The red and puffy gums that sometimes accompany the onset of periodontal (gum) disease don't always catch your attention. You may not even get any symptoms at all, in fact, until the disease has become well advanced.

That's why regular dental visits are so important for gum health: For while you may not notice anything abnormal about your gums, we have a simple procedure known as periodontal probing that can help diagnose the condition of your gums.

Gum disease is a common bacterial infection that affects millions of people worldwide. It most often begins with plaque, a filmy, bacterial buildup on teeth. These bacteria feed and multiply on the remnant food particles in the film, increasing the chances for an infection.

As it grows—as well as the inflammation the body initiates to fight it—the infection weakens the gum attachment to teeth. This can cause the miniscule gap between gums and teeth at the gum line to widen, forming a void called a periodontal pocket. The deeper and wider the pocket, the more advanced the gum infection.

We may be able to verify the presence of a periodontal pocket by using a long, thin probing instrument with millimeter gradations. We gently insert the probe at various locations around a tooth as far as it will comfortably go. We then record the depth by reading the gradation measures lined up with the top of the gums, as well as observing how snug or loose the probe feels within the gum space.

One to three millimeters signifies a healthy attachment between the tooth and gums—anything more than that usually indicates gum disease. Measurements of 5mm indicates a problem, the higher the number, the more advanced is the periodontal disease.

We use these probe readings and other factors to guide our treatment approach in individual cases of gum disease. With a less-advanced infection we may only need to remove plaque and calculus adhering to the crown and just below the gum line. More advanced gum disease infecting the root area may require surgical access through the gums.

All in all, keeping up with regular dental visits can increase the chances of early diagnosis, when the disease is still in its initial stages. And daily oral hygiene to remove harmful plaque may help you avoid gum disease altogether.

If you would like more information on treating 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 “Understanding Periodontal Pockets.”

Preventing periodontal (gum) disease not only preserves your teeth and gums, it might also benefit the rest of your health. There's growing evidence that gum disease has links to other systemic diseases.

Gum disease usually starts with dental plaque, a thin film of bacteria and food particles, which triggers a bacterial gum infection. Left untreated, the infection advances and steadily breaks down the gums' attachment to teeth.

This can create large ulcerated areas that are too weak to prevent the passing of bacteria and toxins into the bloodstream and other parts of the body. There's growing evidence from epidemiology (the study of the spread and control of disease) that this bloodstream transfer, as well as the inflammation that accompanies gum disease, could affect other body-wide conditions or diseases.

Diabetes. This chronic condition occurs when the body can't adequately produce insulin, a hormone that regulates sugar (glucose) in the blood, or can't respond to it. Diabetes can inhibit healing, cause blindness or lead to death. Both diabetes and gum disease are inflammatory in nature, and there's some evidence inflammation arising from either condition may worsen the other.

Heart disease. Heart attack, congestive heart failure, stroke and other cardiovascular diseases are a leading cause of death. Like diabetes and gum disease, these heart-related conditions are also characterized by inflammation. There are also specific types of bacteria that arise from gum disease that can travel through the body and increase the risk of heart disease.

Arthritis. An autoimmune disease, rheumatoid arthritis causes debilitating pain, particularly involving the joints, and leads to decreased mobility. Interestingly, many newly diagnosed arthritis patients are also found to have some form of periodontal disease—the two diseases, in fact, follow a similar development track. Although this may hint of a connection, we need more research to determine if there are indeed links between the two diseases.

Regardless of any direct relationships between gum disease and other conditions, preventing and treating it can improve both your oral and general health. You can lower your risk of gum disease by practicing daily brushing and flossing and undergoing regular dental cleanings to remove plaque. And at the first sign of gum problems, see your dentist as soon as possible for early intervention—the earlier the better.

If you would like more information on oral health care, 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 “Good Oral Health Leads to Better Health Overall.”

Wearing braces can pose challenges for your daily life and habits. One in particular is trying to keep your teeth and gums clean.

Braces or not, your oral hygiene needs to be thorough. Every day, your teeth accumulate a thin film of bacteria and food particles called dental plaque that can cause tooth decay or gum disease. It's essential to remove as much as possible each day by brushing and flossing.

That's a more difficult task with braces. The brackets and wires interfere with accessing many of your teeth's surfaces with a toothbrush or floss. As a result, braces wearers on average have a higher incidence of dental disease than non-wearers.

But while it's difficult to keep your mouth clean wearing braces, it's not impossible. Here are some tips and tools for making oral hygiene easier during orthodontic treatment.

A low-sugar diet. Besides items like chips that could damage your braces, you should also limit your consumption of foods and snacks with added sugar.  This carbohydrate is a primary food source for disease-causing bacteria. Limiting sugar in your diet can help reduce plaque buildup.

The right toothbrush. Brushing with braces is easier if you use a soft multi-tufted brush with microfine bristles. The smaller bristles maneuver better around the braces than larger bristled brushes. You'll still need to make multiple passes above and below the wires to be sure you're brushing all tooth surfaces.

