DENTAL CARIES AND DENTISTRY- go hand in hand

DEFINITION

It is a destructive process causing decalcification of the tooth enamel and leading to continued destruction of enamel and dentin, and cavitation of the tooth.

 Cavities and tooth decay are among the world's most common health problems. They're especially common in children, teenagers and older adults. But anyone who has teeth can get cavities, including infants.

If cavities aren't treated, they get larger and affect deeper layers of your teeth. They can lead to severe toothache, infection and tooth loss. Regular dental visits and good brushing and flossing habits go a long way toward preventing cavities and tooth decay.

SYMPTOMS

The signs and symptoms of cavities and tooth decay vary depending on their extent and location. When a cavity is just beginning, you may not have any symptoms at all. But your dentist may be able to see that decay is starting and recommend steps to keep it from getting worse.

As the decay gets larger, it may cause such signs and symptoms as:

• Toothache
• Tooth sensitivity
• Mild to sharp pain when eating or drinking something sweet, hot or cold
• Visible holes or pits in your teeth
• Pain when you bite down
• Pus around a tooth, especially when you press on your gums

WHEN TO SEE A DENTIST

You may not be aware that a cavity is forming, so visiting your dentist regularly is your best protection against cavities and tooth decay. If you experience toothache or mouth pain — common signs of cavities — see your dentist as soon as possible.

If a cavity is treated before it starts causing pain, you probably won't need extensive treatment. That's why it's important to have regular dental checkups and cleanings even when your mouth feels fine. By the time you notice symptoms, the damage is getting worse.

CAUSES

Cavities are caused by tooth decay — a process that occurs over time. It begins as the action of bacteria damages the hard surface (enamel) of your teeth, a process that can occur without any noticeable discomfort.

 Decay can then progress to the deeper layers of your teeth in the following steps:

Plaque forms. Your mouth, like many other parts of your body, naturally contains many types of bacteria. Some of these bacteria thrive on food and drinks that contain certain forms of sugar, also known as fermentable carbohydrates. When these sugars aren't cleaned off your teeth, the bacteria quickly begin feeding on them and producing acids. The bacteria, acids, food particles and saliva then form into dental plaque — a sticky film that coats your teeth. If you run your tongue along your teeth, you may be able to feel this plaque forming several hours after you've brushed. The plaque is slightly rough and is more noticeable on your back teeth, especially close to your gums.

Plaque attacks. The acids in plaque remove minerals in your tooth's hard, outer enamel. This erosion causes tiny openings or holes in the enamel — the first stage of cavities. Once areas of enamel are worn away, the bacteria and acid can reach the next layer of your teeth, called dentin. This layer is softer and less resistant to acid than is enamel.

Destruction continues. As tooth decay continues, the bacteria and acid continue their march through your teeth, moving next to the inner tooth material (pulp) that contains nerves and blood vessels. The pulp becomes swollen and irritated from the bacteria. The bone supporting your tooth also may be affected. When decay advances to this extent, you may have severe toothache, sensitivity, pain when biting or other symptoms. Your body also may respond to these bacterial invaders by sending white blood cells to fight the infection. This may result in a tooth abscess.

RISK FACTORS

Cavities are one of our most common worldwide health problems. Everyone who has teeth is at risk of getting them, but the following factors can increase risk:

Tooth location. Decay most frequently occurs in your back teeth (molars and premolars). These teeth have lots of grooves, pits and crannies that are great for grinding food — but they can also collect food particles. As a result, they're harder to keep clean than your smoother and more accessible front teeth. Between your hard-to-reach back teeth, plaque can build and bacteria can thrive, producing the acid that destroys tooth enamel.

Certain foods and drinks. Some foods and drinks are more likely than others to cause decay. Foods that cling to your teeth for a long time, such as milk, ice cream, honey, table sugar, soda, raisins and other dried fruit, cake, cookies, hard candy, breath mints, dry cereal and chips, are more likely to cause decay than are foods that are easily washed away by saliva.

Frequent snacking or sipping. When you steadily snack or sip sodas, you give mouth bacteria more fuel to produce acids that attack your teeth and wear them down.

