Receding Gums: Causes, Dangers and Treatments

By Dr. Omar Aldaoudi, Specialist Prosthodontist

Gum recession or receding gums refers to the loss of gingival (gum) tissue causing the exposure of the roots of the teeth.

Receding gums is a common dental problem in adults over the age of 40, but it can occur in younger ages. It can be generalized or localized and it is progressive in most cases. Usually, the first sign is hypersensitivity to cold and hot drinks. Also, the affected teeth appear longer and the roots are visible, a notch could be felt near the gum line, and spaces between teeth seem larger.

CAUSES

Gum recession has many causes and risk factors:

• periodontal or gum disease
• poor oral hygiene
• aggressive brushing
• hormonal factors
• gingival trauma
• poorly-fitted restorations
• teeth grinding or clenching
• malposition of the teeth
• smoking and chewing tobacco
• genetic predisposition

DANGERS

When gums pull away from your teeth, the roots of your teeth are left exposed and this puts you at risk for tooth and root decay. Left untreated, receding gums can also lead to functional and aesthetic complications.

TREATMENTS

The treatment of the gum recession depends on the cause, your dentist can help you to identify the problem and determine the best treatment plan.

If the recession is caused by periodontal disease, scaling and roots planning, stabilization treatments and perfect oral hygiene are extremely important to avoid further gingival and bone loss.

When the condition is a result of overaggressive brushing, your dentist and hygienist can assist you by demonstrating the proper brushing technique and recommending the best oral hygiene tools adapted to your case.

Also, you can prevent gingival recession by eating healthy food, maintaining a balanced diet, smoking cessation and regular use of night guard if you grind your teeth.

In some advanced cases, gum tissue regeneration and gingival grafting could be performed by a periodontist or oral surgeon.

Visit your dentist and hygienist regularly and inform them in case of family history of gum or periodontal disease.

If you are experiencing hypersensitivity, your dentist may apply desensitizing agents, varnishes and dentine bonding agents, he may also recommend specific toothpaste and mouthwash to reduce and treat the sensitivity.

About Dr. Omar Aldaoudi

Dr. Omar Aldaoudi DU, CES, DIU received his Doctorate in Medical Dentistry in 2003. He then completed advanced specializations and earned his certificate in Fixed and Removable Prosthodontics from the University of Paul Sabatier in Toulouse, France in 2007. Dr. Omar comes to Dr. Michael’s Dental Clinic with vast experience in cosmetic and restorative dentistry, esthetic, functional and prosthetic rehabilitation.

What Is Oral Cancer And Are You at Risk?

April is Oral Cancer Awareness Month.

Regular dental checkup is the first line of defense in early detection of oral cancer.

According to the World Health Organization (WHO), oral cancer ranks eighth among the most common cancer worldwide. Globally, more than 300,000 new cases of lip and oral cavity cancer were estimated to have been diagnosed in 2012.

In the United States, oral and pharyngeal cancer (cancer of the mouth and upper throat) collectively kills nearly one person every hour.

In the Middle East, a multicenter, retrospective study on oral cancer finds that the death rate due to oral cancer in the Middle East is reported to be approximately 2 in 100,000.

Dr. Marwan Al-Obeidi, Clinical Head at Dr. Michael’s Dental Clinics talks about the disease and the role of dentists in its early detection.

What is oral cancer?

Oral Cancers are a part of a group of cancers commonly referred to as head and neck cancers. Oral cancer can affect any part of the oral cavity, particularly the tongue, floor of the mouth, the cheeks, bones, and lips. It is among the most prevalent cancers in the world and its incidence is increasing every year. The prevalence of this cancer is higher in males than females.

What are the causes of oral cancer?

There appears to be a direct link between oral cancer and well-defined predisposing factors. These factors are mainly tobacco smoking and smokeless tobacco (chewing) and alcohol. In fact, the WHO reports that tobacco use (smoking or chewing) and excessive alcohol consumption account for an estimated 90% of oral cancers worldwide.

Exposure of the lip to direct sunlight also accounts for a very high rate of lip cancers in countries with a population exposed to high amounts of direct sunlight such as Australia and indeed the Middle East.

Other risk factors include genetics and a certain group of viruses known as HPV (Human papillomavirus).

What is the role of dentists in oral cancer detection?

Our role as dentists is vital in early detection of oral cancers as early detection has been proven to dramatically increase the chances of successful treatment and survival rates for patients. We are also working very hard as a group of professionals to educate the population on the risks of predisposing factors and trying to raise awareness about this ever growing threat to our health.

It is very important that our patients are aware of any predisposing factors that can affect their health and we are continually trying to reduce the exposure to these factors.

