Gingival Recession: Aetiology and Management

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Questions and Answers

What is gingival recession?

  • The formation of a pocket between the tooth and the gum.
  • The displacement of the gingival soft tissue margin apical to the cemento-enamel junction resulting in exposure of the root surface. (correct)
  • Inflammation of the gums.
  • The loss of bone around the tooth.

What are the two main etiologies of gingival recession?

  • Genetic predisposition and environmental factors
  • Nutritional deficiencies and bacterial infections
  • Poor oral hygiene and dental trauma
  • Mechanical/physical factors and inflammatory factors (correct)

What are the mechanical/physical factors that can cause gingival recession?

  • The tooth brushing technique, dental trauma, and occlusal forces. (correct)
  • Genetic predisposition and dietary deficiencies.
  • Periodontal disease, smoking, and systemic diseases.
  • Stress, anxiety, and sleep deprivation.

According to Table 1, what is the description of Akerly Class III incisal relationships?

<p>Mandibular incisors impinge on the palatal gingival margin of the maxillary teeth and the maxillary incisors impinge on the labial gingival margin of the mandibular incisors. (D)</p> Signup and view all the answers

What is the most common location for gingival recession?

<p>The left side of the mouth (A)</p> Signup and view all the answers

Why is the left side of the mouth more commonly affected by gingival recession?

<p>Most people are right-handed and brush the left side of their mouth first, when they are most vigorous in their tooth brushing. (C)</p> Signup and view all the answers

What is a common characteristic of gingival recession related to mechanical/physical factors?

<p>It is often associated with a history of dental trauma. (B)</p> Signup and view all the answers

True or False: Gingival recession is only a concern for individuals with poor oral hygiene.

<p>False (B)</p> Signup and view all the answers

What is a common cause of localized recession defects?

<p>Dental trauma (A), Excessive tooth brushing (B), Periodontal disease (D)</p> Signup and view all the answers

What is the primary goal of treating dentine hypersensitivity?

<p>Blocking the dentinal tubules (A)</p> Signup and view all the answers

Which of the following treatment options can be used to cover the root surface and block dentinal tubules?

<p>All of the above (D)</p> Signup and view all the answers

What is the significance of symmetry in the zenith of anterior teeth?

<p>It contributes to facial aesthetics (C)</p> Signup and view all the answers

In cases of localized recession defects, what is the primary consideration before using composite bonding?

<p>The patient's lip line (C)</p> Signup and view all the answers

What is the primary rationale for treating dentine hypersensitivity?

<p>To improve the patient's quality of life (D)</p> Signup and view all the answers

Which of the following is NOT a common treatment option for dentine hypersensitivity?

<p>Tooth whitening (C)</p> Signup and view all the answers

What is the primary method for treating localized recession defects using composite bonding?

<p>Closing the black triangles (B)</p> Signup and view all the answers

What is a primary factor contributing to gingival recession?

<p>Direct mechanical influences (C)</p> Signup and view all the answers

When might treatment for gingival recession be considered necessary?

<p>If there are concerns about aesthetics or sensitivity (A)</p> Signup and view all the answers

Which of the following statements is true regarding treatment options for gingival recession?

<p>Non-surgical options are available to restore aesthetics (B)</p> Signup and view all the answers

What may not be a concern for some patients with gingival recession?

<p>Presence of plaque buildup (D)</p> Signup and view all the answers

Which condition might prompt a patient to seek treatment for gingival recession?

<p>Increased aesthetic concerns (D)</p> Signup and view all the answers

What is the focus of subsequent papers in the series about gingival recession?

<p>Surgical treatment options for localized recession defects (B)</p> Signup and view all the answers

What might influence whether patients express concern about gingival recession?

<p>Personal aesthetic values (D)</p> Signup and view all the answers

Which of the following is NOT mentioned as an aetiological factor in gingival recession?

<p>Hormonal changes (C)</p> Signup and view all the answers

What can be a potential consequence of a Class II Div 1 or Class II Div 2 incisal relationship?

<p>Localized recession of teeth (B)</p> Signup and view all the answers

How can high fraenal attachments affect periodontal health?

<p>They may cause localized recession due to poor oral hygiene (B)</p> Signup and view all the answers

What might lead to recession due to iatrogenic damage?

<p>Rough restoration surfaces (C)</p> Signup and view all the answers

What is the relationship between alveolar dehiscence and gingival biotype?

<p>Thin gingival biotype increases the risk of recession (D)</p> Signup and view all the answers

Which factor has poor evidence linking it to gum recession?

