I am proud of not having cavities, but the bad breath and bleeding gums are actually more terrible.

When I was in junior high school, my parents pointed out to me bluntly: "You have bad breath." When I happily told my parents some interesting stories, they would interrupt me, turn their heads away and say, "Your mouth stinks." For a sensitive adolescent girl, this was very damaging to her self-esteem.

My parents disliked my bad breath, but they didn't think it was a disease. They just said "I might have a bad stomach." Indeed, gastrointestinal problems such as poor digestion and Helicobacter pylori infection can also cause bad breath. Although I didn't understand these at the time, I never thought of going to the hospital. I thought: Bad breath, brush your teeth well, drink more water, eat lighter, it can always be solved. From then on, I developed a habit of covering my mouth with my hands when talking to others at close range.

Young, but with a long medical history

At the same time, I found that my gums began to bleed. The foam I spit out when brushing my teeth was no longer a pure white mass - it started with a little blood streak, and gradually became all pink and crimson. In serious cases, the sink even looked like a murder scene. Another day, I was holding a big apple and biting it, and suddenly I found that it was not just the marks of my front teeth left on the apple, but also blood! Looking at the bloody flesh, I felt sick, and from then on I had to cut the fruit into small pieces and put them into my mouth one bite at a time. Everyone thought I was a picky person because of this. Later, my gums would bleed when I gently sucked them, and sometimes I would bleed spontaneously, and even rinsing my mouth would not stop the bleeding immediately.

Being young and ignorant, I never thought of linking bad breath with bleeding gums, nor did I think that I had serious problems with my mouth. Because from childhood to adulthood, I have hardly ever had a toothache. Sometimes I accidentally saw that the cross-section of a classmate's back molars was black, which was ugly, but I secretly rejoiced: "It must be because they don't pay attention to hygiene. I don't have cavities, my teeth are clean." My parents also have no awareness of oral health care. "Toothache is not a disease." They will only go to the dentistry department reluctantly when their teeth hurt badly - this is probably a common problem among the Chinese population, not to mention our small county town. Therefore, I never saw a dentist when I was a child.

I didn't expect that "no cavities" was also a foreshadowing.

I don't want to go to the dentist, I took too many detours

As time went by, I was admitted to a medical school and learned some clinical medicine knowledge, but I still knew nothing about stomatology. In my knowledge framework, long-term gingival bleeding can be considered as coagulation abnormality, but I have no other systemic manifestations, so I decisively ruled it out; bad breath must be Helicobacter pylori infection, and there are no other symptoms, so I will not treat it for the time being.

Until one day, my then pampered boyfriend said he should have his teeth cleaned. I was very curious. It turns out that "teeth cleaning" is also called "teeth cleaning". As the name suggests, it is to clean teeth. The scientific name is "supragingival scaling". It can remove dental plaque and tartar on the surface of teeth. It is an oral health care treatment that needs to be performed regularly to prevent and treat periodontitis. Common symptoms of periodontitis are: red, swollen and bleeding gums, and there may also be bad breath.

I thought that this "teeth cleaning" might improve my oral problems, so I decided to give it a try. But my dad tried to stop me and said, "My friend is a very good dentist in my hometown. He said that teeth cleaning is not a good thing and will hurt your teeth. Don't go for teeth cleaning when you have nothing to do!" I ignored the advice of this "dentist friend" and gave my dad a health education based on the only oral health knowledge I had just learned. Finally, I resolutely went to a well-known chain dental clinic to experience my first teeth cleaning in my life.

There, I asked the dental hygienist, "Why do my gums always bleed?" He said, "Do you stay up late, work too hard, or like spicy food?" I subjectively chose to believe him and comforted myself: I was right. It seems that my bleeding gums are not a disease, but a lifestyle problem. I don't need to see a dentist anymore. The dental hygienist also said that my dental calculus is not serious. A few days after the dental cleaning, the bleeding gums and bad breath seemed to improve, but they returned to their original state not long after.

Later, my good friend said that she had "periodontitis" and her symptoms were similar to mine, but it seemed to be milder than mine. She had done "subgingival scaling" and it was very painful. She was very distressed: "I always felt that scaling was useless. After a few months, bleeding started again." Her words guided me and also misled me. I began to think that I might need to try subgingival scaling, but I felt that it was "incurable" anyway, I was used to these symptoms, and it didn't affect my life much; and I really didn't want to see a dentist, it was painful and troublesome! So I put the matter aside again. But during this period, under her recommendation, I tried electric toothbrushes, dental floss, water floss, and mouthwash, but there was no obvious effect.

