Gingival recession, also known as gum recession in medicine, refers to the retreat of the gum margin towards the tooth root, exposing the tooth root. It is common among the elderly. It is related to factors such as incorrect brushing methods, periodontitis, abnormal tooth position, physiological structure factors, excessive force, bad habits, and poor restorations. Gingival recession treatment requires the removal of related stimuli and the correction of bad living habits. Gingival recession caused by diseases such as periodontitis should be treated according to the cause.
Clinical classification
Miller classification is the most widely used classification:
1. Class I
The gingival margin is retracted but does not reach the mucogingival junction, and there is no loss of alveolar bone or soft tissue on the adjacent surfaces.
2. Class II
The gingival margin is retracted to or beyond the mucogingival junction without loss of interproximal alveolar bone or soft tissue.
3. Class III
The gingival margin has retracted to or beyond the gingival junction, with loss of adjacent alveolar bone or soft tissue, and is located apically to the cementoenamel junction but still coronally to the labially retracted gingival margin.
4. Category IV
The gingival margin has retracted beyond the mucogingival junction, and the interproximal bone loss has reached the level of the labial receding gingival margin.
Epidemiology
Infectious
Not contagious.
Prone population
Elderly people are more likely to develop the disease.
Causes
Overview
There are many factors that cause gum recession. Common factors that cause gum recession include incorrect brushing methods, periodontitis, abnormal tooth position, physiological structure factors, excessive force, bad habits, poor restorations, etc.
Basic Cause
1. Incorrect brushing methods can cause gum recession, such as large-scale horizontal brushing, using a toothbrush with hard bristles, and using too coarse particles of dentifrice. Gum recession is more common in the curved area of the dental arch, such as canines and premolars, because the roots of these parts are more prominent, the labial bone plate is thin, and they are easily mechanically stimulated to cause gum recession.
2. For teeth with periodontitis, due to the formation of periodontal pockets, the epithelial attachment position has moved to the root side, but due to the inflammation and swelling of the pocket wall, the root margin is still at a high position. After basic periodontal treatment and surgery, or if the patient improves oral hygiene, the inflammation of the periodontal pocket wall subsides, and the gingival margin position may recede, exposing the tooth root directly to the oral cavity.
3. Abnormal tooth position, such as biased towards the cheek or tongue, means that the alveolar bone plate on that side is thinner or even absent, and the gums on its surface are very likely to recede due to mechanical factors such as food friction.
4. The attachment position of the lip and cheek frenulum is too close to the gingival margin, or the pulling effect of the lip and cheek muscles may cause “peeling” effect on the gums and cause retraction.
5. (Occlusal) trauma and excessive or inappropriate orthodontic force cause bone absorption on the force-bearing side, and gingival recession may also occur. If the teeth are pushed beyond the alveolar process during orthodontic expansion, gingival recession is likely to occur.
6. Bad habits, such as habitually injuring the gums with fingernails, knives and other objects, can cause the gums of individual teeth to recede or become defective in strange and irregular shapes, or even expose bone.
7. Poor restorations may compress the gums and cause gum atrophy.
Risk factors
1. Old age.
2. Suffering from diseases such as periodontitis.
3. Wearing poor restorations.
4. Abnormal tooth position.
5. Have received orthodontic treatment.
6. Bad living habits, such as incorrect brushing of teeth and use of toothpicks.
symptom
Overview
Gingival recession refers to the retreat of the gingival margin toward the tooth root, exposing the tooth root. It can also cause longer crowns, exposed roots, caries, wedge-shaped defects, dentin sensitivity, pulp congestion and degeneration, food impaction, and plaque accumulation.
Typical symptoms
1. Location
Gingival recession can occur on individual teeth or the entire mouth. It is more common on the labial and buccal sides than on the lingual and palatal sides. However, the palatal root surface of maxillary molars is also more susceptible to severe gingival recession, which may be caused by the large inclination of the tooth root and the severe wear of the occlusal surface, which makes the crown lean toward the buccal side and the palatal root lean toward the palatal side, resulting in bone absorption on the palatal side.
2. Symptoms
Gingival recession, if not accompanied by inflammation, does not constitute a disease in itself except that it causes a longer clinical crown and affects the appearance. However, the exposed root surface is prone to caries; the thin cementum on the root surface is mechanically ground away, which is prone to wedge-shaped defects or dentin sensitivity, and even causes pulp congestion and degeneration due to long-term stimulation; the recession of the interdental papilla increases the interproximal space, which is prone to food impaction and plaque accumulation, and also causes a “black triangle” in the anterior teeth area that affects the appearance.
Associated symptoms
When gum recession is caused by periodontitis, it is also accompanied by symptoms of periodontitis, such as changes in gum color, bad breath, loose teeth, etc.
complication
When gingival recession is accompanied by severe damage to periodontal supporting tissues, teeth may be pathologically displaced due to external forces; in addition, if periodontitis continues to progress, root bifurcation lesions may also occur.