to do this he cut open an L-shaped flap in the pink gum tissue, cut out the white connective tissue underneath, then sewed the gum tissue back up.
• Perio inserted the connective tissue underneath my lower incisor gum tissue, then sewed it all together with the gum tissue higher than it was to start with. Since the graft went under my gums, you can't see it - the area looks "normal" like the rest of my gums.

The entire procedure was done under an operating microscope and the stitches were done with the thinnest thread I have ever seen - nothing at all like the big fat threads used to sew up my mouth after getting teeth pulled. My perio also explained what he was doing every step of the way, which was important to me.

When the anesthetic started wearing off, my gums and palate were throbbing and mildly painful, but the flurbiprofen took away all of the pain. I only needed to take it for 2 days and then I had no pain at all, unless I ate something that brushed against one of the stitches on the roof of my mouth. The incision didn't hurt, only the area right under one of the stitches did. I had to chew on the other side of my mouth until the stitches came out. I think it would have been difficult to eat for a week if they had cut both sides of my palate (which they may need to do for you to get enough graft material for 6 teeth).

I couldn't brush the graft area at all for a week (after a week they gave me a super soft toothbrush to use that wouldn't disturb the graft. It was so soft that I doubt it cleaned much at all, but at least I could brush). I couldn't floss the area for a month. I almost cried when they told me I could resume regular brushing and flossing.

I took arnica, enzymes (including bromelain), quercetin, turmeric and fish oil during the first week to reduce swelling, which really helped. I also iced the area with frozen peas for the first 24 hours. I was determined to heal quickly. My periodontist was surprised at how fast I healed.

Before the procedure I asked my periodontist about using Alloderm (the product made from cadaver tissue) rather than my own tissue, and he said that the long term results were better using your own tissue. Apparently the Alloderm tends to shrink during the healing process, and what looks like good coverage on the day of the graft is not so good 6 months or a year down the road.

A few weeks after the gum graft I also had a frenectomy done to cut the muscular attachment under my lower incisors. It was pulling on the graft and gum tissue and had to go. You may want to ask if this is an issue for you as well.

I hope this helps. Any other questions, please let me know. I hope your procedure goes well.

[I love my teeth]

Hi Lynn..

I had 3 grafts done before braces, so as not to have issues after. Apparently, I had "thin gums". I did it in 2 separate appointments. No sedation, just novacaine-----lots and lots of it! At least 20+ pricks. The graft came from the palate. To be honest, the hardest part of the recovery was the soreness from the needles, not the actual graft itself. As scary as it seems, no big deal. Mine was done is Feb/March 2009....I can hardly remember the experience to even tell you about it!

best of luck!
Christine

[bbsadmin]

I really appreciate your posts! I am SO not looking forward to this, but I know it's necessary.

It's good to know that just having local anesthetic is tolerable. I will probably take something beforehand to relax me, anyway. I'm not usually nervous in procedures (needed a root canal and a cap a few years ago when a molar cracked, and that was OK).

You have reminded me of something about novocaine. Sometimes they put epinephrine in it, and that makes me so jumpy and shaky my knees practically give out on me. This happened when I was getting that root canal a few years ago. They numbed me up, then suggested I use the bathroom before they get started. In the bathroom, I noticed that my whole body was shaking and my knees felt wobbly, which was really weird. When I got back to the chair, I said to the doc: "I am feeling so shaky but I know that I'm not nervous. It feels like when the allergist used to give me epi in my allergy shots." And the doc replied, "there is epinephrine in the novocaine....it makes it last longer. Otherwise it would wear off and we'd need to give you more shots halfway through." And I sat there thinking, "Oh great, I'm going to feel shaky for half a day until the stupid epi wears off!"

So that's another question to ask the doctor about. Because I just can't stand taking any stimulants -- not caffeine, not sudafed, nothing. It's possible that if I take a Lorazapam beforehand, it could counter the effect of the epi. I am assuming that they will use epi in the Novocaine....I think it's standard in long dental procedures.

I would rather use my own tissue for a whole bunch of reasons. Thank you for telling me that the cadaver tissue usually shrinks more. I haven't begun researching that aspect of things yet.

[RavenGirl]

I will probably need a gum graft as well, mostly on the bottom from having braces the first time. When I went in for my consult I asked my ortho if the receding issue would cause a problem for treatment.. He didn't seem to worried. I'm going to ask my dentist on monday his opinion on monday when he takes my extraction sutures out.