Don't wait until you lose your alveolar bone to appreciate it

One morning, I found a small swelling on the inner side of the gums of one of my front teeth! My teeth felt so sore and soft! I couldn't bite anything! I panicked and hurried to make an appointment. I even made an appointment with the director of the dental department of a nearby large hospital.

The director was very busy, and the interns were almost the only ones who greeted me the whole time. First, the intern took me to take a periapical X-ray. He pointed at the film and said to me seriously: "Look, your alveolar bone has been absorbed by more than half, and there is also a little erosion in that part." He told me that once the alveolar bone is gone, it is gone and will not grow back on its own. We can only control it to slow down the disappearance of the surviving alveolar bone. This was the first time in my life that I learned to read a periapical X-ray. I felt cold in my heart, as if I heard from him that I had an incurable terminal illness.

Back in the clinic, the intern started to teach me the Bass brushing method with a tooth model. I realized that my brushing method had been wrong for so many years! It turned out that a 45° angle was not enough. The bristles had to be pushed between the gums and the tooth surface (i.e. the gingival sulcus) to vibrate horizontally with a small amplitude, and then slide down to bring out the dirt. My boyfriend once taught me to brush my teeth like this, but I ignored it because I was inexplicably worried that my gums would be poked. The intern did another probing on me, and the director came over in his busy schedule and said, "You see, her bite is not particularly good either." He also said some numerical values ​​that I didn't understand, but from their tone I could tell that my periodontitis was more serious. The director suddenly asked me, "Treatment or medication? Medication may have some side effects." I didn't understand what he meant, so I asked, "What does treatment mean?" The director said, "That's treatment!" He turned around and said to the intern, "Talk to her," and turned around to do something else. Even though I have seen the busy scenes of expert clinics, I was still confused.

The intern slowly explained to me that treatment is to develop a treatment plan based on individual conditions, first cleaning the teeth, then scaling, and possibly orthodontics, or even surgery. I trembled, but still asked the most worrying question: "How much will it cost?" He scratched his head and said he didn't know, maybe several thousand yuan. The poor female college student felt her money tightened and her heart ached after hearing this.

Finally, the director finally started to pay attention to me. Because I was very young, and the bleeding was mainly on one side of the lateral incisor (the teeth outside the front teeth), and there was no clear history of trauma, so he suspected that I was eating hard objects or eating melon seeds. I nodded doubtfully. According to their diagnosis and treatment plan, I should go back and practice Bass brushing first; learning to brush teeth is the meaning of cleaning and further treatment. I immediately bought a small-headed soft-bristled toothbrush and began to brush my teeth carefully in front of the mirror. At first, I was extremely unskilled and it took 20 minutes to brush my teeth once. Now I can brush them clean in 2 to 3 minutes. Looking back, I am very grateful to the intern who taught me the Bass brushing method step by step, which will benefit me for life. In fact, it is often mentioned in various popular science articles. Here I recommend that everyone must learn it carefully.

I told my dad about this medical experience (asking for money), but he said, "I often get these small swellings on my gums, and the swelling goes down in a few days. Is there any need to make such a fuss?" I insisted, "My oral problem has been shelved for years. If I don't treat it, it will be hopeless! I don't want to be like you, always getting food stuck in my teeth (turns out this is my family history). This is a big hospital and they won't cheat me out of my money. I'm a medical student and I understand what's going on." Only then did he reluctantly agree to me.

From now on, I will go to the dentist honestly

Later, for various reasons, I went to the Department of Stomatology of the affiliated hospital of our medical college for further treatment and made an appointment with a young doctor. She performed supragingival scaling, subgingival scaling, root planing, and medication on me. In short, she cleaned my teeth and gums inside and out. Because my friend once told me that scaling was extremely uncomfortable, I was a little nervous at the time, but the actual experience was okay. I personally felt that it was about the same as ordinary teeth cleaning. After scaling, the bleeding gums almost disappeared.

I went back for a follow-up two weeks later and had a simple teeth cleaning. The doctor said to me: "You may still have some gum bleeding and tooth sensitivity in the next few days. You can have a follow-up check every six months." I was so happy that I only needed to have a check-up every six months! The two visits only cost a few hundred yuan in total! At this time, I realized that my friend's words about subgingival scaling "not curing" actually meant that it required long-term follow-up, similar to the control of chronic diseases - but we can't give up treatment just because it requires long-term control!

After this initial diagnosis and treatment, my gums really stopped bleeding, and my boyfriend said that my bad breath was also relieved (I am very grateful to my boyfriend for enduring my bad breath due to periodontitis for so many years and trying to help me solve my oral problems many times but I ignored him). Because my alveolar bone had been severely eroded, after treatment, the swelling and receding of the gums left a large gap on one side of the front teeth, which leaked air when I blew air and water when I drank water. But I was mentally prepared, and the bleeding gums and bad breath that had troubled me for many years were solved, so I could accept it calmly.