Bedtime infant feeding. Parents and caregivers are encouraged not to give babies bedtime bottles filled with milk, formula, juice or other sugar-containing liquids. These beverages will remain on teeth for hours while your baby sleeps, providing food for decay-causing bacteria. This damage is often called baby bottle tooth decay. Letting a toddler who's transitioning from a bottle wander around drinking from a "sippy" cup can cause similar damage.

Inadequate brushing. If you don't clean your teeth soon after eating and drinking, plaque forms quickly and the first stages of decay can begin.

Not getting enough fluoride. Fluoride is a naturally occurring mineral that helps avoid cavities — and can even reverse the earliest stages of tooth damage — by helping teeth repair themselves. Because of its benefits for teeth, fluoride is now added to many public water supplies. It's also a common ingredient in toothpaste and mouth rinses. If you drink bottled or filtered water that doesn't contain fluoride, you may miss out on its protective benefits. On the other hand, some bottled water may contain added fluoride. If your drinking water and tooth care products also contain fluoride, it's possible that babies and children could get too much.

 Younger or older age. In India, cavities are the most common chronic disease among children and teenagers. Older adults are also at higher risk as more of us keep our teeth as we age. Over time, teeth can wear down and gums may recede, making teeth more vulnerable to root decay. Tooth roots are naturally covered with a coating called cementum, but cementum is quickly lost when the root surface is exposed. The underlying dentin is softer than enamel and more susceptible to decay. Older adults also may use more medications that can reduce saliva flow, increasing the risk of tooth decay.

Dry mouth. Dry mouth is caused by a lack of saliva, which helps prevent tooth decay by washing away food and plaque from your teeth. Substances found in saliva also help counter the acid produced by decay-producing bacteria and can even help repair early tooth decay.

Worn fillings or dental devices. Over the years, dental fillings can weaken, begin to break down or develop rough edges. These developments can allow plaque to build up more easily and make it harder to remove. Fillings and dental devices can also leak or stop fitting well, allowing decay to begin underneath them.

Eating disorders. Anorexia and bulimia can lead to significant tooth erosion and cavities. Stomach acid from repeated purging (vomiting) washes over the teeth and begins dissolving the enamel. In addition, people with eating disorders may sip soda or other acidic drinks throughout the day, which also helps create a continual acid bath over the teeth. Eating disorders can also interfere with saliva production.

Heartburn. Gastroesophageal reflux disease (GERD), acid reflux and heartburn can cause stomach acid to flow into your mouth, wearing away the enamel of your teeth. If your dentist notices enamel loss and doesn't think this loss is caused by grinding your teeth, consult your physician to see if gastric reflux is the cause. Untreated reflux can cause significant tooth damage that is costly to correct.

Certain cancer treatments. Having radiation to your head or neck can increase your risk of cavities by reducing saliva production, which prevents cavity-producing bacteria from being washed away. Certain chemotherapy drugs also tend to cause dry mouth.

COMPLICATIONS

Cavities and tooth decay are so common that you may not take them seriously. And you may think that it doesn't matter if children get cavities in their baby teeth. However, cavities and tooth decay can have serious and lasting complications, even for children who haven't yet gotten their permanent teeth.

Complications may include:

PAIN                                                                                                                       TOOTH LOSS

                                  

                                                                                    

                                                                          


          

BROKEN TEETH     

                                                                  SERIOUS INFECTIONS

Also above mentioned things may lead to chewing problems and ultimately degrading the general health of the person

In addition, when cavities and decay become severe and very painful, they can interfere with daily living. The pain may prevent you from going to school or work, for instance. If it's too painful or difficult to chew or eat, you may lose weight or develop nutrition problems. Cavities that affect your appearance or result in tooth loss may affect your confidence and self-esteem. In rare cases, an abscess from a cavity can cause serious or even life-threatening infections when not properly treated.

Above all dental caries or tooth decay is the disease of negligence regular checkups will help you identify cavities and other dental conditions before they cause troubling symptoms and lead to more-serious problems. The sooner you seek care, the better your chances of reversing the earliest stages of tooth decay and preventing its progression.

After reading this entire section if you're experiencing pain or sensitivity in your teeth, make an appointment with your dentist as soon as possible.

