Why do My Gums Need Therapy?

Dentista on Copacabana Beach 

Love was in the air.  I just returned from a family wedding in Buzios, Brazil.  What a trip, 6000 miles away from home!  Our nephew married a lovely lady from Brazil.  How fun to be there and learn about a new country.  Of course my favorite part, besides the wedding, being with family, and exploring the local cuisine, was learning about the dental side of things.  I was thrilled to hear how important oral health is to Brazilians.  Nephew Jake explained how folks there brush after every meal and take oral health seriously.  I saw many adults with braces- even our waiter had orthodontics!  Everywhere I looked, I saw beautiful, bright, clean teeth.  Love that!


Along the way I received a question that I thought worth writing about for this blog.

Why do you need a "deep cleaning," or "gum therapy"?   What does a deep cleaning do that a regular cleaning doesn't?  And how does a dental cleaning help my heart?
Love these questions!

Dentistas! 

Just to be clear, entire text books have been written about gum disease,  dentists go to school for many years to study this.  I'm going to hopefully distill it down to digestible nuggets for you.  This is not intended to diagnose your gum infection or substitute for your dental professional's opinion and diagnosis in any way.  If you still have questions, please comment at the bottom of this post or email me at barbaratritz@gmail.com.  I look forward to hearing from all of you!




We need a slight detour to discuss what a "cleaning" is, what gum disease is, and how that differs from periodontal disease:

Here's what healthy teeth and gums look like

First: what is a "Cleaning"? 

Actually, let's no longer call it a "cleaning".  I'm not cleaning your teeth.  That's what we do to our homes, our cars, and the dog.  I'm a dental therapist.  When you come see me for your "regular recare appointment", we are doing gum therapy or an oral wellness evaluation.   A "prophy" (short for prophylaxis) is supposed to be a light scaling (that's the scraping part) and polish.  Your insurance calls this "removal of plaque, calculus (tartar) and stains from the tooth structures in the permanent and transitional dentition.  It is intended to control local irritational factors."  It should take no more than 15 to 20 minutes to perform.  It should be an easy, preventive appointment.  (This is in addition to the oral cancer screening, and other preventive activities I perform.)   This is really for people with healthy mouths- no bleeding, no infection, no bone loss, no recession, no mobility, and no pus.  (Yay, especially no pus.)   This appointment is all about what's ABOVE the gumline.   Healthy happy mouths- see what a healthy mouth looks like and take the healthy mouth challenge- click here!   If you are doing your job, controlling your tartar build up and doing your preventive things at home, this appointment is easy and pain-free. Really! 

If your appointment is not "easy peasy," if it hurts, if you taste blood, then you may indeed have a gum infection.  I have ZERO tolerance for bleeding gums and I encourage you to have ZERO tolerance as well.  Remember: healthy things don't bleed.  But, that said, NOT all bleeding is due to bacterial/pathogen-induced gum inflammation, and your dental professional can help you figure out "why" your gums are bleeding.  The bleeding still may indicate infection, just not the cause. The cause could be gum disease, or it could be from medication, mouth breathing, diabetes, leukemia, hormones, dietary supplements or lack there of, vitamin deficiencies, or more.  So while bleeding may not signal gum disease, you need to sleuth out the "why".  

 I always start by looking for and at the pathogens: bacterial, fungal and viral.    My chairside phase contrast microscope gives me and my patient proof there's a problem.  Seeing is believing so click here to see what the bacteria do under the gums. I want to see what "bad germs" are lurking there causing the gums to bleed and thus causing infection.   If there's still bleeding after doing gum therapy, I send out for a periodontal pathogen test to a laboratory - that test tells us what else is still going on.  They look for other bad bugs.  If there's no pathogenic activity on my phase contrast microscope screen but still bleeding, it's time to sleuth further.   (Read my post on Braggin' Rights from A to Z to see why!)  A referral to your physician to get blood work and a physical is the next step.  Don't stop until you get answers.  

Next: Gum Disease

Most folks- approximately  75% of the population have some form of gum disease.  You can see why we'd start looking here first.  This infection ranges from the mild form, called gingivitis, all the way to severe periodontitis.  Half of all Americans over age 30 have periodontal disease!  Yikes!  It can start in childhood and never really gets resolved.  Often I hear "my gums always bleed..." well, you've probably always had a gum infection... 

So, what's the difference between  gingivitis and periodontitis?

Gingivitis along with tooth decay 

Gingivitis-  this is an infection of the gum tissues that surround your teeth.  The infection is just in the gum tissue and has not entered the jawbone, yet.  The infection is a real, honest to gosh infection.  It harbors bad pathogens that need to be eliminated.  And, yes, I realize insurance does not cover the treatment for this infection. (Probably because of the above statistic.)  The pathogens associated with gingivitis are very bad apples- such as Fusobacterium, Prevotella, and Campylobacter. (Don't they even sound scary!?) Click on the links and click here too and see what they can do to the body.  The pathogens live happily on your teeth, along your gum-lines and even in your tonsils.  They love your mouth.  It's warm, dark, undisturbed and there's plenty of food for them.  The longer they are undisturbed, the more bacteria babies they make, growing their colonies, inviting other bacteria and pathogens to join them.  They even have instant messaging-  they talk to each other through quorum sensing!  We now call this growth of bacteria a biofilm rather than "plaque."  A maturing biofilm is much more aggressive and destructive, and it migrates. This is the turning point between gingivitis and periodontitis.  It grows and moves down under your gumline.  More bad pathogens join the party.  Then the destruction really occurs- it attacks your jawbone.  After that? They keep moving and penetrate your body's lungs, brain, heart and more to start infections there as well.  

