Can Bleeding Gums Kill You?

Maybe you’re thinking: “Wow, Doc! We’re being a little dramatic here, aren’t we?”  Well, read on.

No doubt, this title will elicit a few snickers and maybe even the occasional one-liner like “No, but I know someone whose breath could kill!” Nevertheless, the possibly shocking truth is that yes, bleeding gums can kill you.

As a practicing dentist, I see all levels of home care. There are patients who practice excellent hygiene and have firm, pink and healthy gums or teeth without cavities. Then there are those who probably wouldn’t recognize a toothbrush if it poked them in the eye and whose mouths have so much plaque it looks like they just finished eating cottage cheese.

The bottom line is – where along this spectrum do you fall – and what can it mean for your overall health?

As I write this, I recall a question posed to me by one of my patients just yesterday. He told me that one of his “lady friends” had recently passed away. According to his story, he had seen her a few weeks ago and then noticed she wasn’t around very much. When he asked about her, he learned she had died as a result of complications following a dental abscess. His question “is that possible?” reflected an incredulity that is typical when it comes to the effects of oral health on the body.

Again, my answer was “yes, it’s possible.” Severe sepsis, which is basically a systemic inflammatory response to infection, can lead to organ failure and death. His friend was forty-two years old.

Obviously, this is an extreme example of infection traveling from one site and affecting the entire organism, but there are more subtle examples that are no less significant. Take bleeding gums. There are probably few people who haven’t experienced this phenomenon at some point or another in their lifetimes. If you are a hypochondriac, you probably should stop reading right now. If, on the other hand, you are just interested in knowing what significant step you can take to reduce your risk for heart attack or stroke, read on.

If I were to speculate, I think that many physicians and dentists probably still don’t think of tooth-related infections as systemic risk factors. The science behind this concept, however, is clear. In fact, a number of studies have been completed which clearly show the following:

  • Tooth-related infection can cause death
  • Infection equates to heart attack and stroke
  • Periodontal diseases are a portal for systemic inflammation and disease
  • If you have a periodontal infection you are going to have elevated C-reactive proteins, and C-reactive proteins are four times more predictive of cardiovascular complications than cholesterol

References for these studies will be made available on my website. But that represents a relatively small sampling of the articles which conclude red gums represent a disease process unto itself. This observation is the critical point.

If red gums represent inflammation and infection, then bleeding gums are definitely not something you should ignore. Even if you are not worried about your health, you may be surprised to know that many clinicians believe that aging is caused by systemic inflammation. There are a few studies supporting this theory as well, but the point is simple: don’t ignore your oral health. You might even look younger if you take care of your teeth! One of the simplest ways to reduce inflammation is to control the bacteria in your mouth. Start by brushing after meals and flossing every day. Eat a proper diet rich in vitamins and minerals. Get enough rest. Exercise, and reduce stress.

Also, don’t forget to visit your dentist regularly. Because so many dental conditions are symptom-free in their early stages, patients can be hit hard by neglect. The perception of “no pain, no problems” is often misleading when it comes to dental problems. Couple this with the fact that in tough economic times, people tend to put off what they perceive as optional or unpleasant, and you can have a formula for disaster – financial, or otherwise….


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Applying for Dental School

I have been out of dental school for (cough) a few years now, so I wasn’t particularly curious about the subject of applying to dental schools for myself. But a friend raised the question recently, and it made me wonder – beyond the United States – what are the best dental schools in the world today?

If, like me, you would have expected the top five dental schools to include several in the U.S., then – just like me – you would have been wrong.

So how many U.S. dental schools made the top five? One.

And was it number one?  Nope.  It was number three. That’s not too shabby, but I was also a little surprised to learn that it the University of Michigan. Not because I have anything against that particular dental school at all, even if it’s not my alma mater.

I just didn’t realize they performed that much research, and that was one of the key factors for which they were recognized.

Quacquarelli Symonds (QS), which bills itself as the world’s largest highest education network, rated the University of Michigan as the top dental school in the United States, for the fourth year in a row. With an emphasis on research, the school received more funding from the National Institute of Dental and Craniofacial Research in 2017 than any other dental institution in the country. Funded projects totaling $16.3 million addressed cavity prevention in children, head and neck cancer, and regenerating lost tissue due to disease, injury or congenital disorders.

So who topped the list? The University of Hong Kong Faculty of Dentistry took the top spot for the third year in a row. They were followed by King’s College London Dental Institute at number two. The University of Michigan slipped from their second place standing last year.  Next the Academic Centre for Dentistry Amsterdam and Tokyo Medical and Dental University rounded out the top five.

