Your Gum Tissue ‘Biotype’ Could Determine How Gum Disease Affects You

Periodontal (gum) disease can cause a number of devastating effects that could eventually lead to tooth loss. However, you may be more prone to a particular effect depending on the individual characteristics of your gums.

There are two basic types of gum tissues or “periodontal biotypes” that we inherit from our parents: thick or thin. These can often be identified by sight — thinner gum tissues present a more pronounced arch around the teeth and appear more scalloped; thicker tissues present a flatter arch appearance. While there are size variations within each biotype, one or the other tends to predominate within certain populations: those of European or African descent typically possess the thick biotype, while Asians tend to possess the thin biotype.

In relation to gum disease, those with thin gum tissues are more prone to gum recession. The diseased tissues pull up and away (recede) from a tooth, eventually exposing the tooth’s root surface. Receding gums thus cause higher sensitivity to temperature changes or pressure, and can accelerate tooth decay. It’s also unattractive as the normal pink triangles of gum tissue between teeth (papillae) may be lost, leaving only a dark spot between the teeth or making the more yellow-colored root surface visible.

While thicker gum tissues are more resilient to gum recession, they’re more prone to the development of periodontal pockets. In this case, the slight gap between teeth and gums grows longer as the infected tissues pull away from the teeth as the underlying bone tissue is lost. The resulting void becomes deeper and more prone to infection and will ultimately result in further bone loss and decreased survivability for the tooth.

Either of these conditions will require extensive treatment beyond basic plaque control. Severe gum recession, for example, may require grafting techniques to cover exposed teeth and encourage new tissue growth. Periodontal pockets, in turn, must be accessed and cleaned of infection: the deeper the pocket the more invasive the treatment, including surgery.

Regardless of what type of gum tissue you have, it’s important for you to take steps to lower your risk of gum disease. First and foremost, practice effective daily hygiene with brushing and flossing to remove bacterial plaque, the main cause of gum disease. You should also visit us at least twice a year (or more, if you’ve developed gum disease) for those all important cleanings and checkups.

If you would like more information on hereditary factors for gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Genetics & Gum Tissue Types.”

Word Quiz on Oral Hygiene

Yes, you brush your teeth every day. But how much do you really know about this important habit? Test your knowledge with our quiz on dental vocabulary.

Choose the correct meaning for:

  1. Oral Hygiene
    1. Clean language
    2. The practice of keeping your teeth and gums clean
    3. A shade of lipstick
    4. A type of dental surgery
  2. Biofilm
    1. A movie about a person’s life, such as “Ray Charles”
    2. A new kind of cling wrap
    3. An accumulation of bacteria that forms a whitish, sticky film
    4. A tooth whitener
  3. Dental plaque
    1. A type of instrument used to clean teeth
    2. Bacteria that accumulate on teeth and gums
    3. An award given at the Dental Oscar ceremony
    4. Your dentist’s framed diploma
  4. Inflammation
    1. The body’s response to harmful bacteria
    2. A condition in which your gums become red and swollen and bleed easily
    3. A cause of gingivitis
    4. All of the above
  5. Periodontal disease
    1. Any disease caused by bacteria
    2. Tooth decay
    3. Whitish sores on the lips
    4. Gum disease caused by dental plaque
  6. Disclosants
    1. Simple dyes that can stain plaque and make it visible
    2. Television reality shows
    3. Dental x-rays
    4. A section of your annual tax report
  7. Gingivitis
    1. Any infection in the oral area
    2. Tooth decay
    3. Inflammation of the gums that can lead to periodontal disease
    4. All of the above
  8. Dental caries
    1. Gum disease
    2. A task carried out during your teeth cleaning
    3. A technique of orthodontia
    4. Tooth decay
  9. Fluoride
    1. A mineral that has been found to prevent tooth decay
    2. The location of a famous dental school
    3. A gasoline additive
    4. A type of house paint
  10. Inter-dental Area
    1. Referring to the area between your teeth
    2. The area regular proper flossing will keep clean
    3. Area that wood points and specially designed brushes can be used to clean
    4. All of the above

Answers: 1. b, 2. c, 3. b, 4. d, 5. d, 6. a, 7. c, 8. d, 9. a, 10. d

How did you do on our quiz? The more you know about keeping your teeth and gums clean and healthy, the better you will look and feel. Contact us today to schedule an appointment or to discuss your questions about oral hygiene. You can also learn more by reading the Dear Doctor article, “Oral Hygiene Behavior.”

Which is Better for Cleaning Your Teeth: Ultrasonic or Hand Tools?

