Gum Disease
Is that a silly question?
Many people admit to only going when something goes wrong and they need an obvious problem fixed. Reports show that proportionately fewer people attend for regular dental check-ups and hygiene sessions. Why?
Not so many years ago most people either went or knew they ‘should’ visit their dentist every six months. Are people less convinced of the need to do so now? If so, there could be a number of reasons:
- We have had a six year recession which we may well not be out of yet.
- The general level of dental health of some (not all) of the population has improved over the years.
- A few years ago there was a report, endorsed by the government of the day, suggesting that half yearly check-ups and cleanings weren’t really necessary.
- The increased use of electric tooth brushes may raise the perception of better oral hygiene and so less need for professional attention.
What do most people want and expect of their own teeth?
Quite simply ….to keep their own teeth healthy, comfortable, functional and aesthetic for their entire lives, which may well run to nine decades or more. That is quite a contrast to people fifty years ago who often ‘expected’ to lose their teeth by their forties and spend the rest of their lives wearing plastic dentures. Can such expectations be reasonably fulfilled without appropriate professional dental help? Probably not. What does it take to optimise the chances of achieving those goals? It has to be a combination of excellent home oral hygiene and good regular preventative dental care and maintenance. The answer is in maintaining a plaque-free mouth that results in strong healthy teeth and dentistry that lasts.
What is the dentist’s role?
The human body is much like any other machine, say a motor car. If you want a car to last, to run smoothly and efficiently, not to keep breaking down, to minimise expensive and preventable repairs and to be safe, it’s not even enough to just have MOTs (a legal requirement); you need to have it serviced regularly. This should be done by mechanics you trust.
The teeth are amongst the hardest working structures of the human body, they take a lot of pressure and even abuse. Like cars, they need regular servicing.
A check-up can take 2 minutes or it can take half an hour. A thorough, worthwhile and effective half yearly dental check should incorporate:
- Evaluating gum health and looking for signs of infection/inflammation (eg. bleeding, pocketing).
- Checking for early failure of older restorations (leakage or fractures) and evidence of any new decay.
- Evaluating any changes or increases in aggressive tooth wear (dental night-time grinding).
- Checking that the bite of upper to lower teeth remains evenly balanced.
- Looking for any signs of oral cancer.
Usually a scaling/cleaning hygiene session is carried out on the same visit. This has tremendous value even in a mouth that is cleaned well at home twice a day.
- Plaque and tartar deposits are removed from areas that are difficult to access by the patient him/herself.
- Home hygiene techniques (even with an electric toothbrush) can be monitored and corrected as appropriate.
- A high level of awareness and motivation is maintained by continuously reminding and refocusing on hygiene techniques.
Anecdotal evidence in my own practice over the last seventeen years has shown that it is the patients with the healthiest teeth that come regularly every six months and it is the patients that come regularly that have the healthiest teeth; a classic chicken and egg scenario. These are also the patients who end up with the least dental crises, the lowest long term dental expenses and actually …the nicest smiles.
Patients who return after significant absences (and it is usually some dental crisis that prompts them to do so), most often show evidence of plaque accumulation – swollen, bleeding even tender gums as well as stained, darker teeth, Not infrequently visual or x-ray examination may show up areas of decaying leakage as well. Dental care, instead of being preventative, becomes reparative or curative.
To finish … a true story
I recently saw a patient that used to be under my care for a few years until about ten years ago. I had completed a beautiful porcelain aesthetic correction on all her upper front and side teeth. She had very good oral hygiene and was well motivated. However as she did not live or work in London, she registered with her own local (private) dentist and saw him regularly for the last ten years. For whatever reasons, most of which involved a large degree of ‘supervised’ neglect by that dentist, her hygiene levels slid and plaque was allowed to accumulate under the gum levels around all the dentistry I had previously placed. An upper front ‘gum abscess’ had formed, which, in effect was being ignored by that dentist. This finally pushed that patient to return to me for an opinion and treatment. Moreover, she was still a beautiful middle aged lady who now had become ashamed of her damaged smile. She needed to have the gum disorders reversed and all the reconstructive treatment replaced. Although she now has an immaculately healthy ( plaque free) mouth and a beautiful smile once again, it took many hours and a considerable financial investment to correct what was a result of avoidable and preventable neglect .
