Gum graft diary: Day 5 & stitches

Sutures, sutures

The swelling is still hanging around but is not any worse. Still painful and sore in places where the stitches have been pulling particularly hard.  Graft is mostly pale pink and white; however, one tooth is particularly painful and the grafted area there is red.  

Even though the AlloDerm graft should ideally be completely covered by your own gum tissue, all the movement caused by the swelling can mean that parts of it get exposed.  You will notice this as white bits that stick out behind the pink gum tissue.  

This is OK - a little bit of exposure (maybe 1mm or so - you may even get away with more). Those exposed white bits can eventually be incorporated into your own gum tissue just like the rest, and you will see them gradually get pink as they become vascularised. Be gentle with them to increase their chances of survival, otherwise they can get knocked off - in which case they definitely won't be incorporated into the gums.  For AlloDerm patients, compliance with post-surgical care (soft diet!) is more important than for those with connective tissue grafts (grafts that used their own mouth tissue).

Today's theme: Stitches

Your stitches will go through a lot in the first few days while they cope with the swelling. The graft will pull against them and look puckered, with horribly uneven edges because the tissue is only held down in the places where the sutures have been placed.  As the swelling goes down, things may look uneven because the stitches aren't straining to hold such big puffy gums any more, and bits of the graft may become exposed. A few of the stitches may become loose as well.  

You will have two layers of stitches:

• Graft sutures: The lower layer of stitches holds the grafting material in place inside the pouch created for it underneath your gums. They will probably also put some glue-like material in there (Emdogain) that helps to stimulate tissue regeneration.
• Surface sutures: The second layer of stitches holds your gums over the graft. For alloderm, this is particularly important as the donor material should not be exposed to air.  

I was impressed with the method my surgeon used. She glued all of my teeth together at the top to create anchors that she could sling the stitches around. The glue is just a little dot of white/clear liquid between each tooth, a bit like composite filling material.  I think it looks really neat, and the stitches are straight and line up with the gaps between my teeth. 

I don't remember my surgeon back in 2012 doing this.  Maybe he did and I didn't notice, but the stitches certainly look nicer this time around. 

My loose stitch!

However, one of the bonds between my teeth popped off so the stitch is hanging loose. My periodontist asked me to send a photo - on this basis she said it was probably fine and I should just leave it.


She left the ends of the stitches quite long as well - apparently to give a bit more room for flexing if needed.  My previous surgeon back in 2012 cut the stitches short, so that seems to be a personal preference.  

Gum graft diary: Day 4 & food

Keeping on

Hamster face is still very much in evidence - even worse than yesterday - but I hope this is the peak now.  Looks like I have a mouth full of marshmallows.  The swelling is worse on my left side.  

The grafts themselves are looking paler - pink and shiny, white at the edges - and they sit well above the normal gum level on several teeth.  Everything feels very tight as the graft pulls against the stitches. It hurts more than yesterday in certain places where the swelling has been particularly bad, feeling stingy, sore and hot. It does feel OK with painkillers, but the tight/hot sensations can be quite worrying - best not to think about it. 

I still need to be careful when washing my face, or even rubbing my nose, as this can hurt.  You may want to moisturise your face a lot since the skin has been stretched by the swelling and it can get quite dry, especially if you are icing too. 

Since I've had grafts on all of my teeth (top and bottom at the same time), I should probably be extra careful about eating. Hence, today's theme... 

Today's theme: Food, glorious food

Typically, post-op instructions will tell you to keep to a soft diet for a few weeks and give some uninspiring examples of what you can eat - let me read mine out to you: milkshakes, soups, yoghurts, scrambled eggs, steamed vegetables. 

