Gum Loss Treatment

Gum Recession Causes, Concerns and Therapies for Correction

Gum recession is a prevalent dental issue that involves the gradual loss of gum tissue, exposing the roots of teeth. This condition can lead to various problems, including increased tooth sensitivity, aesthetic concerns, and a heightened risk of tooth decay. Understanding the causes, implications, and treatment options for gum recession is essential in order to prevent future loss and to predictably reverse the effects by specific dental treatments. This summary covers subjects including gum recession, gum loss, gum grafting, gum repair and gum surgery.

What is Gum Recession?

Gum recession occurs when the gum tissue surrounding the teeth pulls back or recedes, revealing more of the tooth and/or its root. This condition can affect one or multiple teeth and gum recession of 1-2mm over a lifetime is considered normal.

• Recession Type 1 (RT1): This is the mildest form, and involves gum loss only without any breakdown of the ligament that sits between the teeth. Pictured are two examples of RT1 gum recession marked in red, with green markings outlining where the gum should be or once was.
  

Recession Type 2 (RT2): A moderate gum loss affecting the connective tissue that holds the teeth to the bone, but not as much as the gum loss on the outside or facial part of the tooth. Pictured in red is an area of RT2 showing a black space opening between the teeth, indicating a more progressed condition.

• Recession Type 3 (RT3): A severe gum loss affecting the connective tissue and ligament as much or greater than the facial gum loss. This is highlighted by black triangle formation (marked red) which can cause aesthetic and function related problems.  
  

Causes of Gum Recession

• Periodontal Disease: Periodontal disease is a bacterial infection that affects the supporting structures of the teeth, often due to poor oral hygiene, genetics, medical abnormalities such as CHD and diabetes leading to an adverse healing response to the bacterial load. The infection breaks down the supporting structures including the gum creating a gum and tooth loss over time.
  
• Aggressive Brushing: Using a hard-bristled toothbrush or brushing too vigorously can damage gum tissue and contribute to it thinning with time. It is crucial to use gentle brushing techniques and soft-bristled toothbrushes according to the Bass technique or that advised by your dentist.
  
• Genetics: Some individuals may have a genetic predisposition to gum recession due to their gum type being very thin. A family history of periodontal disease increases susceptibility to this condition.
  
• Hormonal Changes: Hormonal fluctuations, particularly in women during pregnancy, menstruation, or menopause, can make gums more sensitive and prone to recession.
  
• Misaligned Teeth: Crooked teeth or bite issues can exert excessive force on the bone and gums, leading to recession over time.
  
• Overloading: Clenching or grinding teeth can place undue stress on gum tissue, contributing to recession.
  
• Oral Piercings: Jewellery in the lip or tongue can irritate the gums, causing recession.

• Growing Older: 1-2mm of gum recession is safe and within normal limits over a lifetime.
  
  Concerns Associated with Gum Recession
  
  Gum recession can lead to several significant concerns:
  
• Increased Tooth Sensitivity: Exposed tooth roots are made of cementum and can be hypersensitive to hot, cold, and certain foods, leading to discomfort. Root cementum is not as strong as enamel.
  
• Aesthetics: Receding gums can create an uneven smile and make teeth appear longer, affecting confidence. Black triangle formation creates negative space within the smile, indicating the loss or absence of a key components of a good smile – healthy and full gum tissues.
  
• Risk of Tooth Decay: Exposed roots are more susceptible to decay, heightening the risk of cavities and other dental problems. They are more susceptible due to the relative lack of inorganic substrate within cementum versus enamel.
  
• Potential Tooth Loss: Advanced gum recession can lead to tooth mobility and loss if not addressed early.
  
• Progression of Periodontal Disease: Gum recession often indicates underlying periodontal disease, which can have further health implications if untreated.
  
  How to fix or reverse Gum Recession
  
  Successful treatment of gum recession depends on its severity and underlying causes. The first line of management is to ensure it is not progressing, which includes managing any health conditions and stabilising the gum position.

Preventative

Improved Oral Hygiene: Maintaining good oral hygiene practices, including regular brushing, flossing, and using an antimicrobial mouthwash.

