Gum Recession Treatment

Gum recession is when the gum margin moves back towards the root and exposes root surface that is normally covered. The tooth looks longer than it should, a step or a change in colour appears between the crown and the root, and cold water starts to sting. The exposed root has no enamel, so it is more vulnerable to wear and decay than the crown of the tooth.

Treatment is not a single procedure but a decision in three steps: find the cause of the recession, stop it progressing, and only if it is necessary replace the lost tissue surgically. For many patients the first two steps are enough.

Why do gums recede?

Usually several factors are at work together. The ones we see most often:

• Hard, horizontal brushing. Scrubbing back and forth with a hard-bristled brush and too much pressure leaves its mark, especially on the canines and premolars. It is surprisingly common in people who take great care of their teeth.
• Thin gum tissue. Some people are born with thin, almost translucent gums over an equally thin wall of bone. This tissue copes less well with both brushing and inflammation.
• Periodontitis. As inflammation destroys the bone holding the tooth, the gum follows it down. In this situation recession also appears between the teeth, and treating the gum disease has to come first.
• Orthodontic movement. When braces or aligners push a tooth outwards, beyond the bone, an already thin bony wall can be breached. This is more common on the lower front teeth.
• The frenum (lip tie). If the band of tissue connecting the lip to the gum attaches very close to the gum margin, it pulls on the margin every time the lip moves.
• Other causes. Lip or tongue piercings, tobacco use, and the edges of fillings or crowns that overhang the gum margin.

Does all gum recession need treatment?

No. Operating on a millimetre of recession that has not changed in years, causes no sensitivity and does not show when you smile is not the right call. In that situation we correct your brushing habits, measure and photograph the area, and compare at each check-up. Once the cause has been removed, a good share of recession stays the same for years.

Stopping the cause first

A graft placed while the cause is still at work can be lost to the same forces. So before any surgery:

• You switch to a soft-bristled brush; we practise together in the chair, brushing without pressure, with small movements from the gum towards the tooth.
• If the gums are inflamed, a scale and polish comes first, followed by a deep clean if needed. We do not graft into inflamed tissue.
• A problematic frenum is released with a minor procedure, and overhanging filling edges are corrected.
• If orthodontic treatment is planned, areas with thin tissue are assessed before it starts.

What are the treatment options?

The choice depends on how deep the recession is, how many teeth it affects, the level of bone and gum between the teeth, and how thick the tissue is.

• Desensitising treatments. Varnishes and special toothpastes reduce the sensitivity; they do not cover the root.
• A filling at the neck of the tooth. If brushing has worn a notch into the root surface, it is closed with a tooth-coloured filling. The gum does not come back, but the wear stops.
• Connective tissue graft. A thin piece of tissue taken from the palate is placed under the gum; it both covers the root and thickens the gum. It is the method used most often for root coverage; the details are on the connective tissue graft page.
• Free gingival graft. Used mainly on the lower front teeth when no band of firm gum is left at all, to rebuild that band. Because its colour can stay different from the surrounding tissue, it is chosen less often within the smile line.
• Tissue substitutes. For patients who do not want tissue taken from the palate, or who have recession on many teeth, collagen-based matrices can be used. The results may not be as predictable as with the patient's own tissue.

Can the root be fully covered?

Not always, and you need to know this before the procedure. What decides it is the level of bone and gum on either side of the receded tooth: if the areas between the teeth are intact, good coverage can be expected; if there is loss there too, coverage will be partial. At the examination we measure each tooth separately and tell you at the outset how much coverage we expect on each one, and on which teeth the aim is only to thicken the tissue.

How is it linked to sensitivity?

The dentine on the root surface is full of microscopic tubules running towards the nerve. Without enamel to protect it, cold, sweet things or the touch of a toothbrush reach the nerve through these tubules and cause a short, sharp twinge. Sensitivity caused by recession can usually be brought under control with treatment for sensitive teeth. But not every twinge comes from recession; decay, a crack or clenching can cause similar symptoms, so we tell them apart first.

What does the cost depend on?

The cost depends on how many teeth are treated, whether a graft is needed, whether your own tissue or a matrix is used, and whether gum treatment is needed beforehand. After the examination and measurements at our clinic in Bayraklı, İzmir, we draw up a plan for you and you receive a written, itemised quote.