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Patient Education

Dental decay (caries) and periodontal (gum) disease are among the most common diseases afflicting mankind, especially in the so-called advanced nations.

The higher the standard of living, the more likely it is for tooth loss to occur.

As has been shown already, both dental caries and periodontal disease are the result of bacterial action, in the plaque, which collects on the teeth and gums.

If it is possible to cleanse the mouth completely of the bacterial plaque and maintain it that way, there would be low incidence of tooth decay or any other gum problems.

Dental diseases are not considered to be lethal and therefore attitudes on the part of governments and public are of a different nature. However, the cost of dental disease in pain, suffering, treatment and loss of work is enormous. Measures to reduce or eliminate dental problems would result in a vast benefit to the population.

Bleeding Gums
Bleeding gums is among the common conditions affecting the oral cavity. The Chinese might have noticed bleeding gums as early as 2500 BC. They termed the associated diseases as “Ya-Kon” which means diseases of soft tissue surrounding the teeth. This problem still continues to affect us even with so many modern facilities available in the field of oral care.
Bleeding gums is an affliction that affects 75% of the population. If untreated it can complicate any existing disease such as Stroke, Diabetes and Heart disease.

What are the causes for bleeding gums?

  • Long standing information for gums: Poor maintenance of the teeth, such as inadequate brushing or failure to rinse the mouth after meals results in a thin layer of food and bacteria covering the tooth surface. This bacterium is the chief culprit behind the inflammation. The gums during the stage of infection become soft, spongy and swollen. Trauma to the gums by hard brushing or tooth picking with sharp objects result in gingival bleeding.
  • Bleeding can also be due to injury of the gums by any sharp food item e.g., fish bone.
  • Hot food and chemicals can end up burning the gums, further resulting in bleeding. For e.g. Some people still follow the practice of placing pain relieving tablets on the gum adjacent to the painful tooth, which invariably causes burns.
  • Certain rapidly spreading infections can damage the blood vessels of the gums resulting in bleeding. One such disease is ANUG
  • Deficiency of Vitamin C causes problems with the blood vessels, hence causing bleeding in the gums. Ancient sailors were known to suffer from this problem until some one came up with the bright idea of stocking the ships with oranges during travel. As we know oranges are a rich source of vitamin C.
  • Certain general illness of the body can also precipitate gingival bleeding.

a.Allergic reactions.
b.Increase in number of cells called platelets. These are cells, which join together to form a plate that blocks the
bleeding from an injured vessel.
c.Failure in Blood clotting mechanism due to deficiency of a few important components.
d.Cancerous condition called leukemia.
e.Certain drugs such as aspirin and anti-coagulants, which prevent the normal clotting mechanism of the blood.

How does the condition present itself?
Bleeding of the gums may occur with or without associated pain .The pain if present is usually dull in nature.

Bleeding is usually noticed during brushing, or in the saliva,while spitting.
Eating of any coarse food items may induce bleeding.

How it is diagnosed?

The dentist, using an instrument called probe, diagnoses this condition. This instrument is a sharp thin metal which , when passed along the margin between the tooth and the gum causes spontaneous bleeding. Blood tests taken show any problems with the clotting mechanism, if present.

How are bleeding gums treated?

If long standing inflammation is the cause of bleeding then removal of the source of bacteria will result in improvement of the situation. If the source is mild to moderate in collection. Proper maintenance of the teeth by the patient is more than sufficient. If the source is moderate to severe in collection then professional help is required. Serious systemic problems might have to be treated to correct bleeding from these diseases.

MORE INFORMATION Bleeding gums are indication of a slowly progressing disease of the gums, which may further involve the bone supporting the tooth and ultimately result in tooth loss.


You cannot be taught to play tennis or golf by reading about them. You must be instructed, and you must practice. Similarly, you should learn the right way of brushing under the strict supervision of your dentist.

The tooth has five surfaces – front, back, the two sides and the chewing surface. Brush the top and bottom teeth separately. Most dentists agree that the bristle tips should be applied at 45 degrees to the gum area just above where the teeth emerge and should concentrate on the gum margins (where most people miss). The bristles are moved back and forth with a gentle circular scrubbing motion and short strokes. Do not forget the teeth right at the back of the mouth and also the inside surface of the teeth. Finally brush all the biting surfaces. It often takes three or four visits to teach someone to brush effectively!

Tips on Brushing

•Do not put too much toothpaste on the brush, it will foam up and make you want to spit and rinse too soon. Studies show that once people get to the spit and rinse stage they stop brushing even though some teeth have not been brushed.
•Do not wet your brush before applying the paste or before starting to brush. It alters the action of the bristles and prevents them removing plaque effectively.

