Good evening Gretchen, how are you today? Good, how are you? I’m doing well. Any concerns for me? Areas in the mouth that you want me to address? When I brush my teeth, my gums bleed. Okay, let me just take a quick peek. Alright. Alright, you have gingivitis and what that is is just a bacterial infection caused from plaque retention, especially in-between your gums. After I probed your teeth, I saw readings of four millimeters and kind of generalized throughout. And what that kind of shows me is that the gum tissue being inflamed kind of creates what we call a pseudo pocket. So, really once you have the inflammation under control and you are doing proper brushing and flossing that will actually reduce the pocket depths. It could reduce it one millimeter. It could reduce it to two. Or it may not reduce it all depending upon the amount of inflammation you have going on in your mouth. Now, you are in your first trimester, correct? Yep So, hormonal changes also cause an increase in gingivitis and you had a lot of generalized bleeding upon probing, mainly in-between your teeth. So, that is showing me that you are not flossing enough or you are not flossing properly. So, how many times a day do you floss currently? Um, I don’t really floss everyday, I only floss when I need it. So, basically if you get a piece of food stuck you are removing it with some floss. Ok, so I recommend that you floss one to two times a day, twice ideally because of the situation that you are in with the amount of gingivitis and inflammation you have and because of your hormonal changes. So, we are going to go over flossing. And you are just going to twist the floss on your middle finger and then get a close grip. You are going to wrap it around your index finger so you have a tight grip. So you can control the floss easier. Actually, tell me when you can see. Good. We are going to see saw it in, bring it around like a “C”. Down, up and around “C” shaped. You are going to do that. I’m going to have you show me. We are going to go over brushing technique. Like that? Very nice. It seems like you have no problem reaching the areas. Okay and brushing should be done at a 45 degree angle upward towards the gum tissue. What you are going to want to do is you’re going to feel it put a little pressure on the brush. You are going to feel it get a little bit under the gum tissue, you are going to feel a little bit of pressure. And you are going to jiggle the brush, you are not going to go in scrubbing because you can actually cause more damage to your tissue. So you’re going to do is angle it 45 degrees up underneath the gums and jiggle. You’re going to do about two teeth at a time for at least two minutes. I’m just going to have you demonstrate. Okay I can’t see Tell me when you can see. Okay, there we go. Okay, you can go to the sweeping method. Is that good? Good and because you did not have any other areas of concern, no active decay or no shadows between your teeth, we are not going to take x-rays. It is safe to take x-rays, however we don’t feel a need for them right now. How about mouth rinse? Do you use any mouth wash at home, currently? No, I don’t. Um, I would actually recommend that you use a fluoridated mouth rinse, such as ACT fluoride, it’s A-C-T and you can get that over the counter at any grocery store. And what you do is you’ll use that once a day. I prefer it at night because you do not have as much saliva production at night. So I recommend that you actually rinse with that at night. Also, we are going to go over a little nutrition. So, are you taking your pre-natal vitamins? Yes. Okay, it is good for folic acid. The only thing that you want to be careful is you don’t have any pre-natal vitamins with Fluoride in them because they could cross the placenta. However, Fluoride trays we do recommend every visit to kind of keep your teeth re-mineralized and that is actually just a local so it doesn’t become systemic so that you can have at every treatment. So you don’t have to worry abut Fluoride trays or treatment or Fluoride mouth rinse. So, I just want to show you a few pictures regarding gingivitis. So you have more of an idea of what it entails. This is just a progression of what we call periodontal disease, which is gingivitis and periodontitis. And because you are pregnant, you are at a higher risk for getting periodontitis, which is irreversible. It entails losing actual attachment, which is gum tissue that wraps around the tooth, as well as, bone loss if it progresses. So, you’re in a state right now where you’re no longer healthy, but you are actually have plague retention and it’s bi-products irritate the gum tissue. So you see more of a blunted, rounded papilla, which is the areas that are inbetween the teeth. We want to get you back to the healthy state, where you have more of the scalped appearance of the tissue and it is tighter to the gums and it is not going to bleed and it is not going to be sensitive. So, normally if you are brushing and you see bleeding, that is the first sign that there is something is going on and needs to be addressed. Periodontitis, as you can see, progresses. You are going to see root surfaces and that also puts you at a risk. So you want to prevent getting to the stage of periodontitis and actually resort back to healthy tissue, which can be done because gingivitis is a reversible process with flossing and brushing, but you really have to be on flossing at least once a day. So, also, I might recommend that you chew xylitol gum. It helps prevent cavities, it reduces the bacteria in your mouth currently. So, instead of maybe, I don’t know if you are chewing on ice chips, which is bad for your teeth or if you feel like you need to chew gum. Get any type of gum with xylitol in it. You will see it, it will be on the ingredients. Because you want to reduce the bacteria in your mouth because it can be transferred to the baby. And even after the baby is born, if you have high levels of bacteria for cavity production or for gingivitis or periodontitis, that can also be transferred through saliva, kissing, kissing your child that can be transferred. How are you with morning sickness? Um, I have been throwing up a lot lately. Have you? Okay, so what you want to do. The problem with that is the acids in your stomach come up and they hit the tongue surfaces of your teeth. And what they are going to do is cause erosion and what that does is kind of wears away your natural enamel, it thins it out, it reduces the anatomy. So you are getting more of a smooth appearance instead of having your normal anatomy, which is actually good for your teeth, its good for function. You need to keep that so I recommend rinsing out with water, brushing your teeth whenever possible after throwing up. I know brushing may be difficult, but at least rinsing with water. Make sure that you get all the acids out that you can. Actually brushing, I think right away after erosion is not actually a good thing because you are actually kind of pushing in the acids, so I recommend you refrain from brushing right after getting sick, but just rinsing out with water actually would be better and then brushing later.
Any questions for me?