Dr. Giorgio Petricca
BSc, MSc, DMD, Dip. Perio. MSC, FRCD(C)
Certified Specialist in Periodontics
When the gum tissue that surrounds your teeth wears away, more of the tooth and its roots are exposed. And if left untreated, gum recession can put you at risk for losing teeth. However, Periodontal & Implant Clinic can help restore oral health with gum treatment procedures in Nanaimo. In this regard, some common questions made by patients are, "Isn't age a risk for receding gums? What if I don't do anything? Will I lose my tooth?" But first, let's look at what gum recession means before we answer these questions.
Tooth-supporting Structures – Outwards in (in the Following Order)
Mucosa – Reddish in colour, shiny, delicate, mobile, unattached. Analogous to the clothing on our body (a drape, a cover but not supporting anything per se).
Keratinized gingiva (gum) – Pink, thick, firm, not shiny, immobile. Analogous to the skin on our body (a protective cover, and supportive in that it keeps foreign objects from entering our body). Keratin is a protein commonly found in hair, skin, and nails. The protein gives all of these structures toughness as it does in the pink-type gum around our teeth.
Found immediately under the soft tissue/gums around our teeth. The distance from the gumline around our teeth and the crest of bone around our teeth is 3 to 5mm. This relationship is constant around every tooth.
A fraction of a millimeter in thickness, the proverbial "shock-absorber." When we clench our teeth there is some "give" (movement) of our teeth, and this is because of this periodontal ligament. Nerve fibres within the ligament also act like sensors allowing us to tell apart different hardness/texture in food, and how hard or light we need to bite/chew.
Dr. Petricca’s Motto: Gum/Tissue Protects Bone and Bone Supports Tissue/Gum
Gum recession IS preceded by bone loss. Thus procedures aimed at restoring lost gum or reinforcing the gum prevents not only further gum recession, but ALSO further bone loss.
Q: Is age a risk factor for receding gums?
Age alone is not a risk factor. However, one can think of our mouth as being subject to the effects of time. That is the longer we live, the more cumulative damage our gums sustain. As well, genetics plays an important role in that some people have thick gums and some thin – with thinner gums being seen as less resistant to breakdown over time. Finally, gum disease (periodontal disease), which exists in everyone (since our mouth is NOT sterile) typically has a slow gradual deteriorative course causing bone loss and thus ultimately gum recession.
Gum Grafting – Two Types
1. Root Coverage (Connective Tissue Graft)
Involves taking tissue from UNDER the surface of our palate (roof of our mouth or side walls) and placing over an exposed root(s). Sources of donor tissue include:
2. Non-root Coverage (Free Gingival Graft)
Involves taking a thin layer of the surface our of palate (side walls) and placing it where the pink gum (keratinized gum) meets the red gum (mucosa). It is aimed at creating more pink gum (attached quality gum) which prevents further recession but does NOT cover an exposed root per se.
"This patient came to me already having had a graft with human cadaver tissue (top), but she did not feel the benefits and so was referred to my office. I did a free gingival graft with patient's own tissue (bottom) and patient is no longer in discomfort."
Q: Which type of graft should I have? How much of my exposed root can be covered?
Dr. Miller in the early ‘80s came up with a classification system to help us predict how much root coverage is possible. To sum things up, one needs to visualize the shape/architecture of our gums (which is usually mirrored in kind by the underlying architecture of bone).
Our gums are usually scalloped (wave-form) such that the gums for upper teeth rise on the mid-face of a tooth and fall (towards the tooth edge) in between our teeth. The little triangles of gum that fill the gaps between our teeth are known as papillae. The height and width of one's papillae limit blood supply between teeth and therefore how much root coverage is possible. Any loss of height of papillae limits root coverage. And compared to shorter, wider (more "stout") papillae, skinny, tall papillae tend to be less stable (likely to shrink) over time without any manipulation (surgery or other trauma).
To find out which graft is best suited for your needs, please schedule a consultation. During the consultation, we can review what we see together, and discover what your options are based on what is achievable.