Dental plaque (a film of bacteria that forms on your teeth) is known to be the main cause of periodontal (gum) disease. When the bacteria settle on your teeth they form a whitish film called biofilm. Those that are not removed cause formation of “pockets,” areas of separation between the teeth and their surrounding gums, in which plaque hardens into deposits known as calculus or tartar. The purpose of having your teeth cleaned regularly by a trained professional hygienist is to remove deposits of plaque and calculus. Removal of hard deposits on your teeth is called “scaling.” This can be done either by using hand-held scalers or by newer technology: ultrasonic power scalers.

Let’s take a look at the strengths and weaknesses of both types of instruments.

Power Scalers

How they work: These instruments use the energy of ultrasonic vibration to crush and remove hard, calcified deposits of calculus. They also create shockwaves that disrupt bacterial cells. Use of these tools includes washing and flushing the pockets and any exposed root surfaces with water.

Pros: They are as effective as manual instruments for calculus removal in shallow gum pockets and significantly more effective in pockets greater than 4mm. They are very effective in removing calculus from root surfaces and from within periodontal pockets. Their small tips can penetrate deeper into periodontal pockets than manual instruments and are more comfortable to experience, and they are more effective for cleaning difficult nooks and crannies. Coolant sprays flush the area and remove bacteria and their by-products. They require less time than manual instruments.

Cons: A contaminated mist may form so that the hygienist needs to wear protective equipment. The vibration of the ultrasonic instruments may make it difficult to feel if the root surface is completely smooth and free of calculus. Power scalers affect some heart pacemakers.

Conventional Hand-held Scalers

How they work: These depend on the skill and knowledge of the hygienist to manipulate them and scrape away calculus (tartar) from teeth and within pockets.

Pros: They are equally effective for plaque and calculus removal from shallow gum pockets. They do not interfere with electronic equipment like heart pacemakers. They can be used more easily on teeth in which there are areas of demineralization (areas where minerals have been removed from the tooth’s enamel, making it more vulnerable to decay). They are easier on the tooth’s surface and are thus better for use with porcelain or composite restoration, or sensitive teeth.

Cons: They take longer to complete a cleaning. Sometimes they cause more discomfort than ultrasonic scalers.

In most cases the choice of scalers is not really an either/or situation. Most experts say that the best results come through using both types of instruments. As a result, cleanings can be done with effective and efficient outcomes and greater patient comfort.

Contact us today to schedule an appointment to discuss your questions about dental cleanings. You can also learn more by reading the Dear Doctor magazine article, “Dental Cleanings Using Ultrasonic Scalers.”

Where – and How – Does it Hurt? Getting to the Source of Tooth Pain

Although toothaches are common, not all tooth pain originates from the same source. But regardless of its cause, you need to take prompt action to find out and begin treatment.

Sensitive teeth, for example, usually cause a quick stab of pain when you eat or drink something hot or cold or when you bite down. If the pain lasts only a second or two, you may have a small area of decay in a tooth, a loose filling or an exposed root. The latter often occurs either because of over-aggressive brushing or periodontal (gum) disease. In both cases, the gums may have shrunk back or receded to expose the root surface.

A sharp pain when biting down may be a sign of decay or a loose filling; it could also mean you have a fractured or cracked tooth. For any of those causes, you’ll need treatment to repair the problem and relieve the pain.

You may also experience a lingering tooth pain ranging from dull to sharp, or localized to one tooth or seeming to radiate from a general area, such as above the upper jaw. There are a number of possible causes, but two prominent ones are an abscess (a localized area of infection that’s become inflamed) or deep decay within the pulp, the heart of a tooth.

This usually calls for a root canal treatment for the affected tooth. In this procedure we drill an access hole into the pulp and clear it of infected and dead tissue. We then fill the empty pulp chamber and root canals with a special filling and seal the access hole. Later, we bond a permanent artificial crown to the tooth to further protect it from re-infection.

Whether your pain is momentary or lingering, dull or sharp, you should see us as soon as possible to determine its cause. You should still see us even if sharp, lingering pain goes away — this could simply mean the infected nerves in the pulp have died but not the infection. The sooner you have the cause of your pain treated, the better your chances of a happy and less costly outcome.

If you would like more information on tooth pain and what to do about it, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Pain? Don’t Wait!

What You Should Do When Your Child has a Toothache

It can be daunting for parents to know just what to do when their child complains of an ache or pain. What if your child tells you their tooth hurts — is that cause for alarm? That’s actually not so easy to determine, but there are some things you should do when your child has a toothache.

First, try to determine from your child exactly where the pain is coming from and how long it’s been hurting. Look for an apparent cause for the pain: the most common is tooth decay, considered a type of infection caused by bacteria, and normally indicated by brown spots or tiny holes (cavities) on the biting surfaces or between teeth. Look for swelling or tenderness in the gum tissues, a sign of a possible abscess. Debris caught between teeth may also cause pain.

