DIABETES & ORAL HEALTH

Diabetes is a condition in which the body does not produce or properly use insulin.

Diabetes makes all the tissues in your body more susceptible to infection.

Gum disease is caused by the bacteria in plaque- a sticky, colourless film that forms on your teeth. The plaque releases toxins that irritate your gums.

It is a painless infection of the tissues surrounding and supporting the teeth and is the largest cause of tooth loss.

In fact, people with diabetes are twice as likely to develop gum disease when their blood glucose (sugar ) levels are poorly controlled.

6 steps for diabetic to achieve a healthier body & teeth:

1. Self-identify signs and symptoms of gum disease

     #Bleeding gums

         #Swollen gums

         #Bad breath

         #Receeding gums

         #Loose teeth/mobile

      

     2. Inform your dentist if you have any medical problems

    3. Perform regular dental check up annually

    4. Comply with long term maintenance care ( every 3 to 6 months )

    5. Stop smoking , eat healtily and exercise regularly for oral and general 

       health

    6. Effective plaque removal as bacteria in plaque are the main cause of gum

        disease

  

~Brush twice a day with an appropriate toothbrush and toothpaste

~Brush twice a day with an appropriate toothbrush and toothpaste

~Clean you tongue

~Oral rinse as advised by dentist

~Change toothbrush every 3 months if necessary

Preventing or controlling gum disease depends on teamwork. The best defence against this complication of diabetes is good blood sugar control, combined with daily brushing and flossing and regular dental check-ups.

不要病从口入先护好牙齿为重

  牙齿，与其他人体器官一样，都是非常重要的，虽不致缺一不可，但却是我们保住容貌的第一防线。

 

  为什么会说牙齿与容貌有关，因为牙齿是孤形排列，把脸部支撑起来。当其中一个部位悬空后，脸部会因为失去支撑而跟着垮下来，所以能完整保护整副牙，就可以维持脸部完整，即使非不得已拔掉一颗，也要配戴假牙，以维持牙齿的完整性。

 

  “再者，如不填补回空洞，旁边的牙也会因为失去依靠而移位,松脱，最终可能被逼拔掉，所以拔牙之后一定要做假牙填补回去。很多老人因为牙齿逐渐退化脱落后，没有做假牙填补空隙，以致脸部变形，所以牙齿对我们的样貌有很大的影响。”

   
保住容貌，牙齿一颗都不能少。

  

                  

                  

                   

    牙齿就如人体其他器官一样，会随着年龄而退化，但如果能做到每年定期检查，趁早知道牙齿出现毛病，及早治疗，就可以避免拔牙。

 

   “第一及第二阶段的蛀牙，可以通过各种治疗来拯救损坏的牙齿，但若蛀牙情况已经深入到牙龈，唯有拔掉或植牙。”

 

    医学进步，牙医也不落人后，很多以前认为不能补，就必须拔掉有问题的牙齿，现在都已经有了各种崭新技术可以保住牙齿，如根管治疗（root canal therapy)，俗称的“挑牙根”或植牙，都可以保留真牙的牙齿技术。

 

     当牙齿出现不正常情况时，最好马上就医，如发现牙齿松动，可能是牙龈疾病，如能在牙齿开始出现松动时就治疗，或许就能保住牙齿，而不是把它视为牙齿自然退化的现象。

     牙龈疾病，又称牙周病，是最常见的口腔问题之一，其成因是牙齿周围的软组织和骨骼受到破坏，可能会造成牙齿脱落。而破坏者就是我们经常吃进嘴里，却没有清洗干净的食物残渣，久而久之就变成牙石，造成牙周病。

 

      他表示，牙周病是可以治疗的，但一些人却把它视为老人问题，不予理会。其实，只要把牙龈的细菌清楚，就能让牙齿“长寿”多几年。

    

           

 

 

  一些人体疾病可能也是通过口而感染的，如高血压,肺病,糖尿病等，尤其是糖尿病，更是直接与牙龈有关。如牙龈细菌严重，就会直接引发各种并发症，如糖尿病，进而影响心脏，引起心血管阻塞，因为口腔里的细菌可以通过血管攻击心脏。

                                

