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The gums are also called the periodontium which means perio for around and dontium for tooth as the gums are literally present "around the tooth." There is a softer mucosal portion that runs along the tooth in a curved manner and a stronger fibrous portion that connects the tooth to the jaw bone. Together, they provide the structural support for the tooth to be held in place. In addition they also have an aesthetic value with the healthy pink color.
The mouth has the largest number of bacteria in the body, which act on the food debris that is present on the tooth and the gums. This causes infection in both the gums and the tooth.
Types: Periodontal disease can be localized or general.
- Localized disease happens when a tooth is not accessible for thorough cleaning. The inside surface of lower incisors and outer surfaces of the upper last molars are common areas of localized periodontal disease.
- Generalized periodontal disease can be due to conditions like pregnancy, puberty, diabetes problem where gums around all the teeth are affected.
Symptoms: In both the cases, the following symptoms ensue:
- The gums are of a healthy pink color and if they turn darker hue of pink
- Swollen and/or painful gums
- Spontaneous bleeding: This may be localized or generalized
- Chronic bad breath: Due to food accumulation in the infected gums
- If it continues to form an abscess, pressure on the gums can produce pus
- Bad taste in the mouth (arising from pus in the gums)
- Gingival recession, producing an effect of having longer tooth
- Dentin is exposed leading sensitivity to hot or cold foods
- Loosening of the tooth
- Painful chewing, as it puts pressure on the inflamed periodontium
- Dentist will identify what are called pockets, which is an indication of severity - the deeper the pockets, the severe the disease.
Management and Prevention: Gum disease is very easy to identify and can be completely cured.
- Regular brushing and flossing can help maintain regular oral hygiene
- With each brushing session, plain finger massage of the gums improves blood circulation and their overall health
- Regular use of mouth rinse is a good way to improve gum health
- Regular visits to the dentist can help keep a check on the health of the teeth and the gums - early identification of disease and early treatment
- Once it has set in, deep scaling followed by root planing may be required to thoroughly clear out the infection
- More surgical options like gingival grafts, flap surgery, bone grafting in case of severe bone loss may be required.
- Management of conditions like diabetes
The best way to avoid periodontal disease is to know its symptoms, follow oral hygiene practices, and consult a dentist regularly.
Overall oral health consists of health of both the soft and the hard tissues in the mouth. While teeth are the hard tissues, the soft tissues include the lips, tongue, cheek, palate, and most importantly the gums. The gums or the periodontium (perio - around, dont - tooth) surrounds the tooth and provides nutritional support and structural support with its connective tissue. The gums are the unsung heroes in maintaining a healthy set of teeth.
It is common observation that dental decay is more attended to than gum disease. The symptoms associated with decay, be it discoloration, food lodgment, sensitivity, and sometimes pain are a lot more demanding.
The bad news is that the same bacteria have a harmful effect on the gums too. The good news is that gum disease also (like tooth decay), takes time to develop. The bacteria in the mouth and the plaque are the main initiators of gum disease too. It is more innocuous and not immediately attended to, sometime even gets ignored for years until it become severe and mandates treatment. Certain medical conditions like pregnancy, diabetes, stroke, etc., lead to greater severity of the gum disease.
Chronic gum or periodontal disease, if left untreated, can even lead to multiple tooth loss and require dentures much earlier than required. It is not difficult to diagnose gum disease as the symptoms are quite easy to identify, including
- Red, swollen, or painful gums: As with any infection, redness and swelling and pain are the first symptoms of gum disease too.
- Spontaneous bleeding of gums: The gums can look spongy and puffed and can sometimes bleed without even a touch
- Chronic bad breath: The bacteria are constantly acting on the food debris to produce acid, leading to a bad breath (halitosis)
- Pressure on the gums can produce pus: Cumulative infection can lead to gingival abscess
- Bad taste in the mouth: If there is an abscess, it will discharge pus into the mouth, leading to this metallic taste
- Gingival recession, where the tooth appears to have grown longer. The gum line recedes from its original place, exposing more of the tooth. This also causes greater sensitivity, especially to hot or cold foods
- Slight loosening of the teeth (in severe cases) as the fibers loosen their hold around the tooth.
