Gingival dehiscence is a condition where the bone of the tooth wears away below the gumline, exposing the root. The outline of the root appears like a cylinder, protruding beneath the gumline. This occurs most frequently on the facial surface of the tooth (the surface that faces forward). Here’s what you should know about this condition and treating it.
What are the stages of gingival dehiscence?
There are three basic stages of dehiscence, including:
- Gingival recession
- Alveolar bone loss
- Root exposure
Let’s look at each of these in more detail.
Gingival recession occurs as the gums begin to pull away from the crown of the teeth. These are commonly called receding gums. As it progresses, the bone below the gumline is exposed.
Alveolar bone loss
The alveolar bone is a thicker ridge of bone that holds the tooth sockets. As gingival recession continues, alveolar bone loss occurs. This alveolar bone loss due to dehiscence is also referred to as resorption.
As the bone continues to thin and be resorbed, eventually the roots of the teeth will be exposed through the gumline. These roots can be very sensitive as they contain bundles of nerves.
Classes of dehiscence
Gingival dehiscence generally occurs bilaterally on anterior teeth; that is, it occurs most often on both sides in the front of the mouth.
There are four classes of gum recession that can lead to dental dehiscence: Class I to Class IV.
This is moderate levels of gum recession that has not yet resulted in soft tissue or bone loss.
The recession has not gone below the mucogingival junction (the place where the mucosa of the gums that is immoveable meets the more supple mucosa found in the cheeks and the floor of the mouth).
This class of gum recession has still not damaged soft tissues or bone, but begins to extend into or beyond the mucogingival junction.
Bone loss begins to occur and soft tissue damage is also present. Damage is limited to the area where the tooth root meets the dental pulp.
Bone loss and soft tissue damage occurs, reaching well into the tooth’s roots.
Dental fenestration may occur in conjunction with gingival dehiscence. These two conditions are remarkably similar, with the main difference that there is no marginal bone loss with dental fenestration. In both conditions, the root is covered only by the periosteum (connective tissue that overlays the tooth) and a thin layer of gum tissue. With dental fenestration, there is still bone at the coronal end of the tooth. One of these two conditions occur in approximately 20% of teeth.
What causes gingival dehiscence?
Gingival dehiscence has a number of different causes, starting, as with most serious oral health issues, with poor oral hygiene. Improper or inadequate brushing and flossing causes gums to recede over time.
This recession combined with the following other predisposing factors can cause bone dehiscence.
- Tooth position: Tooth position refers to the way in which the actual tooth is located in the socket of the alveolar bone.
- Attachment of the gingiva: Gum tissue attachment is also a key factor in causing dehiscence. If the gingiva is poorly or loosely attached to the teeth, this makes it more susceptible to gum recession. Once gum recession begins, the teeth and their roots become vulnerable.
- Thin bony housing: The bony housing refers to the alveolus, the lining in the alveolar bone in which the tooth inserts. If this is thin, it is less able to do its job of keeping the tooth in place in the alveolar bone.
What gingival dehiscence treatment works?
The goal of gingival dehiscence treatment is to cover the exposed tooth root and try to stimulate gingival repair and bone regrowth. While this is not always possible, a dentist can typically get some degree of coverage for the exposed root, regardless of the class of gum recession.
In all cases, the first step is to make sure that the exposed tooth root is completely free from bacteria before proceeding. If bacteria is sealed into the repaired gum, this can cause a dangerous infection.
Your dentist has several options when it comes to covering the tooth root. They fall under two categori