Receding Gums: Causes and Ways to Treat Them

What Are Receding Gums?

Receding gums, or gingival recession, is defined as the exposure of the root surface by an apical migration of the gingiva. It means it goes down, and the root, which is otherwise covered with gingiva, is totally or partially visible.

Receding gums have four classes (Miller PD-1985), and among them,

• Classes I and II have 100 percent complete coverage and an excellent prognosis. The best time to have treatment for this biggest hurdle of esthetic dentistry is for Class I and Class II gingival recession. There is very little sensitivity and even fewer chances of root caries.

• Classes III and IV have partial coverage and a poor prognosis.

Who Will Develop Gum Recession?

Gum recession is mostly seen in individuals who:

• Smoke.

• Have poor oral hygiene.

• Takes in alcohol.

• Genetic predisposition.

• Has a history of diabetes.

• Has diseases like human immunodeficiency virus (HIV).

• Has hormonal changes, especially in females.

What Are the Causes of Receding Gums?

The common causes of receding gums are:

• Brushing too aggressively.

• The buildup of dental plaque.

• Periodontal issues.

• Trauma to the gum tissue.

• Misalignment of the tooth.

• Smoking.

• Piercing of the lip and tongue.

How Can You Diagnose Gum Recession Early?

• The dentist diagnoses receding gums during regular checkups by measuring the extent of gingival recession in each tooth using a periodontal probe.

• Bone loss is also a common symptom of gum recession, so the dentist also measures the periodontal pocket around each tooth.

Does Gingival Recession Matter to Your Oral Health?

Yes, gingival recession does matter for oral health, as recession leads to tooth loss in most individuals. Teeth will eventually fall out when insufficient gum tissue holds them firmly in the socket. Therefore, gum recession can be avoided by regular dental checkups.

When there is a gingival recession:

• Tooth roots are exposed, which leads to sensitivity to hot, cold, or sweet foods.

• An individual is more prone to caries on root surfaces

• There will be an accumulation of plaque that will lead to the progression of gum disease.

• If left unnoticed for a long time, it leads to loosening of teeth.

How Are Receding Gums Treated?

The treatment of receding gums depends on the underlying cause of the condition.

1. Non-Surgically: Mild gum recession can be corrected non-surgically through:

• Topical Antibiotics: Antibiotics reduce bacterial infection and help control gum swelling.

• Dental Bonding: These bonding agents cover the exposed root surfaces with tooth-colored resin, which helps reduce tooth sensitivity.

• Orthodontics: Orthodontic treatment corrects malaligned teeth, reducing pressure on the gums and preventing further recession.

2. Surgically: Receding gums are treated surgically through gum grafting, where tissue from the palate or donor source is placed over exposed roots. Another option is flap surgery to reposition gum tissue and cover the recession.

What Are the Types of Grafts Available?

Gum graft surgery is performed to complete the gum recession.

Different types of grafts are

Autogenous Grafts:

Among autogenous grafts, the first and most ancient graft is the free gingival graft. It is a graft taken from the palate (best site) and transplanted into the recipient site (where there is a gingival recession). It has the best advantage of increasing the width of keratinized tissue, which, in turn, prevents the further progression of recession. However, it has two main disadvantages, namely:

• The creation of painful post-operative wounds at the palate.
• Poor matching of aesthetics. In other words, the recipient site does not blend well with adjacent tissues. Blood supply is sometimes compromised with this graft.

Subepithelial Connective Tissue Graft (SCTG):

A subepithelial connective tissue graft (SCTG) came into force to compensate for the disadvantages of a free gingival graft. It is a gold standard for treating gingival recession because it offers many advantages, like good blending, less painful postoperative wounds, and increased keratinized tissue. However, there is only one disadvantage: it requires the palate to be almost three to four millimeters thick; otherwise, the procedure cannot be performed. Also, being a technique-sensitive procedure, it is difficult to perform compared to a free gingival graft (FGG).

Rotational Flaps:

Rotational flaps exist to compensate for the disadvantages associated with autogenous grafts. These flaps can be moved laterally (side direction) or coronally (upward direction). Coronally advanced flap (CAF) refers to the coronal movement of the flap, while the lateral pedicle flap refers to the lateral movement of the flap. The lateral pedicle flap (LP) is indicated in anterior teeth where a large donor tissue (from the adjacent tooth) can be moved to the recipient site. It also prevents further recession development by increasing the keratinized tissue and providing good esthetics.

There are two more variants called

• Transposition flap.

• Double papilla flap.

They have some disadvantages. Hence, the coronally advanced flap is better than these flaps. It provides good color blending and eliminates the need for donor and recipient tissue. It is used in single and multiple recessions and in combination with free gingival grafts and subepithelial connective tissue grafts (bilaminar technique). The only disadvantage associated with it is vestibular shallowing in the lower teeth.

Semilunar Coronally Advanced Flap:

Another variant is the semilunar coronally advanced flap, which does not use sutures. It is the most atraumatic technique among all graft surgeries. The only limitation of this technique is that at least three millimeters of keratinized gingiva are present in the tissue.

Many adjuncts are used in combination with these grafts. Such as:

Emdogain:

A derivative containing an enamel matrix. It is used as an adjunct to coronally advanced flaps in treating moderate recession. However, cost remains the crucial factor for its less widespread use.

Guided Tissue Regeneration (GTR):

It is the oldest adjunct among all options. It is used as a membrane beneath the coronally advanced flap. The membrane could be resorbable (Vicryl) or non-resorbable (polytetrafluoroethane). It is specially indicated with deep recessions of four to five millimeters. However, the major problem with the procedure is a poor adaptation to the root convexity.

Autologous Concentrates:

Autologous concentrates like platelet-rich plasma (PRP) and fibrin have been extensively used in recession treatment. These platelet-rich concentrates have enormous growth factors, like platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF). The main advantages of these concentrates are increased keratinized tissue, sound healing, and increased tissue thickness. Growth factors also increase the blood supply. Besides recession treatment, they are used in extraction sockets and implant surgeries to promote healing.

How Can Receding Gums Be Prevented?

Receding gums can be prevented by taking proper care of your oral health. This can be achieved by:

• Brushing with a soft-bristle toothbrush twice daily.

• Flossing teeth regularly.

• Using mouthwash.

• Quitting smoking.

• Maintaining a balanced diet.

• Regular dental visits.

• Observing any abnormal changes occurring in the mouth.

Conclusion:

Recession treatment remains a stumbling block in the success of aesthetic surgery. Its eradication lies not only in the hands of clinicians but also in patients’ cooperation. Early diagnosis remains the key to success. Various procedures are available, but the best approach is the one that causes the least trauma, maximum root coverage, and further prevention.

Key Takeaway From iCliniq

• Receding gums are one of the most common dental problems. In this condition, the margin of the gum tissue around the teeth wears off, exposing the tooth root.

• It can develop due to brushing too aggressively, buildup of dental plaque, periodontal issues, trauma to the gum tissue, tooth misalignment, smoking, and piercing of the lip and tongue.

If you have receding gums or know someone suffering from gum issues, you can always ask our iCliniq periodontist, who can treat your problems and give you healthy teeth.