Exploring the impact of gingival recession on oral health-related quality of life: a qualitative study

Abstract

Introduction

Gingival recession, a prevalent periodontal condition characterized by apical migration of the gingival margin and root exposure, can cause tooth sensitivity, aesthetic concerns, and functional discomfort. While quantitative studies have linked gingival recession to reduced oral health–related quality of life (OHRQoL), standardized questionnaires may not fully capture the condition-specific, psychological, and social impacts experienced by patients. Qualitative research offers an in-depth understanding of patients’ lived experiences and perspectives, providing insights essential to patient-centered care. This study aimed to explore how individuals with gingival recession perceive and describe their experiences and the impact of the condition on their oral health–related quality of life (OHRQoL).

Methods

Semi-structured interviews were conducted with fifteen adults clinically diagnosed with gingival recession who sought care in Isfahan and met eligibility criteria, including no prior graft treatment and the ability to participate in an in-person interview. A qualitative approach with content analysis was used to identify key themes, and data collection continued until thematic saturation was achieved. We applied credibility, dependability, transferability, and confirmability through qualitative research procedures to enhance rigor.

Results

Participants reported substantial effects of gingival recession on their daily lives, which clustered into three major themes: (1) Biomedical issues, including pain, tooth sensitivity, food impaction, difficulty eating, challenges in maintaining oral hygiene, and concerns about tooth mobility and root caries; (2) Psychological issues, such as dissatisfaction with dental aesthetics, reduced self-confidence, anxiety about disease progression and treatment consequences, and regret over past oral behaviors; and (3) Social issues, reflected in avoidance of social interactions, discomfort when others commented on their teeth, and heightened awareness of similar conditions in peers. These findings illustrate the broad functional, emotional, and social burden imposed by gingival recession.

Conclusions

Gingival recession substantially affects patients’ oral health–related quality of life, impacting functional, psychological, and social well-being, and extends beyond commonly recognized symptoms to include emotional and cognitive concerns such as regret, reduced self-esteem, and anxiety about disease progression and treatment outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-026-08265-y.

Introduction

Oral and dental diseases are significant public health concerns with high prevalence and incidence rates [1]. These conditions adversely affect individuals’ lifestyles through pain, discomfort, and function [2]. One such condition, periodontal disease, is a chronic inflammatory disorder that destroys tooth-supporting tissues [3]. Emerging evidence links periodontal diseases to systemic health issues, including cardiovascular disease, diabetes, and respiratory illnesses [4, 5]. The underlying mechanisms involve the dissemination of pathogenic bacteria via the bloodstream and the detrimental effects of inflammation [3].

Gingival recession is a common periodontal condition characterized by the apical migration of the gingival margin beyond the cementoenamel junction (CEJ), resulting in exposure of the tooth root surface. Clinically, it is diagnosed through intraoral examination by measuring the distance between the CEJ and the free gingival margin using a periodontal probe. This condition is frequently associated with loss of periodontal attachment, esthetic concerns, dentin hypersensitivity, and an increased risk of root caries. Gingival recession may affect both natural teeth and dental implants and can compromise oral function and patient quality of life [6]. Epidemiological studies indicate that approximately two-thirds of the global population experience some degree of gingival recession [7]. Its etiology is multifactorial and includes traumatic tooth brushing, plaque-induced inflammation, periodontal disease, thin gingival biotype, malpositioned teeth, high frenum attachment, and iatrogenic factors [8].Clinically, gingival recession is commonly classified using the Miller classification system, which categorizes recession defects into four classes (I–IV) based on the extent of soft tissue loss and interdental bone loss [9]. This classification is widely used to predict the prognosis of root coverage procedures and guide treatment planning.

