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Receding gum tissue can be an issue especially as we get older. Normal healthy gum tissue will follow snugly against the conforms of our teeth. Gum recession occurs when the gum tissue recedes or pulls away from teeth exposing the root below. This creates an esthetic issue as well as a functional one. The roots of our teeth do not have a protective layer of enamel. This can make your teeth sensitive to hot and cold as well as increase your risk of tooth decay. Once recession occurs, this tissue cannot grow back to its original state. There are treatments to restore lost gum tissue and bring your smile back to its original healthy state.

What Causes Gum Tissue To Recede?

Several factors can cause our gum tissue to recede including:

Periodontal Disease (ranges from ginigivitis to advanced periodontitis) – Periodontal disease (also called gum disease), refers infections of the structures around the teeth, which include the gums, periodontal ligament and alveolar bone. In the earliest stage of periodontal disease — gingivitis — the infection affects the gums. In more severe forms of the disease, all of the tissues are involved. This inflammation occurs due to an accumulation of bacterial deposits called plaque.

Contributing factors of periodontal disease include:

-poor oral hygiene maintenance

-misaligned or crooked teeth

-damaged or faulty fillings

-bridges or partial dentures that no longer fit

-genetics

-hormonal changes due to pregnancy or oral contraceptives

-medications that cause dry mouth (xerostomia)

-certain immune disorders

-stress

-tobacco use

Periodontal Disease Stages

-Gingivitis causes gum redness, swelling, and sometimes bleeding. If left untreated, gingivitis can progress to periodontitis.

Periodontitis is the advanced stage of periodontal disease and can cause the gums to recede. As the gum and connective tissues pull away from the tooth, a pocket forms between the tooth and gum, which begins to accumulate bacteria. Over time, the bacteria cause further damage and inflammation. If the gums recede too much, it may lead to bone loss, which can cause teeth to loosen or fall out over time.

Is Incorrect Brushing The Cause?

Maintaining a regular brushing and flossing regimen is essential for maintaining good oral hygiene. However, using an incorrect brushing technique could actually contribute to receding gums. The part of the gum that comes into contact with the crown of the tooth is called the gingival margin. Brushing incorrectly or too hard can damage the gingival margin, possibly triggering gum inflammation and recession.

Incorrect brushing techniques can include:

-brushing too forcefully

-using a hard or medium bristled toothbrush

-brushing the teeth in a broad, horizontal motion

Teeth grinding and clenching

Some people grind their teeth together while sleeping. This motion of teeth grinding puts intense pressure on the gums, which can cause them to react by receding over time. Teeth grinding can also cause teeth to become loose in their sockets. Grinding creates deep pockets between the tooth and the gum, where bacteria can collect. These bacteria trigger gum inflammation, which can then worsen gum recession.

Injury

Sustaining direct trauma to the gum tissue may cause the gums to recede in that area. These injuries could include:

-during a fall or other accident

-during dental procedures

-while wearing ill fitting partial dentures

-trauma while playing contact sports

Treatments For Receding Gums

Scaling and root planing

Scaling and root planing is one of the first treatments for receding gums that a dentist will recommend. This procedure will remove plaque and tartar from below the gumline, where routine brushing cannot reach. Root planing removes plaque and tartar specifically from the roots of teeth. Following removal of plaque and tartar your dentist or hygienist will use special instruments to smooth the roots, which helps the gums re-attach to the tooth.

Gum Tissue Grafting

Your dentist may recommend gum graft surgery if your gums have severely receded to the point where surgical intervention is needed. During gum grafting, a surgeon will take a small piece of gum tissue from a different area in the mouth and transplant it to cover the exposed tooth roots. This gum tissue grafting helps prevent bone loss and the gums from receding farther. It can also protect the previously exposed tooth roots from decay and tooth sensitivity

Pinhole Surgical Technique

Pinhole surgical technique is a fairly new treatment for mild to moderate receding gums. Pinhole Surgical Technique is a minimally invasive procedure that requires no incisions and no suturing. It is a quick and effective treatment for gum recession that is virtually pain-free and requires only a very short recovery time. Patients can resume normal activities the same day as their procedure.

