Receding gums are common and often
unnoticed at an early stage. There are many risk factors, but age is a main one
– 88% of people older than 65 have receding gums in at least one tooth--hence the term "long in the tooth" to refer to an older person.
Since gums protect fragile tooth roots
from bacteria, plaque and other insults, the main concern with receding gums is
that when the roots of the teeth become exposed, they are at risk for decay,
infection, and loss. Treatment can stop or reverse the process of gum recession
if begun at an early stage.
If the recession is severe and the patient
has symptoms such as tooth sensitivity, pain, or infection, a variety of
treatment options are available. These include deep cleaning, medicine to fight
infections, and even tissue grafts.
What are the gums?
The gums are also known as the gingivae. The gingiva is the
moist pink tissue in the mouth that meets the base of the teeth. There are two
such gums - one for the upper, and one for the lower set of teeth.
The gingiva is a dense tissue with a
good supply of blood vessels beneath a moist surface. The surface is called
mucous membrane. It is joined to the rest of the mouth lining but is pink
instead of shiny red. The gums tightly surround the teeth up
to the neck of each one and are firmly attached to the jaw bone. The gums
usually cover the roots of the teeth, protecting them as they are more fragile
than the rest of the teeth.
Gingival recession exposes the fragile
tooth roots to bacteria, plaque, and other forms of decay.
Why do gums recede?
Poor oral hygiene and periodontal
disease are linked to gingival recession. But receding gums can happen in
people with good standards of oral hygiene, too.
Broadly, there are two causes of
receding gums:
- Physical wear of the gums
- Inflammation of the gum tissues - this is a reaction of the immune system
Some people are more prone to receding
gums because of inherited factors. These factors include their tooth position
and gum thickness.
Physical wear of the gums by vigorous
tooth brushing or use of hard bristles is a common cause of receding gums. People with this problem might otherwise have
good oral hygiene. The teeth and gums otherwise appear healthy when receding
gums are caused by over-brushing. This
type of recession often affects the left side more. This is because most people
use a toothbrush in their right hand and so put more pressure on the left gums.
The pattern also tends to affect the side gums more than the front.
Other physical factors that push the
gums back include lip piercings, misaligned teeth, and damage caused by dental
treatment.
As far as inflammation goes, some
people are more prone to the inflammatory causes of receding gums. Thinner gum
tissue makes inflammation caused by plaque more likely. The gums are more
delicate in some people.
Related to inflammation, periodontal
disease is a common cause of gum recession. Periodontal disease causes the loss
of the supporting bone around a tooth through an inflammatory reaction. The gum
recession tends to affect all the teeth in a similar way.
Periodontal disease is caused by plaque
buildup. Plaque is a sticky film that forms on the teeth. Bacteria, mucus,
cells, and other particles are involved in the formation of plaque.
When plaque builds up on teeth, it
causes:
- Inflamed gums known as gingivitis. This condition can lead to periodontitis
- Periodontitis results in spaces between the gums and teeth and loss of connective fibers and bone around the tooth roots. This leads to receding gums
Tartar is hardened plaque and cannot be
removed by tooth brushing. Instead, it must be removed at a dentist's office,
generally by the hygienist, but sometimes by scaling by the dentist.
Problems caused by receding gums
Many people with receding gums have no
concern about them early on. Many others are unaware that they have recession.
For some, though, the concern may be about:
- Appearance
- Fear of tooth loss
- Sensitivity due to exposed tooth roots
Assessing concerns about the way gums
look may include checking how much of the gums are exposed. For some people, the gums show when talking
and smiling. Others have a different lip line that does not expose the gums to
view.
Treatment for receding gums
Most of the time, mild gum recession does
not need treatment. Dentists may simply give advice about prevention and offer
to monitor the gums. Teaching people how to brush gently but effectively is a
good early intervention.
For people who do need treatment, a
number of options are available:
- Desensitizing agents, varnishes, and dentine bonding agents: These aim to reduce any sensitivity that may develop in the exposed tooth root. This treats the nerve symptoms and helps to keep normal oral hygiene by allowing brushing of sensitive teeth to continue
- Composite restoration: Tooth-colored composite resins are used to cover the root surface. They can also close black gaps between teeth. I happen to be proud of my skill in this area.
- Pink porcelain or composite: This is the same pink color of the gums.
- Removable gingival veneers made from acrylic or silicone.
- Orthodontics: Treatments designed to move the position of teeth can correct the gum margin.
- Surgery: Tissue is grafted from elsewhere in the mouth and heals over the gum recession.
Keep smiling,
Dr. Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut.
She is a Clinical Instructor at the UConn School of Dental Medicine,
and has won several awards naming her regional “Best Dentist” and “Top
Dentist.” She is an active member of the Connecticut State Dental
Association and the American Dental Association. Tel: 860-561-2121
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