Diet and Dental Health

The prevention of dental decay begins with cutting down the amount of sugars taken in all forms. Most people think we refer only to sweets as the culprits. But there are other dangerous sugar-containing foods as well

Some of them are:
1. All sugars (including honey)
2. Soft drinks such as colas and
3. Nearly all cereals
4. Cakes, biscuits and puddings.
5. Jam on your bread, marmalade on your toast.
6. Chocolates, sweets and toffees.
7. Peppermint sweets (they are the most dangerous because people believe the peppermint taste to be ‘medicinal’. These sweets are almost pure sugar).

As has been shown already, both dental caries and periodontal disease are the result of bacterial action, in the plaque, which collects on the teeth and gums.

A chocolate candy bar of about 50 grams may contain the equivalent of ten teaspoons of sugar! A slice of two-layer chocolate cake may be the equivalent of fifteen teaspoons of sugar!

These sugars are not an essential part of a normal diet. Hence reducing the total intake, will not only benefit the teeth, but also the general health. However, it is the frequency of sugar intake, more than the total consumption, which is important in influencing tooth decay. It was shown that the acid formed on the tooth in seconds from sugar might take twenty minutes or more to disappear from the mouth. Thus, small sugary snacks every two or three hours throughout the day will keep the teeth bathed in a dangerous acid state.

If Children must have sweets, they should have them only once a day (preferably during meal time). But it is better to recommend sugar-free snacks. A good list would contain:

Fruits: Apples, Oranges, Pears, Bananas
Vegetables: Carrots, Celery, Tomatoes, Lettuce, Cucumber, also Nuts, Crisps, Cheese (in cubes), Eggs, Milk, Yogurt.

In this way if we eliminate sugar, we reduce the formation of plaque by depriving the bacteria of the food, from which they form the acid.

The damage by erosion that, say, lemon juice can do to the enamel will have to be seen to be believed, So avoid frequent tooth contact with lemons, grapefruit, vinegar and other strongly acid substances.

The chemist’s shop may also be a source of danger to the teeth, many cough and throat sweets, lozenges, syrups, and elixirs are loaded with sugar, sometimes up to 50-60 percent. This is to make the product palatable.

Fissure Sealants

Decay frequently commences in the irregular fissures on the biting surfaces of the teeth, especially the molars. These fissures are difficult to clean thoroughly – a toothbrush bristle does not penetrate to the bottom of the fissure. Apart from cleaning the teeth and apply fluoride, some dentists believe that these fissures can and should be sealed off from bacterial infection by the application of special resins called

This resin like material is made to flow into the crevices of the biting surfaces where they are hardened by the chemical action or a special light. Usually at least the four first molars are so treated. This procedure does not give an excuse to avoid flouride application on all the teeth. Again in our view, fissure sealants are rarely necessary as a routine and add to the cost of prevention without a commensurate benefit. But your dentist must advise you. His results may be better than ours, and fissure sealants are being improved all the time.


A few dentists began using fluoride solutions as a preventive measure against dental decay over thirty years ago. This was by direct application, i.e. the regular painting of fluoride on the teeth of children from the age of two years. Since then the amount of the decay in such treated children has been negligible compared with other. But it can be a time-consuming procedure although inexpensive compared with the cost and discomfort of dental decay. The addition of minute quantities of fluoride to the water supply, to bring the concentration up to the level found naturally in some waters, has been shown to confer resistance to dental decay.

Studies of the action of drinking water containing one part of fluoride in a million parts of water have been carried out in many countries in the world. The conclusion was that fluoride at a level of 1 mg per liter has been drunk for generations by millions of people throughout their lives. Since fluoridation was introduced, millions more have been drinking water with fluoride at this level. Fluoride in water, added or naturally present, at a level of approximately 1 mg/liter over the years of tooth formation substantially reduces dental caries throughout life.

In the absence of water fluoridation your dentist or hygienist can put fluoride directly on your child’s teeth. This takes a few minutes and a strong recommendation is that it be applied at four-monthly intervals, i.e. three times a year.

Fluoride tablets and solutions can be obtained from your local chemist (see your dentist about prescribing the correct dosage) and these involve remembering to administer the correct amount daily, which may be a chore for some. But it is important to discuss all this with your dentist first. Some few complaints have been made about ‘allergic reaction’ to the fluoride tablet-administration. Investigations have rarely shown any true allergic response and any temporary upset has usually been due to other causes.