Gum graft diary: Day 8 & review appointment

Time for a check-up

I went back to the surgery today for a checkup and was told that everything looks like it is healing nicely. 

The surgeon tightened up all of the loose stitches for me. Not sure exactly what she did, but it seemed to be a case of adding more of the composite that is gluing my teeth together underneath the stitch so that it holds tight.  

My next appointment is in 2 weeks time.  The normal protocol is for stitches to be left in for 4 weeks after AlloDerm, which is longer than for a gum graft with your own tissue.  However, the periodontist said that the stitches are not really active after 3 weeks, it is mainly a precaution. 

Gum graft diary: Day 7 & exercise

Things look ugly

The contrast between the pink gum and the white donor tissue is even greater today.  As before, my top arch looks much worse than my bottom arch.  On the top arch, the gums are still swollen and cover large parts of my teeth - on the bottom, they have shrunk back down.  Swelling on the outside of my face is much better and there is only a little left. 

Today's theme: Exercise

If you don't love exercise, then the post-op instructions to take it easy will not have bothered you.  

On the other hand, I am sure there are others out there like me who need a daily hit of endorphins, and skipping so may gym sessions is a real struggle.   I did, however, spend a ton of time researching the issue so that I could find an excuse to get back to exercise faster.  Here's what I found:

• Post-op instructions vary in terms of the length of time you need to rest, from around 4-7 days specifically for alloderm - sometimes less for grafts with your own tissue.  My surgeon recommended 7 days off exercise and I will stick to it. Yours may suggest something different - so best to pay attention. In the case of alloderm, I feel you need to be extra-careful because it needs to be (mostly) covered by your own gum tissue if it is going to take. Otherwise it will just degrade, so you need to avoid anything that might put it at risk.
• Longer-term, exercise can help healing. OK, the evidence comes from cuts on people's arms, but the mechanisms are probably similar - through promoting blood flow and spikes in hormones that are beneficial for healing. This doesn't mean you can skip the rest stage, but you can feel better about easing back into an exercise regime once that rest period is over.
• Ease into activity. Low impact options like stationary bikes can be introduced sooner compared to higher impact exercise. With contact sports, you will obviously need to wait longer.  Obviously, do not engage in activity where there is any risk of being hit in the face.

This was the most frustrating part for me, although I know a lot of people will welcome the rest.  What are your thoughts? Let us know in the comments!

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! 

Things to stock up on

How to make recovery suck less

You're about to go through a major surgery, so it's good to prepare first and make sure you have everything you need for a speedy, comfy recovery.  

These are all things that I personally found helpful - although you might not need everything here.  

Mouth rinses and gels for sore gums

I found that these products helped to speed up the healing process and maximise the chances that the graft takes:

• Curasept. If you are given Corsodyl, buy this instead!  It has the same active ingredient but it won't stain your teeth.
• Gengigel Gel. This really helped to soothe my mouth when it was feeling hot, tight, dry or sore. The gel is easy to use and thick enough that it seems to last in the mouth for a good while. Gengigel has been shown to help speed up healing and reduce inflammation, and I found it really works. 
• Gengigel Mouthrinse. This was also useful to make sure I could get the product into all nooks and crannies. This stuff helps to heal gums! 

Things to help with swelling

Excessive swelling is a big reason that grafts fail - this is because it can pull the stitches loose and expose the immature graft underneath.  Icing in the early stages can help - once the swelling sets in there isn't much you can do except wait for it to go down.  The key is in prevention during the first 24 hours (after this, ice feels nice but doesn't reduce the swelling much).

• Ice packs - any kind of reusable gel ones are great. I have Theraflex ones, which have held up for years and years. They remain soft enough when frozen to mould nicely to your face.
• Swanson Enteric Bromelain. Enteric bromelain can help to reduce swelling after surgery or injury. Check with your doctor before adding supplements.

Things to help with bruising

You might not have a big problem with bruising, but if you do, these things can help:

• Nelsons Arnicare Arnica Cream.  Brings down bruising like magic. 
• Vitamin K. Used by plastic surgeons to reduce post-surgical trauma, but please check with your periodontist first. 

