Beyond the Recession: Innovative Treatments for Gum Tissue Restoration

Hi, everybody. I'm Dr. Sandhya Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body. As we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most natural way. Welcome to today's show. We will be talking about gum recession. What is gum recession? Why is it a problem? How can you prevent it, and especially how to treat it? What are the options today? So what is recession? Basically, when you smile and you start seeing a little bit yellowish and the gums are starting to go up on the upper teeth, especially on the sides. Actually, that's a very common area where the premolars are for you to develop gum recession. And as the root gets exposed, you might be experiencing some sensitivity. The problem with gum recession is that when gum recedes, the bone recedes as well. So 12 millimeter typically is not a problem. It's an area that we actually monitor. But when you're actually ending up and you're seeing 5, 6, 7 millimeters at the root exposed, that can become a problem. Why is it a problem? Well, the loss of bone around the tooth can actually cause the teeth to loosen, start to have mobility, and they can start to shift. Some of you might have seen that. Let's say the front teeth are starting to get recession. You start to see the root of the teeth, and all of a sudden they start to shift, they start to buck forward, or maybe you start to develop spaces in between the teeth. The other issue with recession is that you can develop cavities. The roots are not meant to be exposed to the oral environment because they're softer than the enamel. The enamel is the top layer, which is white. And from the gum line into the bone, we have the dentin, or the root surface, which is actually have a lot more porous. And cavities can develop a lot faster than on the enamel. But besides the sensitivity and the cavities that might develop, it just doesn't look good. And some of my patients come to me and say, you know what I'm starting to see? You know, that, you know, I'm becoming long in the tooth, and I really don't like it. So how can you prevent it? Well, in order to know how to prevent it, let's look at what causes gum recession, because then we look at each cause and we see how we can prevent it. The number one cause of recession is definitely heavy Brushing. Some of you have a really heavy handed, so you're taking a brush and really scrub side to side, especially up and down. The up and down motion definitely will drive your gums upwards and cause gum recession. And what type of brush you're using becomes important. Something like an electric brush can actually be okay to use. However, the rotary brushes, the ones that actually are based on friction, such as an oral B brush that actually rotates and scrubs, can actually cause gum recession, especially in people that have thin gums or thin biotype. So more of the sonic type brushes are actually gentler for your gums. If you have a thicker gum tissue, you don't have to worry about it. Actually, the friction type brushes can work very well for you heavy brushing. So I recommend, if you're using a manual brush, definitely soft bristles that are actually in a small circular motion. That's the way I like to clean at the gum. And definitely you don't need to brush your gums. A lot of people think, oh yeah, my, I think I have to brush my gums. No, you don't. You want to brush the teeth and just under the gum. That's what you want to target. So that's why the bristle should be directed 45 degrees into the gum to avoid brushing the gums, which can actually cause gum recession. Clenching and grinding is another reason why you can see gum recession. Why? Because you're putting a lot of stress on your teeth, especially if you don't wear a night guard. All that stress is now going somewhere. It's the law of physics. When you're putting stress in one place, it will manifest itself in another. In this case, it can manifest itself into basically the wear of the teeth, but also could be the wear of the gums. So if the teeth are moving at night or while you're clenching and grinding, it'll cause that gum to recede. Well, easier said than done to tell you don't clench and grind, but there are certain techniques. It's going to be a whole nother episode on what we can do with clenching and grinding. If you have thin gums, you definitely will have more of a propensity to recede. If you have thin gums, you have to be super careful on how you brush them, how you take care of them. Also taking collagen supplementation, it's not going to help thicken the gum, but it'll help to maintain nice healthy collagen. And in your gums and in your skin in general, inflammation is also a big cause of recession. If you're not brushing enough, if you develop gingivitis, that'll slowly cause your gums to recede. Stopping inflammation is an important part in stopping recession. How do you stop inflammation? By brushing and flossing regularly, getting professional cleanings on a regular basis, and taking vitamin C. Vitamin C is a great anti inflammatory antioxidant for the gums. Tooth movement can also cause gum recession. So oftentimes, if you're going to straighten your teeth because you don't like the way they look, you have some crowding. It's very important to look at the gums first. And your dentist and your orthodontist will always look at this to see if I'm going to move the tooth and try to predict if you're going to get gum recession. But oftentimes, if the teeth are brought out too much out of your jawbone, you definitely can end up with recession, especially if the gums are very thin. Sometimes gum grafting is inevitable. We have to do it in order to preserve your teeth and the jawbone trauma. Trauma can definitely cause gum recession. And it could be trauma from eating chips, for example. And trust me, I'm a chip lover myself, but if you eat chips and you injure your gum, you get a cut into your gum that can actually heal. Now with recession, another thing that can cause trauma to the gums is actually a tongue ring. I've seen actually some of the worst gum traumas from tongue rings that get caught behind the teeth and pull the gum right off of the tooth. That can not only be very painful, but it can cause a big defect in the site that it has to be repaired by a periodontist. Lip rings also can cause actually trauma to the gum. So be very careful when deciding to get a ring. When do we treat recession? This is another important topic because some people might say, oh my God, I have a little gum recession. Maybe I need a gum