Receding Gums

Most dental conditions pass by unnoticed by the patient until the manifestation of pain and the reach of an advanced clinical stage, but gum recession is generally not one of these. The reason? It can be a quite visible change that patients notice, causing them to seek professional dental advice swiftly.¹ In fact gingival or gum recession is a condition in which the gingival marginal soft tissue recedes apically to the cement-enamel junction (CEJ), sometimes exposing the root of the tooth.^1–3

With more than two-thirds of the population worldwide found to be affected by gum recession, it is not a condition to be taken lightly.⁴ When it comes to its causes, they can be several, some physiological, others ethnical, mechanical by trauma, anatomical, or even pathological and inflammatory.^1,3 It can also frequently result from a combination of predisposing factors.

As for gum recession treatment options, they include first and foremost the management of the etiological factors depending on the diagnosis, then the management of the sequelae like hypersensitivity and root caries, and finally surgical management when necessary and possible.¹ In the article below, we will explore gum recession in depth, starting with what causes it, what it looks like, how it is prevented, and the treatment options.

What Causes Receding Gums?

While the list of possible receding gums causes can be quite long, they can be classified as anatomical, physiological, pathological, and traumatic causes.1,3,5 We will explore below The main known and documented causes in the literature and explain how each can lead to gum recession:

Physiological Causes of Gum Recession:

• Orthodontic Treatment : When teeth are moved towards an area with thin bone, gum recession can occur following the loss of bone in this area as the tooth is moved.⁶ This is one of the reasons why orthodontic movement should always be carefully planned, to avoid loss of bone in the form of dehiscence and subsequent gum recession. Nevertheless, orthodontic tooth recession should not be considered as the primary cause of gingival retraction.⁶

Pathological Causes of Recessed Gums

• Gum disease: Periodontal disease is one of the main primary causes of receding gums. In this case, as a result of the enzymatic processes and bone loss induced by the inflammation, gingival tissue is lost and the recession appears.^1,6 Recessions due to periodontal disease are frequently seen on several teeth and all surfaces, in conjunction with bone loss.¹

• Poor Oral hygiene: When food debris accumulates on the teeth and between them and the oral hygiene is improper or poor, plaque accumulates on teeth which can lead to gum disease and gum recession.^1,8

Trauma-related Causes of Gum Recession

• Improper brushing techniques: Inappropriate daily brushing and its physical wounds to gingival tissues is another one of the primary causes of receding gums.6,8 If you don’t brush your teeth the right way and are traumatically using the tooth brush over delicate gingival margins, this will slowly but surely lead to gingival recession.⁶ It has also been proved by Kocht et al. that hard bristles also contribute to that,⁹ so the choice of your toothbrush is also important, not only the technique.

What Do Receding Gums Look Like?

To properly diagnose gum recession, it is important to consult a professional who would be able to recognize its visual characteristics and symptoms.
It is defined by the American Association of Periodontology that gum recession is visually diagnosed when the gingival marginal soft tissue is seen receded apically to the cement-enamel junction (CEJ), exposing the root and making the teeth appear longer than they used to.^2,3 Additionally, the patients often report receding gums symptoms like hypersensitivity.¹

To sum the above up, below is a list of the symptoms of receding gums:^1,10

• Teeth that appear longer than before, causing aesthetic concern.

• Increased hypersensitivity due to root exposure and exposed dentine.

• Loose or separating teeth resulting in a change in the way the teeth fit together.

How to Prevent Receding Gums

The best protection against receding gums is regular check-ups with a dental professional and a good oral health routine. A proper oral hygiene and regular dental visits help in fact to remove plaque bacteria and therefore keeping your gums healthy. By eliminating one of the most important determinants in the onset of gum recession, which is poor oral hygiene as previously mentioned, you would then avoid gum inflammation that in turn would lead to recessions.^1,6,8 It is also important as aforementioned to have a proper brushing technique because toothbrushing trauma is also one of the main primary causes of receding gums.^6,9

Gum Recession Treatment

Surgical gum recession treatment:

Gum grafts can be an optimal solution for receding gums, with a primary aim of getting complete root coverage, knowing that this is not always entirely achievable.^11,12 The techniques that are most used for this are known as pedicle-flap surgical techniques and are of two types: the coronally advanced flap initially developed by Norberg and later modified by Zucchelli and De Sanctis, and the rotational flaps.^11–13 Another type of surgery is known as the tunnel technique.¹³ A combined restorative and surgical approach has also been suggested when the recession is associated with noncarious cervical lesions, and has been proven to lead to high patient satisfaction since it allows to cover the yellowish color of the dentin that was proven to be a major point of concern esthetically for the patient.¹⁴

Non-surgical gum recession treatment:

Although gum grafts are well-studied, secure and efficient, not all patients are willing to undergo gingival augmentation surgeries. In such cases, specific guidelines can help manage symptoms without fully reversing the gum recession:

• Identifying the exact etiology of the defect.¹³

• Implementing a supportive oral hygiene regime to prevent further recession, including teaching the correct brushing technique, making sure the toothbrush used is soft, prescribing an efficient adjunctive mouthwash, and getting proper dental scaling and root planing.¹³

• If the patient is suffering from hypersensitivity, he should be prescribed a desensitizing toothpaste that would help in occluding the dentinal tubules and thereby reducing fluid movement, nociceptor activation, and sensitivity.¹³

• High fluoride applications over time can also help by inducing the apposition of secondary dentine with the possibility of eventually leading to some relief by occlusion of the dentinal tubules as well.¹³

• Low and high-intensity laser therapies are also another way to treat dentinal hypersensitivity caused by gum recession, and aim to either avoid exceeding the pain thresholds by depolarizing the cells with low-intensity therapy, or by occluding the dentinal tubules with high-intensity therapy.¹³

Having read all the above, it is evident that considering the irreversible nature of gum recession, preventive measures are of the highest importance, and patient awareness should be raised about the matter to avoid getting to that point of no return. Therefore, showing up at your regular dental checkups and practicing good oral hygiene are of major importance when it comes to the detection and management of receding gums, and noticing symptoms should incite you to seek professional advice. So having brushed up on the matter, adopt proper oral hygiene with the right oral care products, and keep receding gums away.