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Pretty in Pink: The Sign of Healthy Gums




I don’t think it would be an overstatement to say that gum health is the foundation to one’s overall oral health. Gum tissues act as the tattletales, if you will, of all homecare activities, or the lack there of. Without good gum health, bone loss can occur, followed by tooth loss, or in other words periodontal disease.  Unfortunately, nearly 50% of the population suffers from some level of gum disease, which is a decrease of the estimated 80-90% infected when I began my career as a dental hygienist in the early 80’s. I’m dating myself with this admission, but so is the title of this blog so I might as well own it! (Oh how I loved Andrew McCarthy in the 80’s) Well, this brings us to the incredibly important topic of home care habits and keeping our gum tissue in the PINK!

Pink tissue that is tightly wrapped around the tooth is the description of healthy gums that are void of inflammation or infection. Gum tissue that is brighter pink, red, or bluish-purple in color, puffy in appearance, especially the pointed areas between the teeth, and bleed with brushing or flossing is gum tissue battling infection, generally in the midst of unremoved bacteria. This is an example of some level of periodontal disease and, if not addressed, can lead to bone loss and eventual tooth loss.

Whether it’s the earlier stages of gingivitis or full-blown periodontitis, regular constant plaque removal is the cornerstone of success and maintenance of an existing oral condition. Whether you are fortunate to have a healthy mouth or if you have been told you have pocketing or some other evidence of gum disease, daily plaque removal is paramount to controlling bacterial infections and keeping your teeth. So this is why the hygienist’s nag. It’s not because we are cranky, or angry with our spouse, or even that we hate our jobs. On the contrary! Your dental hygienist, I would venture to guess, is probably most likely an overachiever that has it in her mind that she, and she alone, will conquer all gum disease in the U.S. and the World…. and she is starting with YOU (such a geek)!

So let’s review some tools that are recommended for use to avoid gingivitis. These gadgets are available in our office and may have even been given to you already…maybe they are just hanging around in a drawer in the guest bathroom somewhere in your home! Well, let’s dust them off and get to work. Who knows, you might even grow addicted and help your hygienist reach her goal of curing periodontal disease one patient at a time!

First things first…The TOOTHBRUSH. Whether electric or manual, the toothbrush is one of two of the most important home dental tools known to man! Overstatement? I think not! (…soap box) In either case, the toothbrush is vital in removing plaque from the surfaces of the teeth that face the cheek/lips and tongue. The areas that are located inside as well as out! The majority of plaque on these surfaces collects mostly around the gum line, so it is important to concentrate efforts at the neck of the teeth where the gum and tooth meet. Over brushing or hard bristles can lead to accelerated gum loss or recession, so a soft bristled toothbrush with light pressure is recommended. Electric toothbrushes are extremely effective at plaque removal, but successful home care is not limited to the use of an electric brush. Slow, overlapping circular strokes of the brush on each tooth can be just as effective at controlling bacteria and preventing gingivitis.

FLOSSING could arguably be the second most critical home tool often nagged about by your, again, loving dental hygienist. Thorough effective flossing, without a doubt in my mind, results in healthy, tight gum tissue and squeaky clean teeth that harbor little to no cavity contributing food debris. Can I make this any clearer? This is not a case of “an old hygienist that can’t change with the science.” I LOVE SCIENCE! I CRAVE SCIENCE! Which is why I just about lost my mind when the U.S. Department of Health and Human Services made a statement to the effect that flossing was not as valuable as they thought? What? How many hygienist or dental professionals were on that decision-making committee? I would venture to say none! I feel confident enough to say that after thirty plus years in practice that I have noticed, without a doubt, that those who floss have far less dental concerns, infections, decay, bleeding, pain and tooth loss than those that do not floss. This is my opinion but hardly mine alone. Within hours of this report being released, the ADA and ADHA pleaded to the public …DO NOT TOSS THE FLOSS!

Now if you’re a skeptic, and I can appreciate skeptics… remember, I love science chock full of proven theories…let me ask you what on earth would be the motivation for the entire dental profession wanting the entire human race to floss? Do we have stock in string? No, but that’s a thought! It’s because we are health care professionals! We know this works. We want you to keep your teeth. We want you to be able to eat, chew, and digest in a way that is healthy for your body. We are determined to help patients altogether avoid or at the very least control gum disease. There are plenty of other things we can worry about even if we do stop gum disease in its tracks, in fact, I challenge you all to try! Start flossing every day and let’s see if the dental hygiene profession becomes stagnate…a lost art…a forgotten wasteland… Is anybody falling for this? Didn’t think so…but I will keep trying because I, along with all of my colleagues are ridding the world of decay and gum disease one patient at a time (well trying…).

