DIABETES SUPPORT GROUP

DAVID L. BURNS D.D.S.

JANUARY 7, 2004

M a y a C l i n i c

A n I n t e r v i e w W i t h R o b e r t R i z z a , M . D .

W H S : W h a t i s d i a b e t e s ?

D r . R i z z a : D i a b e t e s i s a d i s e a s e i n w h i c h y o u r b l o o ds u g a r ( g l u c o s e ) c o n c e n t r a t i o n i s h i g h e r t h a n n o r m a l .T h e s e h i g h l e v e l s c a n o c c u r a n y - t i m e d u r i n g t h e d a y .A h i g h l e v e l e a r l y i n t h e m o r n i n g i s r e f e r r e d t o a s ah i g h f a s t i n g g l u - c o s e . W h e n i t ' s h i g h a f t e r y o u e a t am e a l , i t ' s r e f e r r e d t o a s a h i g h p o s t p r a n d i a l g l u c o s e . .

W H S : W h a t ' s t h e d i f f e r e n c e b e t w e e n t y p e 1 a n dt y p e 2 d i a b e t e s ?

D r . R i z z a : T h e y ' r e d i f f e r e n t d i s e a s e p r o c e s s e s . I nt y p e 1 ( f o r m e r l y c a l l e d j u v e n i l e o r i n s u l i n -d e p e n d e n t d i a b e t e s ) y o u r b o d y d e s t r o y s a l l t h ei n s u l i n - s e c r e t i n g c e l l s ( b e t a c e l l s ) i n y o u rp a n c r e a s . T h i s i s b e l i e v e d t o b e a d i s o r d e r o f y o u ri n t e r n a l i m m u n e s y s t e m . . I n t y p e 2 ( f o r - m e r l yc a l l e d a d u l t - o n s e t o r n o n i n s u l i n - d e p e n - d e n td i a b e t e s ) y o u r p a n c r e a s m a k e s i n s u l i n , b u t n o te n o u g h f o r y o u r b o d y ' s n e e d s . T h a t c a n b eb e c a u s e y o u r b o d y n e e d s a l o t o f i n s u l i n , w h i c h i sr e f e r r e d t o a s i n s u l i n r e s i s - t a n c e , o r i t c o u l d b eb e c a u s e y o u r b o d y h a s g r e a t d i f f i c u l t y s e c r e t i n gi n s u l i n . T h e r e ' s a l w a y s a b a l a n c e b e t w e e n h o wm u c h i n s u l i n y o u r b o d y m a k e s v e r s u s h o w m u c hy o u rb o d y n e e d s . F o r e x a m p l e , y o u r b o d y m a k e s ac e r t a i n a m o u n t o f i n s u l i n . B u t i f y o u ' r e o v e r -w e i g h t o r y o u ' r e s e d e n t a r y , y o u r b o d y n e e d sm o r e . Y o u r b l o o d s u g a r g o e s u p b e c a u s e y o uc a n ' t s e c r e t e a s m u c h i n s u l i n a s y o u n e e d . O n t h eo t h e r h a n d , y o u c o u l d h a v e a g e n e t i c a b n o r m a l i t yi n t h e w a y y o u s e c r e t e i n s u l i n , s o e v e n t h o u g hy o u ' r e l e a n a n d f i t , y o u s t i l l m a y n o t h a v e q u i t ee n o u g h , a n d y o u r b l o o d s u g a r g o e s u p . T h i s i sw h y y o u m a y s e e a t h i n o l d e r a d u l t w i t h t y p e 2d i a b e t e s o r a v e r y h e a v y y o u n g p e r s o n w i t h t y p e2 d i a b e t e s . .

b u t i t ' s n o t r e a l l y n e c e s s a r y ; t h e t h e r a p y i s s t i l l t h es a m e . 8

W H S : C a n d i a b e t e s b e p r e v e n t e d ?

