What You Should Know About Receding Gums

Recently, I received several questions about receding gums, so I thought I'd blog about it.  Receding gums is also known as “gingival recession.”   Ideally, healthy, pink gum tissue normally covers the root of the tooth. This can become exposed when the gum is pushed back or if the tooth is in an abnormal position.

 

Receding gums are common and often unnoticed at an early stage. There are many risk factors, but age is a main one – 88% of people older than 65 have receding gums in at least one tooth--hence the term "long in the tooth" to refer to an older person. 

Since gums protect fragile tooth roots from bacteria, plaque and other insults, the main concern with receding gums is that when the roots of the teeth become exposed, they are at risk for decay, infection, and loss. Treatment can stop or reverse the process of gum recession if begun at an early stage. 

If the recession is severe and the patient has symptoms such as tooth sensitivity, pain, or infection, a variety of treatment options are available. These include deep cleaning, medicine to fight infections, and even tissue grafts. 

What are the gums?

The gums are also known as the gingivae. The gingiva is the moist pink tissue in the mouth that meets the base of the teeth. There are two such gums - one for the upper, and one for the lower set of teeth. 

The gingiva is a dense tissue with a good supply of blood vessels beneath a moist surface. The surface is called mucous membrane. It is joined to the rest of the mouth lining but is pink instead of shiny red.  The gums tightly surround the teeth up to the neck of each one and are firmly attached to the jaw bone. The gums usually cover the roots of the teeth, protecting them as they are more fragile than the rest of the teeth. 

Gingival recession exposes the fragile tooth roots to bacteria, plaque, and other forms of decay. 

Why do gums recede?

Poor oral hygiene and periodontal disease are linked to gingival recession. But receding gums can happen in people with good standards of oral hygiene, too.

Broadly, there are two causes of receding gums:

• Physical wear of the gums
• Inflammation of the gum tissues - this is a reaction of the immune system

Some people are more prone to receding gums because of inherited factors. These factors include their tooth position and gum thickness. 

Physical wear of the gums by vigorous tooth brushing or use of hard bristles is a common cause of receding gums.  People with this problem might otherwise have good oral hygiene. The teeth and gums otherwise appear healthy when receding gums are caused by over-brushing.  This type of recession often affects the left side more. This is because most people use a toothbrush in their right hand and so put more pressure on the left gums. The pattern also tends to affect the side gums more than the front. 

Other physical factors that push the gums back include lip piercings, misaligned teeth, and damage caused by dental treatment. 

As far as inflammation goes, some people are more prone to the inflammatory causes of receding gums. Thinner gum tissue makes inflammation caused by plaque more likely. The gums are more delicate in some people. 

Related to inflammation, periodontal disease is a common cause of gum recession. Periodontal disease causes the loss of the supporting bone around a tooth through an inflammatory reaction. The gum recession tends to affect all the teeth in a similar way. 

Periodontal disease is caused by plaque buildup. Plaque is a sticky film that forms on the teeth. Bacteria, mucus, cells, and other particles are involved in the formation of plaque.

When plaque builds up on teeth, it causes:

• Inflamed gums known as gingivitis. This condition can lead to periodontitis
• Periodontitis results in spaces between the gums and teeth and loss of connective fibers and bone around the tooth roots. This leads to receding gums

Tartar is hardened plaque and cannot be removed by tooth brushing. Instead, it must be removed at a dentist's office, generally by the hygienist, but sometimes by scaling by the dentist. 

Problems caused by receding gums

Many people with receding gums have no concern about them early on. Many others are unaware that they have recession.

For some, though, the concern may be about:

• Appearance
• Fear of tooth loss
• Sensitivity due to exposed tooth roots

Assessing concerns about the way gums look may include checking how much of the gums are exposed.  For some people, the gums show when talking and smiling. Others have a different lip line that does not expose the gums to view. 

Treatment for receding gums

Most of the time, mild gum recession does not need treatment. Dentists may simply give advice about prevention and offer to monitor the gums. Teaching people how to brush gently but effectively is a good early intervention. 

For people who do need treatment, a number of options are available:

• Desensitizing agents, varnishes, and dentine bonding agents: These aim to reduce any sensitivity that may develop in the exposed tooth root. This treats the nerve symptoms and helps to keep normal oral hygiene by allowing brushing of sensitive teeth to continue
• Composite restoration: Tooth-colored composite resins are used to cover the root surface. They can also close black gaps between teeth.  I happen to be proud of my skill in this area.
• Pink porcelain or composite: This is the same pink color of the gums.
• Removable gingival veneers made from acrylic or silicone.
• Orthodontics: Treatments designed to move the position of teeth can correct the gum margin.
• Surgery: Tissue is grafted from elsewhere in the mouth and heals over the gum recession. 

Keep smiling,

 

 

Dr. Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut.  She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121

The Five Biggest Dental Problems for People Over 50

As the average life-span continues to increase, I have some good news for you: older Americans are keeping their teeth longer than ever before and the average number of teeth people retain into old age is increasing, according to elder care researchers for the American Dental Association and The Center for Clinical Research at the Boston University Goldman School of Dental Medicine.

