Gum disease, receding gums, gum inflammation (gingivitis)

What are receding gums?

Symptoms of receding gums (gingival recession)

Symptoms of gum inflammation (gingivitis)

Causes of receding gums and gum inflammation (gingivitis/ periodontal disease)

Treatment of receding gums and gingivitis

Gum disease references

What are receding gums?

Healthy gums are firm, a pale colour, and cover the roots of the teeth. Normally the lower two thirds of a tooth is buried in the jaw bone.

Receding gums (gingival recession) is a loss of gum tissue causing exposure of the roots of the teeth. Gum recession is a problem that can start in the teens, but is more common in older adults. Gum recession is usually a progressive disorder that happens day-by-day over many years. This is why is more common over the age of 40. Many people do not notice that they have gum recession because it happens so slowly.

Symptoms of receding gums (gingival recession)

• Teeth may appear longer than is normal (a larger part of the tooth is visible if the gums are receding).
• The roots of the tooth are exposed and visible. Exposed roots can be sensitive and painful, leading to further damage and decay.
• There is a notch in the tooth at the gum line.
• Sensitivity to hot and cold foods and drinks, or to sweet, sour, or spicy foods. If the gums no longer cover the cementum, the exposed dentin tubules may also be sensitive.
• Change in the tooth's colour (due to the colour difference between enamel and cementum).
• Spaces between teeth seem wider (the spaces may be the same but seem larger because the gums no longer cover them). If the gaps between the teeth are actually wider, then the bone and support structures of the teeth may be eroding, a common condition known as Periodontitis or Pyorrhea.
• Cavities below the normal gum line. Eventually this loss of bone around the teeth leads to the formation of deep gum pockets. Bacteria in these pockets cause further infection and bone destruction.
• One or more teeth may be loose.

Symptoms of gum inflammation (gingivitis)

If the gum recession is caused by gingivitis, the following symptoms may also be present:

• Puffy, purple-red, or swollen gums.
• Gums are shiny where they are swollen and stretched.
• Gums bleed when brushing or flossing. An early symptom is bleeding without pain.
• Bad breath (halitosis).
• Advanced gum disease can be painful, and can cause loss of otherwise healthy teeth. If left untreated, gingivitis can progress to periodontitis which involves progressive loss of the alveolar bone (the bone around the teeth). Eventually it leads to the loosening of teeth, and their subsequent loss.

In some cases, when gingivitis is treated it reveals a gum recession problem that was previously masked by the gums swelling.

Causes of receding gums and gum inflammation (gingivitis/ periodontal disease)

• Poor dental hygiene. Most people don't know how to clean their teeth properly. Dentists are not taught the most effective brushing technique in dental school (because it is too effective and reduces profitable dental problems). Incorrect brushing or flossing lets bacteria build up between the teeth and in the sulcus (the space between the gum and the tooth). Sulcular bacteria form colonies and are the main cause of gum disease (gingivitis / gum inflammation / periodontal disease) and tooth decay.
  Plaque is a soft, colourless biofilm formed by mouth bacteria. If not removed, it tends to harden after a couple of days and form calculus (tartar). Tartar is calcified mineral deposits on the teeth. It tends to stain easily, and is visible as brown or yellow stains on the teeth. It can also accumulate under the edges of the gums.
  The most common bacteria associated with gum disease is porphyromonas gingivalis.
  Infection of the gums causes a chronic inflammatory response which can contribute to the hardening and narrowing of arteries (atherosclerosis), cardiovascular disease, stroke and a variety of other diseases depending on the individual. Gum disease and loss of teeth are also correlated with a significantly shorter life. Most doctors don't make the connection between periodontal disease and other chronic ailments, so they continue for years. (1)
• Poor brushing technique. Aggressive brushing wears down the teeth and the gums. Brushing for too long with many strokes, and brushing too hard will wear down both the top and the sides of the teeth and damage the gums, causing them to recede. Use a soft toothbrush and the correct brushing technique.
• Toothpicks. Beware of using toothpicks, especially if they are too wide. Aggressive use of toothpicks can damage the gums. If food is stuck between the teeth try to use a thin, non-invasive toothpick, or dental floss. When using floss, do not pull down on the gums.
• Poor diet high in sugar and refined carbohydrates.
• Eating and digestive disorders. Both acid reflux and vomiting are harmful to the teeth and gums. Acid from the stomach erodes tooth enamel and damages gum tissue.
• Sjogren's syndrome. Between 2% and 6% of adults suffer from this ailment, with the prevalence being nine times higher in women than men, and in older people rather than younger.
• Grinding of the teeth (Bruxism).
• Tobacco. Dipping tobacco (holding in the mouth) affects the mucus membrane lining in the mouth and will cause receding gums over time.
• Malocclusion (misaligned bite), or adult orthodontic movement of teeth. A dentist may be needed to provide a splint or brace.
• Body piercing - metal in the lip or tongue can damage the gum by rubbing against it.
• Sensitivity to Sodium Lauryl Sulphate (SLS), an ingredient in most commercial toothpastes.
• Pregnancy - some women are prone to gum inflammation during pregnancy.
• Pharmaceutical drugs - some drugs can cause gingivitis.

