Diabetics and Periodontal / Gum Health

• Periodontitis is a common chronic inflammatory disease characterized by the destruction of the supporting structures of the teeth. It is highly prevalent.

• Epidemiological data confirm that diabetes is a major risk factor for periodontitis. There is a clear relationship between the degree of hyperglycemia (high blood sugar levels) and the severity of periodontitis. There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycemic control.

• Incidences of macro albuminuria and end-stage renal diseases are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis compared to diabetic individuals without severe periodontitis.

What is periodontitis?

Periodontitis is a broad term and for the purpose of simple definition it is inflammation of the gum and supporting structures (including underlying bone).It takes into account the clinical presentation, age at diagnosis, rate of disease progression, and systemic and local factors that may increase risk.

Periodontitis is a slowly progressing disease but the tissue destruction that occurs is largely irreversible and is divided broadly as:

1.Gingivitis: where the inflammation is confined to the gingiva(gums), and is reversible with good oral hygiene

2. Periodontitis: where the inflammation extends and results in tissue destruction and alveolar bone resorption(that is underlying bone).

3. Periodontal Pockets:Tissue destruction in periodontitis results in the breakdown of the collagen fibers of the periodontal ligament(fibrous  attachment of tooth to bone) resulting in the formation of a periodontal pocket between the gingiva and the tooth.

4. ‘Pockets’ are not evident on simple visual inspection, and assessment using a periodontal probe in dentist’s office is essential. In the early stages, the condition is typically asymptomatic; it is not usually painful, and many patients are unaware until the condition has progressed enough to result in tooth mobility. The pockets deepen as a result of the further destruction of fibers of the periodontal ligament and the resorption of the alveolar bone that occurs parallel with the progressing attachment loss.

5. Advanced periodontitis is characterized by gingival(gum) erythema(redness) and edema(swelling), gingival bleeding, gingival recession, tooth mobility, drifting of teeth, suppuration from periodontal pockets, and tooth loss.

Associations between diabetes and periodontitis

•  Diabetes has been unequivocally confirmed as a major risk factor for periodontitis. The level of glycemic control is of key importance in determining increased risk. The majority of research has focused on type 2 diabetes mellitus as a risk factor for periodontitis, probably because both diseases have historically tended to develop in patients in their 40s and 50s. However, type 1 diabetes mellitus also increases the risk of periodontitis, and all patients with diabetes (including children and young adults) should be considered to be at increased risk of periodontitis..

•  Dentists have long been aware of the importance of a diagnosis of diabetes in their patients, and various oral conditions are associated with diabetes, including xerostomia and candidal infections as well as periodontitis.

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       • People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk.

·     • Research has suggested that the relationship between diabetes and periodontal disease goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

·      • Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with high blood sugar. This puts people with diabetes at increased risk for diabetic complications.

Clinical signs of periodontitis:

•  Increased redness of the gum tissues along the teeth is a classic sign of gingivitis, a condition that indicates that there is an active inflammatory response to bacterial infection.

• The use of a toothbrush or a toothpick to gently touch the gums of diabetic patients with inflammation will provoke bleeding that will cease within minutes. Dentists always suggest a thorough dental examination if such bleeding is common throughout a patient's mouth.

• The presence of white or gray deposits on teeth suggests that dental treatment may be necessary.

•  Spacing between upper front teeth and mobile teeth are other signs of periodontitis.

Conclusion

Patients with diabetes are usually poorly informed about the relationship between periodontitis and diabetes. Therefore, health care providers of patients with diabetes should be aware of this link and inform their patients about the need for good oral health.

Referral of patients with uncontrolled diabetes for a dental evaluation and periodontal treatment may result in better control of blood glucose levels.

Diabetic patients should therefore get routine dental check updone at least every six months.

Author: Dr Justin Jacob

WISDOM TEETH

“Wisdom teeth” are the four permanent adult molar teeth located at the back corners of your mouth on the top and bottom. These teeth are usually seen to erupt in the late teens or early 20s and may need to be removed based on your dentist’s recommendations. Wisdom teeth are called wisdom teeth because they come through at an age when one is said to get wisdom or become mature. For some it comes and goes without event; for most, as is frequently seen in the dental office the eruption of wisdom teeth can become a problem as they can cause crowding in your mouth, erupt in the wrong position, or become impacted.

How many wisdom teeth does one have?

There are usually four.

Can we extract all four together at the same time?

It is possible to extract all four under general anaesthesia if one does not have any other major health issues.

One can extract upper and lower teeth on the same side on the same day if one is up to it and does not have any major health issues.

Do we need x-rays/other diagnostic tests before tooth extraction?

An X-ray is always recommended before a third molar extraction as your dentist will be able to assess the root morphology, level of the tooth in the mouth, proximity to sinus or nerve and difficulty of the tooth extraction beforehand.

