Questions I should ask my dentist about a new problem
September 7, 2014 7:13 AM   Subscribe

After every meal, I end up with gum pain that's caused by food getting stuck between two molars. This is a new problem that suddenly surfaced about three weeks ago.

Flossing and brushing don't remove the food. I can blast it out with a Waterpik, but the Waterpiking is itself painful and often results in bleeding from the affected area. No other parts of my mouth are sensitive or prone to bleeding – just that one spot between two particular teeth.

I saw my dentist a few days after the problem surfaced. He was not very concerned. He cleaned out the area, told me to rinse with salt water, and said that the problem would likely resolve itself.

Unfortunately, the problem hasn't gone away. It's true, though, that there is less pain now from the food, and there is less bleeding from the Waterpiking. But this is still very much an ongoing issue.

What should I ask my dentist when I see him again in a few days? He has a history of recommending expensive treatments, and I currently don't have any dental insurance. I've done some Googling, and I think what I have is a periodontal pocket, but I wasn't impressed with the amount or quality of information that's available on-line.

I'm hoping to find some fairly simple & inexpensive way to address this issue – a way that avoids radical treatments like orthodontia to close the gap between the teeth, or getting bone grafts, or some such expensive craziness that he might recommend. Anyone here have success with oil pulling, or rinsing with baking soda solutions, or something like that?
posted by alex1965 to Health & Fitness (13 answers total) 1 user marked this as a favorite
 
If you aren't experiencing pain and your dentist wasn't too concerned, I'd be willing to bet you have a gingival pocket rather than a periodontal pocket. Same thing, just less severity, and regular, focused brushing, rinsing (with Listerine or the like) and flossing will reverse it. It does take quite a bit of time, though.
posted by xingcat at 7:27 AM on September 7, 2014


I had some movement in my teeth that now causes food to be trapped between two teeth. I have been obsessive about my teeth ever since I went through extensive orthodontia in my youth, so I was concerned. Here's what my dentist told me: You have to floss like crazy because it could cause decay down the road.

Your dentist gave you the low cost 'fix' to your problem, Waterpik. That may be the extent of what can be done without further intervention. I'm sure he'll be happy to suggest expensive options, but really, if time and attention can fix the problem, why not just do as suggested?
posted by Ruthless Bunny at 7:28 AM on September 7, 2014


I have a similar problem with gaps that trap food between some of my molars. This was causing "pockets" (dental term) in my gums that could have led to periodontal disease.

At my dentists advice I started flossing several times a day, and also started using Soft Picks which are kind of like little tooth picks with brushes on the end. The soft picks are gentler than floss, and they get stuff out that floss doesn't get. I also carried soft picks around in my wallet to use after every meal.

In addition, I started chewing sugarless gum (with xylitol) to clean my teeth between meals.

The combination of these practices worked. I was amazed to discover how much food I was finding between my teeth, and by getting it out I've corrected the problem with my gums.
posted by alms at 7:30 AM on September 7, 2014 [2 favorites]


Three other notes:

My dentist dentist told me there was nothing she could do to remove the gap between my molars where food was being caught.

I asked about getting a Waterpik and she didn't think that would help.

The gum-chewing helps pull bits of food out from between my teeth, plus the xylitol helps promote overall dental health (see the Wikipedia article linked above).
posted by alms at 7:34 AM on September 7, 2014


Go back to your dentist. Trapped food alone shouldn't hurt like that, unless it is jammed, like a popcorn husk. What you're describing sounds more like an infection.
posted by SLC Mom at 9:18 AM on September 7, 2014


I would see a periodontist rather than a regular dentist and get a thorough (terrible, bloody, unpleasant) cleaning. They will also give you an assessment on the pockets.
posted by poffin boffin at 9:22 AM on September 7, 2014


I had a spot like that and my dentist recommended tying a knot in my floss for that area. Just move the knot gently and slowly thru the space.
posted by JujuB at 11:50 AM on September 7, 2014


Dental student here, hopefully this answer will be useful for you.

Here’s a couple of things to consider
1. Do you have any fillings in the teeth where the food is getting caught? If you have a filling in that area the contact point between the teeth might not be ideally contoured, which could cause food impaction. I assume your dentist has already ruled this out, because it’s an easy fix (new filling with proper contact)

2. Are the teeth touching each other (to put another way are they contacting each other)? One way to test if you aren’t sure is to floss the area and if you feel the “snap” as the floss as it moves past the contact then they are touching. If there is no contact then you’re definitely going to always get food impacted in that area. Nothing you or your dentist can really do short of doing orthodontics (braces, or invisalign).

3. The reason for your pain may be due to some localized periodontal disease in that area. You do not need to go to a periodontist (yet!). Dentists (and hygienists) are able to treat most cases of periodontal disease and will probably be able to do it cheaper than a periodontist. When you go back ask your dentist to measure the pocket depth between those teeth. Ask him if its deeper than normal. If it is then ask him if it would be beneficial to scale and root plane that area. In addition I would also ask him or the hygienist to measure the pockets of all your teeth to make sure you don’t have periodontal disease elsewhere.

Assuming you do have periodontal disease I want you to know that scaling and root planing probably won’t solve your issue of food impaction, but it will stop it from getting worse. Once you start losing bone around your teeth it’s not coming back without more expensive grafting procedures (which you do need a periodontist for). One extra thing you can do is buy some proxy brushes (same thing as those soft picks someone else mentioned) and use those. Don’t force them! Just a little pressure to get in between the teeth should be enough to dislodge the food, if you have to force it then you need a smaller size brush.

