Dear Dr. Mady: I have a couple of lower front teeth that are positioned more forward than the rest and the gum has receded. The teeth are somewhat sensitive now and my dentist has referred me to a periodontist that wants to do a gum grafting procedure. What causes this condition, what is grafting and will fix the problem? Elizabeth in East Windsor

Dear Elizabeth, It sounds like you have a classic case of gum or gingival recession. In addition to being esthetically displeasing, recession can create mild to severe sensitivity if the teeth involved posses a live nerve. It is technically an abnormal and undesirable migration of the gingival margin away from the tooth or clinical crown of the tooth. The clinical crown refers to the portion on the tooth covered by enamel that shows above the gum.
            Recession causes the root surface of the tooth to become exposed, where there is no enamel, but a thin, gritty layer of cementum covering a root composed of dentin, which is not as hard as enamel. It is exposure of this root that creates problems, including temperature and brushing sensitivity. Also this surface erodes more quickly from acidic food and beverages and is more susceptible to any type of dental disease.
            As far as esthetics, a nice smile can be inhibited because teeth with recession appear longer. If the smile or gum line is not even, the smile can be compromised and so can self confidence.
            This condition can be localized to a few teeth as in your case, or generalized throughout the mouth. When it is generalized the cause is usually from gum or periodontal disease. This is a much worse and can be a less treatable situation, depending on the case.
            The main option for improving this condition is a procedure known as gingival grafting or gum grafting. A graft involves the need of gum tissue from a donor site, usually the palate or roof of the mouth. The periodontist (gum specialist) gently, surgically removes a small piece of needed tissue and places it over the recessed area. Fine sutures are placed to assist in healing. A dressing is then placed over the surgical site and it can be removed with the sutures about a week later. After about six weeks, it is almost unnoticeable.
            There are tissue banked grafting materials available if a good donor site can not be attained, but natural tissue of your own is the best. This method of surgery is usually very successful due to the fact that the grafted gum tissue gets blood supply from both the bone in the area and from the adjacent gingival tissues. It is usually completed by a periodontist using local anesthetic and the entire procedure does not take too long. Yours will probably take less than an hour.
            As far as pain, you may experience some mild discomfort for the first few days up to a week, which can be easily controlled with over the counter analgesics and occasionally prescriptions. I personally feel that getting a tooth extracted causes more post operative discomfort that a gingival grafting procedure.
            Today, the success rate is high for this treatment. If you have any concerns, I am sure your periodontist should be able to address them.

            Any questions for Dr. Mady can be e-mailed to and also visit his blog at (dental education network)
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5


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