Transcript Slide 1
Bleeding gums More than 80% of adults have some form of periodontal disease and 99% of those have no signs to indicate they have a problem. patient's mouth is a portal to patient's body. More than 90% of all systemic diseases have oral manifestations! When pt research the problem of bleeding gums, pt will quickly realize that EVERYONE has a toothpaste solution to this problem. Tooth anatomy The structure of the tooth includes dentin, pulp and other tissues, blood vessels and nerves imbedded in the bony jaw. Above the gum line, the tooth is protected by the hard enamel covering. Bleeding gums can be a sign that pt are at risk for, or already have, gum disease. However, persistent gum bleeding may be due to serious medical conditions such as leukemia and bleeding and platelet disorders. INCIDENCES Bleeding gums is more commonly seen in adults. In case of children, it is mostly due to injury due to improper brushing. In case of adults or the aged, it is often found to be related with disease. Females have higher incidences than males. Marginal gingivitis is most common i.e. bleeding from gums comes usually from / near the base of the teeth. Causes Bleeding gums are mainly due to inadequate plaque removal from the teeth at the gum line. This will lead to a condition called gingivitis, or inflamed gums. If plaque is not removed through regular brushing and dental appointments, it will harden into what is known as tartar. Ultimately, this will lead to increased bleeding and a more advanced form of gum and jawbone disease known as periodontitis. Other causes of bleeding gums include: Use of blood thinners Brushing too hard Improper flossing Infection, which can be either tooth or gum-related Scurvy Vitamin K deficiency Hormonal changes during pregnancy Leukemia Ill-fitting dentures Idiopathic thrombocytopenic purpura Bleeding disorders Diabetes Dry mouth Certain medications Infection Bacterial infection Viral infection Periodontal disease Dental caries Blood dyscrasias Aplastic anaemia Neoplastic infiltration Thrombocytopenia Hemophelia Bleeding gums may be due to Injury / trauma which may be caused by a blow, insertion of foreign substances, tooth picking, dentures, improper brushing, flossing, etc. It may also get injured from irritation of chemicals/acids in foods, drinks, mouth fresheners, tooth whiteners and medicines Disease conditions can also cause bleeding gums. For example Gum problems – infection of gums, retracted or receded gums, weak & spongy gums Dental problems – caries, excessive tartar/plaque formation, periodontitis, etc Mouth – Mouth sores can also spread infection to gums to cause bleeding. Blood disorders - Bleeding & clotting disorders - deficiency of coagulation factors, Thrombocytopenic purpura, haemophilia, leukemia, etc., can cause bleeding. Systemic – Liver disorders, kidney disorders, arterial/capillary diseases, diabetes, heart disorders, etc., can also reflect as bleeding gums. Nutritional and physiological – Vitamin C & K deficiency will lead to bleeding disorders. Pregnancy and hormonal changes can also cause bleed gums occasionally. Poor oral hygiene often causes bleeding due to infection and weakness. PATHOPHYSIOLOGY - Infection (bacterial / viral / fungal) arises in the gums and teeth produce acids and toxins which usually erode and cause inflammation of the gums. The inflammation makes gums swollen, red and spongy which increases the tendency to bleed and weakens the stability of the teeth by recession. * Bleeding on slightest injury or even touch * Red, tender or swollen gums * Blood with bloody taste in mouth * Sometimes, due to bleeding gums,pus can be squeezed from the gums * Bad breath * Recession of gums from the teeth * Sensitive teeth * Loose and shaky teeth Difficulty and discomfort in mastication and food intake occasionally due to pain and sensitiveness For persistent bleeding gums, there are some essential tests: * oral examination of teeth and gums * X-rays of teeth and jaw * Blood analysis * Tc, Dc, Esr, Hb%, sugar, calcium, urea, and creatinine * Coagulation factors and serum prothrombin time * Bleeding and clotting time Gingivitis Inflammation of the gums is called gingivitis. Bacteria in plaque around the teeth release enzymes (collagenases) that can damage and erode the gum tissues. The infected gums swell, bleed Bleeding gums complications pt must know it is important to brush away the problem in initial period itself. Otherwise, complications like constant bleeding, swelling and pain in gums, periodontal disease, jaw bone disease, and finally tooth loss can occur. General treatment of bleeding gums To keep healthy and smiling teeth, it is essential to keep the gums healthy. The first and best treatment is maintaining oral and dental hygiene. Do it with proper brushing techniques. Due to a wide range of problems occurring in the gums and teeth, most of the patients are prescribed antibiotics and varieties of paste to control infection.. For complete cure, treatment should be started at the early stage; otherwise, the gums may recede or shrink, paving way for infection to enter the base of the teeth to loosen it. Once gums get retracted and receded, gaining normalcy is tough, but even though we make gums healthy by treatment, it will not adhere to the teeth as tightly as before. In that case, the cementum of the teeth will be exposed to cause sensitive teeth. Therefore, treating bleeding gums earlier is a must. Usually, pain is always preferable to numbness, where some people go for benumbing the gum with gum gel for pain relief and arresting the bleeding. It will work only temporarily and in this case, the disease often advances further, causing more and more pain and more and more complications, since this type of temporary alleviating maneuver