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Stages of dental disease
Periodontal disease or gum disease is a progressive, painless infection of the gums leading to loss of bone around the teeth. This can be successfully treated. Untreated periodontal disease not only causes tooth loss but it can potentially contribute to health problems.

It is best to have a dentist or periodontist examine your mouth. Signs of gum disease include bleeding gums when brushing or flossing, loose teeth, swelling in the mouth, shifting of teeth, and bad breath. However, most people have very few subjective symptoms and are first diagnosed by their dentist.

Dental infections pose a risk to heart valves, and may be implicated in hardening of the arteries, heart attack, stroke, and spontaneous, pre–term births.

Stages of dental disease

Health
Gums have a healthy pink color. The gum line hugs teeth tightly and there is no bleeding.

Gingivitis
Gums bleed easily when you brush or when probed gently during examination. Gums are inflamed and sensitive to touch. Possible bad breath and bad taste might result. Gums between teeth may look bluish–red in color.

Early Periodontitis
Gums may begin to pull away from the teeth. Bleeding, puffiness and inflammation become more pronounced. There is bad breath, bad taste and slight loss of bone shows up horizontally on an X–ray. Pockets of 3–4mm between teeth and gums are found in one or more areas of the mouth.

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Moderate Periodontitis
Gum boils or abscesses may develop. Teeth look longer as gums begin to recede. Front teeth may begin to drift, showing spaces. Bad breath and bad taste develop. There is both horizontal and angular bone loss. X–ray pockets between teeth and gums range from 4–6mm deep.

Advanced Periodontitis
Teeth may become mobile or loose. Bad breath and bad taste are constant. Roots may be exposed and are sensitive to hot and cold. There is severe horizontal and angular bone loss which shows up on an X–ray. Pockets between teeth and gum are now in excess of 5mm deep.

Tooth brushing is one of the most important aspects of good oral hygiene. Others include flossing, good diet and visiting the dentist regularly. Brushes should be replaced often, usually after three to four months or after a bad cold or flu. Ideally, one should brush after each meal, but at least mornings and before bedtime should be made part of one’s normal routine.

Other common questions are what types of bristles should a toothbrush have. If one uses a synthetic soft bristled toothbrush that is replaced often, it will not cause this irritation.

Sequence of Brushing
Each person has their own method of brushing, however, an easy technique is to divide the mouth into six sections. Place the toothbrush slightly on the gums or gingivae at a 45 degree angle and partly on the tooth. Gently brush back and forth. After brushing in this fashion, move the brush further down away from the gums and onto the rest of the teeth. Go further anteriorly until you reach the next one third. You should now be on the anterior six teeth.

Repeat the procedure. Move on to the four back left teeth, repeating the back and forth motions. Once completed, brush the left four posterior teeth, on the biting or occlusal surfaces. Roll to the inside tongue or lingual side of the teeth. Again, place the brush at a 45 degree angle on the gums and tooth. Follow this procedure now going from left to anterior to right upper back teeth. This is now repeated by dropping down to the lower teeth. Follow the same instructions.

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Outer/inner surface of teeth
Place your toothbrush at a 45–degree angle against your gums and gently brush back and forth.

Chewing surface
Use the toothbrush as shown, and applying slight pressure, brush back and forth over the chewing surface.

Inside surface of the front teeth
Angle the brush as shown and use gentle back and forth strokes with the end of the brush.

Tongue
Brush the tongue in a back to front sweeping motion to remove food particles and freshen your mouth or you can use one of the many tongue scrapers available.

Flossing the teeth is a very important adjunct to tooth brushing for good oral hygiene. Studies have even demonstrated that those who floss regularly have a decrease in periodontal disease, bad breath, and cavity incidence. Flossing, as many people believe, is not used to remove food particles only. It is used to remove plaque under the gums, which is the invisible film of bacteria that constantly forms on teeth.

Floss allows one to go in between the teeth, and scrape the surfaces clear of this plaque and bacteria. A few of the commercially available brands of floss are:

• Johnson’s Reach
• Oral B
• Colgate

The cost may vary between INR 45 to INR 70

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Technique
A 12 to 18 inch piece of floss should be used first. By placing a few inches around the middle fingers on either hand, and then using the thumbs for control, one places the floss in between teeth. Again, you can divide the mouth into sections. The important thing to remember is that you should get sufficient pressure to get in between the teeth. Pressure should be placed on either side of the teeth once the floss is in correct position. One must get under the gumline to loosen the debris, plaque, and bacteria. This area is called the sulcus. A good way to remember how long to stay in this area and clean, is to count the up and down strokes on each tooth. Eight to ten strokes on each surface should be quite sufficient. The amount of time might seem excessive, but the rewards are great for your dental health. One should floss each day.