Receding gums is a sign of the long-standing and low grade infection of gums that leads to the loss of bone and fibers supporting the tooth. The infection is known as periodontitis where the word perio means gums, dont means tooth and itis means inflammation.
A dentist evaluates the receding gums and refers it to a periodontist. A periodontist is specilized in diagnosing and treating the diseases linked to gums and tooth supporting structures.
The gum infection initiates with the plaque and tartar buidup. Over time the bacteria and its products present in the dental plaque and calclus (tartar) destroy the tooth attachment fibers and bone resulting in receding gum lines.
Causes of gum recession are discussed in detail here.
The dentist uses an explorer (a calibrated instrument) to diagnose and measure the depth of the periodontal pocket.
Periapical x-rays, bitewing x-rays or OPG (a full mouth x-ray) are taken either alone or in combination to diagnose the number of teeth affected and the depth of pockets and bone loss in them.
• Complete blood picture: Gum disease induced inflammation elevates the C-reactive protein levels, white blood cell and platelet count in blood. These are all the markers of inflammation in the body.
• Blood glucose level: Receding gums commonly affects people with uncontrolled diabetes. High blood glucose level causes cholesterol to deposit in the walls of blood vessels. Over the years these deposits make the blood vessels narrow and hard.
The thickened blood vessels reduce the flow of nutrients to the tissues and removal of wastes away from them. This reduced blood flow weakens the gums and bone and makes them at a greater risk for infection.
The treatment of receding gums is a long process to reduce the pocket depth and promote the formation of new bone. The treatment is divided into three phases:
• Initial therapy or non-surgical therapy
• Corrective therapy or surgical therapy
• Maintenance therapy
Initial therapy or non-surgical therapy for receding gums
This therapy for receding gums is given at the early stage of gum inflammation to control the plaque formation and to identify and remove the modifiable risk factors.
The therapy is assessed after 8-12 weeks because healing of tissues or periodontal fibers take a minimum of 6 weeks. The initial therapy includes the following measures
Cessation of risk factors
Patients are asked to stop smoking, alcohol drinking and chewing pan masala etc,. These habits are linked to the development of receding gums.
Manual and electronic toothbrush readily removes dental plaque if proper protocols are used. These protocols are
• Brush teeth for at least two minutes and twice a day with a fluoridated toothpaste
• Use a soft bristles toothbrush with a small head.
• Place a brush at 45 degree on the gums and swipe it onto the teeth (modified bass technique).
An effective toothbrush cleans only 65% of a tooth surface and leaves the food debris stuck in between the teeth. Therefore, patient are asked to use interdental cleaning devices ( for instance, dental floss, tape and powered flossing device) to clean these spaces.
Use of mouthwashes and toothpastes
Dentist recommends medicated mouthwashes and toothpastes to control the periodontitis. Active agents added in the mouthwashes and toothpastes work to control the plaque, gum inflammation, bad breath and tooth decay.
Chlorhexidine, triclosan, cetylpyridinium chloride and essential oil such as thymol are common anti-inflammatory ingredients added in mouthwashes and toothpastes.
Scaling and root planning
Scaling and root planning removes calculus, bacterial colonies and their byproducts from the teeth, smoothens the tooth surface and allows the gum infection to heal.
In general it takes around 3 months of treatment interval to control the disease.
Scalers are operated either by using hand instruments or by ultrasonic device. Ultrasonic scalers, however, remove calculus from the deep pockets more effectively.
Dentists also prescribes topical or antibiotic tablets to control the formation of bacterial bioﬁlms.
Suspension of antibiotics such as insertion, gels or implants etc. are placed in periodontal pockets where they slowly release the drug over time. However, oral antibiotics infection cures more widespread infection of gums.
Thus, patients should keep in mind that the antibiotics are merely an additional treatment to mechanical therapy i.e, toothbrushing and not its replacement.
Tissue stimulating proteins are available in the form of a gel. A gel applied to a diseased tooth root helps in developing tooth cementum and growth of bone and gum tissue.
Corrective therapy or surgical treatments for receding gums
Surgery may be required if inflammation and deep pockets remain after the periodontal deep cleaning and antibiotic therapy.
Flap Surgery (Pocket reduction surgery)
A dentist or periodontist performs a flap surgery. During the surgery a horizontal cut is made through the gums and all the tartar and infected tissue is removed.
The gums are then repositioned and sutured or stitched back on the teeth. Now the gum attach to the clean teeth with reduced pocket depth.
This sometimes results in the teeth appearing longer.
Soft tissue grafts.
In cases where gum tissue has been lost as a consequence of long standing infection, you may require a soft tissue graft.
During the procedure, a small tissue is taken from the roof of your mouth and is used to cover exposed root of the tooth.
In addition to flap surgery, your periodontist or dentist may recommend bone regenerative surgery to replace bone lost as result of periodontitis.
Bone grafting is a procedure where a natural or synthetic bone is placed in the area of bone loss to promote bone growth. The technique is called guided tissue regeneration.
During the surgery, a small piece of mesh-like material is placed between the bone and gums. This keeps the gum tissue from growing into the area where the bone is supposed to be, allowing the bone and gums to regrow.
Growth factors or bio-active substances are also given to accelerate wound healing and regeneration.
Maintenance therapy for receding gums
The maintenance therapy is suggested for the prevention of recurrence of disease and for the maintenance of periodontal health. Therefore, the non-surgical measures are continued for 6 months to one year.
A 6 monthly follow ups are also scheduled to evaluate the health status of the gums.
Receding gums is a sign of chronic gum infection that results in the loss of bone and fibers supporting the teeth.
The plaque and calculus buildup around the teeth causes inflammation of the gums tissues and over times leads to the loss of tooth supporting apatus.
The treatment receding gums of involves non-surgical and surgical phases, followed by maintenance phase.
The non-surgical protocols for receding gums involves proper brushing, flossing, professional cleaning of deep pockets (scaling and root planning) and antibiotic therapy.
The surgical approaches include flap surgeries, soft and bone grafts to reduce the pockets depth and promote bone growth.