Alongside health promotion, we also have a duty to carefully examine the whole oral cavity during each checkup appointment. As dentists, we are uniquely placed in a privileged position to be able to see most of our patients every 6 months for routine dental examinations. It is at these examinations that a general oral cancer screen is carried out where not only do we discuss any predisposing factors but we also actively screen for any abnormal lesions in the mouth.

How is oral cancer detection done during dental checkups?

As part of your routine dental exam, your dentist will feel for any lumps or irregular tissue changes in your neck, head, face, and oral cavity. When examining your mouth, your dentist will look for any sores or discolored tissue as well as check for any signs and symptoms mentioned above.

Your dentist may perform a biopsy if he or she sees tissue in your mouth that looks suspicious. This test is painless and involves taking a small sample of the tissue, and analyzing it for abnormal cells. Alternatively, if the tissue looks more suspicious, your dentist may recommend a referral to a more experienced specialist colleague who will carry out further tests if necessary. These tests are vital to detect oral cancer early, before it has had a chance to progress and spread.

What are the warning signs of oral cancer?

Oral cancer can present itself in many ways and is usually pain free at the early stages. It can present as simple swellings or lumps or even a patch on the oral mucosa (soft tissues) which can appear as just a redness or even a simple ulcer which doesn't heal. Other signs to look out for are a change in the hoarseness of the voice or difficulty in swallowing and movement of the tongue can be found to be constricted. All of the above can usually be accompanied by a dramatic decrease in weight over a relatively short period of time.

Importance of regular dental visits

It is very important to regularly visit your dentist even if you are not experiencing any symptoms as oral cancer often remains pain-free for several months and the patient is usually unaware of any abnormalities.

On your appointment, you should inform your dentist of all habits that could be predisposing to cancerous lesions such as tobacco use and alcohol consumption and any other medical conditions you may have. It is also important to inform your patient of any family history of cancer. The dentist will give you advice regarding these factors before carrying out a detailed examination of your oral cavity to ensure that no lesions or abnormalities are seen.

Remember, early detection is critical for successful treatment so if you haven't seen your dentist for a while, book a checkup appointment now and make sure that not only your teeth are healthy but your whole mouth is disease free!

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Early Childhood Caries: A Major Health Concern

By: Dr.Carol Onyango DMD, MPH

1.        What is Early Childhood Caries (ECC)?

Dental caries is a chronic infectious disease caused by bacteria that breaks down sugar into acids which erode teeth over time. 

If a child under the age of six years old has at least one cavity, missing tooth due to dental caries or a filling on any baby tooth, then they are considered to have early childhood caries. 

If they are younger than three years old, and have a cavity on any tooth surface, then this is severe early childhood caries.

2.      What are the risk factors of early childhood caries?

Apart from poor oral hygiene, there are several risk factors that increase chances of getting ECC.  Young children are at risk of early childhood caries if their caregiver has high levels of the bacteria causing decay.  The disease can be transferred to the child through saliva for instance, when sharing utensils or cleaning a pacifier with the mouth. 

Other risk factors include a high consumption of sugar particularly between meals.  The most obvious foods that cause decay are chocolates, sweets, cookies, juice, sodas and so on.  However, sticky sweet foods such as raisins, dates and some dried fruit also increase the risk of tooth decay.  Some medicines given to children are flavoured with high amounts of sugar and this too may increase the risk of early childhood caries. 

Putting sweet drinks in sippy cups and milk bottles and/or allowing children to go to sleep with milk in a bottle increases the risk of developing ECC as well.

3.      What are the consequences of ECC?

The health of children’s teeth should not be minimised just because they are “baby teeth.”  When children have ECC, the resulting pain and infection can cause several major problems.  Most children are not very good at describing pain and parents may become aware of the severity only as a result of restless nights or poor sleep, poor eating habits and lack of concentration in school; all of which are very important for proper growth and development of the child. 

In addition, if ECC is left untreated for a while, the infection can become serious leading to high fever, admission into the hospital, emergency room visits and a much higher cost of treatment.  Children who have ECC are also more likely to develop caries in their permanent teeth if changes are not made early on.

4.      How can ECC be prevented?

a)      Mothers should make sure that they have a dental check-up and complete any necessary treatment to avoid passing on decay-causing bacteria to their children.

b)      Parents should also minimise saliva sharing activities such as cleaning pacifiers with the mouth and sharing utensils.

c)       Parents should bring their children to visit a paediatric dentist by age one to establish a dental home for their child.

d)      Oral hygiene is very important.  Parents should brush their children’s teeth at least twice daily with an age-appropriate toothbrush and fluoride toothpaste.  For children under age 3, a smear amount of fluoride toothpaste is sufficient while a pea-size amount should be used for children between 3 and 8 years old.

e)      Children at risk of getting early childhood caries should visit their paediatric dentist for professionally applied fluoride.

f)        Minimising consumption of sugar overall and also sweet snacks and drinks between meals.

g)      Minimising the consumption of processed foods that have high amounts of hidden sugars will also prevent tooth decay.

h)      Prevent putting children to bed with milk in a bottle and/or wipe teeth with a wet cloth after night-time milk feeding.

i)        Avoid putting juices and other sweet drinks in baby bottles and sippy cups.

j)        As children approach their first birthday, they should be encouraged to drink from a regular cup.

