Gingivitis – Treatment Options Available for Treating the Disease

You’re brushing your teeth, and when you rinse and spit, you see a little blood. No big deal, you think to yourself. It happens all the time. Well, it’s time to think again-and get to a dentist­because that bit of blood may be a much bigger deal than you think. It may be a sign of gingivitis, the first stage of gum disease. According to the American Dental Association (ADA), gum disease-not dental caries, or “cavities” -is the leading cause of tooth loss among adults.

Gingivitis is inflammation, swelling, and bleeding of the gum tissue caused by the bacteria that naturally coat everyone’s teeth. The bacteria form a sticky, whitish film on the teeth called plaque. If plaque isn’t thoroughly removed every day, the bacteria produce toxins that irritate the gums and make them red, swollen, and likely to bleed easily. Eventually, the toxins destroy gum tissue, causing it to separate from the tooth and form pockets. The pockets hold more bacteria and detach even further. This is periodontitis, an irreversible stage of gum disease that can destroy the bone and soft tissue that support the teeth.

If you have gingivitis, you’re not alone. According to the ADA and the American Academy of Periodontology, three out of four adults have gingivitis. Most gingivitis results from poor oral hygiene-not brushing and flossing correctly or often enough and not having teeth professionally cleaned on a regular basis. Ronald Wismer, D.M.D., a dentist in private practice in Beaverton, Oregon, who routinely sees gingivitis among his patients, says other factors may increase the risk of developing gingivitis. “Stress is a big factor in gingivitis,” he says. “Hormonal imbalances like pregnancy, menstruation, and the changing hormones of adolescence can increase gingivitis. Some diseases like diabetes and drugs like Dilantin [phenytoin] can cause a gingivitis flare-up. Even habitually breathing through the mouth, which tends to dry out the gums and cause an overgrowth of gum tissue, can increase your risk of developing gingivitis.”

For most of us, it’s lack of good oral hygiene that’s the problem. Good oral hygiene is also a major part of the solution. “The clinical definition of gingivitis is that it involves only the gums, explains Sandra Hazard, D.M.D., managing dentist for Willamette Dental Group, Inc., in Oregon, “so it’s entirely reversible. If you can get things cleaned up, the damage can be taken care of.”

If you suspect that you have gingivitis, you need to see a dentist, because only a dentist can diagnose gum disease. If you have been diagnosed with gingivitis, the following tips, used in addition to your dentist’s advice and treatments, can help you improve your oral-hygiene habits and keep gum disease from stealing your smile.

Use the “three-three” rule. Whenever possible, brush your teeth three times a day for at least three minutes each time. The ADA says that most people spend less than one minute per day on dental hygiene. Ken Waddell, D.M.D., a dentist in private practice in Tigard, Oregon, understands why people don’t brush and floss more. “Undoubtedly, brushing and flossing are the two most boring activities on earth, so we don’t devote enough time to them,” he says. “But to do it right, you’ve got to brush for at least three minutes each time.” (For more information on proper brushing technique, see TARTAR AND PLAQUE.)

Try brushing dry. Waddell says you can take some of the boredom out of dental hygiene by “dry” brushing-or brushing without toothpaste-while doing other activities such as watching television.

Be consistent. “Find a routine and stick with it,” suggests Waddell. “Start at one spot in the mouth each time and work around the mouth the same way each time. It’ll help you be consistent and prevent missing tooth surfaces.”

Lighten up. One of the biggest mistakes people make when they brush is pushing too hard with the toothbrush, says Waddell. Try the following experiment. Apply the bristles of your toothbrush to the back of your hand. Push as hard as you normally would for toothbrushing, and try to move the brush around. Then apply only a tiny amount of pressure and move the brush. You’ll find that the hard pressure doesn’t allow the tips of the bristles-the part of the brush that cleans the teeth- to move.

In addition, Waddell says to avoid a “traveling” stroke. Instead of moving the brush up and down and traveling rapidly over several teeth, brush a couple of teeth at a time, holding the brush in one place.

