The problem of receding gums is a common one resulting from a variety of causes. These include advanced gum disease, aggressive brushing, the ageing process, genetics, poor general health, as well as poor hygiene practices. However, it is possible to have dentures fitted even when you have receding gums, but suitability depends on several important factors which we outline in this article. We also discuss the need to deal with the issue of gum health in general before dentures can be considered, and how to prevent or halt the progression of receding gums. Lastly, we examine emerging science on treating those who suffer with receding gums and look at other alternatives if you are an unlikely candidate for dentures because of receding gums.
What causes gum disease and receding gums?
To begin, let’s examine what gum disease is, its relation to receding gums, and the problems these pose for partial denture wearers.
What is gum disease?
Gum disease is a common condition affecting 3 of every 10 Australian adults. If not addressed promptly, gum disease can be progressive. Also known as gingivitis in the early stages, gum disease presents as bleeding, swollen and inflamed gums, often accompanied by a bad taste and halitosis (bad breath). If untreated, gingivitis advances to periodontal disease, or periodontitis.[i] As symptoms worsen, gum tissue around the tooth weakens allowing pockets to form between the gums and teeth into which bacteria collect causing infection. As the disease progresses, the gum tissue shrinks away from the natural teeth exposing the top of the tooth root, a condition known as receding gums. Teeth may be painful and become loose. There may be changes to the jaw alignment and bite because of subsequent bone loss. Increased sensitivity to sweet, or hot and cold foods and drinks occurs. At the extreme stage of gum disease chewing becomes very painful and difficult, pus may ooze from the pockets between teeth and gums, and teeth fall out. [ii]
In the early stages of gum disease, treatment and care can reverse the condition, but if left untreated, it can progress to infections and major gum disease affecting not just your mouth but also your general health.[iii]
What causes gum disease?
Gum disease is primarily caused by plaque, a film of bacteria that attaches to the surface of the teeth and adjacent gums.[iv][v] As the plaque hardens it becomes calculus and can only be removed by your dentist.
The following factors predisposing you to gum disease include:
- Illicit drug use: heroin, crystal meth, speed
- Poor oral hygiene
- Smoking
- Being stressed
- Poor nutrition
- Certain medications (which dry up saliva)
- Hormonal changes - going through puberty or pregnancy[vi]
- Obesity
- Medical conditions like HIV/AIDS, diabetes, rheumatoid arthritis, Crohn’s disease
- Cancer treatments[vii]
Advanced gum disease or periodontitis can be managed but not reversed, so prevention is key.
How can I prevent gum disease?
- Adopt a nourishing diet.
- Practise good oral hygiene, including correct care of remaining natural teeth.
- Adopting proper brushing techniques using a soft bristled brush and flossing daily will help prevent and even reverse early gum disease.
- Visit your dental practitioner regularly to keep your mouth healthy.viii The stealthy nature of gum disease requires regular monitoring by your oral health practitioner. Because gum disease can progress painlessly in the early stages, it is critical you have regular oral health checks to detect and manage any damage before the condition becomes irreversible.
Can dentures be fitted to receding gums?
While fitting dentures is still an option for those with receding gums, there can be challenges. Each patient is different, and therefore must be carefully evaluated by a dental prosthetist for their unique situation and likelihood of success.
Gum recession triggers a series of changes in the mouth altering the natural oral contours and jawbone structure including bone loss. Any reduction of the bony ridge (alveolar ridge) and surrounding gum tissue on which removable dentures sit can affect the denture’s stability.
Loose dentures are uncomfortable, difficult to eat with, and may rub and cause sore spots with a possibility of infection, further exacerbating the receding gums condition.
Your dental prosthetist will firstly address any oral health issues you have then consider how advanced the gum recession is, whether there is sufficient alveolar ridge remaining for the denture to sit on, taking into account attaining an adequate measure of comfort and fit.
Denture design and receding gums
Denture design and fit is largely governed by an individual’s clinical and aesthetic needs. Wearing a removable partial denture creates the potential for plaque formation on any remaining teeth.[ix] Therefore, when taking impressions of the mouth, your prosthetist takes into account placement of clasps to avoid areas of gum recession to prevent further damage.