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! 

Gum graft diary: Day 1 - the surgery

Before the surgery

I was quite nervous in the morning, but I did a huge workout (no exercise for 7 days after the surgery) and ate a massive lunch consisting of all the crunchy, crispy, chewy delicious things that would be forbidden for the next few weeks. 

At the clinic

I opted for oral sedation, which is essentially a sleeping pill that I took half an hour before surgery, along with the first dose of antibiotics. The oral sedation leaves you mostly conscious through the surgery itself so that you can still respond to instructions, but makes the time go by faster. Since my surgery was around 4.5 hours long, the surgeon recommended this to me.

PS - last time, in 2012, I went without oral sedation. The surgery was about 2 hours, and it was totally fine. 

Personally, I didn't find too much of a difference - although it was definitely relaxing, I didn't think it was essential.  But I am not a nervous patient. If you are really nervous, definitely go for the sedation.

In the chair

Many people will tell you that the worst part is the injections, and I agree.  For the rest, you can just feel sensations of pressure, maybe some tugging, but that's about it. There really is nothing to be afraid of. 

During a very long surgery like mine, the anaesthetic might wear off. Don't worry, it doesn't just suddenly disappear from your system and leave you in agony - you will just notice a sharper tugging feeling and maybe a little pain (like during the injections). Just stick up your hand and ask for more numbing.  

Halfway through the surgery, we stopped and I took oral painkillers (ibuprofen), since the anaesthetic would have worn off on my top arch while the surgeon was still working on the bottom arch.  

My surgery was done using the "tunnel" technique, which means all that tugging had involved:

• Root planing - to clean your teeth and prepare the surfaces so that the graft will be able to attach to them
• Incisions - cutting into the gum to create a pocket for the alloderm, leaving the papilla (the bit of gum between your teeth) intact
• Dissection - using an instrument to lift the gum away and to join up all the pockets from the bone
• Hydrate the alloderm material and insert it into the first pouch - the alloderm itself looks unremarkable, a sort of white/pink rectangle of soft material.
• Pull the AlloDerm through all of the pouches - so it lies across all the teeth that are being grafted. 
• Suture the AlloDerm in place, then suture the gums over the AlloDerm - this part may take the longest, as there are about 4 loops per stitch. 

The tunnel technique is best because it leaves the papilla intact, and that means better blood supply to the graft area.  Blood supply is absolutely key in making sure that the graft takes! 

Afterwards

My husband picked me up from the surgery and we got a taxi home.  I held a small icebag on my face on the way back and went straight to bed. I didn't have any noticeable pain or bleeding overnight.  Fingers crossed for a good outcome this time!

If my surgery sounds like it was a breeze, that's because it was!  I think a lot of it has to do with choosing a very experienced surgeon, as I've read a lot of horror stories - but if you are reading them and getting scared, please be assured that there are lots of good experiences too!  

Has anyone else got a story they want to share? Good or bad, leave a comment below and you will probably help someone out! 

Gum graft diary: Before the big day - all about supplements

What supplements to take prior to getting a gum graft?

OK, you have a date booked in, but what supplements can you take pre- and post-op so that your recovery doesn’t totally suck?

The first time I had a gum graft in 2012, I did no preparation and it was miserable.  I prepared obsessively for my second time in 2017 – probably overkill – but I was determined to minimise discomfort.    

I’m not a general believer in vitamins and supplements for day-to-day life, but you’re about to put your body through some surgery/trauma and there are things that it needs to recover.

There are a boatload of recommendations for various vitamins and minerals to be taken prior to any kind of surgery. There is research to back up most of these, due to their role in accelerating wound healing and immune function.  A few useful links are here and here for you to read at your leisure, or you can skip to the summary below. 

I spent days reading up on the research and there does seem to be good evidence that these things help – but A LOT of things apparently help!  I've listed the supplements I personally took below… most are fairly cheap solutions and they have research to support them.  You don’t have to take any of these if you don’t want to, I’m just sharing what I felt was helpful for me.

