Gum recession is relatively common. Many patients see a gum specialist or Periodontist due to concerns with receding gums. In general, receding gums do not ordinarily grow back without dental treatment. However, there are many useful things we could do to prevent and treat gum recession.
The Gingival or gum recession occurs when the edge of the gum tissue (gingival margin) moves away from the crown of the tooth. Healthy gum tissue forms a protective collar around a tooth. When gums recede, exposing the tooth’s root, sensitivity to food may result. Patients may experience discomfort or pain when eating certain type of food such as an ice cream or drinking an ice-cold drink. Tooth root decay may also develop because the softer root surface decays more readily than the enamel on the tooth’s crown.
Causes of Gum recession
There are several causes of gum recession. This include patients suffering from “gum disease” (periodontitis), excessive tooth brushing, trauma to the gums, abnormal tooth position or simply hereditary. A person simply may have thin, fragile or insufficient gums that are prone to recession. This is especially so in patients where a tooth protrudes or crowded. As a result, inadequate jawbone covers the tooth’s root causing an increased risk for gum recession.
The signs and symptoms which may indicate gum recession include sensitivity, loose tooth, teeth appearing longer than normal, roots are exposed, tooth feels notched at the gum line, change in the tooth’s colour or spaces between teeth seems larger. The most common symptom is sensitivity to hot, cold, sweet, sour or spicy food and drink. The pain tends to be of short duration and feels sharp lasting for seconds.
Treatments
The type of treatment required is dependent on what’s causing the gum recession and the severity of the recession. It is important that we find out what the causative factor is because when minor recession is ignored, continued recession and bone loss around teeth are likely. Most people may not be aware that gum recession may also include bone loss around teeth. The key thing is to see a Periodontist to find out.
If the gum recession is due to excessive brushing, a periodontist or dentist can show you the most effective brushing technique or oral hygiene methods.
If the gum recession is due to periodontitis (“gums and bone loss”), the first step is to see a periodontist and the initial treatment involves deep cleaning (“scaling and root planning”). For many patients, this treatment along with excellent oral hygiene at home and regular check-ups or maintenance can help stop periodontitis and prevent further gum loss. In some patients with severe periodontitis, more advanced treatment such as gum surgery or regenerative therapy would be required.
Gum recession can be reduced by a gum graft procedure (“periodontal plastic surgery”). These procedures help to create more attached gingiva (thick, pink and firm tissue that hugs the teeth) to prevent gum recession from progressing, helps cover exposed roots, enhances the appearance of the gum line during smiling and prevents or treats root sensitivity. This procedure is essentially cosmetic surgery for gums.
Before gum graftAfter gum graft
What to do next?
You do not need a referral. Simply reach out to our friendly team at Toorak Dental Specialist Centre on 03 85887702 or info@tdsc.com.au who would be happy to organise an appointment for you with Dr Constantine Ong.
I was asked for my thoughts on the practice of Periodontology a few years ago and today I reflected on those thoughts again. Although, there have been advances in Periodontology over the years, the fundamentals I believe have not changed. Hence, I have decided to re-publish those thoughts which were original written in dentistry.co.uk
My preventive ethos is simple, I encourage patients to attend regularly for reviews and spend time brushing well with the appropriate cleaning kit twice a day.
The periodontium is the very foundation for teeth and it is important to have a strong and healthy foundation for a beautiful smile.
Research shows that inflammatory diseases of the mouth such as periodontal diseases are directly associated with diabetes and heart disease.
Treating inflammation helps manage periodontal diseases and so, in turn, helps in the management of chronic inflammatory conditions.
The power of three
Periodontal treatment is divided into three phases.
The initial phase is focused on plaque control and deep cleaning (root surface debridement) to reduce the plaque and tartar from gum pockets. After a few weeks, we reassess the response to this therapy.
The second phase is corrective and, sometimes, involves surgery at the deeper sites.
The need for this kind of treatment is usually decided upon and planned at the reassessment appointment. After this, the third phase is the maintenance phase that usually involves three-monthly recalls to a hygienist.
The patient’s journey is a vital part of my treatment ethos. There is no dental treatment that can be described as relaxing, but I do try to ensure it is as comfortable as possible.
