This is when the gum recedes away from the surface of the teeth giving the appearance of longer teeth. However, it can lead to unsightly aesthetics with spacing developing between the teeth. More often than not this makes oral hygiene very difficult to upkeep and subsequently the gums can fall into a deteriorating cycle. Intervention is often required to correct the condition.
The two main causes of receding gums are gum disease (periodontitis), and trauma from toothbrushing. Some people are more susceptible than others, particularly if their gums are thin and local factors such as a fraenum (a little fleshy tissue muscle attachment) can also contribute to local recession. There is some evidence that grinding and clenching may also give the appearance of receding gums, when in fact it causes micro-fractures with enamel at the gum line ‘falling off’ making the teeth look longer. If the cause is periodontitis, management involves treating and stabilising the disease in order to prevent further destruction. However, if toothbrush trauma is the cause, prevention may be somewhat more complicated, because it is very difficult to simply “not brush so hard”
WAYS TO HELP PREVENT TOOTHBRUSH TRAUMA
- Use a small headed, soft textured toothbrush. Toothbrushes particularly for sensitive teeth are suitable as they tend to fulfil both these requirements.
- Run the toothbrush under warm water before using it; this will soften it further.
- Start brushing the areas with least recession first – these are frequently the inside surfaces of the teeth. By the time you get to the outer surfaces, the toothbrush is likely to be softer, and you probably won’t be brushing quite so hard.
- Use a technique involving small circular or scrubbing motions, whereby you brush one tooth at a time. Avoid large scrubbing horizontal or vertical movements. This can be demonstrated by your dentist, hygienist or periodontist.
- Change your toothbrush the minute it starts to look frayed at the edges – a toothbrush like this causes more damage and is less effective at cleaning. The better your toothbrushing technique becomes, the less rapidly your toothbrush will become frayed.
- Avoid using very abrasive toothpastes, such as smokers or whitening toothpastes.
- Avoid brushing too frequently or when particularly stressed, as you’re likely to take your aggression out on your teeth!
- Avoid brushing teeth after drinking orange juice or other acidic foods. If you already have some recession, brushing the exposed softer root surfaces, when they have just been softened further by acids, will cause further destruction to the tooth and can lead to wear cavities that need to be filled.
- Electric toothbrushes, especially those with flexible heads which control the force of brushing, can be particularly useful. A sonicare toothbrush is ideal in these cases.
MANAGEMENT OF RECESSION
The first line of treatment is prevention, making sure that the primary cause has been addressed and that preventative measures are effective in ensuring that no further recession occurs.
A common symptom of recession is sensitive teeth – this can be managed with the use of sensitive toothpastes, fluoride applications such as gels, varnishes and mouthwashes, application of desensitising agents, and fillings. Laser treatment can also help.
Surgical procedures – if the recession is affecting appearance, making the teeth very sensitive or affecting ability to clean effectively, surgical procedures can be carried out to replace gum where it has been lost. This cannot be applied to all cases of recession and each case needs to be assessed on an individual basis. Grafting procedures may be used, whereby tissue is taken from elsewhere in the mouth and transferred to the affected site. In some case we can use artificial grafting materials or tissue taken from cadavers to treat multiple recession sites. Various other surgical procedures are available and can be used where appropriate. For localised recession, fraenectomy procedures may be needed to ‘cut away’ soft tissue that is pulling the gum line down, and we carry this our using lasers.
- Gum recession is not something that simply occurs with old age
- The underlying cause needs to be addressed.
- It is frequently managed conservatively through preventative measures
- More advanced procedures are available and may be necessary to manage recession defects, for both cosmetic and preventative reasons.