ReviewGingival recession—its significance and management
Introduction
Many dental conditions pass by patients unnoticed until they have reached a clinically advanced stage and pain or major oral symptoms result. Gingival recession can however often be a very visible dental change that is noted by patients and which may cause them to seek the advice of a dentist. The significance of any gingival recession may vary considerably depending on the aetiology, extent and associated symptoms in each case. This paper aims to provide the reader with an understanding of the factors relating to the development of gingival recession and how a patient presenting with gingival recession should be managed. The paper reviews the prevalence and current concepts of the mechanisms and aetiology of gingival recession. The signs and symptoms of gingival recession are presented and the principles of assessment and management of the patient with gingival recession are discussed.
Gingival recession or marginal tissue recession is defined as the location of the marginal tissue apical to the cement–enamel junction (CEJ) with exposure of the root surface [1]. The CEJ is not always an easy structure to locate clinically but at sites of recession the CEJ will be supragingival and therefore more easily detectable. The CEJ may, of course, have been lost with placement of a restoration but estimation of its original position can be made and exposed root surface coronal to the gingival margin will indicate that recession has occurred.
Section snippets
Prevalence
Studies have shown a range in the prevalence of gingival recession. A prevalence of 75% has been reported in a group of military personnel [2] and of 90% in older institutionalised subjects [3]. In a US study with 9689 subjects the prevalence of gingival recession of 1mm or greater was 58% for persons between 30 and 90 years of age and 22.3% teeth per person on average were involved [4]. Prevalence and extent of gingival recession increased with age with a prevalence of 37.8% and extent of 8.6%
Mechanisms
The mechanisms by which gingival recession occurs are still unclear. Animal studies have shown that apical migration of the junctional epithelium can occur in the absence of plaque and inflammatory cells [12], [13]. A relationship has been found between the age of the experimental animal and extent of apical migration though not between the presence of gingivitis and the recession [14]. These findings lent support to a hypothesis from the 1920s, that physiological apical migration of the
Aetiology
Gingival recession results from apical migration of the gingival tissues. Recession may exist in the presence of normal sulci and undiseased interdental crestal bone levels or may occur as part of the pathogenesis of periodontal disease where alveolar bone is lost. Frequently recession results from a combination of predisposing factors.
Pain
A common symptom linked with recession is cervical dentine hypersensitivity. However not all teeth with recession will give rise to this problem. Recession will uncover the cervical dentine but other cofactors are required to give rise to the patent dentine tubules responsible for the pain experienced [59]. However dentine hypersensitivity may be the patient's primary concern in relation to their recession and their reason for presentation. The pain is usually of a sharp and short duration and
History, examination and diagnosis
Management of a patient with gingival recession will begin, as for all patients, with a thorough history and examination. This should include a dental charting and periodontal screening using the Basic Periodontal Examination (BPE: the British Society of Periodontology's modification of the CPITN system) [68]. The BPE is used to identify the presence of periodontal problems requiring further investigation and management. Recession is not a component of the BPE except where combined recession
Management of patients with gingival recession
The patient should be offered a clear explanation of the factors that have caused the gingival recession and how further progression may be combated. The patient should be advised about the long-term prognosis of the tooth and reassured as appropriate.
The further management of gingival recession can be divided into the management of the aetiological factors associated with recession (Section 7.1) and the management of the sequelae of recession (Section 7.2).
Conclusions
Gingival recession is a common condition seen in both dentally aware populations and those with limited access to dental care. The aetiology of the condition is multifactorial but is commonly associated with underlying alveolar morphology, toothbrushing, mechanical trauma and periodontal disease and means that in some patients gingival recession may be a sign of periodontal disease. Gingival recession is also a common outcome of the therapies delivered to treat periodontal disease. Though
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