Q1. I have badly receding gums, although they are not inflamed or infected. I have seen many dentists, get regular cleanings, have a night guard, and use sensitive teeth toothpaste. However, I want to know if there is some way to prevent further recession, like a rinse, or some way to neutralize the acidity of the saliva. I don't want to lose my teeth.
— Esther, California
With any oral problem, dentists always need to review the diagnosis and the causative agents of the issue to determine the best treatment plan. There are a number of reasons why gum recession could present itself, including:
- Overzealous toothbrushing with hard toothbrush bristles.
- An inherited predisposition for thin gum (gingiva) tissue.
- Malpositioned teeth, which leads to the spreading or crowding of teeth.
- Clenching and grinding of teeth, which some dentists believe causes recession.
- Nervous habits like inserting foreign objects in the mouth or scratching the gums with foreign objects.
Based on your question, it sounds to me as though you are aware of your gum recession and doing the right things: getting regular cleanings, using a night guard, and using sensitive tooth toothpaste. Here are some tips to help you prevent further gum recession:
- Make sure your dentist teaches you how to properly brush and floss.
- Use only ultrasoft toothbrushes.
- Make sure your bite is comfortable and has been adjusted if necessary.
- Consider orthodontic therapy to realign your teeth into proper position, which can also increase the zone of gum tissue.
- Consider gum grafting to increase the zone of attached gingiva or gum tissue; you may even want to consider covering the roots of your teeth.
- Continue to wear a night guard each night to reduce stress on your teeth when sleeping.
- Avoid putting any foreign objects into your mouth that might cause gum recession.
Gentle toothbrushing with a soft brush and regular three-month cleanings by a dentist to monitor the amount of gum tissue you have are the only ways to really keep things under control. You can add increased amounts of gum tissue at the gum line or increase the gum line of the tooth with special types of gum grafts, which would require surgery by a periodontist.
Q2. What would cause the gum to turn white (in spots) and become rough? My sister has this presently and has an appointment in a week with a dental surgeon, but she is worried now. Can you help?
— Joyce, South Carolina
It is not normal for gum tissue to turn white with roughened spots. There are a number of possible causes of this, including:
- Chronic irritation of the tissue due to a sharp edge on a chipped or fractured tooth or a filling or crown that does not fit well
- Irritation or burning of the tissue by tooth whitening products that are acidic and thus caustic in nature
- Chewing tobacco, which can damage tissue as well as cause cancer
- Nervous habits, including biting the lips or the inner walls of the cheeks
- Abnormal benign and cancerous growths. Unfortunately, oral cancer is one of the leading types of skin cancers in the body. It can be very serious and thus must be detected as early as possible.
- Various types of systemic (bodywide) diseases that have mouth manifestations. This category includes conditions caused by medications, infections, stress, autoimmune diseases, aging, reduction in saliva, and idiopathic (unknown) causes. Some of these conditions are serious, while many of them are not.
Without more information, it's impossible for me to determine what might be affecting your sister's gums. She is taking the right action by seeing a dental surgeon or oral pathologist.
Q3. Is deep cleaning a good or bad idea for possible gum disease? Can it cause more problems than it helps?
That's a good question. In my office, I explain to patients that we try to fight periodontal disease with conservative types of cleaning and antibiotics before considering surgical therapy. These techniques can be quite successful if performed well and if the patient works hard at good oral hygiene at home.
"Deep cleaning" often means scaling and root planing to a dentist or periodontist. Scaling is the process by which plaque (bacteria and food mixture) and calculus (tartar or mineralized plaque deposits) are removed from both supragingival (above the gum) and subgingival (below the gum) tooth surfaces. In my practice , root planing involves four or more hours of treatment over several visits. Local anesthesia is provided, and plaque, calculus, and parts of the surface of the roots are removed with fine scalers and ultrasonic instruments. This "planes" the roots under the gum to provide a smooth, clean surface to which the gums can reattach. After treatment, the gingival (gum) tissue will become tight, pink, and healthy, with no bleeding or redness. Hopefully, the pockets that have formed between the teeth and the gums will shrink, reducing the need for surgical intervention.
Root planing is a good treatment for gum disease. However, the patient must be aware of certain issues:
- If you have a medical history of heart valve problems, artificial joints, or certain other medical conditions, you must be premedicated with an appropriate antibiotic to kill the bacteria that get into the bloodstream during the procedure.
- After root planing, teeth can become temporarily sensitive to cold air or cold liquids.
- After treatment, the gums will shrink as they get healthy and spaces between the teeth may develop. You may also experience gum recession on the outside surfaces of some of your teeth, but either situation is better than leaving gum disease insufficiently treated.
