Receding Gums

Receding Gums

Also called: Gum Line Receding, Gum Recession, Gum Receding

Summary

The gums (gingiva) are the soft tissues of the mouth that surround and support teeth. Healthy gums fit snugly against teeth. When gum lines pull away from the teeth, it is called receding gums or gum recession.

Receding gums expose more of the root (cementum) to tooth decay and cavities and may create spaces or pockets between the teeth and gums. Those spaces can become repositories for food particles and harmful bacteria that are more difficult to brush and floss away. Since more of the root surface is exposed, teeth anchored by receding gums may be more sensitive to hot and cold or sweet and sour sensations (sensitive teeth). Teeth may also appear longer than normal because the gums cover less of the tooth surface.

Receding gums can be caused by a number of factors, including brushing too hard, mouth injuries or trauma, smoking, oral piercing, misaligned, gapped or crooked teeth and periodontal disease – the inflammation and infection of the gums, bones and tissues that anchor teeth to the jaw.

Receding gums are usually symptoms of an underlying disease, such as periodontal disease  or an injury (such as trauma or abrasion). Some people may have gums that are naturally thin and therefore are more prone to recession. Older people are also more likely to have the condition because recession increases with age. Diagnosing the cause of gum recession includes a dental examination, x-rays and dental history and family medical history.

Depending on the severity of the recession and the underlying cause, treatment can be surgical or non-surgical. For some, improving home oral care alone may be enough to restore gums to their previous healthy condition. Toothbrushes with pressure-sensitive handles – that automatically shut off when too much pressure is applied to the teeth – can be used to reduce gum recession caused by brushing too hard. People experiencing tooth sensitivity may need to use desensitizing toothpaste. A bonded resin can be applied to exposed roots to make them less sensitive.

For more severe recession, patients may be referred to a periodontist. Soft tissue graft (also called gum graft) surgery can restore receded gum lines and cover sensitive roots.

Smokers and those who are malnourished, immunocompromised (HIV/AIDS) or have uncontrolled diabetes may have difficulty treating or controlling gum recession.

For most people, gum recession is preventable with good oral hygiene and regular dental checkups. The American Dental Association recommends that individuals stop (or do not start) smoking or wearing oral jewelry since both increase the risk of gum recession.

About receding gums

Receding gums occur when the gums (gingiva) pull away from the teeth. This causes the teeth to look longer than normal and exposes the roots (cementum). Those with receding gum lines may have toothy smiles. They may also be more sensitive to hot and cold or sweet and sour sensations (sensitive teeth). Root caries (cavities), decay, infection and tooth loss are also more likely when gums recede.

Gums are attached to the teeth and provide a protective seal to keep germs such as bacteria from entering the body through blood vessels in the mouth tissue. Healthy gums are pink and fit snugly against the bottom of the crown, the portion on the tooth visible above the gum line. When gums recede, there is loss of this attachment to the teeth and more of the cementum (root covering) is exposed. The cementum is thinner and less durable than enamel.

Teeth become sensitive because tiny tubules in the dentin (a layer of the tooth beneath the enamel and cementum) are more exposed to stimuli (e.g., hot and cold). Nerve endings in the tooth can interpret signals from those hypersensitive tubules as sharp pain. The discomfort can last a few seconds and subside or ease into a dull ache.

Improper cleaning techniques (brushing too hard and using a hard-bristled toothbrush) are a key reason for gum recession. Many people put too much pressure on the brush or snap the dental floss too tightly between teeth. This causes abrasions on the gums. Over time, the gums retract and recede from the gum line (gingival atrophy).

Other forms of trauma, such as oral piercings, can damage the inner mouth tissue, causing irritation, abrasions and bleeding – all of which can lead to gum recession.

The spaces or pockets formed between teeth and gums when gums recede can harbor food particles and encourage rapid growth of harmful bacteria. Cavities in the tooth’s root can develop as the plaque and bacteria attack the cementum. Uncontrolled plaque and bacteria on the gums and teeth can also increase the risk of developing a more serious gum condition called periodontal disease.

Other symptoms related to receding gums

For some people, the most visible sign of gum recession can be found by looking in the mirror. A receding gum line makes teeth look longer. There may be a change in the tooth’s color below the gum line, indicating exposure of the sensitive roots (cementum). However, those with gum recession may not notice they have the condition, especially if it occurs in the back molars or other, less visible areas of the mouth.

The following related signs and symptoms may occur in conjunction with gum recession:

  • Puffy, red or swollen (inflamed) gums (gingivitis)
  • Gum bleeding while brushing or flossing
  • Bad breath (halitosis)
  • Spaces developing between teeth
  • Gapped teeth
  • Changes in bite or protruding teeth (malocclusion)
  • Shifting or loose teeth
  • Exposed roots
  • Teeth that are sensitive when touched by dental instruments or hot, cold, sweet or spicy foods
  • Cavities in the roots (below the gum line)

Potential causes of receding gums

There are several potential causes of receding gums. The two most often identified are gum abrasion caused by brushing too hard and gum recession caused by or associated with periodontal disease (PD) – the inflammation and infection of the gums, bones and tissues that anchor teeth to the jaw.

