Periodontal disease: what it is and how to avoid it

Periodontal disease is an infection of the tissues that support your teeth.

There is a very slight gap (called a sulcus) between the tooth and the gum.

Periodontal diseases attack this gap and cause a breakdown in the attachment of the tooth and its supporting tissues.

When the tissues are damaged, the sulcus develops into a pocket and, as the disease gets more severe, the pocket usually gets deeper.

The two major stages of periodontal disease are gingivitis and periodontitis.

Gingivitis is a milder and reversible form of periodontal disease that only affects the gums. Gingivitis may lead to periodontitis, which is a more serious, destructive form of periodontal disease.

There are several factors that have been shown to increase the risk of developing periodontal disease:
– Systemic diseases such as diabetes
– Some types of medication
– Crooked teeth
– Bridges that no longer fit properly
– Fillings that have become defective
– Smoking
– Pregnancy

And there are a number of warning signs that can suggest a possible problem:
– Gums that bleed easily
– Red, swollen, tender gums
– Gums that have pulled away from the teeth
– Persistent bad breath or taste
– Permanent teeth that are loose or separating
– Any change in the way your teeth fit together when you bite
– Any change in the fit of partial dentures

However, it’s also possible to have periodontal disease with no warning signs.

It’s therefore important to have regular dental checkups and periodontal examinations.

If you have developed periodontal disease, the treatment will depend on how far it has progressed.

You can take steps to prevent periodontal disease from becoming more serious or recurring.

Good dental hygiene practices such as brushing twice a day, cleaning between your teeth, eating a healthy diet and having regular visits to the dentist will make a huge difference.

Choosing the right toothbrush for your needs

It would be easy to get overwhelmed by the huge range of dental care products now available.

Even looking just at toothbrushes present a wide range of choices.

There are hundreds of manual and powered toothbrushes to choose from.

Start by looking for products that carry the American Dental Association Seal of Acceptance – this is an important symbol of a the product’s safety and effectiveness.

When you buy a toothbrush, replace it every three to four months. Replace it sooner if the bristles become frayed as a worn toothbrush will not clean your teeth properly.

Make it easy for your children to brush their teeth by choosing a child-sized toothbrush and make it more interesting for them by selecting fun colors and designs.

Often people who have difficulties with hand, arm or shoulder movements find that powered toothbrushes are the best choice. However, it’s also possible to make a few small changes to modify a manual toothbrush and make it easier to use.

For example, you can:

– Enlarge the handle with a sponge, rubber ball, or bicycle handle grip
– Lengthen the handle with a piece of wood or plastic
– Bend the handle slightly while running it under hot water

Your dentist will give you tips on what toothbrushes would be right for your needs.

Your options if you have many missing or damaged teeth

People who have not followed adequate dental care for some years may have already lost most of their teeth and feel a little hopeless.

Sometimes they ask a dentist to remove the remaining teeth as they are often broken and have deep cavities.

It’s true that, sometimes, removal of the remaining teeth and replacing them with full dentures is the only option.

But more often there are other options available.

Some or all of the remaining teeth could be repaired and used in conjunction with a partial denture. While a full denture replaces all of the teeth on the upper or lower jaw, a partial denture replaces some of the teeth.

If only a few weak teeth remain on the upper jaw, it might be preferable to have them extracted and a full upper denture made. Full upper dentures can be more secure than lower ones as the upper denture gets added stability from the palate and is not easily dislodged by the tongue.

If only a few teeth remain on the lower jaw, however, the dentist will usually aim to save them and use a partial denture if necessary.

Ideally, all teeth that can be saved should be saved but this is not always possible – often due to finances.

In such cases, having teeth removed and dentures may be the only option.

How dentistry has developed over the last 300 years

When you visit a modern dental surgery, it’s hard to imagine the challenges of dental treatment without all the latest technology.

Yet specialists have been taking care of people’s teeth for thousands of years.

Here are some of the key developments over the last 300 years.

1723: French surgeon Pierre Fauchard – credited as being the father of modern dentistry – publishes the first book to describe a comprehensive system for the practice of dentistry.

1760: John Baker, the earliest medically-trained dentist to practice in America, immigrates from England and sets up practice.

1790: John Greenwood adapts his mother’s foot treadle spinning wheel to rotate a drill.

