This article first appeared in the January 1st, 2015 issue of Lianhe Zaobao LOHAS. For the benefit of those who missed the article, or who cannot access the publication in Chinese, we have summarized the content of the article below.
According to Dr Edwin Heng, dental specialist in periodontics at Specialist Dental Group®, it is estimated that as many as 85% of Singaporean adults have gum disease (periodontitis), and 10% of them are in the advanced stages.
Dr Heng pointed out that gum disease generally starts from middle age; although young adults are not excluded. The symptoms of gum disease include bleeding during teeth brushing, red and swollen gums, cavities and bad breath. Bleeding gums is a common dental issue which used to be related to the lack of Vitamin C; however these days, there is a higher chance that it is a sign of gum disease. He further emphasized that for diabetic patients who do not control their blood glucose level, gum disease will spread rapidly. Apart from this, some high blood pressure medication and radiation therapy for cancer treatment will reduce the secretion of saliva, thus increasing the amount of bacteria in the mouth. This will worsen pre-existing conditions of cavities and gum disease. Bleeding gums may also be attributed to side effects from certain medications, and will require a change in medication from their doctors.
“If treatment for gum disease is delayed for a prolonged period of time, the gums and supporting dental bone will start to recede; causing toothache and loose teeth. In serious cases, tooth extraction may be inevitable.”
Some patients seek treatment with the dentist for bleeding gums, and through clinical examination, the dentist may possibly discover that the bleeding could be due to other blood related conditions, and advise for them to seek the appropriate medical treatment. Dr Heng added that scientific studies have proven that the bacteria which cause gum inflammation can enter the heart from the mouth (via bloodstream), triggering heart inflammation (myocarditis) and other serious diseases.
Calculus, gum pockets and mouth sores
Dr Edwin Heng explained that gum disease is caused by bacteria which adhere to the teeth’s surface. When there is a lack of proper dental hygiene, over an extended period of time, dental plaque will accumulate on the gumline.
The bacteria in dental plaque secrete toxins, irritating the surrounding tissue such as gums, periodontal ligament and alveolar bone.
The continual accumulation of dental plaque will mineralize and form into calculus. The coarse surface of calculus will encourage accumulation of more dental plaque and gum infection will persist.
With no proper oral hygiene, the gums of a patient with gum infection separate from its dental roots, creating spaces in between, developing into gum pockets (periodontal pockets). Gum pockets are food traps, which can lead to more dental plaque and tartar accumulation, resulting in persistent periodontal issues.
At this point, gum tissues may develop pus and even sores; gums and dental bones will continue to recede, exposing the dental roots and thus increasing the chances of dental root decay. If dental infection persists and worsens, and dental bones continue to recede, the teeth will start to lose their support and loosen, leading to eventual tooth loss.
Dr Heng pointed out that if dental plaque accumulates, infection will set in the gums and cause a mild form of gum disease also known as gingivitis. When the body’s immune system is not at its optimum and the body’s ability to heal poor; hence oral tissues consisting of gums, soft tissues in the oral cavity and dental bones will be affected. As the condition deteriorates gradually, it will progress to a more serious gum disease, termed ‘periodontitis’.
Gums can affect one’s appearance
Dr Heng said that taking good care of one’s gums not only helps to maintain one’s oral health, it also helps to maintain a beautiful smile. He believes that for a good impression, other than one’s facial structure, a well-balanced integration of teeth and gums is equally important.
Healthy gums are usually appear pink with a smooth structure, and are firm and elastic to touch. The gums adhere to teeth tightly and gradually thin towards the top. Excessive gum display, uneven colours, swollen gums and exposed tooth roots affect your smile.
Dr Heng stated that two common aesthetic gum issues are having receding gums and too much gums showing (gummy smile). He analyzed that the main reason for localized gum recession is brushing too hard, and patient may also be affected by teeth sensitivity at the same time.
