What is the aftercare for the first week after a gum graft?

What to expect, step by step

Stop lifting your lip to look at it

This is the instruction patients ignore most and the one that does the most avoidable damage. A gum graft is sutured under tension in the exact spot your lip stretches over. Pulling the lip or cheek outward to see the site applies direct pull to the graft margin.

The graft has no blood supply from the tooth root underneath it. It depends on new vessels growing in from the tissue at its edges over the first days. Repeated stretching in that window is precisely how a margin gets pulled away before it has taken hold.

The urge to check is strong because the graft passes through an alarming white phase in the first week. That white film is normal fibrin, not dead tissue. Knowing that in advance is usually enough to stop the mirror checks.

If you need reassurance, take one photo with your phone using minimal lip movement, or better, send a photo to your periodontist's office. Most practices would much rather look at a picture than have you tugging at the site several times a day.

The first week checklist

Everything on this list is about protecting a graft that is still building its blood supply.

• No brushing or flossing at the graft site, which can damage it and lead to failure
• Brush every other tooth in your mouth normally, twice a day
• Use the antimicrobial rinse your periodontist prescribed, on their schedule, without vigorous swishing
• Soft, cool foods only, chewed on the opposite side
• No straws, no smoking, no vaping, no alcohol
• No exercise, heavy lifting or strenuous exertion for at least the full week
• Do not pull your lip or cheek out to look at the graft
• Do not touch the site with your tongue, fingers, toothpicks or interdental brushes
• Keep the palatal stent or dressing in exactly as instructed
• Sleep with your head slightly elevated for the first couple of nights
• Keep your follow up appointment even if you feel fine

Palatal stent care

If a clear acrylic stent was made for the roof of your mouth, it is shielding an open wound from food, your tongue and pressure. Protective coverings for the palatal donor site are used specifically to improve patient comfort and protect healing.

Instructions vary between practices. Some have you wear it continuously for the first days including meals, some have you remove it to eat and clean. There is no single correct answer, so follow what you were told rather than a general rule from the internet.

When you do take it out, rinse it and clean it the way you were shown, and put it back promptly. Do not scrub the exposed wound while the stent is off, and do not leave it out for hours because it feels strange.

Expect it to affect your speech for a few days. That is normal and temporary. A stent that has cracked, gone loose, fallen out repeatedly or is digging into tissue is worth a call for adjustment.

What is normal in week one

Swelling, tenderness, pink tinged saliva, a white or gray film over both wound sites, sensitivity to temperature, mild bruising in the cheek or lip, and stitches you can see or feel are all expected.

So is the graft looking wrong. It will be pale, raised, outlined and a different color from the gum next to it. It should look that way in week one.

What is not routine is pain that is increasing after day 4, bleeding that will not stop with pressure, fever, pus, or a firm patch of white tissue that has come off the tooth. Those get a phone call.

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