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Periodontal Disease: Did The Romans Really Have Less Gum Disease Than Us?

Gum Disease: Why Romans had teeth to smile about

A recent article in The Times newspaper claims the Romans suffered from  less periodontal disease than we do today. Really? We know they didn’t have access to the same modern dentistry and mouth-care techniques back then, so what was their secret? Was it really all down to not smoking and less sugar in the  diet, or are there other factors at play? Dr Galgut challenges some of the views proffered by Professor Frances Hughes and suggests some other reasons for the lowered incidence of periodontal disease found in our ancient forebears.
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Four of the Best Foods and Drinks for Healthy Teeth

According to the National Obesity Council, the UK is the world’s 6th most obese nation. And according to the World Health Organisation, nearly 100% of adults in industrialised countries (of which we are one) have dental cavities. That paints us in a pretty unhealthy light! When it comes to our health and overall well-being, more often than not we focus on what we perceive to be the more pressing health issues prevalent in our society today: Diseases such as diabetes, heart disease, strokes and arthritis – conditions which are often directly or indirectly associated with the alarming rise in obesity and our culture of unhealthy living.  One issue that we don’t tend to prioritise, until we actually have a problem, is our teeth, or rather the health of our teeth and gums.  Read More

Is There a Cure for Aggressive Periodontitis?

Is There a Cure for Aggressive Periodontitis?

Aggressive periodontitis is more common than a lot of people think, nevertheless many people are unaware of the symptoms and occurrence of this disease. The most obvious features of the disease include hasty attachment loss and bone obliteration and genetic aggregation of the teeth. This can result in very early tooth loss if not tackled in a timely and efficient manner. The diagnosis of the disease is similar for all patients, but the treatment can vary from person to person due to their different characteristics and the intensity of the disease. It is definitely curable and should be treated as early as possible in order to avoid any kind of severe loss of the teeth. Unfortunately, once it has reached the very advanced stages, the patient  would usually have a lot of bone loss and once the bone has gone it cannot be regenerated. This does not however mean that the disease cannot be successfully treated and managed, often without the need for surgery.

It is possible to graft bone into the areas around the teeth by taking it from somewhere else in your body such as your hip or your ribs, but the problem with aggressive periodontitis is that the bone erodes away because of an exaggerated destructive response of your gums, and this excessive destructive process usually affects the grafted bone so it melts away as well.

However, as I said, even in extreme cases, all is not lost. Textbooks state that if you lose more than a 3rd of the bone around your teeth the teeth have a hopeless prognosis and need to be extracted.  That is very often what a dentist will tell their patient because this is what they have been taught. And from a ‘text book’ point of view, he/she is right.  This is where the services of a periodontal expert can reap dividends. As a periodontal specialist in North London, I have been treating very advanced cases of periodontal disease with bone loss for many years and in most cases the condition can be managed and treated in different ways and in some cases very successfully without any tooth loss at all!

Scaling and Root Planing Treatments

Aggressive periodontitis is a disease much like the high blood pressure and diabetes which, whilst unfortunately cannot be completely cured, can be controlled and managed exceptionally well with medical treatment and specialist after care. Depending on the time of diagnosis and the intensity of the disease, the treatment will vary accordingly. If the disease is diagnosed at an early stage, then your periodontal specialist will  have several options for treatment – one of which is Scaling and Root Planing. This works by removing plaque and calculus in all the areas around the teeth and gums and also flattening the surface of the root. Scaling and Root Planing treatment helps significantly in getting rid of the mouth bacteria which is mostly just along the gum line of the teeth. This kind of treatment works best where there is early stage detection of the disease or for cases which have not developed viciously. If the situation is severe and it is not timely diagnosed, then many periodontal specialists go for other complex treatments where periodontal surgery is highly likely to be the treatment proposed.

Gum graft surgery

This is the preferred surgical treatment for Aggressive periodontitis as suggested by many periodontal experts. The surgery repairs the loss and also prevents any further damage or loss of the gum bones. Gum graft surgery is done to cover roots and encourage development of new gum tissues on the gum line where there is a shortage excessive gingival recession. In graft surgery for gums, the surgeon takes the gum tissues from any relevant part of your body (for example your hip or rib) or any other donor’s source to fill the exposed root of the teeth. This filling is done tooth by tooth. It can be done either for one tooth or several teeth as per the requirement and condition of the root under each tooth until the gum line is completely recovered, and the sensitivity is reduced.  As stated above, however, the problem with aggressive periodontitis is that the bone erodes away because of an exaggerated destructive response of your gums, and this excessive destructive process usually affects the grafted bone so it melts away as well. This is why I always propose looking at non-surgical and far less invasive treatments where at all possible. I have developed a practice over 20 years specializing in exactly that, and now lecture extensively on the subject of non-surgical treatment of periodontal disease, including aggressive periodontitis. Read more about my published work.

In conclusion, Aggressive periodontitis can be a serious condition with a fairly grim prognosis if it is not caught and treated in a timely fashion. An early diagnosis of the disease involves far simpler treatment processes. Nevertheless, even severe or chronic conditions can sometimes be treated without the need for surgery.
Of course, your periodontal specialist is the one to consult for an individual diagnosis and prognosis of your condition.
I offer both telephone and face-to-face consultations and can work together with your own dentist to provide the best treatment plan for you. You can contact me here for further advice on periodontal treatment.
Take heart, even in severe cases of aggressive periodontitis, all is not lost 🙂
Take care and I hope to hear from you soon.

