Recession is the movement of the gums away from the crowns of the teeth. This is what Shakespeare called becoming “long of tooth.” We often associate this with aging though it is not at all inevitable, no matter how old we are.
One crucial fact that people often miss about recession is that, frequently, it also involves loss of the underlying bone. Since it is bone that holds the teeth in place, not the gum, this is an important consideration.
As we see the teeth become longer, we realize the gum is shrinking. What we often don’t understand is that the bone may be receding as well. This is probably because we don’t see the bone, so we don’t think about it. But we all know that the roots of the teeth are embedded in bone. It should, therefore, stand to reason that if the gum was receding and nothing was happening to the bone then, eventually, we would see bone exposed. Of course, we never see bone exposed. Our bodies will not allow that to happen – our genetics require that bone is always covered, by gum or skin. Therefore, you can be assured that if your gum is shrinking then you are most likely losing bone as well. This should be of concern. Besides the cosmetic consequences of receding gums, we need the bone to remain intact and healthy, so we keep our teeth for a lifetime.
When discussing recession, it is important to distinguish recession between and around the teeth from recession only on the face of the teeth.
When we lose gum and bone between the teeth, there is generally only one reason. This is periodontal disease, an infection caused by the bacteria that live in our mouths and colonize the exposed surfaces of the teeth. If they are not removed in a timely fashion by good oral hygiene and regular professional cleanings, then this can result in bone loss around the teeth, not just on the facial surfaces. One other cause of bone loss between the teeth is aggressive oral hygiene. Fortunately, this is rather uncommon. Remember that hard home care is not good home care. It is all about slowly and efficiently with proper technique. We are always happy to review proper technique with our patients!
There are many causes of recession on the facial surfaces of the teeth. One is aggressive oral hygiene, especially if the gum over the teeth is naturally thin. This is why we no longer recommend medium or hard toothbrushes. Another is a history of orthodontic treatment, especially when the teeth are moved outward to correct crowding. Again, this is more likely to happen when the overlying gum is naturally thin. Thirdly, recession can occur if the overlying gum is subject repeatedly to an acid environment. Finally, frequent grinding and/or clenching of the teeth, during the day or night or both, can lead to recession.
Thus, correction of recession depends on an accurate diagnosis as to the underlying cause. Recession on the facial of the teeth can be corrected by various techniques, assuming the underlying cause is addressed. This will be discussed in a future article. Recession that also involves the gum and bone between the teeth, which results in what is often described as black triangles, is much more difficult to correct. Sometimes the best we can do is prevent future loss of gum and bone with effective periodontal therapy.