A tooth is surrounded by two different types of gum tissue. The gingiva is the part that is around the neck of the tooth and attached to the underlying bone. Immovable and tough, the attached gingiva deflects food as it hits the gum.
The second type is called alveolar mucosa, or looser gum below the attached gingiva. This tissue contains muscle and allows movement of the cheeks and lips thanks to its flexibility. The constant contracting of the muscles in the alveolar mucosa pulls on the bottom edge of the attached gingiva. A normally attached gingiva is wide and strong enough to act as a barrier to prevent the gum from being pulled down in a receding fashion.
Those patients without sufficient attached gingiva can see their gum slowly continue to recede over time, even though the patient may be very conscientious about their oral health. This is just an anatomic condition, not an infection associated with periodontal disease. However, the bone won’t allow itself to become exposed to the oral cavity and move down with the gum.
A lack of attached gingiva is often associated with a high frenum attachment, which exaggerates the pull on the gum margin and causes strain on the gum. The frenum is a naturally occurring muscle attachment, typically seen between the front teeth. If pulling is seen on the gum margin or recession, the frenum has to be surgically released from the gum with a frenectomy. A new band of hard gum is also added to re-establish an adequate amount of attached gingiva.
Even one’s normal, non-diseased, attached gum can be worn away over time, most commonly from vigorous brushing. We often see this in those with naturally thin tissues or when the tissues have been stretched during orthodontic care. If we find there is still adequate attached gum to act as a muscle barrier, the treatment given for recession is to prevent any future damage while brushing. An attached gum that’s worn to the point where it can’t resist the constant pull of the mucosa will continue to recede unless a new hard band of gum is placed. Recession can eventually cause tooth loss if left unchecked by a professional.
Gingival grafting is the treatment of missing attached gum. The muscle pulling down is surgically resected and repositioned away from the gum margin. A small piece of attached gingiva is then taken from the roof of the mouth and transplanted to the necessary area. A new layer of attached gum is formed and the quick healing process of the roof of the mouth begins to take place. Patients can enjoy the benefits of this procedure with no fear of postoperative pain, which can be managed effectively with over-the-counter pain medication. Patients find the most difficult part not chewing on the area for two weeks.
If you desire to cover up the exposed root surface, a different surgical technique will be used. Keep in mind, however, that root coverage procedures are primarily done for cosmetic reasons or when there is exceptional root sensitivity after recession.