Your gums may shrink back for lots of reasons. After treatment for gum disease, the gums will shrink back as they heal and become healthier. Your gums will shrink back naturally with time to a certain extent. This will be made worse by a really aggressive scrubbing action when brushing your teeth. An electric toothbrush will often not allow you to brush too hard so can help you minimise this. They do the hard work for you so you don’t end up scrubbing.
Treatment with braces can cause the gums to shrink back if the teeth are moved too far out of their original position. If the bone around the tooth after braces treatment is thin, the gum has less blood coming to it and so will shrink back more readily. This most commonly happens around lower front teeth, where the bone around your teeth is always thinnest.
Some people think that grinding your teeth can also cause the gums to shrink back because of the biting forces going through the teeth.
Whatever the reason, the downsides of recession are the same. Where the gum has shrunk back to reveal the root surface, this will often be very sensitive to temperature. The root surface doesn’t have a covering of enamel to protect it so any change in temperature can irritate the nerve quite easily.
The root surface is at risk of wearing away when it is exposed. This is again because the root surface doesn’t have a covering of enamel to protect it. What can happen is little cavities start to form near the gum line. These are not cavities caused by decay. They are cavities caused by wear. The risk with these cavities, left untreated is that they will continue to get bigger and bigger. As they get bigger and deeper, they will cause more irritation to the nerve. They will also act to undermine the rest of the tooth, meaning that the structure of the tooth is weaker and more at risk of fracture in the long term.
There are different ways that recession and exposed root surfaces can be treated.
Option 1;Leave them alone
Often, there isn’t much wrong with this. If they aren’t too sensitive and there isn’t much wear then you could just do nothing. The downside of leaving the root surface is that any wear happening when you brush can get worse.
Option 2; Repair the root surface
If the root surface is worn or very sensitive, a protective layer over the root surface can protect against further wear and insulate the tooth.
The procedure is very simple. We do not remove any tooth structure. We are looking to protect and preserve all of the remaining root that is left. Your dentist needs to very carefully clean and prepare the area of the tooth. A glue layer is bonded to the root surface before the tooth is then built back up to it’s original shape.
The material used is the same as a tooth coloured filling material. If you like, you can use a combination of tooth coloured and gum coloured material so that it looks like there is gum there rather than it looking like a very long tooth.
Disclaimer: The gum coloured materials only look good from a social distance. In conversation, from a distance of about a metre, it will look good. If you lift up your lip and stare at it close up in the mirror, you are going to be able to see that the material is not gum. It is a layer bonded to the surface of your tooth.
The benefit of placing a protective layer over the root surface is that it should reduce sensitivity. It will insulate the nerve. It will also make sure that the tooth underneath is preserved as it is; any further wear that happens will happen to the protective layer rather than the tooth itself. The final benefit is that by adding to the root surface, you are supporting the tooth above and hopefully adding a bit of strength back to the tooth.
These protective layers may wear with time but they are very simple to repair and they are shielding the tooth from this wear and maintaining the strength of the remaining root surface.
It’s a really non-invasive treatment and very comfortable to have done. It’s often a good idea to have the area numbed first to protect against any sensitivity when washing the tooth but after that, it’s a piece of cake.
Option 3; Surgical replacement of the gum
This is something that would often require a gum specialist and is much more complex than option 2. This involves one or more surgical procedures to graft the gum back into place. Sometimes, grafts need to be taken from your palate and attached to the area where the gum is missing.
The benefit of this option is that it will probably give you the best looking result as it is actual gum that will be covering the root surface.
The main downside is that it requires surgical procedures. After a surgical procedure, you will experience some discomfort, pain and swelling. The end result is unpredictable, especially in bigger areas of recession.
You need enough gum there already to make it work. If you have lost the gum between the teeth, there is pretty much no chance of this being successful.
Option 4; Gum veneer
A veneer is just a thin covering.
So a gum veneer is just a thin covering that can be worn over where gums have shrunk back. This gives the illusion of natural gum. To be clear, a gum veneer is very different from porcelain veneers discussed in the articles on cosmetic dentistry.
Gum veneers are particularly good for patients who have had gum disease and have a ‘gummy’ smile. If you show a lot of gum when you smile and you can see spaces between your teeth that look like black triangles, this may be a good option for you.
A gum veneer is something that you can take in and out. You should take it out at night to let the gums breath. But it is a simple and relatively inexpensive way of disguising gaps around the necks of you teeth and giving the illusion of gum being there.
All that is required is a couple of detailed impressions by your dentist and it can be manufactured for you.
They often look fantastic and give a much more predictable and painless result than the surgical alternative.