Eating Just Isn’t The Same With Dentures - Avoid This Silent Disease

Dr. Tara Baksh (BDS, BSC) General Dental Practitioner of Island Dental Care

The reason dentists encourage us to brush our teeth at least twice a day and ideally after each meal is to remove the buildup of plaque from our teeth. According to the National Institute of Dental and Craniofacial Research, “Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean.” The organization’s site went on to say that, “The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily.”  Gingivitis is reversible, however the second stage of gum disease – periodontitis is not.

In periodontitis the gum starts to pull away from the teeth and form small pockets around the tooth. Bacteria in those pockets around the tooth get infected and increasingly new forms of bacteria form that over time cause erosion to the jaw and ligaments that help to hold the teeth in your mouth naturally. Dr. Tara Baksh a practicing dentist in Grenada is concerned about the number of patients that come to her office with periodontal disease.  This silent disease of the gums can lead to destruction of the bone of the jaw and ultimately tooth loss.  It is called silent because the destruction can go on for years, without causing pain until the very end when it is too little, too late. She is concerned that some dentist in Grenada are not recognizing its signs so by the time the patient come to her office the condition is already chronic.

“Periodontitis is something that I am seeing a lot of here [in Grenada] and what does upset me a little bit is that I find it is going undiagnosed for many years.  The problem with periodontitis is it is called a silent disease. It’s not one where, you know, you are going to get pain.  Yes there are versions of it that happen very, very quickly but most commonly periodontal disease happens over years. You’re talking 5 to 10 years in the making and a lot of people don’t understand that. When they [patients] come to me they have pain and it’s caused by the periodontal disease.  By that time it is well advanced and I am talking tooth mobile [shaky/loose] that if I could take out if I wanted to or they have an abscess because the bacteria load is so much - they now have an abscess. And in cases like that there is nothing you can do but extract the tooth; because you can’t keep a tooth in there, that’s not supported by bone or anything. So unfortunately in many of the cases that I see, by the time I see them they are advanced and they have to end up losing two, three teeth.”

Cancer, HIV/AIDS and diabetic patients are particularly at high risk for developing periodontitis because their slightly lowered immune system, the body a longer time to fight off infections in the mouth and so the disease festers quickly. However the root cause of gum disease is poor dental hygiene. The lack of brushing and flossing often puts a person at great risk for developing gum disease.  Although hereditary genetics does play a factor, meaning if an immediate family member has this particular disease it can make you more susceptible to it, however with diligent care you may be able to prevent it.  

When periodontitis sets in the patient will have to get their affected tooth or teeth removed and according to Dr. Baksh, dentures are not always comfortable, “We don’t like to do extractions, because when you do extractions, you lose your teeth.  What are you going to eat on? Okay yes, you have a denture. Everyone is like, “Oh yes, pull out your teeth and get a denture,” but that’s not what you want to do. Not everybody understands how difficult it is to adapt to this cumbersome denture in your mouth, and you don’t want to have to do that if you don’t have to. You want to keep your natural teeth. And then your quality of life goes down as well.  There are certain foods that you are not going to enjoy eating anymore. Depending on the type of denture you have, the roof of your mouth is covered. You can’t feel the texture of the food, you can’t taste the texture of the food. Food gets stuck under the dentures. It’s just not nice. You don’t want to [get] dentures if you don’t have to. So therefore you would want to look after your teeth.”

Dr. Baksh who is part of a group that is developing an Oral Health Policy for Grenada says there are additional benefits for going to the dentist twice a year.  She said dentists can often notice underlying health issues based on the conditions of inner walls of the mouth, tongue and gums.  For certain vitamin deficiencies for example the tongue may appear discolored. Regarding periodontitis, if a dentist notices rapid bone loss they may suspect the patient has an underline health issue and is unaware, “We as dentist want patients to understand the importance of coming to the dentist, as recommended, which is twice a year – every six months. There is a lot of things that we can detect in the mouth before it actually manifests itself on the body. A lot of patients are pretty surprised when I say to them, “Do you have this [condition]?” and they haven’t mentioned it to me. And they would be like, “How do you know that?”” The general dental practitioner says she can notice if a patient is anemic, has diabetes, Crohn's disease or even AIDS or HIV. When she notices these early warning signs she would say to the patient, “I think you should go to your doctor and get a blood test and make sure all your levels are good,” and just educate them in that way.  They usually quite surprised that I can tell these things.”

