Your doctor speaks II; Gum Diseases: what Can Be Done?

The University of Illinois Medical Center campus in Chicago percents your doctor speaks during this series doctors in the colleges of medicine dentistry pharmacy nursing and graduate college at the University of Iowa and I will discuss the latest advances in cancer and heart research. Painless dentistry psychiatry nursing care and modern drugs. All of these and more will be presented on your doctor's speaks. Your host for this series is Jack Reed AMA coordinator of public service radio and TV programming for the University of Illinois Medical Center campus and champagne Urbana. This is Jack remember. Our guest today is Dr Sigman Porter assistant professor Harold optics get that right yet. University of Illinois I College of Dentistry. We're going to discuss with Dr. Porter gum disease. First of all doctor the word I stumble over what does it mean perio down ticks.

They're going to write that on the study of diseases and surrounding structures of teeth. This may sound like a very limited area like working on little toes but gum disease is probably the most prevalent disease on the face of the earth. We have found that a certain percentage of the population doesn't have cavities Carys but we find that there are very very few people who in their lifetime does not have gum disease. The major cause of tooth loss after the age of 30 is gum disease. So periodontal X is a study of this particular subject. Now we are the probably the oldest specialty in dentistry. Having gone back to or bought one thousand five hundred ever it is only recently in the last 20 or 30 years that we really have made

very rapid strides in this field and particularly since World War 2 we have advanced tremendously. I must admit however there are still a long way to go. Gum disease is commonly called Pyar Riya. Yeah fasten our high rear is about as useful a term as saying that you have consumption when you have a chest cold. There really isn't any such thing as Pirate which translates as possibly gums. I might say that gum disease is about 30 or 40 different types of disease today and so what you would call PIO Rhea is really one of these 30 or 40 and it's very very chronic type. Generally there are some acute diseases such as Trench Mouth which I'll get into later. And there are some diseases that are caused mainly by neglect on the patient. Now let me start into the field of gums by saying that the old adage you know

the teeth are good but the gums have to go. That's right it is a truism. And years ago when people had called piracy on quote It was merely a matter of time till I lost her teeth. Today if gum disease is detected early and if it's treated properly there is no reason for anyone to lose any of their teeth at any time during their life. That's a big statement. It is and even if I'm 50 percent or 100 percent raw it will come very shortly. Let me tell you some of the various kinds of gum diseases that we have and how they arise and then we will speak of the treatment I think wrong that everybody is familiar with is a disease that used to be called trench mouth. It's a horrible name. It is. It is today called acute necrotizing ulcerative Ginger Vitus. Just stay with the name. That's just as bad I think Vinson's

disease for short. Oh it was at one time the thought to be an infectious disease. And I'm certainly sure that many of the people listening today will still think that trench mouth is an infectious disease that means you could catch it from somebody and drinking from a fountain or from a glass. The answer is No. It is a disease our stress strain and worry combined with some degree of neglect. All it World War One. All these soldiers were standing in the trenches up to the knees of water. Somebody was shooting out. They didn't eat very well they certainly didn't brush their teeth at every meal after a meal and thus they called a trench mouth. Last year after World War II we began to look at a little more closely and we found that it wasn't so much an infectious disease but one of stress worry and strain. We may see one case a week here at the university. But come final examination week we see 50. So it was finals are over. Back you go to being normal.

So what I'm saying is that there's more to it than that I'm just giving you here. But it is not an infectious disease and we usually don't have to put it is a deep seated psychological problem. It's usually something like Final exams as I've just said or you've lost your job and this stress and strain combined with the fact that you may have a little tinge of itis which is a little infection we got from not brushing to well will lead you to have instances ease. It's cleared up very easily. How was cleared up by Anna biotics cleaning up the mouth with scaling off the tire and showing the patient how to brush her teeth and if they'll keep their mouth clean. The disease will probably not return. How would they know they had a use of their trench mouth. There is a certain manifestations. Yes the gums are red and swollen. The little points in between the teeth disappear and become holes between the teeth. There's a bad taste. A metallic taste as a fetid odor and it's painful. It

