Do you think your teeth look short? Do you feel like more of your gingiva shows than your teeth, creating a  “gummy” smile? Are uneven gums creating lopsidedness in your teeth? If so, adjusting the shape and length of your gums using recontouring can provide significant results. When you expose more of your white tooth enamel, it helps your smile look fuller, brighter, and overall healthier.

Also called “crown lengthening,” there are times when we need to shorten the height of your gums for health purposes. For example, if you have a tooth that needs a crown but is significantly worn down, we can reduce the gumlines so that more tooth is visible. This type of crown lengthening is used for restorative purposes, reducing the need for alternatives, such as tooth extractions. Therapeutic gingival contouring is also recommended for people who have chronic gum disease. This type of treatment is called “pocket reduction.” This is fairly similar to crown lengthening, however, it’s done for the purpose of reducing the depth of the pocket under your gums, where plaque and tartar accumulate. By shortening the depth of your periodontal pocket, the area becomes easier to clean with floss, thus reducing your chances of relapse and tooth loss.

In the past, gum recontouring was performed using invasive, surgical techniques. Fortunately, that’s no longer the case. Most Kois dentists incorporate gentle, soft-tissue laser technology which allows for minimally invasive treatments, including gingival contouring. The best part is that  the procedure of gum contouring with a laser is fast and practically pain free.

Numbing gel may be used during the process but it’s rare that the area needs to be numbed with local anesthetic. If for any reason you experience minor irritation, a warm saltwater rinse or ibuprofen is usually all that you need. Additionally, using lasers for gum recontouring eliminates the need for surgical techniques, sutures, or bandages. The laser gently cauterizes the tissue, so that bleeding and swelling are practically non-existent. This means your diet and exercise routines can return to normal soon after the procedure.

Talk to your dentist to learn more about gingival contouring, treating gummy smiles, crown lengthening, and more.

If bleeding gums is just now starting to be something than you’re seeing, the first place to start is with your home hygiene routine: 1. Start by brushing gently along the gumlines, massaging the gums as you go. 2. Brush for at least two minutes twice per day. 3. Floss daily around each tooth thoroughly, rubbing the strand up and down against the tooth, extending down below the gumlines. It may take up to two weeks to see complete reversal of the bleeding or gingivitis symptoms.

If symptoms persist, see dentist for a periodontal screening. There may be existing bone loss, a heavy amount of tartar buildup, or even a rough filling with an overhang that’s causing the gum irritation. In order to eliminate the active oral infection you may undergo a thorough deep cleaning and be given a dedicated home hygiene routine. Never ignore bleeding gums. When infection affects your oral health, it can have a direct impact on your overall wellness as your immune system works harder to control swelling and bacteria levels.

Red/Purple Areas Are most often an indication of inflammation, infection, trauma or surface blood vessels. Blood conditions such as thrombocytopenia and amyloidosis can create red/purple areas in your mouth. Individuals who smoke, have dry mouth or a weakened immune system, are more susceptible to yeast infections that cause inflammation and may appear as reddened areas with a white covering. Oral infections may be reddened and appear raised compared to the surrounding tissue. People with bite problems, broken teeth or an ill-fitting denture may have traumatized or inflamed tissues that look red and even ulcerated. Blood vessels often become more apparent in your mouth as you grow older and they show up as red/dark purple bumps. Brown Areas Usually caused by pigmentation in the gums or  the lining of your mouth. Populations with darker skin tones tend to have these brown areas and are a variation of normal mouth tissue appearance. Black Areas Usually benign “amalgam tattoos” and occur when gums or tissues are traumatized during the placement or removal of silver fillings. Amalgam tattoos won't grow or change over time and don't pose a health risk. However, black areas can also indicate a more serious condition, so it is important to have your dentist determine what has caused the change in coloration.

Note the size, location and duration of the area. Determine if it is painful and recall if you may have traumatized the area. If a colored area persists beyond one week, have it examined by your dentist.

