What Can I Do About Receding Gums?

Gingival shrinkage can be limited to a single tooth or multiple teeth, or it can occur universally. The shrinking gums can be pigmented and tough, healthy without inflammation, and can be red and swollen. Some patients with shrinking gums may have other symptoms. Consequences of gum withdrawal are:

Ouyang Xiangying	(Chief physician)	Department of Periodontology, Peking University Stomatological Hospital
Kang Jun	(Chief physician)	Department of Periodontology, Peking University Stomatological Hospital
Shi Dong	(Deputy Chief Physician)	Department of Periodontology, Peking University Stomatological Hospital

Healthy gums cover the entire surface of the roots. When the gums recede toward the roots and the roots are exposed, they are called Gingival Recession. They are mainly associated with periodontitis. At the same time, the alveolar bones also occur in the gums. absorb. It has been reported that almost 100% of people over the age of 50 have varying degrees of gum recession, but there is also evidence that some older periodontal healthy elderly do not experience gum recession. The so-called senile gum recession may be due to the periodontal tissue This is caused by the cumulative effects of mechanical damage and inflammatory stimuli.

Western Medicine Name: Gum receding
English name: Gingival Recession
Affiliated Department: Department of Physiology-Stomatology

Disease site: Oral cavity
The main symptoms: The toner is tough, healthy and non-inflammatory, and can be congested, red and swollen
Main cause: After periodontitis treatment, anatomical factors, improper brushing, orthodontic force and excessive tooth force, poor restorations

Clinical manifestations of gingival recession

Gingival withdrawal affects aesthetics

When the gingival recession of the current lip side occurs, it often causes the crown to become longer, the yellow roots to be exposed, the gap between the teeth to increase (like a "black triangle"), and the height of the gums to be inconsistent. Patients who smile or laugh can expose their gums.

Sensitive gum root retraction

The root is composed of dentin and surface cementum. The cementum of the dental neck is very thin, and about 10% of the cervical neck lacks cementum coverage. In addition, the infected cementum on the surface of the root surface is in the process of curettage. After being scraped, the dentin will be directly exposed to the oral environment after the gums recede. Cold, heat, sweetness, and mechanical stimuli (brushing) can be transmitted to the pulp cavity through the dentin tubules, causing sensitive symptoms. This sensitivity is mainly irritating, with a short time, and the symptoms disappear after the stimulus is removed. Under the premise of reducing local irritation, most of these symptoms can gradually disappear, and the sensitivity of the roots after scraping can last for about 2 weeks to 1 month. The severity of symptoms varies depending on the individual sensitivity of the patient and the degree of curettage. It should be noted that not all patients undergoing curettage will experience symptoms of root sensitivity.

Gum withdrawal food impaction and root caries

When the gingiva between adjacent teeth shrinks, the gap between the teeth increases. When eating, it often causes food to be embedded horizontally in the gap between the teeth. It is difficult to remove it simply by cleaning with a toothbrush. Long-term retention can lead to demineralization of the root surface and formation of root caries. Sometimes even caries around the root surface of the teeth. ^[1] ^[2]

Common causes of gum withdrawal

Gingival withdrawal after periodontitis treatment

With periodontitis, the gums will show redness and swelling to varying degrees. At this time, the roots of the gums are often covered with swollen gums and will not be exposed to the oral environment. However, the alveolar bones under the gums have already been absorbed and reduced to varying degrees. Basic periodontal treatment will cause gingival recession and root surface exposure after controlling inflammation. It should be emphasized that gingival recession occurs after the treatment of periodontal inflammation, but it is not the damage caused by the treatment. The loss of root surface adhesion is caused by periodontitis but is not covered by the swollen gums during the inflammatory period. (figure 1)

Anatomical factors of gum withdrawal

The teeth are generally arranged in the dental arch, and the bucco-lingual bone plate maintains a certain thickness. However, due to the dislocation, some teeth are too biased to the lip and buccal side, which causes the lip and buccal side bone plate to be very thin and even open the window Intact but alveolar bone defect covering the underlying root surface) or bone cracking (often manifested as a "V" defect from the top of the epiphysis), this type of tooth underwent trauma or orthodontic force on the labial cheek bone plate It is easily absorbed and the gums recede. In addition, the anatomical factors that may cause gingival recession include gingival adhesion (gingival attached to the root surface, which does not move with lip and cheek pulling) is too narrow, gingival is too thin, and the lip and cheek tie is too close to the gingival margin.

Gingival shrinkage improper brushing

The bristles of the toothbrush used are too stiff, the cross-brushing method of saw sawing, the brushing force is too strong and so on. It is more common on the lip and buccal side, especially at the corners of the dental arch, such as the canine and premolar locations, which are often associated with wedge-shaped defects. In addition, improper use of dental floss, interdental brushes, and toothpicks can cause the gum nipples to shrink and the gaps between the teeth to become larger. Gingival withdrawal caused by improper brushing is more common in patients with healthy gums and better oral hygiene. (figure 2)

Gingival retraction orthodontic force and excessive cohesion

When the teeth are moved within the range of the alveolar bone or the tongue during the orthodontic process, gingival recession is less likely to occur. If the teeth are moved or tilted beyond the range of the alveolar bone, the gingival recession is often prone to occur.

Gingival recession prosthesis

When there is a restoration in the mouth, the health of the gums also depends on a good restoration design and location. When the edge of the fixed prosthesis is too deep under the gingiva, the edges are not tight, or there is obvious overhang of the prosthesis, gum inflammation and gingival recession are more likely to occur; the removable denture ring is too low, or the edge of the base is pressed against the gums. Causes gum trauma and gum withdrawal. (image 3)

In addition, there may be a correlation between gum withdrawal and smoking. Related mechanisms include reducing blood flow to the gums and altering the gum's immune response, but these have yet to be confirmed.

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Prevention and treatment of gum shrinkage

Because the shrinkage of the gums is accompanied by the absorption of the alveolar bone below, once the gums shrink, except for a few affected teeth, which can cover the exposed root surface through gingival surgery, most of the shrinkage of the gums is difficult to regenerate and return to the original Height, so care should be taken to avoid gum receding.

A small, uniform withdrawal of the gums is generally asymptomatic and requires no treatment.

If the gingival recession continues to progress, the cause should be identified, treatment factors should be eliminated (such as changing tooth brushing habits, adjusting orthodontic strength, and correcting bad restorations, etc.) to prevent the gingival recession from further aggravating.

In addition, the symptomatic treatment of the accompanying lesions of the gingival recession should be dealt with: reduce the local irritation of the teeth with sensitive root surface (avoid ingestion of food that is too hot or cold, use warm water for brushing, etc.), and use desensitizing toothpaste to desensitize; Affects the person who eats, can use sodium fluoride paste (or 2% sodium fluoride solution) for local application, fluorinated mineralized liquid gargle, etc. There is no special treatment method for horizontal food impaction. To pay attention to timely cleaning, you can use interdental brushes, dental floss, and toothpicks to clean the adjacent surfaces of the teeth; patients with root caries should be filled in time. ^[1] ^[2] ^[3]