Gingival recession is influenced by a combination of periodontal, local, mechanical, iatrogenic, and anatomical factors. Periodontal disease, characterized by inflammation and interdental bone loss, can compromise the periodontal support and lead to apical migration of the gingival margin [10]. Local factors—most notably plaque accumulation—promote chronic inflammation, thereby increasing the likelihood of recession when left unmanaged [11]. Mechanical factors, such as traumatic toothbrushing or other excessive forces applied to the gingiva, contribute to epithelial abrasion and subsequent recession [12]. Iatrogenic factors, including orthodontic tooth movement and the placement of subgingival restorations or crowns, may alter the biological width or produce plaque-retentive conditions that predispose tissues to recession [13]. In addition, several anatomical characteristics can increase susceptibility to gingival recession. These include alveolar bone fenestrations—localized areas where the root surface is exposed through a window-like defect in the bone—and dehiscences, which are more extensive defects in which the bone covering the root is absent along its cervical portion. Other predisposing anatomical factors include abnormal tooth positioning, improper eruption pathways, and variations in tooth morphology that reduce the amount of available keratinized tissue [13].

Behavioral and lifestyle factors may also contribute to gingival recession. Tobacco use—whether smoking or smokeless forms—impairs vascularization and immune responses within the gingival tissues, increasing susceptibility to periodontal breakdown and recession [14]. Poor nutritional status, particularly deficiencies in vitamins essential for tissue integrity and wound healing, can compromise the gingiva’s ability to respond to inflammation or mechanical stress [15]. In addition, trauma from lip or tongue piercings may lead to chronic mechanical irritation of the gingival margin, especially when jewelry repeatedly contacts the gingiva, ultimately resulting in localized recession [16].

Although gingival recession may remain asymptomatic for some individuals, it can lead to several biomedical consequences, including heightened tooth sensitivity, root caries, and non-carious cervical lesions resulting from the exposure of root surfaces. Beyond these physical effects, gingival recession can also carry psychological implications, particularly when the recession occurs in esthetically visible areas [17, 18] Patients may experience dissatisfaction with their appearance or reduced self-confidence due to the perceived unaesthetic elongation of teeth [18]. These biomedical and psychological effects can further influence social dimensions of oral health–related quality of life (OHRQoL), such as reluctance to smile, speak, or engage comfortably in social interactions [18, 19].

According to the literature, many individuals with gingival recession are unaware of the condition and report minimal impact on their daily life; however, others experience significant concern and reduced OHRQoL, particularly those affected by aesthetic issues or dentin hypersensitivity resulting from cervical exposure [17, 20, 21].

Many studies have assessed the impact of gingival recession on OHRQoL using quantitative instruments such as the Oral Health Impact Profile (OHIP-14) or the OHRQoL-UK questionnaire. For instance, Wagner and colleagues found that greater recession (≥ 2 mm) was significantly associated with worse OHIP-14 scores, especially in domains of physical pain and psychological discomfort [20]. Yılmaz et al., in a cross-sectional cohort of 205 patients, used the OHRQoL-United Kingdom (OHRQoL-UK) and reported that hypersensitivity and aesthetic concerns substantially lowered quality-of-life scores among those aware of their gingival recession [17]. Although these instruments are standardized measures for assessing oral health–related quality of life, they were not specifically developed for gingival recession; therefore, certain condition-specific aspects may not be fully captured by these general oral-health questionnaires.

Although several quantitative studies have explored the impact of gingival recession on OHRQOL, qualitative research remains scarce, particularly in understanding the psychological and social dimensions. To date, no specific instrument has been developed to assess oral health–related quality of life in patients with gingival recession [22].

Qualitative analysis, as a cognitive method, provides a deep and interpretive understanding of the social world by examining individuals’ social and material conditions, experiences, thoughts, perspectives, behaviors, and histories. This approach offers a valuable perspective for addressing research questions that quantitative studies cannot adequately answer [23, 24]. Qualitative studies are also essential for enhancing patient-centered care, providing valuable insights into patients’ experiences, preferences, and needs. Exploring healthcare’s emotional and personal aspects, these studies help providers understand patients’ unique challenges, allowing for more tailored and effective treatments. Ultimately, integrating qualitative research fosters an empathetic healthcare environment that prioritizes patient voices [25, 26].

This research adopts a philosophical–practical approach, setting it apart from conventional quantitative designs. It represents a preliminary step that provides qualitative evidence and helps shed light on this important area [27].

