Gum recession or receding gums is an oral disease where the margin of the gums surrounding the teeth pulls back or wears away. Leading cause of gum recession are periodontal disease, vigorous brushing, hormonal change, chewing tobacco, crooked or misaligned teeth, etc. The popular treatment of receding gums is soft tissue grafting and flap surgery. You can watch out for early signs of gums recession such as inflammation of gums, an appearance of the long tooth, bleeding gums, bad breath, etc.
Read on to know what can be done about receding gums even if they do not grow back on their own, when to see a dentist, what are the causes, treatment, and prevention.
What are receding gums?
Gum recession or receding gums is an oral ailment that appears as pulling back of the gums from around the teeth. Many people have varying degrees of gingival recession.
It is one of the most under-diagnosed pathologies of the oral cavity. We see a substantial portion of the roots in severe cases along with some part of the underlying bone. We often see this as elongation of teeth in the mouth (1).
Gums or gingiva has a high turnover, which means it replaces the existing tissue and cells fast. But regeneration of lost tissue is not seen without any therapeutic intervention.
Early signs of gum recession
Gum recession is a periodontal problem, which means it involves surrounding tooth structure such as gums (gingiva), periodontal ligaments, alveolar bone underlying the gingiva and vasculature of the gingiva.
Gum recession does not hit you head on without any prior warning. So what all warning signs to look for if you suspect this issue?
Warning signs pre-recession –
- Starts with bad breath
- Inflammation of gums
- Bleeding gums with or without a stimulus
- Mobility or rotation of teeth
- Gap between teeth or diastema
- Visibility of root or tooth structure beyond the height of gum (elongation of teeth)
- Color change in the gums- reddish to bluish purple
- Fluid or pus coming out of the gingiva or tooth pocket
- Painful gums
- Increasing sensitivity of teeth to hot or cold
When you spot one or more of the problems mentioned above extending over a week, you should consult a dentist or this will worsen and lead to recession of gums.
Causes of receding gums
There are multiple causes of the gingival recession and they are –
Low-level and long-lasting trauma
Brushing too hard or using fast and intense motions while brushing we often damage the fragile gingiva over a period of time. Since brushing is a daily activity, the damage is long lasting as the gingiva doesn’t get time to heal. Thus, leading to recession.
Chronic inflammatory periodontal disease
Periodontal diseases, which is long-standing inflammation of the gums and surrounding tooth structure, lead to loss of gingiva.
This happens as a result of enzymatic digestion of the tissue, in addition to bone loss. If not treated in time there is massive bone loss and falling out of teeth from the sockets over time.
Many periodontal treatment modalities imply considerable tissue loss due to the need for surgical tissue removal. After surgical procedures, there is a decrease in periodontal tissue swelling.
But the procedure itself causes tissue loss. Hence, there is gum recession.
Initially, primary trauma to the tooth might induce symptoms characterized by pain combined with a modest increase in tooth mobility. This might last for days, weeks or even months. Finally leading to inflammation followed by the recession of the gums. (3)
Classification or degrees of recession
Why should we know this? Because depending upon the grade of recession we know when the condition has worsened and we need to see a dentist.
Class 1 being the best and class 4 the worst state. Initially, the basis for the gingival recession classification was based on the depth and width of the recession area (2).
Later Miller proposed a classification system which is probably most widely used for describing the gingival recession. The classification is based on the extent of recession beyond mucogingival junction or MCJ so we first need to understand what that is.
MCJ is nothing but the junction between the upper margin of the gingiva that we can see and the underlying mucosa or more vascular tissue. We grade recession according to loss of gingiva from its margins extending beyond the crown part of the tooth, exposing the roots.
Marginal gingival recession not extending to the mucogingival junction (MGJ). There is no loss of bone or soft-tissue. This means visibly we can see just the margins dipping with little or no exposure of the root.
The marginal recession that extends beyond or to the MGJ. There is no loss of bone or soft-tissue. In this case, we can see a little root structure. There is still no mobility in the teeth.
Marginal tissue recession that extends beyond or to the MGJ. There is a loss of interdental bone or soft-tissue. Here we see a substantial portion of the root with noticeable mobility in the teeth when touched.
Marginal tissue recession that extends beyond or to the MGJ. There is a loss of interdental bone. Here as we understand, there is a loss of bone structure between two adjacent teeth.
Hence, we can see more than two-thirds of the root with spontaneously moving and rotating teeth in the socket.
Receding gums treatment
Soft tissue grafting and flap surgery is the only valid treatment for receding gums. No home remedy is advisable since it may worsen the condition.
A graft is basically a part of tissue cut out from a healthy area in the oral cavity which replaces lost gingiva. Various techniques are used for soft tissue grafting.
Connective tissue graft
This technique can be used when there is deep tissue loss, which is a loss of gingiva along with underlying blood vessels. Oral home hygiene plays a crucial rule during the healing time and patient compliance as well.
Free gingival graft
This technique is most commonly used when there is gum recession or fragile gingival tissue loss around teeth or dental implants.
Free gingival graft has the best results for increasing the gingival thickness.
This technique used when there are several teeth, that is more than three teeth have gum recessions. Alloderm is a sterilized human tissue graft which replaces lost gingiva.
Pinhole surgical technique
There are multiple ongoing studies to investigate the feasibility of this novel surgical approach to root coverage. The pinhole surgical technique (PST) is a promising new approach. For this no secondary surgical site is necessary. (4)
Prevention of gum recession
Once gingiva is lost, no surgical skill can restore it to match the original consistency and functionality. There is also always a scope of significant relapse.
Regular brushing, flossing & mouthwash
To prevent gum recession, regular brushing (twice a day) is advisable with daily use of floss and mouthwash. A proper technique for brushing is implemented in cases of recession. In this, small circular motions are made while cleaning the tooth surface.
The bristles should be swept over the sides of the teeth towards their upper surfaces in a single motion rather than repeated scrubbing.
This is known as the Charter’s method, and it effectively cleans in between teeth without hurting the gums. A soft bristle toothbrush is advised for cases of receding gums.
Leave bad habits
Smoking or chewing tobacco in any form can cause trauma to your gums, so quitting such habits is highly recommended.
Frequent visits to a dentist
A frequent visit, preferable once in two months, to the dentist for regular cleaning and treatment of other teeth related issues is advisable.
Because many other ailments like malaligned teeth can also create undue pressure on gums leading to recession. Always watch out for teeth sensitivity as it is a vital sign for unhealthy oral tissues.
These are some of the ways to have a healthy set of pearly whites and disease-free gums.
Do gums grow back after the recession?
People often ask if gums grow back after the recession. The answer is NO, gums do not grow on their own. Surgical intervention, such as soft tissue grafting, is the only solution to fix gums to a certain extent.
Over to you on receding gums
For a sparkling smile, not just teeth but healthy gums are also essential. Like every soft tissue, once gums are lost in a significant amount, they won’t grow back. Hence, proper gum care never hurts more than periodontal surgery.