This is particularly important in periodontics as the success of the treatment is largely dependent on the patient being compliant, and the patient is more likely to be compliant with our advice if their experience has been rewarding.
The power of a shared philosophy
A treatment plan is devised following an initial consultation with me.
I ensure the whole team, from the practice manager and receptionist to the dental nurse and hygienist, is singing the same tune.
We have regular meetings, during which ideas are shared. We also attend lectures and conferences together and, I find, it is useful to have a simple practice manual with flow charts to which the team may refer.
For a practice to be effective, it needs a shared ideology.
I also try to get to know my referring dentists and encourage them to join us for our practice continuous professional development lectures and case discussion so they too may share in my treatment philosophy and play their role in the long-term management of the stabilised, but still susceptible, periodontitis patients.
The power of predictability
My philosophy is to treat the patient and not just the mouth.
Similarly, I treat the whole mouth, including the gums and supporting bone, and not just the teeth.
Most patients who have decided to see a specialist for treatment have already made a conscientious decision to seek healthier gums and teeth.
My role is to provide them with the most predictable treatment and I find they appreciate that.
If you are honest with your patients, they will listen. Any complex work we do in periodontics or implant dentistry would be futile unless we have the patient on board in maintaining excellent oral hygiene.
Following adequate periodontal treatment, it should be borne in mind that the replacement of any missing teeth with implant-supported reconstructions should also include a maintenance programme, because patients who have lost teeth as a result of periodontal disease are also at risk of developing peri-implantitis (Ong et al. 2008).
The power of a power brush
The oral hygiene kit I would advise periodontitis patients to have would be an electric toothbrush (smaller oscillating-rotating brush head for effective access), interdental brushes and fluoride toothpaste.
I always recommended power brushes as most patients welcome any help they can get in stabilising their periodontal disease.
I find Oral-B brushes to be effective and patient friendly.
From a periodontal perspective, mechanical plaque removal and the use of a stabilised stannous fluoride toothpaste are key in maintaining healthy gums and tooth-supporting structures.
References
Ong, C., Ivanovski, S., Needleman, I., Moles, D., Retzepi, M., Tonetti, M. and Donos, N. (2008) ‘Systematic review of implant outcomes in treated periodontitis subjects’, Journal of Clinical Periodontology, May; 35 (5) 438-62.
Most people may not know that teeth do not sit solidly in the jaw bone, but there is a layer of soft tissue called periodontal ligament which takes some of the stress of the biting load as well as acting as a monitoring mechanism which tells your brain in detecting how much of the load to use when chewing (e.g. hard or soft food). Consequently, it is normal for very slight movement of your teeth especially for the smaller teeth such as your lower front incisor teeth.
However, larger movement of your teeth or any obvious wobbliness of your teeth could be a sign of more serious underlying issues. Loose teeth are most commonly found as a result of bone loss or loss of the supporting tissue of your teeth due to periodontal/”gum” disease. Teeth may also become loose due to heavy clenching or grinding of the teeth. This could occur when you have been very stressed and not surprisingly during the COVID-19 lockdowns, there were many people who have been very stressed due to the uncertainty or fear of catching the virus.
A tooth may also become loose due to fracture from trauma or even looseness of the filling rather than the tooth itself.
In certain individuals, there may be a combination of teeth grinding habits on a reduced periodontal support, meaning a person may grind and also have had lost of bone support due to gum disease. In these individuals, they may have lost a few teeth particularly the back teeth due to periodontal disease and have placed too much load on the remaining teeth (e.g. remaining front teeth).
In all cases, it is of paramount importance, to visit an experienced periodontist to ascertain the root cause of the tooth mobility or looseness.
How do I make my teeth strong again?
Due to the many potential causes of tooth mobility, it is important that the correct diagnosis is made at the start. The treatment should obviously be geared towards finding out the cause of the tooth mobility, to treat the underlying disease and preventing further deterioration.
What if I have gum or periodontal disease?
Gum or periodontal disease in most cases would require treatment. It should not be ignored, as continued recession and further bone loss around teeth are likely.
The first step in the treatment is to see a periodontist and the initial treatment involves deep cleaning (“scaling and root planning”). For many patients, this treatment along with excellent oral hygiene at home and regular check-ups or maintenance can help stop periodontitis and prevent further gum or bone loss. This will also help to strengthen the teeth so that your teeth will feel tighter.
