Silent disease "The Gum Disease" most common yet most ignored

Gum disease is prominent and most commonly affecting disease irrespective of age. It is an inflammation of the gum line that can progress to affect the bone that surrounds and supports your teeth.  Oral cavity contains variety of bacteria. These bacteria build plaque, an invisible sticky, colorless layer of germs on the teeth. These bacteria form toxins that irritate and damage the gums. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist can help remove tartar.

Stages of progression of gum disease

The three stages of gum disease — from least to most severe — are gingivitis, periodontitis and advanced periodontitis.

Simple way to understand and control gum disease.

Plaque a substance which helps bacteria to adhere to tooth, thus bacteria the cause for the disease is in close vicinity to gums. The bacterial toxins continuously leaches in soft tissue (gums), and it causes progression of inflammation and infection. Gums become reddened, swollen and detached from tooth surface. This stage is commonly called “Gingivitis”

This detachment and pseudo enlargement of gums creates a space for food and debris lodgment which creates inaccessible area for proper hygiene maintenance, there by deteriorating the reversible form of disease to potentially irreversibly. This is called as pocket formation, a space formed between tooth and gums. The sign and symptom is characterized by bleeding on brushing and pain.

Succession of disease to permanent damage stage

If still professional help is not taken then condition worsens to loss of tooth supporting tissue and bone, thus weakening tooth support. This stage is officially called as “Periodontitis”

Progression to Advanced periodontitis.

It’s an advanced stage where there is an appreciable destruction of supporting fibers and bone, which transforms to visible tooth mobility and gums recession. This is the stage where there is a clear need for the surgical treatment depending upon the amount loss of supporting structure, if unrestorable condition persists then tooth removal is the final choice.

Co-relation between gum disease and medical issues

·    Atherosclerosis and heart disease — Gum disease may increase the risk of clogged arteries and heart disease. It also is believed to worsen existing heart disease.

·     Stroke — Gum disease may increase the risk of the type of stroke that is caused by blocked arteries.

·     Premature births — A woman who has gum disease during pregnancy may be more likely to deliver her baby too early. The infant may be more likely to be of low birth weight.

·      Diabetes — Diabetic patients with periodontal disease may have more trouble controlling their blood sugar than diabetic patients with healthy gums.

·      Respiratory disease — Bacteria involved in gum disease may cause lung infections or worsen existing lung conditions. This is particularly important for elderly adults in institutions such as nursing homes. In this group, bacteria from the mouth may reach the lungs and may cause severe pneumonia.

Risks and Prevention

The bacteria in plaque are the main cause of periodontal disease. But several other factors also can contribute. They include other diseases, medicines and oral habits. These factors can increase your risk of gum disease or make it worse once the infection has set in.

·         Genetic susceptibility-- Some people are more prone to severe gum disease than others

·         Smoking and tobacco use

·         Misaligned or crowded teeth, braces or bridgework

·         Grinding, clenching of teeth

·      Stress — Stress can make periodontal disease worse and harder to treat. Stress weakens your body's immune system. This makes it harder for your body to fight off infection, including periodontal disease.

·      Fluctuating hormones — Whenever hormone levels go up and down in the body, changes can occur in the mouth. Puberty and pregnancy can temporarily increase the risk and severity of gum disease. So can menopause.

·       Medicines — Several types of medicines can cause dry mouth, or xerostomia. This may lead to tooth decay (cavities). Other medicines may cause the gums to enlarge. This makes them more likely to trap plaque.

·     Diseases — People with certain diseases have a higher risk of developing periodontal disease. For example, people with diabetes are more likely to get periodontitis than people without diabetes. Their gum disease is also likely to be more severe. Other diseases that increase periodontal disease risk include inflammatory conditions such as rheumatoid arthritis and HIV infection. Having one of these diseases can make the control of your periodontal disease more difficult. But a good dentist who is aware of these problems can give you guidance on how to maintain your periodontal health.

·     Poor nutrition — Nutrition is important for overall good health, including a working immune system and healthy gums and mouth. Severe vitamin C deficiency (scurvy) can cause bleeding gums.

Considerations before deciding Dental bridge or Dental implants

Teeth replacements have come a long way in the last 30 years. Missing or extracted teeth raise common concerns of infection, injury, periodontal disease, or other reasons but the proper replacement is the key to a confident smile. When you’re missing a tooth, you have two options for replacement – install a dental implant or a dental bridge. Unfortunately, many patients don’t have the information they need to make the best choice for their oral health and smile.

In the past, a bridge was your only choice, and still involves more than just the missing tooth. A bridge is a non-removable prothesis that is used to replace a missing tooth. A bridge literally bridges the gap between the two natural teeth replacing the tooth that’s missing between them. The adjacent teeth need to be "prepared" in order to fabricate the bridge.

