Jennifer Nelson

	Your patients can have a great smile and a healthy-looking mouth - and still have gingival gum recession. Receding gums can become concerning if the roots of the teeth become exposed, leaving them susceptible to decay, infection or loss.

	Gum recession is a slow process where the pink tissue surrounding teeth wears away, thus exposing the tooth’s root. Patients don’t always realize it’s happening at first. But if treatment begins early, you can stop or even reverse gum recession in your patients.

	The most common reason for gum recession is inflammation around gum tissue. Patients can physically wear away the gums by too vigorously brushing their teeth.

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	“Whenever they brush too hard, it can actually cause more damage than periodontal disease or cavities,” says Sarah Thiel, RDH, a clinical practitioner and CEO of CE Zoom. “If you’re brushing your gums off, then your bone is actually decreasing too.”

	Thiel explains to patients that bone is what holds teeth in. Brushing too hard can cause recession, which means bone is also decreasing. Thiel recommends an electric toothbrush that has a pressure protection sensor to gauge how hard patients brush, which helps those who have recession, or are prone to it, to brush using the right pressure.

	Some people are prone to gingival gum recession due to genetic factors such as thick gums, the position of their teeth, or medical conditions like hormonal changes and diabetes. Gum recession can also be caused by oral piercings, misaligned teeth, certain medications and bruxism, or teeth grinding.

	People who use tobacco products can also be predisposed to recession. “Tobacco products are known to leave behind a sticky plaque that makes gums more likely to recede,” says Jennifer Silver, DDS, of Macleod Trail Dental in Calgary, Alberta.

	What’s more, aging can play a role in recession. Eighty-eight percent of patients 65 or older have gum recession around at least one tooth, according to a study in the 

Journal of the American Dental Association

	And inflamed gums from poor oral hygiene can cause gingivitis (explained to patients as early gum disease) and periodontitis (explained as late-stage gum disease), which are conditions that lead to recession and bone loss.

	Even though tooth brushing habits are the No. 1 reason for most patients’ gum recession, Silver tells her patients not to let the fear of brushing too hard keep them from practicing proper dental hygiene.

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“If you don’t brush and floss your teeth on a regular basis, you are at a far greater risk of developing a receding gum line. That’s because when too much plaque builds up on teeth, it weakens enamel along with the teeth and all surrounding tissues - including gums.”

	How to address receding gums with your patients

	Keeping patients in the know about what gum recession is, its likely causes and why it’s best to not ignore it can be critical to their oral health. Every patient who has some recession, is prone to it, or has conditions that make it more likely should understand what it is and how they can monitor any recession and help prevent it.

	Here are a few questions to discuss with patients about gingival gum recession:

			Do any of their teeth suddenly look longer?

			Are they experiencing any tooth sensitivity?

			Do they think they have bad breath often?

			Does food frequently get stuck in a particular spot?

			Do they grind their teeth? (Fitting patients for a night dental guard is helpful because teeth grinding weakens teeth and can contribute to receding gums.)

			Do they have current or prior tobacco use?

			What kind of toothbrush do they use and do they think they might brush too hard?

	Talk to patients about treatment for gum recession

	Getting patients started on treatment for gum recession early is important for the success of their oral health. Silver stresses, “Receding gums do not grow back.” But there are several options to treat them. The first is for a dentist to clean out the pocket and remove all bacteria before reaffixing the gum in the proper position.

	“Treatment includes having a dentist deep clean the area to remove plaque buildup on the teeth and root surface,” Silver says. The root itself can be smoothed out so that it’s not as easy for bacteria to thrive there.

	Antibiotics are sometimes necessary to help remove existing bacterial threats in the mouth.

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	For patients who have had recession for a while, the jaw bone may already be impacted, in which case a full regeneration may be necessary. This involves the use of graft tissue, membrane, or some type of regenerative material to help redevelop bone and tissue that has been lost. With the regenerative material in place, the gums can be secured back into position to restore the appearance of a healthy smile.

	Give patients preventive gum recession pointers

	Patients should know that they can help prevent gum recession by not brushing teeth too hard, using a soft bristle brush and brushing gently for at least two minutes twice per day. Thiel says one trick to brushing gently with a manual toothbrush is to hold it with your thumb, index and middle finger, instead of your fist. You won’t be able to press as hard.

	“Plus, it makes you focus. People can get in autopilot mode when they brush, but at least if you are just holding the toothbrush with three fingers, you can’t push as hard,” Thiel says.

