Gum Recession: Causes, Symptoms and Treatment Methods

Gingival recession is a condition in which the gingival margin recedes towards the root of the tooth, exposing the tooth root. This condition not only causes aesthetic concerns, but can also lead to complaints such as sensitivity and pain. In Turkey, more than 40% of adults have varying degrees of gingival recession.

If you feel sensitivity in your teeth or notice that your teeth look longer than they used to when you look in the mirror, you may be experiencing gum recession.

What is Gingival Recession?

Gum recession is a condition in which the gum pulls away from the root of the tooth, pulling it downwards and exposing the tooth root. Normally, the gums act as a protective barrier between the crown and the root of the teeth. However, for various reasons, the gums may recede and the root surfaces of the teeth may be exposed.

Gum recession is usually a gradual process and can often progress without obvious symptoms. Therefore, regular dental check-ups are of great importance for early diagnosis.

Gingival Anatomy

Healthy gums in general:

• Light pink in color (may be darker depending on pigmentation)

• It has a tight and elastic structure

• Fully wraps the neck of the teeth

• It has an "orange peel" appearance Gum tissue consists of three parts:

1. Free Gingiva: It is the free edge of the gum between the tooth and the gum. It forms the gingival groove (sulcus).

2. Adherent Gingiva: The part below the free gingiva that is tightly attached to the jawbone.

3. Mucogingival Junction: The place where the adherent gingiva and the oral mucosa meet.

Gingival recession usually begins with a decrease in the amount of adherent gums and may reach the mucogingival junction in progressive cases.

Causes of Gum Recession

1. Inadequate Oral Hygiene

Inadequate oral hygiene causes dental plaque to build up and eventually turn into tartar. Tartar can lead to gingivitis (gingivitis) and a more serious disease called periodontitis. As a result of these diseases, gum tissue is destroyed and recession begins.

2. Wrong Tooth Brushing Technique

Brushing too hard or the wrong brushing technique can also cause gum recession. In particular:

• Using a hard-bristled toothbrush

• Brushing with excessive pressure

• Brushing with horizontal movements

These habits can erode gum tissue and lead to recession over time. Dentists usually recommend soft-bristled brushes and gentle, circular brushing movements at a 45-degree angle.

3. Gum Diseases

Gum diseases such as gingivitis (gingivitis) and periodontitis (inflammation of the gums and surrounding tissues) are among the main causes of gum recession. These diseases are caused by inflammation caused by bacteria that destroy the gums and the tissues that connect the gums to the jawbone.

Left untreated, periodontitis can cause not only gum recession but also tooth loss. In Turkey, about 70% of adults over the age of 35 have varying degrees of periodontitis.

4. Genetic Factors

Some people may have genetically thinner gum tissue or be more prone to gum disease. This can predispose to gum recession even if other risk factors are not present.

5. Wrong Alignment of Teeth

Crowded teeth or malocclusion can cause some teeth to be overloaded. Over time, this can lead to gum recession in that area. In addition, teeth that are not properly aligned are more difficult to clean, increasing the risk of plaque buildup and gum disease.

6. Lip or Tongue Piercing

Oral piercings, especially lip and tongue piercings, can cause constant friction and trauma to gum tissue. Studies show that people with lip piercings have about 4 times the risk of gum recession in the front teeth than those without.

7. Tobacco Use

The use of tobacco products such as cigarettes, cigars and hookahs significantly increases the risk of gum disease. Tobacco:

• Reduces blood flow to the gums

• Weakens the immune system

• Reduces the ability of gum tissue to heal

Studies show that the rate of gum recession in smokers is 2-3 times higher than in non-smokers.

8. Bruxism (Tooth Grinding)

Unconscious clenching or grinding (bruxism), especially at night while sleeping, puts excessive pressure on the teeth and surrounding tissues. This constant pressure can lead to gum recession over time.

Stress, anxiety, sleep disorders and malocclusion are among the main causes of bruxism. Night plaques recommended by the dentist can reduce the negative effects of this condition on the gums.

9. Hormonal Changes

Hormonal changes, especially in women during pregnancy, puberty and menopause, can make the gum tissue more sensitive. During these periods, the risk of gingivitis increases and gum recession may develop if proper care is not provided.

During pregnancy, about 40% of women develop a type of gingivitis called "pregnancy gingivitis".

