Though there are a considerable amount of causes for the gum recession the exact mechanism behind the loss of attachment has not been clearly defined.
Beck & Koch exclaimed that patients with a long-standing history of periodontal disease exhibit recession. These sites harbor bacterial plaque resulting in the production of toxins and cytokines leading to tissue destruction, alveolar bone loss and loss of attachment. Others believe recession might be due to chronic trauma to the gums forming necrotic tissue.
CONSEQUENSES CAUSED BY GUM RECESSION:
- Pain & dentin hypersensitivity.
- Fear of loss of teeth.
- Aesthetic changes (changes in appearance or smile).
- Plaque retention with gum bleeding.
- Root caries.
- Abrasion (wearing away of the surface of the teeth).
TREATMENT OF GUM RECESSION:
The treatment process to regain the attachment is a steady & long-term process hence the co-operation of the patient is very much needed. The process is explained clearly to the patient and the duration of recovery of attachment is also mentioned.
Manual brushing: An atraumatic brushing technique is advised with the use of a soft/ medium nylon bristled toothbrush. Bass technique of brushing/roll method of brushing is recommended. Periodic dental check-up & review to record the plaque levels.
Electronic tooth brushing: They show decreased gum damage even after using it for longer duration. The brush has a rotary movement of the head hence lesser gingival abrasions, mechanical trauma, and reduced plaque retention.
Interdental cleaning: The use of Interdental brushes or floss is recommended. This aids in reducing the risk of progression of periodontal disease and root caries.
Smoke cessation: Smoking is the causative agent and major risk factor for various diseases. The patient is advised about the interference of his/her habit in their lifestyle, health, and prognosis of the treatment must be spoken in detail. Professional support for guidance in smoke cessation must be referred.
Traumatic habits: The patient is advised to quit habits like nail-biting, pencil biting, tooth picking, etc. Awareness regarding the effects of these habits on their oral health is discussed.
Tooth position and orthodontic procedures: Reposition of the tooth within the arch with lingual movement will increase the thickness of the gingiva and decreases the buccal recession.
Precautions to control plaque retention during orthodontic treatment must be educated to prevent gum recession. As poor oral hygiene practice may impact in inflammation of the gums and bone loss. In case dehiscence (bony defect) tissue grafting is suggested before commencing tooth movement.
Partial dentures & restoration: A well-designed denture with good support & relief for the underlying structures will prevent trauma. Supragingival (above the gums) restorations are preferred to reduce plaque accumulation and retention of debris.
Overhanging should be checked after restoration and a proper contour to be maintained without precipitating any local irritant. The patient is educated on the maintenance of good oral hygiene practices while wearing dentures and steps to clean the dentures daily.
Treatment for periodontal diseases: To prevent the progression of recession the levels of plaque controls are to be kept in check. The treatment proceeds in 3 stages namely:
Initial therapy: patient education followed by removal of plaque, calculus & any plaque retention factors.
Corrective therapy: To restore the lost function and aesthetics.
Supportive therapy: Maintenance of the recovered function and aesthetics for the long term.