Flossing tools. Traditional flossing using just your fingers can be next to impossible to perform with braces. But a tool like a floss holder or threader can make it easier to get between teeth. You might also try a water flosser that removes plaque from between teeth with a pressurized spray of water.

Dental treatments. Your dentist can give your teeth extra protection while you're wearing braces with topically applied fluoride to strengthen enamel. Using mouthrinses with an antibacterial ingredient like chlorhexidine may also reduce harmful bacteria.

Be sure you also keep up regular visits with your family dentist while wearing braces, and especially if you begin to notice puffy and reddened gums or unusual spots on your teeth. The sooner any case of dental disease is detected, the less impact it will have on your dental health.

If you would like more information on dental care while undergoing orthodontic treatment, 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 “Caring for Teeth During Orthodontic Treatment.”

Narcotics have long played an important role in easing severe pain caused by disease, trauma or treatment. Healthcare professionals, including dentists, continue to prescribe them as a matter of course.

But narcotics are also addictive and can be dangerous if abused. Although addictions often arise from using illegal drugs like heroin, they can begin with prescriptive narcotics like morphine or oxycodone that were initially used by patients for legitimate reasons.

As a result, many healthcare providers are looking for alternatives to narcotics and new protocols for pain management. This has led to an emerging approach among dentists to use non-addictive non-steroidal anti-inflammatory drugs (NSAIDs) as their first choice for pain management, reserving narcotics for more acute situations.

Routinely used by the public to reduce mild to moderate pain, NSAIDs like acetaminophen, ibuprofen or aspirin have also been found to be effective for managing pain after many dental procedures or minor surgeries. NSAIDs also have fewer side effects than narcotics, and most can be obtained without a prescription.

Dentists have also found that alternating ibuprofen and acetaminophen can greatly increase the pain relief effect. As such, they can be used for many more after-care situations for which narcotics would have been previously prescribed. Using combined usage, dentists can further limit the use of narcotics to only the most severe pain situations.

Research from the early 2010s backs up this new approach. A study published in the Journal of the American Dental Association (JADA) concluded that patients receiving this combined ibuprofen/acetaminophen usage fared better than those only receiving either one individually. The method could also match the relief power of narcotics in after care for a wide range of procedures.

The NSAID approach is growing in popularity, but it hasn't yet displaced the first-line use of narcotics by dental professionals. The hesitancy to adopt the newer approach is fueled as much by patients, who worry it won't be as adequate as narcotics to manage their pain after dental work, as with dentists.

But as more patients experience effective results after dental work with NSAIDs alone, the new approach should gain even more momentum. And in the end, it promises to be a safer way to manage pain.

If you would like more information on dental pain management, 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 “Are Opioids (Narcotics) the Best Way to Manage Dental Pain?”

A wave of madness is about to sweep across Indianapolis and onto television screens across America—March Madness, that is. That's right: After its cancellation in 2020 due to COVID-19, the famed NCAA men's basketball tournament is back with all 68 games scheduled to be played in and around Indianapolis. As you can imagine, there will be numerous health precautions, and not just for the pandemic—there should also be mouthguards aplenty.

Why mouthguards? Although you might think football and hockey would be rougher on players' teeth, gums and jaws, basketball actually tops the list of sports with the most dental injuries. Such an injury occurring from a split-second contact with another player could take years to overcome.

Fortunately, mouthguards are a proven way to reduce sports-related mouth injuries among professional and amateur basketball athletes. Made of a pliable plastic, mouthguards cushion against blunt forces to the mouth generated during play (and not only formal games—practices and scrimmages too).

But while wearing a mouthguard is a no-brainer, choosing one can be a little intimidating. True, they all work on the same principle, but there are dozens of types, designs and price ranges.

We can, however, distill them down to two basic categories: “boil and bite” and custom mouthguards. You'll find the first kind online or in a local retail sporting goods store. It's named so because you first place it in hot water to soften it, and then place it in the mouth and bite down to create an individual fit.

As an inexpensive option, boil and bite mouthguards provide a level of protection. But they also tend to be bulky and uncomfortable, which can tempt players to wear them less. And the softer plastic (compared to custom guards) allows for a lot of jaw (and in turn, teeth) movement, which can cause teeth to loosen over time.

Custom mouthguards, on the other hand, are created by dentists based on impressions made of the wearer's mouth. As such, the fit tends to be more precise, requiring less material than the boil and bite variety, thus affording a greater degree of comfort. And there's less potentially damaging jaw movement with a custom mouthguard. As you might imagine, custom mouthguards are more expensive, but compared to the potential treatment cost for a sports-related dental injury, it's money well spent.

Investing in a custom mouthguard for your family basketball (or football, hockey or baseball) player is a sound way to protect their dental health. And that's not madness at all.

If you would like more information about athletic mouthguards, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Athletic Mouthguards.”