Gums
Gums
Beneath every great grin is a good set of gums. They''''re the scarcely seen tissues that combine efforts with the underlying bone to provide pillar and posthole for a snug-fitting set of strong teeth.
When they''''re in good health, your gums are either pink or grayish brown depending on the color of your skin. Gingiva--as gums are called in medical language--both cover and protect the hidden roots of your teeth. They have important tie-down tissues called periodontal ligaments that tightly lash each tooth to the bony sockets in your jaw.
Each tooth is held in a kind of cradle. "It''''s suspended like a swing in the bone socket, and the ligaments look like little whiskers that attach the tooth root to the bone," says Ray C. Williams, D.M.D., professor and chairman of the Department of Periodontics at the University of North Carolina School of Dentistry at Chapel Hill.
Unhealthy gums look shiny, red and swollen. They bleed easily, even when you''''re brushing gently. What pushes our gums across the line from lusty pink or brown to angry red is advancing plaque. That''''s the soft, sticky web that bacteria weave over our teeth and gum line.
Some of us produce more plaque than others, and dentists have found that this tends to run in families. But if we carefully brush and floss away plaque daily, our gums should always be in the pink of health.
What you need to watch out for--especially if your family has always had gum problems--is plaque that builds up and seeps below the gum line. As plaque irritates the gums, the gums swell and lose their grip on the teeth. A moat starts to form between the gum line and the teeth, growing ever deeper as gum disease develops.
Mild gum disease--gingivitis--is "generally reversible if you brush and floss and remove the plaque," says Dr. Williams. "Your gums will revert back to healthy tissue."
No More Loose Teeth
Leave gingivitis untreated, however, and dire things start to happen. Eventually, you''''ll get hard, yellowish brown crusts of tartar--calculus--which is formed when minerals in your saliva bond with plaque. Tartar is so hard that it takes professional cleaning to remove it--you can''''t do it at home. Once you have it, tartar starts to trap even more plaque.
When plaque and tartar continue their inexorable march down to the roots of your teeth, you have the beginnings of serious gum disease, called periodontitis. Bacteria in the plaque start eating away the whiskery ligaments that connect tooth to bone. Eventually, teeth loosen. Then bacteria bully their way down to naked bone, where they undermine the last connection. Untethered to gum or bone, the tooth can fall out.
That''''s the extreme--the very worst. Still, Americans do lose more teeth to gum disease than to tooth decay. The best way to nip gum disease in the bud--besides routine flossing and brushing--is to visit your dentist regularly. That way you''''ll spot gum disease when you can easily treat it.
Either a dentist or periodontist (a gum specialist) can treat gum disease by cleaning out the plaque, tartar and bacteria from the gums. Maybe a good cleaning is all that''''s necessary--the gum will heal right up and hug a tooth.
Other times, surgery is necessary to remove the diseased tissue and fix the damage. If the tooth is loose, a periodontist can often graft gum tissue to correct areas of recession. Periodontists have new techniques to regenerate gum tissue, too.
Another innovation: The periodontist tucks a tetracycline-treated string, such as Acticipe R, between the tooth and gum to get rid of bacteria. Usually, the string is removed after ten days. There are also antibiotic gels being developed.
It''''s much easier to brush and floss, of course, than to endure a periodontist''''s attention and go through the treatments. There are times in a woman''''s life, however, when she may need even more than the usual brush-and-floss routine to guarantee gum health.
Hormonal Heck to Pay
"Women have to know there are certain times in their lives when hormones make them more susceptible to gum disease," says Barbara J. Steinberg, D.D.S., professor of dental medicine at the Medical College of Pennsylvania in Philadelphia.
Our gums contain hormone receptors. High levels of female hormones make the gum membranes permeable, thus causing an increase in fluids in the gum tissue, which makes the tissue swell and redden.
Hormone increases exaggerate the way gum tissues react to irritants in plaque, making gums more sensitive to even small amounts of plaque. Gums get puffy from plaque when hormone levels are high, especially during puberty, before menstruation and during pregnancy. Since birth control pills mimic some of the hormonal changes that happen at pregnancy, they too can cause gum changes. But then the puffiness goes down when hormone levels return to normal.
Other health factors that can raise your risks for gum disease include diabetes and epilepsy as well as smoking--which impairs the bacteria-fighting cells in your mouth.
Battling Bacteria
More than 40 different kinds of bacteria are rambling around your mouth on any given day. So keeping an eye on them--and stopping them in their tracks--takes vigilance.
Here''''s how to stay on your guard.
Get full disclosure. Colorful and revealing, disclosing tablets give you a visual report card on your brushing and flossing technique. You can get the tablets from your pharmacy or dentist.
