When most people think of oral health, the first thing that comes to mind is what you see in the mirror, and what other people see when they see you – your teeth. But the condition of your gums is just as important.

Healthy gums ensure that teeth remain in place along the jawline, as they, in combination with connective tissues and ligaments, form the structure that supports each tooth at the root. This support is essential to preserving teeth for a person’s lifetime.

The phrase “long in the tooth” comes from the history of horse trading, as Kentucky Health host Dr. Wayne Tuckson explained in a recent episode. Back when horses were the dominant means of transportation, unscrupulous traders would, on occasion, attempt to sell an older horse off as a young one. When that happened, it was up to a savvy buyer to verify the horse’s age by examining its mouth to see how much of each tooth was exposed above the gumline.

So as the phrase describes, receding gums may be a sign of age, and a certain amount can be expected as one becomes elderly. But gum disease earlier in life is not inevitable and can lead to unnecessary tooth loss. And it can be brought about by the same bad oral hygiene habits that cause tooth decay – consuming too much sugar, lack of brushing and flossing, and drinking soda and juice.

Other factors contribute to gum disease as well, including the catch-all culprit, smoking. Although Kentucky has recently made progress in oral health rankings, far too many people in the commonwealth have poor dental hygiene habits, leading to tooth decay and gum disease. As a result, nearly half of Kentuckians age 65 and older report either having partial or full edentulism (tooth loss).

As part of our ongoing Inside Oral Health Care initiative, funded in part by the Foundation for a Healthy Kentucky, KET’s production team interviewed several prominent dentists about the state of oral health in the commonwealth. Here is some of their advice for maintaining overall periodontal health and avoiding gum disease.

Gum Disease: Buildup Effects Lead to Tooth Loss

Gum disease generally comes in two stages. The milder form, gingivitis, occurs when plaque builds up due to lack of brushing and flossing and hardens into tartar. Tartar, which cannot be removed by brushing, causes inflammation and bleeding of the gums. Gingivitis can be remedied by following a daily dental hygiene regimen and regular dental visits, but if left untreated it will lead to periodontitis.

Periodontitis develops when gums recede and plaque and tartar begin to collect below the gumline, forming sockets that then become infected. The body’s immune system fights the bacteria, and that activity weakens the periodontal support system that holds a tooth in place.

“Gingivitis is the inflammation of the gums only, where there would not necessarily be bone loss,” says Dr. Michael Mansfield, DMD, an assistant professor at the Department of General Dentistry and Oral Medicine at the University of Louisville’s School of Dentistry. “Once you get bone loss, we tend to speak of that in terms of periodontitis, where you are losing foundation. Gingivitis you can think of as being reversible. With periodontitis, you lose the foundation and it’s hard to put it back – you can’t do that.”

A growing list of diseases are linked to gum disease, with inflammation being the common denominator. According to Mansfield, inflammation of the gums is often exacerbated by diabetes. He says that periodontal disease can also affect rheumatoid arthritis, as the inflammation present in gum tissue “goes systemic to the joints in the body.”

Tips for Maintaining Healthy Gums

Visit the dentist regularly:  The most important step for preventing gum loss is to visit your dentist twice yearly so that any build-up of tartar and gingivitis can be addressed before cavities, decay, and periodontitis develop.

“A person who has a six-month regular checkup, most of them are cavity-free for the most part of their life,” says Dr. Bill Collins, DMD, who practices in Pikeville and also performs dental outreach at Red Bird Mission in Eastern Kentucky. “Those people that don’t show up…we see a lot of rampant decay.”

Avoid hard-bristle toothbrushes. Following the American Dental Association’s “two times two” brushing schedule – at morning and at night – and limiting sugar intake are the most important things a person can do to reduce tooth decay, which is the biggest cause of gum disease. However, persons should also avoid ever using a hard-bristle toothbrush during cleaning, says Dr. Robert Henry, DMD, chief of dentistry at the Department of Veterans Affairs Medical Center in Lexington.

“A hard toothbrush can actually cause you to have recession, because it’s brushing your gums away,” he says. “You want to use a soft-bristle brush. In fact, if you have an ADA-approved brush, it’s always going to be soft, because they don’t approve medium- and hard-bristle brushes.”

Don’t smoke. “Believe it or not, smoking is a high risk factor for tooth loss,” says Henry. “Spitting tobacco, all of these things are intrinsically going to be caustic to that oral environment, and can cause the recession which can lead to more gum disease.”

Even if you have complete tooth loss and use dentures, you should still avoid smoking, which damages the gingiva and can lead to periodontitis, reducing dentures’ effectiveness.

Floss daily, and do it correctly. Last summer, the Associated Press reported that daily flossing had been dropped by the dietary guidelines issued by the Departments of Agriculture and Health and Human Services. The news generated much media interest, and several general-audience articles appeared in magazines and newspapers that critically examined the research behind dental floss and its use.

Soon afterward, the Department of Health and Human Services issued a statement reaffirming the importance of regular flossing as part of routine oral health care. The American Dental Association has long recommended daily flossing or use of another interdental cleaner (such as small brushes, water flossers or special picks). Dr. Collins, president of the Kentucky Dental Association, agrees.

“Just because flossing is not mentioned in a government article doesn’t mean it’s not important,” he says. “Just because there are no long-term documented studies doesn’t mean that flossing does not provide a positive result. We have seen patients with beginning periodontitis that we convince to floss, and they return with less tartar than we noticed originally. We also see inflammation decrease in the gums.”

Collins advises his patients to floss once a day, preferably before bedtime. He says this helps reduce the effects of dry mouth, which can harden plaque overnight and make it harder to remove.

He says the correct flossing technique is to move the string up and down the tooth rather than in a see-saw, slicing motion. The floss should be positioned like the letter “C” along the side of the tooth.

Using a proper flossing motion will not cause the gums to bleed, Collins says. Patients can learn proper flossing technique for self-care when visiting their dentist for a regular six-month checkup.

This KET article is part of the Inside Oral Health Care initiative, funded in part by the Foundation for a Healthy Kentucky.