Periodontology - Gingival Recession

Gingival recession, which is also known as receding gums, is the exposure of the roots of the teeth. The condition is caused by a loss of gum tissue and the retraction of the gingival margin from the crown of the teeth. Gum recession is a common issue in adults who are over 40 years old, however, it may also begin to occur around 10 years old.

Classification

Various classification systems have been used to classify gingival recession. Miller’s classification system is most commonly used. Many cases cannot effectively be classified based on the criteria of the standard classification systems. Kumar & Masamatti's classification system gives a comprehensive depiction of recession defect. It can also be used to include cases which cannot be classified according to the existing classification systems. A separate classification system for palatal recessions (PR) has also been provided. A new comprehensive classification system classifies recession based on the position of interdental papilla and the buccal, lingual and/or palatal recessions. Kumar & Masamatti's classification system works to overcome the limitations associated with Miller's classification.

Causes

There are numerous possible causes for gingival recession. A few of these causes include:

• Gum disease
• Aggressive teeth brushing
• Incorrect flossing, such as flossing in an aggressive manner
• Thin, fragile or insufficient gingival tissue that is hereditary and predisposes the patient to gingival recession
• Dipping tobacco, which is known to affect the mucous membrane lining in the mouth and can lead to receding gums over time
• Self-inflicted trauma. This can include habits such as digging an object into the gum.
• Scurvy or a vitamin C deficiency
• Acute necrotizing ulcerative gingivitis
• Abnormal tooth position or crowding
• Piercings in the lip or tongue which can wear away the gum from persistent rubbing
• Intentional gingival retraction

Symptoms

Gum recession is not generally considered to be an acute condition. In most cases, gums which are receding is a progressive condition that occurs gradually over time. As a result, gum recession is more common in patients who are over the age of 40. Because the change in the gums is minimal, patients don’t always notice the condition right away and get used to the minor adjustments. Receding gums can go unnoticed until the condition begins to cause symptoms.

The following signs and symptoms may indicate the presences of receding gums:

• Movement of the teeth
• Overly sensitive teeth. This may include short and sharp pain.
• Teeth might appear longer than usual. For example, a larger part of the crown is visible when the gums are receding
• The roots of the teeth are visibly exposed
• The tooth has the feeling of notches at the gum line
• Changes in the color of the teeth. This is often a result of the color difference between the enamel and the cementum
• The presence of spaces between teeth. While the space actually remains the same, it appears larger because the gums don’t fill the space
• Cavities exist below the gum line

When the gum recession is caused by gingivitis, the following symptoms may also occur:

• Swollen, puffy, inflamed or red gums
• Bleeding of the gums when brushing and/or flossing
• Bad breath or halitosis

In some cases, the treatment of gingivitis reveals that a gum recession problem previously existed and was masked by swollen gums.