Getting old often means getting gum recession. But even preretirees are at risk.
About 71% of people in their 50s have some form of receding gums. For ages 80 to 90, the odds go up to 90%.
The real question isn’t whether you’re going to experience gum tissue pulling away from the tooth and exposing the root. The tougher issue is what to do about it.
Your dentist may refer you to a periodontist. It’s unlikely that a periodontist who confirms your gum recession will say, “Oh, it’s nothing. Leave it be. Wait a decade and we’ll go from there.”
It’s far more likely that you’ll hear alarming information about how your receding gums create a nesting area for harmful bacteria to thrive. This can promote decay and other problems that can lead to loss of teeth. You may also hear that once recession starts, it’s hard to predict the rate of decline. (Brace for scary phrases such as “deteriorate rapidly” and “risk of full arch restoration.”)
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The periodontist may propose a gum tissue graft. This procedure aims to cover exposed root and thicken your gum line, thus reducing your risk of gum disease.
In some cases, however, the bone loss that accompanies gum recession can mean that a tissue graft is no longer viable. It’s too late. Then the question arises: If and when the tooth becomes wiggly, should you plan to have it extracted, get a bone graft and top it off with a dental implant and restorative crown?
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None of these options are cheap or enjoyable. A simple tissue graft performed by a periodontist might cost $2,000 to $3,000, although the price can vary widely based on many variables. A dental implant can cost double that—or more—depending on whether you need a bone graft, the level of sedation you want and other factors. And if you get an implant, expect yet another hefty bill from the dentist to screw the restorative crown into place.
We trust medical providers to offer sound advice. With periodontists and oral surgeons, trust boils down to putting faith in them to make cost-effective recommendations that increase our long-term oral health.
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Cynics might wonder whether that trust is warranted. The periodontist recommends grafting while the oral surgeon insists it is too late for gum grafts (due to too much bone loss) and urges a dental implant instead. Each promotes their services. Are they more intent on generating business than giving dispassionate advice?
Patients who ask lots of smart questions—and get clear, convincing answers—gain confidence in their treatment plan.
Sally Cram, DDS, a periodontist in Washington, D.C., advises that you ask, “Why do I have this recession?” It’s a good starting point for learning about your condition and deciding what to do next.
“Treating gum recession without knowing its cause can make the outcome unsuccessful,” said Cram, national spokesperson for the American Dental Association. “Different causes have different solutions.”
She cites two examples:
1) If you have a bad bite—or overcrowded or overlapping teeth—then addressing the recession may involve orthodontics to align your bite.
2) If your recession is caused by periodontal disease, then you may benefit from a deep cleaning procedure in which the periodontist may place an antibiotic under the gum to kill infection-causing bacteria.
Depending on the severity of your gum recession, it may make sense to adopt a term associated with prostate cancer: watchful waiting. If your tooth is not in imminent danger of falling out and you face no other serious oral health threat, perhaps you can wait six months and see if the recession worsens.
Dentists and periodontists measure recession in millimeters and track it over time. Meanwhile, you can discuss proper brushing protocol and oral hygiene tips with your dentist to make sure you are preventing further damage.
If you’re in your 50s and up, you may have experienced unpleasant gum grafting procedures decades ago. It’s not as bad today.
“All around, it’s a much better procedure from a comfort standpoint,” Cram said. “The success rate has improved. It’s upwards of 90-95%.”
Earlier techniques sliced tissue from the palate and sutured it around the teeth. The resulting wound was painful and healed slowly.
I recall with dread getting gum grafts in the 1980s. The periodontist basically took a cheese grater to the roof of my mouth and stitched the tissue to the recession site.
Guess what? It didn’t work. The tissue didn’t adhere and I was left with lots of pain and no gain.
The current approach, called a connective tissue graft, typically involves lifting a flap of skin in the palate, removing tissue under the flap and stitching it to the area around the exposed root. Then the pouch is sutured shut, which avoids an open wound.
Before you agree to this or any procedure, vet your periodontist to ensure you’ve found a technically adept pro. You want someone with experience using the microsurgical tools necessary for connective tissue grafts.
Leena Palomo, DDS, professor and chair of periodontology and implant dentistry at NYU College of Dentistry, suggests that you confirm your periodontist is board-certified with the American Board of Periodontology.
Once you decide to pay for any dental or periodontal procedure, limit your risk factors to increase your odds of success. Nadeem Karimbux, dean of Tufts University School of Dental Medicine, lists red flags that can cause long-term problems:
1) diabetes
2) smoking
3) history of bone loss and gum disease
4) a bad bite (what dentists call malocclusion)
5) a lack of commitment to diligent dental care (i.e., not brushing properly or getting frequent dental cleanings)
To cut costs, check if dental schools in your area accept new patients. In exchange for having dental students work on your case (under the supervision of professors), you’ll save money.
“We’re usually about two-thirds of the cost of what you might pay [for private-practice periodontists],” Karimbux said.
