Gum disease is also known as periodontitis. It is a very common disease that can affect you  without clear symptoms or pain. The condition may go undetected for years before a patient becomes aware of it.

How it starts:

We all have some plaque covering our teeth.

If we do not clean our teeth thoroughly, the harmless bacteria population inside the plaque changes into a harmful one that irritates the gum margin around the teeth. The immune system fights the dangerous bacteria and its products, with its own potent defensive products. The constant battle between the body and the bacteria damages the surrounding tissue that supports the tooth. The tooth then slowly loses the attachment between its surface and the surrounding bone. The bone is destroyed and the tooth becomes loose to the point were it no longer can function and has to be taken out.

The initial phase of the disease is called Gingivitis. Gingivitis is a reversible process. This means that if the plaque is removed the gum will go back to the original healthy status with no persistent damage. A big percentage of the population has gingivitis.

If the plaque is not removed, it turns into calculus (tartar). Calculus is a hard layer that is attached to the surface of the tooth and is not easily cleaned with a conventional toothbrush.

If calculus is left long enough, the minor infection or Gingivitis turns into a more severe infection: Periodontitis. Periodontitis is an irreversible process. This means that even when the infection is treated and the bacteria are removed, the damage caused by the disease cannot be fully repaired. The bone level around the affected tooth recedes and a pocket is created between the tooth and the gums.

The longer you leave the disease untreated, the more difficult it is to cure.

Regular visits to the dentist and simple oral hygiene instructions such as brushing and flossing can prevent gingivitis from turning into periodontitis.

Symptoms:

The affected gums bleed easily, swell and change colour from light pink into dark red. Gum infection often causes bad breath.

In patients suffering from gum disease, the affected teeth can be tender to the touch.

Treatment

A big part of gum disease treatment relies on the patient’s cooperation with the dentist. The treatment plan may consist of:

• Oral hygiene instructions in brushing, flossing and using interdental brushes.
• Scaling: removing the plaque and the calculus.
• Root planing: smoothing the surface of the root after scaling.

The above treatments are often carrried out by a hygienist.

• Gum surgery: is used to reach the infected area and change the gum structure to make it easier for the patient to clean between the teeth.
• Using antibacterial mouthwashes and gels.
• Treatment with antibiotics injected directly in the infected pockets.

Why do some people get gum disease more than others?

Some people get gum disease easier than others because of their genetic disposition.

Such people are prone to attracting harmful bacteria and their immune system reacts differently towards the plaque causing more damage to its own gum structure.

Smoking is another contributing factor to gum disease as nicotine impairs the body’s immune system’s ability to fight the gum disease.

Pregnancy: during pregnancy the hormone balance in a woman’s body changes affecting even the gums. The gums become swollen and bleed easily when brushed amd are far more reactive to the effects of plaque. Careful cleaning and flossing is necessary to eliminate the plaque and help the gums during the pregnancy until the hormone balance is restored again when the baby is born and after breast feeding is finished.

Grinding or clenching the teeth is also known as bruxism.

Bruxism can occur at any age, from young children with milk teeth to adults. People are usually unaware of the condition as it occurs mostly during sleep. But there are a number of visible signs of grinding:

• Flat shiny areas on the chewing surface of the tooth.
• The impression of the teeth on the side of the tongue.
• Linea Alba: a white line on the inside of the cheek along the bite line caused by chewing the insides of the cheeks.

Until today there is no clear explanation as to why we suffer from bruxism, but we know the condition is influenced by many factors, including stress.

Bruxism is a common condition that may vary in intensity and frequency. It becomes more intense and frequent with stress.

Many people can live with bruxism if it occurs in a mild form.

When do I have to do something about it?

You should seek professional help from a doctor or a dentist if:

• The grinding is wearing down your teeth: when the enamel is worn down, it makes the teeth more sensitive.
• Your teeth or the dental restorations in your teeth start to break.
• You start to lose the enamel close to the gum line.
• It causes the enamel to crack.
• You suffer from tension headaches, a stiff neck and shoulders.
• You experience tender jaw muscles in the morning.
• You have tender teeth: during the grinding phase certain teeth are exposed to pressure more than others hence the tenderness.
• The grinding is so loud during the night that your partner’s sleep is disturbed.
• You damage the inside tissue of the cheeks while grinding.

