Gingival recession is a pathological movement of the gum margin
away from the tooth. This causes the root surface of the tooth
to be exposed.
root surface causes pain upon exposure to cold and hot liquids
and foods, and can be very sensitive
to tooth brushing.
Gingival recession is also unaesthetic, especially if the tooth is
located in the front of the mouth when the person speaks or smiles.
Some people have a very wide smile and show many teeth when they smile.
An uneven gum line can be distracting and even compromise a beautiful,
Gingival recession in its localized (single tooth or a few effected
teeth) or generalized form (many teeth throughout the mouth) is an
undesirable condition resulting in root exposure. The result often
is not esthetic and may lead to thermal hypersensitivity and root caries.
Exposed root surfaces also are prone to abrasion. Studies of Gingival
recession found that they correlated to the prevalence of recession
to trauma (aggressive brushing), sex, mal-positioned teeth (crooked
or overlapped teeth), inflammation and tobacco consumption. Recent
surveys reviewed revealed that 88 percent of people 65 years of age
and older and 50 percent of people 18 to 64 years of age have one or
more sites with recession. The presence and extent of gingival recession
also increased with age. More than 50 percent of the population has
one or more sites with gingival recession of 1 mm or more. The prevalence
of gingival recession was found in patients with both good and poor
oral hygiene. It has been proposed that recession is multi-factorial,
with one type being associated with anatomical factors and another
type with physiological or pathological factors. Recession has been
found more frequently on buccal surfaces than on other aspects of the
CLINICAL IMPLICATIONS: Patients should be knowledgeable about the etiology,
prevalence and associating factors of gingival recession, as well as
treatment options, so that appropriate treatment modalities can be
elected. Treatments for gingival recession include gingival grafting,
guided tissue regeneration and orthodontic therapy. Such treatments
typically result in esthetic improvement, elimination of sensitivity
and a decreased risk of developing root caries. Various clinical reports
on the reconstruction of gingival recession defects have been published
in the past decade. Several techniques have been used to achieve root
coverage, including creation of free gingival grafts, laterally positioned
flaps or semilunar coronally positioned flaps, as well as guided tissue
regeneration and connective tissue grafting. Recent focus has been
on the importance of connective tissue grafting, combined with a recent
approach known as the tunnel procedure, in managing gingival recession
defects with a single operation.
This procedure originated in 1985 with an envelope design and a subepithelial
connective tissue graft for single gingival recession defects and is
used today for coverage of multiple adjacent gingival recession defects.
Histological evaluation of such connective tissue grafts demonstrates
periodontal regeneration in human subjects. Clinical trials have yielded
good results, including early tissue healing because of increased blood
supply, good esthetic results, excellent patient cooperation and avoidance
of secondary periodontal plastic surgery. These benefits underline
the appropriateness of this technique, which improves the success rate
of connective tissue grafting and increases the amount of root coverage.
The causes of gum recession are usually two:
- Brushing too hard with a toothbrush . Only an ultra-soft
toothbrush should be used with slight pressure. If the bristles
on your toothbrush are bending out, then that is a sign that
you are brushing too hard.
- Gingival infection from plaque. Plaque is continuously
made from bacteria. Eight hours after a professional cleaning
from a dentist, plaque will form again. This is why plaque
needs to be removed daily. If plaque is not removed, the gum
tissue will become inflamed. Inflammation is very complicated
and is orchestrated by thousands of chemicals that modulate
each other. One of the effects of inflammation on the gums
is that it causes the epithelium, which is the outer layer
of tissue, to proliferate and outgrow its blood supply, thus
causing the gum tissue to die and move away from the tooth.
Within the last several years, periodontal plastic surgery techniques
have been perfected to correct gum recession. The surgical technique
involves transplanting tissue from the inner surface of the roof of
the mouth to cover the exposed root surface. The newly grafted tissue
is then covered with gum tissue taken from around the affected tooth.
This surgical technique has a high success rate because the grafted
tissue obtains blood supply from two areas, the bone and the adjacent
tissue. The procedure usually takes about 40-55 minutes under local
anesthesia. Post-operatively, patients do very well. Patients may experience
some soreness to mild discomfort for one week, which is completely
controlled with over the counter and prescription medications.