How to save my teeth?

Dispelling Myths about Gum Disease: The Truth Behind Healthy Teeth and Gums

CHICAGO—February 18, 2010—The American Academy of Periodontology (AAP) estimates that approximately three out of four Americans suffer from some form of gum disease – from mild cases of gingivitis, to the more severe form known as periodontitis. However, despite this prevalence, approximately only three percent seek treatment for their gum disease. With increasingly more research indicating that gum disease may be linked to several other diseases, including diabetes, heart disease and certain forms of cancer, maintaining healthy teeth and gums has become more important that ever.

According to Samuel Low, DDS, MS, Associate Dean and professor of periodontology at the University of Florida College of Dentistry, and President of the American Academy of Periodontology, the discrepancy between the prevalence of gum disease and the lack of treatment can likely be blamed on a lack of understanding of the effect periodontal disease can have on overall health. “Patients do not always seek the periodontal care they require because they are not aware of the long-term and potentially dangerous implications of untreated gum disease,” says Dr. Low. “Unfortunately, there are a variety of myths surrounding periodontal disease and its repercussions.”

In order to help distinguish between fact and fallacy regarding periodontal disease, the AAP has identified and addressed below some common misconceptions about oral health.

  • Bleeding gums are not that big of a deal.
    Red, swollen and bleeding gums are an important sign of periodontal disease. If you notice bleeding while brushing or flossing, or when eating certain foods, you should schedule a visit with your dental professional to be evaluated for periodontal disease. Studies have shown that in addition to tooth loss, gum disease may contribute to the progression of other diseases, including heart disease and diabetes, so it is important that you begin treating periodontal disease as soon as possible.
  • You don’t need to floss every day.
    Routine oral care, which includes brushing after every meal and before bedtime, and flossing at least once a day, is the best way to prevent gum disease. However, a recent survey estimates that only 13.5 percent of Americans floss each day. It is vital that you keep up with your daily oral care, and see a dental professional for a thorough check-up twice a year. If gum disease is diagnosed, a consultation with a periodontist, a dentist who specializes in treating periodontal disease, may be beneficial.
  • A visit to the periodontist will be scary.
    Periodontists are gum disease experts. They have received three or more years of specialized training following dental school centered on the diagnosis, treatment and prevention of periodontal disease. Periodontists are equipped with the latest treatments and technologies, using innovative tools such as digital radiography, ultrasound technology, biomarker measurement and laser therapy to help make your visit more comfortable.
  • A tooth lost to gum disease is a tooth lost forever.
    Gum disease is a major cause of tooth loss in adults. However, in addition to treating gum disease, periodontists are also experts in placing dental implants – a convenient and comfortable way to permanently replace missing teeth. A dental implant is an artificial tooth root that is placed into the jaw to hold a replacement tooth. Studies have shown that dental implants have a 98 percent success rate, and with proper care, allow you to speak, eat and smile with confidence. In fact, a survey conducted by the American Academy of Periodontology found that over 70 percent of respondents reported being “pleased” or “extremely satisfied” with the results of their dental implants.
  • Poor oral hygiene is the only way to develop gum disease.
    Forgoing good oral hygiene can certainly contribute to the progression of gum disease, but there are a variety of other factors that can also impact your risk. For instance, tobacco use has been shown to greatly increase your chance of developing gum disease. Stress, poor diet, and even genetics, can also play a role in the health of your gums.

Here are some tips for saving your teeth:

  • When given a choice between tooth extraction and root canal treatment, always opt for a root canal. No denture, bridge or implant will look, feel and function as well as a natural tooth.
  • Act immediately when you experience symptoms of swelling or pain. Most endodontists can accommodate emergency cases, even on weekends, ensuring you’ll be seen quickly.
  • If your dentist recommends tooth extraction, ask whether the root canal is an option.
  • If you’re told root canal is not an option, ask why and request a referral to an endodontist or use the AAE’s Find an Endodontist search tool to find a practice near you.

Root canals treatment from an endodontist is virtually painless and often leaves you with less discomfort during recovery than if you have your natural tooth extracted. Thanks to modern techniques and effective anesthesia, patients who experience root canals are six times more likely to describe it as painless than patients who have a tooth extracted! Take the time to learn more about root canal treatment and some of the common misconceptions about it and then take the first step to a pain-free, healthy mouth by visiting an endodontist near you.

How does endodontic treatment save the tooth?