Grief and When to Get Help

Grief - that feeling of intense sorrow can be a stressful time in a person’s life.   It transcends the loss of a loved one due to death as it can range from news of a devastating illness, loss of property after a natural disaster, realization of betrayal, divorce, death anniversaries, or of hearing of a favorite celebrity’s untimely death and other general disappointments.

There are five classic stages of grief a person may go through one at a time or another and not necessarily in the order that they appear in the list, but for most multiple stages can occur at the same time. 

  The stages are:

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

There is no cookie cutter way for a person to deal with grief, as each person is different.  The grieving process may feel like your emotions are tossing you around like the waves of the ocean.  This unfortunately is very normal and simply a part of the grieving process.  The final truth about grief is that the initial sting of the loss may wear off but a person never gets over it.  A person instead can learn to live within their ‘new normal’ when he or she gets to a place of acceptance.  Triggers however can make a person feel like they are revisiting the stages of grief all over again. Triggers are reminders that can be as subtle as a fragrance, dreams, or doing new things are realizing what once was is no longer a tangible reality.  However there are times when a person may need some additional support to walk them through their grieving process especially when the grief becomes debilitating.  Healthguide.org calls this complicated grief.

Symptoms of complicated grief include:

• Extreme anger or bitterness over the loss
• Searching for the person in familiar places
• Feeling that life is empty or meaningless
• Blame yourself for the loss or for failing to prevent it
• Unable to perform normal daily activities
• Denial or prolonged sense  of disbelief
• Avoiding things that remind you of your loved one

If you or someone you know is exhibiting any of signs of complicated grief it may be time to get some help. Counseling is typically available through pastoral or church ministries in all communities or from professional counseling services. 

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Coming Soon - Men's Health Series

Central Health  - Grenada  just completed producing a four part series on Men's Health. Its goal is to educate men about various diseases that affect them.  We hope to encourage men to get screened early and to start taking good care of themselves.

We at Central Health are always on look out for opportunities to promote good physical and spiritual health, by providing education and information.

Very soon this series will be distributed throughout Grenada, Carriacou and Petite Martinique on the airwaves.  Stay Tuned!

Men: Uncontrolled Diabetes May Lead To Erection Difficulties

Robert Yearwood, MD, MBBS, FRCS, DM-Surgery, FCCOS

Urologist and Surgeon - Ocean House Medical Services

Erectile Dysfunction (ED) - the inability to sustain an erection when sexually aroused, is a complication of diabetes that affects some men.  This condition is caused by neuropathy (nerve damage). 

A practicing urologist and surgeon in Grenada Dr. Robert J. Yearwood, says that there is a direct correlation between uncontrolled diabetes and ED, “Erectile Dysfunction in males is a lot more common than people think because it is certainly not something that people talk about - but a major or leading cause of erectile dysfunction is diabetes.”  Dr. Yearwood went on to say that diabetic patients taking their medications as prescribed, following a healthy diet plan and exercising daily can lower men’s risk of developing this particular complication of diabetes, “Some people are still able to get an erection but the quality might be diminished and another thing too -  just to just sort of stick a pin here - diabetes is not the only cause of erectile dysfunction; and because you have diabetes it does not mean you will get erectile dysfunction. So everyone who is a diabetic don’t think, that they have erectile dysfunction but if you are diabetic and you don’t look after yourself; take your medication as prescribed [or] stick to the diet plan, the chance of you getting erectile dysfunction is very high.”

The United States’ National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) and National Institutes of Health (NIH) states that nerve damage is likely due to a combination of factors, these include:

• high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin
• damage to the blood vessels that carry oxygen and nutrients to nerves
• inflammation in nerves
• inherited traits that increase susceptibility to nerve disease
• lifestyle factors, such as smoking or alcohol use

Neuropathy is one of several complications associated with diabetes when the blood glucose levels are not controlled.  Other complications that can develop are eye disease, kidney failure, dental disease, heart disease, stroke and amputations - due to poor circulation in the extremities, in the legs, feet and fingers. Additionally, neuropathy is not limited to just ED. It depends on which nerves of the body have become damaged due to the long periods of high glucose (sugar) levels.  NIDDK/NIH list other symptoms caused by nerve damage that both men as well as women can experience, these are:

• numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
• wasting of the muscles of the feet or hands
• indigestion, nausea, or vomiting
• diarrhea or constipation
• dizziness or faintness due to a drop in blood pressure after standing or sitting up
• problems with urination
• erectile dysfunction in men or vaginal dryness in women
• weakness

Patients who notice any of these symptoms are encouraged to tell their doctor immediately.

This article was written by Central Health - Grenada in recognition of November being diabetes awareness month.