Gum Recession and Periodontal Disease

By Joey & Luke

Many people ask me what exactly is gum recession and what causes it. Gum recession is when the gums pull downwards from where they would naturally be connected to the tooth structure. Gum tissue 'should' connect to the tooth surface at the interface of the root and crown of tooth. When it pulls down from this area, the soft root is exposed.

Sometimes recession can be caused by things that can be corrected, for example in the case, if someone was using a hard toothbrush with poor brushing technique. In many cases, though, it can be a combination of many factors.

Recession of the gums can be caused by malocclusion/poor bite, which means that there are teeth meeting together in a fashion that is traumatic to the teeth, the tissues of the mouth and possibly even the jaw joint (TMJ). Over time, malocclusion may lead to recession of the gums. When teeth are not in proper alignment or certain teeth are hitting harder together than others, the first thing that may happen is gum recession. Grinding and clenching the teeth may also cause gum recession. Once again, it comes back to trauma. The excess forces that the teeth and jaw endure due to grinding and clenching can cause the gums to pull away from the natural gum line and move downwards. When you grind or clench your teeth, a dentist would typically recommend a night guard to be worn while you sleep. A night guard can help prevent jaw strain and excess forces to the teeth/gums.

Yet another example of what causes gum recession is bacteria. Just as bacteria in the mouth can cause cavities and gum infections, recession can also be bacterial-related. When bacterial plaque is left behind on the tooth and below the gum line, certain types of bacteria can cause inflammation and infection thus causing the gums to withdraw from the bacterial trauma, thus they recede. When the gums recede due to bacteria, it is called periodontal disease.

In some circumstances, gum recession may be due to a tight or low lying frenum attachment. A frenum is a small band of tissue that connects the lip or cheek tissue to the gum tissue of the jaw. Occasionally the frenum is very tight or it connects quite low, adjacent to the gums around the teeth. When it connects very close to the gum line of the teeth, it can put stress on the gum and causes it to recede. A situation likes this may warrant altering how the frenum attaches to the gum tissue, in which case a laser would be used to painlessly separate it. This is called a frenectomy.

Gum recession can be a hazard to your teeth. When the gums recede away from their natural level they move downwards and start to expose the root of the tooth. The root of the tooth is made of what is called cementum and this cemenutm is soft and susceptible to being worn away. This cementum does not replenish itself; so when disappears, it is gone for good. The problem with cementum being exposed is; increased risk of developing cavities, sensitivity of the teeth to cold/hot/sweets because there is no protection to the interior pulp and possible wearing away of the cemental surface (abrasion and abfractions). Simply put, the cementum should not be exposed.

To protect exposed roots, a few things may be recommended. At some times, coverage of the root may be done with white bonding/filling material, which can protect the cementum surface from the toothbrush, stimulus and may prevent decay from occurring on the surface. At other times coverage of the exposed roots may be done with tissue grafting. This tissue may come from the patient's own mouth (palatal tissue) or may be from an acellular dermal matrix (Alloderm). When gum grafting is performed, the hope is to achieve full coverage of the root and return the appearance of the tooth back to 'normal.' Before any of these procedures are performed it is essential that elimination of other factors as described above; malocclusion, grinding/clenching and bacterial infection is taken into account. These factors need to be corrected prior to bonding or grafting so either treatment has a chance to succeed.

A full assessment is needed prior to any treatment recommendation and should be fully evaluated by a dentist.