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The treatment for gum recession (when the gums shrink, or pull away from, the teeth) depends on the cause. If the gums have become unattached from the tooth, it is important to treat gum recession. Otherwise it is likely to get worse.
If gum recession is due to brushing too hard, your dental office staff can show you a better way to clean your teeth.
If recession is due to periodontal (gum) diseases, the first step usually involves a special cleaning, called scaling and root planing. This removes plaque and tartar deposits on the tooth and root surfaces. This scaling and root planing helps gum tissues heal. For many patients, this treatment plus excellent oral care at home and regular dental checkups can help stop periodontal disease and gum loss.
If recession is advanced, a gum graft may be needed. A graft is when a thin piece of gum tissue is taken from another place in the patient's mouth and attached to the place where the gum tissue has receded. Once the graft heals, it covers the exposed tooth root. Tissue grafts may be done around one tooth or several teeth. Grafts protect the tooth root from sensitivity and decay. A graft can also be used to make a smile look better.
When I detect very early signs of gum recession, I counsel my patients on the proper way to brush. Although recession does not self-correct, we can prevent further damage by carefully monitoring the patient's oral hygiene habits. Always use a soft brush, or better yet, an electric brush like the Sonicare. Used properly, damage should not ensue. Electric brushes should be used in a passive way -- you should never scrub with them.
When a lot of root is exposed, and the gum tissue adjacent to the root is thinning, it is important to refer the patient to the periodontist for a subepithelial graft. Tissue is taken from under the skin of the palate and sutured over the root where needed. Excellent results are expected from this procedure.
It is important to know that when a tooth loses gum tissue, it is also losing bone. In order for a tooth to have an excellent prognosis, the grafting procedure is an excellent solution.
Gum recession is defined as having tooth root surface that is exposed to the oral cavity instead of being covered by gum tissue. Treating recession could be done for many reasons including:
- Prevention of root cavities: The root of a tooth is not covered with enamel and is therefore more susceptible to decay.
- Reduction of temperature sensitivity, especially cold: The root surface of a tooth is very porous and conducts temperature changes more profoundly than the enamel covered crown.
- Improvement of aesthetics: Having teeth that are longer than other can give our smile a very aged appearance, returning the teeth to proper length restores youthfulness.
- Addition of tissue thickness: People have either thick or thin gum tissue. Those with thin tissue are very susceptible to recession all their lives. Adding thickness to the tissue can help prevent recession.
Treatment of recession could range from using a sensitive tooth paste to surgery. Consultation with a dentist or periodontist can help you find the right treatment for your problem.
The three most common ways to correct gum recession are the:
- Free gingival graft: This is a method where the outer layer of tissue is removed from your palate. It is transplanted and sutured in place around the teeth with the problem. The corrected area often looks a little whiter than the surrounding native gum tissue once healed. This is the oldest and most studied method of the three but also has the highest amount of discomfort associated with the donor site.
- Sub-epithelial connective tissue graft: This is a method where the middle layer of tissue is removed from your palate or another area. It is transplanted and sutured in place around the teeth with the problem. Once healed the corrected area looks identical to the surrounding tissue. This is the second oldest technique of the three and is associated with moderate discomfort of the donor site.
- Soft tissue allograft: This is a method where a product made from human tissue is substituted for the patient’s own tissue. Once healed the corrected area looks identical to the surrounding tissue. This is the newest of the three techniques and has no pain associated with the donor site as one is not needed.
The periodontist that your dentist works with is a specialist in these techniques and will be able to guide you in the right direction when making treatment decisions.
Gum recession is typically treated in a periodontal office. This can be treated today with a minimally invasive gingival graft procedure, using your own tissue from another area of the mouth, using donor (cadaver) tissue or using a recently available synthetic collagen. Your periodontist will determine which option is best for you.
The surgical procedure, if it is not for cosmetic reasons, is usually covered by your dental insurance. For a one tooth gingival graft, the procedure is less than an hour and it is usually done using just local anesthetic. After the procedure, some discomfort is to be expected, usually easily controlled with non-narcotic over-the-counter pain medication.
Recent advances in periodontal plastic surgery techniques, such as periodontal regeneration, root coverage procedures with gum graft surgery, and procedures combined with dental extractions or post extraction for dental implant site development, have significantly improved the ability to restore damaged periodontal (gum) tissues. Early diagnosis is critical to periodontal disease management and offers a patient the best chance of preserving their natural teeth.
Options for gum graft surgery continue to increase as new technologies advance in the marketplace. It is important to assess the evidence of newer therapies in comparison to well-documented procedures such as the free gingival graft for gingival augmentation, and the connective tissue graft for root coverage.
Langer and Langer introduced the connective tissue graft for root coverage procedures in 1985. When the treatment goal for gum recession is a combination of providing root coverage and augmenting the zone of attached gingiva, the connective tissue graft is the gold standard procedure.
The added vascular supply available utilizing a connective tissue graft allows for successful, predictable root coverage procedures,a s it is a layered procedure with the primary flap advanced coronally over the graft to achieve partial or complete primary closure. In comparison to the connective tissue graft, a free gingival graft has only a periosteal blood supply and is therfore more limited in achieving root coverage.
Connective tissue grafts can be harvested from either the maxillary palate or the maxillary tuberosity. A variety of successful incision designs have been developed over the years that, depending on the tissue thickness of the palate, are indicated to allow adequate graft thickness and potential primary closure of the donor site wound.
To promote longevity of the therapeutic result recent breakthroughs in combining the application of biologic agents such as Enamel Matrix Derivative (Emdogain) or recombinant human platelet-derived growth factor (Gem 21S) to stimulate healing with advanced surgical techniques have been shown to improve early wound healing.
This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.