Gum Graft No Problem

I had a gum graft (on 6 teeth) a week ago, here's my story.

Backstory - I've had recession for years (fairly severe on 1 tooth, moderate on 5 others).  My dentist would measure the recession at every cleaning and it never increased, so although he always recommended I see a periodontist, I was hesitant to do so without more cause.  Last year I starting using a Sonicare tooth brush and whitening toothpaste (evidently both no-nos for people with recession or weak gingiva) and at my next cleaning all the recessions increased.  So off to the periodontist I went.  He took a look and recommended a gum graft on all 6 teeth (bottom jaw middle, #22-27) because he said I had weak gingiva and inadequate bone support beneath those teeth and he thought the recession would continue to get worse.  After I agreed to the surgery they poured some goop into my mouth to take an impression of the roof of my mouth so they could make a guard for it that I would wear after surgery.  I think waiting for that goop to harden (while not gagging) and having the hygienist pry it out after it did harden were the worst part of the entire experience for me. 

Pre-Op - The periodontist gave me a nifty little checklist of things to do prior to the surgery.  Main items were to arrange for someone to take me to and pick me up from the surgery, fill my prescriptions (Triazolam, Ibuprofen, Amoxicillin, Hydrocodone & Chloraseptic oral rinse - 3 bottles) and shop for soft food.  I started taking the ibuprofen and amoxicillin the day before the surgery, and had to fast completely for 6-8 hours prior to surgery.

Operation - My brother dropped me off at the periodontist's office at 7 AM.  I took the triazolam with me and the receptionist had me take one with a tiny bit of water right away.  About 15 minutes later they asked me how I felt.  Well, I didn't feel any different, so I took the other triazolam.  15 minutes later when they asked me how I felt I still didn't feel any different, but I wasn't freaking out or stressed really so I said we could get the show on the road.  They took me back to a room and had me sit in a chair like the ones you sit in when you get your teeth cleaned at the dentist.  They reclined the chair, had me start breathing oxygen, dimmed the lights and told me to just relax for a while.  At this point I popped my earphones in and listened to my Ipod which I had pre-filled with relaxing and soothing music.  I kept the Ipod going the entire time during the procedure but had the volume low enough so I could hear the periodontist and hygienist.  About 10 minutes later the periodontist came in and asked me how I felt.  I still wasn't feeling anything from the triazolam but at this point I was ready to get it over with.  The periodontist asked me if I wanted nitrous gas, which I accepted, and the hygienist replaced the oxygen I was breathing with nitrous and they left me alone for a few minutes to let the nitrous do its work.  Then they came back in and got started by reclining the chair all the way back and rubbing some topical gel over my gums and the roof of my mouth to numb it.  The gel worked very quickly and everything was numb, including my bottom lip which felt very strange, like it was ballooning up to humongous proportions.  I asked for a mirror to look at it but they told me it was still the same size as always, and then I played for a while by touching bottom and top lips at the same time trying to compare the sizes (I think this must be proof that the triazolam and/or nitrous were working!).  The periodontist tested the roof of my mouth and gums by poking them with something and I couldn't feel it at all, so then he started injecting the novicaine.  After that I lost track of exactly what he was doing.  He had described the procedure to me so I knew it involved cutting a flap in the roof of my mouth, harvesting some gum tissue and attaching it to my gums where the recession was, but I couldn't feel anything other than some pressure in my mouth.  At some point I dozed off and when I came to he was sewing the new gum tissue on.  The entire procedure took just under 3 hours.  When it was over they put the guard for the roof of my mouth in (there wasn't any gauze or anything over the graft site), put me in a wheelchair and wheeled me out to my brother's car.  Back at his place I drank a smoothie, an ensure and some water, took another ibuprofen and amoxicillin and took a hydrocodone (I was still numb but the hygienist told me I should take one just in case) and laid down for a nap.

Post-Op Day 1 - When I woke up from my nap I was a little groggy from the hydrocodone and my mouth was still numb.  I don't know exactly when the numbness wore off, but it wasn't replaced by any pain.  I couldn't resist taking a look at my gums but I was careful not to pull on my lip.  They looked a little gross and the stitching was wrapped around the teeth everywhere and threaded thru the gums, but there wasn't any bleeding.  The rest of the day I just relaxed and watched tv.  I didn't eat anything that had to be chewed, I stuck with yogurt, pudding, milkshakes and apple sauce (nothing hot either, I was told that hot foods cause bleeding).  I did use ice packs, 10 minutes on, 10 minutes off, all day while I was awake.  I felt fine that evening so I drove myself home and went to bed.