Despite the global prevalence of gingival recession and its documented associations with tooth sensitivity, aesthetic concerns, and functional discomfort, limited research has explored how patients personally experience this condition. Although OHRQoL survey studies exist, they do not fully capture the subjective meanings, daily impacts, and contextual factors shaping patients’ lived experiences. Notably, there is currently no qualitative study in Iran that specifically focuses on oral health–related quality of life in patients suffering from gingival recession. Therefore, this study aimed to explore how individuals with gingival recession perceive and describe the biomedical, psychological, and social impacts of the condition.

Materials and methods

This study employed a qualitative approach with content analysis to explore the factors affecting OHRQoL in patients with various types and severities of gingival recession [28]. Data were collected through in-depth interviews to capture participants’ lived experiences and perceptions of their gingival condition. An inductive approach was adopted because the researchers recognized that some factors influencing quality of life in this population are context-specific, culturally shaped, and insufficiently captured by existing theories and instruments. Therefore, the analysis avoided predefined categories, allowing classifications, concepts, and terminology to emerge organically from the data, thereby reflecting the essence of participants’ experiences [29].

Researcher’s subjectivity

In conducting this qualitative study, the research team maintained ongoing reflexivity to recognize and manage their own perspectives and potential biases. As clinicians, we had frequent interactions with patients experiencing gingival recession, which evoked both professional concern and personal empathy for the ways their condition affected daily life. Aware that our familiarity with the clinical manifestations could unconsciously shape interpretation, we deliberately reflected on our assumptions at each stage of the study to ensure that our analysis remained grounded in the patients’ own voices rather than our expectations. Many participants expressed the emotional and functional burdens of gingival recession, highlighting struggles that had not been fully captured in previous quantitative studies relying on standard OHRQoL measures. Recognizing these insights reinforced our commitment to prioritize the lived experiences of participants and to convey their perspectives authentically, while continually questioning how our clinical background might influence the research process. This conscious reflexive practice helped ensure that the findings genuinely represented the participants’ experiences, supporting the broader goal of informing patient-centered care and improving clinical understanding and educational approaches for dental professionals.

Ethical considerations

Permission to conduct the study was obtained from the director of the specialist periodontology clinic, ensuring that participant rights were protected following the policies of the School of Dentistry at Isfahan University of Medical Sciences. The Ethics Committee of Isfahan University of Medical Sciences approved the study protocol (Approval ID: IR.MUI.RESEARCH.REC.1402.125).

Study population

The target population for this study consisted of individuals experiencing gingival recession who either reported concerns related to this condition or sought treatment at one university hospital in Isfahan. Isfahan is a large city in central Iran with a population of approximately 2 million people, including substantial marginalized communities. The city has a mix of public and private dental services, though access may vary across different neighborhoods. Potential participants were identified in person at the university clinic and confirmed to have gingival recession through clinical examination by a periodontist, either prior to or during the course of treatment. Participants with any degree of gingival recession according to the Miller classification (Classes I–IV) were eligible for inclusion [9]. In addition, maximum variation sampling was deliberately applied to ensure the highest possible heterogeneity with respect to clinical characteristics, including severity of recession, number of teeth affected, and extent of recession measured in millimeters. This strategy was used to enhance the richness and diversity of perspectives in this qualitative study.

Eligible participants met the following criteria: they had not received any form of surgical periodontal treatment, including gingival graft procedures, prior to the interview; they were able to communicate effectively for interviews; and they were willing to participate. Participants may have received non-surgical interventions, such as oral hygiene instruction, professional plaque control, scaling and root planing, or desensitizing therapies. Patients were invited in person during their clinic visit, and interview appointments were scheduled according to participants’ preferences. All interviews were conducted face-to-face in a private setting, ensuring comfort, confidentiality, and openness.

Data collection

Data were collected through semi-structured, in-depth interviews. The interview guide was developed based on a review of the literature on oral health–related quality of life and patient-centered dental care, and refined through input from the research team to ensure relevance and comprehensiveness (Supplementary File 1).