Unfortunately, there have been few studies over the centuries on the impact of floss and the oral bacterial population. It’s a boring study of which we already know the result. So no one wanted to do this study, and no one wanted to fund this study…or so I read. But I can assure you when I floss your teeth I can see that I am reducing the bacterial population on that tooth. It is virtually mass destruction when I swipe that floss across the surface of the enamel. However, am I eradicating all the bacteria from your mouth when I floss or can you when you floss for that matter? NO!!!! We are not clearing every tiny organism from your mouth, that would be impossible. Bacteria are a normal part of the mouth and lots of ‘em! But when they gather on the tooth surface and colonize, and begin living off the food and sugars in your mouth, byproducts result in the form of acid production or endotoxins resulting in decay or gum disease respectfully. Now that sounds pretty scientific to me, and by the way, that is proven. That does happen all day, every day…twice on Sunday? Not sure about that… but I can’t say more about flossing. It took me many years to appreciate the value…again due to my need to prove and prove again the value of something before I give it my stamp of approval. But for this I do. I really, really do…

This leads me to all the “other” dental aids available. And there are countless. More than I know. Some are territorial, meaning I can attend a dental convention and learn of different dental aids fueling enthusiasm in a particular part of the country. Some tool that is catching on but these raves are all about design, branding, and ease of use but the desired outcome is the same…removing plaque. So I truly do not feel any one thing is best but more about what is going to motivate you to want to use this plaque remover daily? What floats your boat? If it is safe and effective, then I’m on board…get it? Such a great pun!

PROXABRUSHES, PIKS, RUBBER TIPS and the like!

Well, the majority of the tools to be discussed are generally used for the surfaces in between the teeth. They can be used to assist the floss…an adjunct if you will, but I still like the floss to make an appearance regularly. The reason being is floss reaches further below the gum line, where many other “in between” items just touch the surface. And since most of the periodontal bacteria produce destructive properties that cause bone loss and tooth loss, there is more success in keeping dental health if we can disturb those bacteria 3 to 4 mm below the surface…ideally every 12 hours or so. Using any of these aids will, however, help to reduce the overall bacterial population and will help to remove the bugs just below the gum line.

The Proxabrush looks like a little bottlebrush. Some are straight; some tapered. Some are thicker, and some thinner, top help reach very large or super tight spaces. Its purpose is to remove the plaque between the teeth and is to be used with an “in and out” motion. This tool works very well, brushing the surfaces of both teeth simultaneously! However, though I love this tool even for myself, It does not reach below the gum line at all. It is not designed to go below, and subsequently, bacteria are being left just under the loose collar of gum tissue that surrounds every tooth. It will have a great impact on the decay-causing bacteria that collects on the enamel between the teeth but will not reach the bugs more responsible for a potential periodontal infection. Piks have the same result. These are fantastic stimulators of the gum tissue and help to reduce microbes from in between the teeth, but also have limited access to areas below the gum tissue margin. The design and style on these ranges from barbed to smooth, triangular or round, soft or hard, wooden and plastic. We have most of these on hand in the office. Many of you have had them placed in your bag. Frankly, for me, your preference is my preference. I will give tips on the safest way to incorporate a new dental tool but generally speaking, when used properly all dental aids will help achieve dental health.

The Rubber tip is that old fashioned thing at the end of our toothbrushes when we were growing up that did not fit in the toothbrush holder! Come to find out that thing is useful! Who knew? The fact is, the rubber tip can single-handedly reduce inflammation at the margin of the gum line and help clean out plaque from areas with loose gum tissue that can trap food debris. A common spot is the wisdom teeth, especially during eruption, when the tissue is covering much of the biting surface. It is also a leader in gum stimulation, hence the name. It is used to trace the scalloped margins of the gum tissue.

Another aid deserving of at least an honorable mention is the End Tuft Brush. This brush possesses a small conglomerate of bristles at the end which can be used in hard to reach places such as the wisdom tooth’s surface next to the cheek.

The goal is to have healthy, tight PINK gum tissue and generally speaking, is quite easy to achieve with a little time and dedication. Our teeth take quite a beating from us through the years. We use them all day every day throughout our entire lives. It is only right to give them a little maintenance to keep them running smooth for a lifetime. Red, puffy, bleeding gums are a sign of gingivitis, or worse, periodontal disease. One is reversible with daily homecare habits and regular cleanings. The latter becomes a long-lasting battle, requiring the frequent visits, deep scaling, more time and more money…resulting in the unavoidable recommendation of brushing, flossing, piking, and stimulating daily. In the end, you get away with nothing so put the time in now. After all, gum tissue with gingivitis will keep no secrets…they will only be as loyal to you as you have been to them!

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