Gums constantly sore - recession

[cuddylier]

I'm a 24 male and I first noticed considerable gum recession on my front lower teeth at the end of February and made an appointment to see my dentist in March. They said the only thing I needed to do was make sure to brush the now exposed parts of the tooth and that's all I needed to do, at this point I had no pain, sensitivity or bleeding and the recession was only visual. My dentist mentioned that the recession was likely accelerated by the fact I have a permanent retainer on the back of my front lower teeth from orthodontics I had as a teenager, therefore potentially making the gums thinner. I've had a relatively bad brushing technique for most of my life up until this point where I brushed for too long (10+ minutes), and using incorrect methods, twice a day, not usually too hard though, this most likely contributed significantly to the recession occurring too as well as some recession on the front upper teeth.

A few weeks after my March dentist appointment, I started to suffer pain on my gums everywhere (still zero bleeding) in my mouth, which was noticeable constantly and didn't seem to be affected by anything (food eaten etc), this was at the same time as I changed my brushing technique to small circles and brushed for 3 minutes twice daily along with starting to floss (something I'd never done before). When I flossed for the first time, there was only a tiny amount of bleeding for a few days and none after that however it did seem to make the soreness of my gums worse even though I was doing it very gentally and ensured I only went under the gums a little. I started to notice what looked like black staining appearing on my teeth around this time too, it was especially prominent in between my teeth and where the gums meet the teeth, areas that were more black seemed to hurt in between the teeth, and still do.

I made an appointment to see a new dentist on 24th July to get a 2nd opinion on the recession (as it was slowly getting worse) and the gum soreness at the same time (also because my original dentist was still closed due to covid). They said I was cleaning everything okay, I didn't have gum disease and that they couldn't see any cause for my gum soreness, they gave me a few things to try, an ultra soft toothbrush (I had been using a soft toothbrush since March), to massage my gums with my finger daily and to use a different brushing technique; brushing down from the gums in strokes, like this. They also mentioned that in my case, I don't need to floss. They said that they didn't necessarily recommend any treatment for the recession and that in the future e.g. in 10 years time, I would start to have sensitivity on the front lower teeth.

Since the appointment on 24th July, things haven't improved and have got a little worse, soreness is a bit more pronounced all around my mouth (especially when my brush hits my gums, even the slightest touch is sore, it feels like it's stinging), especially on the recession on the front lower and upper teeth. Small red patches have formed where my gums meet the teeth, especially in the areas where it's more sore. I will be soon revisiting my dentist as they asked me to get back in contact if things haven't improved.

Does anyone have any opinions on what this might be? I presume if my dentist cannot figure out the cause after a second visit then they may refer me to a periodontist (or I will myself if I see my Dentist and I not getting anywhere).

I'm concerned my gums look a little sad and don't wish things to progress unnecessarily, my teeth and gums before this have historically always been totally fine and no fillings/decay, I've always visited the dentist every 6 months.

TLDR: Gums are sore but do not bleed whatsoever, dentist has confirmed it's not gum disease, tried everything I can think of including an ultrasoft toothbrush, brushing for 3 - 5 minutes slowly and carefully with the brushing technique seen in this video that was also recommended by my dentist but soreness has not resolved.

Pictures:

side

Front lower 1

Front lower 2

Front lower 3

Top upper

 

[Dr M]

Good day

On the picture it looks like you have marginal inflammation. This could be because of a lot of things. Firstly, I never advise my patients to brush for 3-5min. Brushing too long, even using the correct methods, can actually damage your gingiva and teeth. 2 mins of brushing is usually enough.
If you changed toothpastes recently, it might also be that the tooth paste is causing a reaction with your gums. Although it is not often seen, certain patients have been known to show an auto-immune reaction to SLS or sodium lauryl sulfate in toothpaste. Try changing to a different toothpaste.
Chronic inflammation could also be sign of a bacterial infection. For this a short course of anti-biotics might be needed in order to clear it up permanently.
Do you suffer from any system conditions? Diabetes? Smoking?

 

[cuddylier]

Good day

On the picture it looks like you have marginal inflammation. This could be because of a lot of things. Firstly, I never advise my patients to brush for 3-5min. Brushing too long, even using the correct methods, can actually damage your gingiva and teeth. 2 mins of brushing is usually enough.
If you changed toothpastes recently, it might also be that the tooth paste is causing a reaction with your gums. Although it is not often seen, certain patients have been known to show an auto-immune reaction to SLS or sodium lauryl sulfate in toothpaste. Try changing to a different toothpaste.
Chronic inflammation could also be sign of a bacterial infection. For this a short course of anti-biotics might be needed in order to clear it up permanently.
Do you suffer from any system conditions? Diabetes? Smoking?

Thank you very much for your response.