Treatment

• A bite guard : Your dentist can provide you with a custom-made bite guard. It should be worn over the upper or lower teeth and mostly during sleeping hours, but may also be worn during the day.
• Relaxation: by choosing a suitable way for you to de-stress such as: aromatherapy, massage, hypnotherapy etc.
• Medication: see your doctor for muscle relaxants

Dry mouth is also known as Xerostomia.

Not until we suffer from a dry mouth, do we appreciate the role of saliva.

People may suffer from low saliva production for many reasons.

The most common ones are:

• Taking medication such as antidepressants, antihistamines and medication for treating high blood pressure.
• After receiving radiation therapy in the head-neck area. This can damage the salivary cells and limit the production of saliva.
• Suffering from other systemic diseases like Sjogren’s syndrome and diabetes.
• Surgery to the neck area where the salivary glands are affected.
• Smoking
• Alcohol

As we age some of us will experience lower saliva production and hence a drier mouth.

The role of saliva:

• Lubricates the mouth.
• Protects the teeth from decay and gum disease.
• Enzymes in the saliva soften and break down the food to make it easier to swallow and taste.
• Protects the tongue, lips and the inside of the cheeks from drying up and cracking.
• Facilitates speech.

What should I do if I have a dry mouth?

• If dry mouth is caused by a specific medication, ask your doctor for alternative medicine if possible.
• If the cause of your dry mouth is lower salivary gland function, try to stimulate it by chewing sugar free gums.
• There are also medicines that could be prescribed by your dentist or doctor to stimulate the salivary glands.
• If your saliva production is extremely low, you could use saliva replacing products.

Other tips that may help:

• Visit your dentist regularly to monitor your oral health…this can mean 4 or 5 monthly check ups.
• Use mouth lubricators to protect lips and tongue from cracking and to facilitate speech.
• Drink sugar free fluids with food to facilitate chewing and swallowing and even for better digestion.
• Brush your teeth and gums gently and meticulously to prevent decay and gum disease.
• Rinse with mouth washes rich in Fluoride. Fluoride neutralises early decay and strengthens the surface of the tooth.
• Avoid alcohol as it dehydrates the mouth.

Posted by Dr. Yasmin George.

Tooth decay is also known as Dental Caries.

It is the dissolving of the tooth surface in a slow process.

Our teeth are covered with PLAQUE.  Plaque is a thin layer of bacteria, its products and food debris. When we eat and drink sugary products, the bacteria in the plaque convert the sugar into harmful acid and other by-products.

The longer the plaque stays on our teeth and the more frquwnt the sugary products are that we consume, the quicker the decay progresses.

Tooth decay is usually first found in the deep fissures (the deepest part of the chewing surface on the tooth) and between the teeth.

It is easy for plaque to build up there and it is more difficult to clean it with the toothbrush.

Symptoms:

Symptoms vary from person to person. Some people start feeling sensitivity as soon as the decay has broken the first and the hardest layer of the tooth, the enamel. Others will not feel anything even if the second and the thickest layer of the tooth, the dentine is damaged and the pulp with all the nerves and the blood vessels is infected.

How do I know that I have tooth decay?

The best way of knowing is to be examined by your dentist. The dentist takes radiographs (X-rays) of your teeth and he or she will be able to tell whether you have an established decay or early decay.

Prevention:

• Good oral hygiene, regular visits to your dentist and controlled sugar intake prevents decay from developing
• Fluoride based toothpastes and mouthwashes are recommended.
• Flossing or cleaning between the teeth is also important.

Treatment

The most common treatment for tooth decay is fillings. Under local anaesthetic the dentist or the therapist removes the decay and fills the cavity (hole) that arises after the cleaning with a choice of different materials. White composite (tooth coloured fillings) are now available. Amalgam (the silver filling) was predominantly used before the tooth coloured fillings were developed.

Your dentist may advise to repair the damage caused by the decay with an porcelain onlay (CEREC) or a crown.

Cerec treatment can be completed in one visit.

Depending on the size of the damage and the location on the tooth, a filling is not always suitable.

Root canal treatment is also known as a root filling or an RCT or endodontic treatment….

If a tooth is infected (an abscess)  or badly damaged by trauma (such as a blow during sport) or damaged by deep decay , a root canal treatment is necessary to deal with the pain and infection and enable the patient to keep the tooth….unless of course the patient decides to have the tooth extracted.

