What is gum disease?

Periodontal disease (gum disease) is a chronic bacterial infection of the gums and bone supporting the teeth. It is a major cause of tooth loss in adults. However, because gum disease is usually painless, you may not even know you have it. Gum disease is caused by plaque bacteria which form a sticky film on the tooth surface. These plaque bacteria release toxins that can damage the gums. As the amount of plaque increases the saliva in your mouth can begin to mineralise the plaque to form tartar (calculus). These hard deposits on the roots of the teeth only serve to promote more plaque formation and further damage to the gums.

Types of Gum disease

There are two main types of gum disease- gingivitis and periodontitis. Gingivitis is very common and may affect up to 70% of the population. Periodontitis affects around 30% of adults over age of 30. Both these infections can be treated and controlled, but the earlier they are diagnosed and managed, generally the better the prognosis for your teeth.

A patient with generalised gingivitis. Note the red, swollen, inflammed gum tissues around the teeth. These gums bleed easily on brushing.

Diagnosis and treatment

Diagnosis and treatment of periodontitis in its early stages will significantly enhance the prognosis for the dentition. If you have not had a periodontal screening examination with your dentist in the last 12 months, make it a priority. Remember, most patients who present with periodontitis are completely unaware of a gum problem being present in their mouth because it rarely causes pain until it becomes very severe, by which time it may be too late to save your teeth.

What are the warning signs of gum disease?

Periodontal disease is typically painless and often the signs are subtle. Some of the symptoms may include:

• gums that bleed easily with brushing or flossing
• red, swollen or tender gums
• pus between gums and teeth
• gums that pull away from the teeth
• persistent bad breath
• loose or separating teeth
• a change in the way your teeth fit together when you bite

Normal healthy gumsHealthy gums and bone anchor teeth firmly in place.

PeriodontitisUnremoved plaque hardens into calculus (tartar), As plaque and calculus continue to build up, the gums begin to recede( pull away) from the teeth, and pockets form between the teeth and gums.

Advanced PeriodontitisThe gums recede further, destroying more bone and the periodontal ligament. Even healthy teeth may become loose and need to be extracted

An increasing amount of research also suggests that there is evidence linking chronic periodontal disease to conditions such as coronary heart disease, diabetes and respiratory disease. Moreover, current research suggests that if you have periodontal disease during pregnancy you may be significantly more likely to have a baby born prematurely or with a low birth weight. Keeping your gums healthy will ensure a better chance of good general health.

A case of advanced Periodontitis. Very swollen gums, loose teeth, staining and heavy plaque and calculus deposits on all the teeth.

Heavy calculus (tartar) deposits on the inside aspect of the lower incisor teeth in a patient with periodontitis.

Patient with advanced periodontitis showing severe loss of bone and gum recession.

Risk Factors for Gum Disease

The main cause of periodontal disease is bacterial plaque. Oral bacteria form a sticky, colourless film on your teeth. These bacteria release various toxic by-products which irritate your gum tissues. While plaque bacteria are the main cause of periodontal disease there are other factors, such as those outlined below, that can also affect the health of your gums.

Smoking and Tobacco Use

The use of tobacco is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Smoking also increases the risk of periodontal disease and recent research has shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. Smoking also reduces the ability of your gums to heal properly following treatment, which may mean a less successful treatment outcome. Patients who smoke are also more prone to developing post operative infections following treatment. For these reasons all patients are encouraged to quit smoking as part of their periodontal therapy.

Genetics

Recent studies suggest that approximately 30% of the population may be genetically more susceptible to developing gum disease. Thus, some individuals are more prone to periodontal disease. Often the susceptibility to periodontal infection can be traced though families. Patients with a susceptibility to periodontal disease may require more intensive maintenance and more frequent recall for hygiene treatment.

Pregnancy & Puberty

At certain times such as puberty, menopause, menstruation and pregnancy your gum tissues may be more susceptible to irritation and infection. During these particular times  your body experiences specific hormonal changes which can affect your gum tissues. Your gums may become more sensitive and at times react strongly to the hormonal fluctuations. Recent research also suggests that pregnant women with chronic gum disease are up to seven times more likely to deliver pre-term, low-birth-weight babies.

