Gum recession: causes, symptoms, elimination without surgery, how to stop

The recession of the gum (apical displacement of the gingival margin) is a decrease in soft gingival tissue in the vertical direction, which leads to a gradual exposure of the tooth neck. According to statistics, this pathological process is more often observed in adulthood, but the tendency of its occurrence in children and young people is growing every year. This trend is associated with the high availability of orthodontic treatment of bracket systems, a tendency to chronic stress, urbanization, etc. Often the recession of the gum does not bother people, if it is located on the inner surface of the gum (from the side of the sky). This is due to the fact that with such localization the aesthetic properties of a person's smile are not violated, since the defect is not visually determined. However, with the appearance of even a small loss of gums from the side of the lips and cheeks, a person immediately notices it. The tooth appears elongated, which makes it disproportionate to others. And if the teeth are genetically of an elongated shape, then the recession can create very unpleasant consequences for the aesthetics of a smile.

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Symptoms of the gum recession

Symptoms of gum recession may not appear for a long time. Often a person is disturbed by unpleasant sensations, which are caused by improper setting of the crown or a seal, inflammation of the gums, pain in the teeth, joint, etc. Against the background of these symptoms, the clinical picture of the recession looks very meager and unobtrusive. The first signs of this pathological process is the appearance of a small defect of the gum. Most often it has the form of a narrow vertical strip. This symptomatology suggests that the recession is at the first stage (when the root is bare, up to 3 mm). If the process proceeds from the side of the mouth, then a person may not pay attention to the presence of a defect. In this case, the recession will not cause any complaints. The second stage - denudation of roots from 3 to 5 mm. Thus the defect becomes not only longer, but also wider. At this stage, a person may be concerned about aesthetic shortcomings, which are associated with a decrease in gingival tissue. Perhaps the appearance of hypersensitivity of the tooth, which is due to the denudation of its cement.

At the third stage, the gum recession is more than 5 mm. At the same time, aesthetic problems become very noticeable, and the symptom of increased sensitivity of the tooth becomes more pronounced.

In the generalized form, the loss of the gum occurs in the region of 4 teeth or more. If the reason for the loss of gums is orthodontic treatment with non-removable devices, the complaints will be to reduce the aesthetics of a smile. If the reason for the recession is periodontitis, then there will be a whole complex of symptoms. Inflammation of the gums provokes permanent bleeding at the slightest trauma. Violation of the gingival attachment leads to the formation of periodontal pockets, from which purulent contents can be released. A person feels pain, itching and tingling in the gums. Saliva becomes viscous, there is an unpleasant aftertaste in the mouth, which does not disappear after brushing your teeth. The gums look bright red, its edges have a swollen, ragged appearance that visually looks very unattractive.

With parodontosis, the gum has a pale pink hue, which indicates that there is no inflammation. However, the recession with this disease spreads throughout the entire dentition. Progression of gum loss can continue until the entire tooth is completely bare. Interestingly, a large loss of bone and gums does not always lead to significant tooth mobility. This is due to the fact that in the region of the top of the root there is a process of deposition of cement, which leads to hyper-cementosis. Between the tooth and the remaining gum in a large amount of deposited solid dental deposits (tartar), which also prevents excessive tooth mobility.

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Forms

The classification of Miller's gum recession is the most popular among foreign and domestic specialists. The author divided the types of apical displacement of the gum into four classes, depending on the depth of the lesion.

The first class includes narrow and wide recessions, which do not damage the gingival papillae (triangular areas of the gum between the teeth) and bone tissue. The defect does not reach the mucous-gingival line (the place where the gum passes into the mobile mucosa).

The second class is represented by narrow and wide recessions that reach the mucus-gum line and can cross it. The height of the gingival papilla is not changed, the integrity of the bone is not broken.

The third class can include recessions of the first and second classes, in which there is a moderate loss of bone or the height of the interdental papillae.

The fourth class includes recessions of the first and second classes, in which there is a pronounced loss of bone or the height of the interdental papillae.