D r . R i z z a : Y e s . G e n e r a l l y , y o u c a n p r e v e n tt y p e 2 d i a b e t e s i f y o u s t a y l e a n a n d f i t . T h a t w a yy o u r b o d y h a s t h e a b i l i t y t o p r o d u c e e n o u g hi n s u l i n f o r y o u r n e e d s . . W i t h t y p e 1 , i t ' s m o r ec o m p l i c a t e d . T h i s i s a d i s e a s e i n w h i c h y o ud e v e l o p a n t i b o d i e s o r s o m e i m - m u n ea b n o r m a l i t i e s a g a i n s t t h e b e t a c e l l s i n y o u rp a n c r e a s . B u t i n t e r e s t i n g l y , e v e r y b o d y w h o h a st h e s e i m m u n e a b n o r m a l i t i e s d o e s n ' t n e c e s s a r i l yd e v e l o p t y p e 1 d i a b e t e s . F o r e x a m - p l e , i f y o uh a v e a n i d e n t i c a l t w i n w h o h a st y p e 1 d i a b e t e s , y o u o n l y h a v e a p p r o x i m a t e l y a 5 0p e r c e n t c h a n c e o f g e t t i n g t h e d i s e a s e , t o o . I f y o ut e s t e d t h e a u n t s , u n c l e s , b r o t h e r s , s i s - t e r s ,m o t h e r s a n d f a t h e r s o f p e o p l e w i t h t y p e1 d i a b e t e s , y o u ' d f i n d t h a t m a n y h a v e a n t i - b o d i e sa g a i n s t t h e i r b e t a c e l l s , w h i c h s a y s t h i s d e s t r u c t i v ep r o c e s s i s g o i n g o n , y e t t h e y n e v e r g e t d i a b e t e s .T h e p r o b l e m w e h a v e w i t h t y p e1 d i a b e t e s i s t h a t w e d o n ' t k n o w h o w t o p r e - d i c tw h o i s g o i n g t o g o o n t o d e v e l o p t h e d i s - e a s e a n dw h o i s n ' t . . W e b e l i e v e t h a t s o m e o t h e r p r o c e s s i sg o i n g o n . B e s i d e s a g e n e t i c p r e d i s p o s i t i o n ,p e r h a p s a n e n v i r o n m e n t a l t r i g g e r i s n e c e s s a r y o rs o m e o t h e r i n i t i a t i n g

I f a c t o r t h a t c a r r i e s t h e d i s e a s e p r o c e s s f o r w a r d ,r e s u l t i n g i n d i a b e t e s . .

W H S : W h a t i s p r e - d i a b e t e s ?

D r . R i z z a : P r e - d i a b e t e s i s a t e r m t h a t i m p l i e s t h a ty o u h a v e c e r t a i n f a c t o r s t h a t p l a c e y o u a t h i g h r i s ko f p r o g r e s s i n g t o d i a b e t e s . F o r i n s t a n c e , a n o r m a lf a s t i n g b l o o d s u g a r i s 8 0 t o 1 0 0 . Y o u h a v ed i a b e t e s i f y o u r f a s t i n g b l o o d s u g a r i s m o r e t h a n1 2 6 . B u t i f y o u h a v e a b l o o d s u g a r t h a t ' s b e t w e e n1 0 0 a n d 1 2 5 , y o u d o n ' t h a v e d i a b e t e s y e t , b u tc l e a r l y y o u rb l o o d s u g a r i s a l r e a d y a b n o r m a l . T h i s i s w h e ny o u r d o c t o r m a y s a y y o u ' r e p r e - d i a b e t i c . H a v i n g ab l o o d s u g a r i n t h i s p r e - d i a b e t e sI r a n g e p u t s y o u a t a v e r y h i g h r i s k o f p r o g r e s s -i n g t o d i a b e t e s u n l e s s y o u d o s o m e t h i n ga b o u t i t , s u c h a s l o s e w e i g h t a n d e x e r c i s e . Y o u

W H S : W h i c h t y p e i s m o s t l i k e l y t o a f f e c t a d u l tw o m e n ?