The point is, you don't have to make yourself more miserable than necessary by sticking to a liquid diet - soft is OK, i.e. avoid things with sharp edges and avoid things that need chewing.  Here are a few ideas:

Morning protein

• Protein shakes - protein is great to aid healing and they can be delicious!  Being lactose intolerant, I struggle to find tasty shakes that aren't based on whey protein, but there are a few good vegan options out there. I find they blend easier with water rather than trying soya or nut milk, and any variety of sins can be covered by adding extra cocoa powder, honey, fruit etc.  Here's a picture of my breakfast, mmm. This is the Sunwarrior chocolate blend. I like it because it is vegan and mixed protein from different plant sources so that you get a complete profile.
• Puddings, yoghurts and desserts - yay!  Things like jelly, custard, rice pudding, trifles - all OK. Being on a soft diet can be a pleasure! The folks at Muller have a great selection of rice puds so you don't have to get bored. For my fellow lactose intolerants, Alpro soya desserts are the bomb (my favourite is the dark chocolate flavour - even people who eat dairy like these! I have many different flavours on the go at the same time to avoid boredom. 
• Potato cakes - I love toast but that's off the cards. Potato cakes are an acceptable substitute if you're craving something toasted. I like the Paul Rankin ones because they stay soft and gooey in the middle (crispy ones are dangerous for delicate gums).  
• Smoothies - home-made, any combination, the variety is endless.  Add oats for a bit more body, or smooth peanut butter. Hell, add a cookie if you want, as long as it blends up smooth it is OK.  
• Porridge - go check out the porridge aisle at a big supermarket and you will be amazed at the technology these days... dozens of options.  I am enjoying ones from Rude Health at the moment.
• Pasta, cous cous, quinoa and all those carbs - just don't put anything like nuts, seeds or crunchy veg in. Keep it all soft and smooth, baby. 

Actually, you can pretty much make most things work if you overcook them and mush them up.  But it is fun to have some specific comfort foods in the house.

Any more suggestions? Let's help each other out with delicious ideas! 

Gum graft diary: Day 3 & medication

How's the pain?

My face is more puffy and painful than yesterday - a bit of a hamster face look today.  I have to be careful not to accidentally ding the areas when washing my face.  Swelling will usually tend to get worse for a few days after any kind of surgery (peaking at day 3-5).  My face is tender, stiff and hot - icing helps.

The grafts themselves have swelled up a bit more, so I can see the ones on my front teeth without lifting my lip. It is a mix of pink gum tissue and white AlloDerm at the edges and around the tracks of the stitches. I remember this from last time, so I am not worried. But it is certainly not attractive. 

When the graft site is swelled like this, it can pull on the stitches and the whole area looks puckered, totally gross and definitely not gum-shaped.  In some areas the swelling can mean that most of your teeth are covered. I notice that the graft is sitting higher up on some of my teeth whereas on others it is lower.  Don't worry, the gum contours will settle back in time once the swelling subsides.  

Today has been fairly pain-free - I feel that I can thank the skill of my surgeon and also my extensive list of medications for this. Even if you don't have pain, it is still a good idea to take the meds. Let's take a look shall we?

Today's theme: Medication

Here's a picture of my goody bag:

My goodie bag

• Antibiotics: Amoxicillin, the old faithful. One every 8 hours for the next 7 days
• Painkillers: Ibuprofen and co-codamol (paracetamol and codeine). Every 8 hours - although to be honest, I've only taken the ibuprofen (200mg, mainly to help with the swelling)
• Anti inflammatory: Dexamethoasone. Starting with 3 a day for 2 days, then 2, then down to 1

When I had my previous surgery in 2012, and also when I had a wisdom tooth out, my face blew up like a balloon.  It caused much amusement for all, but it also really, really hurt!  

This time, I think the anti-inflammatory has done a spectacular job - swelling is still happening but much better controlled... Hurrah for medication!  I don't think it is given out as standard, but when I explained my previous issues to the surgeon she added this to my goody bag and I am very grateful.  

I'm also taking the following supplements to give my body as much support as possible (please check with your doctor before adding supplements):

• Wellwoman original

• Swanson Ubiquinol 

• Swanson Enteric Bromelain 

Have you had gum grafts - were there any medications that particularly helped you?  Leave your comments and tips below, let's all help each other!