Gum Recession: What Causes It, Whether It Can Be Reversed, and What Treatment Looks Like

Receding gums don’t reverse on their own — but they can be stopped, and in significant cases, restored. Dr. Liza Wakim explains what causes gum recession, what treatment involves, and when a graft is actually needed.

Gum recession is one of those things that tends to go unnoticed for a long time — and then becomes impossible to ignore once it’s progressed enough to cause sensitivity, affect appearance, or prompt a comment from a dentist about exposed root surfaces.

If you’ve been told your gums are receding, or if you’ve noticed your teeth looking longer than they used to, this article is for what I’d tell you in the chair: what’s driving it, what the implications are, and what can actually be done.

What gum recession is

Gum recession occurs when the gum tissue that surrounds the teeth pulls back — or is lost — exposing more of the tooth and sometimes the root surface below the enamel line. The root surface is covered by cementum, a softer, more porous material than enamel, which makes exposed roots more vulnerable to sensitivity, decay, and further tissue loss.

Recession can affect a single tooth, a few teeth, or be generalized across multiple areas of the mouth. It can develop slowly over years or progress more quickly depending on the cause.

What causes gum recession

Periodontal disease. The most common cause of significant gum recession is gum disease — the bacterial infection that destroys the attachment between the gum tissue and the teeth, and the bone supporting them. As the disease progresses, the gum tissue recedes along with the bone loss underneath it. Recession from periodontal disease is typically generalized across multiple teeth rather than isolated.

Aggressive or incorrect brushing. This is the cause I see most often in patients who don’t have gum disease — and it’s also the most preventable. Brushing with a medium or hard bristled toothbrush, applying excessive pressure, or using a horizontal scrubbing motion rather than a gentle circular technique physically abrades the gum tissue over time. The recession this causes tends to be most pronounced on the outer surfaces of the front teeth — particularly the canines — where the brushing force is heaviest.

Thin gum tissue or thin bone — gingival biotype. Some people simply have naturally thin gum tissue and thin underlying bone, which makes them more susceptible to recession regardless of their oral hygiene habits. Patients with this anatomy may experience recession even with excellent technique and no gum disease. Genetics plays a role.

Orthodontic treatment. Moving teeth outside the natural envelope of bone — which can happen when teeth are moved too aggressively or into positions that exceed the available bone support — can cause or accelerate recession. This isn’t universal, and well-planned orthodontic treatment accounts for bone support, but it’s a relevant consideration.

Tooth position. Teeth that are naturally positioned outside the arch — particularly teeth that sit forward of the normal position — often have thinner overlying bone and gum tissue and are more susceptible to recession.

Clenching and grinding. Heavy bruxism creates excessive force on the teeth and can contribute to recession by stressing the attachment between the gum and tooth.

Tobacco use. Smoking and smokeless tobacco affect gum tissue health and are significant risk factors for both periodontal disease and recession.

Piercings. Lip and tongue piercings that repeatedly contact the gum tissue can cause localized recession at the contact point — a cause that often gets missed until the recession is already significant.

Can gum recession be reversed?

The honest answer is: it depends on the cause and the severity, and in most cases, the tissue that’s already gone does not grow back on its own.

Unlike the reversibility of early gingivitis — where healthy gum tissue can be restored with professional cleaning and improved home care — true gum recession involves loss of tissue and often loss of underlying bone. The architecture that’s been lost doesn’t regenerate spontaneously.

What can happen is stabilization — stopping further recession from occurring — combined with treatment to address the cause. For mild recession, this is often adequate. For more significant recession, particularly where roots are exposed in a way that affects appearance, causes significant sensitivity, or compromises the long-term health of the tooth, a soft tissue graft can restore tissue to the area.

What treatment looks like

Addressing the cause first. Before any tissue grafting is considered, the underlying cause needs to be identified and managed. If gum disease is driving the recession, it’s treated. If aggressive brushing is the culprit, technique and tool changes are addressed. If grinding is a contributing factor, a nightguard is part of the plan. Grafting recession that’s still actively progressing from an unaddressed cause is not a good outcome.

Technique and tool correction. For recession caused by brushing trauma, switching to a soft-bristled brush, reducing pressure, and correcting technique often stops the progression meaningfully. This is the most straightforward intervention and should always be the starting point for mild recession without active gum disease.

Desensitizing treatments. Exposed root surfaces are often sensitive — to cold, to sweet foods, to air. Desensitizing toothpastes and in-office fluoride varnish applications help manage this while the underlying situation is being addressed.

Soft tissue grafting. For recession that is significant enough — whether because of sensitivity, appearance, or the long-term vulnerability of an exposed root — a soft tissue graft can restore tissue to the affected area. The most commonly used technique is a connective tissue graft, in which tissue from the palate is harvested and placed at the recession site, where it integrates and covers the exposed root.

The procedure is done under local anesthesia and involves two surgical sites — the donor site at the palate and the recipient site at the recession area. Recovery takes one to two weeks, during which diet and activity are restricted to protect both sites during healing.

In appropriate cases and with an experienced provider, soft tissue grafting produces very good outcomes — covering exposed root surfaces, improving appearance, reducing sensitivity, and providing the area with a more resilient tissue attachment going forward.

For patients whose recession is too widespread or whose anatomy doesn’t support conventional grafting, there are additional techniques — including the use of processed donor tissue, which avoids the palatal donor site — that I discuss with patients on a case-by-case basis.

When to have the conversation

If you’ve noticed your teeth looking longer, you have persistent sensitivity along the gumline, or your dentist has mentioned recession, it’s worth an evaluation that specifically addresses what’s driving it and where things currently stand. Recession that’s caught and stabilized early is a different clinical situation from recession that’s been progressing untreated for years.

Serving patients in Washington, PA and the greater Pittsburgh area.