Regards

Dr P.B.Sood

IMPLANTS BOON WITH A BOOM

As we age we experience an array of changes within our body and overall health. Among these changes are tooth loss, most commonly caused by tooth decay, gum disease and excessive wear and tear. Missing teeth can add years to a person's appearance, making it difficult for an individual to smile without feeling self-conscious. Not to mention that performing normal day-to-day activities, like eating and talking, become both challenging and frustrating.

THEN WHAT TO DO?

Then what we need to go for replacements or prosthetic rehabilitations

Why Replace Missing Teeth?

Missing teeth have more far-reaching effects than just an older appearance and lack of confidence. As soon as a tooth is lost, the supporting bone begins to deteriorate. Additionally, gaps in your teeth can affect the surrounding teeth, causing them to shift into the gaps and influencing how the jaw closes. And since food can easily become trapped in these spaces, the risk of tooth decay and gum disease increases.

Its best to replace a tooth as soon as its lost as this will prevent the progression of bone loss, reduce the shifting of your surrounding teeth and avoid additional decay. Delaying tooth restoration for an extended period time will only limit your possibilities for successful restoration, make chewing foods more difficult and lead to more serious health problems.

NOW WHAT COULD BE DONE?

When we need to replace one tooth or several missing teeth, we want a solution that will restore your smile as close to your natural teeth as possible. Dental implants from our experienced implant dentist is the only dental treatment available that replaces the entire missing tooth while preserving the bone and restoring normal functions.

WHAT IS THIS IMPLANT?

Used to replace one tooth or multiple teeth, dental implants are artificial tooth roots that are securely affixed into your jaw to hold a replacement tooth. They are designed to replicate your natural teeth while restoring function and preventing further decay, dental diseases and bone loss.

BENEFITS OF DENTAL IMPLANTS

Dental implants are comfortable, long-lasting and secure, making this restoration treatment a practical choice for patients no longer wanting to wear removable dentures. Unlike traditional, dentures, dental implants offer a fixed permanent solution to missing teeth. With implants, there is no fear of slipping or falling out, no messy adhesives, no discomfort and no difficulty eating or talking.

The Implant Advantage:

·       Restore proper chewing functions

·       Convenience and confidence that teeth won't move or loosen

·       No messy adhesives

·       Improved speech

·       Prevent progressive bone loss and gum recession by mimicking the roots of natural teeth

·       Look and feel like natural teeth

·       Convenient oral hygiene

·       Renewed self-confidence and improved self-esteem

If you, like millions of other adults, have lost one or more teeth, you are probably all too familiar with the unpleasant consequences. The benefits of dental implants far outweigh any other tooth restoration procedure. Not everyone is a candidate for dental implants, however, and in some cases, dentures will be the most suitable treatment. Schedule an appointment with your dentist and find out if implants are a viable solution for restoring your smile for a lifetime.

Regards

Dr P.B SOOD

Fourth Molars

Most people have about four "wisdom teeth". These are also known as "third molars", one in each quadrant. They are way in the back where there is usually not enough room. Often, but not always, they need to be removed because of limited space, angled eruption, impaction, or they just can't erupt properly. Sometimes there are no wisdom teeth at all; they just didn't form. There also may be one, two or three of them.

Every now and then there is a patient with extra wisdom teeth. Often these are called "fourth molars". Here is a panoramic x-ray showing the developing fourth molars. If there is not enough room for wisdom teeth (third molars), there for sure won't be enough room for any extras.

DIABETES- A COSTLY DISEASE

DIABETES- A COSTLY DISEASE

DIABETES?

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels, that result from defects in insulin secretion, or action, or both. Diabetes mellitus, commonly referred to as diabetes (as it will be in this article) was first identified as a disease associated with "sweet urine," and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine.

Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime.

IMPACT OF DIABETES.

Over time, diabetes can lead to blindness, kidney failure, and nerve damage. These types of damage are the result of damage to small vessels, referred to as microvascular disease. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart disease, and other large blood vessel diseases. This is referred to as macrovascular disease. Diabetes affects approximately 17 million people (about 8% of the population) in the United States. In addition, an estimated additional 12 million people in the United States have diabetes and don't even know it.

