Gum grafts - Before or after braces?

**IHIC** · 09-06-2010, 06:51 PM

Has anyone here had gum grafts because of gum recession? (either prior to braces or after).

If anyone from the UK has had gum grafts, what were you charged for this? (I have no idea of the cost ranges, but can guess they are very expensive).

I have had some gum recession on my lower front teeth for a few years, and I was told by my dentist this was because of brushing too hard and my deep overbite.

I was inspecting my teeth earlier and noticed some gum recession on my upper front two teeth ... although I had noticed the gum recession on my left tooth a couple of years ago, today I noticed that the gum on my right tooth has started to receed also

. When I discovered the recession on my left tooth a couple of years ago, it didn't really bother me because I just thought it was due to the tooth being out of line/crooked.

I went to see my dentist in July because I had a few issues I was worried about. I was convinced I had gum disease, from reading on the internet. He checked my mouth and said I didn't have gum disease and told me he probed/pressed my gums quite hard and they did not bleed, he was happy to send me away without saying there was an issue. He has always said my teeth and gums are fine.

Just lately (before studying my teeth in the mirror and noticing the recession on my upper right front tooth) I have noticed a sensation of tightening feeling at the gum line above the right tooth, it feels as if the gum is getting 'tight'. It doesn't bleed when I brush or floss. It just feels dry/tight sometimes.

Here are a couple of photos showing the recession on my two upper front teeth:

Here you can see the recession on the right front tooth (I am aware the teeth next to the front teeth have recession too), you can also see part of the recession on my left tooth (your right)

Here you can see the recession on the left front tooth (I wanted to get a photo from the side, but my cameras battery died. It looks worse from the side because of how the tooth is positioned/angled!)

I only really noticed the recession when looking at the photos. When I look in the mirror it doesn't look bad, but on the photos looks worse than in the mirror.

I haven't got a brace yet, my 2nd consultation (with a different ortho) is in 2 weeks. I have read many a time that braces can cause some recession, so I am worried mine will get worse!

If you have gum recession prior to getting a brace, do orthodontists normally suggest you get a gum graft prior to having the brace fitted? or do they suggest to wait until Orthodontic treatment is finished?

**MsMichelle** · 09-06-2010, 08:55 PM

My best friend and my cousin both had gum grafts after their braces came off.

With my best friend hers happened because of the braces and with my cousin her's happened because of it as well. When I asked my ortho early on in my treatment she said that sometimes with some people it happens because of 'shock' to the gums including brushing hard, incorrect flossing and incorrect usage of a water pik *which is why she is kind of against advising her patients use of it*.

I am sorry that this has happened and make sure when you go for your second consultation be sure to ask your ortho what they think. Good luck!

**MCOMarkhamOrthodontist** · 09-07-2010, 03:55 AM

There are a couple of different schools of thought. One of them is that the grafts should be done before orthodontic treatment to ensure there is good support for the teeth as they move. However, as teeth move, there may be a need to regraft after treatment.

Another thought is to do them after treatment, so that they grafts can be done with the teeth in their final positions. However, if there is a lack of support during treatment, this could lead to a compromise in the health of the teeth in the bone.

Speak to your orthodontist and periodontist to help you make the most informed decision possible. Good luck!

**IHIC** · 09-07-2010, 09:26 AM

Thank you both.

It's all getting me down lately. I keep finding things or coming up against things that are going to cause an issue... a few weeks back I thought the only thing making me wait was the consultations! Now I've noticed receeding gums and God knows what else.

I don't have a periodontist. I have never seen one, or been referred to one. I have tried to Google the prices of gum grafts in the UK and all I have managed to find is £350-£600 per area/tooth! that is so expensive. Basically, if I need gum grafts, I will have to forget having Orthodontic treatment, as I cannot afford both

. I could leave the brace and do the gum grafts, but if my teeth alignment/bite is causing some of the recession, I'll be back to square one again anyway... hmm. I just can't afford both.

**Sunny** · 09-07-2010, 09:51 AM

IHIC I think talking to a perio will help.

I have gum recession as a result of minor gum disease and brushing incorrectly. I was treated for the gum disease about two years before ortho treatment. My perio said that gum grafts were not necessary and to take care of the sensitivity by brushing with a toothpaste designed for sensitive teeth. I've had once yearly checks with my perio and last year was told not to return, unless instructed to by my dentist.