Best Way to Brush Your Teeth to Prevent Gum Disease?

Recently, The Times ran an article suggesting that dentists are confused over the best way to brush your teeth. Really? Could it really be true that “in reality dentists have no real idea of the best way to brush your teeth” to prevent gum disease, periodontal disease and other nasties? Or, worse, that the advice your parents gave you to brush twice a day is “based on habit rather than solid research”. Could it really be that the reason why nearly half of all adults in the UK suffer from some kind of gum disease is because dentists have been advising their patients wrongly?

Below is  a copy of the article ‘Dentist’s divided over best way to brush’ as it was run in Times, on Saturday 9th August, together with my comments, and my advice, based on over 25 years of research and clinical practice, on how best to brush your teeth to prevent gum disease and periodontits.

Dentists divided over best way to brush

Chris Smyth Health Correspondent

“Some demand a circular motion, others call a 45-degree angle, and there are still partisans of the horizontal scrub. Yet in reality dentists have no real idea of the best way to brush your teeth, researchers have concluded.
A range of contradictory advice is offered by dentists, governments and the makers of toothbrushes, yet there is little evidence to support any of it, scientists have said. Even the advice to brush twice a day for two minutes is based on habit rather than solid research, according to scientists who surveyed dozens of studies for an article in the British Dental Journal.
The senior author of the research, Professor Aubrey Sheiham, of University College London, said: “If people hear one thing from a dental association, another from a toothbrush company and something else from their dentist, no wonder they are confused about how to brush. In this study we found an unacceptably inconsistent array of advice from different sources.” He added: “There is no evidence to suggest that complicated techniques are any better than a simple, gentle scrub.”
Professor Sheiham said that brushing after eating sweet or sugary drinks made little difference to tooth decay, and John Wainwright, who carried out the study, said ensuring toothpaste contained fluoride was more important than any brushing technique.
“I advise my patients to focus their brushing on areas where plaque is most likely to collect – the biting surfaces and where the teeth and gums meet – and to use a gentle scrubbing motion,” Dr Wainwright said, adding that holding the toothbrush in a pencil grip might help to stop gums being damaged by overzealous brushing.
He conceded: “We can give these kinds of rationale, but the evidence that’s available doesn’t score highly. The current situation, where not just individuals dentists but different dental organizations worldwide, are all issuing different brushing guidelines isn’t just confusing, it’s undermining faith and trust in the profession as a whole. For something most people do twice a day, you would expect dentists to send a clearer message to their patients on how to brush their teeth.”
Professor Damien Walmsley, a scientific adviser to the British Dental Association, said: “No technique is superior to the other but a dental professional will check what the patient does and tweak the technique accordingly.
“Take two minutes to brush all surfaces of the teeth in a systematic manner, using fluoridated toothpaste; brush at least twice a day; and spit, don’t rinse the mouth after brushing [to avoid washing away the fluoride].”
Nigel Carter, the chief executive of the British Dental Health Foundation, said: “There’s no real evidence on which is the best way of tooth-brushing. They will all have benefits and drawbacks.”
Although people in Britain are told advised to brush twice a day, Dr Carter said there was no international agreement. “Virtually the whole of South America says one minute, three times a day,” he said. “It’s based on habit and there’s no robust research.”
He said that it was probably not necessary for children to brush for two minutes but establishing that habit during supervised brushing up to the age of seven ensured that it would be carried on into later life.”

[The Times, Saturday 9th August 2014]

So, are we dentists really confused about the best way to brush your teeth – Of course we’re not!

In my opinion, the study by Professor Aubrey Sheiham is yet another example of academics sitting in their ivory towers spending lots of money and resources on totally irrelevant clinical research.  Anyone in the real world of clinical dentistry as opposed to academia knows that people are different, their levels of manual dexterity is different, their mouths the different, and even different parts of their mouths of different.  Not only that, but there are many different toothbrushes and other oral hygiene aids and there are many different ways of achieving a nice clean mouth only an academic, divorced from the reality of clinical practice could dream up the preposterous idea that there is some universal tooth brushing technique that is the best for everyone.

There is no such thing as the best way to clean your teeth, any more than there is a best motorcar or a best T-shirt, or even the best dentist!  The idea that one tooth brushing technique is good for everyone is simply stupid.  People who suffer from gum recession need to brush their teeth in a different way to those who do not, and the secret of achieving good oral hygiene is not a matter of the best toothbrush, or the best dental floss, or the best technique, but rather it is the best combination of technique and oral hygiene aids for you which might be different to everybody else.

In my own practice I recommend different techniques and different toothbrushes and different oral hygiene aids because I believe everybody is an individual and therefore need individual attention that is tailored to their needs specifically rather than assuming that what is good for Professor Aubrey Sheiham is good for the rest of us!

The general advice, as suggested in the article:

•    Brush for two minutes, twice a day
•    Brush all the surfaces in a systematic manner
•    Use fluoridated toothpaste
•    After brushing, spit. Don’t rinse the fluoride away
[Source: Damien Walmsley]

is of course true, however, if you are suffering from any unusual symptoms or are worried about gum disease, periodontitis or are suffering from bleeding, itchy gums, why not not take advantage of my ‘Ask a dentist online‘ service?

Alternatively, I offer a telephone support service, where I can discuss with your dentist, the best treatment pan for you. Please contact me for details.

I look forward to answering your questions, and giving you an individual service and care plan 🙂