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Friday, April 18, 2014
Healing after gum graft surgery
I had my second of four gum graft surgeries. During this one the periodontist took connective tissue from the top palate roof of my mouth and sutured it to the bottom right gum to grow more tissue and heal recession. This time he sutured criss cross on the roof of my mouth. Well the connective tissue up there sloughed off with the packing and sutures, and now I have a gaping hole in the roof of my mouth about an inch long, a half an inch wide and a half an inch deep. Raw nerve endings are exposed sending both sharp, sore, and radiating pain into my eye socket, ears, and sinus areas. I am concerned about the gum graft on the bottom taking. And I am supposed to have two more of these surgeries to save my teeth and protect my health. The periodontist said this hasn`t happened with a patient in 15 years. Will my mouth heal? Will the hole close up? Am I being treated correctly? I am very upset over this ordeal. please respond, thank you.
Will my mouth heal?
Yes, your mouth will heal. The graft on the lower is not giving you any problems thus far. Connective tissue grafts have a very high success rate.
Will the hole close up?
Yes, the hole will close up. This is just a matter of time. The pain you are experiencing has to do with underlying connective tissue being exposed to the oral cavity and getting irritated by rubbing of the tongue and food.
You are right about your assumption. Once you pass 14 days post-operative, the superficial layer of the skin of the donor site will become thicker. You will start feeling much better once this happens. Usually, it takes between 6 to 8 weeks after the surgery for the depression on the tissue to fill up completely.
Continue to take the prescribed pain medications consistently according to the indications of the bottle. If they are over the counter, follow the directions on the label. Do not stop it if you start feeling better. Pain medication is more efficacious if taken continuously every certain number of hours. Do this until you pass day 14 post-operative.
Am I being treated correctly?
This is a relatively, not infrequent, "normal" complication, where the tissue sloughs. It has to do with the size of the graft that was taken. Every individual's healing pattern is different, and the same is true for the pain threshold.
However, one suggested approach is to fabricate a plastic vacuum form of your upper arch. This is a clear, thin plastic that snaps press-fit onto your teeth, and is trimmed to make sure that the palate is covered in its entirety. Thus, it will provide pressure to the donor site after the surgery, and avoid irritation from food and the tongue. You could consider this for the following surgeries. It will certainly have a positive effect.
One other consideration is to rule out the possibility of having a tooth with the nerve flaring up as the result of this procedure. Sometimes, if the roots of teeth in the vicinity of the donor site get exposed from the sloughing, the nerves could get irritated and shoot pain, very similar to what you have described. One last thing will be to rule out the presence of infection as well. If there is no infection present, the likelihood of a positive outcome is much greater.
- Go see your periodontist as soon as you can for a post-operative check. Ask if you could take stronger (prescription) pain medications to help with the pain.
- Use warm salt water rinses several times per day (about 4 to 6 times). This will help reduce the tissue swelling without disturbing the healing of both the grafted and the donor sites.
- In addition to the warm salt water, you could use hydrogen peroxide (1 part) dissolved in (3 parts) of warm water. Rinse with this 2 to 3 times a day. This will help to cleanse both sites of debris and dead cells.
Jose I Arauz-Dutari, DMD
Formerly, Assistant Professor of Periodontics
School of Dental Medicine
Case Western Reserve University