Q-1. Which types of dental diseases are of common occurrence?
A-1.
Generally two types of diseases are seen in teeth
i) Tooth decay and
ii) Pyorrhea.
Patient experiences pain in tooth decay therefore he immediately visits the dentist for treatment whereas in pyorrhoea no pain is experienced although it leads to gradual bone loss and loosening of the teeth. Due to absence of pain in pyorrhea, there is lack of awareness about this disease in the patients.
Q-2. What is pyorrhoea? Which type of disease or condition is it?
A-2.
Pyorrhoea is a type of disease that causes infection of gums that surround and hold the teeth. This infection spreads into the underlying bone, consequently weakening the bone as well as the tooth.
In simple words, this disease can be compared with termites' attack where it weakens the wood by gradually destructing it, similarly in pyorrhoea the bacteria spreads the infection from gums to the underlying bone and gradually weakens the tooth support.
Q-3. What are the common causes of pyorrhoea?
A-3.
Improper tooth brushing/cleaning and negligence in maintaining oral hygiene leads topyorrhoea. Presence of tartar around gums and teeth is mainly responsible for pyorrhoea,as it contains harmful bacteria that cause infection. Moreover, malnutrition, smoking, tobacco chewing, diabetes, vitamin deficiency, stress, etc. are also some of the factors that indirectly cause pyorrhoea.
Q-4. Do various general diseases affecting the body have a role in initiation and progression of pyorrhoea?
A-4.
Yes, as mentioned earlier, the following are some of the diseases that may increase the likelihood of developing pyorrhoea and may facilitate its progression
- Diabetes
- Vitamin, calcium and other nutritional deficiencies
- Stress
- Smoking and tobacco consumption
- Hormonal changes during pregnancy
- Blood disorders
- Thyroid problems
- Tumours etc.
In all of these diseases, there is an increase in the chances of developing and progressingpyorrhoea.
Q-5. Which are the symptoms of pyorrhea?
A-5.
The following are the symptoms of pyorrhoea:
- Bleeding during brushing / spontaneous bleeding
- Redness in gums
- Swollen gums
- Stickiness in mouth , especially in the morning
- Hypersensitivity on intake of hot & cold beverages
- Bad breath
- Pus discharge from gums
- Gradual / increased spacing between teeth
- Exposure of roots of teeth
- Food lodgment between teeth
- Urge to dig within gums between two teeth with pin/toothpick and with a sense of relief on resultant bleeding.
- Tendency to suck from gums
- Loosening of teeth
Pyorrhoea is not a continuously progressing disease. There is an alternative period of activity and inactivity. During active period of disease, patient experiences aggravated symptoms, whereas during an inactive period these symptoms are suppressed. Because of the suppressed symptoms, the patient assumes that the disease is cured/ decreased, though this is a misconception.
NOTE: Patients may not experience all the symptoms, if only few of them are present, they may have pyorrhoea and should seek doctor's advice.
Q-6. What are the different types of pyorrhoea?
A-6.
There are mainly two types of pyorrhoea.
i) Adult/ chronicperiodontitis/ pyorrhoea.
ii) Juvenileperiodontitis/pyorrhoea.
Adult/chronic pyorrhea generally occurs in individuals above 30 years of age. It mainly occurs due to deposition of plaque and calculus/tartar around the teeth and gums. It spreads at slow rate.
Juvenile pyorrhoea occurs in young age individuals and / or teenagers mainly due to lack of immunity towards certain bacteria.Plaque and calculus/tartar deposition is very less yet pronounced signs and symptoms of pyorrhoea are seen. It spreads at faster rate which results in early loss of teeth.
Q-7. Is pyorrhoea a hereditary disease?
A-7.
Yes, it may be inherited. Various scientific studies have concluded that if any of your elder family members, from paternal and maternal side had suffered from this disease, it may be inherited / it may run in family.
Q-8. Myths and Facts regarding pyorrhoea.
A-8.
People have certain misconcepts about this disease which are misleading. Here are some facts to create awareness amongst general population.
Myth-I: There is no pain in pyorrhoea, so treatment is not needed/required
Fact-I: Pyorrhoea is a disease of gums which causes weakening and loss of the underlying bone and damage of surrounding nerves that carry the messages to brain. Therefore, pain is not experienced in this disease.
Despite of lack of pain, if any of sign/symptom mentioned earlier appears, the patient must consult the dentist/periodontist/gum specialist immediately.
Myth-II: Inspite of undergoing treatment for pyorrhoea, it reoccurs and there is no permanent cure/solution for it.
Fact-II: Proper care of teeth and gums has to be taken following the treatment of pyorrhoea to prevent its reccurrence. Regular follow-up visits should be made to monitor the overall health of the gums. During these follow-up visits, if any deposits of plaque and calculus/tartar are present, it can be removed and further disease development can be prevented.
