Almost nobody leaves the dentist feeling confident about their oral hygiene routine. You can brush and floss all you want, but you’ll probably go home with a bunch of new pointers swirling around in your head: You brush too hard. You’re using the wrong toothpaste. You should sleep with a mouthguard. Your dentist’s attention to detail has merit—half of people between the age of 18 and 64 have gum recession, and the causes go beyond just good oral hygiene. Here's what you can do about it.
What is gum recession?
The gums (or gingiva) surround and protect the delicate roots of the teeth. Erosion over time or inflammation from plaque can cause the gums to recede and leave the roots exposed. The roots of your teeth lack protective enamel, and exposed roots are vulnerable to bacteria and infection. “Your roots are very much organic, so disease or cavities happen much faster on the roots,” says Alon Frydman, an associate professor of clinical dentistry and board-certified periodontist at the Herman Ostrow School of Dentistry at USC.
What's so bad about gum recession?
For some people, aesthetics alone are enough to fear gum recession. Nobody wants the creepy smile that comes when your teeth look too long. But the problem extends beyond looks.
With no gums to protect them, the roots feel hypersensitive to sweet, hot, and especially cold. Plaque can build up on the exposed root and cause nasty-looking lesions called root caries. “It’s definitely something that can lead to really bad breath,” Frydman says. “It’s basically a giant apartment complex full of bacteria.”
Perry Klokkevold, the director of the postgraduate periodontics residency program at UCLA, says gum recession can cause a snowball effect. When your gums recede, those areas become difficult to clean. This leads to inflammation and—yup—more recession. In rare cases, gum recession can result in tooth loss.
What causes gum recession?
It might seem counterintuitive, but most of us need to ease off the toothbrush as brushing too hard erodes your gums. Other than low-level trauma, bacteria and inflammation cause gum recession. Grinding your teeth, despite common thought, does not. “You actually lose the tooth structure above the gums,” Frydman says. This merely looks similar to gum recession. An influx of hormones, such as during puberty or pregnancy, makes the gums vulnerable to disease.
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This is just one risk factor of many during these influxes: Teenagers, for instance, aren’t the best about brushing their teeth, and pregnant women face challenges that can hinder oral hygiene (erratic sleeping and eating schedules). Orthodontic movement, such as braces or Invisalign, can make you more susceptible to gum recession. The slight movement of the teeth exposes the more fragile parts of your teeth and makes the gums more delicate.
Some people are just born with thinner gums, too. Thinner gums won’t recede on their own, but they are more likely to recede from hard brushing and forgetting to floss.
How do I know if I have gum recession?
Gums recede gradually, so it’s an easy problem to overlook. Sensitivity to cold liquids or food is an early sign. You can also examine your mouth in the mirror: “Typically, the root is slightly darker than the crown,” Klokkevold says. The crown is the white, enamel-covered part of the tooth you are supposed to see. Klokkevold recommends looking for the dark, exposed roots in the mirror. The root isn’t always darker than the crown, however, because brushing too hard polishes the root. It’s worth running your finger along your teeth to feel if there’s a notch where your exposed and enamel-less roots meet the crown. Ask your dental hygienist if your gums receded at your next cleaning. (You’re getting a dental cleaning twice a year, right?)
How can I prevent gum recession?
Good oral hygiene in general is a prerequisite. Brush gently and move the toothbrush in small, circular motions, and don’t forget to floss. Your dentist might recommend fillings to protect the exposed roots. If you get fillings, you need to clean them well. They create an edge that accumulates plaque. “If not cleaned well, this can perpetuate gum inflammation and more recession,” Klokkevold says. There aren't any specific foods that hurt your gums on their own, but forgetting to brush and floss leads to plaque and gum disease.
Can I reverse gum recession?
Not really. “There are exceptions to the rule, but in general, once the gum recedes it will not regenerate without treatment,” Klokkevold says. If your gum recession is extreme, you need to see a periodontist and consider a gum graft. Dentists take tissue from the roof of your mouth and replace where your gums have eroded. Another technique called guided tissue regeneration uses a collagen membrane soaked in blood platelets to repair the gums.
Grafts can cost as little as $500 and as much as $10,000 depending on how much work you need (insurance generally covers a portion of the cost). The earlier you address recession, the less it will cost to fix. You’re also more likely to fix your smile and decrease root sensitivity. A periodontist can cover more of your roots if the gums remain somewhat intact.
“You really have to be your own advocate,” Frydman says. “Is the recession something that you have pain associated with? You can take it upon yourself to go see a periodontist. Is it something where you don’t like the appearance? Take it upon yourself to go see a periodontist.”
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