Definition & Overview

Gum surgery is a dental procedure performed to treat gum or periodontal disease, which occurs due to bacterial infection that affects the gum tissue, causing inflammation, swelling, redness, and loss of the bones surrounding the teeth. Periodontal disease begins to develop when bacteria in the mouth are already attached to the teeth and gums. A biofilm called dental plaque forms as the bacteria grow and multiply. Dental plaque can be removed by the usual oral hygiene practices such as brushing the teeth and flossing and by undergoing periodic scaling and root planing procedure. If the dental plaque is not removed and is left to remain on the teeth surface for a long time, the gingival tissues are likely to become inflamed until gum disease develops.

A gum disease in its early stages is usually called gingivitis. When the gingivitis develops as more plaque builds up on the teeth surface, a serious gum disease called periodontitis develops. If a person’s gum disease becomes too severe, surgery may be the only feasible option, and the dentist is likely to discuss the type of surgery that will best suit the patient. There are different types of gum surgery depending on the condition of the patient’s gum, including pocket reduction or gingival flap surgery, regeneration, crown lengthening, and soft tissue graft.

Who Should Undergo & Expected Results

Gum surgery is performed on people with periodontitis or gum disease, which is common in adults, especially those who are between 30 and 40 years old. Gum disease is troubling and is likely to cause enormous harm as it is normally painless at first, which allows the condition to worsen before the person even becomes aware of it. Symptoms may start to manifest when the disease has already progressed.

Below are the common symptoms of gum disease:

  • Tenderness
  • Bleeding
  • Redness
  • Swelling
  • Sensitivity to hot and cold
  • Bad breath
  • Pain while chewing
  • Loose teeth
  • Receding gums
  • The teeth don’t seem to fit when biting

Good oral hygiene is important to avoid the development of gum disease. However, there are certain factors that can increase one’s risk of having unhealthy gums even with proper oral care, such as certain medications, genetics, and some chronic illnesses such as diabetes. Pregnancy also makes a person’s gums more sensitive, red, and swollen.

The usual objective of gum surgery is to get rid of pockets, regenerate gum tissues, and to fix the form of the gums to improve its function and appearance. The goal is to fix the problems inside the mouth that may contribute to dental hygiene problems and to make sure that the condition of the mouth becomes conducive to proper long-term maintenance, thus making it easier for the patient to maintain proper oral health.

After the surgery, the teeth and gums will be nursed back to health and it is expected that optimum oral health will be achieved. During the surgery, the gums are made to fit around the teeth tightly; this will make it easier to keep the gums and teeth healthy and clean. The symptoms of gum disease such as swelling and bad breath will also be put out, and the teeth are expected to look more aesthetically-pleasing. To achieve optimum results, patients are expected to take better care of the teeth and gums following the surgery and to follow all the advice and instructions that the dentist will provide. This typically involves the use of an antimicrobial fluoride toothpaste, floss, and antibacterial mouthwash.

How Does the Procedure Work?

The main method as to how the procedure works depends on the specific type of gum surgery that is being performed.

  • Gingival flap surgery or pocket reduction – This is done by lifting back the gums, making it easier for the dentist to remove the tartar and dental plaque. The gums are then folded back to make sure that all the bacteria are removed. The gums are separated from the teeth by cutting the gum tissue before they are cleaned using ultrasonic scaling device and a couple of hand instruments. After the procedure, the gums are sutured back in place so that the tissue will surround the teeth more tightly. The gum tissues are secured tightly around the tooth instead of allowing it to grow back by itself. This is to make it harder for bacteria to accumulate in that space again. The pocket reduction or gingival flap surgery is done when the pockets have a depth of greater than 5 millimeters. This is the surgery that is typically performed on patients diagnosed with moderate to severe periodontitis.

  • Regeneration procedure – In this procedure, the surgeon also folds back the gums to remove the bacteria. This is followed by the insertion of bone grafts, membranes, and tissue-stimulating proteins into the gums. These materials will help the tissues within the gums to regenerate so it will fit the teeth more snugly.

  • Crown lengthening procedure – In this procedure, the periodontist first gets rid of excess gum tissue around the teeth. While the gum tissue is numbed, the extra tissues are cut and eliminated. Removing this overgrowth of tissues will make the teeth appear longer. Aside from the oral health benefits of this procedure, it also improves the cosmetic appearance of the teeth.

  • Soft tissue graft procedure – In this procedure, sample tissue from another area of the mouth is attached to the damaged area. Typically, the tissue is taken from the roof of the mouth. Like the crown lengthening procedure, this procedure also has cosmetic purposes because it covers up receding gums and exposed roots.

Possible Complications & Risks

After the surgery, the patient may experience mild to moderate discomfort for a few days. This is relieved using non-steroidal, anti-inflammatory, and analgesic medications such as ibuprofen or Celebrex. Antibiotics and antibacterial mouthwash are also very helpful as they do not just speed up the healing process but they also protect the wound from getting infected.

Also, the teeth and gums may be prone to bleeding after the surgery. Thus, it is best to avoid heavy physical activities for a few days until the gums are fully healed.

References:

  • Amsterdam JT. Oral medicine. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa: Mosby Elsevier; 2013:chap 70.

  • Kawar N, Gajendrareddy PK, Hart T. Periodontal disease for the primary care physician. Dis Mon. 2011;57(4):174-183.

  • Chow AW. Infections of the oral cavity, neck, and head. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 60.

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