What to Expect During Gum Graft Surgery—and How to Recover Faster

Gum graft surgery treats gum recession, which occurs when the gums recede, exposing the roots of the teeth. Also known as gingival resection or gingival graft, this surgery involves removing gum tissue from one part of the mouth and transferring it to the affected area.

Periodontists (gum specialists) perform gum graft surgery and play an important role in protecting your teeth. 

Gum recession affects 40-88% of adults in the United States and is often a sign of advanced gum disease, known as periodontitis. Receding gums change the appearance of your teeth, cause tooth sensitivity, increase the risk of cavities and tooth decay, and can lead to wear and tear on the enamel of teeth. Gum graft surgery can help manage these symptoms, prevent tooth loss, and protect the jawbones from damage.

To prepare for gum graft surgery, periodontists will perform a full exam, take x-rays (images) of your teeth and mouth, and prepare a treatment plan. For the surgery, they’ll use several techniques. All methods involve collecting gum tissue, either from your own mouth or a donor’s, and using it to treat your gum recession.

Before the appointment, avoid smoking tobacco or cannabis for at least one week if this applies to you. You may also need to stop taking blood-thinning medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), like Motrin (ibuprofen), and beta-blockers, which are primarily used to manage cardiovascular (heart) conditions. 

The Procedure

A periodontist will perform a gum graft while you’re awake and numb your mouth to help prevent pain. This surgery takes about an hour per tooth. The surgery requires several steps, including:

1. Anesthesia: For pain, periodontists use localized anesthetic (numbing) injections or other options, like nitrous oxide (laughing gas). Providers don’t typically use general anesthesia, a medicine that causes you to sleep, for this procedure.
2. Site preparation: A small cut is made in the gum near the affected tooth, creating a flap. They’ll also clean out the tooth root.
3. Harvesting: If using tissue from your mouth, the periodontist will cut out a small piece of inner tissue from the roof of the mouth (or palate). They use a small cut on the surface, which they stitch shut and clean off.   
4. Synthetic/Donated Tissue: Donated gum tissue or synthetic tissue, also known as acellular dermal matrix graft, may be used. 
5. Grafting: The periodontist then grafts the tissue. They place the harvested gum over the exposed tooth root, reposition existing gum, and complete the transplant. Gauze is used to control the bleeding.

After surgery, you will need to wait in the office so the periodontist can ensure there is no excessive bleeding and the gauze has hardened properly. The gauze must remain in place for at least 30 minutes. The dressing may fall off on its own within a couple of days, or your periodontist will remove it during your next appointment. Someone will need to take you home if you’ve had general anesthesia.

Your periodontist will also let you know how to safely care for your gums as they heal:

• Avoid brushing or flossing the affected area for 48 hours
• Use antibacterial mouthwash to clean the area while brushing and flossing other parts of the mouth
• After 48 hours, you can start lightly brushing the site

It takes one to two weeks before you can begin brushing or flossing normally. Before returning to your regular oral hygiene routine, make sure your periodontist has given you the okay.

Feeling pain and discomfort following a gum graft is normal, especially in the first two days. Swelling, bleeding, bruising, and tenderness or soreness in affected areas are common side effects.

You can try to manage your pain if you:

• Take over-the-counter (OTC) pain relievers, such as Motrin or Tylenol (acetaminophen). With severe pain, your provider may prescribe stronger pain relievers
• Avoid touching affected areas, especially while they’re healing
• Have soft foods or drinks such as smoothies, yogurt, Jell-o, or scrambled eggs

The pain and discomfort should disappear over time, with swelling, bruising, and other symptoms fading by the second week after the procedure. Your periodontist will monitor your gums and let you know when they have fully healed.

Surgery is typically successful and should restore the appearance of the receding gums. Complications are possible and may include excessive bleeding and infection. In more severe cases, gum graft rejection is possible, which is when the transplanted tissue fails to properly combine with the gum.

The gum graft should fully fuse with the surrounding tissue within four to 12 weeks, with symptom recovery often taking about two weeks. Healing time will vary from person to person and depend on the extent of the work done.

Here’s what you can expect as you recover:

• Day 1: Gum pain, discomfort, and bleeding are typical in the first 24 hours. Avoid brushing or flossing the surgical sites, and only drink liquids or eat very soft foods. Clean the affected area using antibacterial mouthwash.
• Week 1: The pain should improve within the first 48 hours, with swelling lasting about three or four days and bruising lasting up to a week. Gently brush your teeth, but not your gums, around the affected areas. The periodontist will remove any stitches if necessary during your follow-up visit.
• Week 2: Typically, your gums become less swollen, and bruises go away. If you’re taking medications, ask your periodontist when you can stop them. You can continue to incorporate more solid foods. Don’t resume normal brushing or flossing without your provider’s consent.  
• Weeks 3-4: As the gum continues to heal, the tooth sensitivity and lingering symptoms subside. Your diet and oral hygiene patterns return to normal. The grafted tissue adopts the same pigment as the surrounding gum.
• Months 2-3: Following a gum graft, your periodontist may schedule additional exams or more frequent cleanings. You’ll need to maintain good oral hygiene habits.

Following certain dietary guidelines when recovering from a gum graft is important. This means avoiding foods that can irritate or harm the area until your gums heal. In the first day or two, this means a cool, liquid diet. You should also avoid carbonated beverages and alcohol for at least a week.

As you start to feel better over the first two weeks, you can gradually reintroduce other food options. Start with softer foods like boiled carrots, oatmeal, eggs, noodles, pasta, and fish. Hold off on very hot, cold, crunchy, spicy, or acidic foods until you get the go-ahead from your periodontist.

In most cases, you’re able to eat normal food at about two weeks. When you do resume eating, be gentle on your mouth and jaw. Cut food into small pieces, chew slowly and gently, and avoid using affected areas.

Along with managing diet, several steps can aid in recovery from gum graft surgery. In the first few days after the procedure, rest and protect your mouth. You should avoid even moderate physical activities, such as running, swimming, or racket sports, for at least one week.

Pressure on the gums can also cause strain and damage. If you play a wind or brass instrument, avoid playing until you fully recover. You should also avoid drinking with a straw or other activities, like blowing up balloons.

Though severe complications are rare, gum graft surgery carries risks. Infection from a gum graft can spread to other parts of the body. Gum graft rejection can cause necrosis, resulting in tissue death and subsequent tooth and bone loss.  

Contact your healthcare provider if you experience any complications. Let your periodontist know immediately if you experience:

• Persistent or worsening pain in the gums after one week
• Fever (body temperature above 101°F), redness or swelling in the gums
• Gum graft turning white and becoming painful, a sign of graft rejection
• Puss (milky fluid) oozing from the affected area
• Chronically (consistently) bad breath

A gum graft is a surgery where a periodontist takes and moves gum tissue to treat severely receding gums, tooth sensitivity, pain, and to help prevent tooth loss.

It typically takes about two to four weeks to fully recover from this surgery. During recovery, dietary changes and other steps will help protect your treated gums and promote proper healing. If you experience complications, such as an infection, fever, or gum graft rejection, contact your healthcare provider.