Grinding or Clenching your Teeth

Tooth grinding typically occurs at night while you are asleep and is also know as bruxism. Your jaw joint may click on opening or may be painful at times. If you wake up with frequent headaches and show wear on your teeth, you may be grinding your teeth. Tooth grinding may worsen your gum health if you have pre-existing periodontal disease.

Diabetes

Diabetes is one of the main risk factors in periodontal disease. Diabetics are generally more prone to developing infections, including periodontal disease. Periodontal disease is often more severe in diabetics and can be more difficult to treat, depending you the level of diabetic control.

Stress

Chronic stress can have a negative effect of you body’s immune system. This may in turn make you more susceptible to periodontal disease as it can make it more difficult for the body to fight off infection.

Medications

Certain drugs, such as antidepressants, oral contraceptives and some heart medicines, can have an effect on your oral health. You should always inform your dental professional of the medications you are taking so that these can be taken into consideration.

Poor Nutrition

A diet low in important vitamins and nutrients can compromise the body’s immune system and make it harder for the body to fight off infection. One of the more common conditions is iron deficiency. Deficiencies such as this can worsen the condition of your gums.

Other Systemic Diseases

Certain diseases may worsen your gum disease by interfering with the way your body’s defences deal with infection. Some examples include uncontrolled diabetes, radiation therapy, chemotherapy, corticosteroid use.

Maintaining Periodontal Health

After your gum disease has been diagnosed and treated, ongoing supportive treatment to maintain your periodontal heath will be recommended.

Supportive Periodontal Therapy

This consists of structured and regular hygiene treatment that is aimed at preventing and reducing the possibility of the recurrence and progression of periodontal disease. Each patient will have specific maintenance requirements which will need to be professionally tailored to their needs. The Oral Hygiene Spa at the Institute of Dental Implants & Periodontics provides the highest level of periodontal maintenance under the specialist supervision of a Periodontist.

Good Oral Hygiene Habits

As part of your periodontal treatment you will be given careful oral hygiene instruction and shown the right ‘tools’ to use. It is important that you regularly remove plaque bacteria through brushing, flossing, and regular professional cleaning. Good oral hygiene will leave you with a fresh, healthy mouth and reduce your risk of further gum disease. There are other risk factors that may compromise your periodontal health such as stress, diabetes, genetics, and pregnancy. These other factors may be transient, but should be discussed with your dental health professional.

Corneal collagen cross-linking is a technique which uses UV light and a photosensitizer to strengthen chemical bonds in the cornea. The goal of the treatment is to halt progressive and irregular changes in corneal shape known as ectasia. These ectatic changes are typically marked by corneal thinning and an increase in the anterior and/or posterior curvatures of the cornea, and often lead to high levels of myopia and astigmatism. The most common form of ectasia is keratoconus and less often ectasia is seen after laser vision correction such as LASIK.

Cross-linking of collagen refers to the ability of collagen fibrils to form strong chemical bonds with adjacent fibrils. In the cornea, collagen cross-linking occurs naturally with aging due to an oxidative deamination reaction that takes place within the end chains of the collagen. It has been hypothesized that this natural cross-linkage of collagen explains why keratoectasia (corneal ectasia) often progresses most rapidly in adolescence or early adulthood but tends to stabilize in patients after middle-age.

In addition to the cross-linking that occurs commonly with corneal maturation, there are several other pathways that can lead to crosslinkage. Glycation refers to a reaction seen predominantly in diabetics that can lead to the formation of additional bonds between collagen. In the pathway most relevant to this topic, oxidation has been shown to be able to trigger corneal crosslinkage through the release of oxygen free radicals.

The term ocular hypertension usually refers to any situation in which the pressure inside the eye, called intraocular pressure, is higher than normal. Eye pressure is measured in millimeters of mercury (mm Hg). Normal eye pressure ranges from 10-21 mm Hg. Ocular hypertension is an eye pressure of greater than 21 mm Hg.