The tooth is anaesthetised (in a few situations local anaesthitic is not needed), the tooth is then ‘isolated’  and the dentist can then do the treatment over one or two visits.

Root canal treatment is removing the tissue from the inside of the tooth, cleaning and ‘sterilising’ the inside of the tooth and replacing it with a filling.

When do I need a root canal treatment?

If decay is left untreated, it reaches the pulp inside the tooth and damages the pulp tissue (that consists of nerves, blood vessels, lymphatic vessels and other tissues), causing an infection.

The infection can develop with or without pain. If not treated, an abscess  can form around the root of the tooth in the jawbone causing pain and swelling.

The abscess can be treated temporarily with antibiotics. But to get rid of the abscess and save the tooth, a root canal treatment is necessary.

A tooth does not always have to be infected to need a root canal treatment.

For example, if a tooth is badly broken and not sufficient to put a crown on, a root filling is performed. A post or a screw is placed inside the tooth to form the foundation that is used to put the crown on. This extensive treatment is referred to as a post and crown and usually done when there is no other treatment option…

Are root canal treatments always successful?

There is always a risk of the root canal treatment failing and the abscess returning. An abscess can return months or years after a root canal treatment is completed.

However success rates can be as high as 95% if the treatment is done carefuly and thoroughly, this means longer appointments than say for a routine filling…

Some reasons for failure are:

1. Extremely resistant infectious bacteria.
2. Complicated root canal system in the tooth.
3. The choice of tools and materials used to perform the root canal treatment.
4. A poor quality filling on top of the root filling

Your dentist may decide to perform the root canal treatment or to refer you to a specialist, endodontist if it looks to be particularly difficult.

Do I need to have a crown after root canal treatment?

In order to get access to the nerve room inside the tooth during root canal treatment, your dentist has to remove a considerable amount of tooth substance. This can weaken the tooth and make it more vulnerable to pressure if the tooth is rebuilt with conventional filling materials. Therefore your dentist may recommend a crown to be put on top of the rootfilled tooth after the root canal treatment has been completed to protect the tooth from cracking and maintain a good seal over the root filling. 

Why did my tooth discolour after root canal treatment?

Some rootfilling materials can discolour teeth. This matters more when the treated teeth are in the front. This may happen within months or years after the root canal treatment. To get rid of the discolouration, the tooth can be  whitened from the inside or a ‘veneer’ of porcelain placed over the front of the tooth..

In certain cases where the tooth is heavily discoloured, the internal whitening (internal bleaching of teeth) needs to be repeated. If the tooth does not respond to internal whitening, a crown may be the choice of treatment.

There are many reasons behind sensitive teeth. Here are some of the most common:

• Brushing injuries: usually on the outer surfaces of the teeth facing the lips and the cheeks. Brushing hard can damage the gums and make them recede, exposing the sensitive root surface. The root surface is not covered with the hard enamel, which makes it vulnerable to hard brushing and more damage.
• Grinding/clenching: If you grind/clench your teeth, small cracks can develop in the tooth enamel making it sensitive to temperature changes or sweet and sour.
• Drinking acidic juices or fizzy drinks frequently: Frequent consumption of these beverages dissolves the hard enamel and the sensitive dentine is exposed.
• Bulimia: a characteristic of this eating disorder is self-induced vomiting. This exposes the teeth to the acidic content of the stomach leading to the dissolving of the enamel and the exposing of the sensitive dentine.
• Bad habits: such as biting nails or pens.
• Broken teeth or broken fillings.
• Gum disease: If you suffer from gum disease, the gums around the teeth will recede and the sensitive part of the teeth is exposed.

If you experience teeth sensitivity, see your dentist for treatment. This may vary depending on the cause.

There are many products that you can buy over the counter to treat the symptoms of teeth sensitivity.

Tips to minimise teeth sensitivity:

• If you are a hard-brusher change to a softer toothbrush
• Use toothpastes for sensitive teeth
• Use mouthwashes containing Fluoride to strengthen the teeth
• If you are a grinder/clencher you need to see your dentist who will provide you with a bite guard to protect your teeth from the grinding forces.
• If you have broken teeth or fillings see your dentist for treatment.

Posted by Dr. Yasmin George