A gum graft is a surgical procedure performed to restore gum tissue lost due to recession, where the gum line pulls back and exposes the tooth roots. This treatment protects exposed root surfaces from decay, reduces sensitivity, and improves gum health. The tissue used is typically taken from the roof of the mouth or a donor source and secured over the recession area. For success, the transplanted tissue must establish a new blood supply and integrate fully with the surrounding gums.
Distinguishing Normal Healing from Signs of Failure
Immediately following the procedure, it is normal to experience post-operative symptoms that should not be mistaken for graft failure. Mild to moderate pain is expected, particularly at the donor site if your own tissue was used, and this pain should be manageable with prescribed or over-the-counter medication. Slight swelling and minor, intermittent bleeding or oozing for the first 24 to 48 hours are also typical as the body begins healing.
A white or yellowish film over the grafted tissue is often a normal sign of healing. This film is fibrin, a protein involved in blood clotting, or a protective layer of sloughing tissue that forms as the new tissue integrates. This initial healing phase, where symptoms are most noticeable, usually lasts one week before discomfort and swelling significantly subside.
Warning signs of failure are symptoms that are severe, escalating, or prolonged beyond the expected timeline. Excessive, bright red bleeding that persists or restarts heavily more than 48 hours after the surgery is a major indicator of trouble. Severe pain that worsens over time, is not controlled by medication, or is accompanied by throbbing can also signal a complication, such as infection.
Visible deterioration of the grafted tissue is another sign of potential failure. If the graft turns dark gray or black and looks lifeless, it indicates a loss of blood supply and tissue death. The presence of purulent discharge (pus) around the surgical site is a clear sign of bacterial infection. A graft that physically shrinks, pulls away, or visibly detaches from the underlying tissue has failed to integrate and requires immediate attention.
Common Reasons Gum Grafts Fail
The most common cause of gum graft failure is a lack of adequate blood supply to the transplanted tissue. The graft must successfully re-establish circulation from the receiving site to survive and integrate; anything that compromises this process can lead to tissue death. Smoking is a significant factor in poor outcomes because nicotine constricts blood vessels, directly inhibiting blood flow to the surgical area.
Physical trauma to the delicate graft site is another frequent cause of failure, particularly during the first few weeks of healing. Actions like aggressive brushing, touching the area with the tongue or fingers, or eating hard, crunchy, or sharp foods can dislodge the graft. Any movement or pressure on the newly placed tissue can interrupt the fragile process of cellular attachment and integration.
Bacterial infection at the surgical site can also prevent the graft from taking hold. If bacteria gain entry, they can compromise the healing process, leading to inflammation and tissue breakdown. Underlying systemic health issues, such as poorly controlled diabetes, can impair the body’s ability to heal and fight off infection, increasing the risk of graft failure.
Immediate Steps If You Suspect Failure
If any warning signs appear, the most important step is to contact your periodontist or dental surgeon right away. Early intervention can often make the difference between saving a partially compromised graft and needing a complete revision procedure. Do not wait for your next scheduled follow-up appointment, especially if you observe signs of infection or visible graft detachment.
While waiting for professional guidance, avoid aggressive action that might further damage the site. Do not attempt to clean the area vigorously, probe it, or pull at any detached tissue. You can perform a gentle rinse with warm salt water, which may help keep the area clean and reduce inflammation, unless your surgeon has advised against it.
Refrain from taking any medication that might thin the blood, such as aspirin or certain non-steroidal anti-inflammatory drugs (NSAIDs), if you are experiencing persistent or heavy bleeding. Your periodontist will provide specific instructions on which pain relievers are safe. You must strictly adhere to a soft, non-chewing diet to prevent mechanical pressure on the graft site until your dentist can assess the situation.