1790: Josiah Flagg, a prominent American dentist, constructs the first chair made specifically for dental patients.

1832: James Snell invents the first reclining dental chair.

1841: Alabama enacts the first dental practice act, regulating dentistry in the United States.

1844: Horace Wells, a Connecticut dentist, discovers that nitrous oxide can be used as an anesthesia and successfully uses it to conduct several extractions in his private practice.

1880s: The collapsible metal tube revolutionizes toothpaste manufacturing and marketing.

1890: Willoughby Miller notes the microbial basis of dental decay in a book which started a world-wide movement to promote regular toothbrushing and flossing.

1896: New Orleans dentist C. Edmond Kells takes the first dental x-ray of a living person in the U.S.

1938: The nylon toothbrush, the first made with synthetic bristles, appears on the market.

1945: The water fluoridation era begins when the cities of Newburgh, New York, and Grand Rapids, Michigan, add sodium fluoride to their public water systems.

1950s: The first fluoride toothpastes are marketed.

1960: The first commercial electric toothbrush, developed in Switzerland after World War II, is introduced in the United States. A cordless, rechargeable model follows in 1961.

Diabetes and your dental health: How your diet can affect your teeth

When diabetes is not controlled properly, high glucose levels in saliva may create problems that lead to an increased risk of tooth decay.

Your teeth are covered with plaque, a sticky film of bacteria. After you eat food that contains sugars or starches, the bacteria react with these sugars to release acids that attack tooth enamel. This can cause the enamel to break down and may eventually result in cavities.

Brushing twice a day with fluoride toothpaste and cleaning between your teeth with floss or an interdental cleaner helps remove decay-causing plaque.

Plaque that is not removed can eventually harden into calculus, or tartar. When tartar collects above the gumline, it becomes more difficult to clean thoroughly between teeth. This can lead to chronic inflammation and infection in the mouth.

Because diabetes reduces the body’s resistance to infection, the gums are among the tissues likely to be affected.
Periodontal diseases are infections of the gum and bone that hold your teeth in place. Patients with inadequate blood sugar control appear to develop periodontal disease more often and more severely, and they lose more teeth than those who have good control of their diabetes.

Because of the lower resistance and longer healing process, periodontal diseases often appear to be more frequent and more severe among persons with diabetes.

You can help reduce these risks through good maintenance of blood sugar levels, a well-balanced diet, good oral care at home and regular dental checkups.

Understanding your wisdom teeth

Many patients ask whether wisdom teeth are really necessary since so many people have them removed.

The fact is that wisdom teeth are a valuable asset to the mouth when they are healthy and properly positioned.

However, problems can occur that sometimes make it better to have them removed.

For example, when the jaw isn’t large enough, the wisdom teeth can become impacted – misaligned or unable to grow in properly. They may grow sideways, emerge only part way from the gum or remain trapped beneath the gum and bone.

The reasons wisdom teeth may have to be extracted include:
– The teeth have only partially erupted. This leaves an opening for bacteria which cause infection.
– There is a chance the wisdom teeth will damage adjacent teeth.
– A cyst forms which may destroy surrounding structures such as bone or tooth roots.

Ask your dentist about the health and positioning of your wisdom teeth.

Your dentist will tell you if there are any issues and will recommend any steps needed.

How medication and anesthesia can help make your visit to the dentist easier

Your dentist will do everything possible to make your visit as relaxed and comfortable as possible.

Depending on the treatment you are receiving, there are several medications available to help.

Some drugs control pain, some help you relax and others put you into a deep sleep during dental treatment.

The best approach will depend on the type of procedure being undertaken, your overall health – including any history of allergies – and the degree of anxiety you feel.

Some of the options your dentist might discuss include:

Analgesics: These are the most commonly used drugs for relief of toothache or pain following dental treatment. They includes aspirin, acetaminophen and anti-inflammatory drugs such as Ibuprofen. There is a separate category of ‘narcotic analgesics’ – such as those containing codeine – which are used for more severe pain.

Local anesthesia: Topical anesthetics are applied to mouth tissues with a swab to prevent pain on the surface level. They may also be used to soothe mouth sores. Injectable local anesthetics prevent pain in a specific area of your mouth during treatment by blocking the nerves that sense or transmit pain and numbing mouth tissues.