10. Aging

The risk of gum recession increases with age. As a result of activities such as tooth brushing and chewing for many years, abrasions may occur in the gum tissue. In addition, the elasticity of the gum tissue decreases with age and becomes thinner.

Research shows that more than 80% of people over the age of 65 have gum recession in at least one tooth.

Symptoms of Gum Recession

1. Visual Changes in Teeth

Teeth with receding gums may appear longer than they normally are. The complaint "My teeth have grown longer" is one of the most typical symptoms of gum recession.

2. Tooth Sensitivity

When the gum recedes, the root surface of the tooth, which is not covered with enamel, is exposed. The root surface is highly sensitive to stimuli such as hot, cold, sweet and sour. For this reason:

• When drinking cold drinks

• When eating hot food

• When consuming sweet or sour foods

• When cold air comes into contact with teeth

A sudden and sharp pain may be felt. This sensitivity is usually temporary and goes away when the stimulus is removed.

3. Discoloration of the Root of the Tooth

The color of the exposed tooth root is different from the enamel. While the enamel appears shiny and white, the root surface usually has a more yellowish or brownish tint.

4. Pitting at the junction of tooth and gum

In areas with receding gums, small pits (V-shaped defects) can be seen at the junction of the tooth and gum. These pits may not be completely cleaned even when brushing teeth and create a favorable environment for plaque accumulation.

5. Increased Gaps Between Teeth

In advanced cases of gingival recession, the gaps between the teeth may increase as a result of the receding gums. This can lead to aesthetic problems called "black triangles".

6. Bleeding Gums

Gum recession is often seen with gum disease. Therefore, bleeding gums can occur during brushing or flossing. Healthy gums do not bleed; therefore, bleeding gums are an important symptom that you should consult a dentist.

7. Tooth Mobility

In advanced cases of gum recession, the teeth may feel wobbly or mobile because the supporting tissues of the tooth have also been damaged. This is a serious symptom that requires urgent consultation with a dentist.

8. Bad breath or bad taste in the mouth

Bacteria can accumulate in the pockets that develop with gum recession. These bacteria can cause bad breath (halitosis) and an unpleasant taste in the mouth.

9. Caries Formation in the Tooth Neck

The exposed tooth root is less resistant to decay than tooth enamel. Therefore, areas with receding gums may develop tooth neck caries over time.

10. Aesthetic Concerns

Gum recession, especially in the front teeth, can cause aesthetic discomfort. Tooth roots exposed during smiling can make a person feel insecure and avoid smiling in social environments.

Diagnosis of Gum Recession

Gum recession is usually diagnosed by a dentist or periodontologist. The diagnostic process includes the following steps:

1. Clinical Examination

The dentist first performs a visual examination and evaluates the following factors:

• The amount of gum recession

• Number of teeth affected

• Gingival tissue characteristics (color, texture, thickness)

• Symptoms of gingivitis

• Presence of calculus

• Alignment of teeth

• Frenulum (the thin tissue that connects the lip to the gum) position

2. Periodontal Drilling

The dentist measures the depth of the gum pocket using a special measuring instrument (periodontal probe). Normally, a healthy gum pocket is between 0.5 and 1 mm deep.

The same instrument is also used to measure the amount of gum recession. This is done by measuring the distance between the enamel-cement boundary (where the crown and root of the tooth meet) and the gingival margin.

3. Radiographic Examination

Radiographs (x-rays) are used to assess:

• Amount of alveolar bone loss

• Pattern of bone loss

• Condition of tooth roots

• Location of neighboring anatomical structures

4. Assessment of Risk Factors

The dentist also assesses the following risk factors:

• Tooth brushing technique

• Oral hygiene habits

• Tobacco use

• Presence of bruxism

• Orthodontic treatment history

• Systemic diseases

• Medicines used

Complications of Gum Recession

Untreated gum recession can lead to various complications:

1. Tooth Sensitivity and Pain

Exposed tooth roots are highly sensitive to stimuli such as hot, cold, sweet and sour. This sensitivity can turn into severe pain over time and negatively affect the quality of daily life.

2. Tooth Decay

The tooth root is less resistant to caries than tooth enamel. Root surfaces exposed as a result of gum recession are at risk for caries formation.

3. Aesthetic Problems

Gum recession, especially in the front teeth, can cause aesthetic discomfort. This may negatively affect the self-confidence of the person.

4. Tooth Loss

In advanced cases of gum recession, the destruction of the supporting tissues of the tooth can progress, resulting in tooth loss.