always allow the disease in the track with temporary hurdle. Therefore, treatment of bleeding gums locally with this type of gum gel will not help in the long run. We should always aim at treating the cause and symptoms internally with internal medicines for reviving complete cure Soft bristle tooth brushes to brush gently Vitamin supplements in case of deficiency Take care for Well balanced nutritious diet Proper mastication Brush away the food particles in mouth after every meal Proper brushing i.e. gentle and careful. Ill-fitting dentures if any .Oral hygiene and dental health .Gargle with salty warm water after every meal Bleeding gums prevention Everyone who want to prevent bleeding gums should avoid hard and fast brushing, hard diets and snacks which can cause injury such as chips, sour foods or drinks, hot drinks, carbonated acid drinks, sticky chocolates, pain-killers, blood thinners and unnecessary medication. pt should rinse mouth with mouth fresheners often. Tobacco chewing, betel nut chewing and smoking is something that pt should also avoid. Take care of plaque deposits by proper cleaning and visiting dentist regularly. Use soft bristle toothbrushes to brush gently and use vitamin supplements in case of deficiency. Use well-balanced nutritious diet, proper mastication, and brush away the food particles in the mouth after every meal. Oral hygiene and dental health is very important as well. Try to gargle with salty warm water after every meal INTRODUCTION OF DANTA ACCORDING TO AYURVEDA Danta i.e. tooth is also known as “Ruchakasthi” and is a variety of bony tissue. The word “Ruchaka” means that which imparts taste and “asthi”means bone. There are 32 permanent teeth and 24 deciduous teeth. It appears that over 5000 years since the time of kashyap, children of have lost 4of their deciduous teeth and at present only 20 deciduous teeth are present .even many adults at present either do not have their wisdom teeth or they are very much underdeveloped. Hence the number of permanent teeth usually present in adults varies from 28 to 32 The time taken for the eruption of a teeth is the same number in terms of days as the month in which the tooth erupted ,eg if the central incisor erupts in the sixth month it will take 6 days for complete eruption. the primary teeth will fall in the same year as the month, at which it erupted. The central incisiors,the lateral incisors ,the cannines and the molars are called as Rajadanta, Vasta,Danshtra and Hanavya respectively . There are 2 each of rajdanta, Vasta and Danshtra and 6 of Hanavya in each upper as well as lower jaw.The bony tissue as well as the bone marrow are the primary tissues from which the tissue develop. NORMAL TEETH AND GUMS Normal healthy teeth are strong ,white ,dense , smooth , clean ,slightly ,prominent, well developed and evenly placed in relation to each other. They do not decay and are not affected by disease. The gums are even ,pink , smooth ,dense, and steady. Gums are known as Dantamansa or Dantaveshta . Thus diet and tonics good for bony and muscular tissue are useful for teeth and gums respectively. According to Sushrut there are 15 diseases of the roots of teeth and gums. However ,Yogratnakar and vaghbhat has included 1more (Dantavidradhi)as the sixteenth disease.Apart from this Madhavnidana has given reference of karala,thus increasing the number to 17.Now lets discuss some of them in brief DISEASE SYNONYMS ABNORMALITY OF GUMS 1. Samvruta-danta 2. vivruta-danta 1.Hypertrophy of gums 2.atrophy of gums *TRAUMATIC 3.Dantavaidarbha Injury to gums DOSHAS AFFECTED *DOSHAJANA 4.Adhimansa Pericoronitis of wisdom teeth Kaphaja 5.Dantaveshtha Chronic suppurative gingivitis raktaja 6.Upakusha Recurrent acute suppurative gingivitis Pitaj +raktaja 7.Sheetada Chronic suppurative recessive gingivitis Kafaj+raktaj 8.Soushira Suppurative periodontitis Kaphaj+rakataj 9.Mahasoushira Necrotising Tridoshaj ulcerative gingivo-stomatitis 10.Paridara Atrophic gingivitis Tridoshaj 11.Dantavidaran Alveolar abscess with sinus Tridoshaj 12.Dantapupputak Periodonta Kaphaj+rakataj l abscess 13.Dantavidradhi Alveolar Tridoshaj+raktaj abscess 14.Dantamans arbuda Tumors of Tridoshaj+kaphaj gums 15.Dantmansasruk Bleeding from gums Raktaj +pitta HEALTH AND HYGIENE OF TEETH Each teeth should be brushed individually by koorchaka i.e, a soft tooth brush .the brush should be rotated over gums and the teeth in the vertical manner i.e from below upwards in the lower jaw and from above downward in the upper jaw .Side to side brushing must be avoided, as it may damage the necks of the teeth and also the gums .one should rinse and gargle the mouth after brushing the teeth as well as after eating any food . A soft brush can be made by bitting and chewing the tips of fresh stem of the following plants: *Arka *Nyagrodha *Khadir *Karanja *Arjuna *Katunimb ACCORDING TO PRAKRUTI LIST OF PLANT WHICH SHOULD BE USED FOR DANTDHAWAN Constitution Characteristics of gums Stem indicated Taste Vata Thin, atrophic, Glycerrhiza dry and rough Khadira Madhur Pitta Spongy,inflamm Nimba Arjun and red Tikta Kapha Hypertrophic and whitish Karanja Arka Katu Rakta-Pitta Bleeding and spongy gums khadira Kashaya TOOTH POWDER Triphala Trijataka With honey and saindhav for kapha and pitta constitution. Trikatu With honey and saindhav for kapha constitution. DIET HARMFUL FOR GUMS Pungent and salty food , drumstick, Chana ,Bringal, fish and raw mango are harmful for gums.Curds ,Til, Mustard ,Chilly Garlic ,fermented food items,Jaggery,Alcoholic prepration and incompatible diet should be avoided.Also person suffering from bleeding gums should avoid exposure to sun ,exercise traveling ,induction of sweating,sexual intercourse, smoking and brushing teeth .Cold environment has beneficial effects in this condition.