Gum Recession — Causes, Signs and Modern Treatments

Gum recession is the gradual loss of gum tissue around a tooth, so that part of the root surface that normally sits beneath the gum becomes visible. It is one of the most common gum conditions we see in adults, and one of the most often overlooked, because it develops slowly and is usually painless.

The visible change is the end of a slower process. Beneath the gum margin, the supporting tissues around the tooth (the firm attached gum, the ligament and the bone) are under strain. The gum is not pulling back on its own; it is responding to one or more underlying drivers. Recession that is identified early can usually be slowed or held, and the earlier it is found, the more conservative the options.

Signs to look out for

• Sensitivity to cold, air or sweet foods at one tooth or a small group of teeth. The exposed root has no enamel covering, so it reacts more readily. See our page on sensitive teeth.
• Teeth that look longer than they used to. The tooth has not changed; the gum line has moved.
• A visible root surface. The root is usually more yellow than the crown, so a receded tooth can look two-toned.
• Dark triangles between teeth at the gum line, where the small point of gum between teeth has reduced.
• A notch or ledge at the gum line that catches a fingernail or the toothbrush.
• Bleeding when brushing or flossing, which can mean gum disease is contributing.
• Teeth that feel loose or have moved, which can indicate bone loss beneath the recession.

Why it is easy to miss

Many people first notice recession only when a cold drink makes one tooth wince, or when they compare an old photograph with their smile today. A clinical examination measures the gum margin, checks for bleeding and pocketing, and records the starting point so that any change can be tracked over time.

Gum recession rarely has a single cause. In most patients we find one main driver and one or two contributing factors, and lasting control depends on identifying all of them.

The main causes

• Heavy toothbrushing. The most common cause we see. A firm brush, strong pressure and a side-to-side scrubbing action wear the gum margin back over years. Electric toothbrushes pressed hard can do the same. The remedy is technique, not a different gadget.
• Gum disease. Long-standing inflammation breaks down the tissues that support the teeth. Untreated gingivitis can progress to periodontitis, which causes both recession and bone loss. See our page on gum disease and bleeding gums.
• Thin gum tissue. Some people naturally have a thin band of gum around the teeth. It is not a cause on its own, but it makes every other driver more effective.
• Grinding and clenching. Repeated heavy forces at night load the teeth and the surrounding tissues, and are often linked with notches at the gum line. See teeth grinding and bruxism.
• Tooth position. A tooth that sits outside the line of the arch often has thinner gum and bone over it, and is more vulnerable. See crooked teeth.
• Lip and tongue piercings. Jewellery that rubs against the gum produces localised recession on nearby teeth.

Other risk factors

Smoking reduces blood flow to the gums and masks the bleeding that would otherwise warn of gum disease. Over-vigorous flossing or poorly sized interdental brushes can cause local damage. A tight muscle attachment between the lip and gum, hormonal changes and some general health conditions can also play a part. Orthodontic movement that is not carefully planned can contribute, which is why we assess the gum tissue before any straightening treatment.

Recession at a young age usually points to technique, tooth position, thin tissue or a piercing rather than age itself. The examination is how we tell which applies to you.