First, floss and brush your teeth as usual. Then chew a tablet and swish the particles around your mouth, says Richard H. Price, D.M.D., clinical instructor of dentistry at Boston University Henry Goldman School of Dentistry. Rinse with water, then examine your teeth in a mirror. Wherever you see a red stain, that''''s plaque. Those are places where you need to brush more enthusiastically and floss more thoroughly next time.
| Your Personal Floss-ophy Today''''s choice of flosses runs the gamut from thick to thin, flavored to plain, waxed to unwaxed. So . . . what''''ll it be? "Picking out floss is like picking out carpenter''''s tools," says Jeffrey M. Shubach, D.M.D., a family dentist in private practice in Voorhees, New Jersey. "You have to find what works best in your hands. It''''s more important that you use it than that it be any special kind." Here''''s a quartet of floss choices--all available at most drugstores. Unwaxed or waxed. "There''''s a theory that unwaxed dental floss is better than waxed floss because the waxed leaves a small wax residue," says Dr. Shubach. "If you can use unwaxed just as easily as waxed, you might as well use it. But if your teeth rip it to shreds, go to waxed floss." Extra-fine. This is the thinnest floss, for people whose teeth shred even waxed floss. Precision. The last resort for intransigent shredders, single-strand Precision brand floss slides through tight teeth with great ease. It costs twice as much as regular floss. "It''''s a godsend, though, if your teeth shred everything else," says Richard H. Price, D.M.D., clinical instructor of dentistry at Boston University Henry Goldman School of Dentistry. Super. Super Floss comes in packets of single strands that look like regular floss, but has a stiffened end made for threading under and around braces. This kind of floss also maneuvers around fixed bridges--teeth that are connected to neighboring teeth with little or no space between. |
Flood the lowlife. "Even the most valiant patients may sometimes need extra assistance to combat bacteria and plaque," says Kenneth Burrell, D.D.S., senior director of the Council on Scientific Affairs for the American Dental Association. For reinforcement when hormone levels are high, your dentist may prescribe an antibacterial mouth rinse that contains the ingredient chlorhexidine. To get it, you''''ll need a prescription from your dentist.
Over-the-counter mouthwashes such as Listerine have been shown to fight bacteria, too, so they''''re good substitutes if you don''''t have a prescription for chlorhexidine.
Break up the bugs. With an oral irrigator such as a Water Pik, you aim a stream of water at the gum line to hose off the bacteria. "The irrigator interrupts bacteria formation. Your purpose is to disrupt its ecological niche," says Dr. Price.
Instead of using water, you can fill an irrigator with an antibacterial mouth rinse such as Listerine, or a prescription mouth rinse such as Peridex or Periogard. "They have been shown to decrease plaque buildup," he says.
But don''''t drive ''''em deeper. "Don''''t turn the Water Pik on high," warns Dr. Price. "That creates a little firehose action that could jam bacteria deeper into the gum." So make sure you set the device on medium or low.
| Deep Pockets |
| Deep pockets are fine things to have in a coat or a jacket. In your mouth, though, deep pockets between your teeth and gums are a sign of trouble. Healthy gums have a little space that dentists call a sulcus, lying between the gum line and the tooth. When plaque inflames the gum, though, the gum swells, then moves away from the tooth. The sulcus turns into a large, unhealthy space between gum, tooth and bone that dentists then call a pocket. They start tracking its depth with a slim periodontal probe, inserting the probe to measure the pocket''''s depth in millimeters. The deeper the pocket, the harder it is to get the area below the gum line properly clean, says Jeffrey M. Shubach, D.M.D., a family dentist in private practice in Voorhees, New Jersey. If plaque spreads unchecked, it turns into tartar; the gums may recede and the pockets may deepen. Then bacteria in the plaque can erode the roots and the bone that supports them. This condition, called periodontitis, requires tedious ongoing care and maintenance. |  When gums are healthy, they fit snugly around the base of the tooth, as shown in this cut-away
illustration. If plaque builds up around the edge of the tooth, it can cause painful inflammation--the beginnings of gum disease. Bacteria in the plaque can damage the bone and the fibers that anchor the tooth. A gum pocket develops between the gum and tooth. |
When to Get Finicky
When hormones are running high, brushing twice a day may not be enough; you''''ll probably need to remove plaque after every meal or snack. Here are some other steps to help your gums stay healthy.
De-gunk the spaces. Some dentists recommend using wooden dental sticks, such as Stim-U-Dent, in addition to flossing. A Stim-U-Dent, which you can find in most drugstores, is shaped like a large toothpick that''''s three-sided, so it looks triangular in cross section. The pointed end is like the narrow tip of a pyramid. Here''''s how to use it.
