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.

Before coming to me, my patient had been to four or five clinics. All of them had recommended extracting the teeth and replacing them with implants, and had offered a costly plan. As always, I listened first and then moved on to the examination. The looseness in the teeth was class 1 mobility, which does not call for extraction, and its cause was gum inflammation.

I explained that I did not recommend extraction and that with gum treatment we could keep the teeth for many years. The mobility would not disappear completely but would reduce considerably; if needed, we could extend the life of the teeth by joining them with what we call a splint. After the gum treatment we joined the teeth using fillings alone. We are now in our fourth year; the patient has no complaints and everything is fine at check-ups.

The cause of this picture was inadequate oral hygiene, and a lasting solution does not come from removing the current problem alone. I prescribed a toothbrush and an interdental brush and showed their use hands-on in front of the mirror. A lasting solution is reached by getting to the root of the problem.