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Questions about Gum Disease

  1. What IS gum disease?
  2. Are there different forms that are more or less serious?
  3. What kinds of treatment is needed for gum disease?
  4. My dentist thinks I need “deep cleaning” – what is that and how is it different from a normal cleaning?
  5. What is root planing – might I need that?
  6. My gums seem puffy and red around the teeth and bleed when I brush – what might be going on there?
  7. The dentist says my teeth are mobile – what does that mean and how serious is that?
  8. What is recession – my dentist says I have it, but I don’t know if it is really serious?

Answers about Gum Disease.

  1. What IS gum disease?  There are two forms – gingivitis and periodontitis.  Both involve inflammation, which is the body’s attempt to fight invading bacteria with the immune system.  Gingivitis is common and happens when you don’t keep your teeth and gums clean enough by regular brushing.  The PLAQUE bacteria which build up will cause this inflammatory response.  For Periodontitis, the bacteria are different.  The formation of deeper pockets in the gum tissue around a tooth allows a bacterial type to colonize in this pocket with the exclusion of air.  These ANAEROBIC bacteria are much more harmful than those that survive well in air.  Once you get deep enough pockets for these anaerobes to survive, you are on the downward spiral of periodontitis, and it requires professional help to arrest the progression………………… BACK to questions
  2. Are there different forms that are more or less serious?  Yes.  Gingivitis is the least serious and easily managed by you at home.  Periodontitis is more potentially harmful as the years go by, and requires professional help.  We ALL have gingivitis and periodontitis at various times in our lives.  There are more rare forms of gum disease – Rapidly Progressing Periodontitis is quite serious, as is ANUG – Acute Necrotizing Ulcerative Gingivitis.  Both of those sound ominous, and both are.  ANUG is easier to take care of, and is often a one-time thing, whereas the former will produce severe bone loss, which is not reversible, in particular parts of the mouth………………… BACK to questions
  3. What kinds of treatment are needed for gum disease?  For “garden variety” gingivitis, get instruction about good home care, brushing and flossing, and things are going to get better quickly.   It is NOT an irreversible situation.  For periodontitis you will typically need to have a professional remove the CALCULUS (tartar is the older term) from the teeth underneath the gumline, maybe from the enamel surface or the root surface.  As calculus is scraped off the root surface with sharp instruments, you must be anesthetized, and the root is smoothed at the same time, helping to minimize the formation of more calculus.  This is called ROOT PLANING.  If the professional cannot get the instrument (curettes) far enough into the depth of the pocket to remove the calculus adequately, the periodontist may have to actually surgically cut and pull back the gum tissue from the teeth, plane the root surfaces deeper than would be otherwise possible, and then suture the gum tissue back again.  This takes time to heal and it is not a pleasant process.  ……………….. .BACK to questions
  4. My dentist thinks I need “deep cleaning” – what is that and how is it different from a normal cleaning?  Good question!  Have the dentist show you the calculus on the sides of the teeth on the X-rays – it will look like little spikes of whiter material stuck on the root.  See cases in Chapter IV.3. If it is far enough below the line where the enamel and the root connect, root planning is required.  Root planing these areas required anesthesia, and the dentist will have you come either two or four times to clean your teeth quadrant by quadrant.  IF the calculus on the X-ray is near the CEJ – that junction between the cementum covering of the root and the enamel – then a simple cleaning by a skilled hygienist can take care of the problem for the whole mouth.  If you have gum recession, the cleaning can be even easier.  DEEP CLEANING is not an accepted term in dentistry – but is used to convince patients that they need something more than a routine cleaning (prophylaxis), so they can be charged more.  When I do a cleaning I can remove everything that needs to be removed below the gumline for the whole mouth, up to the point where root planing is necessary – there is no procedure in between!……………….. BACK to questions
  5. What is root planing – might I need that?  It consists of removal of hard, mineralized calculus deposits deep down on the root of the tooth near the bottom of a deeper periodontal pocket.  It requires the use of specialized instruments, curettes, that are designed to fit down into the pocket without doing any damage, and then scraping upward to remove the deposits.  These deposits are MADE and INHABITED by the anaerobic bacteria that cause bone loss, recession and pocketing in the gum tissues around each tooth.  If you have such deposits in a deep pocket, it is a sign that root planing is necessary…………………BACK to questions
  6. My gums seem puffy and red around the teeth and bleed when I brush – what might be going on there?  You have gingival inflammation – either as a consequence of gingivitis or periodontitis.  You should go into the dentist to access the situation and either council you on better home care, or as well to remove deposits in the office to potentially arrest the problem.  The red, puffy and bleeding look is not a healthy look, and even if just for the esthetic result, it should be gotten under control………………..BACK to questions
  7. The dentist says my teeth are mobile – what does that mean and how serious is that?  It depends on the amount of mobility whether it is serious or not.  I can push on a patient’s tooth and almost always see a little movement, from outside to inside (facial to lingual), even for people in their 20s.  This is normal.  It just means that the connection between the tooth root and the bone is somewhat flexible, which it is designed to be.  There is a ligament connecting the root to the bone, where the tooth sits in something like a hammock, and this ligament will allow for some movement.  If the movement approaches 1 mm from facial to lingual, that is suggestive of significant periodontal problems.  Typically, as periodontal disease progresses and the bone level around each tooth is lowered, there is LESS bone holding the root of the tooth in place, and mobility is very likely.  Now – periodontal bone loss is not the only reason for mobility.  If you are traumatizing your tooth by hard biting on it repeatedly, it can make just that tooth mobile.  Generalized mobility suggests periodontal disease.  If the inside-out movement approaches 2 mm, then it is significantly more serious, and the most serious is when the bone loss is so far down the root of the tooth that there is virtually NO prevention of facial to lingual movement, and even you can push the tooth down INTO the bone, meaning there is no support under the apex of the root.  ………………..BACK to questions
  8. What is recession – my dentist says I have it, but I don’t know if it is really serious?  Recession, in its most simple terms, means you can SEE the root of the tooth.  You can have recession generally, or on just one or two teeth.  It is usually a consequence of periodontal disease, where the pocket gets deeper, calculus and bacteria are allowed to stay, producing harmful chemicals which damage the connection between the gum tissue and the tooth, and cause the bone to resorb down the side of the tooth, bringing the gumline down with it.  It is a definite indication of periodontitis, which can be serious.  On the other hand, if your are in you late 60s and 70s, if you don’t have any recession, that would be rare.  Eventually pretty much everyone gets it, it’s just a matter of how far you allow it to progress at your age.  Recession at a young age is an esthetic difficulty, but at an older age it seems to be more normal and acceptable. For discussion about hot the gingival tissues are SUPPOSED to be, and their function, see Chapter II.3. ……………….. BACK to questions