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What causes receding gumlines

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I see that some of my teeth have gumlines that are receding. I’m fairly good at my oral hygiene. I brush twice a day and floss once. What could be causing this? Is there a way to fix it?

Candace

Dear Candace,

Woman covering her mouth with her hands

I’m glad you wrote. I can tell you care about your teeth a great deal and do your best to take care of them. There are a few reasons you could be dealing with receding gums.

  • Gum Disease

If plaque or food gets trapped under your gums, it is not only an irritant but can cause the teeth to become loose. I don’t know who your dentist is but most dentists check for this at each of your cleanings and checkups. Some discount clinics, though, will skip this step. You can call your dentist and ask how your gums looked at your last checkup or just go in for another one.

  • Brushing too Aggressively

If you are super aggressive about brushing and using a hard-bristled toothbrush. I always recommend to use a soft-bristled brush. It does a great job and is safer for your gums.

  • Bruxism

This is when you grind or clench your teeth. This can cause notches on your teeth at the gumline. When that does happen, it will cause your teeth to recede. This is also dangerous for your teeth. A simple nightguard, which your dentist can custom fit to your bite, which will protect your teeth. Without that, you will end up grinding your teeth down to nubs, which will require every tooth in your mouth to be crowned. That is known as a full mouth reconstruction and can cost you up to $60k.

Repairing Receding Gums

There is gum surgery which can be done to repair your gums. Periodontists do the surgery. Some dentists do it as well. A few, including Dr. Delaune, invest in further training to learn the pinhole technique.

Unlike traditional gum grafting surgery, this requires no scalpels or sutures. It’s worth looking into.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

For whiter teeth do i brush before or after tea?

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I had teeth whitening done about a month ago and am hoping to maintain the results as long as possible. However, I’m getting conflicting information as to whether I should be brushing before or after my tea. One person said that if I brush before, I’m opening up pores on my teeth and they’ll pick up stains quicker. Another person said that if I brush after tea, which is what I’ve been doing to get the tea off my teeth quickly, I’ll damage my teeth because the tea is acidic. Which is correct?

Thank you,

Maya

Dear Maya,

womean covering her mouth with her hand
When your teeth are stained it can be embarrassing to smile.

You’re asking good questions. Your teeth whitening results will last longer if you’re mindful with your tea habits. Ideally, you’d give up tea, but since that’s probably not realistic, let’s focus on what you can do when you indulge anyway.

Drink in One Session and Don’t Sip for a Prolonged Period of Time

It sounds like you’ve got this one nailed, but it’s worth mentioning. People who sip on tea and coffee all morning or all day pick up stains faster than those who finish their drinks in one go.

It’s Ok to Brush Before Tea

The concept of “pores” opening when you brush is an urban legend. While you do have tubules in your teeth, they have plugs in them. Very few things disrupt those plugs, but it’s generally restricted to things that happen in the dental chair, such as restorative work and professional teeth whitening.

The tubules develop new plugs within a day or two, so you’d want to avoid tea during that span so you don’t sabotage your efforts but otherwise, you’re good to go in that department.

Be Wary of Brushing After Tea

The problem with acidic foods and beverages is that they lower the pH of your mouth. Ideally, it should be closer to a 7.0, but a little variation in either direction isn’t too much cause for concern. When your mouth is more on the acidic side (anything below 7.0), your teeth demineralize. That means they lose calcium, phosphorus, and other minerals that make them strong and block decay. Your enamel and dentin will also soften for a period of time after consuming an acidic beverage.

However, as your pH returns to normal, they’ll pick up the minerals in your saliva (remineralize) and will harden again. Problems set in when you either don’t provide your teeth with an environment to remineralize or you brush while the enamel is still “soft.” In doing so, you can actually remove the softened layer and it doesn’t grow back. That’s referred to as acid erosion, though there are several alternate causes of it.