Prevention Of Gum Tissue Recession

-Practice good oral hygiene

The following oral hygiene tips can help avoid receding gum tissue:

-flossing between the teeth at least once per day preferably after each meal

-fluoride toothpaste

-brushing your teeth 2x/day using a soft bristled toothbrush

-using an antiseptic mouthwash to reduce bacteria and flush out debris

-choosing a size and shape of toothbrush that allows access to all parts of the mouth

-replacing toothbrushes at least every 2–4 months or as recommended by your dentist

-maintaining a regular schedule of dental appointments

-Wear A Mouthguard

Wearing a mouthguard at night can help prevent gum recession due to teeth grinding. Mouthguards create an even pressure across the jaw and act as a physical barrier to separate the top and bottom teeth. Mouthguards can be bought at your local pharmacy. A dentist can also make a customized mouthguard, which will provide a better fit and be much more comfortable and long lasting

-Replace Dentures That Do Not Fit

Partial dentures that once fit well can become incompatible with the mouth over time. This can happen for several reasons, including:

-the bone and gum ridges shrinking over time

-differences or changes in jaw alignment

-overall wear and tear of the partial dentures over time

Ill fitting partial dentures can rub and irritate the gums, causing the gums to recede around healthy teeth. People can prevent this by replacing partial dentures as needed. If you are concerned have your dentist evaluate your partial dentures at your next visit.

-Maintain Regular Dental Visits

Attending regular dental checkups is vital for detecting the early stages of gum recession. Routine examinations also allow your dentist to identify and replace any failing restorations or ill fitting partial dentures, which can contribute to receding gums.

Gum Recession Conclusion

Unfortunately once the gum tissues have receded, they cannot grow back on their own. With Advancements on treatment your dentist can reattach and restore gum tissue around the teeth. Remember to maintain a good oral hygiene program at home and seeing your dentist regularly can help prevent, slow, or stop gum recession. If you notice changes in your smile speak to your dentist to see what options are right for you.




Dental implants have become highly utilized in dentistry. Oftentimes, another procedure called a bone graft, is required to aide in the stabilization of  dental implants. The success of dental implants depends on the quality and quantity of bone present. If the bone is of poor quality or low quantity the dental implants have a much lower chance of success. Adequate bone structure is required for a dental implant to integrate (become one with the surrounding bone), and be strong enough to chew on. Bone grafting is a surgical procedure that can increase the quality and/or quality of the bone to then directly effect the chance of dental implants success. Not all dental implants require bone grafts, so when do you need them?

When Are Dental Bone Grafts Needed For Dental Implants?

The existing bone has insufficient width. This could be a genetic factor where the bone width is lacking naturally or it could be from damage over time from periodontal disease.

The existing bone has insufficient height. The height of the bone is just as critical as the width as it ensures the dental implant is properly anchored to support the stress of function (biting and chewing food).

The maxillary sinus is too close to area of placement. This usually means that there is not enough bone between the tooth area and the sinus. Generally this can be fixed by lifting the sinus membrane (Sinus Lift) and placing bone graft material.

Inadequate bone as a result of previous tooth or teeth removal. Sometimes when teeth are removed or fall out, bone can be removed as well. The bone will also decrease and remodel once the tooth is removed as it no longer is needed to hold a tooth in place.

Not enough bone due to periodontal disease or trauma. Periodontal disease and trauma can lead to there not being enough bone for a successful dental implant.

Inadequate bone due to defect in development that affects growth of bone in the jaw.

Insufficient bone caused by the removal of cysts or tumors in the mouth. If the removal of a cyst or tumor is required there will also be removal of some of the bone, there may not be enough left for the dental implant to be successful. After removal of oral pathology, healing time is required so that bone quality and quantity can be reevaluated.

Bone Grafting Procedure

Where Does the Bone Come From?

