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The Evolution of Buccal GingivalRecessions in a Student Population:

A 5-Year Follow-UpGiuseppe Daprile,* Maria Rosaria Gatto,* and Luigi Checchi*

Background: Data from cross-sectional studies revealedthat gingival recession commonly occurred in subjects witha good standard of oral hygiene, but very little has beenreported about longitudinal changes in the presence and ex-tent of gingival recession in a similar sample of the population.The aim of this study was to follow up on the evolution of gin-gival recession at buccal tooth surfaces in a student popula-

tion attending the fifth year at Bologna University DentalSchool who had been examined in a study 5 years earlier.Methods:The clinical examination involved assessment of

the number of buccal surfaces with plaque and buccal gingivalrecession. Information about toothbrushing habits (brushingtechnique and frequency and toothbrush bristle stiffness) wascollected in an interview.

Results:The number of subjects with at least one recessionand the total number of recessions had increased significantly.Comparing data from the baseline and the present study, nosignificant differences were observed for toothbrush type andfrequency of toothbrushing, whereas the use of correct brush-ing techniques increased to 87% of the subjects.

Conclusion:The percentage of affected sites increased withthe level of oral hygiene education, and this increase developeddespite a reduction in the frequency of dangerous toothbrush-ing habits. J Periodontol 2007;78:611-614.

KEY WORDS

Gingival recession; longitudinal study; oral hygiene;toothbrushing.

Gingival recession is defined com-

monly as an apical shift in thegingival margin over the ce-mento-enamel junction with root surfaceexposure. This gingival pathology is notaesthetically pleasing and can be asso-ciated with sensitivity and root decay.A review of important studies1,2about thesubject suggested that recession of thegingiva at buccal surfaces can occur as aconsequence of plaque-induced inflam-mation and mechanical trauma by dailytooth cleaning. Moreover, data fromcross-sectional studies3-5 revealed thatgingival recession commonly occurs insubjects with a good standard of oralhygiene, but very little has been reportedabout longitudinal changes in the pres-ence and extent of gingival recessions ina similar sample of the population.

Furthermore, many investigators6-11

studied toothbrushing variables (tooth-brush type, techniques, and brushingfrequency) and their influence on thedevelopment of gingival recession; how-ever, few data are available after an

appropriate modification of dangeroushabits.

In a pilot study for a program of sys-tematic evaluation of the prevalence ofgingival buccal recession, Checchi et al.12

examined a population of subjects at-tending the first and the final years atBologna University Dental School. Final-year students presented a high level oforal hygiene but also a higher prevalenceof buccal recession compared to the

* Department of Periodontology, School of Dentistry, University of Bologna, Bologna, Italy.

doi: 10.1902/jop.2007.060277

J Periodontol April 2007

611

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first-year group. The purpose of the present study wasto follow up the evolution of gingival recession and themodification of oral hygiene that occurred in the first-year group after the completionof their course of study.

MATERIALS AND METHODS

In this study, 23 of the 27 subjects attending the firstyear were reexamined at the completion of theircourse of study after 5 years. The remaining four sub-jects failed to complete their studies in the same timeperiod and were excluded from the study. The sample

was composed of 10 males and 13 females, ranging inage from 23 to 25 years. In the follow-up period, noneof the subjects had orthodontic treatment or restora-tions next to the gingival margin. The protocol wasconducted in accordance with the Helsinki Declara-tion of 1975, as revised in 2000. The subjects pro-

vided informed consent to participate in the study.The study was conducted from October 1996 toNovember 2001.

At baseline, first-year students were chosen be-cause they were at the beginning of their universityexperience and had no specific knowledge of oral

hygiene techniques as taught in dental school. Onthe contrary, at the completion of studies, the samestudents received oral hygiene instruction in accor-dance with the most up-to-date scientific trends.

Oral hygiene habits were recorded for each subject.The same dentist performed the baseline and secondexaminations. All measurements were single and ap-proximated to the nearest millimeter. Table 1 reportsthe variables considered in the hygiene habits evalu-ation and in the intraoral examination.

Statistical AnalysisThe McNemar x2 test was used for comparison ofsubjects at baseline and at the second examination.The Wilcoxon test was used to compare the other pa-rameters, given that no hypothesis could be made onthe form of the distributions.

RESULTS

Six hundred thirty-eight teeth were examined (thirdmolars were excluded, and six teeth were missingfor various reasons); the mean number of teeth perperson was 27.7 0.8. No teeth were missing fromthe baseline examination.

Table 2 shows the prevalence of gingival buccal re-cession at the baseline and second examinations. Thenumber of subjects with at least one recession was sig-nificantly higher at the second examination comparedto baseline (82.6% versus 47.8%, respectively). More-over, the number of recessions found at the second

Table 1.

Oral Hygiene Habits and IntraoralExamination Variables

Oral Hygiene Habits

Toothbrush bristle stiffness; classified as hard, medium, orsoft

Daily br ushing frequency

Buccal brushing technique; classified as simple (horizontal,

vertical, and rotary movements) and complex (Bass or

roll technique)

Intraoral Examination

Buccal gingival recession 1 mm, measured from gingival

margin to cemento-enamel junction; for molars, the

gingival recession was measured at the deepest buccal

point

Number of buccal surfaces with plaque

Table 2.

Prevalence of Gingival Recession

Baseline Second Examination P Value

Subjects with at least one recession (N [%]) 11 (47.8) 19 (82.6) 0.001

Recessions (N) 28 64 0.001

Recessions = 1 mm (N) 22 51 0.003

Recessions >1 mm (N) 6 13 0.035

Worsened recessions (N) 6

Improved recessions (N) 6

Recessions >1 mm not present at baseline (N) 4

Recessions per subject (mean N) 1.2 2.8

Receded surfaces (%) 4.3 10

Gingival Recession in a Student Population: 5-Year Follow-Up Volume 78 Number 4

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examination had doubled, with a high statistical sig-nificance (P=0.001).

Figure 1 shows the distribution of buccal recessionson maxillary and mandibular teeth at baseline and atthe second examination. Maxillary and mandibularbicuspids had the highest number of receded surfacesat baseline (13 of 28 recessions), whereas maxillarymolars and mandibular bicuspids were affected themost frequently at the second examination (14 and15 of 64 recessions, respectively). Moreover, the sec-

ond examination showed six worsened recessions

(in five subjects), six improved re-cessions (in six subjects), and fourrecessions >1 mm that were notpresent at the baseline examina-tion.

Table 3 shows the change in the

oral hygiene habits: no differenceswere found in daily brushing fre-quency or percentage of subjectsusing hard-bristle toothbrushes.On the contrary, a highly signifi-cant difference was found in thepercentage of subjects using acomplex technique of toothbrush-ing (Bass or roll technique). Themean number of buccal surfaceswith plaque was significantly lowerat the second examination com-

pared to baseline, showing an im-provement in the oral hygiene.

The mean number of buccalsurfaces with plaque in teeth withrecession decreased from 27 11.9 at baseline to 10 5.8 atthe second examination, althoughthis result was not statistically sig-nificant. Moreover, seven subjectswho did not show any recession atbaseline presented only recededsurfaces without plaque at the

second examination.

DISCUSSION

At baseline, 47.8% of the subjects(age range, 18 to 20 years) had atleast one buccal recession. If wecompare this result to those re-ported on subjects with a similarage range, it is close to values pre-sented by Khocht et al.11 (43.1%)and Serino et al.13 (44%) in adultpopulations

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