Understanding the reasons behind bleeding gums is essential in maintaining oral health and preventing further complications. So why are your gums bleeding when you brush and floss? Let’s take a look at some of the major culprits.

Gingivitis

The earliest stage of gum disease, gingivitis, is characterized by inflammation caused by plaque buildup at the gumline. Symptoms often include redness, swelling, and bleeding during brushing or flossing [1]. Without proper treatment, gingivitis can progress to more severe periodontal disease.

Improper Brushing or Flossing Techniques

Using a toothbrush with hard bristles or brushing too aggressively can damage the gums, leading to bleeding. Similarly, flossing harshly or incorrectly can cause trauma to the gum tissue, causing bleeding. It’s crucial to ensure proper brushing and flossing techniques to protect your gums.

Poor Oral Hygiene

Failing to maintain adequate oral hygiene can lead to the buildup of plaque and tartar, both of which can irritate the gums. This can ultimately result in bleeding when brushing or flossing your teeth.

Vitamin Deficiencies

A deficiency in vitamin C can lead to gum bleeding. Vitamin C is crucial for repairing tissues and maintaining the overall health of gums [2]. Likewise, low levels of Vitamin K, which helps blood clotting, can also contribute to gum bleeding.

Certain Medications

Certain medications, such as blood thinners and some over-the-counter pain relievers, can increase the likelihood of gum bleeding as they interfere with the blood’s ability to clot. Your dentist can help assess if your medication is causing your gum bleeding.

Hormonal Changes

Pregnancy, menstruation, and menopause cause hormonal changes that can make gums more sensitive and prone to bleeding [3]. It’s not uncommon for pregnant people, teenagers, and older women to have more sensitive and bleeding gums.

Addressing and Preventing Bleeding Gums

If your gums bleed when you brush or floss, it’s important to:

• Take good care of your smile. Use a soft-bristled toothbrush and fluoride toothpaste. Make sure to brush at least twice daily (at least 30 minutes after eating) and floss at least once a day. 
• Eat a healthy diet. Incorporate foods rich in vitamins C and K into your diet, such as citrus fruits, leafy greens, and broccoli, to strengthen your gums and overall dental health.
• Stay hydrated. Drinking plenty of water helps wash away food particles and bacteria from your teeth and gums, reducing the likelihood of plaque buildup.
• See your dentist. Regular check-ups and professional cleanings with your dentist can help identify and treat any underlying issues before they become severe.
• Adjust lifestyle habits. Reduce or quit smoking and limit alcohol consumption, as both can contribute to gum disease and associated symptoms.

Ask Your Dentist About Your Gum Health

If bleeding persists despite adhering to good oral hygiene practices or if it’s accompanied by other symptoms such as swelling, bad breath, or receding gums, it’s crucial to seek professional advice. Contact your dentist to book an exam to assess your gum health. Your gums play a crucial role in a healthy body and smile, so don’t wait!

Sources:

1. https://www.mouthhealthy.org/all-topics-a-z/bleeding-gums
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC8784414/
3. https://www.mouthhealthy.org/all-topics-a-z/womens-hormones-and-dental-health

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Diabetes—a condition in which the body doesn’t make or use insulin, or blood sugar, properly—can make it more difficult to prevent gum disease, and gum disease can increase your risk for complications from diabetes.

But what exactly is the relationship between these two disorders? Here’s what you need to know about diabetes and periodontal disease.

If You Have Diabetes, You’re More Likely to Get Gum Disease

People with type 2 diabetes tend to have high blood sugar, which can encourage harmful bacteria to proliferate in your oral cavity. These bacteria can increase your risk for gum disease by causing more plaque growth in your mouth.

While the early stage of gum disease, called gingivitis, can usually be reversed with a deep cleaning, advancing periodontal disease tends to be harder to treat. In addition, patients with diabetes may have trouble getting their gum disease under control.

Diabetes can also make it more likely for people to experience infections such as the active infection seen in periodontal disease [1].

Patients With Untreated Diabetes Are Especially at Risk

Untreated or undiagnosed diabetes is not only dangerous for your health, but can put you at even higher risk for gum disease. High blood sugar can make infection both more likely and harder to treat. Patients who have poorly-controlled blood sugar tend to have worse cases of periodontal disease, including severely inflamed gum tissue, bleeding, and tooth loss [2].

