Supporting Structures of Teeth

Although we only see the top part of our teeth, called the crown, there is much more beneath the surface. Teeth have long and complex roots that extend deep into the jawbone, anchoring the teeth in place and allowing communication between the teeth and the rest of the body. Between each tooth and the bone is a connecting piece called the periodontal ligament, or PDL. Finally, overlaying the jawbone and surrounding the necks of the teeth are the gums, which protect the bone and seal the PDL from bacterial invasion.

Different Types of Gums

If you look at your gums in the mirror, you may notice that the area closer to your teeth appears pinker, thicker and has a texture similar to an orange peel. As you move away from the teeth, the gums become thinner, slightly redder and smoother in texture. (It’s okay if you just walked over to a mirror and started putting your fingers in your mouth!) The gums closer to the teeth are thicker to better seal the teeth from bacterial penetration in the high-traffic, food-chewing area.

Gum Thickness and Biotypes

Just as people come in various body sizes, gum (and bone) thickness and composition also vary due to genetics. This trait, known as “gingival biotype,” refers to the natural thickness, strength and resilience of one’s gums. Generally, people with a smaller body type often have a thinner gingival biotype, while those with a larger body type tend to have a thicker one. Individuals with a thinner biotype are more likely to experience gingival recession over the course of their lifetime.

Bone Loss and Gum Recession

As we age, most people will experience some loss of bone support around their tooth roots. This is a normal part of aging that affects a large portion of the population. Generally, if this bone loss simply makes more of the tooth root visible, it doesn’t pose a problem. However, if it progresses quickly, it can lead to tooth sensitivity (due to the exposure of the delicate root) and increased vulnerability to bacteria. In such cases, intervention may be recommended.

Gum recession can commonly present more issues when it is localized on specific surfaces of the tooth root, such as the side facing the cheek. This is usually due to a combination of factors, including a thin biotype, thin bone on the cheek side of the tooth, genetic predisposition and unbalanced bite forces. While some believe that harsh toothbrushing causes gums to wear away, I find the other factors more significant contributors.

Problems Associated With Gum Recession and Possible Solutions

As mentioned, gum recession can lead to tooth sensitivity and exposure of vulnerable areas of the tooth to bacterial infiltration, which can eventually progress to gum disease and, if untreated, even tooth loss. Recession can also cause cosmetic concerns. With more spacing between teeth, some people develop what is commonly called “black triangles” — gaps between the teeth that are not occupied by tooth or gum. Patients can also feel dissatisfied if their teeth appear longer than they used to.

Solutions

Recession-linked problems can be addressed in several ways. Solutions can be grouped into two main categories: (1) gum correction and (2) tooth correction. Simply put, gums can either be thickened or added to, or teeth can be widened or covered. Depending on the symptoms and severity, one would choose either option (1) or (2) or a combination of the two. Some common procedures to address these issues include free gingival grafts, connective tissue grafts, Class V composite restorations, bonding and crowns.

Is Treatment Necessary?

A key point to note is that gingival recession is usually a slow process, allowing time for monitoring over months or even years. Dentists may recommend preventive measures before more serious problems arise, which is often wise, but patients usually have ample time to consider their options.

One option is to wait and only treat gum recession if a dentist observes an actual problem developing. It is important to understand what is causing your gum recession so you can make informed decisions about potential treatments and weigh the risks and benefits of any procedure. No treatment is guaranteed to work every time, so knowing why you developed a certain problem will help you understand why a particular procedure may have a higher or lower chance of success.

If you enjoyed this, please provide feedback at bit.ly/doctorkleinman to make future columns possible.

Dr. Isaac Kleinman is a general dentist at My Dentist Fair Lawn, in New Jersey. He works to provide customized care that serves the best interests of each patient. He can be reached with questions at [email protected].