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Dentistry/Terribly puffy and red gums over veneers only

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QUESTION: I had porcelain veneers done about ten years ago on my front six teeth. My gums remained pink for about 6-7 years. Over the last couple years, however, the gums above the veneers have gotten progressively puffier and more red. They're embarrassingly unsightly, and I avoid social interactions because of them.

My dentist (who installed the veneers) was stumped on the issue, curious how the gum problem was only above the veneers. He suggested a more "intense" cleaning regimen of mouthwash and gently massaging the gum-line to promote bloodflow. Unfortunately, this hasn't changed anything.

I grind my teeth during sleep, and so I've been using a molded, non-ceramic mouthguard at night for a while now. However, it doesn't touch the gums in any way. (Just thought I'd mention this for reference, as it's been suggested that bruxism can cause bad/swollen/red gums)

I'm at wit's end with this, feeling like things can never get better, and that I'll be stuck with these hellish-looking monstrosities for the rest of my life, maybe even leading to losing my teeth.

I've read through your past

I'm desperate and will try anything -- even if it means hiking barefoot to the snowy crest of Mount Kilimanjaro to retrieve a rare healing herb. Anything!

ANSWER: Dear Stu,

With your grinding, you're lucky to have kept your veneers all these years.  Most clencher-grinders begin losing veneers within the first 2 years of their being placed.

My first guess would be that your veneers might be coming loose.  If not loose, then leaking at the gumline.  They may need to be removed, allow the gums to heal, then replace them. Sometimes clenching alone, with increasing age, loss of immunity and increased inflammatory response will cause your gums to become red and swollen when they were not before.

My first move would be to clean the area around the gumlines of the veneers, have you rinse with chlorhexidine 3 times a day, both before and after brushing, then return to your dentist several weeks after the cleaning to see if the inflammation reduced, and if there is leakage or decay under the veneers.  If decay, they must be removed and replaced.  If no decay, and the regimen is working, stick with the regimen, and have your teeth cleaned and checked every 3 months.

The fact that this started recently also may indicate the beginnings of generalized gum disease.  Have your dentist check the rest of your gums to be sure they are firmly attached to your teeth.

---------- FOLLOW-UP ----------

QUESTION: Great, thanks so much! I'll do just that (I already even have the Chlorhexidine).

Regarding flossing, what regimen do you propose I follow? I have both disposable floss-picks and a Waterpik. My gums usually bleed when I use the floss-picks, but at the same time, I've heard that the Waterpik can't clean some places that the floss can (and vice versa).

I'm wondering if 1.) should I continue flossing during this regimen, or is the bleeding/inflammation going to aggravate the healing/de-inflaming process? And 2.) if I should keep flossing, what would be best to use between floss-picks and/or Waterpik (or both)?

Oh, and 3.) I found a recommendation online to use hydrogen peroxide diluted in a Waterpik with the "gums"-pik attachment, thereby getting the Waterpik jet up under the puffy gumline. The review said that, apparently, the hydrogen peroxide can pierce a certain type of bacteria like nothing else can, and it's important to have the waterpik gum-pik sending it deep into the pockets.

Is there any merit or validity to this, and should I do anything like this in tangent to the regimen you proposed? I don't mind either way -- I'm just willing and ready to do anything to resolve this problem.

Thanks!

Answer
I am one of a very few dentists who do not love floss.  I especially do NOT like Floss piks, as they tend to snap the floss down into your already inflamed gums, lacerate them, and spread the infection

I prefer Go Betweens (tiny toothbrushes on a wire), if you can easily fit them between your teeth.  Easier to use than floss, they actually brush the in-betweens of your teeth, and treat your gums better and more gently than floss. If they fit, dip them into chlorhexidine before you use them, for better disinfection between your teeth.

If the Water-pik works, use it with chlorhexidine in the tank. If not, stop.  Do NOT use the gum-pik.  This tends to spread infection.

Let's start your regimen for 2 weeks, then get back to me with how you're doing.  

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Howard Finnk, D.D.S., P.A., CEO

Expertise

I am a Family, Implant and Cosmetic dentist. I will answer questions on any aspect of dentistry and matters relating to the smile, gums, jaws and lower face. Member American Dental Association, Florida Dental Association, Broward County Dental Association, and Atlantic Coast District Dental Association. I have served as District Council Member of Alpha Omega, as well as serving for one term as its President. I am also a member of The Vedder Honors Society, Broward Dental Research Clinic, and Mount Sinai Hospital Guild. I have served as a Volunteer for Project Dental Health and The Tri-County Dental Health Council.

Experience

Having attained over 30 years of clinical experience in private practice in Michigan, in 2001 I was re-certified by taking and passing the Florida State Dental Board Examination. After moving to Florida, I spent nearly 10 years re-honing my skills while working as an Associate Dentist for several large dental groups. In September, 2004, I was appointed Adjunct Clinical Professor at Nova University's College of Dental Medicine. I am certified in placement of Mini Dental Implants, and I am Director of The Florida Implant Center (floridaimplantcenter.com). On March 1, 2010, at the age of 62, I began all over again by buying a dental practice near my home in the Fort Lauderdale area. As sole owner and Chief Dental Officer of the new Nob Hill Dental Center (nobhilldentalcenter.com), I can now carefully provide dental care to patients who care, all within a caring, joyful environment. Over my career lifetime, I have provided thousands of diagnoses, fillings, crowns, bridges, root canals, periodontal treatments, TMJ therapies, partials, dentures and extractions, and dozens of implants for my patients. The only aspect of dentistry with which I have very little experience is orthodontics.

Organizations
American Dental Association, Florida Dental Association, Broward County Dental Association, Atlantic Coast District Dental Society, Vedder Honors Society, Broward Dental Research Clinic, Alpha Omega Alumni Association, and American Association of Dental Implantologists. Formerly, American Academy of General Dentistry, Michigan Dental Association, Macomb Dental Society, Detroit District Dental Society, Tri-County Dental Health Council (a charitable dental care organization)

Publications
"How To Save Money At The Dentist" Going to press soon.

Education/Credentials
Bachelor of Arts and Sciences in Psychology from Wayne State University Doctor of Dental Surgery from University of Detroit College of Dentistry Adjunct Clinical Professor, Special Needs Department, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, Florida

Awards and Honors
Membership in The Vedder Honors Society

Past/Present Clients
HIPAA rules do not allow me to post this information.

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