“These gum issues should be treated in a timely mannner. Gum recession treatment involves a minor surgical procedure where a small piece of tissue from the palate is harvested and placed over the missing gum. If the patient does not have sufficient “donor” tissue from the palate, there is also the option of using pre-packaged sterilized allodermic tissue from human/animal origins to add to the missing gum.”
Dr Edwin Heng said the treatment for gummy smile involves cutting away the extra gums to expose the tooth underneath. Dr Heng also added that helping patients achieve the “ideal” smile often requires the periodontist (gum treatment specialist) to work together with an orthodontist (teeth alignment).
Root Canal Treatment
Dr Edwin Heng said that treatment of periodontal disease usually requires tartar that hides in 3 to 5 millimeters deep in gum pockets to be thoroughly cleaned. If the patient has other serious dental issues, then a periodontal flap surgery may be required to clean the tartar effectively.
Dr Heng emphasized that patients need to do go through regular check-ups once every three or six months. Most importantly, these patients need to strictly maintain good oral care regimes; otherwise periodontal disease may flare up again.
Dr Heng said that decayed teeth are a common dental issue among the elderly and even in the young ones. Once decay is found, a visit to your dentist for dental fillings may prolong the retention of your natural tooth. Should the extent of the decay reach the pulp of the tooth, then root canal treatment will be required.
He also mentioned that people with decayed teeth with no remaining dental crown may still able to keep their teeth and maintain their periodontal ligament. Soft tissues inside your oral cavity consist of nerves, blood vessels, lymph and epithelial cells, capable of transmitting sensations. Once the decayed tooth is extracted, soft tissues which adhere to the tooth will disappear.
Dr Heng explained that after root canal treatment, the position of the natural tooth can be retained. This prevents the adjacent teeth from shifting, and cavities and gum problems from occurring. In addition, stave off the loss of dental bones after extraction; hence not affecting one’s facial structure and the stability of dentures.
He added on that patients who have other medical conditions such as heart disease, diabetes, tuberculosis and hemophilia should not have their teeth extracted to reduce the risks involved.
Dental implants and bone grafting
Dr Edwin Heng said that, during the course of treatment for periodontal disease, some patients may require dental implants. Patients with a missing tooth or several missing teeth can choose dental implants, which is both an aesthetically pleasing and functional solution.
Dr Heng explained that regular dental visits prior to dental implant placement are essential. A dental implant is a titanium screw manufactured to mimic the cylindrical shape of your dental root, and inserted into the missing tooth site with a minor surgical procedure.
“Three to five months later, when dental implant root has integrated with the jaw bones, a dental crown will be placed.”
Dr Heng said that as some patients have severely receded jaw bones, before undergoing dental implants, bone grafting will be required. “We will place the patient’s, donor’s, animal or man-made bone graft materials underneath the gums and allow the bone graft materials to integrate with the body tissues. Six month later, after the wound is completely healed, the dental implant will be placed.”
He added that as a result of continual receding from the jaw bones, elderly patients who have dentures often complain of loose dentures and often have to change a new set every three to five years.
Dentures fitted on the upper jaw are held together by a suction piece and does not loosened easily. However, should dentures on the lower jaw not have enough natural teeth to hold the piece together, then patients will experience difficulty chewing; and after sometime, as the jaw bone recedes and the nerves are exposed; extreme pain.
Now, the dentist can place two implants in the patient’s lower jaw bone to assist in supporting the dentures, hence resolving the problem of having loose dentures.
Dr Edwin Heng is a Dental Specialist in Periodontics at Specialist Dental Group®, Gleneagles. He was awarded the Singapore Armed Forces (SAF) Postgraduate Scholarship and was also attached to the prestigious Harvard University School of Dental Medicine as a Visiting Adjunct Faculty. Dr Heng has a special interest in teeth hypersensitivity, esthetic gum surgery and dental implants. For more information, visit www.specialistdentalgroup.com
Source: © Singapore Press Holdings Limited. Reproduced with permission