Podcast
Questions and Answers
What is the primary factor that must be maintained while measuring recession at the Cement Enamel Junction (CEJ)?
What is the primary factor that must be maintained while measuring recession at the Cement Enamel Junction (CEJ)?
How is Loss of Attachment (LOA) quantified?
How is Loss of Attachment (LOA) quantified?
What should be done immediately after noting recession in a patient?
What should be done immediately after noting recession in a patient?
Which term is NOT synonymous with Loss of Attachment (LOA)?
Which term is NOT synonymous with Loss of Attachment (LOA)?
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In Miller’s Classification of Recession, which aspect is primarily focused on?
In Miller’s Classification of Recession, which aspect is primarily focused on?
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What is the primary purpose of applying a gingival veneer in patients with advanced and generalized recession?
What is the primary purpose of applying a gingival veneer in patients with advanced and generalized recession?
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Why is case selection considered vital when recommending composite restorations?
Why is case selection considered vital when recommending composite restorations?
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Which approach should be taken to manage gingival recession without any immediate intervention?
Which approach should be taken to manage gingival recession without any immediate intervention?
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What additional recommendations should be provided to patients experiencing tooth sensitivity?
What additional recommendations should be provided to patients experiencing tooth sensitivity?
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What role does the coaching of tooth brushing technique play in the management of gingival recession?
What role does the coaching of tooth brushing technique play in the management of gingival recession?
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What is a significant consequence of poor marginal fit of restorations?
What is a significant consequence of poor marginal fit of restorations?
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What effect does smoking have on periodontal health?
What effect does smoking have on periodontal health?
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Which of the following is a result of orthodontic movement in patients with thin biotypes?
Which of the following is a result of orthodontic movement in patients with thin biotypes?
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What is a potential aesthetic concern related to gingival recession?
What is a potential aesthetic concern related to gingival recession?
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How is dentine hypersensitivity related to gingival recession?
How is dentine hypersensitivity related to gingival recession?
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What risk is increased due to exposed root surfaces from gingival recession?
What risk is increased due to exposed root surfaces from gingival recession?
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What is a potential consequence of gingival recession affecting food intake?
What is a potential consequence of gingival recession affecting food intake?
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What can hyperaemia of the pulp result from in terms of dental issues?
What can hyperaemia of the pulp result from in terms of dental issues?
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What is the relationship described when lower incisors impact palatally of the upper incisors?
What is the relationship described when lower incisors impact palatally of the upper incisors?
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Which of the following factors is associated with localized periodontal issues due to marked frenal attachments?
Which of the following factors is associated with localized periodontal issues due to marked frenal attachments?
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What should patients be warned about when undergoing treatment for periodontal disease?
What should patients be warned about when undergoing treatment for periodontal disease?
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Which gingival biotype is characterized by delicate, translucent tissue and minimal attached gingiva?
Which gingival biotype is characterized by delicate, translucent tissue and minimal attached gingiva?
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What sign is commonly associated with periodontal disease concerning the gingival margin?
What sign is commonly associated with periodontal disease concerning the gingival margin?
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Which of the following is NOT considered an aetiological factor behind recession?
Which of the following is NOT considered an aetiological factor behind recession?
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How can smoking contribute to periodontal issues?
How can smoking contribute to periodontal issues?
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Which of the following statements is true regarding the effects of orthodontic tooth movement?
Which of the following statements is true regarding the effects of orthodontic tooth movement?
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What is one consequence of food stagnation in dental hygiene?
What is one consequence of food stagnation in dental hygiene?
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Which type of trauma is associated with recession due to toothbrush usage?
Which type of trauma is associated with recession due to toothbrush usage?
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Which of the following is considered an iatrogenic factor in tooth recession?
Which of the following is considered an iatrogenic factor in tooth recession?
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What is the role of a dental professional in managing traumatic recession?
What is the role of a dental professional in managing traumatic recession?
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What should be measured to monitor gingival recession effectively?
What should be measured to monitor gingival recession effectively?