Use a softie. Often, people choose toothbrushes that have bristles that are too stiff. “Stiff bristles can actually injure the gums and create gingivitis,” says Jack W Clinton, D.M.D., associate dean of Patient Services at Oregon Health Sciences University School of Dentistry in Portland. “The softer the bristles, the less you have to worry about technique. ”

Brush your tongue and palate. In addition to brushing your teeth, Waddell advises brushing your tongue and the roof of your mouth to cut down on the amount of bacteria present and to increase circulation in the tissue.

Electrify ‘em. Okay, so you hate to brush. It’s awkward and boring, or maybe it’s too difficult because you don’t have as much dexterity as you used to. Try one of the new “rotary” electric toothbrushes. “I advise anyone I see who has a gum disorder to use an electric toothbrush,” says Waddell. But, he warns, not all electric toothbrushes are created equal. Ask your dentist for a recommendation.

Floss, and floss again. “No matter how good a tooth brusher you are, you aren’t going to get your toothbrush bristles in between your teeth,” says Hazard. “That’s why flossing becomes important.” You might want to try a waxed floss (it may be easier to move between the teeth without getting hung up). Whenever possible, floss at least twice a day, advises Wismer. (For more information on proper flossing technique, see TARTAR AND PLAQUE.)

Irrigate it. While water irrigation devices like the Waterpik don’t take the place of flossing, they do clean debris out from pocket areas and from between the teeth and they massage the gums, says Hazard.

Use tartar-control toothpaste. Tartar is a hardened material that often contains bacterial debris and sometimes even plaque. “Tartar-control toothpastes help control some of the mineralization of plaque,” says Hazard. “Look for products that have the American Dental Association Seal of Acceptance or Recognition, which means they’ve been put through a testing process and their claims have been proven.”

Brush with baking soda. Once or twice a week, brush your teeth with baking soda. “Baking soda is a good abrasive, but not too abrasive so that it damages the enamel,” says Hazard. “It cleans the teeth well and makes the gums feel terrific.” Make a paste with a little baking soda and water, and brush thoroughly, especially around the gum line. Not only will the baking soda scrub off the plaque, it also neutralizes acidic bacterial wastes, deodorizes, and polishes your teeth.

Rinse it. Despite what many of the television advertisements seem to say, only one over-the­counter dental rinse, Listerine, has the acceptance of the ADA’s Council on Dental Therapeutics for reducing plaque. Ask your dentist if he or she thinks adding Listerine to your dental arsenal would be helpful for you. Hazard warns, however, that no mouth rinse will take the place of thorough brushing and flossing.

Bring on the salt water. Clinton recommends rinsing the mouth with a warm saltwater solution (half a teaspoon of salt to four ounces of warm water). Swish it around in your mouth for 30 seconds and spit (don’t swallow). “The salt water is very soothing to the inflamed tissue and gets rid of some of the bacteria,” says Clinton.

Swish. If you can’t brush right after eating, at least rinse your mouth out thoroughly with water, advises Clinton. “Even plain water can flush out debris and help prevent the inflammation of gingivitis,” he says.

Eat a balanced diet for overall good health. According to some researchers, a poor diet may cause gum diease to progress more rapidly or may increase the severity of the condition. So be sure to choose a wide variety of foods from the basic food groups-fruits and vegetables, breads and cereals, meat and dairy products-to make sure you are giving your body all of the nutrients it needs for good health.

Schedule regular dental appointments. Having your teeth professionally cleaned and checked on a regular basis is essential for preventing and treating gum disease. It is especially important since you can have gum disease-or a recurrence of it-without noticing any symptoms. Talk to your dentist about how often you should schedule appointments. Then be sure to keep those appointments.

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Grinding Teeth

Everybody handles excess stress differently. Same people develop an ulcer, some people develop high blood pressure, and some people grind Or clench their teeth.