From an economic perspective, the total annual cost of diabetes in 1997 was estimated to be 98 billion dollars in the United States. The per capita cost resulting from diabetes in 1997 amounted to $10,071.00; while healthcare costs for people without diabetes incurred a per capita cost of $2,699.00. During this same year, 13.9 million days of hospital stay were attributed to diabetes, while 30.3 million physician office visits were diabetes related. Remember, these numbers reflect only the population in the United States. Globally, the statistics are staggering

Diabetes is the third leading cause of death in the United States after heart disease and cancer

WHAT ARE THE DIFFERENT TYPES OF DIABETES?

There are two major types of diabetes, called type 1 and type 2.

Type 1 diabetes was also called insulin dependent diabetes mellitus (IDDM), or juvenile onset diabetes mellitus. In type 1 diabetes, the pancreas undergoes an autoimmune attack by the body itself, and is rendered incapable of making insulin.

It is believed that the tendency to develop abnormal antibodies in type 1 diabetes is, in part, genetically inherited, though the details are not fully understood..

Type 2 diabetes was also referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult onset diabetes mellitus (AODM). In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body's needs, particularly in the face of insulin resistance A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and muscle cells).

In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective and suboptimal.

Gestational diabetes- Diabetes can occur temporarily during pregnancy and usually resolves once the baby is born.

"Secondary" diabetes refers to elevated blood sugar levels from another medical condition. Secondary diabetes may develop when the pancreatic tissue responsible for the production of insulin is destroyed by disease, such as chronic pancreatitis (inflammation of the pancreas by toxins like excessive alcohol), trauma, or surgical removal of the pancreas.

Diabetes can also result from other hormonal disturbances, such as excessive growth hormone production (acromegaly) and Cushing's syndrome. In acromegaly, a pituitary gland tumor at the base of the brain causes excessive production of growth hormone, leading to hyperglycemia. In Cushing's syndrome, the adrenal glands produce an excess of cortisol, which promotes blood sugar elevation.

In addition, certain medications may worsen diabetes control, or "unmask" latent diabetes. This is seen most commonly when steroid medications (such as prednisone) are taken and also with medications used in the treatment of HIV infection (AIDS).

 CAUSES OF DIABETES

Insufficient production of insulin (either absolutely or relative to the body's needs), production of defective insulin (which is uncommon), or the inability of cells to use insulin properly and efficiently leads to hyperglycemia and diabetes. This latter condition affects mostly the cells of muscle and fat tissues, and results in a condition known as "insulin resistance.", if someone is resistant to insulin, the body can, to some degree, increase production of insulin and overcome the level of resistance. After time, if production decreases and insulin cannot be released as vigorously, hyperglycemia develops.

 Without insulin, the cells become starved of glucose energy despite the presence of abundant glucose in the bloodstream. In certain types of diabetes, the cells' inability to utilize glucose gives rise to the ironic situation of "starvation in the midst of plenty". The abundant, unutilized glucose is wastefully excreted in the urine.

SYMPTOMS OF DIABETES

The early symptoms of untreated diabetes are related to elevated blood sugar levels, and loss of glucose in the urine. High amounts of glucose in the urine can cause increased urine output and lead to dehydration. Dehydration causes increased thirst and water consumption.

The inability of insulin to perform normally has effects on protein, fat and carbohydrate metabolism. Insulin is an anabolic hormone, that is, one that encourages storage of fat and protein.

A relative or absolute insulin deficiency eventually leads to weight loss despite an increase in appetite.

Some untreated diabetes patients also complain of fatigue, nausea and vomiting.

Patients with diabetes are prone to developing infections of the bladder, skin, and vaginal areas.

Fluctuations in blood glucose levels can lead to blurred vision. Extremely elevated glucose levels can lead to lethargy and coma.

ORAL MANIFESTATION OF DIABETES MELLITUS

No specific oral lesion is related to diabetes. However in uncontrolled Diabetes  effects can be dramatic. People with Diabetes can have

·         Rapidly progressive Periodontal disease

·         Gingivitis

·         Oral Candidiasis(thrush)

·         Dry mouth (Xerostomia)

·         Burning sensation of oral and tongue mucosa

·         Poor healing of oral ulcers and wounds.

