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How are Your Gums?

Many people are not very concerned about their gums until it’s almost too late.

Gum disease (periodontal disease) is a painless and progressive ailment of the gums and bone that can cause a lot of damage. It usually remains unnoticed by the patient until the teeth become loose unless the dental staff point out the trouble. The focus of dentistry has shifted towards prevention in recent years and is moving even more that way.

The way to prevent periodontal disease is to keep the teeth clean. The causative agent for periodontal disease is ultimately dental plaque (the soft white stuff that builds up on your teeth after a few hours without brushing). The way this works is that the soft white stuff (plaque) on your teeth begins to calcify (turn hard) after it has been undisturbed on the teeth for a while. In some people this calcification starts in only a few hours, whereas in other people it may take days to start to harden. Once the plaque turns hard, it cannot be removed with regular home tools like a toothbrush and floss. Once it is hard, it is called calculus (tartar), and it has to be removed by the dentist or dental hygienist at the dental office. Calculus is the reason patients need to come to the dentist or dental hygienist periodically to get their teeth cleaned.

Calculus on the teeth causes new plaque to form very quickly on its surface because plaque attaches easily to a rough surface and the calculus is rough. You may have held out for a couple of years without a dental cleaning before and you might remember that when you did, the inside of your lower front teeth felt like sandpaper. That rough surface is like a magnet for new plaque. The new plaque puts out acid, which irritates the gums in the area where the calculus is located. Calculus really is pretty harmless to the teeth, but the new plaque on its surface is very damaging to the gums. Once the acid from plaque has been in the area for a few hours, the gums become inflamed because they are irritated and the body is sending in cells that are part of the immune system that are designed to get rid of foreign bodies like a splinter of wood in your finger. You might have noticed that when you get a wood splinter in your finger, if you can’t get it out after a while the body makes it disappear somehow. This is done with certain cells in the immune system that are sent in when a foreign body is identified. The immune system cells tear down the foreign body until it is gone. That same thing is happening when the acid from plaque on the surface of calculus is detected by the immune system. But the immune system cannot remove the calculus because it is not within the reach of the blood supply since it is on the surface of the teeth. Since the calculus is not removed by the immune system, the acid produced by the plaque on the surface of the calculus keeps causing inflammation. Long term, the same cells that destroy a splinter of wood in your finger begin to destroy the bone under the inflamed gums. This is a slow process, but it is progressive (keeps going) until the calculus is removed. With current technology, sometimes the bone can be grown in the area again, but usually it cannot.

Once enough bone has been removed by the action of calculus, plaque, and the immune system, it becomes impossible to clean the plaque off the teeth at home even if there is no calculus in the area. This is because when the immune system destroys bone around the teeth, typically gums stay at the same level as they were before even as the bone underneath them is destroyed. A toothbrush and floss can usually only extend under the gums a maximum of 3 millimeters. More depth than that requires special home tools or thinning of the gums by a dentist so that the patient can clean the plaque off at home every day a couple of times to avoid further damage.

The profession has set standards that are upheld by our regulatory bodies to maximize the preventive potential of the science that is known about dental diseases and periodontal disease is no exception. The standard of care in this part of the field of dentistry is that the depth of the gums is measured and the results discussed with the patient at least once every year on every person. This involves the dentist or dental hygienist measuring the depth of the gums in six locations on each and every tooth at least once per year. Insurance companies have been slow to respond to the standard of care in this field. However, the dentist and the dental hygienist are responsible to make sure this and all other standards of care in the field are upheld. Doing less is by definition below the standard of care. No astute patient wants treatment below the standard of care, but because of costs some push for the dental staff to ignore the standard of care. Yearly assessment of the depth of the gums around the teeth is an absolute necessity if you are to expect your teeth will last as long as you do. Make sure you ask your dentist if you have questions about the health of your gums and what you might do to make sure your teeth remain strong and your gums remain healthy. 

- This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)

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