- Painful chewing, it puts extra pressure on the fibers of the periodontium.
Some people are more prone for gum disease than others. The risk factors include smoking, increased
female hormones, and chronic illnesses like diabetes and cancer.
Management: Regular visits to the dentist can help identify these at an early stage and manage both progression and severity. Additionally, managing risk factors like smoking and chronic illnesses also is helpful.
Often paraesthesia is caused due to the needle injury. When the dentist inserts the needle for a block, the patient might experience a sharp sensation on the tongue equivalent to that of an electric shock. This is known as paraesthesia and is defined as a change in the sensation or anesthesia that is persistent and the duration generally extends. This condition cannot be prevented and is a complication in some patients who undergo a dental treatment. Though it is commonly seen in the implant therapy, paraesthesia is more of a dental malpractice.
The feeling of the electric shock is felt when the needle comes in close contact with a nearby nerve. This is enough to develop paraesthesia. Severing of the nerves with a local anesthesia and small gauge needle is uncommon. The exact cause of paresthesia has not been ruled out, but it is believed that the block happens because of using 4% solutions of local anesthesias. In case a paresthesia occurs, then it usually gets resolved within some days, weeks or months, but if it lasts for more than 6-9 months, then it is considered to be permanent.
When the paraesthesia is due to a surgical trauma, then getting help from an oral and maxillofacial surgeon is recommended. They assess that if a surgical intervention can be used to fix the problem. In case the paraesthesia is due to the anesthesia given locally by the dentist, then he/she does the following:
- Patient Management: Reassurance of the patient is must as they get jittery about the situation. The dentist often speaks about the condition with the patient personally. The patient is made to understand how a paraesthesia might have occurred and how much time it would take to resolve. This is also recorded in the patient book so as to avoid any such incidents in the future.
- Examination of the patient: The dentist should discuss the whole phenomenon and procedure of how paraesthesia can take place. It is important to let the patient know that the condition subsides, but it might take some time. The extent and the degree of paraesthesia should be assessed and the findings should be noted in the examination records.
- Follow up with patient: It is the dentist's duty to keep a tab on the follow up with the patient. The patient should go for a re-checkup within 1 month of developing a paraesthesia and then again in 1-2 month intervals. The visits could be more and can last until the paraesthesia completely resolves. Improving signs and symptoms usually promise that the paraesthesia is getting better. If paraesthesia is still persistent, then help from an oral and maxillofacial surgeon should be taken for a surgical approach.
Brushing your teeth may come naturally to you, but do you know that you may not be doing it right?
To avoid all kinds of dental problems like gum disease, you need to be aware of the mistakes that you may be making while brushing; and these are:
1. Using the wrong toothbrush - One should select their toothbrush keeping in mind the size of their mouth. It should make you feel good rather than cause feelings of discomfort in your hand and mouth. Using the right toothbrush especially brushes with soft bristles is a must if you don't want your gums and teeth getting hurt.
2. Not giving it enough time - In order to keep your mouth healthy, you should never forego the important dental principle of brushing your teeth twice a day. More importantly, you should brush for a minimum of 2 minutes.
3. Using the wrong technique - The right brushing technique is also vital for sound oral health. To do this, divide the mouth into four parts and spend 30 seconds on each part. While side-to-side wide brush strokes can hurt your gum line, short strokes at a 45-degree angle to the gums in up and down motion are what you should be doing whenever you brush close to the gums. Ideally, you should use soft brushes in up and down strokes to avoid wear and tear of your teeth.
4. Brushing right after having acidic drinks and foods - Whether it is apple or orange juice, coffee, diet sodas or sour candies, these beverages and foods contain acid that can make your tooth enamel softer. Brushing right after having these foods or beverages can wear away the enamel of your teeth. Ideally, you should wait 30 minutes before brushing your teeth so as to allow the saliva in your mouth to restore the state of your tooth enamel.
5. Not changing your toothbrush - Once you see signs of wear and tear on your toothbrush, it's a signal that you need to get a new one. Problems like broken bristles, dip in flexibility and breakage are signs that you need to look out for in your toothbrush. You should change your toothbrush every 3 to 4 months.