Receding Gums: What Causes It and What Actually Stops It

“My gums are receding” is the second most common reason patients come to this practice, after bleeding. It is also the condition with the most folklore attached. Here is what is actually going on.

The One Thing Almost Every Case Has in Common

Thin tissue. Some people are born with a thick, broad band of firm gum around their teeth; others have a thin, delicate one. Thin tissue survives normal life poorly. A slightly aggressive toothbrush, a tooth that sits forward in the arch, a pull from the lip, and it gives way. Thick tissue shrugs off the same insults. That is why two people with identical habits can have completely different gumlines, and why recession so often runs in families. This is not just clinical impression: reviewing the evidence for the 2017 World Workshop of the American Academy of Periodontology and the European Federation of Periodontology, Cortellini and Bissada concluded that thin periodontal phenotypes are at greater risk of developing gingival recession.

Thickness is worth separating from width, because the field spent decades conflating them. In 1972, Lang and Löe reported that every tooth surface with less than 2 mm of keratinized gingiva showed inflammation, while most surfaces with more than 2 mm were healthy, and that two-millimetre figure became the rule of thumb for how much firm gum a tooth needed. Fifteen years later, Wennström monitored sites left with almost no attached gingiva for five years and found that lacking an adequate band did not produce more recession in patients keeping the area clean. Both are worth knowing. The apico-coronal width of the band turned out to matter less than how thick it is and how the teeth are cleaned, which is why the modern conversation is about phenotype rather than millimetres of gum.

The Triggers

• Brushing. Not brushing too much, brushing too hard, with a scrubbing motion and a stiff brush. The teeth that recede first are the ones you reach easiest with your dominant hand. The systematic review by Heasman and colleagues in the Journal of Clinical Periodontology identified a horizontal or scrubbing method, bristle hardness, and brushing frequency and duration as the toothbrushing factors most often associated with recession, though it concluded that the evidence linking the two remains largely inconclusive.
• Tooth position. A tooth that sits outside the arch has almost no bone over its root on that side, and the gum over it is thin by definition. Orthodontic movement can create or fix this. In the AAP Regeneration Workshop review by Kim and Neiva, the probability of recession during tooth movement in a thin phenotype was judged high enough to justify gingival augmentation beforehand, and facial movement of a tooth outside the alveolar process was singled out as a case to consider grafting.
• Frenum pull. A band of tissue from the lip that attaches close to the gumline tugs on it with every movement. Whether that alone causes recession has not been established; the reason to release one is usually the pull it puts on tissue that is already thin.
• Clenching and grinding. Often blamed, but the 2017 World Workshop consensus concluded there is no evidence that occlusal forces cause gingival recession. Grinding is worth treating for the damage it does to teeth and restorations, not as a cause of recession.
• Gum disease. Recession from periodontitis looks different: it comes with pockets, bleeding, and bone loss, and it needs the disease treated first.
• Piercings and habits. A lip or tongue stud rubbing the same spot for years will wear the gum away.

What Home Changes Do

Switching to a soft brush and a gentle circular technique stops the damage from brushing, and recession often halts at that point in patients with reasonably thick tissue. A night guard helps when grinding is the driver. Neither one regrows tissue. Gum does not grow back on its own, and no toothpaste, oil, or rinse changes that.

When a Graft Is the Answer

A graft is the only thing that covers an exposed root and, more importantly, thickens the tissue so it stops receding. Which graft depends on the goal. If the root shows in the smile and needs covering, a connective tissue graft placed under the gum gives the best coverage and blends in. If the goal is a durable band of firm gum on a lower tooth where thickness matters more than looks, a free gingival graft is the more predictable choice. That split is borne out in the systematic review Chambrone and Tatakis prepared for the AAP Regeneration Workshop, where connective tissue graft procedures gave the best percentages of mean and complete root coverage along with a significant gain in keratinized tissue. Gum grafting explains both, and the case pages show what each looks like before and after.

When to Act

Recession that is not getting worse, on a tooth that is not sensitive, with thick tissue below it, can be watched. Recession that is progressing, sensitive, or sitting on thin tissue should be treated before it goes further, because the more root that is exposed, the harder complete coverage becomes. Receding gums has the signs that mean it is time.

Whether a particular tooth should be watched or treated comes down to a measurement rather than a judgment call. Request a consult or call (512) 346-6097.