What This Guide Covers and Who It Is For
This guide explains how orthodontic treatment with braces can affect your gum tissue and what you can do about it.
Gum recession means the gum tissue pulls back from the tooth, exposing more of the root surface. This can cause sensitivity, change the way your smile looks, and leave roots vulnerable to decay. When it happens during or after braces, patients often wonder whether the braces caused it.
The relationship between orthodontics and gum recession is not always straightforward. Several factors work together, including your genetics, your gum tissue type, how your teeth are moved, and how well you care for your teeth during treatment. This guide breaks down each factor so you can have informed conversations with your orthodontist and periodontist.
This information is for anyone considering braces, currently wearing braces, or dealing with recession that appeared after orthodontic treatment. It is also useful for parents evaluating orthodontic options for teens.
How Braces Can Contribute to Gum Recession
Braces do not directly destroy gum tissue, but they can create conditions that make recession more likely in certain patients.
Gingival Biotype: Your Tissue Type Matters Most
The single biggest risk factor for recession during braces is your gingival biotype. This term describes the thickness and shape of the gum tissue and underlying bone around your teeth.
A thin gingival biotype means you have thin, delicate gum tissue and a thin layer of bone covering the tooth roots. When orthodontic forces move teeth, especially forward through thin bone, the tissue can break down more easily. A thick biotype provides more of a buffer against the mechanical stress of tooth movement.
Your periodontist can assess your biotype during an examination. In many cases, they measure tissue thickness with a probe or simply observe how translucent the tissue appears when a probe is placed behind it. Thin tissue typically looks more transparent.
Direction and Speed of Tooth Movement
The way teeth are moved during orthodontic treatment influences recession risk. Moving a tooth outward through the front of the jaw bone, called labial movement or proclination, is the highest-risk direction for gum problems.
When a tooth is pushed beyond the boundaries of the bone that supports it, the thin bone on the outer surface can resorb, meaning the body breaks it down. Without bone support, the overlying gum tissue often recedes. This is particularly common with lower front teeth, which naturally sit in a narrow ridge of bone.
The speed of movement also matters. Aggressive forces applied over a short period give tissues less time to adapt. Slower, more controlled forces typically result in better tissue response.
Oral Hygiene and Gum Inflammation
Plaque control during braces is one of the most important factors you can control. Brackets, wires, and bands create areas where plaque, a sticky film of bacteria, accumulates easily. [2]
When plaque builds up along the gumline, it triggers gingivitis, which is inflammation of the gum tissue. Gums become red, swollen, and may bleed when you brush. If gingivitis is not resolved, it can progress to periodontitis, a more serious condition where the bone and connective tissue that hold teeth in place begin to break down. [1]
Periodontitis during orthodontic treatment is a recipe for recession. The combination of bacterial damage to the supporting structures and mechanical forces from braces can cause tissue loss that would not have occurred from either factor alone.
Other Contributing Risk Factors
Several other factors can increase recession risk during braces. Tooth crowding or misalignment before treatment sometimes means teeth already sit outside the ideal bone envelope. Correcting severe crowding may require movements that push teeth toward the edges of available bone.
Habits like lip biting, tongue thrusting, or aggressive toothbrushing can add stress to gum tissue that is already under pressure from orthodontic forces. Smoking and tobacco use also reduce blood flow to gum tissue and slow healing, making recession more likely. [1]
Some patients have a frenum, a small band of tissue connecting the lip or cheek to the gum, that pulls on the tissue near a tooth. During orthodontic movement, this pull can worsen recession in that specific area.
Prevention: Protecting Your Gums Before and During Braces
Preventing recession during orthodontics starts with a thorough evaluation before treatment begins and consistent care throughout.
Pre-Treatment Periodontal Evaluation
A periodontal evaluation before starting braces can identify risk factors early. This is especially important for adults, patients with visible gum recession, or anyone with a history of gum disease. [1]
During this evaluation, a periodontist measures pocket depths around each tooth, checks for bone loss on X-rays, assesses gum tissue thickness, and looks for areas where tissue is already pulling away from teeth. If problems are found, they can often be addressed before orthodontic treatment starts.
For patients with a thin biotype and planned tooth movements that carry high recession risk, the periodontist may recommend a preventive soft tissue graft. This procedure adds thickness to the gum tissue before braces are placed, giving the area more protection during tooth movement.
Oral Hygiene Strategies During Treatment
Keeping teeth and gums clean with braces requires more effort than without them. The brackets and wires trap food and make brushing less effective if you use the same technique as before. [2]
Brush at least twice a day, angling the bristles toward the gumline at a 45-degree angle. Use a soft-bristled toothbrush or an electric toothbrush with a small round head designed for orthodontic patients. Floss daily using floss threaders, orthodontic flossers, or a water flosser to clean between teeth and under the wire.
Your orthodontist or hygienist should check your gum health at every adjustment visit. If gums appear inflamed or bleeding, they can coach you on technique improvements or recommend a prescription-strength mouth rinse. Regular professional cleanings, typically every three to six months, help remove plaque and tartar from areas that are hard to reach at home.
