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Active Living
Full Listing with story descriptions
A Healthy Balance
Ankle Sprains
Active Kids, Healthy Kids
Active Kids in Winter
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Children, Nutrition & Exercise
Beat the Heat!
Cold Weather Workouts
Concussions
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Exercise is Medicine
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From Surviving to Thriving
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Get Moving!
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Jump Start Weight Loss
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Live Actively
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Plantar Fasciitis
Prehistoric Workout
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7 Wonders of Walking
Adolescent Health
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Chronic Diseases in Teens
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Female Physical Exam
First Period
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A Woman's Physical
Your First Job
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Childbirth
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Advice from the Maternity Clinic
Advice from the Maternity Clinic (Part 2)
Alcohol in Pregnancy
Building a Better Baby
Birthing Etiquette
Birth Plans
Birthing Procedure Trends
Bleeding in Pregnancy
Breastfeeding Benefits
Caesarean Section by Request
Care for the New Mother
Cord Blood Banking
Delaying Motherhood
Blue after Baby or Postpartum Depression
Diabetes in Pregnancy
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Evolving Ideas about Pregnancy and Birth
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Folic Acid in Pregnancy
High Blood Pressure in Pregnancy
Getting a latch on breastfeeding
Group B Streptococcus
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In-Vitro Fertilization
Low Birth Weight Babies
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Nausea & Vomiting in Pregnancy
Pain Relief in Labour
Prenatal Classes
Preterm Labour
Planning a Pregnancy
Pregnancy Weight
Prenatal Care Providers
Postpartum Repetitive Strain Injuries
RH Disease
Rupture of Membranes Before Labour
Sex During Pregnancy
Skin Changes in Pregnancy
Smoking and Pregnancy
Support During Labour
Travelling While Pregnant
Ultrasound for Fun & Photos
Natural Remedies in Pregnancy
Vaccinations During Pregnancy
Vacuum & Forceps for Delivery
Vaginal Birth After Caesarean
When Baby Comes Home
Childhood
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Asthma in Children
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Introducing Solid Foods
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Not Just Baby Fat
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Safe Summer Fun
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When to go to the Doctor
Whooping Cough
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Yeast Infections in Children
Chronic Pain
Full Listing with story descriptions
Introduction
Managing Your Pain
Movement Matters
Moving Forward
Nutrition
Opioids
Pacing
Pain Medications
Prevention
Returning to Work
Understanding and Goal Setting
When Pain Doesn't End
Dental Health
Full Listing with story descriptions
Antibiotics and Dental Surgery
Baby Bottle Tooth Decay
Baby Teeth
Bad Breath (Halitosis)
Children's Dental Injuries
Choosing a Dentist
Cosmetic Dentistry
Mouth Guards
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First Dental Visit
Headaches
A Healthy Mouth
Healthy Mouth, Healthy Body
Jaw Joint and Muscle Problems
Keeping it Clean
Laser Use in Dentistry
Mouth Protection Equipment
Oral Cancer Screening
Oral Healthcare
Oral health and long term care
Oral Health Care Products
Orthodontics
Orthodontist First Visit
Painless Dentistry
Periodontal Disease
Removable Dentures
Root Canal
Seniors Oral Care
Sensitive Teeth
The Smile You Want
Sore Mouth, Aching Jaw
Snoring and Sleep Apnea
Smiling through the Senior Years
Teeth for Life
Temporomandibular Disorders (TMD)
Tobacco Risks to Oral Health
Tongue Piercing
Tooth Whitening
Travel Dentistry
Water Fluoridation
Wisdom Teeth
Your Healthy Smile
DIABETES
Full Listing with story descriptions
10,000 Steps
A1C Test
Accurate Blood Glucose Testing
Alchohol and Diabetes
A Diabetes Success Story
ABCs of Diabetes Management
Alternate Site Testing
Artery Health
ASA Therapy
Benefits of Insulin
Benefits of Breakfast
Blood Glucose Medications
Blood Glucose Myths
Blood Glucose Testing