For the record, black tea is usually a 4.9-5.5 pH, making it one of the more acidic things you can introduce into your mouth, though it will vary depending on how you brew it and other factors. Coffee is usually around a 4.5- 6.0 pH, for comparison. Sodas and juices—especially citrus juice—can go as low as 2.0. Battery acid is a 0.0.

Rinse or Rebalance After Tea Instead of Brushing

One of the easiest ways to remove any residual tea is to give your mouth a quick rinse with water after you finish. If you have concerns about acid erosion or demineralization, you can also restore balance by using a pH neutral mouthwash after or by mixing one part baking soda to eight parts water and rinsing with that.

Fluoride may be an alternative to help create stronger teeth as well, though it obviously does nothing for staining. It doesn’t work in exactly the same way minerals will, but it also isn’t quite as sensitive to environmental factors, which is why it’s been trusted as a cavity-fighting tool for generations.

This blog is sponsored by New Orleans Dentist Dr. Duane Delaune.

does tmj mean surgery?

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I’m 27 years old and have been dealing with a significant amount of jaw pain. I did some research online and it sounds like I may have TMJ. Everything I read says the treatments for this are jaw reconstruction or having all your teeth re-made. That sounds terrifying to me. In fact, I’m a little too scared to see a dentist about it in case they say that is what I need. Are there any other options? What happens if I just don’t treat it and just deal with the pain with medications?

Morgan

Dear Morgan,

close up of temporomadibular joint
TMJ disorder has various causes and solutions

Before you panic, let me assure you there are many causes and solutions for TMJ Disorder. As you can see from the image above, your TMJ joint is similar to your knee joint. It has movable parts and a disc which serves as a buffer. There are also lots of muscles that help with the various movements requisite to good jaw function. This is known as the temporomandibular joint (hence the TMJ).

Treatments like full-mouth reconstruction or jaw surgery are for the most severe cases, usually after years of going without treatment or a tragic accident. It doesn’t sound like that is what you’re dealing with.

The first step to any treatment is a diagnosis of what is causing the problem in the first place.

Two Causes for TMJ Disorder

One common cause for this is pressure you’ve put on the jaw joint. This is done through clenching your jaw or grinding your teeth. This often happens without a patient even realizing it because they do it in their sleep.

If you get treatment for this early on, before too much damage is done, there is no invasive treatment. It can often be handled simply by wearing a night guard to protect your teeth and add some cushion to assist with the pressure on your jaw.

Another cause is misalignment of your bite. Our teeth shift over time. It could be that yours have shifted in a way that has caused pressure on your jaw.

In some cases, this can be fixed with orthodontics such as Invisalign. Other, more severe cases, will require a full-mouth reconstruction. This latter treatment can also happen if you don’t get teeth grinding under control and your teeth get worn down to nubs.

Full-Mouth Reconstruction

With this procedure a dentist has to crown all of your teeth. This is either because they are too worn down from grinding or your bite is so far out of alignment this is necessary to repair it.

This is quite an advanced procedure and would require a dentist with significant training in TMJ Disorders as well as cosmetic dentistry.

Look for a dentist who trained at one of the following:

  • Dawson Academy
  • J.D Pankey Institute
  • The Las Vegas Institute of Advanced Dental Studies

This will take care of their TMJ qualifications. To find out if they’re also a great cosmetic dentist, go to the mynewsmile.com website to see if they’re recommended . They pre-screen cosmetic dentists for both their technical skill and artistry.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

Can My Dentist Treat My TMJ?

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I was talking to my dentist about some jaw pain. He asked me a few questions and said he thinks I have TMJ disorder. We scheduled a follow-up appointment to run some additional tests and discuss treatment. After I got home I started wondering if instead of just going to my general dentist about this I should schedule an appointment with a TMJ Dentist. What do you think? Is it safe to stay with my dentist for this?

Miranda W.

