Periodontal (gum) disease is a devastating infection that eventually causes tooth loss if not treated. Plaque removal, antibiotics and possible surgical intervention have proven quite effective in stopping the infection and restoring diseased tissues; however, the more advanced the disease, the more difficult it can be to treat. It’s important then to know the warning signs of gum disease.
Bleeding gums are the most common early sign of gum disease. The infection triggers tissue inflammation, the body’s defensive response to isolate and fight bacteria. As the inflammation becomes chronic, however, it can weaken the gum tissues, which will then bleed easily.
Bleeding, though, is often overlooked as normal, perhaps from brushing too hard. In actuality, bleeding gums is not normal: if your gums routinely bleed during normal brushing and flossing, you should contact us for an examination as soon as possible. Similarly, if your gums are red, swollen or tender to the touch, this is also a sign of inflammation and an indication of infection.
Gum disease is often called a “silent” disease, meaning it can develop without any indication of pain or discomfort. Sometimes, though, bacteria can concentrate in a particular portion of the gum tissue to form a periodontal abscess. In this case, the abscessed tissue can become very painful, swollen and red, and may even discharge pus.
There are also advanced signs of gum disease. If your teeth are painfully sensitive when you brush, consume something hot or cold, or when you bite down, this may mean the gums have pulled back (receded) from the teeth and the highly sensitive dentin and roots are now exposed. Teeth that appear to have moved or that feel loose may mean the gum tissues have significantly detached from the teeth as increasing amount of bone loss occurs. If you see any of these signs you should contact us without delay.
Regardless of the level of disease advancement when diagnosed, prompt treatment should begin as soon as possible. This is the only way to bring the infection under control and give the gum tissues a chance to heal and rejuvenate. From then on, it’s a matter of renewed dental hygiene, frequent cleanings and checkups and an ever vigilant eye for signs of returning infection.
If you would like more information on the diagnosis and treatment of gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Warning Signs of Periodontal (Gum) Disease.”
We’ve come a long way since the early 1980s when we first identified the HIV virus. Although approximately 35 million people worldwide (including a million Americans) now have the virus, many are living relatively long and normal lives thanks to advanced antiretroviral drugs.
Still, HIV patients must remain vigilant about their health, especially their oral health. In fact, problems with the teeth, gums and other oral structures could be a sign the virus has or is moving into the full disease stage, acquired immunodeficiency syndrome (AIDS). That’s why you or a loved one with the virus should maintain regular dental checkups or see your dentist when you notice any oral abnormalities.
One of the most common conditions among HIV-positive patients is a fungal infection called candidiasis (or “thrush”). It may appear first as deep cracks at the corners of the mouth and then appear on the tongue and roof of the mouth as red lesions. The infection may also cause creamy, white patches that leave a reddened or bleeding surface when wiped.
HIV-positive patients may also suffer from reduced salivary flow. Because saliva helps neutralize excess mouth acid after we eat as well as limit bacterial growth, its absence significantly increases the risk of dental disease. One of the most prominent for HIV-positive patients is periodontal (gum) disease, a bacterial infection normally caused by dental plaque.
While gum disease is prevalent among people in general, one particular form is of grave concern to HIV-positive patients. Necrotizing ulcerative periodontitis (NUP) is characterized by spontaneous gum bleeding, ulcerations and a foul odor. The disease itself can cause loosening and eventually loss of teeth, but it’s also notable as a sign of a patient’s deteriorating immune system. The patient should not only undergo dental treatment (including antibiotics), but also see their primary care physician for updates in treating and managing their overall symptoms.
Above all, HIV-positive patients must be extra diligent about oral hygiene, including daily brushing and flossing. Your dentist may also recommend other measures like saliva stimulators or chlorhexidine mouthrinses to reduce the growth of disease-causing bacteria. Together, you should be able to reduce the effects of HIV-induced teeth and gum problems for a healthier mouth and better quality of life.
If you would like more information on oral care for HIV-AIDS patients, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “HIV-AIDS & Oral Health.”
There's more to your dental visit than preventing or treating teeth or gum problems. We're also on the lookout for a number of potential soft tissue problems that could occur in or around your mouth.
Here are 4 examples of such problems we can detect and help you manage.
Lumps. Whenever you accidentally bite the inside of your mouth, the wound you create forms a protective layer of hard collagen. Unfortunately, the “callous” can rise higher than the surrounding cheek surface and easily get in the way of your teeth again. With successive bites and more scar tissue you'll soon notice a prominent lump. Although not a health danger, it becomes annoying with each successive bite. We can surgically remove the lump and flatten out the mouth surface.
Canker sores. Known as aphthous ulcers, these round sores with a yellow-gray center and a red “halo” can break out on the inside cheeks, tongue or back of the throat. Unless they don't heal within a couple of weeks or seem to be increasing in frequency, they're nothing to worry about. They can, however, cause a burning or stinging sensation. We can reduce this discomfort and speed healing with over-the-counter ointments or prescription options like topical or injected steroids.
