What exactly happened when the gums began to recede?

In life, many people will encounter the problem of gum recession. Although this problem is not a difficult disease, if it exists for a long time, it is really difficult for the gums to recover. Gum recession not only brings aesthetic problems, but also secondary problems such as tooth sensitivity and root caries. Therefore, many people want to know why gums shrink and how to prevent it?

This is the real name of gum recession

Gum atrophy is actually a common name. From a professional perspective, "gum recession" is a more accurate term. This is because "atrophy" often reflects aging changes. In fact, on the one hand, elderly people with healthy periodontal health will not experience obvious gum atrophy. On the other hand, adults with healthy periodontal health will also experience asymptomatic and difficult-to-detect gum atrophy.

Therefore, gingival recession as a pathological phenomenon is often related to pathological processes caused by various damages, and it is more accurately called "gingival recession".

The causes of gum recession are not simple

As a common oral manifestation, gingival recession is actually caused by multiple factors. These factors can be roughly divided into two categories: susceptible factors and inducing factors. The former is related to congenital development, equivalent to internal factors, such as thin gingival tissue, insufficient epithelial keratinization, lack of alveolar bone support, etc.; the latter is related to acquired habits or diseases, equivalent to external factors, such as incorrect brushing methods, smoking, periodontitis and its treatment, orthodontics, etc. To effectively prevent the occurrence of gingival recession, the key lies in the control of inducing factors.

Image source: Reference 1

1. The impact of improper oral health care measures on gingival recession

Gum recession is closely related to improper selection and incorrect use of oral care tools. The most commonly used oral care tool is the toothbrush. Improper selection of toothbrushes and incorrect brushing methods may not only fail to effectively remove the dental plaque that causes periodontitis, making the gums unable to stay away from biological hazards, but may also cause mechanical damage to the gums, such as brushing too hard, too frequently, or using toothbrushes with too hard bristles. When cleaning between teeth, using toothpicks or using dental floss incorrectly can also cause mechanical damage to the gums.

2 Effects of periodontitis and its treatment on gingival recession

The initiator of periodontitis is periodontal pathogens. These bacteria themselves and the enzymes, toxins and other substances they produce can damage the gums. In the progressive stage of periodontitis, although the gums appear swollen and proliferated from the outside, they are getting weaker and weaker inside, and the part where the gums are connected to the teeth is constantly moving from the original neck of the tooth to the root of the tooth. In other words, the gums are like being "uncovered" from the surface of the teeth and "torn" off little by little. After professional treatment of periodontitis, on the one hand, the swelling and hyperplasia of the gums gradually subside; on the other hand, the part of the gums that has been separated from the teeth cannot be re-bonded, resulting in the fact of gum recession. Therefore, when the gums are swollen, the gum recession is fully exposed.

Additionally, scaling, root planing, or periodontal surgery may cause gum recession.

3 Effects of smoking on gingival recession

The effect of smoking on gum recession can be reflected in two aspects: first, it aggravates the gingival inflammation response by promoting the growth of periodontal pathogens; second, it directly causes chemical damage to the gum tissue.

Taking good care of your oral health is the top priority in preventing gum recession

1. Selection and use of toothbrushes

There are three key points when choosing a toothbrush: the brush head, the bristles, and the brush handle. The key point related to preventing gum recession is the bristles, that is, you should choose a soft-bristled toothbrush. Soft-bristled toothbrushes can not only reduce mechanical damage to the gums, but also massage the gums, which is beneficial to maintaining gum health.

There are many professional brushing methods, but the most effective method for protecting the gums is the modified BASS method, one of the key actions of which is the horizontal vibration method (or short horizontal brushing method), which is named because the direction of this action is horizontal and the amplitude of the back-and-forth movement is small. The key technical point is that part of the bristles should be inserted into the gingival sulcus formed at the junction of the gums and teeth, and part of the bristles should be placed on the gums, so it is not only conducive to removing dental plaque in this area, but also can massage the gums.

2 Selection and use of dental floss

The choice of dental floss can be considered from two aspects:

First, the form. Dental floss is generally divided into two types: dental floss coils and dental floss sticks. It is generally believed that the former can be bent into a "C" shape to surround the tooth surface, with a larger fit range and higher cleaning efficiency, and is therefore highly recommended by most dentists; the latter part of the dental floss is stretched into a straight line, with a smaller fit range and lower cleaning efficiency. But in fact, the part of the teeth that must be cleaned with dental floss is only the contact area, so the advantage of the former is not very obvious; and for most people, the latter is easier to master and therefore more practical. So here is a sincere suggestion: if you find it difficult to use a dental floss coil, you might as well use a dental floss stick.

Source: Professional textbooks

The second is the texture, including material, thickness, and whether it contains wax. It is generally believed that nylon dental floss of moderate thickness is suitable. Obviously, the friction generated by waxed dental floss is less than that of unwaxed dental floss, so the former is suitable for removing food residues and soft plaque, while the latter is suitable for removing dental plaque.

There are three key points to the correct use of dental floss sticks: alignment, sliding, and scraping. "Alignment" means aligning the direction of the gap between teeth, because the directions of different gaps are different, and only by aligning the direction can the dental floss enter the gap smoothly; "sliding" means that after aligning the dental floss between teeth, it slowly slides into and passes through the contact area in a horizontal sawing motion, which can avoid violent pressure on the gap between teeth and eventually hurt the gums; "scraping" means keeping the dental floss close to the tooth surface and relying on friction to remove dental plaque, food residues, etc. from the gap between teeth.

In summary, gum recession may be caused by mechanical damage, biological damage or chemical damage, with mechanical damage and biological damage being the main causes. The most effective way to ensure that the gums are away from mechanical damage and biological damage is to do the most basic daily oral care. Although professional methods such as teeth cleaning are more powerful in controlling dental plaque, it is impossible to do it frequently, and at most once every six months. As the saying goes, a three-foot-thick ice does not form overnight, and only effective daily health care measures can truly protect your oral health!

References

1 Chan HL, Chun YH, MacEachern M,et al. Does Gingival Recession Require Surgical Treatment?[J]. Dent Clin North Am, 2015, 59(4): 981-996.

2 Meng Huanxin, ed. Periodontology (4th edition) [M]. Beijing: People's Medical Publishing House, 2012.

3 Imber JC, Kasaj A. Treatment of Gingival Recession: When and How? [J]. Int Dent J, 2021, 71(3): 178-187.

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