bleeds when it brushes and it comes and goes and periodic episodes and you can usually pinpoint these things by saying last week I lost my job and my gums got bad this week. I found a new job and my government got better. Well that's Vincent's disease. Psychosomatic gum disease. Well not quite but almost. OK. Now other diseases. Well the most common the garden variety is periodontitis periodontitis is the major killer of teeth. Wow. It is a disease that usually starts when the patient is in their early 20s and it takes 20 or 30 years as a rule for the disease to manifest itself in the form of teeth being lost. These are the patients we see down here at the university who have to lose teeth because of abscesses or pockets and whose teeth are loose and ice is coming out of them. My goodness and this is the type of a problem

that took 20 or 30 years to work. And I might say that it could have probably if not prevented been made so that it would have taken a lot longer for the patient to lose their teeth if they had rushed. The disease is caused by an accumulation of tartar under the gums. It is caused by the teeth not meeting together properly. It is caused by patients grinding their teeth and causing undue stress upon certainties. It is caused by improper diet and we could go on and make a list of about 20 or 30 various items such as poor fillings or high bridges or the patient improperly using certain teeth. Each one of these things would not cause a patient to lose or teeth but all of these things combinations working together over a long period of time will be enough to overcome the body's resistance to withstand these particular

forces and cause the bone around teeth to disappear. And when too much bone has been lost the teeth are lost. Intriguing gum disease any gum disease. Our main aim is to eliminate all the specific points or etiologies of the gum disease. And when we've eliminated them all to show the patient how to brush their teeth so that they can prevent a good portion of these from coming back. And on our part keeping an eye on the patient getting those spots that they can't get by themselves with brushing and making sure that some of the problems don't return. And in this way we eliminate the cause of the disease and thus keep the patient's teeth. If one would have maybe two or three of the things that you mentioned in our pocket in the tooth and improper biting and if I had to grind it you'd better be a good warning sign that you better go so you're not necessarily necessary that's what I said.

A lot of people grind their teeth and a great many people have pockets. This does not mean it's a foregone conclusion that you're going to lose your teeth. The odds are pretty good it is up to the dentist to recognize this disease. Most people who have periodontitis do not know that they have this deep this problem rather go to the last stage of the disease. That's when the teeth become loose. They make it bleeding from the gums may even have a little puss coming out. Many people don't even have this problem. And the day they usually have a problem is the day it was the teeth. Because this is a very chronic problem. I like to liken it to a Las Vegas trip. The gum break style. 51 percent and the body heals at 49 percent. Now that's better than Las Vegas as far as I saw him. But you go on like this for 10 or 20 years and you slowly lose a little bit more than heals. Not enough so that it hurts or that you're even aware of the problem. It's

smoldering and one day you wake up and so much has been lost that the teeth have to be lost. So it is such a disease that in most cases patients are even aware of it. We see cases here at the university where the patient would say How come my dentist didn't tell me about this problem. It was yeah I'll come in. How come I've gone to my dentist every six months of my life and I still have to lose my days. Yeah why bother. It's not the Dennis fault it's the patient's fault. I am not entirely but partially in the respect that when you have a pocket and you have your teeth cleaned out first of all let me let me digress for a moment explain a pocket as we've been talking about is a space between the gum and the tooth I want it. You're going to liken it to the space how nice your fingernails every time you eat dinner. Food packs in these spaces no matter how hard you brush your teeth. You cannot get the food out there. Well this food becomes tired.

It breaks down because of bacterial action. And this in turn leaves the gums to become infected. Now gum is only a skin that covers the bone and it's the bone that holds your teeth and the infection in your gum in many respects affects this bone and causes it to disappear very slowly however. Now this space this pocket is the cause of the whole problem. When you have pockets and have your teeth cleaned you go home that night from the dentist's office and you eat dinner and food packs right back into the holes again. And six months later if you are good at your appointments you come wandering back into the dentist's office and he cleans your mouth again. But this food has been in there for well not six months but a good portion of it. I see. So unless the pockets are eliminated or unless you are very vigorous in brushing your teeth you will not be able to conquer the pockets.

