Gum recession/grafting

[bsg61]

I am 49, female and recently found out I had severe gum recession (5mm) on about 4 lower teeth and less recession (but still reportedly significant) on 4 other teeth (lower and upper).

I never noticed it as I never had symptoms and never inspected my gums. I went for cleanings for years every 6 months, later in life around every 8 months, and I did not go at all in 2009. The recession was pointed out to me by a new hygienist at the dental practice I went to for 20 years. I feel I received substandard care until this new hygienist came along. I do not have insurance.

I consulted a periodontist in private practice who advised I need subepithelial connective tissue grafts on about 8 teeth. When I asked him if the surgery was elective, he said no, if this was only for esthetic reasons would it be elective. He was adamant that I *need* this surgery.
I realized I was brushing the wrong way and (ouch) unconsciously biting down on the toothbrush. I was woefully ignorant about proper dental hygiene although I did floss most nights. I did brush at least twice a day but I think for only about 45 seconds. I was told by my prior dentist that my teeth point lingually which may have caused the root to pull through the gum, and also I have genetically thin tissue...and a history of orthodonture. My teeth always looked good when I looked in the mirror and I never had any symptoms.

If I have all the grafts this perio is recommending, the cost will be $5,000.00 not to mention the pain and aggravation.

This perio is convinced the recession will get worse and I will be setting myself up for future problems if I don't do it. Now that I am aware of it I will admit that it feels uncomfortable as the gums have that "rolled" texture. I have occasional transient sensitivity.

I have read conflicting opinions on the need for this procedure and my original dentist said that he has seen people have it done, and then in a few years they have to have it done again. Can my palate afford that MUCH donor tissue over and over again?

What is the worst case scenario if I just step up my oral hygiene routine, brush very gently being sure to remove the plaque from the recessed areas and live with the recession and NOT go through with this surgery?

 

[irbrenda]

What is the worst case scenario if I just step up my oral hygiene routine, brush very gently being sure to remove the plaque from the recessed areas and live with the recession and NOT go through with this surgery?

I was told the same thing by my dentist due to normal aging gum recession. Told me to go see a periodontist who would possibly do grafting, etc. I flipped. I never had problems with my mouth, and didn't care to start having any in the future. So, I asked the same question: what if I step up my dental care and he sort of shrugged his shoulders and said, "If that's what you want to do, we can try that."

Long story short: It's been 3 years since I was told to see a perio and I have been religiously having cleanings every 3 months besides stepping up care at home myself. Dental hygienist is pleased all the time and says I'm looking good!

I have not had any issues at all other than a root canal for the first time last week that I caused to happen myself!

I avoid extra dentist/doctor suggestions of all kinds and just go on living. If and when the time comes, then I seek out a higher up.

I would try the stepped up suggestion first before pursuing gum torture!

 

[Corky]

I was told the same thing by my dentist due to normal aging gum recession. Told me to go see a periodontist who would possibly do grafting, etc. I flipped. I never had problems with my mouth, and didn't care to start having any in the future. So, I asked the same question: what if I step up my dental care and he sort of shrugged his shoulders and said, "If that's what you want to do, we can try that."

Long story short: It's been 3 years since I was told to see a perio and I have been religiously having cleanings every 3 months besides stepping up care at home myself. Dental hygienist is pleased all the time and says I'm looking good!

I have not had any issues at all other than a root canal for the first time last week that I caused to happen myself!

I avoid extra dentist/doctor suggestions of all kinds and just go on living. If and when the time comes, then I seek out a higher up.

I would try the stepped up suggestion first before pursuing gum torture!

I had more or less the same the other day but without the suggestion of gum grafting. I felt not worth it for 12 and 2 bits teeth.

You get to an age and learn where the old saying "Getting long in the tooth comes from" LOL.

Me, I am actually looking forward to the day when I have teeth like stars - come out at night.

Seriously, though at the end of the day, it should be what YOU want. Maybe stepping up your regime might help. I've got the same problem and that's what I'm going to try too while looking for a good dentist who will take into consideration what I want and at least meet me half-way.

 

[bsg61]

Thanks for your replies.

Since I've stepped up my oral hygiene regimen and I'm paying extra attention to those teeth, and gently brushing CORRECTly for 2 minutes now, I am noticing that I have increased sensitivity on those 4 lower teeth. I don't know if it's just because I am aware there is a problem there now which makes me hypersensitive or maybe because the roots are exposed and I'm brushing those areas, it is causing more sensitivity.

My anxiety about this is still present. I do fear it will get worse but all the research I've done on grafting says it doesn't do much and the healing time is pretty significant. The connective tissue grafts (which my perio proposed) are not nearly as bad as the free gingival grafts which from what I've read, are pretty horrific.

I had an appointment for the graft last week but I rescheduled for the day after Labor day as I just wasn't ready to go through with it AND drop $1250.00 for the first graft.....when I don't have significant symptoms. It's hard to know who to believe and it does get expensive to keep going for different opinions...not to mention the confusion from too many opinions.

BTW... irbrenda my original dentist told me that gum recession is not always just age-related, some people do not get it as they age and others who are fairly young, like me, do get it. irbrenda, do you know how many mm your recession was?

 

[bsg61]

I was hoping for a dentist to weigh in here. I have been reading that gum grafts often can not "take" and I just don't know if is it worth the pain, aggravation and expense.

Also, can an electric toothbrush (e.g. Sonicare) help or can this make recession worse? I'm worried about using an electric toothbrush on the exposed roots of the teeth as I'm afraid I'll cause abrasion or further gum recession.