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Which factor is NOT typically associated with recession due to poor oral hygiene?
Which factor is NOT typically associated with recession due to poor oral hygiene?
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How does the shape of the gingival biotype relate to recession?
How does the shape of the gingival biotype relate to recession?
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What should be done when educating patients about the risks of recession?
What should be done when educating patients about the risks of recession?
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What is the primary purpose of monitoring gingival recession in patients?
What is the primary purpose of monitoring gingival recession in patients?
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Which factors are most commonly associated with gingival recession (GR)?
Which factors are most commonly associated with gingival recession (GR)?
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What is required for successful gingival graft surgery?
What is required for successful gingival graft surgery?
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What is NOT a consideration when performing periodontal surgery?
What is NOT a consideration when performing periodontal surgery?
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Which statement best describes the general population at risk for periodontal disease?
Which statement best describes the general population at risk for periodontal disease?
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What is a critical step to take when measuring gingival recession (GR)?
What is a critical step to take when measuring gingival recession (GR)?
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Which treatment modality is commonly used for addressing gingival recession?
Which treatment modality is commonly used for addressing gingival recession?
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What is an important factor for assessing treatment needs for gingival recession?
What is an important factor for assessing treatment needs for gingival recession?
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Study Notes
Gingival Recession
- Gingival recession is the displacement of the gingival margin apically to the cemento-enamel junction, leading to root surface exposure.
Intended Learning Outcomes
- Understand the various factors contributing to gingival recession, including aetiology (causes).
- Recognize the oral health impact on the dental patient due to recession.
- Learn methods for measuring and monitoring recession.
- Identify different treatment options for gingival recession.
Definition
- Gingival recession is the apical displacement of the gingival margin relative to the cemento-enamel junction, exposing the root surface.
Revision of Healthy Gingival Tissues
- Alveolar mucosa, mucogingival junction, attached gingiva, free gingiva, interdental papilla, and stippling are parts of healthy gingival tissue
- Free gingiva + Attached gingiva = Keratinized Tissue (KT)
Clinical Appearance
- Determine if gingival recession is localized or generalized.
Recession
- Usually, recession is confined to one aspect (labial or buccal) of a tooth.
- Recession doesn't automatically compromise periodontal support.
- Underlying causes of recession need to be considered.
Causative Factors of Gingival Recession
- Mechanical factors (e.g., toothbrush trauma, traumatic incisor relationship, trauma from foreign bodies, abnormal frenum attachment, iatrogenic damage)
- Inflammatory factors (e.g., gingival biotype, periodontal disease, smoking, poor marginal fit of restorations, orthodontic tooth movement).
Mechanical Factors
- Toothbrush trauma (aggressive brushing technique, inappropriate oral hygiene aids)
- Traumatic incisor relationship (lower incisors impacting the upper incisors)
- Trauma from foreign bodies (e.g., lip or tongue studs)
- Abnormal frenum attachment (apical pull on gingival tissues, hindering oral hygiene)
- Iatrogenic damage (damage during dental procedures)
Toothbrush Trauma
- Prolonged aggressive brushing technique is a major cause
- Often coupled with improper oral hygiene aids
Trauma from Foreign Bodies
- Examples include lower lip studs and tongue studs
Traumatic Incisal Relationship
- The bite is characterized by lower incisors impacting palatally against the upper incisors
Abnormal Frenum Attachments
- A pronounced frenum attachment can exert an apical pull on the gingival tissues, making oral hygiene difficult, and leading to localized periodontal issues and recession.
Iatrogenic Damage
- A known risk relating to successful periodontal treatment
- Patients should be cautioned about the effects of recession during periodontal treatments
Inflammatory Factors
- Gingival biotype (delicate, translucent tissue is more susceptible)
- Periodontal disease (apical migration of the gingival margin)
- Smoking (affects periodontal status, increasing susceptibility to periodontal disease)
- Poor marginal fit of restorations (low-grade irritant, subgingival margins)
- Orthodontic tooth movement (accelerated movement)
Gingival Biotype
- Delicate and almost translucent appearance.
