A patient presents with localized recession on tooth #11 only. There are no signs of periodontal disease on other teeth. What is the most likely cause?

Correct answer: B. Toothbrush abrasion or parafunctional habit

• A. Amalgam tattoos are submucosal pigmentations and do not cause gingival recession.
• B. CORRECT. Single-tooth recession in the absence of generalized periodontal disease is most commonly caused by localized mechanical trauma — aggressive toothbrushing technique (abrasion) or a parafunctional habit (e.g., fingernail biting, pen biting). Prominent root position (buccal version) also predisposes to recession.
• C. Systemic diseases that affect the periodontium (e.g., leukemia, diabetes) produce generalized, not isolated single-tooth, gingival changes.
• D. Periodontitis causing recession at only one tooth in an otherwise healthy mouth is unusual. Periodontitis typically produces a more generalized pattern of attachment loss.