Thursday, June 26, 2014

Why Do My Gums Hurt and Bleed?

It seems that everyday, one of my patients will have gums that bleed and hurt. They often wonder why.

Healthy gums should have a coral pink appearance and should not bleed readily. In addition, the texture should be stippled. In other words, it should have a texture similar to an orange. When they get somewhat glossy, it's because the gums are edematous (puffy from excess fluid). This is an early warning sign.

What are the causes of bleeding gums?

  • Inadequate hygiene at or below the gumline
  • Calculus (Tartar)
  • Certain Hormones
  • Certain Drugs
  • Foreign Bodies
  • Crowded/Crooked Teeth

The primary cause of bleeding gums is inadequate oral hygiene. When plaque is left at or below the gumline, it acts as an irritant or foreign body not much different than a splinter in your finger. Some people have told me that they don't brush at the gumline because it hurts and bleeds. The last thing you want to do is to avoid brushing at the gumline. You must remove the debris or it will never get better. A chronic bleeding gum condition will lead to gum loss, bone loss and ultimately, tooth loss.

Proper hygiene becomes exceedingly
difficult when the pocket exceeds 3mm
Calculus is plaque that has mineralized. It becomes hard and attaches to the tooth surfaces. This is a bigger problem than plaque.

Women undergo many hormonal changes during pregnancy. The gums become enlarged and will therefore create more difficulty in removing debris during routine oral hygiene.

Certain drugs like Dilantin (anti-epileptic medication), will cause gingival hyperplasia which means the gums will grow. Again, this makes hygiene much more challenging.

Foreign bodies also cause inflammation. The most common one that I've seen are popcorn kernel husks. They notoriously get stuck between the tooth and gums. They can be difficult to remove at home.

Crowded/crooked teeth are more difficult to keep clean. There is an increased risk of developing gingivitis.


The best thing anyone can do for their oral health is to meticulously brush and floss. I prefer electric toothbrushes over manual ones because the plaque is removed more thoroughly. It is also much gentler on the gums. Some people can be too aggressive with a manual toothbrush. Your dentist or hygienist can demonstrate proper flossing and brushing techniques.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Wednesday, June 18, 2014


I have been getting questioned lately on the use and safety of e-cigs. Therefore it is the topic of this week's blog.

It was invented in 1963 by Herbert Gilbert. It was later reintroduced by a Chinese Pharmacist (Hon Lik) in 2003. They have become quite popular in recent years.

What exactly are e-cigs?

Basically, they are cigarette shaped tubes which contain a battery powered heating element. When activated, the heat ignites the ingredients to produce a vapor. They were created as a "safe alternative" to cigarettes.

Are e-cigs safe?

Here is a concise answer......NO.

Yes, they relatively safer than traditional cigarettes, BUT they are still dangerous.

Here are some things to consider:

  • E-cigs eliminate smoke and tar which we all know are very detrimental to our health. So, we eliminate the negative effects of smoke and tar.

  • E-cigs contain three major ingredients.....Nicotine, propylene glycol and unspecified flavorings.

    • Nicotine is highly addictive. There are many adverse effects with this drug alone which are too numerous to list. Most of these effects can be categorized as cardiovascular, muscular, neurologic and psychotic. There is also a link to an impaired immune system.

    • Propylene glycol has been designated GRAS (generally recognized as safe) by the FDA since 1997. It is commonly used in foods and is generally recognized as safe when consumed. However, I completely disagree with the assertion that it is safe when inhaled. Chemically, it is a mineral oil. When the lungs are exposed to mineral oils, lung function is impaired. In addition, it acts as an irritant. So I say....NO, IT IS NOT GENERALLY RECOGNIZED AS SAFE IN THE LUNGS.

    • Unspecified flavorings......Huh?!?

  • Excessive heat as we all know can damage everything it comes in contact with. Damage to the cells lining the entire airway is a real risk.

  • The vast majority of these e-cigs are manufactured in China. There are some major issues with consistency and variability in the products (even within the same factory).

  • Second-hand vapor is still an issue.

In conclusion, if you are already a cigarette smoker, then perhaps this is a safer alternative in your quest to completely eliminate the habit. If you aren't currently a smoker and believe that "vaping" is a safe alternative, then think again. I advise you to never start.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit