Addressing Gingival Recession

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Dr Boota Singh Ubhi discusses the causes and treatments for gingival recession

There are many possible causes for gingival recession, including build-up of calculus leading to disease and inflammation [1], history of and current ‘hard’ tooth brushing [2], and misaligned teeth [3]. Lifestyle habits like smoking [4] and features such as lip piercings [5] have also been shown to promote the development of gingival recession.

A major impact of the condition is what it does to the smile aesthetics – this is often the main complaint from the patient. It can also lead to plaque retention, gingival bleeding and inflammation, loose teeth and pain or discomfort [6]. Recession can also cause dentine hypersensitivity [7] and lead to continued discomfort for the patient that could affect their quality of life.

Where minor recession has occurred and it is detected early, there are some fairly simple treatment options available. Revision of home care routines and a review of any existing restorations or tooth alignment can help stop the condition from progressing any further. Where infection is identified, the appropriate topical antibiotics, antiseptics or antimicrobials can be applied. Alternatively, orthodontic treatment may be considered.

In cases of advanced recession, more complex intervention may be required, such as periodontal plastic surgery. This encompasses a wide range of surgical procedures that involve improving the soft tissue aesthetics by restoring the position of the gingiva.

The main surgical procedures employed for root coverage can generally be placed into one of two categories [8]:

1. Pedicle soft tissue graft procedures
These grafts allow soft tissue to be repositioned over the defect, but as they remain attached they retain their own blood supply. This type of graft includes coronally advanced flaps and laterally positioned flaps.

2. Free soft tissue graft procedures
Where there is insufficient soft tissue close to the defect or tissue thickness needs to be increased, these procedures involve placing a grafted material from elsewhere – usually the palate. These include free gingival grafts and connective tissue grafts.

A connective tissue graft covered with an overlying flap is widely considered to be the gold standard treatment for gingival recession defects in the profession. It is believed that the two blood supplies afforded by this technique provide an optimal aesthetic outcome [9].

Appropriate treatment

Treatment for gingival recession should always begin with less invasive procedures when possible, but more complex intervention may be required for advanced cases. Referral to a colleague with the appropriate skills and experience may be in the best interests of your patient and working with my specialist team at BPI Dental could offer a solution. Accepting referrals for an array of periodontal plastic surgery procedures – including connective tissue grafts, as well as crown lengthening and ridge augmentation – the team can offer an extension to your services and ensure your patients receive the highest quality care.

Author

Dr Boota Singh Ubhi is a specialist periodontist and implant surgeon. He leads a select team of experts at Birmingham Periodontal & Implant (BPI) Dental. For more information regarding his team’s referral services visit www.bpidental.co.uk, call 0121 427 3210 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

References:

1] Van Palenstein Helderman WH, Lembariti BS, Van Der Weijden GA, Van't Hof MA. Gingival recession and its association with calculus in subjects deprived of prophylactic dental care. Journal of Clinical Periodontology. 1998;25(2); 106–111.

2] Khocht A, Simon G, Person P, Denepitiya JL. Gingival recession in relation to history of hard toothbrush use. Journal of Periodontology. 1993;64(9); 900–905.

3] Gorman W J. Prevalence and etiology of gingival recession. J Periodontol 1967; 38; 316–322.

4] Banihashemrad SA, Fatemi K, Najafi MH. Effect of smoking on gingival recession. Dent Res J. 2018;5(1): 1-4

5] Er N, Ozkavaf A, Berberoglu A, Yamalik N. An unusual cause of gingival recession: oral piercing. J Periodontol 2000; 71; 1767–1769.

6] Healthline. Receding gums. Symptoms of receding gums. https://www.healthline.com/health/dental-oral-health-receding-gums#causes [Accessed September 2018]

7] Strasslet HE, Drisko CL, Alexander DC. Dentin hypersensitivity: Its inter-relationship to gingival recession and acid erosion. Aegis Dental Network. June 2008; 29(5) https://www.aegisdentalnetwork.com/special-issues/2008/06/dentin-hypersensitivity-relationship-to-gingival-recession [Accessed September 2018]

8] Alghamdi H, Babay N, Sukumaran A. Surgical management of gingival recession: A clinical update. The Saudi Dental Journal. 2009;21(2); 83-94. doi:10.1016/j.sdentj.2009.07.006.

9] Wilcko M.T., Wilcko W.M., Murphy K.G., Carroll W.J., Ferguson D.J., Miley D.D. Full-thickness flap/subepithelial connective tissue grafting with intramarrow penetrations: three case reports of lingual root coverage. Int. J. Periodont. Rest. Dent. 2005;25(6): 561–569.