Post-Op Day 2 Forward - The next morning when I woke up I ate some more soft non-chew food and began using the oral rinse.  I wasn't in any pain but just took it easy all day, basically sat on the couch and read and watched tv.  At some point I tried soft food that required chewing and was able to get some jello and ice cream down no problem.  I continued using the ibuprofen and amoxicillin (until they were gone days later) and the oral rinse.  I also kept on with the ice packs, 10 minutes on, 10 minutes off the 2nd day.  There was no swelling that I could tell but my jaw was a little tender the 2nd day.  I brushed my teeth that night being very careful not to get anywhere close to the gum graft spots.  I kept the guard in pretty much 24-7 except I took it out to clean it each night.  My main annoyances from this whole thing relate to that guard.  It would frequently come out while I was trying to chew something, and towards the end of each day it would start to make my top teeth ache a bit.  By the 3rd day (procedure was on a Wed, so this was Friday) my life was pretty much back to normal other than what I was eating.  I went to the gym on the 3rd day and did some light cardio and had no problem.  All in all, I took 3 days off from work but could have gone in the 3rd day if I'd wanted to.

One Week Checkup - I went back to the periodontist yesterday for my first checkup.  I was glad to be going because somewhere around day 5 one of the ends of the stitches came loose and I could feel it with my tongue and it was driving me crazy.  I was also hoping that he'd tell me I could ditch the guard.  The checkup took all of 10 minutes.  He took a look at the roof of my mouth and said it looked like it was healing nicely but that I should continue to wear the guard for another week.  He took a look at the gums and said everything looked amazing.  He cut off the end of the stitch that was loose and told me if more came loose I could snip them myself or they'd eventually dissolve on their own.  So that's where things stand now.  I'm continuing with soft food, using the oral rinse until all 3 bottles are gone and brushing my other teeth carefully, avoiding hot liquids and foods and keeping the guard in at all times (for one more week only!).  I go back in 3 weeks for my month checkup.  The periodontist said the gums should be attached by then and I may be able to eat something that requires me to bite into it by that time (but it could be a few more weeks after that depending on how things go).

Finances - If you're interested in how much a gum graft costs, in total (initial consultation, prescriptions and the procedure itself) it was around $3k.  My dental insurance covered a good bit of it and I'd beefed up my flexible spending account to cover the rest.  The breakdown of costs is $80 for initial consultation, $50 to fill the prescriptions, $1,200 for the graft of the first tooth, $1,100 for the graft of the other 5 teeth ($220 per tooth), $500 for biologic materials used to help the healing, $149 for various other including the nitrous.

sbk sbk
34 Responses Jun 26, 2008

which dental insurance and plan did you use?

Gum Flap Surgery Cost

I have to have gum grafts, and I to put it off for years, until it has become absolutely necessary. Thank you so much for this informative post; it has lessened my anxiety.

Thank you!!!! You answered all my questions and concerns

Hi Can you please tell me where you had your dental surgery and when
Really grateful

Where (city & state) did you have your dental surgery and what was the total cost of the prodecure?

Does the stitches hurt? ;/ I'm asked to go for gum grafting because even after braces my teeth looked weird with protruding gums...

Thanks for sharing your experience. That's very helpful for other people planning to have this done.

thanks for the information.
please if u can tell which insurance company u have along with the plan coz I have 5 teeth needs grafting, really need have a insurance. thank u