The interviews were conducted by the main investigator under the supervision of, a researcher experienced in qualitative methodology. As this qualitative study employed a semi-structured approach, the interviews did not require that all questions and prompts in the interview guide were asked. Instead, the flow of each interview was guided by the participants’ responses, allowing emerging topics to shape subsequent questions. The interviewer used a small set of broad, guiding prompts—such as asking participants to describe how gingival recession affects their daily life, oral health, emotions, or social interactions—to initiate discussion and encourage participants to articulate their experiences in depth. Additional probing questions were introduced as needed to further explore issues raised by participants. Prior to data collection, both the interviewer and supervisor familiarized themselves with existing literature on OHRQoL in individuals with gingival recession to ensure informed and contextually sensitive interviewing.

Data collection continued until data saturation was reached, meaning that additional interviews no longer yielded new codes, themes, or insights. Saturation was achieved after 12 interviews, and to ensure completeness, three more interviews were conducted. Since no new codes emerged during these additional interviews, this confirmed that the dataset adequately captured the range of participants’ experiences and perceptions of gingival recession.

Interviews were audio-recorded and transcribed verbatim to create detailed textual data. Transcripts were securely stored on a password-protected institutional server accessible only to the research team. All participants provided written informed consent prior to participation and were informed of the voluntary nature of the study and their right to withdraw at any time. No physical or psychological risks were anticipated, and participants were free to skip questions or stop the interview if uncomfortable.

Analysis

Transcripts were read repeatedly by S.S. and O.F. to develop a comprehensive understanding of participants’ experiences. Meaningful segments were systematically coded to capture key concepts and patterns [30] [ref]. After rigorous content analysis, an initial pool of 221 codes was generated, which were subsequently classified and organized into three major themes. The coding process was iterative, incorporating additional interviews to refine and enrich the dataset [31] [ref]. Codes were grouped based on conceptual similarities, and relationships among categories were examined to identify overarching themes [32] [ref]. This rigorous approach provided detailed insights into the biomedical, psychological, and social factors influencing the lived experiences of patients with gingival recession. MAXQDA version 20 software was employed to assist with coding and data management, enhancing the efficiency and rigor of the analysis [33] [ref].

Rigor enhancement

To enhance the rigor of this study, we applied established qualitative criteria of credibility, dependability, transferability, and confirmability [34–36]. For credibility, the research team engaged deeply with participants by spending extended time during interviews and follow-up discussions, ensuring a thorough understanding of their experiences with gingival recession [26]. Initial findings were verified through member checking, where participants reviewed and confirmed the interpretations of their statements, and through peer debriefing with three co-authors to reduce potential bias. Maximum variation sampling was employed to capture a diverse range of experiences, including participants of different ages, genders, and severities and types of gingival recession, thereby strengthening both credibility and confirmability. To support transferability, the preliminary findings were shared with five individuals who had gingival recession but were not part of the main study, and their feedback confirmed that the results reflected broader patient experiences [35, 36].

Results

The study included 15 participants aged 27 to 70 years, with diverse educational backgrounds ranging from high school diploma to master’s degrees, a nearly balanced gender distribution, and varying degrees of gingival recession. The participant’s demographic data is shown in Table 1. Content analysis of the interviews revealed that lived experiences of patients with gingival recession can be understood across three major themes: biomedical, psychological, and social dimensions (Fig. 1). Below, each theme is described in detail to provide a comprehensive understanding of participants’ experiences.

Table 1.

Key Characteristics of participants

Participant ID	Age	Education	Sex
P1	42	Bachelor	Female
P2	41	Bachelor	Female
P3	34	Master	Male
P4	38	Bachelor	Male
P5	38	Diploma	Female
P6	39	Bachelor	Female
P7	54	Associate	Female
P8	29	Associate	Male
P9	41	Bachelor	Male
P10	55	Diploma	Female
P11	45	Diploma	Female
P12	70	Associate	Male
P13	47	Bachelor	Female
P14	27	Bachelor	Male
P15	54	Bachelor	Female

Fig. 1.

