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What causes swelling in the gums?

DOCTOR OF THE MONTH - May 2018
May 2018
User rating for this question
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Answered by

Dentist
Practicing since : 2011
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the patient had guided tissue regeneration

1.Bottom right of mouth – gums torn after a procedure in October 2017 –– I don’t want to leave my gums flapping around I was told by a periodontist that they will not heal properly that way and need to be corrected so things do not get in there - been in pain – looks so bad compared to prior to surgery (it’s disfigured) .Could you please explain the situation to me? Is gum grafting an option there? Can you reattach the gums? This is huge problem for my personal appearance, and I’ve has been in pain, etc . Could you please explain what the problem / complication is? Could you please repair this? What underlying tissue/bone is the exposed? What will it look like after? What treatment options do I have?? Could you please provide some options and recommendations>?


2.Can you reconstruct the papilla? Please see before and after phoots of surgery. I am very disappointed with what happened with my papillas . can you do grafting on them, etc to reconstruct them? Can you provide me with options and recomemdnations?


3.Did the grafting take in the top of my mouth? Did the grafting take in the upper front part of my mouth? It looks horrible to me. It doesn’t look like the graft took and it doesn’t feel good at all. Do you agree? I received several dental opinions that I should have you or a qualified another qualified periodontist take the grafting out that was put in during the procedure taken out. I was thinking in the front upper 4 teeth for sure. Will you please do this for me and make it a lot better aesthetically ?the gums are separated from the papillia are not continuous with the free gingiva that way they were prior to surgery - can you please make it continuous the way it was prior to surgery and remove the grafting and reposition the LABIAL FRENUM to where it was prior to surgery? Could you please provide some options and recommednations>? did the graft take? the papilla is smaller, and is not as continuous with my free gingiva – this does not look like any other gum grafting that I’ve had in the past . I really do not feel good about the appearance. The papillas look almost completely lost now.




4.Do you recommend extracting any teeth and putting dental implants with other grafting? Will this improve my mouth health? Would it Make things better aesthetically?

5. Can I get the grafting removed or redone? I hate the way it looks

see attached photos of problems

Tue, 17 Apr 2018 in Dental Health
 
 
Answered by Dr. Honey Arora 43 minutes later
Brief Answer:
Please provide clear pictures.

Detailed Answer:
Hi..
So sorry to hear about the discomfort that you are facing.
Will try my level best to help you here.

I have viewed the images but they are blurred on magnification and also dark.

So first of all please attach clear and bright pictures.
From the images as much I can assess is that the papillae are not continuous with free gingiva because there is swelling of the gums.

Secondly I would like to know when was the treatment done, appropriate date?
It will help in explaining that you should wait for some time or not?

Do you still have pain present?

Also do you have any latest x rays, if yes please upload?

Please revert back..

Regards..
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 24 minutes later
see attached photo titled post surgery

the free gingiva between the middle front two teeth lifts up and it looks like the papillia is gone and the grafting does not feel well or look well either. could you please try to answer my questions.

what would oyu do if this was your son or your brother?

yes there is pain
 
 
Answered by Dr. Honey Arora 49 minutes later
Brief Answer:
It can take 6-8 weeks for healing to complete.

Detailed Answer:
Hi..
I have seen the image and gums appear slightly swollen and also the right lateral incisor still have gum recession..

If there is pain then it is still not a good sign..

If the free gingiva is detached and easily lifts up then probably the graft is not properly attached.
In that case the gum grafting can be redone.

-If your teeth are firm and immobile then getting them extracted and placing implants should be avoided..

-Loss of interdental papilla solely because of soft tissue damage can be restored completely by reconstructive techniques; but reconstruction is generally incomplete if the loss is due to severe periodontal disease and interdental bone resorption.

So please get a panoromic x ray done as I need to see that is the interdental bone still present or is lost..

If it is lost then complete restoration of interdental papillae is not possible.

Hope this helps..

Regards.
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 40 minutes later
can you please review IMG_0180.PNG      what is happening to the gums on the bottom right part of my mouth? why is the flap loose? why is the , alveolar bone. D, subepithelial connective tissue. E, oral epithelium. F, free gingival margin. not all proper? what is happening to me it looks disfigured?

please see xray copy "xray now" to see if interdental bone is still present or is lost?

is there still a papilla in between the upper front middle two teeth? can it be restored completely and by what reconstructive technique?

how are you smart like this if you are only a general dentist?
 