5. Nutrition Problems

Avoiding certain foods and beverages due to tooth sensitivity and pain can negatively affect eating habits.

Treatment of Gum Recession

The treatment of gum recession varies according to the severity of the recession, its causes and the patient's expectations. The main goals of treatment are as follows:

• Stop the progression of the disease

• Relieve sensitivity and pain

• Improving aesthetic appearance

• Prevent tooth loss

• Facilitate the maintenance of oral hygiene

Conservative (Non-Surgical) Treatments

1. Oral Hygiene Training

The first step in the treatment of receding gums is to teach proper oral hygiene techniques. Dentist or dental hygienist:

• Correct tooth brushing technique (Bass technique),

• Flossing,

• Use of interface brushes,

• Choosing the appropriate toothpaste

teaches the patient. If hard brushing or incorrect technique is the cause of gum recession, changing these habits is an important part of the treatment.

2. Tartar Cleaning (Detertraj)

In case of gum recession due to gum disease, a professional dental cleaning is necessary. This procedure:

• Removes hard and soft deposits on the teeth

• Reduces gingivitis

• Reduces bacterial load

• Contributes to the improvement of gum health

Scaling is usually recommended to be repeated every 6 months.

3. Root Surface Smoothing

In cases of advanced periodontal disease, root surface smoothing (curettage) may be performed in addition to scaling. In this procedure:

• Bacteria and toxins accumulated in gum pockets are removed

• Roughnesses on the root surface are smoothed

• Bacterial attachment surfaces are reduced

Root planing is usually performed under local anesthesia and is effective in stopping the progression of gum recession.

4. Desensitizing Treatments

Various treatments can be applied for sensitivity caused by gingival recession:

1. Topical Agents:

• Toothpastes containing potassium nitrate: Blocks nerve conduction

• Products containing fluoride: Clogs dentin tubules

• Products containing oxalate: Form calcium oxalate crystals and clog dentinal tubules

• Products containing bioactive glass: Plugs dentinal tubules and promotes remineralization

2. Professional Applications:

• High concentration fluoride application

• Varnish applications

• Adhesive systems

• Laser treatment

Restorative Treatments

Restorative treatments are also an option to eliminate aesthetic problems and sensitivity caused by gum recession:

• Composite Restorations: Tooth-colored filling materials can be used to cover exposed root surfaces.

• Ceramic Veneers: Porcelain laminate veneers can be used for more extensive aesthetic issues.

• Crown Lengthening Prostheses: Specialized dentures with prosthetic gums can mask gum recession.

Surgical Treatments

In cases where conservative treatments are inadequate or in advanced cases of gum recession, surgical interventions may be necessary.

1. Free Gum Graft

Free gum grafting is a procedure to increase the amount of adherent gums. In this procedure:

• Gum tissue taken from the palate is placed in the receding area

• The graft is sutured to the recipient site

• The healing process takes 2-3 weeks

This technique is particularly preferred in cases where the amount of adherent gingiva is insufficient.

2. Connective Tissue Graft

Connective tissue grafting is one of the most successful surgical methods for the treatment of gum recession. In this technique:

• Connective tissue taken from the palate is placed under the receding area

• The gum in the recipient area is closed over the graft

• The graft adheres to the root surface and promotes the formation of new gum tissue

Connective tissue graft is superior in terms of aesthetic results and has a higher success rate of root closure.

3. Coronally Shifted Flap

The coronally shifted flap technique is preferred in cases with sufficient amount of adherent gingiva. In this technique:

• The gum tissue around the receding area is released

• The freed tissue is slid upwards to cover the tooth root

• The tissue is sutured in its new position

This technique can be used alone or with a connective tissue graft.

4. Directed Tissue Regeneration

Guided tissue regeneration (GTR) may be preferred in cases of bone loss with gingival recession. In this technique:

• Resorbable membranes are placed between the root surface and gingival tissue

• The membrane allows bone and periodontal ligament cells to migrate into the area

• Prevents epithelial cells from migrating into the field

5. Platelet Rich Fibrin (PRF) and Platelet Rich Plasma (PRP)

In recent years, the use of platelet-derived growth factors in the treatment of gingival recession has gained popularity. These techniques:

• Uses growth factors derived from the patient's own blood

• Accelerates tissue healing

• Improves graft success

PRF and PRP are often used in combination with other surgical techniques.

Post-Treatment Care

After surgical or non-surgical treatments, there are considerations to ensure the success and long-term stabilization of the treatment.