Blood Glucose Testing Tips
Blood Sugar Lows
Blood Glucose Monitors
C-Peptide Testing
Canada Food Guide Revisited
Carbohydrate Counting
Catastrophic Drug Plan
CDA Guidelines for Diabetes
Celiac Disease and Diabetes
Celebrating Health
Childhood Diagnosis of Diabetes
Children and Type 2 Diabetes
Cholesterol-lowering Medications
Colds and Diabetes
Constipation
Continuous Blood Glucose Monitoring
Cutting Edge
Dangers of Uncontrolled High Blood Pressure
Debunking Diabetes Myths
Driving and Diabetes
Diabetes and Menopause
Diabetes and OTC Medications
Diabetes Care Team
Diabetes and Celiac
Diabetes and Depression
Diabetes Diet
Diabetes Distress
Diabetes Eating on a Shoestring Budget
Diabetes Etiquette
Diabetes and Oral Health
Diabetes and Thyroid Disease
Diabetes and Your Mouth
Diabetes and Your Eyes
Diabetes in Cats
Diabetes in Dogs
Diabetes Management ABCs
Diabetes Meter Technicians
Diabetes Myths
Diabetic Ketoacidosis
Diabetic Retinopathy
Diet Tips for South Asians
Dining Out
Drinking and Diabetes
The Discovery of Insulin
Eating Disorders
Easing the Strain of Stress
Eating to Protect Your Kidneys
Eating Well During Shift Work
Eggs in a Diabetic Diet
Emotional Eating
Emotions of Diabetes Diagnosis
Erectile Dysfunction
Exercise Excuses
Why Fad Diets Fail
Fats
Fibre
Fill Your Day with Energy
Financial Support for Diabetes
Food Temptation
Foot Care
Footwear and Foot Health
Fruits and Veggies
Gastroparesis
Gestational Diabetes
Get Active
Get Physical
Gift Ideas
Glucose Meters
Glycemic Index and Glycemic Loads
The Glycemic Index
Going Green in the Kitchen
Grocery Shopping Tips
Guidelines for Diabetes Management
Holiday Party Survival Guide
Health Information on the 'Net
Healthy Happy Holidays
Healthy Beverage Choices
Health Benefits of Soy
Healthy Restaurant Meals
High Blood Pressure and Diabetes
High Blood Pressure
HbA1c Test
Healthy Eating for Active People
High Blood Lipids
Home from the Hospital
Home Alone and Sick
Hypoglycemic Unawareness
Impaired Glucose Tolerance
Immunization & Diabetes
Incretins-a Hormone Treatment
Injecting Insulin
Insulin Discovery-The Story
Insulin
Insulin Handling
Insulin - the Key to Energy Management
Insulin Pumps
Insulin Pen Needles
Insulin Pump Infusion Sets
Insulin Pump Therapy
Immunization and Diabetes
Internet Health Sites
Islet Cell Transplantation
Insurance
Ketones
Kidney Disease - Reducing the Risk
Living with Diagnosis of Diabetes
Living Powerfully with Diabetes
Low Blood Glucose
Managing Diabetes
Managing Blood Glucose
Metformin
Nutrition Food Labels
Meal Planning
Your Medication Expert
Medication Research Studies
Metabolic Syndrome
Microalbuminuria
New Diabetes Technologies
Natural Medicines and Diabetes
No Need for Insulin?
Not Snoozing
Over-the-Counter Medications
Oral Health and Diabetes
Osteoporosis and Diabetes
Diabetes and OTC Medications
Pedicure Precautions
Peripheral Arterial Disease
Pet Diabetes
Planning for Pregnancy
Prebiotics and Probiotics
Preparing for Activity
Putting off Insulin
Reducing Stress of Surgery
Safe and Successful Travel
Schizophrenia and Diabetes
Sensible Snacking
Setting Health Goals
Setting Goals for Physical Activity
Sharps Disposal
Shorter Insulin Needles
Sleep - a Missing Link
Smart Snacking
Smart Summer Nutrition
Snack Bars
Snacking with Diabetes
Sodium
Social Media & Diabetes
Solving the Insurance Puzzle
Stress and Diabetes
Success in School
Supplements
Supporting Spouse with Diabetes
Sweeteners
Sugar, Carbs and Blood Glucose Control
Think Positive with Diabetes
Tiny Bites Equal Big Calories
Travelling with Diabetes
Tips for a Better You
Tobacco Use and Diabetes
Top 10 Reasons to Exercise
Treating Low Blood Glucose
Treating Hypoglycemia - Role of Glucagon
Tune up Your Diet
Type 1.5 Diabetes
Type 2 Diabetes
Understanding Diabetes
Understanding Diabetes Medications
Understanding Ketones
Used Sharps
Urinary Incontinence
Vacationing with Diabetes
Vegetarian Eating for Diabetes
Vitamin D
Walking
Wise Choices About Natural Medicines
Wonderful Water
Natural Medicines & Diabetes
World Diabetes Day
Your Medicine Cupboard
Zimbabwe Hand Jive
Family Medicine
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ADHD in Children
Allergic Rhinitis
Allergies
Antibiotic Use
Arthritis
Aspirin Every Day?
Asthma
Back Pain
Back Pain Myths
Back Pain - Lower
Birth Control
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Carpal Tunnel Syndrome
Check-Up
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Contact Lenses
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COPD
Cost of Doctor's Visit
