Gingival (gum) recession is the process in which the margin of the gum tissue that surrounds the teeth moves apically away from the cementoenamel junction, exposing more of the tooth or the tooth’s root. Healthy, attached gingival tissue can only exist in the presence of healthy, supporting alveolar bone; when one or more of the causative factors listed below are present, gingival recession is likely to be observed.
There are a number of factors that can cause the gingival margins to recede, including:
- Improper tooth brushing with a hard bristle toothbrush
- Periodontal disease
- Poor oral hygiene and plaque accumulation
- Hereditary factors (Periodontal and Gingival Biotype)
- Intraoral use of tobacco products
- Clenching or teeth grinding
- Traumatic contact between opposing teeth
- Teeth being moved excessively against the buccofacial cortical bone
Recession & clear aligners
Recession is rarely observed during orthodontic treatment with clear aligners, but the poorly monitored use of fixed braces and auxiliary appliances, e.g. rapid palatal expanders, can result in teeth being excessively moved buccofacially, overwhelming the thin cortical plate of alveolar bone, producing the unwanted recession.
Reducing the excessive pressure as soon as observed may stop the recession, however, once the bone is lost, it will not regenerate sufficiently to replace the lost tissue.
These are situations where gingival grafting to cover the recession may be indicated prior to orthodontic treatment. Consultation with a periodontist is suggested in the management of moderate to severe recession.
Actions to take
When the first signs of gingival recession are observed, it is imperative that the etiology be determined. Is the pathology due to:
- soft tissue issues,
- traumatic contacts,
- or consequential tooth movement?
The initial considerations should be given to the patient’s toothbrushing technique and toothbrush, and confirmed to be in accord with the dentist’s instructions and recommendations for improving the oral hygiene regimen.
In cases where large deposits of plaque have formed, the patient should have it removed as soon as possible.
Extreme recession may need to be treated surgically with a periodontal flap repositioned to cover the exposed roots and interproximal spaces.
Habitual use of pipe smoking, chewing tobacco, or other caustic agent can irritate the tissues and cause the inflammatory response that leads to potential recession and bone loss. The patient should be advised to discontinue the harmful habit.
Clenching or grinding the teeth together tightly and frequently (bruxism) may be another reason the tissue and bone succumb to the inflammatory response. Nocturnal use of a mouthguard may reduce the damaging enamel wear and associated tissue recession.
Even in the absence of this muscular hyperactivity, an isolated high or traumatic contact between two teeth somewhere in the occlusion may be the stimulant that results in the tissue and bone breakdown. An analytic equilibration to remove the traumatic contacts and balance the occlusion may help soothe the discomfort and allow the tissue to respond positively back to health.
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