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. 

Digital Radiography in Dentistry- A reform for Better

A common myth, that is time involved and  fear associated with accepting dental treatment, are days of the past with changes in technology. Modern technology has changed the dentistry to a much smoother and comfortable procedure. Dentistry without proper and advanced technology is tiresome, painful and less efficient both for patient and dentist.  

There are numerous metamorphoses in dentistry, one which is most frequently and a useful aid in diagnosing is radiography. We all have come across dental issues and might have come across the conventional film based radiography/X-rays, but presently the conventional films are being replaced by digitized images.

Digital radiography are one of the newest X-ray techniques. Standard X-ray film is replaced with a flat electronic pad or sensor. The image goes into a computer, where it can be viewed on a screen, stored or printed out.

Comfort and time conservation- These digital radiography procedure are not only comfortable but also help in a more clearer picture with better visualization of minute details and, it also conserves time of both dentist and patient.

Approach towards preventive aspect- Tiny changes therefore can be caught earlier with required necessary measures.

Radiation exposure- In fact, digital X-rays use up to 90 percent less radiation than film X-rays. While conventional dental X-rays are relatively safe, digital radiography is an excellent option. 

Diagnostic proficiency- Unlike film, digital X-ray images can be enhanced to assist in making a precise diagnosis. Images can be magnified, sharpened, colorized, or displayed as a negative. These software-controlled enhancements optimize the image but do not alter the data - you can always “go back” to view the original image. Digital tools such as these are built right into the software that drives the digital radiography system.

Easy Storage- Digitized data also can be preserved lifelong so changes can be better compared and appreciated, thereby helping in precision in the treatment rendered.

Green dentistry- A step towards green dentistry, acceptance of this newer technique is also increased as they are environment friendly, because digital radiography is without the use of harmful, chemicals like developer and fixer used in processing the film.

Transferring records- The advantages are many but the comfort is also when a second opinion is required digital image can be transferred quickly and without any distortion.

Patients perceive the acquisition and incorporation of new technologies as dentists caring enough to provide them with the best diagnostic treatment available. 

Dental Crown a ..life line...for root canal treated teeth

Root canal is one of the advanced and revolutionary treatments in dentistry to save infected and badly decayed natural tooth. The term “root canal” comes from cleaning of the canals inside the tooth’s root after the removal of infected pulp and followed by disinfecting and filling tooth roots. Once the dentist has an access to the tooth’s roots, the infected dental pulp is removed and the roots are treated with antibiotics.

Why crowns are advised

To better understand the need for dental crowns, it’s necessary to understand why root canal therapy results in large tissue loss

Similar to a cavity filling procedure, tissue is removed from the tooth. This requires the removal of any diseased tissue within and around the cavity. Once a cavity has reached the roots of a tooth, it has usually compromised a relatively large portion of the tooth.

As there is no blood supply, over the time this causes tooth to become brittle and likely to fracture. Permanent fillings after root canals protect the treated teeth from bacteria and to strengthen them in the process but, without the extra protection, which crown provides, there are chances of tooth fracture. Another advantage of crowns is that they restore the natural appearance of your teeth.

Benefits of dental crown

Dental fillings are effective ways of replacing lost tooth tissue. However, they can only fill gaps in a tooth that is otherwise healthy and relatively strong. Root canal therapy tends to weaken a tooth to the point where it shouldn’t be just filled, but also protected on the exterior. More importantly, the dental pulp has been removed, which is responsible for generating new, healthy tissues within a tooth. Consequently, dental crowns are needed for superior restoration.

o    Structural support: Crowns simultaneously fill lost tissue while serving as the tooth’s outer layer. In this way, crowns restore strength to a tooth that would be too weak to function on its own.

o    Protection: By capping the natural crown of a tooth, dental crowns protect a tooth from injury, stress, and abrasion.

o    Preservation: Without a crown, the alternative for many teeth would be extraction and replacement. A crown allows patients to preserve a natural tooth, rather than replace it with a dental implant or bridge.

o     Durability: By using porcelain, dental crowns can easily last 15 years or longer without wear or damage. With the right care, porcelain crowns are effective permanent restorations.  

o    Realistic appearance: Porcelain is the most effective dental material for mimicking the shape and color of natural teeth. And because it’s stain resistant, your porcelain crown will continue to shine for years.

What are the repercussions of waiting?

o    Nothing will happen.

o    The tooth could chip- simple repair. Or it could crack and would need a crown.

o    In rare cases waiting could cause a RE- root canal to be needed.

o    The tooth could split, which could require crown lengthening or extraction.

o    These are things that your dentist should be prepared to talk over with you.

What are the options?

In some cases, while a crown is one option, there can be others. You might opt for a filling instead. Keep in mind, however, that a filling does not prevent you from needing a crown later on. Also, if a substantial portion of your tooth needs filling, a better solution is usually the crown because fillings do not give you the same kind of protection as crowns do. Also, if the filling is extremely large, it can cause the tooth to break, making it irreparable.

Nicotine !!!!!!!!! stains.....not only teeth but LIFE too....