Collaborative Monitoring by Your Orthodontist and Periodontist
For patients identified as high risk, the orthodontist and periodontist should communicate throughout treatment. This collaboration allows the orthodontist to adjust force levels, change the direction of movement, or pause treatment if recession begins to develop.
Periodic periodontal check-ups during active orthodontic treatment, sometimes every three to four months, let the periodontist track changes in tissue levels and pocket depths. Catching early signs of recession, such as a change in tissue margin position or increasing probing depths, gives the team time to intervene before significant damage occurs.
If you notice that your gums are pulling back from a tooth, your teeth look longer than before, or you experience new sensitivity near the gumline during braces, let your orthodontist know right away. Early reporting can make a meaningful difference in outcomes.
Treatment Options If Recession Occurs
If gum recession develops during or after braces, several treatment options are available depending on the severity and location.
Gum Graft Surgery
Gum grafting is the most common surgical treatment for recession. A periodontist places a piece of tissue over the exposed root to restore gum coverage and add thickness to the area.
Several graft types exist. A connective tissue graft takes tissue from beneath the surface of the palate (roof of the mouth) and places it at the recession site. A free gingival graft takes a small section of tissue directly from the palate surface. Allografts use processed donor tissue, avoiding a second surgical site in your mouth.
The choice of graft type depends on how much recession is present, the thickness of your remaining tissue, and the location in your mouth. Your periodontist will recommend the approach most likely to succeed for your specific situation.
Recovery from gum graft surgery typically takes one to two weeks for initial healing, though full tissue maturation can take several months. You will eat soft foods, avoid brushing the surgical area for a period, and attend follow-up visits so the periodontist can monitor healing.
Timing: During Braces vs. After Removal
If recession appears while braces are still on, the decision about when to graft depends on the severity. Mild recession may be monitored while the orthodontist adjusts the treatment plan to reduce further stress on the area.
In more significant cases, a graft may be performed during active orthodontic treatment. The orthodontist typically pauses movement of the affected tooth for several weeks to allow the graft to heal. This coordination requires clear communication between both specialists.
In many cases, grafting is performed after braces are removed and the teeth have settled into their final positions. This allows the periodontist to treat the area without the complication of ongoing tooth movement and brackets covering the tooth surfaces.
Non-Surgical Management
Not all recession requires surgery. If the recession is minimal, not progressing, and the patient has no sensitivity or cosmetic concerns, the periodontist may recommend monitoring the area with regular check-ups.
Desensitizing toothpastes or professional fluoride applications can help manage root sensitivity without surgery. Improving oral hygiene technique and switching to a softer toothbrush can also help prevent further tissue loss.
If the recession is caused by an active gum disease process, the periodontist will address the infection first with scaling and root planing, a deep cleaning procedure that removes bacteria and tartar from below the gumline. Once the disease is controlled, the team can decide whether a graft is needed. [1]
Cost Factors for Gum Recession Treatment
The cost of treating gum recession varies based on the type of procedure, the number of teeth involved, and your geographic location.
Gum graft surgery typically ranges from $600 to $3,000 per area treated. Costs vary by location, provider, and case complexity. A single tooth graft is at the lower end, while grafting multiple adjacent teeth in one session is at the higher end. Using donor tissue (allografts) may add to the material cost compared to tissue taken from your own palate.
Many dental insurance plans cover gum graft surgery when it is deemed medically necessary, meaning the recession is causing or likely to cause functional problems such as root decay, sensitivity, or progressive bone loss. Cosmetic-only cases may not be covered. Contact your insurance carrier before treatment to understand your specific benefits.
The periodontal evaluation before braces is typically a standard dental exam and may be partially covered by insurance. If your orthodontist refers you to a periodontist, ask both offices about how insurance coordination works for the two specialties.
When to See a Periodontist
A periodontist is a dentist with additional training in the gums, bone, and other structures that support teeth. You should see one if specific signs appear before, during, or after orthodontic treatment.
Before braces, seek a periodontal evaluation if you have visible recession on any teeth, a history of gum disease, thin or translucent gum tissue, or if your general dentist or orthodontist recommends it. Adults starting orthodontic treatment for the first time benefit from this screening since age-related bone and tissue changes can increase risk. [1]
During braces, see a periodontist if you notice gums pulling away from one or more teeth, new or worsening tooth sensitivity near the gumline, persistent gum bleeding that does not improve with better brushing, or teeth that appear to be getting longer. Your orthodontist may also refer you if they observe tissue changes at an adjustment appointment.
After braces, a periodontal visit is appropriate if recession becomes apparent once the brackets are removed. Sometimes recession that started during treatment becomes more visible after appliances come off. Early evaluation gives you the best range of treatment options.
- Before braces: Existing recession, thin tissue, history of gum disease, adult patients starting treatment
- During braces: Gums pulling back, new sensitivity, persistent bleeding, teeth appearing longer
- After braces: Visible recession at bracket removal, ongoing sensitivity, cosmetic concerns about gumline
Find a Periodontist Near You
If you are planning orthodontic treatment, currently wearing braces, or noticing signs of gum recession, a periodontist can evaluate your tissue and recommend the right approach. Visit the periodontics page on My Specialty Dentist to search for a board-certified periodontist in your area who can work alongside your orthodontist to protect your gum health.
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