Gingival recession is a common dental condition where the gum tissue surrounding the teeth gradually pulls back from the tooth surface. This recession exposes the tooth’s root structure, which lacks the protection of hard enamel. The condition is progressive and can lead to serious oral health issues. When the softer cementum covering the root is exposed, it causes increased temperature sensitivity and makes the area susceptible to abrasion and root decay. Addressing recession requires identifying and eliminating the underlying causes, followed by treatments to halt further damage and repair the lost tissue.
Identifying the Roots of Gum Recession
Gum recession is often multifactorial, caused by a combination of biological and behavioral elements acting on the gum tissue. The most common biological cause is periodontal disease, a bacterial infection that leads to chronic inflammation. This infection slowly destroys the supporting bone and soft tissue that anchors the teeth, causing the gingival margin to migrate downward as underlying structures are lost.
Mechanical trauma is another frequent cause, typically resulting from aggressive or incorrect tooth brushing technique. Scrubbing horizontally with excessive force, especially with a hard-bristled toothbrush, physically wears away the gum tissue. This abrasion can be particularly damaging to individuals who have a genetically thin gingival biotype, referring to naturally thinner gum tissue that is less resilient to physical stress.
Other contributing factors include the chronic use of tobacco products, which compromises gum health and blood flow. Misaligned teeth or an abnormal bite force can place undue pressure on certain teeth, stressing the surrounding gum and bone. Teeth positioned outside of the jawbone’s natural arch may have a thinner layer of bone and tissue, making them more prone to recession.
Stopping Further Recession Through Non-Surgical Management
Before any repair can be attempted, the progression of gum recession must be stopped by controlling the causative factors. This process begins with behavioral modification, primarily correcting improper oral hygiene habits. Patients must transition to using a soft-bristled toothbrush and adopt a gentle vertical or circular motion rather than an aggressive horizontal scrub, which minimizes further mechanical trauma to the gums.
Professional intervention is often required to manage the biological cause of periodontal disease through a deep cleaning procedure known as Scaling and Root Planing (SRP). This non-surgical treatment removes hardened plaque (calculus) and bacterial toxins from below the gum line in the periodontal pockets. During the root planing phase, the exposed root surfaces are smoothed to remove bacterial byproducts and encourage the gum tissue to reattach more firmly to the clean tooth surface.
While SRP and improved home care are effective at controlling inflammation and halting the recession’s advance, these non-surgical methods generally cannot regrow the lost gum tissue. The treatment stabilizes the condition and prepares the mouth for potential restorative procedures. This stabilization is important because attempting to repair the gumline without first addressing the underlying infection or trauma often leads to the failure of the surgical repair.
Repairing the Gumline with Surgical Treatments
When the underlying causes of recession have been managed and there is a significant amount of exposed root surface, surgical procedures are necessary to repair the gumline and cover the exposed roots. The goal of these procedures is to regenerate lost tissue, which is most often achieved through various gum grafting techniques. These grafts not only improve aesthetics but also protect the vulnerable root surface from decay and reduce dentin hypersensitivity.
Gum Grafting Techniques
- Connective Tissue Graft: This method is often considered the gold standard for achieving predictable root coverage. A small flap is created on the roof of the mouth, and tissue is harvested from the layer just beneath the surface, leaving the top layer intact. This subepithelial connective tissue is then placed over the exposed root and secured with sutures, acting as a scaffold to promote new gum tissue growth.
- Free Gingival Graft: A similar technique where a small piece of tissue is taken directly from the palate’s surface and placed onto the recession site. This method is effective for increasing the amount of thick, durable gum tissue, though the initial appearance may differ slightly before it fully blends in.
- Pedicle Graft: This involves making a partial incision in the gum tissue adjacent to the recession site and then sliding that tissue laterally or coronally to cover the exposed root. This technique is only feasible when there is sufficient healthy gum tissue immediately next to the area needing repair, but it offers the advantage of maintaining its own blood supply.
- Pinhole Surgical Technique (PST): A less invasive alternative that uses a very small opening (pinhole) created in the gum tissue above the affected area. Specialized instruments are inserted through this entry point to gently loosen the existing gum tissue, which is then repositioned to slide down and cover the exposed root surfaces.
The PST procedure avoids the need to harvest tissue from the palate and often uses collagen strips to stabilize the newly positioned gum tissue, encouraging healing. Since there are no large incisions or sutures required for the repositioning, this technique typically results in less post-operative discomfort and a faster recovery time compared to conventional grafting. Regardless of the surgical method used, post-procedure care is necessary, often involving soft foods, gentle cleaning of the area, and follow-up appointments to ensure the graft or repositioned tissue is healing correctly and adhering to the root surface.