But every silver lining has a cloud. As people keep their teeth longer, there are more problems that are likely to arise, which is why Dr. Elzbieta W. Basil, DMD, a family and cosmetic dentist with offices in West Hartford Center and Downtown New Britain says keeping up with regular dental visits is so important. Here are the most common problems, and what you can do about them:

Tooth Decay/Tooth Erosion

Yes, people over 50 can get cavities. You can get them on the surfaces of teeth that have never been a problem before, but you can also get them around old fillings or at the root of your tooth. This is because, as you age, the root of your tooth becomes softer and sometimes more exposed.

The Fix: Flouride.  It’s not just for kids.  Fluoride is one of the 10 most important health measures developed in the 20th century.   Almost 80 percent of people in the United States have fluorinated water, but if you don’t, you should probably add a daily fluoride rinse to your brushing habit. Or ask your doctor about a stronger fluoride prescription gel, or high fluoride toothpaste, like Fluoridex (which we use in our house). If you are starting to get cavities, even if your water has fluoride, consider a fluoride rinse. Ask your dentist if that’s right for you.

Dry mouth

Saliva protects us against tooth decay. But if you’re not producing it, your teeth may be at risk. The calcium and phosphate present in saliva prevent demineralization of your teeth. How do you know if you have dry mouth? You’ll have a sticky feeling in your mouth, trouble swallowing, dry throat, and dry, cracked lips. You may notice a metallic taste in your mouth or persistent bad breath. You may or may not feel thirsty. Dry mouth is often caused by medications, and as people age, they take more medications. It can also result from smoking or from a blow to the head that somehow damages the salivary glands.

The Fix: If you have dry mouth, you should try to stimulate saliva production. Some people just sip water all day while others find that chewing sugar-free xylitol candies or gum helps. As a dentist, I can also prescribe a prescription saliva substitute or recommend over-the-counter formulations for you to try.

Gum disease

If your gums are swollen, red, or bleed easily, you’ve got gingivitis, an early form of gum disease that can progress and be dangerous. Untreated gingivitis often becomes periodontitis, which is when the gum pulls away from the tooth and creates pockets which can become infected. If this condition develops and continues unchecked, it could cause the loss of bones in your jaw and eventually, the loss of the teeth themselves.

The Fix: The best fix for this condition is regular dentist visits. You may need to visit your dentist more frequently so that your teeth can be cleaned and your gums treated for the condition.  While I recommend twice-a-year cleanings for people in good health, it might be more a more prudent preventative step to schedule 3 or 4 cleanings a year if certain diseases or conditions are present.  People who don’t have good access to dental care are more likely to have gum disease, and of course, to lose teeth.

Oral cancer

More than 43,000 Americans will be diagnosed with oral cancers this year, and more than 8,000 will die from it, according to The Oral Cancer Foundation. Oral cancer incidence definitely increases as you get older, Jones says, and is very often linked to smoking and heavy alcohol use. Recently, the number of cases has risen because doctors have discovered that the Human Papilloma Virus also can cause oral cancer.

The Fix: Only about half of people who develop oral cancer survive the disease. The best hope for survival is to discover it at its earliest stages—in which case there is an 80 percent chance of surviving for five years. A comprehensive dental exam should include a check for oral cancer. Your dentist will hold your tongue and check the soft tissue in your mouth as well as your throat and jaw. If he or she does not, it’s time to find another dentist.

Tooth crowding

Are you noticing that food is getting stuck in new places in your mouth? Or that the overlapping tooth that was cute in your teens now seems to be overlapping even more? You’re not imagining it. As you age, your teeth shift, according to the American Association of Orthodontists. And that can be problematic, not because you’ll look different, but because it can make your teeth more difficult to clean, leading to more decay. It’s also of concern because misaligned teeth can lead to teeth erosion and damage to the supporting tissue and bone. Add to that the tendency of older adults to have periodontal disease, and you could end up losing your teeth even faster.

The Fix: If your teeth have really shifted, you could see an orthodontist, who may fit you with a retainer, spacer, or even braces, such as Invisalign, or other non-traditional system. This may not be necessary, but you should discuss with your dentist whether your teeth are shifting at your regular check up. If they are, it may mean only that you need to go to the dentist more regularly for more frequent cleanings.

Bonus topic: Teeth Whitening

It's not so much a problem as it is a fantastic option to keep you looking much younger!

Keep smiling,

 

Dr. Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut.  She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121

The Changing Definition of Oral Health

The FDI World Dental Federation (established in Paris in 1900 as Fédération Dentaire Internationale) is the world's leading organization representing the dental profession.  It serves as the principal representative body for over one million dentists worldwide, and it's membership includes over 200 national dental associations and specialist groups from over 130 countries.  Last week, the FDI launched a new definition of ‘Oral Health’ – positioning it as an integral part of general health and well-being – at its Annual World Dental Congress, which happened to be held in my native Poland. The definition was adopted by over 200 national dental associations.

Before we get to the new definition, it is interesting to note that “Oral Health” has been defined by several different organizations in vastly different manners.

