Gum Recession

Gingival recession ,receding gum, refers to exposure in the roots of the teeth caused by a loss of gum tissue and/or retraction of the gingival margin from the crown of the teeth. Gum recession is a common problem in adults.

There are several possible causes for gingival recession:

• Abnormal tooth position, such as tooth crowding, giving inadequate cover of one or more teeth by the jaw bone
• Hereditary thin, fragile or insufficient gingival tissue.
• [Overaggressive brushing,which causes the enamel at the gum line to be washed away by scrubbing the sides of the teeth
• Periodontal disease
• Eating disorders, from self-induced vomiting
• Grinding of the teeth (bruxism)
• Adult orthodontic movement of teeth.
• Piercings in the lip or tongue that wear away the gum by rubbing against it.

In most cases, receding of gums is a progressive condition that occurs gradually over the years. Receding gums may remain unnoticed until the condition starts to cause symptoms.

• Teeth become sensitive to hot and cold or to sweet, sour, or spicy foods. If the cementum covering the root is not protected anymore by the gums, it is easily abraded exposing the dentin tubules to external stimuli.

• Teeth may also appear longer than normal
• The darker roots of the tooth are exposed and visible.
• The tooth feels notched at the gum line
• Spaces between teeth seem to grow .The space is the same, but it seems larger because the gums do not fill it any more.
• Cavities below the gum line

Treatment should start with addressing the problem which caused the gum recession. If overactive brushing is the cause, the patient should consider a more gentle brushing technique. If poor plaque control was a contributing factor, improved oral hygiene must be performed, combined with regular professional dental cleanings as prophylaxis.

If severe calculus, tartar) was the cause, then a procedure called scaling and root planing may be necessary to clean the teeth and heal inflammation in the gingiva, gums. If malocclusion, incorrect bite, was a factor, an occlusal adjustment or bite splint may be recommended.

If cause-specific measures are insufficient, soft-tissue graft surgery may be used to create more gingiva. The tissue used may be tissue from another site in the patient's mouth, or it can be freeze-dried tissue products or synthetic membranes.

A gingival graft, or periodontal plastic surgery, is a generic name for a number of surgical periodontal procedures whose combined aim is to cover an area of exposed tooth root surface with grafted oral tissue. The covering of exposed root surfaces accomplishes the prevention of further root exposure, eliminated sensitivity, decreased susceptibility to root caries and cosmetic improvement.

Specific procedures

-Coronally and apically positioned flaps, are a form of a pedicle grafts in that gingival tissue is loosened up and moved either coronally or apically. This requires enough thickness and width of gingival tissue at the base of the recession defect.

-A free gingival graft is a procedure where a small layer of tissue is removed from the palate of the patient's mouth and then relocated to the site of gum recession. It is fixed into place and will serve to protect the exposed root. The donor site will heal without damage. This procedure is used to increase the thickness of very thin gum tissue.

-A subepithelial connective tissue graft takes tissue from under healthy gum tissue in the palate, which may be placed at the area of gum recession. This procedure has the advantage of excellent predictability of root coverage,as well as decreased pain at the palatal donor site compared to the free gingival graft. The subepithelial connective tissue graft is a very common procedure for covering exposed roots.

-A lateral pedicle graft, or pedicle graft, takes tissue from the area immediately adjacent to the damaged gingiva. This is not always an option, as the constraint that there must be sufficient tissue immediately lateral to the area of interest is an onerous one. When this procedure is performed, the transplant tissue is cut away and rotated over the damaged area. This can place the donor area at risk of recession as well.

- An synthetic matrix, such as Mucograft, uses synthtic tissue as a source for the graft. The advantage of this procedure is no need for a palatal donor site, and though some periodontists consider it equally successful as a subepithelial connective tissue graft,[6] others consider it less successful

-Guided bone reconstruction is a technique in which bone growth is enhanced by preventing soft tissue ingrowth into the desired area and utilizes either resorbable or nonresorbable membranes.

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