Turut Berduka Cita

Atas meninggal dunia :

FRANS NATA PRAJA SIALLAGAN, SE

Anak dari : DJAUTAR SIALLAGAN, SH dan KONTI DAMANIK

Meninggal : Pada Hari Kamis, 13 Desember 2007 sekitar Jam 21, di Medan

Disemayamkan di rumah duka : Jl. Parorot Nagori Pamatang Simalungun Kec. Siantar

Dikebumikan pada Hari Sabtu, 15 Desember 2007

Merebaknya DBD di Simalungun. Drg. Hargo Basuki : Jangan Saling Menyalahkan

Tapian Dolok-SK : Merebaknya wabah penyakit Demam Berdarah Dengue (DBD), ternyata tidak hanya menimbulkan keresahan masyarakat semata. Tetapi juga menimbulkan silang pendapat yang cenderung saling menyalahkan. Siapapun tidak ingin keluarganya terkena penyakit DBD tersebut, " Demikian dikatakan Drg. Hargo Basuki, Kepala Puskesmas Tapian Dolok, kepada SK, Kamis (6/12) di Simalungun.

"Tidak perlu saling menyalahkan, penyakit ini disebabkan virus yang hingga kini belum ada obatnya. Yang perlu kita lakukan adalah upaya pencegahan dan penanggulangan bagi mereka yang telah terserang penyakit DBD ini, " Jelas Basuki. Lebih lanjut Basuki menambahkan, yang penting dikembangkan saat ini adalah rasa tanggung jawab kita bersama atas kondisi lingkungan dimana pun berada. Perlu diketahui, katanya bahwa virus ini tersebar luas melalui gigitan nyamuk Aedes Agepty. Uniknya nyamuk itu tumbuh dan berkembang mengikuti perkembangan musim panas dan penghujan. Daya tahan nyamuk ini terhadap suhu udara panas cukup baik sehingga mampu menanti saat yang tepat untuk menetas. Siapa sangka kalau ternyata telurnya telah menebar di tempat-tempat yang kering. Dan pada saat hujan maka dengan sendirinya telur nyamuk akan menetas. Jadi bukan menunggu hujan baru nyamuk tersebut bertelur. Untuk itu sudah saatnya kita bersama-sama bersikap waspada terhadap lingkungan kita, katanya. Tindakan preventif dengan segera menganulir barang bekas yang berserakan di sekitar lingkungan, menutup potensi mudahnya nyamuk tersebut berkembang. Memberikan pelayanan terbaik bagi masyarakat yang telah terserang penyakit ini, dengan segera memberikan kemudahan bagi penderita. Hal yang perlu diingat adalah mewaspadai jadwal nyamuk ini menghisap darah. Biasanya nyamuk ini mengisap darah mulai siang Pukul : 09.00 sd 11.00 WIB dan 16.00 sd 17.00 WIB, katanya. (dede)

Dikutip dari : HARIAN SINAR KEADILAN, Edisi :073 Tahun 1, Jumat, 07 Desember 2007. Halaman 2

Mumps

Mumps is a disease caused by a virus that usually spreads through saliva and can infect many parts of the body, especially the parotid salivary glands. These glands, which produce saliva for the mouth, are found toward the back of each cheek, in the area between the ear and jaw. In cases of mumps, these glands typically swell and become painful.
The disease has been recognized for several centuries, and medical historians argue over whether the name "mumps" comes from an old word for "lump" or an old word for "mumble."
Mumps was common until the mumps vaccine was licensed in 1967. Before the vaccine, more than 200,000 cases occurred each year in the United States. Since then the number of cases has dropped to fewer than 1,000 a year, and epidemics have become fairly rare. As in the prevaccine era, most cases of mumps are still in children ages 5 to 14, but the proportion of young adults who become infected has been rising slowly over the last two decades. Mumps infections are uncommon in children younger than 1 year old.
After a case of mumps it is very unusual to have a second bout because one attack of mumps almost always gives lifelong protection against another. However, other infections can also cause swelling in the salivary glands, which might lead a parent to mistakenly think a child has had mumps more than once.

