Realsmile Dentistry Miami Beach

Have you looked closely at your smile lately and noticed that your teeth look longer than you think they should? A smile that looks “toothy” can be a sign of gum recession, a common condition that affects millions of adults. When gums lose their snug attachment to the neck of the teeth, they can start to recede — eventually exposing the yellowish cementum, the surface layer of the tooth’s roots. Not only does that look unsightly, especially in highly visible areas of the mouth, but it can also cause discomfort.

Gum disease is a major cause of gum recession. However, recession can happen even in a healthy mouth, especially in people who have thin gum tissue. The type of gum tissue a person has — thin or thick — is determined by genetics. Thin gum tissue recedes more easily since it is more vulnerable to wear and tear — especially as we age. On the other hand, thicker gum tissue is more robust and less likely to be damaged by trauma and inflammation. Severe gum recession can make it harder for you to smile, talk, and eat with confidence and comfort; fortunately, there are many effective ways to treat it. Let’s take a closer look at how this problem occurs and what can be done about it.

The Role of Gums

In a healthy situation, gums form a tight band around the tooth’s enamel — the hard, mineralized surface — and are firmly attached to tooth’s roots and underlying bone. Gums act as a barrier to the sometimes harsh environment of the mouth, preventing bacteria from infecting bone and tooth roots (figure 1). They are also the “wear and tear” tissue that gives protection during high-stress functions like eating, chewing, and brushing.

The gums are firmly attached to teeth by tiny collagen fibers called the gingival fibers. However, the bonds between the tooth and its surrounding bone and gum tissue can be disturbed by trauma, inflammation, and unfavorable tooth positions. When the fibers holding the gums to the tooth detach or are compromised, gums start to recede away from enamel and expose more of the tooth — including its root.

This is when many people begin to notice tooth sensitivity. Unlike the crown (chewing surface) of the tooth, the root does not have the protection of hard enamel. That’s why it is more vulnerable to hot and cold stimuli, as well as trauma — and, unfortunately for dental health, decay. The elongated appearance of the tooth and the slight color difference between the crown and root can also give the smile an unappealing look. In some cases, gaps shaped like black triangles can appear between teeth where gums are missing, which will become traps for food debris and plaque.

Why Are Your Gums Receding?

Many people may not even be aware that their gums are receding until some of these concerns show up. Your dentist can identify why this is happening, and then address the factors that are causing recession.

One of the main culprits is periodontal (“peri” – around; “odont” – tooth) or gum disease, which if left untreated, can wreak havoc on the supporting tissues of teeth. Gum disease is a bacterial infection that eventually causes bone loss (figure 2). As the bone in your jaw is lost, the gums pull away from teeth, creating small spaces or pockets. These in turn harbor more bacteria, which cause further damage to gums and bone — and potentially more noticeable gum recession.

Poor oral hygiene is a major factor in gum disease. When teeth and gums aren’t properly cared for — with brushing, flossing, and regular professional cleanings — a sticky deposit of bacteria-laden plaque remains on the teeth. Plaque contains various toxins produced by the bacteria which promote infection, inflammation and chronic disease. In the absence of good oral hygiene, it can harden into a mineralized deposit called tartar (or dental calculus), which you can’t remove at home.

Ironically, overzealous hygiene habits can also cause problems; in fact, it is probably the most common cause of gum recession. Aggressively brushing your teeth in a sawing motion can wear away enamel, irritate or inflame the gum tissue, and eventually lead to gum recession. Remember that good brushing should not hurt! If over-aggressive brushing is an issue, try using a soft bristle or electric toothbrush with gentle circular motions.

There are several other habits that can lead to oral health problems: tobacco use (especially chewing tobacco), picking at the gum line, pricking it with sharp objects, and introducing foreign objects in the mouth, like oral piercings. All of these can damage gums and cause recession.

Finally, gum recession may be caused by a tooth that has simply erupted (emerged) in the wrong place: not in the center of the jaw’s bony ridge, as it ideally should. When this occurs, some areas on the root may have inadequate bone support, and consequently little or no gum tissue protection (figure 3). This may happen naturally, or in some cases because of orthodontic treatment.

