Do we have to treat gingival recessions?

I still get amazed -though it happens on an everyday basis -that patients concerned about having gingival recessions have been wandering around dental offices without receiving a solution.

Mostly, I hear stories like “Just brush better”, “NO treatment is necessary”, or worse: ”NO treatment is available”

Others, tell the patients that available treatment only have short term results, or they risk terrible postoperative consequences from a dreadful palatal graft, etc..

Wether out of plain ignorance, impotence, or lack of ethics, nowadays there is ample scientific and clinical evidence to show that all the above answers are JUST NOT TRUE.

The greatest concern of most of my patients is losing a tooth due to the «receding gum».

The great majority of recessions are shallow (less han 2 mm), have not compromised the band of attached gingiva, and can be mostly non-progressive if adequate etiological factors are controlled.

On the other and, there is a smaller number of deep recessions (4 mm or more), likely compromising the attached gingiva, with gingival/mucosal inflammation difficult to control, that can be deemed as «progressive» and thus endangering tooth long term survival.

Ironically, most of the patients that I see in my office consulting about gingival recessions have the latter -dangerous- ones. I guess they are probably the more desperate patients, that see their recessions progressing and envision an inevitable result.

Anyway, each patient is unique, and upon a consultation, I usually perform the following steps:

Gingival Recession Checklist:

  1. Listen to your patient concern: If tooth loss is the issue, then you must discern wether the recession is dangerous or is not. Esthetic concerns, or tooth hipersensitivity associated with recessions are a very valid concern as well.
  2. Determine the cause. Etiologic factors associated with the recession are often multifactorial. Usually there are underlying anatomical risk factors, which are triggered by developing factors such as traumatic toothbrushing, uncontrolled gingival inflammation, chemical or physical injuries. Identifying these, is an integral part of the clinical and radiographic diagnosis.
  3. Establish potential future course of action. Determine the feasibility of treatment based on the expectations of the patient and your available resources. Estimate a treated and untreated prognosis. Prepare an present to the patient an integral treatment plan strategy that controls etiological factors before designing and carrying out your beautiful surgery

and remember…if you are not comfortable with the treatment of gingival recessions, be true to yourself. Just refer him or her to someone that does; or take the step towards acquiring knowledge and skill in this matter.

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