Normally, the gums will cover the entire root surface of the teeth and end where the hard outer layer of the tops of the teeth, the enamel, ends. If the gums recede down the surface of the teeth, the root surface may become exposed.
The root surface is made of a material know as dentin. Unlike enamel, this surface can in many people become very sensitive. It does have actual live cells that extend in microscopic tubules that rise to the surface of the tooth. The dentin found along the root surface is also much softer than enamel causing several added problems. First, being softer, the root surface can easily abrade causing a deep cleft along the root surface. Second, the softness of the root surface leaves the area more prone to decay, especially if the area is sensitive to brushing and not being cleaned as well.
How does this first occur? In most cases improper toothbrushing is the culprit. Using a hard brush or abrasive toothpaste may further advance the damage. In other patients, the problem may have been genetic, occurring naturally. Advancing periodontal (gum) disease is also a cause of recession. Lastly, teeth grinding (dental bruxism) contributes by weakening the tooth structure near the gumline.
Proper instruction on toothbrushing and getting sound advice on which toothbrushes and toothpastes to use are the first steps in preventing the recession from continuing. A very low abrasive toothpaste is recommended (Colgate Regular or Rembrandt). If sensitivity is present, the hygienist may recommend a desensitizing toothpaste (Sensodyne, Denquel, or Crest Sensitivity), or even a prescription high-dose fluoride toothpaste (Prevident). If active gum disease is still present, we will often recommend Clo-Sys toothpaste or rinse. Abrasive or tarter-control toothpastes should be avoided. In-office fluoride treatments should also be applied every six months to help prevent sensitivity and root decay.
If the sensitivity is more pronounced, the dental office may have to “coat” the root surface with a special clear desensitizing agent that will soak into the root surface. Occasionally the root may need a special tooth colored restoration to protect it.
When the root surfaces are exposed from recession, the roots may become sensitive to cold foods or acidic foods. Many mouthwashes and acidic foods like citrus juices, wine, apple juice, or yogurt may also aggravate sensitivity. Also brush before and not after eating acidic foods.
In the most severe cases, the recession can continue down the root surface and become a self-perpetuating problem. This will occur if the recession continues to recede below the mucogingival junction, becoming a mucogingival defect. In this case the thick gums that surround and bind firmly to the teeth and bone beneath, have been eroded. What remains after this more severe erosion is the freely movable “alveolar” gingiva, which is unable to resist further recession. This problem is correctable only by performing a tissue graft to re-establish the band of thick recession-resistant gums around the teeth. The purpose of this procedure is to prevent further recession and leave the area stable for the future.
