Ferit Kaval

Bleeding gums are a sign of gum inflammation. The cause is usually an incorrect brushing technique, or brushing being skipped. Various systemic conditions may also play a part, but oral hygiene accounts for 90-95 per cent of these cases.

When brushing is inadequate, food collects between the teeth and especially between the tooth and the gum. Bacteria feed on glucose just as we do; they multiply around that debris and form first dental plaque and, in time, calculus. That is how gum inflammation begins.

So what do we do? First we remove the cause, the calculus: we determine which of scaling, curettage and flap procedures are needed, carry them out, and clear the inflamed tissue that has formed. Then we improve oral hygiene so that the same thing does not keep happening.

I prescribe a toothbrush and ask the patient to bring it to the follow-up appointment, where I demonstrate brushing hands-on. After that we maintain the result with scaling at least every six months and routine check-ups.

I hear this belief almost every week, and because it leads patients to postpone the cleaning for years, I make a particular point of addressing it. In scaling we take nothing from the tooth itself; we remove the calculus and bacterial plaque that have attached themselves to it. What is worn away is not the tooth but the agent of disease sitting on it.

So what about the gaps and spaces felt after a cleaning? They were not opened by the cleaning; they were already there. The calculus had filled those spaces, and the inflamed, swollen gum had covered them over. Once the deposits are gone and the gum returns to health, the picture the disease built up over the years comes into view. The cleaning does not create the problem; it makes the hidden problem visible.

What really does the damage is postponing the cleaning out of this fear. Every month the calculus stays, it goes on affecting the gum and the bone that carries the tooth. I tell my patients this: scaling is not the procedure that wears your teeth away, it is the procedure that protects the tissues carrying them; and done regularly, it gets shorter and more comfortable every time.

A patient had come for an entirely different reason; during the examination I asked whether their gums bled when they brushed. 'Of course they bleed,' they said. 'Doesn't everyone's?' Since their youth they had accepted the bleeding they saw at every brushing as normal; it had never crossed their mind that it might be the sign of a disease.

That day, before the actual treatment, we sat down and talked. I explained that bleeding is the language of the gum, and that a healthy gum does not bleed with brushing. We did the cleaning, I prescribed a toothbrush and asked them to bring it along to the follow-up; at that session we practised brushing together at the sink.

When they came to the next check-up, their first words were 'it doesn't bleed any more when I brush'; they said it with pride, almost as an achievement. And they were right, because that result had been won not by me in the clinic but by them at home. Seeing that a symptom they had thought normal for years could actually be put right changed their whole relationship with their dental health.