·         Never read anywhere but there is a slight increase in dental decay probably due to Xerostomia

·         And multiple teeth showing periapical lesions

TREATMENTS

Would not go into the details of treatments related to this disease but would advice every dentist to always keep a consideration that any of your patient could have diabetes so always monitor their reports before and during Dental treatment.

Dentistry and Hypertension : Relationship

EFFECTS OF HYPERTENSION AND MEDICATIONS ON ORAL HEALTH

It is an unfortunate trade off in life that as we age and acquire more wisdom and experience, we also increase the likelihood of having health problems.

Senior citizens are more likely to have high blood pressure and be taking multiple medications than when they were young. Seniors should be prepared and informed when they go to their dentist for treatment.

A very large group of population, many who are seniors, suffer from high blood pressure, or hypertension. Hypertension, often referred to as the "silent killer," is defined by repeatedly having a blood pressure reading greater than 140/90. Hypertension is dangerous because it increases the risk of heart attack, stroke, kidney and eye damage. A person can have hypertension for years and not know about it because there are little or no symptoms.

People with hypertension are generally advised to reduce salt intake, lose weight, and increase aerobic exercise. If these measures are not sufficient, a number of drugs are needed to reduce the blood pressure. The main drugs given to hypertensive patients are diuretics, beta-blockers, calcium channel blockers, and angiotensin converting enzyme (ACE) inhibitors. These drugs reduce blood pressure by decreasing blood volume, decreasing the force of heart contractions, and relaxing blood vessel walls, respectively.

As Dentists, we are concerned with how well-controlled the hypertension is. Patients with poorly controlled hypertension will often bleed more after routine oral surgery. Patients who take hypertensive drugs may be more sensitive to the small amounts of epinephrine in dental anesthetics as well as need a greater level of assistance when being elevated in a dental chair from a supine (lying on the back) position.

Many medications used by seniors, as well as some diseases, can cause the mouth to become dry. Saliva protects the mouth because it helps wash away food, neutralize bacterial acids, and lubricates the mouth. A lack of saliva in the mouth increases the chance of developing cavities, gum disease, irritations in the mouth, and it also makes it more difficult to wear dentures, speak and swallow food.

Some of the types of medications that can cause dry mouth are antihistimines, antidepressants, painkillers, diuretics (water pills) and decongestants, to name a few. Disease conditions such as Sjogren's Syndrome and radiation treatment in the head and neck region can also cause dry mouth. Your dentist can recommend certain methods to restore moisture. Consider sugar-free lozenges or gum, and artificial saliva can be used in some cases. Brushing your teeth and flossing are extremely important, as is the use of a fluoride containing mouth rinse. In some cases, the use of a custom-made mouth tray worn before bed is needed to deliver a higher dose of fluoride to protect the teeth and gums.

Today's dentist needs to work closely with the senior's medical doctor and specialists to ensure safe and effective senior dental care. It is import to inform your dentist about any health conditions you have, and the medications you are taking. Your dentist should be aware of the special needs, and potential problems that seniors face.

Pyorrhoea : An overview

What Is Pyorrhoea? What Causes Pyorrhoea?

Pyorrhoea means "inflammation around the tooth" - it is a serious gum infection that damages the soft tissue and bone that supports the tooth. All periodontal diseases, including pyorrhoea, are infections which affect the periodontium. The periodontium are the tissues around a tooth, tissues that support the tooth. With pyorrhoea, the alveolar bone around the teeth is slowly and progressively lost. Microorganisms, such as bacteria, stick to the surface of the tooth and multiply - an overactive immune system reacts with inflammation.

 Untreated pyorrhoea will eventually result in tooth loss, and may increase the risk of stroke, heart attack and other health problems. Bacterial plaque, a sticky, colorless membrane that develops over the surface of teeth, is the most common cause of periodontal disease.

 In dentistry, periodontics deals with the prevention, diagnosis and treatment of diseases involving the gums and structures which support teeth. There are eight dental specialties, of which periodontics is one. If you want dental implants, you see a periodontist.

In most cases, pyorrhoea is preventable. It is usually caused by poor oral hygiene.

