Do receded gums rule out orthodontics?

[dentalguy]

When I was a kid my routine of dental hygiene wasn’t great. Often I’d skip cleaning my teeth at night only to ‘make up’ for this by brushing my teeth overly severely the next morning. When I got braces in my teens this behaviour was amplified as I found cleaning more cumbersome; I lazily avoided it only then to take into absolutely scrubbing my teeth to put things right. This was particularly sore on my gums as I was rubbing back and forth on the bottoms of the outside of my teeth below the tracks of my brace. The result was that the hard bristle brushes I used then scoured and bled my gums regularly seemingly causing them to recede over time.

I could really kick myself now when I think what I did to my gums/teeth over the years through a combination of lax hygiene and then ridiculously excessive brushing.

However, although it was too late for the damage already done, since I realised the harm my brushing was doing I have taken things much more gently; thankfully, it seems my gums haven’t moved for the last ten years.

Interestingly, the condition of my gums hasn’t been raised as an issue by any of the dentists, or even oral and maxillo-facial consultants I’ve seen over the years since my braces were removed. Indeed, on my recent visit to the dentist I mentioned my concerns and she said there was nothing to worry about.

So why the topic then? Well, a few years ago I went for an assessment with an orthodontist and having taken x-rays and looked at my mouth he informed me that orthodontic treatment wouldn’t be advisable as I was one of the small number of people whose gums had receded with previous work. On hearing this I was a little taken aback while at the same time too embarrassed to explain what I felt was the real reason behind the recession. Indeed, although he seemed quite young, I was probably somewhat resigned at the time to him being right given his professional expertise as opposed to my… er, casual assumptions.

However, examining my teeth since has really convinced me that severe brushing was the problem as it’s the teeth that were most easy to scrub – around the cuspids (fang teeth) – that have the most gum recession. By comparison there’s little or no recession elsewhere.

My concerns about this returned recently when speaking on the phone to the registrar at a clinic where I may be able to undergo SARPE. One thing he mentioned was that a patient had to have healthy teeth and gums for the procedure. It’s not that I think my teeth and gums are unhealthy, it’s just that my gums may not be up to the mark for the intensive work that might be required.

Even if previous orthodontics didn’t do it, is the presence of a receded gum line going to bring down the boom on any hope of me having orthodontic or othognathic work to correct my bite? Am I a lost cause?

Here’s a link to my picks and story so far: viewtopic.php?t=31490

[changes09]

first what you want to do is make an appointment with a periodontist. periodontists are dentists that can perorm gum grafts. which is taking gum from somwhere in your mouth (like the upper palet) and move it to the places where your gums are recceded. Like a skin graft. You can also go and talk to another orthodontist. You will be surprised how opinions differ from dentist to dentist

[amandajane]

I think changes, is on to something. I went to several orthodontist before I felt like I knew which one was right for me. When I look at your pictures your gums look fine, nice and pink the way they should be. But those are just pictures and not real life. If your flossing you should have pink gums.
On the overbrushing part, they back of the Crest toothpaste says brush after meals or at least two times a day. Hope that helps!

Theres my 2 cents.

My story: viewtopic.php?t=31380[url]

I have another adjustment coming up in a few days!Yeah![/url]

[sauerkraut]

If it's any comfort, my gum recession is much worse than yours -- also a result of overbrushing. That led to severe gum disease and needed periodontal "surgery" where they sort of lift up the gum pockets and scrape them out (or something like that ). I have some bone loss as well.

Despite all that I've undergone SARPE and have had braces a bit over a year now. My teeth haven't fallen out yet. My ortho only went ahead when he had it in writing from the dentist/periodontist that my gums were able to take it. It's likely that I'll need gum grafts when it's all over (I've got another surgery still to come). I think I'm right in saying that some people who need gum grafts have them at the beginning instead.

I agree with changes and amandajane that a consultation with a periodontist is a good idea -- in fact your ortho may well insist upon it.

Hope all goes well for you

[Wobblydeb]

I'd agree that your gum recession doesn't look too bad at all ... I'm not a dental professional though, so definitely seek a second opinion!

I've had fixed braces in the past, and got a similar amount on my canine and even worse on my molars. Like you, I'm not convinced it was the orthodontic work though, but more to do with bad brushing technique around the braces and those darn molar bands. My sister has even worse recession and she never had braces.....

I've had Invisalign for nearly a year now, and my gum line has worsened slightly. Not enough that I can see the changes, I have just felt the sensitivity that comes when new dentine gets exposed.

[GiverSSJ]

I know a lot of adults nowadays are going to get braces anyway. A lot of adults grew up in homes where teeth weren't "number one" so dentists see every type of smile. I know before braces are placed, orthos will tell you get all "necessary dental work" done before getting braced. That's what I was told anyway yesterday.

[32withbraces]

i had a bit of gum disease.my orthi insisted i see a periodontist and had to get the ok from him before i started braces

[dentalguy]

Thanks for the reassuring replies. Yeah, I find it hard to believe that jaw surgery and orthodontics would be a no no if your gums/teeth were less than perfect. After all, these things can be treated separately and ultimately the surgery might be necessary to alleviate a functional problem that's even more serious. Surely complications can be worked around if the problems they pose are more than compensated for by the benefits of the procedure.

