Gum recession is where the margin of your gum starts to wear away, exposing more tooth structure, and creating black triangles in orthodontics. This results in your tooth getting longer and usually causes sensitivity. Typically this is caused by periodontal disease (where bacteria sits around your teeth and destroys gum tissue and supporting bone), aggressive tooth brushing, genetics, poor oral hygiene/insufficient dental care, hormonal changes, tobacco products, grinding/clenching of your teeth, crooked/misaligned teeth and oral piercings. 

How is Gum Recession Prevented and Treated?


There are many factors that can help prevent gum recession and black triangles in orthodontics. Good oral hygiene – brushing, flossing, and going regularly to see your dentist and dental hygienist for regular check-ups and cleanings – are all very important. You also should make sure you are not brushing too hard as that can wear away gum tissue significantly. In these situations, brushing with an electric toothbrush may be recommended. Grinding/clenching your teeth can also put a lot of force on the teeth leading to some recession. Nightguards are often recommended for grinders in order to prevent further damage. Further, oral jewelry is often harmful as it rubs against your gum tissue causing it to recede. Lastly, with dental crowding and minimal room, some teeth are positioned outside of the dental arch in areas without much bone or gum tissue – so they are at significant risk for gum recession. 


Treatment of mild gum recession is normally done by having a deep cleaning done by your dental hygienist. If there is excess bone loss or large pockets present (the space from where your gum starts to where it attaches to your tooth), then gum surgery may be recommended. A periodontist is best to see when this happens. There are several different procedures the periodontist can do to help such as deep cleaning and reattaching the gum tissue to your tooth reducing the size of your pockets. Alternatively, a gum graft could be placed around the exposed area of the tooth or sometimes a bone and gum graft is done together (placing bone to regenerate around the tooth for support and adding a gum graft to cover the exposed tooth). 


Gum Recession in Teenagers vs. Adults


Gum recession and black triangles caused by gum recession are more common in adults than teenagers in general, but that doesn’t mean it can’t occur in children especially in orthodontic treatment. While having braces on, there tends to be more food/build-up accumulating around your braces which is why it is so important to practice good oral hygiene. 

Alternatively, when orthodontic treatment is performed on teenagers, often the bite needs to be corrected because of a jaw issue. If the discrepancy between the upper and lower jaw is significant, jaw surgery may be recommended. If jaw surgery is declined, the teeth, which are housed inside the jawbones, need to be moved significantly. Teeth have limits to how much they can be moved and if moved too far and outside of the bone, gum recession may occur. 


What are Black Triangles?


Black triangles occur when the gum tissue does not fill in the area underneath the contact point of two teeth. In a normal, healthy situation gum fills in this area known as the gingival papilla. 

Black triangles can be caused by many factors:


  • Gum recession/disease
  • Older age
  • Orthodontic treatment
  • Abnormal tooth shape

The reason why many adults get black triangles due to gum recession is that their dental crowding was not treated earlier. Gum tissue is generally more responsive as a child. When teeth are crowded and overlapped, the gum is not able to grow in the contact area between them. However, if the teeth are aligned as a child, the gum tissue will naturally reform into that area. When orthodontics is performed in an adult, the chances of the gum tissue regrowing in previously crowded contacts is much lower. Therefore, the black triangles are not caused by orthodontics – they were always there and orthodontics just exposes them.


How to Reduce Black Triangles


Depending on a number of factors, we may be able to reduce or even eliminate black triangles. The simplest solution is called interproximal reduction (IPR). IPR is routinely performed in orthodontics and is a strategy to help resolve crowding. By taking a thin piece of sandpaper, it allows recontouring the sides of teeth, making them less triangular. When teeth are less triangular, their contact point moves lower down, thus reducing a triangle. Alternatively, the contact point between two teeth can also be lowered simply by moving a tooth (if it has an incorrect orientation). 


A more invasive approach to reducing black triangles in orthodontics is cosmetic dentistry – such as bonding, veneers, or crowns. Dermal fillers may also be injected into gingival papilla to enlarge them. Lastly, some gum surgeries performed by periodontists may also help reduce or eliminate black triangles in orthodontics. 


In Summary


Ultimately, the best way to prevent black triangles from gum recession is by maintaining good oral hygiene with brushing and flossing and visiting your dentist/dental hygienist regularly. 

If you have any questions, Walt Orthodontics is happy to offer digital appointments during the COVID-19 crisis. Contact us today for your complimentary consultation. 


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