	There’s also a surprising link between heart disease and gum disease. The 

 reports that people with periodontitis may have two or three times the risk for heart attack and stroke than people without gum problems. Be sure to share that information with your patients.

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	You should also make sure patients know that a variety of dental issues can occur if receding gums are ignored. For instance, their teeth are more susceptible to decay and cavities because food debris tends to build up in the pockets created by receding gums. Long term, this puts excess pressure on their jaw structure and can lead to tooth loss. No one wants to have cavities filled and teeth extracted if they don’t have to.

	Talk to patients about preventing and treating gum recession. Information you provide is the frontline in improving your patients’ oral health.

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Information you provide your patients about gum recession could be the frontline in improving their oral health. 

What your patients NEED to know about gum recession

	You’ve heard of FOMO (fear of missing out), but what about FOTD (fear of the dentist)? It’s possible that nine to 15 percent of Americans avoid dental treatment because of anxiety or fear, according to the Columbia University College of Dental Medicine. In fact, dental fear isn’t affected by age or education, and it’s slightly more prevalent in women than men.

	While some people don’t relish going to the dentist and apprehension is normal, 

 doesn’t usually keep them from the dentist for decades. Dental phobia, on the other hand, is an intense, unreasonable fear that can keep folks from seeing the dentist and getting the treatment they need. People with severe dental phobia may not only put off routine dental exams but ignore pain, gum disease, and even broken or missing teeth because of FOTD.

	Studies show that people are typically afraid of three things at the dentist’s office: loss of control, embarrassment and 

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	So how can you help patients with both dental anxiety and the more serious dental phobia, which can leave patients terrified or panic stricken? Here are six things your practice can do to help:

	1. Ask every patient how he or she is feeling about the dental treatment when he or she in the chair

Dental anxiety and the more severe dental phobia were once shoved under the proverbial dental tray and not spoken much about. Patients kept mum and were silently terrified while dental professionals all but ignored the issue. No longer is this acceptable.

	Broach the subject with patients to get a feel for who’s mildly anxious or worse, panicked. Then take appropriate steps to ease their fears. Distractions like headphones for music or television can help. Aromatherapy with lavender scent is being used for anxiety in treatment rooms. Squeezing a stress ball or having a warm weighted blanket over patients can also provide additional relief. For patients who are apprehensive of the procedure, getting them to verbalize what it is about the treatment that’s most upsetting is key.

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	“Once the dentist knows the specific trigger, he or she can address it by explaining how the procedure will go, what the patient will feel. Essentially walk them through the procedure so they know what to expect,” says Jorge Vasquez, DMD, dental director at Solstice Benefits.

	For patients who are extremely anxious, provide them with an SOS signal, such as raising their hand. That means you’ll stop whatever you’re doing. Loss of control is one of the main causes of dental anxiety and this gives the patient back some control. Patients know that if they have discomfort, fear, a question or they need a rest, then raising their hand will provide it.

 with your patients on a human level, as opposed to a doctor-patient relationship, makes the lines of communication more readily open, explains Vasquez. Patients feel that they’re visiting an office where they’ll find friends and not just a doctor. Open up dialogue with every patient about work, hobbies, travel and family, and be sure to make personal connections that you can easily return to by keeping a mental discourse about what you’ve talked about every time you see them. These connections can make a big difference when it comes to patients’ fears.

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	4. Address the fear or pain or embarrassment

	Since fear of pain isn’t altogether unfounded, dental anxiety and phobias can be wrapped around the perceived pain of dental procedures, especially needles. How can you help patients deal? Address the elephant in the room. Discuss sedation, nitrous oxide and how a topical anesthetic works, along with how a slow injection allows for tissues to numb gradually and can make for a painless injection. The more information patients have about improved techniques and equipment, the better to quell their anxieties. If embarrassment may be responsible for their unease, then offer an empathetic chairside manner. You can also discuss your own personal dental challenges or mention treating other patients successfully for the same issues.

 reports that psychologists are now working in dentistry to treat some of patients’ worst dental phobias. While not every dental practice can support a resident psychologist, patients can be encouraged to practice Cognitive Behavioral Therapy (CBT), a type of talk therapy combined with behavior changes that desensitizes patients to the dental drills, needles and equipment responsible for their fears. Through talk therapy, patients can work on effective coping strategies, such as replacing negative self-talk like “This will hurt” or “This procedure will take forever” with positive language such as, “I’ll be thrilled with the result of my dental work.”

