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By Dr. James M. Maragos, DDS, PC
April 09, 2019
Category: Oral Health
DrTravisStorkDontIgnoreBleedingGums

Are bleeding gums something you should be concerned about? Dear Doctor magazine recently posed that question to Dr. Travis Stork, an emergency room physician and host of the syndicated TV show The Doctors. He answered with two questions of his own: “If you started bleeding from your eyeball, would you seek medical attention?” Needless to say, most everyone would. “So,” he asked, “why is it that when we bleed all the time when we floss that we think it’s no big deal?” As it turns out, that’s an excellent question — and one that’s often misunderstood.

First of all, let’s clarify what we mean by “bleeding all the time.” As many as 90 percent of people occasionally experience bleeding gums when they clean their teeth — particularly if they don’t do it often, or are just starting a flossing routine. But if your gums bleed regularly when you brush or floss, it almost certainly means there’s a problem. Many think bleeding gums is a sign they are brushing too hard; this is possible, but unlikely. It’s much more probable that irritated and bleeding gums are a sign of periodontal (gum) disease.

How common is this malady? According to the U.S. Centers for Disease Control, nearly half of all  Americans over age 30 have mild, moderate or severe gum disease — and that number increases to 70.1 percent for those over 65! Periodontal disease can occur when a bacteria-rich biofilm in the mouth (also called plaque) is allowed to build up on tooth and gum surfaces. Plaque causes the gums to become inflamed, as the immune system responds to the bacteria. Eventually, this can cause gum tissue to pull away from the teeth, forming bacteria-filled “pockets” under the gum surface. If left untreated, it can lead to more serious infection, and even tooth loss.

What should you do if your gums bleed regularly when brushing or flossing? The first step is to come in for a thorough examination. In combination with a regular oral exam (and possibly x-rays or other diagnostic tests), a simple (and painless) instrument called a periodontal probe can be used to determine how far any periodontal disease may have progressed. Armed with this information, we can determine the most effective way to fight the battle against gum disease.

Above all, don’t wait too long to come in for an exam! As Dr. Stork notes, bleeding gums are “a sign that things aren’t quite right.”  If you would like more information about bleeding gums, please contact us or schedule an appointment. You can read more in the Dear Doctor magazine article “Bleeding Gums.” You can read the entire interview with Dr. Travis Stork in Dear Doctor magazine.

By Dr. James M. Maragos, DDS, PC
February 08, 2019
Category: Oral Health
Tags: gum disease  
StopGumDiseaseBeforeitHarmsYourHealth

If you're over 30 your chances for developing periodontal (gum) disease are better than half. And it's not a minor matter—untreated gum disease can lead not only to tooth loss, but to an increased risk of cardiovascular disease and other inflammatory conditions.

Fortunately, we have effective ways to treat gum disease, even in advanced stages. But the best approach by far in avoiding a devastating outcome for your teeth is to prevent gum disease from developing in the first place.

It helps first to know how gum disease begins. The most common cause is dental plaque, a thin biofilm of food particles on tooth surfaces that harbors the bacteria that triggers the disease. If you keep your teeth clean of built-up plaque and tartar (calcified plaque) with daily brushing and flossing and regular dental cleanings, you'll minimize the growth of disease-causing bacteria.

If you don't practice effective oral hygiene, however, within a few days you could develop an initial infection called gingivitis. This form affects the outermost layers of the gums and triggers a defensive response from the body known as inflammation. Ordinarily, inflammation helps protect surrounding tissues from infection spread, but it can damage your gums if it becomes chronic. Your weakened gums may begin to detach from the teeth, forming voids filled with inflammation known as periodontal pockets. Eventually, the infection can spread to the supporting bone and lead to tooth loss.

In addition to a dedicated oral hygiene and dental care program, you should also be on the lookout for early signs of gingivitis. Infected gums can become red, swollen and tender to the touch. You may notice they bleed easily while brushing and flossing, or a foul taste or breath that won't go away even after brushing. And if some of your teeth feel loose or don't seem to bite together as they used to, this is a sign of advanced gum disease that deserves your dentist's immediate attention.

Practicing preventive hygiene is the best way to stop gum disease before it starts. But if gum disease does happen, catching it early can be a game-changer, both for your teeth and your smile.

If you would like more information on preventing and treating gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “How Gum Disease Gets Started.”

By Dr. James M. Maragos, DDS, PC
November 30, 2018
Category: Oral Health
Tags: braces   gum disease  
TheRiskforGumDiseaseIncreasesWhileWearingBraces

Your child has had braces for a few months and making good progress with correcting a poor bite (malocclusion), but you’ve also noticed something else: his gums are becoming red and swollen.

These are symptoms of gingivitis, a periodontal (gum) disease. It’s an infection that arises when plaque, a thin film of bacteria and food particles, isn’t adequately removed from teeth with daily brushing and flossing. The braces increase the risk for gingivitis.

This is because the hardware — metal or plastic brackets cemented to the teeth and joined together by metal bands — makes it more difficult to reach many areas of the teeth with a brush or floss string. The plaque left behind can trigger an infection that causes inflammation (swelling) and bleeding.

