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Receding gum tissue can be an issue especially as we get older. Normal healthy gum tissue will follow snugly against the conforms of our teeth. Gum recession occurs when the gum tissue recedes or pulls away from teeth exposing the root below. This creates an esthetic issue as well as a functional one. The roots of our teeth do not have a protective layer of enamel. This can make your teeth sensitive to hot and cold as well as increase your risk of tooth decay. Once recession occurs, this tissue cannot grow back to its original state. There are treatments to restore lost gum tissue and bring your smile back to its original healthy state.

What Causes Gum Tissue To Recede?

Several factors can cause our gum tissue to recede including:

Periodontal Disease (ranges from ginigivitis to advanced periodontitis) – Periodontal disease (also called gum disease), refers infections of the structures around the teeth, which include the gums, periodontal ligament and alveolar bone. In the earliest stage of periodontal disease — gingivitis — the infection affects the gums. In more severe forms of the disease, all of the tissues are involved. This inflammation occurs due to an accumulation of bacterial deposits called plaque.

Contributing factors of periodontal disease include:

-poor oral hygiene maintenance

-misaligned or crooked teeth

-damaged or faulty fillings

-bridges or partial dentures that no longer fit

-genetics

-hormonal changes due to pregnancy or oral contraceptives

-medications that cause dry mouth (xerostomia)

-certain immune disorders

-stress

-tobacco use

Periodontal Disease Stages

-Gingivitis causes gum redness, swelling, and sometimes bleeding. If left untreated, gingivitis can progress to periodontitis.

Periodontitis is the advanced stage of periodontal disease and can cause the gums to recede. As the gum and connective tissues pull away from the tooth, a pocket forms between the tooth and gum, which begins to accumulate bacteria. Over time, the bacteria cause further damage and inflammation. If the gums recede too much, it may lead to bone loss, which can cause teeth to loosen or fall out over time.

Is Incorrect Brushing The Cause?

Maintaining a regular brushing and flossing regimen is essential for maintaining good oral hygiene. However, using an incorrect brushing technique could actually contribute to receding gums. The part of the gum that comes into contact with the crown of the tooth is called the gingival margin. Brushing incorrectly or too hard can damage the gingival margin, possibly triggering gum inflammation and recession.

Incorrect brushing techniques can include:

-brushing too forcefully

-using a hard or medium bristled toothbrush

-brushing the teeth in a broad, horizontal motion

Teeth grinding and clenching

Some people grind their teeth together while sleeping. This motion of teeth grinding puts intense pressure on the gums, which can cause them to react by receding over time. Teeth grinding can also cause teeth to become loose in their sockets. Grinding creates deep pockets between the tooth and the gum, where bacteria can collect. These bacteria trigger gum inflammation, which can then worsen gum recession.

Injury

Sustaining direct trauma to the gum tissue may cause the gums to recede in that area. These injuries could include:

-during a fall or other accident

-during dental procedures

-while wearing ill fitting partial dentures

-trauma while playing contact sports

Treatments For Receding Gums

Scaling and root planing

Scaling and root planing is one of the first treatments for receding gums that a dentist will recommend. This procedure will remove plaque and tartar from below the gumline, where routine brushing cannot reach. Root planing removes plaque and tartar specifically from the roots of teeth. Following removal of plaque and tartar your dentist or hygienist will use special instruments to smooth the roots, which helps the gums re-attach to the tooth.

Gum Tissue Grafting

Your dentist may recommend gum graft surgery if your gums have severely receded to the point where surgical intervention is needed. During gum grafting, a surgeon will take a small piece of gum tissue from a different area in the mouth and transplant it to cover the exposed tooth roots. This gum tissue grafting helps prevent bone loss and the gums from receding farther. It can also protect the previously exposed tooth roots from decay and tooth sensitivity

Pinhole Surgical Technique

Pinhole surgical technique is a fairly new treatment for mild to moderate receding gums. Pinhole Surgical Technique is a minimally invasive procedure that requires no incisions and no suturing. It is a quick and effective treatment for gum recession that is virtually pain-free and requires only a very short recovery time. Patients can resume normal activities the same day as their procedure.

Prevention Of Gum Tissue Recession

-Practice good oral hygiene

The following oral hygiene tips can help avoid receding gum tissue:

-flossing between the teeth at least once per day preferably after each meal

-fluoride toothpaste

-brushing your teeth 2x/day using a soft bristled toothbrush

-using an antiseptic mouthwash to reduce bacteria and flush out debris

-choosing a size and shape of toothbrush that allows access to all parts of the mouth

-replacing toothbrushes at least every 2–4 months or as recommended by your dentist

-maintaining a regular schedule of dental appointments

-Wear A Mouthguard

Wearing a mouthguard at night can help prevent gum recession due to teeth grinding. Mouthguards create an even pressure across the jaw and act as a physical barrier to separate the top and bottom teeth. Mouthguards can be bought at your local pharmacy. A dentist can also make a customized mouthguard, which will provide a better fit and be much more comfortable and long lasting

-Replace Dentures That Do Not Fit

Partial dentures that once fit well can become incompatible with the mouth over time. This can happen for several reasons, including:

-the bone and gum ridges shrinking over time

-differences or changes in jaw alignment

-overall wear and tear of the partial dentures over time

Ill fitting partial dentures can rub and irritate the gums, causing the gums to recede around healthy teeth. People can prevent this by replacing partial dentures as needed. If you are concerned have your dentist evaluate your partial dentures at your next visit.