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Diagnostic Tests
Do I Need a Bone Density Test?
Doctor Visit
Driving Vision
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Does My Sore Knee Require an MRI?
Do I Need an Annual Physical?
Eczema
Electronic Medical Records
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Family Doctor
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Floaters and Flashes
Food Poisoning
5 Ways to Stay Healthy
Gallbladder
Get Active!
Glare
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How to Talk to Your Doctor
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Medical Digital Technology
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Stroke
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Win by Losing
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Bites and Stings
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First Aid Travel Kit
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Get Active!
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Have Health, Will Travel
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Abuse
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Canada's New Blood System
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Physiotherapy Visit
Planning for End of LIfe
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Schizophrenia
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Soy
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Nutrition
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5 Tips to Manage Weight
10 Ways to Cut Down on Fat
Battle the Bulge
Boost Your Bone Strength
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Breakfast is Important
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Building Your Bones
Celiac Disease
Challenging the Milk Myth
Diet Reality Check
Drink Up!
Eating Smarter & Cheaper
Energy Drinks
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Food for Active Kids
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Healthy Diet, Healthy Smile
Healthy Eating for Boomers and Zoomers
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Healthy Eating on Business Travel
Healthy Ethnic Meals
Fad Diets
Fruits & Veggies - 5-10 a Day
Fats
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Feeding Your Kids
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Food Chemistry 101
Food and Mood
Getting Kids to MOVE
Healthy Eating for Teens
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New Ingredients for Your Shopping Cart
Iron
Kid's Food
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Mercury Levels in Fish
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Nutrition on the Net
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Nutrition Questions Top 5
Nutrition for Menopause
Essential Omega-3
Preventing Cancer Through Nutrition
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Power of Fruits & Veggies
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After a Heart Attack
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Changing Role of the Pharmacist
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Backpack Pain
Bacteria Fight Back
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Childhood Obesity
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The Flu and You
Heading Home for a Visit
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H1N1 Virus - Plan Ahead
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Keys to Preventing Cancer
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Preventing Cancer through Nutrition
Quit Smoking 101
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Should You Immunize?
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15 Great Reasons to Breastfeed
Anemia
Approaching Menopause
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Breast Cancer - Genetic Risks
Breast Cancer Self-Exam
Breast Cancer Screening Guidelines Changes
Breast Health
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Hormone Replacement Therapy
The IUD
Menopause - What Men Should Know
Menstrual Bleeding - Abnormal
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Third Generation Birth Control Pills
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xx
Sexually Transmitted Infections
Urinary Incontinence
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Viagra for Women
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Your Pelvic Floor
Family Health Online / Pharmacy at Safeway
Family Health Magazine - DENTAL HEALTH