Dear Miranda,

A woman holding her jaw from TMJ pain

Your doubts are based on a common misunderstanding about TMJ. There isn’t really such a thing as a TMJ Dentist. By that I mean there isn’t a recognized TMJ specialty with the American Dental Association (ADA). All TMJ dentists are just general dentists. That being said, it doesn’t mean every general dentist is qualified to treat TMJ. It does require specialized training. So how do you know if your particular dentist has what it takes?

The first thing I’d do is check their website. If they have a TMJ page, check to see if they list any specific training. If they don’t have a page, check their bio. They should list some respected institute where they did post-doctoral studies in TMJ diagnosis and treatment. For instance, Dr. Delaune trained at the esteemed Dawson Academy. Other respected institutes would be among the following:

  • The Las Vegas Institute for Advanced Dental Studies (LVI)
  • The Kois Center
  • The Pankey Institute
  • Spear Institute

There are others, but these are among the best.

Warning Signs about TMJ Dentist

One thing to be aware of is aggressiveness in treatment. Dentists with expertise in TMJ will start with the least invasive treatment options first. If your dentist goes straight to suggesting a full mouth reconstruction, I’d quickly get a second opinion. Those are only necessary in severe cases and other solutions are tried first.

Often jaw pain can be caused by teeth grinding or clenching. Patients may not even recognize they’re doing it, especially if it only occurs while they’re sleeping. In that case, wearing a simple custom-fitted night guard is all you need to solve the problem.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

Is it Normal to Need a Root Canal Because of Porcelain Veneers?

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I had porcelain veneers placed. I really love them. The change they’ve made to my smile makes me feel beautiful. The only problem I’ve run into is tooth sensitivity, especially cold substances. My dentist said this can happen and I’ll need a root canal treatment. Shouldn’t he have warned me this was a possibility? I’m terrified of the idea of a root canal. Is it absolutely necessary, or ore there other options to explore first?

Corrine – Maryland

Corrine,

The need for a root canal treatment is actually very rare with porcelain veneers. Your teeth are made up of layers. Those layers protect the nerves in your teeth. Exposed or bothered nerves cause the sensitivity. If someone has thin enamel or larger than normal pores, that can lead to sensitivity. Porcelain veneers usually help with that because even though there might be some minor shaving for tooth preparation, the veneer itself adds extra protection.

The nerves respond to their environment. If nothing is going on around it, it will generally stay pretty happy. Initially, when you had your veneers placed, your nerves could have popped their heads up wondering what was going on, but that should have settled down fairly quickly. If several weeks have gone by and it’s still acting up, some investigating needs to be done— before you get a root canal treatment. The cause of the sensitivity needs to be nailed down.

I can think of two things right off the bat which should be looked into.
1. The bond between the veneers and your teeth could be damaged allowing things to get between the teeth.

2. Your bite could be off. If your bite has never been off before, improperly placed veneers can throw it off. If your bite is off, the teeth can be continually bumping up against one another angering the nerve. If it’s from the veneers, some adjustments can be made to repair that.

This blog is brought to you by Dr. Duane Delaune.

It’s been six months and I still have no teeth!

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About six months ago, I decided to try and do something about a couple of my lower front teeth that were loose. After doing some research, I decided that my best option was dental implants, but knew it was going to be very expensive. I started looking around for a doctor who could do affordable dental implants and when I came across an ad for a doctor a few miles away from where I lived, I was sure I had found the right person for the job. At my consultation, he priced everything out for me. He said I should go ahead and have the teeth pulled that day and that I needed bone beads to help with the healing (I had to pay for that because my insurance wouldn’t cover it). I went ahead with his recommendation and waited six months — with a toothless smile no less — to go back for the surgery. Much to my disappointment,  he told me that he couldn’t move forward until I had more procedures done – including bone grafting and gum treatment. Now I’m thinking it would have just been better to keep my teeth because I’m having to spend more and more money and I’m still toothless. I feel like my smile is ruined. What can I do? — Christina

 

Christina,
There’s several concerns here, but the biggest one would be that your dentist didn’t first address why you teeth were loose. If you had periodontal disease, you should have never been considered for implants until that was under control. I’m guess that is why he is now saying you need additional gum treatments.  Since the teeth are gone, there’s no way to know if they could have been saved.