Stress, it’s now believed, is the major cause of grinding and clenching, say dental researchers. In the past, a malocclusion (the way your teeth fit together) got the blame, and dentists would grind e teeth dawn, trying to readjust the bite.

In a small percentage of cases, sleep patterns are responsible, says Daniel M. Laskin, D.D.S., M.S., professor and chairman of the Department of Oral and Maxillofacial Surgery and director of the TMJ and Facial Pain Research Center at the Medical college of Virginia in Richmond. The reasons children grind remain unclear.

The problem with bruxism, as the habit of inding and clenching is called, is the wear and tear on your teeth. “It can wear away tooth enamel, causing decay and sensitive teeth,” says Laskin. Expensive dental work can get destroyed in the process, too. “And, you can get aching jaw muscles, which may be confused with pain in the joint and the symptoms of temporomandibular [ jaw] joint disorder [TMJ],” Laskin adds. (See TMJ.)

Prolonged grinding may damage the jaw joint enough ta cause osteoarthritis, says John D. Rugh, Ph.D., professor in the Department of Ortho­dontics and director of research for the Dental school at the University of Texas Health Science center at San Antonio. And it can increase bone loss in periadontal (gum) disease, although it does at actually cause gum disease.

Yau may inherit the tendency to grind, says Rugh. Three times as many women as men brux, says Thomas F. Truhe, D.D.S., codirector of the Princeton Dental Resource Center in New Jersey. Bruxism is most common in those between 20 and 40 years of age.

Ironically, the regular grinder may do less harm than the intermittent grinder-sort of like the weekend athlete who’s not in shape for intense activity. The regular grinder can wear down teeth, but his or her muscles get stronger from the habit, says Laskin.

Clenching may do more harm than grinding, adds Laskin. “Your jaws are constructed for bruxing, or chewing, but clenching loads the joint isometrically and can end up causing degenerative changes in the joint.”

People who grind are usually aware of their habit, too, says Laskin. They wake up with a stiff or tired jaw, or their spouse hears the noise during the night. Clenchers, on the other hand, may be ignorant of their problem. “If you notice the pain gets worse as the day goes on, then you’re doing something in the daytime,” says Laskin.

Here’s what you can do to try to stop bruxing and to cope with discomfort until you do:

Wear a night guard. Your dentist can make a plastic or acrylic appliance for you to wear at night. It will redistribute the forces from grinding and protect your teeth from damage. “It’s a little like banging your head against the wall and putting a pillow between your head and the wall so it doesn’t hurt anymore,” says Rugh. Opinions are divided as to whether it will actually keep you from grinding. Your dentist will want to see you regularly to check for any tooth movement or cavities that might result from wearing such an appliance. Keep in mind, however, that in order for the night guard to do any good, you must remember to put it in.

Keep your lips sealed, but your teeth apart. Your teeth should be touching only when you’re chewing or swallowing. Drop your jaw and feel the muscles relax-then try to maintain that feeling.

Take a warm bath before bedtime. You may temporarily relax your jaw muscles, although they may not stay that way, says Laskin.

Exercise. Your body, not your jaw, that is. A walk or other mild exercise may help relieve some of the tension and stress that’s causing bruxism, says Rugh.

Remind yourself. If you’re a daytime clencher, you can put a red dot on your phone, stickers on your wrist­watch, or even a string on your finger to remind you to keep your jaw relaxed, says Rugh.

Relieve stress. “Change jobs, get a divorce, get married, move the kids out, but if you can relieve stress, you can relieve the bruxism,” says Rugh.

“Don’t forget that good things as well as bad things can cause stress,” says Laskin. “I’ve had patients say they don’t have any stress, then they go on to say they’ve got a wonderful husband, two kids, a great job, they’re active in the PTA, they do this and that, and it’s all good, but it’s overload.” (See “Stress Thermometer.”)

Learn coping skills. See a psychologist or psychiatrist. Take an assertiveness training course. Practice techniques such as progressive relaxation or guided imagery or self-hypnosis. Listen to relaxation tapes. In other words, find something that helps you to better handle the stress in your life.