I am shocked how well all of your procedures went. I am 36 hours post-op and cant sleep from horrendous pain and I have taken 2 percocets and 1200mg of ibuprofen (I do feel 60% better after the 2nd percocet). I had mild recession, 1mm, and the work was on 2 teeth. Tissue frm my palate was used and my palate is swollen but the pain is nothing much. What kills me is the surgical site. The side of my face where the procedure is done is so swollen my lip line is very crooked, lifted upwards. I do not know where any of you went, but can you share please? I went to Columbia University and yes it was greatly reduced in price but the perio was a pleasant enough fellow and did not create any disasters of any kind. I was given only ibuprofen and periodex rinse. I had to go to the ER this morning and get the perc rx. The ER doc was taken aback by the swelling and what appeared to her as a procedure which would have warranted a higher grade anti-inflammatory and some pain killers. the kind soul gave me the pain killers and I have been trying to outpace the pain ever since. How come none of you have a swollen face? I have a very high pain tolerance, I have worked out after tearing parts because what is a little pain? The perio also put his stitching loop into a part of my gum that was not numbed and I flinched but let him sew as my eyes watered. But this pain here has humbled me. I think had they given me a good anti-inflammatory as I asked, the swelling would not be so bad and therefore the pain would be much less. No wonder they were irritated with me at work when I said I needed 2 days off, It appears that is not needed unless you go to periodontist hell. Please, someone tell me where to go in NYC, particularly Manhattan. I will wait until I am financially situated before I get the other 2 teeth done because everything is more expensive in Manhattan but I sure as heck will not allow anyone to turn me into frankenstein again. Any advice? Periodontist names? thank you, sleepless at 4am

Thanks for posting this. Very helpful!!

Who is you peridontist? I just got an estimimate for $11500 for six grafts plus six adjacent grafts. There is no discount for the grafts after the first. They are $1250 each and $360 each for the adjacents.

Sounds close to my estimate. 3+3 adjacent was over $5100. $1050 each plus half price for adjacent teeth.

I'm curious how your mouth feels 1 month, 3 months, 6 months later, etc. Like, does it feel like something is packed into your gums, or do they feel normal?

I just had this done this morning. I had my lower 3 front teeth done. I was actually really nervous but they gave me an IV sedation for the whole thing and I slept right through it. It took 3 hours, came home and went back to sleep then woke up fine. I can't even tell anything has been done other than the gauze and mouth guard. No pain yet, no swelling, this has seriously been easier than getting a deep cleaning at least that left me in pain for a couple of days. I don't have insurance but I got in on a study one company was doing that my Dr.s office informed me of. I payed 2575 total for the surgery and pre and post op's and IV fluids. Then it was 60 for my presc<x>riptions. I will gladly pay it again so I don't end up like so many other people who I have spoke too who say they waited to long and lost their teeth.

Wow, posting on the same day of surgery! I'd love to know how "well" your gums will look when all is healed (how long does that take anyway?). Perhaps it's relative to the recession &amp; of course quality of the dentist. My gumline above my two top teeth have receded almost noticeably fast over the past month. I am convinced something environmental (stress, medication, teeth shifting) is the cause b/c I treat my teeth way too well for this rapid recession. Have you, or anyone else reading this, experienced very rapid gum recession? I am afraid that even if I get the surgery, b/c the cause may be outside of the normal, "Brush too hard", "Don't floss enough", "Don't smoke", then I will face this problem again in the very near future. Any comments are welcome!

Mine came from gum disease and the fact that I had been a smoker for over 13 years. I had lost a lot of bone due to the amount of recession and now my gums are pink and covering all of bone that was placed in. It looks amazing and I can't wait to see what the end result is. Well worth every penny and don't be scared to ask for any deals, I flat out told them I couldn't afford the start price of 3800 and once I wasn't rushing to make my appointment, they contacted me with the offer of a case study. These Dr's are in the business to make money and have other options for those like me who are paying cash.

I had my graft done 1 month ago today for my 2 front center bottom teeth. I don't like dentists and would venture to guess I may be one of the only people my age who was actually struck in the face by 2 different dentists when I was very young (I'm 43). Anyway, different story for a different day...<br />
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I have to admit, I feel almost guilty at the extremely low discomfort and almost ZERO pain I felt during or after the surgery. I took the prescribed steroids the day before, then 3 Advil right before the surgery. I opted for cadaver tissue, but only had the local anesthetic - which was the worst part - about 5 or 6 shots. No nitrous or anti-anxiety meds though, and the steroids might have even made me a little irritable to boot.<br />
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After the surgery, I drove myself home, and took only one Vicodin, and put some ice on my chin. I waited for any sign of trace of pain, but it never came. I took one more Vicodin before bed just in case, but the next morning, no pain at all. I just continued with the steroids and antibiotics, but didn't even have to take Advil.<br />
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I have to admit, it really has been quite the opposite of what I expected.