Brushing too hard and too vigorously, and using hard-bristled toothbrushes, can cause the gums to recede. Applying too much pressure on the teeth, scraping or raking the brush horizontally across the gums (rather than gently pressing) or snapping dental floss between the teeth (rather than gliding it through) causes abrasions, injury or trauma to the gums. This irritation can lead to inflammation, redness and bleeding. After months or years, gums can begin to recede (gingival atrophy).

Gum recession associated with periodontal disease is part of the body’s immune response to bacteria on the gums and teeth. The immune system’s reaction to toxins produced by these bacteria can cause inflammation and, eventually, gum recession.

Age can also cause receding gums, especially if the gums have been subjected to aggressive brushing. In addition, older women can have bone loss associated with lack of estrogen and osteoporosis. As the alveolar bone supporting the gums and teeth erodes, this can cause gums to recede.

Gum recession can also be caused by:

  • Abnormal oral frenum. The piece of tissue connecting the lip muscles to the gums between the two front teeth can pull too tightly on gums in both the upper and lower jaw. In the upper teeth, the tissue is called the maxillary labial frenum (frenulum). When talking and eating, the frenum moves in line with the upper teeth and gums. If the frenum is too tight, it pulls against the gums causing them to recede. A gap can form (gapped teeth or maxillary diastema). In the lower jaw, a similar process can occur with the mandibular labial frenum (located on the lower outside gums) and the lingual frenum (the cord under the tongue that connects the tongue to the floor of the mouth). A condition called tongue-tied results when the lingual frenum is too tight. In addition to causing gum recession and gapped teeth in the lower teeth, being tongue-tied can also cause speech difficulties.
  • Misaligned or crooked teeth.  When teeth are crooked or curved into or away from the natural line of teeth (dentition), gums do not fit snugly against them. A tooth that is positioned in the arch (by dropping down from the upper jaw or pushing up in the lower jaw) also does not have normal gum attachment. These misalignments can cause gum recession around the affected teeth and create bite problems (malocclusion).
  • Mouth trauma or injury. When teeth are knocked out or when mouth surgery stitches burst open (dehiscence), gums can recede around the tooth. Oral piercing with jewelry that rubs against gum tissue can also cause the gums to recede.

Diagnosing causes of receding gums

A dentist or dental hygienist can assess overall gum health during the recommended twice yearly dental checkup examination. However, for gum recession caused by mouth injury or trauma, immediate medical attention is often necessary.

Diagnosing the cause of gum recession usually involves a comprehensive oral evaluation to assess overall health of the oral cavity. The dentist may also complete a Periodontal Screening & Recording (PSR) examination, a quick diagnostic tool designed by the American Dental Association for early detection of periodontal disease.

The evaluations typically include the following:

  • Dental history and family medical history. Provides information about the type and duration of symptoms, other systemic conditions (such as heart disease, HIV, diabetes, pregnancy), prescription drug use, oral hygiene habits and family dental history.
  • X-rays. Reveal pocket formation, bone and ligament loss, tooth alignment and any root cavities. A full-mouth x-ray of all the teeth, gums and bones can be taken in the dentist’s office.
  • Periodontal probe. Measures each tooth and tells the depth of dental pockets formed between the gums and teeth (sulcus). The probe is a thin measuring rod with a rounded tip and notches indicating millimeters (mm). It is placed at six points around each tooth: three on the inner (tongue) side and three on the outer (facing the cheek) side. The deeper the pocket, the more gum recession. A pocket of 1 to 3 mm is normal. Anything above that may indicate gum recession.
  • Toothmovement. Indicates if there has been gum recession or bone loss. The dentist may gently shake a tooth to see if it is loose. This is done for sports injuries and accidents where teeth are partially or completely knocked out.
  • Occlusion. Shows the bite alignment. Teeth that shift when gums recede may fit together differently when biting, leading to malocclusion. This can cause chewing problems.

Treatment options for receding gums

Depending on the severity and cause of the gum recession, treatment may be performed by a dentist, an oral and maxillofacial surgeon, an orthodontist or a periodontist (a specialist who treats diseases and conditions related to gums, bones and tissues in the mouth). They may recommend surgical or non-surgical treatment options or a combination of both.

All patients with receding gums (no matter the cause) are advised to practice good oral hygiene. This includes a regimen of brushing at least twice daily (perhaps after every meal) and flossing at least once daily to remove plaque and tartar from teeth and gums. This may also include use of antibiotic mouthwash to reduce harmful bacteria levels in the mouth. Dentists may also recommend using oral irrigators or interdental aids (picks and threaders) to help clean hard-to-reach areas between crooked and misaligned teeth, in the molars or around bridges and braces.

The non-surgical treatment options for gum recession may include:

  • Desensitizing toothpaste. For those with painful, sensitive teeth, brushing with toothpastes containing compounds that block the nerve response in the teeth may help eliminate pain. Several applications of the toothpaste may be necessary.

