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If you’ve recently had a gum graft and it looks a whitish gray you may be wondering why? Is it normal or should you be concerned?
First, let’s put your mind at rest. Yes, it’s normal. The graft isn’t infected or failing.
During the normal healing process, the gum graft site goes through many color changes. It will get red and puffy, then white or gray with sloughing for up to two weeks. The tissue will change to pink or the natural color of your gums as the area heals.
The dentists here at Gum Disease Guide aim to explain why the gum graft may look gray in this post.
The Graft Procedure Creates A Wound
When you have a gum graft, soft tissue from the roof of your mouth, healthy gum or donor tissue is placed over the graft site and sutured into place.
In the case of a connective tissue graft, the recipient site (the area of gum recession) is first prepared. A bit of gum is separated from the bone exposing a bleeding area.
A graft site is also prepared for a free gingival graft. A small amount of surface epithelium is removed.
The graft area becomes a wound that needs to heal. Your body has everything it needs to heal the area. As the wound heals the area changes color and can look a whitish gray at times.
The healing process is discussed below and explains why you might notice gray tissue around the injury site.
The Healing Process
There are 4 main stages in the healing process. This process is similar to wound healing in any other part of the body.
- Rapid hemostasis – vessels constrict to restrict blood flow and platelets stick together with threads of fibrin to make a clot.
- Inflammation – pro-inflammatory cells and growth factors are released from the graft and surrounding tissue. The area swells.
- Proliferation – Granulation tissue forms in the third stage of healing. Cells involved in tissue and blood vessel regeneration migrate to the area. Collagen is synthesized, and epithelial tissue and blood vessels form to deliver blood to the area.
- Tissue remodeling – the blood vessels and tissue matures.
Why Does My Gum Graft Look Gray?
When you have a gum graft, whether it is a free gingival, connective tissue or a pedicle (lateral) graft the soft tissue binds the root surface underneath and the neighboring bone surface. For the graft to be successful new blood vessels must form, in a process called angiogenesis. These vessels bring the blood carrying oxygen and immune cells.
The grafted material can often look gray until a blood supply is established. Gum tissue requires a blood supply, which gives it pink/red color. The grafted material is not connected to the blood supply. Without a blood supply, it looks pale.
During the wound healing process, the grafted site will go through many color changes as the area heals and develops a blood supply. We’ve indicated some of these stages below.
There’s No Blood Supply
At the time of transplantation, the area with donor tissue looks pale as there is no blood supply to the area.
In 2 days it becomes grayish white due to a lack of oxygen in the tissue (this happens because the blood supply to the area has not yet been connected), and then it gradually changes to your normal gum color as the grafted tissue develops a blood supply and the tissue matures.
Swelling
The graft will also look swollen as the surrounding tissue delivers plasma (the fluid that carries blood, white and platelet cells around the blood vessels) to the area. As the blood vessels grow into the grafted gum tissue the swelling subsides.
Granulation Tissue Develops
You may also notice that the area is shiny at first, but after 2-3 days it becomes grainy as granulation tissue develops to protect the site until the new gum tissue can form.
The granulation tissue plays a key role in repairing the area and protecting it from damage. It is new connective tissue, immune cells and microscopic blood vessels forming on the surfaces of a wound.
The very top layers of the graft become thin and gray as the grafted gum tissue starts to heal between days 4 and 11. Then as the grafted material starts to mature the grafted tissue looks more like gum tissue in the rest of your mouth.
The Surrounding Gum Tissues Look Red
You may also find that the area around the graft looks red and inflamed for 3-4 days post-procedure.
When To Call The Dentist
If you have any concerns about your gum graft your periodontist should be your first port of call as they know about your specific case and are in the best place to advise you.
If you experience any of the conditions listed below, contact your periodontist immediately for treatment.
- Yellow or white pus or fluid oozing from the site
- Brown or black tissue
- Persistent inflammation
- Sharp pain when you eat or speak or a constant dull ache
- Loosening sutures
Final Thoughts on Why Does My Gum Graft Look Gray
Graft sites are often covered with a surgical dressing to protect the surgical site and keep you comfortable. This usually stays in place for 7-14 days. It’s unlikely that you will see the color changes taking place under the dressing.
You should lightly brush only the biting surfaces of the teeth in the areas where the dressing is. This will help protect the graft. Remember to follow any advice you have been given following your surgery such as what to eat and when to exercise.
In the other areas of the mouth, you should maintain excellent oral hygiene, brushing the teeth twice a day with an electric brush and carefully cleaning the interdental spaces with a Gum Pocket Brush or interdental brushes.