So in treating diseases we usually like to eliminate the pockets. I do it well. We have various methods of doing that. One of the easiest and best methods is to go in and use instruments and clean out all of tartar and infection. This causes the gums to shrink and it will be exactly like your fingernails for a king. And there would be no more space between your government a tooth. This is very very easy. This is called scaling and cure a tallish. Today we even have an instrument called the kava truck which in part is very easy to use and helps clean off all this target. It works by sound waves. So with this in part I say in part has eliminated the use of those instruments so it's great. Yeah. Another point I might make is that there is an instrument on the market a water cleansing device. Oh yes I want to hear what do they call it. Well you mention the name I want and this is also very good. Sorry about that for getting out food. Now let me go a step further.

If a patient has gone to the nest every six months of their life and had a cleaning right man they can still lose their teeth as many people will testify. And the answer to this and the reason for this rather is because they do not brush their teeth. Most people in this country as studies have shown brushed their teeth once a day in the morning to get the bad taste out of their mouth. I see and this is also I might add. The reason we have mouthwash is today because it's an easy way of getting the bad taste out of your mouth. But then the patient goes and has breakfast and a coffee snack and a lunch and an afternoon snack and dinner and before bedtime snack and they go to sleep and they wake up the next morning and they start to brush their teeth. All that stuff has been there 24 hours. I'll even take the patient and his only 30 percent of the population airbrushes twice a day. Yeah I do I do regret that. Ok ok most of the infection most of the Tartar is

formed within a couple hours after having eaten so you brushed before breakfast and you brushed before bedtime and usually there's a 12 hour span there and I don't do them. I was after you were wonderful. Did you brush after lunch today I haven't done no no I have buy add celery and I have carrots and things. Well that's fine that's a good food. Incidentally I think you hit the heart of the problem here. Now the other problem is this. Let's take the ideal patient who brushes after each meal. They don't do it properly. That may be the first reason they may not do it effectively. I mean put it that way. Second of all there are five surfaces of a tooth. There is the front surface that you look at when you see the mirror. There's the top surface upon which you chew and that is the inside surface where the tongue usually takes action. Those are three surfaces and those are the surfaces reached by a tooth brush. Now the in-between surfaces are the surfaces that are

usually missed by the patient because the tooth brush will not get there so that if the ideal patient brush is three times a day this is infinitely better than once a day. But there is still a chance that this patient has not been able to reach in between the teeth. Do you remember that little rubber point that's always on the end of a jacket off right. Right. So you can go in the bathroom right next I can go another way. That's the thing that gets in between the teeth. What about dental floss dental floss is also excellent but I'd be willing to venture that there are very few people in this audience who use a tooth brush. The rubber tip and dental floss. Yeah and if they do I'd venture to say that they have pretty good Miles. One is patient neglect misery because you paint a pretty bleak picture here my teeth are going to fall at age 55 if a patient will brush their teeth as I said before and see the dentist so that he can get those spots they missed. But I mean brush their teeth properly there is no reason why they should lose their

teeth. I'm certainly sure that there must be some people listening to me today who will say but I do brush three times a day and I ask them very honestly do they brush in between their teeth. Do they do it effectively. Have they asked their dentist for advice recently as to whether or not they're brushing properly. Have they checked to see if the Aller fillings are missing teeth replaced. Because if you're missing certain teeth then the few teeth that you have left on that site have to do double duty. And if you're missing by some chance all the back teeth are one side just on the bottom then you have to do all you chewing on the left side that does make a present a problem. So all the teeth that are left on the right side don't have any antagonist. They do no work and you do all the chewing on your left side. And then when you lose your teeth on the left side you just can't figure out why in the same vein about brushing teeth. It is a duration important. How long should you brush fire.

