The gingiva, commonly known as gum tissue, is a specialized soft tissue that forms a protective seal around the base of the teeth, shielding the sensitive tooth roots and the underlying jawbone from bacteria and trauma. Gum recession occurs when this tissue pulls away from the tooth surface, exposing the root and creating small pockets where bacteria can accumulate, potentially leading to sensitivity and decay. While the body is capable of healing minor wounds, once significant gum tissue is lost, it generally cannot regrow or return to its original position naturally. This limitation makes professional intervention necessary to restore the protective barrier and prevent further deterioration of oral health.
The Biological Reality of Gum Tissue
The biological architecture of the gingiva dictates its limited ability to regenerate vertically once recession has occurred. Gum tissue is composed of an outer epithelial layer and an inner connective tissue layer, primarily made up of collagen fibers. This structure, while durable for its protective function, lacks the specific stem cell populations required for the substantial, directed regrowth needed to cover an exposed tooth root.
The healing that occurs after a minor injury is typically repair, not true regeneration. When the epithelial attachment to the tooth is severed, the remaining tissue heals through scar formation rather than replicating the complex arrangement of the original gumline. This is distinct from the body’s ability to heal a simple cut on the skin. The unique environment of the mouth, with its constant bacterial presence, also complicates the potential for natural regeneration of the complex periodontal structures.
Main Contributors to Gum Recession
The most common pathological cause of gum recession is periodontal disease, a bacterial infection that leads to inflammation and the destruction of the supporting bone and tissue around the teeth. As the infection progresses from gingivitis to periodontitis, the chronic inflammatory response causes the supporting alveolar bone to resorb, and the gum tissue follows this bone loss, migrating down the tooth root. The destruction of the gingival connective tissue is driven by enzymatic digestion and the inflammatory process.
Another frequent cause is mechanical trauma from aggressive or improper oral hygiene habits. Brushing too hard with a medium or hard-bristled toothbrush, or using a vigorous back-and-forth scrubbing motion, can physically wear away the delicate gum tissue over time. This chronic, low-level trauma gradually leads to recession, often seen with associated tooth surface wear near the gumline.
Other factors also contribute to the degradation of the tissue. Misaligned teeth or an abnormal bite can create uneven pressure on certain teeth, which causes the bone and gum to recede in those specific areas. Genetic predisposition plays a significant role, as individuals with naturally thin gum tissue are far more susceptible to recession even with minor trauma or inflammation. Finally, tobacco use constricts blood vessels in the mouth, which reduces oxygen supply to the tissues and impairs their ability to heal, significantly increasing the risk of gum disease and subsequent recession.
Corrective Treatments for Lost Gum Tissue
Since natural regeneration is not possible, professional dental treatment focuses on corrective and restorative procedures. The first step in treating recession, particularly when periodontal disease is involved, is often scaling and root planing, a deep cleaning procedure. This non-surgical treatment involves removing plaque and calculus (tartar) from below the gumline and smoothing the tooth root surfaces. This process eliminates the source of infection and inflammation, halting the progression of tissue destruction and preparing the root for surgical repair.
For more advanced recession that requires covering the exposed tooth root, various gum grafting procedures are employed by a periodontist.
Connective Tissue Grafting
This is the most common technique. A small piece of sub-epithelial connective tissue is harvested from beneath a flap on the roof of the mouth. This tissue is then carefully placed and stitched over the exposed root, where it serves as a scaffold to encourage new tissue growth and root coverage.
Free Gingival Graft
This method involves taking a small piece of the top layer of tissue directly from the palate. This technique is often used to increase the total thickness of thin gum tissue, making it more resilient against future recession.
Pedicle Graft
This technique uses tissue adjacent to the recessed area. The tissue is partially cut, leaving one edge attached for blood supply, and then stretched laterally or coronally to cover the exposed root before being sutured into place.
Pinhole Surgical Technique (PST)
PST is a less invasive alternative to traditional grafting. This technique involves making a small pin-sized hole in the gum tissue. Specialized instruments are then inserted to gently loosen the existing gum tissue, allowing the periodontist to slide and reposition the tissue back over the exposed root surface without the need for scalpels or sutures. Collagen strips may be placed through the pinhole to help stabilize the repositioned tissue.
Stopping Recession Before It Starts
The most effective strategy for managing gum recession is to prevent it from happening or progressing further. Adopting a proper brushing technique is paramount, which includes using a soft-bristled toothbrush and employing gentle, circular motions rather than abrasive horizontal scrubbing. Holding the brush at a 45-degree angle toward the gumline helps clean effectively without causing trauma.
Quitting all forms of tobacco use is necessary, as smoking compromises the health of gum tissue and impairs its ability to fight infection. For individuals who grind or clench their teeth (bruxism), a custom-fitted nightguard can protect the teeth and gums from excessive forces. Regular professional checkups and cleanings allow a dental professional to monitor gum health and remove hardened plaque. Addressing misaligned teeth through orthodontic evaluation helps distribute biting forces evenly across the dental arch.