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My Teeth Are Sensitive, But I Don’t Have Cavities

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I don’t have any cavities, but on both sides of my mouth, the canine tooth and the one behind it are sensitive. I really notice it when I brush my teeth or eat or drink something cold. I am 54 years old. What could be causing the sensitivity? Is there anything I can do to decrease it? – Ingram from Baltimore

Ingram,

Thank you for contacting Pumphrey Periodontics of Atlanta. Before recommending treatment, Dr. Pumphrey would need to examine your teeth and gums to determine the cause of sensitivity. We will explain factors that can cause tooth sensitivity.

Why Are Your Teeth Sensitive?

Tooth sensitivity can have several causes, including receding gums, tooth enamel damage, and overbleaching teeth.

  • Tooth enamel damage – Decayed or damaged tooth enamel can cause sensitivity and discomfort. Acidic foods and drinks, brushing your teeth too vigorously, or grinding your teeth can wear the enamel. Cold food or drinks, even cold air, can increase sensitivity. Your dentist can remineralize your tooth enamel.
  • Over-bleaching your teeth – Whitening gel penetrates your tooth enamel and can irritate tooth nerves. If you whiten your teeth too often, sensitivity can linger. Discontinue whitening and speak with your dentist to determine when it is safe to resume treatment.
  • Receding gums – Genetics, hormonal changes, aggressive brushing, gum disease, and age can cause gum recession and tooth sensitivity. Your periodontist may recommend gum grafting or the Pinhole Gum Rejuvenation® technique to reposition your gums and resolve recession.
Before-and-after gum graft Pinhole Surgical Technique from Atlanta periodontist Dr. David Pumphry

Gum graft – Pinhole Gum Rejuvenation
Completed by Dr. David Pumphrey of Atlanta

What Can You Do About Sensitive Teeth?

After an exam and x-rays, your dentist will recommend appropriate treatment to reduce the sensitivity. If you continue to experience teeth sensitivity, use toothpaste for sensitive teeth and speak with your dentist about your concerns. If gum recession contributes to tooth sensitivity, your dentist may refer you to a periodontist for gum restoration.

Atlanta periodontist Dr. David Pumphrey sponsors this post.

 

Deep Cleanings and My Teeth Still Fall Out

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Since last December, I’ve been getting deep cleanings, and my teeth still fall out. This is crazy. My dentist says I don’t come often enough (three weeks). I am so frustrated. My teeth are so damaged that I prefer to quit the anxiety of losing teeth, get them extracted, and just get dentures. Is there anything else my dentist should try? Thank You. Earl from Cleveland, OH

Earl,

Thank you for contacting us. We understand that your experience must be frustrating. Dr. Pumphrey would need to x-ray your teeth and examine them and your gums for an accurate diagnosis. Still, if you continue to lose teeth despite deep cleaning, you have advanced gum disease that is not improving. An underlying condition may prevent your gums from healing, so you need intervention from a gum specialist (periodontist).

What Are Your Options for Implant Dentures?

all-on-four dental implants

All-on-4 Dental Implants

Although individual implants are not within your budget, implant dentures may be more affordable. Four to six implants can support a denture. A periodontist can evaluate your health, determine if you have lost jawbone volume, and how to prevent you from losing more teeth. Your oral health and the condition of your teeth will determine whether your remaining teeth are savable.

What Can You Expect with Removable Dentures?

Removable dentures decrease your chewing efficiency. Dentures can help you feel better about your oral health and smile when natural teeth deteriorate. A periodontist must treat your gum disease before taking impressions of your mouth and preparing you for dentures.

Request a referral to a periodontist to discuss treatment for improving gum disease and whether you are a candidate for implant dentures. Stabilizing a denture with implants will relieve your gums and jawbones from the pressure of a denture rubbing on them.

You can self-refer if your dentist refuses to refer you to a periodontist. Your family members and acquaintances may be able to refer you to a periodontist. Otherwise, you can search online and look at each doctor’s training, experience, and patient cases.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post. Call to request a consultation.

Why Do I Have White Spots on My Gums?

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Man looking in a handheld mirror, portraying white spots on gums and the need for a periodontistI noticed a patchy white spot on my lower left gums last month, but I didn’t think anything of it. When I see minor issues in my mouth or on my skin, I do not pay much attention to them unless I have symptoms with them. I forgot about the white spot. This morning while flossing, I noticed five or six white spots on my lower gums. I didn’t memorize the location of the first spot I saw last month, so I don’t know if it went away or if it’s one of the five or six. Now, I am concerned and wondering why I have the spots. What causes white spots on the gums? – Thanks in advance. Devon from Fort Wayne, IN

Devon,

Thank you for contacting Dr. Pumphrey’s office with your question. Dr. Pumphrey would need to complete an exam to determine the cause of the white spots on your gums, but we will provide general information.

