Why does gum recession occur

Local periosteum receives stimuli from deformed mediators, so as to have new overlying layers laid, thereby covering and causing the buccal cortical plate to become thicker as the teeth are buccally displaced, which compensates for frontal resorption at the periodontal wall of the alveolar cortical plate Fig 8. Orthodontic movement not only affects periodontal tissue volume and shape, but deflection also deforms the alveolar bone process network of osteocytes, which controls bone shape and volume according to functional demand.

Buccal bone deflection as a whole provides periosteal stimuli, so as to have new buccal cortical plate layers laid. Whenever movement of individual teeth is rendered necessary, light forces should be applied and body movement carried out, so as to allow the same compensating periosteal mechanism to act.

In other words, whatever undergoes resorption at the periodontal surface of the alveolar bone ends up being laid at the corresponding outer buccal surface. Gingival recession might be present in some teeth separately; however, whenever it is generally present, it often affects a whole segment in the dental arch, thus horizontally retracting periodontal tissue attachment, including gingival papillae. As for shape and distribution, they might as well be:.

In cases of severe apical migration, V-shaped recession is known as " Stillman's cleft. U-shaped gingival recession associated with inadequate traumatic brushing is surrounded by healthy gingiva and is usually associated with abrasion, with a smooth, polished surface. There are cases of U-shaped retraction in which the area of root exposure is surrounded by a peripheral festoon made up of swollen, inflamed gingival tissue resulting from local dental plaque buildup.

A few classical studies found in Periodontology literature refer to the aforementioned condition as " McCall's festoon. In its generalized or horizontal form, gingival retraction is associated with chronic inflammatory destructive periodontal disease. Loss of periodontal support in proximal areas results in compensatory remodeling on the buccal and lingual surfaces, leading to apical displacement of marginal gingiva, including interdental papillae.

The periosteum is firmly inserted into the surface of cortical bone through Sharpey's fibers that, in turn, are inserted into bone matrix, predominantly made up of collagen Figs 1 , 8. The periosteum connective tissue 16 is divided into two different contiguous layers:. However, it is predominantly fibrous and aims at providing protection to the surface. This layer originates collagen fibers responsible for periosteum insertion into the subjacent cortical bone. This intermediate zone formed by numerous capillaries could represent a third layer that differs in terms of thickness from the periosteum.

From the periosteum all blood nutrition of bone structure is established. The surgical flap of the periosteum is inevitably a traumatic procedure that implies in loss of biological feasibility of the cortical bone surface layer. The osteocytes of the surface layer die and the bone matrix layer that hosted them undergoes resorption - with or without compensatory bone neoformation, depending on local conditions.

The most important indicator of bone vitality and feasibility is the presence of osteocytes within bone lacunae or osteoplasts. Without them, the bone is likely to undergo resorption and to be repositioned posteriorly. When periodontal surgery is performed on free cortical surfaces with thin alveolar bone cortical bone, the split thickness flap technique causes the periosteum to adhere to the cortical bone, thus avoiding surface resorption and, as a consequence, preventing post-surgical bone dehiscence and fenestration.

In many cases, the buccal surface of incisors and canines, especially the mandibular ones, is so thin that one has the clear impression of mineralized bone being non existing at palpation. The periosteum might be, and usually is, present; with a delicate, thin, underlying bone plate which is little mineralized, thus characterizing a cortical plate that plays the role of the outer bone plate.

In a few studies, the buccal alveolar cortical plate is unperceivable by CT scans, leading the examiner to believe that the examined region has no supporting periodontal structure. Similarly, in 3D tomographic reconstruction of the anterior region, one might have the wrong impression that incisors are lacking structure and buccal bone organization. In the majority of 3D reconstruction cases, an irregular granulated surface is found in incisors roots, thus suggesting root surface irregularity.

It is likely that such an imaging irregularity suggests the presence of periosteum and the thin, delicate buccal bone plate. In other words, it is difficult to determine the limits of bone dehiscence and fenestration precisely when the bone plate presents with a thin, delicate structure.

Likewise, it is also difficult to establish the limits of cervical bone precisely. In many procedures performed on maxillary bones with a view to isolating the mineralized portion and teeth from soft tissues, when the periosteum adhered to the alveolar process is removed, the thin layer of mineralized tissue, which is strongly associated with and placed between the periosteum and the periodontal ligament of the area, is also removed.

Future analyses will give the impression that many dehiscences and fenestrations are present; however, this is not true, since they originated from the preparation of anatomical pieces. Once buccal periodontal fragility has been identified and confirmed by means of imaging examination, in which it might be invisible due to structural fragility, tooth movement plan can be prepared, so as to position the root structure towards the center of the bone.

Periodontal tissue structure and organization will remain normal, but more resistant to mechanical action resulting from inadequate brushing, dental plaque buildup and occasional occlusal interference, whether resulting from bruxism and clenching or not. Alveolar cortical bones and areas of tendon insertion are the only areas in the human skeleton lacking periosteum.

