You look in the mirror and notice that one tooth suddenly appears longer than the others. Maybe the root looks darker, cold water causes sensitivity, or the edge of an older crown or veneer has become visible.
Does that mean you have gum disease? Did you brush too hard? Will it continue getting worse? And can the gum grow back?
In this episode of Not Just a Dentist, Dr. Rob Raimondi and Dr. Marc Sclafani are joined by board-certified periodontist Dr. Hector Sarmiento for a detailed conversation about gum recession.
They explain why recession is not one single diagnosis. It is a visible finding that can have several possible causes, including naturally thin tissue, limited supporting bone, tooth position, inflammation, periodontal disease, orthodontic movement, brushing habits, trauma, and existing dental restorations.
The conversation covers:
The goal of treatment is not always to cover every millimeter of exposed root. Depending on the patient, the priority may be stopping progression, strengthening the tissue, reducing sensitivity, protecting the tooth, improving cleansability, or preparing the area for future dental treatment.
This episode is intended for educational purposes only and does not replace an individualized periodontal or dental evaluation.
DR. ROBERT RAIMONDI:
Welcome to Not Just a Dentist, the podcast where we go beyond the surface to explore the connection between oral health, whole-body health, confidence, and longevity. I’m Dr. Robert Raimondi, prosthodontist and co-founder of One Manhattan Dental in New York City.
DR. MARC SCLAFANI:
And I’m Dr. Marc Sclafani, also a prosthodontist and co-founder of One Manhattan Dental.
DR. RAIMONDI:
Today we’re talking about something patients notice all the time, sometimes before anyone has formally diagnosed it: gum recession. You look in the mirror, pull your lip down, and suddenly one tooth looks longer. Maybe the root looks more yellow. Maybe cold water is bothering it. Maybe you can see the edge of an old crown or veneer. And then you search online and within a few minutes you’re looking at photographs of gum grafts and wondering what happened. So today we want to explain what recession actually is, why it happens, when it matters, when it can simply be watched, and what treatment can realistically accomplish. We’re joined by Dr. Hector Sarmiento, our periodontist at One Manhattan Dental.
DR. SCLAFANI:
Hector, welcome.
DR. HECTOR SARMIENTO:
Thank you. It’s great to be here.
DR. SCLAFANI:
Give people the simple version. What does a periodontist do, and when does a restorative dentist or general dentist call you?
DR. SARMIENTO:
A periodontist treats the supporting structures around the teeth. That includes the gum tissue, the bone, and the attachment that helps hold a tooth in place. We treat periodontal disease, gum recession, bone loss, and problems around implants. We also help prepare the foundation before restorative, cosmetic, orthodontic, or implant treatment. A lot of what we do is not just treating disease after it becomes severe. It is identifying risk, stabilizing tissue, and creating a healthier or more predictable foundation for whatever treatment comes next.
DR. RAIMONDI:
That foundation is really the point of this episode. A patient sees the edge of the gum. But the visible gumline is only one part of the anatomy.
DR. SCLAFANI:
Let’s start with the basic question. What is gum recession?
DR. SARMIENTO:
Gum recession means the margin of the gum has moved away from its previous position and part of the root surface has become exposed. The crown of the tooth, the part people normally see, is covered by enamel. The root is not covered by enamel. It is made of a different material, and it behaves differently. That is why the exposed area may look more yellow or darker. It may also feel more sensitive to cold, air, touch, or certain foods.
DR. SCLAFANI:
Patients will often say, “My tooth got longer.”
DR. SARMIENTO:
Exactly. The tooth itself did not grow. More of the tooth became visible because the gumline changed.
DR. RAIMONDI:
And the gum is not just a curtain that slid down independently.
DR. SARMIENTO:
Correct. We have to look at what is happening to the attachment and the bone underneath. Sometimes the bone has been lost. Sometimes the bone was naturally very thin or absent over part of the root. Sometimes the tooth is positioned near the edge of the supporting bone. So recession is what you see. The diagnosis is why it happened.
DR. SCLAFANI:
That’s an important distinction. Two patients can have the same amount of visible root, but one may have a stable anatomical issue and another may have active periodontal disease.
DR. SARMIENTO:
Yes. They may look similar in a photograph and require very different treatment.
DR. RAIMONDI:
Walk us through the anatomy in a way a patient can visualize.
DR. SARMIENTO:
You have the crown of the tooth above the gumline and the root below it. The root sits in bone, and the periodontal ligament connects the root to that bone. The gum tissue covers and protects the area. There is a natural boundary where the enamel of the crown ends and the root surface begins. We use that boundary as a reference point when we measure recession. We do not just look and say, “That seems worse.” We measure the distance from that reference point to the current gum margin. We also measure the pocket around the tooth, evaluate tissue thickness, look at the position of the tooth, and evaluate the bone.