My gum recession 'looks' much worse than yours and I've been told there's still no need to gum grafts. My advice ... don't waste time worrying. Get checked and get on with living!

**IHIC** · 09-07-2010, 10:32 AM

Originally Posted by Sunny

IHIC I think talking to a perio will help.

I have gum recession as a result of minor gum disease and brushing incorrectly. I was treated for the gum disease about two years before ortho treatment. My perio said that gum grafts were not necessary and to take care of the sensitivity by brushing with a toothpaste designed for sensitive teeth. I've had once yearly checks with my perio and last year was told not to return, unless instructed to by my dentist.

My gum recession 'looks' much worse than yours and I've been told there's still no need to gum grafts. My advice ... don't waste time worrying. Get checked and get on with living!

Thanks Sunny. Your story sounds reassuring

. Did you have to wait 2 years to start Ortho treatment after your treatment for gum disease? or did you just suddenly decide 2 years later to go for a brace?

Although the gum recession on my upper two front teeth is bothering me now, I fear it getting worse. But I am mainly worried having Orthodontic treatment will make it worse and compromise the stability of my teeth because I already have recession. At 24 years of age, I don't want to get to my 30's and have teeth getting loose/falling out (or maybe I am just over worrying again).

I managed to get a photo from the left side to show the recession on the front left tooth, which is the worst out of the two. The tooth is pointing diagonally, and in the picture I think you can see the start of the root (from looking at the picture, it does look as if the gums around the cenral incisors and lateral incisor look inflamed - but I don't notice this when looking in the mirror):

Thanks for your advice and you're right, I shouldn't keep worrying so much! I just desperately want straight teeth!

I see the Ortho for my consultation on the 20th September. I then have an appointment booked with my Dentist on the 7th October, I will mention it to my Dentist. Although, when I had my appointment in July, he said everything looked fine... but could see from my body language/face I wasn't convinced, and said "I can refer you to a periodontist if it would make you feel better" but I just said I'd see how it goes.

**Sunny** · 09-07-2010, 10:55 AM

My perio treatment was due to seeing a dentist after returning from working in a third world country. Ortho work was never mentioned during that stage. When I found the ortho I wanted to treat me, he said I needed a perio report before he'd treat me, due to the gum damage he could see. He said as long as the perio was happy there'd be no problem.

I now work for my ortho and he regularly asks his older patients to get a perio report completed before treatment. This has the added advantage of making sure a perio is then known to those patients, as many have never seen one before.

Gums can 'shrink' as we age and for some people this can happen earlier ... genetics can play a role.

See a perio ... maybe get a dentist to recommend someone. Remember that seeing a perio about gum issues, is the same as seeing an ortho about tooth movement and a dentist about dental health. A dentist can definitely give you advice about your gums ... but a perio is the specialist in this area.

Good luck!

**josie** · 09-07-2010, 03:30 PM

IHIC, I'm not sure if we have separate perios like they seem to in the US and Australia - as far as I know, it's your regular dentist who deals with tooth _and_ gum health here - but either way, your dentist is the place to start.

It's a statistical fact (she says, ducking!) that most people over the age of 30 have some gum recession. So don't panic. Gum recession isn't gum disease. (Although the latter can cause the former, there are many other causes of recession - like brushing too hard.) I too brushed too hard and have receding gums on certain teeth. I have a soft bristled brush now, I only brush twice a day (no more) and I brush very gently when I'm brushing the gum area especially. I also use Gengigel at night, before going to bed - I put it along the gumline where the recession is: Gengigel Gingival Gel 20ml - ExpressChemist.co.uk - Buy Online Using it every night, the tube lasts about a month. I don't know anything about gum grafts, but I wouldn't have thought your gums were bad enough (I'm no expert though). It's also worth considering whether any of the recession is visible when you smile - if it's not visible and if you manage your gums so it doesn't get any worse or recede more now, then would you still want gum grafts?

**IHIC** · 09-10-2010, 02:28 PM

Grrrr! I just typed up a reply to this thread and then my laptop decides to restart itself and I lost all my post!

. I'll try and remember what I typed and start again

Originally Posted by Sunny

See a perio ... maybe get a dentist to recommend someone. Remember that seeing a perio about gum issues, is the same as seeing an ortho about tooth movement and a dentist about dental health. A dentist can definitely give you advice about your gums ... but a perio is the specialist in this area.

Good luck!

I will ask my Dentist about seeing a Periodontist during my next appointment. He did mention it last time, I should have taken him up on the offer!