Gum Recession: Tooth Sensitivity, Causes, and Treatment

What is gum recession and why does it cause sensitivity?

The crown of a tooth — the part visible above the gumline — is covered by enamel, the hardest substance in the body. Below the gumline, the root is covered by cementum, a softer material that is far less resistant to acids, bacteria, or physical wear.

When the gum recedes, the cementum-covered root becomes exposed. Root surfaces contain tiny channels (dentinal tubules) that connect the outer surface to the nerve inside the tooth. Temperature changes, sweet foods, or even air can transmit sensations through these channels, causing the sharp, brief pain of dentinal hypersensitivity 2Ref 2Poulsen S, Errboe M, Lescay Mevil Y, Glenny AM (2006).Potassium containing toothpastes for dentine hypersensitivity.Desensitizing toothpastes (potassium nitrate) for treating dentinal hypersensitivity from exposed root surfaces — support for recommending them as a first-line option..

What causes gum recession?

Periodontal (gum) disease is the most common cause. Bacterial plaque accumulates at the gumline; the resulting infection and inflammation gradually destroy the supporting bone and gum tissue, causing the gums to recede 1Ref 1Smiley CJ, Tracy SL, Abt E, Michalowicz BS, John MT, Gunsolley J, Cobb CM, Rossmann J, Harrel SK, Forrest JL, Hujoel PP, Noraian KW, Greenwell H, Frantsve-Hawley J, Estrich C, Hanson N (2015).Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts.Scaling and root planing as the evidence-based nonsurgical treatment for periodontal disease, which is the primary driver of gum recession and ongoing tissue destruction.. Periodontitis affects over 47% of US adults aged 30 and older 3Ref 3Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ (2012).Prevalence of periodontitis in adults in the United States: 2009 and 2010.Periodontal disease (periodontitis) is the most common cause of gum recession; over 47% of US adults aged ≥30 years have some form of periodontitis..

Aggressive tooth brushing — brushing too hard, or using a hard-bristled toothbrush — physically abrades the gum tissue over time. This is particularly common at the outer surfaces of back teeth.

Thin gum tissue — some people naturally have thinner gum tissue that is more susceptible to recession, regardless of brushing habits.

Tobacco use — smoking and chewing tobacco contribute to gum disease and impair healing.

Teeth grinding (bruxism) — excessive biting forces can contribute to recession, particularly on the facial surfaces of teeth.

Orthodontic treatment — moving teeth outside the normal bony housing can sometimes thin the gum tissue. An orthodontist will monitor for this.

Oral piercings — lip or tongue piercings that repeatedly contact gum tissue can cause localized recession.

How is gum recession treated?

Addressing the underlying cause Treatment always begins by managing the cause. If periodontal disease is present, scaling and root planing removes the bacterial deposits driving ongoing destruction 1Ref 1Smiley CJ, Tracy SL, Abt E, Michalowicz BS, John MT, Gunsolley J, Cobb CM, Rossmann J, Harrel SK, Forrest JL, Hujoel PP, Noraian KW, Greenwell H, Frantsve-Hawley J, Estrich C, Hanson N (2015).Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts.Scaling and root planing as the evidence-based nonsurgical treatment for periodontal disease, which is the primary driver of gum recession and ongoing tissue destruction.. If over-brushing is a factor, switching to a soft-bristled toothbrush and using gentle circular or Bass technique brushing is important.

Desensitizing treatments For sensitivity from exposed roots: - Toothpastes formulated with potassium nitrate or stannous fluoride can reduce sensitivity over time 2Ref 2Poulsen S, Errboe M, Lescay Mevil Y, Glenny AM (2006).Potassium containing toothpastes for dentine hypersensitivity.Desensitizing toothpastes (potassium nitrate) for treating dentinal hypersensitivity from exposed root surfaces — support for recommending them as a first-line option. - Fluoride varnishes or bonding agents applied by a dentist provide a physical barrier over the root surface - Prescription fluoride products both reduce sensitivity and protect against root-surface caries

Connective tissue or gum graft surgery When recession is significant — particularly when little keratinized (firm) gum tissue remains, or when root exposure is causing esthetic concerns or continued susceptibility to decay — a gum graft may be recommended. A periodontist typically takes tissue from the palate (roof of the mouth) or uses donor tissue and grafts it over the exposed root.

Recovery from gum grafting involves a few weeks of dietary restrictions and careful oral hygiene technique. The graft site is initially tender, and patients typically eat soft foods for one to two weeks. Most people resume normal activities within a few days, though the area remains sensitive for a while longer.

What does gum graft recovery feel like?

The first few days after a gum graft are typically the most uncomfortable. Swelling and soreness at both the graft and donor sites are expected. Your periodontist will provide specific instructions, which typically include:

• Eating only soft foods (yogurt, eggs, mashed vegetables, smoothies) for one to two weeks
• Avoiding brushing over the surgical site until cleared by the dentist
• Using a prescribed mouth rinse rather than brushing to keep the area clean
• Taking pain medication as directed (usually ibuprofen or acetaminophen)
• Avoiding strenuous physical activity for a few days

The graft takes several weeks to fully integrate. Follow-up appointments allow the periodontist to monitor healing and gradually return you to normal hygiene at the surgical site.

Can gum recession be reversed without surgery?

Gum tissue that has receded does not grow back on its own. What non-surgical treatment can achieve is:

• Stopping further progression by controlling gum disease and modifying risk factors 1Ref 1Smiley CJ, Tracy SL, Abt E, Michalowicz BS, John MT, Gunsolley J, Cobb CM, Rossmann J, Harrel SK, Forrest JL, Hujoel PP, Noraian KW, Greenwell H, Frantsve-Hawley J, Estrich C, Hanson N (2015).Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts.Scaling and root planing as the evidence-based nonsurgical treatment for periodontal disease, which is the primary driver of gum recession and ongoing tissue destruction.
• Reducing sensitivity through desensitizing products and fluoride 2Ref 2Poulsen S, Errboe M, Lescay Mevil Y, Glenny AM (2006).Potassium containing toothpastes for dentine hypersensitivity.Desensitizing toothpastes (potassium nitrate) for treating dentinal hypersensitivity from exposed root surfaces — support for recommending them as a first-line option.
• Protecting exposed roots from decay with prescription fluoride and regular monitoring

Whether surgery is needed depends on how much tissue remains, the degree of recession, and your individual risk for further loss. A periodontist can advise on whether surgical correction would be beneficial in your specific situation.