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HEALTH: Dr Nalin R. Dhamecha, BDS MFGDP, UKDental HealthDental Diseases and TreatmentPart 2Dental disease is disease of the teethand gums. Tooth decay (dental caries)and gum disease (periodontal disease)can exist independently or in combination.Dental diseases can also affect other areasof the mouth and the severity can range from asimple mouth ulcer or a small cavity in a toothto the more serious mouth cancer.Dentists and other dental health professionals,such as dental hygienists, provide treatmentand advice to help prevent dental disease. Specialistdentists provide specific types of dentaltreatment on teeth and gums. For example, endodontistscarry out root canal treatments andperiodontists carry out gum treatments.Although other dental diseases exist, cariesand periodontal disease are by far the most commondental diseases. The most common causesof tooth loss are tooth decay and gum disease.Tooth StructureA tooth is composed of a hard outer layercalled enamel, and a softer inner layer calleddentine. In the centre of the tooth is the pulp.The pulp contains the nerves and blood vessels.Enamel is the hardest substance in the humanbody (of similar hardness to diamond). Itis brittle and can fracture when the underlyingdentine is weakened by decay (caries).Dentine constitutes the bulk of the tooth. Itis softer than enamel and is darker than enamel.The dentine is sensitive to hot, cold and sweetsubstances. Cementum covers the root surfaceof the tooth. It is of similar hardness to bone.The cementum has fibres (the periodontal ligament)running from it to the bone and this helpsattach the tooth to the jaw bone.The pulp is a soft tissue within the tooth. It isfound in the centre of the tooth and in the rootcanals of the teeth.Dental CariesDental caries, also known as tooth decay, ora cavity, is the breakdown of the dental hardtissues. It is a bacterial infection. Specific typesof bacteria produce acid in the presence of fermentablesugars, such as, sucrose, fructose andglucose. The acid attacks the mineral content ofthe enamel causing demineralization and subsequentdestruction of the hard surface of thetooth. This can eventually lead to a hole or cavityin the tooth. The extent of caries can varydepending on the type of tooth and where thedecay develops. Early caries can be undetectedas it may not cause any pain. If the caries becomesextensive, then it may cause toothache.Other signs of caries include change in toothcolour, tooth crumbling or breaking away andfoul breath.Regular dental check ups can detect earlysigns of caries and provide preventive advice.Diet, in particular sugar consumption in variousforms, is associated with the development ofcaries. The frequency of sugar consumption is54 Swaminarayan Bliss u May-June 2013
far more significant in the development of cariesthan the amount consumed at any one time.The longer the sugar stays in contact with thetooth surface, the greater the acidic attack onthe surface and hence risk of decay. Saliva acts toneutralize the acid and reverse the effect of theacid in the mouth, but this can take between 30minutes to 1 hour.During an acid attack, the enamel starts todissolve and this is the demineralization process.As the acid attack reduces, the enamel undergoesa phase of remineralization to repair itself.When episodes of demineralization exceed episodesof remineralization, caries develop.Stages of CariesThe stages of caries development are as follows:n Small pit – an initial break in the enamelsurface that can be probed with a fine dentalinstrument by a dentist.n Blue/white lesion – caries destroys dentineunder the enamel more rapidly since thedentine is softer than the enamel.n Open cavity – more enamel collapses andthere is an obvious ‘hole’ in the tooth.n Pulpitis – when the nerve is reached, thepulp becomes inflamed and pain occurs.n Apical abscess formation – infectionspreads and the tooth becomes dead. Pusforms and swelling may occur.Treatment for CariesNot all tooth decay will cause pain. Smallcarious lesions on a tooth surface may not benoticed until it is carefully examined by a dentist.Simple fissure caries can occur in the complexgrooves on the biting surface of molarteeth. Once tooth decay is diagnosed it usuallyrequires treatment.Simple FillingsSimple carious cavities are cleaned and filledwith a filling material. This usually involves havinga local anaesthetic to make the tooth numb.The caries is then removed using a dental drill.The cavity is made clean and filled with the chosenfilling material.The filling seals the cavity and allows thetooth to function as normal. The filling in thetooth will also take away toothache that mayhave been there previously.Children may have special preventive sealantsplaced into the complex fissures of molarteeth to prevent caries developing if the dentistfeels this would benefit the child.Complex Fillings and CrownsMore extensive cavities and decay would requirelarger fillings that would cover more ofthe tooth surface. If the filling covers a lot ofthe tooth surface then there may not be enoughsupport for the tooth and the risk of the toothbreaking is high. In this case, the tooth may requirea crown.A crown, or cap, is a covering placed overteeth to restore their function. Crowns can bemade of metal, e.g., gold, precious alloys or porcelain(white crowns).For a tooth to receive a crown, the toothis first filed and shaped into a stump shape.Moulds or impressions are then taken of thetooth. A dental technician then constructs thecrown. This is then fixed onto the tooth with aspecial bonding material by a dentist.Crowns can be made so that they either coverthe whole tooth surface (full crowns) or theycover it partially (inlays or onlays). The type ofcrown or restoration that is the most beneficialfor the tooth is assessed by the dentist.Root Canal Treatment (EndodonticTreatment)When tooth decay is very extensive and invadesthe pulp (or nerve) of the tooth then theroot canal treatment may be performed. TheMay-June 2013 u Swaminarayan Bliss 55
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May-June 2013Annual Subscription `
Page 3 and 4: May-June 2013Vol. 36 No. 3SWAMINARA
Page 5 and 6: BHAGAVAD GITA: Gujarati: Sadhu Bhad
Page 7 and 8: the words, ‘ØÌÌô sïçÂ ·¤
Page 9 and 10: At the spot where he haddefeated As
Page 13 and 14: was the best place to visit in Ahme
Page 15 and 16: Shahibaug: 1856564321Shahibaug: 190
Page 17 and 18: the throng of devotees may damage t
Page 19 and 20: murtis of Nar-NarayanShriji Maharaj
Page 21 and 22: Sabha Mandap and BethakSabha Mandap
Page 23 and 24: Rang Mahol and Sacred WellDuring th
Page 25 and 26: Bhagwan Swaminarayan praised the Sa
Page 27 and 28: Dudheshwar GhatThis Ghat (above) li
Page 29 and 30: visits to Lake Kankariya.“Kãnkar
Page 31 and 32: Chandola LakeChandola Lake (above)
Page 33 and 34: of Ahmedabad. Whenever his processi
Page 35 and 36: Mohanlal Sheth’s HomeMohanbhai wa
Page 37 and 38: Ambaba’s HomeAmbaba was a female
Page 39 and 40: Akbar, Jehangir, Shah Jahan and oth
Page 41 and 42: Delhi Darwaja (Gate)To exit the old
Page 43 and 44: (Contd. from pg. 7)very speciality
Page 45 and 46: darshan at these mandirs to bless t
Page 47 and 48: Nilkanth Mahadev MandirAsarva villa
Page 49 and 50: Mahalakshmi MandirThe mandir lies i
Page 51 and 52: 1948, pp. 140-141).The report state
Page 53: at Akshar Bungalow in Shahibaug. Th
Page 57 and 58: tor to review your medication and t
Page 59 and 60: 12, Saturday; Swamishri’s 73 rd B
Page 61 and 62: Living with SwamishriJanuary-Februa
Page 63 and 64: BAPS NewsPushpadolotsav Celebration
Page 65 and 66: each of the 73 youths. Blessing the
Page 67 and 68: ful, rigorous yet supportive awards
Page 69 and 70: National Seminar on Shri Sahajanand
Page 71 and 72: 1 2341. Newly initiated sadhus with
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