Gum Surgery: What to Know About Periodontal Surgery
Read on to learn about types of gum surgery, the conditions they treat, and what to expect before, during, and after gum surgery.
Gum surgery, also known as “periodontal surgery,” is a type of dental surgery. Gum surgeries aim to:
- treat gum infections and remove bacteria
- regenerate damaged or lost bone
- regrow healthy gum tissue
- reduce periodontal pockets, which are spaces under the gumline that can fill with bacteria, plaque, and tartar
- prevent bone and tooth loss
There are several types of gum surgery. Gum surgery usually occurs in a periodontist’s office, although some procedures may require treatment in a hospital.
People who may require hospital care for gum surgery include:
- young children
- adults with dementia
- anyone unable to remain still in a dental chair, regardless of sedation
Gum surgery may be necessary to reduce the risk of losing a tooth or teeth due to these conditions:
Gum recession due to periodontal disease exposes the tooth root. This affects the appearance of the teeth, making them look longer. The exposed root can also become sensitive and open to decay.
Gum graft surgery can reduce further gum recession and cover and protect exposed roots while improving your smile.
This periodontal or gum disease involves swollen and red gums. Gums may bleed easily when flossing, brushing, or crewing.
This stage of gum disease is usually reversible with professional treatments such as laser treatment and scaling and root planing, followed by dedicated home care. Gum surgery is the next step if these nonsurgical approaches do not restore periodontal health.
As the disease progresses, gum tissue separates from the teeth to form pockets, exposing more of the teeth. Inflammation can destroy gum tissue and bone structure that support teeth in place and lead to tooth loss and bone loss.
Facial trauma involves physical injury to the mouth, teeth, face, or jaw. Another name is “maxillofacial trauma.” Sports, motor vehicle accidents, or accidents such as falling or tripping are common causes of maxillofacial trauma.
Sometimes, the gumline covers too much of the tooth or teeth. During gum surgery, the periodontist removes the excess gum tissue to expose more of the crown of the tooth and sculpt the gumline.
Here are the most common gum surgeries, the reasons for performing them, and what happens during the surgery.
Periodontal pocket procedures
With periodontal disease, the gum tissues and bone no longer snugly support the teeth. This forms pockets around the teeth. As these spaces become larger, bacteria can accumulate under the gum tissue. This leads to tissue and bone damage and loss.
Surgery may be necessary for periodontal disease when more conservative procedures, such as scaling and root planing, are ineffective. Scaling and root planing are deep cleaning procedures that dentists usually use as first-line treatments for gum disease.
The goal of this surgery is to save the tooth. The procedure has other names, including “open flap surgery” and “pocket reduction surgery.”
During a periodontal pocket procedure, the periodontist or surgeon:
- pulls back an area of the gum
- cleans the roots of a tooth and removes any bacteria
- smooths out bumpy areas to reduce the chances of bacteria growing in crevices
- repairs damaged bone, if necessary
- sutures the gum back in place
Gum graft surgery
A gum graft or soft tissue graft treats gum recession. With gum recession, the roots of teeth are exposed. This can cause pain, especially when exposed to heat and cold. It can also lead to bone loss.
The surgeon covers the exposed area with a skin graft during gum graft surgery. The graft may be taken from your palate (the roof of your mouth) or a type of donor tissue. The graft may involve one tooth or multiple teeth. As it heals, the graft forms a strong band. Gum graft surgery can help:
- reduce tooth sensitivity
- prevent additional gum recession in the treated area
- prevent bone loss
- improve the appearance of your smile
- periodontal disease
- physical injury to the jaw, mouth, or teeth
- lesion or tumor removal
- congenital irregularities
During a bone graft, the surgeon:
- puts an incision in the gum to open the area
- cleans all bacteria and removes destroyed bone
- replaces missing bone with material from the patient or a synthetic bone option
- puts the gum tissue back in place and sutures the incision.
The bone graft material is considered a mineral reservoir to facilitate new bone growth.
Dental crown lengthening
Excess gum tissue can make the teeth appear shorter than they are. Some people may call this a “gummy smile.” During dental crown lengthening, the periodontist removes excess gum tissue and bone, if necessary, to expose more of the teeth and make them look longer. This is usually considered a cosmetic procedure and may not be covered by insurance.
In some cases, this procedure may involve bone removal to access a decayed or fractured area of tooth to put a crown or bridge into place. This is not a cosmetic procedure and may be covered by insurance.
Periodontists and oral surgeons are two dental professionals who usually perform gum surgeries.
A periodontist is a gum surgery specialist. They care for people who have gum disease, injured their gums through trauma, or are looking for plastic surgery to enhance their appearance.
An oral and maxillofacial surgeon also performs gum surgery, particularly when it involves bone grafts, tissue regeneration, or reconstruction surgery.
Your care team will most likely send you pre- and postsurgery instructions. The procedure instructions may include information about prescription and over-the-counter (OTC) medications or products you will need.
It is important to fill these prescriptions and purchase the necessary supplies a few days before surgery. This way, you will have everything you need to start your recovery.
