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Diagnoses

Gingival recession

About this diagnosis

Diagnoses are associated with common findings which are used to prescribe appropriate treatment.

Alternate terms: Exposed tooth roots.

Gingival recession, more commonly called "receding gums" is a condition in which the attachment fibers holding the gingiva ("gums") to the tooth and bone detach or are otherwise compromised, and the tooth root is exposed. The tooth may or may not be sensitive.

Causes of gingival recession may include periodontal disease (i.e. bacterial origin), chronic heavy bite stress, or simply unfavorable tooth position in the dental arch. Aggressive toothbrushing has been implicated as a causative factor in gingival recession for many years. Its role has been challenged more recently, however, in favor of bite stress. It is also possible that aggressive brushing and exposure of tooth roots to an acidic environment may aggravate the problem of gingival recession that began another way.
Learn more: Diagnoses › Abfractions and abrasions

Gingival recession (receding gums) caused exposed sensitive tooth root to need graft

Figure 1: Gingival recession. This patient complained of a sensitive tooth. The photograph shows receded gums and an exposed tooth root. "CEJ" indicates the cementum-enamel junction, where the white glassy shell of enamel tapers off. Normally, gingival attachment fibers would connect the pink, "keratinized" gums ("K") to the darker colored cementum of the tooth root. The thin zone of keratinized gum tissue around the exposed root will not hold up to tooth brushing and food abrasion over time. "M" is the unattached "mucosa", which is thin enough for the underlying blood vessels to show through. Note that the V-shaped gingival "papillae" are still intact between the teeth.

Deciding Whether to Treat Gingival Recession

Before discussing options for treatment, it is important to consider why treatment may be recommended at all.

The first reason is sensitivity. Exposed tooth roots may be sensitive, due to the exposed dentin. If this is the only reason treatment is being considered, your options may include use of sensitivity formula toothpaste, topical fluoride treatment, or application of desensitizing medications. If sensitivity disappears following these treatments, but then returns weeks or months later, the gingival recession may be progressing, and the underlying cause(s) should be identified and treated appropriately.

The second reason is that the root is less resistant to development of tooth decay than the enamel-covered crown. This is particularly true in patients who experience "Xerostomia" (chronic dry mouth), due to the loss of their number one defense against decay—saliva. Saliva flushes and rinses away gross plaque, and helps to buffer acid levels in the mouth. Xerostomia is common in elderly patients, and in patients who take certain medications. If gumline cavities develop following gingival recession, fillings can be placed into the root.
Learn more: Diagnoses › Xerostomia

The third reason to consider treating gingival recession is that receded gums frequently lack an adequate width of keratinized tissue to resist tooth brushing and food abrasion over time. In such cases, the recession generally continues. The underlying bone may also begin to recede, and the tooth can loosen over time.

Is the recession active? Treatment of gingival recession should be recommended if it is found to be actively progressing. This can be determined by your dentist or periodontist, who can track movement of the free gingival margin with photographs and periodontal measurements at successive checkups.

If there is adequate tooth-supporting ("alveolar") bone present, it may be possible to surgically cover the exposed tooth root (Figure 1 under "Treatment options") and regain an adequate width of tough, keratinized gum tissue around the affected tooth. The procedure for this is called a "sub-epithelial connective tissue graft", a surgical periodontal procedure. The likelihood of success of this procedure restoring the normal gingival contours is especially good if the "papillae" (V-shaped gum tisse between teeth) remain intact (Figure 1).