I just took a bit of time to get back to this as I was searching for a local periodontist. I'm not sure how it works in the US but here there don't seem to be any standalone periodontists in the way that you'd have orthodontists that do nothing else other than orthodontistry. Periodontics just seems to be an extra offered by some dental clinics. However, whether it's just me being cynical or a more justified suspicion, I'm concerned that this might be a fancy description for your casual common or garden gum check and clean. I don't want to go for an appointment with someone that is no more specialised in 'gum-checking' than my regular dentist.

Anyway, I was doing some searching online and came across the website of a local dental clinic – http://www.belmoredental.co.uk. The site has a section on periodontics under the treatments heading and they also do orthodontic work. This left me thinking that I might be able to get both an examination of my gums and an opinion, given their experience, of whether my teeth might stand up to intensive work. I sent the owner Sinead – I believe it's a family business – the following email...

Hi

I was looking through the Belmore Dental website and noticed that your clinic carries out periodontal work. I was going to ring in and book an appointment but then decided that it might be best to outline my concerns in an email; explaining things over the phone isn't always successful.

I'm a 27 year old male and when in my teens I caused some damage to my gums by the strange combination of a lack of care and over brushing. I was wearing a brace at the time and my dental hygiene was hit and miss and, to be honest, fairly woeful. So to 'put this right' I took into severely scrubbing my teeth in a back and forth motion. As I had train tracks it meant that I was either cleaning above or below the attachment points. This resulted in a lot of scouring along the gum line and on a few teeth I seem to have rubbed the gum down to a level that exposed the root. Worse still, so enthusiastic was I for this extreme 'cleaning' that I think the exposed roots have been rubbed down in a few places.

The teeth that have received the most damage tend to be those protruding a little further out of line than those they're next to; they probably experienced the most force from the brush. In addition, the damage seems to be worse on the right side of my mouth presumably because I'm right handed. In contrast to all this, teeth further back in my mouth and those sitting a little further in seem to be fine with little or no gum damage.

Since I realised the error of my ways and altered my brushing habits there appears to have been no further damage in the last ten years.

What I'm interested in having done at Belmore, as well as a general look at things, is a check to see if there's any bacteria/plaque beneath the gum line. One particular area of receded gum above a premolar now feels a bit tender. If you provide the treatment, and deem it necessary, I would be happy to undergo scaling and root planing.

My second query revolves around the above and the prospect of orthodontic treatment/orthognathic surgery. Solely for functional reasons, I'm exploring the possibility of having my bite fixed properly and given the clinic's work in orthodontics I wonder if I could attain an assessment of whether my teeth/gums/jaws are in a fit state for such work. Due to a misaligned bite and discomfort caused by this I would be quite prepared, if it were deemed necessary, to undergo orthognathic surgery to alleviate the problem. It would be very helpful to receive an opinion from someone with experience in this field before taking the next step.

I would be keen to hear back if any of these concerns can be catered for and if you could give me an idea of the fees involved.

Currently, I attend another dental practice in Enniskillen but they don't seem to provide specialised periodontal treatment. I should add that the concerns expressed here are solely my own and that when examined an experienced professional might very well consider the damage of little concern. But I'm sure a check up won't do any harm.

Regards,

[sagittarius11]

Thanks for the reassuring replies. Yeah, I find it hard to believe that jaw surgery and orthodontics would be a no no if your gums/teeth were less than perfect. After all, these things can be treated separately and ultimately the surgery might be necessary to alleviate a functional problem that's even more serious. Surely complications can be worked around if the problems they pose are more than compensated for by the benefits of the procedure.

I just took a bit of time to get back to this as I was searching for a local periodontist. I'm not sure how it works in the US but here there don't seem to be any standalone periodontists in the way that you'd have orthodontists that do nothing else other than orthodontistry. Periodontics just seems to be an extra offered by some dental clinics. However, whether it's just me being cynical or a more justified suspicion, I'm concerned that this might be a fancy description for your casual common or garden gum check and clean. I don't want to go for an appointment with someone that is no more specialised in 'gum-checking' than my regular dentist.

[/quote]

I gather that you live in Northern Ireland. I am not quite sure how it works there but suppose it should be similar to England. I live in London and also needed some periodontic treatment before I started having braces one month ago. I can say that there are many standalone periodontists in London, just as orthodontists but many of them don't have websites. This is because patients seldom go directly to periodontists - they are usually referred to a periodontist by their dentists or orthodontists. Before starting treatment, my orthodontist insisted that I had to see a periodontist as I also have some gum recession and inflammation. He let me choose one in three periodontists who he is working with and then made a referal. I chose the one in the Harley street area as he is also a university lecturer and he did the work very well. I had sort of scaling and root planning. At the beginning he took all necessary X-rays to see how much depodit I had under the gums and then two 1.5 hour visits for the treatment. My gums improved considerably after that and I am quite happy although it was very expensive ( I had to pay £300 for each visit). Now I have to made regular visits to my periodontist during I am in baraces as I have a very serious gum recession on on tooth and he needs to monitor it together with my orthodontist. If things are worsen then a sugery would be needed. I am not quite sure but from what I get from my orthodontist and periodontist, it seems like nothing is impossible so I think it is worth to go to several orthodontists to have second opinion. If he is happy to give you the treatment he should be able to refer you to a periodontist to do some check-up.