Fissures in Teeth/ Gum recession

Fissures are little dimples or notches on the tooth surface. Some teeth have peculiar distinct fissures which are very narrow and very deep. As a result it is not possible to clean them with a normal toothbrush. Consequently the risk of developing tooth decay increases, as you can see on the picture below:

 

The chewing surfaces of the back teeth are not smooth, as other areas of your teeth are. Instead, they are filled with tiny grooves referred to as “pits and fissures,” which trap bacteria and food particles. The bristles on a toothbrush can’t always reach all the way into these dark, moist little crevices. This creates the perfect conditions for tooth decay.

There are often no symptoms of cavities, which is why important of visiting a dentist so that cavities can be diagnosed and treated early before they get large enough to cause symptoms. Early in its development, caries may affect only enamel. As the cavity progresses, the decay gets near the nerve (pulp) and can cause pain, which gets progressively worse especially with exposure to heat, cold, sweet foods or drinks. If the decay gets large enough, part of the tooth may fracture off, leaving a large visible hole, and the tooth may be sensitive to biting pressure. Bad breath and or a bad taste in the mouth are also symptoms.
The tip of a dental explorer, which is used for caries diagnosis.
A person experiencing caries may not be aware of the disease.The earliest sign of a new carious lesion is the appearance of a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel. This is referred to as incipient decay. As the lesion continues to demineralize, it can turn brown but will eventually turn into a cavitation (“cavity”). Before the cavity forms, the process is reversible, but once a cavity forms, the lost tooth structure cannot be regenerated. A lesion which appears brown and shiny suggests dental caries were once present but the demineralization process has stopped, leaving a stain. A brown spot which is dull in appearance is probably a sign of active caries.
As the enamel and dentin are destroyed, the cavity becomes more noticeable. The affected areas of the tooth change color and become soft to the touch. Once the decay passes through enamel, the dentinal tubules, which have passages to the nerve of the tooth, become exposed and causes pain in the tooth. The pain may worsen with exposure to heat, cold, or sweet foods and drinks.
Treatments for cavities include fillings, crowns and root canals. If the lesion is very small and just beginning, it can be treated with fluoride paste and varnish to help stop the progression of the demineralization. If the cavity is formed, however, there is only one option: to remove the decay and put a filling in its place. 

Classification of caries

Grade I (incipient): Surface texture: Soft, can be penetrated with a Dental Explorer; No surface defect; Pigmentation:variable, Light tan to brown

Grade II (shallow) : Surface texture: Soft, irregular, rough can be penetrated with a Dental Explorer; Surface defekt: (<0.5 mm in depth); Pigmentation:variable, Light tan to brown

Gingival recession (receding gums) is the exposure in the roots of the teeth caused by a loss of  gum tissue and/or retraction of the gingival marginfrom the crown of the teeth. Gum recession is a common problem in adults over the age of 40, but it may also occur starting from the teens.

 In healthy teeth, enamel protects the underlying layer of dentin, which is softer than enamel. The tooth roots are protected by gums. But if the enamel is worn down or if the gum line has receded, then the dentin becomes exposed. Dentin contains thousands of microscopic tubules, or channels, leading to the tooth's pulp. When exposed to the elements, these dentinal tubules allow heat, cold, acidic or even sticky substances to reach the nerves inside the tooth, causing pain.

Symptoms:The roots of the tooth are exposed and visible .The tooth feels notched at the gum line.

Causes: Overaggressive brushing, which causes the enamel at the gum line to be worn away over time by scrubbing the sides of the teeth in a washboard fashion.

Treatment should start with addressing the problem(s) that caused the gum recession. If overactive brushing is the cause, the patient should consider purchasing a softer toothbrush and use a more gentle brushing technique. If poor plaque  control was a contributing factor, improved oral hygiene must be performed, combined with regular professional dental cleanings as prophylaxis. If severe calculus (tartar) was the cause, then a procedure called scaling and root planing may be necessary to clean the teeth and heal inflammation in the gingiva (gums).