Advancing a plan of action for those receding gums
The dental checkup was supposed to be routine, just the latest in a long line of preventive exams. So as someone who prided herself on excellent oral care, 34-year-old Nina Saffari could hardly believe what her dentist was telling her. She’d essentially brushed her gums away, he said, and might need surgery to repair the damage.
Years of conscientious, but overly aggressive brushing had kept her teeth free of cavities but had damaged her gums. The tissue was now contracting, or pulling back -- a condition known as gum recession -- and the roots of her teeth were exposed. Soft tissue grafts might be necessary, her dentist said, to cover the exposed roots.
Americans get such news frequently. One recent study, by the school of dental medicine at the State University of New York at Buffalo, found that 88% of people 65 and older and 50% of people 18 to 64 have one or more areas of recession.
Overzealous tooth brushing -- particularly with hard-bristled brushes -- is one of the most common causes. Brushing scratches the gums, and, over time, the repeated injuries lead to scarring and contraction of these tissues.
The other extreme -- not brushing adequately -- can also lead to gum recession. If bacteria in the plaque on teeth are allowed to overgrow, the adjacent gum tissue can become inflamed.
Eventually this inflammation may not only damage the gum tissue but also destroy the bone that surrounds and anchors the teeth, a condition called periodontitis.
“Gum disease is more than just gums,” says Don Clem, a periodontist in Fullerton. The health of a tooth depends on the integrity of the surrounding bone.
But people with gum recession should not overreact; not everyone needs surgery. In fact, most gum recession procedures are performed simply for cosmetic reasons.
As the gums pull back, teeth can begin to appear too long. Some people are bothered by the appearance of these areas, particularly when recession affects teeth at the front of the mouth. Grafts help return the gumline to normal and improve the aesthetics of the smile.
Simple preventive measures are sometimes all that are necessary to stop gum recession from progressing.
Improved hygiene can help keep inflammation under control; switching from a hard toothbrush to a soft one can prevent gum injuries.
“Hard and medium toothbrushes don’t remove bacteria and plaque any better than a soft toothbrush,” Clem says.
When recession worsens in spite of this conservative approach, surgery may be necessary, particularly when inflammation is the cause. Uncontrolled inflammation can cause ongoing recession and bone loss. Skin grafts to cover the exposed roots of the teeth will help prevent further losses and may actually reverse some of the damage. “Once you place connective tissue back on the root surface, you get a small increase in bone,” says Clem.
Perhaps more important than the graft, however, is the need to clear away any plaque and tartar that cling to the root surfaces beneath the gumline. Otherwise they provide a continuing harbor for inflammation-causing bacteria.
When the gums are not inflamed, the decision about whether surgery is necessary is less clear because it’s impossible to tell if gum recession will worsen. “Gum recession doesn’t always progress,” says Mike Rethman, president of the American Academy of Periodontology.
One examination can’t determine whether the condition is advancing. The recession needs to be monitored over time.
If gum recession is causing discomfort, treatment may be indicated even if the condition doesn’t appear to be worsening. Teeth with exposed root surfaces are often highly sensitive, particularly to hot and cold. Covering the exposed roots with skin grafts can help alleviate these symptoms.
Some periodontists are more aggressive than others in recommending gum recession surgery. They argue that the exposed root surfaces of the teeth are susceptible to decay and should be covered to prevent cavities. (In fact, the risk of cavities developing in these areas is actually quite small in healthy middle-aged people; the risk appears to increase significantly only in the elderly.)
Others believe that recession is almost always progressive, and discourage waiting because the problems may get more complicated to treat and the outcomes more unpredictable.
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Dr. Valerie Ulene is a board- certified specialist in preventive medicine practicing in Los Angeles. She can be reached at themd@att.net. The M.D. appears the first Monday of the month.