Can Periodontal Disease Make Diabetes Worse?

The relationship between periodontal disease and diabetes is complex, but in general, gum disease can make diabetes worse.

Gum disease increases blood sugar by triggering an immune response to the bacteria involved in gum disease. Infections such as periodontal disease create a stress reaction that can cause the body to increase cortisol and adrenaline, which can increase the production of glucose [3].

So just as periodontal disease can make diabetes worse, so diabetes can make periodontal disease worse. Experts are still understanding the link, but there are ways you can protect yourself from gum disease if you have diabetes!

How You Can Help Protect Your Teeth and Gums

Whether or not you have diabetes, you can help keep gum disease away by brushing your teeth twice a day, flossing once a day, and visiting your dentist every six months. If you have diabetes, it’s essential to take care of yourself and receive treatment as necessary to help protect your body and your smile.

If you live with diabetes and are considered to be at high risk for gum disease, your dentist may suggest you come in more often for checkups and cleanings to help prevent periodontal disease and help keep your diabetes under control.

With what we know about the link between periodontal disease and diabetes, managing your risk for gum disease as well as your diabetes is essential to your health. Always keep your dental appointments to support your oral health, as they may help support your diabetes management as well!

Sources:
1. https://www.perio.org/consumer/gum-disease-and-diabetes.htm
2. https://spectrum.diabetesjournals.org/content/24/4/195
3. https://www.ada.org/~/media/ADA/Publications/Files/FTDP_July2013_2.pdf?la=en

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What are the consequences of ignoring gum disease? The ramifications can affect more than your smile. Here’s what happens when gum disease is ignored and how it can affect your oral and bodily health!

Chronic Bad Breath

Gingivitis often begins with the noticeable symptom of chronic bad breath. You or your partner may notice that your breath is constantly off, and it may get worse as gum disease goes untreated. You may brush, floss, and use mouthwash, but the bad breath never completely goes away.

Bad breath is often the result of poor oral hygiene which can cause food and bacteria to
accumulate between teeth and cause gum inflammation [1]. Eventually, these bacteria will lead to pockets of infection around the gumline, which can not only cause bad breath, but contribute to a bad taste in the mouth as well.

Gum Recession

As gum disease progresses, you may begin to notice your gums receding. Receding gums can expose dentin—the softer layer of your tooth beneath the enamel—and even tooth roots.

You may notice that your teeth look longer, or begin to see discoloration near your gumline. When gums pull back from the teeth in this way, the result isn’t just longer-looking teeth, but sensitive teeth as well [2]. While gum recession has a few causes, including brushing too harshly, one of the most common is gum disease!

Loose Teeth

In its latter stages, periodontal disease can weaken the ligaments, or connective tissue, that help anchor teeth in place. The continuing infection will cause the pockets of bacteria to get larger, and teeth may begin to feel loose or feel as though they are shifting in your mouth.

Loose teeth can not only fit together differently, but also make it difficult or uncomfortable to chew. Gum disease is one of the leading causes of tooth loss, and without treatment, this devastating oral health problem could eventually cost you your smile.

Other Health Complications

Gum disease doesn’t just affect your teeth. Research has linked bacteria from gum disease to other inflammatory conditions in the body, including heart disease, diabetes, and even certain types of cancer [3]. Periodontal disease also poses particular risks for expecting mothers—active gum inflammation has been associated with an increased risk for delivering babies prematurely as well as babies with a low birth weight [4].

There Is Treatment for Gum Disease!

Preventable and treatable, periodontal disease isn’t a condition you have to live with. Your dentist can detect the early stages of gingivitis to help you reverse gum inflammation, and even for those with active periodontal disease, there is treatment. Get in touch with your dentist today to get a screening for gum disease!

Sources:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570844/
2. https://www.ada.org/~/media/ADA/Publications/Files/FTDP_Sept2013_2.pdf?la=en

3. https://www.perio.org/consumer/gum-disease-and-other-diseases
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217279/

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But is flossing really that important to your dental health? Here’s how much flossing can impact your oral health, as well as how often you should consider flossing to see the benefits!