Signs and Symptoms
Cases of mumps may start with a

fever of up to 103 degrees Fahrenheit (39.4 degrees Celsius), as well as a headache and loss of appetite. The well-known hallmark of mumps is swelling and pain in the parotid glands, making the child look like a hamster with food in its cheeks. The glands usually become increasingly swollen and painful over a period of 1 to 3 days. The pain gets worse when the child swallows, talks, chews, or drinks acidic juices (like orange juice).
Both the left and right parotid glands may be affected, with one side swelling a few days before the other, or only one side may swell. In rare cases, mumps will attack other groups of salivary glands instead of the parotids. If this happens, swelling may be noticed under the tongue, under the jaw, or all the way down to the front of the chest.
Mumps can lead to inflammation and swelling of the brain and other organs, although this is not common. Encephalitis (inflammation of the brain) and meningitis (inflammation of the lining of the brain and spinal cord) are both rare complications of mumps. Symptoms appear in the first week after the parotid glands begin to swell and may include: high fever, stiff neck, headache, nausea and vomiting, drowsiness, convulsions, and other signs of brain involvement.
Mumps in adolescent and adult males may also result in the development of orchitis, an inflammation of the testicles. Usually one testicle becomes swollen and painful about 7 to 10 days after the parotids swell. This is accompanied by a high fever, shaking chills, headache, nausea, vomiting, and abdominal pain that can sometimes be mistaken for appendicitis if the right testicle is affected. After 3 to 7 days, testicular pain and swelling subside, usually at about the same time that the fever passes. In some cases, both testicles are involved. Even with involvement of both testicles, sterility is only a rare complication of orchitis.
Additionally, mumps may affect the pancreas or, in females, the ovaries, causing pain and tenderness in parts of the abdomen.
In some cases, signs and symptoms of mumps are so mild that no one suspects a mumps infection. Doctors believe that about one in three people may have a mumps infection without symptoms.

Contagiousness
The mumps virus is contagious and spreads in tiny drops of fluid from the mouth and nose of someone who is infected. It can be passed to others through sneezing, coughing, or even laughing. The virus can also spread to other people through direct contact, such as picking up tissues or using drinking glasses that have been used by the infected person.
People who have mumps are most contagious from 2 days before symptoms begin to 6 days after they end. The virus can also spread from people who are infected but have no symptoms.

Prevention
Mumps can be prevented by vaccination. The

vaccine can be given alone or as part of the measles-mumps-rubella (MMR) immunization, which is usually given to children at 12 to 15 months of age. A second dose of MMR is generally given at 4 to 6 years of age. As is the case with all immunization schedules, there are important exceptions and special circumstances.If they haven't already received them, students who are attending colleges and other post-high school institutions should be sure they have had two doses of the MMR vaccine. During a measles outbreak, your doctor may recommend additional shots of the vaccine, if your child is 1 to 4 years old. Your child's doctor will have the most current information.

Incubation
The incubation period for mumps can be 12 to 25 days, but the average is 16 to 18 days.

Duration
Children usually recover from mumps in about 10 to 12 days. It takes about 1 week for the swelling to disappear in each parotid gland, but both glands don't usually swell at the same time.

Professional Treatment
If you think that your child has mumps, call your child's doctor, who can confirm the diagnosis and work with you to monitor your child's progress and watch for any complications. The doctor can also notify the health authorities who keep track of childhood immunization programs and mumps outbreaks.
Because mumps is caused by a virus, it cannot be treated with antibiotics.
At home, monitor and keep track of your child's temperature. You can use nonaspirin fever medications such as acetaminophen or ibuprofen to bring down a fever. These medicines will also help relieve pain in the swollen parotid glands. Unless instructed by your child's doctor, aspirin should not be used in children with viral illnesses because the use of aspirin in such cases has been associated with the development of

Reye syndrome, which can lead to liver failure and death.
You can also soothe your child's swollen parotid glands with either warm or cold packs. Serve a soft, bland diet that does not require a lot of chewing and encourage your child to drink plenty of fluids. Avoid serving tart or acidic fruit juices (like orange juice, grapefruit juice, or lemonade) that make parotid pain worse. Water, decaffeinated soft drinks, and tea are better tolerated.
When mumps involves the testicles, the doctor may prescribe stronger medications for pain and swelling and provide instructions on how to apply warm or cool packs to soothe the area and how to provide extra support for the testicles.
A child with mumps doesn't need to stay in bed, but may play quietly. Ask your doctor about the best time for your child to return to school.

When to Call Your Child's Doctor
Call your child's doctor if you suspect that your child has mumps. If your child has been diagnosed with mumps, keep track of your child's temperature and call the doctor if it climbs above 101 degrees Fahrenheit (38.3 degrees Celsius).
Because mumps can also involve the brain and its membranes, call the doctor immediately if your child has any of the following: stiff neck, convulsions (seizures), extreme drowsiness, severe headache, or changes of consciousness. Watch for abdominal pain that can mean involvement of the pancreas in either sex or involvement of the ovaries in girls. In boys, watch for high fever with pain and swelling of the testicles.