It’s no more a secret that tobacco usage is bad for health and can lead to multitude of problems. Nicotine and tar are two culprits in regard to the tobacco stains, though nicotine is colorless but when it comes in contact with oxygen it becomes yellow. Yellow stains on the teeth of nicotine users are common, yet embarrassing. One side it causes oral health problem while on the other side affects the personality, lack of self confidence. Luckily these stains are extrinsic and can be removed.

Removing tobacco stains from teeth.

Over the counter available whitening toothpaste claim to remove stains, but they often work by abrasive/erosive action. Abrasive action causes wear of the hardest layer (enamel) of the tooth there by increase in the chances of sensitivity, while erosive action is due the acidic content which dissolves tooth. Thus, care is advised before using them.

Another easily available material for removing extrinsic stains is white strips. But the drawback with the same is that it is only effectively done on front teeth but has hard time in reaching nooks and corner of teeth. The most effective way to remove this is bleaching of teeth. But before, bleaching professional cleaning is to be done to prevent the blotchy appearance.

Powered tooth brush has proved itself in reducing stains but still can’t remove those stains completely.

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. 

Finicky about fluoride in dentistry....facts to explore

Dental decay is, by far, the most common and costly oral health problem in all age groups. It is one of the principal causes of tooth loss from early childhood through middle age. Decay continues to be problematic for middle-aged and older adults, particularly root decay because of receding gums. Older adults may experience similar or higher levels of dental decay than do children. In addition to its effects in the mouth, dental decay can affect general well-being by interfering with an individual’s ability to eat certain foods and by impacting an individual’s emotional and social well-being by causing pain and discomfort. Dental decay, particularly in the front teeth, can detract from appearance, thus affecting self-esteem and employability. In addition to impacting emotional and social wellbeing, the consequences of dental disease are reflected in the cost of its treatment.

Again, the goal must be prevention rather than repair. Fluoridation is presently the most cost-effective method for the prevention of dental decay for residents of a community

What’s fluoride ????? and it’s spotlight effect in dentistry

There are several examples of how everyday products are fortified to enhance the health— iodine is added to salt, folic acid is added to breads and cereals, and Vitamin D is added to milk.

Fluoride is not a medication, but rather a nutrient found naturally in some areas but deficient in others and when present at the right level, Fluoride is often called Nature’s Cavity Fighter and for good reason. Having 0.7 to 1.2 parts of fluoride for every million parts of water has been shown to have the best effect. Fluoride in drinking water has two beneficial effects: preventing tooth decay and contributing to healthy bones.

Fluoride a natural guardian

It is important to note that dental decay is caused by dental plaque, a thin, sticky, colorless deposit of bacteria that constantly forms on teeth. When sugar and other carbohydrates are eaten, the bacteria in plaque produce acids that attack the tooth enamel. After repeated attacks, the enamel breaks down, and a cavity (hole) is formed. There are a number of factors that increase an individual’s risk for dental decay:

§  Snacking habits

§  Poor oral hygiene

§  No (or little) access to a dentist

§  Sticky/sugary/carbohydrate diet

§  Increased consumption of fruit juices/ soft beverages

§  Bridges, crowns, braces, and other restoration procedures

§  Irregular/ misaligned teeth

§  A history of tooth decay (cavities).

How fluoride plays its role?

It potentiates its effect in broadly 2 ways

·         Systemic/ through our body

·         Topical/ applied directly to tooth

When Is Fluoride Intake Most Critical?

It is certainly important for infants and children between the ages of 6 months and 16 years to be exposed to fluoride. This is the time frame during which the primary and permanent teeth come in. However, adults benefit from fluoride, too.

Systemic fluorides are those ingested into the body. During tooth formation, ingested fluorides become incorporated into tooth structures. Fluorides ingested regularly during the time when teeth are developing (pre-eruptively) are deposited throughout the entire tooth surface and provide longer-lasting protection than those applied topically. Systemic fluorides can also give topical protection because ingested fluoride is present in saliva, which continually bathes the teeth providing a reservoir of fluoride that can be incorporated into the tooth surface to prevent decay.

Children who have fluoride when their teeth are developing tend to have shallower grooves in their teeth, so plaque (thin, sticky film of bacteria) can be more easily removed.

Topical fluorides strengthen teeth already present in the mouth (posteruptively). In this method of delivery, fluoride is incorporated into the surface of teeth making them more decay-resistant. Topically applied fluoride provides local protection on the tooth surface. Topical fluorides include toothpastes, mouthrinses and professionally applied fluoride foams, gels and varnishes. As mentioned previously, systemic fluorides also provide topical protection.

Fluoride is said to protect the teeth in two ways:

§  Protection from demineralization - when bacteria in the mouth combine with sugars they produce acid. This acid can erode tooth enamel and damage our teeth. Fluoride can protect teeth from demineralization by making teeth resistant to acid attack.

Fluoride disrupts the process of tooth decay by:

§  Providing an environment where better quality enamel is formed, which is much more resistant to acid attack

§  Reducing the bacteria's (bacteria in plaque) ability to produce acid, a major cause of tooth decay.

§  Remineralization - if there is already some damage to teeth caused by acid, fluoride accumulates in the demineralized areas and begins strengthening the enamel, a process called remineralization.