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The battle in your mouth.


David M. took pride in his appearance.He exercised daily, watched his weight, rarely ate junk food, and brushed his teeth twice a day. And as he had done since he was a child, he went to the dentist twice a year--only as an adult he never actually saw the dentist, just the hygienist who cleaned his teeth.

"I never got cavities,' he says, "soI thought it was a waste of time and money to have the dentist look at my teeth.'

David, age 32, now wishes he hadspent the extra time and money. Two years ago, David finally saw the dentist about a pain in his jaw. X-rays revealed an impacted wisdom tooth and moderate-to-severe periodontal disease as well.

David's case is typical, says Dr.William Wright, a senior periodontal researcher at the National Institute of Dental Research. "People don't go to the dentist for periodontal disease, because they don't know it's occurring,' he explains. "They go for some other reason, and while they are there, the gun disease is picked up by the dentist.'

David is not alone. The AmericanDental Association says three of every four adults suffer some form of gum disease during their lives. Gum disease is silent and sneaky, causing virtually no paid in its early stages. Lack of pain is one reason gum disease accounts for 70 percent of all lost teeth. By the time people discover they have gun disease, it's sometimes too late to save all their teeth.

David had thought about seeing thedentist when his gums began bleeding during brushing. "I wasn't in paid, though,' he recalls, "and a few weeks later my gums stopped bleeding. I figured that whatever the problem was, it had disappeared.'

Dr. Jerry Rosenbaum, a periodontistin Fort Lauderdale, Florida, hears such statements frequently. "A lot of people don't think anything's wrong when they see a pink toothbrush,' he says. "But gums aren't supposed to bleed. When they do, it's a sign of gum disease, and to ignore this early sign is to risk losing your teeth.'

"This lack of alarming symptomsis one of the reasons gum disease progresses,' Dr. Wright says. "There may be a little bit of bleeding, but that may cease after a fairly short period of time because the disease is going deeper down the root.'

The War in Your Mouth

Gum disease, the most destructiveof all oral disorders, is actually a group of diseases caused by bacteria that form constantly in the mouth. The prime culprit is a sticky, colorless film of bacteria called plaque.

Think of gum disease as a smallwar being fought in your mouth. When the plaque bacteria win a skirmish, they multiply, causing more plaque, which irritates the gum tissues and makes them tender, swollen, and prone to bleeding. Plaque not removed daily hardens into crustlike calculus, or tartar, which forms around the edges of the gum tissues and irritates them further. The gum's reaction to the invading bacteria is called gingivitis, literally, an inflammation of the gum tissues.

Gingivitis, an early stage of gumdisease, is the only stage that can be totally reversed by proper daily brushing and flossing, plus regular professional cleanings. But left unchecked, gingivitis may progress to periodontal disease--much more damaging to the gums and to the bone structure that supports the teeth. "The bacteria get down under the gums and start producing toxins,' Dr. Wright explains. "These toxins go into the soft tissue cells of the gum and overwhelm the local defense mechanisms--the good bacteria.'

The skirmish is now a full-fledgedbattle. To evade the bad bacteria, the gum tissues pull away from the germcoated tooth surface and form pockets in the gum that quickly fill with more plaque and calculus.

The body now tries to fight back byinflaming the area under attack. "It's a snowballing effect,' Dr. Wright says. "Inflammation is a defensive mechanism of the body to protect itself from any sort of foreign attack. Unfortunately, the inflammation destroys the microscopic fibers that hold the gum tissue to the bone and the bone to the tooth. Eventually, the body tries to rid itself of the diseasecovered tooth, which is now seen as a foreign body.' Of course, lost teeth mean the war is over--the victory belongs to the bad bacteria.


"The best way to prevent gum diseaseis to understand first that you cannot totally prevent it,' says Dr. Erwin Barrington, a professor of periodontics at the University of Illinois College of Dentistry and a past president of the American Academy of Periodontics. "Gum disease is a naturally occurring disease that is going to strike you at some time in your life. It's part of the human condition. It's not 100 percent preventable, but it is controllable. But,' he adds, "once the disease has progressed, it must be treated. It won't just go away.'

The treatment used on periodontaldisease depends on how far the disease has progressed. David had already developed deep pockets in his gums and much bone loss. His dentist recommended a nonsurgical procedure called scaling and root planing. Scaling removes the accoumulated calculus from the teeth, and root planing smooths the root and removes toxins embedded in the root surface.

"Sometimes scaling and root planingmay be the only therapy that's needed,' Dr. Wright says. Not for David. In parts of his mouth, the pockets were too deep to fully clean, so his dentist had to perform a surgical technique--flap curetage --to reach the other diseased tissues.

"Research has shown,' Dr.Wright says, "that there are two overriding factors as to how successful a periodontal treatment will be, regardless of what technique is used. The first is frequent follow-up visits to the dentist for maintenance and checkups. The second is the ability of the patient to perform excellent bacteria control at home.' By excellent bacteria, or plaque, control, Dr. Wright means proper brushing and flossing. "They are the basic techniques that we use to prevent the disease process,' he explains.

"Most people don't understand thefull impact of improper brushing and flossing,' Dr. Barrington says. "Plaque control done properly once a pay is more than adequate. Done improperly, even three or four times a day is not going to make a difference.'

"You want to get as many bristlesof the toothbrush as you can into the crevice where the tooth comes out from the gum tissue,' Dr. Rosenbaum explains. "Then vibrate those bristles to break up the bacterial plaque. The most efficient way to do this is to take the brush at a 45-degree angle and aim it right where the tooth comes out of the gum. Then wiggle it and roll it away from the gum to sweep away the plaque.' He adds: "Even if you go to a dentist twice a year for a cleaning, if you're not brushing properly, the inflammation of the gums will occur due to the build-up of plaque.'

"Prevention is the key to success incontrolling gum disease,' Dr. Wright says. "If you let it progress to its later stages, gum disease becomes a difficult, and sometimes impossible, disease to treat, and you may end up losing all your teeth.'

So don't ignore the warning signs.Remember, you only get one set of permanent teeth, and they're meant to last a lifetime.
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Title Annotation:gum disease
Author:Senz, Laurie S.
Publication:Saturday Evening Post
Date:Mar 1, 1987
Previous Article:Pushing the panic button.
Next Article:Hugging your way to health.

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