Recently Sarah Michelle Gellar of Buffy the Vampire Slayer fame revealed that she had a gum graft in her mouth. “After years of being what is known as an aggressive brusher, I had to have dental surgery.”*

Is there such a thing as brushing too hard?

Brushing hard should not be equated with brushing thoroughly. Although enamel is the hardest substance in the body – even harder than bone – it is surrounded by delicate gum tissue. Enamel also does not cover or protect the root surfaces of teeth. Using too much force can damage gum tissue, causing it to erode or disappear entirely. Aggressive brushing can also create defects in the root area. 

Instead, take a systematic approach to brushing. Begin with the upper teeth, clean the outside (cheek facing) surfaces, then the chewing surfaces, followed by the inside (tongue facing) areas. Repeat this for the lower teeth. The entire process should take approximately two minutes. 

What happens when the gum is damaged?

Repeated insult to the gum may cause it to recede, thereby revealing the root of the tooth. In general, roots are darker in color than the crown or top portion of the tooth and your tooth may appear as two-toned. For some, this presents an esthetic issue. The phrase “long in the tooth,” where more tooth is visible, conjures up an image of old age. 

Further, once the root surface is exposed, aggressive brushing can create actual defects, or divots, in the root itself. The area can become sensitive to temperature, cold air, or the toothbrush when the bristles contact the sensitive spot. These defects are also perfect hiding places for food particles, creating an even more vulnerable area for cavities to form. And no one wants to worry about a stubborn stuck remnant of lettuce while enjoying a salad. 

What are the options?

• A desensitizing product

If the area is sensitive, brushing with a desensitizing toothpaste may relieve the symptoms. Regular application of fluoride or other desensitizing agents may also help. Discuss this with your dentist.

• A filling

A composite resin, tooth-colored filling can be placed in the root defect to reduce the sensitivity and eliminate food impaction. Since these fillings rest on the side of the tooth, they’re not as secure as fillings in the center of the tooth and do occasionally fall out.

• Gum grafting

A piece of gum tissue is placed and grafted onto the area. The tissue can be taken from another location in your mouth, commonly the roof (palate) and less frequently from neighboring teeth. Alternatively, the gum tissue can be obtained from a tissue bank. 

Regardless of the technique, gum grafting works best when it’s done early, before the recession becomes pronounced and any bone loss has occurred. Ironically, that’s when you’re least likely to commit to such a procedure. Think of the gum like a curtain that drapes over the underlying supporting bone of the tooth. If there isn’t adequate bone to support that curtain of gum, then it’s likely that any grafting will not hold up over time.

At first glance, a filling seems like a much easier, more comfortable, less costly procedure than gum grafting. Should grafting be desired in the future, the presence of a filling may reduce the chances of success for the graft. At a minimum, the filling will need to be removed prior to the graft.

Do you clench or grind your teeth?

Chances are you may not even be aware of such habits. It’s important to get an accurate diagnosis. Just as overly hard brushing can damage the gum and root, repeatedly exerting excessive forces on your teeth can result in unfavorable consequences. In addition to tooth wear, breakage, or looseness, clenching and grinding can also lead to gum recession and root defects.

How to avoid gum recession:

• Use a soft brush – Synthetic bristles are manufactured in different stiffnesses. Always select a soft one. With natural bristles, such as boar bristles, evaluate the softness before using.
• Brush softly 
• Don’t brush too frequently – Brushing your teeth five times a day is probably too often. 
• Brush for no more than two minutes – Set a timer if you have a tendency to brush for a long time. Electric brushes generally have built-in timers.
• With an electric brush, let it do the work for you – Keep your hand passive and simply guide the brush. There’s no need to use additional pressure.
• Manage your clenching and grinding – Discuss possible therapies with your dentist, including a mouthguard.

Smile like a celebrity

While gum recession affects many, sometimes it takes a celebrity to highlight this, especially if you’re causing the damage by overzealous brushing. Not only is gum recession a cosmetic challenge, but it can also result in harmful consequences to your teeth and health. Now is the time to focus on softer brushing.

*https://www.cnn.com/2023/10/06/entertainment/sarah-michelle-gellar-surgery/index.html

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By Teresa Yang, DDS

Teresa Yang, DDS, has practiced dentistry in the Los Angeles area for more than thirty years. She started and developed two practices from scratch, which is unique in today’s insurance-driven world. She has taught clinical dentistry and patient management at UCLA School of Dentistry, has written extensively on dental topics, and is a member of the Forbes Health Advisory Panel. Dr. Yang’s philosophy has always been to put the patient’s interest first: “A person is more than a mouth and a set of teeth.” She is the author of Nothing But the Tooth/An Insider’s Guide to Dental Health (Rowman & Littlefield, August 23, 2023). Learn more at teresayangdds.com.