Advantages of Bridges

Esthetic, functional, predictable, reliable

Less costly

Requires less time for final result

Disadvantages of Bridges

Requires enamel removal of adjacent teeth

If adjacent teeth have crowns, they must be redone

Tooth decay is potential problem

Root canal treatment may be required if nerves are affected

Greater tendency for gum disease

Less longevity than implants

Today, dentists offer an alternative that involves less collateral damage- TOOTH IMPLANT. A dental implant is actually a root replacement, and unlike the root of a tooth, it is actually fused to the bone of the jaw. A crown is attached to the implant and in effect it becomes a stand-alone tooth, functioning and appearing just like the natural tooth you have lost. The crown is the part you see in the mouth, and the root is the part that is encased in bone and keeps the tooth in place.

Advantages of Dental Implants

Esthetic, functional, predictable, reliable

Does not affect adjacent teeth

Does not decay

Less likely to develop gum disease

Placing the implant in the bone prevents future bone loss because the bone and the titanium rod actually begin to bond together. The bone does not know the difference between the root of the natural tooth and the titanium rod.

Disadvantages of Dental Implants

More expensive

More planning time

Requires minor surgery

Requires healing time before permanent tooth replacement

Health of surrounding tissue plays important than age.

For a successful dental implant procedure, a patient's health is more important than age. Because this procedure requires healing to work effectively, candidates who aren’t ideal include smokers, patients with weakened immune systems or patients with diabetes.

You probably shouldn’t get an implant if you grind your teeth while sleeping. Also, oral surgeons generally rule out children because their jawbones have not yet matured.

Changes in your oral care routine

Your ability to keep your mouth healthy will be easier with an implant. Dental bridges are cemented or "fixed" in the mouth, and involve at least three crowns connected together to fill the space of the missing tooth. This design creates challenges when brushing and flossing, so extra oral hygiene instruction and meticulous home care are crucial. In contrast, implants can replace teeth individually without affecting other teeth, making regular home care more successful. You can effectively brush and floss around an implant just like your natural tooth.

DURABILITY

Dental implants are more durable than bridges, allowing them to provide protection that lasts a lifetime. Dental implant treatment has a track record of reliable, long-term successful outcomes and is often considered “more predictable” than other treatments.

Toothache hurts so much.......Reason and Remedies ???

Whether you are experiencing a toothache now, have experienced a toothache in the past or are hoping to avoid a toothache in the future, your teeth will benefit very much from a routine of good dental hygiene and regular check-ups at the dentist or dental hygienist.

It has been said that a toothache is the most intense pain that can be experienced. Surprisingly, Teeth only feel pain. There are no other tooth feelings. If a nerve happens to be exposed in there, everything is pain. Cold is pain. Warm is pain. Wet is pain. Touch is pain. There's just nothing else and that's a pretty unique situation in the human body. In fact, a really bad toothache can feel like your head is exploding.

Why toothache is extremely painful?

The face and head, including your teeth, are richly served by the nervous system and make for an exquisitely sensitive and responsive anatomic region.

The mouth and jaw are hooked directly to the ​trigeminal nerve, which is one of several cranial nerves: nerves that link directly to the brain rather than link to the spinal cord. So, teeth are linked up to a nervous short-circuit of sorts. ​Additionally, your teeth have an abundance of neural connections to the pain centers in the brain. This seems to amplify the noxious “distress signals.”

Why a toothache hurts so bad

When your finger is infected, it normally swells up because of your body’s own immune response. This is possible because the tissues in your finger are relatively soft and flexible. When you have an infection in a tooth, the immune response is the same – but a tooth cannot swell up the same way as a finger can. The infection is caught inside the hard tissues of the tooth, causing a very large pressure. This is the reason for the intense toothache. When the pressure gets too high, the infection will start to work it’s way out of the tooth through the root and into the surrounding bone structure. From here it will continue to push it’s way out through the hard tissues. At this point the toothache is especially painful. Eventually you might develop an abscess, which can normally be seen in the mouth around the area of the root of the tooth which is infected. Sometimes the abscess is even outside the mouth under the chin.

When the abscess bursts, the pressure is off and many people feel an instant relief from the toothache. This does not mean that the problem is solved, however. The reason for the toothache - the infection - is still there and treatment is necessary.

What can be done about a toothache?

There are only two ways of treating an infected tooth effectively. The simple solution is to pull out the tooth but ideally it’s not advisable if you have restorable tooth. Since most people feel that it is best to keep their teeth as long as possible, however, the more common and preferred treatment - when possible - is root canal therapy. There may be a need to combine the treatment with medication to control the infection.

