Care of the Gums and Related Structures
Periodontics comprises the treatment of diseases of the gums and related structures and the prevention of such diseases. To properly maintain periodontal structures, patients should not only brush, floss and use mouthwash, but also have regular checkups that can detect problems early. Routine cleanings, periodontal examinations, bite evaluations, early interventions and fluoride treatments can avoid costly repairs. The frequency of maintenance visits (including calculus removal and X-ray examinations) is based on an assessment of the frequency of cavity formation, the rate of calculus formation, the condition of the gums and any other special problem. Once current treatment is completed, the patient should be placed on a recall schedule and notified when the next checkup is due.
During periodontal examinations, the dentist and hygienist look for the following:
- Swollen, erythematous (very red) gum tissue
- Staining or sticky, tar-like deposits (tartar, calculus)
- Receding gums, root exposure
- Bad breath, dryness of the mouth
- Over-worn teeth, clenching and grinding patterns (bruxism)
- Evidence of smoking or chewing tobacco: “smoker’s palate,” red inflammation on the roof of the mouth, black hairy tongue and pre-cancerous or cancerous oral lesions
At cleaning (prophylaxis) appointments with hygienist, the following will always occur:
- Complete dental examination by both the doctor and hygienist
- Removal of calculus (tartar) and plaque
- Polishing of the teeth.
When advisable, appropriate X-rays will be taken at this dental cleaning appointment.
When periodontal disease is detected, the doctor will suggest either a non-surgical or surgical treatment, as appropriate to the situation.
It is well documented that periodontal problems can contribute to many general health problems, including:
- Low infant birth weight
- Respiratory disease
- Heart disease
- Complications of diabetes
- Poor weight retention
- Loss of taste and smell
- Complications of arthritis
Pregnant women must be particularly careful of signs of swelling (gingivitis) and bleeding of the gums. These may be seen as early as the second month of pregnancy and might reach a peak by the middle of the third trimester. For patients who develop so-called pregnancy gingivitis, I suggest at least 2 cleanings during the period of pregnancy and, in extreme cases, 1 cleaning per trimester.
There are many risk factors for developing periodontal disease, including:
- Heart disease
- Respiratory disease
- Inadequate home care
- Hereditary predisposition
How to brush:
- Use a soft-bristled brush (synthetic bristles preferably, because natural bristles, being more porous, may harbor oral bacteria). Be sure it is the right size—generally smaller is better than larger.
- Place the bristles at a 45-degree angle to the teeth. Slide the tips of the brush at the end of the gums. Always feel the bristles on the gums.
- Jiggle the bristles very gently so that any plaque growing under the gum will loosen.
- Be sure to brush the outside, the tongue side and the chewing surfaces of each tooth.
- For the front teeth, brush the inside surfaces of the upper and lower jaws by using the tip of the brush.
- Brushing your tongue will help freshen your breath. Debris and bacteria can coat your tongue and cause bad breath.
- Electric toothbrushes, including the Sonicare® are also good to use.
- A thorough brushing should take 2 to 3 minutes. Don’t rush.
Keep the following tips in mind:
- Don’t rush your brush
- Brush gently not just teeth, but also gums and tongue
- Brush twice daily
- A pea-sized amount of fluoride toothpaste is sufficient
- Replace your toothbrush frequently
How to floss:
- Break off a 14-inch length (about 35 centimeters) of floss and wrap it around 2 fingers, leaving a 2-inch length (5 centimeters) of floss between them.
- Using your thumbs and forefingers to guide the floss, gently insert it between the teeth in a sawing motion.
- Curve the floss into a C shape around each tooth and under the gum line. Gently move the floss down, cleaning the side of each tooth.
- Floss holders are recommended for patients that have difficulty holding the floss securely.
Daily flossing should accomplish the following:
- Clean between the teeth and gum line
- Disrupt plaque colony build-up
- Prevent damage to gums and bone
- Massage gum tissue
Here are more tips to keep in mind:
- Floss every day
- Floss gently, and don’t rush
How to rinse:
Rinse with mouthwash after each home-care session. I will be glad to recommend an appropriate mouthwash for you.
Rinse and spit with 1 to 2 tablespoons each time, and be sure not to eat or drink anything after for twenty minutes.
Some useful dental aids:
- Desensitizing toothpaste
- Concentrated fluoride
- Medicated rinses
- Floss holders
- Interdental/proximal brushes (e.g., Proxabrush®)
- Irrigation devices (e.g., Interplak®)
- Electric toothbrushes
- Rubber tip stimulators
- Tongue cleaners