It’s necessary to have endodontic or root canal treatment when the inside of your tooth (the pulp) becomes inflamed or infected as a result of deep decay, repeated dental procedures, faulty crowns or a crack or chip in the tooth. Trauma to your tooth may also cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

When you undergo a root canal or other endodontic treatment, the inflamed or infected pulp is removed and the inside of the tooth is carefully cleaned and disinfected, then filled and sealed with a rubber-like material called gutta-percha. Afterward, the tooth is restored with a crown or filling for protection and will continue to function like any other tooth.

Endodontic treatment helps you maintain your natural smile, continue eating the foods you love and limits the need for ongoing dental work. With proper care, most teeth that have had root canal treatment can last a lifetime.

For more detailed information on root canals, click to visit our Root Canals Explained page that offers a step-by-step explanation of the procedure.

7 Daily Ways to Protect Your Teeth

Take care of your teeth

Some say the eyes are the window to the soul. But if you really want to know what someone’s about, check their smile. A welcoming show of pearly whites makes a great first impression, while a tight-lipped smile or whiff of bad breath does the opposite.

Read on for tips on how to make sure you’re giving your teeth the care they deserve.

1. Brush two times a day for two minutes

Brush your teeth for two minutes, twice a day, says the American Dental Association (ADA). This will keep your teeth in top form. Brushing your teeth and tongue with a soft-bristled toothbrush and fluoride toothpaste cleans food and bacteria from your mouth. Brushing also washes out particles that eat away at your teeth and cause cavities.

2. A morning brush fights morning breath

The mouth is 98.6ºF (37ºC). Warm and wet, it’s filled with food particles and bacteria. These lead to deposits called plaque. When it builds up, it calcifies, or hardens, on your teeth to form tartar, also called calculus. Not only does tartar irritate your gums, it can lead to gum disease as well as cause bad breath.

Be sure to brush in the morning to help get rid of the plaque that’s built up overnight.

3. Don’t overbrush

If you brush more than twice a day, for longer than four minutes total, you could wear down the enamel layer that protects your teeth.

When tooth enamel isn’t there, it exposes a layer of dentin. Dentin has tiny holes that lead to nerve endings. When these are triggered, you might feel all sorts of pain. According to the Centers for Disease Control and Prevention, almost 20 percent of American adults have experienced pain and sensitivity in their teeth.

4. Don’t turbocharge

It’s also possible to brush too hard. Brush your teeth like you’re polishing an eggshell. If your toothbrush looks like someone sat on it, you’re applying too much pressure.

Enamel is strong enough to protect teeth from everything that goes on inside your mouth, from eating and drinking to beginning the digestive process. Children and teens have softer enamel than adults, leaving their teeth more prone to cavities and erosion from food and drink.

5. Make sure you floss every day

Want to avoid minimal scraping at your next checkup? Flossing loosens the particles that brushing misses. It also removes plaque, and in so doing prevents the buildup of tartar. While it’s easy to brush plaque away, you need a dentist to remove tartar.

6. It doesn’t matter when you do it

You finally have an answer to the age-old question: “Which comes first, flossing or brushing?” It doesn’t matter, according to the ADA, as long as you do it every day.

7. Stay away from soda

“Sip All Day, Get Decay” is a campaign from the Minnesota Dental Association to warn people of the dangers of soft drinks. It’s not just sugar soda, but diet soda, too, that harms teeth. The acid in soda attacks teeth. Once acid eats away at enamel, it goes on to create cavities, leaves stains on the tooth surface, and erodes the inside structure of the tooth. To avoid drinking-related tooth decay, limit soft drinks and take good care of your teeth.

Tooth decay is the destruction of tooth structure and can affect both the enamel (the outer coating of the tooth) and the dentin layer of the tooth.

Tooth decay occurs when foods containing carbohydrates (sugars and starches), such as breads, cereals, milk, soda, fruits, cakes, or candy are left on the teeth. Bacteria that live in the mouth digest these foods, turning them into acids. The bacteria, acid, food debris, and saliva combine to form plaque, which clings to the teeth. The acids in plaque dissolve the enamel surface of the teeth, creating holes in the teeth called cavities.