How do I go about home teeth whitening?

Our dental hygienist Dulene Swanepoel talks about home teeth whitening and shares tips on how to prevent tooth sensitivity.

Immediately-loaded Dental Implants: What You Need To Know

Dr. Michael’s Dental Clinic’s Oral Maxillofacial Surgeon Dr. Walter Goriwoda, MD, DMD answers the most commonly asked questions about immediately-loaded dental implants.

1. What are immediately loaded implants? Are same day implants the same as immediately loaded implants?

In modern dentistry, missing teeth should be ideally restored by insertion of dental implants. In many cases and specifically in the aesthetic regions, where patient would show gaps after tooth extraction, a single dental implant can be placed immediately after tooth extraction into the fresh extraction socket. In most cases, the implant is stable enough to be loaded with an immediate implant crown. To allow for osseointegration of the implant, the surrounding bone has to grow right onto the implants surface without being disturbed by any movements of the implant. This is why the immediate crown on a newly inserted single dental single implant should not be subjected to any masticatory forces for several weeks.

In cases where rehabilitation of all teeth in upper or lower jaws is necessary, at least 4 implants (better more) should be inserted into one jaw. The whole dentition can then be attached to these implants as a suprastructure. Due to different biomechanics, minor masticatory (chewing) forces can be tolerated immediately.

The term same day implants is mainly used for advertising purposes, but indeed comprises immediate loading of the newly placed dental implant.

2. Who are the best candidates for immediately loaded implants?

Ideally the best candidates are young, healthy, nonsmoking patients without any periodontal disease and sufficient amount of bone, which of course is almost never the case! There is always a specific reason for the necessity to remove a tooth/teeth and each case has to be investigated individually for the suitability of extraction with immediate implant placement and loading. In general, there is very few absolute contraindications.

3. What are the benefits of immediately loaded implants?

Following a conservative treatment modality means to wait 3-6 months after tooth extraction. Then the implant is placed and another 3 months for osseointegration are awaited before the restoration with a crown takes place. This is an almost unacceptable long period of time for our modern society! But more importantly, another negative side effect might occur during this waiting periods which is resorption of bone and recession of gums.

Insertion of a dental implant right after tooth extraction with immediate placement of a crown has a superior outcome when it comes to the long term aesthetics of the surrounding tissues. The alveolar bone surrounding the newly placed immediately restored implant and its surrounding gums will be preserved to its maximum degree. It should be the treatment modality of choice for aesthetic areas where the patient shows gums when smiling!

And of course it is a nice side effect for the patient to get a complete dental rehabilitation in a day and not to suffer from a socially unacceptable tooth gap for several months neither to struggle with some temporary removable denture.

4. What is the success rate of immediately loaded implants?

The success rates of extraction with immediate implant placement and immediate loading of primary stable implants do not differ from the conservative treatment modality, when the suitability is clinically assessed prior to surgery. Prognosis can be compromised due to periodontal disease, insufficient oral hygiene, or systemic disease but then all dental surgical procedures are more prone to complications independent of which implant insertion concept was followed.

5. What is the procedure like? How many appointments will it take to get the implants and crowns done?

The removal of the tooth is the more invasive surgical part. Inserting the dental implant into the fresh extraction socket is easily practicable. In most cases the implant is stable enough in the anterior jaw and can be immediately restored with a chairside custom made temporary crown. The whole procedure of dental rehabilitation is done in one session only and takes approximately 2 hours.

6. What can patients expect after receiving their implants?

Depending on each patient individually and the location of extraction and implant placement, some amount of swelling and pain, must be expected for about 3-5 days and even bruising might occur.

7. How often should patients come to visit their oral surgeon after the implants are done?

It is advisable to have a follow-up with the surgeon approximately a week after implant placement and again prior to restoration with the permanent crown. In the long term, the implant maintenance constitutes of regular sessions with the dental hygienist and normal follow-ups with the dentist.

5 Things You Should Know About Fluoride & Your Child’s Teeth

By  Dr. Carol Onyango, DMD, MPH

1. What is fluoride?

Fluoride is a compound that contains the natural element known as fluorine. Routinely using small amounts of fluoride can help prevent tooth decay. Studies have shown that in places with community water fluoridation, decay rates have reduced by over 50 per cent and children grow up with fewer cavities. Where fluoride is not available in the community water, the use of toothpaste, mouth rinses and professionally applied gels and varnishes containing fluoride as the active ingredient is highly recommended to help reduce tooth decay.

