Gum Graft For Teeth 24-25+11

 I've had a habit of brushing too long and too hard all my life, plus my gums were damaged (ripped off in some places!) by orthodontic procedures in my childhood. Now I'm 37. Dr. Haller at Monterey Dentistry in CA told me for a couple years in a row "I don't like that recession" and tried to get me to go to a periodontist she referred me to for a consultation for gum grafts. I was frightened of the idea of getting a dental implant or graft of any kind so I blew it off. Lately I started having the impression my front lower teeth (#24-25) aren't that secure in my mouth. They move very little when I push on them a bit, it's barely noticeable, so I wondered if I'm just imagining things due to stress or fear. But out of fear of having my teeth get looser and eventually fall out, I finally went to the periodontist Haller referred me to, Dr. Keeley. I actually ended up seeing Dr. Rezvan at Dr. Keeley's office. Apparently he's the junior partner.

Rezvan recommended I get connective tissue grafts for teeth 24-25+11. He downplayed the seriousness of the procedure and didn't mention that there would be pain and bleeding until I asked him what problems or risks were associated with the procedure. When I asked him if I needed to be careful about what I ate, such as not eating acidy fruits after the procedure, he said no, that would be no problem. This seemed counterintuitive and in fact contradicted what I've read in these experience reports as far as how various acidy foods cause pain when eaten post-op. He didn't mention anything about possibly needing time off from work or go into any details about what I'd need to do for post-op self care. On the up side he seemed happy to answer my questions without rushing, though his explanations turned out to be very superficial.

As I could tell Rezvan was downplaying the downside and revealing as little as possible in order not to scare me off and to get my business, and because I was quoted $1400 for each of two grafts, plus $460 for IV sedation and $112 for the initial consultation, making this a huge expense ($3372 total) the coverage of which his office claimed there was really no insurance I could buy, I did a bunch of research on the web to check on my options.

ADMA looked attractive because they don't have to slice into the palate to acquire donor tissue. But I concluded ADMA isn't a good alternative partly because there have been questions about how ethically donor tissue is sourced. In other words, they hopefully aren't outright stealing tissue from random dead people around the world anymore (http://www.tga.gov.au/media/2006/060629-alloderm.htm and http://www.redorbit.com/news/health/242746/lip_injections_made_from_cadavers/), but they may be pushing contracts for release of body parts for "medical study" into the hands of bereaved family members in emergency rooms who can't think straight and aren't in any shape to read the fine print. There are too few safeguards in place and there have been complaints and problems in the past. Who wants to receive a "donation" that may have been sourced through theft, coercion, deceit, or worse? Also, this article http://www.thejcdp.com/issue026/rahmani/05rahmani.htm says "Harris41 concluded an acellular dermal matrix and a subepithelial graft can produce similar amounts of root coverage in a short-term period.  However, the results with an acellular dermal matrix tended to break down in the long-term, while the long-term results with a subepithelial graft tended to remain stable.  In that study only 32% of the cases treated with ADMA demonstrated improved results or remained stable with time." So it's not even all that effective in the long term.

I decided to see a different dentist in order to seek a referral to another periodontist who talks a bit more frankly about the procedure, has a lot of experience, and hopefully offers a price closer to market (perhaps $1000 per graft) and some of the things which seem to provide patients with the best op and post-op experiences according to these reports, such as SCTG (sub-epithelial connective tissue graft) rather than FGG (free gingival graft), sewing the palate closed thoroughly after removing tissue, covering the wound with putty/packing, good education about post-op self care, and IV sedation.

Will update.

Update Apr. 7, 2009

I used yelp.com reviews to find a very well reviewed periodontist, Paola Guglielmoni, in San Francisco. She had great bedside manner and showed a genuine interest in making sure I understood my options and had all my questions answered.

She had a very different assessment from Dr. Rezvan had made. She said because my oral hygiene is excellent I will likely never lose my teeth whether or not I get a gum graft. There'd only be a chance of problems occurring in the future if for some reason I weren't to keep my oral hygiene excellent. This immediately rang much more true than what I'd heard from Rezvan because I recalled my grandmother having been extremely "long in the tooth" or in other words having remarkable recession like I am gradually getting, but not losing any teeth because she brushed well. I realize this is not the case for many people with recession as a result of not taking good care of their teeth, but it seems to be the case in my family line, that we just have a genetic predisposition to have thin and receding gums.

Paola said she'd have the graft done if it were her mouth, just to reinforce the teeth and gums to make sure there were no problems in the future, but she said there was no hurry. I could wait a year or two or longer and it should be no problem. Huge contrast with Rezvan who said don't wait more than a few months, and definitely not a year. The reason to have the procedure within a year or two is basically in case the gums noticably recede further and there is less tissue to attach a graft to then it could be more difficult to have a successful surgery with a graft that sticks. She also said in 2 to 5 years some periodontists should have the technology in house to grow a living piece of a patient's tissue in a lab instead of taking a chunk out of the roof of your mouth and transplanting it, so this procedure should become a whole different ball game in just a few years, certainly far less painful and traumatic to the mouth and people's lives.

