Tooth Loss

Tooth loss is one of the traumatic events in anyone's life. A tooth is a living organ; an it's loss is a loss of an organ; albeit a small organ.
The effects of tooth loss are far reaching and contrary to popular belief; loss of one tooth (except wisdom teeth perhaps) can cause a cascade of events that alters the harmony of dental functions.

Let's first list the functions of teeth:
1. Biting and chewing food.
2. Speech.
3. Aesthetic functions.
4. Preserving the integrity of the jaw bone.

Tooth loss can affect some or all of the mentioned functions depending on the type and number of teeth lost.
1. Biting and chewing: It has been proven that the loss of one molar reduces the chewing efficiency by 10%. If you have one or more molars missing on one side of your mouth for example; you would find yourself chewing on the side with most molars present as the food is chewed more effectively when there is a larger surface to grind it.
If you have one or more of your front teeth missing; your biting shifts to the side with more incisors; you start biting on one side, or just cut your food into small pieces to be able to chew.
Indigestion and stomach problems could develop as a result of swallowing partially chewed food as your chewing capacity reduces; which further complicates your choice of food. Hence; the fewer the number of natural teeth you have; the more selective and limited you become in your choice of food.
Remember; if you even have false teeth; for example a part denture to restore some of your missing teeth; you would find that in most cases; you prefer to chew on your own teeth as you can feel the texture of the food better.

2.Speech: Loss of one molar would not affect your speech much; but the more teeth you lose; the more your speech would suffer; especially when you lose a front tooth. Just see how it affects the speech of children when they start losing their front baby teeth. And remember that false teeth- unless they are fixed- would alter your speech even more initially until you get used to them.

3. Aesthetics: Tooth loss can alter the appearance dramatically; as you lose back teeth; you start smiling less to hide the gaps which appear when you smile fully. The effect is more dramatic when you lose front teeth of course. Losing many molar teeth will reduce the support to your cheek muscles and will cause them to sag in producing an aged appearance.
Furthermore; when you lose back teeth; you start chewing on the front teeth; as these teeth are not designed for chewing (thin enamel and small roots); they start to wear down rapidly; or change position (move forward creating spacing and buck-tooth appearance). Wear causes your upper and lower jaws to move closer together when you close your mouth; therefore creating an aged appearance. Movement could cause looseness of the teeth and their eventual loss due to overloading.
4. Preservation of the jaw bone's integrity: The jaw bone is present to support healthy teeth; when teeth are lost, the supporting part of the jaw bone disappears. This process is progressive and does not stop; it is more rapid in the first 6 months after tooth loss; however it continues at a slower pace over time. When the supporting bone reduces in volume; replacing the missing tooth or teeth with an artificial restoration becomes more and more difficult; and sometimes; sadly; impossible. Take for instance full denture wearers; some of whom have to endure the movement of a loose denture as the jaw bone is so small that nothing could be done to make their teeth more retentive.
Also; when the jawbone reduces in volume; it alters facial appearance dramatically.

Effects of tooth loss could be summarised as:

1. Physical effects: Alteration of chewing ability and speech. In some cases indigestion; stomach problems and malnutrition. Headaches and clicking of the jaw joint are not uncommon as the harmony of the whole dentition is altered leading to tooth movement and the creation of an uneven bite. This leads to jaw joint dysfunction which brings about clicking; headaches and migraines.

2. Psychological effects: Tooth loss causes people to be continuously conscious of their appearance and their reduced chewing ability. The psychological trauma of tooth loss could in some cases lead to clinical depression. Due to the effect on facial appearance, the diminished ability to smile fully with confidence; and altered dietary habits; some people do not socialise often and become reclusive.

Recent advances in preventive and restorative dentistry has made the prevention of tooth loss possible; and if teeth are lost for one reason or the other; the replacement teeth could be as natural as possible; and as durable as possible. This is fantastic news for those who are losing or lost their teeth and would love to eat comfortably and smile again with confidence!

