Gum recession

By Dr. George Ghidrai

Receding gums can be scary and uncomfortable...

Gum recession can change the look of your teeth (they will appear longer than normal) and can lead to an increased teeth sensitivity to cold, sugar, and brushing.

What is gum recession?

Gum recession or gingival recession is the process in which the margin of the gum tissue that surrounds the teeth, pulls back, exposing more of the tooth, or leaving part of the tooth's root naked.

The healthy gum

In a healthy situation, teeth erupt into the mouth with the roots fully centered in, and surrounded by jawbone. The gum tissues operate like an investing curtain covering the bone; they surround the necks of the teeth acting as a seal to prevent food from settling in between the teeth.

healthy gum tissue

types of gingiva

There are two types of gingiva in the mouth:

• attached gingiva: a 2-3 mm band of bright pink tissue firmly attached to the underlying bone (marked with a, image above)
• the mucosa, or unattached gingiva: a darker, larger area of unattached gum tissue that folds into the cheeks (marked with b, image above)

Gingival recession occurs when the edge of the attached gingiva (called the gingival margin) moves away from the crown of the tooth. Many times, the spaces between teeth can open up as the gum recedes, allowing food to get trapped.

What are the causes of gum recession ?

Gum recession is not inevitable. It is true that gum recession can occur as we age, even in a healthy mouth, but a lot can be done to keep this process to a minimum. There are a number of factors that can cause gingival recession:

1. Periodontal disease

   Periodontal diseases are probably the most common causes of gum recession. Periodontal diseases are plaque-induced inflammatory conditions that affect one or more of the periodontal structures : gingiva, alveolar bone, cementum, periodontal ligaments.

   Gingival recession is a sign that usually occurs in the later stages of gingivitis. When gum recession is caused by periodontal disease, the gums are normally bright red and swollen, tender or painful to the touch and may be bleeding after brushing or flossing.

   As a result, if your oral health habits are questionable, gum recession may be a result of periodontitis.

2. Abnormal tooth positioning

   Crooked or misaligned teeth (or bite) can cause gum recession. Here is the reason:

   When a tooth is not in its normal position, it will erupt outside of the protective bony housing. This means that at least on one side, the bone surrounding the tooth is thin or non-existent. Since the gum tissue has to cover the bone, a thin or non-existent bone will result in thin or no gum tissue.

   This is an important consideration for orthodontic tooth movement. During orthodontic treatment, if tooth roots are moved outside the bony housing, gum recession is likely to follow.

3. Genetics

   Some people are born with an inherently thicker type of gum tissue, while others have very thin tissues. Another important factor is the band of attached gingiva. If this band is too thin, it can be easily compromised by trauma or periodontal disease, both of which contribute to gum recession.

   Moreover, if one or both of your parents have gum recession, you're at a higher risk for receding gum.

4. Aggressive tooth brushing

   Over-aggressive tooth brushing can traumatize, inflame and tear gingival tissues, resulting in gum recession. Of course, it is great to be keen about oral care, but remember that it doesn't take force to remove bacterial plaque.

   First, use a soft toothbrush and make sure to change it as often as needed (every 4 weeks for a manual toothbrush and every 3 months for an electric toothbrush head). Brush gently and use a toothpaste that is not too abrasive (see tooth brushing technique).

5. Bruxism or grinding your teeth

   Involuntary grinding of the teeth (especially during the night) can cause many dental problems. Clenching or grinding your teeth can put too much force on the teeth, causing gums to recede.

   Be sure to inform your dentist right away if you think you are grinding your teeth. Teeth grinding can be treated with a nightguard (you should wear it at night while you sleep) and several other options.

6. Other causes

   • Trauma to gum tissue -- The gum tissue may recede when a traumatic injury has occurred on a tooth or teeth.
   • Tobacco products -- Tobacco users are more likely to have sticky plaque on their teeth that is difficult to remove and can cause gum recession.
   • Piercing of the lip or tongue -- Piercing can rub the gums and irritate them to the point that gum tissue is worn away.

How can we prevent and treat gum recession ?

A lot can be done to prevent and treat gum recession. Many times, gingival recession is a result of a combination of factors and its causes are not always simple to determine.

To figure out why your gums are receding it is best to see your dentist. Your dentist will help you identify the cause and will instruct you on how to address it. Treatment methods vary according to the type and severity of the recession:

• If gum recession is due to excessive or aggressive brushing, a staff member can show you more effective oral hygiene methods. You may also have to re-evaluate your flossing habits, get a mouthguard (in case of bruxism) and buy a softer and better toothbrush.

• If recession is due to periodontal disease, the first step usually involves a special cleaning, called scaling and root planing (see gingivitis treatment). For many patients, this treatment along with excellent oral hygiene at home and regular dental checkups can help stop periodontal disease and prevent further gingival loss.

• Sometimes gum recession can be caused by crooked or misaligned teeth or an improper bite. If this is the case, your dentist may recommend orthodontic tooth movement to reposition teeth within their bony housing.

• Some cases with a more advanced recession may need a surgical approach. The procedure is called gum graft. A gum graft is a relatively simple surgical procedure which aims to cover an area of exposed tooth root surface with grafted oral tissue.

  an example of gum graft to cover
  an area of exposed tooth root

In any case, when minor recession is ignored, continued recession and bone loss around teeth are likely. Catching the disease in an early stage may reduce the treatment procedure to some simple instructions: gentle brushing and flossing, avoiding trauma, cleaning the gum line gently etc. Therefore, it is best to see your dentist as soon as you notice the first signs of gum recession.