1. Recovery Process

The healing process after surgical treatments usually proceeds as follows:

• First 24-48 hours: Blood clot formation

• 3-14 days: Early recovery phase

• 2-4 weeks: Maturation phase

• 1-3 months: Remodeling phase

2. Medication Use

Medicines that may be prescribed by the dentist after surgical treatments:

• Antibiotics: To reduce the risk of infection

• Painkillers: To control post-operative pain

• Antiseptic mouthwashes: To support plaque control

It is important for the success of the treatment to use the medicines as and when prescribed by the dentist.

3. Nutrition Recommendations

Nutritional recommendations after surgical treatment:

• First 24-48 hours: Soft and warm foods should be preferred

• Avoid hard, acidic, spicy and very hot/cold foods

• Chewing should be done without putting pressure on the treated area

• Adequate fluid intake should be ensured

4. Oral Hygiene

Oral hygiene practices after treatment:

• First 24 hours: Do not brush or floss the treated area

• 24 hours later: Gentle brushing with a very soft bristle brush can be started

• First 2 weeks: Use of antiseptic mouthwash (chlorhexidine)

• After 2 weeks: Gradual transition to normal oral hygiene routine

5. Control Appointments

Regular follow-up appointments after treatment:

• First week: Suture removal and evaluation of early healing

• First month: Evaluation of early results

• Third month: Evaluation of medium-term results

• Sixth month and beyond: Evaluation of long-term stabilization

Methods to Prevent Gum Recession

Gum recession is largely preventable with proper care and preventive measures. Here are strategies that can be applied to prevent gum recession:

1. Correct Tooth Brushing Technique

• Use a soft-bristled toothbrush: Hard-bristled brushes can damage gum tissue.

• Use bass technique: The bristles should be placed at a 45-degree angle to the gum margin and brushing should be done with gentle, vibrating movements.

• Do not apply excessive pressure: It is sufficient to apply gentle pressure when brushing.

• Avoid horizontal brushing movements: Horizontal brushing is one of the main causes of gum recession.

• Brush at least twice a day: Regular brushing in the morning and evening prevents plaque build-up.

• Brushing duration: Brush for at least 2 minutes.

Electric toothbrushes can prevent excessive pressure thanks to pressure sensors.

2. Use of Dental Floss and Interdental Brush

• Daily flossing: Removes plaque between teeth where the toothbrush cannot reach.

• Correct flossing technique: The floss should be placed gently between the teeth without damaging the gum tissue and should be used in the shape of the letter C to wrap around the tooth.

• Interdental brushes: Particularly effective between large interdental spaces and under bridges.

• Water jet (oral irrigator): Can be used in addition to flossing and interdental brushes.

3. Regular Dental Checkups

• Check-up every 6 months: Assessment of tooth and gum health

• Professional cleaning at least once a year: Removal of tartar

• Evaluation of risk factors: Identification of factors that increase the risk of gingival recession

• Early intervention: Intervening in early problems can prevent further treatment

4. Choosing the Right Toothpaste

• Pastes with low abrasive content: Putties with a low Relative Dentin Abrasion (RDA) value should be preferred.

• Sensitivity-relieving pastes: If there is sensitivity in areas with gum recession, pastes with desensitizing ingredients may be preferred.

• Pastes containing fluoride: It helps prevent root surface caries.

• Antibacterial pastes: May help control plaque.

5. Bruxism (Tooth Grinding) Treatment

• Use of night trays: Night aligners, specially prepared by the dentist, reduce the negative effects of teeth clenching and grinding.

• Stress management: Management of stress factors underlying bruxism

• Muscle relaxation exercises: Helps relax the jaw muscles

• Improving sleep patterns: Quality sleep can reduce bruxism

6. Abstinence from Tobacco Products

Tobacco products are one of the most important factors that negatively affect gum health:

• Quitting smoking: Rapid and positive effects on gum health

• Avoid other tobacco products: Products such as cigars, hookahs, chewing tobacco also negatively affect gum health

7. Balanced Nutrition

• Foods rich in vitamin C: Vitamin C is essential for collagen production and supports gum health (citrus fruits, kiwi, strawberries, peppers)

• Foods rich in calcium: Supports bone and tooth health (dairy products, almonds, green leafy vegetables)

• Foods containing antioxidants: Help reduce inflammation (green tea, grapes, blueberries)

• Avoid foods and drinks high in sugar and acids: These foods can increase gingivitis

Home Care and Advice for Sensitive Teeth

Daily oral care routine for people with receding gums and recommendations for sensitive teeth:

1. Special Care for Sensitive Teeth

• Desensitizing toothpastes: Start to work within 2-4 weeks with regular use.