European schools dominated the top ten, but U.S. schools followed in force for the top twenty.

Harvard School of Dental Medicine, The University of North Carolina at Chapel Hill School of Dentistry, the University of Washington School of Dentistry, and the New York University School of Dentistry, took up the eleventh through fifteenth slots. The University of Pennsylvania, Penn Dental Medicine, came in eighteenth.

What I find interesting about these analyses, however, is that the criteria for what makes a top school are not necessarily what would be important to me as a prospective student – unless I planned on a career in dental research.

Now, I’m not saying that graduating from the University of Michigan Dental School or Harvard are only good if you are interested in research. I’m sure they graduate many excellent clinicians.  But in my estimation, when you graduate, you want to feel prepared to deliver dentistry to your patients confidently.

Isn’t that what happens when one graduates from dental school? Apparently not in every case.

Years ago, I was faced with the same decision so many young dental students have to consider today.  What school should I apply to? Geography, tuition, and reputation were all factors I took into account. At one point, I thought I had my choices narrowed down to two schools – both in the same city. One was an Ivy League school and the other one with a solid reputation.

As luck would have it, I was invited to a barbecue and met a dentist who had the good fortune to teach at both institutions at different times. So, I asked him, if you had the choice, where would you go?  He reflected upon the question for a moment and answered this way: “If you want to learn how to talk about dentistry go to (the Ivy League) school.  If you want to learn how to do dentistry, go to the other one.”

Basically, what he was saying was that while the first school was excellent, the other school prepared you for the real world of dentistry better.

How much better?  I can answer that.

I knew I wasn’t inclined toward a career in research. I wanted to become a dentist and work with people on a day-to-day basis.  I took his advice and chose the school that I felt would prepare me to do just that.  I have to say, I was happy with my decision. When the time came for me to hang up my shingle, I definitely felt prepared. I wanted to start seeing my own patients.  And I loved the next twenty-seven years of clinical practice.  I honestly continued to love coming to work after all that time.

But let’s backtrack for a moment. While still a dental student I also had the good luck to have been elected a Trustee for the American Student Dental Association. As such, one of my responsibilities was to act as a liaison between students in the dental schools of my region and the part of the American Dental Association (ADA) dedicated to its future members. The ADA wanted to know what concerned new graduates and it was interested in seeing what could be done to help them.

My district included three Ivy League schools, as well as the two oldest dental schools in the country. I had a chance to travel a great deal while still a student and I spoke to many people about what they perceived as their greatest challenges upon graduation. The overwhelming majority of times, the conversation drifted in the direction of the student wanting to do a General Practice Residency (if they weren’t planning on a specialty) or, they told me they planned to work as an associate for a few years before starting their own practice.

By contrast, most of my classmates were ready to hang their shingles and get started upon graduation.

This spoke volumes to me and, in retrospect, I was grateful to that doctor from the barbecue.

If you are a prospective dental student, ask yourself, what do you envision doing when you get out.  Do you love academia?  There is definitely a place and a need for research.  Dentistry is a dynamic field and both dental science and technology evolve at breakneck speeds.  There are many aspects of dental research that one could pursue.

But if, like me, you know that you are going to become what we refer to as a “wet-fingered” dentist, research what your clinical experience will be like. What will you get to do? Just the basics, or will you have chance to learn about the growing needs of your patient base? Patients will want to see you deliver tooth whitening as well as replace missing teeth or stabilize loose dentures with implants. They will want to correct uneven or discolored teeth with veneers.  And more. Much more.

Dentistry can be a lot of fun and very fulfilling. It can also be challenging. But if you do choose the profession, research your schools well, and do your best to do your best. Good luck!

When was the last time you had a dental exam?

Many people believe that since they aren’t experiencing dental symptoms – like tooth pain or bleeding gums – then all must be well.

Unfortunately, a sizable number of dental problems, including cavities and periodontal disease (bone loss around your teeth), just don’t produce obvious symptoms in their early stages.  At least not symptoms that tend to be obvious to patients.

In fact, by the time people the average person experiences pain, his dental issue is typically pretty far along.  And all too often, by then, the problem can also be quite expensive to handle.

It might amaze you to discover the types of problems your average dentist encounters every week, many of which you would expect to be painful, but they just aren’t.  They can still result in tooth loss though.

Pretty much anyone who has ever worked in a dental office for any length of time will tell you this is so.  And they will tell you that you can inform some people that they have a problem, but unless it is “real” to them, they just won’t do anything about it.

