Mobile dental hygienist advocates for oral health: Exploring gum recession and dental root caries

By Chia “Francis” Lin

In addition to my mobile dental hygiene practice for the homebound, I also work in private practice and community health settings. Being a dental hygienist is not just about cleaning teeth; I am an investigator for my patients as well. I would like to discuss two common dental issues: Gum recession and dental root caries. My role as a dental health advocate is to help identify patients’ dental problems and improve the best we could together.

A receding gumline is prevalent and present in almost all patients I see. Some factors for gum recession are poor oral hygiene, gum disease, trauma, grinding and genetics. Gum tissue recedes because there is no bone structure to support the soft tissue. This exposes the root part of the tooth which is vulnerable to dental decay and sensitivity. The number one treatment should always be going over oral hygiene home care with the patient. Brushing too hard or not brushing well enough both contribute to gum recession. If surgical treatment is warranted, the specialist can take a piece of tissue from the palate to graft onto the site of the receded area; however, recession may come back over time.

Tooth sensitivity is a common side effect of recession. In private practice, we use a bleach solution on a cotton pallet to put directly on the root surface to stop hypersensitivity with great results. This is an easy and non-invasive way of treating sensitivity besides using anti-sensitivity toothpaste. Products containing potassium nitrate, calcium phosphate, arginine and stannous fluoride are effective in managing sensitivity. Receding gumlines are very hard to prevent, even with excellent brushing and flossing technique. It comes with aging, health conditions and stress in life in general.

Dental root caries(decay) happens when there is recession of the gum tissue, exposing the root surface of the tooth. The root surface has no enamel to protect itself from pH changes and bacteria in the mouth and therefore decay can set in. Along with excellent oral hygiene home care and a proper diet, patients may need extra protection such as fluoride or chlorohexidine varnish and prescription fluoridated toothpaste. Silver Diamine Fluoride is often used in health clinics for arresting the spread of dental decay, especially in young children and elderly populations; it is cost-effective and quick and easy to use. However, it does leave a dark stain on decayed teeth.

Other treatments for root caries may be removing the decayed part and replacing it with a white filling. Sometimes teeth with root caries are crowned or “capped” to completely cover up the tooth so it is not exposed to the elements of the mouth anymore. In a recent case, we observed a young woman with severe acid reflux during pregnancy causing generalized destruction to her lower back teeth with some so severely decayed that she will need root canal procedures. This shows that dental root caries can be caused by systemic health issues and should be treated by both a dentist and a GI specialist. 

For questions, please email clinrdhap@gmail.com.