In certain cases, more advanced treatment may be required to repair the damaged bone supporting tissue with surgery or regeneration (rebuilding) of the lost supporting bone and soft tissue.
What if I am afraid of biting because my teeth are loose?
People with treated gum disease may have their teeth splinted or stuck together to reduce the amount of movement. This would give you the added confidence when chewing. In certain cases, if the teeth are too wobbly, replacement of the teeth would be required.
What if my partner tells me that I grind at night?
Clenching or grinding of teeth may lead to not only loose teeth but may also cause jaw-ache, jaw clicking, pain on biting hard food or pain at the region of the muscles which support your jaws (such as headache at the temple), worn teeth or fracturing of your teeth or fillings.
A mouthguard or an occlusal splint may be required. This is worn when you sleep to protect your teeth from excessive biting force on your teeth. In patients with jaw pain, relaxing your jaw by avoiding the chewing of hard food temporarily or the use of hot towel placed at the region of your jaw muscles may help. In severe cases, anti-inflammatory painkillers may be necessary.
What if I am afraid of losing more teeth due to gum disease and my current teeth are already quite loose?
For some people who have already had gum treatment, it may be sensible to consider the replacement of the gaps in your mouth with dental implants, dentures or bridges so that the chewing load could be spread to more teeth and thus help to strengthen your own natural teeth.
In some cases, long term planning in terms of replacement of the loose teeth may also need to be considered.
What should I do now and do I need a referral to see a gum specialist?
You do not need a referral from your dentist or doctor to see a gum specialist. Our specialist periodontist, Dr Constantine Ong, will carry out a comprehensive assessment and discuss the various treatment options in detail with you. Take the first step now by contacting us.
“Many dental surgeries are closed or are only seeing patients for emergencies, it is even more important than ever to brush properly and carry out inter-dental brushing or flossing regularly.”
Everyone is trying to manage this uncertain and trying times in different ways. Brushing your teeth and gums or keeping a good dental hygiene might not be on the top of the list of the things to do in the middle of the COVID-19 pandemic.
That view will change very quickly if you have a painful gum abscess or your teeth became loose, and you can’t get in to see a periodontist (gum specialist).
Preventative measures, eating habits and having a regular brushing routine should be built into your daily routine especially for patients with periodontitis (gum disease). Gum disease is common and if left untreated, may lead to bone loss around the teeth. This may lead to loose teeth and teeth being lost.
How do I know if I have gum disease?
Gum disease is caused by the bacteria in plaque which is not removed during brushing. Plaque is a thin and sticky film which forms on your teeth. If the plaque is not removed by brushing, it can harden into tartar or calculus. As the calculus forms near the gumline, the plaque underneath releases harmful poisons causing the gums to become irritated, inflamed and present as bleeding gums. Clinically, this is presented as a condition called gingivitis.
The gums start to pull away from the teeth when it becomes inflamed and the gaps between the gums and the teeth called pockets deepened and become infected. In susceptible individuals, the bone supporting the teeth is destroyed, and healthy teeth can become loose and fall out. This disease is called periodontitis.
Gum disease (gingivitis) will usually presents with red, swollen gums that bleed when you brush or clean between your teeth. If the gum disease progresses to periodontitis, the bone supporting the teeth will be destroyed and teeth will become loose or wobbly, look longer (gum recession), bigger gaps will form between teeth, bad breath and the teeth may move or misalign over time. Sometimes, your teeth may become sensitive. However, more often than not, it is usually painless unless there is an acute infection such as gum abscess (gum boil or “pimple” containing pus). There has been suggestions of a link between periodontitis and health problems such as heart disease, strokes, preterm and still born births. It is therefore sometimes known as “The Silent Killer.”
How do I take care of my gums?
Oral care routine
It is important to remove plaque and food from around your teeth and gums in order to stop your gums from becoming inflamed, swollen and infected (and teeth from getting decay). Once the plaque harden into calculus, this would need to be removed by a dental professional.