In some cases, a CBCT is advised to get a three-dimensional view of the tooth. Sometimes your dentist finds in the x-ray close proximity of the nerve to the tooth, in such cases that warrants a cbct which helps in giving a clearer picture of the position of the mandibular canal to tooth.

What Are the Risks for a Wisdom Tooth Extraction?

While most wisdom tooth extractions don't result in long-term complications, problems can occur after the procedure:

• Dry socket is when the post-surgical blood clot dislodges from the surgical wound (the socket) and exposes bone below. Dry socket can be painful and delay the healing process.
• Trapped food particles or bacteria cause infection in the socket.
• Sinus issues due to inflammation.
• Nerve damage to the lower lip, tongue or chin.

Why it is necessary to get wisdom teeth removed?

A wisdom tooth is extracted to correct an actual problem or to prevent problems that may come up in the future. Some of the problems that can occur when wisdom teeth come in are:

Your jaw may not be large enough for them, and they may become impacted /jammed in and unable to break through your gums.

Your wisdom teeth may break partway through your gums, causing a flap of gum tissue to grow over them. Food and germs can get trapped under the flap and cause your gums to become red, swollen, and painful. These are signs of infection.

More serious problems can develop from impacted teeth, such as infection, damage to other teeth and bone, or a cyst.

One or more of your wisdom teeth may come in at an awkward angle, with the top of the tooth facing forward, backward, or to either side.

What Happens During Wisdom Teeth Removal?

Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anaesthetic -- the same type used to numb a tooth prior to having a cavity filled. If you have had any prior instances of local anaesthetic allergic reactions, inform your dentist.

In most situations, as the tooth is impacted, surgical removal of the tooth is likely to be done.

Your dentist will make a cut in the gum tissue to expose the tooth and bone and thereby make access.

In some cases, bone needs to be removed that blocks access to the root.

In some instances, sectioning the tooth in two or three pieces for easy removal is done as the tooth might be excessively angulated or bulky.

Then the tooth is removed.

What are the Post-surgical instructions to be followed?

• Most people have little to no pain after surgery. You'll likely have swelling and mild discomfort for 3 or so days. Your mouth may need a few weeks to completely heal.
• Place an ice pack externally over the surgical site to help reduce swelling.
• Your dentist will prescribe antibiotics and analgesics to help in the speedy recovery and healing of the site.
• Avoid hot foodstuffs and forceful spitting.
• Brushing of the extracted site should be done only after 24 hours and gently.
• Saltwater gargling or rinsing with a mouth wash after 24 hours will help in the healing process.
• Also, an important and overlooked factor to consider is practicing some effective and easy mouth exercises like the opening and closing of the mouth to allow a three-finger mouth opening. This helps to prevent stiffness (trismus) of the jaw muscle.

The amount of discomfort will depend on how easy or difficult it was to take the tooth out. It is best to stay fairly quiet and relaxed for 24 hours afterward to make sure there are no bleeding problems. There may be stitches to help the gum heal over. Your dentist will probably want to see you again about a week later to check on the healing and to remove any stitches.

What are the likely complications?

Contact your dentist if there is

• Pus oozing from the socket.
• Pain or swelling not subsiding even after three days.
• Excessive bleeding after 24 hours. Remember a slight amount of bleeding is likely to be seen on the first day after extraction which is normal.
• Difficulty in swallowing.

Always remember just as none else has your thumbprint, no two mouths are alike. Therefore it is always best to get your dentist’s advice instead of taking well-intended advice from others.

Author: Dr.Justin Jacob

FOOD IMPACTION

Food impaction is one of the common complaints seen at the dental office. A good percentage of patients present with this complaint.

What is Food Impaction?

Food impaction is the forceful lodgment of food particles into the gums. Continuous food impaction into the gums causes gum diseases, gum abscess, and tooth decay. This is felt especially after a meal, the tiny food particles get stuck in between teeth and do not rinse off easily. It gives an uncomfortable feeling between the teeth and causes irritation in the gums.

What are the causes of food impaction to occur?

• Hidden tooth decay, that is decay or cavity seen in between teeth
• Broken down or faulty fillings
• Irregularly aligned teeth or crowded teeth.
• Preexisting gum disease.

What are the symptoms of food impaction?

• Difficulty and pain while chewing.
• Gum irritation.
• Swollen and spongy gums.
• Nagging pain in the area.
• Bleeding in the gums.
• Food does not rinse off easily.
• Foul smell in the mouth.

How to treat food impaction?

• Getting cavities restored or filled to its proper shape and form.
• Replacing faulty and broken down fillings if damage to the tooth/teeth is extensive, crown /bridge needs to be done for the tooth /teeth.
• Getting orthodontic treatment to correct teeth alignment or order.
• Regular annual scaling or cleaning of teeth.
• Proper oral hygiene techniques to be followed. Learning proper brushing technique, use of interdental brushes or dental floss as instructed by your dentist.
• Get regular half-yearly or annual checkup is done at your dental clinic

Author: Dr.Justin Jacob