Toothbrush Abrasion and Interproximal Gingival Recession
Toothbrush abrasion alone cannot directly cause interproximal gingival recession because toothbrush bristles do not physically reach the interproximal spaces between teeth. 1, 2
Anatomical Limitations
- The interproximal areas (spaces between teeth) are protected from direct toothbrush contact by the contact points between adjacent teeth 1
- Toothbrush bristles primarily contact the facial (buccal) and lingual surfaces of teeth, not the interdental papillae 2
- Gingival recession from toothbrushing trauma occurs almost exclusively on facial surfaces where direct mechanical contact occurs 1, 3
Evidence on Toothbrush-Related Recession
The relationship between toothbrushing and recession is complex and primarily affects accessible surfaces:
- A systematic review found inconclusive data to support or refute the association between toothbrushing and gingival recession overall, with only one Level I randomized controlled trial showing toothbrushes actually reduced recessions on buccal surfaces over 18 months 4
- Of 17 observational studies reviewed, eight reported a positive association between brushing frequency and recession, while two found no relationship—but these studies focused on facial surfaces, not interproximal areas 4
- Long-term studies do not support the development of recession following toothbrushing, though short-term studies suggest gingival trauma and abrasion may occur 1
Multifactorial Etiology of Interproximal Recession
Interproximal gingival recession develops through different mechanisms:
- Gingival recession has a multifactorial etiology with anatomical and pathological factors being primary drivers 1, 5
- Periodontal disease is the predominant cause of interproximal recession, as inflammation and bone loss affect the interdental papillae 1
- Thin buccal bone plates or dehiscences can predispose teeth to recession, but these are anatomical factors rather than mechanical trauma from brushing 5
Critical Clinical Distinction
The key pitfall is confusing facial recession (which may have a toothbrushing component) with interproximal recession (which does not). 1, 2 When evaluating recession patterns:
- Isolated facial recession in patients with good oral hygiene and no periodontal disease suggests possible traumatic brushing 3
- Interproximal recession accompanied by facial recession indicates periodontal disease or anatomical predisposition rather than mechanical trauma 1, 5
- Toothbrush abrasion may cause wear at the cemento-enamel junction on accessible surfaces, potentially contributing to supporting periodontium destruction, but this mechanism still requires direct brush contact 1