As lockdown continues, and we face another few months of life without access to our traditional gym settings, I have been inundated with questions regarding training strategies that can be implemented at home.
When you build a house, you need great foundations. The foundations ensure stability, strength and longevity.
The gums are the foundations of the teeth. Healthy gums ensure that the natural teeth and any fillings, crowns, bridges or dental implants have the best chance of lasting a long time. Additionally, the mouth is the gateway to the rest of the body so having an unhealthy mouth can be detrimental to general health.
The gums have early warning signs that they are unhealthy - swelling and bleeding. You might notice bleeding when you brush your teeth, floss or even eat. If this bleeding is allowed to persist it can lead to gum disease where the gums recede and the teeth become loose, as the bone under the gum breaks down. It is really important to address bleeding gums quickly, before it reaches the bone, because the bone cannot grow back.
The most common cause of inflamed gums is plaque. Plaque is the thin film on the teeth that builds up throughout the day. It is mainly made up of bacteria and is hardly visible at first. It is mainly found where the tooth and gum meet, and may feel a bit “furry” when you run your tongue over it.
Bacteria in the plaque irritates the gums and can cause them to become inflamed and swollen which can then either be seen by redness or bleeding when touched.
There are certain situations where the gums bleed more, which will be explained later in this article. There are also general conditions affecting the body that negatively influence gum health which will we will also explore.
Smoking masks signs of gingival inflammation and bleeding. This is because the small blood vessels pull away from the surface of the gum due to the localised effect of the smoke. Smoking also increases the risk of developing gum disease by 10 times! The combination of masked inflammation and increased risk often results in smokers having more severe gum disease which can go unnoticed for longer if they are not regularly seeing a dental professional. Treatment for periodontal disease is less successful in smokers, as is the longevity of dental implants.
In most cases the gums won’t bleed if the teeth are cleaned efficiently every day. Getting rid of plaque daily with an effective oral hygiene routine reduces the chance of developing gingivitis and therefore the chance of subsequent gum bleeding is lowered. An effective oral hygiene routine includes toothbrushing (ideally with an electric toothbrush) and cleaning in between the teeth with either floss or interdental brushes. Brushing the teeth right down to the gums is the most effective way to prevent plaque build-up, using a 45degree angle into the gum line. If using a manual toothbrush, use small massaging circular motions with the brush at the gums. If using an electric toothbrush, ensure to keep the brush still at the gum line to get the full effect of the vibrations or oscillations of the electric brush. In both techniques it is important to brush one tooth at a time and not scrub backwards and forwards.
Mouthwashes should not be used as a replacement to brushing or flossing the teeth, that would be like using a perfume or aftershave without showering! A mouthwash might make things feel fresher temporarily but mouthwashes cannot penetrate the plaque layer. They should only be used at a separate time to brushing otherwise it washes away the ingredients in the toothpaste.
Once the gums have started to bleed it is important to get on top of a proper teeth cleaning routine. A small amount of bleeding can often be resolved at home with more dedicated and concentrated oral care (i.e. flossing or using interdental brushes daily). If the bleeding persists after one week seek professional help from your dental hygienist.
Dental hygienists are specially trained in the health of the gums; they diagnose and treat gingivitis and periodontal disease. They will assess the oral health using a combination of visual examination, probing of the gums to check for bleeding and “pockets” and possibly x-rays to assess bone levels. Gingivitis and Periodontal disease can only be diagnosed by a dental professional. This is why it is so important to regularly attend a dental practice to ensure any issues are caught and treated early.
A dental hygienist will normally give the teeth a thorough professional clean (scale and polish) at your appointment to get rid of remaining plaque, any harder calcified deposits and lift any staining off the teeth. They will also help you get to grips with an effective oral hygiene routine to do at home.
They can either be seen alongside a general dentist appointment or can even be booked independently without the need for seeing a dentist first. Most people should attend a dental hygienist appointment every 6 months as a matter of course, although there are situations where more frequent visits may be needed.
If the gum inflammation is more advanced more than one appointment might be needed to get things back on track. If periodontal disease has started to set in and destroy the surrounding bone it may be necessary to have a course of “periodontal therapy” which is deep cleaning under the gums over a few appointments usually with local aesthetic injections. This is to clean out bacteria and harder deposits from under the gums to give them a chance to heal. Patients having undergone this treatment should see their dental hygienist every 3 months.
Lots of people misguidedly turn to mouthwashes and other topical adjuncts when faced with gum bleeding. This is inappropriate because the bacteria that cause gum inflammation are chemically resistant but physically vulnerable meaning that they are much more effectively dealt with, by proper cleaning with tooth brushes and interdental cleaning! Mouthwashes, gels and other topical formulations should only be explored on the guidance of your dental professional once mechanical cleaning is at the best it can be.
There are things that can make bleeding gums worse, these include;
Pregnancy - Due to hormonal fluctuations the gums can over react to plaque. This is known as pregnancy gingivitis. Pregnancy can also contribute to the formation of localised gum swellings that look like raspberries – these are known as pregnancy epulis. Both occur more in the first trimester and often resolve after the baby is born. Oral care at home should be kept up or even increased during pregnancy and it is advisable to see your dental hygienist during this time to help combat any gum inflammation.
Certain Medications - These can either cause the gums to bleed or make the bleeding worse. The following are some examples (but not an exhaustive list):
Systemic Diseases - There may be other reasons why the gums are bleeding; this is why it is important to discuss your oral health with your dental professional on a regular basis.
An important take home message is that bleeding gums are not normal. It means that they are unhealthy. Ensure that the teeth are efficiently cleaned every day with a toothbrush and interdental cleaning methods. See your dental professionals as often as they suggest as a matter of course. However, if any gum bleeding is not resolved between appointments – for instance, 10 days from increasing your oral hygiene regime, or you are simply worried about your gums – seek the advice of a dental professional.
Want to keep learning? Find more articles from Frances Robinson:
Imagine playing a complex board game where everyone is playing by their own rules, except you don’t know what the rules are or how to invent your own. That’s what life can feel like when we haven’t learnt the skill of healthy personal boundaries.
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