Orthodontic Treatment: If misaligned teeth contribute to gum recession, orthodontic intervention may help align teeth and relieve pressure on the gums.

Active

Once stabilised, the active management may involve a technique referred to as a Coronally Advanced Flap (CAF) and a Connective Tissue Graft (CTG). This is a technical term for reversing gum recession via a gum graft and repositioning the gum back to its most ideal position.

At the appointment for a gum graft, the stages of the treatment are required to be extremely precise and involve:

Preparation: The area is numbed with local anesthesia
Flap Creation: The gum tissue is carefully lifted from the area experiencing recession.

Tissue Harvesting: A small section of connective tissue is removed from the palate. This area is stitched to allow it to heal naturally.
Graft Placement: The harvested tissue is placed over the exposed root surfaces. This is stitched into place with resorbable polyglactin sutures.
Tissue Advancement: The flap is repositioned over the exposed tooth roots, providing coverage and securing it in place with fine stitches made of a prolene or expanded PTFE.
Healing: Over time, the gum tissue heals, covering the exposed roots and improving aesthetics.

Advantages of the CAF-CTG method

– Minimal discomfort and quicker recovery compared to other surgical methods

– Preserves the integrity of the original gum tissue

– Provides robust coverage of exposed roots with connective tissue which is collagen. This is the most resistant tissue to father gum recessions

– The graft originates from your own body so there is no risk of rejection of the graft.

Preoperative Instructions for Gum Surgery

Preparing for gum surgery is vital for success. Here are key instructions to be aware of:

Oral Hygiene: Maintain excellent oral hygiene leading up to the surgery, including consistent brushing and flossing.
Diet: Avoid alcohol, tobacco, vaping and other smoke products for at least 2 weeks before the procedure and consume a light meal beforehand.
Logistics: Ensure you have planned for a day of recovery without any strenuous exercise or long haul travel.

Postoperative Instructions for Optimal Recovery

Following these postoperative guidelines is essential for effective healing:

Rest: Limit strenuous physical activity for 24 to 48 hours after surgery to facilitate recovery.
Diet: Stick to a soft diet for the initial days. Avoid hard, crunchy, or spicy foods that may irritate the surgical area.
Oral Hygiene: Avoid brushing the area for the first seven days. Use a prescribed mouthwash and brush all other teeth as normal.
Manage Swelling and Bruising: Apply ice packs to the outside of your cheek for the first 24 hours to reduce swelling, which typically peaks at 48 hours.
Follow-Up Appointments: Attend all scheduled follow-up appointments to monitor healing and remove sutures if necessary.
Avoid: Refrain from smoking and consuming alcohol for at least two weeks post-surgery, as these can hinder healing.
Monitor: Contact your dentist if you experience excessive bleeding, severe pain, or signs of infection, such as fever or unusual discharge.

Porcelain Veneers and Ceramics

If you prefer not to undergo a gum graft, ceramics offer an excellent alternative to cover and seal the exposed areas of root. This involves 3 stages of treatment that can also address other cosmetic issues, such as black triangles, colour issues, alignment, shape and overall balance of the smile. Read more about porcelain veneers here.

Gingival Veneers

The final option for treating gum loss and recession is a gingival veneer. This is a removable, plastic (acrylic) prosthetic replacement for gum tissue that is highly effective at covering areas of gum loss, but has major disadvantages of being removable and prosthetic gum not appearing as lifelike as genuine gum tissue.

Conclusion

Gum recession is a significant dental issue that can lead to various complications if not treated adequately. By understanding its causes and recognising early signs, individuals can take proactive steps to seek timely treatment from our dentists at Marylebone Smile Clinic. Non-surgical options, along with advanced surgical techniques like the Coronally Advanced Flap (CAF) and Connective Tissue Graft (CTG), effectively address gum recession, restoring both function and aesthetics.

Preventive measures, including proper oral hygiene and regular dental check-ups, are essential for preserving gum health. If you suspect gum recession or experience concerning symptoms, please send us a message to discuss your options.

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