Dr Asha Narde, a senior Conservative Dentist and Endodontist, has been in clinical practice at Juhu, Mumbai since 1995. She graduated from the Nair Hospital Dental College in 1990 and later did her post graduation from the KLES Dental College, Belgaum, in 1994. Dr Narde is a Consulting Endodontist at The Centre For Advanced Dentistry, Breach Candy Hospital and for the past 16 years has been working alongside Dr Rajeev Narvekar in South Mumbai.
A great majority of her patients are 60 years and above, and providing optimum dental care has been her mission. She is part of the fraternity that trains young dentists in the field of geriatric dentistry to understand and provide the needs of the ageing population in an objective manner.
Our ageing population has become more aware about their needs. They are questioning ways and trends of preserving their teeth, trying to understand the importance of teeth- which was easier being ignored. Now the elderly are more curious about their oral health to help maintain and preserve their teeth.
The mouth is an important aspect of their body, because if you want to suitably nourish your body, you need to chew well and that requires a healthy oral cavity.
Oral health is a very important aspect for our ageing elders. And maintaining your oral health in our rising population where 8% of our population is the elderly, which is expected to rise to 12% by 2025 becomes a concern.
We do not give enough attention and priority to our oral health, we run to physicians at the drop of a hat because more than 50% of our elders suffer from some kind of medical condition such as diabetes, hypertension, cardiac issues, arthritis, cancer, neurological and degenerative disorders, respiratory problems. But at the same time we have 20% of our elders who suffer from some kind of depression/ disability. And amongst this is our oral health, which makes it very important for us to preserve our oral health.
The average life expectancy is around 72.6 years and is expected to rise to 79.2 in another 2 decades.
Maintaining a healthy dentition is very important from a structural, functional and psychosocial point of view.
There are studies which have shown that our teeth are a predictor of mortality. Which means if you have a high number of teeth, independent of the illnesses you have, there is a chance that you will tend to live longer.
Teeth are required and necessary from a nutrition point of view. And to have proper nutritional health and a balanced diet, you need to have your mouth in a good condition.
If chewing is not done properly and you tend to swallow your food whole then your entire system tends to get affected. Your daily nutritional intake is affected.
You need to preserve your teeth- whether they are supporting a crown or a bridge or a denture.
Lastly, we need our teeth to have a good oral appearance and to avoid bad breath.
We need our teeth to have a healthy smile in place.
Common dental problems:
- Cavities in the teeth: seen in people with a high carbohydrate diet or individuals with poor oral hygiene
- Gum disease: this is seen when the gum around the teeth starts to become loose and the bone starts eroding away leading to conditions such as gingivitis, periodontitis
- Flattening of the teeth known as atresia, which is an age relate change due to mechanical forces such as hard brushes, acid secretion from the gastric juiced or due to consumption of food items which large amounts of acid in them. This can lead to erosion of teeth. Sometimes, we also tend to clench our teeth.
- Dryness of mouth: this can be due to the medications the individual is on for the medical conditions
- Partial/ total tooth loss
- Oral cancers
Cavities lead to loss of tooth structure which thereby leads to pain, discomfort, difficulty in day to day functioning.
When plaque that remains around the tooth due to inadequate brushing, the bacteria that are present in the soft deposits act on the enamel leading to a breakdown of the enamel to the tooth turning into chalky white, decalcified surface.
The surface is porous in nature.
There is more and more penetration of the bacteria and the acid that is released by the bacteria, making the surface of the tooth become soft.
When the enamel is lost, the inner layer within the tooth, which is called the dentine, is exposed too the oral environment which means that the food which you eat gets stuck on the dentine.
The dentine is a sensitive part of the tooth. There are fine nerve endings in the dentine.
Which is why when you have something hot or cold, you feel a pain because the sensitive part of the tooth is exposed to the environment.
Since this surface is softer, the bacteria can act on it faster resulting in breakdown of this surface. When this surface is broken down further, it penetrates deeper into the pulp (the nerve and blood vessel of the tooth).
When you have extensive decay which extends from the enamel to the dentine and reaches the pulp, resulting in inflammation of the soft tissue, which progresses to the tip of the root around the bone and rusts in infection.
When it reaches this stage is when the patient starts complaining of pain on chewing, severe dental pain.
In such conditions, it is not possible to simply remove the decay and fill the cavity.
The soft tissue that is present within the tooth, the pulp, needs to be removed, cleaned out and a filling needs to be out.
And that is what Root Canal Treatment is all about.
A root canal treatment involves clearing out the soft tissue and decay which has occurred because of the bacteria. Removing it, cleaning it and then making the environment absolutely sterile followed by placing a filling material.
Root canal treatment helps us protect and keep the tooth in function, in the mouth.
There are fine fibres around the tooth known as periodontal fibres which are connected to the bone. When the root canaled tooth comes back to a healthy state, the sensation of hot and cold is lost but the ligament gives us the feel and the amount of pressure which is required to chew our food. Thereby preserving and reinstating the function of the tooth in the mouth.
Occasionally, a crown is also placed, this is because when there is extensive decay, the tooth structure is also lost making the tooth weak. Thus, doing a root canal treatment followed by placing a crown over the tooth, it becomes strong like before.
There are some conditions where the patient can present with sensitivity in the tooth but the structure of the tooth is intact. This can be because the bacteria penetrating and infecting the pulp by entering from the gum tissue.
In these cases too, a root canal treatment is advised, in addition to gum treatment.