Periodontal Disease
Beat the silent tooth killer

Yes! It is possible to retain your teeth for the rest of your life. Beat the silent tooth killer periodontal disease and you have it made.

  • Up to 75 per cent of adults over age 30 have gum disease, the leading cause of tooth loss.
  • A 'pink' toothbrush can be a warning of damage caused by bleeding from the tissues.
  • Plaque or bacteria are the primary causes of periodontal diseases.
  • Complete care once daily will keep those bad bugs in check.

Periodontal disease is, in fact, a group of diseases. These diseases begin quietly, attacking the gums, bones and ligaments that anchor the teeth to the bone. Another name often used to describe the condition is gum disease. Up to 75 per cent of adults over age 30 suffer from gum disease - the leading cause of tooth loss.

Fig. 1 - cross section lower molar toothThe supporting structures of a tooth

Nature has designed a wonderful supporting system for the tooth (1A). The tooth is suspended in the jaw bone (1B) by a very thin, fine but strong system of ligaments (1C). Gingival (gum) tissue covers the bone (1D).

Around the neck of the tooth, the gum dips down to form a 2 to 3 mm deep crevice or sullus that surrounds the tooth. At the base of the sullus, in a healthy mouth, the gums form a tight cuff and seal - a fantastic barrier to the mouth bacteria and irritants.

Types of periodontal disease

When the surface of the gum tissue becomes inflamed and diseased, the condition is known as gingivitis. If allowed to continue, the surface gum inflammation can move into the deeper supporting structures of the bone and ligament and is known as periodontitis. Depending how severe the disease is, it is classified as mild, moderate or advanced. The most serious form of the disease tends to be slow, progressive and chronic. If not treated, it will lead to complete destruction of the supporting tissues, abscesses, and finally loss of the tooth.

Periodontitus can affect children but is rare. It is known as prepubertal periodontitus. A form of the disease affecting teenagers is known as juvenile periodontitus and can affect a few or many teeth. A rather aggressive form of periodontal disease known as rapidly progressive periodontitus has been described. This usually affects young adults aged 20 to 30 and will result in early tooth loss if untreated.

Signs of periodontal disease

The signs of periodontal diseases are subtle. A 'pink'” toothbrush can be a warning of damage caused by bleeding from the tissues. Persistent bad breath and taste are other warning signs. The gums may appear to be red, swollen and feel tender. The roots of the teeth may become visible. The teeth can loosen and separate, resulting in a bite change. Also, a change in the fit of a partial denture may be noticed. Pain and abscesses tend to occur in the final stages of the disease, usually when it is too late to save the tooth.

If you have any of these problems, ask your dentist to do a complete gum check-up. You can consult with a periodontist (gum specialist) for an evaluation without a referral.

Cause of periodontal disease

fig. 2-3: peridontal diseasePeriodontal disease is caused by certain types of bacteria (germs) that normally grow in the mouth. These bacteria organize to form colonies called plaque that collect at the tooth gum margins as an invisible, sticky film. With poor care of the teeth, the bacteria will grow and penetrate the tooth gum margins. Finally they spread into the underlying bone.

At the same time, the film of bacteria will harden to form calcium deposits called calculus on the teeth. Calculus attaches tightly to the tooth surfaces above and below the gum margins. These deposits, once formed cannot be brushed away. It takes a professional such as a dentist or hygienist, to remove the local irritants that have accumulated.

The bacteria continue to thrive on the rough surfaces of the calculus. If they establish themselves below the gum surfaces they produce toxins that damage the gum and bone tissue. With time the crevices around the teeth deepen as the bone underneath recedes to form a diseased space called a periodontal pocket (Fig. 2).

As the disease progresses the pockets get deeper until the root end is reached. The surface gum tissue may still look normal since the disease has progressed far below the surface (Fig. 3).

At this stage, the bacteria may begin to grow more rapidly to form a gum boil or abscess causing the tooth to become loose and tender. There might still be hope for the involved tooth if the abscess and inflammation can be controlled. If discomfort or pain persists, the only option is to remove the tooth.

Periodontal disease does not affect all the teeth at the same time nor to the same degree. Generally the back teeth have more severe breakdown than those in front. The difficulty in plaque removal and complicated root shapes account for this difference.

