How to get a dentist to take my inflamed and bleeding gums seriously?

May 6, 2015 11:49 AM

I went through a period of time where I didn't take as good care of my teeth as I should have due to excessive stress in my life. I wasn't flossing, didn't brush very often and also was grinding and clenching my teeth a lot.

I developed gingivitis as a result and my dentist cleaned my teeth and told me to take better care of them. I proceeded to let them go again but this time around the gums appeared to be extremely inflamed and was accompanied by a sour taste. I have since been able to get most of my gums back into good shape and the taste has dissipated a lot but there is still one section that is very inflamed and is causing me sensitivity. It is dark red and located above two of my front teeth. It bleeds a lot when I brush the area and I am very concerned there is an infection deep within the gum. This part of my gum has been like this for about 8 months.

I have been back to two different dentists since the inflammation and bleeding has started and they both confirmed they see inflammation (one even called it an infection) but said it should clear up with the use of a sonicare, waterpik and flossing. I have done all of these and the inflammation and bleeding remains. What can I do on my next visit to a new dentist to ensure this issue gets taken care of once and for all? Should I push for a deep cleaning or use of antibiotics in the inflamed section? I know there's a link between gum problems and overall health and I also don't want this to progress to periodontitis or bone/teeth loss. Any advice on how I can convince my dentist to take take measures to help me clear this up would be greatly appreciated.

posted by sely to Health & Fitness (17 answers total)

You are the patient. You have the right to be assertive about the health, so make sure you are. Say all of the things that you've said in this post. Write down a history of your gum troubles. If your dentist still doesn't take your issue seriously, vote with your wallet and go see another one.
posted by Fister Roboto at 11:58 AM on May 6, 2015

You've seen two dentists and received the same info, so I think you're doing a great job of advocating for yourself already.

Next time you go in, make sure you give them the full timeline.

My gums have been bleeding for [x] months. I noticed an improvement in areas [a] and [b] but this area [c] has shown no improvement. I have been using [care routine] religiously since my appointment in [month], but still, no improvement in area [c]. I'm concerned that there may be a deeper infection than what my regular home care can correct, and I need your suggestions for what comes next, to protect my overall gum health.

Be very clear and very specific.
posted by phunniemee at 11:58 AM on May 6, 2015 [4 favorites]

Asking a new dentist is a good thing. Be careful of a deep cleaning. Many push for that just because its big bucks. In the meantime check your diet. Lack of certain vitamins cause gums to bleed along with allergies. You may have something lodged in there too. Popcorn hulls are notorious for jamming up into gums and causing all kinds of grief. I would recommend a good rinse with salt water or even a peroxide based mouthwash on a regular basis.
posted by PJMoore at 12:00 PM on May 6, 2015 [2 favorites]

I am wondering why you continue to go to new dentists? I would think that a follow-up visit to a previous dentist would yield an escalated level of care - ie, once they see you've done all of the sonicare, etc as you've outlined above, they should take the next step and prescribe you an antibiotic in order to clear the infection. A new dentist is always going to start at Step 1, which your last two dentists appear to have done.
posted by vignettist at 12:27 PM on May 6, 2015 [16 favorites]

Yeah, I'm thinking it's going to be better for a healthcare provider to evaluate a condition over time. If you see a new one each time, s/he will start from square one.

If you do decide to go back to your previous one, ask:
-why aren't you more concerned since this has been going on for x months.
-what changes/progress should i be seeing?
-how long will this take to heal? or will it be like this permanently?
-I know there's a link between gum problems and overall health and I also don't want this to progress to periodontitis or bone/teeth loss. Do you think there is a serious health risk here? If not, why not?
posted by Beti at 1:01 PM on May 6, 2015 [1 favorite]

Are you sure there is a good treatment other than maintaining good oral hygiene and letting the gum heal? I ask because I'm in a similar boat, and my dentist definitely is concerned about it. He said I needed to take better care of my teeth or they would fall out. But he told me the same thing that your dentist told you. I'm supposed to be really good about brushing and flossing and come back for another appointment in four months. I think there's a chance that there is no magic treatment that will "take care of it once and for all," and you're just going to have to keep plugging away with the brushing and flossing and wait for it to clear up.

So anyway, if it were me (which it sort of is), I would keep plugging away with the brushing and flossing and then at your next appointment explain that you're concerned that your gum still hasn't healed after however many months and ask if there's any additional treatment you could pursue.
posted by ArbitraryAndCapricious at 1:28 PM on May 6, 2015

Go get an opinion from a periodontist. That bleeding section probably needs to be cut out.

