Bite Point

Gum Tissue *Is* The Issue!

 

Yes, we cannot focus on the teeth and forget about the gums.  There are something like 160,000 dental hygienists in the US who would all get very upset with me if I didn't discuss the health of our gums!

Gum Disease- Periodontal Disease in our technical lingo- is a painless bacterial infection of the gums and bone around the teeth. This infection can destroy the bone around your teeth.  Periodontal disease has been known to create certain health risks.  Good "periodontal health" is a key component of a healthy body.  A periodontist is a specialist within dentistry who treats gum disease and, in many cases, places implants that replace missing teeth and bone.

It takes three things for peridontal disease to happen.  We need a "host", that's the person.  We need germs- there are around 14 different types that can potentially cause periodontal disease in humans.  At least, that's as of the last time I spoke to one of my academic friends about it- they keep re-naming the germs every time I turn around.  I'm told that there are excellent reasons for this re-naming process having to do with DNA sequencing and the better understanding that it gives to the classification of bacteria, but sometimes I suspect that there are conferences in Gstaad, Switzerland where periodontal researchers ski and drink beer until the wee hours of the morning and then say, "Let's play a cruel joke on the dental students and rename all of our bacteria..."

Sorry for the digression!  So, the third thing that is involved in periodontal disease is that pesky biofilm that you may recall from our discussion of cavities.  To recap: “A biofilm is a structured community of microorganisms encapsulated within a self-developed polymeric matrix and adherent to a living or inert surface.”

So we have germs inhabiting a biofilm around the roots of the teeth in a person.  If the person's immune system is susceptible to some of the different types of germs then a great deal of inflammation results in a little band of tissue around the neck of each tooth.  The inflammation acts up, then calms down, then acts up again and goes through these cycles many times until the jawbone is damaged and even, to an extent, lost.  At later stages of this process, loose teeth and receding, bleeding gums can result.  We mustn't be lulled into complacency by either the small size of that band of gums, or the lack of pain during the early and middle stages of this process.  Periodontal disease can be devastating to one's appearance, ability to taste and chew, and even to one's overall health.

Here's how periodontal disease affects overall health:

-18% of all preterm low birth weight babies are attributable to periodontal disease.

-There is a correlation between cardiovascular incidents (heart attacks, strokes) and periodontal disease.

-There is an even higher (but as yet not fully studied) correlation between pulmonary disease and gum disease- because patients with this condition are aspirating harmful germs into their lungs 24x7.

Genetic susceptibility is very important to consider.  It turns out that 65% of the population are fairly resistant to periodontal disease.  This does not mean that we should be complacent; if the system is overloaded, so to speak, with vast amounts of tartar and the mouth is not clean, then gum disease will still occur.  There are then 35% of the population that are susceptible to periodontal disease, 15% being highly susceptible.  Dr. Sam Low of the University of Florida classifies patients as "Green Dots" and "Red Dots", referring to the stickers that they place on the outside of patient charts.  Bottom line: if you're a "Red Dot", you are disease-prone and you had better keep up with your "home care", the way that you clean your teeth daily on your own, and you'd better be seeing your dentist and perhaps your periodontist four times per year.  If you're a "Green Dot", then the same level of home care will still keep you free of disease, and will also help prevent cavities, ensure that food tastes better, and improve your breath.  These techniques are healthful for everyone; it's just that "Red Dots" have to be hypervigilant and will run downhill very very quickly if they go off the wagon, so to speak.

In future posts we need to discuss home care measures and risk factors like smoking.  For now please remember that periodontal disease is a preventable disease, it's one that is generally painless yet very serious (like hypertension or glaucoma), and success in fighting it is much more up to the patient than the dentist.  It's a disease of patient compliance or non-compliance, unfortunately.

And next time you're in Gstaad skiing, (I don't ski), please stop by the periodontal conference and tell them that I like the current bacterial names just fine, thank you very much.  I'm getting too old to memorize five names for the same thing!

Good deeds do, sometimes, go unpunished

 

As long as I'm on this Wilberforce and Abolitionist tangent, I'd like to point out that there are, in fact, exceptions to the old adage that "No good deed goes unpunished".  One of my favourite movies ever is 2007's "Amazing Grace".  Ioan Gruffudd plays William Wilberforce, who, as a member of Parliament, navigated the world of 18th Century backroom politics to end the slave trade in the British Empire.  He is my favourite leader of all time.  He faced such terrible odds, wrecked his health, sacrificed everything but never gave up his dream and prevailed in the end.  It took most of his life...