Multivitamin and mineral formula

• What’s it for?  Instead of buying everything that is supposed to help individually, I just got a multivitamin that looked like it covered all of the bases and was reasonably affordable.  
• What type? Anything that includes high doses of  B vitamins, vitamin K, Biotin, Zinc, Selenium, Chromium.
• What dosage? As directed
• Price? My choice was Wellwoman, which was the cheapest high quality multivitamin/mineral formula I could find that covered all bases.  The Wellman formula is pretty similar, but I went for Wellwoman because of its higher dosage of B vitamins and other lovely things more targeted to supporting healthy skin.
• Wellwoman original: see it here (UK) or here (US)

Vitamin C

Your multivitamin of choice may or may not already have a ton of vitamin C, but we’re talking about way more than the recommended daily intake here so you may want to boost it. 

• What’s it for?  Helps immune response, protects against free radical damage and also aids the production of collagen and components of connective tissue. It’s considered so essential to these functions that A&E patients are given infusions of vitamin C.  
• What type? L-absorbic acid is the gold standard.
• What dosage? Take high dosages for 2 weeks prior to surgery to ensure that your blood concentration is high.  Continue with 1-2g per day during the healing period
• Price? Cheap as chips. I either get it in powder form from Amazon for a few quid. But it is also found in most cold and flu vitamins, where you can get the added bonus of zinc (which also helps healing). I quite like Sambucol because it tastes delicious.
• Vitamin C powder: see it here (UK) or here (US)
• Sambucol Black Elderberry tablets: see it here (UK) or here (US)

Co-enzyme Q10 / Ubiquinol

There are several studies purporting a link between Co Q10 and gum health. Personally, I don't feel the need to take it all the time, only for the surgery. 

• What’s it for? Improved mitochondrial energy activity and reduces recovery time. Especially helpful for gum tissue.
• What type?  Ubiquinol is the reduced form of CO Q10 that is better absorbed in the body
• What dosage? 150mg daily, before and after surgery.
• Price? These are usually pretty expensive - I got mine from Amazon - here are some suggestions:
• Solgar Ubiquinol - see it here (UK) or here (US)
• Swanson Ubiquinol - see it here (UK) or here (US)

Bromelain

A lot of the discomfort after your gum graft will be due to the swelling.  Since I am a champion sweller, this was one of interest to me. Skip if this does not apply to you, and please consult your surgeon because it may interfere with certain medications.

• What’s it for? Used to reduce swelling after surgery or injury 
• What type? Studies seem to be mainly on the enteric coated type (the kind that only dissolves once it reaches your intestines
• What dosage? Start 3 days before surgery and continue for 7 days after. 500-2,500mg per day
• Price? I got mine on Amazon, as it was the only place that I could find the enteric type
• Swanson Enteric Bromelain - see it here (UK) or here (US) 

Do you have anything to add?  As ever, everyone is different, and we can help each other by sharing our experiences! 

Introduction

Hello all and welcome to my blog!  If you are about to have - or are thinking about having - a gum graft, you'll know that there is a lot of scary information out there about how much it hurts.  

I had a graft of all my teeth (yup, every one of those suckers) using AlloDerm in June 2017.  I will take you through my experience in this blog, and hopefully it will help someone out. 

The biggest problem that led to gum recession in my case was years of tooth grinding at night (bruxism).  I had several well-meaning dentists over the years who made the problem worse - I'll put that in another post for those of you who share similar issues.  

Other things that can contribute to gum recession are brushing too hard, trauma from objects in the mouth (piercings, retainers...), those darn genetics (some people just have thinner gum tissue) - more on that here.

If your dentist is recommending you for a gum graft, please read on.

Please note that I am absolutely 100% not a medical professional!  I am just a regular person who wants to share their experience and hopefully give you some useful information.  I'm sure we can all help each other better by sharing information, so please leave comments to help others.  All opinions are my own and all the products I mention are things I genuinely used and found helpful.