?
Dr. Tang: Well, the first sign you’ll probably get with gum disease is probably bleeding gums and sometimes you might get swollen gums. So the gums appear puffy especially underneath the braces. And these could be the first warning signs. So if you are in doubt, always get your local dentist or your orthodontist to have a look and really check it out properly.
Dr. Chang: And this one common, very common question I get is, “My gums bleed when brushing. Should I stop brushing in that area? I mean what should I do? I mean I’m worried my gums – I mean I’m worried about bleeding.”
Dr. Tang: Andrew, I assume we’re talking about gum disease. So that’s basically a plaque related issue. So if you control the plaque well, most of the time, the bleeding gum will stop.
Dr. Chang: And that actually means spending an extra time brushing where you have this sort of situation where you haven’t cleaned well. You’ve got this food debris on your teeth let’s say for a day or two and it has been causing your gums to bleed. Don’t stay away from that area even though it may bleed a bit.
Dr. Tang: Exactly. In fact, you should do it more. And you find that if you brush really well for a few days, the bleeding gums actually stop. Now, if it still doesn’t stop, there might be some other underlying problems which you should really get your local dentist or orthodontist to have a look.
Dr. Chang: And as an orthodontist, can I say that one of the very, very common areas I see with patients and this goes with children, with teenagers, with adults, with braces, one of the areas that they don’t spend or the gums usually going to be puffy are the lower front teeth where the braces are closest together. So this is one area where actually I would suggest to all patients to actually spend more time cleaning that area.
So – which leads us to the next question. Let’s say if we have gum disease, and this is – how can it be treated? Let’s say, I’ve seen my orthodontist. I’ve seen my dentist and he says, “This is something which is a bit more than the usual gingivitis or the swelling gums that goes away after a couple of days of good brushing.” What should I do?
Dr. Tang: OK. Generally, there are two types of gum disease. One is gingivitis, which is reversible in nature. Another one is really – is we call periodontitis, which is irreversible in nature. So essentially for periodontitis, we’re dealing with two problems. First problem is infection in the gum and second problem is the bone loss that occurs as a result of the infection.
Dr. Chang: And that – I mean how would I know? Let’s say, if I got this thing called periodontitis, how would I know that I’ve got this condition? You did mention bone loss. I mean I presumed, are you talking about – would I have one of my teeth be loss? I mean what actually happens? If you can take a stage that you see in your practice, I mean there are stages, the gradual progression of this.
Dr. Tang: OK. The first thing you can do is get your local dentist or orthodontist to have a look and to check for the presence of infection. There are several parameters that we look at in the clinical setting.
Dr. Chang: You mean there are several things that you look for like when you see the patient?
Dr. Tang: That’s right. We check for inflammation. We check for swellings. We check for gum pockets. And in terms of bone loss, we definitely send the patient for x-rays. That will really tell us how much bone the patient had lost over the years as a result of periodontitis.
Dr. Chang: I see. OK.
Dr. Chang: So, can this gum disease be treated? And can a patient who has gum disease after gum treatment have gum disease again?
Dr. Tang: So like I said, a gum disease is simply and infection in the gum that leads to bone loss around the teeth. There is definitely a treatment for gum disease. So that involves a very good oral hygiene. So basic brushing and also professional cleaning which involves removing the bacteria under the gum.
Dr. Chang: As in like seeing one who has got expertise in this, as in a professional?
Dr. Tang: Yeah, a dentist, a h