Recession (“Gums receding” & Root exposure)
I still hear people
telling me that they used to “brush too hard” and that’s the reason they have
receding gums. For the most part, the
basis for this comes from a series of articles written in the 1950’s that in
fact did not present any research to support these statements. Since the late 1960’s manufacturers have used
polished tipped nylon bristles and in fact have determined that these are safe
and cause no appreciable wear to tooth surfaces even at levels that people
would never reach in their lifetimes.
Tooth pastes (dentifrices) have also been formulated to prevent wear to
tooth surfaces. More recent research
techniques have described, in detail, the bio-mechanical reasons for the
development of recession.
So what causes it?
First, when teeth come into the mouth in a crooked position the gum
tissues may not come to the level that they should, and prominent root surfaces
may not be covered by the bone of the jaw.
Also because of this poor eruption pattern the type of tissue (gingiva)
may also not cover and surround the tooth as desired.
These several reasons are the most common to explain
recession on front teeth.
Second, natural variations in the position of muscle attachments
going to the lips may cause undo pressure on the gum tissues (gingivae) pulling
the gums away from the tooth root.
Third, the most
common reason overall is due to unnatural angles of forces acting on the teeth.
Teeth are supported in
their bony socket by a series of connective tissue ligaments . These ligaments
act as a “shock absorber” for the millions of times you load the teeth in
normal function (eating,etc.) in your life.
A millimeter or two of the gums shrinking over decades of use is not unexpected
and usually is painless and has little health consequences, except that
sometimes the spaces between the teeth get a little bit bigger.
However, the problem is when the tooth is subjected to a lot
of forces that are coming from angles or from the side, such as in cases where
people grind their teeth, clench their teeth, or, even more commonly, have
crooked or angled teeth so they chew on the “sides” of their teeth.
Modern research techniques in stress analysis have
demonstrated that teeth will, in fact, bend under angular loads of force. This prevents the teeth from breaking, but
will result in a breakdown of the tooth material at the point where the tooth
bends. The common groove that people
will notice on some teeth at or near the gumline are result of this tooth
breakdown. These grooves can get pretty
substantial and may require a “filling” to fill in the space and an
“adjustment”, or recontouring of the top of the tooth, to try and redirect the
forces. See image to the right >>
Fourth, accidental
trauma from food or poor cleaning techniques can also cut the gingivae. People wearing removable partial dentures can
also cause recession to some of the supporting teeth. Though this is a combined issue of trauma and
increased function from the load of the clasps of the denture.
Fifth and an
important consideration. If a person
has gum disease, the resultant bone and tissue loss is also considered
recession. However, this recession is
considered pathological and bacterial based.
The treatment can be very different than what we are discussing in this
article. The focus of this article is
recession (though considered pathological) that is mechanical in origin, which
is the most common.
Why can it hurt and be
sensitive to cold?
If you look at the tooth
root under a microscope, it is not solid.
In fact, it looks like Swiss cheese!
You may have seen this in advertisements on TV or magazines for
sensitive teeth toothpastes. These holes
are connected to the “nerve” (soft tissue inside the tooth)of the tooth, so the
tooth will respond to cold and some types of spices with an uncomfortable
response. With time these holes become
“plugged up” and the direct connection ceases, but those teeth with active recession
will continue to lose the outermost layers of the tooth and the holes on the
root surface continue to reopen.
What is the treatment?
There are different levels of treatment.
The first is to
“plug the holes”.
That is how the “sensitive toothpastes” work,
and why you need to continue using them.
Flouride treatments can also help, working in a similar manner.
The second is to
cover it.
Fillings into the recession area to “cover the holes” are
commonly used. Gum surgery techniques
are also used to cover the area and also address the esthetic issues that
recession can cause.
The third is to
change it.
If the most common source of recession is the unnatural,
angled forces applied to the teeth, then attempts to change these forces to
become more “vertical” are indicated.
The most common of these are the “adjustments” to recontour the
teeth as previously mentioned. The second is to restore some of the teeth
(canines or “eye”teeth) which can wear down over time and no longer provide a
guiding , protective function. The third and often best technique is
orthodontic. Teeth which are angled or
crooked can be realigned in a more vertical manner so the forces of chewing
become more vertical as well. Most of
the time, sensitivity will completely disappear, and we have seen cases where
the gum tissues will start to “come back”, though rarely to perfect levels. A
combination of all of these usually give the best results.
What happens if I do
nothing?
It is rare that someone will lose a tooth primarily because
of recession. It’s not going to just
fall out one day.
The teeth will continue to remain sensitive and be
uncomfortable.
As the tooth loss on the root continues the “nerve “ of the
tooth can die. Though the tooth will no
longer bother you, endodontic (root canal) treatment may be indicated.
As the tooth loss continues and the root becomes weaker, the
remaining tooth can fracture off.
If you do develop any periodontal (gum) problems in the
future, the angular forces will contribute to the speed at which the disease
will progress, and could interfere with
treatment and your ability to heal.
Many will find the “long in the tooth” look to be
unappealing.
You may become more susceptible to decay of root surfaces,
which in fact is different from the common decay of children and adults. With many of the medications that we are
taking as we age , reduced salivary flow is a side effect, and the increase in
root decay as a result of that reduced salivary flow, is an alarming trend.
If you have questions, please contact our office at
703-820-0809.