Dr. Carol Onyango, DMD, MPH 
Specialist Pediatric Dentis

2. How does fluoride prevent cavities?

When sugar is broken down, it forms an acid which attacks and weakens the tooth enamel by causing the loss of minerals and creating cavities. Fluoride helps prevent this loss of minerals and encourages strengthening of the enamel in areas where cavities are just beginning to develop. Fluoride also affects the bacteria that help in causing the acid attacks on the teeth. When the use of fluoride is combined with a healthy diet and good oral hygiene, the risk for decay is reduced even further.

3. Is fluoride safe?

There is confirmation from clinical studies that fluoride use in the appropriate quantities for the prevention and control of tooth decay is both safe and highly effective. However, products containing fluoride should be stored out of reach of young children.

4. What happens if my child swallows fluoridated toothpaste while brushing?

To avoid ingesting excessive amounts of fluoride, always monitor children to make sure that they are using the correct amount of fluoride toothpaste for their age. This should be a smear amount for children less than three years of age and a pea-size amount for children aged 3-8 twice daily.

5. My child’s dentist suggests fluoride varnish? What is it for?

Topical fluoride is used and applied by a dental professional to prevent tooth decay. It comes in the form of gels, foams and varnish. Gels or foams are placed in trays and held against the teeth for up to 4 minutes while fluoride varnish is “painted” on teeth.

Image: American Academy of Pediatric Dentistry
Comparison of a smear (left) with a pea-sized (right) amount

What You Need to Know About White Spots and Braces

Written by: Dr. Argiro Kechagia, Specialist Orthodontist

A very common problem that can occur while a patient has braces is the formation of white spots during treatment and it is always a bit disappointing to find that your teeth are marked with chalky white patches after your braces are removed.

But why?

Many believe that braces can cause these spots to appear, but in reality they are the result of plaque build-up just like any other form of tooth decay. These chalky patches, or dental decalcification, affect 24% of all teenagers without braces. That number jumps up to 50% in teenagers with braces. Although braces are not directly responsible for causing these white spots to form on your teeth, they can complicate the process of plaque removal. The white, chalky marks on the teeth appear when acids created by the plaque, remove minerals from the tooth surface and change the way it reflects light. Decalcification, most commonly affects the region between the gums and the brackets where plaque is most difficult to remove. So, braces do not cause white spots, bad oral hygiene does!

Can I prevent it?

Of course you can; and it is very simple, brush your teeth. Keep the plaque to a minimum. When you brush, be sure to focus on the areas that are obstructed by your brackets and wires, place the bristles of your brush underneath the wire. Finally, try to avoid having sodas and other foods that are high in sugar and acid, as these build plaque fast.

What if I have them already? Can I make them disappear?

1. The first step is to improve your oral hygiene with meticulous brushing in order to give some time (around 6 months) to the enamel to re-mineralize the affected tooth surfaces. All white spots improve some with time and minor ones may disappear altogether.
2. After 6 months our dentist can give you low concentration fluoride rinses and remineralization pastes that can be used in order to improve further the appearance of white spots.
3. Alternatively, bleaching, as it lightens the enamel, can make white spots to blend in better and actually improve as the effects of the bleaching wear off.
4. A newer technique, known as “caries infiltration,” involves injecting a liquid tooth-colored resin, which has optical properties closer to natural enamel, beneath the surface enamel in the area of the white spot. This makes the spot less opaque and more translucent like normal enamel.
5. For more severe problems, your dentist may perform microabrasion (removing superficial white spots), cosmetic bonding (replacing damaged enamel), or place porcelain veneers (covering badly damaged surfaces).

 Always remember that the best treatment is prevention.

Dr. Michael's Blog: Top 100 Dental Blogs in the World

23rd February 2016, Dubai, UAE: Great news! Anuj Agarwal, Founder of Feedspot, has announced that Dr. Michael’s Dental Blog & Beyond ranks #6 out of all the dental blogs in the world!

“After extensive research, our editorial team has come up with 100 of the best, most valuable, informative and up-to-date blogs exploring the latest news and issues of the heart of dentistry and oral health including opinion, comments, facts, tips and information from leading dental experts in the world,” Anuj wrote.

“I personally give you a high-five and want to thank you for your contribution to this world. This is the most comprehensive list of top Dental blogs on the internet and I’m honoured to have you as part of this!!”

“We are more than thrilled that all our hard work paid off. Our team started the blog in February 2012 and has written 224 articles up to this date,”said Dr. Michael Formenius.

“The goal was to be the best and most consistent source of everything dental in the entire region. Our team wrote day in and day out covering every dental topic imaginable. We have a great team at Dr. Michael’s. Congratulations, everyone!”

One thing is for sure, we won’t be parking our pens (or our computers) anytime soon.

Thank you, Feedspot!