They may come back a few years later (or maybe sooner) – usually with an emergency – desperately wanting to save the tooth that you told them about earlier.  Of course, by now, it may be too late.  And very often they will have forgotten it was ever discussed at all, because it was never a realistic problem for them to begin with.

Human nature can be funny that way.

So, keeping that in mind, it’s generally a good idea to get checked out by a dentist.  Regularly.

The best news you can hear is that everything looks great.

But sometimes getting a confirmation that you don’t have cavities or gum disease is not the only reason to get a dental exam.  Over the years, I have detected cancer (not just oral cancer) – as well as a host of other non-dental problems – that might have been overlooked had the patient not scheduled an exam.  Obviously, we refer patients to an appropriate specialist for treatment when we discover medical problems outside the scope of dental practice.

Other benefits of getting a dental exam:  I can recall many patients who told me that what they thought were unrelated health problems simply resolved when their oral problems were gotten under control.  These have included digestive problems, low energy problems, elevated blood cell counts, hypertension, and more.

Over the years, some people have told me they don’t want to get a dental exam because they don’t want to discover they have any problems.   I guess that works.

Just maybe not too well.

Your overall health is connected to your oral health.  Take a look at this infographic.  Then think it over. . . .



Do Dental Implants Make Financial Sense?

Because tooth-loss so often creates long-lasting and generally negative effects for personal health and, not infrequently, appearance – the entire array of tooth replacement options has long been an important subject in the dental field.  Dentists not infrequently discuss which options are best for their patients, given different circumstances.  And if there is any debate in the profession at all, you can be sure the public will also question which options make the most sense for them.

The truth is there is no one right answer.  Each person’s circumstances differ – whether the reasons are anatomic, functional, emotional, or financial.

But the question is still an important one to ask, because patients face new realities when they lose even one tooth.  These changes include (but are not limited to):

  • Difficulty chewing
  • Altered speech
  • Food impaction
  • Jaw pain
  • Drifting teeth

And, then there are the secondary effects:

  • Poor health resulting from a changing diet
  • Compromised appearance
  • Self-consciousness/embarrassment
  • An inability to wear dentures
  • Financial challenges created by the need to address these problems

It is this last point that I want to touch upon here, because I have observed a good deal of confusion surrounding dental implants.  As a dentist, I am obligated to review all options with an individual when discussing their tooth replacement options – regardless of affordability.  I can’t, and don’t, pre-judge anyone financially when discussing their choices.

Commonly, though, when I raise the subject of dental implants, I get an immediate reaction along the lines: “Oh, forget it. I could never afford that.  How about a bridge?”

Now, I’m not going to try to convince you that implants are cheap. Restore a full mouth with dental implants and it is likely to be costly.  Nevertheless, cheap is relative.  For some of my patients, even a small filling can be perceived as expensive.  For my wealthy patients, they might be prepared to spend any price for what they perceive will serve them best.  Lucky them.  Right?

What I hope to do here, however, is to show you when an implant may make the most sense for a person. And — at least, when when it comes to replacing a single tooth — a dental implant may just be the way to go.

But first, permit me to remind you again – there is no one right answer for everybody.  Your choices may be very different depending upon whether you are 25 or 85 years old, for example.

I’m sure you can fill-in still other reasons that affect your decision-making process.  But for now, let’s consider the following scenario:

A patient loses one tooth.

For the sake of argument, we’ll call it a lower right first molar.   Suddenly, the patient realizes this is annoying.  Their bite is changing; their gums are sore.  They feel the need to do something.  Now.

Here are a few options. I’m just going to list the main ones, but there are sub-sets to some of these:

  1. Do nothing anyway.
  2. A removable denture.
  3. A non-removable bridge,
  4. A dental implant.

For the purposes of this discussion, the patient has already decided that doing nothing isn’t working for them.

So, the next option is a removable denture.  I usually get “the face” on this one.

And with good reason.  Food gets caught around partial dentures every time you eat.  You will have to remove the appliance after EVERY meal and clean it separately from your own teeth.  Certain foods will also cause it to dislodge as you eat, allowing some of the food to get caught between the denture and your gums.  The cost – depending upon what kind of partial you have made – will typically range between $750 and $1,500. The recommended replacement time: every 5 to 7 years.  The reality – people replace them roughly every 15 years.  Sometimes more.  The longer they put off the replacement though, the more issues they may face with the replacement.

Bottom line:  Removable dentures are potentially uncomfortable.  Average lifetime replacement cost if you are 25 years old, (based on an average life expectancy of about 79 years, and an average 10-year replacement rate – not adjusting for inflation) is going to be nearly $7,000.

