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Celiac disease is a serious genetic autoimmune disease with over 300 symptoms, and most people manifest with a combination of them. It is caused by intolerance to gluten, which is a protein found in wheat, rye, barley, and other cereals. Gluten is usually present in the small intestine, and in patients with celiac disease, the lining of the small intestine gets attacked. Consequently, a number of organs and/or body systems are affected, making it extremely difficult to pointedly say that a person has celiac disease.
These symptoms cover almost all systems of the body including reproductive to digestive, cardiovascular to endocrine, respiratory to neuromuscular, and even affect the bones, and the teeth. Another major variation also is the age at which celiac disease becomes symptomatic. While some show symptoms quite early in their childhood, some others show symptoms later in their life, and some may not manifest with any symptoms all through their life.
Talking of the oral/dental symptoms, there are two main causes for concern one involving the soft tissues and the other involving the teeth. Let us look at the two in a little more detail.
Similar to the canker sores or the usual mouth ulcers, celiac disease also cause whitish sores. Unlike the canker sores which appear on the lips, the celiac mouth sores are common on the insides of the cheek, gums, lips, palate, and sometimes even the tongue. The appearance is very similar to that of aphthous ulcers, which have a whitish or grayish margin. They appear at random with no specific reason. The soft tissue lining of the digestive system is present from the stomach or intestine all the way to the mouth, and therefore these ulcers are seen. These can be quite discomforting and interfere with nutrition. Topical creams and/or gels can be applied to treat them. If celiac disease is diagnosed by then, abstaining from a gluten-free diet will help relieve the symptoms. Else, they may continue to recur and symptomatic treatment would be required.
The second oral symptom of celiac disease is the presence of visible defects of discoloration in the enamel. There are usually white, brown or yellow spots, usually discolored on the incisors and molars (front and back teeth). The bad news with the tooth issue is that these do not go away once a gluten-free diet is adopted. Depending on the severity, these may require tooth whitening treatments ranging from bleaching to veneers to full crowns.
The next time you have a group of symptoms, with the above two oral symptoms, contact your doctor and have a detailed discussion. It does not take much effort to diagnose and treat celiac disease.
The smile is the first thing we notice about a person, and more than anything else, it reveals the teeth first. We all yearn for that set of perfectly aligned teeth that are pearly white in color. However, this is not a reality in all people.
Due to various reasons, the teeth are not always bright and white. In some cases, the high fluoride content in the water can lead to fluorosis, which causes irregular patches on the teeth. Chewing tobacco and smoking are another reason for teeth discoloration, ranging from yellow to brown to black. The most inevitable of all reasons is ageing, where they naturally change to a darker shade of yellow. However, dental technology has also improved to come up with various solutions, so that the dream for that set of pearly whites can be made a reality.
Bleaching is by far the most commonly used method for teeth whitening. The tooth has an outer layer called enamel, a next layer called dentin, and a final inner layer called the pulp. The enamel contains organic particles that give the tooth its color, and the bleach material attacks these organic particles and thereby removes the stains.
It is always advisable to use tooth bleaching under the supervision of a dentist. A thorough examination and diagnosis is required before deciding on one of the two modes of bleaching.
- In-office bleaching: This involves use of whitening gels that are not available over the counter. The gel is applied on the discolored portions of the teeth to leave a whiter tooth behind after the stipulated time.
- Home bleaching: In cases where more regular application is desired, the patient is given a kit which has customized trays and the whitening gel. The patient is educated on a schedule including how and when to apply the gel and instructions for this application.
In addition, for minor discolorations, there are other options as below:
- Whitening strips: These strips are similar to adhesive bandage and contain the bleaching agent. They are applied onto the tooth and left for usually about 30 minutes to take effect.
- Brush-on whitening: These gels are applied directly on the tooth and left for a while or overnight if required.
- Whitening chewing gum: For the chewing gum lovers, this could be an option. These chewing gums are similar to any chewing gum but include bleaching agents.
Side effects: Sensitivity and gum irritation are the two common side effects of bleaching. This could be either from the chemical or the trays that are used. The need to repeat the treatment again is another shortcoming. Repeated visits to the dentist may be needed once or twice a year to maintain the pearly white smile!
A generation ago, we would not see so many adolescents with braces as we do currently. Orthodontics, the branch of dentistry involved in the use of braces to align and move teeth to form that perfect arch, has seen rapid advancements in the past few decades and continues to grow at a rapid pace.
The fundamental principle is that the teeth is held in place by surrounding elastic tissues, and minor constant forces can be applied to align them better. Small metal brackets are applied on the teeth and a wire is passed through them so that there is a constant force on the teeth. The amount and direction of force is managed by the doctor. The younger the age, the more elastic the tissue is, the easier it is to move teeth.
There are two main things to understand in terms of your options, relation of age with orthodontic treatment and the choices of braces.
Firstly, correlation with age. Over the years, more people in their 20s and early 30s are choosing to have braces. Though the teeth and more importantly the surrounding periodontium become less elastic with age, the amount of force exerted is increased and therefore tooth movement is enabled. Also, in older patients, tooth removal may be required more frequently to make space for proper alignment.
Secondly, the choices of the braces:
- In the earlier days, bands were placed around the teeth and a wire was then connecting all these bands to enable tooth movement. Gradually, this made way to small brackets being placed on the front surface of the teeth, and a wire running through it and elastic bands connecting the bracket and the wire. This is the most effective way of moving teeth, though not esthetic. To make it look different, the ligatures could be colored.
- For people who are constantly in the public eye, the metal braces were a deterrent and so lingual braces became popular. The brackets are applied on the inner surface of the teeth and are not seen easily. The amount of force here varies from the earlier one, and not all conditions can be treated by this method.
- The next development was the development of ceramic braces, which are also applied to the front surface of the teeth and can be used in most cases. These are more expensive than the metallic braces.
- Removable aligners is another option, which are trays which need to be worn for close to 18 hours a day to induce tooth movement. This is esthetic and no metal shows during talking or smiling.
So, if you want to improve your smile, visit your dentist and find out how!