Gingival Recession

The occurrence of gingival recession is a precursor to the loss of cementum, the exposure of dentin, and the subsequent development of hypersensitivity (Figure 5). Recession can occur for a variety of reasons.

Anatomically, some teeth may exhibit a narrow zone of attached gingiva. If this narrow zone of attached gingiva is further reduced by recession, little to no gingiva is left to cover and protect the cervical area of the tooth. Tooth apposition also may predispose a tooth to gingival tissue loss since the buccal alveolar plate may be thin.

Excessive and abrasive use of any oral hygiene device can lead to gingival recession, although toothbrush type and the technique used are the primary contributing factors. However, it is not believed that the toothbrush alone causes loss of enamel or cementum.40,41 Gingiva can be lost secondary to tissue destructive processes of periodontitis, necrotizing ulcerative gingivitis (NUG), and viral disorders, such as HIV. Surgical and nonsurgical periodontal treatment can result in gingival recession and root exposure. Certain other surgical and restorative procedures, such as crown preparations, may also contribute to gingival recession and root exposure.

There is some speculation that gingival recession is a natural sequela of aging. In a sample of more than 500 people over 65 years of age, 39% of the tooth surfaces had gingival recession.42 There was not a significant increase across age groups, although there was a trend toward more recession in older groups. It is unclear whether recession occurs as a result of the aging process alone because it is difficult to eliminate the additive life-time effects of toothbrushing, the use of other oral hygiene devices, and oral habits.