Bone grafting procedures involve the use of your bone, cadaver bone, cow bone, and synthetic bone. Your own bone will most likely come from your chin or ramus (the back part of your lower jaw). If your dentist is unable to get enough bone from either of these areas, they may need to get bone from your hip or shin bone (tibia) instead. The hip is considered to be a better source because the hip bone can provide a large amount of bone. The marrow from either the hip or shin (tibia) contains bone-forming cells. However bone taken from your hip requires a visit to the hospital along with general anesthesia. Cadaver bone and cow bone is sterilized and broken down into small chips for easy placement.  Man made synthetic materials are also widely used for bone grafting. The synthetic bone acts as a scaffold for new bone to build on.

Newer products containing growth factors have also been developed.  Some are used to enhance bone graft materials and others are used in place of bone grafting. One of these products, BMP-2 stimulates certain body cells to turn into bone. The BMP-2 protein occurs naturally in the body.

What Happens During Bone Grafting?

A good example is a patient that needs to have a single tooth extracted and wants to have it replaced with a dental implant and dental crown. There may be a bone defect in the area or the tooth is large and needs to have some bone placed to fill in the expansive space. In this case, a dental bone graft is ideal and necessary to support the future dental implant.

Before the procedure, you will need to have either a CT scan or a cone-beam computed tomography (CBCT) scan. The images of a CT or CBCT provide valuable information about bone quantity and show where important nerves and sinuses are located which need to be avoided. A CBCT actually provides a 3-D image of your bone and any defects present. Local anesthesia will be used to numb the area where the bone augmentation is needed (called the recipient site) as well as the area from where bone will be removed (donor site) if using your own bone. An incision in the gum tissue where the implant will be placed is made to determine how much and what type of bone is needed.

The most common type of graft is called a socket graft. This is used to fill the space left behind by the lost tooth. The material used most often in a socket graft is often comprised of cow bone. This bone is harvested from known healthy cows and is processed through a freeze drying procedure that renders a sterile end product containing only the mineral content of natural bone. The graft is applied to the empty hole immediately after a tooth extraction and is secured using sutures (stitches).

Following the bone grafting procedure the patient will be given antibiotics, pain medicine, and an antibacterial mouthwash. You will need to avoid certain foods. You also will be told how to avoid putting pressure on the area or damaging it while it heals. If you wear a denture, you may not be able to wear it for a month or longer while the area heals. If you have natural teeth around the bone graft, your dentist may make a temporary removable bridge or denture to help protect the area.

Success of Bone Grafting

The success rate for bone grafts in the jaws for the purpose of placing dental implants is very high. However, there is a small chance that the bone graft will fail, even if your own bone was used. Bone grafts are not rejected like organ transplants. It is not exactly known why some dental grafts fail. There is a higher risk of failure in patients with diabetes, who smoke, or have periodontal disease. A failed graft can be removed. Once the area has healed, your dentist may choose to place a second bone graft.

Dental Bone Grafts Conclusion

Without dental bone grafts many would be unable to restore their smiles with dental implants. Just like dental implants, dental bone grafts are highly successful procedures to restore a smile to its natural state. Every case is different and the need for bone grafting varies from person to person and tooth to tooth. You can discuss the need for possible bone grafting with your dentist to see if it would benefit your procedure.



Use of an anti bacterial mouthwash can be an important part of everyone’s dental hygiene. Many people have been instructed to brush and floss regularly but did you know that using an anti bacterial mouthrinse can be just as important? Walking down the aisle of any grocery or drug store can be quite confusing as there are a ton of options.

Types Of Mouthwash

Therapeutic Mouthwash. This type of mouthwash is meant to fight off dental diseases like tooth decay and periodontal disease. These will have anti bacterial and anti plaque (tartar control) properties. By reducing plaque and tartar you will decrease the risk of periodontal disease as well as decrease gum inflammation. They may also contain fluoride which will help in the fight against tooth decay.

