Dr. Garrett here! Many of us have what is called “gum recession.” This is when the gum tissue covering the roots of our teeth begins to migrate down the surface of the root. Recession can be caused by many things, but the main causes are: clenching and/or grinding your teeth, brushing too hard, and periodontal disease. When we clench and grind our teeth together, there is micro-movement of the tooth. This causes pressure and inflammation in the bone holding our teeth in place. As a result, the bone resorbs down the root surface. Tissue follows bone, and thus you get a recession defect. Brushing our teeth too hard physically wears away the gum tissue around our teeth, and also causes inflammation of the supporting bone. Lastly, periodontal disease is a bacterial process where the inflammation caused by the presence of pathogens in and around our gums causes the supporting bone to essentially dissolve away. As said before, the gum tissue follows where the bone is going and recession results. We typically do not see the actual recession in patients with active periodontal disease because their gums are inflamed and puffy. When the disease is removed however, the now healthy gum tissue recedes to where the bone is.
Treating these various sources of recession is the most important aspect of resolving receding gums. This may include wearing a night guard when sleeping to prevent grinding and clenching. It may also include changing our brushing habits and/or using a softer toothbrush. A Sonicare toothbrush is my favorite solution for those “aggressive brushers.” For patients with periodontal disease, a deep cleaning to remove the inflamed tissue and bacteria is essential. Followed by quarterly visits until healthy tissue is re-established. The addition of antimicrobials and antibiotics may even be necessary.
Once the source of the recession is treated, it is time to consider covering these exposed root surfaces. Why cover them? Well, exposed roots can cause severe sensitivity to cold food and air. Additionally, the thin tissue that remains around a tooth with recession is often thin and prone to further disease. So how can we cover these roots? The best method involves grafting new tissue to the exposed root surface. This is done in two different ways. The first has been around for a long time, and can work quite well. It involves removing a slice of tissue from the roof a patient’s mouth, and then transplanting that tissue to the exposed root surface. The advantage of this procedure is the graft rejection is rare due to the fact that we are reusing the patient’s own tissue. There are two large disadvantages to this type of grafting, however. First, the donor site on the roof of the mouth is extremely painful! Many patients state that the pain in this area is worse than any mouth pain they have ever experienced. Second, the color and texture of the grafted tissue is much different than the normal tissue the covers the root surface. We usually call these grafts “tire patches” due to their appearance (see below). In many situations, this can be a cosmetic issue.
The second method for covering exposed root surfaces is through the use of donor tissue. This is called an allograft. This is human tissue harvested from carefully selected human donors that has been thoroughly sterilized. No person has ever been found to have transmitted a disease from one of these grafts! The allograft is surgically placed over the exposed root surface in a similar manner as the first method. The main difference being that no donor site surgery is performed, completely eliminating the pain and morbidity associated with this surgery. The area where the tissue is grafted will have some slight soreness, but most patients report the discomfort to be quite minimal. The tissue, when healed, is indistinguishable from the surrounding gum tissue. Thus, it is an excellent procedure for areas where esthetics would be a concern (see below for example).
I am pleased to say that I am now performing this procedure in the office and have been very excited with the results. We have been able to eliminate cutting out tissue from the sensitive palate area of the mouth, thus making it a much more comfortable procedure. In addition, by avoiding the referral to a specialist we are able to keep your costs down significantly. If you have any questions or comments about this surgery, please do not hesitate to ask any of us!