Q4. I have 2-3 mm of gum recession, just on the lingual surface of my maxillary molars. Sometimes the tissue there swells and is very painful and feels raw. I can't seem to associate it with anything I might be doing wrong. I don't brush too hard and I use a Sonicare electric toothbrush. The dentist I worked with said it appeared as if I never had enough of a margin of tissue in that area to begin with. Is this possible and what can be done about this before furcations develop?
— Susan, Texas
Your question is a good one and I'm impressed with your use of dental terminology. Recession of the gum on the lingual, or tongue-facing, surfaces of the upper molars can occur as teeth wear away and extrude or elevate out of their sockets. Gum recession can also occur as teeth move in toward the arch. Usually, teeth shift as a result of braces or if extra space develops because adjacent teeth are removed or fall out.
As teeth move, if any disease is present, sometimes the tissue and bone recedes. Tissue and bone recession may also be caused by braces that were worn in younger years, depending on the position and rotation of the teeth, and also the firmness of your toothbrush bristles and how hard you brush. As you mentioned, recession can also occur from chronic irritation caused by brushing too hard in the area. Swelling can even occur if food, bacteria, or seeds get trapped under the gum. Additionally, if you wear any kind of appliances such as night guards or orthodontic retainers that could rub on the gum, this can cause swelling as well. Obviously, without seeing you in person, it is difficult to determine the exact cause.
I would certainly ask your dentist to refer you to a periodontist to see if there is something that can be done. There are all sorts of gum grafting procedures that may help you to grow some tissue back (or transplant gum tissue in) to cover the roots of your teeth. Grafting on the top of your mouth (the palate) or on the lingual inside surface of the upper molars is very difficult. If you are not in pain and your dentist has measured these defects and found them to be stable, then it might be best to leave them alone. A competent periodontist would be the best person to evaluate your condition further.
Q5. Is it possible to get gum disease or a gum infection from unsanitized dental instruments? If so, do the signs appear within a short period of time, and what might they include?
— Emma, New York
It's very rare for anyone to develop gum disease from unsanitary dental equipment. First of all, it would not be easy to determine whether the equipment was the direct cause of a gum infection, and secondly, typical periodontal (gum) disease does not appear suddenly and with symptoms such as swelling that might indicate an infection caused by contaminated instruments. Gum disease develops over time due to bacteria buildup and the patient's lack of good oral hygiene or frequent cleanings.
A small percentage of people will develop gum disease no matter how well they keep up with their oral hygiene habits. However, 95 percent of people who maintain excellent oral-hygiene and see their dentist regularly for monitoring, X-rays, and cleanings can either prevent further periodontal disease or help reduce or eliminate it.
While improperly sanitized dental equipment would not cause true periodontal disease, it is possible to get an infection as a result of being treated with unsanitary dental equipment — or from something like a popcorn kernel or seed getting stuck in a tooth. A dental infection of this type would cause symptoms like gum swelling or abscesses, or the other cardinal signs of infection such as fever, redness, bleeding, pus, and a bad taste and smell in the mouth. The general recommendation for dealing with a dental infection, whatever the cause, is to clean out the area and start taking an antibiotic. Within a couple of days you should feel better and within a week the antibiotic can be stopped.
Consult your dentist right away if you notice any symptoms of a dental infection so that you can begin treatment with an antibiotic and get a thorough dental cleaning if necessary.
Q6. I am having a root canal in three weeks, and a lump appeared on the gum yesterday next to the tooth that needs the root canal. I was told that it was a gum abscess. Is it safe to wait just three weeks now? What are the potential ramifications of this abscess?
— Angela, Montana
The type of gum abscess you're dealing with is not caused by gum disease. If a root canal is needed and has been diagnosed by your dentist, then most likely the gum is swollen because the tooth has a root canal infection, which may be draining into the gum tissue around that tooth. An abscess is a large accumulation of bacteria that the body is having trouble fighting and tries to roll off into a sac. I would call your dentist and find out whether you can see either the same or a new root canal specialist as soon as possible to get started on treatment. I would not wait three weeks. If the reason for this wait time is that this is the only endodontist (a dentist who specializes in root canal therapy) in your area, then I would consider starting antibiotic therapy as soon as possible to keep the infection from getting worse. There are also general dentists who are qualified to perform root canal therapy, but this would be a decision you'd have to make with your dentist. Either way, I would definitely not wait to seek treatment for the gum abscess. Inflammation and infection can travel through the body if not treated in time. Antibiotic therapy or root canal treatment can help solve the problem and restore your oral health.
Learn more in the Everyday Health Dental Health Center.