In Conversation with Doctors


Your Gum Bleeds!

by Dato’ Emeritus Professor Dr. Hashim Yaacob,Consultant Oral and Dental Surgeon,FASc, DDSc (Hon), FRCPath (UK), FDSRCS (Eng) Ad Eundem, FDSRCPS (Glasg),FFOPRCPA (Aust), MSc (Lon), BDS (Otago), Dip Islam Stud(UIAM)

We are going to have fun looking at our gum in sickness and in health

This is a sight of a super healthy gum and teeth. It is devoid of any abnormality or disease.

The pink gum between the teeth is drawn into a knife-edge sharpness and the teeth are whiter than white.

Life is short, except for a few. So, smile while you still have your teeth and gum. It makes you attractive, alleviates your mood, relieves stress and stays positive

The gum above is swollen and looks not only soggy but also boggy, inflamed and bleeds.

This man has severe gum disease known as gingivitis. The swelling and bleeding due to infection has spread in addition, to beneath the gum level, and is now known as periodontitis. These are chronic diseases. Because he now looks hideous, he does like to smile any longer.

However, gingivitis and periodontitis can also be the result of certain blood disorders, drug complications, clotting defects, or even after being kicked in the teeth by the wife. Good practice of oral hygiene very much can reduce the effects.

This is the normal anatomy of the tooth. It is engulfed by bone to make it stable and firm. Covering the bone and the neck of the tooth is the gum, exposing only the head called the crown.

With the accumulation of dental plaque, which we will learn later, the gum begins to become inflamed, redder in colour and slightly swollen.

If left unbrushed, more plaque will accumulate on the teeth and around the gum, causing increased inflammation. The gum swells and the teeth which was once whiter than white have become yellowish as a result of being covered by the breakfast, lunch and dinner materials which has failed to be swallowed.

If we were to take an instrument and scrape the surface of the tooth with it, we shall obtain a whitish mass at the end of the instrument, looking not unlike mashed potatoes from some fast-food outlets. This whitish mashed potato-like mass is the culprit that will ultimately cause swollen and bleeding gums. It is called dental plaque.

The inflammation of the gum has progressed and became worse as time passes by without tooth brushing. Tooth-brushing can cause discomfort, pain even, and definitely bleeding on slight touch.

This is a diagram of the enemy of teeth and gums, ie the dental plaque. On the first day after tooth- brushing, round-shaped cocci, rods, and a little filamentous bacteriae colonized the tooth surface. By the fifth day there will be more filaments and rods. Come the 7th day spirochaets appear.

Some of the bacteriae will manufacture extra-cellullar sugar called dextran to enhance the adherence of dental plaque to the tooth surface, and to act as nutrients for the bacteriae.

The bulk of the dental plaque increases in thickness and volume if it is left alone. The amount of plaque is proportional in severerity to the amount of inflammatory damage to the gum and teeth. This occurs through the production of acids and toxins produced by the bacteriae.

The bacteriae at the bottom of the plaque mass finally become overburdened by the weight of the above, as well as by the anaerobic condition that prevails. These bacteriae shrink and become less active with some dying and dead, very much like the proverb “Hidup segan mati tak mahu”.

Had Niel Diamond listened to this lecture, I think he would have modified the lyric of his song to be “He is heavy, he aint my brother”.

By the end of 2 weeks, if the dental plaque is not removed, minerals from the saliva will enter the plaque, and gradually will make it harder each day. This is called calculus. If you are not mathematically disposed, you may call it “tartar” or simply stone. This stone can no longer be removed by tooth brush. You will need the dental surgeon to help you.

The mass around the bottom of the lower teeth is new stone while on the top teeth is older, and has turned dark or black, and hard.

As life itself is not static so is the stone. It creeps and advances successfully forward to push the gum upwards or downwards bringing with it infection to the deeper layers of the gum, tooth and the supporting bone.

As a result the gum recedes and retreats, and the tooth will appear longer, ugly and wobbly.

At this stage there are only two options left for treatment: firstly is to perform gum surgery, which will restore the gum to health, but the tooth will still appear long. Secondly, extraction of the tooth. Hence whatever is done, such a person will end up with a long tooth, or tooth no longer.

A lady patient once asked me the cost of a tooth extraction. I told her RM400.00. She exclaimed “What! For a few minutes’ job you charge RM400?” And I replied “I can do it very slowly for you if you wish”.

The management of the diseases of the gum and teeth as shown in the top photograph is far from difficult.

Accordingly, the Dental surgeon will remove the stone and clean the teeth and the gum with all his skill and armamentarium, together with a vigorous oral hygiene instruction for the patient to abide by.

If God is willing, the mouth will restore itself to health again to become like the photograph shown below.

Due to his neglect of oral hygiene, the teeth of this guy are badly broken down, his gum bleeds with severe gum inflammation, tooth decay, chronic periodic pain and bad breath.

As such, he no longer is armed to the teeth, and will not be capable of fighting tooth and nail.

Many believe that when a lady becomes pregnant, she will have a bleeding, swollen gum and will lose a tooth. This is as false as believing the night has fallen, when the sun is still shining bright. If this belief were true, soon enough the world will be toothless.

The pregnant lady should not have all those troubles, if she keeps her oral hygiene spick and span.

The above photo shows the teeth and gum of a 71 year old person. This is put up in an effort to show that teeth can last as long as the life of its owner if he looks after his oral hygiene.

I would like to leave you with words which you might wish to adopt :

“I want to be able as days go by, to always look at myself, straight in the gum and say, in the setting sun, I no longer would like to have a bleeding gum. I shall beat gum disease once and forever”.

Ladies and Gentlemen, it has been my great pleasure to have addressed you. Before parting, I would like to say : Smile with your healthy teeth and gum. You are never fully dressed without a smile. A smile is the prettiest thing you can ever wear.

Thank you. Good-bye. May your God be with you.