To prevent tooth decay:

  • Brush your teeth at least twice a day with a fluoride-containing toothpaste. Preferably, brush after each meal and especially before going to bed.
  • Clean between your teeth daily with dental floss or interdental cleaners, such as the Oral-B Interdental Brush, Reach Stim-U-Dent, or Sulcabrush.
  • Rinse daily with a fluoride-containing mouthwash. Some rinses also have antiseptic ingredients to help kill bacteria that cause plaque.
  • Eat nutritious and balanced meals and limit snacks. Avoid carbohydrates such as candy, pretzels and chips, which can remain on the tooth surface. If sticky foods are eaten, brush your teeth soon afterwards.
  • Check with your dentist about use of supplemental fluoride, which strengthens your teeth.
  • Ask your dentist about dental sealants (a plastic protective coating) applied to the chewing surfaces of your back teeth (molars) to protect them from decay.
  • Drink fluoridated water. At least a pint of fluoridated water each day is needed to protect children from tooth decay.
  • Visit your dentist regularly for professional cleanings and oral exam.

Researchers are developing new means to prevent tooth decay. One study found that a chewing gum that contains the sweetener xylitol temporarily retarded the growth of bacteria that cause tooth decay. In addition, several materials that slowly release fluoride over time, which will help prevent further decay, are being explored. These materials would be placed between teeth or in pits and fissures of teeth. Toothpastes and mouth rinses that can reverse and “heal” early cavities are also being studied.

What Are The Stages Of Gum Disease?

What is Gum Disease?

Gum disease is an inflammation of the gums that can progress to affect the bone that surrounds and supports your teeth. It is caused by the bacteria in plaque, a sticky, colorless film that constantly forms on your teeth. If not removed through daily brushing and flossing, plaque can build up and the bacteria infect not only your gums and teeth, but eventually the gum tissue and bone that support the teeth. This can cause them to become loose, fall out or have to be removed by a dentist.

There are three stages of gum disease:

  • Gingivitis: this is the earliest stage of gum disease, an inflammation of the gums caused by plaque buildup at the gumline. If daily brushing and flossing do not remove the plaque, it produces toxins (poisons) that can irritate the gum tissue, causing gingivitis. You may notice some bleeding during brushing and flossing. At this early stage in gum disease, damage can be improved, since the bone and connective tissue that hold the teeth in place are not yet affected.
  • Periodontitis: at this stage, the supporting bone and fibers that hold your teeth in place are irreversibly damaged. Your gums may begin to form a pocket below the gumline, which traps food and plaque. Proper dental treatment and improved home care can usually help prevent further damage.
  • Advanced Periodontitis: in this final stage of gum disease, the fibers and bone supporting your teeth are destroyed, which can cause your teeth to shift or loosen. This can affect your bite and, if aggressive treatment can’t save them, teeth may need to be removed.

How do I Know if I Have Gum Disease?

Gum disease can occur at any age, but it is most common among adults. If detected in its early stages, gum disease can be improved so see your dentist if you notice any of the following symptoms:

  • Gums that are red, puffy or swollen, or tender
  • Gums that bleed during brushing or flossing
  • Teeth that look longer because your gums have receded
  • Gums that have separated, or pulled away, from your teeth, creating a pocket
  • Changes in the way your teeth fit together when you bite
  • Pus coming from between your teeth and gums
  • Constant bad breath or a bad taste in your mouth

How is Gum Disease Treated?

  • The early stages of gum disease can often improve with proper brushing and flossing. Good oral health will help keep plaque from building up.
  • A professional cleaning by your dentist or hygienist is the only way to remove plaque that has built up and hardened into tartar. Your dentist or hygienist will clean or “scale” your teeth to remove the tartar above and below the gumline. If your condition is more severe, a root planing procedure may be performed. Root planing helps to smooth irregularities on the roots of the teeth making it more difficult for plaque to deposit there.

By scheduling regular checkups, early stage gum disease can be treated before it leads to a much more serious condition. If your condition is more advanced, treatment in the dental office will be required.

Healthy Gums – healthy gums are firm and don’t bleed. They fit snugly around the teeth.
Gingivitis – gums are mildly inflamed, may appear red or swollen and may bleed during brushing.
Periodontitis – gums begin to separate and recede from the teeth. This allows plaque to move toward the roots, supporting fibers and bone.
Advanced Periodontitis – supporting fibers and bone are destroyed. Teeth become loose and may need to be removed.

Have a Loose Tooth? You’ll Need This Two-Phase Treatment to Save It

Although periodontal (gum) disease usually affects your gums first, your teeth may eventually suffer. That’s because the disease can damage both attaching gum tissues and supporting bone.