Myth-III: In adult periodontitis, teeth need to be removed and replaced with denture.
Fact-III: In patients withinitial and moderate adult periodontitis, if appropriate treatment protocol (i.e. scaling followed by gum surgery) is followed, the teeth can be retained and maintained for a long period of time.
Myth-IV: Cleaning of teeth weakens the teeth
Fact- IV: This is a big misconception. In the treatment of pyorrhoea, special instruments known as ultrasonic scalers are used to clean the tartar deposits, around the gums and teeth, due to which a little space is created between the teeth and the gums. This space gradually gets filled with gums and a healthy union between teeth and gums is achieved. This strengthens the bonding between the teeth and gums.
NOTE: It is advisable to get yourteeth cleaned every 6 months.
Myth-V: Only cleaning of teeth can cure pyorrhoea.
Fact- V: During cleaning of teeth, only superficial tartar is removed, but the deposits in the deeper areas are removed by surgical opening of gums. If this is not done, then infections in the deeper areas cannot be eliminated.
Only cleaning of teeth is advised when infection is restricted to gums and does not involve the underlying bone.
In cases, where underlying bone is also involved, gum surgery has to be performed.
Myth-VI: Pyorrhoea is a lifelong/long lasting disease like diabetes & higher blood pressure(hypertension) and hence cannot be cured.
Fact-VI: This is a misconception. Pyorrhoea can definitely be cured by proper diagnosis and treatment.
Q-9. At what stage of the disease, patient should consult the gum specialist?
A-9.
Generally, patients visit gum specialist when their teeth become loose/mobile which is duringa very advanced stage. We suggest that you should visit the dentist on appearance of initial signs like bleeding gums, bad breath and stickiness in mouth, spacing between teeth. At this stage, the disease can be eliminated in early stages.
Q-10. How is pyorrhoea diagnosed?
A-10.
Pyorrhoea can be easily diagnosed through clinical signs and symptoms but x-rays (i.e. IOPA, RVG, and OPG) facilitate in assessing the amount of bone loss. CTSCAN/DENTASCAN are the newer advanced diagnostic techniques used by gum specialist for evaluating the amount of bone. These together help in determining the treatment plan and need for surgery.
Q-11. What is the treatment plan of pyorrhoea? OR What is the step by step approach to treat pyorrhoea?
A-11.
Treatment of pyorrhoea/periodontitis is done in two stages.
In first stage, the tartar present between the teeth and gums is removed using scalers, which resolves the inflammation/redness and swelling present in gums and decreases bleeding from gums.
In second stage, gum surgery/flap surgery is done in which, the gums are separated from the tooth and removal of tartar from deeper areas is done, bone is reshaped and the gums are closed and sutured in position. In some cases, the lost bone can be reconstructed using bone substitutes/bone grafting materials.
After first stage of treatment i.e. after scaling, the bleeding from gums reduces and hence the patient may not return for flap surgeryand hence the disease is not completely eliminated and the signs and symptoms may recur.
Q-12. What is the importance of surgery/ flap surgery in treatment ofpyorrhoea?
A-12.
As said earlier, scaling/cleaning removes only superficial deposits but those bacterial deposits that are in deeper structures cannot be eliminated.
To prevent further progression and to eliminate the disease from its roots, flap surgery must be performed wherein the deposits and bacteria from the deeper root surfaces can be removed thoroughly.
Q-13. There are various beliefs for gum surgery i.e.
i) General anesthesia and hospitalization is required for surgery.
ii) The injection given in gums in upper part of jaw during or before gum surgery is harmful to eyes.
iii) There is too much blood loss during gum surgery.
iv) After surgery, teeth are loosened and gums become weak. Are they true??
A-13.
Myth-I: General anesthesia and hospitalization is required for the surgery.
Fact-I: This is a total misconception. Generally, only localized part of the mouth that requires surgery is anaesthetized with the use of local anesthesia. The patient is conscious throughout the surgery. The effect of anesthesia lasts for 3-4 hours, during which that area becomes numb and no pain is experienced. The patient can perform his normal routine activities post-surgery.
Myth-II: Injection given in the upper jaw affects the eyes.
Fact-II: This injection has no effecton the eyes.Injection given in the upper jaw only anesthetizes the gums around the teeth, skin of palate and lip.
Myth-III: Large amount of blood is lost during surgery.
Fact-III: Whenever a cut is made in any part of the body, small amount of blood is always lost. But, during flap surgery, the blood gets mixed with the saliva and when the patient spits or gargles during surgery he/she feels that a lot of blood is lost. Instead the blood loss in gum surgery is less as compared to other surgeries.
