I read with interest the October JADA "For the Dental Patient" feature, "Gingival Recession: Causes and Treatment" (
JADA 2007;138[10]:1404[Free Full Text]
). My personal feeling is that the treatment is excellent, but the diagnosis is incorrect, giving patients a misunderstanding of what actually may have happened.
None of the teeth are, as the article explains, protruded or crowded. All at one time were completely covered with healthy gingival tissue, as evidenced by the contour that remains. Other quadrants are not pictured to show whether heredity or some habit may have been involved. The enamel on the teeth, on the other hand, is completely smoothed, rounded and devoid of characteristic lines and grooves, and the root surfaces are glasslike and smooth. The cuspid that is normally prominent has the deepest grooving and the highest recession, indicating that whatever happened to it took place first.
Later on, as the grooving reached a depth where the other teeth could be affected by the process of microabrasion from toothpaste abuse, they, too, were grooved in a similar manner. One could almost draw a straight line from groove to groove, as the composite depths all seem to line up. This rules out abfraction and suggests, rather, that toothpastes as well as patient brushing habits are the real problem.
As a side note, if abfraction were real, one would have to explain why the groove does not extend around the entire tooth, and also why the surface is glasslike and polished, rather than rough. Stopping the use of toothpaste is a more permanent solution, as the beautiful surgery that is presented in the picture may ultimately need to be redone.