Factors contributing to periodontal disease

Plaque or bacteria are the primary causes of periodontal diseases. However, some factors can affect the progression of the disease.

Diagnosis of periodontal diseases

Periodontal disease is diagnosed by a dental professional after a full examination. Your visit usually begins with medical-dental questions where you are asked your chief complaint. You are also asked about medications you use and medical conditions that can affect the course of periodontal disease.

fig. 4: Probe in the pocketTo determine the degree of disease involvement, a periodontal probe is gently teased into the spaces between the gum and tooth. The lines on the probe allow the dentist to gauge the depth of the spaces present. There are lines on the probe which when positioned with the outside gum margin (Fig. 4) allow for a measurement to be taken. Generally a range up to 3 mm is considered normal, based on six measurements taken around each tooth. Recession (root showing) and mobility of the teeth are recorded.

A full evaluation of the supporting structures of the teeth requires an x-ray examination. If you have all of your teeth, eighteen pictures are needed. The radiation to the head and neck is less than a half day out in the sunshine. The x-ray pictures will allow the dentist to evaluate root lengths of the individual teeth as well as existing bone levels. Abscesses, decay or underlying changes can be identified. An analysis of your bite is done as well since clenching and grinding habits of the teeth may contribute to the disease process.

Finally, based on the clinical and x-ray information, you will receive a comprehensive treatment plan. The goals of periodontal therapy are to:

Oral Hygiene

An important part of controlling periodontal disease is the daily cleaning of the tooth gum margins. Since periodontal disease is caused by bacteria that are found in the mouth, they must be stopped from forming the plaque that will damage the tooth supporting structures.

Brushing and flossing are the basic oral hygiene techniques recommended for plaque removal around the tooth. Other oral hygiene aids such as rubber tips, toothpicks and oral irrigators may be recommended to help fine tune the cleaning process.

Many of the powered toothbrushes available make brushing much more efficient than hand brushing. The powered brush would be a worthwhile purchase if you do not seem to have time to brush properly or if arthritis affects your hands.

Plaque will reform over 24 hours so it is important to try to keep a regular schedule. Complete care once daily will keep those bad bugs in check. Bedtime is usually best for your thorough home care session. Pick a time and place for tooth cleaning that works for you.

Your dental practitioner will help design and customize an effective daily cleaning program for you. Often plaque removal is best done out of the bathroom - for instance, while reading or watching television.

Non-Surgical Therapy - Scaling and Root Planing

As mentioned earlier, when bacteria are left to accumulate on the teeth, they form deposits called calculus. The calculus deposits unfortunately cannot be removed by brushing and flossing. Only a professional can gain access to remove all the deposits.

The professional cleaning that removes plaque, calculus, and bacterial endotoxins from the root surface is known as scaling and root planing. Removal of the calculus combined with proper oral hygiene will allow the gum tissue to form a tight seal at the neck of the tooth. The seal will prevent bacterial penetration into the pocket. With the professional cleanings, tissue health and color will dramatically improve. Gum sensitivity and bleeding will reduce as well.

Fig. 5: calculus on rootSpecial hand instruments called scalers and curettes have been developed to remove the calculus in an effective and comfortable manner (Fig. 5). The fine curettes come in different sizes and shapes. The instruments are designed so they can be gently teased into the pockets in order to scrape off the very adherent calculus deposits.

If the teeth or gum tissues are sensitive, your dentist can numb the teeth and tissues with a local anesthetic (freezing) to assure your comfort. Scaling and root planing is a meticulous process and may take a number of appointments. A quality professional cleaning will be the first step necessary in establishing periodontal health.

Fine ultrasonic instruments have been developed to make calculus removal even more efficient and comfortable. The ultrasonic tips come in various shapes to help access the nooks and depressions on the root surfaces where the calculus deposits may be hiding. These high-tech instruments introduce a fine water or antiseptic solution to help flush out deposits and bacteria.