- Minimal attached gingiva.
- Friable tissue.
Periodontal Disease
- Apical migration of the gingival margin is a common indicator.
Smoking
- Smoking has a detrimental impact on periodontal health and increases susceptibility to periodontal disease.
Poor Marginal Fit of Restorations
- Low-grade irritant from sub-gingival margins can impinge on the biologic width.
- Potential for plaque stagnation.
- Contributing factor for recession in susceptible patients.
Orthodontic Movement
- Tooth movement may cause gingival recession, especially in thin tissue biotypes during rapid orthodontic procedures in adults.
Impact of Gingival Recession on the Patient
- Dentine hypersensitivity
- Aesthetic concerns
- Root caries
- Food trapping
- Plaque stagnation
- Difficulty with comfort (e.g., eating)
Dentine Hypersensitivity
- Recession exposes dentine.
- Hyperaemia of pulp may also result.
Aesthetic Considerations
- Risk of poor aesthetics.
- Black triangles.
Root Caries
- Exposed root surface is less mineralised and more susceptible to caries than enamel
Plaque Stagnation and Food Trapping
- Poor oral hygiene can lead to food and plaque stagnation in recessed areas.
- Recommending appropriate oral hygiene aids is important.
Summary of Causative Factors
- Provide descriptions of each causative factor.
- Explain how they cause recession.
- Explain the consequences of recession and related risks
Measuring and Monitoring Recession
- Measure distance from the cemento-enamel junction (CEJ) to the gingival margin.
- Ensure the probe is held parallel to the long axis of the tooth.
- Use a probe with clear markings
Loss of Attachment (LOA)
- Combined effect of recession and probing depth.
- Sometimes referred to as clinical loss of attachment (CLOA) or clinical attachment loss (CAL).
Recession in the Patient
- Steps to identifying, monitoring, and treating recession:
- Refer patient.
- Inform patient
- Monitor.
- Identify underlying cause.
- Treat as needed.
- Measure and record the recession.
- Educate the patient.
Miller's Classification of Recession
- Different classifications based on extent of recession: Class I, II, III, IV
- Descriptions for each class include the location of recession relative to the mucogingival junction, and the loss (or absence of loss) of interdental bone or soft tissue.
Management of Gingival Recession
- Patient education
- Monitoring
- Reduction of habitual factors
- Periodontal stabilisation
- Do nothing and stabilize (treatments may be used)
Advice to Patient
- Tooth brushing technique coaching with appropriate oral hygiene aids.
- Recommending appropriate adjuncts for sensitivity (e.g., desensitizing agents).
- Habitual advice.
Treatment Modalities for Clinical Symptoms
- Periodontal treatment.
- Desensitizing agents.
- Gingival veneers.
- Composite restorations.
- Referral for surgical intervention
Gingival Veneer
- Removable acrylic facing that improves aesthetics for advanced/generalized recession cases.
- Case selection is crucial.
Restorations
- Composite restorations to protect exposed dentin (especially in cervical regions), which is sensitive and prone to caries.
- Case selection is crucial.
Gingival Graft Surgery
- Complex periodontal surgery procedure.
- Involves transplanting palatal gingival tissue to the affected site.
Monitoring Gingival Recession
- Record all recession points.
- Monitor and respond to treatment needs accordingly.
- Refer to specialist as necessary.
Summary Revision Slide
- Include a summary of gingival recession definitions.
- Discuss measurement of recession/loss of attachment (LOA).
- Include descriptions of all causative factors (mechanical and inflammatory).
- Discuss the impact on the patient.
- Discuss treatment modalities.
References
- The references provided are related to treatment recommendations, studies regarding gingival recession, along with other related topics in periodontics. Each reference is associated with a research study or publication supporting the study conclusions.
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Description
This quiz covers the essential aspects of gingival recession, including its definition, causes, and clinical implications. Participants will learn about the impact of recession on oral health and explore various treatment options. Test your knowledge on how to measure and monitor gingival condition.
