Short answer: Gum recession is when the gum margin pulls back and exposes the root of the tooth. The most common causes are hard or incorrect brushing, gum disease, a thin gum type and teeth positioned outside the bone; bruxism and smoking can also contribute. Treatment starts by addressing the cause; sensitivity treatment, fillings and, in suitable cases, surgical methods such as a connective tissue graft may be used.
If you have looked in the mirror and noticed that some of your teeth look longer than they used to, or you feel a sharp twinge at the neck of your teeth when you drink something cold, gum recession may be the reason. Gum recession usually progresses slowly and silently; most people only notice it once there is obvious sensitivity or a visible change. In this article we explain what gum recession is, its main causes and symptoms, the treatment options, especially the connective tissue graft, and what you can do to keep it from progressing.
What is gum recession?
Gum recession is when the edge of the gum moves back from its normal level toward the root, exposing the root surface that is normally covered by gum. In the medical literature it is called gingival recession. It can affect a single tooth or several teeth.
The root surface lacks the hard enamel layer that covers the crown of the tooth. Instead, it has cementum, a softer and more permeable tissue, with dentin underneath. That is why exposed roots can become sensitive to heat, cold and sweets and more prone to wear and decay. Gum recession often involves not only the gum but also the bone beneath it; the degree of bone and gum loss between the teeth is an important factor that also determines the result treatment can achieve.
What causes gum recession?
The most common causes of gum recession are hard or incorrect brushing, gum disease, a thin gum type and teeth positioned outside the boundaries of the bone; factors such as clenching, orthodontic tooth movement and smoking can also contribute. In most people, more than one cause plays a role.
- Hard or incorrect brushing: Using a hard-bristled brush and scrubbing horizontally with pressure can wear away the gum, especially in people with a thin gum type. This kind of recession is often seen on canines and premolars, even in people who brush regularly.
- Gum disease (periodontitis): Inflammation caused by bacterial plaque destroys the bone and connective tissue that support the teeth. When that support is lost, the gum recedes as well. This type of recession usually comes with loss between the teeth too.
- Clenching and grinding (bruxism): Excessive forces on the teeth are thought to contribute to recession by creating wear notches at the neck of the tooth and straining the supporting tissues.
- Orthodontic treatment and tooth position: Moving teeth outward in areas where the bone is thin, or a tooth already sitting outside the bone boundary, can set the stage for thin gum to recede. This risk is more pronounced in the lower front teeth. Well-planned orthodontic treatment, on the other hand, can sometimes improve the situation by moving a root that has drifted outside the bone back into it.
- Thin gum type: People who have inherited a thin, delicate gum type are more prone to recession.
- Other factors: Smoking, lip or tongue piercings, muscle attachments that pull on the gum (frenulum), and fillings or crowns that do not fit well at the gum line can also cause recession.
We discuss how gum health is monitored during orthodontic treatment and clear aligner use, along with other issues that may come up, in our article on clear aligner problems.
What are the symptoms of gum recession?
The most commonly noticed signs of gum recession are teeth that look longer, sensitivity at the neck of the tooth that increases with cold, heat and brushing, and a differently colored root surface showing at the gum line.
- A tooth that looks longer than it used to
- A yellowish root surface appearing at the neck of the tooth
- A brief, sharp twinge with cold drinks, exposure to air or brushing
- A step or notch at the neck of the tooth that you can feel with a fingernail
- Dark gaps between the teeth caused by loss of the gum triangles
- Decay on the root surface
- Loose teeth in advanced cases
Mild recession often causes no symptoms at all and is noticed during a routine checkup. When recession is related to gum disease, bleeding while brushing, bad breath and swollen gums may also occur.
How is gum recession treated? Connective tissue grafts and other methods
Treatment of gum recession starts with eliminating the cause; after that, the goals are to relieve sensitivity, protect the exposed root surface and, in suitable cases, cover the root surface again with gum grafts. Which method is appropriate depends on the depth of the recession, the bone situation between the teeth and the patient's expectations.
Protective and supportive treatments
- Correcting brushing habits: Switching to a soft-bristled brush and using the right technique is the first step in stopping mechanically caused recession from progressing.
- Gum treatment: If there is gum disease, inflammation is brought under control with tartar removal and deep cleaning of the root surfaces.
- Sensitivity treatment: Desensitizing toothpastes and in-office fluoride or sealing agents can be used.
- Tooth-colored fillings: Wear notches at the neck of the tooth can be covered with composite fillings.
- Night guard: May be recommended to protect the teeth if you clench.
Surgical gum treatments
- Connective tissue graft: A small piece of connective tissue, usually taken from the palate, is placed under the gum in the receded area, and the gum is positioned to cover the root surface. It is one of the most commonly used and most widely researched methods for root coverage.
- Free gingival graft: Used to thicken the tissue when there is very little firm, attached gum in the area.
- Repositioning the gum (flap techniques): Neighboring gum tissue is moved to cover the receded area; it is often used together with a graft.
- Tunnel techniques: A graft can be placed inside a tunnel created in the gum without making an incision.
- Tissue substitutes: In some cases, collagen-based matrices can be used instead of taking tissue from the palate.
How much of the root surface can be covered depends mainly on the degree of bone and gum loss between the teeth. When this loss is small, covering most of the root surface may be possible, whereas full coverage is generally not expected with advanced loss. That is why realistic expectations should be discussed with your dentist before treatment.
How can gum recession be prevented?
The basic ways to prevent gum recession are brushing gently with the right technique using a soft-bristled brush, cleaning between your teeth every day, getting gum disease treated early and going to regular dental checkups.
- Place the brush at about a 45-degree angle to the gum line and brush with small movements, without pressing.
- Electric toothbrushes with pressure sensors can help if you tend to press hard.
- Clean between your teeth once a day with floss or an interdental brush.
- If you smoke, get support to quit.
- If you clench your teeth, let your dentist know.
- Ask for your gum thickness and bone condition to be evaluated before and during orthodontic treatment.
- Have it checked whether any oral piercings touch your gums.
When should you see a dentist about gum recession?
When you notice that your teeth look longer, that the necks of your teeth have become sensitive or that your gum line has changed, it is wise to get an early examination to identify the cause of the recession and stop it from progressing. At our polyclinic in Oran, Çankaya, the amount of recession is measured and recorded, possible causes are evaluated, and the options that suit you, from protective measures to gum grafts, are discussed openly.
Frequently asked questions
Do receding gums grow back on their own?
Receded gums generally do not return to their former level on their own. Eliminating the cause can stop the recession from progressing. Covering the root surface again may be possible in suitable cases with surgical methods such as gum grafts.
Does gum recession lead to tooth loss?
Mild recession does not cause tooth loss on its own. However, if the recession is due to gum disease and the loss of supporting bone progresses, teeth can become loose and may be lost. That is why identifying the cause early is important.
Can braces or clear aligners cause gum recession?
Orthodontic treatment can increase the risk of recession, particularly in areas with thin gum and bone, if teeth are moved outside the bone boundary. This risk can be reduced with proper planning and gum monitoring. In some cases, orthodontic treatment can improve the situation by bringing the root back into the bone.
What is recovery like after a gum graft?
In the first days after a graft, there may be tenderness both at the graft site and on the palate where the tissue was taken. During this period you need to follow your dentist's advice, such as eating soft foods and not brushing the area. Healing time varies with the technique used.
