He Had Been Brushing His Gums Away for Thirty Years

Quick answer: Gums can recede from cleaning too hard as well as from cleaning too little. Firm bristles, heavy pressure and a scrubbing action wear notches into the root surface and push the gum back. The damage does not reverse on its own, but it stops the day the technique changes.

The call

He came in about sensitivity, which turned out not to be the problem. Cold water on the upper left had become unbearable for Ilan, 58, from Nofei Aviv, and he had reached the point of drinking everything at room temperature.

He was, by any ordinary measure, a conscientious patient. He brushed twice daily, sometimes three times. He used a firm brush because it felt like it was doing more. He pressed hard, and he scrubbed side to side, because that was how he had been taught as a boy in the seventies.

Every one of those habits was the problem.

What we found

Recession of 3 to 5mm on the outer surfaces of the upper premolars and canines on both sides, worst on the left — he is right-handed, and right-handed people press harder on the left side of the mouth.

At the gum line, wedge-shaped notches cut into the root surface. Some were a millimetre deep with sharp, polished edges. The exposed root surfaces were highly sensitive to air and cold.

The pattern is diagnostic. Toothbrush abrasion appears on the outer surfaces, spares the tongue side, is worse on the side opposite the dominant hand, and affects the teeth that stick out most in the arch — canines and premolars, which take the brunt of a sideways scrub. Gum disease, by contrast, affects sites all round the mouth and comes with bleeding and pockets.

His gums were otherwise healthy. Pocket depths were 1 to 2mm, no bleeding anywhere. His plaque control was, ironically, excellent.

Two other contributors we checked for. Acidic diet softens the root surface so brushing removes more — he drank grapefruit juice most mornings. And clenching flexes the tooth at the neck, which some evidence suggests makes those notches form more readily. He had wear facets consistent with clenching.

What we did

Technique first, because nothing else holds without it. An electric brush with a pressure sensor, which does the work for him and stops when he presses. A soft brush head. Small circles at the gum line rather than sideways scrubbing. Brushing before breakfast rather than immediately after acidic drinks, since enamel and dentine are softened for a while after acid exposure.

Restored the deepest notches with bonded composite — five teeth. This seals the exposed dentine, which resolves most of the sensitivity, and restores the tooth contour so plaque does not collect in the groove.

Desensitising for the remaining shallow areas: high-fluoride toothpaste and in-surgery varnish.

What we did not do is graft. Gum grafting can cover exposed roots and is worth considering where recession is progressing, where the appearance matters to the patient, or where there is too little firm gum left. His recession was stable, on back teeth he does not display, with adequate attached gum. Grafting five sites for a problem that had stopped would have been treating the dentist's discomfort rather than the patient's.

The outcome

Sensitivity resolved within about six weeks of the restorations. Photographs and measurements at one, two and three years show no further recession — the wear stopped when the scrubbing did.

What to do if this happens to you

1. Use a soft brush. Firm bristles offer no cleaning advantage and cause this.
2. Let an electric brush do the work. Choose one with a pressure sensor, and heed it.
3. Small circles, not sideways scrubbing, angled into the gum line.
4. Do not brush straight after anything acidic. Wait an hour, or brush beforehand.
5. Ask whether recession is stable or progressing. It determines whether grafting is worth it.
6. Get deep notches restored. They collect plaque and weaken the tooth at its narrowest point.

Sensitive teeth or gums that look longer than they used to? Ramat Beit Shemesh Urgent Dental Care will work out which cause it is. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh

This is a composite clinical story. It reflects a presentation we see regularly in Beit Shemesh and Ramat Beit Shemesh; the name and details are illustrative and are not those of a real patient.