If the periodontal disease is advanced, an antibiotic may be prescribed along with the scaling and root planing. Irrigation of the infected pockets with an antibiotic or antiseptic solution can be help as well in chasing those 'bad bugs' away during the professional cleanings.

Non-surgical scaling and root planing procedures are a highly effective method controlling gum inflammation and eliminating periodontal disease. However, there are limits to the extent of healing possible through scaling and root planing procedures alone.

Surgical Therapy

To create optimal health, there is a critical level of calculus removal necessary from the root surfaces in order form a gum seal around the neck of the tooth. The deeper the pockets are, the more difficult it is to achieve this level. That is why early detection of the disease is so important. In the early phase of periodontal disease the pockets tends to be shallow making calculus removal so much easier.

Fig. 5-8: peridontal surgeryIf disease activity continues in spite of proper oral hygiene and careful scaling and root planing, surgical options may be considered. Surgery allows access to the deeper areas of the root surfaces for complete calculus removal. However, if a person is not practising optimum oral hygiene, surgical therapy is not a good idea since healing will be poor. The commitment to daily plaque removal must be very strong to assure optimum healing and post-surgical success.

The surgical treatment is considered a minor surgical procedure that can easily be done in the dental office with local anesthesia (freezing). Once the problem is identified, a small incision is made on the inside and outside tooth gum margins of the involved teeth (Fig. 6). The gum tissue is gently teased away from the necks of the teeth to give access to the underlying root surfaces (Fig. 7).

The root surfaces are inspected and all residual calculus is removed. The infected tissues located in the bony defects are removed as well. Where disease has eroded the bony surfaces, the bone may need to be smoothed. This will allow the gum tissues to snug up tightly around the necks of the teeth when stitched back into place (Fig. 8).

A small dressing (cast) is placed around the surgical site for comfort. The stitches and dressing are usually removed about a week later. We do not seem to slow patients down too much. Most are back to normal activities the next day. Healing progresses very rapidly in the mouth!

Surgical reconstructive techniques have also been developed to help restore the lost bone and gum tissues due to periodontal disease. Bone and gum grafts are available to be used in appropriate locations. Your periodontist can offer the best surgical options for your particular problem.

Supportive Periodontal Therapy - Monitoring and Cleaning

To prevent return of periodontal disease, regular visits to your dental professional are necessary. Reinforcement of oral hygiene, inspection of the supporting structures and professional cleanings all serve to maintain the existing bone levels.

Much research has been done to investigate the best recall interval for a professional cleaning. If you have had periodontal disease, it appears that intervals of three to four months between visits are successful in preventing recurrence of disease. Otherwise, a six month interval is likely adequate to maintain health.

Everyone is different and has unique requirements. Factors such as rate of calculus build-up, depth of periodontal pockets, oral hygiene and susceptibility to periodontal disease are all taken into account when establishing a personal recall interval. An ideal recall interval provides a quality professional cleaning at the time the bad bacteria are trying to re-establish themselves in the pockets.

Periodontal Disease and Other Health Issues

Recently a case control study of 124 pregnant or postpartum mothers showed that periodontal disease represents a clinically significant risk factor for pre-term low birth weight babies. If the mother had periodontal disease, there was a seven-fold chance of delivering a pre-term low birth weight baby. The low grade bacterial infection might affect the placenta. Further investigations are underway.

There may also be an increased risk of bacterial pneumonia for those with active periodontal disease and poor oral hygiene. The bacteria from the gums may travel to the lungs and cause serious infections. Patients in intensive care units and nursing home residents who are at greater risk for bacterial pneumonia may be infected by this process.

Periodontal disease may be a risk factor for heart disease and stroke. Increased bone loss in the mouth seems to be associated with heart and stroke problems. It is believed that periodontal bacteria infections can block the blood vessels and cause these serious health problems. New research, knowledge and diagnostic tests are helping to improve our already successful result.

By keeping your gum and teeth healthy, you can continue to enjoy the crunch of biting into an apple. If you have any concerns about your gum conditions, contact a periodontist for a gum check-up. Your teeth are worth it!

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FAMILY HEALTH is written with the assistance of
College of Family Physicans of Canada
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
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