My gums have receded and I can see the root

Where the enamel ends is where the gum begins. The visible part of the tooth is covered by enamel, the hardest tissue in the body; the root below the gum has no enamel and is covered by a much thinner, softer layer. When the gum recedes, this layer is exposed to the mouth: the teeth look longer, black triangles appear between them, and when you run your fingernail along the neck of the tooth you feel the step where the enamel gives way to the root.

The cause we see most often is brushing too hard, and it turns up precisely in the patients who take the most care of their mouths. Brushing with a hard-bristled brush, scrubbing sideways and pressing down, pushes the gum margin back over the years and leaves a wedge-shaped notch at the neck of the tooth. The recession here comes not from inflammation but from mechanical wear: the gum is pink and does not bleed, yet it has still receded. In a right-handed patient, the left side being more affected is the tell-tale sign.

The second cause is gum disease, and the mechanism is different. Tartar and plaque cause inflammation at the gum margin; when the inflammation reaches the bone, the bone holding the tooth is lost and the gum recedes after it. It comes with bleeding, bad breath, redness and pockets that get deeper. Here the real problem is not the gum but the bone underneath. Widespread bone loss that has progressed horizontally does not come back; only where a narrow, deep defect is left around the tooth can some bone be regained with regenerative surgery. X-rays and pocket measurements tell you which situation you are in.

The third is thin gum and thin bone that you are born with. In some mouths the bone covering the outer surface of the root is as thin as paper, and the gum over it shows the outline of the root; the same structure is seen in teeth positioned outside the arch, towards the front. In a mouth like this, even an ordinary brushing habit is enough to start recession.

The fourth is grinding your teeth at night. Grinding does not break down a healthy mouth on its own; in an area that is already thin, it speeds up recession through the excess load on the neck of the tooth and deepens the notch. The signs are a tired jaw in the morning, flattened and shiny tooth surfaces, and sensitivity you feel as soon as you wake up. Smoking, meanwhile, impairs the blood supply to the gum and hides the early warnings.

Recession itself is not urgent; it progresses slowly and takes years to notice. There are three situations that are urgent: swelling and discharge in the gum, throbbing pain that gets worse at night, and a tooth that starts to move within a short time. These are signs of active infection or advanced bone loss and need to be seen the same day. Otherwise there is no need to rush; but as long as the cause is at work, recession only goes one way.

Once the cause is removed, the recession stops, the tissue firms up and the sensitivity eases; but the height that has been lost does not come back on its own. Covering the root again needs a separate surgical procedure; the most predictable way is to place connective tissue taken from the palate over the root surface. How much of the root this surgery will cover is decided by the bone between the teeth.

Two areas of recession that look the same can have different causes and head in different directions. The aim of this sequence is not to measure the recession but to find what is causing it.

1. 1

   We map the recession

   On every tooth we record in millimetres how far below the enamel the gum margin sits, and we take photographs. A single record does not tell you anything; the real information comes from the second measurement months later.

2. 2

   We measure the pocket depth

   With a thin probe we check how deep down the gum is attached to the tooth. In a mouth with shallow pockets and no bleeding, the cause is mechanical; with deep, bleeding pockets, it is inflammation. Because the two are treated differently, we make the distinction on the first day.

3. 3

   We want to see your toothbrush and how you brush

   Bring the brush you use with you; bristles splayed outwards show that you press down. Then we hand you the brush and watch how you brush. The way people describe it and the movement they actually make do not match.

4. 4

   We check your bite and signs of grinding

   We look at which tooth makes contact first, flattening of the biting edges and wedge-shaped notches at the necks of the teeth. If these signs are there, a night guard becomes part of the plan; work done without taking the load off does not last as long.

5. 5

   X-rays and, if needed, a CBCT scan

   A plain X-ray shows the bone level between the teeth but not the thickness of the bone covering the outer surface of the root; we see that with a cone beam CT (CBCT) scan. If advanced bone loss is being discussed, we do not make a decision without this image.

These are not alternatives to choose between but steps applied in order. Without the first two, the later ones do not last.

Receding gums do not cause pain on their own; that is why people put them off for years. The price is paid in the order below.

The sequence below applies to the route that starts with correcting how you brush and gum treatment. If root coverage surgery is chosen, its own healing time is added on top.

1. The first two weeks

   When a patient changes how they brush, the gums stay tender for a few days and bleeding temporarily increases. This is a sign that the inflamed tissue is starting to clear up; it is not a reason to brush less. The effect of sensitivity toothpaste is felt towards the end of this period.

2. Six to eight weeks

   The bleeding stops, the gum margin firms up and its colour changes from dark red to light pink. We repeat the recession measurements at this point. If the figures are the same as on the first day, the goal has been reached: the real gain is that the recession has stopped.

3. If root coverage surgery was done

   The procedure is done under local anaesthetic, and you go home the same day. For the first week you do not brush that area but clean it with an antiseptic solution; the stitches are removed within one to two weeks. The area of the palate where the tissue was taken is uncomfortable for a few days.

4. A check-up every six months

   Once the recession has stopped, the job is to confirm that it has stopped: we measure the same points with the same method. A millimetre of recession starting again tells us the cause has come back, and if it is caught early, the rest never happens.

We do not give a single figure on this page: with receding gums, the route can end with correcting how you brush or go as far as surgery, and the difference between the two is large. We tell you the right figure after an examination and X-rays, with the scope in writing. These are the items that determine the price:

The cause of the recession

With recession caused by mechanical wear, the work is correcting technique and follow-up. With recession caused by inflammation, pocket treatment and the number of sessions come into it; the two are not costed the same way.

How many teeth are affected

Covering the root on a single tooth and covering several neighbouring teeth along an arch in the same session are costed separately. A figure given without seeing your mouth is bound to change at the clinic.

Whether surgery is needed

A connective tissue graft is a separate surgical procedure; the preparation, the suture material used and the check-up appointments affect the total. For a patient who chooses only to stop the recession, this item does not come into it at all.

Procedures done alongside it

Filling the notches at the necks of the teeth, a night guard and treatment of root decay, if there is any, are separate items. After the examination we write down, one by one, which of them are needed.