<p>Aberrant fraenal attachments (B)</p> Signup and view all the answers

Which of the following factors can make it difficult to maintain oral hygiene?

<p>High fraenal attachments (C)</p> Signup and view all the answers

What type of damage can contribute to localised periodontal problems?

<p>Iatrogenic damage from treatments (D)</p> Signup and view all the answers

Which area is most likely to show generalised recession due to gingival issues?

<p>All surfaces of teeth (C)</p> Signup and view all the answers

What is a common cause of gingival recession associated with tooth loss?

<p>Periodontal disease (B)</p> Signup and view all the answers

What negative outcome can occur due to gingival recession?

<p>Dentine hypersensitivity (B)</p> Signup and view all the answers

Which structure is described as the highest point of the gingival margin around a tooth?

<p>Gingival zenith (A)</p> Signup and view all the answers

According to studies, where is the average gingival zenith position relative to the midline on central incisors?

<p>1 mm distal (B)</p> Signup and view all the answers

Which factors contribute to poor aesthetics in gingival biotypes?

<p>Recession and connective tissue loss (B)</p> Signup and view all the answers

What might be a treatment approach to address gingival recession and patient's aesthetic concerns?

<p>Understanding the gingival zenith position (A)</p> Signup and view all the answers

What should be considered when treating sensitivity caused by gingival recession?

<p>Longer contact time with toothpaste agents (B)</p> Signup and view all the answers

What can be a result of inadequate management of gingival recession?

<p>Exacerbation of sensitivity and further recession (B)</p> Signup and view all the answers

What is the primary concern addressed by careful placement of a composite restoration?

<p>Addressing sensitivity and aesthetics (C)</p> Signup and view all the answers

Which of the following treatment options is NOT mentioned as a non-surgical option for treating recession?

<p>Composite veneer (B)</p> Signup and view all the answers

Which of the following statements about desensitizing agents is CORRECT based on the text?

<p>Desensitizing agents work by occluding dentinal tubules. (C)</p> Signup and view all the answers

What is the main reason why careful placement of composite restoration is crucial regarding plaque retention?

<p>To prevent the formation of plaque-retentive margins. (B)</p> Signup and view all the answers

Which of the following is NOT a possible reason why surgical treatment might not be suitable for a patient with gingival recession?

<p>Lack of available surgeons (C)</p> Signup and view all the answers

Based on the text, what is the most accurate conclusion about the effectiveness of various treatment modalities for dentine hypersensitivity?

<p>The effectiveness of different treatment modalities for dentine hypersensitivity is not definitively established. (A)</p> Signup and view all the answers

Which of the following treatment options is LEAST likely to be considered for a patient with a high concern for aesthetics?

<p>Surgery (B)</p> Signup and view all the answers

What is the main reason behind the suggestion that the evidence for strontium or potassium containing desensitizing agents is weak?

<p>There is limited scientific evidence to support their effectiveness. (D)</p> Signup and view all the answers

Flashcards

Gingival recession

The loss of gum tissue resulting in exposure of tooth roots.

Aetiology of gingival recession

The study of factors causing gingival recession, including inflammation.

Non-surgical treatments

Methods to manage gingival recession without surgery, focusing on aesthetics and sensitivity.

Indirect factors

External influences like inflammation leading to gingival recession.

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Dentine hypersensitivity

Pain or discomfort in teeth due to exposed dentin.

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Aesthetic concerns

Patient worries about the appearance of receding gums.

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Surgical treatment options

Procedures aimed at correcting localized defects in gum tissue.

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Mechanical influences

Direct physical forces affecting gum tissue resulting in recession.

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Class II Division 1

A classification of malocclusion where upper incisors are protruded.

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Alveolar dehiscence

A condition where there is a lack of bone over the tooth root, leading to recession.

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Thin gingival biotype

A type of gum tissue that is less resistant to recession due to its thickness.

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Aberrant frena

Unusual frenal attachments that can affect gum positioning.

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Signs of recession

Indicators of gum recession include visible tooth roots and gingival margin migration.

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Iatrogenic damage

Harm caused by medical or dental treatments that can lead to recession.

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Plaque trap

Areas where plaque accumulates due to poor fitting of restorations.

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Oral hygiene difficulties

Challenges in maintaining clean gums due to anatomical issues.

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Akerly Classification

Classifies traumatic incisal relationships into four classes based on incisor impingement.

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Class I Akerly

Mandibular incisors impinge on the palatal mucosa.

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Class II Akerly Div 1

Mandibular incisors on palatal gingival margin of maxillary incisors.

