WHAT CAN YOU DO ABOUT RECEDING GUMS?

Receding gums cause the exposure of the tooth’s root due to a shift in the gum’s margin. This may result in tooth sensitivity, tooth wear, or root decay. In addition, receding gums make teeth appear longer than usual, leading to poor aesthetics. Exposure of the root surface also enables bacterial growth, steadily damaging the tooth.  

About 58% of Americans over 30 have reported more than a 1mm shift in the gum margin from the tooth surface. Gum recession increases with age. It can also be caused due to gum diseases, trauma from aggressive tooth brushing, or misalignment of teeth. If unattended, individuals may experience a further shift in the gum margin and related consequences.

In this article, we discuss the causes, symptoms, and management of receding gums. 

What are the causes of receding gums?

Here are several factors that contribute to receding gums: 

• Vigorous brushing: Vigorous brushing or the use of a hard bristle toothbrush cause continuous trauma to the underlying gums. This often results in the receding of gums.
• Poor oral hygiene maintenance: Inadequate brushing or flossing of teeth encourages the deposition of tartar between the teeth and gums. Professional teeth cleaning is recommended to remove the tartar. If untreated, long-standing tartar rich in bacteria can lead to gum recession. 
• Periodontal disease: Teeth affected by periodontal disease tend to lose bone and gum support that holds the teeth in their place. The loss of bone support causes gums to recede. 
• Misaligned bite: Crooked teeth in upper and lower arches form a misaligned bite that exerts too much force on the gums and bone. This causes gums to recede, exposing the root surface. 
• High frenal attachments: Frenum is a thin line of soft tissue connecting the lips' inner part to the gums. If the frenum is attached close to the gum margin (also known as high frenum), it may create forces causing gums to recede.
• Thin gum: Research suggests that individuals with thin gums (<1mm of thickness) are more prone to recession than those with thick gums. 
• Poor marginal fit of crowns or overhanging fillings: The placement of crowns or bridge with poor marginal fit or overhanging fillings allow deposition of plaque (a bacterial film) or tartar. This causes inflammation and subsequent recession of gums.   
• Post-treatment affect: Application of uncontrolled forces as a part of teeth straightening procedure often leads to loss of supporting bone and reduction in the thickness of gums. This increases the risk of developing recession. Gum recession is also one of the drawbacks of gum surgery, performed to treat severe periodontal disease. 
• Smoking: Research suggests that the recession of gums is higher in smokers than non-smokers. 
• Improper design of partial dentures: Improper design of removable partial dentures often impinges the gums and allows tartar to deposit. This increases the risk of gum recession. 
• Trauma from oral piercings: Tongue or lip piercings constantly contact the gum tissue causing trauma. This continuous trauma from an oral piercing can cause gums to recede. 

What are the symptoms of gum recession?

The most common symptoms associated with gum recession include:

• Tooth sensitivity: Tooth sensitivity or pain is common in individuals with gum recession. Exposed root surfaces are covered externally by a thin layer of cementum and an inner layer of dentine. The cementum layer easily gets removed on traumatic brushing, intake of acidic food, or inadequate oral hygiene practices, exposing the dentin layer. The exposed dentin layer contains dentinal tubules (fluid-filled canals) which are close to the nerve. On intake of hot or cold foods, dentinal tubules stimulate the nerves causing pain or discomfort. This pain is sharp and of short duration. 
• Retention of tartar and gum bleeding: Individuals avoid brushing their teeth in the areas of gum recession due to the fear of tooth sensitivity or pain. This allows the retention of tartar, rich in bacteria. High bacterial activity over a period of time causes gum inflammation leading to bleeding gums. 
• Root decay: As the root surfaces of the teeth are exposed to the oral environment, they are at risk of developing root decay. About 20-40% of healthy adult individuals are at risk of developing root decay. 
• Tooth wear: Aggressive brushing often wears off the protective layer on the surface of teeth (abrasion) and injures the gums. Abrasion typically looks like a V-shaped indentation on the outer surface of teeth. 
• Inaesthetic appearance: Receding gums in the front teeth may give an elongated appearance. Individuals may find it visually displeasing and become conscious while smiling or talking. 
• Fear of losing a tooth: Individuals with periodontal disease demonstrate loss of bone and gum tissue which may result in tooth mobility (loosening of teeth). This instills a sense of fear among individuals that they may lose their teeth.  