Although some colored areas are normal variations of mouth tissue, many indicate underlying disease processes. If your colored area is caused by inflammation or infection, it will likely get worse as time goes on. If it is caused by ongoing trauma, it will also worsen with time. In the rare event that it is cancer, it can lead to disfigurement or death if not diagnosed.

Mouth ulcers may be caused by the following:

• Hot or spicy food
• Repeated rubbing from an ill-fitting denture
• Stress (canker sores or “aphthous ulcers”)
• A viral infection
• Erosive Lichen Planus (an autoimmune disorder)
• Cancer

Most mouth ulcers are caused by trauma (pizza burns) or stress (canker sores). People with weakened immune systems may be more susceptible to both canker sores and certain viral infections which show up as groups of small ulcers in the mouth. Trauma from an ill-fitting denture can also cause ulcers. More rarely, mouth ulcers may be caused by cancer.

Note the size, appearance, location and duration of the ulcer. Determine if it is painful, and recall if you may have traumatized the area. If an ulcer persists beyond one week, have the area examined by your dentist.

If the ulcer is the result of a disease process, it may worsen if left untreated. If it is caused by ongoing trauma, it may also worsen with time. In the rare event that it is cancer, it can lead to disfigurement or death if not diagnosed and treated in a timely manner.

White spots in your mouth may be due to the following:

• Chronic cheek biting causing scar tissue or a “Fibroma” to form
• Smoking
• Repeated rubbing from an ill-fitting denture
• Repeated rubbing from chewing food on gums in an area where teeth have been lost
• Yeast infection
• Lichen Planus (an autoimmune disorder)
• Syphilis
• Cancer

People who smoke and those who experience dry mouth or a weakened immune system are more susceptible to yeast infections, which may appear as white spots. People who smoke often develop white areas in their mouth, which are caused by tissue irritation from the smoke. People who grind their teeth commonly develop white lines on their cheeks from trauma. Trauma can also cause areas of whiteness when a denture is ill fitting or food rubs against a ridge area where teeth have been removed.

Note the size, location and duration of the spot. Determine if it is painful and recall if you may have traumatized the area. If a white spot persists beyond one week, have the area examined by your dentist.

If the white spot is the result of a disease process or a yeast infection, it will likely worsen if left untreated. If a white spot is caused by ongoing trauma, it will also worsen with time. In the rare event that it is cancer, it can lead to disfigurement or death if not diagnosed and treated in a timely manner.

Being “long in the teeth” isn’t necessarily due to aging. Rather, gums can start to recede and pull away from the teeth due to things like aggressive brushing, existing periodontal disease, past trauma, or even bruxism (grinding.) When they do, it’s impossible to get the gums to grow back on their own. Instead, intervention such as a graft may be needed.

There are a number of different approaches that a dentist can take to addressing receding gumlines. If the recession is very mild,an option may be to place a small amount of tooth colored composite (white bonding) over the area of the root that’s visible, simply for aesthetic purposes. More moderate to severe gum recession can compromise the health of a tooth. In such instances, a gum graft or pinhole type procedure may be best. These therapies aim to re-cover the exposed tooth surfaces, bringing the gum margins back to a normal and healthy level. When the new gum tissue “takes” after a minor oral surgery, it’s important to clean delicately around the area and care for it so that recession doesn’t reoccur. Aggressive scrubbing or clenching/grinding habits will need to be addressed to preserve the results of your soft tissue therapy.

Gingivitis occurs when plaque is allowed to build up around a tooth and create a sticky layer which causes a gum infection. If you look in your mouth you will see redness, swelling and bleeding of the gum around your tooth. Periodontitis occurs in susceptible patients when a long-term gum infection is not treated. Infection and resultant inflammation lead to the loss of ligaments and bone around the root of your tooth. Factors which significantly increase the risk of developing periodontitis include:

• Genetics
• Smoking
• Diabetes
• Medications (certain anti-seizure, blood pressure, and
• immunosuppressant medications)
• Stress
• Poor Oral Hygiene

Bleeding gums are usually just one symptom of periodontal disease, even if they’re the most noticeable when you’re flossing or brushing. Other conditions to be on the lookout for include: • Gum recession • Bad breath • Tartar buildup • Tooth mobility • Food packing between your teeth When treated promptly, gum disease can be halted before tooth mobility or loss have a chance to occur. But overlooking bleeding gums when you brush and occasionally floss is dangerous. Left untreated, such oral infections can allow plaque biofilm to spread directly from your mouth into your cardiovascular system, placing a significant strain on your body.

