What is Gum Recession?

Receding gums is a common presentation in the mouth. The frequency of gums receding increases with age.

Presentation of gum recession:

• In the absence of periodontitis, the recession is seen at the mid-point of the tooth only. The gum between the teeth (interdental papilla) remains at its natural position.
• In individuals with periodontitis the recession is seen predominantly between the teeth. There is loss of the interdental papilla, resulting in what are known as black triangles. There may also be recession at the mid-point of the teeth.

Factors that contribute to gum recession:

1. Teeth brushing: Recent evidence now suggests that the link between improper brushing and gum recession is inconclusive. Some studies do suggest that increased frequency of brushing, use of hard bristle brushes, poor brushing technique and excessive brushing force could contribute to possible gum recession.
2. Anatomical factors: thin gums, poor quality of the gum tissue and thin bone at the front of the teeth can increase the risk of gum recession. Other factors such as muscle pull (frenulum) can also contribute to the problem.
3. Position of the teeth: If the roots of the teeth are positioned closer to the outside of the bony envelope, there is minimal to no bone, and this can increase the risk of recession
4. Restorations: Fillings placed around the gum margin can contribute to gum recession especially when the existing gum type is thin
5. Orthodontic treatment: Movement of teeth if a more forward position can result in recession. This is a common presentation around the lower front teeth after certain types of orthodontic treatment
6. Bruxing: There is limited evidence to suggest that teeth involved in grinding/clenching habits were linked with gum recession

Problems associated with gum recession:

Gum recession can indirectly increase the risk of tooth loss. Gum recession can make it more difficult to clean the mouth well. This can result in inflammation and start/progression of gum disease, which can result in loss of teeth. However, if individuals can maintain a high level of hygiene, which is possible even in cases of severe recession, the teeth can be maintained for several years.

Gum recession can be unsightly as the teeth look longer or there can be dark spaces between the teeth. Receding gums can make the teeth more sensitive to hot, cold or sweet food and drink.

Gum recession can also increase the risk of individuals getting decay or rapid wear of the surface of the teeth.

Prevention of recession:

• Maintaining good oral hygiene by brushing twice and using interdental brushes once daily
• Correct teethbrushing techniques using a soft-medium brush 
• Electric brushes with pressure sensors are useful to avoid excessive brushing force
• Wearing a mouth guard if you are known to grind or clench your teeth
• Orthodontic treatment being carried out by a suitably trained professional such as an orthodontist

Management of recession:

• Careful cleaning around the entire gum margin using a gentle brushing technique and appropriate brushes such as The Precision Brush
• Regular visits to an appropriate dental professional, such a periodontis,t to monitor and/or manage gum recession
• Removal/repositioning of the frenulum and gum grafting may be considered in selective cases. A periodontist would be able to advise on the suitability of such procedures
• Carefully done composite restorations can help close/reduce black triangles. This must be done very carefully to avoid ledges which can contribute to gum disease
• In extreme cases of recession, a gingival veneer could be considered. This is a removable appliance which covers the areas of recession that would be used for temporary aesthetic improvement, eg during social occasions.

References:

Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Clin Periodontol. 2018;45(Suppl 20):S190–S198.

Fan J, Caton JG. Occlusal trauma and excessive occlusal forces: Narrative review, case definitions, and diagnostic considerations. J Clin Periodontol. 2018;45(Suppl 20):S199–S206.