Gum Recession and Electric Toothbrushes

I just received this question from a friend:

Hi Ben

Had a most interesting meeting with a 55 year old DDS
yesterday. He notes that a significant number of his patients
are showing more and more signs of recession. (Age noted)
He has just started flagging his patients who are using electric
tooth brushes and thinks this might be a mega contributing cause.

What say you??

Let’s establish right off the bat that if it were a simple answer, we should all know what it is by now. Instead the cause of recession is usually one of a number of reasons or even a combination of a number of reasons.

Tissue type: Thick versus thin. People with thick gingiva (gums) have little to no recession. The reason is obvious, their gums are thick enough to resist trauma.

Toothbrush trauma: Usually we attribute this to hard or medium bristle brushes, yet I have seen trauma by patients who use soft bristle brushes (one clue this may be occurring is that they need a new toothbrush every few weeks). Some of these folks, if given an electric toothbrush, and not trained, will use them just like normal toothbrushes — that is to say, when they go to operate them they will still vigorously scrub their teeth and gums. These people could cause recession with electric toothbrushes even if we took the batteries away.

Dental floss trauma: Some people saw their gums or snap the floss into the gums. This again is the result of never having been shown how to effectively floss.

Overcompensating guilt: Some people think they will save money by not seeing dentists regularly and therefore, in order to stay “healthy” they scrub longer and harder. This misses any infections that have moved beyond the range of the toothbrush or dental floss and adds trauma to the list of problems they will discover they have when they finally decide it’s time once again for a check-up.

Crowded teeth: When teeth are in the wrong place they are often not encased with as much bone as they need. When a tooth is “sticking out” it’s a trauma magnet. Orthodontists worry about recession whenever they are moving teeth where bone and soft tissues are thin. This is why they sometimes recommend extracting a few teeth or having a periodontist graft thicker tissue over at-risk teeth.

Periodontal Disease: What supports the gums? The answer is the underlying bone. If this bone is lost due to infections, then the gums are more at risk of receding, even when people are performing correct oral hygiene techniques. Because periodontitis may be an underlying cause of recession, dentists and dental hygienists should consider using the discovery of new recession as a flag reminding them to perform a comprehensive periodontal evaluation and establishing a baseline record for future tracking purposes.

Iatrogenic procedures (caused by treatment): Dentists and dental hygienists can cause or contribute to recession by over-aggressive root instrumentation (scaling and root planing) in areas where pocket depths are shallow. Subgingival crown margins or subgingival cement can cause recession through an uncontrolled inflammatory process we call biologic width invasion or encroachment.

Age: There is some very mild recession associated with age, but this is completely different to the recession we see with toothbrush trauma or periodontitis. Just remember, the longer you live the more every other influence on recession mentioned above can have an effect.

Finally, keep in mind that recession, unless it is surgically, or orthodontically, corrected will remain long after the cause has been corrected. In other words, someone might have scrubbed his teeth with a Brillo pad years ago and has since become a model toothbrusher, but still, the evidence of past trauma remains.

Now, with all this in mind, here is my opinion on electric toothbrushes — I like them, if used correctly.

Does everyone need an electric toothbrush? No, but if someone has been traumatizing the gums with a regular toothbrush, it is often easier to direct them to use an electric toothbrush over attempting to modify their current technique. This is because many of these people brush until they feel a “tingle.” When we tell them to lighten up and they lose the tingle, they no longer believe they are brushing adequately. Electric toothbrushes with timers solve this feedback problem by substituting the timer for the tingle.

 

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