Bleeding, inflammation, and pocket depths of the gums. A dentist can determine all three, but when gauging the state of your gums at home, bleeding when brushing or flossing is a sign that some form of gum disease is present. This can be due to inflammation from plaque or calculus. Have this checked at a dental visit before the gum condition progresses with time. If you’re a smoker, your gums probably won’t bleed, because nicotine constricts the tissue, so this may be masked Otherwise, bleeding when brushing or flossing indicates a need for some further attention.

Periodontal disease changes the approach to tooth brushing, and standard techniques must be modified. For patients with a large amount of exposed root structure, the surface of these teeth above the gums is often too large for a toothbrush to completely cover in one round of brushing. Brushing all the crowns of the teeth, then going back and brushing all the roots like a second set of teeth, may be needed to prevent further periodontal disease and ensure sufficient brushing.

Untreated gingivitis will progress to periodontitis. The numbers you hear called out during the periodontal portion of your exam describe the gum health. 1-3 millimeters is a desirable, healthy number. If the gums bleed, gingivitis is usually present. 4 millimeter depths = slight periodontitis, and define the official point where the gum is loosing its connection to the tooth. Next comes bone loss as bacteria migrate further under the gums. 5 millimeters = moderate periodontitis, and anything 6 millimeters or more is severe. For slight periodontitis, the gums usually return to a healthy state if the proper cleanings are obtained. For moderate periodontitis, it is still possible. For anything severe, very few sites recover to their previous state, and specialized cleanings or surgery become necessary. If the gums don’t rebound, cleanings every 3 months may be needed for the rest of a person’s life to prevent further bone loss. The only other way to get out of these cleanings is by having gum surgery.

Calculus forms on teeth from plaque and food debris that doesn’t get fully flossed and brushed off. This material is usually very hard – like cement. In smokers, it is especially tenacious. This is because the smoke quickly dries the plaque on the surfaces, making it very hard. It becomes “smoked” on. As a result, smokers often have exponential periodontal disease. If you smoke, brushing BEFORE you smoke can help reduce this effect.

A large source of cavities and gum disease comes from a lack of SUFFICIENT flossing. In my experience, it takes about 12 brush strokes with a manual toothbrush to fully get plaque off the surface of a tooth. One surface. Many teeth have 3 to 4 surfaces accessible to the brush. You want the floss to contact each the tooth surface where the brush can’t go: in-between teeth, and the back of the BACK-MOST tooth or teeth. Moving the floss up and down once is not enough. You must curl it around each in-between surface, and move it up-and-down several times to wipe the plaque off. I recommend 4-6 times each tooth surface.

A follow-up point to the last flossing tip: if you only floss at night, you may be leaving food in-between your teeth for an entire day. Breakfast, lunch, dinner… This can cause gum disease, bad breath, and the risk for cavities forming on these surfaces of teeth. Try to floss, even if briefly, after another meal in the day – especially if there was meat. Your oral health will benefit in the long run.

Scaling and root planing is the first type of treatment for periodontal disease. It is often a procedure that can be over-prescribed. If seeing a new dentist and a sudden unexpected diagnosis of periodontal disease is given with a large dental bill, it can be very helpful to get a second opinion. Lots of things need to be considered when prescribing this treatment, particularly: (1) whether you’ve had the procedure before and your condition is STABLE rather than progressing (a new dentist may not know its history), (2) whether the diagnosis was in fact accurate, and (3) whether you should see a specialist, rather than continue the same pattern of cleanings.

“Scaling and root planing” is a standard treatment for periodontitis. It can either cure or stabilize the condition. The earlier it is treated, the better are the chances for the gums recovering. When you hear the dentist or hygienist calling out numbers while measuring your gums, anything 4 or more is concerning. Typical prognoses for scaling and root planing are:
Slight periodontitis (4mm pocketing): good
Moderate periodontitis (5mm pocketing): questionable to good
Severe periodontitis (6mm pocketing or more): questionable to hopeless, not often treatable without gum surgery – which improves the prognosis.

For more than 30 years, dentistry and medicine have been trying to find more than a correlation between oral bacteria and cardiovascular disease, and now they have. Oral bacteria that cause plaque, gum inflammation, and periodontal (gum) disease make their way into the blood through the gums, and contribute to plaque in the arteries by causing inflammation. Circulating fats from our meals then stick to those areas in the arteries and become plaques. This is particularly problematic in patients with periodontal disease, where these bacteria fester in the deep pockets of the gums. In the publication “Quantitative detection of periodontopathic bacteria in atherosclerotic plaques from coronary arteries”, Gaetti-Jardim et al. found 47.3% of bacteria DNA in atherosclerotic plaques in patients with periodontal disease was from oral bacteria, while only 7.3% was found in patients without periodontal disease. Maintaining healthy gums means there are fewer inflammatory bacteria in your blood. Plaque on your teeth leads to plaque in your arteries. So take good care of your teeth and gums, and make sure periodontal disease is treated before it becomes a chronic problem. 

Smokers often have aggressive gum disease and plaque buildup on their teeth. This is because any plaque on the teeth gets dried by the smoke, and essentially “smoked” onto the tooth – becoming incredibly hard to remove. For anyone who likes cigars, cigarettes, vaping, or any type of smoking product, brushing and flossing beforehand can reduce this problem tremendously. Brush with water only, as there is some evidence that whitening products, such as those in toothpastes, can increase the risk of oral cancer when used closely with tobacco.