Can Braces Cause Gum Recession?
Yes, braces can contribute to gum recession in some cases, though the relationship is more nuanced than a simple cause and effect. Orthodontic treatment moves teeth through bone by applying controlled forces. When a tooth is moved toward the outer edge of the bone (labially or buccally), the bone and gum tissue on that side can thin and recede. If the bone is already thin in that area, the tooth root may move partially outside the bone envelope, leading to gum recession.
Not everyone who wears braces develops recession. Most orthodontic patients complete treatment without significant gum changes. The risk depends on the thickness of your bone and gum tissue, the direction and extent of tooth movement, the forces applied, and how well you maintain your oral hygiene during treatment.
Risk Factors for Gum Recession During Braces
Understanding your risk factors before starting orthodontic treatment helps both you and your orthodontist plan accordingly. Several factors increase the likelihood of developing gum recession from braces.
Thin Gingival Biotype
Gingival biotype refers to the thickness of your gum tissue and the underlying bone. People with a thin biotype have delicate, translucent gum tissue and a thin layer of bone covering the tooth roots. This tissue has less margin for error during orthodontic movement. A thin biotype is more common on lower front teeth and upper canines, which are the teeth most frequently affected by orthodontic-related recession.
Your periodontist can assess your biotype during a clinical exam. If your tissue is thin, this information should be shared with your orthodontist before treatment begins so that tooth movement can be planned within the bone boundaries.
Aggressive or Excessive Tooth Movement
Moving teeth too quickly or moving them outside the boundaries of the bone (the alveolar housing) puts the gum tissue at risk. Expansion of a narrow arch, significant proclination (tipping teeth forward), and moving teeth into areas with limited bone support are the orthodontic movements most associated with recession.
Heavy forces applied to teeth can also accelerate bone loss around the roots. Modern orthodontic techniques emphasize light, controlled forces that allow the bone to remodel gradually as the teeth move, reducing the risk of tissue damage.
Poor Oral Hygiene During Treatment
Brackets, wires, and bands make teeth harder to clean. When plaque accumulates around orthodontic appliances, it causes gum inflammation (gingivitis). Chronic inflammation during the 18 to 24 months of typical orthodontic treatment can damage the gum tissue and the bone that supports the teeth.
If gingivitis progresses to periodontitis (infection of the deeper supporting structures), permanent bone loss can occur. This bone loss combined with orthodontic tooth movement significantly increases the risk of recession. Maintaining excellent oral hygiene throughout treatment is one of the most important things you can do to protect your gums.
Other Contributing Factors
- Pre-existing recession before braces: Teeth that already have some recession are more vulnerable to further tissue loss during orthodontic treatment.
- Tongue thrusting or lip habits: Habits that push the teeth forward place additional outward force on teeth that may already be at the bone margin.
- Teeth positioned outside the bone: Some patients have teeth that are already partially outside the normal bone envelope before treatment begins. Moving these teeth further in the same direction increases recession risk.
- Smoking: Tobacco use reduces blood supply to the gums and impairs healing, making tissue more susceptible to recession from any cause.
- Age: Adult orthodontic patients may have less bone density and thinner tissue than younger patients, though age alone is not a contraindication.
How to Prevent Gum Recession During Braces
Prevention starts before braces go on and continues throughout treatment. The most effective approach involves coordination between your orthodontist and a periodontist.
Periodontal Evaluation Before Orthodontics
A periodontal evaluation before starting braces is recommended for any patient with signs of thin tissue, existing recession, or gum disease. The periodontist measures the thickness of the gum tissue, checks for bone loss, and identifies teeth that may be at risk during orthodontic movement.
In some cases, the periodontist may recommend a preventive gum graft (connective tissue graft or free gingival graft) before orthodontic treatment begins. This adds thickness to the tissue in vulnerable areas and creates a stronger foundation that can better withstand the forces of tooth movement.
Maintaining Oral Hygiene with Braces
Keeping your teeth and gums clean during orthodontic treatment requires more effort than usual, but it is one of the most impactful things you can do to prevent recession.
- Brush after every meal using a soft-bristled brush or an orthodontic brush designed to clean around brackets and wires
- Use an interdental brush (proxy brush) to clean between brackets and under wires where a regular toothbrush cannot reach
- Floss daily using a floss threader, orthodontic flosser, or water flosser to clean between teeth below the wire
- Use a fluoride rinse daily to strengthen enamel and reduce plaque accumulation
- Schedule professional cleanings every 3 to 4 months during orthodontic treatment rather than the standard 6-month interval
Monitoring During Treatment
Your orthodontist should monitor your gum health at every adjustment appointment. If recession begins to develop on a specific tooth, the treatment plan can be adjusted. This may involve reducing the force on that tooth, changing the direction of movement, or pausing treatment on that tooth while the tissue stabilizes.
