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Oral Hygiene

Gum recession or root exposure is a disease or pathological process that is characterized by visible roots, sensitivity to cold or touch, and in extreme cases, loose teeth. Age is not a proven primary factor for gum recession. Significant concerns regarding root recession are as follows (least to most important):

  • Cosmetics
  • Tooth sensitivity to cold stimuli or touch
  • Loss of a "firm collar" of tissue around the neck of the tooth that functions as a protective mechanism for the underlying bone
  • Root caries, or cavities in the roots
  • Permanent loss of bone support for the roots

Roots are porous in nature, much like a sponge. They have holes and tunnels in them, called tubules that accumulate food particles, by-products and bacteria when exposed. This invasion very rapidly results in loss of mineralization of the tooth, and cavities invade the root when it is exposed. A firm band of tissue called “attached tissue” is usually attached to a root and provides a cinching affect around the teeth, much like a tie around a neck, to protect foreign material from getting down between the teeth and gums and thus infecting the bone. This important protection is lost with gum recession. Therefore, when the bone is exposed to foreign materials, it recedes to protect itself along with the gum. This provides significant loss of bone support for the tooth that is permanent. Bone loss usually cannot be replaced.

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Most people have wisdom teeth -- those teeth that grow in the very back of your mouth -- as young adults. Although some people may have enough room in their mouths to accommodate their wisdom teeth, others may need to have them extracted to prevent other dental problems, including overcrowding.

According to the American Dental Association, your wisdom teeth may need to be extracted if they are growing in sideways and could impact other teeth. They should also be removed if the teeth are only partially emerged for an extended period. This allows the bacteria to form around the teeth and could cause an infection.

If you experience pain, stiffness or swelling in your jaw or other tooth pain, you should consult your dentist to see if your wisdom teeth may be causing the problems. Your dentist may refer you to an oral surgeon to see if your wisdom teeth need to be extracted.

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People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don't have their diabetes under control are especially at risk.

A study in the November issue of the Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are. Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.

This recommendation is supported by a study reported in the Journal of Periodontology in 1997 involving 113 Pima Indians with both diabetes and periodontal disease. The study found that when their periodontal infections were treated, the management of their diabetes markedly improved.

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For a long time we've known that risk factors such as smoking, alcohol use, and drug use contribute to mothers having babies that are born prematurely at a low birth weight. Now evidence is mounting that suggests a new risk factor – periodontal disease. Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small.

More research is needed to confirm how periodontal disease may affect pregnancy outcomes. It appears that periodontal disease triggers increased levels of biological fluids that induce labor. Furthermore, data suggests that women whose periodontal condition worsens during pregnancy have an even higher risk of having a premature baby.

All infections are cause for concern among pregnant women because they pose a risk to the health of the baby. Dental experts recommend that women considering pregnancy have a periodontal evaluation.

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Bacterial respiratory infections are thought to be acquired through aspiration (inhaling) of fine droplets from the mouth and throat into the lungs. These droplets contain germs that can breed and multiply within the lungs to cause damage. Recent research suggests that bacteria found in the throat, as well as bacteria found in the mouth, can be drawn into the lower respiratory tract. This can cause infections or worsen existing lung conditions. People with respiratory diseases, such as chronic obstructive pulmonary disease, typically suffer from reduced protective systems, making it difficult to eliminate bacteria from the lungs.

Scientists have found that bacteria that grow in the oral cavity can be aspirated into the lung to cause respiratory diseases such as pneumonia, especially in people with periodontal disease. This discovery leads researchers to believe that these respiratory bacteria can travel from the oral cavity into the lungs to cause infection.

Chronic obstructive pulmonary disease (COPD) causes persistent obstruction of the airways. The main cause of this disease is thought to be long-term smoking. Chemicals from smoke or air pollution irritate the airways to cause obstruction. Further damage to the tissue and working function of the lungs can be prevented, but already damaged tissue cannot be restored - untreated or undetected COPD can result in irreversible damage. Scientists believe that through the aspiration process, bacteria can cause frequent bouts of infection in patients with COPD. Studies are now in progress to learn to what extent oral hygiene and periodontal disease may be associated with more frequent bouts of respiratory disease in COPD patients.

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Prevention and Maintenance

Once your periodontal treatment is completed it is very important you maintain regular professional cleanings. Research states that a three month recall is adequate and recommended. This is necessary because it takes three months for the bacteria to repopulate and start to cause destruction of gingival tissue attachment and bone loss. Good oral hygiene at home is essential to help keep periodontal disease from becoming more serious or from reoccurring. A few minutes a day is enough to care for your teeth and gums. You do not have to lose teeth to periodontal disease. Brush and clean between your teeth, eat a balanced diet, stay active and schedule regular dental visits for a lifetime of healthy smiles.

How do I know if I have gum disease?

Your dental professional will determine if you have gum disease at every professional cleaning, which should occur every 6 months. Since early gum disease or gingivitis is reversible, it is important you see your dental professional if you see any of the following:

  • Gums that bleed or are red, puffy, swollen or sore
  • Gums that have pulled away from the teeth
  • Changes in the way your teeth fit together
  • Pus or a creamy discharge that appears around the teeth or gums
  • Constant bad breath or a bad taste in your mouth

What should I do if I have gum disease?

