The term “subgingival” means “below the gum line.” This hidden zone plays a significant role in dental health, as it is where many common oral issues can begin and progress. Understanding this area is important for maintaining a healthy mouth and preventing more severe conditions.
Understanding the Gum Line
The gum line, or gingiva, is the soft tissue surrounding the base of your teeth, forming a protective seal. The small space between the tooth surface and the surrounding gum tissue is known as the gingival sulcus or gum pocket. In a healthy mouth, this sulcus is shallow, measuring 3 millimeters or less in depth, allowing for effective cleaning with standard oral hygiene practices.
The subgingival space is an oxygen-poor area where specific types of bacteria can thrive. The junctional epithelium, located at the base of the gingival sulcus, has spaces between its cells that can allow plaque bacteria to enter the underlying gum tissue, potentially leading to inflammation.
Common Dental Issues Below the Gum Line
Plaque, a sticky biofilm of bacteria, forms on teeth surfaces. When this plaque is not removed, minerals in saliva can cause it to harden into calculus, also known as tartar. This calculus can form quickly. Subgingival calculus is dark brown to greenish-black and adheres to the tooth roots below the gum line, making it difficult to see and remove without professional intervention.
The accumulation of plaque and calculus below the gum line can trigger an inflammatory response, leading to gingivitis, the earliest stage of gum disease. Symptoms of gingivitis include red, swollen, and tender gums that may bleed easily, especially during brushing or flossing. If left untreated, gingivitis can progress to periodontitis, a more severe form of gum disease where inflammation causes the gums to pull away from the teeth, forming deeper spaces called periodontal pockets. These pockets provide a protected environment for harmful anaerobic bacteria to multiply, and bacterial toxins, along with chronic inflammation, can begin to break down the connective tissues and bone supporting the teeth. This destruction can ultimately lead to gum recession, persistent bad breath, and even tooth loss.
Professional Care for Subgingival Health
Dental professionals address issues in the subgingival area through procedures like scaling and root planing, often referred to as a “deep cleaning.” Scaling involves removing plaque and calculus from tooth surfaces below the gum line along the root. This is performed using specialized dental tools, which may include an irrigation process to deliver antimicrobial agents.
Following scaling, root planing is performed to smooth the root surfaces of the teeth. This procedure removes remaining debris and rough spots. Smoothing the root surfaces helps prevent the reattachment of bacteria and promotes the healing of gum tissue, allowing it to re-adhere to the tooth roots. Local anesthesia is administered to ensure patient comfort during these procedures, especially for inflamed areas. In some cases, dentists may recommend antibiotic therapy, applied directly into gum pockets or taken orally, to help control bacterial growth and promote healing after scaling and root planing. For more severe cases of periodontitis, additional interventions like periodontal surgery may be necessary to address bone loss.
Daily Practices for Healthy Gums
Maintaining subgingival health begins with daily oral hygiene. Brushing your teeth twice a day for at least two minutes with a soft-bristled toothbrush and fluoride toothpaste is recommended. When brushing, hold the toothbrush at a 45-degree angle to your gums and use short, gentle strokes to clean along the gum line, as this is where plaque tends to accumulate.
Flossing daily is also important for removing plaque and food particles from between your teeth and below the gum line, areas that a toothbrush cannot effectively reach. To floss properly, guide the floss gently between your teeth, curving it into a C-shape around each tooth, and slide it up and down beneath the gum line, using a clean section for each tooth to avoid spreading bacteria. Regular dental check-ups and professional cleanings are also important for removing hardened tartar that cannot be removed at home. A balanced diet and avoiding smoking also contribute to overall gum health.