Tooth : Lovely and Bad "What A Lovely Face! Absolutely beautiful"

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It was a moment of sheer joy to see 24-year-old Saba in her bridal attire. How pretty she was looking! And yet, when she smiled, the discoloured uneven teeth .... how they marred her beauty.

The face of an individual is said to be and truly is the most important identity in his or her personality. It cannot be over emphasized that a balanced, harmonious and aesthetic face is abundantly contributed by the balance, harmony and aesthetic of the jaws and the teeth. On the other hand, for the healthy functioning of the various organs of the body, good nourishing food is required and this reaches our digestive system only after thorough chewing by the teeth. So, the teeth are important tools to be looked after and serviced well for good health as well as aesthetics.

Every one who suffers one time or the other from tooth decay or gum disease would realize the importance of proper care in this regard.

Today dentistry has become a highly specialized field of health science; having branched off into 10 recognized areas. They are Oral and Maxillofacial surgery, Orthodontics, Endodontics and Conservative dentistry, Pediatric dentistry, Periodontics, Prosthodontics, Implant dentistry, oral medicine, oral pathology and microbiology and community dentistry.

Tooth Decay

The prevalence of tooth decay (dental caries) is ever increasing with the progress of human civilization. In the olden days, people used to eat raw and fibrous food more than the cooked ones, and they used their teeth for cutting and chewing. Now, because of the trend of eating oily, soft and sticky carbohydrate types of diet, a lot of foodstuffs may remain on the tooth surface where they cause decay in presence of cariogenic micro-organisms resulting in infections.

When the mouth is not washed properly after taking chocolates, sweets and other carbohydrate type of sticky eatables, it can remain in spaces between the teeth and on the teeth surfaces and harbour millions of harmful microorganisms holding them together in close contact with the teeth. Some acids are produced as a result of fermentation of carbohydrates by the enzymes liberated by the microorganisms. The acids dissolve the tooth structure; thereby initiate the process of dental caries.

In the initial phase when cavities form, there is no pain as enamel (visible white protective covering of the tooth) is being destroyed. After that, the inner dentine layer is being dissolved and cold and hot water, sweets etc. cause sensitivity. Unlike wounds inflicted on rest of our body structure, in dental caries, it is not repaired by our body. If it is cleaned at this stage and filled with various filling materials like silver amalgam or shade matched tooth coloured materials available with the dental surgeon, the tooth can be saved from further damage.

In advanced decay, when the caries process is extended to the pulp at the core of the tooth, which is the vital center comprising the nerves, arteries, veins and lymph vessels, it become exposed to the bacteria in saliva. Pain is a pointer in this case. If the pulp exposures are very small (l mm or less) and the inflamed pulp is vital, pulp capping is done on the clean exposure site and around it. If the pulp is so damaged that it cannot repair itself, it dies and becomes a source of infection. The infection spreads through the pulp to the tissues that surround and support the tooth in the jaw. At this stage, the tooth can be saved by cleaning, medicating and filling the infected and putrefying pulp, which is called the Root Canal Therapy (RCT). Left untreated, the tooth eventually must be removed.

Gum Disease (Pyorrhoea)

Gum disease or periodontal disease is the most prevalent disease known to mankind. This disease affects the adults and children equally and it slowly grows.

In the absence of proper teeth cleaning, the food pieces remain in between the teeth and a thin, colourless sticky layer forms on the teeth. This contains bacteria in it and it is called BACTERIAL PLAQUE. When accumulated, bacteria in plaque produce many toxins, which irritate the gums and cause infection.

In the beginning, while brushing, the patient may notice some bleeding from the gums. His gums may be congested and swollen. This is the early stage of gum disease. With the passage of time, the tissue that attaches the gums to the teeth get destroyed start receding and pockets may form in them. Gums become pulpy and bleed easily with formation of pus. Eventually the irritants destroy the bone supporting the teeth. And unless treated, the affected teeth become loose. The infection from here can spread to a variety of organs all over the body, the most fatal one is bacterial endocarditis i.e. inflammation of cover of the heart, may subsequently destroy the heart valves.

Other factors increasing the risk or severity of gum disease include injury to the gums and supporting structures by physical and chemical irritants in the mouth, wrong brushing, stagnation of food particles, improper use of tooth picks, badly aligned teeth, unreplaced missing teeth, poorly fitting dentures and fillings, habits like clenching, grinding teeth and poor nutrition. In many cases, diabetes, some blood diseases, allergy and even prolonged tension can lead to this disease. In some cases, the use of oral contraceptives, anti-epilepsy drugs, steroids etc. and pregnancy can give rise to or aggravate the condition. It is always wise to tell the dental surgeon about the other past and present illness of the patient and medication in use.

When it comes to fight the caries in the teeth, it is accepted that small quantities of fluoride help to protect the teeth. The best form of incorporating fluoride into the teeth is to add it to drinking water, milk, salt etc. An optimum level of fluoride of one part per million of drinking water is sufficient. An excess level of fluoride can cause brownish discolouration of the teeth and disturbed formation of teeth and bone and sometime serious toxicity results. In such cases defluoridation is also essential.

Dental Care Tips

Avoid sugary and sticky food as far as possible. But if you do succumb, brush the teeth and rinse the mouth thoroughly after ingestion.
Maintain personal hygiene; brush your teeth at least twice a day at the morning and bedtime.
Use a fluoride toothpaste or powder, mouthwash and dental floss.
Fake adequate nutritious diet during teeth-development.
Check fluoride level in drinking water.
Avoid antibiotics like tetracycline during pregnancy and childhood.
Avoid beetle nut, tobacco, bidi, alcohol etc.
Visit the dental surgeon at least twice a year, even if you are not aware of any problems for professional advice and care.

A dental surgeon may spot early gum disease even though it is symptomless to you.

Submitted By
Dr. Ajit Patangia, BDS (IND), DDS(USA), MS (USA)
The author is a Consultant, Department of Dental Surgery.

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