D r . R i z z a : M o s t a d u l t w o m e n w h o h a v e d i a -b e t e s h a v e t y p e 2 . T h a t ' s n o t t o s a y t h a t y o u c a n ' td e v e l o p t y p e 1 a s a n a d u l t . I n f a c t , a b o u t 1 0p e r c e n t t o 1 5 p e r c e n t o f a d u l t s w h o d e v e l - o pd i a b e t e s h a v e t y p e 1 . C e r t a i n t e s t s c a n b e u s e d t oh e l p d e t e r m i n e w h i c h t y p e y o u h a v e ,

S t i P P 4 : $ M E N T T O J A N U A R Y 2 0 0 4

An Interview With Robert Rizza, M.D.

WHS: What is diabetes?

Dr. Rizza: Diabetes is a disease in which your bloodsugar (glucose) concentration is higher than normal.These high levels can occur any- time during the day.A high level early in the morning is referred to as ahigh fasting glu- cose. When it's high after you eat ameal, it's referred to as a high postprandial glucose. .

body needs. For example, your body makes a

WHS: What's the difference between type 1 andtype 2 diabetes?

Dr. Rizza: They're different disease processes. Intype 1 (formerly called juvenile or insulin-dependent diabetes) your body destroys all theinsulin-secreting cells (beta cells) in yourpancreas. This is believed to be a disorder of yourinternal immune system. .In type 2 (for- merlycalled adult-onset or noninsulin-depen- dentdiabetes) your pancreas makes insulin, but notenough for your body's needs. That can bebecause your body needs a lot of insulin, which isreferred to as insulin resis- tance, or it could bebecause your body has great difficulty secretinginsulin. There's always a balance between howmuch insulin your body makes versus how muchyour

body needs. For example, your body makes acertain amount of insulin. But if you're over-weight or you're sedentary, your body needsmore. Your blood sugar goes up because youcan't secrete as much insulin as you need. On theother hand, you could have a genetic abnormalityin the way you secrete insulin, so even thoughyou're lean and fit, you still may not have quiteenough, and your blood sugar goes up. This iswhy you may see a thin older adult with type 2diabetes or a very heavy young person with type2 diabetes. .

WHS: Which type is most likely to affect adultwomen?

Dr. Rizza: Most adult women who have dia-betes have type 2. That's not to say that you can'tdevelop type 1 as an adult. In fact, about 10percent to 15 percent of adults who devel- opdiabetes have type 1. Certain tests can be used tohelp determine which type you have,

type 2 diabetes if you stay lean and fit. That way your body has the ability to produce enough insulin foryour needs. .With type 1, it's more complicated. This is a disease in which you develop antibodies or someim- mune abnormalities against the beta cells in your pancreas. But interestingly, everybody who has theseimmune abnormalities doesn't necessarily develop type 1 diabetes. For exam- ple, if you

WHS: Can diabetes be prevented?

Dr. Rizza: Yes. Generally, you can prevent

WHS: Can diabetes be prevented?Dr. Rizza: Yes. Generally, you can prevent type 2 diabetes if youstay lean and fit. That way your body has the ability to produceenough insulin for your needs. With type 1, it’s more complicated.This is a disease in which you develop antibodies or some immuneabnormalities against the beta cells in your pancreas. But interesting-ly, everybody who has these immune abnormalities doesn’t necessarilydevelop type 1 diabetes. For example, if you

For exam- ple, if you have an identical twin whohastype 1 diabetes, you only have approximately a 50percent chance of getting the disease, too. If youtested the aunts, uncles, brothers, sis- ters,mothers and fathers of people with type1 diabetes, you'd find that many have anti- bodiesagainst their beta cells, which says this destructiveprocess is going on, yet they never get diabetes.The problem we have with type1 diabetes is that we don't know how to pre- dictwho is going to go on to develop the dis- ease andwho isn't. .We believe that some other process isgoing on. Besides a genetic predisposition,perhaps an environmental trigger is necessary orsome other initiating

Ifactor that carries the disease process forward,resulting in diabetes. .

