Gingival recession occurs when the margin of the gum tissue pulls back from the tooth, exposing the root surface below. This is a common dental problem that becomes more prevalent in older adults. When the root is exposed, the absence of protective enamel leads to increased tooth sensitivity to hot and cold temperatures and a higher risk of root decay. Addressing recession is important for comfort, aesthetics, and preserving the long-term health of the affected teeth.
Identifying the Root Causes
Effective management begins with identifying and eliminating the factors causing tissue loss. One of the most frequent mechanical factors is aggressive or improper brushing, where excessive force or the use of a hard-bristled toothbrush can physically wear away the delicate gum tissue. This trauma often results in a horizontal or wedge-shaped defect at the gumline.
A biological cause involves periodontal disease, which is a bacterial infection that destroys the gum tissue and the underlying bone structure supporting the teeth. As the infection progresses, the inflammatory response leads to the destruction and migration of the gum line away from the infection source. Poor oral hygiene allows plaque to harden into calculus or tartar, which harbors bacteria and accelerates this destructive process beneath the gumline.
Other contributing factors include genetic predisposition, as some individuals naturally have thinner or more fragile gum tissue, making them more susceptible to recession. Misaligned teeth or an uneven bite can place excessive, uneven pressure on specific areas of the gum and bone, which can contribute to recession. The habit of grinding or clenching teeth, known as bruxism, also exerts mechanical stress on the supporting structures of the teeth. Furthermore, tobacco use, whether smoking or chewing, impairs blood flow to the gum tissues and makes them more vulnerable to damage and disease.
Strategies for Halting Progression (Non-Surgical Management)
The initial step in managing recession is to eliminate the causal factors and stop the condition from worsening. Patients must correct any aggressive brushing habits by switching to a soft or ultra-soft bristled toothbrush and using gentle, circular motions rather than horizontal scrubbing. Using an electric toothbrush with a built-in pressure sensor can help prevent the application of excessive force.
For individuals experiencing tooth sensitivity due to exposed root surfaces, desensitizing toothpastes containing ingredients like potassium nitrate or strontium chloride can help. These agents work by blocking the tiny tubules in the exposed dentin, reducing the fluid movement that causes the sensation of pain. If bruxism is a factor, a dentist may recommend a custom-fitted occlusal guard or nightguard to protect the teeth and gums from the destructive forces of grinding and clenching.
Dental professionals intervene with procedures such as professional cleanings, or prophylaxis, to remove plaque and tartar from above the gumline. If gum disease is a contributing factor, a more involved procedure called scaling and root planing (SRP) is performed. This deep cleaning removes calculus and bacteria from below the gumline and smooths the root surfaces to encourage the gum tissue to reattach to the tooth. SRP is effective in treating early to moderate periodontal disease and helping to stabilize the gum tissue.
Professional Restorative Treatments
When gum recession is moderate to severe, surgical procedures become necessary to restore the lost tissue and cover the exposed tooth roots. These restorative treatments are typically performed by a periodontist, a dental specialist focused on the gums and supporting bone. The primary surgical intervention is gum grafting, which aims to replace the missing gum tissue and protect the exposed root surface from decay and abrasion.
The most common method is the connective-tissue graft, where tissue is harvested from beneath a flap on the roof of the mouth and stitched over the recession site. The free gingival graft is similar, using a small amount of tissue directly from the palate to thicken the existing gum tissue. Another option is the pedicle graft, which involves taking a flap of gum tissue from an area adjacent to the recession site and repositioning it to cover the exposed root.
Alternative surgical approaches include the Pinhole Surgical Technique, which involves making a small hole in the gum and using specialized instruments to gently loosen the tissue and slide it over the exposed root surface without traditional sutures. For cases involving bone loss, regenerative procedures may be employed using tissue-stimulating proteins, guided tissue regeneration membranes, or bone grafts to encourage the natural regrowth of bone and soft tissue. Following any surgical procedure, patients must adhere to specific post-operative care instructions to allow for successful healing and integration of the new tissue.