“If you don’t make time for your wellness, you will be forced to make time for your illness.” This includes dental hygiene and understanding gum disease!
Dentists have always emphasized the importance of flossing, but I never fully grasped the consequences. I was never taught that brushing too hard was bad, or that the night guards I purchased on Amazon could be ineffective, or that skipping mouthwash could do more harm than good. My understanding grew as my dental bills increased. My hygienist’s explanations, combined with my own research, made it clear that preventing gum issues is super important.
I want to avoid spending thousands of dollars to fix my teeth and I don’t want my teeth to fall out earlier than they need to. Research also suggests a link between poor dental habits and heart disease or dementia, highlighting the need for consistent and long-term changes.
I’ve been flossing regularly for almost a decade, but that alone hasn’t been enough. Two years ago, I invested in a high-quality night guard instead of a cheap one. I was not consistently using mouthwash. I also thought I was brushing my teeth just fine – but I’m not going to take any more chances. I purchased an electric toothbrush to optimize how I brush. I now understand that mouthwash is more than something extra to do just because.
Had I known sooner exactly why flossing, mouthwashing, and brushing correctly are so important, I might have adopted these habits earlier. It would have been greater motivation to make change. I didn’t realize that the issues I’m encountering now are irreversible and can only get worse.
Dental jargon made dental issues seem less real
Dental jargon made the issues seem less real, so I didn’t fully grasp the seriousness of the issues. Because I didn’t get a true grasp of the terms, I didn’t take things as seriously. Two months ago I could not have explained gingivitis to anyone. I only knew tartar as “the hard white stuff” on teeth.
A quick Google search and here was my aha moment: plaque and tartar are basically different names for bacteria. Okay, makes sense. It sounds obvious, but I never made the connection. If plaque had instead been described as “a film of bacteria” and tartar as “calcified bacteria” during my dental visits, I might have taken my oral care more seriously.
Here are some definitions before we continue:
- Plaque: Soft, sticky film of bacteria that forms on teeth. It can cause tooth decay and gum disease
- Tartar: Hard, calcified plaque (bacteria) that builds up on teeth and can only be removed by a dentist. It also contributes to gum disease and tooth decay
- Gingivitis: Early stage of gum disease causing gum redness, swelling, and bleeding. Usually reversible with good oral hygiene
- Periodontitis: Advanced gum disease where gums pull away from teeth, causing bone loss and potential tooth loss. It results from untreated gingivitis
What do the numbers mean when they poke around your gums?
You know when the hygienist pokes around at your gums and reads numbers out loud? Well hygienists are measuring pocket depths between your teeth and gums. This measurement indicates gum health and the extent of gum recession.
- 1 to 3 millimeters: Healthy gums
- 4 millimeters: Indicates gingivitis or early periodontitis
- Greater than 4 millimeters: Suggests periodontitis, with deeper pockets that can harbor more bacteria and make it more difficult to maintain good oral hygiene
The higher the numbers, the greater the risk of gum disease, leading to potential tooth loss. My hygienist had asked me a few weeks ago if any of my teeth felt wobbly because the bone density of my teeth appeared to be decreasing. Yikes. The answer was no, thankfully.
Gum recession is not reversible
Gum recession cannot be reversed and cannot be fixed without expensive, and sometimes painful, surgical procedures. Gum grafting is one type of procedure that takes a small piece of tissue from another part of your mouth and is then attached to the recessed gum area. This can cost anywhere from $600 to $3,500 per tooth.
Gum recession can lead to tooth loss or other health issues
Risk of tooth loss
Healthy gums are what help to hold teeth firmly in place. When gums pull away from the teeth, it reduces the amount of tissue that supports them. This makes them more vulnerable to loosening or falling out over time.
Gum recession also exposes the roots of the teeth, which are more susceptible to infection. Gaps are created between the teeth and gums and this is where bacteria can accumulate. Trapped bacteria can lead to infections that can further deteriorate gum tissue and bone, making teeth weaker and more susceptible to falling out.
A dental implant to replace a missing tooth can cost anywhere from $3,000 to $5,000 each (with partial or no insurance coverage).
Nerve exposure and teeth sensitivity
First, a recap on the anatomy of a tooth:
- Enamel: The outermost layer of the tooth above the gumline. This is a hard substance that protects the tooth from damage and sensitivity
- Dentin: Beneath the enamel is dentin, a more sensitive, and porous layer that contains tiny tubules leading to the tooth’s nerve center (pulp)
- Root: The tooth’s root, which is normally covered by the gums, is made up of dentin (i.e., not protected by enamel)
When the gums recede, they pull away from the tooth, exposing the root (covered by dentin instead of enamel). Since dentin is porous and more sensitive than enamel, exposure to hot, cold, sweet, or acidic foods can cause discomfort. This happens because the tiny tubules in the dentin allow stimuli to reach the nerves inside the tooth.
Nerve exposure can also increase the risk of infections requiring the need for root canals. Root canals can cost anywhere from $500 to over $1000 per tooth, and are often only partially covered by insurance.
Gum disease can increase the risk of heart disease
Everything in the body is connected. I learned this from my trips to physical therapy – where my hip and knee issues are not due to issues with my hip or knee, but stem from issues with weak glutes, ankles, and ankle mobility. Gut health can impact depression and anxiety. Similarly, recessed gums (an indicator of gum disease) might possibly increase the risk of heart disease or even dementia.
