Question

I (60, m) go to the dentist twice a year. I have had three loose teeth for a year. My dentist took x-rays. Diagnosis: slight bone and gum recession. Apart from a good cleaning, there is no other way to counteract this finding. J. D. in B. 

Short answer

All bacteria on the tooth and root surface, including under the gums, must be professionally removed by the dentist or dental hygienist. This requires several sessions. In addition, perfect daily tooth cleaning by the patient is necessary to prevent re-infection.

Every oral cavity is teeming with bacteria. They multiply constantly and rapidly. If these bacteria are not removed thoroughly on a regular basis, they form a thick (1 mm) bacterial film (plaque). 

If the plaque on the tooth surfaces and at the gumline is not removed, the gums will react with inflammation (gingivitis) after just two days. Pure gingivitis will heal again as soon as the bacteria are removed. Bleeding gums are an alarm signal for inflammation and mean that more regular and improved hygiene is necessary. 

Bone loss 

However, if the bacterial film remains in place for a longer period of time, the inflammation can spread from the gums to the bone. Inflammation of the bone (periodontitis) always means bone loss. The bone will recede towards the root tip of the tooth and the tooth will eventually lose its support. This process usually takes place very slowly over many years and is generally painless. As a result, periodontitis can often not be recognized by the patient until the tooth becomes loose. 

Regular measurements necessary 

Even the dentist and dental hygienist cannot recognize periodontitis with the naked eye. Regular specific measurements of the gums and x-rays are necessary to detect this disease at an early stage and to be able to intervene immediately. Tooth loosening indicates an advanced stage.

Remove bacteria professionally 

The treatment consists of the professional removal of all bacteria on the tooth and root surface, including under the gums, by the dentist or dental hygienist. This requires several sessions, possibly including gum surgery. In addition, perfect daily tooth cleaning, including all interdental spaces, by the patient themselves is necessary to prevent re-infection. This cleaning should be specifically demonstrated and practiced with the patient. Regular professional checks of the gums and the patient's hygiene efforts are essential. Disinfectant rinsing solutions or occasionally antibiotics are often necessary to support this.  

Author: Dr. med. dent. Jürg Eppenberger
Published in: Neue Luzerner Zeitung on January 08, 2007