Trigeminal Neuralgia

Introduction
Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable.
You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area.
Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery.

Signs and symptoms
An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia.
People who have experienced severe trigeminal neuralgia have described the pain as:

• Lightning-like or electric-shock-like
• Shooting
• Jabbing
• Like having live wires in your face

Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time.

Causes

Branches of the trigeminal nerve

The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux.
The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia.
After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face:

• The first branch controls sensation in your eye, upper eyelid and forehead.
• The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum.
• The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing.

You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face.
Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include:

• Compression by a tumor
• Multiple sclerosis
• A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system

A variety of triggers, many subtle, may set off the pain. These triggers may include:

• Shaving
• Stroking your face
• Eating
• Drinking
• Brushing your teeth
• Talking
• Putting on makeup
• Encountering a breeze
• Smiling

Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases.

When to seek medical advice
Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth.
If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor.

Screening and diagnosis
If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain.
If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected.
Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head.

Treatment
Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you.
Medications

• Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea.
• Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness.
• Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness.
• Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision.
  

Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin).

Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option.

Surgery

The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve:

• Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure.
• Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling.
• Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew.
• Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root.
  An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions.
  PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years.
• Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve.
  MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve.
• Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead.
• Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known.

Coping skills
Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life.
You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area.

Root Canals Procedure Description - Endodontics

Preserving Natural Teeth
Nothing is as good as a natural tooth! And sometimes your natural tooth may need Endodontic (root canal) treatment for it to remain a healthy part of your mouth.
Signs to look for include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling or tenderness in the nearby gums. But sometimes there are no symptoms.Most patients report that having Endodontic (root canal) treatment today is as unremarkable as having a cavity filled.

Tooth Anatomy
A tooth is made up of three main structures:

1. The hard outer covering of ENAMEL
2. The underlying layer of DENTIN
3. A soft tissue - the PULP- that is comprised of the blood supply, and the nerve of the tooth, which is housed in the hollow root canal space.. The pulp partially nourishes the root from the inside.

Infection of the Pulp
Sometimes the pulp inside your tooth becomes inflamed or infected. This can be caused by deep decay, repeated dental procedures on the tooth, a crack or chip in the tooth, or a physical blow (trauma) to the tooth.In any other part of your body, if a similar tissue becomes diseased, the body merely throws it off and forms new tissue. However, a tooth is a unique and different situation.Because the soft tissue within the tooth is totally encased within hard tissue, the body cannot get to it in order to effect a repair.

Treatment by a Dentist or Endodontist (root canal specialist)
It is the role of the dentist or specialist to do what the body is unable to do.Various procedures and technologies are used to access and remove the soft tissue located in the internal spaces (canals). The dentist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the canal areas, then fills and seals the space..When large amounts of tooth structure are missing or compromised due to the disease process, it may be necessary for the doctor to place a post down into the canal space to function as an anchor for the new crown or cap that may be needed to fully restore the tooth.Although many patients may be in great pain before seeing the dentist, measures are taken by the dentist to assure pain is relieved and that they are comfortable during the procedure.

Root Canals cause Dead Teeth?

A popular myth....When the endodontic treatment is complete, the tooth is by no means dead. It receives quite adequate support from the surrounding tissues and may be expected to last as long as any other natural tooth.

Post Operative Care - Root Canal Treatment

For the first few days after treatment, the treated tooth may feel sensitive - especially if there was pain or infection before the procedure. Discomfort arising from endodontic treatment can be relieved with medications.You should not chew or bite on the treated tooth until you have had it restored (usually with a crown) by your dentist, because it could fracture..Restorations should be completed on a timely basis. Root canal failure can occur if treatment is not completed in its entirety.

Best Treatment Choice? Dentist verus Endodontist

Endodontic specialists have had advanced training and typically have technologies not available to non-specialists that enable them to provide successful treatment in special, truly difficult cases. The decision to consult a specialist is usually based on the complexity of treatment.

Gingivitis

Introduction
If your gums are swollen, tender and bleed easily when you brush your teeth, you're not alone — nearly 80 percent of American adults have some form of gum (periodontal) disease. One of the most common of these is gingivitis, which develops when bacteria multiply and build up between your teeth and gums, leading to irritation, inflammation and bleeding. If not treated, gingivitis can progress to more-serious gum diseases, such as periodontitis, and eventually to the destruction of bone and to tooth loss.
Yet gingivitis is both preventable and treatable. Although factors such as medications and lowered immunity make you more susceptible to gingivitis, the most common cause is poor oral hygiene. Daily brushing and flossing and regular professional cleanings can significantly reduce your risk of developing this potentially serious condition. If you already have gingivitis, professional cleaning can reverse the damage.