 
Answered by Dr. Honey Arora 28 minutes later
Brief Answer:
When was the graft and GTR done?

Detailed Answer:
Hi..
Can be please tell that when was the treatment done, I need to know the approximate time?

Answers to your questions:

-In the image of the lower right side I can see the gums are not attached, rather the papillae are considerably covering the interdental area..
The root exposure is there due to lack of bone in that area..
So in lower right side, surgical contouring can be done..
Gum grafts can also be placed to properly contour the area.

In your x rays, I can see significant bone loss.
Due to bone loss there is recession of papillae and you can see black triangles in between your upper front teeth.
This can be attempted to recontour by surgical procedure, using a palatal graft.

But anything can be re-attempted if there is no significant improvement in the specified time that is needed to heal the surgical site after surgical procedure..

So please let me know that how long it has been since you have got the treatment done.

Please revert back..

Regards.
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 3 hours later
the procedure was done 2 -3 weeks ago.
Follow up questions:

1. I'm not sure if i understand what you mean by recontour the papilla using palatal graft - do you think the papilla in between the middle front two teeth can be restored completely or improved?
2.how soon can surgical contouring be done to the lower right side of the mouth where the gums are attached? how soon can gum grafts be placed there?
3. The the free gingiva in the photo "post-surgery" is also detached and /lifts up and is in pain - does this mean that the graft is not properly attached.? what treatment would you recommend? In that case the gum grafting can be redone" how long after the surgery can the grafting be redone? how is it redone ? can the grafting still be removed at this point? can the papillia be restored? will the appearance be better?
4. if the gum graft looks too thick compared ot the rest of the tissue what can the patient have done to thin out the tissue?
5. can the patient simply have the grafting removed? how is gum grafting "redone" if it is not originally not attached?
 
 
Answered by Dr. Honey Arora 48 minutes later
Brief Answer:
You can wait for some time.

Detailed Answer:
Hi..
As the procedure is done 2-3 weeks ago, you can wait for another 1-2 weeks and see how it progress.

Now answers to your questions.

1.Yes the papillae can be improved but less chances to restore completely.

2.Wait for another 2weeks as the gums are still under healing phase.

3.The free gingiva is appearing swollen and it can be a cause for it to appear soft and spongy making it lift.

4.If gum graft is appearing very thick then it can be corrected but the patient cannot do it on its own, rather the Dentist has to do it.

5.No the graft cannot be removed and left as it is, as some portion must be attached to the underlying tissues..
New gum graft procedure will require a thin graft from other donor sites like the palate and then placed or packed at the recession site.

Hope this helps .

Regards..
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 1 hour later
additional questions:

1. still in pain where the grafting lifts up and the free gingiva is detached

you said --- If there is pain then it is still not a good sign.. What is the problem?

If the free gingiva is detached and easily lifts up then probably the graft is not properly attached.
In that case the gum grafting can be redone

If the patient was your brother or son, what would you recommend for that sitatuion? The patient wants it improved or redone. can it be done in a week or two What options are there?

2. If the patient requests a new gum graft procedure how is this done? Will the old graft that is not properly attached be removed at the time of the procedure?
 
 
Answered by Dr. Honey Arora 2 hours later
Brief Answer:
Pain can be due to Infection or graft failure.

Detailed Answer:
Hi..
Pain can be due to Infection in gums or graft failure.
So for a confirmation, a clinical examination and probing is a must...

You should wait for a period of about 15 days..
If there is no improvement then a clinical examination should be done..

The sloughed old graft can be removed and fresh graft can be placed..

Hope this helps..

Regards.
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 2 hours later
can you please review the picture "before" and "post-surgery" . do you notice how the free gingiva is not attached the way it was in the before photo? everyone says the grafting looks so bad and is not connected to the free gingiva and there is pain there/
what would you recommend to your patient (say if it was your brother or son). do you think the grafting can be redone to make it look like the before photo and also attach the gingiva?looking at the before photo and the post-surgery photo did the patient receive a FRENECTOMY?

 
 
Answered by Dr. Honey Arora 11 hours later
Brief Answer:
Get a clinical examination done.

Detailed Answer:
Hi..
A clinical examination is needed to see what is the extent of attachment of free gingiva..
As per image it is appearing unattached..
As I explained before gum grafts can be re done.

