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Gingival Recession: An Equal Opportunity Condition





By Back Mike Wong • June 4, 2019

Gingival recession affects many of us as we grow older, but it can become a problem at any age. In fact, according to one study, while 88% of adults age 65 and older experience gingival recession, 50% of adults between the ages of 18 and 64 develop it in multiple sites.1 Correlations between recession and past orthodontic treatment, and tongue and lip piercing in young adults have also surfaced.2

When gums recede, the gumline is often left with uneven margins, and dentin and roots may be exposed, making teeth appear extra long — not a great look for most of us. It can also result in tooth sensitivity, hasten bone degeneration, and expose roots to the ravages of root caries,3 said to affect more than half of US adults over the age of 75.4

How Gingival Recession Starts

The etiology of gingival recession is actually a pretty mixed bag, ranging from poor oral hygiene to overly enthusiastic brushing with hard bristles and poor technique. Habits such as bruxism and tobacco chewing are also said to be contributing factors. And it may be precipitated by various types of oral surgery. But some people are simply anatomically predisposed to it.5

Whatever the cause, gingival recession is sure to progress if left untreated. No matter how good the self-care is. This is especially true for older adults with xerostomia, for whom the risk of root caries is high. Fortunately, much can be done to both prevent and treat recession.6

Strategies for Treatment

Treatment options depend on the degree of the recession, which may be determined with the help of classification systems, such as that developed by P.D. Miller, DDS. The Miller system classifies recession severity, beginning with Class I, the least severe, and ending with Class IV, which reflects zero root coverage with severe bone and soft tissue loss.7

For patients at risk for root caries, assessment via Caries Management By Risk Assessment (CAMBRA), thorough plaque removal and good oral hygiene are indicated. Application of fluoride and other therapeutic agents, such as silver diamine fluoride, are also beneficial.8 Restorative options may include the use of glass ionomer cement.6,9

An option for root coverage is gingival grafting using autograft, allograft, xenograft, or alloplast (synthetic) materials. Grafting often involves the use of growth factors, in the form of gels made from in platelet-rich plasma and platelet-rich fibrin. Growth factors offer normal healing, though at an accelerated rate.10

To relieve hypersensitivity, nonsurgical treatments may involve the topical application of formulations such as fluoride varnish, which can also be applied as a preventive measure against root caries.

Efficiency and Safety

Isolation plays a significant role in treating gingival recession as many of the agents and therapies mentioned above require it. For instance, moisture control is tremendously important to the success of fluoride varnish application and use of most restorative materials. And both suction and retraction are must-haves during any types of surgical procedures, such as grafting.

Fortunately, with isolation systems such as the Isolite, Isovac and Isodry lineup, clinicians can enjoy the benefits of efficiency, thanks to a clear, dry field, and safety, courtesy of a flexible, transparent mouth shield that protects patients from aspiration of foreign objects. Add Isolite’s shadowless illumination and a cure-safe amber light, and your odds for success are amplified.

Not every case of gingival recession warrants an all-hands-on-deck approach. But timely diagnosis and appropriate intervention will give you the best chance of helping your patients keep their teeth well into their golden years.

 

REFERENCES

  1. Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc. 2003;134:220–225.
  2. Slutzkey S, Levin L. Gingival recession in young adults: occurrence, severity, and relationship to past orthodontic treatment and oral piercing. Am J Orthod Dentofacial Orthop. 2008;134:652–656.
  3. Stone R. Change agents. Mentor. 2017;8(6):32–36.
  4. Centers for Disease Control and Prevention. Public health and aging: retention of natural teeth among older adults—United States, 2002. MMWR Morb Mortal Wkly Rep. 2003;52:1226–1229.
  5. Satheesh K. Advance your understanding of gingival recession. Mentor. 2018;9(2):28–32.
  6. Marsh L. Roots: the caries generation. Mentor. 2015; 7(2):30–32.
  7. Miller PD. Miller classification of marginal tissue recession revisited after 35 years. Compend Contin Educ Dent. 2018;39:514–520.
  8. Gregory D, Hyde S. Root caries in older adults. J Calif Dent Assoc. 2015;43:439–445.