Why Do You Have White Spots on Your Gums?

The cause of white spots on your gums can be one of several conditions, including canker sores, oral thrush, gingival reactive keratotic lesions, leukoplakia, or oral lichen planus. We will explain each of these conditions.

1. Canker Sores

Canker sores are small, raised ulcers on the inside of your mouth. They are benign and non-contagious. Although canker sores most often appear on the inside of the lip, they can cause white spots on your gums.

What causes canker sores?

Canker sore causes include:

  • Stress
  • Acidic foods
  • Injury
  • Dental appliances, such as braces or dentures that do not fit well
  • Nonsteroidal anti-inflammatory drugs, including ibuprofen

2. Gingival Reactive Keratotic Lesions

Gingival reactive keratotic lesions are white spots on oral tissue that can be benign or dysplastic, containing abnormal cells that may become cancerous.

What causes gingival reactive keratotic lesions?

Heat and chemicals may irritate gum tissue and cause lesions, including:

  • Tobacco use
  • Heavy alcohol consumption
  • Reaction to toothpaste or dental cleaning gels, powders, or liquids

3. Leukoplakia

Leukoplakia is thick white patches inside your mouth on your gums, sides of your cheeks, the bottom of your mouth, or tongue. The patches are generally not painful. An October 2020 article in the Journal of the National Cancer Institute says oral leukoplakia is the most common oral precancerous lesion.

What causes leukoplakia?

Although the exact cause of leukoplakia is unknown, common oral tissue irritants that can lead to the condition include:

  • Smoking
  • Chewing tobacco, paan, or betel nuts
  • Excessive alcohol consumption

4. Oral lichen planus

Oral lichen planus is a chronic inflammatory, an autoimmune condition that causes your body to attack your oral tissue. White patches of raised tissue can appear almost anywhere in your mouth, including your gums, inner lip tissue, tongue, insides of your cheeks, and palate. The lesions require regular monitoring by your periodontist for early detection of cancerous cells.

What causes oral lichen planus?

The exact cause of oral lichen planus is unknown, but these factors may trigger it:

  • Certain medications
  • Oral injury
  • Reaction to dental chemicals or materials and resulting infection

5. Oral thrush

Oral thrush is an infection that causes white, raised lesions on your tongue and the insides of your cheeks. Sometimes, it spreads to your gums or the roof of your mouth. The condition is benign but contagious if you are exposed to the saliva of someone who has oral thrush.

What causes oral thrush?

An overgrowth of the Candida fungus causes oral thrush. Factors that lead to Candida overgrowth include:

  • Illness
  • Stress
  • Medications

What Is the Treatment for White Spots on Your Gums?

The treatment for white spots on your gums depends on their cause. Rather than schedule an appointment with your medical doctor or general dentist, schedule an exam with a periodontist (a gum specialist with three years of advanced training) for an accurate diagnosis. Your periodontist may biopsy your oral tissue as part of the diagnosis. Afterward, they will explain your treatment options. Avoid guessing at the cause of your condition and treating it yourself, which can delay proper care and make things worse.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

I’m Afraid I Might Swallow a Loose Dental Implant

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I got five dental implants in February, and one of them is loose. Should I leave it alone or remove it? How long can I wait to do something about it? I am afraid that I might swallow the implant if it comes out while I am eating. Unfortunately, a family emergency has me out of town to help my mother move, and I am afraid to see a dentist in another state if something goes wrong. Whether I see a dentist or not, I am not much help to my family if I need implant surgery while I am here. Thank you. Russ from Nashville

Russ,

Thank you for your question.

Should You Remove a Loose Implant?

You should not remove a loose implant because it decreases the chances that a periodontist can save it. When you remove an implant, the tissue will grow in the surgical site. Although you are out of town, look for a periodontist (gum, teeth, and bone specialist) for advice. It is urgent.

Why Is Your Dental Implant Loose?

A dental implant can loosen during healing or months or years after recovery. What causes it?

Early dental implant loosening

  • Smoking, which narrows blood vessels and delays healing
  • Implants placed in the wrong location
  • Lack of bone volume
  • Gum disease
  • Trauma to the implant
  • Premature stress on the implant

Late dental implant loosening

  • Gum disease
  • Infection
  • Pressure from the position of replacement teeth
  • Oral trauma
  • Cheap or defective implant fixtures

What Is the Treatment for a Loose Implant?