According to Medilexicon's medical dictionary, Pyorrhoea is:

1. Inflammation of the periodontium.

2. A chronic inflammatory disease of the periodontium occurring in response to bacterial plaque on the adjacent teeth; characterized by gingivitis, destruction of the alveolar bone and periodontal ligament, apical migration of the epithelial attachment resulting in the formation of periodontal pockets, and ultimately loosening and exfoliation of the teeth.

What is the difference between pyorrhoea and gingivitis?

Gingivitis occurs before pyorrhoea. Gingivitis usually refers to gum inflammation while pyorrhoea refers to gum disease and the destruction of tissue and/or bone. Initially, with gingivitis, bacteria plaque accumulates on the surface of the tooth, causing the gums to go red and inflamed; teeth may bleed when brushing them. Even though the gums are irritated and bothersome, the teeth are not loose. There is no irreversible damage to bone or surrounding tissue.

Untreated gingivitis can progress to pyorrhoea. With pyorrhoea, the gum and bone pulls away from the teeth, forming large pockets. Debris collects in the spaces between the gums and teeth, and infect the area. The patient's immune system attacks bacteria as the plaque spreads below the gum line. Bone and connective tissue that hold the tooth start to break down - this is caused by toxins produced by the bacteria. Teeth become loose and can fall out.

Put simply, Pyorrhoea involves irreversible changes to the supporting structures of the teeth, while gingivitis does not.

What are the signs and symptoms of pyorrhoea?

A symptom is something we feel and describe to the doctor, while a sign is something others, including the doctor can see. For example, pain is a symptom while redness or inflammation is a sign.

Pyorrhoea signs and symptoms can include:

·         Inflamed (swollen) gums, gum swelling recurs

·         Gums are bright red, sometimes purple

·         Gums hurt when touched

·         Gums recede, making teeth look longer

·         Extra spaces appear between the teeth

·         Pus may appear between the teeth and gums

·         Bleeding when brushing teeth

·         Bleeding when flossing

·         Metallic taste in the mouth

·         Halitosis (bad breath)

·         Loose teeth

The patient's "bite" feels different because the teeth do not fit the same

What are the causes of pyorrhoea?

Dental plaque forms on teeth - this is a pale-yellow biofilm that develops naturally on teeth. If is formed by bacteria that try to attach themselves to the tooth's smooth surface.

Brushing teeth gets rid of plaque, but it soon builds up; within a day or so.

If it is not removed, within two or three days it hardens into tartar. Tartar is much harder to remove than plaque. Another name for tartar is calculus. Getting rid of tartar requires a professional - you cannot do it yourself.

Plaque can gradually and progressively damage teeth and surrounding tissue. At first, the patient may develop gingivitis - inflammation of the gum around the base of the teeth.

Persistent gingivitis can result in pockets developing between the teeth and gums. These pockets fill up with bacteria.

Bacterial toxins and our immune system's response to infection start destroying the bone and connective tissue that hold teeth in place. Eventually the teeth start becoming loose, and can even fall out.

What are the risk factors for pyorrhoea?

A risk factor is something that increases the risk of developing a condition or disease. For example, obesity is a risk factor for diabetes type 2 - this means that obese people have a higher chance of developing diabetes. The following risk factors are linked to a higher risk of pyorrhoea:

·         Smoking - regular smokers are much more likely to develop gum problems. Smoking also undermines the efficacy of treatments.

·         Hormonal changes in females - puberty, pregnancy, and the menopause are moments in life when a female's hormones undergo changes. Such changes raise the risk of developing gum diseases.

 ·         Diabetes - patients who live with diabetes have a much higher incidence of gum disease than other   individuals of the same age

·         AIDS - people with AIDS have more gum diseases

·         Cancer - cancer, and some cancer treatments can make gum diseases more of a problem

·         Some drugs - some medications that reduce saliva are linked to gum disease risk.

·         Genetics - some people are more genetically susceptible to gum diseases

Diagnosing pyorrhoea

A qualified dentist should find it fairly straightforward to diagnose pyorrhoea. The dentist will ask the patient questions regarding symptoms and carry out an examination of his/her mouth.

The dentist will examine the patient's mouth using a periodontal probe - a thin, silver stick-like object with a bend at one end. The probe is inserted next to the tooth, under the gum line. If the tooth is healthy, the probe should not slide far below the gum line. In cases of pyorrhoea, the probe will reach deeper under the gum line.