  • Desensitizing agents. A dentist can apply fluoride gels, resins and other desensitizing agents to exposed areas of the teeth and roots.

  • Debridement. For recession caused by bacterial infection, a professional deep cleaning of periodontal pockets. The hygienist typically schedules four appointments, one for each quadrant of the mouth. This includes scaling – scraping the tooth above and below the gum line to remove plaque and tartar. Root planing is also performed to smooth away crevices or holes on the root surface that might harbor bacteria. Polishing buffs the crowns of the teeth to make them resistant to plaque growth. These deep cleanings may be conducted every three months or more frequently to control plaque and tartar buildup.

  • Orthodontics. Those with misaligned or crooked teeth may be referred to an orthodontist for evaluation. braces may be recommended to realign and straighten teeth, improve the bite and stop further gum recession. 

Surgical procedures to correct gum recession may include:

  • Soft tissue graft. Replaces or restores dead or receded gum tissue. This is also called gum graft surgery. There are three different kinds of gum grafts. In the pedicle graft, the periodontist cuts gum tissue from around an adjacent teeth (leaving a piece still connected to the gums for blood supply) and moves it over to cover a receded gum line. The free gingival graft cuts a sliver of gum tissue from the roof of the mouth (palate) and sews (sutures) it into place over areas where there may be root exposure. Donor gum tissue may also be used for this procedure. In the connective-tissue graft, the periodontist makes an incision in the roof of the mouth and removes connective tissue from inside. That tissue is then slipped under gum tissue near an exposed root and sutured into place.

  • Root canal treatment. Removes the tooth’s nerve tissue when root exposure causes tooth sensitivity. If desensitizing toothpastes and gels fail to eliminate pain from tooth sensitivity or if a root cavity forms beneath a receded gum line, it may be necessary to perform root canal therapy.  (See also Root canal treatment). The multi-step procedure can be conducted through the crown of the tooth or by cutting a flap in the gums (gum flap surgery) and cutting out decayed or hypersensitive tooth tissue. If the root canal treatment is perform through the crown an artificial crown (cap) is placed on the tooth afterward to strengthen it.

  • Frenectomy or frenulectomy. Minor surgery to loosen the oral frenum that may be causing excessive pulling on the gums. The oral frenum (the connective tissue that joins the upper and lower lips to the gums and the tongue to the floor of the mouth) is cut. The frenectomy is performed on the upper lip and lower outer lip and the frenulectomy on the tissue under the tongue. The procedures are done under local or general anesthesia depending on the age of the patient.

  • Oral Surgery. Those with mouth trauma or injuries (such as teeth and bones knocked out or shattered during sporting events or accidents) may require surgery to reconstruct damaged bones or to replant teeth. Tetanus shots and/or antibiotics are often given to reduce the risk of infection. Gum grafts (surgery that uses palate tissue or donor tissue to restore dead, injured or receded gums) may then be needed to restore a normal gum line.

Following surgery or other gum recession treatment, the patient may undergo maintenance therapy. This includes follow up comprehensive examinations every three to six months to evaluate success of treatment and to insure against further gum recession.

Prevention methods for receding gums

Most cases of gum recession are preventable with good oral hygiene. Since plaque is constantly forming on teeth, brushing and flossing daily to prevent bacteria buildup is an important preventative tool. In addition, the following steps can be taken to avoid receding gums:

  • Regular dental visits. The American Dental Association (ADA) recommends dental checkups every six months. The dentist or dental hygienist can assess gum health, including gum recession, and recommend steps to prevent gum erosion.
  • Proper brushing. The ADA recommends using a soft toothbrush, holding the brush at a 45-degree angle and brushing in short gentle strokes (only two or three teeth at a time). Hygienists can provide instructions on proper brushing to prevent harming the gums. Using a powered toothbrush helps regulate brush strokes. Pressure-sensitive toothbrushes (that shut off automatically when too much pressure is applied to the teeth) can also help reduce the chances of gum abrasion.
  • Healthy diet. Eating a balanced diet that is rich in calcium (for strong bones and teeth) and vitamin C (an immune system booster) can help prevent bacteria from contributing to gum recession. Avoiding sugars (sweets, candy) also promotes good oral health.
  • Quit (or do not start) smoking. Smoke and tobacco use increase the risk of developing periodontal disease, receding gums and oral cancer.
  • Avoid harmful practices. This includes oral piercing and use of drugs that contribute to gum disorders. Tooth misalignments should be corrected or repaired.

Questions for your doctor about receding gums

Preparing questions in advance can help patients to have more meaningful discussions with their dentists regarding their conditions. Patients may wish to ask their doctor the following receding gums-related questions:

  1. Am I at risk for gum recession?
  2. Is my gum recession reversible?
  3. How can I prevent receding gums?
  4. Will braces cause or worsen gum recession?
  5. Do I have any risk factors that require more frequent dental cleanings to prevent gum recession?
  6. Does chewing gum or tobacco increase my chances of having a receding gum line?
  7. How do I know if I’m brushing too hard?
  8. Are surgical treatments appropriate options for me?
  9. How quickly does it take to heal following gum surgery?
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