Gingivectomy is a surgical procedure by which a dentist removes diseased or enlarged gum tissue. Gingivectomy is also called Periodontal Flap surgery because this surgery aims at eliminating periodontitis and deep gum or periodontal pockets.
A periodontal pocket is the formation of small space between the gums and teeth due to inflammation and swelling of gums. Once these pockets enlarge, it leads to loosening or falling of teeth. This condition is called periodontitis, and it is severe gum disease.
The root of gum disease is plaque accumulation and tartar development. Plaque and tartar accumulation are bacterial deposits on teeth that require professional cleaning by a dentist.
If the condition is not treated in time then excessive plaque and tartar build-up lead to gingivitis and progress into periodontitis.
You will need gingivectomy once the gum disease progresses to periodontitis. Gingivectomy also makes your smile better by reducing enlarged gums in some cases.
Let’s see in details about gingivectomy and what to expect from it. If you want to avoid having this surgery, you should also know the causes of gum disease, treatment, and prevention.
What is Gingivectomy?
Gingivectomy, as the term suggests, is the removal of gums (Gingiva- Gums, Otomy- Removal). When our gums are more than usual in amount or diseased, a dentist cuts off the extra gums.
Gingivectomy reduces diseased gum tissue and improves your overall gum health. Periodontitis is a severe gum disease which leads to falling off of teeth from sockets. Periodontitis requires gingival surgery for treatment. The surgery is a simple procedure.
The dentist examines our gums and marks the amount of gum that he will remove. Then a right amount of numbing agent or anesthesia is given in your gums so that you don’t feel any discomfort.
Dentists use surgical knives or lasers to remove the gum tissue. Scaling and root planning may be done to reduce the plaque formation and prevent future gum disease.
After the procedure is complete, the dentist places a cooling pack consisting of Eugenol over the gums. Eugenol soothes any post-operative swelling and pain. Gums heal after seven days of the surgery. (1)
Why might you require gingivectomy?
Gingivectomy is done for the following two reasons.
When you smile and more of gums are seen compared to teeth, dentists call it a gummy smile. A gummy smile looks unattractive so most of us want the removal of excess gum for a natural smile.
The procedure increases the overall length of the crown part of our teeth. Hence, it is also known as a crown lengthening procedure. The procedure that removes excess gum tissue covering our teeth is Gingivectomy.
Gum disease that shows deep gum pockets requires gingivectomy. Gum pockets are the natural spaces present between the gums and teeth. A healthy gum pocket contains fluids and minerals for the nourishment of the gums and teeth.
In healthy gums, the depth of gum pockets is up to 2 mm, but in diseased gums, the pocket depth increases more than 3 mm. Increase in pocket depth causes loss of attachment between the gums and teeth.
The teeth loosen in the socket due to the loss in attachment with the gums and eventually, they fall. Also, along with increased pocket depth, you will notice a massive increase in the amount of gum tissue.
Gingivectomy is done to decrease the pocket depth and remove some amount of diseased gum.
This gum disease is called Periodontitis. Periodontitis can only be treated with Gingivectomy or Periodontal flap surgery. (2)
Signs of gum disease
In mild cases of gingivitis, there may be no discomfort or noticeable symptoms. Signs and symptoms of severe gingivitis that requires gingivectomy are-
- Red or bluish-purple gums
- Extremely enlarged gums
- Bleeding gums
- Bad breath
- Deep gum pockets
- Receding Gums
- Fragile gums
Causes of gum disease
The following might cause gingivitis, i.e., swelling of gums. If gingivitis persists, then it progresses to periodontitis and requires gum surgery.
- Bacteria and plaque accumulation between and around the teeth.
- Hormonal changes may occur during puberty, menopause, menstrual cycle and pregnancy. The gingiva might become more sensitive to inflammation during a hormone rise.
- Cancer, diabetes, and HIV patients show a higher risk of gingivitis.
- Gum health may be affected by some medications, especially if those medications reduce the flow of saliva.
- Smoking is a known cause to increase the incidence of gingivitis and other oral health problems.
- Advanced age is a reason for gingivitis.
- Poor nutrition is a reason behind poor health leading down to gingivitis.
- A family history of gingivitis
The procedure of Gingivectomy – What to expect under the knife?
The dentist follows these steps on the day of surgery –
Marking of the gums
The dentist examines our gums and marks the area of the gum that he will remove.
The dentist injects a small amount of local anesthesia in our gums. The anesthesia works for up to 6 hours and completely numbs the gums.
Removal of the gums
The dentist removes the gum tissue with the help of special surgical knives. These knives are called Kirkland’s knife and Orban’s knife. Nowadays dentists use NdYag or CO2 lasers. Lasers reduce the healing time and also reduce bleeding.
Once the diseased gums are gone, the dentist applies a pack over the gums. This pack is called Perio pack. It contains eugenol which reduces post-op swelling and pain. We can remove this pack after 8 to 10 hours of the surgery.
Post-therapy care – Pain and Symptom management
Post-op instructions for a gingivectomy include the following.
A small amount of bleeding occurs for 1 to 2 days after a gingivectomy. If bleeding starts again, we can put damp gauze over the bleeding area and bite on it for 30 minutes with firm pressure.
Dentists advise us not to rinse mouth or brush teeth on the day of surgery. The day after surgery, you can rinse with a solution of warm salt water every 6 hours. You should brush your teeth using care around the area of surgery.
Swelling after a gingivectomy is very common. You can apply an ice pack for 30 minutes following the gingivectomy. (3)
For pain, you can take any over the counter pain tablet as directed by the dentist.
You should drink lots of liquids and eat food that you can swallow without chewing. Clear liquid diets such as ginger ale may be most comfortable on your stomach.
Dentists also add these to the list of instructions-
- Do not spit for 24 hours. It may increase bleeding.
- Do not smoke after the surgery.
- Do not use mouthwash for 24 hours.
- Do not bend over and lift heavy objects or get overheated.
- Do not use a straw for drinking for up to 24 hours. Drinking through a straw may disturb the blood clot and induce bleeding.
- Make sure to sleep with head elevated on two pillows.
- If the pain increases after 48 hours, please call your dentist immediately.
Can we avoid gingivectomy?
If you can prevent periodontitis, then there will be no need for gingivectomy. The only way to nip periodontitis in the bud is to avert gingivitis. Gingivitis is prevented by maintaining good oral hygiene and following these precautions-
Brushing twice daily, flossing and using mouthwash every day is the best way to maintain good oral health. Maintaining good oral hygiene is the best way to prevent gingivitis.
Regular dental visits
Visiting your dentist for regular cleaning to keep plaque and tartar away is necessary. Seeing your dentist once a month or at least twice a year is advisable to maintain good oral hygiene.
Good health practices
Eating healthy is an excellent way to maintain good health and fight any bacterial attack on the gums. There is an overall reduction in the chances of suffering from gingivitis if you are healthy.
Over to you
Gingivectomy or gum surgery is a minor dental procedure. Periodontists perform this common procedure often, so you need not panic. Having healthy gums is essential to retain our set of 32 pearly whites.
Delaying gum surgery can worsen the condition of our gums, and you may start losing teeth. So, as soon as you see an increase in gum size or loose teeth in our mouth, you should see your dentist.
Periodontitis is entirely curable with Gingivectomy, and the gums heal in a few weeks after surgery.