Dental implant with parts highlighted - crown, abutment, and implant screw

Please do not remove a loose implant or any of its parts

A periodontist will use a 3-D CT scan and complete an exam to determine why your implant is loose. Depending on the cause of the issue, the periodontist may do one or more of the following:

Please do not wait until you return home to see an experienced periodontist. Ask family members to contact their dentists for help finding a periodontist or search online for an experienced provider. Get help right away.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

Why Are My Gums Sore?

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Close-up of teeth and gums for info on why gums are soreSore gums are common. Gum disease is usually the cause, but it is not always the problem. If your gums are sore, don’t ignore them. Why not? Healthy gums cover the tooth neck—between the crown and roots. Our gums protect tooth roots and the bone that supports them. So, a gum problem can lead to issues with your teeth or bone. What could be the cause of your sore gums? We explain seven possible causes of sore gums what to do about them.

Why Are Your Gums Sore?

Irritation to your gum tissue causes sore gums. And the source of the irritation can be external—such as rough oral hygiene habits or tobacco use. Or the cause may be internal, such as a side effect of medication or a vitamin deficiency. Explore seven possible causes of gum disease.

1. Gum Disease

Gum disease is the most common cause of sore gums. Gum disease affects more than 47 percent of U.S. adults age 30 and over. And research shows that gum disease affects more men (56.4 percent) than women.

Gingivitis is a mild form of gum disease in its beginning stage. It can have these effects on your gums:

  • Tenderness
  • Swelling
  • Recession

Untreated gingivitis progresses to periodontitis, or advanced gum disease. Periodontitis symptoms include:

  • Soreness
  • Swelling
  • Bleeding
  • Painful chewing
  • Red or purple gums
  • Changes in your bite
  • Loose teeth
  • Bad breath

2. Brushing Too Hard

A hard-bristled toothbrush or brushing your teeth and gums too hard can make your gums sore. Try brushing with a non-abrasive toothpaste and a soft-bristled manual or electric toothbrush. And go easy on your gums, applying gentle pressure.

3. Improper Flossing

Flossing usually does not hurt your teeth. But flossing too hard or too often can make your gums sore. Limit flossing to once daily. But if food gets lodged between your teeth or gums before your usual floss time, it is okay to use floss to remove it.

4. Prescription Medication

The American Dental Association article, How Medications Can Affect Your Oral Health, confirms that some medications can cause oral soft tissue reactions. The signs and symptoms may include gum irritation, swelling, and overgrowth. And if you already have dental plaque buildup, the risk of sore gums increases.

Examples of medications that can cause gum soreness:

  • Nifedipine, verapamil, diltiazem, and amlodipine – Treats high blood pressure
  • Cyclosporine – Suppresses the immune system to prevent organ transplant rejection
  • Phenytoin – Treats and prevents seizures

Talk to your doctor if you suspect that prescription medication makes your gums sore.

5. Vitamin Deficiency

The American Dental Association emphasizes the importance of adequate nutrition and vitamins for healthy gums and teeth. When your body lacks the minerals it needs, inflammation can result. Folic acid and vitamin C deficiencies can lead to swollen gums.

Folic acid

Folic acid supports blood flow, tissue growth, and cell function. Without enough folic acid, gums can swell become sore. And your risk of gum disease will increase.

Vitamin C

Vitamin C promotes tissue growth and repair and helps your body fight infection. Without it, gums can swell and bleed more easily.

If you think a vitamin deficiency is the cause of your sore gums, talk to your doctor about it before taking supplements.

6. Hormonal Changes in Women

Hormonal changes can affect the way your body supplies blood to your gums. These factors may alter a woman’s hormones and cause sore gums:

  • Birth control pills – Altered hormones can affect your body’s response to plaque.
  • Menopause – When hormones decrease saliva, sensitivity to heat and cold in your mouth can increase and irritate gum tissue.
  • Pregnancy – Increased progesterone can affect how your body handles tooth plaque and lead to infection and soreness.

Hormonal imbalance can be challenging to correct. Consult with your doctor.

7. Tobacco Use

The American Academy of Periodontology confirms that tobacco use is one of the highest risk factors that lead to gum disease. Chemicals in tobacco irritate gum tissue and cause soreness and swelling. Also, tobacco weakens your body’s immune system and makes it difficult to fight infection. So as bacteria builds up between your teeth and gums, your inflamed gums will be sore. Quitting the habit will make a difference.

Summary

Gum disease is the primary cause of gum soreness. But other reasons include rough oral hygiene habits, prescription medication, vitamin deficiency, hormone changes, and tobacco use. If you have ongoing gum soreness, don’t ignore it or guess what is causing it. Schedule an appointment with a gum specialist, or periodontist.

