Gum recession describes the process where the gum tissue pulls back, exposing more of the tooth’s surface or the root. This common condition can lead to sensitivity, root decay, and aesthetic concerns. For people considering orthodontic treatment, the relationship between braces and gum health is complex, requiring careful consideration of individual biological factors and treatment mechanics.
Primary Causes of Gum Recession
Gum recession is a multi-factorial condition, meaning it is rarely caused by a single issue. Aggressive tooth brushing, often categorized as mechanical trauma, is a frequent cause. Excessive force or using a medium-to-hard-bristled toothbrush can physically wear away the delicate gum tissue over time.
Periodontal disease, an inflammatory condition resulting from bacterial plaque accumulation, is another prominent factor. The toxins from the bacteria trigger an inflammatory response that ultimately destroys the supporting bone and soft tissue, causing the gum line to migrate downward.
Genetic makeup also plays a significant role, as some people inherit a “thin biotype” of gum tissue that is more susceptible to recession and damage. Finally, chronic habits like clenching or grinding, known as occlusal trauma, place excessive pressure on supporting structures, contributing to tissue and bone breakdown.
How Tooth Movement Affects Gum Tissue
Orthodontic treatment primarily moves teeth, not the gum tissue itself. Its effect on recession is secondary to changes in tooth and bone position. If recession is caused by a severely tipped or misaligned tooth, moving it into a more upright and stable position within the jawbone can be beneficial. This repositioning can stabilize or improve the gum margin by placing the tooth root back inside a healthier envelope of supporting bone.
However, tooth movement also carries a risk of worsening existing recession, particularly if the treatment plan involves pushing a tooth too far toward the lip or cheek. When a tooth is moved outside the bony housing, the thin layer of alveolar bone can be lost, which the overlying gum tissue often follows. This risk is significantly higher in patients with a thin gingival biotype.
Orthodontic forces must be controlled and slow to allow the bone and gum tissue time to remodel and adapt, reducing the chance of tissue loss. Clear aligners, like traditional braces, still move teeth through the bone and must be monitored carefully. While aligners may be less likely to cause irritation than fixed brackets, poor hygiene can trap bacteria against the gums, leading to inflammation and subsequent recession.
Surgical and Non-Orthodontic Treatments
Dedicated treatments for gum recession are primarily periodontal procedures designed to restore lost tissue, contrasting with the tooth-straightening goal of orthodontics. The first step for recession related to inflammation is often non-surgical therapy, such as scaling and root planing, which is a deep cleaning procedure to remove tartar and bacterial toxins from below the gumline. This helps eliminate the cause of inflammation, encouraging the gum tissue to heal and tighten around the tooth.
For significant root exposure, soft tissue grafting is the recognized gold standard for achieving root coverage. Connective tissue grafts, the most common type, involve taking tissue from beneath a flap on the roof of the mouth and placing it over the exposed root. Alternatively, a pedicle graft involves moving gum tissue from an adjacent, healthy tooth sideways to cover the recession, maintaining its blood supply.
A less invasive option is the Pinhole Surgical Technique, where a tiny hole is made in the gum, and specialized instruments are used to gently loosen and reposition the existing gum tissue over the exposed root surface. Orthodontic treatment is frequently coordinated with these procedures; sometimes, a gum graft is performed before braces to reinforce thin tissue, or it may be done after tooth movement to correct any remaining recession.
Protecting Gums During Orthodontic Care
Maintaining gum health during orthodontic treatment requires meticulous and specialized hygiene practices. The presence of brackets and wires makes plaque removal more challenging, increasing the risk of inflammation that can lead to recession. Patients should use a soft-bristled toothbrush and apply gentle pressure, as aggressive scrubbing can damage the already fragile gum margins.
Specialized tools are needed to clean around the appliances effectively. Interdental brushes, also known as proxy brushes, are used to clean beneath the archwire and between the brackets. Daily flossing is accomplished with the aid of floss threaders or a water flosser to navigate the wire.
Regular professional monitoring is also necessary, and patients undergoing orthodontics should often have periodontal check-ups every three to six months. If a thin gum biotype or early signs of recession are identified, the orthodontist and periodontist can collaborate on early intervention, which may include a periodontal procedure or adjusting the direction of tooth movement to protect the gum line.