Although its definition has evolved through the years, ocular hypertension is commonly defined as a condition with the following criteria:

• An intraocular pressure of greater than 21 mm Hg is measured in one or both eyes at two or more office visits. Pressure inside the eye is measured using an instrument called a tonometer.
• The optic nerve appears normal.
• No signs of glaucoma are evident on visual field testing, which is a test to assess your peripheral (or side) vision.
• To determine other possible causes for your high eye pressure, an ophthalmologist (a medical doctor who specializes in eye care and surgery) assesses whether your drainage system (called the “angle”) is open or closed. The angle is seen using a technique called gonioscopy. This technique involves the use of a special contact lens to examine the drainage angles (or channels) in your eyes to see if they are open, narrowed, or closed.
• No signs of any ocular disease are present. Some eye diseases can increase the pressure inside the eye.

Ocular hypertension should not be considered a disease by itself. Instead, ocular hypertension is a term that is used to describe individuals who should be observed more closely than the general population for the onset of glaucoma. For this reason, another term to refer to a person with ocular hypertension is “glaucoma suspect,” or someone whom the ophthalmologist is concerned may have or may develop glaucoma because of elevated pressure inside the eyes. An eye exam may show a glaucoma-damaged optic nerve.

As mentioned above, increased intraocular pressure can result from other eye conditions. However, within this article, ocular hypertension primarily refers to increased intraocular pressure without any optic nerve damage or vision loss. Glaucoma occurs when increased intraocular pressure, optic nerve damage, and vision loss are present.

Ocular Hypertension Causes

Elevated intraocular pressure is a concern in people with ocular hypertension because it is one of the main risk factors for glaucoma.

High pressure inside the eye is caused by an imbalance in the production and drainage of fluid in the eye (aqueous humor). The channels that normally drain the fluid from inside the eye do not function properly. More fluid is continually being produced but cannot be drained because of the improperly functioning drainage channels. This results in an increased amount of fluid inside the eye, thus raising the pressure.

Another way to think of high pressure inside the eye is to imagine a water balloon. The more water that is put into the balloon, the higher the pressure inside the balloon. The same situation exists with too much fluid inside the eye—the more fluid, the higher the pressure. Also, just like a water balloon can burst if too much water is put into it, the optic nerve in the eye can be damaged by too high of a pressure.

Medical Treatment:

The goal of medical treatment is to reduce the pressure before it causes glaucomatous loss of vision. Medical treatment is always initiated for those people who are believed to be at the greatest risk for developing glaucoma and for those with signs of optic nerve damage.

How your ophthalmologist chooses to treat you is highly individualized. Depending on your particular situation, you may be treated with medications or just observed. Your doctor will discuss the pros and cons of medical treatment versus observation with you.

• If you are experiencing symptoms like halos, blurred vision, or pain, or if your intraocular pressure has recently increased and then continues to increase on subsequent visits, your ophthalmologist will most likely start medical treatment.

Your intraocular pressure is evaluated periodically using these guidelines:

• If your intraocular pressure is 28 mm Hg or higher, you are treated with medicines. After 1 month of taking the drug, you have a follow-up visit with your ophthalmologist to see if the medicine is lowering the pressure and there are no side effects. If the drug is working, then follow-up visits are scheduled every 3-4 months.
• If your intraocular pressure is 26-27 mm Hg, the pressure is rechecked in 2-3 weeks after your initial visit. On your second visit, if the pressure is still within 3 mm Hg of the reading at the initial visit, then follow-up visits are scheduled every 3-4 months. If the pressure is lower on your second visit, then the length of time between follow-up visits is longer and is determined by your ophthalmologist. At least once a year, visual field testing is done and your optic nerve is examined.
• If your intraocular pressure is 22-25 mm Hg, the pressure is rechecked in 2-3 months. At the second visit, if the pressure is still within 3 mm Hg of the reading at the initial visit, then your next visit is in 6 months and includes visual field testing and an optic nerve examination. Testing is repeated at least yearly.

What Is Albinism?

What Causes Albinism?

Who Is at Risk for Albinism?

What Are the Symptoms of Albinism?

How Is Albinism Diagnosed?

What Are the Treatments for Albinism?

Endoscopic Sleeve Gastroplasty: A Promising New Weight Loss Procedure

Endoscopic sleeve gastroplasty offers an effective weight loss intervention at lower cost and higher patient satisfaction, potentially filling this gap in the management of obesity.”