However, poor fitting or loose dentures may exacerbate gum disease and receding gums by further irritating or abrading tissue and allowing entry to harmful bacteria like those causing plaque.[x] Since the build-up of plaque is a precursor to gingivitis and periodontitis, maintaining good oral hygiene and care of natural teeth should be prioritised. Good denture hygiene also plays a crucial role. Close attention to all denture surfaces is crucial, especially those adjacent to gingival margins (where teeth and gums meet) to prevent gum disease forming in remaining natural teeth.[xi]
What are the alternatives to a removeable denture if I have severe gum disease?
If you have insufficient bone and gum tissue remaining to support removable dentures because of advanced gum disease, there are several alternatives available. These include implant-supported dentures, and dental implants. Your oral health provider will evaluate your clinical situation and offer the best alternatives for you.
However, the same reasons excluding you from removeable dentures may also exclude you from some of the alternatives. If you have significant bone loss, a bone graft may be necessary before implants are possible. In some cases, the best treatment for chronic periodontitis is removal of all the teeth before the disease completely erodes the bone. Because gum disease cannot exist without natural teeth, low grade infections resolve and there is an improvement of underlying systemic disease like diabetes.
Promising research
While there is presently no cure for periodontal disease, a new study published in 2019 showed promising results. Yet to be trialled on humans at the time of publication, the technique involved combined biological and mechanical means to repair and regenerate bone and gum tissue.[xii] A thin, impregnated membrane was surgically implanted between the diseased gum and tooth to isolate infection and simultaneously deliver medication, antibiotics and growth factor to the affected tissue.[xiii] Given the devastating impact tooth loss and gum disease can have on a person’s general health, mental wellbeing and ability to enjoy life, the pursuit of this kind of research is critical.
A final word: Can dentures be fitted to receding gums?
Be reassured that dentures can be successfully fitted to receding gums. However, oral health must first be stabilised and optimised to ensure denture wearing success into the future. In this article we discussed the importance of regular monitoring of your partial denture by your dental prosthetist to halt further deterioration. In instances where receding gums rule out removable dentures, other options are offered. New research gives hope for the underlying causes of receding gums in the form of treatment to restore and even reverse gum disease like gingivitis and periodontitis.
References
[i] https://www.dentalhealth.org/gum-disease
[ii] https://www.healthdirect.gov.au/gum-disease
[iii] https://www.healthdirect.gov.au/gum-disease
[iv] https://www.dentalhealth.org/news/promising-new-treatment-could-regenerate-gum-tissue-and-prevent-tooth-loss
[v] https://www.healthdirect.gov.au/gum-disease
[vi] https://www.healthdirect.gov.au/gum-disease
[vii] https://www.mayoclinic.org/diseases-conditions/periodontitis/symptoms-causes/syc-20354473
[viii] https://www.healthdirect.gov.au/gum-disease#:~:text=Gum%20disease%20occurs%20when%20the%20tissue%20that%20surrounds,lead%20to%20more%20serious%20gum%20disease%20and%20infection.
[ix] https://www.sciencedirect.com/science/article/abs/pii/0022391387902757
[x] Wright, P. S., & Hellyer, P. H. (1995). Gingival recession related to removable partial dentures in older patients. The Journal of prosthetic dentistry, 74(6), 602-607.
[xi] https://www.sciencedirect.com/science/article/abs/pii/0022391387902757
[xii] Mohammad Mahdi Hasani-Sadrabadi, Patricia Sarrion, Nako Nakatsuka, Thomas D. Young, Nika Taghdiri, Sahar Ansari, Tara Aghaloo, Song Li, Ali Khademhosseini, Paul S. Weiss, and Alireza Moshaverinia (2019) ‘Hierarchically Patterned Polydopamine-Containing Membranes for Periodontal Tissue Engineering’, ACS Nano Article ASAP, DOI: 10.1021/acsnano.8b09623
[xiii] https://www.dentalhealth.org/news/promising-new-treatment-could-regenerate-gum-tissue-and-prevent-tooth-loss
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