Most of it is my fault.. The braces came off and my teeth got absolutely horrible - 12-13 cavities each checkup. I did brush multiple times a day but it didn't seem to help, so eventually I more or less gave up until a few years ago.

[Rusty'sMom]

I am a 50-something and I have had two gum grafts years apart with only novacaine. I consider myself to be a BIG BABY when it comes to dental pain ( I will take the shot for anything if it is offered) and I had no difficulty during either of the procedures, or afterward. The graft was taken from my palate and one was for upper and the other lower, no issues. I did take a Xanax on my own prior to the procedure and my periodontist gave me two Advils to take in the chair before he started. Several shots of novacaine and an hour or so later I walked out of there just fine and dandy. Be sure to comply with follow up directions. My doc had me with ice inside and outside the mouth and the swelling and pain were tolerable with just Advil! I also know that I am going to need at least one more gum graft when these braces come off! Not looking forward to it, but I will deal with it when the time comes. Good luck, don't worry!

[bbsadmin]

Well I just returned from the periodontist. Indeed, I need to have this done, sooner rather than later.

Trick or treat -- I'll be having it done on Halloween.

I really do need all 4 teeth done. He will try to do it all in one appointment, but couldn't guarantee because it depends on how much tissue he can take from the palate.

Uugh, I'm not looking forward to this. But who am I to complain, when so many of you guys undergo jaw surgery, and so many other more complicated procedures!

I'll just have to make sure to eat all my candy before the 31st!

[klobird]

Hey Lynne,

So many things that I have read about your story are similar to mine, from the flurosis to needing the gum grafts in the same exact place after braces...I can't remember if you had an overjet too...

I already know also that it's in the cards for me...and I have seen all of the gruesome videos that I never should have watched. But after totally inundating my brain with gum grafts, gum grafts, gum grafts....well, it doesnt scare me so much anymore..
I think I will choose IV sedation--I had mouth surgery last November with IV sedation (for a suspicious lump that turned out to be nothing, done by an oral surgeon)...well, anyway it was really truly a piece of cake, stitches and all....and that seems to be the overriding opinion from all of the stories that I've read about gum grafts. (Although from my viewpoint that seems hard to believe... ) .

I really truly wish I was having mine as soon as you...then I wouldn't have to think about it for the next 18 months!!!

I wish you all the best with the whole surgery thing!

[bbsadmin]

Truthfully I was hoping he would say that I could wait until after the new year, but there was no way to tell if the recession would get a lot worse between now and then. So I just wanted to get it over with.

I was mentally beating myself up for waiting so long to see the periodontist again (last time I saw him was 6 years ago, but I've been keeping an eye on the situation all these years). But he told me that if I'd come in with 1mm less of recession, he wouldn't have wanted to do the procedure yet -- he said that now is the time. So that made me feel better.

He also explained that while my orthodontic work 10 years ago had exacerbated the recession, it hadn't actually caused it. He said that recession is more about genetics -- if you are born with thin gum tissue, among other factors, it can happen.

He might actually write an article for ArchWired about orthodontics and periodontal health.

So, I have a couple of weeks to get my ducks in a row so I can plan to spend several days feeling miserable at the beginning of November. But I've been through worse. Lord knows, the sinus surgery I had a few years ago was a way miserable recovery because all I could tolerate taking was Tylenol and boy did my head huuuuuurrrtttt for about 10 days!

[bbsadmin]

Well, today is the day. Uugh. I decided to go for the sedation. The more I think about being awake (but slightly doped up by Lorazapam) in the dental chair for up to 3 hours when they do this really doesn't appeal to me. Getting a tooth filled or drilled while awake is one thing; but knowing that they're cutting your gums....it's a little too much for me to take. When I did a lot of soul searching, I decided that being put to sleep for the whole thing was probably better.

I'll post again later after it's done, although I will probably wind up sleeping for most of today.

I really don't want to do this right now, but I know that if I don't do it now, I will need to just re-schedule and do it later. So I might as well get it over with.

My fridge is stocked with jello, applesauce, fruit smoothies, etc. Hopefully all will progress well and the "miserable" part of this will pass quickly. I've been through worse...certainly the sinus surgery I had 2 years ago was more gut wrenching (and hurt like hell afterwards...all I could tolerate taking was Tylenol!)

I'll speak to you guys later.

-Lynn

[benj]

Best of luck today Lynn... Wishing you a speedy recovery