In the next posting; I will discuss the traditional and most up to date methods for replacing missing teeth. The science and technology has improved so much so that even if you are missing all your teeth; you can have fixed teeth in one day!

Thank You for reading and see you next time!

Sam Mohamed

No More Gum Bleeding

Hello again.

Last time we talked about the real cause of gum disease; and that it is a preventable condition. To have healthy gums you are required to have as little plaque deposits as possible; therefore; effective mechanical cleaning of all the tooth surfaces is the only way to prevent gum disease and get rid of gum bleeding completely.

Mechanical cleaning include:

a. Periodic professional cleaning, i.e. visiting the dentist regularly and perhaps having a session with the hygienist every 3-6 months for plaque/tartar management and review of any problem areas. Here you also obtain valuable advice on the appropriate home care routine that is suitable for you.

b. Home care: Home care must be regular, systematic and follows a certain routine that would remove all soft plaque deposits from all surfaces of all teeth. Plaque mainly accumulates around the neck of the tooth, i.e. that part that meets the gum; and between the teeth. It is mainly between the teeth that the most plaque activity exist and where gum disease (and cavities) start.

I shall explain the two fudamental ways (correct brushing techniques, and interdental brushing) of effectively removing plaque from all the tooth surfaces simply and correctly in a few seconds; but first let's try to answer some very common questions:

1. Is a hard toothbrush better than a medium? You should not be using a hard toothbrush at all; it is not the hardness of the toothbrush that effects the cleaning; it is mainly the technique.

2. Are electric toothbrushes better than manual? Yes; if used correctly; however; you do not have to buy an expensive electric brush if you know how to use your manual brush effectively.

3. Do mouthwashes prevent gum disease? In addition to a good oral hygiene routine; yes. However; mouthwashes alone do not prevent or cure gum disease. Overuse of mouthwashes could be harmful and many brands cause staining of teeth and tongue.

Effective Brushing Technique

Scrubbing your teeth with your toothbrush (manual or electric); cleans your teeth; however scrubbing causes wear of the enamel at the necks of the teeth which create wedge-shaped grooves that are sometimes sensitive. Moreover; this traumatic way of brushing causes gum

recession (see picture above).

The correct way to brush is a much recommended technique called Modified Bass Technique, please click on the following link to play a video describing the technique.

http://www.youtube.com/watch?v=bR7rPFuyeBE&feature=related

After watching this video; please brush your teeth using this technique twice a day for one week. Then post your comments on the blog an let me have some feedback on how you are getting on.

Effective Cleaning Between The Teeth

(Interdental Cleaning)

Cleaning between the teeth is just as important as brushing with your toothbrush. As I mentioned before; your toothbrush (electric, ultrasonic or manual) cannot get between your teeth to effectively clean the plaque off. Flossing is effective if carried out correctly; however; in my experience; most patients would not floss regularly for many reasons; a few to mention here:

a. I have to use both hands and I have a small mouth.

b. Not easy to get between the back teeth.

c. It gets stuck.

d. It makes my gum bleed.

Well; enough excuses!!! The above picture displays some "interdental"brushes; there are many brands available; however, you need advice from your dentist or hygienist on which brand and which size or sizes are suitable to you (as the gaps between your teeth can vary in size across your moth).

Technique:

Used like a toothpick, you simply insert the brush gently between your teeth, under bridges, between crown or veneers; and move it gently in an in and out fashion about 4-5 times. You then pull it out; wash it and move to the next space and so on till you finish cleaning between your teeth. No toothpaste required.

Initially; you may find some bleeding and the gums may be sore; this is due to the inflammation that the plaque caused, so do not panic and do not stop; it should get better in a few days as the inflammation subsides and the gums firm up.

Again; please post your comments after following this routine for a few days. And remember; you need to visit your dentist regularly as without professional advice; you may still be at risk of gum disease.

