Gum recession, where the gum tissue pulls back from the tooth surface, is a common concern for people considering orthodontic treatment. This exposes the sensitive root of the tooth, often leading to increased sensitivity and an altered cosmetic appearance. The relationship between braces and receding gums is complex, involving biological and mechanical forces. Orthodontic treatment can either address underlying issues contributing to recession or potentially exacerbate the problem if not managed correctly. The outcome depends heavily on pre-treatment assessment, precise tooth movement, and meticulous oral hygiene practices.
What Causes Gum Recession
Gum recession is primarily a symptom of underlying issues that cause the marginal soft tissue to degrade or pull away from the tooth. The most prevalent cause is periodontal disease, an inflammatory condition resulting from the long-term buildup of bacterial plaque and hard calculus deposits. This chronic inflammation slowly destroys the supporting bone and soft tissue around the teeth, leading to recession.
Another significant factor is aggressive toothbrushing, especially when using a hard-bristled brush or applying excessive force horizontally along the gumline. This repeated trauma physically wears away the gingival tissue over time. Genetic predisposition also plays a large part, as individuals born with a thin gum biotype or naturally less bone support are more vulnerable to recession. Furthermore, teeth that are significantly misaligned or jutting out of the bone arch can experience mechanical stress that weakens the surrounding tissue.
The Dual Impact of Braces on Gum Tissue
Orthodontic treatment applies controlled forces to move teeth, which can have both beneficial and detrimental effects on gum health. Moving teeth into positions where bone support is thin, especially toward the lip or cheek, can strain the gum tissue. This movement can push the tooth root beyond the boundary of the alveolar bone (fenestration or dehiscence), often resulting in gum recession. Braces also create more surfaces—brackets and wires—where food and plaque accumulate, making cleaning difficult. Poor oral hygiene during treatment can quickly lead to gingivitis, which, if left untreated, progresses to periodontitis and subsequent gum recession.
Conversely, braces offer a powerful solution for correcting alignment issues that contribute to recession. Severely crowded or crooked teeth are difficult to clean, creating chronic plaque traps that fuel gum inflammation and bone loss. Aligning these teeth makes the entire tooth surface accessible for effective brushing and flossing. Correcting a traumatic occlusion, or a bad bite, also reduces the uneven forces that cause tissue breakdown. Moving teeth into the center of the supporting bone arch can stabilize the gum line, lessening mechanical stress.
Using Orthodontics to Manage Existing Recession
When a patient already has existing gum recession, the orthodontic treatment plan must be carefully coordinated between the orthodontist and a periodontist. The first step involves stabilizing gum health by ensuring all active gum disease is treated, often through scaling and root planing.
Gum Grafting
In many cases, soft tissue grafting is recommended either before or during orthodontic movement. Gum grafting procedures, such as connective tissue grafts, aim to thicken the fragile gum tissue or cover the exposed tooth root. This creates a more robust foundation for the teeth.
Once the gums are healthy and stable, tooth movement must be executed with slow and light forces to minimize stress on the surrounding tissues. The orthodontist carefully plans the movement to ensure the tooth remains within the protective boundaries of the alveolar bone. If recession occurs during treatment, the orthodontist may need to temporarily pause tooth movement or adjust the mechanics to relieve pressure. This multi-disciplinary approach ensures that the goal of a straight smile does not compromise long-term gum health.
Maintaining Gum Health During Treatment
Maintaining meticulous gum health is paramount for any patient undergoing orthodontic treatment to prevent new or worsening recession. Because braces create numerous ledges and traps for food particles, brushing frequency should increase to after every meal or snack. Patients should use a soft-bristled toothbrush, angling the bristles at 45 degrees toward the gum line and brushing gently above and below the brackets.
Traditional flossing is challenging with wires, so specialized tools are necessary to clean between the teeth effectively. Floss threaders or interdental brushes are designed to navigate beneath the archwire. A water flosser can be particularly useful for dislodging plaque and food debris from around the brackets and along the gum line. Regular appointments with a dentist or dental hygienist for professional cleanings are required more frequently than usual. These check-ups allow for the removal of hard-to-reach plaque and calculus and provide an opportunity to monitor the gums for early signs of inflammation or recession.