Dental Education Lecture: Gum Surgery

Conservative treatment for gum diseases is cleaning and local application of antibiotic.  When our gum diseases are severe, these conservative modes do not resolve all of problems.  We may turn to gum surgery.  We are going to talk about what gum surgery can do for us.

Fig.1 shows healthy, lovely, pinkish gums between two of upper front teeth.  When we do not brush or floss well, plaque and tartar (tartar in short, yellow in Fig.2) accumulates on tooth surface and causes adjacent gums to be very angry, red-faced, puffy and easily bleeding.

Young healthy gums cover part of our crowns and all of the roots.  To see the roots in Fig.1, we need to lift the gums as indicated by a curved arrow in Fig.3.  Two arrowheads point to a root, whereas single arrow points to the junction between the root and crown.

Tartar initially settles down on crown surface (Fig.4, below arrow) and later on extends to the root surface of the tooth on your left side.  If you keep ignoring your oral hygiene, tartar gains more footsteps on your root surface (Fig.5).  According to extent of the nasty deposition, you may need regular (Fig.4) or deep (Fig.5) cleaning.

When tartar extends very deep underneath the gums (Fig.6), deep cleaning may not completely remove the deepest portion of tartar (Fig.7).  After deep cleaning, the doctor may need to lift the gums to remove the residual tartar (Fig.8) to help gums recover fully.

"I am very busy.  I know that my gum disease is very severe and that I need gum surgery.  Can I skip deep cleaning and get gum surgery done directly?".  The answer is no.

Most of gum diseases can be treated sufficiently by regular or deep cleaning.  After cleaning, gum inflammation is reduced dramatically.  Some of patients with severe gum diseases may not need gum surgery after deep cleaning. We will decide this when you return to office for follow-up after cleaning.   If it happens that we still need gum surgery, gum bleeding is decreased when the gums are being lifted. This allows the surgeon to see clearly and to remove the residual tartar entirely (Fig.8). If we skip deep cleaning before gum surgery, there will be a lot of bleeding when the gums are being raised (multiple red spots, Fig.6).

In brief, we should perform deep cleaning before gum surgery if needed.  Surgery allows us to remove irritants completely.  In previous lectures, we learn that there is bone loss associated with the more severe type of gum diseases: periodontitis.  Gum surgery also allow the surgeon to fix problem of bone loss.  By contrast, the mild type of gum diseases, gingivitis has no bone loss.

The gray area between two roots in Fig.3 is alveolar bone in a normal person.  In fact the alveolar bone surrounds our root and keeps our tooth in place.  In gingivitis, there is no or minimal bone loss (Fig.4).  As gum diseases get worse, there is more bone loss.  Compare the height of gray areas in Fig.4 to 6.  During gum surgery, the surgeon uses bone harvested from other part of your body or artificial bone to increase bone height (dark gray area in Fig.8).  

If you have scheduled an appointment for gum surgery, please read and sign the consent and take it to our dental office, thanks.

Xin Wei, DDS, PhD, MS 1st edition 04/22/2001, last revision 07/12/2011