why do my gums bleed?

Bleeding Gums

Why do my gums bleed?  Common complaint patients say to me is their gums bleed when brushing their teeth or when they are flossing.  And as such bleeding gums is often a sign of bacterial infection and gingival irritation.

What are some causes of bleeding gums?

• Gingivitis - Gums are irritated and may be swollen.  This may be due to plaque and bacteria buildup along the gum line, and is typically from insufficient brushing and flossing.  
• Periodontitis - Gums and supporting bony structures of the teeth have bacterial and calculus (hardened bacteria and plaque buildup) irritation.  
• Pregnancy - Swollen and bleeding gums may occur during pregnancy due to increased level of progesterone. 
• Immunosuppressants - Patients who have undergone organ transplants may be placed on medications such as cyclosporine.  Cyclosporine is an immunosuppressant used in organ transplant recipients and for psoriasis.  Calcium channel blocker agents such nifedipine and amlodipine have also been associated with gingival overgrowth.  Nifedipine and Cyclosporine may cause drug-induced gingival overgrowth, and thus in combination with plaque buildup, this leads to bleeding gums. 

How to treat bleeding gums?

Primary method would be to ensure daily habit of brushing and flossing.  Regular 6month checkups and dental cleanings are helpful  Main benefit of using dental floss is that it physically removes bacteria and plaque trapped in between the teeth and along the gum line.  A water pick may also be a useful adjunct tool.

Bleeding gums due to periodontitis may require a "deep cleaning" or root scaling and planing to remove hardened bacteria and calculus beneath the gum line.  After the deep cleaning is done, more frequent maintenance cleanings and diligent at-home care may be required to prevent the calculus buildup from reoccurring.

Pregnancy induced gingival overgrowth and bleeding gums would require the patient to be extra diligent with daily brushing and flossing.  After delivery when progesterone levels go back to normal levels, the gum inflammation and swelling would typically improve on its own.

For those on immunosuppressants such as cyclosporine and nifedipine, regular dental cleanings and at home daily brushing and flossing is critical to ensure optimal gum health.  Good oral hygiene is critical to ensure teeth and gums stay healthy during treatment.

If you have any questions regarding why your gums bleed, be sure to consult your family dentist and hygienist. 

From your gentle family dentist in Redmond and Bellevue,
Peter Chien, DMD, MPH
www.bellevuefamilydentistry.com
(425) 614-1600

Cracked tooth syndrome, biting hurts

Cracked Tooth

During an unexpected emergency dental visit, a patient may complain a tooth has pain when biting and this may suggest cracked tooth syndrome.  They may not able to put any pressure on the tooth, and may avoid eating on that side.

A thorough visual examination with a digital x-ray would be required to determine the exact cause.  A common cause of pain upon eating is a cracked tooth, but there are other possible causes to consider that are listed below. 

COMMON CAUSES OF PAIN UPON BITING

• During biting, the ligament surrounding the tooth's root has been injured.  This ligament is called the periodontal ligament (PDL)
• The tooth recently had a filling that was close to the tooth's nerve, and you are now trying to eat on that tooth
• The tooth recently had a root canal without a crown, and you are now trying to eat with that tooth
• The tooth had a root canal and filling/crown many months/years back, and now it's starting to hurt when biting down.
• The tooth has cracked and you are not able to place any pressure on that tooth

POSSIBLE SOLUTIONS TO ADDRESS PAIN UPON EATING

• If a tooth's ligament is injured, the typical scenario is to allow 3-4 weeks healing time to see if the ligament will repair itself.  If the PDL ligament is still injured, the tooth may need to be evaluated for root canal treatment.
• If the tooth had a filling that was close to the nerve due to a deep cavity, it is recommended to allow 2-3 weeks to see if the nerve will "settle down."  If the tooth still has pain upon afterwards, the tooth may need to be evaluated for root canal treatment.
• If the tooth recently had a root canal and you are having discomfort eating on the tooth, it is highly recommended a crown be placed on that tooth, especially if the tooth is a molar or premolar.
• If the tooth has an existing root canal and crown, and it's now starting to hurt when biting, there may be a deep internal root fracture.  This tooth would need to be evaluated for possible root canal retreatment or extraction.
• If the tooth has cracked, it may exhibit cracked tooth syndrome.

WHAT IS CRACKED TOOTH SYNDROME?

Cracked tooth syndrome is the presence of an internal fracture inside the tooth.  A piece of tooth may or may not "feel loose" though it may be sore to place biting pressure.  The severity of the symptoms and treatment would be determined by the extent of the fracture if it is in the enamel or if it has extended to the dentin or pulp.

A typical cause is due to excessive biting forces from inherent natural heavy eating forces, or from night time grinding (bruxism).  A common symptom is you are not able to eat on that tooth, and this tooth would need to be evaluated for a porcelain crown and/or root canal treatment.  If the fracture is too extensive, the tooth may need to be extracted.

If you have any questions about cracked tooth syndrome or what may be causing pain upon biting, be sure to consult your family dentist.

