Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications.
People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don’t have their diabetes under control are especially at risk.
A study in the Journal of Periodontology found that poorly controlledtype 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are.
Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.
Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.
This recommendation is supported by a study reported in the Journal of Periodontology in 1997 involving 113 Pima Indians with both diabetes and periodontal disease. The study found that when their periodontal infections were treated, the management of their diabetes markedly improved.
-Source: perio.org-
Researchers have found that people with gum disease are almost twice as likely to suffer from coronary artery disease. – American Academy of Periodontology
Heart Disease
Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.
Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.
Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.
Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.
Stroke
Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.
-Source: perio.org-
When you have heart disease, maintaning goor oral health is important. Remember:
Make sure your dentist and hygienist know you have a heart problem
Have regular dental checkups
Maintain good oral health by brushing and flossing twice a day
Electrosurgery is the application of a high-frequency electric current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue. (These terms are used in specific ways for this methodology—see below). Its benefits include the ability to make precise cuts with limited blood loss. Electrosurgical devices are frequently used during surgical operations helping to prevent blood loss in hospital operating rooms or in outpatient procedures.
In electrosurgical procedures, the tissue is heated by an electric current. Although electrical devices may be used for the cauterization of tissue in some applications, electrosurgery is usually used to refer to a quite different method than electrocautery. The latter uses heat conduction from a probe heated to a glowing temperature by a direct current (much in the manner of a soldering iron). This may be accomplished by direct current from dry-cells in a penlight-type device. Electrosurgery, by contrast, uses alternating current to directly heat the tissue itself. When this results in destruction of small blood vessels and halting of bleeding, it is technically a process of electrocoagulation, although “electrocautery” is sometimes loosely and nontechnically used to describe it. (Source from Wiakipidia)
Electrosurgery unit
Using electrosurgery in oral surgery procedures
Electrocautery is a very useful tool to make a cut or excise soft tissue just like a scaple blade does. While a cut is made; at the same time, electrosurgery coagulate the surrounding blood vessels make surgery bloodless. This will improve visibility during surgery and less blood loss. More over, healing of a wound with electrosurgery is proven to be faster that wound made by scaple blade.
Electrosurgery: Coagulating the gum area before impression taking during tooth preparation for crown fabrication
Dental procedure which can be done with
Excision of lesions (eg. cysts, tumors)
Gum surgery
Implant placement
Crown lengthening
Coagulating the gum area before impression taking during tooth preparation for crowns/bridges
Advantages of using electrocautery
Less bleeding
Can be use to control bleeding
Wound heal faster with electrosurgery than using scaple blade
Tartar (calculus) are deposits that have built up on the teeth over time. Dental cleanings involve removing plaque (soft, sticky, bacteria infested film) and tartar (calculus) deposits that have built up on the teeth over time. Your teeth are continually bathed in saliva which contains calcium and other substances which help strengthen and protect the teeth. While this is a good thing, it also means that we tend to get a build-up of calcium deposits on the teeth. This chalky substance will eventually build up over time. Usually it is tooth coloured and can easily be mistaken as part of the teeth, but it also can vary from brown to black in colour.
If the calculus (or tartar, as dentists like to call it) is allowed to accumulate on the teeth it will unfortunately provide the right conditions for bacteria to thrive next to the gums. The purpose of the scaling and polishing is basically to leave the surfaces of the teeth clean and smooth so that bacteria are unable to stick to them and you have a better chance of keeping the teeth clean during your regular home care. Also it leaves your teeth feeling lovely and smooth and clean, which is nice when you run your tongue around them.
Dental surgeon or dental hygienist uses specialized instruments to gently remove these deposits without harming the teeth.
1) Ultrasonic instrument (Scaler)
Ultrasonic Scaling
Commonly used first is an ultrasonic instrument or scaler unit which uses tickling vibrations to knock larger pieces of tartar loose. It also sprays a cooling mist of water while it works to wash away debris and keep the area at a proper temperature. The device typically emits a humming or high pitched whistling sound. This may seem louder than it actually is because the sound may get amplified inside your head, just like when you put an electric toothbrush into your mouth.
The ultrasonic instrument tips are curved and rounded and are always kept in motion around the teeth. They are by no means sharp since their purpose is to knock tartar loose and not to cut into the teeth. It is best to inform the operator if the sensations are too strong or ticklish so that they can adjust the setting appropriately on the device or modify the pressure applied.
With larger deposits that have hardened on, it can take some time to remove these, just like trying to remove baked-on grime on a stove that has been left over a long time. So your cleaning may take longer than future cleanings. Imagine not cleaning a house for six months versus cleaning it every week. The six-month job is going to take longer than doing smaller weekly jobs.
2) Air polishing
After the dentist has done scaling using the ultrasonic scaler, he will proceed with polishing either using air polishing or polishing cup. Air polishing is an alternative more advance method than the polishing cup and paste method. It requires a special ultrasonic unit (e.g. Air Flow from EMS) that allows use of this insert in the handpiece.
EMS Air polishing unit
Air polishing uses medical-grade sodium bicarbonate and water in a jet of compressed air to “sandblast” the surface of the enamel leaving your teeth smooth and clean.