This brings us to the last blog on gum disease. In the next series; I shall talk about tooth loss, its effects and how teeth are replaced.

See you soon

Sam Mohamed

Using interdental brushes once every evening is sufficient, and it is advisable to use it before you use your toothbrush.

Gum Disease Explained

Gum disease is a preventable condition in most cases. However; it needs to be diagnosed first. As it was mentioned in the previous posting; gum disease is relatively silent and may not cause any significant symptoms. Strangely enough; the most common symptom of gum disease mostly overlooked by many; and sometimes considered as "normal"; is bleeding gums.
Bleeding when brushing or spontaneously; is never normal. Imagine rubbing your skin or eye then discovering that this lead to some bleeding; would you consider this normal? Would you just overlook it, and consider it as "one of those things that happens from time to time"? Hardly.
Gum tissue is naturally tough; as it must resist the trauma of heat and cold; rough and tough foodstuff, brushing and many other stimuli. Gum bleeding is a sign of inflammation caused by bacteria present in the plaque that accumulates around the gum tissue, and not effectively removed by regular homecare.
The enzymes and toxins secreted by the plaque bacteria cause damage that starts the process of inflammation; which in turn changes the natural toughness of the gum tissue. As a result; and in response to the attack by plaque bacteria; the tiny blood vessels in the gum tissue start to open up to increase the flow of blood which contains the necessary defense cells. The gum tissue becomes swollen and bleeds easily and profusely to minor trauma e.g. brushing and chewing.
Surprisingly; many people; when experiencing bleeding gums; think that brushing lightly; brushing with a soft brush; or even not brushing at all would stop the bleeding! Indeed it may; but not because the cause of the bleeding has been eliminated; the plaque will still be there and the damage that it is causing would certainly continue.
Now; you may think that I am assuming that you do not brush your teeth! I never said that; in fact I know you do, may be once , twice or even more per day; however; this does not mean that you are "cleaning" all the plaque off. Most of us; including myself; when we were young; were given a toothbrush and toothpaste and were asked to brush twice a day; and that was it! No one showed us how to "clean" the plaque off; in fact no one showed us what the plaque looks like! Much like giving someone a hairbrush and asking them to brush their hair and make it tidy without a mirror in sight! And expecting a good job!
Most people brush; most people use toothpaste; most people use mouthwashes; but most people expect these things to do the job of cleaning the plaque off! The sad fact is..they won't. It is you who can clean the plaque off and prevent gum disease from causing irreparable damage. If you do not have gum disease; you would most certainly not lose any teeth; and you would not spend a lot of money on your dental care!
In the next posting; I shall be summarizing the signs and symptoms of gum disease; and explaining how you could effectively clean the plaque off; improve your gum health; and prevent the incidence/recurrence of gum disease.

See you soon.
Sam Mohamed

Gum Health Matters

Hello again and welcome to my blog.
The main aim of this blog is to provide a comprehensive guide to dental health; with free advice for all ages and in all dental matters. From time to time I shall feature interviews with some dental care professionals about a certain dental topic which I think is of interest to you. I would also be happy to receive comments and questions about any dental health matters; However; I would not comment on any treatment carried out by other dentists or provide a second opinion; I shall give honest, down to earth, free of jargon advice and that is a promise!

I thought long about the next point; and decided it should be gum health. because if you have healthy gums; the chances are that you have good, and healthy teeth. So here goes:

GUM HEALTH:
Healthy gums are the foundation of healthy teeth. The gums form the first barrier against mouth bacteria which; in sufficient amounts; could cause advanced gum disease and eventual tooth loss.



So; How does gum disease start; and what causes it?

Well; gum disease is caused by plaque bacteria mainly. Plaque is a film of bacteria and other substances which cling to the tooth surface. If plaque is left unremoved; it increases in thickness and the bacteria increases in number. Bacteria inside the plaque film are very toxic to gum tissue; and the first sign of gum disease is gum bleeding when you brush or spontaneously. Gum bleeding is not caused by brushing; it is caused by plaque bacteria secreting toxins and causing gum inflammation.