  • Get regular professional cleanings and checkups. Your dental professional will remove the plaque and tartar that forms under the gums that has been shown to cause gum disease
  • Do not smoke cigarettes or use other forms of tobacco
  • Brush and floss daily to keep the gum tissue healthy

Studies have indicated links between your mouth and overall health, such as:

  • People with diabetes are more likely to develop gum disease and result in tooth loss. · · · The plaque in your mouth has been found to clog arteries around your heart leading to heart disease and stroke.
  • Pre-term low birth weight babies are more likely to occur in mothers with gum disease.
  • The chemicals that lead to gingivitis are the same chemicals that play an important role in heart disease and rheumatoid arthritis.

Good Oral Hygiene-Daily Brushing and Flossing


Step One: For the outer tooth surfaces, place the toothbrush at a 45-degree angle toward the gumline. Use gentle, short strokes, moving the brush back and forth against the teeth and gums.
Step Two: Use this same motion to clean the chewing and inner tooth surfaces.
Step Three: To clean the inner front tooth surfaces, hold the brush upright and use gentle up-and-down strokes with the tip of the brush.
Step Four: Don't forget to brush along the gumline, and make sure you reach the teeth right at the back Also give your tongue a brushing - it'll help keep your breath fresh!


Step 1: Take about 18 inches (50cm) of floss and loosely wrap most of it around each middle finger (wrapping more around one finger than the other) leaving 2 inches (5cm) of floss in between.
Step 2: With your thumbs and index fingers holding the floss taut, gently slide it down between your teeth, while being careful not to snap it down on your gums.
Step 3: Curve the floss around each tooth in a "C" shape and gently move it up and down the sides of each tooth, including under the gumline. Unroll a new section of floss as you move from tooth to tooth. At first, flossing might feel awkward. But stick with it! With just a little patience and practice, it will begin to feel as natural as brushing your teeth.

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Dental Professionals associate gum disease to fall under 3 stages:


This is the first stage of gum disease. Some indications that you may have gingivitis may involve tender and some bleeding of your gums when you brush or floss. Gingivitis is reversible when corrective measures are undertaken. Some of these measures involve routine professional cleanings and proper brushing and flossing on a daily basis. Usually when the above measures are undertaken no bleeding or tenderness of the tissues should result. This lack of bleeding and tenderness indicates that the gingivitis has been reversed back to a degree of health. Untreated gingivitis can advance to periodontitis.


This is considered the second stage of periodontal disease. At this stage plaque and tarter forms under the gums which is not accessible by brushing and flossing alone, and professional therapeutic methods need to be incorporated. Plaque and tarter causes an infection, which may damage the bone and the attachment of the gums to the teeth. You may notice that your gums start to pull away from the gums and more tenderness and bleeding may result. Proper dental care may involve tissue and root therapy or "deep cleanings" with the incorporation of other therapies depending on the involvement of the disease. Professional intervention is very important to prevent further damage of this disease. The first step involves a special deep cleaning or tissue and root therapy. This procedure helps gum tissue heal and periodontal pockets to shrink. A local anesthetic is often used to make you more comfortable. Usually, treatment occurs in one appointment. Sometimes antibiotics may be inserted under the gums to aid in healing of the gingival tissues. Also, a medication via a pill may be recommended to control infection or to aid in healing. A month after therapy an examination will determine if further treatment is required.

Advanced Periodontitis

In this final stage of gum disease, the bone and the attachment of the gums to the teeth has been destroyed. This may cause your teeth to shift or loosen and can affect how your teeth come together. You may notice a bad taste or smell in your mouth. Proper dental care must be initiated to save the teeth or they may need to be removed. Professional intervention may involve pocket reduction therapy and bone grafting along with the incorporation of other therapies.

Pocket reduction therapy is required when the gingival tissues have not resolved after initial treatment or tissue and root therapy. This is usually necessary when gingival tissues have not shrunk enough or when the supporting bone around the teeth has been lost. Since the gingival tissue have not shrunk they provide a greater place for bacteria to live and attack the bone and tissue causing further damage to occur. Pocket reduction therapy turns or pulls back the gingival tissue and removes tartar and smoothes the roots so that the gingival tissue can reattach. Diseased tissue is also removed to allow the gingival tissue to heal. The gingival tissue is sutured back into place into a new position to make the gingival tissue snug around the tooth and aid in healing. Sometimes bone grafts may be necessary to correct for bony defects that occur around teeth and where roots divide to prevent loss of teeth.

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Inflammation is your body’s normal way of healing itself after injury or infection. It is a natural process that lets your defense cells enter the site of injury or infection and allow for healing to occur. However, if the inflammation process goes on for a period of time it causes tissue damage. This is the case in long-term, chronic diseases such as arthritis. Oral inflammation can also lead to gingivitis, periodontitis and eventually, tooth loss.

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Heart Disease

Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.

Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries. Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.


Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

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The mouth may contribute to your body’s overall amount of inflammation. Your mouth is home to many different types of bacteria. Many of these types of bacteria are harmless but some cause cavities while others cause inflammation of the gums or gingivitis. When the bacteria get out of control it results in red, swollen, puffy and tender gums. A common sign of gingivitis is gums that bleed easily when you brush or floss.

Your mouth is directly related to the body by the bloodstream. This means that when you have inflammation in the mouth it affects your overall health or parts of the body. Studies have shown that oral inflammation may be linked to problems in other parts of the body. Some of these problems are heart disease, diabetes, arthritis and periodontal disease.

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