Maintaining your usual brushing regime with fluoride toothpaste and interdental brushing/flossing daily to keep in mind the followings:
a. Brush regularly twice a day. Last thing at night and one other time during the day. It is important to brush your teeth as well as the gum level. An electric toothbrush can be more effective in plaque removal but both manual and electric toothbrush would work providing that you spent time to brush thoroughly. A toothbrush with a small sized head would be useful to reach all parts of the mouth. Soft bristles would be better for your gums and you must ensure that the head of the brush is not worn or the bristles are not splayed. In general, change to a fresh brush once every 3 months. In patients with untreated gum disease, gum bleeding may be a presenting sign, it is crucial that patients continue to brush regularly and thoroughly both the teeth and gums rather than avoid brushing due to concern with gum bleeding. If the gum bleeding does not stop after 1 to 2 weeks, you should seek advise from a dental professional.
b. Use a fluoride toothpaste. Current recommedation would be to spit out after brushing and do not rinse, so that the fluoride stays on your teeth longer.
c. Flossing or interdental brushes (e.g. Tepe brushes or piksters) of different sizes are essential for brushing in between your teeth for patients with gum disease. Cleaning in between your teeth removes plaque and food particles that are stuck between your teeth and the gumline. These are the areas which a toothbrush can’t reach. This regime would need to be carried out once a day and without the need to put toothpaste on the interdental brushes. This is an effective way to remove the bacteria contained in the plaque. Interdental brushing is usually carried out prior to normal tooth brushing but can be carried out at any time of the day.
d. The use of mouthwash is not essential but may be helpful. Anecdotal evidence would suggest that the use of mouthwash with 1% Peroxide or 0.2% Chlorhexidine Gluconate for 30 seconds to 1 minute works well against reducing the viral load. Since COVID-19 is a virus, this may help to reduce the risk of spreading a virus.
e. For patients who may be concerned with bad breath. Tongue brushing or cleaning to remove the sulphur-producing bacteria may help to improve a patient’s breath.
f. Remember to wash your hands with soap for 20 seconds and dry them with a towel.
Don’t forget: 3 to 6 monthly check-ups and cleans are important for gum maintenance for patients with periodontitis. If you are unable to see a Periodontist due to the COVID-19 pandemic, ensure that you reschedule to the next available appointment. In the meantime, patients who have concerns, should approach our Periodontist for a virtual consultation.
2. Diet or eating habit matters
During this “Stay Home” period, don’t let yourself go by feasting on snacks and junk food and neglecting your health. Most people think that eating high level of sweets and sugar in your diet causes decay. This is partly true, however, it is how often you have sugar in your diet, not necessarily the amount, that causes most of the problems. It takes an hour for your mouth to neutralise the acid caused by eating and drinking sugar. It is therefore important to limit the number of attacks by having sugary foods and drinks just at mealtimes. Drinking water and chewing sugar-free gum would also help to neutralise the acid more quickly.
Limit fizzy drinks, fruit juices, energy drinks or even excessive Vitamin C supplements (capsules or tablets are preferred in comparison to chewable tablets or dissolvable tablets) because they can cause dental erosion (acid in food and drinks wears away the enamel of the teeth) and may lead to sensitivity.
3. Stay hydrated by drinking plenty of water
Stay hydrated is important for both your oral and general health. Lack of fluids may lead to dry mouth. A reduction of saliva in your mouth also increases tooth decay and gum inflammation as the all important saliva which normally helps to remove food particles and acid that keeps the oral bacteria at bay.
How to avoid catching or spreading the coronavirus (COVID-19)
Never share a toothbrush
No matter how close you are to the people you live with, sharing your toothbrush is not hygienic. That is one way that viruses can spread to other people. The toothbrush heads should be stored and kept apart from other toothbrushes in your household.
2. Clean your bathroom regularly and close the toilet lid before you flush
There has been some studies to suggest that virus can be spread by faecal matter. It is important to keep your toothbrush away from your toilet.
3. Change your toothbrush regularly
To ensure the effectiveness of your brushing, your toothbrush should be changed regularly. If you have had the coronavirus or suspect that you may have, get a new toothbrush after your isolation period.
4. Visiting your Periodontist and stay connected
Maintaining regular visits with your periodontist will always be important. However, during this period of uncertainty in order to limit the transmission risk of COVID-19, dentists are subject to restrictions and are only able to provide dental treatment on an urgent basis. Nevertheless, you can still reach out to your periodontist or stay connected via virtual or online consultation.
Lastly, stay safe and stay strong. Always be kind!