Yes! Flossing Gets Where Your Toothbrush Can’t Reach

The fact is that, as great as your toothbrush is, it can’t get to those tight spaces between your teeth. However, plaque, bacteria, and food particles can quickly build up in these areas. Some experts estimate that you miss about 40 percent of your mouth when you brush but don’t floss [1].

Brushing only removes plaque and bacteria from the surfaces of your teeth, but where two teeth touch, your toothbrush can’t reach. This makes flossing absolutely necessary to clean plaque out of these areas where it can accumulate and cause oral health problems!

Flossing Can Help Prevent Tooth Decay, Gum Disease, and Bad Breath

Flossing goes a long way towards preventing cavities and even gum disease [2]. Your teeth are constantly exposed to bacteria and food particles that combine to make plaque, which can damage tooth enamel when not removed regularly. Plaque can also accumulate around the gumline, which can lead to gum disease.

By not removing plaque from between your teeth, you increase your risk for gum disease and tooth decay. One of the symptoms of gum disease is chronic bad breath that doesn’t go away even with brushing and using mouthwash. You need to floss to get a truly clean smile!

How Often Should You Floss for the Most Benefits?

Good news—you only need to floss once every day to see the benefits. Flossing more than once isn’t necessary unless you have food stuck in your teeth. Although it doesn’t matter what time of day you floss, there is some evidence that flossing before you brush may be better [3].

If you haven’t flossed in a while and begin a new flossing routine, keep in mind that your gums might experience some discomfort at first, including soreness and bleeding. However, these symptoms should go away as you settle into your routine, so follow up with your dentist if they continue to happen.

Remember to be gentle when you floss, as flossing too harshly can damage your gum tissue and even contribute to gum recession.

Don’t Ignore Flossing for Your Oral Health!

Flossing plays an essential role in keeping your smile clean to prevent many common oral health issues. Floss is relatively inexpensive, but if you prefer, you can invest in interdental cleaners to make flossing easier, particularly if you have mobility concerns. Don’t skip flossing for your smile!

Sources:
1. https://www.webmd.com/oral-health/features/still-not-flossing-more-reasons-why-
2. https://www.perio.org/consumer/AAP-recommends-flossing-as-essential
3. https://www.perio.org/consumer/brush-or-floss-first

The post Is Flossing Really That Important to Your Dental Health? appeared first on Your Dental Health Resource.

You can prevent gum recession, but first, you need to know what causes it in order to prevent it. Think about it—you can’t prevent your house from getting dirty if you don’t know where the dirt is coming from! Here’s how you can prevent gum recession.

Focus on Preventing Gum Disease

Gum recession is commonly a result of gum disease [1]. When bacteria and plaque aren’t properly and consistently removed from around the gumline, they can build up and begin to irritate the gum tissue. This can result in the gum tissue receding from the teeth.

Gum disease can be influenced by many factors, among them crooked teeth and poor oral health. Some people are also more likely to get gum disease based on genetics. If you focus on preventing gum disease with proper oral care, a nutritious diet, and regular dental visits, it’ll go a long way towards preventing gum recession!

Be Careful Not to Brush Too Hard

Brushing your teeth is necessary to protect your pearly whites, but aggressive brushing can damage them. Forceful brushing is not only unnecessary, but can have negative effects on the softer tissues of your mouth, such as your gums [2].

If you brush your teeth with a firm-bristled toothbrush, you may be causing unnecessary irritation to your gum tissue. The quality of your brushing matters more than how forcefully you brush, so be gentle and next time you need a new toothbrush, look for a soft-bristled one to protect your gum tissue!

Get a Checkup to See If You Grind Your Teeth

Teeth grinding can be harmful to your teeth as well as your gums. If you already have gum inflammation or recession, teeth grinding can make your symptoms worse. Grinding or clenching your teeth puts enormous pressure on your teeth, which can also affect gum tissue.

Get a checkup with your dentist to check for signs of teeth grinding that could be affecting your gum tissue as well. Your dentist can also evaluate your risk for gum disease to determine if you’re at risk for gum recession and discuss preventative steps to take with you!

Worried About Gum Recession?

If you’re seeing potential signs of gum recession or are concerned about preventing gum recession, it’s time to visit your dentist. The best way to prevent gum recession, in addition to taking proper care of your teeth, is to ensure you aren’t at risk for gum disease and don’t have any damaging habits such as teeth grinding that could influence your risk for the condition!