WHS: What is pre-diabetes?

Dr. Rizza: Pre-diabetes is a term that implies thatyou have certain factors that place you at high riskof progressing to diabetes. For instance, a normalfasting blood sugar is 80 to 100. You havediabetes if your fasting blood sugar is more than126. But if you have a blood sugar that's between100 and 125, you don't have diabetes yet, butclearly yourblood sugar is already abnormal. This is whenyour doctor may say you're pre-diabetic. Having ablood sugar in this pre-diabetesIrange puts you at a very high risk of progress-ing to diabetes unless you do somethingabout it, such as lose weight and exercise. You

may not have fallen off the side of a cliff, but you'regetting pretty close to the edge. .

WHS: Who should be screened for diabetes?

Dr. Rizza: The American Diabetes Association(ADA) says that everyone, particularly those whoare overweight, should be screened for diabetesevery three years beginning at age 45. Testingshould be more frequent for people who areoverweight who also have other risk factors suchas a family history of diabetes, a sedentarylifestyle, high blood pressure, and highcholesterol and triglyceride levels. 8

WHS: What tests are done to screen for diabetes?Dr. Rizza: Two tests are most often done. One isa simple blood test called a fasting blood sugar.This test is easier and faster to perform. If yourresult is greater than 126, then it indi- catesdiabetes. The other test is called a two- hourglucose tolerance test. In that test you're given asweet liquid to drink and then two hours later ablood sugar test is done. If the result is greaterthan 200, then you have dia- betes. The ADArecommends a fasting blood sugar test first, but ifyou're at high risk of diabetes -or the results ofyour fasting test are abnormal -your doctor mayconsider doing a two-hour glucose tolerance test.8

WHS: What are the treatments for diabetes?

Dr. Rizza: Treatment for diabetes is meant torestore the balance between insulin need andinsulin availability. We start with lifestylemodification -losing weight and exercising. Ifyou can accomplish these, you can dramati- callydecrease how much insulin your body requires, soyou may need to do nothingmore. Of course, this is easier said than done.Many people need to take medications fordiabetes. There are three major classes of med-ications -pills that make you secrete more insulin,pills that make the liver produce less glucose, andpills that make insulin work bet- ter. Insulin isused when pills aren't enough to keep blood sugarin the normal range. .

WHS: What new treatments are on the horizon? Dr.Rizza: There are a variety of new treat- ments beingstudied, some of them at Mayo. All the onesmentioned here are in advanced stages of testing andmay be ready within the next one to three years. .Onemedicine comes from a gastrointestinal hormone calledGLP1,

Ithe hormone that tells your pancreas that food iscoming and to get ready to secrete insulin. Thismedicine is remarkable because it stimu- latesinsulin secretion, it inhibits glucagon - thehormone that raises blood sugar -and it delays therate at which food empties from your stomach, sothe medicine can ease into your bloodstream. Butwhat's particularly encouraging is that GLPlmakes you secrete insulin only when your bloodsugar is high,so the risk of getting low blood sugar (hypo-glycemia) is negligible. .The problem with

the GLP hormone is that it only lasts for about aminute or two and then is rapidly degraded. Butwhat's being developed now are analogs to thehormone, in other words, similar sub- stances thataren't degraded so quickly. .In other studies, adrug is being developed that inhibits the enzymethat degrades GLP. So rather than giving youGLP, you would take a pill to boost your body'snatural GLP, giving you the same effect ofstimulating insulin secretion. .Studies are beingdone to find bet- ter ways of delivering insulinthan by giving yourself injections every day. Oneshowing promise is insulin that you inhale. Somedata say it works fine, but now the question iswhether it'll be safe for long-term use. .

WHS: What other important facts would you like ourreaders to know about?

