Don’t gum up the works

A new edition of a 34-year-old book on gum disease – written by a veteran Israeli periodontal disease specialist – tells you all you need to know, in simple terms.

By JUDY SIEGEL-ITZKOVICH
A woman with perfect teeth chews on a lollipop (photo credit: INGIMAGE)
A woman with perfect teeth chews on a lollipop
(photo credit: INGIMAGE)
"Don’t be false to your teeth – or your teeth will be false to you,” said one American dentist many years ago. Now, Israeli dentist Dr. Sheldon Dov Sydney warns readers in a new book, Ignore Your Teeth and They’ll Go Away: The Complete Guide to Gum Disease.
The message is the same, but the proportion of people who are losing their natural teeth due to neglect – cavities and gum infections – continues to rise.
Eighty percent of all adults and 40% of all children are afflicted with some form of gum disease. Over half will lose all their teeth by age 65. Yet, he writes, the devastating effects of gum disease such as tooth loss and halitosis (bad breath) are, for most patients, preventable.
The new book is the fourth edition of the volume (since 1982) written by Sydney, who has served on the faculty of Tel Aviv University’s dental school for 30 years, headed the periodontal medicine unit at Meir Medical Center in Kfar Saba and is a longtime faculty member at the University of Maryland’s dental faculty.
The volume is the most-sold, most professionally reviewed and most recommended patient guide to periodontal disease.
Thousands of periodontists have purchased the 161-page, soft-cover volume issued by Devida Publications of Baltimore to show to their own patients.
The fourth edition was updated and expanded with a full chapter on dental implants.
The word “periodontal” comes from the Latin for “around” (peri) and “tooth” (odont). The word identifies the location of the diseases and conditions affecting the structures surrounding and supporting the teeth, Sydney writes. But “gum disease” has become the popular layman’s term for it.
Sydney notes that “significant progress has emerged since the last edition in the treatment of gum disease,” but the situation is still gloomy. “The more you understand about gum disease, the better your chances of keeping your teeth for a lifetime of healthy, beautiful smiles.”
The author notes that gum disease goes back to the beginning of mankind.
Embalmed Egyptian mummies were found with it, and ancient papyri contain significant references to the problem and suggestions for treatment. Archeological digs in Mesopotamia uncovered “exquisitely designed golden toothpicks” used for removing food deposits from between the teeth. Clay tablets from the Babylonian and Assyrian periods contain evidence of periodontal disease and the need to treat gum problems with massage plus herbal medicine.
A 4,500-year-old Chinese medicine volume included extensive discussion of oral diseases. The “early Hebrews recognized the importance of oral hygiene,” Sydney continues, and cites Talmudic writings on dental conditions.
A jawbone excavated from ancient Sidon (currently in Lebanon) and dated to 1000 BCE shows an early tooth replacement technique in which incisors were taken from another person’s mouth and held together with wire.
Among the ancient remedies proposed for gum disease were chewing unripe pears and apples and “keeping their juices in the mouth,” applying opium, honey, oil of roses, astringent mouthwashes and dentifrice powders.
When man began to explore the seas, the long voyages without fresh produce caused sailors to suffer extreme vitamin deficiencies, resulting in scurvy, which affected the jawbones so badly that sailors’ teeth would loosen, and they would slash each other’s gums to reduce pressure from pus.
SYDNEY PRESENTS anatomical drawings of the mouth and jaws and explanations of the small spaces between the teeth and bone that contain fibrous threads to hold the tooth in place. Gums (gingiva) extend from the tissues of the jaws to the “necks” of the teeth. Triangular sections you see from outside are called papilla, and when these are healthy, they are well defined and coral-pink colored. When inflamed, they are red (and often inflamed).
Warning signs for periodontal diseases include gums that bleed when you brush your teeth; red, swollen or tender gums; bad breath; gums that have shrunken and moved away from the teeth; changes in the way teeth on the top and bottom come together; pus between the gums and the teeth; and loose or separated teeth.
A biofilm (plaque) composed of bacteria is the main cause of gum disease and forms within minutes of brushing one’s teeth, the author notes. If the sticky plaque accumulates, it eventually releases toxins that lead to the destruction of the gums.
Although most people would be very worried if they saw blood oozing out of their ear or coughed up from the lungs, Sydney notes that most people with periodontal disease don’t get excited when they see blood when brushing their teeth or biting on an apple.
Gingivitis is an early gum infection and is reversible, but if left untreated by a dental hygienist or dentist becomes chronic. Pockets develop in the gums as they separate from the teeth, and food particles get stuck in them.
“Left completely alone with no effort to remove it, plaque will reach a maximum thickness of a soft, white material in about 30 days,” he writes. The bacteria accumulate and become more virulent. Gums recede, and the roots of the teeth become exposed. Then the teeth begin to wobble and fall out.