Dr. David Pumphrey, an Atlanta periodontist with more than 35 years of experience, sponsors this post.

Clear Choice Pricing

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I need some advice. A previous dentist talked me into removing all my teeth. I am haunted by giving in to that because I really feel at least twelve are them were salvageable. I know that is water under the bridge, but it would have saved me the problem I am facing now. That same dentist told me I could just get dentures now and them add dental implants later. Now I am thinking he said that because he doesn’t do dental implants and he wanted the fee for the dentures. They have been a disaster from the beginning. They hurt constantly and I have a horrible gag reflex. At the moment, I only wear them (and then only the top ones) when I have to go in public. I need teeth! I decided to go to a Clear Choice Dental Implant center to learn about the all on four procedure. They said I was a good candidate and quoted me $67,000. Then, when they found out my age offered me a senior citizen discount which brought it down to $53,000. That is a $14,000 difference. Were they overcharging to begin with? It is still too high for me. Is there a better route for me to go?

Elaine

Dear Elaine,

diagram of all-on-four dental implants

Wow! You have been put through the mill. Let’s start with your old dentist. Let me first say he is one of the laziest dentists I have heard of in a long time. We go into our business in order help take care of teeth. I am sorry he did this to you. All we can do now is salvage the damage as much as possible.

Clear Choice may not be your best option. I would suggest getting a second opinion. Their pricing seems arbitrary to me, and I’m guessing that you could get a lower fee for an all-on-4 dental implant procedure from some other very qualified dental implant dentist. It sounds like they are pricing it with bone grafting in mind. However, the main point of doing an all-on-4 is to work around the need for bone grafting to begin with.

You did not mention how long it has been since your teeth were extracted. If it hasn’t been too long, you may not even need to have bone grafting done. In that case you can go with straight implant overdentures. I would start by having some really good diagnostics done, with an experienced implant dentist, to see what you are dealing with. Once you know how much bone you have you can make some decisions.

If you don’t need bone grafting, get implant overdentures. If you do need bone grafting, you have two choices. First, it is a possibility that you can get the all-on-four procedure done. Just bear in mind if one part of it fails the whole thing will need to be redone. Your other option is to have the bone grafting done and still get the implant overdentures. I would do a good consult first and discuss the pros and cons of each in your specific case before making a decision.

This blog is brought to you by Atlanta Periodontist Dr. David Pumphrey.

Thick Crowns and Gum Disease

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I had six dental crowns done many years ago on my front teeth. I loved how they looked and they functioned beautifully. As they were getting old, I had to replace them. Unfortunately, no dentist I’ve been to since has been able to get them right. This is dentist number three trying to replace them and match my previous results. The latest dentist placed e.max crowns. They are way too thick. When I complained about it he said he did that because my gums are thick. Is there any way for me to get a beautiful result? Will taking these crowns off break the teeth? I’m worried because they’re already fragile already.

Frannie

Dear Frannie,

There is no reason to make thick dental crowns just because your gums are thick. He doesn’t understand the functional principles at play here. It is more important to have a natural emergence angle where the crown meets the tooth. Thick crowns cause a serious functional problem.

an image showing the resutl of thick dental crownsOn the left, I have an image of what happens when the dental crowns on a tooth are too thick. As you can see, it creates a protected area where the crown and tooth meet. This creates a problem where disease-causing bacteria can multiply and food particles will also get to in there and make it impossible to clean.

This means you will develop gum disease. Not only will you need a periodontist to treat that, but if left untreated you can end up losing your teeth.

e.Max Crowns are made of lithium disilicate. This is a very tough material, which has to be ground off. It can be removed, but your dentist has to do it carefully and methodically. As long as your dentist is good and knows what he’s doing, the underlying teeth will not be damaged. I’m going to be honest, I don’t think your dentist is up for the job.

Because he’s put your teeth in danger with these thick crowns, I’d just ask for a refund and then go to a different dentist to do it. One way to figure out if they can do this is to go to them for a second opinion on the crowns and see if they have the same reaction I do.

This blog is brought to you by Atlanta Dentist Dr. David Pumphrey.

Maryland Bridge Before Dental Implant

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My daughter has a genetically missing lateral incisor. We’ve made plans to get her a dental implant but are having a problem with her temporary restoration. Her dentist placed a Maryland Bridge but is having trouble getting it to stay on. We tried using ceramic wings because we thought that would be more aesthetic. Now we’re wondering if metal wings would be better to keep it on. Will that make her tooth dark? Is there a better solution?