The movie is so very inspiring.  It also occurs to me that it is nearly impossible for us now, at the dawn of the 21st Century, to imagine the attitudes of the people at that time, and the ghastly reality of slavery and the trade in human beings.  Well, this movie brings it to life in astonishing ways.  And- before we condemn the common people of that time for looking the other way, we should remember that those times, just like ours, were complicated...

As the Abolitionist movement took hold of the British public consciousness, many people began to protest the practice of slavery and started to make changes in their own personal lives in order to "make a difference", as we say today.  Boycotting sugar was a popular protest tactic.  This was partly because conditions on sugar plantations were extraordinarily intolerable.

Let's take an excerpt from www.abolition.org for a concise explanation: 

"After Parliament rejected the Abolition Bill in 1791, abolitionists took action by sidestepping Parliament entirely and calling for a boycott on Britain's largest import, slave-grown sugar.

The Transatlantic Slave Trade flourished because a market existed for produce created using enslaved labour: rum, cotton, tobacco, coffee and particularly sugar.  The abolitionists understood that profits from the sugar they used in tea or cakes kept the Slave Trade running.

If economic pressure could be put on slave-dependent industries, then this might hasten the end of the trade.  An anti-sugar pamphlet by William Fox was published in 1791; it ran to 25 editions and sold 70,000 copies in four months.  Spurred on by pamphlets and posters, by 1792, about 400,000 people in Britain were boycotting slave-grown sugar.  Some people managed without, others used sugar from the East Indies, where it was produced by free labour.

The boycott was revived in the 1820's, as the English movement pushed for the total abolition of slavery in the British colonies.  Abolitionists also campaigned for people to stop purchasing at shops that sold sugar produced using enslaved labour and some traders used notices- similar to the fair trade notices of today- to let customers know that their sugar did not involve slave-labour.

These campaigns were primarily supported by the female anti-slavery associations, who distributed thousands of pamphlets and leaflets door-to-door, in an effort to persuade British consumers not to buy West Indian sugar.  English ceramic manufacturers responded by making sugar bowls and tea sets inscribed with anti-slavery slogans.  (see above)

Although the effect may not have been crippling to the industry, it brought together abolitionists in common cause and, at a time when only a small fraction of the population could vote, citizens (particularly women) found the power to act when Parliament did not."

Wilberforce's wife, Barbara Spooner, was one of the young English women who infuriated her parents by refusing to use sugar in her tea.

Now to the dental implications of all of this!  In the early 1800's the ability of dentistry to restore decayed teeth was very limited, to say the least.  People's smiles were often ruined by decayed, missing and heavily stained teeth and there was very little that the dentists of the time could do about it.  Have a look at any portrait from those days and compare it to modern photographs, especially photographs in American magazines!  Nowadays we see all the way back to the upper second molars, gleaming in their light-shaded beauty, when a model smiles at us.  In Pre-Victorian portraits mouths are tightly closed, even when the subject is smiling.  Oral disease was a disaster in those days.

Now consider these many Abolitionist women protesting in many ways, including boycotting sugar.  At the same time as they were taking social action they were avoiding cavities, preserving their oral health, their smile, and their beauty.  They were also reducing their chances of contracting diabetes, untreatable at the time, not to mention reducing obesity and a host of other ills.

So, as we can see, good deeds do, sometimes, go unpunished.

*Last thought- as we modern consumers are beaten upon again and again by powerful business and government interests, why is it that we, with all of our advantages of internet-driven Social Networking, cannot organize to fight back so well as the Pre-Victorians in Britain did all those years ago?

Leadership

If truth be told, a leader must first and foremost surround herself with people who want to be led, who desire to go somewhere. Bovine indifference will not do.

And- the best leaders are perceptive enough to recognize when someone in their tribe wants to lead, and selfless enough to become a follower for a time. Give me results, not ideology; give me growth, not ego.

 

 

 

(That's Ioan Gruffudd playing William Wilberforce, who, as a Member of Parliament, navigated the world of 18th Century backroom politics to end the slave trade in the British Empire.  He is my favourite leader of all time.  He faced such terrible odds, wrecked his health, sacrificed everything but never gave up his dream and prevailed in the end.  It took most of his life...)

"I'm Done!"

When someone has hurt you, or let you down, just refused to get on the train with you, the train that you think is the right one- it's very satisfying to end it, to say, "I'm done".

Of course, "leaning into The Dip" and overcoming such challenges is even more satisfying, isn't it?

 

The Resurgence of Dental Caries

“Water, water, everywhere,

Nor any drop to drink.”