Lastly, don’t waste your time on oil pulling. It isn’t a practice that anyone needs to do. Brushing and flossing is what counts.

Hope this helps, if you feel like returning to the thread after you see your dentist I’d be curious to hear what he says.
posted by jModug at 12:56 PM on September 7, 2014 [1 favorite]


I had this problem between two of my upper bicuspids. My dentist was able to build up a filling in one of the teeth to eliminate the gap and get rid of the problem.

Is you a new problem for you? If so see if your dentist can figure out what changed to cause the issue.

It may be time for a second opinion.
posted by mygoditsbob at 7:33 PM on September 7, 2014


jModbug, thanks for the detailed answer.

The problem is not caused by a filling. The dentist took an x-ray when I was there last time. There is nothing wrong with the teeth themselves, save for a gap between them. The teeth are not touching each other at all, and there is no "snap" when I floss.

My dental hygienist measures the depth of the pockets every time I get my teeth cleaned. She always tells me that they're too big.

If I continue paying careful attention to that area (i.e., I keep doing the Waterpiking after every meal, and I floss and use mouthwash), do you think the pocket will decrease in size? My dentist said he already scaled it the last time I was there. He didn't say anything about planing, though.

Is it possible to reduce the gap between the teeth by filling it with the compound they use for fillings? I'm certainly not getting orthodontia done. What about using a pellet of Arestin in the pocket? Might that work? Any other advice?

Thanks again.
posted by alex1965 at 4:25 AM on September 8, 2014


PS What do you think about using a chlorhexidine rinse? Or is there some other kind of special mouthwash I should use? Thanks.
posted by alex1965 at 4:37 AM on September 8, 2014


If I continue paying careful attention to that area (i.e., I keep doing the Waterpiking after every meal, and I floss and use mouthwash), do you think the pocket will decrease in size? My dentist said he already scaled it the last time I was there. He didn't say anything about planing, though.
Unfortunately, I don't think the pocket will get smaller, but it is very important to keep up the oral hygiene regiment to stop the pocket from getting bigger. Root planing is a procedure similar to a regular scaling, but is more involved. Its purpose is to remove all the plaque and calculus (similar to scaling), but also to remove any infected cementum (which is the part of the root that connects with your gums), as well as induce bleeding in that area. In some cases this will allow the pocket to decrease in size, because as the tissues heal the inflammation is reduced and there is a potential to create an epithelial attachment of the tooth and gums.
I can't say whether or not you need this procedure without knowing the pocket depths. Your dentist/hygienist may have already done it, sometimes they generalize and say scaling when they mean scaling and root planing. Usually, anyone with a pocket depth of 5 mm or more could benefit from a root planing procedure.

Is it possible to reduce the gap between the teeth by filling it with the compound they use for fillings? I'm certainly not getting orthodontia done.
They could potentially put in a filling to close the gap, but it would be pretty unorthodox to do a filling on a tooth without a cavity. Also the gap would have to be very small (smaller than 1 mm) for it to be beneficial, otherwise the tooth would be too bulbous and you would get worse food impaction in that area.

What about using a pellet of Arestin in the pocket? Might that work?
Usually this is reserved for people with aggressive periodontal disease who need a little more help than what a root planing can offer. You probably don't have aggressive periodontal disease, because if you did your dentist would be much more concerned.

PS What do you think about using a chlorhexidine rinse? Or is there some other kind of special mouthwash I should use?
Chlorhexidine is a good mouth wash for lowering the amount of bacteria in your mouth, but it's not going to make the pocket smaller or stop food from getting stuck in there.

Any other advice?
To summarize I think you might be a candidate for root planing. Ask your dentist/hygienist if they think you would benefit from it. Ask what the pocket depth size is in that area and if you have any bone loss. Ask if and where you have any large pockets (4 mm or more) or bone loss elsewhere in your mouth too. If they are saying you do have large pockets and bone loss then you most likely do have periodontal disease and need treatment for it. Lastly, it can't hurt to get a second opinion, but any dentist or hygienist should be able to treat for periodontal disease. If they aren't comfortable treating it then they should be able to at least recognize it and refer you to a periodontist.

I think the most that you can do on your own is to keep brushing and flossing to prevent further problems. The bleeding will lessen as you continually keep the area clean. Carry around one of those proxy brushes in your car or wallet to use after a meal. Let me know if you have other questions.
posted by jModug at 6:41 AM on September 8, 2014


If I continue paying careful attention to that area (i.e., I keep doing the Waterpiking after every meal, and I floss and use mouthwash), do you think the pocket will decrease in size?

I was able to resolve the issue of pockets using the program described above.

I went to the dentist and was informed that I had major pockets developing and was on my way to getting periodontal disease. After that visit I started flossing and using soft picks after every meal and snack, and I chewed sugarless gum with xylitol regularly after eating to remove any remaining traces of food. When I returned to the dentist eight months later the pockets had resolved. My dentist no longer had any concern about my gum health or the possibility of my developing periodontal disease.

I'd really recommend trying out soft picks in place of or in addition to the Waterpik. They are easier to use and gentler than floss; you can carry them around with you so you can clean your teeth after eating away from home; and they really work: they get stuff out of your teeth that even floss doesn't get out.

Is it possible to reduce the gap between the teeth by filling it with the compound they use for fillings?

I had the same thought and asked my dentist about it. She said it wasn't possible, and that I just needed to keep cleaning my teeth the way I've been doing.
posted by alms at 8:22 AM on September 8, 2014


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