How the gum works and why its edge moves
The edge of the gum is supported by a thin plate of bone that covers the outside of the root. If this plate is thin or absent from birth, the gums above it are poorly supplied with blood and easily recede with any injury or inflammation. Dentists talk about thin and thick gum biotypes: with thin ones, recession develops noticeably more often. Additionally, the edge of the gum is pulled down by a highly attached frenulum or cord of mucous membrane. Therefore, recession is usually the result of a combination of anatomy and a permanent traumatic factor.
- Thin gingival biotype and bone deficiency at the root
- Mechanical injury when brushing teeth
- Chronic inflammation in gingivitis and periodontitis
- Short frenulum or mucous cord traction
- Overload of the tooth due to improper closure
- Pressure during orthodontic tooth movement
Causes and risk factors
The most common household reason is cleaning with a hard brush with strong pressure and horizontal movements. The second most common is periodontitis: tartar maintains inflammation, the bone dissolves, and the gums recede after it. In adolescents and young adults, recession often appears after orthodontic treatment if the tooth is moved beyond the bone plate. Lip and tongue piercing constantly rubs the gum at one point. Smoking impairs blood supply and healing, so the process goes faster in smokers.
- Hard brush and aggressive cleaning technique
- Tartar, gingivitis, periodontitis
- Malocclusions and crowded teeth
- Orthodontic treatment without bone reserve
- Short frenulum of the lip or tongue
- Lip and tongue piercing
- Smoking
- Bruxism
Symptoms
The first thing that usually appears is discomfort from a cold drink or air, as well as pain when brushing the area at the edge of the gum. The tooth gradually appears longer than its neighbors, and dark triangular spaces open between the teeth in which food gets stuck. The exposed root is softer than the enamel, so caries quickly occurs on it and the surface wears off. If the recession is associated with periodontitis, bleeding, bad breath and tooth mobility are added. With isolated recession from trauma, the gums look pale and dense, without inflammation.
- Sensitivity to cold and when brushing
- The tooth has visually lengthened
- Yellow root surface visible
- Gaps between teeth, food getting stuck
- Caries and wedge-shaped defects at the cervix
- Bleeding gums due to periodontitis
Diagnostics
The dentist measures the height of the exposed root and the width of the attached gum, probes the gingival sulcus, and evaluates the biotype and mobility of the teeth. It is important to distinguish recession from a periodontal pocket: in the first case, the gum has retreated, but the attachment is preserved, in the second, the ligament and bone are destroyed. Sighting or panoramic X-rays show the level of bone between the teeth, which determines whether the root can be surgically capped. Additionally, the closure of the teeth, the presence of frenulums and traces of traumatic brushing are checked.
- Inspection and probing of the gingival sulcus
- Measuring the depth and width of a recession
- Gum biotype assessment
- Spot or panoramic shot
- Assessment of occlusion and tooth mobility
- Checking your teeth brushing technique
Treatment and prevention
The first step is to remove the cause: choose a soft brush and the right technique, remove dental plaque, cure inflammation, polish overloaded areas if necessary, or refer them to an orthodontist. This is often enough to stop the process. To cover the exposed root, gum plastic surgery is used: a connective tissue or free gum graft from the palate, a coronally displaced flap, and in case of frenulum traction, vestibuloplasty or frenuloplasty. Sensitivity is relieved with fluoride varnish and pastes with potassium compounds or fluorides. The earlier treatment is started, the higher the chance of completely closing the root.
- Soft brush, no-pressure cleaning technique
- Professional hygiene and periodontitis treatment
- Fluoridation and sensitivity medications
- Gum grafting with graft or flap
- Frenumplasty, vestibuloplasty
- Orthodontic correction of teeth position
- Stop smoking and mouth piercings