Soy suggestion would be to consult a Periodontist and get evaluated..

For seeing whether Frenulectomy was done or not please upload clear picture.
The images are blurred on magnification.

Get some else to click pictures for you and you hold the upper lip elevated upwards..

Please revert back with clear picture..

Regards.
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 43 minutes later
see attached photo of my gums today "upper front 11 4 2017" .



why are the gums lifting up and not connected to the papilla? why is the papilla not there anymore? what can be done
was a Frenulectomy done?

Thanks
 
 
Answered by Dr. Honey Arora 43 minutes later
Brief Answer:
Frenulum is present.

Detailed Answer:
Hi..
Frenulum is present and clearly visible..
The gums are lifting due to incomplete attachment to underlying tissues..

Hope this helps..

Regards.
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 1 hour later
1. Can the papillia in the most recent photo I sent you be reconstructed.
2. What do you recommended due to the incomplete attachment ? Can the gum grafting be redone? Does that mean the graft failed?
3. What do you recommend to improve aesthetics of the gums? Redo the gum graft and reconstruct the papillia? Can the situation be improved?
 
 
Answered by Dr. Honey Arora 5 hours later
Brief Answer:
Yes, the condition can be improved.

Detailed Answer:
Hi..

Answers to your questions:

-Yes the graft can be re-done and papillae csn be improved in appearance..

-A clinical examination is a must to see if the graft is completely detached or not and then it it can be decided if it is failed.

-Yes the aesthetic or appearrence will improve.

Hope this helps..

Regards..
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 8 days later
1.please see attached "picture 1" - with that extent of gum recession and bone loss - would dental implants improve appearance for the patient? can the gums and bone be built up so the dental implant does not look as "long"? can the gums be rebuilt or is plastic or some fake pink thing the only possibility there? that tooth is loose would dental implant be a better option?

2.also see picture 0108 - is a gum graft a possibility on the molars there to cover the root? what can be done to approve aesthetics?


3. what can the patient do to approve aesthetics of teeth and gums ?
4. see picture "upper front" the tissue "lifts up" is not "continuous" and is detached. also there is pain under where the gums lift up? what treamtnet options would you recommend? what can be done to approve aesthetics? can the gum graft be redone so the tissue is smooth and continuous? the papillia underneath is barely there now - it is only in the back of the teeth. if you or it was your brother who was the patient, what would you ask the periodntists to do for you?
5. what would you ask the peridontist to do if you were the patient? obviously the patient is not happy . what would ask of a modification surgery(s)?

the patient is desperate for an extensive restorative dentistry so he could have a better life. he is getting harassed everywhere because of this. what improvements do you think can be made? please help.
 
 
Answered by Dr. Honey Arora 15 minutes later
Brief Answer:
Yes, dental implants can be an option.

Detailed Answer:
Hi.
Here are the answers:

1. Yes in upper teeth as they are loose with significant recession, the teeth can be removed and bone graft can be placed followed by implant placement.
If bone graft is done then you will not have the problem of long looking implant or gum simulation is also not needed mostly.

2.There is no picture labelled 0108, so please upload again.

3.To improve Aesthetics proper treatment and replacement of teeth should be done.

4.The gum is lifting due to incomplete attachment of the gum graft, so get it examined by the Periodontist and if the graft is not properly attached then it can be re-done.

5. Ask the Periodontist if he can redo the graft procedure to improve the appearrence as well as attachment of gums to teeth.

Hope this helps..

Regards.
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 6 hours later
that helped

1. do you think the periodontist can redo the graft procedure and reattach the gums in the attached photo - • "upper front 11 4 2017.png" ? do you think the papilla could be reconstructed there?

2. is a gum graft possible in attached photo "IMG_0180.PNG " on each of the teeth in the photo? especially the last molar?

3. can you elaborate on what can be done to approve Aesthetics?

4. I do not understand what you mean when you said ". Yes in upper teeth as they are loose with significant recession, the teeth can be removed and bone graft can be placed followed by implant placement.
If bone graft is done then you will not have the problem of long looking implant or gum simulation is also not needed mostly."

Does that mean gum and bone grafting can be done to restore all of the lost gum and bone tissue without artificial pink acrylic ?

5. what are the most expensive materials used in dental implants? can dental implants or crowns placed on dental implants be shaped to the exact same measurements as the patients own teeth that were taken in a mold?