   饮食习惯是决定我们牙齿寿命期的关键，就如我们都知道糖对牙齿不好，会引起蛀牙，但不表示不可以吃糖，只要记住任何食物都可以吃，不过记得吃后要刷牙，或漱口， 避免牙腔与细菌同在，导致蛀牙。



   若根据这种说法， 一天三餐就要刷3次牙。但一些专家却提出牙齿不要刷太多次， 早晚一次就足够， 否则会损坏牙齿。其实是应该吃过一餐就刷牙， 但不是用力去刷。

想要一颗健康的牙齿，必须养成良好的饮食习惯，保持口腔卫生清洁。

DENTINE HYPERSENSITIVITY

Sensitivity occurs due to loss of enamel (outer most layer of crown structure) or cementum (outer most layer of root structure) which leads to the exposure of the underlying dentin. So the main reason of sensitivity is exposure of dentin.

How do you know if you have sensitive teeth?

You may have sensitive teeth if you experience short, sharp pain in response to cold, heat, and pressure. Common triggers of sensitive teeth can be
- Cold or hot drinks
- Cold air
- Some dental proceduresSome of the most common causes of sensitive teeth include:

abrasion cavity 

attrition due to 

Why dentine layer exposed?

Receding Gums

Receding gums can be caused by conditions such as gum disease, which can expose the tooth's dentine and cause sensitivity. In contrast, brushing too hard with hard bristle toothbrush also will damage the tooth surface.

Brushing

Brushing too vigorously and hard bristle toothbrush can cause receding gums, causing further exposure of the dentine.

Gum Disease

When gum disease gets worse and damages the tissues and bone that support the teeth. One sign of periodontitis is sensitive teeth, as the receding gums leave dentine exposed. 

Teeth Grinding

If you grind your teeth when you sleep or during the day, you may be wearing down enamel.

•        Prevent gum disease by practice good oral hygiene.
•      Use a toothpaste specially formulated to treat the pain of sensitive

               teeth

•      Don't brush too hard.
•      Use a soft toothbrush, preferably one designed especially for sensitive 

               teeth

•      Avoid acidic foods that can wear away tooth enamel, such as wine, 

              vinegar salad dressings and soft drinks.

•      Avoid grinding your teeth. Ask your dentist about a mouth guard for 

              night time use.

•       See your dentist for regular check-ups, dental care recommendations and advice for your        

              sensitive teeth.

•       Dentcoating your sensitive teeth  http://www.dentcoat.com/startseite.html

TEETH WHITENING

A smile is one of the first things that people realise about those they meet. The bigger and brighter the smile, the friendlier they seem.

If you are one of those people who feel obliged to cover your mouth with your hand when you laugh, and smile with your lips firmly closed, you are an ideal candidate for teeth whitening. 

What causes teeth to yellow?

1. smoking 
2. coffee/tea/wine
3. diseases
4. aging

What is teeth whitening?

It is an effective way of bringing the shade of your teeth closer to lighter and whiter colour.

The peroxide oxidizing agent ( hydrogen peroxide) penetrates the porosities in the rod-like crystal structure of enamel and breaks down stain deposits in the dentin without removing any of the tooth surface.

How long does it take?

In office teeth whitening may take up to 1 hour. effects can be seen immediately after the treatment and teeth will continue to whiten in the next 8-10 hours.

Prescribed whitening kits may be done in the comfort of your home. Effects can be seen in 2 to 6 weeks normally.

Keep in mind that at home whitening products are suggested to be used as a maintenance method, after the professional teeth whitening treatment. 

How long will the effects last?

The effects of whitening normally last up to two years, but it depends on the lifestyle habits of each person. 

After the procedure, you should refrain from smoking or drinking tea/coffee/red wine. 

Are there any side effects?

There are generally no side effects. You may feel the following after treatment, but they are usually temporary and should disappear within few days after treatment:

-sensitive to cold air after the treatment

-soreness of the gum

Can anyone do teeth whitening?

It is not suitable or young children, pregnant woman and lactating mothers.

DENTAL TRAUMA EMERGENCY--AVULSION OF TOOTH

Living and growing carry a high risk of trauma. A child will not learn to walk without falling, and few children reach 4 years of age without having received a blow to the mouth.

