May 2022 Social Commentary
What is one piece of advice you always give patients who present with existing gingival recession?
I explain that most recession is caused by malocclusion and bruxism, and that they need to make sure they are brushing well enough to remove all of the plaque along the gumline—no more tippy-toe brushing!
Not only do I ask about history of orthodontic treatment or bruxism, I ask if they experience sensitivity from cold. I usually recommend a low -abrasive toothpaste for sensitivity and a good toothbrush. I explain how root surfaces are different from enamel and ways they can prevent further wear or recession.
I will question their dental history such as clenching/bruxism, aggressive method of brushing, etc. Explain how clenching can affect their teeth overall. I go over how gingival recession can be addressed with a night guard or orthodontic treatment for malocclusion.
After a few short screening questions, I educate patients about myofunctional disorders and teach proper tongue posture for reducing daytime clenching. Awareness about this helps patients rewire their brains to nasal breathe, which subsequently reduces clenching, as the tongue stimulates the palate and releases serotonin. It takes awhile, but after constantly catching themselves mouth breathing followed by clenching, they slowly retrain the brain! The serotonin released also helps to relax the central nervous system, so overall they won’t feel as compelled to clench due to stress. It brings mindfulness and gives them an action when catching themself clenching during the day.
Brush longer, not harder.
Have you had a periodontist evaluate you for gingival grafts?
Chelsie Groves, BSDH, RDH Dimensions Facebook Commenter
Use a power toothbrush and don’t brush too hard. Brushing should not be “scrubbing” your teeth.
Heather Walker, RDH Dimensions Facebook Commenter
Besides brushing too hard, we evaluate for clenching and grinding. I usually recommend an occlusal appliance.
Ashley A. Jackson, RDH Dimensions Facebook Commenter
Of course there’s so much more to advise but my one piece would be … Be gentle but thorough.
Linda Hirce, RDH Dimensions Facebook Commenter
Occlusion first, then “What toothpaste do you use?”
Erin Haley-Hitz, RDH, BSDH, MS, OM Dimensions Facebook Commenter
I work backwards in my mind trying to find a reason for the recession and dig bit deeper into their medical and dental histories. Is there a history of periodontal therapy or orthodontic treatment? I also look for airway issues, bruxism, abfractions, tethered tissues, etc. I also evaluate patients’ self-care routines by inquiring in a positive way. That way I don’t blame or shame them for anything that may have contributed to the recession. I work to get to the “why.” I find many patients clench and grind, are unable to nasal breathe, or simply don’t know how to nasal breathe. Teaching them some easy biofeedback techniques to break cycles of bruxism or clenching during waking hours and exactly how to nasal breathe are helpful. Managing tethered tissues, such as buccal and labial frenums, is also important.
From Dimensions of Dental Hygiene. May 2022; 20(5)12-13.