SYDNEY LISTS a variety of other gum conditions including canker sores (small, white, ulcerated spots on the inside of the lips or mouth), which are very painful, especially when one eats spicy foods. Anesthetic creams can help reduce the pain during the 10 days they last, but they are usually harmless in the long term.
Some people suffer cuts in the gums from improper use of hard toothbrushes, dental floss and toothpicks, and others unintentionally scratch gums with their fingernails.
Abscesses full of pus resulting from infections under the gum tissue from pre-existing periodontal pockets can cause pain; they can form even in healthy gums as a result of trapped food or even a piece of broken toothpick being stuck in them.
A number of medications such as those used for heart disease or to prevent seizures can affect gums, causing them to puff up.
Even allergies or autoimmune conditions such as psoriasis can affect the gums, Sydney writes.
Tobacco smoking can be the direct cause of bad breath, yellow staining of the teeth and – even worse – oral cancer.
GUM DISEASE is best treated by a periodontal specialist, that is, a dentist who received a DDS degree and then does another three years at least in the field of gum disease and treatment. When you go to a periodontist, you are usually asked to fill out a medical history questionnaire including questions on smoking, diet, medications, allergies, chronic conditions and sensitivities to drugs. The author notes that certain drugs such as oral contraceptives, anti-depressives and heart medications can affect the appearance of the gums, so the dentists should be informed in advance.
A personal dental history will also be taken down, and the periodontist will also look for abnormalities of the head and face to see if there is any external swelling or damage to your temporomandibular joint that connects the upper and lower jaw, which can cause noise and pain. The specialist will use a calibrated periodontal probe to measure the depth of the gum pockets to determine the severity of the damage.
The bite and tooth movement are checked, and x-rays are taken of the mouth.
A number of chronic medical conditions such as diabetes, osteoporosis and heart disease can affect the gums, and diseased gums can, in turn, affect these conditions. Sydney states that recent research has found a link between gum diseases and types of cancer, such as of the blood and kidneys, but this is “only an association, and this does not prove a cause-and-effect relationship.” Much more study of the matter is required, he adds.
Another association is higher levels of prostate-specific antigen (PSA), which is often a sign of prostate cancer, and gum inflammation, but again, no cause-and-effect relationship has been proven.
Chronic inflammation from periodontal disease may even cause impotence in men younger than 30 or older than 70, Sydney writes.
THERE ARE specific genetic factors that predict susceptibility to gum disease, he continues. Smokers are more likely to build up plaque on their teeth, not to mention staining and halitosis. Women’s hormonal changes resulting from pregnancy, menstruation, menopause and contraceptives can also affect the reaction of gum tissue to plaque.
Sydney tells a number of anecdotal stories about patients (whose names were changed) in the book. A young woman named Melanie who had severe fertility problems and was about to go abroad with her husband to adopt a baby arrived at Sydney’s clinic. Noting a healthy mouth but bleeding gums, he asked her if she was pregnant. She said no, that they were desperate and planning to adopt a baby. He advised that she go to get a pregnancy test, and – lo and behold – she indeed was expecting a baby.
You cannot clean your teeth too often, writes Sydney, even after every meal. He also recommends using a disclosing solution or tablet with dye that shows the presence of plaque to be removed with a toothbrush or floss. Even the tongue should be brushed periodically to remove harmful bacteria. He recommends electric toothbrushes for the physically disabled, as well as other people, and even children.
Of course, minimizing sugar intake has a beneficial effect on preventing and fighting gum disease.
Initial treatments for periodontal disease include scaling to remove plaque and planing of the roots, which may be painful so local anesthetics by injection or paste will be used.
Patients suffering from bruxism (grinding or clenching of teeth) can be helped to prevent further damage to tooth surfaces by wearing a bite guard worn at night over the teeth. Untreated, bruxism can result in headaches from constant grinding (especially during sleep) and temporomandibular pain.
Gum surgery is the next-to-the-last treatment for serious periodontal disease, and just the mention of it scares typical patients. Gum pockets can be eliminated to remove excess tissue. Surgery may also be performed on the underlying bone, which can be regenerated today for new tooth-supporting tissues. Hard tissue can be taken from elsewhere in the body or be of other human or animal origin. Synthetic materials are being used when there is no donor.
Last but not least are tooth implants, in which metal posts are screwed into the jaw and covered with crowns to look like healthy, solid teeth in the gums. They can also hold down removable partial dentures.
Sydney urges patients to maintain their healthy gums and teeth after undergoing treatment for periodontal disease so they don’t have to return for more expensive procedures. This, he concludes, “is an excellent investment.”