Gum recession is a sign of chronic (long-standing) gum infection characterised by the destruction of fibres and bone supporting the teeth resulting in receding gum lines. The infection is known as periodontitis.
Severe periodontitis may result in tooth loss and occurs in 5–20% of adults worldwide.
Children and adults can have any of the several forms of periodontitis
• Aggressive or rapid periodontitis
• Long-standing or chronic periodontitis.
• Periodontitis as a manifestation of systemic disease.
All forms of the periodontal disease occur as a result of mixed bacterial infections. However, risk factors play a role to either initiate or modify the rate of progression of the disease.
Modifiable Risk Factors of gum recession
Modifiable risk factors of gum recession can be controlled and help managing the disease.
Gum recession begins with a plaque buildup around the teeth, followed by the inflammation of the gums in the affected area.
The bacteria multiplies in plaque buildup collected on the tooth and extending into a small space between the tooth and gums. In a healthy tooth, this space is 2-3mm in depth and is known as the gingival sulcus.
Brushing and flossing remove the dental plaque and if the plaque is not removed within 48-72 hours, it mineralizes into hard tartar. Tartar is not removed by brushing and requires professional cleaning.
Plaque and tartar accumulation allow bacteria to flourish in the gingival sulcus and produce enzymes such as leukotoxin and collagenase.
Negligence of this situation allow bacteria and their products to slowly eat away bone and fibres supporting the tooth, deepening the depth of the sulcus and exposing the root of the tooth. These deep sulci are now called periodontal pockets.
The whole process takes months or years for an individual to notice a receding gum line.
Research suggests a consistent and positive association between gum recession and smokers. The smokers account for 50% of cases of periodontitis.
In smokers, periodontitis starts with bacterial plaque buildup under the gums but progresses at a faster pace than in non-smokers.
This is because of the effect of nicotine on the blood circulatory system which in turn cuts down blood supply to tissues and decreases the intake of oxygen by haemoglobin.
Nicotine also impacts a smoker’s immune system by decreasing the function capability of different white blood cells.
Smokers show fewer signs of gum disease such as gingival bleeding and swelling compared to nonsmokers because of the effect of nicotine on blood vessels.
Diabetes is a major risk factor for periodontitis and the probability of developing periodontitis increases approximately threefold in people with uncontrolled diabetes.
There is a clear relationship between the increased blood glucose level and the severity of periodontitis.
One of the important signs of diabetes in the mouth is the inflammation and recession of gums. Patients with undiagnosed or poorly controlled diabetes are at a higher risk for gum disease.
Gum recession also progresses more rapidly in uncontrolled diabetics, and the early age of onset of diabetes is seen as a risk factor for more severe gum disease.
The mechanisms that underpin the links between these two conditions are not completely understood but involve aspects of immune functioning i.e, impaired white cell activity.
A two-way relationship exists between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and gum disease negatively affecting the blood glucose level.
The complications of diabetes increase two to three folds in diabetic patients with periodontitis such as end-stage kidney disease and heart disease.
Most well-controlled diabetics maintain good gum health and respond well to periodontal therapy.
Drug-Induced gum recession
Several categories of medicines increase the risk of gum recession in several different ways.
• Medications that decrease the salivary flow, increase the bacterial load and food debris deposition on the teeth and gums which are normally washed away by the constant production of saliva.
• Medicines either in liquid or chewable form that contain added sugars, alter the pH and composition of plaque, making it more able to adhere to the tooth surface.
• Drugs that cause gum enlargement as a side effect interfere with oral hygiene practices and provide a favourable environment for bacterial growth and gum inflammation.
Talk to your dentist if you experience gum enlargement, reduced salivary flow or gum recession after starting a medicine.
Patients with poor stress coping behaviour are at greater risk for severe periodontal disease. Men with anger issues, work stress or financial strains experience more tooth loss and gingival bleeding and are at a 43% higher risk of developing gum recession.
Psychological stress can directly or indirectly affect gum health by various biological mechanisms.
- It can have an indirect effect through the changes in lifestyle such as ignoring oral-hygiene measures, smoking more heavily and consuming more fat and sugar in the diet.
- The release of stress hormones as a consequence of constant stress depress the immune system and compromise the body’s abilty to fight infections.
A positive association has been found between obesity and gum recession across diverse populations. Obesity is characterised by the abnormal or excessive deposition of fat in the fat-storing cells lying under the skin and in abdomen.
The increased body mass index, waist circumference, percentage of subcutaneous body fat, and increased levels of bad fats in the blood are associated with an increased risk to develop periodontitis.
It is correlated to the fat-tissue-derived inflammatory mediators and hormones that affect the whole body metabolism and contribute to the development of a low degree of inflammation in different parts of the body.
Obesity also appears to participate in the occurrence of periodontitis through the increased production of reactive oxygen species that are damaging to cells.
Moreover, dietary trends in obese individuals reveal a significant decrease in raw fruit and vegetable consumption, which are rich sources of vitamin C. In addition, decrease calcium intake and increase intake of soda drinks also adversely impact the gum health.
Both low dietary intake of calcium and vitamin C less than the recommended dietary allowance (RDA) have been associated with gum recession.
Unmodifiable risk factors of gum recession
These are the risk factors that health care practioner or patient can’t alter and requires a different approach to treat receding gums.
Several blood disorders are known to be linked with periodontitis such as leukaemia.
Leukaemia is a cancer of white cells where there is an overproduction of defective white cells that are unable to function. This lack of ability to fight infections predisposes patients to infections like gum infections and later gum recession.
Overgrowth of gum tissue with bleeding may be an early sign of acute leukaemia. Patients with chronic leukaemia experience similar but less severe periodontal changes.
Patients undergoing chemotherapy, radiotherapy or therapy associated with bone marrow transplantation may also suffer some degree of gum recession.
The risk of gum disease increases severalfold during pregnancy. In addition, periodontal attachment loss is more prevalent among the mothers of preterm low birth weight babies compared to mothers with normal-term infants.
The risk of gum disease increases with age. According to a research, the average annual rate of bone loss among the 70-year-old adults is 0.28 mm compared to 0.07 for the 25-year-old individuals.
The male gender is more likely to develop gum recession than the females which is probably related to negligence to maintain oral hygiene.
Socioeconomic status and education
The gum health is better among individuals with higher education and more secure income because of better awareness of oral and general hygiene.
Gum recession is the most prominent sign of long-standing gum infection called periodontitis.
Periodontal disease occurs as a result of mixed bacterial infections. However, there are several risk factors that either initiate or modify the rate of progression of the disease.
The risk factors of gum recession are either modifiable that can be controlled while others are unmodifiable and needs a different approach to manage the disease.
Plaque and tartar buildup, stress, medications, uncontrolled diabetes and obesity are some of the modifiable risk factors.
Unmodifiable risk factors include age, socioeconomic status, gender, pregnancy and blood disorders.