Gingivitis










Normal Tooth

Signs and symptoms

Because early-stage gum disease is seldom painful, you can have gingivitis without even knowing it. Often, though, you're likely to have warning signs such as:

1. Swollen, soft, red gums.
2. Gums that bleed easily, even if they're not sore. Many people first detect a change in their gums when they notice that the bristles of their toothbrush are pink — a sign that gums are bleeding with just slight pressure.
3. A change in the color of your gums from a healthy pink to dusky red.

Causes
Gingivitis begins with plaque. This invisible, sticky film, composed primarily of bacteria, forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth removes plaque, but it re-forms quickly, usually within 24 hours.
Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus), a white substance that makes plaque more difficult to remove and that acts as a reservoir for bacteria. What's more, you usually can't get rid of tartar by brushing and flossing — you'll need a professional cleaning to remove it.
The longer plaque and tartar remain on your teeth, the more they irritate the gingiva, the part of your gum around the base of your teeth. In time, your gums become swollen and bleed easily.
Although plaque is by far the most common cause of gingivitis, other factors can contribute to or aggravate the condition, including:

1. Drugs. Hundreds of prescription and over-the-counter antidepressants and cold remedies contain ingredients that decrease your body's production of saliva. Because saliva has a cleansing effect on your teeth and helps inhibit bacterial growth, this means that plaque and tartar can build up more easily.
   Other drugs, especially anti-seizure medications, calcium channel blockers and drugs that suppress your immune system, sometimes can lead to an overgrowth of gum tissue (gingival hyperplasia), making plaque much tougher to remove.
2. Viral and fungal infections. Although bacteria are responsible for most cases of gingivitis, viral and fungal infections also can affect your gums. Acute herpetic gingivostomatitis is an infection caused by the herpes virus that frequently leads to gum inflammation and to small, painful sores throughout your mouth. Oral thrush, which results when a fungus normally found in your mouth grows out of control, causes creamy white lesions on your tongue and inner cheeks. Sometimes these lesions spread to the roof of your mouth, your tonsils and your gums.
3. Other diseases and conditions. Some health problems not directly associated with your mouth can still affect your gums. People with leukemia may develop gingivitis when leukemic cells invade their gum tissue. Oral lichen planus, a chronic inflammatory disease, and the rare, autoimmune skin diseases pemphigus and pemphigoid can cause gums to become so severely inflamed that they may peel away from the underlying tissue.
4. Hormonal changes. During pregnancy, your gums are more susceptible to the damaging effects of plaque. The problem is compounded if you have morning sickness — nausea and vomiting may make it hard to brush your teeth regularly.
5. Poor nutrition. A poor diet, especially one deficient in calcium, vitamin C and B vitamins, can contribute to periodontal disease. Calcium is important because it helps maintain the strength of your bones, including the bones that support your teeth. Vitamin C helps maintain the integrity of connective tissue. It's also a powerful antioxidant that counters the tissue-destroying effects of free radicals — substances produced when oxygen is metabolized by your body.

Risk factors
Although anyone can develop gingivitis, many people first experience gum problems during puberty and then in varying degrees throughout life. The most common contributing factor is lack of proper oral hygiene, but other factors also can increase your risk, including:

1. Tobacco use. Cigarettes, cigars, pipe smoking and chewing tobacco all promote the growth of bacteria in your mouth and weaken your immune system, making you more vulnerable to infection. In addition, gingivitis treatments are less likely to be effective if you use tobacco.
2. Diabetes. If you have diabetes, elevated blood sugar levels can damage many parts of your body — and your mouth is no exception. Diabetes increases your risk of cavities, gingivitis, tooth loss and a variety of infections. It also makes it more likely that you'll have a dry mouth, which further increases your risk of gum disease.
3. Decreased immunity. If you have a weakened immune system, you're more susceptible to infections of all kinds, including gum infections.

When to seek medical advice
Healthy gums are firm and pale pink. If your gums are puffy, dusky red and bleed easily, see your dentist. The sooner you seek care, the better your chances of reversing damage and preventing more-serious problems.