I'll try restricting to only 2 minutes although I've been slowly brushing my teeth since my problems started, maybe 3 - 5 circles or strokes down for the top and up for the bottom, for each set of teeth my brush can reach, so this partially contributes to the time, I figured going slowly and gental may help but doesn't seem to have, I know I should remain gental most likely though and I'm always aware of the pressure I put on my teeth and gums. I try my best to do what I think is the bare minimum in an effort to avoid inflamating due to too much brushing, I've tried experimenting with different brushing techniques and times but nothing so far has really made a difference meaning I'm somewhat at a loss of what to do.

My toothpaste does have SLS in it but I've been using this specific toothpaste for years, long before my recession and gum soreness came to light so I presume it's likely I don't have a negative reaction to SLS but maybe it's possible to develop one.

I wouldn't say my inflamation is 'chronic' in the sense that I'm in major pain constantly but the moderate pain and inflamation feeling/stingyness is there all the time, I'd guess it's maybe a moderate case. The pain does seem linked with brushing though, pain usually becomes worse after brushing although it can inflame itself randomly later in the day, especially a few hours after taking mouthwash, which seems to calm it down a bit until it wears off.

I don't have any health conditions apart from anxiety in the past, I don't have diabetes nor smoke.

 

[Dr M]

I would maybe then consider getting yet another opinion from a dentist or periodontist. The brown marks look like extrinsic staining which can be polished off, or removed with an ultrasonic scaler.
It is normal that gums bleed when you start flossing, but this should become less and less.
A periodontist will most likely be able to do more advanced tests, if your condition does not improve.

 

[cuddylier]

I would maybe then consider getting yet another opinion from a dentist or periodontist. The brown marks look like extrinsic staining which can be polished off, or removed with an ultrasonic scaler.
It is normal that gums bleed when you start flossing, but this should become less and less.
A periodontist will most likely be able to do more advanced tests, if your condition does not improve.

Thanks again. I will probably go back to my dentist if things don't improve soon and then see if they can refer me to a peridontist if they're out of ideas. It's interesting that I have the extrinsic staining as I don't eat/drink anything that I've read typically causes it. Sadly cleaning isn't available from dentists at the moment in the UK due to covid-19 but I guess it's nothing very urgent, my last cleaning from a dentist was in March.

Due to the state of my gums, I assume you'd agree that it's probably best visiting a peridontist in the near future regardless to see what they can do for me to help rebuild my gums (even in the case where I no longer have pain), especially on the lower bottom, to avoid issues with my teeth in the future, right? My thought is better doing something about it now before it's too late.

 

[cuddylier]

One other thing, my lower canines are quite receeded as you can see from my pictures, this makes them quite difficult to brush as there's more gum exposed on the sides of the tooth to the toothbrush, this seems to have resulted in the gums on the side of the lower canines becoming red and as a result, more sore than other areas of my mouth. I've tried the brush up and small circles technique on these teeth, being very gentle and using little pressure, but sadly it hasn't improved. Do you have any tips on cleaning my lower canines? The upper ones are fine, they seem much less receded.

 

[Dr M]

I would advise continue using the circular method, with an ultra soft toothbrush, but actively try and limit the amount of time you spend on brushing in general. If the dentist could do a professional scale and polish during this Covid period, the condition of your gingiva might improve drastically as soon as they are able to do so.

 

[cuddylier]

Thank you for all of the advice.

I went to my dentist on the 16th September and they found that my gums bled relatively easily, especially on the top front when prodded with a tool, they said it was the beginning of gum disease which makes sense. I was told to brush more thoroughly using small circles up to the gums and when I did, the top front gums improved considerably within a few days and were no longer bright red (which they were by the time I went to my appointment), I was focusing already on brushing right up the gum but obviously not enough.

My dentist recommended a scale and polish (without me mentioning it) so I'm going back for that in a week or two which I hope to improve my overall condition.

I will be asking my dentist for more detail on my next visit but do you have any recommendations about brushing my lower front teeth (where the recession is greatest) and the front bottom canines? I seem to struggle with these areas as they're quite vulnerable due to the already considerable recession. I'm currently doing a mix of small circles and using a single tuft brush on the recessed parts of the front bottom incisors to avoid brushing the gum itself too much away from the edges of the tooth as it seems to irritate it a lot if I do. The lower canines in particular seen to be pretty irritated with small circle gentle brushing, I've pretty sure plaque isn't a problem there (and therefore hopefully not an irritation source) as I've checked with a plaque disclosing tablet but hard to be certain, especially below the gum.

 

[Dr M]

Good day

It seems like you are using the correct technique. Just make sure to use a soft toothbrush. In cases of severe recession, it is important to note that specialist intervention might be required, such as tissue grafts etc, since severe recession won't improve by itself.