Gingival recession and sensitivity

• What is the definition of recession?

  location of gingival margin apical to the cemento - enamel junction resulting in exposure of root surface
• What teeth and surfaces are most commonly affected by recession?


  • Canines and premolars
  • Labial and buccal surfaces

  
• What is Millers Classification of Recession?

  magnitude of a receding gumline, commonly referred to as the measurement of gingival recession
• What is Class 1 of Miller's Classification of Recession?

  Class 1 - Marginal tissue recession not extending to the mucogingival junction No loss of interdental bone or soft tissue

  
• What is Class 2 of Miller's Classification of Recession?

  Marginal tissue recession extends to or beyond the mucogingival junctionNo loss of interdental bone or soft tissue

  
• What is Class 3 of Miller's Classification of Recession?

  Marginal tissue recession extends to or beyond the mucogingival junctionLoss of interdental bone or soft tissue is apical to the CEJ but coronal to the apical extent of the marginal tissue recession

  
• What is Class 4 of Miller's Classification of Recession?

  Marginal tissue recession extends to or beyond the mucogingival junction Loss of interdental bone extends to a level apical to the extent of the marginal tissue recession

  
• What is pathogenesis?

  the manner in which a disease develops
• What can cause recession/loss of attachment of the epithelium?

  1. Plaque induced inflammation of the connective tissues
  2. Trauma induced inflammation of the connective tissues
  3. Connective tissue destruction
  4. Proliferation of the epithelium from both sides
  5. Interconnecting cord of epithelium is formed between oral and pocket epithelium Subsidence of the epithelium surface

  
• What is Aetiology?

  the cause, set of causes, or manner of causation of a disease or condition
• What causes pathological bone disease?

  - periodontal disease - periodontal treatment - smoking

  
• What are causes of dental trauma

  • Tooth brushing
  • Fictitious injury e.g. fingernail picking
  • Malocclusion e.g. class 2 div 2 with a traumatic overbite
  • Poorly designed partial denture
  • Chemical trauma e.g. cocaine Lip / tongue stud
• What are local plaque retentive factors?

  Calculus Subgingival restorative margins High muscle attachments Frenal pulls Overhanging restorations
• What is biological width?

  • distance between the base of the sulcus to alveolar bone
  • a minimum dimension of tissues always present above bone
  • attachment loss with disease or surgery, the body will automatically reestablish biological width
  • Restorations "invading the biological width" can cause gingival recession

  
• How does the restoration margin invade the biological width?

  
• What is orthodontic tooth movement?

  Excessive proclination especially when fixed appliances have or are being used
• Thing gingival tissue contributes to anatomical reasons for tooth movement, true or false?

  True
• What are the three basic stages of bone dehiscence?

  • Gingival recession
  • Alveolar bone loss
  • Root exposure
• What are the complications of gingival recession?

  Pain from exposed dentine - "sensitivity" Root caries Tooth abrasion Plaque retention and gingival inflammation Aesthetic concerns
• How is recession managed?

  • monitor, measure, photographs and models
  • management of aetiological factors
  • management of consequences

  
• What is the first step when managing recession?

  Prescription from the dentist obtained History and examination to identify the aetiological factors
• What 4 things do we look at when we first manage recession?

  Monitor by: 1) Study models 2) Record 3) Pictures 4) Measure
• How are aetiological factors managed in recession?

  • Advise on an atraumatic brushing technique or traumatic habits
  • Advice on smoking cessation
  • Plaque control and OHI
  • Remove all local factors e.g. scaling, overhang removal
  • Correct deficient partial denture design Margins of restorations need to be placed supragingival where possible
• How to we manage the consequences of recession?

  • Dentine Hypersensitivity
  • Root caries
  • Aesthetics
  • Mucogingival surgery
• What desensitising agents can we use?

  • Fluoride
  • Potassium salts
  • Strontium
  • Colgate Sensitive
  • Pro-Relief
  • Desensitising Paste
  • Dentine bonding agents
• What fluoride products are available and how does it work?

  • Fluoride occludes the dentinal tubules
  • Duraphat 22,600 ppm
  • F Gel Kam 0.4% stannous fluoride
  • 1000ppm Fluoride Mouthwash
  • Fluoriguard 2,500 ppm
• How do potassium salts work and what products are available?

  Potassium has a direct desensitising effect on the pulpal nerve fibres Sensodyne F Potassium nitrate 5.0% Colgate sensitive Potassium citrate 5.5%
• How do dentine bonding agents work?

  • Block or occlude the dentinal tubules
  • seal & protect
  • routine restorative bonding agents

  
• How is root caries managed?

  Restoration Diet Advice Fluoride Application
• What can dentists use to cover exposed root surfaces and hide interdental spaces?

  gingival veneers

  
• How can mucogingival surgery be used to manage recession?

  • Root coverage using pellicle grafts
  • Free grafts
  • Guided tissue regeneration
• What is a pellicle graft?

  Maintain their connection with the donor site after placement at the recipient site - lateral or coronally repositioned

  
• What is a free graft?

  Completely deprived of their connection with the donor area E.g. Dissected from the palate and used elsewhere

  
• What is Class 2 of Millers Classification of Recession?

  Marginal tissue recession extends to or beyond the mucogingival junction, no interdental involvement, no loss of interdental bone or soft tissue

  
• What is Class 3 of Miller's Classification of Recession?

  Marginal tissue recession extends to or beyond the mucoginival junction, loss of interdental bone or soft tissue is apical to the CEJ but cornal to the apical extent of the marginal tissue recession.

  
• What is Class 4 of Miller's Classification of Recession?

  Marginal tissue recession extends to or beyond the mucogingival junction. Loss of interdental bone extends to a level apical to the extent of the marginal tissue recession.