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Summary

Gingivectomy is the surgical procedure used to incise the gums in the process of reshaping them for conditions such as periodontitis, gum enlargement, and gummy smiles. Gingivectomy should not be performed if there is any inflammation or if the pockets in the gums around the teeth are not too deep.

Before gingivectomy, the doctor will take your complete medical history, perform blood and radiological tests, and make you sign a consent form. They will also perform a cleaning procedure of your teeth and gums to prepare it for the surgery. The doctor will administer local anaesthesia before the procedure to numb the area. The surgery may be performed by scalpel, laser, or electrosurgery technique.

Once the anaesthesia wears off, you can resume your activities. You may take pain medication as prescribed to lower the discomfort. Eat soft foods and avoid hot drinks for a while after the surgery. You will have to visit the doctor for a follow-up after a week, but if you notice symptoms like nausea, fever, pain that lasts for a day after the surgery, contact your doctor immediately.

  1. What is gingivectomy?
  2. Why is gingivectomy recommended?
  3. Who can and cannot get gingivectomy?
  4. What preparations are needed before gingivectomy?
  5. How is gingivectomy done?
  6. How to care for yourself after gingivectomy?
  7. What are the possible complications/risks of gingivectomy?
  8. When to follow up with your doctor after a gingivectomy?

Gingivectomy is a surgical procedure performed for cutting and reshaping gums.

It is usually done for the treatment of periodontitis (gum disease) when antibiotics and non-surgical treatment (scaling and root planning) do not help. A gingivectomy is also done in conditions like gum enlargement or to correct a gummy smile. The procedure is done by an oral surgeon or a periodontist (gum specialist).

The gums (gingiva) and bone should fit tightly around the teeth. In periodontitis, the damage to the bones and gum leads to the formation of “pockets” around the teeth. Over time, the bacteria build in these pockets and result in tissue and bone loss.

Gingivectomy is indicated in the following conditions: 

  • Pockets caused between the gums and teeth due to periodontitis
  • Enlargement of the gingiva due to a condition known as gingival fibromatosis
  • Gingival enlargement that may be caused by drugs such as phenytoin, cyclosporine, and nifedipine
  • Correction for a gummy smile

The surgery is also recommended for periodontitis the symptoms of which are below:

Symptoms associated with gingival fibromatosis, for which the surgery is recommended include:

  • Progressive enlargement of the gingiva, occasionally covering the entire tooth 
  • Interference with chewing and closing the lips that may affect speech
  • Interference in tooth eruption
  • Prolonged retention of primary teeth
  • Incorrect positioning of the teeth

Gingivectomy may have contraindications depending on the physical health and conditions of the mouth of the person undergoing surgery.

Gingivectomy is contraindicated in the following conditions:

  • When the gum pocket is not very deep
  • Swelling of gingiva is due to inflammation
  • If the pocket extends below the alveolar crest (top part of the bone that holds the teeth)

You may need the following preparation before the surgery: 

  • The doctor will take your general medical history and ask you to undergo the following tests for the evaluation of your health:

  • The doctor may clean the oral cavity to remove all the dental plaque before the surgery. He/she will also give you instructions on cleaning your mouth.
  • Tell your doctor if you are taking any medicines, including any herbal medication. The doctor may ask you to stop taking some of them for a while before and after the procedure.
  • Discontinue smoking as it may delay healing and increase your risk of developing gum infections after the surgery.
  • You will be asked to sign a consent form before the surgery.

The surgery can be performed by any of the following methods:

  • Scalpel gingivectomy: In this method, a scalpel is used to cut the gingival tissue. 
  • Laser gingivectomy: A laser is used to cut the gingiva and thus expose the required tooth.
  • Electrosurgery: In this technique, doctors use electric current to produce heat in a device, which in turn helps cut the gingival tissue.