Dr. Rizza: You hear so much about all the badhealth consequences of diabetes. And it's true thatdiabetes is the number one cause of kid- neydisease, blindness, amputations, heart dis- easeand more. However, these consequences happenonly when diabetes is untreated. If you treat yourdiabetes properly, keep your blood sugar normal,keep your blood pressure normal and keep yourblood lipids normal, you're going to be fine. .

WHS: What's your hope for the .future of diabetescare?

Dr. Rizza: Of course, the ultimate goal is to curediabetes. Until then, my hope for the future is thateveryone will be able to have access to the verybest care for their diabetes. Diabetes requires apartnership between peo- ple, their physicians andother health care providers. We have methodsavailable now that can normalize almosteverybody's blood sugars. But you need to worktogether as a team to make the most of thesemethods. .

C e n t e r p i e c e

E n a m e lD e n t i n

P u l p O r a l h e a l t h c a r e i s i m p o r t a n t t h r o u g h o u t a l l t h e s t a g e s o f

y o u r l i f e . H o w e v e 1 ; s e v e r a l c o n -

d i t i o n s a s s o c i a t e d w i t h a g i n g c a n l e a d t o m o u t hC r o w n

a n d g u m d i s e a s e . I n a d d i t i o n , d e n t a l d i s e a s e i s

n o w c o n s i d e r e d a c o n t r i b u t i n g f a c t o r f o r s o m e c a s e s o f h e a r t

d i s e a s e , p n e u m o n i a , s t r o k e a n d

B o n e

N e r v e a n d

b l o o d s u p p l y

T h e s u r f a c e o f a

R o o t

A c c o r d i n g t o t h e S u r g e o nG e n e r a l ' s r e p o r t " O r a l H e a l t h i nA m e r i c a , 1 I t h e

h e a l t h o f y o u r m o u t h r e f l e c t s y o u rg e n e r a l h e a l t h a n d w e l l -

b e i n g . H o w e v e r , o r a l h e a l t h i s o f t e no v e r l o o k e d a n d u n d e r e m p h a s i z e d .

C e m e n t u m

u n c o n t r o l l e d d i a b e t e s .

h e a l t h y c r o w n i s

e n a m e l , a t h i n l a y e r

c o v e r e d w i t h

N a t u r a l l o o k o f t e e t h a n d g u m sY o u r m o u t h i s p e r h a p s t h e m o s t m u l t i f u n c - t i o n a lp a r t o f y o u r b o d y . O f y o u r m o u t h ' s m a n yf u n c t i o n s , t h e m o s t o b v i o u s a r e b i t i n g , c h e w i n ga n d s w a l l o w i n g f o o d . T h e m o s t i m p o r t a n t t o o l s i nt h i s p r o c e s s a r e y o u r t e e t h .

E a c h o f y o u r t e e t h - m o s t p e o p l e d e v e l o p 3 2 o ft h e m - c a n b e d i v i d e d i n t o t w o p a r t s . T h e v i s i b l ep o r t i o n i s t h e c r o w n . T h e p o r t i o n h i d d e n b e l o wt h e g u m l i n e i s t h e r o o t . T h e s u r - f a c e o f a h e a l t h yc r o w n i s c o v e r e d w i t h e n a m - e l , a t h i n l a y e r o fc a l c i f i e d m a t e r i a l t h a t ' s t h e h a r d e s t s u b s t a n c e i nt h e b o d y . T h e o u t e r s u r - f a c e o f t h e r o o t i s c o v e r e db y c e m e n t u m . T h e p e r i o d o n t a l l i g a m e n t , ac o n n e c t i v e t i s s u e , b i n d s r o o t c e m e n t u m t o t h eb o n e t h a t f o r m s t h e t o o t h s o c k e t .