One advanced sign of this is when one or more teeth become loose. A loose tooth is an alarm bell that you’re about to lose it.

Fortunately, we can often treat loose diseased teeth with a two-phase approach. First and foremost, we need to bring the gum infection under control by removing plaque and calculus (tartar) — the “fuel” for the infection — from all tooth and gum surfaces. Depending on how extensive it is, we have options: we can use specially designed hand instruments to remove plaque and calculus, ultrasonic equipment that loosens and flushes plaque and calculus away, or, if necessary, conventional or laser surgery.

Depending on the extent of the infection, in some cases we may need to use regenerative surgical techniques like gum and bone grafting to replace lost tissue. Healing takes time, though, which leads to the second phase of treatment — securing the loose tooth during gum healing.

The most common way is through a bite adjustment, where teeth are altered to equilibrate chewing forces evenly. This results in all the teeth being hit at the same time allowing the loose teeth to heal and tighten up.

Another option is splinting teeth together. Although there are different methods, the basic idea is to join the loose teeth with stable teeth like pickets in a fence. One way is to bond splinting material across the back surfaces of the involved teeth. Another way is to cut in a small channel across the teeth and insert and bond a rigid strip of metal to splint the teeth in place.

The splint is usually a temporary measure while the gums heal. In some situations, though, we may need to perform a permanent splint by crowning the affected teeth and then splinting the crowns together. If you have a grinding habit we may also prescribe a night guard to limit the damage done while you sleep.

Before deciding on which technique is best for you, we would first need to evaluate the health of the affected teeth to see whether the effort would be worth it. It could be the tooth’s supporting bone structure has become so deteriorated that it might be better to extract the tooth and consider an implant or other replacement. First, though, we would attempt if at all practical to save the tooth — and the sooner we begin treating it, the better your chances for such an outcome.

If you would like more information on loose teeth and gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Treatment for Loose Teeth.”

Saving Your Own Teeth

Severe gum disease or bone recession in the jaw can lead to the loss of teeth. If enough bone is lost around a tooth, the teeth may need to be removed requiring replacement with dental implants, bridges, or removable dentures. These replacement options can be quite expensive and invasive.

Alternative procedures that will let you keep your own teeth are available. At the office of Scott H. Froum, DDS, we specialize in saving natural teeth through a wide range of advanced procedures to rebuild healthy gum tissue or reverse bone loss in the jaw. There are many advantages that can come with saving your natural teeth, including optimal aesthetics and better health of the teeth and gums down the road.

Dr. Froum’s periodontal background and extensive training has allowed him to build a practice that specializes in saving his patient’s teeth. Through the latest technology using fasers, growth factors, and regenerative materials, Dr. Froum has been able to save teeth that other dentists have wanted to extract. There is no better substitute than your own teeth, and Dr. Froum can help you keep them!

Dollars and sense: Saving teeth vs. placing implants

Scott Froum, DDS

Kyle L. Summerford

Figs. 1 and 1a

The long-term success rate of dental implants has been well-documented in the literature1 and is a technology that has been a boon to the financial element of dentistry. Similarly, retention of teeth with moderate to advanced bone loss via various periodontal treatment methods has enjoyed similar to higher long-term success rates.2 The practitioner often relies on clinical experience and therapeutic familiarity when deciding whether to extract periodontally involved teeth and replace with dental implants vs. saving the natural dentition with regenerative or resective therapy. A relatively new concept, however, that should be incorporated into this decision matrix is the long-term cost effectiveness to the patient when comparing treatment modalities.

Retention of periodontally compromised teeth with initial, surgical, and supportive therapy has been shown to have high long-term success rates in the literature.3,4 Typical periodontal treatment for patients with moderate to advanced disease when first presenting to a dental office can consist of quadrant scaling and root planing, osseous surgery with or without regenerative therapy (Figs. 1 and 1a), and supportive periodontal maintenance at specific intervals. Estimated totals for this type of “start-up” treatment are in the range of $2,000 to $4,000 depending on geographic location (see Table A). This treatment, if maintained by the patient with diligent home care, has proven to be effective in terms of the prevention of further periodontal progression and tooth retention over a long-term period.5

When analyzing the cost to maintain this start-up treatment via supportive periodontal therapy with maintenance intervals of three to four times a year with or without local adjunctive antibiotics, dollar amounts range from $500 to $1,000 a year, again dependent upon geographic location. In a small subset of the population (less than 5%), periodontal disease can reoccur after treatment, excluding those patients who demonstrate blatant noncompliance with home care, and treatment will have to be rendered again, increasing the overall costs of this type of therapy.6

