Advances in technology can make dental problems less traumatic, writes Anjana Jha
In 2007, a report published by the Ministry of Health in collaboration with the World Health Organisation revealed the emergence of oro-dental diseases as a considerable public health problem in India. While about 50 per cent of schoolchildren suffer from dental caries, more than 90 per cent of adults have periodontal problems. Dental problems are, in fact, one of the most common health concerns, especially among silvers — the highest percentage of tooth decay is seen in the 65-plus generation. A survey on consumer usage and attitudes conducted across 233 cities in 2005 by Synovate India, a global market research company, attributed this to low awareness levels and poor oral hygiene habits.
Root of the problem
Besides serious oral and dental infections, lack of regular oral care causes nutritional problems. With age, gums begin to recede and expose the roots of teeth. This causes cavities, leading to infection and tooth decay. Poor oral care — often owing to difficulty in arm, wrist or hand movement — also facilitates accumulation of food debris. The plaque build-up secretes acids that can cause gum disease and make teeth unstable. While tooth fractures become common with age, dry mouth is another major dental problem faced by silvers. With age, the production of saliva reduces. Saliva helps re-mineralise damaged dental enamel, and it is a natural mouth cleanser. By checking the growth of bacteria, saliva reduces acidity of waste products and limits dental decay. Dry mouth can also be caused by cancer therapy, medications like diuretics, antihistamines and antidepressants, or diseases. However, contrary to common belief, losing teeth is not a characteristic of ageing. Tooth decay and gum disease are key factors leading to tooth loss at every age.
With bacterial processes damaging major components of teeth — the enamel, dentin and cementum — there’s progressive breakdown of tissues, causing cavities known as dental caries. “Worldwide, dental caries are one of the most common diseases,” says Dr Anupama, cosmetic dentist at Chennai’s Dentistree International Dental Hospital. “Cariogenic bacteria-producing acids from consumption of sugars cause local demineralisation of tooth surface. Early caries may not have any symptoms. But when the decay proceeds beyond the enamel, the teeth become more sensitive to sweet food, hot and cold food and beverages, and even hot and cold temperatures. After common cold, it is the second most common disease in India.”
Of different types — surface, inter-dental, pit and fissure, cervical — caries may initially appear as a small chalky area and then develop into a large
cavitation. Though directly visible at times, radiographs are required to detect it if located in more concealed areas. According to Dr Anupama, besides regular check-up, oral hygiene and dietary modifications like reducing sticky, starchy and refined foods can help keep caries at bay.
» Ensure daily oral care
» Heed signs of dental problem
» Keep mouth moist
» Have an annual check-up
Dental restoration can be either direct (fillings) or indirect (fabricated inlays, onlays, crowns, bridges, veneers). Different materials are used for filling: amalgam, gold, composite resin, glass ionomer cement (GIC) and porcelain. Though one of the most commonly used material for direct restoration, amalgam tends to expand with age, corrodes teeth and requires repair and filling replacement. Composite resins match the colour of natural teeth and bond well. GICs bond well, release fluoride for a long period and do not require layering like composite fillings.
Root canal treatment
Root canal treatment (RCT) becomes necessary when dental caries are very deep and reach the pulp of the tooth. In this restoration technique, the pulp of the crown and the root is replaced with inert materials. Besides protection from future microbial invasion, it helps retain the natural tooth. RCT involves a sequence of treatment, though advances over the past decade or two have reduced the duration.
Crowns and bridges
A crown is a cover placed over the tooth and is used when a filling either fails to strengthen the tooth or replace the lost structure. It is usually made of zirconium, as the material has the translucency of natural teeth, great wear-tear resistance and is most biocompatible. A bridge, also called ‘fixed partial denture’, is used to replace a missing tooth and requires the support of neighbouring teeth. While bridges can be made of porcelain fused to metal (PFM), ceramic or zirconium, PFM is mainly used for posterior teeth and ceramic and zirconium material preferred for anterior teeth.