6. which teeth would look better after being removed based on the photos I attached for you? could you give me the teeth numbers?

7. what are the some of the most advanced procedures and technologies in cosmetic dentistry that are available ?
 
 
Answered by Dr. Honey Arora 2 hours later
Brief Answer:
Answers are provided pointwise.

Detailed Answer:
Hi..
Here are the answers.

1.The graft can be re-done but once a clinical examination has to be done to check for the status of the current graft.
So get examined by a Periodontist.

2. Yes graft can be attempted but Implant can be better option.

3.Grafts and implants as advised in all discussion can very much improve aesthetics.

4.Yes bone graft can help in improving the appearance and the XXXXXXX of implant.

5.Yes crowns can be precised to exact shape and size of natural teeth.

6.Both upper and lower molars.

Hope this helps..

Regards..
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 2 days later
please review " IMG_0164.JPG ". what is the diagnosis ? what treatment options are there?

3. why would dental implants improve aesthetics compared to natural teeth?

4. if I would like crowns précised to the exact shape and size of natural teeth how

5. is it possible to get dental implants on each single tooth

6. would dental implants be a better option in my case
7. can dental implants be made with gum grafting so a patient with severe gum recession does not need to have pink acrylic


this is ruining my life

 
 
Answered by Dr. Honey Arora 12 hours later
Brief Answer:
Please provide more details.

Detailed Answer:
Hi..
I have evaluated the picture and can you tell that have you got gum grafting done in lower right back area also?

Do you have pain in this area also?

As far as your questions are concerned here are a few answers.

-Crowns can improve appearance as implants will be placed after bone grafting and the gum recession will no longer be visible further.

-The tooth size can be precised by taking measurements from your natural teeth.

-Yes, implant can be done on a single tooth also.

-Gum grafting will not be needed with implant as bone grafting will be done..

Please revert back with answers so that I can provide you more details of your queries..

Hope this helps..

Regards..
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 10 hours later
Please review photo IMG_0164.JPG of the upper left part of my mouth where grafting was done in October 2017 - what is happening to the gums there? can it be fixed? can gum grafting be redone to reattach the gums>?
 
 
Answered by Dr. Honey Arora 41 minutes later
Brief Answer:
The image is appearing of lower right side

Detailed Answer:
Hi..
The image you are talking about is of lower not upper side?
Left side pictures you have not attached.
Also it is looking like right side from this image..
So please for better understanding click pictures with midline visible.
Please attach appropriate pictures of the side you are talking about so that I can guide you appropriately..

Please revert back with pictures..

Regards..
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 8 hours later
Hi, I have provided some attachments. Please review them.
 
 
Answered by Dr. Honey Arora 3 hours later
Brief Answer:
Please provide appropriate pictures.

Detailed Answer:
Hi..
In your upper back teeth I can see gum recession but the gums are not completely visible..

So please pull your lip upward and click a picture so that I can see the condition of the gums..

But from the recession that I can see I would not advise you gum graft, rather it is better to get extraction done followed by implant placement..

Hope this helps..

Regards..
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 44 hours later
please see before and after
the picture on the bottom is the after picture
see how the gums are detached below frenulum. they feel bad under there as well

can the gums be reattached to be smooth again just like the before picture?
 
 
Answered by Dr. Honey Arora 11 hours later
Brief Answer:
Get it clinically checked.

Detailed Answer:
Hi.
I have viewed both the images.
First of all a clinical examination should be done to check the level of attachment of the gum grafts..
However if done appropriately the gum grafts can very much improve the appearance..

Hope this helps..

Regards..
Above answer was peer-reviewed by
 
Follow-up: What causes swelling in the gums? 13 minutes later
Does it look like it is attached appropriately.What would you ask the periodontist if you were the patient ? It looks horrible, doyou agreee?the papilla in the front of the teeth is lost too
can this be repaired as well?
 
 
Answered by Dr. Honey Arora 15 hours later
Brief Answer:
Not appearing attached properly..

Detailed Answer:
Hi.
The gums are not appearing attached properly..
Once a thorough clinical examination should be done to check for the level of attachment..
I would ask the Periodontist that what is the level of attachment of the graft and of re-done will it stay?
Papillae can be repaired but complete attachment has less chance due to bone loss..

Hope this helps..

Regards..
Above answer was peer-reviewed by
 
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