Gingival recession: telling brushing trauma from inflammation changes the management

Gingival recession is a frequent finding and its cause is not single, which makes management differ according to origin.

Recession from brushing trauma has recognisable features. It affects buccal surfaces, is most marked on canines and premolars, and the surrounding tissues appear healthy.

It often accompanies cervical abrasion, and the combination of recession and a wedge-shaped notch on the same tooth points with good probability to a mechanical origin.

Inflammatory recession more often affects interproximal surfaces, accompanies bleeding, pockets and attachment loss, and forms part of a generalised periodontal picture.

The distinction changes everything. In the first case brushing technique is corrected and the recession stabilises; in the second the periodontitis is treated, and recession may even increase after therapy as oedema resolves.

Gingival biotype is the predisposing factor. A thin biotype, with delicate gingiva and reduced buccal bone, recedes under stimuli a thick biotype tolerates without consequence.

It is assessed by the transparency of the periodontal probe through the margin: if the probe shows through, the biotype is thin and must be factored into every plan, orthodontic and prosthetic.

Monitoring requires a recorded measurement, not an impression. The distance from the cemento-enamel junction to the gingival margin, noted at every review, shows whether the recession is progressing.

Without that figure, comparison rests on memory, and memory over a single millimetre is not reliable six months later.

Sensitivity is the symptom that brings the patient in, and it is managed with desensitising agents while the cause is corrected. Treating only the symptom lets the recession progress.

The surgical indication is not the recession itself but its documented progression, uncontrollable sensitivity, an aesthetic request in a visible zone, or difficulty cleaning the exposed surface.

A stable, symptomless recession in a non-visible area with good hygiene requires no treatment at all: monitoring it is the correct choice.

In summary: mechanical origin affects buccal surfaces with healthy tissues, inflammatory origin the interproximal ones with periodontitis, a thin biotype predisposes, monitoring requires recorded figures, and surgery is indicated on progression rather than presence.