-Maintain Regular Dental Visits

Attending regular dental checkups is vital for detecting the early stages of gum recession. Routine examinations also allow your dentist to identify and replace any failing restorations or ill fitting partial dentures, which can contribute to receding gums.

Gum Recession Conclusion

Unfortunately once the gum tissues have receded, they cannot grow back on their own. With Advancements on treatment your dentist can reattach and restore gum tissue around the teeth. Remember to maintain a good oral hygiene program at home and seeing your dentist regularly can help prevent, slow, or stop gum recession. If you notice changes in your smile speak to your dentist to see what options are right for you.



Periodontal disease (or commonly called gum disease) is a very serious and chronic dental infection of the periodontal tissues that can result in the breakdown of the tissue as well as the loss of bone that surrounds and supports your teeth. This dental infection disease begins when bacteria and plaque form a sticky bio film on your teeth and causes inflammation of the periodontal tissue.  Periodontal disease will continue a downward progression if this is not resolved by maintaining proper dental care and hygiene. Periodontal disease is the leading cause of tooth loss in adults. Scientific studies show that somewhere between 75% and 95% of all adults are suffering from some stage of periodontal disease.

Periodontal disease and tooth decay (cavities) are caused by different types of bacteria, and are considered to be two separate and distinct conditions, however, you can suffer from both issues. Poor oral hygiene promotes the risk of both cavities and periodontal disease. Swollen and receding gums open up the more vulnerable areas of the tooth…The root areas, which, are not protected by enamel and can break down quickly to form root decay.  On the flip side, in patients with significant tooth decay, the broken down teeth allow for food trap areas which keep periodontal tissue chronically inflamed.

Gingivitis

Periodontitis

Stages of Periodontal Disease

The earliest stage of periodontal disease is gingivitis (or simply inflammation of the gum tissues). This is the most mild form of periodontal disease. Symptoms include red, swollen (or puffy) and inflamed gums due to plaque-bacteria build-up. The gums may also bleed easily during brushing or eating of hard foods. During the earliest of stages the periodontal disease process it can be reversed thru proper brushing, flossing and professional dental care to remove the excess bacterial plaque. If the required oral hygiene does not occur, the periodontal disease then progresses  to the next stage. The majority of people with this early form of periodontal disease, do not even know a dental problem exists. This is a crucial period for the patient, as the condition can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been adversely affected) at this point if it is recognized, diagnosed, and properly treated by a dental professional. Gingivitis is commonly seen during puberty, pregnancy, times of high stress, and menopause, as raging hormones can make you more prone to inflammation. As for the rest of the population, poor dental hygiene is generally the most common cause, followed by medication and certain medical conditions.

Periodontitis

As the periodontal disease progresses it is now becoming harder to treat and control. The difference between gingivitis and periodontitis is that gingivitis only infects the gum tissue that surrounds the teeth while the periodontal disease process also invades the bone that provides support and stability for the teeth. The bacteria eventually invades past the initial the gum line area and destruction begins to the point that gums may begin to separate or pull away from the teeth (taking away support and connective fibers with it). What results are called periodontal pockets. These pockets allow for bacteria to invade below the gum line.  They eventually become loaded with toxic plaque and bacteria that moves and works its way deeper. It begins to erode the bone below the gum line. A patient’s bite will be affected (as the teeth shift or loosen) by the lost support which then affects chewing and other daily functions.

Advanced Periodontitis

As the periodontal disease process advances further, the fibers and bone that provide support for the teeth are broken down and  destroyed. At least half (50%) of the bone support (if not more) will have broken down at this late stage of periodontal disease. It does not grow back naturally. Teeth may begin to loosen. Deep root cleanings and surgical intervention are typical at this stage. This may include cleaning with a periodontal microscope, (Perioscope), grafting of tissue, bone, placement of growth factors, (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets, (Arestin), open periodontal flap surgery, and, possibly even tooth removal.

How Do I Know If I Have Periodontal Disease?

Periodontal disease can happen to a person of any age. It is most common among adults. Remember, if periodontal disease is detected in its earliest stages it can be reversed so it is important to see your dentist right away if you notice any of the following symptoms:

-Gums that are red, puffy or inflamed, or tender.

Periodontitis

X-Ray showing Periodontal Disease Progression

-Gums that bleed easily during routine brushing or flossing.

-Teeth that appear longer due to recession of gum tissue.

-Changes in the way your teeth fit together when you bite or chew.

-Pus coming from between your teeth and gums

-Bad breath odor or bad taste in your mouth.