I spent thousands on dentists before I got a second opinion. Flossed, Sonicaired, industrial-strength toothblaster. The cutting worked.
posted by Mr. Yuck at 1:33 PM on May 6, 2015 [3 favorites]

yeah, stop seeing the tooth people and find a gums person. ask one of your dentists for a periodontist recommendation.
posted by poffin boffin at 2:00 PM on May 6, 2015

My dentist prescribed me chlorohexidine when I was having some gum issues (mine weren't as bad as yours). It worked amazingly well. You don't use it long term, as it can cause staining especially to the back of your teeth. Something else that worked for me was Listerine, and I use that regularly. But yes, I would see another dentist or a periodontist. When I came in with inflamed gums, my dentist jumped to action, so I hope you find one who will take it as seriously.
posted by I_love_the_rain at 2:03 PM on May 6, 2015

For what it's worth, I had similar issues after a period of ill health, and my dentist told me to use a Sonicare and floss daily, and I see him for cleanings and check ups every three months. It's been over two years of that routine, and there has been improvement, but it's been slow. He has never suggested anything other than sticking to the routine and seeing him frequently and I trust him completely.

You didn't develop this condition overnight, and you might need to trust your dentists' (plural! two!) assessment that this needs to be treated and reversed slowly as well.
posted by telegraph at 2:04 PM on May 6, 2015

Response by poster: Thanks for all the great information, everyone. I want to clarify that I had to switch dentists because of a new job and insurance. I also forgot to mention that one of the dentists I saw was a periodontist and he said nothing seemed too extreme. I have a feeling he is used to seeing much more severe cases with deeper pockets and bone loss and didn't think much of it but it is obviously very concerning to me.

I appreciate your advice and will take it into consideration when I see my new dentist.
posted by sely at 2:34 PM on May 6, 2015

You might consider seeing a periodontist. They deal with gum disease and related issues. I love mine.
posted by harrietthespy at 2:56 PM on May 6, 2015

This is a bit off the question but I feel like I should mention it- when I'm very stressed, I push down too hard with my toothbrush, tearing my gums, and I end up with bleeding, sensitive gums. I tried to make myself be aware and stop but, my life gets really stressful sometimes and I kept ending up with the same problem. I finally switched toothbrushes and I haven't had any problems in the past 3 years. I found that Preserve toothbrushes have a gentle bend to them that will not allow me to press down too hard, no matter how stressed I am. It's worth a try.

If you drink orange soda, use tobacco products, or have a lousy diet, you aren't helping yourself at all.
posted by myselfasme at 4:40 PM on May 6, 2015

Nthing that progress on this sort of thing is sloooooooooow. The only thing with which I have seen rapid(ish) improvement, which is to say, months instead of years, was a really religious dental cleaning schedule PLUS the religious sonicare/flossing etc. 3x a year, one of them a deep cleaning/scaling.

It may just be that my situation was worse, though the description sounds similar. But it is possible that some dental practices are much more proactive and intervention-friendly than others. So maybe the way to start with your new dentist would be to sound out their approach before you even go: do they prefer to intervene early or to take a wait-and-see attitude? If the latter, maybe they're not a great fit and rather than go there, find another who's more on your wavelength.
posted by We put our faith in Blast Hardcheese at 5:31 PM on May 6, 2015

When you go in, start by say you have chronic gum inflammation AND you've been brushing with Sonicare, and using Waterpik and flossing (x times per day for each). And you want to know what to do differently.

I have problem gums because of heredity and dry mouth. My dentist, who's otherwise excellent, just kept on saying that proper brushing and flossing should be giving me better results. Things started getting better after the hygienist showed me exactly how to floss: back and forth and up and down. Twice a day also made a big difference -- so try that if you're currently flossing once. I've been using Gumchucks for 5 months, and last week during my cleaning and exam, the dentist and hygienist noticed a significant improvement. Gumchucks allow me to floss deeply and firmly without hurting my fingers. There are two stick-like handles with a replaceable length of floss in between. I'm sure there are places to buy them cheaper than at Amazon.

Rinsing with Listerine was helpful too, but I had to quit because it caused too much of a burning feeling.
posted by wryly at 7:12 PM on May 6, 2015

The Listerine is a great idea - when your gums are healthy. But with the chronic inflammation, I would stick to a warm salt water rinse.

Have you seen any possible signs of abscess? On the gum it would show as a area of redness and finally a pimple-like boil. If you push on the gum with sanitized hands or with an oral care tool, do you feel tenderness that never goes away?

Periodontitis can show in acute/aggressive and chronic forms. If you've seen a gum boil over and over, that's actually a good sign indicating multiple cases of perio with drainage. In very rare cases, this can be serious - but it needs immediate attention. Chronic periodontitis presents as an inflammation of the gum that won't go away, no draining, and can be a very serious condition and do a real number on the bone and many other things.

I would return to a periodontist and ask for a conclusive diagnosis ruling out anything serious. 8 months is, frankly, a long time if you've truly been doing the home rinses, etc. I can't tell after reading your OP again how long of time we are talking since you have had an x-ray and measurement of pocket depths.

IANYD, but wish you all the best!
posted by Gerard Sorme at 7:42 PM on May 6, 2015

One thing which may help-- rinse your toothbrush in near-boiling water before brushing. It makes the bristles softer, and they reach places you'd never reach otherwise.
posted by alexei at 1:34 AM on May 7, 2015