The pain might stem from an injury. Though the lips and outer tissues may appear fine, a blow to the face or other traumatic incident may have damaged the teeth. Without treatment, pulp tissue within a traumatized tooth may die and lead to an infection and potential tooth loss.

If you see any of these signs or symptoms, or the pain keeps your child up at night or continues into the next day, you should contact our office as soon as possible so that we can do a full evaluation of the tooth. In the meantime, there are some things you can do to help lessen the pain. First, clean the teeth to remove any debris. Administer ibuprofen or acetaminophen (in the proper dosage for a child) for pain relief. An ice pack against the jaw may also help, but alternate on and off in five-minute intervals to prevent burning the skin with the ice.

If these steps stop the pain within an hour, you can wait until the next day to make an appointment. If not, this may be indicative of an abscess forming and you should not delay contacting our office. The quicker we can properly diagnose and begin treatment, the less chance your child will suffer from any long-term damage to their teeth.

If you would like more information on caring for a child’s toothache, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “A Child’s Toothache.”

What To Do About A Child’s Toothache

It’s 3:00 PM, your child has just come back from the school playground — and she’s complaining of a toothache that’s making her miserable. She can’t seem to say if there was a particular injury or a blow, but the more she talks about it, the worse it gets. You’re the parent… what are you going to do now?

If you’ve ever been through this type of situation, you know that a calm demeanor and a little TLC can go a long way. But how do you know whether you’re facing a dental emergency, or a routine booboo? Here are a few general rules that may help.

First, relax: Without a fever and facial swelling, a child’s toothache isn’t usually an emergency. But any tooth pain that keeps a child up at night or lasts into the next day should be evaluated by a dentist. Even if it’s nothing but a small cavity (the most common cause of toothache) you don’t want to let it go untreated. That could allow it to turn from a small discomfort into a major problem — like a painful abscess.

There are some things you can do at home to try and get a handle on what’s causing the pain. Encourage the child to show you exactly where the pain is located, and to tell you when and how it started. Then, examine the area closely. Look for obvious brown spots, or even tiny cavities (holes) on biting surfaces or between teeth, which might indicate decay. Also check the gums surrounding the tooth, to see if there are sores or swelling.

You may find evidence of a traumatic injury, like a cut or bruise — or, if only swelling is apparent, it may mean an abscess has formed. If nothing looks amiss, try gently flossing on either side of the hurting tooth. This may dislodge a particle of food that’s causing pain and pressure.

If the pain persists, you can try giving an appropriate dose of ibuprofen or acetaminophen, or applying an ice pack on the outside of the jaw — one minute on and one minute off. But even if you can make the immediate pain go away, don’t neglect the situation that caused it. Unless you’re absolutely sure you know why the toothache occurred, you should bring the child in for an examination. It will put your mind at rest — and maybe prevent a bigger problem down the road.

If you have questions about toothaches in children, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “A Child’s Toothache.”

What Causes Dental Discomfort?

Nothing ruins a thirst-quenching cold beverage or a dish of your favorite ice cream like a sudden pang of tooth sensitivity. If you’re experiencing this problem — and especially if there are other triggers, like biting down — we encourage you to make an appointment. It could be something harmless and temporary, but it’s always prudent to check. At the very least, you’ll feel better once the underlying problem is identified and treated if necessary.

Here are some common sources of tooth sensitivity:

  • Enamel erosion — typically caused by acidic beverages/food, regurgitation of stomach acids (due to gastroesophageal reflux disease [GERD] or the eating disorder bulimia), or improper brushing
  • Tooth decay — a sugary diet and poor dental hygiene may be contributing factors
  • Tooth fracture or chipping due to tooth grinding (bruxism) or other trauma
  • Gum recession due to age, improper tooth brushing, or gum disease
  • Filling that needs repair or replacement
  • Residual effects of recent dental work

Some things you can try at home to minimize sensitivity include:

  • Ease up on the toothbrush; a light touch is all that’s needed to dislodge daily plaque build-up
  • Try using fluoride-containing toothpaste like an ointment over the affected area (fluoride decreases fluid exchange from the oral environment to the nerve inside the tooth)
  • Take a non-steroidal anti-inflammatory such as ibuprofen (use judiciously and according to the package insert guidelines)

Discomfort related to recent dental work should resolve on its own; give it several weeks. If you’re feeling discomfort for another reason, even if the sensitivity subsides, the underlying cause may still require attention.

If you would like more information about tooth sensitivity, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Sensitive Teeth.”

We’ll Help You Maintain Your Oral Health After Gum Disease

It’s been a long road back to oral health for you after periodontal (gum) disease. But after several plaque removal sessions and perhaps even surgical procedures to address deep infection, your gums have regained their healthy pink appearance.