Although implants have typically enjoyed high long-term survival rates,7 their associated initial financial impact is much higher than that of saving the natural dentition.8 Conservative valuations place start-up costs for implant treatment around two to three times higher than saving natural dentition via periodontal therapy (Table 2). In addition, implants are not without complications, and both biologic and/or mechanical complications can be associated with additional treatment costs to the patient. Recently, the literature has been replete with discussion of biologic complications in the form of peri-implant disease. Peri-implant diseases fall into two categories: peri-implant mucositis and peri-implantitis.

The term peri-implant mucositis describes a reversible inflammatory reaction in the mucosa adjacent to an implant,9 a term that has become known as implant gingivitis. Typical treatment involves quadrant scaling and root planing with implant-friendly armamentarium. The literature also has shown that mechanical debridement in conjunction with systemic and/or local antibiotic placement has increased the efficacy of this type of treatment10, but it can obviously be associated with higher treatment costs (Fig. 2). Studies show that the prevalence of peri-implant mucositis can be as high as 50% to 80% of implants in function.11 Peri-implantitis has been defined as an inflammatory process that affects the tissues around an osseointegrated implant in function and, like periodontitis, results in loss of supporting bone.

Fig. 2

Clinical treatment of this disease is often determined by severity, but in general often includes flap surgery, bone grafts, membranes, growth factors, and/or soft-tissue grafts12 (Figs. 3 and 3a). The overall financial impact upon the patient for this type of treatment can be quite high considering the patient was already subject to initial start-up costs of treatment. (Table C). In addition, maintenance intervals after implant therapy should be equal to if not more stringent than those of natural teeth. The prevalence of peri-implantitis has been shown in some studies to range from 11% to as high as 47% of implant sites analyzed.13 A large disparity in percentages can be seen when comparing the prevalence of reoccurring periodontal disease after treatment vs. the percentage of implants that will demonstrate complications after prosthesis insertion. With that said, studies show that periodontal therapy has proven to be cost effective when compared to other types of tooth replacement therapy over a 15-year period evaluation.14

Figs. 3 and 3a

The following tables present actual treatment cost differences between the patient opting to “save” the natural tooth (Treatment Plan A) vs. “removal” with extraction and implant (Treatment Plan B). These fees are dependent on geographic location and represent insurance codes from the New York City, Los Angeles, and Chicago areas.

Table 1

Table 2

Table 3

This information was presented to a real patient in a private practice setting along with long-term survival rate percentages of each of the comparative treatments. After reviewing the survival rates as well as the financial costs in relation to each treatment plan, the patient accepted Treatment Plan A, citing the following reasons: desire to keep her own teeth, less cost, and quicker time to completion.

Another real scenario that took place in a private practice with actual dollar amounts can be seen with Table 3. A patient had already paid for treatment in Table 2 in the $5,000 to $7,000 range and presented to the office with moderate peri-implantitis. In addition to the invested money, she was now going to be responsible for the dollar amounts shown in Table 3.

After reviewing the additional costs and lengthy healing time involved with surgery to correct the ailing implant, the overall costs associated with treatment were in the $8,000 to $9,000 range with more than three years of treatment time invested. Of important note is that most insurance companies limit the amount of reimbursement for implant-related services. Accurate ADA coding and submissions when dealing with insurance companies must occur in order to facilitate services and expedite reimbursements.

In conclusion, when deciding between saving the natural dentition and extracting and placing implants, there are many factors to consider. In addition to long-term success rates, the practitioner and the patient need to consider the long-term economic impact the patient will endure. Both implants and periodontal therapy to save natural teeth have high initial success rates with implants usually demonstrating higher start-up costs. However, when looking at long-term retention rates, teeth often demonstrate fewer complications and have less of a financial impact when correction is needed.

2. Carnevale G, Di Febo G, Tonelli MP, Marin C, Fuzzi M. A retrospective analysis of the periodontal-prosthetic treatment of molars with interradicular lesions. The International Journal of Periodontics & Restorative Dentistry 1991;11:189-205.

3. Hirschfeld L, Wasserman B. A long-term survey of tooth loss in 600 treated periodontal patients. J Periodontol. 1978;49:225-237.