In addition to Miller's classification, the apical displacement of the gum is usually divided according to the extent of the defect. If up to three adjacent teeth are involved in the process, then the recession of the gum is local. When a defect spreads throughout the entire dentition, the pathological process is called a generalized recession of the gum.

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Complications and consequences

Recession can be caused by chronic gum trauma. At the same time, the local defenses of the gingival tissues are significantly reduced. In this regard, the probability of joining the bacterial flora is very high. As a result, development of gingivitis, localized and generalized periodontitis is possible. However, most often the recession is already a symptom of a certain pathological process. As previously stated, periodontitis and periodontitis are almost always accompanied by a decrease in gingival tissue. Ogolenie roots aggravate the condition of the teeth and surrounding tissues. Due to the progression of these diseases, gradual loss or removal of teeth is steadily proceeding. If periodontitis and periodontitis are not treated, they will continue to exist until the last tooth is removed from the oral cavity. These diseases can create obstacles for rational prosthetics. Any removable and non-removable structures, implants are contraindicated to be installed in the presence of inflammatory and destructive processes in the mouth. A recession is one of the reasons that can lead to similar conditions.

[5], [6], [7], [8]

Diagnostics of the gum recession

You can diagnose "gum recession" even at home. For this it is sufficient to see a soft tissue defect that fits the description in the classification. However, to eliminate the pathological process, it is necessary to understand what it was caused by. This requires a comprehensive examination in the office of a dentist. First of all, an anamnesis should be collected. It includes a number of diagnostic issues:

• When was first noticed the loss of the gums?
• What form did the defect have?
• What are the complaints at the moment?
• When was the last time a prosthesis (or a filling)?
• Have you ever had gum treatment?
• Was orthodontic treatment performed?
• What brush is used for cleaning teeth?
• Is there a nocturnal grinding of teeth?
• Are there any problems with the temporomandibular joint? (pain in the morning, clicking, etc.)
• Are there any bad habits (gnawing pencils, nails, etc.)?

The answers to all the above questions are of great value for the diagnosis of diseases that triggered a gum recession.

The next stage in the diagnosis of gingival tissue loss is examination of the oral cavity. The dentist determines the condition of hard tissues of teeth, seals, crowns, prostheses, mucous membrane of the gum, tongue, palate, lips and cheeks. Only a thorough and comprehensive examination will reveal the true cause of the appearance of the defect. Among instrumental methods, sounding is effective. With the help of the periodontal probe, the doctor evaluates the size of the defect, the integrity of the circular ligament of the tooth (which is completely broken during periodontitis), the presence and depth of periodontal pockets.

Excellent results in the diagnosis of recession shows the use of various clinical trials. To determine the presence of gingival inflammation, use the Schiller-Pisarev test. The eponymous solution is applied to the gums and the mucosal color changes are evaluated. If it becomes dark brown, then there is an inflammatory process in the gingival tissues. About chronic destructive processes of bone tissue may indicate a change in bone structure on the radiograph, which is also an important diagnostic method.

Among the laboratory tests, a clinical blood test, a blood test for sugar and a general urine test are distinguished. These data will help to eliminate some systemic diseases that could provoke an apical displacement of the gum.

As a result of thorough diagnosis, the recession gets its status. It includes such parameters as the cause of the recession, predisposing factors, the depth of the lesion, the width of the defect, the thickness of the gum, the Miller class. These data are a kind of card for effective treatment.

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Treatment of the gum recession

Elimination of gum recession is a complex multi-stage intervention, which requires a clear planning. Before the beginning of treatment it is necessary to find out what caused the loss of gum tissue. Only after determining the origin of the pathological process can you understand how to stop the recession of the gums. If aggressive cleaning of teeth promoted this, then change the toothbrush to softer and control the force of pressing it. As a rule, recession, provoked by improper cleaning of teeth, stops aggravated after changing the methods of oral care. After this, the doctor and patient decide together whether to correct the gums or leave it in this form. If the depth of the lesion is large, then the expert's opinion is more significant, since it is about the health of the gums of the entire oral cavity. If the recession is insignificant, then the person can independently decide whether to intervene. In this case, we are talking only about the aesthetic properties of the gum, so the patient's preferences are in the foreground.

