Perhaps you've often wondered why the gums withdraw from teeth, resulting in the occurrence of pain and aesthetic appearance, although you have good oral hygiene. We will briefly present some of the causes that can lead to apical gum displacement, discovering the roots of teeth in some areas, this is a warning to the patient.

Gingival recession may be the clinical expression of a common development through passive eruption (moving towards the apex of the tooth, gum grip levels tooth) or abnormal or pathological circumstances

 In elderly people, gum retraction is considered normal, although physiological, characterized by the degeneration (narrowing, reduction, partial loss of function) of the collagen fibers in the gingival tissue and bone retraction by the reduction in volume of the bone. The elderly often present elongated crowns, visible roots and slight tooth mobility, or lack of it.

This is not a concern if the patient has a proper dental hygiene with an appropriate  brushing technique, associating self-cleaning methods (dental floss, mouthwash, oral shower etc.) and going to a regular dental check-up at least once a year.

For young people and adults, gingival retraction is considered pathological when:

1. Massive deposits of scale are in the gingival sulcus, which will lead to plaque build- up at this level and gum disease, the occurrence of inflammation, pain and bleeding gums.

2. Occlusal trauma (chewing with large forces, harmful for the dental periodontal complex), bruxism (teeth grinding) can cause installation of gum inflammation, destructive phenomena in gingival tissue, with slow retraction of the gum to the tooth root and sometimes with the appearance of small periodontal pockets.

3. Direct trauma. It can be achieved by aggressive brushing, excessive and overly frequent, consequence of the patient's desire to obtain better cleaned teeth.

Thus, by excessive brushing, we can do more harm than good on the gingival tissue, and gingival retraction can be observed without clinical signs of inflammation, especially in the canines and premolars.

In addition to brushing, other factors that may cause direct trauma to the gums, with its retraction can be: using interdental cleaning flossing with uncontrolled forces and incorrect technique, introducing metallic objects in the soft tissues (such as piercings), the direct impact of food especially on the palatal gingiva of the upper molars.

4. Anatomical factors: abnormal eruption, as individual form structure of teeth, abnormal tooth positions and traction exerted by gingival phrenic, ties, aberrant muscle insertions located near the gum line.

5. Causes of restorative nature: excessive fillings, tooth crown incorrectly adjusted and prosthetic crowns with traumatic action on gums.

6. Surgery: the laborious tasks where it`s necessary to make a gingival incision to achieve a flap, or where it is necessary to excise the buds and functional excluded gum line by gingival disease

7. Orthodontic braces as a side effect, over time, induce gingival retraction. This phenomenon occurs because of orthodontic forces applied to the dental-periodontal complex, with have the role of  realignment of the teeth.

8. People with low immunity, vegetarians, vegans, anemic have a stronger predisposition to periodontal illness, to more pronounced gingival bleeding, to the gingival retraction. This tendency is the result of depriving the body of certain nutrients (protein, vitamins), mainly required to have good immunity (the body's defense against pathogens) and then for good performance of its functions. And also the collagen quantity is smaller than other people’s.

In addition to aesthetic discomfort given by gingival retraction, patients can still encounter other problems, not insignificant, which can affect their daily rhythm and social life:

a. Hyperesthesia = hypersensitivity = pain - which may occur during mastication, in touch with metal cutlery, hot food or particularly cold, or cold air intake.

b. Due to hypersensitivity, the patient will be avoiding brushing the area or will perform unfair and inefficient technic, leading to accumulation of dental  plaque and dental caries occurrence in time (unsightly, painful, which can lead to other complications) and gingivitis (gum disease) .

c. It will reduce the efficiency of mechanical or ultrasonic scaling, because the patient can no longer support this therapeutic act.

d. To mask the gingival defect, the patient will tend to limit mouth opening, will laugh being controlled, with phonation amended and over time, these things can lead to depression and nervous anxiety in dealing with others.

How can we treat gingival retraction and its consequences?

First, there will be a more accurate oral hygiene to remove plaque, harmful and destructive. Depending on the severity of gingival retraction, we can choose one of the following ways of treatment:

1. Injection of a certain amount of hyaluronic acid in the retracted gums. The growth in volume and height of the gum covering the tooth is found with a desired esthetic effect to the patient. Although the major advantage of this procedure is to obtain a rapid and acceptable effect to the patient, its disadvantage is that the effect is short-lived and the procedure must be repeated from time to time.

2. Plastic surgery is to bring back the gum in the initial insertion in the tooth. The procedure uses gingival grafts taken from an area within the patient's mouth and trough suture is attached in the exposed gum. Esthetic and functional effect is not 100% sure, it depends on the quality of gingival tissue, on the elasticity of the tissue and of course on the reactivity of the patient and his ability to heal.

3. If none of the above interventions do not convince you, you can opt for a porcelain device (bridge or prosthetic crown) which has the advantage of achieving false gums.

To prevent unpleasant consequences of gingival retraction, our main recommendation is to do regular checks to the dentist and to ask his advice.

Author: Dr. Ema Onutu, M.D. ABC EURODENT

Source: 1. Periodontology, Prof. Dr. Horia Traian Dumitriu, Prof. Dr. Dilvi Dumitriu, Conf.        Dr. Anca Silvia Dumitriu, Ed. Viata Medicala Romaneasca, 2009; 2. http://www.webmd.com/oral-health/guide/receding_gums_causes-treatments

Foto: www.roswellperiodontics.com, www.drgbobet.blogspot.com