Cracked mouth corners. Also known as perleche (from the French lecher, meaning “to lick”), your mouth corners can become dry and irritated and you may begin licking them to soothe the discomfort. Accumulated saliva can trigger a yeast infection, which can spread to other parts of your mouth. We can usually prevent this by prescribing antifungal ointments, and a steroid ointment to control inflammation.
Mouth rash. Peri-oral dermatitis is a red, scaly rash that appears around the outside of the mouth. Because it's often mistaken for acne or other conditions, it's often treated with topical steroids. This actually suppresses the skin's normal healing effects and can actually make the rash worse. The best way to treat it is to stop using any kind of ointment or cream and use only mild soap to wash the area. We can also prescribe antibiotics to help speed the healing process.
If you would like more information on these and other soft tissue problems, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Common Lumps and Bumps in the Mouth,” “Mouth Sores,” and “Cracked Corners of the Mouth.”
Think no one is looking at your smile when you’re out in public? Nick Jonas’ recent experience might convince you otherwise. While the Jonas Brothers were performing during the 2020 Grammys, fans watching on television picked up on some dark matter between his teeth.
To say Twitter lit up is an understatement. For many, it was that thing you couldn’t unsee: Forget the performance, what was that between his teeth? Jonas later fessed up by tweeting, “…At least you all know I eat my greens.”
We’re sure Nick and his brothers take care of their teeth, as most any high-profile entertainer would. You can probably attribute his dental faux pas to trying to squeeze in some nourishment during a rushed performance schedule.
Still, the Grammy incident (Spinachgate?) shows that people do notice when your teeth aren’t as clean as they should be. To avoid that embarrassment, here are some handy tips for keeping your teeth looking their best while you’re on the go.
Start with a clean mouth. You’re more apt to collect food debris during the day if you have built-up plaque on your teeth. This sticky bacterial biofilm attracts new food particles like a magnet. Remove plaque by thoroughly brushing and flossing before you head out the door.
Rinse after eating. Although your saliva helps clear leftover food from your mouth, it may not adequately flush away all the debris. You can assist this process by swishing and rinsing with clean water after a meal.
Keep a little floss handy. Even after rinsing, stubborn bits of food can remain lodged between teeth. So just in case, keep a small bit of emergency floss (or a floss pick) in your purse or wallet to remove any debris you see or feel between your teeth.
Watch what you eat. Some foods—like popcorn, sticky snacks or fibrous vegetables—are notorious for sticking in teeth. Try to avoid eating these foods right before a public appearance where your smile may be critical.
And here’s an added bonus: Not only will these tips help keep your smile attractive on the go, they’ll also help keep it healthy. Rinsing with water, for example, helps lower your mouth’s acid level after eating, a prime factor in tooth decay. And flossing, both as a regular practice and for occasional stuck food, decreases plaque and subsequently your risk of tooth decay and gum disease.
Remember, a healthy mouth is the starting place for a beautiful smile. Keep it that way with dedicated hygiene habits at home or on the go.
With their durability, versatility and life-likeness, there’s no doubt dental implants have revolutionized teeth replacement. If you’re considering dental implants, however, there are some issues that could impact how and when you receive implants, or if you should consider another type of restoration.
Cost. Dental implants are initially more expensive than other tooth restorations, especially for multiple tooth replacement. However, be sure you consider the projected cost over the long-term, not just installation costs. Because of their durability, implants can last decades with little maintenance cost. In the long run, you may actually pay more for dental care with other types of restorations.
Bone health. Dental implants depend on a certain amount of bone to properly situate them for the best crown placement. If you’ve experienced extensive bone loss, however, there may not be enough to support the implant. This can often be overcome with grafting — immediately after extraction, at the time of implantation or a few months before implantation — to encourage bone growth. In some cases, though, bone loss may be so extensive you may need to consider an alternative restoration.
Gum Health. While implants themselves are impervious to infection, they’re supported by gum and bone tissues that can be affected. Infected tissues around an implant could eventually detach and lead to implant failure. If you have periodontal (gum) disease, we must first bring it under control and render your gums infection-free before installing implants. It’s also important to maintain effective oral hygiene and regular dental cleanings and checkups for optimum implant health.
Complications from osteoporosis. People with osteoporosis — in which the bones lose bone density and are more prone to fracture — are often treated with drugs known as bisphosphonates. In less than 1% of cases of long-term use, a patient may develop osteonecrosis in which the bone in the jaw may lose its vitality and die. As with bone loss, this condition could make implant placement difficult or impractical. Most dentists recommend stopping treatment of bisphosphonates for about three months before implant surgery.
If you have any of these issues or other complications with your oral health, be sure to discuss those with us before considering dental implants. With proper planning and care, most of these difficulties can be overcome for a successful outcome.
If you would like more information on pre-existing conditions that may affect implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Osteoporosis & Dental Implants” and “Infections around Implants.”
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