Possible complications of dental trauma:

Ø No obvious injury/fracture

Ø Mobile /loosening of teeth

Ø Crown fracture or crack

Ø Root fracture

Ø Displacement of teeth either axially or laterally-intrusion,extrusion, lateral luxation

Ø Avulsion

   

First aid for avulsed teeth

If a tooth is avulsed, make sure it is a permanent tooth (primary teeth should not be replanted).

1    1. Keep the patient calm.

    2. Find the tooth and pick it up by the crown (the white part). Avoid touching the root.

  3. If the tooth is dirty, wash it briefly (10 seconds) under cold running water and reposition it. Try to encourage the patient / parent to replant the tooth. Bite on a handkerchief to hold it in position.

  4. If this is not possible, place the tooth in a suitable storage medium, e.g. a glass of milk or a special storage media for avulsed teeth if available (e.g. Hanks balanced storage medium or saline).

If the patient is very young, he/she could swallow the tooth if keeping it between molars and cheeck- therefore it is advisable to get the patient to spit in a container(saliva) and place the tooth in it.

Avoid storage in water!

   5. Seek emergency dental treatment immediately.

See your dentist as soon as possible for management. Early and prompt treatment improves the prognosis of the treatment significantly.

怀孕可以看牙吗？孕期中期黄金治疗

有一句俗话：【女生怀一次孕，坏一颗牙】，说明孕妇在孕期中容易出现牙齿疾病的心酸。孕期中常见的牙齿疾病包括：蛀牙、牙髓神经发炎或牙龈炎等。偏偏遇到孕妇存在不少迷思：【怀孕可以看牙吗？】【可以服用牙科药物吗？】【麻醉药会不会影响胎儿健康？】怀孕妇女往往有就医的压力，担心治疗用药会影响胎儿健康，拒怕看牙医，于是隐忍牙齿不适迟迟不去就医，使得牙齿疾病症状越来越严重！

孕妇容易忽视洁牙的重要性

怀孕妇女荷尔蒙的激素会变化，出现不平衡，使得免疫系统也跟着改变，原本在口腔内存在600至700种细菌，也因此失去平衡状态，而特别促使几种细菌滋长增生，再加上忽略牙齿的清洁，随着致病菌增长，发生牙龈炎的概率大大提升。

孕妇出现牙龈炎之后，担心一刷牙就流血，甚至怕疼痛，加上原本怀孕期容易疲累，未注意口腔清洁，只是简单漱口，而忽略刷牙的重要性。此外，怀孕期间的饮食会偏向酸甜，进食次数也会增加，相对的在口腔方面的卫生比较容易疏忽，无法将附着在牙齿表面的牙菌斑清除。

怀孕中期是牙齿治疗黄金期
怀孕期间的牙齿健康不可轻忽，为了增加孕妇的舒适与治疗的安全，应避免在怀孕的初期或

末期做治疗，最佳的治疗时机是怀孕中期即3个月后至7个月之间，即怀孕稳定期接受治疗。至于病人安全和用药安全的部分，牙医师会衡量治疗上的必须行，尽量减少X光暴露量，以及不必要的药物和感染机会。

孕妇在使用药物方面，都必须依照医师诊断开立处方使用，勿自行购买成药使用。一般常用的止痛药，如阿司匹林(Aspirin)等，到目前为止，医师认定是安全的；而抗生素方面，除了四环霉素、氯霉素及链霉素外，一般而言，牙科使用的抗生素，一般对孕妇来说也是安全的。

孕期中不宜进行抽神经，也就是根管治疗

在怀孕期间可以进行一般性洗牙、简单的补牙，在孕期中属于蛀牙严重必须拔牙以及需要进行抽神经（根管治疗）等较为侵入性的牙科疗程则不建议，而是先以适用的止痛药来缓解，等到产后在进行彻底治疗，比较安全。

孕妇照护口腔健康小技巧
1. 维持良好洁牙习惯：饭后刷牙或适用牙线洁牙，将牙缝中的食物残渣清除，并可透过刮除的
方式将齿面的牙菌斑带走。

2. 饭后适度咀嚼无糖口香糖：吃完食物后口中处于酸性环境，最易产生细菌，并破坏牙齿的健康，饭后适度咀嚼无糖口香糖，可以刺激唾液腺分泌，维持口腔内的酸碱平衡，达到降低蛀牙的效果。