Overview of the factors affecting oral health-related quality of life in patients with gingival recession

Biomedical issues

Participants frequently reported functional limitations and intraoral problems that affected their daily oral activities.

Functional limitations primarily involved difficulties with eating and maintaining oral hygiene (Table 2). Many participants described pain and discomfort when consuming hot, cold, acidic, or sweet foods, which made mealtimes stressful and sometimes avoided certain foods entirely. Several participants reported fear of damaging their teeth or feeling pressure when biting, which limited their normal eating habits. Oral hygiene practices were also affected, as participants experienced discomfort while brushing or flossing, leading to anxiety about whether they were adequately cleaning their teeth. Some described a constant emotional burden related to maintaining oral hygiene, feeling compelled to brush frequently but still worried about plaque accumulation or gingival health.

Table 2.

Functional limitations (subcategory of Biomedical issues)

Category	Subcategory	Example from Participants
Eating Challenges	Feeling pain in the teeth	“When I was eating, if something cold or very hot touched my teeth, it felt as though my teeth no longer had any protection.” –P9, 41 “I experience significant discomfort when I consume sour or acidic foods because they considerably irritate my teeth. " –P7, 54 “I occasionally experienced tooth pain, particularly when consuming sweet foods, hot or cold water, or cold beverages. When I ate something warm, my teeth became sensitive.” –P2, 41
	Fear of tooth damage	“For instance, you can no longer bite into a fruit… it feels as though your teeth might fall out.” –P6, 39
	Feeling pressure on the teeth	“Whenever I ate something, I felt pressed. When I visited the doctor, they told me I had gum recession.” P9 ,41
	Food getting stuck between teeth	“While I eat certain foods, such as seeds and pistachios, they often lodge between my teeth.“–P1, 42 “Because of the recession of my gums, food frequently becomes trapped between these two teeth, which bothers me.” P4, 38
Oral Hygiene Challenges	Difficulty adhering to instructions	“I don’t floss that part of my mouth at all. I’m so afraid that something will happen and it might become loose.” –P5, 38 “Brushing my teeth with cold water is also painful, so I must use lukewarm water instead.” –P10, 55 “The doctor taught me a new technique for brushing my teeth. However, now that I have followed his advice, I feel that plaque is still visible, even when I brush gently or use a soft toothbrush.” P4, 38
	Emotional Burden of Maintaining Oral Hygiene	“Because my gums have receded, I feel like I must always brush my teeth. Even then, I still don’t feel clean.” –P13, 47 “I find the new brushing technique I was taught difficult to follow consistently. Sometimes I am in a hurry, and this method takes too much time.” P11, 45 “Because my gums have receded, my teeth accumulate tartar much faster, and I should have them scaled frequently. However, scaling is painful and uncomfortable.” P3, 34

Intraoral problems included bleeding gums, dental sensitivity, pain or discomfort, tooth mobility, root surface caries, and rapid calculus buildup. Participants highlighted how these issues y caused physical discomfort and contributed to fear about their oral health, uncertainty about disease progression, and the need for frequent dental interventions (Table 3). Collectively, biomedical issues reflected the tangible, functional, and physiological challenges imposed by gingival recession on patients’ daily lives.

Table 3.

Intraoral Issues (subcategory of Biomedical issues)

Category	Example from Participants
Gum Bleeding	“Whenever I brush my teeth, my gums start bleeding right away. Even when I try to be gentle, the bleeding makes me nervous, so I stop brushing properly because I’m afraid I’ll make it worse” –P10, 55
Pain & Discomfort	“Sometimes I have a tingling sensation in my gums as if I want to scratch them.” -Participant, unspecified age
Dental Sensitivity	“When the cold wind hits me, especially in winter, I have a toothache.” -Leyla, 39 “When there is a gap between teeth and no gum covering it, it affects its health. For example, even cold air touching my teeth causes pain or feels painful when I eat hot things.” –P7, 54
Tooth Mobility	“I suddenly noticed in the mirror that my gums had receded a lot, and I felt like one of my teeth was loose.” –P5, 38
Root Surface Caries	“I was under constant dental care for my gum recession, and the doctor always told me that nothing needed to be done. However, recently, my tooth developed a cavity on the root due to this recession, so I went back to the doctor, and they suggested a gum graft.” P14, 27
Calculus Buildup	“Since my gums have receded, my teeth accumulate tartar very quickly. I had a dental cleaning done less than a year ago, and there’s already tartar buildup again.” -Layla, 55 “Gingival recession damages teeth over time. For example, my teeth accumulate tartar much more easily than before.” –P10, 55