Indications for air polishing
Heavily smoking stain on the teeth
Staining due to coffee or tea
To remove fine tartar that are still attached to the teeth surface after scaling
Tobacco and coffee stain
Video: Air polishing method with EMS Air Flow®
Advantages of using air polishing
There is no physical contact with the tooth, therefore thermal injury is of no concern.
It is ideally suited for teeth separated by wide diastemata and considerable in shape and size.
Particularly good for cats where teeth are so small that standard cups can create gingival damage.
They are very efficient at removing stains from teeth.
Is scaling & air polishing going to be painful?
Most people find that cleanings are painless, and find the sensations described above – tickling vibrations, the cooling mist of water, and the feeling of pressure during “scraping” – do not cause discomfort. A lot of people even report that they enjoy cleanings and the lovely smooth feel of their teeth afterwards! There may be odd zingy sensations, but many people don’t mind as they only last a nanosecond.
Be sure to let your dentist/hygienist know if you find things are getting too uncomfortable for your liking. They can recommend various options to make the cleaning more enjoyable.
Painful cleaning experiences can be caused by a number of things: a rough dentist or hygienist, exposed dentine (not dangerous, but can make cleanings unpleasant), or sore gum tissues.
In case you may have had painful cleaning experiences in the past, switching to a gentle hygienist/dentist and perhaps a spot of nitrous oxide can often make all the difference. You could also choose to be numbed. If you find the scaling a bit uncomfortable because the gum tissues (rather than the teeth themselves) are sensitive, topical numbing gels can be used.
Introduction
Generally, dentists do everything within their power to preserve your natural teeth. However, in cases of advance caries or periodontitis, a tooth may have to be extracted. Teeth may also be removed for the purposes of orthodontics when teeth are straightened using braces. For example, your front teeth may be skew because there is not enough room for them in your mouth. An orthodontist may, therefore, suggest extraction of certain teeth to make space for teeth in your jaw.
Reasons for Extraction
The most most common reason for extraction is tooth damage due to breakage or decay. There are additional reasons for tooth extraction:
Severe tooth decay or infection.
Extra teeth which are blocking other teeth from coming in.
Severe gum disease which may affect the supporting tissues and bone structures of teeth.
In preparation for orthodontic treatment (braces)
Teeth in the fracture line
Fractured teeth
Insufficient space for wisdom teeth (impacted third molars).
Receiving radiation to the head and neck may require extraction of teeth in the field of radiation.
Deliberate, medically unnecessary, extraction as a particularly dreadful form of physical torture.
Types of Extraction
Extractions are often categorized as “simple” or “surgical”. 1.) Simple extractions are performed on teeth that are visible in the mouth, usually under local anaesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the Periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Typically, when teeth are removed with forceps, slow, steady pressure is applied with controlled force. 2.) Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding jawbone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal. Surgical extractions are usually performed under a general anaesthetic.
Simple Extraction
To extract a tooth, your dentist first administers a local anaesthetic in the area. Next, he firmly places extraction forceps over the crown of the tooth. He manually loosens the tooth, and then removes it. This is the most basic method of tooth extraction. Alternatively, he places an elevator between the tooth and the tooth socket, and carefully levers the tooth out.
However, sometimes it is impossible to remove a tooth using these methods, and then surgical intervention is required. Under local or general anaesthetic, the gum is cut over the relevant area, and the bone exposed. A section of bone is then removed to expose the root of the tooth, which is removed. Finally, the gum is stitched back together again.
What can I Expect After an Extraction?
It is critical to keep the area clean and prevent infection immediately following the removal of a tooth. Your dentist will ask you to bite down gently on a piece of dry, sterile gauze, which you must keep in place for up to 30 to 45 minutes to limit bleeding while clotting takes place. For the next 24 hours, you shouldn’t smoke, rinse your mouth vigorously, or clean the teeth next to the extraction site.
Sterile gauze to be placed at the extracted socket to stop bleeding
A certain amount of pain and discomfort is to be expected following an extraction. In some cases, your dentist will recommend a pain killer or prescribe one for you. It may help to apply an ice pack to the face for 15 minutes at a time. You may also want to drink through a straw, limit strenuous activity, and avoid hot liquids. The day after the extraction, your dentist may suggest that you begin gently rinsing your mouth with warm salt water (do not swallow the water). Under normal circumstances, discomfort should lessen within three days to two weeks. If you have prolonged or severe pain, swelling, bleeding or fever, call your dentist at once.
Instructions after tooth extraction
These are the instruction usually given to reduce complication such as excessive bleeding or infection after extraction:
Please don’t spit or rinse after extraction for today.
Make sure to bite gauze which ha s been placed over the extracted socket.
Please bite the gauze for 30 minutes to allow bleeding ceased.
Please not to change gauze too often.
Take pain killer given if painful.
Avoid taking food or drink which is too hot.
If socket still bleeds; not to be too worry. You can rinse gently with some cold water.
You can brush your teeth but gently and avoid the extraction site.
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People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don’t have their diabetes under control are especially at risk.
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