Take a mild analgesic. Ibuprofen, for example, can dull the pain and help relax stiff muscles.

Apply heat. Warm, moist heat is best. The simplest method: Soak a washcloth in hot water, wring it out, and hold it up to your jaw. You can use a heating pad, although moist heat will penetrate better. A hot shower’s nice, too. “Think of these muscles like the baseball pitcher treats the sore muscles in his pitching arm,” suggests Truhe.

Massage. It works for the rest of your body, so try a gentle massage to your jaw muscles.

Give your jaw muscles a break. Avoid the steak, the hard-crusted bread, and the popcorn for a while. “Your muscles aren’t able to tolerate that much activity,” says Laskin. Chewing gum’s a no-no, too, if your jaw muscles ache.

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Denture Discomfort Remedies for the Treatment of Denture Discomfort

Dentures have come a long way since the wooden teeth worn by George Washington. But, as anyone who has worn them can attest, dentures can cause discomfort. There are two times when dentures often cause discomfort-during the initial “adjustment” phase, when dentures are new, and after several years of wearing, when dentures may stop fitting properly.

Most people become accustomed to their new dentures within a short time. However, at first, you may have difficulty talking and eating. You may find the dentures tend to “slip,” or you may develop sore spots in your mouth.

Even people who have had dentures for years sometimes develop problems with them, usually problems related to fit. “When the teeth are extracted, the dentures sit on the bony ridge that’s left,” says Sandra Hazard, D.M.D., a managing dentist with Willamette ­Dental Group, Inc., in Oregon. “Without the teeth, the stimulation to the bone is gone and, over many years, the bone is reabsorbed by the body. The plastic denture, of course, stays the same but starts to fit badly.”

Poor fit is probably the most common cause of denture discomfort. As the bony ridge shrinks, the dentures can slip, move around, and cause sore areas. Often, people try to refit their dentures by using commercial denture adhesives. But using too much adhesive can change the relationship of the denture to the tissue and result in more soreness. Sometimes the body itself tries to solve the ill­fitting denture problem by causing tissue to overgrow in the mouth.

While dentures will never be as comfortable as your natural teeth, there are plenty of things you can do to prevent and resolve denture discomfort:

Keep those chompers clean. When you first have! your teeth extracted and your new dentures fit, it’ important to keep your dentures clean, because excess bacteria can retard the gums’ healing process, says Hazard.

Once you’re accustomed to your dentures, it’s important to clean them at least twice a day. “Yo can brush them with toothpaste or use a special denture cleaner,” says Hazard.

Jack W Clinton, D.M.D., associate dean of Patient Services at Oregon Health Sciences University School of Dentistry in Portland, plain old soap and water to keep dentures sparkling. “Using a hand brush and soap and I water works great,” he says.

Brush the gums. Don’t forget to brush your gums, too. “You can help maintain the health of the ; tissues that lie underneath the dentures by brushing the gums twice a day with a soft brush”, says Ken Waddell, D.M.D., a dentist in private I practice in Tigard, Oregon.

Brushing the gums, palate, and tongue not only stimulates the tissues and increases circulation, it . also helps reduce bacteria and removes plaque.

Baby your mouth. At least at first, your gums will: need time to adjust to the compression created by. the dentures. Hazard advises patients to eat soft foods during the denture adjustment period to avoid damaging the tender tissues.

Once the gums have healed and your dentist ha: refit your dentures properly, you’ll be able to chell more normally. But Waddell says some foods, sud as apples and corn on the cob, are probably best avoided by people who wear dentures. “Adver­tisements show people with dentures eating all kinds of hard foods,” he says. “But hard foods cause the denture to traumatize the gums and bon of the upper jaw. Cut up your apples and take the corn off the cob.”