From the desk of your gentle family dentist in Bellevue,

Peter Chien, DMD, MPH
www.bellevuefamilydentistry.com
425-614-1600

Pregnancy, Babies, and the Dentist

If you are pregnant or trying to become pregnant, you should inform your dentist so he or she can help you achieve optimal oral health for yourself and your baby.  It is recommended you continue your regular exam and dental cleaning schedule as recommended by your dentist.

Dental Tips for Pregnant Moms

• Brush your teeth twice a day with fluoridated toothpaste to remove plaque buildup.
• Floss daily to help remove plaque between the teeth.
• Inform your dentist and physician of any changes in your health, medication, and diet.
• Any elective dental procedures should be delayed until you give birth.  If dental treatment is necessary and recommended by your dentist, your dentist and obstetrician will advise you of any precautions to be taken. 
• Moms may develop pregnancy gingivitis, gum inflammation that may include swollen and bleeding gums.

What is Pregnancy Gingivitis

• Pregnancy gingivitis is gum inflammation induced by the mother's fluctuation in estrogen and progesterone.  Symptoms may include swollen and bleeding gums, sensitive teeth and gums, and gingival recession.
• Pregnancy gingivitis is common during the second through eighth month of pregnancy.
• Your dentist may recommend additional dental cleanings if the gingivitis promotes excessive bleeding and plaque buildup.

Nutrition Tips for the Mother

• Your baby's teeth develops during the first trimester, hence adequate calcium and vitamin D intake is important for baby's optimal teeth development
• A well rounded diet during all trimesters of pregnancy is needed for your baby to develop his or her teeth.  A balanced diet of fruits, vegetables, dairy, lean proteins, and essential fats is recommended.
• Morning sickness and nausea can make morning brushing difficult.  Be sure to consult with your dentist and obstetrician if you are not able to brush in the morning.
• Be sure to drink abundant amounts of water and calcium.  Water is good for your body and your baby's development.  Daily intake of water will also help clear your teeth free of plaque when you are not able to brush and floss consistently. 

If you have any questions or concerns regarding pregnancy and how it may affect your newborn, be sure to consult your family dentist.

From the desk of your gentle dentist in Bellevue,
Peter Chien, DMD, MPH
www.bellevuefamilydentistry.com
(425) 614-1600

How to remove tooth stains

Extrinsic Stains on Teeth

Stains on teeth often look like dark spots and patches on the outside and inside surfaces of the teeth, and many patients often ask on how to remove them during their dental cleaning visit.

There are typically two types of stains, extrinsic and intrinsic stains.

1. Extrinsic Stains may be caused by repeated short term exposures to tea, coffee, blueberries, wine, and food condiments like ketchup and soy sauce.  They may look like dark black and brown patches on certain parts of the teeth's external surfaces.
2. Intrinsic Stains may be caused by the antibiotic tetracycline taken when the patient as a young child or repeated heavy long term smoking and tobacco habits.  It may also be a result of malformation during embryonic development.  These type of stains may present itself as a dark gray or red internal discoloration where the entire tooth is discolored, and may be very difficult or near impossible to remove.

If the stains are extrinsic they can usually be removed during the cleaning appointment.  The dental hygienist or dentist may use a combination of a high speed vibration tip with water, and hand instruments like a scaler to physically remove the stains.  Water is needed to help cool the high speed tip as it vibrates and removes the stained spots.  A low speed polish may also be used to help smooth the teeth and remove any loose "dark spots."  Minor stains may also be removed by trying an abrasive toothpaste such as whitening toothpaste.

Intrinsic stains are often much harder to treat and remove.  If these stains are a result of food exposure where the teeth have turned "yellow" over time, teeth whitening may help lighten the teeth.

In cases where the intrinsic stains are gray or reddish stains are internal (inside) the teeth, they cannot be removed via a dental cleaning or traditional teeth whitening.  More viable options to address heavily dark or red internal stained teeth include porcelain crowns and veneers or internal bleaching.  Internal bleaching utilizes a high concentration of bleaching solution placed inside the tooth after it has a root canal that allows the tooth to whiten from the inside.

If you have any questions on teeth stains and how to remove the stains from your teeth, be sure to consult your family dentist or dental hygienist.

From the desk of your friendly gentle dentist in Bellevue,

Peter Chien, DMD, MPH
(425) 614-1600
www.bellevuefamilydentistry.com

Kids back to school dental tips

Back to school and the dentist

Parents and kids, it's back to school time, and below are some dental tips and hints to keep children's teeth and gums clean and healthy...and to help your kids off to a good start with great diet and oral health!

DIET

School days can be hectic and in a rush, so don't forget to include healthy snacks that are good for the teeth and the body.  Your body and mouth will appreciate it :)

• Celery and carrot sticks contain fiber and vitamin A; the fiber helps cleanse plaque from teeth
• Apple slices, crunchy fruit high in fiber promoted salivary flow that helps washes bacteria away
• Grapes, raisins, and cranberries are great snacks containing natural sugars for that quick pick me up
• Fruit and yogurt smoothies, high in calcium, good for teeth and bones
• Nonfat or lowfat milk which are rich in calcium and fortified Vitamin D, great for making your kid's teeth strong

ORAL HYGIENE

Important to make sure your children brush in the mornings when they wake up, and also brush and floss in the evening prior to bedtime.  Brush their tongue to remove bacteria and help keep their breath fresh.  If your kids are in current orthodontic treatment (ie. braces) it's especially important for them to brush and floss well, as plaque and bacteria can accumulate on the bands and brackets, and increase risk for cavities.