Psychological issues

Gingival recession also had profound psychological impacts, affecting participants’ self-perception and emotional well-being.

Esthetic concerns were among the most frequently reported issues. Participants noticed changes in the appearance of their teeth, such as increased gaps, misalignment, changes in tooth color, and longer crown length, which negatively influenced their self-image. Many expressed worries about future disease progression, including the possibility of tooth loss or irreversible damage to their gums, which led to persistent anxiety and uncertainty. Some participants reported feelings of regret, blaming themselves for past oral hygiene habits or harmful behaviors, such as improper brushing techniques or smoking, which they perceived as contributing to their condition. Overall, psychological issues reflected the emotional and cognitive burden of living with gingival recession, encompassing both appearance-related concerns and anticipatory worries about the consequences of the disease (Table 4).

Table 4.

Psychological issues

Category	Description	Example from Participants
Compromised Esthetics	Increased Diastema	“The main concern that prompted me to seek treatment was the gap that had developed between my teeth. It had become quite noticeable, approximately 3–4 millimeters.” – P3, 34
	Misaligned Teeth	“I gradually started to feel that my teeth were misaligned. Therefore, I came to see the doctor. I felt terrible about my misaligned teeth.” – P6, 39
	Crown-Root Hue Misunderstanding	“After noticing that my gum had receded, I realized that my tooth had also changed color. It had darkened, and no matter how much I brushed that tooth, it did not help.” – P7, 54
	Increased Crown Length	“When I had my teeth scaled and root planed, it became clear that my teeth had grown longer. I could see the roots in the mirror.” – P1, 42
Concerns Regarding Disease Progression	Future Disease Progression	“I thought to myself, if I do not get gum treatment, my teeth might loosen.” – P3, 34 “I do not want the decay on my root that the doctor told me was caused by gum recession to progress and cause problems for my other healthy teeth.” – P2, 41
	Irreversibility of Disease Consequences	“Before I came to see the doctor, I constantly wondered if my receding gums would ever return to their original state.” – P6, 39 “I was always worried that this condition of my gums would be permanent and that nothing could be done to improve it.” – P3, 34
Feelings of Regret	Poor Oral Hygiene	“I think my gum recession is because I sometimes do not feel like brushing my teeth. Furthermore, I did not use dental floss very often.” – P10, 55
	Harmful Oral Habits	“Unfortunately, I think the main factor that caused my gum recession is brushing. I did not brush very well. I thought that if I brushed harder, it would remove more germs.” – P9, 41 “Unfortunately, I smoked until a few years ago, although I quit now. However, I think the main reason for my gum recession is smoking.” P8, 29

Social issues

The impact of gingival recession extended into social interactions and relationships (Table 5). Many participants described a decrease in self-esteem, particularly in social settings, due to concerns about the appearance of their teeth and gums. Some reported experiencing negative attention from others, such as comments or questions about their dental appearance, which made social interactions uncomfortable. Additionally, several participants reported witnessing negative experiences in others with similar conditions, which heightened their fear and anxiety about potential severe consequences for themselves, such as tooth loss or extensive dental treatment. These social effects highlight how gingival recession can influence not only personal well-being but also social confidence and participation in everyday interactions.

Table 5.