Rooting Out the Problem

Every case of gum recession is slightly different; eliminating its underlying cause is essential to successful treatment outcomes. Your dentist will do a detailed exam to determine the extent and location of the recession and carefully consider the condition of the exposed root and supporting tissue before recommending a treatment that is right for you. Treatment may involve making changes in your oral hygiene practices, and it may also involve eliminating inflammation.

One important consideration is whether the recession is stable or progressing. A teenager who has rapidly progressing gum recession due to trauma will need different intervention than a 60-year-old who may have some degree of gum recession but isn’t losing any more tissue from the progression of the disease. In a situation where cosmetic concerns or discomfort are not issues, and the existing recession is stable, you and your dentist may agree to take a wait-and-watch approach.

Non-Surgical Treatments

If periodontal disease is found, it may be controlled with a treatment called scaling and root planing. This is a thorough professional cleaning that goes below the gum line to not only remove sticky plaque and hardened calculus, but also to smooth the root surfaces, promoting reattachment of the gums and elimination of inflammation. Education about the most effective methods for maintaining good oral hygiene is also an important part of non-surgical treatment. That’s because, if the mouth is not kept healthy and disease free, treatment can be compromised and recession can continue.

When recession is minimal and confined to a small area, a restorative material like tooth-colored composite can be used to correct cosmetic defects and relieve discomfort. Composite is a dental material composed of a plastic and glass mixture that is applied to the exposed root surface. It is then hardened with a special light which bonds the material to the tooth. In certain cases, dental composites can reduce sensitivity and improve the tooth’s appearance.

Sometimes, multiple parts of the mouth have recession, with exposed roots and black triangle gaps. In this situation, if surgery is not a viable option, a gingival mask — a type of artificial gum — may be considered. This prosthetic (artificial) device stays in place in part by using moisture from the mouth, similar to the way a contact lens stays connected to the eye. It is fabricated after taking impressions of your teeth and gums, and custom-fitted to go over them, concealing unappealing gaps in the smile.

Gum Grafts: Rejuvenating Tissue

If gum tissue damage is caused by periodontal disease, or if there isn’t enough tissue remaining, your dentist may recommend periodontal plastic surgery (gum grafting). Gum grafting is typically performed by a periodontist, a dentist who specializes in treating supporting tissues of the teeth. There are many kinds of gum grafts where new tissue is added onto the area of recession, and they often produce excellent results.

When recession occurs in less visible areas of the mouth, a graft may be done to restore and thicken gum tissue. In this procedure, a very thin layer of tissue is taken from the roof of the mouth (palate). A space or “pocket” is created in the area affected by recession, and the donor tissue is inserted into it. The grafted tissue is secured using ultra fine stitches, and in time becomes firmly attached in its new location (figure 4).

Exposed tooth roots can be covered with a different procedure called a subepithelial connective tissue graft. In this procedure, a thin piece of tissue is removed from the inside of the palate. The tissue is then grafted in the area of recession, covering the exposed roots. The grafted tissue is in turn covered with adjacent tissue providing the necessary blood supply for the graft to be successful. Soon, the body’s natural recovery process takes over: New blood vessels begin growing into the graft, and it eventually becomes integrated with the surrounding tissue.

In some situations, existing gum tissue near the site of recession may be used in a procedure called a pedicle graft. Here, the tissue is loosened and then rotated to cover the exposed root surface. Another option is to use laboratory processed tissue (human or animal) which is safe for use in surgery. When covered over with mature gum tissue adjacent to the site of recession, processed tissue can yield excellent results. A successful gum grafting procedure can reduce risk of further recession and help you enjoy a healthier and better-looking smile.

Maintaining Healthy Gums

After treatment is complete and gums are healthy, your job truly starts. Maintaining healthy gums means following your dentist’s instructions for proper at-home care. This will include brushing and flossing regularly and getting professional cleanings every three to six months, depending on your needs. Talk to your dentist about the health of your gums and he or she will be happy to advise you. Getting regular dental visits, maintaining proper hygiene, and avoiding bad habits like smoking will increase the chances that that your gums remain healthy for a very long time.

Authored By: Dr. Louis F. Rose
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