Gingival (gum) recession is the exposure of the root of the tooth due to the loss of gum tissue. This is a very common problem in adults over the age of 40 that generally progresses very slowly over time. In some cases recession may start early in life, and sometimes it can progress quickly leading to relatively rapid destruction of the supporting structures of the tooth.
What causes gum recession?
Gingival recession is generally caused by a combination of factors acting together. These factors include:
- Periodontal disease leads to bone loss around the tooth, and to loss of attachment between the tooth and its supporting structures. This leads to gradual recession of the inflamed and unsupported gum.
- Overaggressive brushing or brushing with a hard toothbrush can also lead to gum recession. Improper / aggressive flossing. This can lead to “floss cuts” and the floss cutting into the attachment between the gum and the tooth. The cumulative trauma over time can lead to significant recession.
- Genetic predisposition. Some people naturally have very thin bone and very thin gums around some or all their teeth. Having thin tissues around the teeth is an important predisposing factor for the development of gingival recession.
- Insufficient band of keratinized gingiva. There are two types of soft tissues surrounding our teeth: 1) a firm pale-pink keratinized gum tissue generally sits around the neck of the teeth and covers the palate, and 2) a loose, thin and relatively friable mucosa that does not contain keratin. Sometimes the band of firm keratinized gum is very narrow or absent and the tooth is surrounded by thin mucosa; this increases the risk of progressive recession.
- Smokeless / chewing tobacco, affects the tissues around the teeth and can cause receding gums.
- Acute or chronic trauma can lead to gum recession. Chronic trauma associated with habits, tongue or lip piercings can also lead to progressive gum recession.
- Abnormal tooth position, tooth crowding, and teeth positioned outside of the natural contour of the jaw bone. This can lead to teeth not having bone on one or more of its surfaces and the gum not being supported.
- Occlusal trauma. Tooth grinding or abnormal tooth position can lead to excessive forces on some teeth. These forces sometimes concentrate around of the neck of the tooth and can lead to loss of tooth structure in this area. These forces may also predispose a tooth to gum recession.
The cause of gingival recession is generally multifactorial – i.e., multiple factors acting together lead to the condition.
The treatment for gingival recession depends on the severity of the condition, risk of further progression, specific anatomy of the gum defect(s), and the contributing factors present in a particular case. Dr. Ronderos will evaluate your condition and determine the best course of treatment. The treatment for gum recession may involve the following:
- Modification of tooth brushing technique. Grasp the toothbrush lightly with your fingertips. Use short vibrating or circular strokes, and brush thoroughly but gently. Spend more time brushing but apply less force.
- Use an extra-soft toothbrush. Never use a medium- or hard-bristle toothbrush.
- Recommended manual brush: Nimbus Microfine (this brush can only be purchased online).
- If you prefer an electric brush, consider using the Philips-Sonicare Toothbrush with the Sensitive brush head, or the Oral-B Electric Toothbrush with the Sensitive Gum Care brush head. The standard bristles for these toothbrushes are too stiff for patients at risk of recession.
- Treatment of active periodontal disease. Some patients with gingival recession have active periodontitis.
- Possible modification of the tooth position, adjustment of the bite to reduce forces on specific teeth, fabrication of occlusal/night guards, and the elimination of any factors that could be associated with the presence of recession.
- Gingival (gum) grafting. The primary goal of gum grafting procedures is to stop the progression of the recession and reduce the risk for further gum loss and bone loss. Gum grafting can also cover the exposed roots to protect them from decay, help reduce tooth sensitivity, and improve esthetics. Not all cases of gum recession need grafting. Patients often elect to monitor their condition and only consider grafting if further progression occurs. Grafting is generally reserved for moderate to severe recession and/or cases with elevated risk for further recession. Please refer to our Gingival Grafting page for further information regarding grafting.
- Monitoring and maintenance care. Frequent dental cleanings and maintenance is imperative to maintain a healthy periodontal condition, healthy gingiva and to prevent further recession. It is also important to monitor the levels of gingival recession and ensure that the gum levels are stable over time.
Many factors are taken into consideration to determine the best treatment option. Dr. Ronderos after a thorough evaluation will explain your current status and the treatment options that will work best for you, your health, and your smile.