Receding gums

Receding gums (gingival recession) refers to exposure in the roots of the teeth caused by a loss of gum tissue and/or retraction of the gingival margin from the crown of the teeth^[1]. Gum recession is a common problem in adults over the age of 40, but it may also occur starting from the teens. It may exist with or without concomitant decrease in crown-to-root ratio (recession of alveolar bone).

1 Causes
2 Symptoms
3 Treatment
4 Gingival grafting
- 4.1 Growth-factor techniques
5 See also
6 References
7 Sources

Causes

There are several possible causes for gum recession:

Abnormal tooth position, such as tooth crowding, giving inadequate cover of one or more teeth by the jaw bone.^[1]
Hereditary thin, fragile or insufficient gingival tissue.^[1]
Overaggressive brushing,^[1] which causes the enamel at the gum line to be worn away by scrubbing the sides of the teeth in a washboard fashion
Periodontal disease^[1]
Inadequate brushing or flossing, which allows bacteria to build up between the teeth, resulting in enzymes eating the bone away from the teeth
Eating disorders, from self-induced vomiting
Dipping tobacco, which affects the mucus membrane lining in the mouth and will cause receding gums over time
Grinding of the teeth (bruxism)
Intentional gingival retraction. For example, the adult tooth may not grow out of the gum, and to remedy this, a procedure called an exposure is done. It involves the gum tissue being cut open to allow the adult tooth to grow out. This is a less common cause of gum recession.
Adult orthodontic movement of teeth.
Piercings in the lip or tongue that wear away the gum by rubbing against it.
Sensitivity to sodium lauryl sulfate (SLS), an ingredient in most commercial toothpastes.
Scurvy

Symptoms

Gum recession is not something that happens overnight. In most cases, receding of gums is a progressive procedure that happens gradually from day to day over the years. That explains the fact that it is common over the age of 40. Because the changes in the condition of the gums from one day to another are minimal, we get used to the gums' appearance and do not notice the changes over longer periods of time. Receding gums may remain unnoticed until someone else talks about it or until the condition starts to cause other problems.

The following signs and symptoms may indicate gum recession:

Sensitive teeth - Teeth become sensitive to hot and cold or to sweet, sour, or spicy foods. If the cementum covering the root is not protected any more by the gums it is easily abraded exposing the dentin tubules to external stimuli.
Teeth may also appear longer than normal (a larger part of the crown is visible if gums are receding).
The roots of the tooth are exposed and visible.
The tooth feels notched at the gum line
Change in the tooth’s color (due to the color difference between enamel and cementum)
Spaces between teeth seem to grow (actually the space is the same but it seems larger because the gums do not fill it any more).
Cavities below the gum line

If the gum recession is caused by gingivitis, the following symptoms may also be present:

Puffy, red, or swollen (inflamed) gums
Gum bleeding while brushing or flossing
Bad breath (halitosis)

In some cases, it is the treatment of gingivitis that reveals a gum recession problem, that was previously masked by the gums swelling.^[2]

Treatment

Treatment should start with addressing the problem which caused the gum recession. If overactive brushing is the cause, the patient should consider purchasing a softer toothbrush and use a more gentle brushing technique. If poor plaque control was a contributing factor, improved oral hygiene must be performed, combined with regular professional dental cleanings as prophylaxis. If severe calculus (tartar) was the cause, then a procedure called scaling and root planing may be necessary to clean the teeth and heal inflammation in the gingiva (gums). If malocclusion (incorrect bite) was a factor, an occlusal adjustment (bite adjustment) or bite splint may be recommended.

If cause-specific measures are insufficient, soft-tissue graft surgery may be used to create more gingiva.^[1] The tissue used may be autologous tissue from another site in the patient's mouth, or it can be freeze-dried tissue products or synthetic membranes.^[1] New research is focused on using stem cells to culture the patients' own gums to replace receded gums.

Gingival grafting

Main article: gum graft

Depending on the shape of the gum recession and the levels of bone around the teeth, areas of gum recession can be regenerated with new gum tissue using a variety of gum grafting "periodontal plastic surgery" procedures performed by a specialist in periodontics (a periodontist). These procedures are typically completed under local anesthesia with or without conscious sedation, as the patient prefers. This may involve repositioning of adjacent gum tissue to cover the recession (called a pedicle graft), Or use of a free graft of gingival or connective tissue from the roof of the mouth (called a free gingival graft or a Subepithelial connective tissue graft). Alternatively, a material called Acellular dermal matrix (processed donated human skin allograft) may be used instead of tissue from the patient's own palate.

Growth-factor techniques

Recent advances have seen the introduction of platelet derived growth factor (PDGF) infused bone graft material. This material is usually combined with the cellular matrix to form a soft bone paste that is then covered by the allograft. The development of this type of bone and tissue cellular matrix (also known as ortho filler), results in greater osseointegration with the patient's healthy bone and soft tissue.

Healing from such procedures requires 2–4 weeks. After a few months the results can be evaluated and in some cases the new tissue needs to be reshaped in a very minor procedure to get an optimal result. In cases where recession is not accompanied by periodontal bone loss, complete or near complete coverage of the recession area is achievable.