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.

Diabetes and oral health

What’s Diabetes and its indication through oral cavity

The oral first signs are red, sore, and bleeding gums. Diabetes affects your body’s ability to process sugar. Food is converted to sugar and used for energy, while in diabetes; the body doesn’t make enough insulin, a hormone that carries sugar from your blood to the cells that need it for energy, thus resulting in high blood sugar levels, which can cause problems with your eyes, nerves, kidneys, heart and oral health.

Other signs in mouth

• You may have less saliva, causing dry mouth.
• Because saliva protects your teeth, thus caries/cavity risk increases.
• Gums may become inflamed and bleed often (gingivitis).
• Taste sensation gets reduced.
• You may experience delayed wound healing.
• You may be susceptible to infections inside of your mouth.
• For children with diabetes, teeth may erupt at an age earlier than is typical.

Diabetics Are More Prone to Gum Disease

Many people do not go to the dentist when their gums bleed while brushing and flossing. This bleeding is not normal, it needs to be addressed. If the plaque is not brushed and flossed away it hardens into tartar and collects under the gum line. To make matters worse, more plaque forms over the tartar, so you can imagine how the problem can escalate. 

Oral cavity is a home to different species to bacteria, but in non-diabetics body immune status is sufficiently strong to handle that to a particular extent, while in diabetics, one can end up with a chronic infection in the gums. When you reach this stage, your gums begin to pull away from your teeth. Pockets form between your teeth and gums. These fill with germs and pus, and deepen. When this happens, you may need gum surgery to save your teeth. If nothing is done, the infection goes on to destroy the bone around your teeth. The teeth may start to move or get loose, this is called as periodontitis.

Periodontal disease is the most common dental disease affecting those living with diabetes, affecting nearly 22% of those diagnosed. Especially with increasing age, poor blood sugar control increases the risk for gum problems. 

Established Evidences

Research also suggests that the relationship between serious gum disease and diabetes is two-way. Not only are people with diabetes more susceptible to serious gum disease, but serious gum disease may have the potential to affect blood glucose control and contribute to the progression of diabetes. Research suggests that people with diabetes are at higher risk for oral health problems, such as gingivitis (an early stage of gum disease) and periodontitis (serious gum disease). People with diabetes are at an increased risk for serious gum disease because they are generally more susceptible to bacterial infection, and have a decreased ability to fight bacteria that invade the gums.

Dentist’s role in fighting gum issues 

Regular dental visits are important. Treating gum disease can help improve blood sugar control in patients living with diabetes, decreasing the progression of the disease. Practicing good oral hygiene and having professional deep cleanings done by your dentist can help to lower your HbA1c. (This is a lab test that shows your average level of blood sugar over the previous three months. It indicates how well you are controlling your diabetes.)

Action plan for future

Teamwork involving self-care and professional care from your dentist will be beneficial in keeping your healthy smile as well as potentially slowing progression of diabetes. Here are five oral health-related things you can do to for optimal wellness:

• Control your blood sugar levels. Use your medications as directed, changing to a healthier diet and even exercising more can help. Good blood sugar control will also help your body fight any bacterial or fungal infections in your mouth and help relieve dry mouth caused by diabetes.
• Avoid smoking.
• If you wear any type of denture, clean it each day.
• Make sure to brush twice a day with a soft brush and floss correctly daily.
• See your dentist for regular checkups.

BRUSHING FREQUENCY AND ORAL HEALTH

The diversity of advise across the countries was thought to be because of lack of good evidence, but regarding the frequency of brushing there seems to be consensus with majority of sources recommending brushing TWICE a day. 

More brushing makes teeth healthier ???

Excessive brushing causes tooth wear due to the abrasive action of toothpaste, there by inviting dental issues. Between twice a day brushing rinse is the safe alternative, adding sugar free chewing gum also enhances the saliva secretion after meals thus helps in attaining the pH of oral cavity towards neutrality in less span of time.

In bleeding gums brushing and flossing should be avoided??

Simple answer to that is OPPOSITE is true. Rather bleeding is an indicative and protective sign thus appraising that disease has moved to advanced stage where professional help is required. Professional treatment rendered is Scaling (deep cleaning in gums), followed by Polishing (makes tooth surface smooth shiny, by removing stains and scratch line, thus reduces the area for bacterial attachment) and fluoride treatment (makes tooth more resistant to decay and kills the remaining microbes) as and where required.