I had gum graft last year. I believe the procedure has caused a new gum recession where they harvested the donor from. Has this happened to anyone else?

Summary:<br />
1. Fees vary by provider, shop around if you want the cheapest but realize it may be from a less experienced surgeon.<br />
2. There are two main types of grafting techniques to cover gingival recession--tissue taken from your mouth (taken from the palate), and placed over recession (termed a subepithelial connective tissue graft) OR processed cadaver tissue placed over recession (allograft). Advantage of cadaver tissue is there is no donor site (palatal wound). Disadvantage of cadaver tissue is it does not have its own blood supply, so if a post-op complication arises, it is not as forgiving as your own tissue is from the palate that has its own blood supply and can fight a complication if it arises. <br />
Equal success rates for both techniques, if post-op instructions are followed<br />
Low post-op pain for both techniques, both techniques allow closure of surgical sites<br />
Allograft may be contraindicated in areas of extremely thin tissue around recession sites<br />
Up to the surgeon to evaluate and recommend treatment preoperatively<br />
3. If tissue is taken from the palate, a stent (mouthpiece) is fabricated. This decreases swelling and pain and keeps the donor site covered <br />
4. DO NOT PULL ON YOUR LIPS TO LOOK AT YOUR GRAFTS. Healing of the grafted site(s) depends on blood vessel in-growth. If the graft is constantly getting moved around, especially during the first week, from stretching your lip out to 'check on it' the fragile new capillaries will be destroyed and the graft could fail (die from lack of blood).

Gingival grafting is a service, and like any service, you get what you pay for. "Excessively high fees" usually accompany decades of experience and high success rates and low post-op complications. I live in Dallas, TX, and the going rates are around $1,200 per tooth. Cadaver tissue is processed human tissue that has been treated to remove all remnants of human cells (so the recipient will not reject the graft), leaving behind a scaffold of collagen. This scaffold facilitates ingrowth of normal gingival tissue. Physicians have been using similar processed tissues for years in burn wards to regenerate skin on burn victims. In periodontics, the success rates are very high, but since the tissue does not have its own blood supply, like tissue from the roof of your mouth has, it is not as forgiving during the initial healing stages, and strict adherence to post-op instructions (take antibiotics, DO NOT LOOK AT THE SURGICAL SITE--micromovement of the graft from muscle tension of the lips will destroy the fragile capillaries that are trying to grow into the graft, take analgesics, use mouthrinse) is a must. Finally, the above comments about excruciating pain from the palatal donor site are exaggerated. The procedure today allows the surgeon to totally close the donor site with sutures, so no underlying bone is exposed. The old technique is termed a free gingival graft, and does leave a ***** of exposed bone, which is very sensitive and is why a palatal stent is fabricated to cover it and help the patient stay comfortable. Root coverage techniques today either use a connective tissue graft (from the palate) or allografts that have high success rates. Good luck

All dentists are different. Hence why people are always so afraid of what may happen. This gives me relief. I'd do one tooth at a time so the cost doesn't weigh on me. How much does one tooth cost?

First tooth was $1,200 but each tooth after that was $220 so much cheaper in long run to do them all at once.

11 days ago, I had gum grafting done for 6 teeth using tissue from my hard palate. The out of pocket cost was $626 after what insurance covered.<br />
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Over the course of the entire post-op, I have taken 3 OTC Ibuprofens, one on the first day because my jaw was sore from being open for an hour and 40 min, and two taken prophylactically after reading stories about other peoples' experiences with excruciating, mind-numbing pain.<br />
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I have an extremely low tolerance for pain (I once cried when I woke up with a stiff neck), so I was quite confused when I experienced no pain whatsoever during this past week and a half. Then I realized that the stories that I read were old (5+ years ago). The procedure must have gotten better within the past couple of years, because my palate is now almost completely healed (can push on it with my tongue and it feels normal).<br />
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The only thing is, the recuperation is a bit inconvenient because I've been eating probably 6 different variations of noodle soup and congee for the entire time, causing me to lose 7 pounds. My periodontist says that I can start chewing normally in 3 more days.<br />
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Bottom line: After putting it off for 2 years, I'm glad I got it done, and I would recommend using hard palate tissue because it's much cheaper and there's no chance for tissue rejection from an autograft.