Morgan

Dear Morgan,

Illustration of the prep for a Maryland bridge

Tooth preparation for a Maryland Bridge

In order for a Maryland Bridge to stay in properly, there needs to be some tooth preparation done. Without that, the wings will just fall off, as you are experiencing. In reality, the non-metal wings will stay better than the metal ones. And yes, your concern about the metal showing through is valid.

Looking at the image to the left, you can see that there is a notch placed into the tooth in order to help anchor the bridge there. I will admit to being a little confused as to why your dentist is placing a Maryland bridge for the temporary tooth replacement. Whenever you have to alter the tooth structure, that is no longer a temporary tooth replacement.

Your dentist was correct that a dental implant is the best tooth replacement. He or she is also correct that there needs to be a temporary replacement there until her jaw is fully developed and ready for a permanent restoration. My only concern is the Maryland Bridge.

In a way, it is a good thing that this hasn’t stayed on because it gives you an opportunity to change her replacement option. In your place, I would ask for a refund on the Maryland Bridge and then get her a dental bridge. This is a much better temporary replacement and it will not affect her other teeth at all. You’ll also find it costs significantly less, which is always a bonus when you are raising a teenager.

This blog is brought to you by Atlanta Periodontist Dr. David Pumphrey.

Dealing with Receding Gums

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I have been clenching my teeth for a long time. I’ve now got a loose tooth. My dentist also said I’ve got some mild gum disease and some receding gums. However, he thinks the gum recession is from the clenching because it is only by those teeth. He wants to do gum surgery to fix those. Is that a necessary thing? It doesn’t look that bad to me.

Kim

Dear Kim,

Before and After Receding Gums

I would like you to get a second opinion from a periodontist. While it is true that clenching or grinding your teeth can cause receding gums, periodontal disease is the most common culprit. You mentioned you have gum disease. It’s important you make sure this isn’t more serious.

If gum disease is left untreated, it will cause significant problems, including bone loss which in turn leads to tooth loss. This isn’t a risk you want to take.

Surgery Free Gum Surgery

If you are worried about that idea of surgery, you may want to consider Pin-hole surgery. This allows you to repair your gums without a scalpel and is even a suture-free treatment using a special technique.

Replacing Your Tooth

I don’t know if the loose tooth is from the clenching, the gum disease, or a combination. This is another reason to ensure your gum disease isn’t more serious than your dentist indicated. Once you treat the gum disease, if your tooth cannot be saved, you will want to get a good replacement. I would like to suggest you get a dental implant. It is the closest to having a natural, healthy tooth again.

This blog is brought to you by Atlanta Dentist Dr. David Pumphrey.

Dentist Refuses to Give Me Dental Implants

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I have been looking forward to getting dental implants the whole time the quarantine was going on. Now that my dentist has opened up and I can finally get my consult, he is refusing to give them to me because he doesn’t think my gums are healthy enough. First, shouldn’t he have mentioned this at my checkups? Second, what do my gums have to do with any of this? Third, would a periodontist be willing to give me implants seeing as they work with gums?

Brent

Dear Brent,

Illustration of a dental implant next to a natrual tooth

It can be quite disheartening to have something you’ve been looking forward to for a while quashed. Let’s start with your first question. Should your dentist have mentioned your gum disease at your checkups? Absolutely. While some dentists are mostly your bread and butter type of dentists who only focus on cavities, it is also important they check on other important health issues such as gum disease, teeth grinding, and oral cancer screenings. If yours isn’t, you will be better served elsewhere. Though, it is possible the gum disease is fairly new and he’s just now seeing it. If that is the case, it is actually good news. That means it will be much simpler to treat.

That leads me to your second question. What do your gums have to do with it? In reality, they have a great impact on your being a good dental implant candidate. If you look at the image I posted above, you will see that both the tooth and the dental implant have bone surrounding them. That bone is the structure that helps retain both your teeth and any dental implants. The way gum disease fits in is how it affects your bone. It begins to eat away at that bone structure and support. If your gum disease advances enough, your teeth can literally just start coming out.

Your third question, Will a periodontist give you dental implants? While I’m sure you could find both a dentist and a periodontist to give you those implants you want. The problem with that is, the dental implants will fail. You won’t even know it is because there wasn’t enough bone. They’ll still have their fee and you’re left with no teeth and no recourse. It is much better to have a dentist tell you, “Let’s fix this first.” than to just take your money and walk away to the bank laughing.

One thing a periodontist can do for you is to treat your gum disease more efficiently and get you to the point where you can actually get the dental implants you want.

This blog is brought to you by Atlanta Periodontist Dr. David Pumphrey.

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