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Lara Coseo
Lara Coseo, Dentist (DDS or equivalent)
Category: Dental
Satisfied Customers: 199
Experience:  Awarded, licensed dentist with over 13 years experience
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About 3 months ago, the V area between 2 upper front teeth

Customer Question

About 3 months ago, the V area between 2 upper front teeth had become inflamed and it would bleed on and off. A regular cleaning did not solve this issue and so 3 weeks ago, I went to a periodontist and had a deep cleaning done as well as Arestin put in the area and he also put me on oral antibiotics as well. However, it's been more than 3 weeks and although the redness has gone away and my gums have turned more pink, this area is still a bit swollen and has not healed 100%. I have been diligent with my oral hygiene, making sure I floss, brush, waterpik, rinse. I have also been supplementing with 1000 mg of vitamin C to promote healing as well as taking other supplements like B complex and zinc. What other treatment options are there? What would be causing this area to not heal?
Submitted: 1 month ago.
Category: Dental
Expert:  Lara Coseo replied 1 month ago.

Good afternoon! I'd be happy to help you figure out what's going on. I'm glad to hear you are following all of the dentist's oral hygiene recommendations and are boosting your immune system. Could you answer a few questions for me?

1) Is there any dental work in this area? Fillings or crowns? If so, how old are they?

2) Did anything in your medical history change at the time this inflammation started, 3 months ago?

3) Did you have any injury to the tissues in that area, including popcorn or tortilla chip debris?

Sincerely,

Dr. Lara

Customer: replied 1 month ago.
Thank you for your reply. I have not had any dental work in this area other than cleanings. Around the time that this occured, I had extensive blood work done and everything came back normal except a vitamin D and B1 deficiency which I have been taking supplements daily since I found out. I have not had any injuries to this area. Also, after the deep cleaning and Arestin, I have been avoiding all crunchy, sharp foods. I am emotionally sick about this because it has been an ongoing issue for quite some time now. It's been more than 3 weeks since the deep cleaning, should it have healed 100% by now?
Expert:  Lara Coseo replied 1 month ago.

I understand why you'd be so worried about this. Everyone heals at a different rate, so it's not completely abnormal for it to not be perfect at 3 weeks post-op. Your periodontist and dentist are probably pleased that it has made some progress. I didn't receive any demographics about you. Are you male or female? What is your age? Any important medical history other than those vitamin deficiencies?

Dr. Lara

Customer: replied 1 month ago.
I am a 30 year old female. No medical history at all. I even had my doctor test me for any auto immune diseases and it all came back negative. If this doesn't heal completely in the next 2-3 weeks, what are some other treatment options? Would another deep cleaning be needed/ helpful?
Expert:  Lara Coseo replied 1 month ago.

Good! I'm glad we can rule out autoimmune diseases. And you're already treating your vitamin deficiencies. Vitamin deficiencies can definitely affect your gum tissue and cause inflammation, so it could be that that was a contributor to the start of this problem.

Is there any chance you are having any big hormone surges? Pregnancy?

Another deep cleaning would only be necessary if they determine that there is still bacteria in the gum tissues (which should not be the case if you're doing a great job with your home care). Do you remember if they used a laser to treat the gums during the deep cleaning? That is a great option for reducing inflammation.

Dr. Lara

Customer: replied 1 month ago.
I am not pregnant and do not know of any hormonal imbalances. The periodontist also had prescribed me chlorhexidin which I used day and night for 2 weeks. I did not receive any laser treatment during the deep cleaning. I believe his office does not have the laser equipment.
Customer: replied 1 month ago.
How much longer should I wait before going back to the periodontist? Is there a specific toothpaste you recommend? I was using an electric toothbrush but my dentist had said it was too abrasive so I switched to a manual extra soft toothbrush and I am making sure to brush thoroughly for 3 minutes.
Expert:  Lara Coseo replied 1 month ago.

Okay, good to know. Hormone changes can cause some major inflammation, so that was my next guess.

I would recommend Biotene toothpaste because it is the mildest brand you can find and will not cause any additional irritation. Using the extra soft toothbrush is the way to go.

I would return to the periodontist at 4 weeks post-op, so one more week.....

Does that answer your question?

Dr. Lara

Customer: replied 1 month ago.
My mouth gets dry while I sleep, is there anything you recommend for that? I am not a mouth breather but I do wear a bottom night guard for bruxism. I try to drink water whenever I wake up in the middle of the night but is there anything else I can do to stop dry mouth?
Expert:  Lara Coseo replied 1 month ago.

I'm so glad you mentioned that! Mouth breathing definitely contributes to inflammation of the gums around front teeth. Does the lower night guard prevent you from closing your lips?

One great product to try for dry mouth is also made by Biotene: their dry mouth gel. It's great to use right before bed. Place a small amount on your tongue and use your tongue to spread it around the inside of your mouth. Then place your nightguard in for the night.

Anything that dries out the tissues will predispose them to inflammation. I have some more information on dry mouth if you'd like. I can upload a PDF for you to view. (I write patient education materials for dental blogs)

Dr. Lara

Expert:  Lara Coseo replied 1 month ago.

Here is the dry mouth article.