Moisten the pointed end in your mouth. "Then push that end in and out three times between each tooth. That will squeeze out all the gunk there," says Dr. Williams.
After that, place the base of the triangle against the gum between two teeth. "Gently rotate and vibrate the stick from side to side as you lift the gum and clean out the debris. Use a light, gentle pressure," advises Jeffrey M. Shubach, D.M.D., a family dentist in private practice in Voorhees, New Jersey.
"Stim-U-Dents are clean, lovely, cheap, simple little things," says Dr. Williams. The dental sticks are also portable and more discreet than floss--perfect for a quick tooth-cleaning session at the office after lunch.
Don''''t be blood shy. Bleeding gums may be an early sign of gum disease--a signal that you''''d better pay a visit to your dentist. In the meantime, however, don''''t let bleeding stop you from flossing and brushing, warns Dr. Steinberg. Early care can stop and even reverse any damage.
Look up. Most of us bend our heads and stare down into the sink when we brush our teeth. Instead, look in the mirror over the sink to watch yourself brush.
"The mirror is a great tool to use for tooth brushing," says David F. Halpern, D.M.D., a dentist in Columbia, Maryland, and a spokes-dentist for the Academy of General Dentistry and the state of Maryland. "You can watch the bristles penetrate into the gum area. If your gums bleed, you can see where the trouble spots are."
Enlist Listerine. In addition to using toothpaste, you can lend your mouth a helping hand if you brush with Listerine--or any other mouthwash that says "antibacterial" on the label and has the approval of the American Dental Association. Brush between your teeth and gums with it, suggests Dr. Halpern.
"Fill the cap from a large bottle with the mouthwash, then dip your toothbrush in it," he suggests. "Hold your toothbrush at a 45-degree angle where the gum meets the tooth. Then press the bristles gently against your teeth so they spread into the gum crevice. Use a small circular motion to dislodge food and bacteria from beneath the gum."
To make sure that you get below the gum line, you can look in the mirror. "The mouthwash will start to kill off the bacteria. It''''s like an antiseptic," he says. When you''''re done, use whatever is left in the cap to rinse out your mouth.
Paste the tartar. Tartar-control toothpaste is another weapon to add to your hygiene arsenal. "It contains sodium pyrophosphates, which interfere with tartar formation," says Dr. Price.
The anti-tartar formulation can irritate the gums, though. "If your gums feel raw or if you have any burning sensations, you may be allergic to the toothpaste," he warns, noting that more women than men seem to have these allergies. If your gums clear up when you switch to a nontartar toothpaste, then you''''ll know that it''''s not your gums, it''''s your toothpaste.
Mention the Pill. If you end up needing dental treatment for your gums, and you''''re also taking birth control pills, "let your dentist know," says Dr. Price. "Antibiotics that are prescribed for dental work can weaken the effects of the Pill. You may need another form of birth control until you''''re finished with the antibiotics."
A Pregnant Pause
It''''s downright odd how folktales tangle up teeth and pregnancy. One myth says that a fetus leaches calcium from the mother''''s teeth for its growth. Not true: It''''s your diet that provides calcium for the growing baby.
Another tale says that you lose a tooth for every child. But if you''''re fastidious about your gums, your teeth are secure.
It''''s not a folktale, however, that women may tend to neglect their gums during pregnancy. That''''s because it can hurt to brush them, according to Dr. Steinberg. "Then the gums get even more sensitive."
Sixty to 75 percent of all pregnant women develop gum disease that ranges from mild to severe, says Dr. Steinberg. It even has a name: pregnancy gingivitis. "It''''s marked by increased redness and swelling and bleeding in response to very small amounts of plaque," she says.
Because of these gum changes, dentists target pregnant women for particular attention, says Dr. Price.
If you''''re pregnant, here are some special tips for gum care.
Go to a pro every 90 days. The key to healthy gums during pregnancy is the removal of all plaque. That''''s why many dentists recommend a professional cleaning every trimester in addition to persnickety home care.
"Serious gum disease doesn''''t go away like morning sickness does. If you don''''t take care of your teeth, your gums won''''t be as good as new after the baby, when hormones rebound," says Dr. Price.
Use the safe zone. There are two stages of pregnancy when dentists may want to avoid any dental treatment besides cleaning: during the first and third trimesters. The first trimester is a delicate time because the fetus is forming; during the third trimester pregnant women are often uncomfortable.
"Schedule elective dental treatment during the second trimester, when the fetus is less vulnerable," says Dr. Steinberg. "And be aware that if you do need x-rays for the dentist to diagnose and treat your problems, there''''s no danger from the low doses of radiation, especially when you''''re wearing a lead apron, which will insulate the baby."
See also Mouth, Teeth