Cosmetic Mouthwash. These include agents to freshen your breath. They can also include whitening agents. Generally, these mouthwashes do not include any therapeutic agents.

Therapeutic Mouthwash Advantages

-Mouthwash With Fluoride. Fluoride mouthwashes have the ability to possibly help decrease the risk of tooth decay. There have been numerous research studies over the years to prove that fluoride can strengthen and reduce the breakdown of enamel thereby reducing the possibility of tooth cavities. This will not work for all but has been proven to be a benefit for many. Some fluorides are also good antibacterials and help fight periodontal disease (example – stannous fluoride).

-Periodontal Disease Fighter. Periodontal disease is caused by plaque from bacteria and food that sticks to teeth. As the bacteria feed on the food particles they release acids that will break down the bone and cause inflammation of the gum tissue. Our body responds and causes bone loss and inflamed, infected gums. An antibacterial mouthwash may help prevent periodontal disease by decreasing the amount of bad bacteria in the mouth. There is also type of rinse (Periogen) that has been found to dissolve tartar, stains, and plaque. This rinse is a great way to keep your teeth from rebuilding tartar between cleanings. This is a powder that can be diluted with water in a waterpik and tends to be even more effective if a capful of your fluoride rinse is added to it.

-Help Keep Pregnancy Gingivitis At Bay. It is important to maintain good oral hygiene at all times but for certain groups it is even more important. For pregnant women it can be critical to control oral health. During pregnancy, a woman’s hormones are elevated which makes them more susceptible to developing periodontal disease if their dental hygiene is not maintained. Periodontal disease in pregnant women has been linked to low weight and pre term babies.

Help Diabetics. Patients with systemic diseases that make them more susceptible to infection like diabetics need to reduce the bacteria they are ingesting. It is even more critical to maintain good oral hygiene and mouthwashes are definitely recommended for those patients.

Therapeutic Mouthwash Disadvantages

-Canker Sore Irritant. This is caused when the alcohol content in your mouthwash is too high. It will irritate the canker sore and make it quite uncomfortable to use.

-Cover Up For Bad Breath. Use of a mouthwash can definitely lead to fresher breath but it is usually only for a short period of time. Only some mouthwashes are formulated to actually neutralize odor causing chemicals (example Closys). Not maintaining your dental hygiene, or chemicals from your diet are usually the underlying factors in most people’s bad breath but the mouthwash will just mask it for a short time.

Alcohol Based Mouthwash. Studies (Listerine) have shown that rinses with alcohol, if used as directed can actually cause saliva production to be stimulated in a semi dry mouth. The alcohol in mouth rinses has historically been used as a way to cause the essential oils (the bacteria killing aspect) in the rinse to keep from separating out in the liquid, and staying mixed. No one wants to rinse with something oily feeling. There are now quite a few alternatives to alcohol to do the job, so alcohol free rinses have become more prevalent. Many people do not like the burning sensation of alcohol, and in people with little to no saliva flow, alcohol based rinses can be quite uncomfortable. The choice is based on personal preferences.

Mouthwash Use Conclusion

Using a mouthwash can be another tool to keep your mouth healthy and free of periodontal disease. If you decide to use a mouthwash as part of your dental hygiene routine remember to continue brushing and flossing as well. They work together not separately. There are a lot of mouthwashes on the market today, talk to your dentist to see which one is right for you.

 



Periodontal disease is a progressive disorder that if left untreated will worsen over time. Many people simply ignore the warning signs or just do not know them. Educating yourself on the signs and symptoms of periodontal disease is a good first step to taking control of the disease and it’s progression.

What Is Periodontal Disease?

Periodontal disease (or gum disease) is a serious and chronic infection of the gum tissue that can result in the staged breakdown of the tissue and the deterioration of bone that surrounds and supports your teeth. This infection process begins when bacteria and plaque form a sticky bio film on your teeth. Biofilm causes a chronic inflammation of the gum tissue.  Periodontal disease will continue to progress if the biofilm is not reduced or removed.   Maintaining proper dental care and hygiene are the most important steps in prevention and halting of the disease. Periodontal disease is the leading cause of tooth loss in adults. Studies show that somewhere between 75% and 95% of all adults are suffering some stage of periodontal disease.