3. 定期接受牙齿检查：孕妇应该定期由牙医师进行口腔检查，孕妇只要能保持合宜的口腔卫生习惯及定期检查，即早治疗将可避免蛀牙及牙周病恶化。

【温馨小叮咛】
避免怀孕妈咪发生牙齿问题而引起焦虑、不安，建议在怀孕之前，就做好口腔卫生的清洁与保养，在计划怀孕前先进性预防，找牙医做全面口腔检查和牙周评估等，如果有需要应该尽早治疗，才不致有任何影响胎儿与母体健康的风险。

智齿，真的非拔不可？

俗称【智齿】的第三大臼齿，是最晚萌发出来的恒牙，约在18到20岁前后容易萌发出来，在口腔中看到，但临床上，因智齿长歪、长不出来，而求诊拔除智齿的患者非常多。

Q1：智齿，一无是处？

人类的牙齿具有不同的咀嚼功能。

• 锋利的门牙及侧门牙--用于切割食物；
• 尖锐的犬齿--咬住并撕裂食物；
• 第一及第二小臼齿--压碎食物；
• 第二大臼齿--咀嚼、磨碎食物，一边吞咽。

但位于齿列最后方的智齿，较没有咀嚼、磨碎食物的实质功能。由于智齿，位于齿列的后方最深处且最晚萌发，也容易因空间不够常常贴着第二大臼齿的牙根横向生长，俗称阻生齿。堆积的食物残渣如果刷不干净，易导致蛀牙、牙周病而祸延第二大臼齿。

为什么智齿很容易长斜、长歪呢？主要是因为现代人的食物普遍较软嫩，少吃坚韧的食物，因此牙弓较小较不发达，使得最后长出来智齿，跟搭车时，买到最后一张车票的人，最容易面临找不到位置的窘境，也常常会在萌发过程推挤到前方的齿列，影响到齿列的整齐度。

而有些埋伏在上下颚骨内的智齿，虽然有可能一辈子都不会长出来，但这些阻生在颚骨内与智齿相关的细胞，还是有可能随着岁月形成齿源性囊肿，或者，因牙龈发炎感染化脓，同样会造成邻牙第二大臼齿的牙周破坏或蛀牙，衍生治疗上的困难。

除非是牙弓够大，智齿长得很正，且能刷得很干净，否则大部分会形成阻生、且萌发过程会推挤前方齿列，以及埋伏在齿槽骨下方长不出来的智齿，我们仍建议可及早作预防性的手术拔除。

Q2：拔智齿，越早越好？

必须要拔除的智齿，最好能在智齿刚长出来，约18到20岁左右时，就拔除，这是因为青少年

时期，智齿刚萌发，牙根还没有完全成形，比较容易拔。

如果等到成年后许多年才拔，颚骨的骨质变得较硬，同时，发育完全的智齿牙根可能又长又弯，变得比较难拔，上颚的支持可能跟鼻窦贴得很近，若拔牙时，造成鼻窦穿孔，有可能让鼻窦跟口腔相同，导致细菌性的鼻窦炎。下排智齿的牙根尖，则可能会贴在下颚齿槽的神经管上，也会增加拔牙后下唇感觉异常的风险，需谨慎评估。

当然，如果是等到临床上出现问题再拔，往往都已经破坏到第二大臼齿周边的齿槽骨及牙周，建议可考虑在青少年期间，拍一张环口片(Panoramic film)，一方面作全口检查，同时并确认智齿萌发的状况来决定是否要做预防性拔除，并建议由熟悉口腔手术的口腔外科专科医师来执行较深部阻生智齿的拔除。

智齿拔出后，不需要做植牙，除非是前方第二大臼齿的齿槽骨有严重流失的现象，或者手术过程中因智齿过深磨掉过多齿槽骨，否则，一般是不太需要補骨粉或是胶原蛋白、再生膜等填充物来诱导齿槽骨再生。

而有风湿性心脏病、有心脏瓣膜疾病或是曾经做过心脏瓣膜手术的患者，在拔牙前的30分钟到1个小时，必须先吃高剂量的抗生素，来预防瞬间的菌血症，降低细菌性心内膜炎的风险。这类患者在看牙医时，务必要提及自己的病史。