Treatment of receding gums and gingivitis

Healing receding gums is a slow process that takes at least a few months and possibly much longer. It is best to tackle it in several directions. First and most importantly, your mouth should no longer be an environment in which bacteria thrive. Oral hygiene is essential to stop the growth of more plaque. Harmful bacteria like sugar and a slightly acid environment. So you want your saliva to be slightly alkaline (say pH 7.3), and have no sugar in your mouth.

The standard dental treatment for gum disease is a thorough cleaning of the teeth and their roots. Scaling is the removal of plaque and tartar from the teeth, and root planing is cleaning the exposed teeth roots. Subgingival curettage is the removal of the surface of the inflamed layer of gum tissue. The latter two of these procedures are usually done with a local anaesthetic, and the dentist may give you oral antibiotics to overcome gum infection or abscess.

• No sugar. Try to avoid sugar in all foods and drinks, and refined carbohydrates (foods with white flour etc). When you are on a healthy diet there is no need to clean your teeth after every meal. It is sufficient to clean your teeth once per day in the evening before bed. Always use dental floss, and take time to carefully and gently brush each tooth. Here are details of the most effective brushing technique for your teeth and gums.
• DMSO. Many people use a 50 percent solution of DMSO as a mouth wash. Others brush their teeth with DMSO.
• Oil pulling. I recommend that you use oil pulling every day or a couple of times a week. If there is a high level of bacteria and plaque (evidenced by bad breath), check the remedies for improved oral hygiene and raising the pH (alkalinity) in the mouth. These remedies also apply to gingivitis (gum inflammation). Hydrogen peroxide also helps with bacterial control.
• Boron is essential for gum health. Supplement with borax to ensure sufficiency in the body and prevent / reverse receding gums.
• Baking soda (sodium bicarbonate) is a good way to raise alkalinity. Take half a teaspoon twice a day in a glass of water on an empty stomach; hold it and swish it in the mouth as long as you can before swallowing. Alternatively, if you are going to continue using this alkaline mouthwash long-term, spit it out after rinsing and holding. You can also brush your teeth with baking soda, or add it to tooth cleaning powder. (If you are using apple cider vinegar, add a little baking soda to it, or rinse with baking soda after drinking it. Never drink neat ACV because it will erode tooth enamel and damage gums).
• Gum turpentine is an excellent anti-bacterial mouth cleanser and breath freshener.
• Sufficient vitamin C, zinc and magnesium are essential for good oral health. One tablespoon of Milk of Magnesia (MgOH) in half a glass of water makes a good mouthwash. Rinse with it but do not drink it. Zinc sulphate (Epsom Salts) may also be used as a mouthwash, but should not be consumed.

References

1. Michael J. LaMonte, Robert J. Genco, Kathleen M. Hovey, Robert B. Wallace, Jo L. Freudenheim, Dominique S. Michaud, Xiaodan Mai, Lesley F. Tinker, Christian R. Salazar, Christopher A. Andrews, Wenjun Li, Charles B. Eaton, Lisa W. Martin, Jean Wactawski-Wende. History of Periodontitis Diagnosis and Edentulism as Predictors of Cardiovascular Disease, Stroke, and Mortality in Postmenopausal Women. Journal of the American Heart Association. 29 March 2017;6:e004518.