	Lisa J. Heaton, Ph.D., a clinical assistant professor of oral health sciences who collaborates with dentists at a special clinic at the University of Washington's School of Dentistry, teaches patients progressive muscle relaxation and diaphragmatic breathing as part of the therapy. Some patients will need more than one session to help them successfully undergo dental treatment, but 

 have shown to be effective in reducing dental anxiety and phobia over time.

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	“Put yourself in their shoes or rather, in their mouths,” says Jon Marashi, DDS, a Beverley Hills celebrity cosmetic dentist. “The only reason we are here is because of them. Customer service and a gentle touch all go a long way to building patient relationships and loyalty.”

	Once you’re on their side, beating FOTD becomes a team effort in which everyone is onboard working toward one goal: excellent dental care combined with a positive, fear-free experience.

Giving your patients a positive, fear-free experience doesn’t have to be a challenge.

6 ways to help patients overcome fear of the dentist

	It’s summer, which means you’ll probably see a lot more kids in your practice, as parents regularly try to schedule their kids’ dental exams while school’s out.

	Though you make their cleaning and exam fun and educational when they visit, getting kids to care about their dental hygiene the rest of year might be more challenging. “Young kids can have a hard time grasping why dental hygiene is so important,” says Bobbi Stanley, DDS, of Stanley Dentistry in Wake County, North Carolina. “Brushing and flossing can feel like a chore if they don’t understand what can happen to teeth that aren’t well-cared for.”

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	Here are eight ways your office can get kids interested in their own dental hygiene:

	When it’s time to talk to mom or dad about how everything looks, remind them that they’re the role models at home when it comes to dental hygiene. “The habits parents set for children will impact their oral health for the rest of their lives, and the better care they take of their teeth when they’re young, the better shape they’ll be in when they have kids of their own,” Stanley says.

	Help make kids as comfortable as possible when they visit. Just like adults, some are more squeamish and reticent to be there than others.

“Our waiting rooms are stocked with toys, puzzles, video games and movies to keep kids entertained, while our exam rooms are decorated with bright, colorful schemes and decals to further contribute to a pleasant atmosphere,” says Steven DeLisle, DDS, founder of Children’s Dentistry of Las Vegas. “This environment helps young children establish a positive relationship with the dentist, transforming the dentist’s office into a place they can look forward to visiting rather than dreading,” DeLisle says. When kids like to visit, it correlates to caring about their teeth.

	A good trick for kids who try to skip out of two minutes of brushing every night? Offer them plaque disclosing tablets and have them chew a tablet after brushing and flossing at night. The harmless dye in the tablet reacts to plaque, so they can see for themselves the spots they missed if they rush through their routine.

	Notify parents via recall that you welcome kids in costume, especially if they have their Halloween costume lying around. “I’ve treated Superman and Cinderella before,” Stanley says. It can be a really good way to give kids an extra dose of courage and make trips to the dentist feel more like a special occasion. “It’s also a good way to reinforce the idea that dentists are the ‘good guys,’ who help superheroes and princesses keep their teeth protected,” she says.

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	Most kids love to be recognized when they do something right, so offering praise for good oral care can lead to even better oral hygiene. Kids need instant gratification, so point out the things that look good or that they’re doing right and make a big deal of it to them, their siblings and their parents.

	Anastasia Turchetta, RDH, a speaker and author in Buffalo, New York, says kids are visual, and to make their health and wellness visits fun, she uses technology like 

, an animated app featuring animal characters to make brushing a fun game, or the augmented reality app Kolibree, an interactive toothbrush for kids that helps motivate them to brush.

	“By gamifying the task of dental care, kids go from thinking of it as a chore and begin to think of it as a fun thing they get to do every day,” Turchetta says.

	“People didn’t always know to brush their teeth at least twice a day,” says Mark Burhenne, DDS, of 

. “The reason you and I brush our teeth twice a day is actually thanks to 

 that told people, ‘Just run your tongue across your teeth. You’ll feel a film. Why would you keep a dingy film on your teeth? Our toothpaste removes the film!’” Burhenne says to teach young kids what it feels like when they run their tongue over their teeth. Does it feel slippery or rough?

