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.

Tooth Sensitivity ....commonest dental problem

Dentinal hypersensitivity, or tooth sensitivity, is a common dental problem. It is experienced as a painful sensation in the teeth, often occurring after eating or drinking something hot, cold, sweet or acidic. Most sufferers are between 20 and 50 years old. Tooth sensitivity can start to happen when the softer, inner part of the tooth called ‘dentine’ becomes exposed. Dentine lies under the enamel and the gums. 

Thousands of microscopic channels run through the dentine towards the centre of the tooth that link to the nerves on the inside of the tooth. When dentine is exposed, these nerves are easily stimulated by external triggers (such as a cold drink), resulting in the characteristic short, sharp sensation of tooth sensitivity.

Common causes of tooth sensitivity include:

Aggressive brushing  

Toothbrush and/or toothpaste damage may be the most frequent cause of sensitive teeth. By brushing too hard and/or using abrasive toothpaste, you may be removing tooth structure at the necks of your teeth resulting in pain, especially to cold drinks, food, and air, but also to physical pressure, hot, sweet and sour.

Lack of a Twice-Daily Routine

Taking a laid-back approach to brushing, flossing and rinsing can let tarter build up along the gum line leading to advanced gum disease there by exposing root surface and a potential cause of tooth sensitivity.   

Cracked tooth

A crack or chip in your tooth may expose the underlying dentin or may fill with bacteria from plaque, causing the nerve to inflame.

Teeth grinding

over time, grinding or clenching your teeth can erode enamel and expose dentin.

Gum disease 

You may have noticed that your gums are starting to pull away from your teeth. This means your gums are receding, exposing sensitive nerve branches living in the tooth’s root. Inflamed or sore gums may cause sensitivity due to the loss of supporting ligaments, which exposes the root surface leading directly to the tooth. Harsh brushing can be culprits.

 Or if you have advanced gingivitis, that is periodontal disease, the gums are moving away from the tooth, exposing the roots.

Tooth decay

Gum disease or other local factors can cause lodgment of food thus resulting in decay which is also a potential cause of tooth sensitivity. Since you see no decay on top of the tooth, you might not be aware a cavity exists, but it can create tiny holes near the gum in front or the back of the tooth.

Tooth whitening 

Using products with peroxide or baking soda can seriously aggravate exposed roots or dentin.

Acidic Diet

If you frequently eat sharp-tasting and/or sour food and drinks, this could be stripping away tooth enamel. Check your regular diet for highly acidic foods like citrus fruits, tomatoes, yogurt, sour cream, aged cheeses and acidic drinks such as orange juice, sports drinks, wine and carbonated drinks including soda, and aim to limit your intake.

5. Sugary Diet

Loading up on sugary treats such as cookies and cake can prompt bacteria to grow, leading to eroding gums that expose sensitive areas of the teeth.

OR

It is possible to experience tooth sensitivity after routine dental procedures such as the placement of a filling or crown, tooth restoration, or even teeth cleaning. Such sensitivity is temporary

Measures in handling sensitivity

Toothpastes for sensitive teeth

Desensitizing agents (there’s loads of different ones on the market now) work by blocking off the dentinal tubules, so that the nerves don’t get stimulated.

They work a lot better by gently massaging the paste or gel into the sore spot with a finger. Do not rinse it off with water or mouthwash. It may take several weeks before the desired effect is achieved.

High-fluoride mouthwashes

You may want to try a non-alcohol mouthwash with a high fluoride content instead. Some of them are specifically designed to reduce sensitivity. They should be used twice a day after brushing – one of those times should be just before you go to bed, so the mouthwash doesn’t get rinsed away when you drink or eat something.

Swish the mouthwash back and forth between the teeth for at least 30 seconds, and do not rinse with water afterwards.

Recaldent

Now there are also available tooth remineralizing agent which have also proved to be beneficial (these are quite expensive though).

Professional Intervention

What can dentists do about sensitive teeth?

Only a dentist can confirm you have dentinal hypersensitivity. If you are experiencing any dental problems, always consult your dentist for advice. If you have dentinal hypersensitivity, you can help to minimize further exposure of the dentine, care for your sensitive teeth and relieve the  symptoms by making some simple changes to your daily oral care routine and dietary habits.

• Depending on the cause of the sensitivity, your dentist may be able to paint special fluoride gels, rinses or varnishes onto the affected teeth
• If this doesn’t help and you can’t put up with the sensitivity, your dentist can seal or put bonding around the neck of the tooth, to cover exposed dentine. You should try the other options first though.
• If you grind your teeth, ask your dentist about the possibility of having a mouthguard made to wear at night.
• If there is a hidden caries probably it needs to filled.

 

Rules for Sensitive Teeth

Continue to follow a good brushing and flossing routine to maintain the good health of your teeth. Use a soft bristle brush and brush gently. Try desensitizing toothpaste. There are several different brands for sensitive teeth. With regular use, you should notice a difference in the degree of sensitivity.

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.