If the pathological process is provoked by a poor-quality seal, crown or prosthesis, then this indicates the inapplicability of these works. In the near future, the removal of insolvent structures and the removal of seals. At the same stage, a preliminary plan for the replacement of defects in teeth and dentitions is determined, which will be implemented after correction of the gum.

In cases of periodontal disease (periodontitis, periodontitis), pathological processes must be translated into persistent remission. In no case can not begin to correct the recession in the presence of destructive and inflammatory processes in the oral cavity.

Methods of gum correction

There are several methods for closing the recession. According to the classification of H. Erpenstein and R. Borchard, a conservative treatment and surgical approach are distinguished. Surgical interventions are divided into single-layer methods, two-layer, directed tissue regeneration and additional techniques.

Conservative method can be used in cases when the cause of recession was aggressive cleaning of teeth. In this case, the correction of the technique of cleaning teeth is carried out and a periodontal bandage is applied to the damaged area. As a dressing, a special gel can act, which has insulating and regenerating properties (for example, GC Coe-Pak). It is also recommended the use of drug therapy. Among the drugs that help to close the recession, regenerate drugs (Methyluracil), multivitamin complexes (Aevit, Superia), antiseptics (chlorhexidine, hydrogen peroxide), phytopreparations (sage infusion, chamomile, dogrose) secrete.

Single-layer surgical methods include 5 types of operations. The most popular and simple of these is the coronally-positioned flap. The essence of the technique is that in the field of recession, the soft tissue site is cut-a flap. Then this flap is stretched in such a way as to close the recession. After this, the wound is sutured and wound healing takes place within a few months. Since this method consists in using only the available tissues, surgical intervention is conducted to close small recessions. For the same reason, this method is not used for a subtle biotype of the gum. An important condition is the distance from the edge of the recession to the mucous-gingival border, which should be at least 4 mm. If the operation is performed correctly, and the postoperative period passes without deviations, then after two or three months no traces of recession and surgical intervention are detected. The rest of the single-layer technique is a laterally displaced flap, a double papillary flap, a semilunar flap, an epithelial connective tissue graft. All these methods are more complex, demanding of the anatomical conditions of the body and fine work of the surgeon. It is very difficult to achieve simultaneous presence of all factors, therefore these methods are used quite rarely.

The meaning of two-layer techniques is to place a connective tissue graft between the primary flap and the tooth surface. This allows to improve the volume of soft tissues, the regenerative properties of the gum, the aesthetic parameters and the speed of wound healing. The most common patchwork operations are as follows:

1. Operation on Langer and Langer.
2. Operation on Bruno.
3. Operation on Raetzke.

The essence of the technique for Langer and Langer is to perform three cuts. One cut is horizontal and crosses the recession. Two vertical sections are located on each side of the recession, as a result, the line of the cut takes the form of an inverted "P". This allows you to peel a square flap and lay the graft between the gum and the tooth.

The Bruno operation is an improved technique for Langer and Langer. Advantages of the updated technology is the absence of vertical sections. This improves the graft blood supply and aesthetic properties of the gum in the recession area. However, the operation protocol without vertical cuts is more complicated.

Technique Raetzke, or "envelope method" can be called the most minimally invasive intervention among these two-layer operations. When closing the recession, any vertical and horizontal cuts are excluded by this method. This approach allows you to preserve the blood supply of the graft and tissues around the recession. Despite the small amount of surgical manipulations, this technique is quite complicated. The surgeon needs to prepare soft tissue in the area of the defect and create a so-called "envelope". Since the review of the operative field is rather organic, it can lead to traumas of the underlying tissues. Therefore, all manipulations must be carried out carefully and without haste. After the creation of the pocket (envelope), a transplant is placed in it, and the wound is sutured.

In addition to these patchwork operations, there are many other techniques for closing the recession of the gum. Quite popular is the method of directed tissue regeneration. Various artificial membranes are used, which are installed instead of the graft. Although they can not be compared in efficiency with a connective tissue transplant, their use is quite popular.