DR. SCLAFANI:
So a patient may think the only question is how many millimeters of root are visible.
DR. SARMIENTO:
But the number by itself does not tell the whole story. We also want to know whether it is changing, whether the tissue is inflamed, whether the root is wearing away, whether there is sensitivity, and whether the tooth has enough supporting bone.
DR. RAIMONDI:
That is also why photographs are helpful. Sometimes a patient says, “This suddenly got worse,” but without a previous measurement or photograph it can be difficult to know whether the recession changed or whether the patient simply noticed it for the first time.
DR. SARMIENTO:
Exactly. Recession can develop gradually and then suddenly become noticeable because of lighting, a photograph, sensitivity, or a change in an old restoration.
DR. SCLAFANI:
One of the first fears is, “Do I have gum disease?”
DR. SARMIENTO:
Recession does not automatically mean active periodontal disease. Someone can have localized recession with healthy tissue, no bleeding, no deep pockets, and no progressive bone loss. On the other hand, periodontal disease can absolutely cause attachment loss, bone loss, and recession. We have to examine the entire situation.
DR. RAIMONDI:
What findings make you think the recession is part of a periodontal disease process?
DR. SARMIENTO:
Bleeding, inflammation, plaque and calculus, deeper probing depths, loss of attachment, bone loss on imaging, mobility, and recession involving multiple areas can all be important. The pattern matters too. Periodontal disease often affects the supporting structures in a way that is different from one isolated tooth with thin tissue.
DR. SCLAFANI:
So the patient should not assume the worst, but also should not ignore it.
DR. SARMIENTO:
Right. Gum recession is common, but common does not mean meaningless. It deserves an evaluation so we can determine whether it is stable anatomy, mechanical trauma, active inflammation, or a combination.
DR. RAIMONDI:
And if inflammation is the cause, you would control that before thinking about a cosmetic correction.
DR. SARMIENTO:
Always. You cannot predictably graft inflamed tissue and ignore the disease process. The cause has to be addressed first.
DR. SCLAFANI:
Patients often ask why one tooth receded while the teeth next to it look normal.
DR. SARMIENTO:
That is very common. We look at the specific anatomy of that tooth. Is it rotated? Is it positioned farther toward the lip or cheek? Is the bone thin or missing over part of the root? Is there a high frenum or muscle attachment pulling on the gum? Is there a filling or crown margin in that area? Is there localized trauma? A single tooth can have a very different environment from the tooth beside it.
DR. RAIMONDI:
The lower front teeth are a common place for patients to notice this.
DR. SARMIENTO:
Yes. The tissue can be thin, the bone can be narrow, and there may be muscle or frenum pull. Crowding can also place one tooth outside the ideal arch form.
DR. SCLAFANI:
What would you want to know before saying anything useful about one isolated area?
DR. SARMIENTO:
I would want to know the tooth position, the tissue thickness, the bone support, the probing measurements, whether the area bleeds, whether it has changed over time, how the patient brushes, and whether there are orthodontic, restorative, or bite-related factors. I would also look for wear on the root. Sometimes there is a notch from abrasion, and that affects both sensitivity and treatment planning.
DR. RAIMONDI:
How much of recession is something a patient caused, and how much is anatomy they were born with?
DR. SARMIENTO:
A significant part can be anatomy. Some people have a thin periodontal phenotype. Their gum tissue and supporting bone are naturally thinner. That does not mean they will definitely develop recession, but they have less biological margin for inflammation, trauma, or movement. The position of the tooth is also very important. If the root is prominent or the tooth sits near the outer edge of the bone, the tissue over it may be more vulnerable.
DR. SCLAFANI:
Patients sometimes feel guilty because they assume they did something wrong.
DR. SARMIENTO:
That is why we should not jump immediately to brushing technique. Brushing may contribute, but the same brushing pressure may affect one tooth and not another because the underlying anatomy is different.
DR. RAIMONDI:
And from a restorative perspective, tissue thickness affects how stable the gumline is around a crown or veneer.
DR. SARMIENTO:
Yes. Before restorative treatment, especially in a visible area, we want to understand whether the tissue is healthy and stable. A thin, unstable gumline may recede later and expose a margin.
DR. SCLAFANI:
So sometimes periodontal treatment is not because the patient is in pain or has active disease. It is preventive, to create a stronger foundation before another procedure.
DR. SARMIENTO:
Exactly. The purpose may be to thicken tissue, improve stability, or reduce the risk associated with planned tooth movement or restoration.
DR. RAIMONDI:
Let’s address the answer people hear constantly: “You brushed too hard.”