You know you get a 30 second I give up half as I'm not foxhound let me say that it doesn't matter if the tooth brush is been angled or straight angle whether it has rounded bristles or straight bristles whether they're natural or not I live where the two row or three row whether I top that or single tufted or what the manufactories the point with a tooth brush is that must be used. Now the only thing I didn't mention was the hardness of a tooth brush. Soft medium hard studies have shown that a soft tooth brush gets the food out very nicely because it bends bands getting between the cracks but it doesn't massage your gums. I do a brush on the other hand will massage the gums but doesn't get in between the cracks so easily and so the manufacturers have come out with a soft tooth brush for medium rather. But except for those small differences and a small difference between a natural bristle and an eye line which is my new skill there really isn't any difference between toothbrushes

and it's a matter of do you use it or don't you. Now let me get on to electric toothbrushes for just a moment. Electric toothbrushes are as the studies have shown a very effective method of getting your mouth clean. They are marvelous for children who do not have the manual dexterity that adults do. They are marvelous for adults who have poor manual dexterity. They are marvelous for patients who because of say cerebral palsy do not have the manual dexterity. They're also good in some cases for patients who just don't have the extra minute to brush. But if you have that time to brush you can brush just as effectively with the old fashioned hand tooth brush as you can with electric. It does it faster and does it easier but it's just as effective as far as toothpaste sculpt. Yeah I don't want to get involved really too deeply in this but as far as guns go there really aren't any toothpaste on the market that are any better.

As far as guns going out after the many other fluoride because All right let's actually have it fly is a marvelous for cavities but I'm speaking on guns. OK. Grand good points far as that goes there are any toothpaste on the market that are any more effective than the others forgot. It's very interesting that we how we got toothpaste. Your grandmother or mother probably used baking soda or salt and around the turn of the century a certain gentleman decided that this had a very bad taste to it. So he had to baking soda a peppermint flavoring. And we had tooth powder so from that point on. And about one thousand twenty eight thousand nine hundred thirty two they decided that this was kind of messy to hold it in your palm and so they put in a cream for and this is how we got toothpaste and that's it and really all toothpaste is with the exception of the fly is an abrasive something for taste so that you can get the plaque which is the film off of your teeth.

Let's let's move into a very About three months left now. If somebody does and you serve like I had 99 percent of us you're going to have some problem with with our gowns and gum disease and what can the periodontist do the periodontist. I rather say what can the dentists do. OK what can a dentist to if the case is not too severe the dentist can clean the teeth show the patient how to brush their teeth. How do you use the injured Demel stimulator that the rubber tip. If the case is more severe some had more advanced type of work may be necessary such as removal of some excess and infected. Or perhaps in a very advanced case where the case would have to be sent to a periodontist some boat transponding to fill in the missing boat and some very difficult problems that we have. But I would say it's not what can the periodontist do but what can the dentist do. Because when the case comes to my

office I could hang a door not a door a notice over my door but saying that through these doors past the worst gums in the world. One patient however was got back to me and said coming in or going out. So I would say that it's in the province of the dentist not the paradox because when it gets to my office sorts of the university right. It's not to I'm not sure that's better. No it's not too late but it's your but is our parting gesture I would say to anybody that was listening today who desired to keep their teeth. Not all of them. Most of them maybe not their entire life but most of their life and really wanted to know how without getting into any detail I would say that they should brush their teeth after each meal for three minutes. Good for us. OK three minutes. That's an effective brushing to buy one of those oral water spray machines to use dental floss and a little rubber tip. A total of about 10 12 minutes a day. And this I would say would be

effective in helping keep their mouth clean. Remember the dentist can't do it by himself and the patient can't do it by themselves. But together they should be able to help the patient Keep it was a combination of the two the dentist doing his part by you going to see him for that annual checkup and then by you taking you to vices you Jenna said and he said you're not brushing properly you know so I allus forget about it and I get my ass six months to get my teeth cleaner a year and outside it and it's so it's a combination of two so they don't actually end up in your office. I hope not. OK I guess dentistry like medicine we're trying to put ourselves out of business but nobody will believe us I believe. Thank you very much it's been a most interesting program I guess and then Dr. Sigmon Porter assistant professor of periodontal University Alumni College of Dentistry. You have just heard another in the series your doctor speaks produced by the University of