Social issues

Category	Description	Example from Participants
Decreased Self-Esteem	Some participants felt dissatisfied with their appearance due to gingival recession, especially in social settings. Women reported this more frequently.	“It has become almost like a mental depression for me. When an appearance is unattractive, you think the person in front of you feels the same way. Therefore, for example, at parties, I avoid smiling anymore.” P5, 38 “I looked in the mirror and noticed that my gum recession was most prominent at the front. I felt a sense of fear as I considered the possibility of losing my front teeth. As a woman, I felt that this would be very unattractive. It would undoubtedly hurt my self-esteem.” P13, 47
Negative Attention from Others	Participants experienced distress when others noticed and commented on their gum recession, particularly in social situations.	“It looks so ugly where my gum is receding, and when I smile, everyone notices. At parties, everyone asks me about it. For example, at a happy party where everyone is laughing, suddenly, in the middle of my laughter, they ask me, what happened to your tooth? It is annoying.” “It has significantly impacted my appearance because there is much space between my teeth. Everyone tells me these areas are empty, and my teeth are very visible.” P11, 45
Witnessing Negative Experiences in Others	Some participants feared experiencing the same severe consequences of gum recession that they had observed in acquaintances or relatives.	“We have a relative with receded gums, and then their teeth became loose. They had to have all their teeth extracted. Now, they’re going through a long and difficult implant process. Naturally, no one wants to lose all their teeth.” P12, 70 “I know someone with the same problem. Owing to gum recession, the roots of their teeth were completely exposed and became loose. When I saw them, I worried the same thing might happen to me.” P4, 38

Discussion

This study conducted in-depth interviews with 15 patients diagnosed with gingival recession to investigate the factors influencing their oral health-related quality of life and to explore their lived experiences with the condition. The findings were organized into three primary domains: biomedical, psychological, and social issues. Intraoral problems directly resulting from gingival recession were a source of dissatisfaction for all participants, including gingival bleeding, pain, discomfort, tooth sensitivity, the sensation of mobile teeth, root surface caries, and rapid calculus accumulation.

Consistent with previous research, participants reported significant difficulties with eating, particularly when consuming hot or cold beverages [17, 20]. Beyond these well-documented issues, our qualitative approach revealed additional psychosocial challenges, such as reduced self-esteem and social anxiety, which have been less extensively addressed in prior studies [37]. Nearly all participants described pain during the consumption of hot or cold foods and beverages, and some reported discomfort when eating acidic or sugary foods, leading at times to avoidance behaviors. Several participants noted frustration with food becoming trapped between teeth, while others expressed concern about tooth mobility or discomfort when chewing hard foods.

Functional limitations associated with gingival recession extended beyond eating difficulties to include challenges in maintaining oral hygiene [37, 38]. Some participants reported that brushing and flossing had become more difficult due to gingival bleeding or fear of aggravating tooth mobility. For certain individuals, these limitations hindered the ability to perform effective oral hygiene, leading to increased concern about oral health maintenance. Many participants perceived a greater need for professional cleaning and found that newly recommended brushing techniques—introduced after their diagnosis—were difficult to implement or failed to produce a completely satisfactory sense of cleanliness.

Gingival recession not only impacts patients’ current oral health-related quality of life but also generates significant concern regarding future disease progression. In this study, psychological distress associated with gingival recession included worries about the advancement of the condition and the perception that its effects might be irreversible. Many participants reported apprehension about the permanent nature of the tissue loss, reflecting a broader anxiety about long-term oral health outcomes. Additionally, some individuals expressed self-blame, attributing their condition to past lapses in oral hygiene or engagement in harmful oral habits, which often led to feelings of regret. Beyond these psychological and behavioral dimensions, esthetic concerns emerged as a critical factor influencing both emotional well-being and quality of life in individuals affected by gingival recession.

Psychological distress emerged as a significant factor affecting oral health-related quality of life among participants in our study, with female participants reporting this concern more frequently. Interviewees described a range of aesthetic complaints, including increased spacing between teeth, tooth misalignment, and, most notably, elongation of the clinical crown. In addition, the difference in coloration between the exposed root surface and the natural crown became apparent due to gingival recession, with the root often appearing darker or more yellowish than the enamel-covered crown. The impact of gingival recession on dental appearance has been consistently highlighted in the literature, underscoring the central role of esthetic concerns in shaping both psychological well-being and perceived quality of life in affected individuals.