B e n e a t h t h e e n a m e l a n d c e m e n t u m l i e s t h eb o d y o f t h e i n n e r t o o t h ( d e n t i n ) . D e n t i n i s s o f t e rt h a n e n a m e l a n d c e m e n t u m , b u t h a r d e r t h a n b o n e .I t s u r r o u n d s t h e h o l l o w t o o t h c o r e ( c a l l e d t h e p u l pc a n a l o r r o o t c a n a l ) , a n a r e a w h e r e n e r v e e n d i n g sa n d b l o o d v e s s e l s s e n s i - t i z e a n d n o u r i s h t h e t o o t h .N e r v e s a n d v e s s e l s f e e d i n t o t h e p u l p c a n a lt h r o u g h a n o p e n i n g a t t h e r o o t t i p .

F i r m , p i n k g u m s ( g i n g i v a ) s u r r o u n d a h e a l t h yt o o t h . A t t h e e d g e o f y o u r g u m l i n e , y o u r g u mt i s s u e f o l d s b a c k u n d e r n e a t h i t s e l f . T h i s c r e a t e sa r o u n d e a c h t o o t h a s n u g g r o o v e c a l l e d t h eg i n g i v a l s u l c u s .

m a t e r i a l t h a t ' s t h e

o f c a l c i f i e d

h a r d e s t s u b s t a n c e

i n t h e h u m a n b o d y .

H e a l t h y t e e t h a n d g u m s w o u l d n ' t r e m a i nh e a l t h y f o r l o n g w i t h o u t s a l i v a . I t ' s s e c r e t e d f r o mg l a n d s t h r o u g h o u t y o u r m o u t h . I t h e l p s c l e a n y o u rm o u t h a n d t e e t h , a i d s i n s w a l l o w - i n g , a n dc o n t a i n s e n z y m e s t h a t a i d d i g e s t i o n a n d h e l pc o n t r o l i n f e c t i o n .

A l m o s t e v e r y o n e i s s u s c e p t i b l e t o g u m d i s -e a s e a n d t o o t h d e c a y . H o w e v e r , s o m e f a c t o r s m a yi n c r e a s e y o u r r i s k . T h e s e i n c l u d e l a c k o ff l u o r i d a t e d w a t e r , p o o r d i e t , f r e q u e n t s n a c k i n g o ns w e e t s , h e r e d i t y a n d t o b a c c o u s e .

T h e o u t e r s u r f a c e

o f t h e r o o t i s

c e m e n t u m , w h i c h

c o v e r e d b y

i s n ' t a s h a r d

P l a y i n g h o s t t o b a c t e r i aY o u r m o u t h , l i k e m a n y o t h e r p a r t s o f y o u r b o d y ,i s h o s t t o b a c t e r i a . T h e s e b a c t e r i a c o n - v e r t s o m eo f t h e s u g a r s a n d c a r b o h y d r a t e s y o u e a t i n t o a c i d .T h e b a c t e r i a a n d a c i d s t h e y f o r m b e c o m e p a r t o ft h e s t i c k y d e p o s i t - c a l l e d d e n t a l p l a q u e - t h a tc l i n g s t o t h e s u r - f a c e o f y o u r t e e t h .

I n a d d i t i o n t o b a c t e r i a , p l a q u e i s c o m p o s e d o fs a l i v a a n d f o o d p a r t i c l e s . O v e r t i m e , p l a q u e c a nh a r d e n a n d f o r m a d i f f i c u l t - t o - r e m o v e s u b s t a n c ec a l l e d t a r t a r { c a l c u l u s ) .