Wisdom teeth.... controversial and problematic

What are wisdom teeth?

“Wisdom teeth,” a rather curious name for teeth if you think about it, is the folklore name for third molar teeth, which usually makes their appearance later in life. Wisdom teeth are the upper and lower third molars, located at the very back of the mouth. They are the third, final set of molars to come in, and they usually sprout during the late teens to early twenties. They are called wisdom teeth because usually they come in between ages 17 and 25.

In the time before modern dentistry, wisdom teeth were usually present. Due to lack of good dental hygiene and non-availability of preventive measures, leading to extensive tooth loss thus there by creating plenty of room to welcome these third molars. Today, dental technology is more advanced than ever, and adults are able to repair and keep more teeth than they were even only 50 years ago.

Though it is not possible to predict the normal eruption of wisdom teeth, as adequate space availability seems to be paramount to allow for successful eruption. Imaging techniques and radiographs are most important to assess the same. However, the fact they can erupt does not guarantee they will. If the normal eruption is compromised, often, removal is necessary to prevent problems. Roughly 60 to 70 percent of all wisdom teeth will be impacted

Why “wisdom teeth” are so problematic?

Wisdom teeth are not, in and of themselves, problematic. It’s the impact they have on the rest of your mouth and your oral hygiene that’s the issue. You may have a problem if any of the following occur:

• Your wisdom teeth break through your gums only partway because of a lack of space. This can cause a flap of gum tissue to grow over them. The flap can trap food and lead to a gum infection.

• They come in crooked or facing the wrong direction.
• Your jaw isn't large enough to give them room. Your wisdom teeth may get stuck (impacted) in your jaw and not be able to break through your gums.
• They are so far back in your mouth or crowded that you have trouble cleaning around them.

• A cyst forms. This can damage the bone or roots.

Effect Of Impacted Wisdom Teeth

The most common consequences of impacted wisdom teeth are periodontal (gum; “perio” – around; “odont” – tooth) problems and are the most frequent consideration for their removal. Their presence can adversely affect the periodontal tissues of the adjacent second molars by disrupting the periodontal tissue attachment (the mechanism that anchors the teeth in their surrounding bone) — leading to their loss by predisposing them to bacterial, plaque-induced, periodontal disease. They can also damage to adjacent tooth roots due to caries and formation of pocket.

Painless: One interesting fact is that in most cases, impacted teeth can exist quite asymptomatically; in other words, you wouldn't even know they are there, let alone causing problems. However, impacted, submerged, third molar teeth interrupt vital structures: in the lower jaw, like the nerves that supplies sensation or in the upper jaw, impacting or entering into the sinus. Conclusively, these teeth are located where they're not supposed to be, yet are causing no pain.

Painful: On other occasions, they will really let you know they are there with a painful pericoronitis (“peri” – around; “corona” – crown; “itis” – inflammation). This is an acute inflammation and infection of the surrounding gum tissues that typically occurs with a partially erupted, lower wisdom tooth. It is temporarily treated with medications.  Since this condition is likely to be recurrent, it is important to have the affected tooth or teeth evaluated for removal.

Impacted teeth results in pain also can result in other unpleasant side effects, including:

• Infection
• Swelling
• Bleeding of the tissue around the tooth
• Bad breath

Impacted teeth cannot grow in properly, and so dentists will recommend their removal in most cases.

Pregnancy and dental treatment .....always recommended

Pregnancy causes profound and remarkable changes in all organ system. The dental team should be aware of the altered physiologic status of the pregnant patient to avoid inappropriate interpretation of normal changes as pathologic. With pregnancy most important change takes place in the cardiovascular and hematological system as a result of the altered hormonal activity. Due to increase in mineralcorticoids, there is the retention of sodium, which in turn leads to water retention, thus total body water and plasma volume increases by 30-40% leading to hemodilution (dilution of blood) there by producing a state of “physiologic anemia of pregnancy”. During the second and third trimester, a decrease in the blood pressure and cardiac output can occur when patient is in supine position due to the compression of inferior venecave by gravid uterus, causing reduction of cardiac output. 

This condition is called supine hypotensive syndrome and is manifested as light headedness, hypotension and syncope. If it occurs, emergency care for situation consists of rolling the patient into her left side to lift the uterus off the venecave and administering 100% oxygen. Pregnant patient may be positioned semi-reclining. The ideal position of the pregnant women in dental chair is left lateral decubitus position with right buttock and hip elevated 15 degrees

Pregnancy and dental work questions are common for expecting moms. There is a general concept that pregnant moms should completely avoid dental treatment rather depend on medications for removal of dental symptoms. This concept is false.