Our findings indicate that gingival recession in the anterior esthetic region extends beyond physical symptoms to produce meaningful psychosocial effects. Participants described reduced self-confidence in social interactions, avoidance of smiling or speaking in public, and discomfort when others commented on the appearance of their teeth. These experiences align with previous research demonstrating that anterior gingival recession and related esthetic concerns negatively affect OHRQoL, self-esteem, and social functioning [17]. Instruments commonly used to capture these impacts include the OHIP, the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and the Psychosocial Impact of Gingival Aesthetics Questionnaire (PIGAQ) [20, 39, 40]. Studies using these tools consistently show that esthetic deficits in the anterior region contribute significantly to social and emotional distress, supporting the patterns expressed by participants in our study [38].

The insights from this study emphasize the importance of a holistic, patient-centered approach in the clinical management of gingival recession Recognizing that patients’ experiences extend beyond physical symptoms to include meaningful psychosocial and functional challenges can help clinicians provide more empathetic and individualized care [41]. These findings highlight the value of clear communication regarding prognosis, supportive discussions about patients’ concerns, and personalized instruction in oral hygiene techniques. Although the present study did not directly examine treatment modalities or the specific factors influencing patient compliance, it provides important insight into the determinants that affect patients’ quality of life. Recognizing these factors may help clinicians better understand patients’ experiences, expectations, and needs. This understanding can support the development of more individualized treatment plans and allow clinicians to tailor therapeutic approaches accordingly. Incorporating these considerations into routine clinical practice may strengthen the patient–clinician relationship and contribute to more effective and satisfactory management of gingival recession, potentially leading to greater patient satisfaction and improved treatment adherence [41].

Although we adhered closely to established methodological standards for qualitative research, certain inherent limitations should be acknowledged when interpreting our findings. This study was conducted within a specific geographical setting and clinical environment in Isfahan city, Iran, involving a limited number of patients who either expressed concerns about gingival recession or sought treatment and were clinically confirmed to have the condition; consequently, the perspectives captured may not reflect those of individuals with gingival recession who do not seek care, whose experiences and opinions may differ substantially. To build a clearer, more comprehensive understanding of patient experiences with gingival recession, further qualitative studies among diverse populations and settings are recommended; these will help clarify context-specific factors and should inform the design of larger quantitative and interventional studies in the future.

Conclusion

This qualitative study demonstrates that gingival recession has a profound and multifaceted impact on patients’ quality of life, encompassing functional, social, and psychological domains. Beyond confirming well-known consequences such as pain, tooth sensitivity, and difficulties in eating and oral hygiene, our findings reveal less-explored dimensions of patient experience. These include feelings of regret over past oral behaviors, decreased self-esteem, anxiety about the future progression of the disease.

Authors’ contributions

OF: Conceptualization, Methodology, Formal analysis, Investigation, Writing—Review & Editing, Supervision. MS: Conceptualization, Methodology, Investigation, Writing—Original Draft, Review & Editing, Funding acquisition, Supervision. SS: Formal analysis, Investigation, Software, Writing—Original Draft. ZM: Conceptualization, Writing—Original Draft, Review & Editing. JY: Conceptualization, Investigation. All authors read and approved the final manuscript.

Funding

The authors received no funding for this research.

Data availability

The dataset supporting the conclusions of this article is available and will be provided upon request from the corresponding author.

Declarations

Ethics approval and consent to participate

Permission to conduct the study was obtained from the director of the specialist periodontology clinic, ensuring that participant rights were protected following the policies of the School of Dentistry at Isfahan University of Medical Sciences. The Ethics Committee of Isfahan University of Medical Sciences approved the study protocol (Approval ID: IR.MUI.RESEARCH.REC.1402.125). The study’s purpose and protocol were explained to each participant, and written consent was obtained before each interview. All participants were fully informed and consented. the study was conducted in compliance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.