If your periodontist plans to use light sedation, called “conscious sedation,” they will provide fasting instructions, such as not eating at least 6 hours before the procedure.
The dental team will insert an IV line into a vein in your arm or hand for light sedation.
Once you are sedated, the periodontist will apply a topical numbing agent to desensitize the gum area. Once the area is numb, the surgeon will inject lidocaine to numb the entire area. This takes about 5 minutes and lasts 1–2 hours.
Once the procedure is over, you should be able to go home. If you have a sedative, you will need someone to take you home. Even if you did not have conscious sedation, having someone with you is still a good idea.
The office will give you instructions on caring for your mouth and gums during the healing period.
It can take a few days to a couple of weeks to recover from gum surgery, depending on the procedure and the extent of the work.
Aftercare instructions may include the following directions:
- Stay upright but inclined by keeping your head above your heart. Do this for the first couple of days. Lying flat may increase pain and the risk of bleeding.
- Change the gauze in your mouth when it is soaked with blood.
- Brush your teeth gently, avoiding the area where the surgery took place.
- Do not spit. If you must remove something from your mouth, such as after you brush your teeth, allow the liquid to drip out of your mouth. Use this technique with mouthwash only if your dentist instructs you to do so.
- Do not suck on a straw or make any similar movement.
- Do not smoke, as this inhibits proper healing and may lengthen recovery time.
- For the first couple of days, consume only soft foods, such as soup or Jell-O. Make sure no small bits of food can get caught in your sutures.
- Keep physical exercise to a minimum. Do not exert yourself, as this may cause more bleeding.
- If you have a surgical dressing that you are to remove yourself, follow the care team’s instructions precisely.
- Do not pull your lip out to check the sutures or the treatment area. This could dislodge the sutures and grafts.
Is gum surgery painful?
Most people feel some level of pain following gum surgery after the anesthetic wears off. You can often manage the pain with OTC medications, although your periodontist may prescribe stronger medications if necessary.
You may hear the phrase, “Keep ahead of the pain.” This means taking pain medication as prescribed even if you are not feeling strong pain. This is especially important the first day or two after surgery.
Applying an ice pack to the area from the outside can help reduce swelling and pain. Remember not to put ice directly on the skin because it can damage it.
When should I call my doctor?
Your periodontist or oral surgeon will discuss the next steps with you before surgery or with your caregiver after surgery. You will likely have a follow-up appointment, but it’s important to know when to call them in case of unexpected symptoms.
Call the office or the after-hours number right away or seek immediate medical care at a hospital emergency department for:
- bleeding that won’t stop or that extends beyond the time indicated on your aftercare instructions
- signs of infection: fever, increasing pain, discharge from the wound
- difficulty breathing
Any surgery, no matter how minor, has risks and potential complications. Here are some of the most common ones and those related to periodontal surgery.
The general risks of surgery include:
- anesthesia reaction, such as an allergic reaction and problems with breathing
- excess bleeding
Most people who have gum surgery do not experience problems afterward, but potential complications include:
- hypersensitivity of the roots
- teeth becoming unstable or moving
- limited jaw motion, called “trismus”
- changes in taste
- nerve or blood vessel damage
Reducing your risk of complications
You can reduce your risk of certain complications by:
- following instructions regarding mouth care, including what types of food to avoid during recovery
- informing your periodontist about any medications or supplements you take
- notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
- taking your medications exactly as directed
- telling all members of your care team if you have allergies
Here are a few other common questions about gum surgery. Christine Frank, D.D.S., has reviewed the answers.
Where is gum surgery performed?
Gum surgery usually occurs in the dental office or clinic. There are some situations where it is necessary to perform the treatment in a hospital. For example, some people may require deeper sedation and recovery in a hospital.
Does gum surgery use anesthesia?
The type of anesthetic necessary for gum surgery depends on the procedure and the person needing the surgery. If your periodontist plans to use light sedation, called “conscious sedation,” you must follow your surgeon’s instructions for fasting before the procedure. Light sedation is given by IV.
A topical anesthetic is used to numb the spot where they will inject a local anesthetic, typically lidocaine. Lidocaine numbs the entire area and lasts 1–2 hours.
How long does it take to recover from gum surgery?
Recovery from gum surgery can take a few days to a few weeks. It all depends on the procedure performed and the amount of repair needed. Your surgeon can provide more guidance on what to expect with recovery.
Gum surgery is a type of dental surgery to treat periodontal disease and injuries or congenital irregularities of the mouth, teeth, face, or jaw. Periodontists and oral surgeons usually perform gum surgeries. Another name for gum surgery is “periodontal surgery.”
Gum surgeries aim to treat gum infections, regenerate bone or gum tissue, and prevent bone or tooth loss. There are several types of gum surgery. Procedures include tissue grafts for gum recession and plastic surgery to enhance smiles.
Depending on the type of surgery, recovery after gum surgery can take days to a few weeks. Carefully following aftercare instructions can speed recovery.