How to manage receding gums?

Several treatment options are available to treat the receding gums. These include:

• Non-surgical treatment options: Small and initial stage gum recession can be treated with non-surgical therapy. These options include the following: 
• Monitoring: Dentists usually do not recommend any treatment in individuals with minimal gum recession with no signs of sensitivity or root decay. Patients are regularly monitored and recommended to maintain good oral hygiene using a soft toothbrush and asked to avoid aggressive tooth brushing. 
• Use of desensitizing agents: Dentists recommend desensitizing agents to individuals who complain of teeth sensitivity in areas with gum recession. Most of the time, individuals may avoid brushing these areas due to sensitivity. This may lead to accumulation of tartar and further progression of gum recession. It is always recommended to undergo professional cleaning of teeth regularly alongside the application of desensitizing agents. Desensitizing agents work by blocking the dentinal tubules from stimulating the nerves. Most commonly used agents in the dental clinic include varnishes, dentine bonding agents, and glass ionomer cement. Dentists recommend desensitizing pastes and mouthwashes for home use. 
• Tooth fillings: Small localized recession defects, cavities, or tooth surfaces that are worn off can be restored with tooth-colored fillings such as composites (resin) or glass ionomer cement. Similarly, exposed root areas can be covered with pink porcelain or pink composites which resemble the color of gums. This improves the aesthetics and reduces tooth sensitivity. 
• Orthodontic treatment: In individuals with a misaligned bite or crooked teeth, orthodontic treatment may be recommended to straighten the teeth and reduce the forces on the gums and teeth. 
• Replacement of the overhanging fillings and unfit crowns: Overhanging fillings and poorly fitted crowns should be replaced with properly contoured fillings and crowns to avoid receding gums. 
• Surgical options: Dentists may recommend several surgeries for individuals who are conscious of their smile due to recession or experience severe sensitivity: 
• Deep cleaning: In individuals with periodontal disease, deep cleaning removes the bacteria-rich tartar on the root surface using specialized instruments. This makes the gum tissue healthy and allows its reattachment to the root surface to a certain extent. 
• Soft tissue grafting: This surgical procedure involves the removal of soft tissue grafts from the palate and their placement on the exposed root surfaces. Later, the extracted soft tissue graft is fixed on the exposed root surfaces using sutures. The patient is recalled after 7-14 days for a regular check-up and suture removal. Recovery may take more than a week. Patients are asked to avoid eating hard, chewy, hot foods and avoid brushing at the operated site until the sutures are removed. Sometimes if an adequate amount of gum tissue is available in the area next to the operated sited, the soft tissue is taken from that area instead of the palate. In individuals with prominent frenum, surgery to remove the frenum can be combined with soft tissue grafting for better results. 
• Regenerative surgery: Regenerative therapy is performed in individuals with significant loss of tooth-supporting bone and gum tissue. In this procedure, the gum tissue is pulled back, and a bone graft with a membrane or regenerative material is placed at the site to enhance the regeneration of bone or gum tissue in that area. Later the gum tissue is secured over the root surface with the help of a suture. 

How to prevent gum recession

Here are some of the ways to prevent the receding of gums:

• Practice good oral hygiene by brushing and flossing twice daily.
• Use a soft-bristled toothbrush.
• Avoid the application of excessive force while brushing.
• Quit smoking if you are a smoker.
• Visit your dentist for regular check-ups and professional teeth cleaning.

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References:

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• Tugnait A, Clerehugh V. Gingival recession-its significance and management. J Dent. 2001 Aug;29(6):381-94.
• Merijohn GK. Management and prevention of gingival recession. Periodontol 2000. 2016 Jun;71(1):228-42.
• Alghamdi H, Babay N, Sukumaran A. Surgical management of gingival recession: A clinical update. Saudi Dent J. 2009 Jul;21(2):83-94. doi: 10.1016/j.sdentj.2009.07.006. Epub
• Allen E, Irwin C, Ziada H, Mullally B, Byrne PJ. Periodontics: 6. The management of gingival recession. Dent Update. 2007 Nov;34(9):534-6, 538-40, 542.
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