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Clear Aligners and Gum Recession: A Comprehensive FAQ Guide

Woman with healthy gums smiling after clear aligner therapy.

One of the big perks of removable clear aligners for many patients is the gentler relationship between the appliance and their teeth. As they’re not a fixed appliance like braces, they do not require:

Rather than pull the teeth into alignment, aligners gently push them into alignment, meaning that they exert less force (and subsequently result in less soreness) than traditional braces. Even so, does that same gentler relationship apply to the gums? Learn more about clear aligners and whether or not they help (or hinder) the gums.

Can Aligners Cause Gum Recession?

Gingival recession is a common problem among adults over the age of 40, but not one which should be taken lightly by younger patients. Recession refers to the loss and retraction of gum tissue, exposing the roots of the teeth and leaving them more vulnerable to sensitivity. This in turn can result in a troubling manifold of other problems, including:

  • Mobility issues
  • Change in tooth color
  • Weaker defenses from periodontal disease
  • Cavities
  • Spacing issues
  • Inflammation
  • Bleeding
  • Persistent bad breath (AKA halitosis)

If you’re wondering whether or not aligners would play a role in this discomfort, the good news is that they most certainly do not as long as your treating doctor does understand the limitation of orthodontic treatment and how that effects the gum tissue.  

Your periodontal ligament tissue will need time to acclimate and stabilize to the new positioning of your teeth, which is why the same clear aligner trays are worn for a few weeks at a time before switching. Therefore, it would be counterintuitive to that stabilization process if aligners contributed to further gum wear and destabilizing.

However, if your orthodontist notices gum recession at your initial complementary consultation, then they will want to resolve that before starting clear aligner treatment. They may do so by deep cleaning the affected area, implementing antibiotics, or ordering any one of the following oral surgical procedures to be performed:

  • Regeneration: The affected gum tissue will be folded, and a regenerative material (such as membranes, tissues, or proteins) will be secured to encourage gum development.
  • Flap scaling: The affected gum tissue will be folded back, and contaminants will be directly removed from the pockets.
  • Soft-tissue graft: Tissue will be cut from the roof or flap of the mouth, and then grafted onto the affected gum region(s). 

Can Aligners Cause Gum Disease?

Periodontal disease is a common oral health issue, and especially so later in life. According to the CDC, nearly 50% of adults aged 30 and older suffer from some form of periodontal disease, and that figure increases to 70% in adults older than 65. However, aligners are not a direct cause of this issue.

You still might be under the misguided impression that clear aligners require less hygienic maintenance than braces, as they are less susceptible to getting food debris caught in them. But that couldn’t be any further from the truth! Though less food debris is caught in aligners, aligners still form a barrier that minimizes saliva contacting the gums and teeth.

This saliva plays an essential role, demineralizing the teeth and protecting the mouth with antibacterial agents. If you’re not careful, aligner wear could indirectly exacerbate the risks of developing periodontal disease. But despite all of that, it would be a misnomer to say that clear aligners could directly cause gum disease.

It would also be a misnomer to say that clear aligners directly help counteract the effects of periodontal disease. The most important factor when reigning in gum disease is not the appliance, but the appliance wearer’s compliance and cleanliness.  Like severe recession, your orthodontist may want to address severe periodontal disease and attempt to reign it in before clear aligner treatment. 

Do Aligners Make Your Gums Bleed? Aligners Irritating Gums?

It’s normal for moderate gum bleeding and inflammation to sometimes occur while wearing clear aligners, especially during the first few days of wearing a new tray. Gum tissue movement can cause extra sensitivity and bleeding around the affected region where the movement is occurring.  Poor home care may cause bleeding as well.  Moreover, the edges of the trays may sometimes rub, scratch, and cut against certain mouth surfaces. 

The edges of your clear aligners can be cut, trimmed, or flattened as needed. If bleeding and inflammation are deep and persists for weeks though, then that could be a sign of oral hygiene neglect on your behalf. Alternatively, it could be symptomatic of periodontal disease that persists and resists your oral hygiene efforts.

If you’re struggling with gum issues while wearing aligners, don’t be afraid to consult an experienced orthodontist for help.