A common insidious problem but has huge impact
By Dr Rosalind Ho BDS Spore MFGDP (UK)
Gum recession is the movement of gum away from its natural level which is at the junction between the root and crown called cemento-enamel junction.
Problems associated with gum recession
1 Esthetic concern – the patient may have longer-looking teeth. If the lip is short or if there is a gummy smile, a tooth that is receded in the gums will present as a sore sight.
2 Sensitivity of teeth may result as roots are innervated (have nerve endings). The patient may feel a sharp stimulus when drinking hot or cold.
3 Food impaction – As gum shrinks, gaps that are unsightly are also food trap areas which may lead to tooth decay if not removed.
4 Speech affected – In severe gum recession, air may escape through the spaces resulting in embarrassment due to splatter of saliva and sounds escaping.
5 Teeth affected in other ways – As recession is accompanied by bone loss, the teeth would become mobile with time resulting in drifting, tilting, and overeruption.
Generally, gums would recede exposing the roots with time. This comes with age as the bone resorbs slowly.
Factors accelerating gum recession
1 Wrong tooth brushing technique – scrubbing the teeth and gums hard and in a horizontal direction may cause the gums to shrink.
Gums should be brushed in a rotary manner with soft-bristled brushes. Biting surfaces of teeth may be scrubbed harder.
Patients with thin tissues are more susceptible to gum recession than those with thick gums.
Management – correct brushing technique ( can be seen on YouTube)
2 Teeth grinding – Also known as bruxism, the gnashing of teeth during sleep can be destructive to the teeth substance as well as the gums causing the latter to recede.
In addition, teeth ‘flex’ causing cut surfaces known as abfraction cavities which are wedged shapes.
Management – restore all root cavities and wear a night guard
3 Trauma – Any injury to the gums can cause them to shrink. The presence of unfavorable bite such as a Class 2 deep bite in which the lower teeth are biting on the inner gums of the upper teeth would cause gums to move away from repeated trauma.
Management — Remove the source of trauma. In the case of a poor bite, Orthodontic treatment will be required. The presence of a tongue piercing or lip stud may also cause injury to the soft tissues and may be best removed if they pose problems.
4 Presence of inflammation – Chronic plaque accumulation, tartar build-up also contribute to a lower level of gums.
Management — Regular scaling and polishing of teeth may prevent this. Anything that increases plaque retention such as the poor fit of crowns, rough restorative surfaces, ineffective cleaning, etc must be rectified. Regular visits to the dentist for check-ups and prophylaxis are advisable.
Surgical intervention may be required to improve the appearance of some teeth with receded gums. Procedures such as gum grafting may be indicated and are best treated by a periodontist.
Prevention is better than cure.
The knowledge that gums are delicate tissues and need proper care cannot be over-emphasized.
Oral health care involves regular and careful attention to teeth, bone, and gums. They in turn serve your general health and well-being.