The procedure for the surgery is as follows:

  • The doctor will administer a local anaesthetic to numbs the area to be operated. 
  • They will make a marking in the region that has to be removed. 
  • Then, the doctor will make an incision along the marking, and excise your gingival tissue. 
  • He/she will shape your gingiva and scratch it to take out the remaining skin tags.
  • After the procedure, a periodontal dressing (putty) will be put on the area. The putty will give protection to the gums while they are healing. 

Not many precautions are needed after a gingivectomy, however, you should keep the following things in mind while at home after the procedure:

  • Resume your normal activities only after you are out of the effect of anaesthesia. Your gums will take a few weeks to heal completely.
  • Apply an ice pack on the area after the surgery and do not consume any hot fluids for a day.
  • You will be able to eat soft foods (eggs, bananas, and pasta) and take little warm or cool fluids (milk, juice and milkshakes) when the dressing is in place.
  • You can remove the surgical dressing after five days. 
  • You may be asked to rinse your mouth daily with a 0.12% chlorhexidine gluconate solution two times a day for two weeks.
  • It will be easier to clean your teeth and gums after surgery. When you brush and floss, use limited water, and do not touch the wound. 
  • You may take pain medication such as ibuprofen or paracetamol to lower the pain after surgery.

Gingivectomy, along with good oral hygiene practices, can help stop gum diseases and make your gums healthy and pink again. This will be because you will be able to clean around and between the teeth properly after the surgery.

When to see the doctor?

Visit or call your oral surgeon when you observe any of the following:

  • Bleeding at the site of surgery for four hours or more after surgery
  • Fever
  • Nausea and vomiting
  • Swelling after two days of surgery
  • Pain that does not subside after a day of surgery

Gingivectomy presents the risk of introducing bacteria into your blood. An infection may also occur in the gum tissues. In the following conditions, you may require antibiotics before the surgery as well as after it:

  • If you have a weakened immune system 
  • If you have any heart problems that will lead to complication such as endocarditis (infection in the heart)
  • If you have had any surgery recently
  • If you have any artificial body parts such as a heart valve

A follow-up appointment takes place about a week after the procedure. During the appointment, your doctor will observe your teeth and gingiva to check your healing.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Michigan Medicine: University of Michigan [internet]. US; Gingivectomy for Gum Disease
  2. American Academy of Periodontology [Internet]. Illinois. US; Peridontal pocket reduction procedures
  3. Shetty AK, Shah HK, Patil MA, Jhota KN. Idiopathic gingival enlargement and its management. J Indian Soc Periodontol. 2010 Oct-Dec; 14(4): 263–265.
  4. Narayan S, Narayan TV, Jacob PC. Correction of gummy smile: a report of two cases. J Indian Soc Periodontol. 2011 Oct;15(4): 421–424. PMID: 22368373.
  5. Tungare S, Paranjpe AG. Drug Induced Gingival Overgrowth (DIGO) [Updated 2019 Dec 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan
  6. Cleveland Clinic. [Internet]. Cleveland. Ohio. US; Periodontitis
  7. GOLDMAN HM. Gingivectomy. Oral Surg Oral Med Oral Pathol. 1951;4(9):1136-1157. PMID: 14882786.
  8. Dhadse PV, Yeltiwar RK, Pandilwar PK, Gosavi SR. Hereditary gingival fibromatosis. J Indian Soc Periodontol. 2012 Oct;16(4):606–609.
  9. International Congress of Oral Implantologists [Internet]. New Jersey. US; Alveolar Crest
  10. Goldman HM. Gingivectomy; indications, contraindications, and method. Am J Orthod Oral Surg. 1946 May;32(Oral Surg):323–326.
  11. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Otolaryngology-Head and Neck Surgery
  12. Mostafa D. A successful management of sever gummy smile using gingivectomy and botulinum toxin injection: A case report. Int J Surg Case Rep. 2018;42:169-174. PMID: 29248835.
  13. Babaji P, Singh V, Chaurasia VR, Jawale MR. Electro surgery in dentistry: report of cases. J Pediatr Dent. 2014;2(1):20–24.
  14. Canadian Dental Association [Internet]. Ottawa. Canada; Care after Minor Oral Surgery
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