Gingival recession (receding gums) refers to the progressive loss of gum tissue, which can eventually result in tooth root exposure if left untreated.  Gum recession is most common in adults over the age of 40, but the process can begin in the teenage years.

Gum recession can be difficult to self-diagnose in its earlier stages because the changes often occur asymptomatically and gradually.  Regular dental check ups will help to prevent gum recession and assess risk factors.

The following symptoms may be indicative of gum recession:

Sensitive teeth – When the gums recede enough to expose the cementum protecting the tooth root, the dentin tubules beneath will become more susceptible to external stimuli.

Visible roots – This is one of the main characteristics of a more severe case of gum recession.

Longer-looking teeth – Individuals experiencing gingival recession often have a “toothy” smile.  The length of the teeth is perfectly normal, but the gum tissue has been lost, making the teeth appear longer.

Halitosis, inflammation and bleeding – These symptoms are characteristic of gingivitis or periodontal disease.  A bacterial infection causes the gums to recede from the teeth and may cause tooth loss if not treated promptly.

 

Causes of Gum Recession

Gum recession is an incredibly widespread problem that we diagnose and treat on a daily basis.  It is important to thoroughly examine the affected areas and make an accurate diagnosis of the actual underlying problem.  Once the cause of the gum recession has been determined, surgical and non surgical procedures can be performed to halt the progress of the recession, and prevent it from occurring in the future.

The most common causes of gingival recession are:

1.Bruxism

2.Periodontal disease

3.Poor oral hygiene

4.Chewing tobacco

5.Overaggressive brushing

 

1. BRUXISM (tooth grinding and clenching)

IS NOT YOUR TOOTHBRUSH NOR YOUR BRUSHING TECHNIQUE!

When you bend a stick too much, the stick breaks from the stress. When you grind on a tooth too much, the tooth flexes, bends and the area where the tooth bends chips off and dissolves leaving a notch. The notch is at the bottom front of the dental crown near the gums and is called a dental abfraction. 

The anatomy of the maxillary bones is the first and main predisposing factor for gum recession, clenching and grinding a tooth towards the thinner part of the bone plate will cause the plate to reabsorb, leading to receding gums and triggering the notch formation.

Years ago dentists and hygienists believed that the primary cause of a dental abfraction was brushing hard but many patients who do not brush also have these tooth notches. Once the abfraction lesion is there the TOOTHPASTE used will in most cases, increase the size of the tooth notches, particularly with soft brushes, since they have a lot more bristles than a medium or a hard brush. 

The most common teeth to suffer with a dental abfraction is the bicuspid teeth, especially the upper bicuspids but the notches can also be found on cuspids ( vampire teeth ) and molars. The notch is below the dental crown on the root surface and is formed because the minerals that form the dental root have dissolved due to the grinding pressures. This exposes the tooth nerve and often causes tooth sensitivity to hot and cold. Desensitizing toothpastes, preferably natural, do help reduce the sensitivity from dental abfractions, but the real cause is from BRUXISM (tooth grinding and clenching). 

Some dentists attempt to fill the dental abfraction notches with white dental fillings, but because the tooth still flexes and bends, these white fillings often pop out of the notch leaving a bigger hole than the original notch. We recommend that patients first get grinding guards or get minor occlusal adjustments before attempting to fill their tooth notches.

If a tooth has an abfraction, the occlusal loading on the tooth can be tested in centric occlusion and in excursive movements with occlusal marking paper. There is a good chance that the tooth with abfraction will have a heavy marking on one of the inclines of a cusp. This damaging lateral force produces stress lines in the tooth and results in tooth break down.

If the patient does not have heavy markings on the inclines, then he may have abnormal activity of the tongue. A ‘normal swallow’ is a swallow that is initiated with the tip of the tongue starting in the area of the maxillary anterior papilla, that continues with a peristaltic like action, pressing up against the roof of the maxilla, forcing the bolus posteriorly and finally down the throat. The tip of the tongue remains in the area of the anterior papilla during the entire swallow. Any other swallow is considered to be the result of abnormal tongue activity. The tongue should not press with any force into, against or between any teeth during the swallow.