The other treatments are probably necessary before moving on with the implant surgery to ensure they don’t fail. Get a second opinion to be sure you’re getting the right treatments. As far as going without teeth for six months, your dentist should have offered you a temporary solution – such as a flipper or partial denture. Either one would not only help with appearance and eating, but also prevent the other teeth from shifting into the open space. You could still get either one of these options now, so schedule a consult with another dentist to find out what they can do.

This post is sponsored by New Orleans cosmetic dentist Dr. Duane Delaune. Read more about why many consider Dr. Delaune to be the best dentist in New Orleans.

Why does my dentist refuse to do mini implants?

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I’ve been wearing a partial denture for several years to correct a missing tooth. At the time, I would have rather had an implant placed, but budget-wise, it was way out of my league. I’ve been working to save money toward an implant, and recently read about mini implants. If I understand correctly, I would have the same result as a traditional implant, but they are quite a bit cheaper. I asked my dentist why he didn’t offer them as an option a few years ago and he basically said they weren’t FDA approved and that he prefers traditional implants – and many dentists would consider them controversial. What does he mean by that? If they are so controversial, why is there so much information out there about them? — Jeremy

Jeremy,
Controversial would be a good word to describe mini implants, but even more it seems is that most dentists really don’t understand mini implants so they tend to avoid them altogether. They are much like  traditional implants in the fact they they are implanted and integrated into the jawbone, however, as the name indicates, they are smaller. The fact that your dentist said they are not FDA approved is simply not true, and that shouldn’t be the case he makes for not suggesting them.

There are many people out there who have to live with missing teeth because dental implants are just too expensive, so mini implants are a viable and cost-effective solution. They are more affordable for a couple of reasons:

  • Less surgery and recovery time
  • They consist of just one piece (rather than separate/multiple parts like traditional implants)

Keep in mind that mini implants are not a solution for everyone, however, they are a viable option and should be considered. Find a dentist in your area that is familiar with mini implants and get a second opinion.

This post is sponsored by New Orleans cosmetic dentist Dr. Duane Delaune. Read more about why many consider Dr. Delaune to be the best dentist in New Orleans.

Get me out of this affordable dental implant nightmare!

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I’m stuck in a dental nightmare and don’t know what to do. I always knew that I couldn’t afford dental implants, but when I found out about an affordable implant option (the dentist called them all-on-4s) I was so excited that there was a way I could improve my smile and not be broke for the rest of my life.

I went for a consultation and it all sounded so easy. The dentist said not to worry because he had done the procedure for lots of patients. He didn’t say much about any risks, so I was totally on board. Now I regret going through with this because one of the implants failed and has pretty much screwed up the whole thing. If I want to try and fix it, I have to have bone grafting and several other expensive procedures done – and I have to pay for it all out of my own pocket. I could barely afford it the first time so there’s no way I can do this all again. I didn’t cause these implants to fail. What can I do? — Lisa

 

Lisa,
All-on-4s have become an effective and affordable implant option, but it’s unfortunate that your dentist didn’t communicate with you about the risks associated with them.  Most patients see high success rates with dental implants, but whether or not they fail relies heavily on the skill of the dentist as well as other things like whether or not you smoke or have other medical conditions that could affect their integrity. You could have the best dentist and none of the other risks factors and implants could still fail – for no reason at all. It’s unfortunate that you are stuck.

When it comes to making implants affordable, many dentists can do mini implants, or even make procedures more budget-friendly by offering financing or payment plans.  You might look into these options, but be cautioned that because all-on-4s are placed at an angle, the bone is likely not stable and the area will need repaired and given time to heal before you can move forward.

Your best bet is to go through the additional procedures, so you can make use of the work you’ve already done. We’d recommend consulting with another dentist and have them check out the other three to be sure they are holding up properly. Unfortunately, you’ll likely be paying for it out-of-pocket, but ask if there are some options available to finance the cost.