The stages of periodontal disease include:

Gingivitis ( inflammation of the gum tissues). This is the initial stage of periodontal disease. This is easily reversible and is the mildest form of periodontal disease. Symptoms include red, swollen (or puffy) and inflamed gums due to plaque-bacteria build-up. The gums may also bleed easily during brushing or eating of hard foods. During this early stage of periodontal disease, the process can be reversed with at home dental hygiene and professional cleanings to remove the biofilm, and tartar. Most of the people with this early form of periodontal disease, do not even know a dental problem exists. This is a crucial period for the patient, as the condition can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been affected) at this point if it is recognized and properly treated. Gingivitis is commonly seen during puberty, pregnancy, times of high stress, and menopause, as hormones can make you more prone to inflammation. As for the rest of the population, poor hygiene is generally the most common cause, followed by medication and certain medical conditions.

Periodontitis. As the disease state progresses, it is now becoming harder to treat and manage. The difference between gingivitis and periodontitis is that gingivitis only infects the gum tissue that surrounds the teeth while the periodontal disease process also invades the bone that provides support and stability for the teeth. The bacteria eventually invades past the initial the gum line area and destruction begins to the point that gums may begin to separate or pull away from the teeth (taking away support and connective fibers with it). What results are called periodontal pockets. These pockets allow for bacteria to invade below the gum line.  They eventually become loaded with toxic plaque and bacteria that moves and works its way deeper. It begins to erode the bone and connective fibers below the gum line. A patient’s bite will be affected (as the teeth shift or loosen) by the lost support which then affects chewing and other functions.

Advanced Periodontitis. As the periodontal disease process advances further, the fibers and bone that provide support for the teeth are destroyed. At least half of the bone support (if not more) will have broken down at this late stage of periodontal disease. It does not grow back naturally. Teeth may begin to loosen. Deep root cleanings and surgical intervention are typical at this stage. This may include cleaning with a periodontal microscope, (Perioscope), grafting of tissue, bone, placement of growth factors, (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets, (Arestin), open flap surgery, and, possibly tooth removal.

Periodontal Disease Warning Signs

Puffy, Swollen Gum Tissue. This is a hallmark sign of gingivitis and periodontal disease in general. Your body’s natural response is to fight off this infection caused by excessive untreated debris. It does this by bringing healing components to the area through the blood vessels. The gums will remain this way until the irritant is removed namely the plaque and bacteria building up on your teeth and below the gum line.

Bleeding Gums. Once the tissues are puffy and receiving extra blood flow to fight off the disease process. This leads to inflamed gum tissue that will bleed easily upon brushing or even eating.

Presence Of Periodontal Pockets. As the disease process progresses and the bacteria and plaque build up the gum tissue will begin to separate from the teeth creating ever larger pockets where bone will be lost. These pockets become very difficult to clean on your own and necessitate further professional help.

Infection And Pus. Once there has been significant advancement of pockets, bleeding ends, and infection begins. Pressing on the gums, flossing or probing by the hygienist tends to release pus into the mouth.

Long Looking Teeth. As we lose bone support, the gum tissue falls back and exposes the root of the tooth. This gives the appearance of longer teeth.

Persistent Bad Breath. While this can be a sign of other more serious medical conditions it is a hallmark of periodontal disease progression. Much of the odor has to do with the infection process, and tartar.

Loose Or Drifting Teeth. Once periodontal disease has advanced, the support tissues are diminished. The further the advancement, the looser the teeth become.

Periodontal Disease Conclusion

Periodontal disease is a progressive disease. There are many signs and stages to help you to be aware of  it’s progression. The disease process involved in periodontal disease can be quite aggressive making it harder and harder to control and treat. It is best to stay ahead of that process by being diligent with at home dental hygiene and maintaining a regular schedule of professional cleanings.