Next, we’ll take up considering a “bridge.”  It’s called a bridge because it spans a gap (like a bridge spans a body of water) with a fake tooth, or teeth, in between the ones that are still there.  The trouble is that you must shave down the supporting teeth to little stubs so that the result will look natural and be strong enough to take the force of daily chewing.  For the most part, bridges look, and can often feel like, your natural teeth; but you do have to floss under the fake tooth after every meal.  Food will get caught under there, whether you perceive it or not.  If you don’t clean it regularly, the life expectancy of your bridge will be shorter.

Now, the cost on this option can really be widely variable, because some teeth need to have fillings replaced before they can be used as supports for the bridge.  In other cases, the teeth may end up with root canals if the process of shaving them down results in lingering sensitivity.  This doesn’t always happen, but it is a risk.  If the tooth needs that additional treatment it will cost you more.

The average cost to replace a single tooth with a bridge is about $3,500.  Again, that can be a little more, or less, depending upon what part of the country – or even what part of a city, you live in.

If, on the other hand, you also need to place or replace fillings on the teeth being used as supports, and you need to do root canals as well, it could be as much as $7,000.

Roughly, double.

The average lifetime replacement cost with the same parameters given above (25 years old with an average life expectancy of 79 years and a 10-year average replacement rate) is going to be: $31,500.  And that assumes that the underlying teeth will be strong enough to survive that many replacements.

That brings us to dental implants.

Here is the breakdown:  The average implant cost in many metropolitan areas is around $1,800 – $2,200.  If you end up needing a bone graft before the implant can be placed, though, add another $550.  (Basically, a graft is adding bone to your jaw when you don’t have enough for the implant.) So far, these costs are just for the implant.  It doesn’t include the cost of the crown.  Add about another $2,100 for the parts needed to make up what supports the crown above the gumline, and the crown itself.  If your tooth is short, and there isn’t enough tooth height to which your crown can be easily cemented, you might need something called a UCLA abutment — it lets your dentist screw down the crown instead of cementing it.  That could cost you more.  How much depends upon the lab your dentist uses, but $500 more wouldn’t be unusual.

On the low end, one implant may cost $3,900.  On the high end, let’s round up to $4,900.

So, what about the average lifetime cost?


That’s less than either partial dentures or bridges!


Because, unless you bite into a rock, grind your teeth uncontrollably, or have some serious illness that causes you to lose bone around the implant – any of which can happen to you with the other options as well – you will probably have your implant for life.  Still, no one can guarantee this because, sometimes, plain ol’ dumb luck will factor into any equation.

But, you can’t get a cavity on an implant.  On the other hand, you still can get a cavity on the teeth that support your partial denture, or bridge (and crowns, for that matter).

So, do the math.  Look at your circumstances, and decide what is right for you.  But when your dentist starts talking to you about dental implants, hear them out.  It just might be more cost effective than you realize.

[Note: The prices mentioned here are just averages in US Dollars at the time of this writing.  Actual costs could be more, or less, depending upon where you live.]

Tooth Extraction Stress

In my experience, extractions freak people out.

So it’s always gratifying when a patient can leave my office joking and smiling after the experience, such as happened in my office two days ago.

In fact, another patient, actually gave me a big hug after her extraction the following day.

And that got me to thinking about this entire area. . . .

No one (usually*) wants to lose teeth.  And we, as dentists, don’t want people to lose them either, but sometimes there is little choice if a tooth has been allowed to get bad enough, or if periodontal disease is so advanced that there is no hope of reversal.  [*Though, I did have a young boy actually request a tooth extraction last week — but I’m pretty sure he was really hoping for a visit from the tooth fairy. ]

Nevertheless, I see many people really work themselves up over the thought of the procedure.  In fact, the first patient I mentioned actually rescheduled her original appointment when she learned she needed the extraction. She had a hard time confronting the idea of removing her tooth.

Trust me.  I get it.

But, to her credit, she did show up for her appointment and when we were done – as I have heard so many times before – she said: “I can’t believe I worked myself up for that.”

Even with her tooth being so badly decayed that there was barely anything to get a hold of, her experience was pretty quick and painless.

So her worry was just stress on top of stress.

My first piece of advice on this point is try not to need an extraction.  Toward that end, try to keep up with regular dental visits, eat a healthy diet, and don’t forget — you control your home care.  But, if you do need to have a tooth removed, talk to your doctor about your concerns.

In most cases, your anticipation of what is to come will be far worse than the experience.  Still, delaying the inevitable is seldom a good thing.  It can make it harder for the doctor too.  So why not just make it easier on everybody?

And relax.  It’ll be ok.