    -Samuel Taylor Coleridge

 

“Sugar, sugar, everywhere,

My teeth are next to the sink.”

    -Rick Wilson, DMD

 

Cavities are back.

 

They were on the decline, you know.  What with water fluoridation, awareness on the part of parents, more people visiting their dentist regularly and realizing the benefits of prevention…  Yet at this point in time, there is so much sugar in our society, not only in foods but in liquid form, that cavities- “dental caries”, in our technical lingo- has had a resurgence that is highly upsetting to US dentists who had made such great strides in reducing it in recent years.

 

Let’s look at caries in various stages of life.  Among US children, dental caries remains the most common chronic disease from age 5 to 17.  It is 5 times more common than asthma!- 59% versus 11%.  (www.cdc.gov.Oral Health: Preventing Cavities, Gum Disease and Tooth Loss. At a Glance 2008)  Among adults ages 35 to 44, 27% have untreated cavities.   Among adults 65 and older, 30%  have untreated cavities.  These last are often particularly damaging types of tooth decay because seniors may have dry mouth due to medications or various disease processes, and this lowers their resistance to cavities dramatically.

 

What causes  cavities to form in our teeth?  When I was in school, we were taught that it was all the fault of one specific germ, name of Streptococcus Mutans.  Inhabiting our mouths as part of the normal “flora”, or complement of bacteria that live around teeth and gums, this particular strep has the singular characteristic that, as it metabolizes some of the sugars that we eat, it kicks out a spectacular amount of acid.  It’s this acid that eats away at our teeth.

 

So- we had our culprit.  But it’s not quite so simple.  Studies by Philip Marsh in the UK have shown that dental caries is a disease of the “biofilm”.  We can turn to Wikipedia for a down and dirty, so to speak, definition of a biofilm:  “A biofilm is a structured community of microorganisms encapsulated within a self-developed polymeric matrix and adherent to a living or inert surface.”  In our mouths, this unfortunately relates to saliva, plaque, foods that we have recently eaten, beverages… the whole nine yards.

 

Now, before you say “I have soft teeth” or “My sister never went to the dentist and skipped brushing and has great teeth, and I always did everything right and look at my mess!”- yes we do hear this- a lot!  Well, before you go there, there’s more- layered on top of all this- dental caries is a behavioral disease!  When it comes right down to it, it’s all about frequency- the frequency with which you ingest any kind of refined carbohydrate.  Make no mistake- even healthy foods have simple sugars in them.  A potato, broccoli, other complex starches- not too much of a problem.  But raisins, for instance, healthy as they are in many ways, contain simple sugars and stick to the teeth for a long time; they end up being more damaging than my personal favorite sweet, chocolate.  In other words, it’s not just candy.  In fact, in modern American culture, liquids are an enormous risk factor for dental caries.  Patients have presented to us with multiple, multiple cavities due to soda, of course, but also sports drinks, green tea with sugar in it…  Green tea is perhaps the healthiest thing that one could put into one’s body, but the sugar wrecks it…

 

There are ways to minimize your risk, of course.  Brushing and cleaning in between teeth after meals is of paramount importance.  Eating a mix of, say, nuts and raisins minimizes the time that the raisins can stick to your teeth- besides, doesn’t “trail mix” taste great, anyway?  Drinking water after snacks is helpful.  What you’re trying to do is reduce the time that it takes for your mouth to clear out these acids-  a half hour, under normal circumstances.  See the implications of this?  The absolute worst thing that you could do is to eat or drink in a sort of, may I say, “grazing” fashion- little bits of food or sips of drink at frequent intervals over long periods of time.  Inevitable disaster for your mouth!  Understanding that this pattern is risky  is the key.

 

A few brief additional notes here.  Diet soda is not quite so bad as regular, since aspartame does not cause cavities, but it still harms and erodes our teeth due to its inherent acidity.  “Splenda” is sucrose, table sugar, that is reversed- it’s like the molecule is being looked at in a mirror.  It doesn’t cause cavities at all because the Strep Mutans can’t recognize it as food- yet.  (I suspect that if we keep pouring potential food past these germs for enough time, in enough people, well let’s just say that our old friend Mr. Mutans will evolve and catch on.)

 

So there you have it.  Keep ‘em clean, and watch how often you indulge in all these wonderful foods that surround us in our society of abundance.  There are new preventive strategies coming out all the time, so stay tuned!

 

And- make sure that your teeth stay in your mouth, not next to that sink…  I believe that this girl has just been lucky so far!

   

                Rick Wilson, DMD