DENTAL TIPS AT SCHOOL

School days can be busy, so here are some ideas to help keep your kids' teeth and gums healthy at school:

• If your child has an orthodontic retainer, make sure the retainer is worn in the mouth at all times unless it's during lunch or snack time.  To prevent retainer loss, keep the retainer in sight at all times and make it habit to wear it when not eating.  It's not uncommon to see kids digging through the school trash  looking for a lost retainer!
• Avoid sucking on hard candy or chewing sugary gum during the day.  Try sugarless gum.
• Avoid sipping on soda or energy drinks during the day.  They are often high in sugar and the high phosphoric acid content can weaken the teeth's enamel.  Bottled or tap water are good substitutes. 
• The occasional soft or hard candy is OK.  Try to rinse the mouth with water after eating to help prevent sugar from remaining on the teeth.
• For lunch try to choose salads and low fat milk.

 If you have questions on how to help and improve your children's oral health at school, be sure to consult with your family dentist and hygienist.

From your gentle family dentist in Bellevue,
Peter Chien, DMD, MPH
www.bellevuefamilydentistry.com
(425) 614-1600

Pregnancy and Going to the Dentist

Pregnant? Might be time to the dentist!

There has long been a common misconception to avoid the dentist when one is pregnant.  The previous thought process was that dental treatment may cause complications during pregnancy.  However recent studies are suggesting that going to dentist while pregnant is actually a good idea because of the excessive time constraints the newborn baby may likely require after the mother has given birth.

Physicians and researchers have determined that a pregnant woman's oral health can directly affect the newborn's systemic and oral health.  For example, a common health concern is cavity causing bacteria such as Streptocacus Mutans can be directly transmitted from the mother to the fetus.  The newborn baby may then be exposed to the bacteria, which can then multiply and grow in the fetus' body, affecting the tooth's development even before the teeth are erupted.  Such excessive bacteria, if not removed, may increase risk of tooth decay and subsequently periodontal and gum disease.

Another common occurrence is if an expectant mother is experiencing tooth pain or has a dental emergency related infection, this may cause physical stress on the mother, which may then indirectly cause systemic stress on the fetus.

Unfortunately most pregnant mothers do not receive sufficient dental care.  Census data in 2010 from the Center for Disease Control show that less than fifty percent of expectant mothers had a dental cleaning while they were pregnant.

It is our hope to increase public awareness the importance of seeing a dentist when a mother is pregnant.  If you have any questions regarding pregnancy and its relationship on the mother's and newborn's oral health, be sure to consult with your family dentist and hygienist.

From your gentle family dentist in Bellevue and Redmond,
Peter Chien, DMD
www.bellevuefamilydentistry.com
425-614-1600

Thumbsucking

Child Thumbsucking

Thumbsucking is a perfectly natural habit children engage in.  Does your child suck his thumb and the parent may be wondering why.  Kids suck on their thumbs, pacifier, finger, or any other small object to give them more security, feel less lonely, and to help them observe their new surroundings.  Children may also suck their thumbs as they go to sleep.

At the age of six years old when children's permanent teeth begin to erupt, continuous thumb sucking may cause issues with the mouth's growth formation, the mouth's roof shape, and as well as teeth position and alignment.  The main factor that determines if a child may develop dental problems with thumbsucking is the intensity of the sucking.  Simply resting the thumb inside the mouth is much less likely to cause oral issues then vigorously sucking the thumb.

ORAL SIGNS OF THUMBSUCKING

• A very narrow and arched shaped upper palate
• Top front teeth are excessively flared outwards
• The child's entire upper teeth appears very narrow and arched

What are some things parents can do to help their child stop thumbsucking?

TIPS TO HELP YOUR CHILD STOP SUCKING THE THUMB

• Kids tend to suck their thumbs or fingers when they feel insecure or when they need a "blanket" for comfort.  Try finding the root cause of the insecurity issues and address them if possible.
• When the child goes to sleep, have the child wear gloves or a sock to discourage the habit.
• Place a bitter paste on the child's thumb after they go to sleep.  Your dentist may be able to prescribe a safe yet bitter medicine to coat the thumb.
• Praise him/her for not sucking the thumb
• If all else fails, have your dentist reinforce the importance of the need to stop sucking the thumb.  The dentist may refer the child to an Orthodontist to place an appliance (ie. fixed palatal crib) that makes thumbsucking uncomfortable to quell the habit.

Children typically stop sucking their thumb prior to the age of six when their permanent teeth start to erupt.  If you notice your child is still sucking their thumb beyond the age of six years old and you notice changes in the child's arch shape and teeth position, be sure to consult your family dentist or orthodontist.

Your family dentist in Bellevue,
Peter Chien, DMD, MPH
(425) 614-1600
www.bellevuefamilydentistry.com