To minimize your risk of future periodontal disease, you must be mindful of the risk factors stated above. Gingivitis is usually well managed by adopting excellent oral hygiene practices. Periodontitis is more difficult to manage. Protocols recommended by your dentist may include:

• Non-Surgical Periodontal Therapy
• Root cleaning (scaling and root planing) at the appropriate intervals to manage your risk for bone loss
• Antibacterial mouth rinses
• Oral antibiotics
• Customized home care instruction
• Smoking cessation counseling
• Surgical Periodontal Therapy
• Recontouring of gum and bone around affected teeth to allow better access for professional root cleaning and daily home care
• Surgical Periodontal Therapy
• Recontouring of gum and bone around affected teeth to allow better access for professional root cleaning and daily home care

Bite problems on periodontally affected teeth can lead to accelerated periodontal disease and loosening of the teeth. If signs of a bite problem are present, the following may be considered to balance your bite and relieve excess pressure on periodontally involved teeth:

• Bite therapies including deprogramming and equilibration
• Orthodontic repositioning of the teeth
• Replacement of worn or damaged teeth
• Replacement of worn or damaged fillings
• Replacement of missing teeth
• Use of a custom-fitted bite guard to protect from grinding or clenching forces

Uncontrolled periodontitis is progressive in nature and will lead to increased bone loss and eventual tooth loss; ultimately affecting your ability to eat and speak. There are also connections between periodontal disease and other chronic diseases of the body such as cardiovascular disease, diabetes and rheumatoid arthritis. In pregnant women, periodontal disease is strongly linked to preterm, low birth weight.

These measurements are the depth of the sulcus or periodontal pocket at six specific points on each tooth. The bottom of the “pocket” is where the gingiva attaches at the root of your tooth. A small probe with millimeter increments marked onto it is slid just under the gums until it rests at the bottom of the pocket. Then the corresponding measurement at the edge of the gums is recorded, so that your dentist knows how deep each pocket is. We call this process a periodontal exam or probing.

A healthy gum sulcus is anywhere up to 3mm deep. We consider this “within normal limits.” But when plaque bacteria, inflammation, and disease start setting in, the tissues at the bottom of the pocket begins to detach from the tooth. At this point a periodontal pocket is created, which leads to a host of other symptoms, including:

• Loss of bone support
• Redness and swelling
• Halitosis
• Tooth mobility
• Gum recession

…and ultimately tooth loss. Depending on the depth of your periodontal pocket, the treatment protocol will be different. Moderate attachment loss (pockets 5-6mm deep) may require a periodontal scaling and root planing (“deep cleaning”) to remove infectious bacteria. Severe pocketing typically calls for more interceptive treatments, such as bone and gum grafting or referral to a specialist.

The only way to clean inside of a periodontal pocket is with regular flossing and/or the use of a water pik/flosser. Unfortunately, floss does not get more than 2-3mm below the gum tissues. If you have moderate to severe pocketing, it will be physically impossible to keep the root surfaces of your teeth clean with traditional floss. Some research does claim that water piks/flossers can clean up to 7mm below the gums, making them more useful than string floss.

While tooth loss is typically the biggest concern associated with periodontal pockets, the infection poses a significant risk to your overall health. Active gum disease drastically increases the risk and severity of systemic health conditions like:

• Heart attack
• Stroke
• High blood pressure
• Diabetes
• Infertility
• Erectile dysfunction
• Preeclampsia
• Pneumonia
• Respiratory illness

…and possibly Alzheimer’s Disease. Seeing a dentist for periodontal treatment isn’t just important for your smile, it’s vital to your health.