The dentist may order an X-ray to see what condition the jaw bone and teeth are in.

What are the treatment options for pyorrhoea?

The main aim of the periodontist, dentist or dental hygienist, when treating pyorrhoea, is to clean out bacteria from the pockets around the teeth and prevent further destruction of bone and tissue.

For best treatment results, the patient must maintain good oral hygiene and care. This involves brushing teeth at least twice a day and flossing once per day. If there is enough space between the teeth, an interdental brush (Proxa-brush) is recommended. Soft-picks can be used when the space between the teeth is smaller. Patients with arthritis, and others with dexterity problems may find that using an electric toothbrush is better for a thorough clean.

It is important that the patient understands that pyorrhoea is a chronic (long-term) inflammatory disease - this means oral hygiene must be maintained for life. This will also involve regular visits to a dentist or dental hygienist.

Initial treatment

It is important to remove plaque and calculus (tartar) to restore periodontal health.

The healthcare professional will use clean (non-surgically) below the gumline. This procedure is called scaling and debridement. Sometimes an ultrasonic device may be used. In the past Root Planing was used (the cemental layer was removed, as well as calculus).

Medications

Prescription antimicrobial mouthrinse - for example chlorhexidine. It controls bacteria when treating gum disease, as well as after surgery. Patients use it like they would a regular mouthwash.

Antiseptic "chip" - this is a small piece of gelatin which is filled with chlorhexidine. It controls bacteria and reduces periodontal pocket size. This medication is placed in the pockets after root planing. The medication is slowly resealed over time.

Antibiotic gel - a gel that contains doxycycline, an antibiotic. This medication controls bacteria and shrinks periodontal pockets. It is placed in the pockets after scaling and root planing. It is a slow-release medication.

Antibiotic microspheres - miniscule particles containing minocycline, an antibiotic. Also used to control bacteria and reduce periodontal pocket size. They are placed into pockets after scaling and root planing. A slow-release medication.

Enzyme suppressant - keeps destructive enzymes in check with a low-dose of doxycycline. Some enzymes can break down gum tissue, this medication holds back the body's enzyme response. Taken orally as a pill, and is used with scaling and root planing.

Oral antibiotics - either in capsule or tablet form and are taken orally. They are used short-term for the treatment of acute or locally persistent periodontal infection.

Advanced pyorrhoea

If good oral hygiene and non-surgical treatments are not enough, the following surgical interventions may be required:

Flap surgery - the healthcare professional performs flap surgery to remove calculus in deep pockets, or to reduce the pocket so that keeping it clean is easier. The gums are lifted back and the tarter is removed. The gums are then sutured back into place so they fit closely to the tooth. After surgery, the gums will heal and high tightly around the tooth. In some cases the teeth may eventually seem longer than they used to.

Bone and tissue grafts - this procedure helps regenerate bone or gum tissue that has been destroyed. With bone grafting, new natural or synthetic bone is placed where bone was lost, promoting bone growth.

In a procedure called guided tissue regeneration, a small piece of mesh-like material is inserted between the gum tissue and bone. This stops the gum from growing into bone space, giving the bone and connective tissue a chance to regrow.

The dentist may also use special proteins (growth factors) that help the body regrow bone naturally.

The dental professional may suggest a soft tissue graft - tissue taken from another part of the mouth, or synthetic material is used to cover exposed tooth roots.

Experts say it is not possible to predict how successful these procedures are - each case is different. Treatment results also depend on how advanced the disease is, how well the patient adheres to a good oral hygiene program, as well as other factors, such as smoking status.

What are the complications of pyorrhoea?

The most common complication from pyorrhoea is the loss of teeth. However, patients with pyorrhoea  may have

·         higher risk of having respiratory problems,

·         stroke

·         coronary artery disease

·         low birth weight babies.

·     Pregnant women with bacterial infections that cause moderate-to-severe periodontal disease have a higher risk of having a premature baby.

·         Pyorrhoea can make it harder for patients with diabetes to control blood sugar.

Courtesy - Glickman , Carranza

 Dr P B Sood