Sources:
1. https://www.perio.org/consumer/gum-disease-symptoms.htm
2. https://www.ncbi.nlm.nih.gov/pubmed/12875306

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Healthy gum tissue is essential to the health of our teeth, as it helps to both support the teeth and protect the roots of the teeth from exposure to hot and cold foods, which can cause painful sensitivity.

What could cause healthy gum tissue to suddenly become swollen and potentially lead to gum disease? Let’s take a closer look at why your gums could be unhappy and need professional treatment to get back to normal!

Bacteria and Plaque

Bacteria and plaque are the primary culprits in gum inflammation and disease. In fact, plaque is actually composed of bacteria and food debris left in the mouth. You know plaque as the sticky coating on your teeth if you haven’t brushed for a few hours.

Plaque can build up on teeth, particularly in areas we miss when brushing. When left unchecked, plaque can begin to irritate the gumline, which can lead to a potential infection. Plaque can eventually form in tartar, a hard substance that will need to be removed by your dentist [1].

Genetics Can Contribute

If your parents have a history of gum disease, it’s more likely that you’ll have gum inflammation or disease at some point in your life.

Why is this? Research shows that certain genes are linked to the development of gum disease [2]. By understanding your risk, you can take precautionary measures to prevent problems with your gums.

And remember, just because your family has a history of gum disease doesn’t mean you’ll get it—but it’s important to be aware of your risk!

Other Factors That Can Impact Your Risk

You’ll be more at risk for gum inflammation and disease if you smoke or use tobacco products. You may also be more at risk if you’re pregnant, as this can cause gums to swell due to different hormones and increased blood flow in the body. For this reason, those who take oral contraceptives may be at more risk as well.

Crooked teeth, which can be difficult to clean, and compromised immunity can all impact your risk for inflamed gum tissue. Even being under a lot of stress—which can impact your immune system—can increase your risk for certain problems with your gums [3].

How to Help Prevent Gum Problems

Fortunately, keeping your gums healthy is simpler than you think. By regularly cleaning your teeth—brushing twice daily and flossing once daily—you can help prevent gum disease.

Combine your home care habits with regular checkups with your dentist, and you can help stop gum disease before it even has a chance to start!

Sources:
1. https://www.nidcr.nih.gov/sites/default/files/2017-09/periodontal-disease_0.pdf
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424192/
3. https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html

The post What Causes Gum Inflammation and Disease? appeared first on Your Dental Health Resource.

Although gingivitis isn’t technically gum disease, it can lead to full-blown gum disease if left untreated. Here are the top causes of this oral health problem and how you can treat it to prevent gum disease from ruining your smile!

Poor Oral Hygiene

Plaque is the most common cause of gingivitis. Plaque consists of bacteria that coats the teeth—if you haven’t brushed for a few hours or overnight, you can often feel plaque beginning to form on your pearly whites!

Typically, you can keep plaque off the surfaces of your teeth and from accumulating around your gumline by brushing and flossing regularly. However, when you skip brushing or flossing, plaque can build up in the mouth and eventually lead to gingivitis [1].

Hormonal Changes

Hormonal changes have the ability to affect the oral cavity, particularly when it comes to gum tissue. In pregnant women, these changes can cause an increased flow of blood to the gums, causing them to appear swollen and to mimic the symptoms of gingivitis [2].

However, don’t immediately write off your symptoms as related to pregnancy. Some women may have gingivitis before they become pregnant, and the hormonal changes during pregnancy can make the condition worse.

You should always follow up with your dentist if you’re experiencing symptoms of gum disease, especially during pregnancy, as women with gum disease are more at risk to give birth to premature babies or babies with low birth weight [3].

Other Causes

There are other factors that can cause gum disease. People whose parents have gingivitis are more likely to develop it, as are people who smoke or use tobacco.

People who have crowded or crooked teeth may have difficulty cleaning all the surfaces of their teeth, leading to more plaque formation and an increased risk of gingivitis. Uncontrolled diabetes can also influence plaque formation in the oral cavity.

Some medications such as anti-seizure medications and even oral contraceptives have also been linked to gingivitis [4].

How Can You Treat Gingivitis?