Depending on your oral health condition, the severity of your gum recession, and personal preferences, gum grafts can be selected from a few different sources. Connective Tissue Grafts —This very common graft uses a piece of connective tissue taken from the roof of your mouth by creating a small flap in the skin, removing some of the tissues underneath, then reattaching/closing the flap. The tissue is then sutured over the exposed tooth root to keep it in place as it heals. Free Gingival Grafts — Similar to connective tissue grafts, free gum grafts use a piece of skin taken from the roof of your mouth (without a flap being made.) Free gingival grafts are usually preferable when a large area of gum tissue needs to be restored. Pedicle Grafts — If there is plenty of gingival tissue adjacent to the tooth with recession, it can be partially sectioned and then stretched over the tooth that’s exposed. Allografts — Donor tissues are a safe and medically processed source (frequently used for burn victims) to prevent the need of harvesting tissue from your own body, which can sometimes be uncomfortable. As such, allografts lessen healing time.

In order for your graft to be successful and prevent infection, you’ll need to practice meticulous oral hygiene as the area heals. Carefully follow your dentist’s recommendations so as not to be too aggressive and cause the graft to fail. Additionally, the circumstances that led up to the reason for needing a graft will need to be kept in check. It could be that you’ve had a habit of aggressive brushing, using a stiff-bristled brush, tend to use smokeless tobacco or cigarettes, or were recently treated for periodontitis. Keep all of these factors in mind, so that your new soft tissue investment will be a success.

The following materials and techniques may be used in your nonsurgical periodontal therapy:

• Hand held instruments known as scalers and ultrasonics to clean the teeth.
• Local anesthetic (numbing) to control sensitivity.
• Antibacterial rinses to help decrease plaque and calculus.
• Antibiotic and antiviral pills to help kill bacteria and viruses and reduce the destructive response some people have to periodontal infections.
• Laser treatment to control bacterial levels around affected areas.

Some potential benefits of non-surgical periodontal therapy include:

• Eliminating the infection present
• Controlling further infections and bone loss
• Reducing swollen and bleeding gums
• Reducing bad breath
• Avoiding tooth loss
• Decreasing the risk for diseases associated with periodontal disease such as cardiovascular disease, diabetes and rheumatoid arthritis
• Decreasing the risk of preterm low birth weight babies in pregnant women

Some potential risks following treatment may include:

• Tenderness of the gums for a period of time
• Open spaces developing between the teeth at the gum line due to shrinkage of previous swollen gums; these spaces may trap food and cause increased temperature sensitivity of the teeth for a period of time.
• Temporary tooth staining from certain antibacterial rinses

The possible benefits of surgical periodontal therapy include:

• Removal of plaque and tartar in previously inaccessible areas.
• Elimination of hard-to-maintain periodontal pockets.
• Improvement of function and appearance.

Some potential risks following treatment include:

• Tenderness of the gums for a period of time.
• Increased temperature sensitivity of the teeth for a period of time.
• Shrinkage of the gums which may lead to longer looking teeth, more root sensitivity, increased spaces between teeth the near gum line and altered aesthetics.
• If gum and bone are being built back up, they may shrink or slough off during healing and the procedure may need to be redone.
• All surgical procedures carry a small risk of infection.

The alternatives to surgical periodontal therapy are non-surgical periodontal therapy and no treatment. It is important to understand that non-surgical periodontal therapy does not replace surgical periodontal therapy. If you do not manage your disease by adopting appropriate periodontal therapies, you must recognize the risk of further periodontal infection and ultimately tooth loss.

After periodontal surgery you shouldn't use hard toothbrushes or other dental hygiene aids that may irritate the surgical site. Post-treatment limitations during healing include avoiding chewing or put forces on the surgical site. As with any wound healing, a faster result with fewer complications will occur if the surgery sight is left unharmed.