Preventive dental cleanings and annual exams during pregnancy are not only safe, but are recommended. The rise in hormone levels during pregnancy causes the gums to swell, bleed, and trap food causing increased irritation to your gums. Preventive dental work while pregnant is essential to avoid oral infections such as gum disease, which has been linked to preterm birth. During pregnancy, dental treatment may be modified but need not be withheld, provided that the risk assessment is made properly for both patient and the fetus.

First trimester – only emergency procedure if utmost necessary should be done. Avoid X-rays as much as possible because baby is in the organogenesis (organ forming stage)

Second trimester – the most safe and comfortable period for the mother to accept dental treatment. Don’t skip your dental check up appointment simply because you are pregnant. It is recommended to atleast get cleaning done once if not done in past 6 month.

Third trimester 

it is very difficult for the pregnant lady to lie on her back for extended period of time. If at all she has to take dental treatment the treatment span should be short , while getting upfrom dental chair, if chair is reclined, it should be straightened slowly.

Coping With Morning Sickness 

If morning sickness is keeping you from brushing your teeth, change to a bland tasting toothpaste during pregnancy. Ask your dentist or hygienist to recommend brands.

Rinse your mouth out with water or a mouth rinse if you suffer from morning sickness and have bouts of frequent vomiting.

Art of restoring a badly decayed/fractured teeth

A post and core is a prosthetic device that is recommended when there is inadequate tooth structure remaining to support a traditional restoration or an artificial crown.

Post and core procedure is painless and does not even require local anesthesia as the tooth has long been dead after the root canal treatment. A post and core can only be made for a tooth that has had root canal treatment.

Some posts are ready made, whereas others are made in the laboratory especially to fit the tooth.

Why are post and cores needed ?

A great deal of dental crown stability depends on the amount of tooth structure that extends into its interior. If very little tooth structure occupies this space, the crown will be easily dislodged, especially by forces directed at its side.

Basically, the core is rebuilding the tooth so it is closer to its original dimensions. Hence, the crown's stability will greatly increase, and therefore its long-term chances for success are maximized.

                                              

Is a post always needed ?

A dental post is generally recognized as just an aid in helping to anchor a dental core to a tooth.

As a rule of thumb, if more than half of a tooth's original crown portion has been lost, a post is needed to assist in anchoring the core to the tooth. If more than half still remains, a core by itself (which basically means a direct build up with composite materials) will probably suffice.

Factors to be considered in making the decision to use a post

Many have stated that the main reason for placing a post is to strengthen the connection between the coronal build-up material and remaining tooth structure to the root portion of the tooth. In my opinion, that is only partially true. Additionally, the following potentially negative or positive factors should be considered in the decision to use a post. All of these factors should be observed before making the decision:

• Quantity of remaining tooth structure

• Quality of remaining tooth structure

• Remaining adjacent teeth

• Occlusion

• Planned restoration to be placed on the tooth

When is a post and core not indicated ?

There are certain conditions that make the use of a post and core device inadvisable :

·         Intense pain, gingival bleeding, suppuration, advance infections, tooth abscesses etc. These situations will be evaluated on a case-by-case basis and the post and core should be placed with the greatest caution.

·         Tooth shows advance mobility. Mobility is an indicator of bone loss around the tooth and it should be evaluated on a dental X-ray as well.

·         When the tooth crown is severely damaged (especially when the tooth is fractured bellow the gumline) and the remaining part of the tooth is not strong enough to support the post.

                                              

Structure

A post and core consists of two parts :

·         The post

The post is a small rod, usually metal/carbon fiber, which is inserted into the root space of the tooth and protrudes from the root a couple of millimetres. The post is then used to hold the core, or a filling in place.

Because the post is inserted into the root canal, a post and core can only be made for a tooth that has had root canal treatment.

·         The core

The core replaces missing tooth structure in preparation for making a new dental crown. Normally, a dental core can be directly built up from composite materials without a post to hold it in place.

However, a dental post can be used to help to anchor the core to the tooth. In this case, the core is generally made off metal alloys and the device is called post and core.

The core is then utilized to hold a dental crown in place. The crown can be a single unit crown or a retainer crown for a dental bridge.

Success rates

The procedure is successful in over 90% of cases.

Potential risks

·         Tooth fracture

·         Root fracture

·         Root canal failure (it is difficult to repeat root canal treatment once the post is in place)

·         Post coming out

·         Post protruding through the side of the root (this is a particular risk if the root is curved)

After Dental Post And Core

Post procedure care                                                       

Patients should avoid eating on the crown, following a post and core procedure. Certain foods, such as hard or chewy sweets, should be avoided as the crown could become loose.

Possible discomfort

Some minor discomfort to be expected after this procedure, but this can be easily controlled with normal painkillers.