Genetically, we all have different widths and thicknesses of attached gingiva. Some people are born with thin or insufficient attached gingiva. In these cases the gum slowly continues to recede over time, even though the patient may be very dedicated to oral health. This situation is not an infection, as seen with periodontal disease, but it still needs to be treated as such.
Unfortunately, when gums recede, bone recession is occurring at the same time. This is caused because the bone, which is just under the gum, will not allow itself to become exposed to the oral cavity. As a result, it moves down with the gum.
A lack of attached gingiva is sometimes associated with a high frenum attachment, which exaggerates the pull on the gum margin. A frenum is a naturally occurring muscle attachment, normally seen between the front teeth (either upper or lower). It is normal to have a frenum, but it should not pull on the gum margin or recession will occur. If pulling is seen, the frenum is surgically released from the gum with a frenectomy. Often a new band of hard gum is also added to re-establish an adequate amount of attached gingiva.
With the wear and tear of time, even normal attached gum can be worn away, generally from vigorous brushing. This often happens in people with naturally thin tissues, or when the tissues have been stretched during orthodontics. If there is still adequate attached gum to act as a barrier to the muscle, the treatment for gum recession is to ensure further damage isn’t done when brushing.
However, if the attached gum is worn to the point where it cannot resist the constant pull of the mucosa, gum recession will continue unless a new hard band of gum is placed. Unchecked, the gum recession can cause tooth loss as the bone recedes with the tissue and tooth support weakens.