Soon we entered the epidemic period, and at this time I finally learned the course "Oral Medicine". In class, I found that even clinical medical students, most people, like me, lacked awareness and knowledge of oral health care. The teacher said: The vast majority of Chinese people have mild or severe periodontitis, but most people ignore the slight discomfort of their teeth and gums. Periodontitis can cause swollen and bleeding gums, alveolar bone erosion, root sensitivity, bad breath and other problems. Long-term development may cause gum recession, leaving gaps between teeth, and even loose and falling teeth. Therefore, it is necessary to treat it in time, and be sure to learn the Bass brushing method! Try to use dental floss instead of dental floss sticks every day! Regular oral health care!

At that time, I had already mastered all this knowledge through my own cases. I even felt a little sad and proud while listening to the class and staring at my big gap between teeth. The teacher also mentioned that patients with periodontitis have a relatively low risk of caries - it turns out that the reason I didn't have cavities when I was a child was not because I brushed my teeth well. After class, my classmates said that they must go to the teacher to see a periodontologist when they return to school. I also secretly decided to ask the teacher why my periodontitis is so serious at such a young age? Are there any deep-seated reasons? Do I need further orthodontics and surgery? Try to find the root cause, develop a long-term plan, and try to delay the progression.

In a blink of an eye, it was time for a follow-up check-up, and my gums were bleeding slightly again, and the symptoms of tooth sensitivity worsened. Due to epidemic restrictions, I could not go back to the school hospital for a follow-up check-up. So my dad found his dentist friend for me. This friend took a look at my teeth, ignored my slightly swollen gums, ignored my tooth sensitivity and bleeding, and said: "Your teeth are very good! No need for cleaning!" I was happy and sad to hear that. I was happy that my rotten teeth could be praised. Compared with those old people in his clinic who covered their cheeks and cried about toothache, they were indeed much better; sadly, I could only wait until I returned to school to go to the periodontology department. Finally, he poked my teeth, suddenly laughed and said: "Oh, are you psychogenic!" I laughed too.

Although the review period has passed 2 months, with the help of daily Bass brushing and dental floss, I only have occasional slight bleeding gums and tooth sensitivity. I look forward to the end of the epidemic and everything returning to normal, so that we can make an appointment to see the dentist.

Doctor's comments

Wang Lei | Attending physician of the Department of Stomatology, Peking University Third Hospital, Haidian Branch, contracted doctor of Mint Dental

Periodontitis is a common oral disease in China, with a prevalence rate of about 80%. It is mainly manifested by inflammation of the gums and alveolar bone. In the early stages, we often only feel bleeding gums or bad breath, so it is easy to ignore it. When it develops to loose teeth or swelling and pus, it is often too late to regret.

Under the long-term stimulation of plaque, soft plaque and tartar, the gums become inflamed, the gum tissue becomes swollen and blunt, and the color turns bright red or dark red. Gingivitis can generally be controlled or cured by regular teeth cleaning. Gingivitis is the early stage of periodontal disease. If controlled in time, the symptoms are reversible. If left untreated, when gingivitis develops into periodontitis, it is not only a problem of bleeding gums, but also irreversible damage to the periodontal tissues and even loose teeth.

When it comes to whether to use dental floss or a dental floss stick when cleaning between teeth, both can be used. The ends of a dental floss stick are stretched tight and straight, making it easier to get into the gaps between teeth. It is more suitable for children or novices, but the cleaning range is smaller than that of soft and long dental floss that can wrap around the sides of the teeth. Just choose a tool that you are comfortable with and can use consistently. Dental floss does not directly remove plaque from teeth, but through mechanical action, that is, we rub back and forth to separate the plaque from the teeth. Remember to rinse your mouth after flossing to flush away the plaque.

Just like the protagonist in the article, when we started to pay attention to it, there was already obvious alveolar bone absorption. We cannot see this change ourselves, but once it happens, it is irreversible. At this time, active treatment can only control its development but cannot return to the previous state.

Therefore, this reminds us that we must start with prevention, learn the correct way to brush our teeth, develop the good habit of regular teeth cleaning, and choose regular medical institutions and professional doctors to protect our teeth and periodontal care.

Sharing of personal experiences does not constitute medical advice and cannot replace the doctor's individualized judgment on specific patients. If you need medical treatment, please go to a regular hospital.

Author: Dongdan Zhu Yilong

Editor: Muyi Yangyang