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Bad Breath (Halitosis) - Curing Bad Breath

Halitosis is better than no breath at all,” jokes one dentist. But the problem of halitosis, or bad breath, has plagued mankind for centuries, leaving few people laughing about it. To conquer bad breath, the ancient Greeks reputedly rinsed with white wine, anise seed, and myrrh, while the Italians mixed up a mouthwash of sage, cinnamon, juniper seeds, root of cypress, and rosemary leaves, according to the Academy of General Dentistry.

Today, Americans spend more than half a billion dollars for mouthwashes that often contain little more than alcohol and flavoring. But people worry about their breath. Indeed, New York Times health columnist Jane E. Brody has written that she receives more questions about bad breath than about any other common medical problem.

Maybe one explanation is the simple fact that you can’t really tell whether you’ve got bad breath. This is a time when you have to depend on the honesty and kindness of friends to let you know. “We’re immune to our own breath,” says Linda Niessen, D.M.D., M.P.H., associate professor and chair of geriatric oral medicine in the Department of Community Health and Preventive Dentistry at Baylor College of Dentistry in Dallas.

What if you’re on your way to that important meeting and you simply must know if your breath will precede you through the door? You can try breathing into a handkerchief or running floss between your teeth, suggests Erwin Barrington, D.D.S., professor of periodontics at the University of Illinois at Chicago.

Fixing bad breath depends on what’s causing it. In 80 to 90 percent of cases, it’s due to something in the mouth. Most often, bad breath is the result of nothing more serious than a dirty mouth. Plaque, the nearly invisible film of bacteria that’s constantly forming in your mouth, is often
responsible. Other dental culprits include cavities and gum disease. “Tooth decay by itself doesn’t smell bad, but the trapped food does,” explains Niessen.

Occasionally, bad breath is due to something in the lungs or gastrointestinal tract or to a systemic (bodywide) condition. “Eating a garlicky meal is one of the most common causes,” says Niessen.

The strong odors of foods like garlic, onions, and alcohol are carried through the bloodstream and, exhaled by the lungs. Another big loser when it comes to turning your breath sour-and harming your health-is tobacco.

In addition, some health problems, such as sinus infections or diabetes (which may give the breath a chemical smell), can cause bad breath, points out, Barrington.

Figuring out the cause of bad breath is the first step, obviously, in doing something about it. Here’s what you can do to keep your breath as fresh as possible:

Keep your mouth clean. “That’s the key thing,” stresses Sebastian G. Ciancio, D.D.S., professor and chairman of the Department of Periodon­toJogy and clinical professor of pharmacology at the School of Dental Medicine at the State University of New York at Buffalo. That means a thorough brushing twice a day. It also means nossing regularly. Food and bacteria trapped between teeth and at the gum line can only be removed with floss; if it’s left to linger, it’s not going to smell nice.

Clean your tongue, too. Bacteria left on your tongue can certainly contribute to less-than-fresh breath, so be sure to brush your tongue after you’ve polished your pearly whites.

Wet your whistle. A dry mouth can equal smelly breath. Saliva helps clean your mouth; it has a natural antibacterial action and it washes away food particles, says Ciancio. (It’s the reduced saliva now at night that explains morning breath, by the way.)

Try chewing sugarless gum or sucking on sugarless mints to stimulate saliva production.

Rinse. If nothing else, at least rinse your mouth with plain water after eating, recommends Virginia L. Woodward, R.D.H., past president of the American Dental Hygienists’ Association.Swishing the water around in your mouth may help to remove some of the food particles left in the mouth after a meal.

Munch on parsley. That green sprig of parsley that came with your meal can do more than decorate your plate. While munching on parsley or spearmint won’t cure bad breath, the scent of the herb itself can help temporarily cover up offending oral odor. (You’re basically trading an offensive odor for a more acceptable one.)

Eat to smell sweet. Foods that help fight plaque may also help fight mouth odor, says Woodward. Opt for celery, carrots, peanuts, or a bit of low-fat cheese if you want something to snack on. “A healthy diet will help your teeth as well,” Barrington points out.

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