• Low abrasive toothpastes: Prevents further abrasion of the root surface.

• Fluoride mouthwashes: Helps to decongest dentinal tubules.

• Careful brushing of sensitive areas: Sensitive areas should be brushed gently.

• Avoid excessively hot and cold foods: Avoid extremely hot and cold foods until the sensitivity subsides.

2. Special Oral Care Products

Special oral care products recommended for people with receding gums:

• Soft bristle toothbrushes: Provides effective cleaning without damaging gum tissue

• Electric toothbrushes: Models with pressure sensors can prevent overpressure

• Ultra-soft interdental brushes: Provides gentle cleaning between teeth

• Desensitizing mouthwashes: Mouthwashes containing fluoride or potassium nitrate may be preferred

• Remineralization gels and creams: Can help strengthen the root surface

3. Natural Methods

Some scientifically proven natural remedies can help support gum health:

• Green tea: Supports gum health thanks to its antioxidant and anti-inflammatory properties.

• Aloe vera: Supports gum health thanks to its anti-inflammatory and antibacterial properties.

• Coconut oil: Thanks to its antibacterial properties, it contributes to oral hygiene.

These natural methods cannot replace professional treatments, but can be used as a complement. It is recommended to consult your dentist before trying any natural method.

Gingival Recession and Systemic Diseases

There may be a relationship between gingival recession and some systemic diseases:

1. Diabetes Mellitus (Diabetes)

Diabetes mellitus is a major risk factor that increases the risk of gum disease and gum recession:

• High blood sugar promotes bacterial growth

• Negatively affects immune system function

• Disrupts collagen metabolism

• Delays wound healing

It is recommended that diabetic patients pay particular attention to oral hygiene and attend regular dental check-ups.

2. Cardiovascular Diseases

There is a bidirectional relationship between cardiovascular diseases and periodontal diseases:

• Periodontal disease may increase the risk of cardiovascular disease

• Cardiovascular diseases can negatively affect the blood supply of periodontal tissues

In individuals with heart disease, endocarditis prophylaxis may be required prior to surgical periodontal treatments.

Frequently Asked Questions About Gum Recession

We have compiled the most curious questions and answers about gingival recession for you:

Is gum recession reversible?

Gum recession cannot be reversed naturally. Once the gum tissue has receded, it cannot be replaced by itself. However, surgical treatments (especially connective tissue grafts) can help to regain receding gums. The success of the treatment depends on the amount and location of the recession and overall oral health.

How common is this problem?

Gum recession is quite common. Studies show that about 50% of adults over the age of 35 have gum recession in at least one tooth. This rate increases with age, with more than 80% of people over the age of 65 experiencing gum recession.

Is gum recession painful?

Gum recession itself is usually painless, but the exposed tooth roots can cause sensitivity and pain. This sensitivity is especially felt when consuming hot, cold, sweet or sour foods and drinks. Desensitizing products and professional treatments can reduce this pain.

Do children get receding gums?

Gum recession in children is rare, but not impossible. Especially in children with incorrect tooth brushing techniques, lip piercings, orthodontic problems or gum disease, gum recession can occur. If in doubt, a pediatric dentist should be consulted.

Is there an increased risk of receding gums during pregnancy?

Yes, the risk of gum recession can increase during pregnancy due to hormonal changes. A condition known as pregnancy gingivitis can cause the gums to become inflamed more easily and can lead to gum recession in the long term. It is recommended that pregnant women pay particular attention to oral hygiene and attend regular dental check-ups.

Gum recession is a common condition that can lead to serious complications if left untreated. Early diagnosis and intervention are critical for treatment success.

The treatment of gingival recession covers a wide spectrum from conservative approaches to surgical procedures. The treatment plan should be individualized according to the severity of recession, causes, patient expectations and systemic health status.

Prevention of gum recession is easier and more economical than treatment. Proper oral hygiene techniques, regular dental check-ups, avoiding tobacco products and a balanced diet are the cornerstones of gum health protection.

Healthy gums are of great importance not only for oral health but also for general health. If you have any suspicions about gum recession, it is recommended that you consult a dentist immediately.