Agh, sorry for the long post, but I forgot to add that the $626 was including the frenectomy. And that I closed my eyes during the procedure so I didn't feel/see anything the entire time. :)

Can I ask what the insurance amount was. I just got an estimate for 9 teeth of nearly $7000 and I think that amount is absurd.

$7000?! That seems kind of steep...
I went back to check my bill and the total for the procedure was $3065. I paid the $626 and the insurance covered the other part.

Good insurance. I get $1500 for the whole year and that's it.

My estimate for six teeth was $5100 (including drugs, etc). Based on their pricing, I would pay $7350 for nine teeth before any other fees for the procedure were added.

I didn't pay this much for my car... hope it's worth it.

1 More Response

I had one ten years ago using tissue from the hard palate. The post-op pain was excruciating. I am scheduled for grafts throughout the remainder of my mouth using cadaver tissue. The cost estimate is close to $10,000. After viewing posts on this site, excessively high rates for this procedure appear to be the norm. Has anyone else paid this much for gum grafts? I'm told this practitioner is the best in the area... but seriously, $10k for 2 hours of work?

I just got a quote for one area of gums to be grafted (one tooth) and it is 2100.00........Using cadivar tissue...I wonder what the success rate is?

I just scheduled to have one tooth done with graft from my palate and two teeth grafted with Alloderm. The cost for preop. surgery and post care is $4819. This seems really high. Any feedback or comments? Thanks!

My daughter needs this same procedure due to very thin gums and she was born without the first la<x>yer of gums which is the strongest. My problem is the cost! We were quoted 1280.00 per tooth! She needs 5 teeth done now and eventually more later on. Our dental insurance is not covering any of the cost. Who was your doctor and where is he located? Thanks for any info.

I realize you posted this a really long time ago so this may be irrelevant, but perhaps it will help someone else. I live in San Francisco and my parents live in Alabama. I'm going to fly to Alabama for a week to get my gum grafts because it will be significantly cheaper. I was quoted $500 per tooth there and flights are only $168 each way. If you have any friends or family in a place with a significantly lower cost of living than where you live it may be worth it to travel for the grafts.

Do they do scaling after gum graft?or whatever it is called when they lift gum line up to clean under??

The guard is sort of like a retainer, it covers the roof of your mouth where they pulled the tissue from so you can't mess with it with your tongue or get any food stuck in it.<br />
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Once the periodontist is satisfied that the graft will stick he does release you back to your normal dentist for cleanings.

After gum graft do you see regular cleaning from regular dentist?

Im having this done in March. Im not scared of anything and i see it as a challenge. I know everything will be ok in the end. Whats this guard thing you have to wear after the procedure? Any pics?

Thank you for your information about procedure & cost of the gum graft.

I didn't have that much anxiety, I was comfortable with the doctor and asked lots of questions before we scheduled the procedure. I did fill my ipod with my favorite calming music and listened to it the morning before the procedure and during the procedure and that helped a lot! Good luck!

My bottom 2 teeth are pretty bad, and have needed gum grafts for about 3 yrs now. I am very nervous about the entire procedure. How did you get passed the anxiety.

The $3k was total cost of the procedure, including what insurance covered (in the end, insurance was capped at $1.5k). For me, since the first tooth was $1k and extra teeth only $200 each it seemed to make sense to do them all at once vs do one and then have to come back and do more later.

Relating to the costs - you say it was $3,000 in total, is this including what insurance covered? Or is this just what came out of pocket for you? I know insurance benefits will depend, but I'm looking to get an idea of how much this could potentially cost for me as my dentist is recommending at least 2 grafts

I did not have a putty bandage, so to peek I just tilted my head down and tried to push my bottom lip out a bit.<br />
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I wouldn't think that swishing would pull the graft away though - do the stitches still look tight?

Hey, question for you - when you "peeked" at the surgical site, were you looking under the putty bandage, or did you not have one? I'm trying to figure out if I may have pulled my graft away by swishing on Day 1 and then looking at the graft site for signs of bleeding. Thought you might know since you're a peeker too. Thanks.