4. Oliver RC, Brown LJ, Loe H. Periodontal diseases in the United States population. J Periodontol. 1998;69:269-278.

5. Axelsson P, Lindhe J, Nyström B. On the prevention of caries and periodontal disease. Journal of Clinical Periodontology, 1991;18:182-189.

6. Magnusson et al. Refractory periodontitis or recurrence of disease. J Clin Periodontol. Mar. 1992;23(3 Pt 2):289-292.

8. Schwendicke F, Graetz C, Stolpe M, Dörfer CE. Retaining or replacing molars with furcation involvement: A cost-effectiveness comparison of different strategies. J Clin Periodontol 2014; 41:1090-1097.

9. Albrektsson T, Isidor F. Consensus report of session IV. In: Lang NP, Karring T, ed. Proceedings of the First European Workshop on Periodontology. London: Quintessence, 1994: 365-369.

10. Salvi et al. Adjunctive local antibiotic therapy in the treatment of peri-implantitis II: Clinical and radiographic outcomes. COIR 2007;18:281-285.

11. Lindhe J, Myle J. Peri-implant diseases: Consensus report of the Sixth European Workshop on Periodontology. J Clin Periodontology 2008;35(suppl 8):282-285.

13. Koldsland O et al. Prevalence of peri-implantitis related to severity of the disease with different degrees of bone loss. J Perio Feb. 2010;81(2)231-238.

14. Pretzl B, Wiedemann D, Cosgarea R, Kaltsch-mitt J, Kim TS, Staehle HJ, Eickholz P. Effort and costs of tooth preservation in supportive periodontal treatment in a German population. Journal of Clinical Periodontology 2009;36:669-676.

Scott Froum, DDS, a graduate of the State University of New York, Stony Brook School of Dental Medicine, is a periodontist in private practice at 1110 2nd Avenue, Suite 305, New York City, New York. He is the editorial director of Perio-Implant Advisory and serves on the editorial advisory board of Dental Economics. Dr. Froum, a diplomate of the American Board of Periodontology, is a clinical associate professor at SUNY Stony Brook School of Dental Medicine in the Department of Periodontology. He serves on the board of editorial consultants for the Academy of Osseointegration’s Academy News. Contact him through his website at drscottfroum.comor (212) 751-8530.

Kyle L. Summerford is CEO and founder of Summerford Solutions, Inc., and editorial director of PennWell’s Dental Assisting Digeste-newsletter. He provides private business coaching for dentists. Mr. Summerford is a professional speaker focusing on topics such as increasing profits, staff etiquette training, and maximizing dental insurance benefits. He is a contributing author for Dental Economics, DentistryIQ, and Perio-Implant Advisory. Visit his website at www.ddsguru.com, available to dentists and team members for educational purposes, or contact him by email at [email protected] with inquiries regarding his practice management consulting services.

Periodontal Gum Treatment

Dawood & Tanner treat the diseases of the gum (Periodontal disease) that cause inflammation and loss of the healthy attachment of the tooth to the gum and jaw bone.

The best treatment is prevention, and if caught early simple hygiene measures may be all that is needed to regain control.

When gum disease becomes established, periodontal (gum) treatment is designed to re-establish a healthy attachment of the tooth to the jaw bone.

Surgery may be carried out to eliminate ingrained deposits of plaque and mineralised tartar (calculus), to regenerate lost or missing bone as well as to improve the types of gum tissue present around the teeth.

Whilst the majority of gum treatments are carried out to treat disease, we might also carry out gum treatments to improve appearance. These rejuvenating treatments are designed to add gum tissue where it is missing, for example as a result of recession, or to sculpt excessive tissues, for example where there is a ‘gummy’ or asymmetrical smile.

As ever, you need to protect your teeth from gum disease, because if it is allowed to progress, a ‘pocket’ develops between the tooth and the gum, and bone around the tooth is lost. If you notice that your gums bleed when brushed or are slightly swollen (and there may be no obvious signs), it is important to have regular dental reviews and hygienist sessions.Teeth compromised by the presence of deep pockets and the loss of the supporting bone, become loose and may move or drift, causing collapse of the ‘bite’, and unsightly spacing. Gum disease is the most important cause of adult tooth loss, and will lead to the need for more extensive treatments, such as Dental Implants.

Image 1: Advanced periodontal disease – many of these teeth are not salvageable. Image 2: Gingivitis- in this case the gums are visibly inflamed. Image 3: Beautiful healthy gums

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