DR. SARMIENTO:
Aggressive brushing can contribute to recession and root wear. Hard bristles, excessive pressure, horizontal scrubbing, and abrasive toothpaste may traumatize the area. But brushing is not automatically the full diagnosis.
DR. SCLAFANI:
You might have two people using the same toothbrush with completely different outcomes.
DR. SARMIENTO:
Correct. One may have thick tissue and good bone support. The other may have thin tissue over a prominent root. We need to identify the setup and the contributing behavior.
DR. RAIMONDI:
What should patients do at home?
DR. SARMIENTO:
Use a soft-bristled toothbrush, apply light pressure, and let the bristles clean along the gumline rather than aggressively scrubbing across it. An electric toothbrush with a pressure sensor can be helpful for someone who tends to press too hard. Technique matters more than trying to “scrub harder” to make the teeth cleaner.
DR. SCLAFANI:
And changing the brushing technique may stop additional trauma, but it does not make the lost tissue grow back.
DR. SARMIENTO:
Right. It can remove a cause or contributor. It cannot reverse established attachment loss by itself.
DR. SCLAFANI:
Can orthodontics cause recession?
DR. SARMIENTO:
Orthodontics does not automatically cause recession. Teeth can be moved safely when treatment is planned within the available supporting anatomy. The risk becomes more important when a tooth already has thin tissue or limited bone, or when it is moved toward or beyond the edge of the bone.
DR. RAIMONDI:
So the question is not simply whether someone had braces or aligners.
DR. SARMIENTO:
Correct. We want to know where the tooth started, where it is being moved, and what support exists around it. Sometimes orthodontics can actually improve the situation by moving a tooth into a better position. In other cases, periodontal treatment may be considered before or during orthodontics to strengthen vulnerable tissue.
DR. SCLAFANI:
That requires communication between the orthodontist, periodontist, and restorative dentist.
DR. SARMIENTO:
Yes. Treatment sequencing matters. If the final plan includes orthodontics, gum grafting, veneers, or crowns, those decisions should not be made independently.
DR. RAIMONDI:
Not every case needs surgery. What does a recession area look like when you are comfortable monitoring it?
DR. SARMIENTO:
A small, stable area may be monitored when the tissue is healthy, there is no active disease, the patient can clean it, the root is not rapidly wearing or decaying, and there is no significant sensitivity. We also consider whether future treatment is planned. An area that is acceptable to monitor today may need a different conversation if the patient is about to begin orthodontics or receive a restoration in that area.
DR. SCLAFANI:
How do you monitor it?
DR. SARMIENTO:
We measure it, document it, photograph it, and compare it over time. A patient can also take a clear photograph at home in consistent lighting, with the lip pulled back in the same way. That does not replace an exam, but it can help show whether the area is changing.
DR. RAIMONDI:
What should make someone schedule an evaluation sooner rather than simply waiting until the next routine visit?
DR. SARMIENTO:
Rapid change, increasing sensitivity, consistent bleeding, swelling, a notch developing in the root, mobility, pain, drainage, bad taste, or recession appearing in several areas. A tooth that feels different when the patient bites also deserves attention.
DR. SCLAFANI:
This is probably the question everyone wants answered. Can the gums grow back?
DR. SARMIENTO:
Established gum recession generally does not grow back on its own. If the tissue is inflamed and swollen, treating the inflammation can change its appearance. But that is not the same as regenerating the original attachment or replacing tissue over an exposed root.
DR. RAIMONDI:
So we should separate several goals: stopping progression, reducing sensitivity, thickening the tissue, and covering the root.
DR. SARMIENTO:
Exactly. Those are different outcomes. Sometimes success means the area stays stable and comfortable. Sometimes we want to create thicker, more maintainable tissue. Sometimes root coverage is possible. Sometimes complete root coverage is not anatomically realistic, but the procedure can still improve the health and stability of the area.
DR. RAIMONDI:
When do you start discussing a graft?
DR. SARMIENTO:
A graft may be considered when the recession is progressing, the tissue is very thin, the root is sensitive, the area is difficult to clean, the root is at risk of decay or abrasion, or future orthodontic or restorative treatment requires a more stable foundation. Cosmetic asymmetry can also be a reason, but the biology comes first.
DR. SCLAFANI:
What does a graft actually accomplish?
DR. SARMIENTO:
Depending on the technique, we may thicken the tissue, create a stronger band of gum, reposition the tissue over the root, or combine those goals. The most common root-coverage procedure uses connective tissue. The tissue is placed beneath the gum and the existing gum is repositioned over it.
DR. RAIMONDI:
And the expected amount of coverage depends on the anatomy.
DR. SARMIENTO:
Yes. If the bone and tissue between the teeth are intact, full root coverage may be more predictable. If there is interproximal attachment or bone loss, the expected result changes. That is why we should be honest about the goal before treatment. A graft can be successful even when it does not recreate the original gumline perfectly.
