A gum graft is a common periodontal surgery used to treat gum recession, placing new tissue over exposed tooth roots. It is natural to closely monitor the surgical site after the procedure, and seeing a change in color from the typical pink gum tissue to white can be alarming. While this color change often suggests a successful and expected part of the healing process, patients understandably become anxious. The white appearance is a complex biological signpost, sometimes indicating protection and sometimes signaling a complication. Understanding the stages of recovery helps distinguish between normal healing and a situation that requires professional attention.
Whiteness as a Sign of Normal Healing
The most common reason for a gum graft to appear white is the body’s natural response to a soft tissue wound. When a graft is transplanted, the tissue temporarily lacks its own blood supply, causing the initial pale or white appearance due to reduced blood flow, known as ischemia. This is an expected phase, particularly in the first few days to a week after surgery, as the graft waits for new blood vessels to form and integrate with the existing tissue.
A protective layer of a protein called fibrin is produced at the surgical site, forming a mesh-like barrier that is white or yellowish. This fibrin layer is essential for healing, acting as a temporary protective dressing over the deeper tissue layers. It shields the delicate, underlying new tissue from bacteria and mechanical stress while the cells begin to regenerate.
Furthermore, the very top layer of the grafted tissue, particularly in certain graft types, naturally dies and sheds off, a process known as epithelial sloughing. This outer layer turns a whitish-gray color because it is no longer receiving nutrients, but this does not mean the entire graft has failed. The shedding of this superficial tissue is necessary to make room for new, healthy tissue to form and is typically complete within the first two weeks.
Non-Biological Reasons for a White Appearance
Sometimes, the whiteness observed is not a direct result of the biological healing process but comes from external sources. Periodontists often use a surgical dressing, sometimes called periodontal putty, to cover the graft site immediately after the procedure. Remnants of this material, which is usually white or pale, can be mistaken for the graft itself turning white.
The use of topical medications or antiseptic rinses prescribed for post-operative care can also leave a temporary film or residue on the tissue surface. These substances may create a localized blanching effect, making the gum tissue appear lighter or white for a brief period after application. Tight sutures used to secure the graft can temporarily compress the tissue, causing a localized lack of blood flow that results in a pale or white color directly under the suture line. This temporary tissue blanching is harmless and resolves as the area adapts.
When Whiteness Signals a Serious Problem
While a pale color is often normal, a whiteness that progresses to a gray or black shade, or appears hard and dry, can signal tissue necrosis (tissue death). Necrosis occurs when the grafted tissue fails to establish a blood supply from the surrounding gum tissue, leading to a loss of viability. This necrotic tissue may look like it is peeling away or sloughing off in large pieces, distinct from normal epithelial shedding.
A problematic white appearance can also be a sign of infection, though this is usually accompanied by other concerning symptoms. Pus, a thick, whitish-yellow fluid, may appear at the graft site, often indicating a bacterial infection. Unlike the protective fibrin layer, an infection is characterized by increasing pain, persistent swelling, and sometimes a foul odor or taste.
The failure of a graft due to poor blood flow or infection can result in the entire transplanted tissue appearing non-viable and pulling away from the underlying bone or tooth root. If the whiteness is spreading, remains for longer than the expected two weeks of initial healing, or is accompanied by systemic symptoms like fever, it moves beyond the realm of normal recovery.
Monitoring Your Graft and Seeking Professional Advice
Monitoring the color of your graft should be done in conjunction with observing other symptoms, as whiteness alone is rarely a definitive sign of failure. Contact your periodontist immediately if you experience severe, unrelenting pain not managed by prescribed medication. Excessive or prolonged bleeding that does not stop after applying gentle pressure is another indicator that the graft may be compromised.
Other warning signs include pus discharge, a foul taste or odor that persists, or swelling that increases after the first two to three days. If the white area begins to spread, turns dark gray or black, or the graft appears loose or dislodged, professional intervention is necessary. To promote healing, avoid touching or disturbing the surgical site, and adhere strictly to all instructions regarding gentle oral hygiene and the use of prescribed rinses.