At this stage; getting the right advice on the appropriate brushing technique in addition to cleaning between the teeth (not with a toothpick!); and following the advice; is sufficient to remove the plaque film and reverse the inflammatory process. This will reduce or eliminate bleeding and return the gum to excellent health. This is the stage of gum disease that dentists call gingivitis.
Gingivitis is preventable and easily treated; you only need to visit your hygienist or dentist regularly to get advice on how to keep your teeth plaque free and your gums healthy and comfortable.

In the next posting, I will be discussing the advanced stages of gum disease; their causes and the ways to prevent their occurrence; and possible ways of managing advanced gum disease; it is worth remembering that without professional help and advice; gum disease could progress quite rapidly and eventual tooth loss could be the result; it is also worth noting that without professional advice and treatment; over the counter remedies alone would not work.

See you soon.

Sam Mohamed

Dental Phobia - The Fear Factor

It is a fact that many people are still frightened to go to the dentist but dental phobia is the main cause of deteriorating dental health.

In this article, I shall attempt to discuss the origins of dental phobia, and to explain how you can overcome such an uncomfortable and distressing condition.

Causes of dental phobia:

1. Uncomfortable or traumatic past dental experience:
The most common cause of dental phobia; and it is thought to be the most difficult to overcome if it happened in early childhood and contributes to a deep-seated fear of dental intervention.

2. Lack of communication:
Anxious dental patients need continuous explanation and reassurance.

If adequate time is not taken to explain, respond to concerns and answer questions; patients often become disillusioned, confused and unsure about the nature and outcome of treatment.

Consequently, anxiety and fear increase to the extent that the patient would not return to the dentist, or visit any other dentist!

3. Invasion of personal space:
The mouth is a body cavity; it is an intimate personal space, therefore, some individuals feel extremely anxious about a very close “invasion” of such a personal space.

4. Fear of needles:
Also known as needle phobia. Individuals with needle phobia will not seek dental treatment, as they are frightened of the dental injection (or any form of injection).

5. “I let my teeth deteriorate, I am ashamed of them, I think I am going to have false teeth”:
Some patients who neglected their dental health for reasons other than fear (demanding work, caring for children, elderly or disabled family member..Etc.) believe that the dentist would be astonished and would remove all their remaining teeth and replace them with dentures.

These individuals have a morbid fear of losing their own teeth and having dentures.

6. Negative or exaggerated remarks from friends or relatives who may not have had a bad experience themselves!

7. Negative media coverage:
Media thrive on bad news! Isolated incidences of dental mishaps are greatly exaggerated for financial gain and space filling!


How can I overcome my fear of dentists?

First, you have to realise that there are thousands of individuals like yourself; dental phobia is like any other fear for example fear of heights or closed spaces. You are not on your own.
Second, you also have to realise that there are professionals who can help you overcome your fear. Through good communication, explanation and reassurance, your fears will tend to reduce, and you will be more in control of your anxiety.

Third, dental anxiety management techniques are now well developed and highly successful. Dental practitioners who practice anxiety management would help you overcome your fears through the administration of certain medications.
Forth, Find an understanding and sympathetic dental practitioner. Usually you would sense the mannerism in the practice from the front desk. If the atmosphere is welcoming, relaxed and courteous, and the staff provide you with enough information and respond to your enquiries; the chances are that you are in the right place.

Fifth, let the staff and dentist know of your dental anxiety, and enquire if they do anxiety management techniques.

Finally, I have to assure all of those who are reading this article and suffer from dental phobia, that help is available, it just takes this first step; making contact, and you may be surprised how confident and comfortable you will feel afterwards!

Here’s to excellent dental health!

In the next article, we shall discuss the value of a great smile and how you can have the smile you always wanted!