Research has suggested that gum disease is a risk factor for heart disease (causality is still to be determined). Gum disease is caused by bacteria that grow in the mouth, which can then enter the bloodstream and travel to other parts of the body. This bacteria can cause inflammation in the heart, which can lead to heart attacks. Bacteria in the bloodstream can lead to inflammation in blood vessels, which can lead to coronary artery disease. Treating cardiovascular diseases can exceed $2000 per year.
Gum disease can speed up the progression of dementia
While research has not fully shown yet that gum disease is a definite cause of dementia, studies suggest that the presence of gum disease can at least exacerbate the symptoms. This means better dental hygiene can help slow the progression of dementia.
Just like with heart disease, the inflammation caused by gum disease can have effects beyond the mouth. Chronic inflammation in the gums can contribute to inflammation in the brain (i.e., the same bacteria in the mouth can travel up to the brain), and this is associated with cognitive decline.
One study found that older adults with gum disease and mouth infections were more likely to develop Alzheimer’s during the study period. Another study found that adults with Alzheimer’s disease have worse gum health than those without.
How does gum disease / periodontitis / gingivitis actually work?
“Gingivitis” used to be just a buzzword I heard on mouthwash commercials. I didn’t understand exactly what it was and how it progresses, and what could happen if it wasn’t addressed.
- When plaque accumulates and spreads to the gum line, gums get inflamed. This is gingivitis and it is reversible through consistent brushing (softly), flossing, and mouthwash
- When gingivitis is not treated, the body triggers a response to fight the infection. This response from the body breaks down bone and the connective tissue holding the teeth in place (i.e., the gums). This then turns into periodontitis, which is NOT reversible
- As the gums break down, they pull away from the teeth, creating gaps (or gum pockets). These pockets are more susceptible to being infected by bacteria, causing more tissue damage from the body fighting it off. The teeth become weaker due to bone loss, and are less held together by the gums, which can result in spreading out of the teeth, and potentially loss of teeth
What causes recessed gums?
Brushing too hard
This is the number one reason for recessed gums. For years I thought that if I brushed my teeth with more force and around my gums that I would be removing more plaque. This is incorrect and has contributed to my gum recession.
I now use an electric toothbrush which is a game changer for me because the vibration of the brush head does the work of cleaning for me (I no longer need to use a brushing motion). Mr. Nacho and I have a Philips Sonicare DiamondClean Smart electric toothbrush. While it’s expensive, it is worth it because it cleans well, is gentle on my gums, lets me know if I’m pushing too hard, when to move the toothbrush to the next section of my mouth, and also alerts when the brush head needs to be replaced.
Teeth grinding
I grind my teeth excessively. Someone once told me that it sounds like I’m chewing on rocks. This grinding (bruxism) exerts excessive and unnatural pressure on teeth and puts stress on the periodontal ligament. This ligament is a thin layer of tissue that connects the tooth to the surrounding bone. Over time, this constant pressure can cause the ligament to weaken or become damaged. When the ligament is compromised, the gums might start to pull away from the teeth, leading to gum recession.
Excessive pressure from grinding can also irritate the gum tissue, leading to inflammation. Over time, inflammation weakens the gum tissue, making it more prone to recession. Chronic inflammation also hinders the tissue’s ability to heal properly, which makes the problem worse.
Not flossing
Thankfully I’ve been a consistent flosser for a long time. However, as I’ve noted, flossing alone won’t solve all problems and has not solved all my problems.
Flossing removes plaque from between your teeth and under the gumline, where a toothbrush can’t reach. Without flossing, plaque (bacteria) thrives between teeth and gums, leading to the formation of tartar, which further irritates and inflames the gums. This gum inflammation obviously leads to long-term gum damage, like what has been described throughout this post.
Not changing out your toothbrush head
I would often wait to change out my toothbrush head because (1) the bristles seemed fine; and (2) I could save some money by squeezing out some more uses out of the toothbrush. Well, I missed the memo that bacteria can live and build up on these bristles and get transferred back into your mouth and gums.
Obviously if the bristles wear down, they’re not as effective at cleaning in between teeth to remove food particles and plaque. The shocking part to me was that bacteria continues to build up and spread to your gums.
The American Dental Association recommends replacing a toothbrush or toothbrush head every 3 to 4 months.
Things I wish I started paying attention to earlier
There are many things I have learned in my mid-thirties about dental hygiene that I wish I had known earlier.
- I would have switched to an electric toothbrush sooner (and not brushed so hard)
- I would have purchased a legit night guard from the dentist (even though it’s expensive) for my teeth grinding
- I would have consistently used mouthwash 1-2 times a day to fight bacteria (note: more than 2 times a day can do more harm than good)
I was already flossing consistently everyday – but again – flossing alone was not enough.
Some final thoughts
Dental health is like your physical health. “If you don’t make time for your wellness, you will be forced to make time for your illness.” It can be annoying and added work, but the alternatives in the long-term can be painful and expensive.
I would encourage people to start researching more about dental health and these procedures. Also make sure you understand what is covered by insurance.
I was told at the dentist that I would need a “deep cleaning” (scaling and root planing), which essentially means two appointments to clean each half of your mouth. This requires numbing half your face so that the hygienist can deep clean under your gums to slow the progression of gum disease. And this may or may not be partially covered by insurance. Once you have a deep cleaning, you need to come back every 3-4 months for a “periodontal maintenance” cleaning (which is more expensive) as opposed to a regular cleaning. It seems like it’s possible you’d never go back to true regular cleanings after this – but due to your oral health status.
Oof. Happy brushing and godspeed!