Endoscopic sleeve gastroplasty falls under the umbrella of endoscopy, a nonsurgical procedure gastroenterologists use to examine a person’s digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, endoscopic sleeve gastroplasty reduces the size of the stomach by creating a sleeve using a set of sutures .

The patients with obesity, endoscopic sleeve gastroplasty reduced excess body weight by 54 percent at one year. Further, the procedure delayed solid food emptying from the stomach and created an earlier feeling of fullness during a meal, which resulted in a more significant and long-lasting weight loss.

Endoscopic sleeve gastroplasty was well tolerated as an outpatient treatment, requiring less than two hours of procedure time. Patients resumed their normal lifestyle within one to three days. The treatment was performed using standard “off-the-shelf” endoscopic tools as opposed to specific weight loss devices or platforms. The cost of endoscopic sleeve gastroplasty is roughly one-third that of bariatric surgery.

What is laryngeal cancer?

Laryngeal cancer occurs when cancerous (malignant) cells form on the tissues of the larynx, or voice box. The larynx contains the vocal folds. The vocal folds vibrate. This makes sound when air is directed against them. A person’s voice is heard when this sound echoes through the throat, mouth, and nose.

What are some signs or symptoms of laryngeal cancer?

A person with laryngeal cancer may notice:

• hoarseness or change in his or her voice
• difficulty swallowing
• a lump in the throat
• bad cough or chest infection
• shortness of breath
• bad breath (halitosis)
• weight loss
• prolonged earache

How is laryngeal cancer diagnosed?

You should visit a doctor if you have any of the above-mentioned symptoms. A doctor will feel your throat for lumps. He or she will also look down your throat with an endoscope, a tube with a special light, to see your larynx. This procedure is called a laryngoscopy. The doctor may need to cut out a small piece of tissue, if the larynx has tissue that does not look normal. The doctor will look at the tissue under a microscope to see if it contains any cancer cells. This procedure is called a biopsy, and it is the only way to diagnose cancer.

What treatments are available for individuals with laryngeal cancer?

One or more of the following approaches may be used depending on the size, location, and time of cancer detection:

• radiation therapy
• chemotherapy
• partial removal of the larynx (laryngectomy)
• total laryngectomy

In these cases, the person may still be able to produce voice. However, the person’s voice may not be the same because of removing parts of the larynx, changes to laryngeal tissue from radiation or chemotherapy, or removal of nearby neck muscles (to prevent or stop the spread of the cancer).

In extreme cases, total laryngectomy, with or without radiation therapy or chemotherapy, may be the only life-saving solution.

Patients who have undergone radiation treatment may have:

• dry and/or red skin at the site of the treatment
• sore throat
• dry mouth (xerostomia)
• sensitive mouth
• mouth sores
• difficulty swallowing
• decreased taste
• fatigue
• breathing difficulties from swelling

Patients who have received chemotherapy, often for the treatment of metastasized cancer (i.e., cancer that has spread), may have:

• nausea or vomiting
• increased chance of infection
• bleeding or bruising
• fatigue
• shortness of breath

These side effects often stop after the chemotherapy is discontinued.

Speech-language pathologists (SLPs) play an important role both before and after surgery.

What is a laryngectomy?

A laryngectomy is the removal of the voice box (larynx) from the neck, usually because of cancer. During this operation, a new route for breathing is surgically created. The end of the windpipe (trachea) is connected to a hole (stoma) made in the neck. Rather than using the mouth and the nose, the person will breathe through this hole.

Because the patient with the laryngectomy breathes through a stoma, the air inhaled into the lungs is no longer warmed or moisturized by structures of the nose and mouth. As a result, the breathing tubes can become irritated and create a thick mucus. This mucus may also crust on the stoma and require routine removal. The patient may benefit from humidifiers and a cover to protect the stoma.

What causes laryngeal cancer?

The following may increase your risk of laryngeal cancer:

• heavy smoking and drinking
• poor eating habits-not enough vitamins from fruits and vegetables
• weakened immune system
• exposure to chemicals and certain substances (e.g., wood dust, paint fumes, soot)
• acid reflux