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Class II Akerly Div 2

Mandibular incisors on palatal margin, maxillary incisors on labial margin of mandibular incisors.

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Class III Akerly

Mandibular incisors touch palatal margin; maxillary incisors touch labial margin of mand. incisors.

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Mechanical Factors

Direct influences causing apical migration of gingival tissues.

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Right-Handed Brushing

Most right-handed individuals brush the left side first, increasing recession likelihood.

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Free Gingival Tissue

The thin and delicate tissue surrounding teeth that can affect aesthetics and health.

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Connective Tissue

A type of tissue that supports, binds, or separates other tissues and organs in the body.

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Gingival Zenith

The highest point of the gingival margin around a tooth, important for aesthetics.

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Cervical Lesions

Dental issues at the cervical area, often leading to cavities or sensitivity.

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Periodontal Disease

A disease affecting the supporting structures of teeth, often leading to recession and tooth loss.

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Tooth Sensitivity

Pain or discomfort in teeth when exposed to certain stimuli (hot, cold, or sweet).

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Dentine hypersensitivity treatment

Methods to stop pain caused by exposed dentin.

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Zenith position

The ideal peak of a tooth's contour in aesthetics.

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Symmetry in aesthetics

The balance of tooth shape and position that impacts smile appearance.

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Composite resin use

Material used to cover defects and improve aesthetics.

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Dentine tubules

Small channels in dentin that can lead to sensitivity when exposed.

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Root surface coverage products

Materials designed to block dentin exposure and sensitivity.

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Black triangles

Spaces between teeth that can appear due to gum recession.

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Interproximal bone loss

Loss of bone between teeth typically seen with periodontal disease.

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Desensitising agents

Products designed to alleviate tooth sensitivity by stabilizing nerves.

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Composite restoration

A dental procedure using a tooth-colored material to restore the shape and function of a tooth.

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Dentine bonding agents

Substances that help seal and protect exposed dentin in teeth.

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Pink porcelain veneers

Cosmetic dental coverings that match the color of gums to restore aesthetics.

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Removable gingival veneers

Temporary dental appliances that cover receding gums to improve appearance.

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Surgery for recession defects

Procedures aiming to repair gum tissue loss due to recession.

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Monitoring and prevention

Ongoing assessment to prevent further gum recession or sensitivity.

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Toothpaste for sensitivity

Special formulas designed to reduce pain from sensitive teeth.

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Study Notes

Gingival Recession: Aetiology and Non-Surgical Management

  • Gingival recession is the displacement of the gingival tissue margin apically to the cemento-enamel junction, exposing the root surface.
  • Prevalence increases with age, and can occur in patients with good or poor oral hygiene and periodontal health.
  • Recession can be due to direct mechanical/physical factors or indirectly from an inflammatory response.
  • Direct mechanical/physical factors include vigorous tooth brushing (especially with hard-bristled toothbrushes), traumatic incisal relationships (Akerly classes II and III), trauma from foreign bodies (e.g., piercings), and teeth that are prominent or misaligned (leading to alveolar dehiscence).
  • Traumatic incisal relationships can cause gingival tissue stripping. Akerly described four classes. Class II and III relationships can lead to localized recession of upper anterior teeth (palatal) or lower anterior teeth (labial).
  • Inflammatory factors include gingival biotype (thin biotypes are more susceptible), periodontal disease leading to bone loss, poor marginal fit of restorations, inadequate crown emergence angles, rough surfaces or overhangs of restorations leading to plaque traps - thus causing inflammation and apical migration of the soft tissue margin.
  • Poor oral hygiene, high frenum attachments, iatrogenic damage from restorative or periodontal interventions, and orthodontic movement (especially labial) of teeth can cause gingival recession.
  • Patient complaints include sensitivity (dentine hypersensitivity) and aesthetic concerns, including uneven gingival zeniths, visibility of black triangles, and poor spacing between teeth.

Non-Surgical Treatment Options

  • Monitoring and prevention of further recession (in cases with minimal defects).
  • Desensitizing agents, varnishes, and dentine bonding agents can treat dentin hypersensitivity.
  • Composite restorations can address small localized defects, and closing "black triangles" caused by recession.
  • Pink porcelain or composite restorations can be utilized in extensive recession to replace lost tissue. Careful placement is important to avoid new plaque build-up.
  • Removable gingival veneers (made from heat cured acrylic or silicone) can restore large volumes of recession and spacing. These veneers can create esthetic symmetry.
  • Orthodontic intervention may be used in some cases to alter tooth position to improve alveolar bone growth and prevent or reverse recession. Can be combined with other techniques.

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