Tiny pinprick in your gums that could stop you needing false teeth
HE HAS always taken care of his teeth. So when Colin Errington was told by his dentist that not only did he have badly receding gums, but he could lose his teeth, the retired banker was shocked.
‘ I could see my gums were receding, but I thought that was just part of getting older,’ says Colin, 71.
‘And my teeth weren’t causing me any pain, so I had no idea of how serious it could be.’
But f our months on, Colin’s upper gums are back to where they should be, thanks to a new surgical technique.
The operation involves making a tiny pinprick above the gum, loosening the gum tissue and then pulling it down into place, so the tissue is effectively stretched.
Around half of Irish adults have receding gums. It is often the result of brushing teeth too hard, causing i nflammation, which causes gum tissue to pull back.
But genetics, gum disease and the ageing process can also trigger inflammation and make the gums recede.
As well as causing teeth to look longer, over time gum recession exposes more of the tooth root, which is normally buried in bone.
‘The root is far more sensitive as it doesn’t have an enamel coating — the hard, protective outer layer of the tooth, which has no nerves or blood supply,’ says consultant and specialist i n periodontics Dr Mark Ide.
‘So if it is exposed it can cause pain and sensitivity.’
WHEN gums recede, it causes pockets, or gaps, to form where the teeth meet the gum line, making it easy for disease-causing bacteria to build up. If l eft untreated, supporting tissue and bone structures of the teeth can be severely damaged — which is why Colin risked tooth loss.
The maintreatment is a connective tissue graft. It’s usually only given in the most serious cases — if a patient is in very bad pain, for example.
With the procedure, a flap of skin is cut at the roof of the mouth (the palate). Tissue is removed from under the flap and stitched to the gum tissue around the exposed root — usually only one or two teeth are treated at a time.
Practitioners of the new procedure, the Pinhole Surgical Techni qu e , claim it’ s not so invasive, so there is less likely to be pain.
And because there is only a small puncture in the gum, heal- ing time is quicker. Colin’s dentist, Dr Sunny Sihra, says: ‘There’s no cutting or stitching, so there is a shorter recuperation.
‘With the standard operation, it can take two or three weeks for the site of the graft to heal. And it can be quite painful.’
Developed in the US by dentist John Chao, the new technique has also been practised in Britain for two years.
It involves making a 2mm hole with a needle, high above the gum, where it folds and meets the inside of the cheek.
The gum tissue is loosened from the jaw bone, says dental surgeon Dr Peter Workman, who also offers the treatment. ‘As the gum becomes loosened or baggy, the needle gently manipulates it down to where it should be at the natural curvature in the tooth, where the enamel meets the root.’
Strips of collagen — a naturally occurring protein that gives skin its elasticity — are then fed into the now baggy gum through the original incision to give it bulk and provide support, while gentle pressure is applied with the fingers to press the gum back into place. The gum inevitably bleeds underneath from the cut and clots.
It is thought this — together with the collagen — helps bind the gum to the surface of the bone.
There are no stitches and the pinhole seals itself in a few weeks, says Dr Workman. The procedure is carried out using a local anaesthetic.
‘It all took about an hour, and during that time you can feel pushing and pressure, but no discomfort,’ says Colin.
‘I was given painkillers for when the anaesthetic wore off, but only had a bit of discomfort that wore off in a day.’
Dr Sihra adds that it is also possible to work on the whole arch of the upper or lower teeth — up to 16 teeth — at a time.
‘You can’t do that with the standard procedure as you’d have to make too many grafts in the roof of the mouth, which would be invasive and painful.’
The patient can’t brush their teeth for at least a month, to avoid disturbing the newly positioned gums, so they must use a mouthwash prescribed by the dentist containing strong antiseptic and disinfecting agents.
‘That did feel strange at first,’ says Colin.
HE ALSO had to avoid hard foodstuffs that could stick between the gums, such as crisps or French bread, for a week. Dr Mark Ide says the new treatment seems to be a ‘reasonable technique’. But he says it’s not suited to everyone.
‘Patients need to have otherwise healthy teeth with no sign of gum disease and be meticulous about hygiene afterwards. Smokers are also ruled out since blood supply to their gums is compromised and so they have poorer healing.’
This could result in loosened teeth.
Luke Cascarini, a consultant oral and maxillofacial surgeon at Guy’s Hospital, London, says: ‘ The fundamental issue is that the gums can’t be permanently reattached to the tooth.
‘Once the substance that binds the gums to normal, healthy roots is lost, you can’t get it back.
‘Long term, I don’t see how the gums will stay attached with either technique.
‘The area is also more difficult to clean since they have to be brushed so delicately after either technique. Overall, in my view, the chances of relapse could be high.’
He says it is important to address the causes of receding gums before they reach an advanced state, such as abrasive brushing.
‘Ask your dentist or hygienist to show you how to brush properly.’
But Colin Errington believes the treatment on his upper teeth is worth the €2,700 he paid.
‘I could see the difference straight away and my wife Carolyn was pleased, too,’ he says.
‘As soon as Dr Sihra mentioned a possibility of losing my teeth I had to do something. I didn’t want false teeth. I’m hoping to keep my teeth as long as possible.’