DR. SCLAFANI:
A major fear is, “Are you taking tissue from the roof of my mouth?”
DR. SARMIENTO:
In a connective-tissue graft, tissue is commonly taken from beneath the surface of the palate. The donor site is managed carefully, and the outer surface may remain largely intact depending on the technique. The patient’s own tissue remains a very important and predictable option.
DR. RAIMONDI:
Are there alternatives?
DR. SARMIENTO:
Donor or allograft materials can be used in selected cases. They may avoid a second surgical site and can be useful when treating multiple teeth. But donor material is not automatically better simply because it sounds less invasive. The choice depends on tissue quality, the number and location of teeth, the desired amount of thickening or coverage, and the patient’s anatomy.
DR. SCLAFANI:
What about tunneling procedures?
DR. SARMIENTO:
Tunneling is one technique in which the tissue is carefully released and graft material is placed underneath without making some of the traditional surface incisions. It can be an excellent approach in the right case, but it is technique-sensitive and not appropriate for every pattern of recession.
DR. RAIMONDI:
What should patients realistically expect after a graft?
DR. SARMIENTO:
There may be swelling, discomfort, and temporary changes to eating and oral hygiene. Patients usually need to avoid brushing or flossing directly over the surgical site for a period of time. They also need to avoid pulling the lip up repeatedly to look at the graft. That can place tension on the healing tissue.
DR. SCLAFANI:
That is hard because everyone wants to check it.
DR. SARMIENTO:
Exactly, but leaving it alone is important. We may recommend softer foods, limiting strenuous exercise, using a prescribed rinse, and following specific medication instructions. The exact recovery depends on how many teeth were treated, the technique, and whether there is a palate donor site.
DR. RAIMONDI:
When can someone return to work?
DR. SARMIENTO:
Many patients can return to non-strenuous work relatively quickly, but swelling and comfort vary. We give individualized instructions. The tissue continues to mature for weeks and months after the initial healing. What it looks like very early is not necessarily the final result.
DR. SCLAFANI:
Let’s connect this to restorative dentistry. Why should the gumline be stable before veneers or crowns?
DR. SARMIENTO:
Because the gumline affects the visible proportions of the teeth and the location of the restoration margin. If recession is active or the tissue is very thin, completing the restoration first may lead to an exposed margin or asymmetry later. We want the tissue healthy and stable before the final restoration is designed whenever possible.
DR. RAIMONDI:
This is where the restorative dentist and periodontist need to plan together. The pink part of the smile and the white part of the smile cannot be designed separately.
DR. SARMIENTO:
Exactly. Sometimes periodontal treatment happens first. Sometimes the restoration needs to be adjusted or replaced because its shape or margin is contributing to inflammation. The sequence depends on the case.
DR. SCLAFANI:
What about recession around an implant?
DR. SARMIENTO:
That is a different and often more difficult problem. An implant does not have the same attachment or blood supply as a natural tooth. Recession may expose metal or restorative components, and tissue reconstruction can be less predictable. Inflammation around an implant also requires careful evaluation because bone loss around an implant can progress.
DR. RAIMONDI:
So patients should not assume that an implant is an easier replacement for a natural tooth with recession.
DR. SARMIENTO:
No. Preserving a natural tooth when it is healthy and maintainable is usually preferable. Implants are valuable, but they are not immune to tissue or bone problems.
DR. RAIMONDI:
After the evaluation or treatment, what helps keep the area stable?
DR. SARMIENTO:
Control inflammation, maintain consistent professional care, use a soft toothbrush with appropriate pressure, and address the specific cause. That may include correcting a traumatic habit, managing smoking or vaping, evaluating bite forces, monitoring orthodontic movement, or improving the shape or cleansability of a restoration.
DR. SCLAFANI:
A graft does not make the area indestructible.
DR. SARMIENTO:
Correct. It strengthens or repositions tissue, but the original risk factors still matter. The most important question is not just, “Can you cover the root?” It is, “Why did this happen, and how do we reduce the chance that it continues?”
DR. SCLAFANI:
If someone notices recession tonight, what should they do?
DR. SARMIENTO:
Do not panic, and do not diagnose it from photographs online. Take a clear photo. Bring it to your dentist or hygienist. Ask whether the area is stable, whether there is inflammation or bone loss, and what is most likely causing it. Not every case needs treatment, but every treatment decision should begin with the cause.
DR. RAIMONDI:
Hector, thank you.
DR. SARMIENTO:
Thank you. This was great.
DR. SCLAFANI:
And thank you for listening to Not Just a Dentist.
DR. RAIMONDI:
Follow One Manhattan Dental for more conversations about dentistry, health, function, and longevity. We’ll see you next time.