In alveolar cortical bones, the periodontal ligament accounts for and plays the role of the periosteum. In the alveolar bone crest, the periodontal ligament as well as the periosteum are continuous, without structural interruption Figs 1 , 8. When root exposure has already been present for a few weeks due to recession, root cementum will have been eliminated and periosteum will have been withdrawn apically with the bone plate.

The root surface exposed to the oral environment is now full of bacterial lipopolysaccharides LPS which, thanks to high toxicity levels, do not allow further recolonization by cementoblasts and reinsertion of periodontal fibers. Even if this tooth is orthodontically moved to a more lingual position, gingival and periosteal cervical levels cannot be restored. The periosteum present in the most apical area of the bone crest naturally remains with the periodontal ligament which, in the tooth socket, plays the role of the periosteum.

Should that be the case, a periodontist is necessary in order to surgically promote gingival tissue reposition. This long junctional epithelium restores clinical and functional normality at the site; however, it is not possible to say that a new ligament and outer bone plate formed at the previously exposed site.

The prognosis at the site will be good under adequate hygiene and brushing conditions. In order to avoid gingival recession, orthodontic intervention must be as early as possible, so as to prevent root surface contamination caused by microbial biofilm buildup and its lipopolysaccharides. Orthodontic movement is able to position the teeth towards the center of the bone, in addition to increasing the structural thickness of buccal periodontal tissues. Orthodontic treatment alone will rarely promote gingival recession which, in general, has as primary causes some of its direct causes.

Orthodontic treatment carried out without any concern about gingival recession triggers one of the most important predisposing factors for the latter, which is represented by the thin, delicate structure found in the buccal, outer bone plate - which is sometimes unperceivable by CT scans.

Orthodontic movement alone might not completely solve cases of previously established gingival recession which require periodontal approach to be carried out.

In cases of V-shaped local gingival recession, which is often associated with occlusal trauma, orthodontically correcting the interference and the traumatic occlusion might cause the process to recede without surgical intervention at the site.

Overly aggressive brushing or flossing: It's great to be enthusiastic about oral care! But make sure you're gently brushing your teeth and not scrubbing hard. Over-brushing can wear down the enamel of your teeth and cause damage and receding gums Genetics: Sometimes dental issues are partly out of our control. If either of your parents has gum recession, you may be at a higher risk. Abnormal tooth positioning: Having teeth that aren't in alignment or a misaligned bite can create undue friction on the area, causing your gums to recede.

Grinding and clenching your teeth: Also called bruxism , this habit can cause many dental issues, including gum recession. Like abnormal tooth positioning, the extra force exerted can wear down your gums. Hormonal changes: Women can go through several stages of dramatic hormone fluctuations in their lifetime, like puberty, pregnancy, and menopause. Unfortunately, these natural life phases can make a woman more susceptible to gum disease and recession.

Trauma to gum tissue: Gum tissue may recede when traumatic injury has occurred. Recession can appear at the site of the damage or close to it. Using tobacco: Smoking and tobacco use increases your risk for receding gums by increasing the likelihood of many dental issues for several reasons, including its weakening of the immune system and its inhibiting of saliva flow, which allows for more plaque to build up. Treatment Options for Receding Gums Once gum tissue has pulled back and away from your teeth, it's gone for good.

Preventing Further Recession Your dentist and dental hygienist will also teach you how to best prevent further gum recession. Was this article helpful? Like Neutral. You also might like. Coupons Shop Now Our Mission. Have questions about your smile? Ask the Colgate Chatbot! When it is left untreated, gum recession occurs. If you aggressively brush your teeth, it can cause enamel to wear away, which can lead to gum recession too.

Proper oral hygiene helps ensure your oral health stays at its best at all times. Changes in hormones: Fluctuations in hormones, like during puberty, pregnancy, or menopause, can make the gums more sensitive and more likely to develop either gum disease or gum recession. This promotes your gums to recede. This procedure can treat the entire mouth in just three or four hours. Our periodontal team can help you decide if you could benefit from this periodontal treatment.

At Premier Periodontics, we use innovative procedures to treat receding gums. One of our most minimally invasive procedures is the Chao Pinhole Surgical Technique. Most cases of mild gum recession do not need treatment. Dentists may advise on prevention and offer to monitor the gums.

Teaching effective but gentle brushing is an effective early intervention. The most obvious, preventable cause is brushing the teeth too harshly or using a hard-bristled toothbrush. Instead, people should use a soft-bristled toothbrush and avoid over brushing, applying gentle strokes. Click here to shop for a wide selection of soft toothbrushes, rated by thousands of customers.

Plaque buildup and tartar can lead to periodontal disease, so maintaining good oral hygiene can also help prevent receding gums. People who have concerns about their teeth or receding gums should visit their dentist to discuss their worries. Read the article in Spanish.

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