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.

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.

Common myth “Scaling/cleaning of teeth causes negative impact on teeth”…..????

Fact- Your mouth is a jungle-home to myriads of bacteria, viruses, fungi, and protozoa. It has been established that the environment present in the human mouth allows the growth of characteristic mouth microorganisms. It provides water and nutrients, as well as a moderate temperature which are conducive for microbial growth. Resident microbes of the mouth adhere to the teeth and gums to resist mechanical flushing from the mouth to stomach. Scaling helps in maintaining oral hygiene, by removal of tartar and deposits on the base of teeth, there by health of gums is also restored, scaling also enhances tooth color by removal of extrinsic stains.

Above graph depicts changes in the quantity of microbes in oral cavity within 24 hours followed by brushing, Hence, its clearly evident that scaling/professional cleaning has for more reaching affect on reduction of microbes and attaining the health of not only oral tissues but the general body too.

The problems that are answered by scaling are:

Bleeding gums

Bad breath

Ugly looking deposits on teeth

Thick inflamed gums

Increase in firmness of gums on teeth

Prevention of bone resorption, thereby better support hence prolonging life of healthy teeth
Reduction of oral bacteria thus less germs to the stomach so healthy body too
With the reduction of microbes, the rate of progression dental caries/cavity is also delayed a lot