This post is sponsored by New Orleans cosmetic dentist Dr. Duane Delaune. Read more about why many consider Dr. Delaune to be the best dentist in New Orleans.

Is there an over-the-counter fix for TMJ?

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My mom and dad have both recently suffered some major medical issues that have caused a lot of stress both physically and financially for our family. There’s just not a lot of extra money right now. I have TMJ and all the stress has caused a flare-up and I literally can’t open my mouth. My jaw has been locked for several weeks. I’m in so much pain! I’ve seen those mouth appliances you can buy at the drug store for about $20. Would one of them help? — Sasha

Dear Sasha,
Sorry to hear that you’re going through so much right now. Hopefully things will get better from here on out. As for the TMJ, there are a couple of things you can try at home to help with the inflammation:

  1. Alternate between heat and ice packs (for about 10 minutes at a time) on your jaw joints
  2. Take 800mg of Ibuprofen three times a day

If the dentist is simply out of the question right now, try the store-bought mouth guard as it will be better than doing nothing. If you’re grinding your teeth a lot, just be careful and check that you’re not wearing it through. Hopefully, though, it will help protect your teeth for now. They come in small, medium, large or one-size-fits-all, but regardless of what you buy, keep in mind that it won’t be a perfect fit since it’s not custom made.

For moderate to severe temporomandibular joint dysfunction like you are experiencing, a custom night guard made by your dentist is really the best way to go. If you have dental insurance they may cover all or even a portion of the cost. Make a call and find out. Another option would be to see if your dentist offers CareCredit. It’s a no-interest medical card you can apply for if you don’t have insurance, but have adequate credit. Check into both of these options since your TMJ is fairly severe – it will be worth it in the end if you can get a custom-fit appliance and get this flare-up under control.

This post is sponsored by New Orleans cosmetic dentist Dr. Duane Delaune. Read more about why many consider Dr. Delaune to be the best dentist in New Orleans.

Am I taking a chance ordering a snap-on smile online?

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I’m looking for a way to save money on a snap-on smile and I found an online company who can do this. It’s also good because I really hate the dentist and would rather not have to spend any time in the dental chair. How hard could it be to get impressions taken of my teeth at home? I researched and found an online company that can help me with the impressions, but I’m a little concerned about their credibility after reading a lot of negative reviews from customers who paid money for orders and never got them. I am wondering if there are any other online companies out there that do this? — Sam

Sam,
WOW… it seems like you can order just about anything online these days. You can definitely find a lot of great deals on all sorts of products, but I’m not sure you want to take a chance with something as important as your smile.

First of all, impressions can’t and shouldn’t be done by the average person. In order to get a good, quality product, there has to be some training. Even if you found a dental assistant who could help you, he or she might not even be able to get the quality you need. And if you did get the impressions done, how would you get the actual snap-on smile ordered? Dental labs can only receive orders from licensed dentists – it’s the law – so there would have to be some sort of dishonesty on someone’s part in order to get that part of the process done. Then there’s all the details like shade, bite, and facial bulk that come into play when the snap-on smile is being made. Do you know how to figure all that out? Probably not.

Furthermore, a Snap-on Smile has to be fit once it comes back from the lab. There will be slight adjustments that need to be made and you won’t have the proper tools or skills to do it correctly, which could end up ruining it all together. Considering all these factors, do you still think it’s a good idea to try and order online?

If it’s price that is your main concern, you should be able to find a dentist in your area that can do a basic snap-on smile for a fairly reasonable cost. Be up-front about your budget and see if they will work with you and possibly charge you a few hundred over lab costs. You just need to be aware that you will get what you pay for, so don’t go into this expecting more than the basics.

This post is sponsored by New Orleans cosmetic dentist Dr. Duane Delaune. Read more about why many consider Dr. Delaune to be the best dentist in New Orleans.