World Health Organization Definition of “Oral Health”

In 2008, the World Health Organization, part of the United Nations, defined oral health as “a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity.”  This is a highly clinical definition dealing only with mechanical function in the oral cavity and diseases of the oral cavity and surrounding structures.

ADA/Surgeon General Definition of “Oral Health”

In 2014, following the first ever report of the US Surgeon General on Oral Health, the ADA defined Oral Health as “a functional, structural, aesthetic, physiologic and psychosocial state of well-being and is essential to an individual’s general health and quality of life.”  It is interesting that this definition adds the (a) aesthetic, (b) psychosocial and (c) interrelation to the patient’s overall health to the definition.

New FDI Definition of “Oral Health”

Now, just last week, the FDI has modified the definition to reflect a more holistic approach to oral health.

As defined by FDI, oral health:

• Is multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex.
• Is a fundamental component of health and physical and mental wellbeing. It exists along a continuum influenced by the values and attitudes of individuals and communities;
• Reflects the physiological, social and psychological attributes that are essential to the quality of life;  
• Is influenced by the individual’s changing experiences, perceptions, expectations and ability to adapt to circumstances.

Why the new definition?  In an email from Poland, Dr. Michael Glick, who was on the committee that advanced the new definition, explained why the old definition needed to be changed. “The old definition lacked a theoretical framework that made assessment and evaluation of oral health hard to measure,” he said. “Furthermore, this new definition moves dentistry from treating disease to treating a person with disease. The new definition uses language that resonates with language commonly used in the healthcare realm — words and concepts that healthcare professionals across disciplines can understand and use.”

David Williams, Ph.D., a professor at Barts and The London School of Medicine and Dentistry at Queen Mary University in London commented, “With this new definition, we want to raise awareness of the different dimensions of oral health and emphasize that oral health does not occur in isolation, but is embedded in the wider framework of overall health.”

It is clear that Oral Health is more than just mechanical use and freedom from oral disease—especially given the huge amounts of data that suggest there is an interrelationship between all types of diseases and oral health.   From my standpoint, it is an interesting development in the understanding of the importance of oral health to overall health and happiness, from a physical, social, and psychological perspective.

Keep smiling, 

Dr. Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut.  She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121

Five (More) Dental Myths Put To Rest

There are many things in life shrouded in mystery.  Urban myths and old wives’ tales always keep our curiosity tickled, and you may be dying to get to the truth of an issue for peace of mind.  Your smile is no different!  There are so many things that people may not know about their smiles; things that they may not know are true or only a myth. 

Your smile is nothing to play around with, and Dr. Elzbieta W. Basil, DMD, a dentist with offices in West Hartford Center and Downtown New Britain, would like to clear up a few myths in order to contribute to your peace of mind.

Myth 1:  Traditional Braces are always better than Invisalign

Invisalign has only been around since about 2000, so there isn’t quite as much long term data yet, but unless you have issues with rotating back teeth or descending teeth that aren’t descended enough, Invisalign does an effective job—and they’re nearly invisible. Of course, since you are supposed to wear them 22 hours per day, they only work if you wear them, and if you are the type who will forget to put them in or refuse to wear them as instructed, perhaps non-removable braces are a better choice.  On the other hand, you have no issues with foods getting stuck and no issues with discomfort from eating, as you can remove them during eating.  Also, there is no issue with pain from wires, because there are none.

Myth 2: Teeth Whitening weakens the durability of your teeth

For those who want to brighten their smiles with teeth whitening, you have nothing to worry about, as this myth is completely false.  When you go to have your smile whitened, the gel that the dentist places on your smile only affects the color of your enamel, not the strength.  Though it is normal to experience some sensitivity with your smile after having the procedure done, it does not weaken the internal structure of your teeth.

Myth 3: You shouldn’t brush or floss if your gums are bleeding

This is actually the exact opposite of what you want to do, and there could be many reasons why your gums could be bleeding.  Bleeding gums is usually a sign of plaque and other particles irritating them, and it is important to remove whatever is aggravating your gums as soon as possible.  Brushing and flossing your teeth as well as you can is one avenue you can take in order to stop your gums from bleeding.  Please note, if your gums continue to bleed, schedule an appointment ASAP, because it can be a sign of many underlying conditions.

Myth 4: Dental Implants don’t look like natural teeth

When it comes to appearance and feel, the only difference between dental implants and real teeth is that an implant is not a real tooth.  They are customized in look, feel and fit exactly like all the other teeth in your collection. If done properly it should be a perfect clone of the missing tooth. It gets its natural feel from the fact that it is fused to your bone. Special care is also taken in the design of the crown to ensure that is almost not distinguishable from your other teeth.

Myth 5: Root Canals are painful

Despite rumors to the contrary, due to modern equipment and techniques, most dental work is now relatively pain-free.  Even modern root canals are mostly just boring now, and not painful.  They just take a long time.

Dental myths plague the minds of many people, and by putting some of them to rest, we hope you are able to experience better oral health and better knowledge regarding your smile.

Keep smiling,

Dr. Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut.  She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121