Your dentist can usually treat gingivitis without special treatment. Typically, patients with gum inflammation need a deep cleaning to remove plaque from around the gumline, and to continue proper oral care habits at home [5].

For patients whose crowded teeth or a medical condition such as diabetes is suspected to be the cause of their gingivitis, correcting these underlying issues can lead to greater chances of success with treating the condition.

Keeping up with your regular dental visits in addition to your oral care at home can help prevent gingivitis! When treating this oral health condition, it’s essential to follow up with your dentist for regular cleanings to ensure that the inflammation doesn’t return and develop into gum disease.

Sources:
1. https://www.mayoclinic.org/diseases-conditions/gingivitis/symptoms-causes/syc-
2. https://www.mouthhealthy.org/en/pregnancy/concerns
3. https://www.perio.org/consumer/AAP_EFP_Pregnancy
4. https://www.mouthhealthy.org/en/az-topics/g/gingivitis
5. https://medlineplus.gov/ency/article/001056.htm

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If left untreated, the gum disease will get worse. Caused by bacteria in the mouth, gum disease—sometimes called periodontal disease—has symptoms such as chronic bad breath, tender or bleeding gums, and sensitive teeth [1].

What stages are seen in patients with gum disease as it gets worse? The following phases can help you better understand how this devastating condition works in the mouth to cause severe consequences.

Gingivitis: Early Gum Disease

Gingivitis, a word that means inflammation of the gums, is the beginning stage of gum disease. Fortunately, in this early phase, gum disease is relatively simple to reverse with a professional cleaning from your dentist and regular home care habits.

When gingivitis is present, you may see swollen gums that appear puffy, see blood when brushing, or bad breath that returns even after brushing or using mouthwash [2]. By getting regular cleanings with your dentist and taking care of your teeth at home, you can prevent gingivitis!

Periodontitis: Moderate to Severe Gum Disease

Periodontitis characterizes a more moderate to severe gum disease in which the gums actually begin to pull away from the teeth. This creates pockets of infection that can cause sensitive teeth, pain, and begin to cause damage to the connective tissue that help hold your teeth in place.

At this stage, your gum disease won’t be able to be reversed with a simple cleaning. Your dentist may suggest a professional treatment that actually goes beneath the gumline to remove bacteria and infection, also known as a root planing and scaling in an attempt to control the condition [3].

Advanced Periodontitis: Severe Gum Disease

Once your gum disease has advanced, your teeth may begin to feel loose as the supporting bone and ligaments will have been damaged by the bacteria and infection present beneath the gumline.

At this stage, gum disease will be more difficult to treat. If your teeth are shifting or loose, an extraction may be the only option to treat your smile [4]. Once your natural teeth are gone, you’ll need to consider replacements once your gum disease is under control.

Are You Seeing Signs of Gum Disease?

If you’re seeing the signs or experiencing the symptoms of gum disease, schedule an appointment with your dentist as soon as possible. Remember, the earlier you treat gum disease, the easier and less invasive your treatment will be. While gum disease is common in adults, it can ruin your natural smile, so don’t delay in seeking professional treatment!

Sources:
1. https://www.nidcr.nih.gov/health-info/gum-disease/more-info
2. https://www.mouthhealthy.org/en/az-topics/g/gingivitis
3.https://www.ada.org/~/media/ADA/Publications/Files/for_the_dental_patient_jan_2011.pdf
4. https://www.nidcr.nih.gov/sites/default/files/2017-09/periodontal-disease_0.pdf

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These signs and symptoms could include a bad taste in the mouth, bad breath that won’t go away even after brushing or using mouthwash, and inflamed gum tissue. Some people may even notice bleeding when they brush or experience shifting teeth.

But what exactly causes someone to get a gum infection? Here’s how gum infections happen and how they’re treated.

Common Causes of Gum Infection

There are several things that could lead to a gum infection, but one of the most common is periodontal (gum) disease [1].

Periodontal disease is typically the result of poor oral hygiene and genetics. Plaque and bacteria build up on the teeth and can work their way below the gumline. When this happens, the connective tissue that help hold your teeth in place are damaged and can cause pockets of infection [2].

Periodontal disease can progress slowly or rapidly depending on the person and the cause. For many people, they won’t experience symptoms until the condition has advanced.

