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Medical Edge Newspaper Column from Mayo Clinic

WHITENING TEETH, TREATING GUM DISEASE

DEAR MAYO CLINIC: Everyone I know is getting their teeth whitened, so I started thinking about it. I’m 60, and a lifelong coffee drinker and former smoker. My teeth are quite stained. When I asked my dentist about it, he said that my gums are too receded for the procedure to be comfortable for me, and also said I should see a specialist about my gums. What causes gum recession, and can it be stopped or reversed? And is there a way for me to whiten my stained teeth? — Oklahoma City

ANSWER: Manufacturers continue to improve the whitening products available over the counter and through the dental office. I suspect that your dentist is concerned about the possibility of some tooth sensitivity or discomfort if the bleach is applied to root surfaces. Many patients can tolerate the bleaching products even if they have exposed roots. If your teeth become sensitive when using bleaching products, they will usually feel better soon after stopping the product.

It was your dentist, not you, who expressed concern about your gums. Because of this, I am curious if you have experienced any symptoms of gum problems, such as: swollen, bright red, tender gums; new spaces developing between your teeth; pus between your teeth and gums; persistent breath order or bad taste in your mouth.

Gums can recede for various reasons, including vigorous or overzealous brushing, especially with a hard-bristle toothbrush. The gum disease periodontitis is also a major cause. Periodontitis is a serious infection that destroys the soft tissue and bone that support your teeth and may eventually cause tooth loss.

Gum disease occurs when bacteria build up between your teeth and gums, leading to irritation, inflammation and bleeding. In the early stages, gum disease is treated with simple oral hygiene — daily brushing, flossing and regular professional cleanings.

If not treated early, gum disease can progress to periodontitis, a condition in which pockets of plaque, tartar and bacteria develop between your gums and teeth. At this point, it’s difficult — and eventually impossible — to adequately clean with a toothbrush or dental floss. Some treatment options for pockets that are more than 3 millimeters include scaling (removing bacteria and tartar from beneath the gums), root planing (smoothing out the root’s surface), antibiotic therapy and surgery. Uncontrolled gum inflammation and infection can lead to bone loss, loosening of teeth and tooth loss.

Paying regular attention to gum health is a key component of good oral hygiene. It’s important that you get a periodontal examination to measure pocket depth each time you visit your dentist. Deep pockets — those that measure more than 3 mm on the probe — are obviously cause for concern. If you have inflammation, pocketing and bone loss, see a periodontist.

— Phillip Sheridan, D.D.S., Dental Specialties, Mayo Clinic, Rochester, Minn.

Additional Resources:
Whitening Teeth
Appointment Information
Information on Oral Health

READERS: No need to dread putting on your shoes because of a bunion. Mayo Clinic Health Letter offers advice to ease the pain from these abnormal bony protrusions that can form at the base of your big toe.

Bunions develop over years of abnormal motion and pressure on your big toe joint. The underlying cause could be flat feet, low arches or shoes that fit improperly. What to do?

— Make sure that your shoes don’t crowd or irritate your toes. Don’t wear shoes that are too tight, narrow or pointed. Avoid high heels that force your toes to the front of your shoes.

— Stretch your shoes. Shoe-stretching devices and sprays can be used on tight shoes to give your toes more room.

— Support your arches. Nonprescription shoe inserts can help keep your foot from leaning inward and alleviate pain.

— Pad the bunion. A self-adhesive pad or nonprescription bunion pad may minimize pain. This generally works only for mild bunions. Padding may actually contribute to crowding with severe bunions and make the problem worse.

— Ice it. If the bunion is inflamed or painful, apply ice several times a day.

— Control the pain. Nonprescription pain relievers may be recommended to control the pain.

— Try physical therapy. Ultrasound therapy or whirlpool baths can provide relief.

— Consider surgery. Surgery generally is not necessary. But if recurring pain interferes with your daily life and other treatments don’t help, it’s an option.

Additional Resources:
Bunions
Appointment Information
More Information on Bunions

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.