If your orthodontist identifies developing recession, a referral to a periodontist during active treatment is appropriate. The periodontist can assess the severity and advise whether treatment should be modified, paused, or supplemented with a gum graft.
Treatment for Gum Recession After Braces
If gum recession has occurred during or after orthodontic treatment, several treatment options are available depending on the severity and the teeth affected.
Gum Graft Surgery
Gum grafting is the primary treatment for significant recession. A periodontist takes a small piece of tissue, usually from the palate (roof of the mouth) or from a tissue bank (allograft), and attaches it over the exposed root surface. The graft adds thickness and coverage to the receded area.
Several gum graft techniques are available, including connective tissue grafts, free gingival grafts, and the pinhole surgical technique. Your periodontist will recommend the approach best suited to your situation. Success rates for root coverage procedures are generally high, particularly when the recession is limited to one or a few teeth and the bone between the teeth is intact.
Timing: During Orthodontics vs. After
The timing of gum graft surgery depends on whether orthodontic treatment is still active. If recession is progressing during active treatment, the periodontist may recommend grafting before braces come off to protect the tooth and prevent further tissue loss. In this scenario, the orthodontist and periodontist coordinate closely on timing.
If the recession is stable and mild, it may be appropriate to wait until after braces are removed to assess the final tooth positions before grafting. Sometimes teeth that appear to have recession during treatment settle into a better position once the braces are off and the tissue has time to adapt.
Non-Surgical Management
Mild recession (1 to 2 millimeters) that is not progressing and does not cause sensitivity may not require surgical treatment. In these cases, your periodontist may recommend monitoring the area at regular intervals, using desensitizing toothpaste if the exposed root is sensitive, and ensuring oral hygiene is excellent to prevent further tissue loss.
A bonded composite restoration can also be applied to exposed root surfaces to reduce sensitivity and improve appearance without surgery. This approach does not restore the gum tissue but protects the root surface.
How Your Orthodontist and Periodontist Work Together
The best outcomes happen when the orthodontist and periodontist communicate throughout the treatment process. Before treatment, the periodontist identifies at-risk areas and may recommend preventive grafting. During treatment, the orthodontist monitors tissue response at each visit and adjusts forces as needed. If recession develops, both specialists coordinate on whether to modify the orthodontic plan, pause treatment, or proceed with grafting.
This collaborative approach is sometimes called interdisciplinary treatment planning. It is standard practice in complex orthodontic cases, particularly for adult patients with thin tissue, pre-existing recession, or periodontal disease. If your orthodontist does not mention a periodontal evaluation and you have concerns about your gum tissue, it is reasonable to request one.
You can find both specialists through the My Specialty Dentist directory. Our [periodontics overview page](/specialties/periodontics) explains what periodontists treat and when to see one.
Cost of Treating Gum Recession from Braces
Gum graft surgery to treat recession typically costs $600 to $3,000 per area treated. The cost depends on the number of teeth involved, the grafting technique used, and whether donor tissue from a tissue bank is used (which adds material cost). Costs vary by location and provider.
Many dental insurance plans cover a portion of gum grafting when it is performed to treat clinical recession, not purely for cosmetic reasons. The orthodontic treatment itself is a separate cost. If preventive grafting is recommended before braces, check with your insurance about coverage under your periodontal benefit.
When to See a Periodontist About Recession and Braces
A general dentist can identify recession, but a periodontist is the specialist with advanced training in gum tissue health, graft surgery, and the specific considerations involved in managing gum tissue during orthodontic treatment.
See a periodontist before starting orthodontic treatment if you have thin or translucent gum tissue, existing recession, or a history of gum disease. See a periodontist during treatment if you notice a tooth looking longer, a root becoming visible, or increased sensitivity on a specific tooth. See a periodontist after treatment if recession developed during braces and you want to explore coverage options.
Learn more about what periodontists treat on our [periodontics overview page](/specialties/periodontics).
Find a Periodontist Near You
Every periodontist on My Specialty Dentist has verified specialty credentials. Search by your location to find a periodontist who can evaluate your gum tissue, coordinate with your orthodontist, and recommend the right treatment if recession has occurred.
Search Periodontists in Your Area