Treatment of Periodontal Disease

Periodontal Disease

Arestin use in Periodontal Disease

The earliest stages of periodontal disease are reversible. This is accomplished thru proper brushing, flossing, and maintaining a regular schedule with your dentist. A professional cleaning by your dentist or hygienist is the only way to remove plaque and tartar especially below the gum line. The hygienist will clean (also called scaling) your teeth to remove the tartar and plaque buildup from above and below the gum line. If the periodontal disease condition worsens, then a root planing procedure may be necessary. Root planing helps smooth irregularities on the roots to make it more difficult for plaque to deposit and stick there. Also makes it easier for you to keep your teeth clean at home. Treatment may also include use of antibiotics.

If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, your periodontitis treatment may require dental surgery. This surgical intervention may include:

-Pocket Reduction Surgery (also called Flap surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. The procedure generally takes from one to three hours and is performed under local anesthesia.

Soft tissue grafts. Gum tissue is often lost as part of the periodontal disease process making your teeth appear longer than normal. You may need to have damaged tissue replaced to return your cosmetic appearance back to normal. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetically pleasing appearance.

Bone graft. This procedure is needed when periodontitis has destroyed the bone surrounding your tooth. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.

-Antibiotics and medicaments – A wide array of antibacterial rinses(Peridex), antibiotics taken in pill form, (Periostat) or localized placement directly into the affected pockets(Arestin), can aide in and promote healing of the affected gum tissue.

-Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.

-Enamel matrix derivative application. Another technique involves the application of a specialized gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue. An example of this is the use of emdogain.

To ensure a successful result following periodontal therapy, patient cooperation in maintaining excellent oral hygiene is essential. More frequent professional cleanings can help reduce the likelihood of the periodontal disease ever returning.

By scheduling regular checkups, early stage periodontal disease can be treated before it leads to a much more serious condition. If your periodontal disease is more advanced, treatment in the dental office will be required. Periodontal disease can be managed and controlled for most patients. Following a regular routine of brushing, flossing, and seeing your dentist should be enough for most to keep periodontal disease at bay.




The #1 goal of periodontal disease treatment is to allow for re formation of and re attachment of the periodontal tissues. The best way (and least invasive) is via regeneration or regrowth. There have been various products come to market over the years that have been considered the next immediate fix in regenerative periodontal therapy. Very few have ever seen the real world clinical results of emdogain. Emdogain is made up of various biological proteins and growth factors that have been scientifically proven (thru clinical research and trials) to regrow periodontal tissue, connective tissue, and bone. Emdogain has been shown to be quite stable and predictable for Periodontal  regeneration of lost periodontal tissues.

How Does Emdogain Work?

Emdogain achieves its clinical results by tricking the body into forming new bone, cementum, and attachment fibers. Emdogain’s secret weapon is in its enamel matrix proteins (also called amelogenins) taken from developing teeth in pigs. Luckily, humans do not recognize these proteins as foreign, as they are similarly found in all mammals. There is also a 0 (zero) chance of transmission of any disease by the proteins. During tooth development, these proteins are secreted onto the root surface that is developing preceding the formation of tooth attachment. Luckily for us, this also occurs when the proteins are placed on the root surface of a tooth that has lost bone and attachment from periodontal disease.

Periodontal regeneration

Emdogain

By reintroducing enamel matrix proteins, you are triggering a biologic response from the body to do what it did naturally during your earliest of development. Enamel matrix proteins are only in the body for a short window of time during human development.When applied to the root surface of teeth, these proteins group and form into an insoluble matrix layer that promotes the attachment of mesenchymal cells. These cells produce new matrix components and growth factors that participate in the regain of tooth attachment. Epithelial cell growth is also inhibited by emdogain. This allows for proper tissue and bone reformation to take place without interference.

Treatment

Periodontal regeneration

Radiograph showing bone level before and after emdogain.

Once your dentist has diagnosed, the presence of periodontal disease. Emdogain will be discussed as the least invasive and most effective way to restore the area back to its natural cosmetic appearance. The area in question is generally referred to as a defect. That term is used because there is a periodontal pocket present where the bone and soft tissue has moved away from attaching to the tooth. This is caused by the periodontal disease process. After the defect has been  exposed so the dentist has full visualization of the area. The area is cleaned and debrided of any inflammation and/or diseased tissue or hard tartar deposits. Emdogain is used to help the tissues repair themselves. Emdogain comes as a premixed gel in a syringe. The material is inserted into the defect area. The area is closed and patient can then go about their normal lives. Obviously, the area might be a little tender and patient should avoid flossing and chewing on that side for a few days to allow proper healing time and no disturbance of emdogain as it does its work.

Post Treatment

In the following two weeks, about 75% of the tooth surface where the defect was present will be covered withPeriodontal Regneration the newly developing tooth tissues. The attachment and supporting  structures begin to reattach to the tooth to aid in keeping the tooth stable and healthy. These new tissues will take about one year to complete the maturation process. For this reason, the area where Emodgain is used, should not be periodontally probed (by your dentist or hygienist) for a period of about 6 months. Emdogain can also be used with soft tissue defects.

Emdogain is not ideal for every defect. Your dentist 89014 will be able to describe to you if emdogain is right for your particular case.