In other cases, your dentist many recommend sedation or general anesthesia.

Your dentist will discuss the best approach to suit your needs.

What to do if your tooth cracks

While our teeth are normally very strong, they can crack for a number of reasons.

Reasons could include tooth decay, trauma/injury, grinding of the teeth or a stress fracture.

Sometimes, our jaw may be stronger than our teeth and the teeth can fracture when we bite heavily on food.

We can protect our teeth in some circumstances – for example it may be advisable to wear a mouthguard during sports.

Taking proper care of the teeth and regular visits to the dentist will help keep your teeth in good shape.

If a tooth cracks, it may become painful if the nerve is exposed and the area can become tender.

If this happens, rinse your mouth with warm water to clean the area and apply a cold compress to reduce swelling. Then call your dentist immediately.

Treatment will depend on where the tooth has fractured, how close it is to the nerve and the overall condition of the tooth.

A cracked tooth may be repaired with silver alloy, gold, porcelain or plastic. Or it may require a crown or overlay or bonding, which applies porcelain or enamel to the fractured tooth.

If you contact your dentist quickly, they will be able to take the most approriate action to preserve the tooth as much as possible.

What will it be like living with dentures?

People who are new to wearing dentures naturally have many questions about how their life will change.

New dentures may feel awkward for a few weeks until you become accustomed to them. The dentures may feel loose while the muscles of your cheek and tongue learn to keep them in place.

During this time, it’s not unusual to experience minor irritation or soreness. You may find that saliva flow temporarily increases.

As your mouth becomes accustomed to the dentures, these problems should diminish.

Dentures can be made to closely resemble your natural teeth so that little change in appearance will be noticeable. Dentures may even improve the look of your smile and help fill out the appearance of your face and profile.

Eating will take a little practice. Start with soft foods cut into small pieces. Chew slowly using both sides of your mouth at the same time to prevent the dentures from tipping. As you become accustomed to chewing, add other foods until you return to your normal diet.

Continue to chew food using both sides of the mouth at the same time. Be cautious with hot or hard foods and sharp-edged bones or shells.

Initially you may also find that wearing dentures changes how you speak. Pronouncing certain words may require practice. Reading out loud and repeating troublesome words will help. If your dentures “click” while you’re talking, speak more slowly.

You may find that your dentures occasionally slip when you laugh, cough or smile.

After your dentures are fitted, you’ll have a few follow-up appointments with your dentist to take care of any initial issues and to answer any questions you have.

Taking care of your dentures

Your dentures are designed to last a very long time so it’s important that you take care of them as you would take care of your own teeth.

They are very delicate and may break easily if dropped even a few inches. So it’s a good idea to stand over a folded towel or a basin of water when handling dentures.

When you are not wearing your dentures, store them away from children and pets.

Like natural teeth, dentures must be brushed daily to remove food deposits and plaque.

Brushing helps prevent dentures from becoming permanently stained and helps your mouth stay healthy.

There are special brushes designed for cleaning dentures but a toothbrush with soft bristles can also be used. Avoid using hard-bristled brushes as these can damage your dentures.

Some denture wearers also use hand soap or mild dishwashing liquid for cleaning and that’s fine. But avoid using powdered household cleansers, which may be too abrasive. Also, avoid using bleach, as this may whiten the pink portion of the denture.

The first step in cleaning dentures is to rinse away loose food particles thoroughly. Moisten the brush and apply denture cleanser. Brush every surface, scrubbing gently to avoid damage.

Dentures may lose their shape if they are allowed to dry out. When they are not worn, dentures should be placed in a denture cleanser soaking solution or in water. Never place dentures in hot water, which could cause them to warp.

Ultrasonic cleaners are also used to care for dentures. However, using an ultrasonic cleaner does not replace a thorough daily brushing.

You can seriously damage your dentures by trying to adjust or repair them yourself. So see your dentist if your dentures break, crack, chip or if one of the teeth becomes loose.

Over time, dentures will need to be relined, rebased, or remade due to normal wear. They may also need to be replaced if they become loose and the teeth show signs of significant wear.

You need to make regular visits to your dentist to make sure the dentures are working as well as possible for you and to check for more serious problems in your mouth such as oral cancer.