Gum Problems

WHEN TO SEE YOUR DOCTOR

* Your gums bleed and there is also swelling, puffiness, soreness or persistent bad breath.

* Sores develop under your dentures.

What Your Symptom Is Telling You

We're not talking about a stick of spearmint that loses its taste too fast. We're talking about problems with the foundation of your smile, the coral-colored tissue that anchors your teeth. We're talking, of course, about your gums. Love them—or leave your teeth behind.

The most common gum problem is bleeding, and it's a sign of inflamed gums, or what dentists call gingivitis. But gingivitis is just the overture for another and more serious "-itis": periodontitis. Once your gum problem has advanced this far, you can lose your teeth.

Gingivitis is caused by the buildup around the teeth and gums of plaque, a gunky, bacteria-filled concoction of food and saliva. As anybody who has ever been face-to-mask with a dental hygienist knows, not brushing and flossing regularly is the main reason for your choppers becoming a plaque warehouse. But other factors play a role in gum problems.

For one thing, this symptom is sexist. Women are much more susceptible to gingivitis than men, according to JoAnne Allen, D.D.S., a dentist in private practice in Albuquerque. During menstrual periods, women's gums generally are more swollen, tender and puffy, Dr. Allen says. Their gums also bleed more easily then. "That doesn't predispose women to gum disease, but it could make it worse if other factors like poor hygiene are present."

Also, she says, almost all women who become pregnant get a temporary gingivitis with swelling and bleeding that gets worse as the baby comes to term.

In fact, that baby might inherit the tendency for its mother's—or father's—gum problems. "Gum problems can be hereditary," says Paul A. Stephens, D.D.S., a dentist in private practice in Gary, Indiana, and president of the Academy of General Dentistry. "Some people just naturally get only a little bit of plaque on their teeth. Others seem to accumulate a lot very rapidly."

Certain medications can cause gums to bleed or swell, says Eric Z. Shapira, D.D.S., a trustee on the national board of the Academy of General Dentistry and a dentist in private practice in Half Moon Bay, California. Medications that can cause problems include oral contraceptives, antidepressants, decongestants, antihistamines, nasal sprays and medications for high blood pressure and heart disease.

And gum problems are more common among people with diabetes and leukemia and those who have dry mouths, who smoke or are under a lot of stress.

Those last two categories—smokers and the stressed—are especially susceptible to trench mouth, a disease common among the soldiers of World War I that is now known as necrotizing ulcerative gingivitis. (You have to add poor hygiene to that mix to be at risk.) People with this type of gingivitis have painful ulcers on their gums, bleeding and breath that goes beyond bad to hellish.

Dentures Can Cause Gum Woes

If dentures aren't properly fitted, or if the jawbone is so deteriorated that it can't hold dentures firmly in place, a person can get ulcerations on their gums. The sores aren't necessarily painful, says Samuel B. Low, D.D.S., assistant dean and director of postgraduate periodontics at the University of Florida's College of Dentistry in Gainesville. But that doesn't mean they should be ignored.

"It's a form of pressure atrophy, just like what happens to your arm when you're wearing a cast for a long time," he says. The surface of the gums becomes loose, and the bone beneath the gums can dissolve.

Symptom Relief

Bleeding and sore gums are the same as most health problems: If you catch them before they get too bad, they're easy to reverse. "Gingivitis is absolutely reversible in the earlier stages," says Dr. Allen.To put bleeding gums in reverse, put your hands on floss and a toothbrush. But make sure to hold that toothbrush the right way.

Put a new angle on your brushing. The best way to get rid of plaque nestling at the intersection of your teeth and gums is to use a soft-bristle toothbrush held at a 45-degree angle to your teeth and moved gently in a sawing or circular motion. This motion is also effective for getting plaque off the teeth themselves.

Decide on daily. Ideally, you should brush after every meal, says Bruce Pihlstrom, D.D.S., professor and director of the Minnesota Clinical Dental Research Center at the University of Minnesota in Minneapolis. If you can't do that, make sure to brush at least once a day.

For flossing, make a C and earn an A. The key to proper flossing is to hook the thread (whether it's waxed or unwaxed doesn't make a difference, say dentists) into the shape of a C around each tooth. Make sure you go slightly below the gum line, moving the floss back and forth and up and down until the teeth on both sides of the thread feel and sound squeaky clean, says Dr. Pihlstrom.

If you draw a little blood the first few times you floss, don't be too concerned: "Flossing causes a little bit of irritation on an area inflamed with gingivitis," he says.

Don't be a stranger to your dentist. "Most people should get a cleaning every six months, while others may want to see their dentist more often," says Dr. Pihlstrom. Those who might want to think about seeing the dentist more frequently include all those who were described at the beginning of this chapter as being more prone to gum disease, such as smokers and people with diabetes, people taking medications that can cause gum problems and people with a family history of gum disease.

Pregnant women, because they're more prone to gum problems, should see their dentist for a cleaning at least three times during their pregnancy.

There'll be a reason to frown if you don't see the dentist regularly. You'll have to remove your smile every night before going to bed. "People who wait longer than six months between visits tend to lose their teeth eventually," says Dr. Allen.

When Gingivitis Becomes Severe

Brushing, flossing and a routine biyearly visit with the hygienist won't make much difference if your gingivitis is severe or has advanced to periodontal disease. At that point, your dentist or hygienist has to get out his equipment to remove the plaque, which is now a concretelike substance called tartar or calculus that has hardened deep inside the pocketlike spaces between your teeth and deteriorating gums.

Let your dentist chip away. The dentist will chip and scrape away the calculus and plaque down to the surface of the roots of your teeth, a process called scaling and planing. It may require a local anesthetic, says Dr. Pihlstrom, and you'll probably need two or three appointments before the job is completed.

See a specialist. If the deterioration is severe, the dentist may refer you to a periodontist, a specialist in mouth, gum and bone disease. "A periodontist can give you a lot of options," says Dr. Pihlstrom. Among them are bone grafts, repair and rebuilding of deep gum pockets and restoration of the gum line.

Tips for False Teeth

Even if you've lost your real teeth and now sport dentures or a partial, you still should be good to your gums. Here's how.

Keep brushing. Dentures aren't called false teeth for nothing. You have to brush them, which helps prevent gum problems. You'll also want to brush your gums. And never leave your dentures in overnight—your gums need a break.

Get a new pair. A pair of dentures doesn't last a lifetime. "It's a big mistake to think that the first set is enough," says Dr. Low. That's because once you've lost your real teeth, the jawbone can erode, robbing your dentures of their snug fit.

"They get loose and cause irritation, but people tend not to do anything about it," he says. Your dentist should check your fit once a year, and chances are you'll need a new pair about every five years.