Most People Deny any Possibility of Gum Disease

Gum disease is best dealt with by a periodontist.When I see a patient for the first time they try to talk me out of finding gum disease in their mouth.  “But Dr, I brush my teeth every day!”  Or, “I have been going to my dentist for years and he never mentioned gum disease.”

I have been a practicing Periodontist for over 30 years, and my opinion is that most dentists and dental hygienists don’t understand periodontal (gum) disease like a specialist like me.  Around 1983 some dental research came out showing that root planing (deep cleaning with anesthesia) was just as effective as Periodontal Surgery.  The research was flawed as it only concerned the front teeth with single roots, but the damage was done.  Ever since, the general dentists have been avoiding sending their patients to a Periodontist.  Instead, they have kept the money in the office by sending them to their in-office Dental Hygienist.  Since dental disease is often very slow and symptom-less until it is time for an extraction,  everyone is happy.  Then you have pain or swelling,  and your friendly dentist notifies you that you need an expensive implant or two.

What I suggested in my last article was getting an exam and basic treatment to get a level of dental health. That is dental prepping.  What I will tell you is what I teach my patients.  Most dental offices skip past teaching oral health quickly because dental insurance doesn’t pay for it.  But, good oral cleaning at least once a day is the most cost effective thing you can do.  Dental disease is usually decay early, gum disease later in life.  Both are caused by dental plaque.  Treatment only repairs the damage, the disease continues.  If you use a water pick device you will notice food particles coming out.  That is not enough, ten per cent of the invisible plaque remains, and the disease continues.

I teach with the patient holding a mirror and watching how to use the following:  any soft toothbrush, any type of floss, a rubber tip stimulator, and a proxybrush in between the teeth and under bridges if there is room.  Lecturing doesn’t work, and that is all you get at most dental offices.  Many patients brush back and forth, and that misses the target and causes grooves in the teeth with time..result, root sensitivity to hot or cold.  I suggest the modified Bass method, which is holding the toothbrush and rubber tip at a 45 degree angle to the tooth and vibrating into the crevice along the gum line, with any kind of fluoride toothpaste.   If your gums are sick, this will bleed and hurt, but improve after several weeks.  The problem with all of these cleaning efforts is that you can only get about three millimeters below the gums, and if you have deeper measurements you are not able to stop the plaque from causing slow bone loss (periodontal disease).  Mouthwash really doesn’t get down there either, a waste of money.

I have retired, but I suggest that you might consider seeing a Periodontist first.  You will get the best diagnosis of your possible gum disease, and may ask for a referral to a top notch dentist.  Periodontists get referrals from many general dentists and see a wide variety of competence.  It was not unusual for me to have seen a patient who has been seeing a dentist regularly, and then the patient is ready for dentures!!.   How shocked and angry the patient becomes.  They have noticed how their teeth have started to drift and get spaces, but nothing was said..or they were sent to the hygienist for a series of deep cleanings,  over and over.  By the way, those cleanings you get every six months are probably regular cleanings that your insurance pays 100%.  They don’t help much.

The inflammation of gum disease can help cause other health problems.  See www.perio.org , the periodontist’s official web site for the best information.  Next time I will talk about alternatives to implants.  Save your money for prepping supplies.  Dr. GrumpyMarine

photo by: Conor Lawless