“The most common cause of losing teeth is not caries but the silent killer called periodontitis [gum disease],” says Dr Anupam Sinha, consultant orthodontist at Orion Orthodontic and Dental Care Centre at Sukhda Hospital in Delhi. “This is an inflammatory disease affecting the tissues surrounding and supporting the teeth. It involves progressive loss of the bone around the teeth; if left untreated, it can lead to loosening and subsequent loss of teeth.” According to Dr Sinha, while plaque builds up on teeth allowing bacteria to develop, calculus (calcified plaque) allows the bacteria to flourish with more plaque build-up, leading to inflammation of the gums called gingivitis. This makes the gums appear swollen and red in colour, and usually causes bleeding of the gums while brushing or eating (especially fruits). Over a long period of time, gums detach from the surface of the teeth, causing what are commonly called pockets. This permits greater food accumulation, calcification, bad breath and eventually develops into periodontitis or gum disease.
In severe periodontitis, flap surgery (periodontal surgery) is advised. This procedure removes the source of infection (calculus and necrosed bone tissue) and covers an area of exposed tooth root surface with grafted tissue. Covering exposed root decreases or eliminates sensitivity, decreases susceptibility to root caries, and improves aesthetics by reducing mobility of teeth.
» Brush your teeth regularly (after every meal, if possible) to remove food debris and plaque.
» Use a small-headed brush to reach hard-to-access corners of the mouth.
» Opt for a soft-bristle toothbrush. Hard bristles damage tissue and cause gums to recede.
» Replace the brush every three months or even sooner if the bristles begin to fray.
» Choose good toothpaste that will help remove tartar and reduce its build-up.
» Floss daily to clean the crevices and gaps between teeth.
» Use a toothbrush or tongue-cleaner to keep the tongue clean.
» Swish a mouthful of water to remove food particles lodged in the teeth after eating.
“Dentures are removable replacements for missing teeth,” says Dr Anuradha Bose, consultant dental surgeon at Kolkata’s Apollo Clinic. “Of two main types — complete and partial — they are typically made of acrylic resin, incorporating porcelain or, at times, metal for additional structural support. Dentures help strengthen expression-controlling muscles that require support of teeth, eliminate pronunciation problems and assist in chewing.”
A meeting with your dentist will help decide whether dentures are the best option; often, dental bridges or implants may be more suitable. The procedure for fixing dentures begins with a wax bite impression of the mouth. After a try-on appointment to fine-tune colour, shape and custom-fit, the final dentures are fabricated. In some cases, extraction of some teeth or surgery may be necessary to improve the bony ridges that stabilise dentures, explains Dr Bose. A complete denture is given to patients who have lost all their teeth whereas a partial denture is a treatment for those who have lost some teeth. Partial dentures can either be made of cast metal or acrylic. Cast metal partial dentures fabricated using metal framework with higher grade denture teeth are stronger, less bulky and offer the best fit. More affordable and bulky, the acrylic partial denture, is attached to natural teeth with small metal clasps.
The main advantage of complete dentures is that it helps the patient to chew and speak properly, restores appearance to a certain extent and makes the patient feel more confident. However, dentures accelerate the ageing process of the face as the distance between nose and chin begins to decrease as soon as natural teeth are extracted. Owing to bone loss, the denture tends to become loose and needs to be realigned.
Mini dental implants
The lower denture often presents difficulty for patients adjusting to dentures for the first time or even experienced denture wearers. Recently, a new procedure called Denture Stabilisation System to secure the lower denture has been introduced; it is referred to as Mini Dental Implants (MDI). It consists of a miniature titanium implant that acts like the root of the tooth and a retaining fixture that is incorporated into the base of the denture. A one-step procedure, it involves minimally invasive surgery with no sutures. “A discussion about dentures cannot be complete without mentioning overdentures,” says Dr Bose. “Unlike a regular denture, where all the teeth are removed, some natural teeth are retained in an overdenture and used to anchor the denture. This fends off bone loss and provides a more stable denture.”