Gum recession: causes, treatment and what to do next

Gum recession is the gum tissue pulling back from the tooth, exposing more of the tooth and eventually the root surface.

The most important thing to understand: gum tissue that has receded does not grow back on its own. Treatment is about stopping it progressing, managing the consequences, and sometimes surgically covering what has been lost. That is why acting early matters more here than in most dental problems.

What you might notice

• Sensitivity to cold, sweet things, or brushing — usually the first sign. Root surface is not covered by enamel and is far more sensitive
• Teeth that look longer than they used to
• A notch or step you can feel at the gumline
• A visible colour change where the enamel ends and the root begins
• Gaps opening between teeth near the gum
• A tooth feeling loose — see us promptly

Recession is gradual, so it often goes unnoticed until sensitivity starts. Comparing an old photograph sometimes makes it obvious.

Causes

Gum disease (periodontitis) — the most common cause, and the most important to identify. Here recession is a symptom of active disease destroying the supporting bone. This one needs treatment, not just monitoring.

Brushing too hard, or with a firm brush — the second most common, and entirely preventable. Typically produces neat notches at the gumline, often worse on the side opposite your writing hand. People who brush conscientiously are the ones who tend to do this.

Grinding or clenching, which loads teeth in ways they are not designed for.

Tooth position — teeth sitting outside the arch have thin bone over the root to begin with.

Orthodontic movement, where teeth have been moved beyond the available bone.

Thin gum tissue, which is largely inherited.

Smoking, and lip or tongue piercings rubbing on the gum.

Trauma, including from habits like fingernail or pen chewing.

Establishing which of these applies to you is the point of the examination — because the treatment for gum disease and the treatment for over-brushing are entirely different.

Telling them apart

Noticeably, gums that are firm and pale pink with recession are usually telling you the problem is mechanical, not infective. Gums that are red, puffy and bleed are telling you the opposite.

Is it stable, or getting worse?

This is the question that actually determines what happens next, and it cannot be answered from a single appointment.

At an examination we record the recession in millimetres at each site, along with the pocket depth beside it. Those two numbers together tell us whether the tooth is losing attachment or simply has a gum that sits lower than it once did. Repeating the measurement at a later visit turns a snapshot into a trend.

Recession that has been 2mm for five years and is causing no sensitivity generally needs nothing but continued monitoring. Recession that has moved 2mm in twelve months needs the cause found and stopped.

This is why the measurements are worth having recorded even when nothing needs treating today.

Why it matters beyond appearance

Root decay. Exposed root surface is softer than enamel and decays faster. This is a particular risk if you also have a dry mouth.

Sensitivity, which can be persistent and genuinely limits what people can eat and drink.

Progression. Recession from untreated periodontitis continues, and bone lost is not recoverable.

Notching (abrasion) at the gumline, which weakens the tooth over time.

Cleaning becomes harder. Exposed root surfaces and the spaces that open between them need interdental brushes rather than floss alone, and plaque left there accelerates everything above.

Treatment

First, identify and stop the cause. Then, depending on what is found:

Technique change — if over-brushing is the cause, switching to a soft or extra-soft brush and brushing gently often stops progression entirely. An electric brush with a pressure sensor helps people who cannot judge it.

Periodontal treatment where gum disease is driving it — deep cleaning below the gumline, then ongoing maintenance. See gum care and periodontics.

Desensitising treatment — fluoride varnish, desensitising agents, or sensitivity toothpaste used consistently over a few weeks.

Composite bonding to cover exposed root surface or fill a notch, reducing sensitivity and protecting the tooth.

A splint if grinding is a factor.

Gum grafting, where tissue is taken from elsewhere or a graft material is used to cover the exposed root. This is a surgical procedure carried out by a registered periodontist, and we refer for it. It is the only way to genuinely restore lost gum, and it is not appropriate or necessary in every case — many people do perfectly well managing sensitivity and stopping progression.

Dealing with the sensitivity

Most people who come in about recession are really coming in about sensitivity. It usually responds, but it takes persistence rather than a single product.

1. Use a sensitivity toothpaste properly. Brush with it, spit, and do not rinse. Smearing a little onto the sensitive area with a fingertip at bedtime and leaving it works better than brushing alone. Give it two to four weeks before judging.
2. Stop the acid erosion. Sparkling water, citrus, wine, sports drinks and reflux all strip the surface faster than it can recover. Rinse with plain water afterwards and wait half an hour before brushing.
3. Change the brush, and check the technique. Splayed bristles within a month is the giveaway.
4. In-chair treatment — fluoride varnish or a desensitising agent applied directly, repeated over a few visits.
5. Seal it. Where a notch or exposed root persists in being sensitive, bonding a thin layer of composite over it is quick, comfortable and usually decisive.

If sensitivity is severe, keeps you awake, or lingers well after the cold has gone, that is a different problem from recession sensitivity and needs assessing — see toothache.

If grafting is being considered

What it is for: covering an exposed root, reducing sensitivity, improving appearance, and adding thicker tissue where there is very little left to lose.

What it involves: a periodontist takes tissue from the palate or uses a graft material, and secures it over the exposed root. It is done under local anaesthetic, takes an hour or so, and is followed by a week or two of taking it gently — soft food, no brushing the site, and a prescribed rinse instead. The palate, where tissue has been taken, is usually the part people notice most.

What it will not do: reverse bone loss from periodontitis, or work reliably where the bone and tissue between the teeth have already been lost. A periodontist assesses that before recommending it, and will say when a site is not a good candidate.

Preventing further recession

• Soft or extra-soft brush, gently. If your bristles splay within a few weeks, you are pressing too hard
• Angle the brush at 45 degrees into the gumline rather than scrubbing across it
• Clean between your teeth daily — gum disease starts where the brush cannot reach
• Do not brush straight after acidic food or drink; wait about 30 minutes
• Keep up your check-ups so changes are measured rather than guessed at
• Stop smoking
• Mention grinding, or a piercing that rubs

When to book

Book an appointment if you have noticed teeth looking longer, new sensitivity, or a notch at the gumline. Book sooner if gums bleed persistently, are red and swollen, or a tooth feels loose or has changed position — those suggest active gum disease rather than simple recession.

At the examination we measure the recession and the gum pockets around each tooth, so there is a baseline to compare against next time. That measurement is what tells us whether it is stable or progressing, and it is worth having recorded even if nothing needs treating today.

We are a general dental practice and hold no specialist registration; surgical gum treatment is referred to a registered periodontist.

Questions we are asked

Will my gums grow back if I brush better? No. Better technique stops it getting worse, which is the realistic and worthwhile goal. Only grafting restores lost tissue.

Is recession just part of getting older? Recession is common with age but is not an inevitable consequence of it. It is usually the accumulated result of one of the causes above, and most of those are modifiable.

Should I switch to an electric toothbrush? For someone who brushes too hard, yes — particularly one with a pressure sensor, which removes the guesswork. The brush matters less than the pressure.

Can whitening make it worse? Whitening does not cause recession, but exposed root surfaces are more sensitive to it and do not lighten the way enamel does. Mention any recession before whitening is planned.

Does a receding gum mean I will lose the tooth? Not on its own. Teeth are lost when the bone support goes, which is what periodontitis does — and that is exactly why establishing the cause is the first step.

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145 · (03) 9088 5808 · Monday to Friday, 8:00am–5:00pm · book online

Read more about gum care and periodontics, bleeding and swollen gums or why teeth become sensitive.

This page is general information and does not replace advice from a registered dental practitioner about your own circumstances. Please see our Disclaimer.