Another key thing that came up in Paola's office was she said my teeth are not at all loose. I had mentioned to Rezvan before that I had this feeling my teeth might be getting loose, a fear I started to have after my dentist told me my recession might lead to all my teeth starting to fall out, and he checked their looseness and then didn't comment on my fear. Paola checked carefully and said my teeth were absolutely not loose or at risk of falling out anytime soon. Huge relief!

Paola thought the idea of using IV sedation for a gum graft was totally overkill and said her patients have no problem going with just a local anaesthetic, particularly the shot in the upper palate that some people in this experience group said was a nightmare. She said getting the shot only hurts for about 30 seconds and isn't that painful, that her patients tolerate it well unless they're super needle or pain-phobic. While this contradicts what many people here said, Paola definitely has my trust because of the great reviews she gets from her patients and from her caring and attentive bedside manner.

Also Paola only charges $1400 for the procedure to graft on gums of teeth 24+25, and she said it was unnecessary to graft on tooth 11 because the recession only measures 3. I spent $165 on the consultation with Paola but it saved me nearly $2000 on what I would've paid going to Rezvan for the procedure.

The moral of the story is: Don't just take your dentist's referral and go to whatever guy down the street they know that does gum grafts. Get a second opinion before you do anything, and get it from somebody who's been doing this long enough to have a bunch of rave customer reviews on the internet about their work. You might save yourself a lot of pain and money! A search about Dr. Rezvan's work on the internet and on yelp turned up absolutely nothing, so no reason to trust what that guy says, whereas Paola had pages of glowing reviews. My experience with the two different doctors very accurately mirrored the reviews I came up with through the internet search.

The other moral of the story is: Use an electric toothbrush. I was using a "soft" toothbrush all these years and it wasn't nearly soft enough. Now that I'm using an electric brush, my teeth feel way cleaner every day and the toothbrush also feels softer and is easier on my gums, slowing whatever natural process of recession is taking place. I can at least thank Rezvan for suggesting this change.

The other really interesting thing is that although my gums and teeth felt weird and sometimes a bit sensitive or slightly uncomfortable off and on after my dentist initially told me I have a recession problem and might start losing teeth and need to see a specialist to consult about a gum graft, after I got the good news from Paola and started to see my mouth as basically quite healthy and not in any imminent risk of tooth loss, all those symptoms of gum and tooth discomfort completely disappeared. Within a few minutes of leaving Paola's office I felt a huge relief of anxiety and I happily started eating hard, chewy things I'd been avoiding for months out of fear of knocking my teeth out. It's been over a month since then and my teeth and gums feel absolutely fine! They feel strong and normal and I have no discomfort at all. I evidently had been having symptoms that were entirely psychosomatic out of fear that something was wrong with my mouth and I could be about to lose teeth. Two big thumbs down to my former dentist doctor Haller for that screw up, and thanks to Paola for clearing it up. I am seeing doctor Wu as my new dentist in Sunnyvale in May. She's more expensive but now that I've learned the high cost to me of poor diagnosis and poor service I got from Haller and Rezvan I know the money will be well spent going with a doctor who like Paola gets stellar reviews from her patients who are so happy with the service they're motivated to go write about it on the internet review sites like yelp.com.

Will update again when I eventually get a gum graft (when I have more money). Fortunately there's no hurry!

elforestero elforestero
36-40, M
4 Responses Mar 13, 2009

Hey, how bad is your gum recession?<br />
Can you see the pulp on any of them?

I agree entirely on a several points: <br />
1) Pick your surgeon carefully. At $1,200, per tooth, everyone wants to do this to you. Some do it very well, but many do not, and the experience is night and day. Stay far away from anyone who wants to do free gingval grafts - quick, brutal, and terribly, needlessly painful. <br />
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2) You do NOT want IV sedation, unless it's given in an operating room by an Anesthesiologist. Speaking as a physician who gives sedation, this involves significant risk even in the most trained hands with the best monitoring. With all due respect to dentists and periodontists, you don't want them giving you drugs that can stop your breathing. Furthermore, you won't need it. My graft procedure was less uncomfortable than having fillings done, and the anesthetic shot does NOT hurt because they numb you with topical lidocaine first. If you can handle gating a cavity filled, you'll have no problem with gum graft. <br />
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3) Also agree with being careful before signing up at all. Get someone with no financial interest in the outcome to explain very clearly and persuasively why this needs to be done, and what the expected benefits are.

i hope all goes well

Wow. Sounds very painfull and expensive! Let us know<br />
<br />
how it turns out!