Periodontitis:

Bone loss and Periodontal disease 

What's the difference?  The aggressiveness of the pathogens and the migration of the infection they create into the jawbone, causing bone loss and thus tooth loss!  That's the short, concise version, here's the longer version!

Now, not everyone who gets gingivitis progresses to periodontitis, but it does in some people. Severe periodontitis affected 743 million people worldwide in 2010.  (And it's a mostly preventable disease!)  
Who gets it more severely?   Risk factors for periodontal disease include but are limited to: smoking, diabetes, systemic diseases, lifestyles, and genetic markers.  Poor homecare is also an important factor.  

We don't know what'll tip it over the edge, either. Some people can harbor the pathogens associated with perio and not have bone loss, while others have the same pathogens and aggressive bone loss.  Not fair, I know!  For some folks, there's a threshold level below which they can stay healthy.  But why play on this edge, gambling?  Control what you can, such as your homecare, manage diabetes, stop smoking, eat healthy, incorporate healthy habits, get excellent preventive dentistry, and be aware of your genetic tendency, especially at a young age!  All of this contributes to keeping your teeth and mouth healthy for a lifetime!  Tooth loss is NOT inevitable. Dentures DO NOT have to be your future. 

 Really, don't wait until the pathogens invade your jawbone and start dissolving it!  Beat gingivitis, not periodontal disease.  (It's easier anyways!) 

Gum Therapy, or rather, Advanced Dental Hygiene Therapy

Deep "cleaning" (arghhh, I said I wouldn't use that word anymore), is really all about "gum therapy."
It is done to remove the tartar and plaque-biofilm from underneath the gumline and start the healing process in the body.  It takes longer and requires more skill.
No matter how well you brush, floss, pick, or water floss, you cannot reach, disrupt, and remove the embedded irritants.  (Check out the video in my post It's a Small, Small, Extra Small World. That's what's living under the gumline in an infected gum.)  The goal is to leave the tooth surface as clean and pathogen free as possible.
This takes the skill of the dental hygienist, and yes, it costs more.
I know it's expensive. Just like you, I don't work for free. (Although I do write this for free.)  This is the skill I have.  I spend many hours reading and learning about gum disease and prevention so you don't have to... so that you can read this!  And I'm impressed that you do!

I use power scalers to shake that tartar off the side of the teeth, then hand scale under the gumline with ozone oil to disinfect, reduce and remove the biofilm.  I finish up with ozone gas around every tooth to further disinfect and permeate the tissues and tooth tubules.  I polish all the teeth, and clean the tongue. Finish with an antibacterial rinse and gargle.  My goal is full mouth disinfection - teeth, gums, tongue, tissues, palate and tonsils.  Realistically, I know there are still some pathogens in the gum tissue, jawbone and in the tooth tubules. That's where customized homecare instructions and patient willingness comes into play.  Even antibiotics may be indicated.  In addition to removing the pathogens, and making it easier to keep things healthy, you can improve your own health by stopping smoking,  and eating better, including supplements.
Your body wants to be healthy, so by removing and reducing the pathogens and other risk factors, it can heal itself.  The goal of gum therapy is: stop the infection, heal the gums, and then, ultimately, bone regeneration.


Can you heal yourself without  Advanced Therapy?  

Well, no, you can't.  Sorry to say.
If it's gotten to the point that the pockets around your gums are deep, you can't access the depths on your own, and therefore end up leaving bacteria and pathogens down under the gumline- you'll be constantly treading water without a visit to your favorite dental hygienist.
You'll also need the skills of your fabulous dental hygienist if there's tartar- it's like hardened cement, and you need the big tools to take it off without damaging the tooth further.

The Gum Disease-Heart Connection

There's a very close connection between infection/inflammation in the mouth and the rest of the body.  I discuss it in length in my posts- When you let Plaque Attack, and Your Mouth Matters.  In reviewing articles for this post I came across a fact worth repeating from the journal of the American Heart Association- Circulation.  
     Here's their conclusion: Dental infection and oral bacteria, especially viridans streptococci may be associated with the development of acute coronary thrombosis.  They studied the thrombi in 101 heart-attack events and found that as many as half were likely triggered by BACTEREMIA that were either periodontal or endodontic (tooth decay/root canal) in origin.  Infections in the gums or teeth travel within the blood system and trigger problems elsewhere in the body.  Love your heart, clean your teeth. 

So, to get back to the original question- do you "need" Advanced Dental Hygiene Therapy??  

The long and short of it is yes, you do.  Your dental professional is really saving your life and health by removing the tartar (which is a coral reef teeming with microbes under your gumline, do you get the picture yet?) and reducing the pathogens living in your mouth.  If you have a gum infection, the goal of gum therapy is to remove the tartar, disinfect the gums, and kill as much of the bacteria and other pathogens as possible.  By returning more frequently to the dental office, you then keep these pathogens below the threshold levels so your immune system can fight them and help you keep healthy. 

Your dental team should be looking at much more than just tartar build up- they need to look at the entire entity that is you- and work with you from the outside in and the inside out. They work with you to remove the pathogens, assess risk factors, look at the genetics and remove triggers that contribute to inflammation.  It's a proactive, preventative health program.   For me, a dental hygiene visit is so much more than just a cleaning.   It's all about prevention, health and total wellness! 

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Stay healthy and Keep Smiling!

Til next Time,
Barbara