Question

The annual check-up at my dentist is regularly frustrating for me (59). The dentist says that my gum problem is due to my poor dental hygiene. I clean my teeth after meals with a gentle toothbrush and also floss in the evening. I usually eat a piece of fruit in between. I don't know how to get my gum problem under control. The idea of losing my teeth because of periodontitis scares me. M. B. in C. 

Short answer

An annual check-up at the dentist alone does not solve the problem in any way. The correct treatment is for the dentist or dental hygienist to meticulously remove all bacteria on the tooth and root surface, including under the gums. This requires several sessions. In addition, perfect daily tooth cleaning is necessary, including in all interdental spaces. Disinfectant rinsing solutions or occasionally even antibiotics must often be used to support this. 

According to the description of your situation, your fear of losing your own teeth and the implant is justified. Every oral cavity is teeming with bacteria. They multiply constantly and rapidly, and plaque (= bacterial film) develops. Bleeding gums are an alarm signal for inflammation (gingivitis) and basically mean that improved, professional hygiene is necessary. Without effective countermeasures, there is a risk that the plaque will also grow under the gums and the bacteria will also multiply under the gums, causing the inflammation of the gums to spread to the bone. Inflammation of the bone (periodontitis) always means bone loss. The bone will recede towards the root tip of the teeth and the teeth will eventually lose their support. This process usually takes place very slowly over many years and is generally painless.

Professional help

Obviously, you are already doing everything you can personally do for your teeth. You need professional help to safely stop this process, as it has happened to your parents and many people from previous generations. Just having an annual check-up at the dentist, even if he cleans your teeth for 10 minutes and admonishes you, will not solve your problem in any way.

Several sessions

The correct treatment consists of meticulous 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, you need to clean your teeth perfectly every day, including all interdental spaces, to prevent re-infection. This cleaning should be practiced with you!

Occasionally even antibiotics

Regular professional checks of the gums and your hygiene efforts are essential, initially at short intervals. Disinfectant rinsing solutions or occasionally even antibiotics are also often necessary. In the vast majority of cases, modern dentistry, if carried out correctly, can preserve the patient's own teeth into old age. 

Author: Dr. med. dent. Jürg Eppenberger
Published in: Neue Luzerner Zeitung on August 18, 2008