We examine the area of abfraction with the patient’s teeth together and lips slightly parted to see whether the tongue is pushing into the tooth, or if salivary bubbles are visible coming between the interproximal spaces. Tongue thrusting can be the result of large tongues or obstructed airways.

When lateral tongue forces traumatize the teeth or if the key requirements of occlusion are not met, a series of deleterious events can occur

• Abfractions
• Gum recession
  
• Sensitive teeth
• Loosening of teeth
• Excessive wear of teeth
• Change in alignment of teeth
• Bone breakdown and bone loss
• Broken or destroyed restorations
• Non-bacterial, non- plaque related gingival recession
• Opening of contacts.

If during lateral excursions there is cuspid rise, the loadingforces of the excursive movement will be directed into the cuspid. Abfractions are frequently found in cases where malaligned cuspids cause initial lateral guidance forces to be exerted on the lingual incline of the buccal cusp of the maxillary bicuspid. Abfractions are also found in patients with slight anterior open bites. Here also, the guidance is coming from the bicuspids, rather than the cuspid.

The common clinical occurrence of class V restoration failure is often blamed on inadequate moisture control. Study by Rees J S and PH Jacobson shows that the presence of a class I restoration, especially an amalgam restoration on the same tooth can influence the prognosis of a class V restoration, They found that the presence of an occlusal restoration increased cuspal movements, which in turn increased the shear forces around the buccal class V cavity.

Lastly, it is important to remember that your cavity preparation and restoration of a class I cavity may cause an abfraction. It is well established that cavity preparation weakens a tooth, resulting in more cuspal movement under occlusal load. In a study by Rees J, under an eccentric 100 N occlusal load, a premolar with an occlusal amalgam restoration showed peak tensile and shear stresses in the buccal cervical region that were in excess of the known failure stress for enamel. Increases in the cavity depth of the occlusal amalgam restorations were found to increase cervical stress more than increases in cavity width.

Here is the last word, the weakening effect of an occlusal cavity preparation may contribute to the development of non carious cervical tooth loss.

References: 1. Rees JS & PH Jacobsen, J Dent 26(4):361-7,1998                2. Rees JS, Eur J Oral Sci 106(6): 1028-32,1998

 

2. Periodontal disease – Periodontal disease can be a result of improper oral hygiene or caused by systemic diseases such as diabetes.  The excess sugars in the mouth and narrowed blood vessels experienced by diabetics create a perfect environment for oral bacteria.  The bacterium causes an infection which progresses deeper and deeper into the gum and bone tissue, eventually resulting in tooth loss.

 
3. Poor oral hygiene – When brushing and flossing are performed improperly or not at all, a plaque build up can begin to affect the teeth.  The plaque contains various bacterial toxins which can promote infection and erode the underlying jawbone.

4. Chewing tobacco – Any kind of tobacco use has devastating effects on the entire oral cavity.  Chewing tobacco in particular, aggravates the gingival lining of the mouth and causes gum recession if used continuously.

5. Overaggressive brushing – As we were all taught at dental school, Over brushing can almost be as dangerous to the gums as too little.  Brushing too hard or brushing with a hard-bristled toothbrush can erode the tooth enamel at the gum line, and irritate or inflame gum tissue. We, however, at the HOME OF BIOLOGICAL DENTISTRY, see this rather as secondary to afbraction lesions or periodontal disease.

 

Treatment of Gum Recession

Every case of gum recession is slightly different, and therefore many treatments are available.  The nature of the problem which caused the recession to begin with needs to be addressed first.

Once the cause of the gingival recession has been addressed, we can help you with surgery of a more cosmetic or restorative nature.  Gum tissue regeneration and gum grafting are excellent ways to restore natural symmetry to the gums and make the smile look more aesthetically pleasing.

If you have any questions or concerns about periodontal disease, periodontal treatments, or gum recession, or would like to schedule an appointment, please contact us today at Tel. +27 12346 2028 / +27 12346 5615 or +27741260768, alternatively e-mail us at info@southafricadentist.com. We look forward to providing you with the personal care you deserve.

Definitions of Tooth Surface Loss*