D e p e n d i n g o n w h e r e p l a q u e a n d t a r t a r f o r m ,t h e y m a y c a u s e :

T o o t h d e c a y ( c a r i e s ) - D e c a y i s a b a c t e r i a l d i s -e a s e o f t e e t h a n d t h e p r i m a r y c a u s e o f t o o t h l o s s .I t i s t h e r e s u l t o f t h r e e i n t e r a c t i n g f a c t o r s : b a c t e r i ag r o w t h , d i e t a r y s u g a r a n d a v u l n e r a - b l e t o o t hs u r f a c e . T h e d e c a y - p r o d u c i n g a c i d t h a t f o r m s i np l a q u e a t t a c k s t h e m i n e r a l s i nt h e t o o t h ' s o u t e r e n a m e l s u r f a c e . T h e e r o s i o nc a u s e d b y t h e p l a q u e l e a d s t o t i n y o p e n i n g s{ c a v i t i e s ) i n t h e e n a m e l , w h i c h y o u m a y n o tn o t i c e i n i t i a l l y . T h e f i r s t s i g n o f d e c a y m a y b ea s e n s a t i o n o f p a i n w h e n y o u e a t s o m e t h i n g s w e e t ,v e r y c o l d o r v e r y h o t . O n c e t h e e n a m e l i sp e n e t r a t e d , t h e u n d e r l y i n g s o f t e r d e n t i n

a s e n a m e l .

M A Y O C L I N I C W O M E N ' S H E A L T H S O U R C E 4 J A N U A R Y 2 0 0 4

According to the SurgeonGeneral's report "Oral Health inAmerica,1I the

health of your mouth reflects yourgeneral health and well-

being. However, oral health is oftenoverlooked and underemphasized.

”

Natural look of teeth and gumsYour mouth is perhaps the most multifunc- tionalpart of your body. Of your mouth's manyfunctions, the most obvious are biting, chewingand swallowing food. The most important tools inthis process are your teeth.

Each of your teeth -most people develop 32 ofthem -can be divided into two parts. The visibleportion is the crown. The portion hidden belowthe gumline is the root. The sur- face of a healthycrown is covered with enam- el, a thin layer ofcalcified material that's the hardest substance inthe body. The outer sur- face of the root is coveredby cementum. The periodontal ligament, aconnective tissue, binds root cementum to thebone that forms the tooth socket.

Beneath the enamel and cementum lies thebody of the inner tooth (dentin). Dentin is softerthan enamel and cementum, but harder than bone.It surrounds the hollow tooth core (called the pulpcanal or root canal), an area where nerve endingsand blood vessels sensi- tize and nourish the tooth.Nerves and vessels feed into the pulp canalthrough an opening at the root tip.

Firm, pink gums (gingiva) surround a healthytooth. At the edge of your gumline, your gumtissue folds back underneath itself. This createsaround each tooth a snug groove called thegingival sulcus.

Healthy teeth and gums wouldn't remainhealthy for long without saliva. It's secreted fromglands throughout your mouth. It helps clean yourmouth and teeth, aids in swallow- ing, andcontains enzymes that aid digestion and helpcontrol infection.

Almost everyone is susceptible to gum dis-ease and tooth decay. However, some factors mayincrease your risk. These include lack offluoridated water, poor diet, frequent snacking onsweets, heredity and tobacco use.

Playing host to bacteriaYour mouth, like many other parts of your body,is host to bacteria. These bacteria con- vert someof the sugars and carbohydrates you eat into acid.The bacteria and acids they form become part ofthe sticky deposit - called dental plaque -thatclings to the sur- face of your teeth.

In addition to bacteria, plaque is composed ofsaliva and food particles. Over time, plaque canharden and form a difficult-to-remove substancecalled tartar {calculus).

Depending on where plaque and tartar form,they may cause:

Tooth decay (caries) -Decay is a bacterial dis-ease of teeth and the primary cause of tooth loss.It is the result of three interacting factors: bacteriagrowth, dietary sugar and a vulnera- ble toothsurface. The decay-producing acid that forms inplaque attacks the minerals inthe tooth's outer enamel surface. The erosioncaused by the plaque leads to tiny openings{cavities) in the enamel, which you may notnotice initially. The first sign of decay may bea sensation of pain when you eat something sweet,very cold or very hot. Once the enamel ispenetrated, the underlying softer dentin

Depending on where plaque and tartar form,they may cause:

Tooth decay (caries) -Decay is a bacterial dis-ease of teeth and the primary cause of tooth loss.It is the result of three interacting factors: bacteriagrowth, dietary sugar and a vulnera- ble toothsurface. The decay-producing acid that forms inplaque attacks the minerals inthe tooth's outer enamel surface. The erosioncaused by the plaque leads to tiny openings{cavities) in the enamel, which you may notnotice initially. The first sign of decay may bea sensation of pain when you eat something sweet,very cold or very hot. Once the enamel ispenetrated, the underlying softer dentin

Gingivitis -This mild, early form of gum dis- easecan cause healthy, pink gums to become red,swollen, tender and prone to bleeding.The swelling and tenderness associated withgingivitis is caused by your immune system'sinflammatory response to plaque or tartar buildupalong your gumline. Gingivitis oftenis painless and goes unnoticed. If unchecked,gingivitis can lead to periodontitis, a more seriousdisease.

Periodontitis -This is an advanced stage of gumdisease that may develop when plaque and tartarextend beneath your gumline. Gradually, yourgums withdraw from around your teeth. Pocketsof infection can form inthis dark, airless region and destroy tissue andyour tooth sockets (alveolar bone). Left untreated,involved teeth eventually loosen and fall out.Chronic periodontal disease is the leading cause oftooth loss in older adults.

In addition, a small percentage of meno- pausal women may experience gum inflam- mation (menopausalgingivitis). This causes

Risk factors with age, gender

Some oral conditions are unique to women atspecific phases of their lives due to several fac-tors, including hormones. For example, duringmenopause, you may notice discomfort in yourmouth, including dry mouth and burn- ingsensations in the gum tissue (burning mouthsyndrome). You may also notice alter- ations intastes, such as salty, peppery or sour.

. Certain diseases that affect the oral cav- ity alsoare more common in women. And, the older youare, the greater your risk of devel- oping diseasesof the mouth. Among the fac- tors that may affectyour oral health are:

Diabetes -This condition puts you at greater riskof developing periodontal disease and otherinfections. It increases even more if your diabetesis poorly controlled. That's because diabetes mayweaken the resistance of your gum tissue tobacterial infection and plaque.In addition, oral infection makes blood glu- coselevels harder to control.

Osteoporosis -Researchers suspect a link be-tween the loss of bone mineral density withosteoporosis and periodontal disease. Losingdensity in the bones that hold your teeth in placemay help speed the degenerative pro- cess ofperiodontal disease. Osteoporosis also may makea good denture fit difficult.

Medications -Some drugs -such as antide-pressants and certain blood pressure drugs - canlead to dry mouth, which increases yourrisk of gum problems and tooth loss.

Wear and tear -As you get older, you may noticethat your mouth feels drier and your gums havepulled back (receded}. Your teeth may darkenslightly and become more brittle and breakable.

Making the effortAdvances in dental technology -such as genetictesting for oral disease or decay risk and theability to initiate the growth of new teeth, boneand tissue -may someday playa prominent role indentistry. However, daily oral hygiene combinedwith regular dental visits -ask your dentist howoften -is still the best way to increase yourchances of a healthy mouth. Caring for yourmouth and gums may help to reflect more than ahealthy smile. It may help to reflect a healthieryou. 8

Cariology &Periodontology

2003.03.12.

Department of Dental & Oral SurgeryWakayama Medical University

Presented by K.Tamaki

Academy of Template Research

60year old memorial presentation

CARIES

CAVITY/ ABSCESS

STREPTOCOCCUS MUTANS

CAVITIES AND PERIODONTAL DISEASE

RADICULAR GRANULOMA

RADICULAR CYST

ALVEOLAR ABSCESS

ABSCESS/ROOT CANAL THERAPY

TREATMENT

外傷歯

PERIODONTAL DISEASE

Dental Plaque & Periodontal Disease

ADVANCED PERIODONTAL DISEASE

TARTAR/CALCULUS

INFECTIOUS ORGANISMS

INFECTION

INFECTION