Around every tooth there is a small collar of gum tissue called the sulcus. In a healthy mouth, the sulcus is 1-3mm deep. At he bottom of the sulcus the gum is attached to the root of the tooth. It is a very important area to keep clean, for it is in this space that gum disease can begin.
In all of our mouths there are bacteria called plaque, which we can feel on our teeth as a fuzzy coating if we don't brush our teeth for a day. It takes about a day for the plaque to organize enough to start to do damage. Whether it is tooth decay or gum disease, the bacterial plaque are to blame.
Toothbrushing can remove the plaque from the cheek side, tongue side, and chewing sides of the teeth. But to clean between them and under the gums in the sulcus, dental floss is necessary. Flossing requires a bit of time and patience, and like any skill it gets easier with practice. The benefits of brushing and flossing are having a mouth that is healthy and free of disease. This contributes to the general health and well-being of the whole body.
If it was only plaque that formed in the mouth, a person could take care of cleaning their own teeth with no problem. However, there is another character in the play of oral health. There are Calcium and Magnesium minerals which float around in the saliva of our mouths, which help to strengthen weak spots in our teeth. This is a good thing and can help to reverse early tooth decay. However, if there is plaque for the minerals to deposit into, and if there are a lot of minerals present, these minerals will crystallize and form tartar, or calculus.
Calculus is hard and firmly attached to the teeth, and cannot be removed with toothbrush and floss. It can form above the gum, or below the gum in the sulcus. It is an irritation to the gum tissue, almost like a sliver in one's finger. It is also an easy surface for bacteria to attach to, so it attracts more plaque, which forms more calculus, making a vicious circle. Who can save the day? It is your dental hygienist to the rescue.
We use specialized instruments to remove the calculus from above and below the gums. These procedures are called scaling and root planing. We use both hand instruments and ultrasonics, and we can administer local anaesthetic to some areas if they are very sensitive. We also polish the teeth to remove stains and to smooth the surfaces, and apply fluoride when it is necessary.
If plaque and calculus have been present on the teeth for a length of time, the gum tissue responds by becoming red, puffy, sore, and bleeding, showing all the signs of infection. If left untreated, this infection can spread into the deeper tissues that support the teeth. The attachment at the bottom of the sulcus breaks away from the root, making the sulcus pocket deeper. The ligaments that suspend the teeth are damaged, the bone around the teeth dissolves under the infection, and the teeth can become loose and eventually fall out. This process of gum disease is speeded up by factors like smoking and poor diet, as well as some systemic diseases like diabetes. In all cases, the care of the dental hygienist can help to reverse the damage and help people to be in control of their dental health. Depending on the degree of disease that is present, the treatment can take one to several appointments, and we will ask people to return for recalls every 3-4 months to monitor their healing process as necessary. We chart the depths of the sulcus to give a baseline of the health of the gums.
There are instances where we refer patients to a gum specialist for a consult and treatment of specific concerns. Working as a team, the hygienist, the dentist and the patient ensure to keep our teeth in optimum condition for our entire life.