 

[brit]

Wow bsg61
I've waited 3 years for someone to ask this. I have severe recession in a couple of places only but have been deemed stable for 11 years by more than one dentist/hygienist.
The ironic thing is if my much trusted general dentist suggested I saw a perio and went graft route I'd be more than willing to do it. Unless I'm a lost cause who knows?
However it seems it's ok to leave it in most cases (because grafting doesn't always work so one dentist told me) so long as you can stabilise the position. I'm not in UK but the UK NHS seems to regard mild recession as normal in anyone over 40 and so don't seem to treat it beyond advising you to use sensitive toothpaste. Of course if you don't stabilise it, it eventually could lead to premature tooth loss.

I always had reasonable oral hygiene (even overbrushed at times) but I keep it stable by flossing daily, brushing gently with a rotary electric (definitely better than normal toothbrush) morning and night, having regular check ups and seeing the hygienist for a basic clean every 6 months. I also use a high flouride toothpaste once a day to help with the sensitivity in the exposed areas. It's worked so far...I think if I were you and I had the luxury of recession being at an early stage (such as you see being fixed on periodontist's websites) I'd try out just one graft as an experiment.

I would also look into the gentler methods using lasers and LANAP deep cleans etc......if you are not yourself convinced of the need then by all means wait and see.
Also take the fear of pain out of the equation by finding a perio with TheWand or similar so the palatal injections aren't a reason to decline lol.

I'd also like the dentists to chime in myself. When do UK dentists refer to periodontists?
I also felt let down by previous UK NHS and private care from dentist alone on cleanings/recession...it does have a genetic component as well and is not just down to scrupulous dental hygiene as some people would have you believe, although that is obviously also important. It was the second private dentist I saw in UK who got me into stabilisation mode and he had a separate hygienist. The first one had done cleanings himself. But even he never mentioned perio...but was very keen to stabilise position.

 

[brit]

I was hoping for a dentist to weigh in here. I have been reading that gum grafts often can not "take" and I just don't know if is it worth the pain, aggravation and expense.

Also, can an electric toothbrush (e.g. Sonicare) help or can this make recession worse? I'm worried about using an electric toothbrush on the exposed roots of the teeth as I'm afraid I'll cause abrasion or further gum recession.

I found Sonicare too severe when I tried someone else's- I still use rotary oral B with the sensitive heads.

 

[bsg61]

Thank you for your reply. My recession is also severe - 5mm on about 4 teeth - and less on other teeth. I had an unfortunately unconscious habit of biting down on my toothbrush which I am sure did not help matters. My hygienist never said a word about ANYTHING for 20 years - no coaching, no warning about recession, no instruction about toothbrushing, etc. She only offered advice when asked and I never thought I had a problem. I never once heard the word "recession" at this dental practice and I thought it was something that only happened to very elderly people.

I don't trust the dentist from this practice I visited for 20 years as when I complained about not ever being alerted to this recession (which happens gradually over the course of many years) until it was severe, he said "we must have missed it" and "you never wanted to spend any money" (I did not have insurance).

Actually, tooth loss from recession alone is extremely rare. Tooth loss from advanced periodontitis is another matter. I do have gingivitis but I am hoping to reverse it and will do anything within my power to keep it from progressing.

I don't believe I am a candidate for LANAP as I do not have "pockets" - mine are normal at this point.

I have received dental opinions online that advise against the connective graft surgery for the reasons I mentioned: doesn't always work, tissue from the graft eventually recedes back down in time, does not correct existing bone loss, is often considered more cosmetic than dentally necessary.

Thanks for your suggestion about the OralB rotary brush...

Wow bsg61
I've waited 3 years for someone to ask this. I have severe recession in a couple of places only but have been deemed stable for 11 years by more than one dentist/hygienist.
The ironic thing is if my much trusted general dentist suggested I saw a perio and went graft route I'd be more than willing to do it. Unless I'm a lost cause who knows?
However it seems it's ok to leave it in most cases (because grafting doesn't always work so one dentist told me) so long as you can stabilise the position. I'm not in UK but the UK NHS seems to regard mild recession as normal in anyone over 40 and so don't seem to treat it beyond advising you to use sensitive toothpaste. Of course if you don't stabilise it, it eventually could lead to premature tooth loss.

I always had reasonable oral hygiene (even overbrushed at times) but I keep it stable by flossing daily, brushing gently with a rotary electric (definitely better than normal toothbrush) morning and night, having regular check ups and seeing the hygienist for a basic clean every 6 months. I also use a high flouride toothpaste once a day to help with the sensitivity in the exposed areas. It's worked so far...I think if I were you and I had the luxury of recession being at an early stage (such as you see being fixed on periodontist's websites) I'd try out just one graft as an experiment.

I would also look into the gentler methods using lasers and LANAP deep cleans etc......if you are not yourself convinced of the need then by all means wait and see.
Also take the fear of pain out of the equation by finding a perio with TheWand or similar so the palatal injections aren't a reason to decline lol.

I'd also like the dentists to chime in myself. When do UK dentists refer to periodontists?
I also felt let down by previous UK NHS and private care from dentist alone on cleanings/recession...it does have a genetic component as well and is not just down to scrupulous dental hygiene as some people would have you believe, although that is obviously also important. It was the second private dentist I saw in UK who got me into stabilisation mode and he had a separate hygienist. The first one had done cleanings himself. But even he never mentioned perio...but was very keen to stabilise position.