To exacerbate the situation, gums don’t always take well to braces and can react by overgrowing. Wearing braces may also coincide with a teenager’s surge in hormones that can accelerate the infection. Untreated, gingivitis can develop into advanced stages of disease that may eventually cause tooth loss. The effect is also heightened as we’re orthodontically putting stress on teeth to move them.

You can stay ahead of gingivitis through extra diligence with daily hygiene, especially taking a little more time to adequately get to all tooth surfaces with your brush and floss. It may also help to switch to a motorized brush or one designed to work around braces. You can make flossing easier by using special threaders to get around the wires or a water flosser that removes plaque with a pulsating water stream.

And don’t forget regular dental visits while wearing braces: we can monitor and treat overgrowth, perform thorough dental cleanings and treat occurrences of gingivitis. In some cases you may need to visit a periodontist, a specialist in gums and supporting teeth structures, for more advanced treatment. And if the disease becomes extensive, the braces may need to be removed temporarily to treat the gums and allow them to heal.

Orthodontic treatment is important for not only creating a new smile but also improving your teeth’s function. Keeping a close eye out for gum disease will make sure it doesn’t sidetrack your efforts in gaining straighter teeth.

If you would like more information on dental care during orthodontics, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Gum Swelling During Orthodontics.”

By Dr. James M. Maragos, DDS, PC
October 11, 2018
Category: Dental Procedures
Tags: tooth decay   gum disease  
StopRootCavitieswithPreventionandPromptTreatment

Tooth decay is a highly destructive dental disease, responsible along with periodontal (gum) disease for most adult tooth loss. And we become even more susceptible to it as we get older.

One form of decay that’s especially prominent among senior adults is a root cavity. Similar to a cavity in the crown (visible tooth), this form instead occurs at or below the gum line in the roots. They happen mainly because the roots have become exposed due to gum recession, a common consequence of periodontal (gum) disease and/or brushing too hard.

Exposed roots are extremely vulnerable to disease because they don’t have the benefit of protective enamel like the tooth crown, covered instead with a thin and less protective mineral-like material called cementum. Normally, that’s not a problem because the gums that would normally cover them offer the bulk of the protection. But with the gums receded, the roots must depend on the less-effective cementum for protection against disease.

Although we treat root cavities in a similar way to those in the crown by removing decayed structure and then filling them, there’s often an added difficulty in accessing them below the gum line. Because of its location we may need to surgically enter through the gums to reach the cavity. This can increase the effort and expense to treat them.

It’s best then to prevent them if at all possible. This means practicing daily brushing and flossing to remove bacterial plaque, the thin, built-up biofilm on teeth most responsible for both tooth decay and gum disease. You should also visit your dentist at least twice a year for professional cleanings and advanced prevention methods like topical fluoride to strengthen any at-risk teeth.

You should also seek immediate treatment at the first sign of gum disease to help prevent gum recession. Even if it has occurred, treating the overall disease could help renew gum attachment. We may also need to support tissue regeneration with grafting surgery.

Root cavities are a serious matter that could lead to tooth loss. But by practicing prevention and getting prompt treatment for any dental disease, you can stop them from destroying your smile.

If you would like more information on diagnosing and treating root cavities, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Root Cavities: Tooth Decay near the Gum Line Affects Many Older Adults.”

By Dr. James M. Maragos, DDS, PC
October 01, 2018
Category: Oral Health
Tags: gum disease  
TreatingGumDiseasearoundToothRootsisHard-butNotImpossible

Periodontal disease may start in the gums’ superficial layers, but it’s not likely to stay there. As the disease moves deeper it can wreak havoc on tooth roots and bone as well as gum tissue attachments. Teeth with multiple roots are in particular peril because of the “forks” called furcations that form where the roots separate from each other. Infected furcations can be very difficult to treat.

We primarily treat gum disease by removing its main source, a thin film of bacteria and food particles called dental plaque that builds up on teeth. To remove it we most often use special hand tools or ultrasonic equipment to vibrate it loose. As the plaque and tartar diminish, the infection begins to wane.

But we can’t be completely successful in stopping the disease if any lingering plaque deposits remain. This especially includes furcations where the infection can cause significant damage to the roots. Although cleaning furcations of plaque can be difficult, it’s not impossible with the aforementioned tools and antimicrobial substances to disinfect the area.

The real problem, though, is access—effectively getting to the furcations to treat them. We may need to perform a surgical procedure called flap surgery where we create a hinged flap in the gum tissue to move it aside and access the root area beneath. Afterward we replace the flap and suture the tissue back in place.

In some cases, the infection may have already caused significant damage to the tissue and underlying bone. We may therefore need to graft gum or bone tissues to these damaged areas to stimulate re-growth. We may also need to surgically reshape the gum attachments around a tooth to make it easier in the future to access and clean the area.

These additional treatments around furcations can be very involved and labor-intensive. That’s why the best outcomes occur if we’re able to start treatment in the early stages of an infection. So, if you notice red, swollen or bleeding gums contact your dentist as soon as possible. Treating gum disease as early as possible will help ensure your tooth roots won’t suffer extensive damage.

If you would like more information on treating gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “What are Furcations? Branching Tooth Roots can be Periodontal Nightmares.”



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James M. Maragos, D.D.S.

Dr. Maragos’ commitment to his community parallels his commitment to his profession. In 2007, he was elected to... 

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