Q: I take good care of my teeth. I have followed recommendations of my dentist religiously – well, not every recommendation but everyone that kept my teeth in good shape. Last week I was surprised that he found I had an abscess. This was hard to believe because I go into the office for cleanings about three times a year. I had felt something in the tooth he found but it wasn’t major and would come and go without a lot of pain. When he showed me the x-ray I couldn’t’ believe the tooth had a problem. He also showed me that the gum around it had receded and was down on the root of the tooth. He also showed me that I wasn’t getting it cleaned properly because he pulled a bunch of gunk out of the gums. He said it was unusual that a tooth with just a small filling would get an abscess. “Why then?” I asked. He said I was having a tough time cleaning the root so plaque was consistently sitting there. He said that bacteria can actually get in through the root without causing decay and infect the nerve. He asked me if I remembered his recommendation for a gum graft in that area so the root would not get more and more exposed to plaque. I said I hadn’t forgotten but I just didn’t think it would happen to me. “What do I do?” I asked. He told me I needed a root canal then crown to cover the whole tooth and root and then a gum graft. It’s frustrating. I guess I’ll go for it – what do you say?
A: Gingival, or gum recession is a problem that most adults will face in their lifetime. It usually has several etiologies (causes). It may be genetic, it may result because of disease caused by poor brushing and flossing habits. Smoking is another big reason that could lead to you having to get a root canal done. Clenching and grinding are also known factors. Some systemic diseases, common or rare, can also weaken the gingiva and underlying bone.
In your situation, it’s important to know that a small filling may also be a deep filling. Trauma from decay and trauma from removing the decay may have been a factor. In any case, root canal therapy is certainly called for if the tooth is still well supported in the bone. A crown that is well done should cover the tooth to the gum. It will be easier to clean than your own teeth and harder for bacteria to attach to.
The graft will obviously prevent further recession. These treatments should allow healing of the tooth and long term service.