Care for sensitive teeth 

Sensitive teeth are usually the result of worn out enamel or exposed tooth roots, although tooth decay may also be the reason for the same. Depending on the circumstances your dentist might recommend- Desensitizing toothpaste, fluoride application or fluoridated toothpaste or if there is any other underlying cause, timely diagnosis will help in preventing worsening of  the condition. 

Ignorance in selecting TOOTHBRUSH...ES

Oral health is the mirror of general health. Because mouth is the “gateway to the body” bacteria from teeth and gums can affect your overall health in number of ways.  It should be kept in mind that there is no substitute for a regular, scheduled brushing but we cannot take toothbrush to a test drive so some times it becomes difficult to select the right one as there are so many in market with each claiming their own advantages, obviously a point of great confusion.

Broad tooth brush head- lacks proper access in small mouth and posterior areas of oral cavity

Tapered toothbrush head a better access in the posterior areas

Not only regular usage of toothbrush but regular replacement of toothbrush also a key factor in enhancing oral hygiene.

Brush Made of Horse Hair 

Historically, toothbrushes were made of horse hairs, with evolution and technological advancements the less efficient and rough tooth brushes were replaced with nylon bristles, and till today researchers are working on enhancing efficiency and comfortability.

Presently, we classify brushes in 2 broad categories

            Manual tooth brushes

            Powered/electric tooth brushes.

Manual toothbrushes are the most commonly used and are inexpensive, with almost equal cleaning efficiency as that of powered brushes by considering few things.

Brushing time also plays a critical and paramount role in giving a better hygiene and results. The most frequently the average time of brushing less than 1 minute has been seen, ideally to access all corners with effective and efficient cleaning, the recommended time duration is 2-3 minutes.

Commercial availability with different designs, shapes, different lengths of bristles assuring a better efficiency, but the key aspect is regular and recommended brushing technique. Bristles quality defines the cleaning efficiency, as per the general belief, harder the brush better the cleaning, but the fact is medium to soft brushes cleanse better with comfort. 

Rather, hard bristles have a negative impact by injuring soft and delicate tissues like gums and gingival and causes cervical abrasion on teeth.

Maintains Hygiene during Orthodontic treatment\

Another important part is toothbrush head, it hold bristle and carries to the area of cleaning. Thus the common belief “bigger the better” does not always holds true. Criteria for selection is the one which compliments mouth and easier to access the area hard to reach.

Flexible handle limits the amount of force applied

Handle though considered the insignificant part but it should be long, non-slippery and flexible, as cleaning does not require huge force, it just requires dexterity and maneuvering. 

Tooth brushing and oral health

It is widely accepted that toothbrushing plays an important role in the prevention of tooth decay, a significant goal to ensure the overall quality of health for all. Toothbrushing is considered fundamental self-care behavior for maintenance of oral health. Even though we’ve been brushing and flossing our teeth for years and years, many of us are surprised to learn that we’re not doing it properly.   When you brush your teeth, you help remove food and plaque — a sticky white film that forms on your teeth and contains bacteria. Brushing before bedtime is especially important, in order to prevent plaque and food particles remaining in contact with the teeth throughout the night.

More brushing makes teeth healthier.

Areas where cervical abrasion is appreciated

Excessive brushing causes tooth wear due to the abrasive in toothpaste, specially at the neck of tooth, there by inviting dental issues. Between twice a day brushing, rinse is the safe alternative; adding sugar free chewing gum also enhances the saliva secretion after meals thus helps in attaining the pH of oral cavity towards neutrality in less span of time, but not a substitute.

Should brushing and flossing should be avoided in bleeding gums?

 

    

No, rather bleeding is an indicative and protective sign thus appraising that disease has moved to advanced stage where professional help is required. Professional treatment rendered is "SCALING" (deep cleaning in gums), followed by polishing (makes tooth surface smooth shiny, by removing stains and scratch line, thus reduces the area for bacterial attachment) and fluoride treatment (makes tooth more resistant to decay and kills the remaining microbes) as and where required.