But now you must face a hard reality: because you’ve had gum disease you’ll need to be extra vigilant with your oral hygiene to avoid another round with this destructive disease. But don’t worry—you won’t have to fight your prevention battle alone. We’ll continue to provide you care that reduces your risk of re-infection. We call that care periodontal maintenance (PM).

The heart of PM care involves regular dental visits for monitoring, cleanings and treatment when necessary. While most patients may visit their dentist at least twice a year, as a previous gum disease patient we may advise more frequent visits, especially if you’ve just finished periodontal treatment. Depending on the extent of your disease, we may begin with a visit every other week or once every two to three months. If your mouth continues to be disease-free we may suggest increasing the time between visits.

During your visit we’ll carefully examine your mouth, as well as screen you for any signs of potential oral cancer. We’re looking for both signs of re-infection or new issues with your teeth and gums. We’ll also assess the effectiveness of your oral hygiene efforts and advise you on ways you can improve.

If we find any signs of disease, we’ll then formulate a treatment plan to effectively deal with it. With frequent visits we have a better chance of discovering re-infection early—and the earlier the better to minimize any further damage. We may also need to take steps to make future PM care easier. This could include gum surgery to alter the tissues around certain teeth for easier access for examination and cleaning.

Our main focus with PM care is to look ahead: what can we do now to prevent a future bout of gum disease or at least lessen its effect? With continued monitoring and care we can drastically reduce your risk for further damage from this destructive disease.

If you would like more information on post-gum disease maintenance, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Periodontal Cleanings.”

Warning Signs of Gum Disease

Do you frequently experience bleeding gums during your daily brushing routine? You might assume that you are brushing too hard and that this bleeding is normal. However, you should know that any bleeding of gum tissue is abnormal and should be considered a potential sign of gum disease.

Gum tissues usually bleed because of dental plaque buildup from poor oral hygiene practices. When the plaque is left around the gum line for a long period of time, 24 hours or more, the gum tissues respond by becoming inflamed — this can quickly become a chronic inflammation.

Here are some other warning signs of gum disease:

  1. Bad Breath. Bad breath is one of the most common signs of gum disease. This is especially true for those who do not floss, because plaque collects in the protected areas between the teeth making them especially prone to gum inflammation. This plaque often produces a pungent smell that causes bad breath.
  2. Red or Sensitive Gums. If you look closely in the mirror, you might see redness of the gums. It may also seem as if your gums are swollen, and in more advanced cases, this can lead to receding gums. Finally, you might notice gum sensitivity when you brush or a sensitivity to hot and cold.
  3. Tooth Loss. If this disease goes untreated, over time, bone loss will cause loose teeth, movement or migration of the teeth into a new and unstable position, and ultimately tooth loss. The rate of progression will depend upon the type of gum disease that you have.
  4. Painful Gums. Once you start to feel acute pain and extremely sore gums, this may mean you have developed a periodontal abscess. When this happens, the bacteria are walled off inside a gum “pocket,” and since your body’s defenses are overwhelmed, there is a battle between the bacteria in that pocket and your body’s defense mechanisms. The result is a collection of pus and extra bone loss. Your gums will be sore, swollen, red and may even discharge pus.

As you can see, the further the disease progresses, the greater the amount of pain and damage that will occur. Therefore, upon the first sign of gum disease, such as bleeding gums, you should schedule an appointment with us immediately.

If you would like more information about gum disease, please contact us. You can also learn more by reading the Dear Doctormagazine article “Warning Signs of Gum Disease.”

Understanding Tooth Sensitivity

Tooth sensitivity is an issue that can range from a slight twinge at times to downright excruciating pain. However, before we continue, understanding the cause of tooth sensitivity is helpful to both relieving and treating it.

Tooth enamel is inert in that it has no nerve supply and thus it protects the teeth from temperature and pressure changes — the main cause of sensitivity. Once it is compromised, worn thin, or exposed due to gum recession, it leaves the delicate nerve fibers within the dentin vulnerable to touch, acid, and temperature change. These nerve fibers most often grab your attention when they come in contact with heat, cold, or a “double whammy” combination of both cold and sweet. They also become sensitive to touch — even the bristles of a soft toothbrush can irritate exposed dentin.

As for the causes of tooth sensitivity, one common cause we see is aggressive brushing. Yes, too much brushing can be bad for you! To be more specific, excessive, improper brushing with a sawing back and forth motion can erode the gum tissues, expose, wear, and even groove the dentin. Another cause for sensitivity can be from the destructive process of tooth decay that eats through the enamel and into the dentin.

If you are experiencing tooth sensitivity or have questions about this condition, please contact us to schedule an appointment. Or you can learn more about this topic by reading the Dear Doctor magazine article “Sensitive Teeth.”