Diseases/Conditions of the Mouth & Teeth and Treatment DISORDER DESCRIPTION Halitosis Bad breath caused by tooth decay, gum disease or throat infection. Gingivitis Inflammation of the gums. Usually caused by poor oral hygiene or systemic disease, such as scurvy or diabetes mellitus. Periodontitis Inflammation of the tissue supporting the teeth. Ulcers/Lesions A break in the inner lining of the mouth, often caused by viral or bacterial infection, stress, vitamin deficiency, or poorly-fitting dentures. Dental decay and gum disease is the most common reason for loss of teeth. Tooth Decay Tooth decay is a gradual process, which if uninterrupted, will eventually lead to an abscess and loss of the tooth. Saliva is normally slightly alkaline, but after a meal, bacteria in the mouth feed on any sugar present and turn it into acids. This acid slowly dissolves the enamel and dentine of the teeth. After an hour or so, the saliva neutralizes the acid and washes it away, but by then the rot has begun. Bacteria grow and reproduce actively in the warm and moist environment around the teeth, particularly in the presence of nutrient-enriched foodstuff. Eventually, an eroding area will develop, called a plaque. Regular brushing of teeth will counter this plaque, but poor dental hygiene may result in the gum being exposed to the plaque, causing gum disease. Tooth decay The inside core of the tooth ultimately becomes infected by the advancing plaque, and the pulp tissue dies, forming an abscess. This is extremely painful and often requires extraction of the tooth, or root canal treatment. If we are lucky, we may get away with only a filling. The most important steps that we can take to prevent this series of events from occurring in our mouths and to our teeth is: • Restrict the intake of sugar • Regular brushing and flossing of the teeth One of the most effective forms of combating tooth decay and oral disease is the use of mouthwashes. Mouthwashes contain a variety of antiseptic compounds that have antibacterial actions. Generally, they are able to halt the growth of bacteria that tend to grow in a medium that is warm and moist, and generously supplied with nutrition for growth. This nutrition for bacterial growth comes from the proteins and starches in the food we eat, but do not always completely remove from the mouth. The rinsing action of the mouthwash serves to reach all areas of the mouth, including those hard-to- reach crevices between the teeth. Importantly, mouthwashes are not regarded as a single solution to oral care, but as an integral part of good, usual oral hygiene. This includes regular brushing of the teeth after every meal, and regular flossing to remove stubborn food from between the teeth. If all these methods are employed, good oral hygiene should be easy to achieve. Mouthwashes are therefore an essential piece of weaponry in the overall oral care armamentarium. Plaque 75% of adults will have gingivitis at some stage in their lives. Supragingival Gingivitis is an early, reversible form of gum disease. Gingivitis is the earliest stage of periodontal disease. Symptoms include increased gingival fluid flow, redness, swelling, and bleeding. In Subgingival advanced cases, ulceration may occur. Gingivitis can lead to periodontitis (advanced gum disease), which left untreated can result in eventual tooth loss. Thorough plaque control may be difficult to achieve because: • Brushing and flossing may not be performed properly • Insufficient time allowed for oral hygiene • Implants, crowns, braces, etc may hamper mechanical efforts • Post-surgical gingival sensitivity may interfere Older people may have limited dexterity Plaque is a generic term describing an amorphous, sticky, gelatinous mat of bacteria that collects on teeth above and below the gum line. It adheres to teeth, and is composed primarily of bacteria and bacterial products. The disease increases as plaque matures, and it may be above or below the gum line. Plaque is accessible to daily routine oral hygiene procedures, but may harden to form tartar. It is directly responsible for the initiation and progression of gum disease (gingivitis), and usually requires professional treatment. It forms pockets; which are relatively inaccessible to routine oral hygiene procedures. It is often associated with periodontitis (advanced gum disease). Plaque that remains in the mouth for more than a day starts to develop into tartar. Supragingival tartar is visible above the gum line, whereas subgingival tartar is not, extending down the root of the tooth. This calculus eventually leads to gingivitis formation from toxins that come from the plaque. Various classification methods exist to assist in the clinical evaluation of gingivitis. These include the Modified Gingival Index (MGI): Modified Gingival index (MGI) 0 1 2 3 4 Severe inflammation Mild inflammation Mild inflammation Moderate (marked redness, No inflammation (slight change in color, (slight change in inflammation(glazin edema and/or little change in texture color, little change in g, redness, edema hypertrophy of the but not the entire texture, involving the and/or hypertrophy marginal or papillary marginal or papillary entire marginal or of the marginal or gingival unit, ulceration or papillary gingival papillary gingival congestion, spontaneous gingival unit) unit) unit) bleeding) The advantages of the MGI are: • non-invasive scoring • no disruption of plaque at the gingival margin or tissue trauma • facilitates calibration of results (allows for repeat examinations) • less potential for infection • produces study results comparable to invasive scoring Most importantly, people may not realize they are at risk for developing gingivitis. Only 40% of people floss daily, and the average time spent brushing teeth is 37 seconds. More than 50% of adults have gingivitis around more than 3 or 4 teeth. Listerine® mouthwash has been developed over many decades, to what is now a sophisticated internationally acceptable brand. The Listerine® brand name was first used in 1879. It provides several benefits: • Kills the bacteria associated with plaque and gingivitis • Disrupts the bacterial cell wall, resulting in cell death • Affects quality and quantity of plaque formation When used as an adjunct to a daily oral hygiene and regular professional care there is no deleterious shift in oral flora or emergence of resistant bacterial strains. No side effects, such as extrinsic tooth stain or tartar formation, were observed or reported. In periodontal treatment, when used as initial therapy, it helps reduce plaque and gingivitis, whereas as maintenance therapy, it helps control plaque and gingivitis. Listerine® is recommended as an antimicrobial mouth-rinse in conjunction with brushing twice daily.
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