graft. Well, no, we look at different things as periodontists. When to treat gum recession. It really depends, number one, on the progression of the recession. So in our office we always take photos. Photos are absolutely necessary, let's say today and maybe in a year from now. So I could tell exactly how fast is this gum receding. If the gum already has receded 3 millimeters, then definitely I would recommend treatment. But let's say you have 1 to 2 millimeter recession, it doesn't bother you, it's not sensitive, it's not in an aesthetic area. Then we can definitely monitor, take photos a year later and see has this recession progressed? If it's progressed, then we just monitor it to make sure that it doesn't get worse. Also, also looking at the quality of the gum remaining, we call this attached versus non attached gum tissue. Attached means exactly that it's strongly attached to the tooth and the surrounding bone. Why is that important? Let's say you're chewing, right? The gum tissue, if it's attached, it doesn't really move. If the gum starts to move around, it's going to recede. The molar and also the bone behind it will recede. And so I always say that the gums are there to protect the bone, the jawbone bone that's holding the tooth in the jawbone. And if the gum is not strong enough, it's not gonna provide that protective layer that the bone needs in order to stabilize. So typically 2 millimeters or more recession, especially when it has this non attached tissue or very loose and thin tissue, requires some form of augmentation. And that augmentation can come from, from different places. However, if it's 2 millimeters or less recession, typically it does not require grafting unless you're bothered by the way it looks. If your gum recession is over 3 millimeters, then what are the options there? So let's go over some of the options that are available on the market today. While we have definitely your own tissue, periodontists oftentimes will recommend to use your own gum tissue to augment an area that has recessed. And by far that's the best kind, the cells that come from you. This could be in the form of your own gum tissue or using PRF or platelet rich fibrin. Platelet rich fibrin. I talked about it before in my previous episodes. I like it a lot because it offers a lot of the growth factors and the fibrin that are necessary to thicken up the tissues. So if you have up to 3 millimeters of recession and you still have adequate attached gum tissue in a site, it could be a great way to reattach the tissues lower to cover some of the root exposed and really rejuvenate and make that soft tissue and gums stronger. However, if you don't have enough attached tissue and you have a lot of the loose type of gum tissue around your teeth, then now we're looking at using your own gum tissue. And where do we take it from? Usually an area that has enough tissue, like the back of the upper teeth and the molar side, or right behind the upper teeth, we make a small incision and we Take some connective tissue cells to graft it in a different site, and you might say, does this grow back? Is this in any way a permanent damage? No, not at all, actually. Interestingly enough, cells have memory, and the tissue where we take it from does grow back. Oftentimes when we're talking about other materials not coming from you, we do have donor grafts from the tissue bank. I always say donor grafts or cadaver soft tissue that comes from the tissue bank is a gift from another human. And this can come in different thicknesses. The advantage of using this is like, I don't have to go to another site to take tissue from somewhere else. So you don't have a second wound that's hard to heal. And those of you that have had gum grafts taken from the roof of the mouth, you know that those can be very painful. If we have multiple teeth that have receded, let's say all your upper teeth have receded. There's not enough gum tissue to take from you. A good choice is using a gift from another human that actually has the collagen fiber without the cells. So the collagen fibrils are really like ropes. Imagine a blanket. So our body uses these ropes like a scaffold for the cells to crawl up against and form your own tissue. So that's why we call this acellular, because the cells from the other person are not included. It's really just the scaffold. And we actually place this under the gum. We pull the gum over the top of this, and you can get really nice results using a gift from another human. Disadvantages of this, this actually has a higher risk of infection, and it does take longer to heal because it's not alive, it's not your own cells. So oftentimes this can be also mixed with PRF to expedite healing. There's also on the market some cow or bovine derivative soft tissue grafting. However, the studies have not been impressive. We don't get enough thickness using cow collagen. And my preference would still be to use your own whenever possible. From a biological perspective, it's always good to use your own cells. Also growth factors, to try to enhance that signal for the tissue thickening. There's a technique out there, you know, that has gotten a lot of press, called pinhole technique. So what is the difference? You might say, oh, I had some patients calling, thinking, you know, that's the best thing. The pinhole surgical technique actually uses bovine cow collagen membranes. So since I'm not a big fan of this. It's not something that I do. The tunneling technique is actually in my opinion, better than the pinhole technique because I don't have to even create a pinhole. We actually use a tunnel to be able to loosen the tissue. So it's minimal detachment of the tissue in order to achieve gum grafting. So a lot of my patients were actually having recession treatment have minimal discomfort because of this reason. PRs, however, can cause some increased swelling in a place. Why? Because we're adding a lot of growth factors. Growth factor actually is like a signal that calls in other cells to do the work. So that can cause some initial swelling the four or five days. But this is absolutely normal because again, inflammation or healthy inflammation brings back good healing. So that's it in a nutshell. I hope that it answers a lot of questions about gum recession. Definitely. If you see that you're developing gum recession, see a periodontist so you can get the options for maintaining your teeth for a lifetime. Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram. Doctorsanda, this is Dr. Sandha. And remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.