Gum disease

The gums of healthy teeth are close up round their necks, and extend up between them, as in G, Fig. 26-2. If gums are diseased by periodontitis, they recede down the necks of the teeth (H, and I, 26-2), which ultimately become loose and are lost. Besides causing sore, bleeding gums, periodontal disease causes more lost teeth in many communities even than caries.

Periodontal disease is the result of a vicious circle. Food particles and plaque accumulate between a tooth and its gum, and cause the gum to slowly recede. This makes the pocket larger, so that food accumulates even more easily. In more severe cases the diseased gums swell, bleed easily (gingivitis), and discharge pus (pyorrhoea), often with severe fetor.

The prevention, and most of the treatment, is improved oral hygiene[md]better tooth-brushing, as in Fig. 26-2, and, when necessary, scaling to remove calculus (hardened plaque) that has accumulated in the crevices (J, 26-2).

You will not find yourself scaling many teeth yourself, but there must be someone in your hospital who does this, and you should be able to teach him how to do it.

PREVENTIVE DENTISTRY CLEANING TEETH Explain to the patient that he should always start with his toothbrush (or toothstick) on his gums, and move it up over his lower teeth, and down over his upper ones, at least 10 times, during at least 2 minutes. This is not easy behind the lower front teeth, and needs much practice. After this, he should rinse out his mouth. If he does not have toothpaste, he can use common salt, or nothing[md]brushing is more important than paste.

SCALING TEETH INDICATIONS. One of the causes of bleeding gums is plaque (tartar) round the teeth. Measure the depth of his gum pockets. If these are less than about 5 mm, scaling may be all he needs, but if they are deeper than this, refer him for gingivectomy. If this is impractical, consider extraction.

Use the spoon end of a scaler (F, in Fig. 26-2) to remove deep calculus (hardened plaque, J, in this figure). This starts just below the gum. Removal may be difficult, because the calculus may stick so firmly to his teeth that scraping it off can cause mild pain and bleeding. Use the point of the scaler to remove plaque from between his teeth. Ask him to rinse his mouth out thoroughly, and then show him how to clean his teeth.

CAUTION ! The most important part of the treatment is to show him how to clean his teeth effectively.

Fig. 26-2 PREVENTIVE DENTISTRY. A, calculus around the lower front teeth. B, and C, using a toothstick on the upper teeth. D, and E, using a toothbrush on the lower teeth. Explain to the patient that he should move the brush vertically from his gums up and over his teeth, and not horizontally along them. F, a dental scaler. G, to J, sections of a tooth ]]and gum. G, healthy gum. H, early periodontal disease. I, severe periodontal disease. J, removing calculus with a scaler. Halestrap DJ, ''Simple Dental Care for Rural Hospitals' (4th edn 1981), pp.7 and 11. The Medical Missionary Association, with kind permission.