Gingival recession is a pathological movement of the gum margin away from the tooth. This causes the root surface of the tooth to be exposed. Exposed root surface causes pain upon exposure to cold and hot liquids and foods, and can be very sensitive to tooth brushing.


Gingival recession is also unaesthetic, especially if the tooth is located in the front of the mouth when the person speaks or smiles. Some people have a very wide smile and show many teeth when they smile. An uneven gum line can be distracting and even compromise a beautiful, pleasing smile.


Gingival recession in its localized (single tooth or a few effected teeth) or generalized form (many teeth throughout the mouth) is an undesirable condition resulting in root exposure. The result often is not esthetic and may lead to thermal hypersensitivity and root caries. Exposed root surfaces also are prone to abrasion. Studies of Gingival recession found that they correlated to the prevalence of recession to trauma (aggressive brushing), sex, mal-positioned teeth (crooked or overlapped teeth), inflammation and tobacco consumption. Recent surveys reviewed revealed that 88 percent of people 65 years of age and older and 50 percent of people 18 to 64 years of age have one or more sites with recession. The presence and extent of gingival recession also increased with age. More than 50 percent of the population has one or more sites with gingival recession of 1 mm or more. The prevalence of gingival recession was found in patients with both good and poor oral hygiene. It has been proposed that recession is multi-factorial, with one type being associated with anatomical factors and another type with physiological or pathological factors. Recession has been found more frequently on buccal surfaces than on other aspects of the teeth.

CLINICAL IMPLICATIONS: Patients should be knowledgeable about the etiology, prevalence and associating factors of gingival recession, as well as treatment options, so that appropriate treatment modalities can be elected. Treatments for gingival recession include gingival grafting, guided tissue regeneration and orthodontic therapy. Such treatments typically result in esthetic improvement, elimination of sensitivity and a decreased risk of developing root caries. Various clinical reports on the reconstruction of gingival recession defects have been published in the past decade. Several techniques have been used to achieve root coverage, including creation of free gingival grafts, laterally positioned flaps or semilunar coronally positioned flaps, as well as guided tissue regeneration and connective tissue grafting. Recent focus has been on the importance of connective tissue grafting, combined with a recent approach known as the tunnel procedure, in managing gingival recession defects with a single operation.

This procedure originated in 1985 with an envelope design and a subepithelial connective tissue graft for single gingival recession defects and is used today for coverage of multiple adjacent gingival recession defects. Histological evaluation of such connective tissue grafts demonstrates periodontal regeneration in human subjects. Clinical trials have yielded good results, including early tissue healing because of increased blood supply, good esthetic results, excellent patient cooperation and avoidance of secondary periodontal plastic surgery. These benefits underline the appropriateness of this technique, which improves the success rate of connective tissue grafting and increases the amount of root coverage.


The causes of gum recession are usually two:

• Brushing too hard with a toothbrush . Only an ultra-soft toothbrush should be used with slight pressure. If the bristles on your toothbrush are bending out, then that is a sign that you are brushing too hard.
• Gingival infection from plaque. Plaque is continuously made from bacteria. Eight hours after a professional cleaning from a dentist, plaque will form again. This is why plaque needs to be removed daily. If plaque is not removed, the gum tissue will become inflamed. Inflammation is very complicated and is orchestrated by thousands of chemicals that modulate each other. One of the effects of inflammation on the gums is that it causes the epithelium, which is the outer layer of tissue, to proliferate and outgrow its blood supply, thus causing the gum tissue to die and move away from the tooth.
  

Within the last several years, periodontal plastic surgery techniques have been perfected to correct gum recession. The surgical technique involves transplanting tissue from the inner surface of the roof of the mouth to cover the exposed root surface. The newly grafted tissue is then covered with gum tissue taken from around the affected tooth. This surgical technique has a high success rate because the grafted tissue obtains blood supply from two areas, the bone and the adjacent tissue. The procedure usually takes about 40-55 minutes under local anesthesia. Post-operatively, patients do very well. Patients may experience some soreness to mild discomfort for one week, which is completely controlled with over the counter and prescription medications.