Receding gums after sixty: why my teeth look longer, and what the dentist did about it

I noticed it in a photograph. My granddaughter's graduation, June 2024, me grinning in the second row, and my two front teeth looked like they belonged to a horse. Longer than I remembered. I went to the bathroom mirror that night and looked, really looked, for the first time in years, and the gum line had crept up so that I could see a band of yellower tooth above the white. That is root. It is not supposed to show.

This is what I learned about receding gums from Dr. Patel over the next few visits, what we did about it, and what I would tell anyone my age who sees the same thing in a photo.

Why gums recede

The dentist gave me three reasons, and he said all three applied to me.

Age. Gum tissue thins and pulls back a little over a lifetime. The National Institute on Aging's teeth and mouth page lists it as common in older adults, which was the first time I had read anything that said this was normal.

Brushing too hard. For forty years I brushed the way I scrubbed a porch: hard, fast, back and forth, with a medium or firm brush because the soft ones felt like they were not doing anything. Dr. Patel showed me the wear notches at the gum line on my eye teeth, little grooves where the brush had worn the tooth and pushed the gum back. He said he sees it in nearly every man my age who grew up before the soft-brush advice.

Gum disease. This is the one that matters most, because it is the one that can get worse. When the gums are inflamed for a long time, the bone underneath them slowly goes, and the gum follows the bone down. The NIDCR's gum disease page explains it better than I can. In my case the dentist measured the pockets around each tooth and found a few fours and one five on the back molars, which meant there was some disease, not just wear.

What exposed roots mean

Two things, and I had both.

Sensitivity. The root of a tooth is not covered with enamel. It is covered with something softer called cementum, and under that is dentin, which has tiny tubes that run to the nerve. Cold water on an exposed root goes straight down those tubes. I had stopped drinking ice water without knowing why. Now I knew.

Decay. Root surfaces are softer than enamel and they decay faster, especially in a dry mouth, which I also had. The two cavities Dr. Patel found in 2022 were both on roots. The NIDCR page on tooth decay has a section on root decay in older adults that I wish I had read ten years earlier.

What the dentist did

A deep cleaning on the back molars, which is a cleaning below the gum line with numbing, one side of the mouth at a time, to get the hardened deposits out of the pockets. Two visits. My plan paid part.

A soft brush and a lesson. The hygienist took my brush away, gave me an extra-soft one, and showed me how to hold it like a pencil, not a hammer, and to angle it at the gum line and move it in tiny circles instead of scrubbing. It took me a month to stop reverting. I now use an electric brush with a pressure sensor that lights up when I push too hard, which it did constantly the first week.

Desensitizing toothpaste with potassium nitrate, used every day. Within a few weeks ice water stopped hurting. I still use it.

Fluoride varnish at each cleaning, and a prescription high-fluoride paste at night, mostly because of the dry mouth but also because exposed roots need all the help they can get.

Watching. Dr. Patel measures the pockets at every visit now and compares them to the chart from the last one. The fours have stayed fours. The five became a four. He said that is what success looks like at my age: not regrowth, but no more loss.

When a graft is needed

I asked about gum grafts because I had seen them advertised. Dr. Patel said they are a real option when recession is severe enough that the root is badly exposed, the tooth is at risk, or the sensitivity cannot be managed. A periodontist takes tissue from the roof of your mouth, or uses donor tissue, and stitches it over the exposed root. It works. It is also surgery, a few thousand dollars per area, and not something he thought I needed yet. The American Academy of Periodontology's patient pages describe what a periodontist does and when a general dentist sends you to one. If your dentist says the word "periodontist," go.

Where a probiotic fits, honestly

I will tell you what I know and what I do not.

Gum recession does not reverse. No tablet, rinse, paste or oil regrows gum tissue. Anything that says otherwise is selling you something. The gum you have lost is gone, and the goal is to keep what is left.

What a probiotic may do is help with the inflammation side. The hygienist told me that some of her patients used a lozenge or tablet with a bacteria called Lactobacillus reuteri alongside their regular cleaning, and that there were studies showing a little less gum bleeding and swelling in people who did. She was careful to say it was a small effect and that it was in addition to brushing and flossing, not instead of them.

I was already taking a probiotic tablet called ProDentim for the morning breath that came with my dry mouth, which I wrote about in the first article. It has reuteri in it. I cannot tell you it did anything for my gums, because I started it at the same time as the deep cleaning and the soft brush and the fluoride, and there is no way for me to separate them out. What I can tell you is that my pocket numbers have held or improved, that my gums do not bleed when I floss anymore, and that I have kept taking it because the breath result was clear and the gum result, if there is one, comes along for free.

If you have recession and bleeding, the order is: dentist, deep cleaning if they say so, soft brush, floss every night, fluoride. Then, if you want to add something, the ProDentim order page lists the strains and the price. I would not buy it hoping for gum regrowth. I would buy it, if at all, the way I did, for the breath, and take any gum benefit as a bonus.

What I would tell my younger self

Buy the soft brush at forty. Hold it like a pencil. Floss, which I did not do until I was sixty-six and which I now do every night at the bathroom sink while Donna reads in the next room and reminds me if I skip it. Go to the dentist every six months even when nothing hurts, because by the time something hurts at the gum line, bone has already gone.

And look at your teeth in photographs once in a while. Mine were trying to tell me something for years, and I was too busy smiling to notice.