As an additional means for carrying out patchwork operations, various nutritional preparations are used. For example, gels based on enamel matrix proteins ("Emdogain" Strauman) activate tissue regeneration, allowing you to increase the probability of the expected result and eliminate the recession faster. Also in combination with single-layer techniques, various allografts and plasma rich in platelets are used. These techniques are currently at the stage of theoretical and practical study, so they are popular primarily in the scientific field.

Currently, laser surgery is common. From classical surgery, it differs only in that instead of mechanical cutting tools (scalpels, scissors) a laser is used. Treatment of gum recession with a laser is not a special and specific operation. The doctor chooses one of the gum correction techniques and uses a laser to perform the incisions. Its advantage is the accuracy of the incisions, the absence of significant bleeding and the more active regeneration of soft tissues. However, the laser installation is an expensive device and requires regular maintenance. This entails a higher price for treatment when it is used.

Despite the large number of synthetic membranes, regenerating gels and other agents, the most effective at present is a connective tissue graft. Techniques with its application allow to cover relatively large defects of the gum with a favorable prognosis for the structure, function and aesthetics of the gum.

In the postoperative period, it is recommended to undergo a course of physiotherapeutic treatment to accelerate the healing of soft gingival tissue. The regeneration is positively affected by UHF therapy, darsonvalization and fluctuorization. The course of procedures includes about 10 visits and is adjusted by the attending physician.

Vitaminotherapy is one of the components of the complex treatment of gum recession. Vitamins of group A, E, C improve the processes of epithelization and local metabolism, which allows to achieve healing of the wound surface without negative consequences and complications. Recommended use of complex drugs: for children and adolescents - Pikovit, for children and adults - Superia, etc.

Many homeopathic preparations show high efficiency while maintaining a satisfactory state of the body in the postoperative period. Such drugs are Lymphomyosot, Traumeel Gel, Mucosa compositum, etc. The dosage is indicated by the attending physician, who prescribes a treatment plan. Despite the distrust of many people, homeopathy has a positive effect when it is used as an adjunctive therapy.

Medicinal herbs after surgery have antiseptic, soothing and anti-inflammatory effect. Solutions of chamomile, sage, oak bark and other herbs are recommended to be applied for 2 weeks after the operation.

After the closure of the recession of the gum, it is recommended to conduct a rational prosthesis, if necessary. At present, veneers, cermets and all-ceramic crowns, bridges and other orthopedic structures are widely used. They will allow to stabilize the load on the teeth and eliminate the appearance of new soft tissue defects in the gums.

Many people are fans of alternative treatment, homeopathy and herbal medicine. Earlier, the effectiveness of these funds in the postoperative period was discussed. However, it is worth noting that with the help of herbs it is impossible to obtain such a result, which can be achieved with surgical intervention. Even in the presence of small defects, self-closure of the gum is not observed in all cases. There are no guarantees that daily rinsing of the oral cavity with therapeutic solutions will eliminate the loss of gum tissue. Moreover, treatment at home can lead to undesirable results. Many drugs depress each other's actions, accumulate in the body, have a toxic effect on various organs and systems. Therefore, treatment should be coordinated with a qualified specialist who can make an effective therapeutic plan.

Prevention

Prevention of the apical displacement of the gums is to prevent the occurrence of predisposing factors in the loss of gingival tissue. It is necessary to use a medium or low hard toothbrush. See the publication - Hygienic cleaning of teeth - types and features, the procedure for hygienic cleaning of teeth. After installing the filling, crown or prosthesis, tell your doctor about any discomfort in the mouth after doing the job. Early correction of the restoration will eliminate the appearance of many adverse effects. It is necessary to prevent the appearance of bad habits and get rid of existing ones. It is important to understand that the teeth are intended only for grinding food, and then they will serve you for many years.

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Forecast

If provoking factors are not eliminated, the recession of the gum will continue to progress and eventually lead to various complications that will result in aggravation of structural, functional and aesthetic deficiencies. In the event that the main causes of the recession were eliminated and quality treatment was carried out, the forecast is very favorable.