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	Getting children used to being in tune with how their mouth feels can help them understand when they should brush. Make sure they can differentiate between fuzzy and slippery teeth. When they’re slippery, they’re clean and when they’re fuzzy, they need to be brushed. Once kids understand some of the reasoning behind good oral hygiene, they’ll take more responsibility for their own teeth.

	Kids get excited through reading and learning, and books about teeth are just the ticket. Age-appropriate books like “

” by Dr. Seuss should be staples in your exam room to get kids excited about taking good care of their teeth.

Tips you can use to help your youngest patients invest in their oral health.

8 ways to get kids to care about dental hygiene

	When it comes to motivating your patients to brush their teeth, there are never enough ideas to try. “Really, when it comes down to it, we have to be a mini psychologist,” says Tina Clarke RDH, BSDH, MED, a clinical hygienist and dental hygiene teacher at Oregon Technical School. “We have to figure out what will motivate our patients to make healthy lifestyle changes.”

	Talking about eating healthy snacks, brushing between meals and avoiding foods that stain teeth is all part of discussing good hygiene. “I encourage all oral health care providers to continue learning about motivational interviewing and intervention with their patients,” Clarke says.

Related article: 6 things to say to get your patients to clean in between their teeth

	Here are five tips that may help you to motivate your patients to brush on a regular basis.

	Using an intraoral camera to show the patient what is actually happening in his or her mouth can be an eye-opening experience. “I often hear, ‘Gross! That is what's in my mouth?’” Clarke says.

Removing a small amount of biofilm and showing it to your patient can be helpful, too.

	“We often notice patients miss brushing areas along the gum lines along the cheek sides of the teeth,” says Rudi As-Sanie, DDS, who practices in Dublin, Ohio. Demonstrating how to properly brush hard-to-reach spots can help patients improve their oral hygiene habits.

	“We suggest to patients to have ‘soft cheeks and lips’ to make sure the toothbrush has enough room to get beyond the lips and cheeks,” As-Sanie says. “For the back teeth, we tell patients to close down about halfway. Patients might think they should open wide to get all those hard-to-reach areas, but a slightly closed soft mouth is the key.”

	3. Encourage the use of an electric toothbrush

	There’s no question that brushing and flossing your teeth is a hygiene chore akin to showering and shaving. And there are times when all of us don’t feel like doing those things. The task involves a bit of work on your patient’s part, but using an electric toothbrush can put some joy, fun and ease into the task. What’s more, an electric toothbrush can reduce some of the chore-like feel of teeth brushing and add an element of fun that makes patients look forward to getting the clean, fresh-mouth feel only an electric brush can offer. Plus, for some patients, brushing with an electric brush is downright more enjoyable. Some patients get excited to turn on their whirring brush and accomplish a task that’s good for their health. Discuss using an electric toothbrush with your patients and offer advice about cost-efficient models.

	Remind your patients that medical conditions show up in their mouths. Sound bites like that are powerful, says Anastasia Turchetta, RDH, a speaker and author in Buffalo, New York. Inflammation and chronic active bacterial infections are topics Turchetta likes to bring up. “Inflammation is linked to most medical conditions and your current state of oral health,” she says.

	Placing greater emphasis on the fact that brushing and flossing aren’t necessarily about keeping bad breath at bay but could also be responsible for staving off heart disease or diabetes ups the level of importance for patients.

	5. Tell them what kind of job they’re doing

	Sure, you have to be tactful since no one want to be admonished at the dentist’s office, but patients do find it motivating to know how well they’re doing. Start with the praise and follow up with the advice. Sometimes dental professionals only think about educating their young patients, but adults need the extra information, too. Sharing information like “You’re doing a great job,” or “You might be missing this spot here,” is usually very helpful in getting patients to brush - and brush better.

	“When I’m talking with people, my biggest thing is to use normal terms,” Clarke says. “We get caught up in using our lingo sometimes.”

	Simply sharing with patients what’s looking good, where they might need to work more, offering a tip on getting the floss between two hard-to-reach back teeth - all of those conversations are fodder for when you have a live body in your chair. After all, remember how motivating it was when your math teacher told you how great your skills at multiplication were, or your piano teacher praised your concerto? Don’t be shy to tell your patients that their dental hygiene skills are on par with a virtuoso.

	Motivating patients to brush takes just a little time and forethought, and your patients will reap the oral hygiene rewards.

Getting your patients to brush on a consistent basis can be a challenge, but these tips can help your patients realize the importance of good oral hygiene. 
