The Cosmetic Dentistry Blog

Dr. Hall,
My problem is excessive tartar build-up. My hygienist has asked me to come in every four months instead of the usual six months in an effort to clean them before the plaque hardens further. My teeth cleaning regime includes flossing once a day, using a Sonacare toothbrush for 10 minutes twice a day, brushing with a regular soft bristled toothbrush and toothpaste, and brushing with baking soda (I added this step when I found that plaque is acidic in nature and thought perhaps the baking soda, as an alkali, might neutralize the plaque). All this, and with my four month checkup approaching, my teeth feel scuzzy and I dread the visit to the hygienist, who, I believe, hates to see me coming!

Any advice on fighting this plaque/tartar problem?
- Judith in Arizona

Judith,
You’re doing all the right things as far as combating this tooth tartar problem.
When you have a lot of tartar or calculus, here’s your checklist:
1. Get your teeth cleaned more frequently.
2. Don’t miss a day flossing or brushing. When you give the plaque more than 24 hours undisturbed, you’re letting it harden into tartar or calculus.
3. The one thing you didn’t mention is a tartar-control toothpaste. Most major brands have a tartar-control formula that will help keep the accumulation of tartar down.

Baking soda is good for your teeth and gums, but it won’t fight tartar.

And then, to help you understand this issue, I should point out the difference between supra-gingival calculus, which is also called tartar, and sub-gingival calculus.

Supra-gingival calculus forms above the gum line, and is visible in the mouth. It contributes to gum disease. But it is relatively soft and easy to remove. When you use the word “tartar,” this is what you’re talking about.

Sub-gingival calculus forms on the root surfaces below the gum line and is not visible in the mouth. It is much harder and more difficult to remove, and is not affected by tartar-control toothpastes. It is also much more serious and if left on the teeth will contribute to serious gum disease which will involve the gradual loosening and loss of your teeth. If you have a lot of it, it can take multiple appointments for a hygienist or a dentist to remove it all.
- Dr. Hall

Dr Hall,
I had my impacted wisdom teeth removed almost 10 years back. The gums near the lower right wisdom tooth have become very sensitive since then. If I brush even lightly in that area, it starts to bleed. My dentist examined it and told me there is no pocket there. He did not find anything abnormal.

I don’t understand why the gums bleed, also sometimes there is a sticky kind of saliva coming out if I rub my finger over the gums. I also have an abnormal bite, for which I use a dental guard at night.

Please help, Thanks
- Nabil from Virginia

Navil,
The answer to your problem is that your gums are probably bleeding because you’re not brushing there. It sounds like you’re not brushing, because you say, “If I brush…” instead of , “When I brush…”

When you don’t brush, you leave plaque bacteria on the teeth next to the gums. The plaque bacteria produce toxins that cause your gums to become inflamed, which makes them bleed when you just touch them. So the answer to your problem is to brush that area, even if it makes your gums bleed. Be gentle, but you’ve got to keep the teeth clean.

I doubt that this has anything to do with your wisdom teeth. After being gone for ten years, you have been completely healed for many years and your body has totally re-shaped the bone and other tissues so that it’s like your wisdom teeth were never there.
- Dr. Hall

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- gum infection
- the best toothbrush is soft
- what about an electric toothbrush

Question:
Yesterday I noticed that I could feel something under my tongue, behind my front teeth. I thought it was from the food I had been eating, but I’m pretty sure that it is actually part of my front tooth, poking up a little from the gum. This has happened from time to time in the past but never quite as prominently, just a little bump. It usually went back to normal after a day or so. This time it feels more pronounced and I am wondering if it’s something to be concerned about and what action, if any, I should take. Will it likely recede again with nothing to worry about. At my last dentist visit (6 months ago) nothing abnormal was found in that area.

Thank you.
- Carol from Boston

Dear Carol,
If I were examining you, the first thing I would check would be gum disease. In gum disease, you can sometimes get a flare-up of the infection that can cause a swelling – a small tooth abscess – near the gumline. So this is a possibility. And there are too many dentists and dental hygienists, unfortunately, who don’t screen regularly for gum disease, or don’t screen thoroughly enough. And many dental insurance companies have policies that pressure dentists not to deal with gum disease because it makes their costs go up.

If it does turn out to be a manifestation of gum disease, I would ask your dentist to refer you to a periodontist – a gum disease specialist. Gum disease is a particularly insidious disease because it progresses so slowly, generally without any symptoms at all, until one day, after it has become advanced gum disease, you notice that your teeth are getting loose. Have that checked carefully.
- Dr. Hall

Question:
I have black deposits on the side of the teeth at the gumline. When I scrape them with a steel scaler, they break down but brushing doesn’t do anything. It’s like a formation of plaques, but it’s not yellow, it’s black. What is it?
- Mr. Worried in New York City

Dear Mr. Worried,
Your black deposits sound like dental calculus, and you should worry. Over time, dental calculus like this can make your teeth get loose and eventually fall out. You need to get to a dentist, have him or her confirm what they are, and if it is this dental calculus, get into a gum disease treatment program.
Dr. Hall

Question:

I was wondering what exactly is the cause of a receding gumline? Even when the gingiva appears healthy..is it malnutrition?? And it’s only really noticably serious on the person’s first premolars…

- Michelle in Texas

Dear Michelle,

There are several possible causes for a receding gumline. I’ll list them here: 1. You could have general gum disease. If that’s the case, you need to visit a general dentist or a gum specialist (periodontist) for treatment. Plaque and other irritants build up under the gumline and will eventually cause your teeth to become loose.

2. The bone in the area of the recession could be thin or missing, causing the root to show through to some extent and the gum to gradually recede over your lifetime. The treatment for this is to be very gentle when you brush. It can sometimes be repaired with a gum graft, which is usually done by a periodontist, though some general dentists can do this.

3. You could have what’s called traumatic occlusion. If you clench or grind your teeth at night, it can cause notches to develop in your teeth at the gumline and your gums will recede from this area. Further gum recession can be prevented or slowed by wearing a nightguard.

4. You could be brushing too aggressively with a hard brush. (The best toothbrush is soft)

- Dr. Hall