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Orthodontics

2010-12-01 14:26:00

What is gingivitis?

Answer: Most everyone brushes their teeth daily, but more often than not there are places where their tooth brushing is just not getting the job done. I believe that tooth brushing is a life skill that needs to be taught at a young age and reviewed frequently and refined over the course of a person’s life. When children are young they do not understand what they are supposed to be accomplishing and they do not have the muscle coordination to control their tooth brush very well. Parents should brush their children’s teeth until their dentist says the child has the skills to keep their teeth clean and cavity free. As the permanent teeth come in and though out life people may have crowded or misaligned teeth or dental changes such as braces, crowns or caps and bridges. As these dental changes occur, their approach to completely cleaning off all of the plaque from their teeth will need to be altered and again our skills need to be reviewed at dental checkups every six months. The secret to dental health starts with understanding the goal of brushing and flossing: plaque removal. Plaque is a thin layer of bacteria that sticks to the teeth. When the dentist or hygienist cleans your teeth the thin film will start to reform on teeth within 10 minutes. That should speak volumes on why brushing more than once a day is very important. If plaque remains on your teeth longer than 12 hours it will become hard and more difficult to remove with your tooth brush. That is why we brush twice daily so we PREVENT the plaque from becoming more difficult to remove. When plaque remains on your teeth it becomes an irritation to the gingival tissue or gums. The gum tissue will become red and swollen and might even bleed. This is known as gingivitis. UNFORTUNATELY, gingivitis does not hurt. If it did hurt I believe people would take it more seriously and take immediate steps to fix it. The good news is that gingivitis is reversible or you can fix it by removing the problem: plaque. But if you do not feel the gingivitis, if you miss the red area when you brush and leave the irritating plaque in the same place day after day, how can you fix the problem? You need to see the dentist or hygienist and have them review with you all of the areas where there is gingivitis and have them work with you on your tooth brushing skills to make sure you can physically remove the plaque every day. This may sound silly, but after working with dental patients for 18 years I have noticed a pattern. In most cases, I can tell if the patient is right handed or left handed by where they have gingivitis. Almost everyone brushes their side teeth better than the front teeth. Brushing on the sides is an easier motion for the arm. The tongue side of the lower front teeth is doubly difficult to clean because it is hard to get the tooth brush bristles along each tooth without deliberate vertical positioning of the tooth brush, and they are bathed by saliva that helps the plaque turn to tartar and stick. But the tell-tale sign that gives away which hand is used to brush is the red gums around the dirtiest teeth in the mouth and they are on the side of the person’s dominant hand. The right handed person puts the tooth brush in the mouth on the left side, flies back and forth from side to side, front to back, top to bottom, and then back to the left, then another figure 8 sweep and again they end up on the left. The front surface of the lower left teeth are usually quite clean. As the tooth brush comes around the front of the mouth it must be flipped to clean the right side. Our lips are in the way so the brush will enter along the side teeth on the right, completely skipping the lateral incisors and canine teeth which are the second and the third tooth from the middle of the mouth. This happens on both the top and the bottom teeth. Once I point this out, everyone in the room starts to think about how they approach brushing and heads start to nod. People understand and recognize they have a similar haphazard pattern. The left handers just reverse it. Now, I can start to educate anyone who will listen. Place fluoridated tooth paste on a soft tooth brush and put it to the farthest tooth back on the upper left. Make ten small circles getting the bristles under the gum line that makes a pocket or turtle neck of tissue around each tooth to completely remove all the plaque hiding there. The tooth brush might hit the jaw bone so do not open too wide in the back. Next move forward one tooth and repeat. Yes, your tooth brush bristles will touch neighboring teeth, but that is a bonus. When you have brushed ten circles per tooth on all of your teeth on the left or when you cannot go any farther in the front because of the lips on the right, then you have a choice of what to do next. You can either flip your tooth brush and start to the left of the middle of the front teeth or you can go to the last tooth on the right side and move forward with ten circles per tooth. This is repeated on the lower teeth and on each surface of the tooth; the front side, the tongue side, and the chewing surfaces. If there are any irregularities in your mouth such as crooked teeth or braces you will need to be sure to brush each surface of those objects because they hold plaque on their edges. The plaque bacteria produce acid that breaks down the enamel. It will soften and become white. Fluoridated toothpaste and complete plaque removal can remineralize the soft enamel and make it strong and hard again. (see 2nd photo) If the plaque is left alone then it will break through the enamel into the dentin and become a cavity. Once the bacteria are in the dentin they can grow much faster and eventually end up in the blood supply of the root canal of the tooth. Our bodies cannot remove the bacteria from the root canal so it will break into the bone. An abscess will result if the cavity is closed by food or material otherwise the infection will drain into the mouth where a putrid smell can occur and the pain is not as bad as the closed abscess. So elbow grease and ingenuity is also important and can save you a lot of trouble. All of these tips will make the obligatory two minutes of brushing fly by and you actually will accomplish the purpose of brushing: plaque removal. Complete plaque removal will require excellent, thorough brushing and flossing as well. Flossing is required because the tooth brush bristles cannot get between the teeth to remove plaque. If this approach to complete plaque removal is repeated daily the gingivitis should resolve. If the gingivitis is left alone then the bacteria in the gum line around the teeth will increase the amount of inflammation of the gum tissue making a deeper pocket and there will be an environment for more harmful bacteria to grow and they will start to destroy the bone that hold the teeth in the mouth. That process is called periodontal disease and the bone loss is not reversible, but permanent. This disease will lead to tooth loss if left alone. So this evening before bed when you get ready to give a tooth brush fly-by to your teeth, slow down and count to ten over and over again brushing each surface of each tooth thoroughly. End the day with the pride of complete plaque removal from every surface on every tooth above and below your gums. As you drift off into a deep sleep, know that there will be an abundance of those sweet smelling bacteria repopulating the crevasses of your pearly whites to greet you in the morning. This morning you will be different. You will be ready to clean your teeth with purpose and you will be better for it. The red line at the top of the teeth is gingivitis. This person’s plaque does have a yellow color to it, but most plaque is white or tooth colored. He reported he brushed earlier that day. The front teeth are just flown by and missed. If this were to continue he would not have front teeth to worry about by 25! This patient is right handed. When she was a child she did not brush well and she has damage to the enamel where her gum line was as a teenager. The plaque resting at the gum line produced acid that broke down the enamel, but not enough to break through and create a cavity. She remineralized her enamel with fluoride toothpaste and proper brushing. The enamel above the white marks is normal because the plaque was removed daily. Today her teeth are healthy, but the stains will not go away.