Are You Long In the Tooth? (and I Don’t Mean Your Age!)

Our teeth are pretty important. They help us speak, eat, and give us confidence when we smile.  The gum tissue surrounding them is just as important, as it helps protect our teeth from bacteria entering where they don’t belong and helps protect our roots from damage.

“Long-appearing teeth” can be a sign of gingival recession.  With recession, the gum line will appear retracted from the crown of the tooth resulting in exposure of the tooth root. Teeth with gingival recession may exhibit sensitivity to cold and are at an increased risk for root surface decay.

You may be at risk for gingival recession if you:

  •  Have thin tissue overlying the roots of your teeth
  •  Have had orthodontic treatment
  •  Brush too forcefully
  • Are a smoker
  • Have poor oral hygiene

In addition to discomfort and potential decay risk, a receding gum line signals a loss of healthy supporting tissue around teeth.  Healthy supporting gum tissue helps protect our teeth when we eat, drink and brush and also helps extend the lifespan of our teeth!

If you’ve lost this important tissue around your teeth, don’t despair! It can be corrected or improved through one or more periodontal procedures.  The technical term for this group of procedures is called mucogingival surgery or periodontal plastic surgery, but most commonly it is referred to as “gum grafting” or “soft tissue grafting.” They are performed by periodontists.

Soft grafting can be aimed at one of three goals:

  1. covering exposed root surfaces
  2. increasing tissue thickness surrounding teeth
  3. increasing “strong gum tissue” (aka keratinized tissue) around teeth

Covering Exposed Root Surfaces

The classic procedure to cover exposed roots involves borrowing the underlying (“connective”) tissue from the roof of your mouth (“palate”) to place in the deficient area, then lifting your gum tissue to the appropriate level and securing it with sutures.  Because the borrowed tissue is placed underneath the gum tissue, the area heals with perfect color matching and practically no signs of scarring or evidence of surgery.  Research shows that using tissue from the palate, called a subepithelial connective tissue graft, provides the most predictable and longest-lasting results for root coverage.  However, some patients wish to avoid a second surgical site, or may not have sufficient tissue to “borrow”.  For these patients, donated tissue may be used instead.  This donated tissue is stripped of any disease-causing factors (don’t worry!) and simply acts as a scaffold for your own gum cells to populate.  Regardless of the source of tissue, this procedure will help correct the level of the gum line and will also provide thicker, more resilient tissue around your teeth.

Increasing Tissue Thickness

If you have thin tissue, your dentist or periodontist may recommend a soft tissue graft as a way to prevent recession.  Furthermore, for some patients, the loss of bone around a tooth can make covering the entire exposed root surface difficult or impossible.  For these patients, a soft tissue graft may be recommended to increase tissue thickness and resilience, thereby preventing future further recession.  Thick tissue is better able to resist trauma from chewing foods, brushing teeth and better able to resist bacterial penetration.  In this procedure, similar to that described above, either your own tissue or donor tissue may be used to augment the deficient area. The gums will then be lifted to the appropriate level or placed back at their original position.

Increasing the Amount of “Strong Tissue” (Keratinized Tissue)

Around our teeth, there are two main types of tissue: masticatory (Latin: “to chew”) tissue and lining tissue.  Masticatory (keratinized) tissue is protective and strong, while lining tissue is only meant to act as a barrier.  In order to keep our teeth healthy and protected, we need a certain amount of masticatory tissue to surround them.  When we have less than this amount, or if we have none at all, our gum tissue can become easily injured or inflamed.  To correct this issue, your periodontist will perform a procedure called a free gingival graft.  In this procedure, the periodontist will borrow a piece of tissue from the roof of the mouth (palate) with the epithelium (overlying skin) attached, and place it at the deficient site.  Free gingival grafting typically doesn’t yield a perfect color match and is therefore mainly used to correct problems in the mandibular (bottom) teeth where it will not visible when smiling or speaking.  However, it can be used to correct multiple problems at once and is the most durable tissue long term.

*For all of the procedures described above, your periodontist may perform a cleaning above and below the gum line to ensure your gums are as healthy as possible prior to surgery.

Soft tissue grafting procedures are common, relatively painless, and are easily performed in-office.  Generally, the appointments last 30-60 minutes, but the results can last for a lifetime!

Most patients who have received soft tissue grafting are ecstatic with their outcomes and happy that they’ve restored the supporting tissue around their teeth, are more comfortable while eating and drinking and have a more esthetic smile.

Curioius if you’re a candidate for soft tissue grafting? Talk to your local periodontist today!

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