Experts say that a number of people with receding gums may have no concerns about it, or might not be aware that their gums are receding. But if you notice a change in appearance—the teeth appear longer and the space between them increases, or there is sensitivity to cold and hot foods or beverages due to exposed roots—you might be experiencing gum recession. Dr Lambert Nduwayezu, a dentist at Polyfam Clinic Kigali, notes that gum recession is the process in which the margin of the gum tissue that surrounds the teeth wears away, or pulls back, exposing more of the tooth, or the tooth’s root. He says that gum recession is a common dental problem. Most people don’t know they have gum recession because it occurs gradually. The first sign of gum recession is usually tooth sensitivity, or you may notice a tooth looks longer than normal. Typically, a notch can be felt near the gum line. Dr AbduKadir Mamataliev, a dentist at Deva Medical Center-Nyarutarama, says that vigorous tooth brushing, or brushing with a hard bristle toothbrush, are common causes of recession and this is often seen in patients with good oral hygiene. He says that this usually presents as localised areas of recession mainly affecting the buccal surfaces of individual teeth or a group of teeth, and will have wedge shaped defects with minimal interproximal recession. For many people, the area of recession is more commonly associated with the left side of their mouth. This relates directly to the fact that most people are right-handed and brush the left side of their mouth first. Dr Mamataliev says that trauma from foreign bodies such as lower lip piercings may also cause recession. Similarly, poorly designed tissue borne partial dentures can also result in gingival stripping, leaving a recession defect. He adds that recession can often occur as a result of any induced damage caused by therapeutic treatment the patient may have. Restorative treatment which involves placement of subgingival margins of restorations can directly affect the biologic width. To re-establish the biologic width, there may be some bone loss and apical migration of the gingival tissues. “Periodontal disease is another common cause of recession which results in the loss of the supporting bone around a tooth. Usually a tooth affected by periodontal disease will lose bone support around the tooth through an inflammatory reaction which results in apical migration of the soft tissue margin. These patients are likely to show generalised signs of recession on all surfaces of the teeth,” Dr Mamataliev says. Dr Nduwayezu says that people who are above the age of 65 are at a higher risk of the condition in at least one tooth. “Others are people who smoke and use tobacco products, and other genetic factors such as people who have thin or weak gums can pass these features on through their genes. Diabetes can also increase the risk of receding gums,” he says. Dr Nduwayezu adds that most importantly, receding gums can be a symptom of underlying dental problems, including gum disease, and can increase the risk of tooth decay and tooth loss. They can also lead to bad breath and bleeding gums. He says that most cases of mild gum recession do not need treatment. Dentists may advise on prevention and offer to monitor the gums. Teaching effective but gentle brushing is an effective early intervention. For people who do need treatment, Dr Nduwayezu says, several options are available, such as desensitising agents, varnishes, and dentin bonding agents. “These products aim to reduce the sensitivity of the exposed tooth root. Desensitising agents treat the nerve symptoms and help preserve oral hygiene by easing the brushing of sensitive teeth,” he says. If the patient’s main complaint is sensitivity and aesthetics are not a concern, then concentrating efforts to treat the sensitivity alone may be enough. Patients suffering from dentine hypersensitivity may avoid brushing areas which are sensitive which can result in accumulation of plaque and further plaque induced recession. It is, therefore, important to treat sensitivity. Treatment of dentine hypersensitivity is based on either blocking the dentinal tubules or preventing nerve stimulation, Dr Mamataliev says. He adds that surgical procedures have been widely described to successfully treat recession defects; however, in some patients surgery may not be a viable option or an option they wish to pursue. With advances in bonding agents and the development of pink ceramics and resin composite materials, it is possible to use gingival coloured porcelain or composites over the root surface to eliminate dentine hypersensitivity and restore aesthetics.