People who use tobacco are more at risk to experience a gum infection as are people who have a compromised immune system, such as people who are receiving immunotherapy drugs such as chemotherapy.

How a Gum Infection Is Treated

Prompt treatment can help reverse your gum disease and prevent it from progressing to the point that you’re at risk for tooth loss. You should ideally contact your dentist as soon as you suspect an infection might be present.

Your dentist will want to conduct a deep cleaning of your teeth—this is often referred to as a root planing and scaling in dentistry—which will help to remove the infection underneath your gums.

Taking care of your teeth and gums at home is going to be vital to healing your gum infection. You may need to adopt healthier eating habits, quit smoking, and, of course, brush and floss daily. In addition, your dentist may prescribe antibiotics to help the infection go away or administer an antibiotic treatment at the office.

If your gum disease doesn’t respond to treatment or has progressed past the point that a good cleaning and antibiotics will help, you may need surgery or gum tissue grafts to help heal your smile.

For dentists that use laser technology, you may be able to receive laser therapy in conjunction with the above treatments for a more comprehensive approach to treating the infection [3].

Keep Your Gums Healthy!

Gums are vital to the health of our teeth and need to be kept healthy. Gums keep our teeth secure in our jaw and support proper oral health.

By regularly visiting your dentist in combination with regular oral health habits, you can prevent gum infections from happening in the first place. Schedule an appointment with your local dentist if you suspect a gum infection is compromising your oral health!

Sources:
1. https://www.cdc.gov/oralhealth/periodontal_disease/index.htm
2. https://www.mouthhealthy.org/en/az-topics/g/gum-disease
3. https://www.perio.org/consumer/gum-disease-laser-therapy

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With an estimated half of American adults over the age of 30 having some form of gum disease, treatment for this condition is common. An initial consultation with your dentist is important to determine if you have gum disease and how severe it is.

Depending on your unique case, gum disease may require a combination of the following
treatment options.

Early Stage: Cleaning

The earliest stage of gum disease is called gingivitis, which is inflammation of the gum tissue. Gum disease is easier to reverse at this stage, and so a professional cleaning from your dentist may be all that’s necessary to remove bacteria and help reverse the inflammation. However, your oral care habits at home are going to help a lot too.

Your dentist may conduct a professional cleaning and have you return to the office to ensure the gum disease is going away, or you may need additional cleanings. Taking care of your teeth at home with brushing and flossing is going to be an important part of your healing process as well.

Next Stage: Deep Cleaning

If your gum disease is a bit more aggressive or has advanced past the point of gingivitis, your dentist will want to conduct a deep cleaning, also called a root planing and scaling [2].

The scaling part happens first—your dentist will remove any plaque, tartar, and infection that may be present to help your gum tissue heal. Next, the root planing helps gum tissue reattach to your teeth and prevent bacteria from getting underneath the gumline.

This deep cleaning may need to be done more than once. It all depends on your unique smile and if this cleaning process is effective at treating your gum disease.

In order to enhance the effectiveness of your root planing and scaling procedure, your dentist may prescribe antibiotics or a mouth rinse to encourage healing.

Advanced: Surgery

If a deep cleaning has been done more than once and isn’t successful, your dentist may discuss the possibility of gum surgery with you to treat your gum disease.

Your dentist will want to remove plaque and infection from areas that may be difficult or
impossible to reach without surgery, allowing the gums to regenerate healthy tissue [3].

With this procedure, your dentist is also able to put your gums back into place to help them reattach properly. There are different types of periodontal surgery, so you and your dentist will talk about which one is right for you.

Preventing Gum Disease

Preventing gum disease is always easier than treating the condition after it’s progressed. While some people are predisposed to gum disease, adopting healthy home care practices such as taking care of your teeth, not smoking, eating healthy, and keeping your dental appointments can help you keep gum disease away.

If you suspect you have gum disease, your dentist can help you reverse the condition with the right care. Remember, the sooner you treat gum disease, the more successful your treatment is likely to be!

Sources:
1. https://www.nidcr.nih.gov/health-info/gum-disease/more-info
2. https://www.ada.org/en/press-room/news-releases/2015-archive/july/the-american-dental-association-releases-guideline-on-gum-disease-treatment
3. https://www.dentistry.uiowa.edu/patient-care-periodontal

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