Diagnosis of gingival recession

While in adolescents it is often the central incisors of the lower jaw that are affected, adults more often show gingival recession on their back teeth in the upper jaw.

Assessing your own gums, for example at home in front of a mirror, is not sufficient for a correct assessment. Without a clinical examination in the dental practice, it is not possible to identify the reason for the receding gums.

Only a proper clinical examination in the dental practice with a so-called gum probe (periodontal probe) can show whether the gums are healthy, whether there is gum inflammation (gingivitis) or whether a disease of the structures holding the teeth (periodontitis) is already present.

Four degrees of severity of gingival recession are distinguished, because the treatment options can also be derived from them.

A simple recession is present when the receding gum margin has not yet reached the movable oral mucosa. In the second degree of severity, the recession has already extended into the movable mucosa. In both cases, the gum margin can be corrected with a surgical procedure.

Because in degrees 3 and 4 jawbone between the teeth has also already been lost, gingival recession in these cases cannot be fully corrected even with surgical measures.

The basic periodontal examination is intended to establish quickly whether there are any gum problems. It is a simple way to identify gingivitis or detect periodontitis.

Using a gum probe (periodontal probe), the penetration depth at the gum margin is measured gently and to the nearest millimetre at selected sites.

After this short examination, further investigations are carried out only if signs of loss of the structures holding the teeth have been found. These investigations include what is known as a periodontal chart and additional X-rays.

In the clinical examination with the gum probe (periodontal probe), the penetration depth of the probe into the gum pocket is measured to the nearest millimetre at up to six sites per tooth. Strictly speaking, the distance between the gum margin and the bottom of the gum pocket is measured. This is called the probing depth. At healthy sites, the probing depth is no more than 3 mm. At sites where gingival recession has already led to loss of the structures holding the tooth, however, the probing depth will also be only a few millimetres.

In addition, a so-called periodontal chart records the height of the jawbone (attachment level) to the nearest millimetre. A periodontal chart is indispensable for the diagnosis and treatment planning of gingival recession. Any dental practice can record the periodontal chart online free of charge and use it further: www.periodontalchart-online.com.

In some cases, the diagnosis of gingival recession can only be confirmed with certainty with the necessary X-rays. The X-rays needed to diagnose gingival recession are selected only after the clinical examination has been completed. This avoids excessive exposure to X-rays.

In the simplest case, an X-ray examination consists of two images (bitewing radiographs) and, in the most extensive case, of a so-called full-mouth X-ray series with up to 14 additional images, or of an orthopantomogram. The X-rays taken must show the jawbone surrounding the teeth and thus make it possible to estimate the severity of bone loss.

Every X-ray taken in the dental practice must be checked for both tooth decay and periodontitis.

In 1999, the first international workshop on the classification of periodontal diseases was held in the USA. The most important change compared with the European classification of 1993 was that the forms of disease were generally no longer defined primarily by the patient's age at the time of first diagnosis (e.g. juvenile and adult periodontitis). Chronic and aggressive periodontitis were introduced as new forms, as was, for example, periodontitis that can be associated with systemic diseases.

The new classification introduced in 2018, however, no longer distinguishes between chronic and aggressive periodontitis. Periodontitis is now described, in line with the classification of diabetes, using so-called staging and grading.