Myth-IV: After surgery, the teeth are loosened and gums become weak.
Fact-IV: Due to the removal of tartar, a space is created between the teeth and gums. Also, during flap surgery the gums are reflected/separated from the tooth. The space that is created gets filled with healthy gums and a healthy and strong reunion of the gums and teeth is achieved with 3-4 weeks approximately. Hence, during this healing period patient feels that the teeth have become loose. But the mobility of the teeth gradually decreases and disappears within 3-4 weeks.
Q-14. If pyorrhoea is not treated at proper time, what are the consequences?
A-14.
If pyorrhoea is not treated at proper time, the plaque and calculus/tartar and infection gradually extends to underlying bone resulting in destruction of the bone. This compromises the support of the teeth that results in loosening/mobility of the teeth.This may further lead to exfoliation of teeth.
Q-15. Once occurred, can pyorrhoea subside without going for surgery and only by keeping the teeth regularly cleaned?
A-15.
No…. Once pyorrhoea has occurred, it has to be treated. Keeping the gums and teeth clean doesn't eliminate pyorrhoea. Once pyorrhoea is treated, regular follow-up for cleaning of teeth and maintenance of oral hygiene is essential.
Q-16. Can pyorrhoea affect major organs of body and how?
A-16.
Yes.
Scientific studies have proven the association of pyorrhoea/periodontitis and
• Heart diseases
• Diabetes
• Adverse pregnancy outcome
• Lung diseases
• Kidney diseases and
• Joint diseases
- The probability of increase in blood sugar levels increases in diabetic patients with pyorrhoea/periodontitis.
- Pyorrhoea may lead to increase in atherosclerosis of arteries which may lead to narrowing of lumen of the arteries & chances to develop heart disease are increased.
- Because of pyorrhoea, chances of preterm delivery causing low birth weight babies increase.
- Pyorrhoea can worsen lung and kidney diseases.
- Recent scientific investigations suggest a definite association between pyorrhoea and joint diseases.
Q-17. By treating pyorrhoea, can blood sugar levels in diabetic patients be decreased?
A-17.
"Periodontitis/pyorrhoea" is the SIXTH complication of diabetes. Patients with diabetes are at increased risk for developing periodontitis/pyorrhoea. Also, presence of pyorrhoea/periodontitis increases the severity of diabetes. Scientific studies have proven that treatment of pyorrhoea/periodontits improves blood sugar levels in diabetic patients.
Q-18. Can pyorrhoea be treated with advanced equipment i.e. LASER?
A-18.
LASER can be surely used to clean the diseased gum lining from inner aspect of the flap. LASER can only treat the soft tissue lining of the gum. The hard deposits have to be removed using scalers. Since, LASER cannot remove the hard deposits, a combination of flap surgery and LASER should be used.
NOTE: LASER is an adjunct to surgery, not an alternative.
Q-19. What precautions should be taken after treatment of pyorrhoea?
A-19.
After treatment of pyorrhoea, patient should be more cautious regarding cleanliness of gums and teeth. Pyorrhoea differs from diseases like typhoid, where medicines can resolve it completely and chances of recurrence are less. In fact, for better treatment outcome for pyorrheoa, patient's contribution and compliance is as important as that of a gum surgeon. After completion of treatment, patient should consult his/her dentist every 3 months, so that even small amount of deposit if present can becleaned and further spread of disease can be prevented. According to periodontist's advice, patient should brush his/her teeth twice a day and if required/suggested, interdental cleansing aid, i.e. toothpick, proxabrush, etc. should be used to keep the gums clean and prevent plaque and calculus formation.
Q-20. How can you prevent the occurrence of pyorrhoea?
A-20.
As an age old tradition, Indians have a tendency to brush their teeth once during the morning. It has been recommended to brush your teeth twice daily using the appropriate brushing technique as advised by your dentist. A regular dental check-up every 6 months is advisable. You should consult your dentist immediately if you notice any one of the signs or symptoms of pyorrhoea/periodontitis.
Q-21. Do anti-hypertensive drugs like nifedipine cause gum problems?
A-21.
Yes, anti-hypertensive drugs like nifedipine may cause over-gowth of gums. The gum over-growth facilitates plaque accumulation, impedes proper tooth brushing and hence leads to further progression of pyorrhoea/periodontitis.
This can be treated by substituion of the anti-hypertensive drug with physicians consent followed by a proper periodontal/gum therapy as advised by the specialist.
Also, there are some other drugs like anti-epiletic drugs (phenytoin) and immunosuppressive drugs (cyclosporin) which have similar side-effects on gums.
NOTE: If you are under any medications, inform your specialist regarding it and the reason for your medications.