Complications
Untreated gingivitis can progress to periodontitis, a much more serious form of gum disease. Periodontitis can cause tooth loss and may even increase your risk of heart attack and stroke. What's more, women with periodontitis are far more likely to give birth to premature babies than women with healthy gums are.

Treatment
Your dentist may treat gingivitis in several ways, but the first step is to thoroughly clean your teeth, removing all traces of plaque and tartar — a procedure known as scaling. The cleaning may be uncomfortable, especially if your gums are already sensitive or you have extensive plaque and tartar buildup.
Gingivitis usually clears up after a professional cleaning as long as you continue to follow a program of good oral hygiene at home. Your dentist may recommend using an antiseptic mouth rinse in addition to brushing and flossing.
At first your gums may bleed after brushing, but this usually lasts just a few days. If you persist, you should see pink, healthy gum tissue in a short time. You'll need to practice good oral hygiene for life, however, so your gum problems don't return. Because misaligned teeth and poorly fitting crowns and bridges make it harder to remove plaque, your dentist may recommend fixing these problems as well.

Prevention
The best way to prevent gingivitis is a program of good dental hygiene, one that you begin early and practice consistently throughout life. That means brushing your teeth at least twice daily — in the morning and before going to bed — and flossing at least once a day. Better yet, brush after every meal or snack or as your dentist recommends. A complete cleaning with a toothbrush and floss should take three to five minutes. Flossing before you brush allows you to clean away the loosened food particles and bacteria.
In addition, follow these tips to keep your gums and your children's gums healthy. Children as young as 6 can develop gingivitis.

• Choose the right toothbrush. Select a toothbrush with soft, end-rounded or polished bristles — stiff or hard bristles are more likely to injure your gums. The size and shape of the brush should allow you to reach every tooth. Remember that only the tips of the brush do the cleaning so there's no need to exert extra pressure. Replace your brush every three to four months or even more often. If the bristles are splayed, you've waited too long.
  Consider investing in an electric toothbrush with rotating or vibrating bristles. Studies have shown these types of toothbrushes to be more effective at removing plaque and maintaining healthy gum tissue than are manual brushes.
• Brush as if your teeth depended on it. Brushing doesn't do much good if you don't do it correctly. Here's what works: To clean outer surfaces of your teeth and gums, use short, back-and-forth, and then up-and-down strokes. Use vertical strokes to clean inner surfaces. To clean the junction between your teeth and gums, hold your brush at a 45-degree angle to your teeth.
• Floss. If you're like most people, this is the part of oral care you tend to ignore. It's true that flossing is a tedious job, which may be why most dentists find their patients don't floss regularly. But flossing is the most effective way to remove plaque and food particles from between your teeth, where toothbrush bristles can't reach.
  To make sure that all the effort you put into flossing is rewarded, be sure you do it correctly. Here's the drill: Use about 18 inches of waxed or unwaxed floss. Hold the floss taut and bent around each tooth in a C shape, scraping up and down each side of each tooth. Each stroke should go slightly below your gumline until you feel resistance. Flossing removes plaque between your teeth and helps massage your gums.
• Pay attention to the brushing action, not the type of toothpaste. Some toothpastes claim to remove plaque and tartar or to kill the bacteria that cause plaque. The truth is that all toothpastes, including natural ones without additives of any kind, remove plaque if you brush properly. And no product can remove tartar below your gumline, although anti-tartar or tartar control toothpastes can help prevent tartar from building up on your teeth. The bottom line? When used properly, inexpensive fluoride toothpastes remove plaque just as thoroughly as specialty toothpastes — it's the brushing action, not the toothpaste, that removes plaque.
• See your dentist. In addition to daily brushing and flossing, see your dentist or hygienist for regular checkups and cleanings.

Complementary and alternative medicine
Because nutrition plays a major role in oral health, many complementary and alternative therapies focus on supplying your body with certain nutrients. Some of these include:

• Coenzyme Q10 (CoQ10, ubiquinone). This substance, which occurs naturally in your body and in a wide variety of foods, plays a key role in the production of cellular energy. It's also a powerful antioxidant — many times more potent than vitamin C. Researchers have studied the potential effect of CoQ10 on a number of conditions, including Parkinson's disease, Alzheimer's disease, cancer, cardiovascular disease and periodontal disease. Among other findings, CoQ10 applied to pockets of diseased gum tissue appears to reduce infection, but no studies have measured the effectiveness of oral CoQ10. You can purchase CoQ10 supplements at natural foods stores and some pharmacies. Look for oil-based capsules, which are far better absorbed and utilized than dry capsules are.
• Vitamin C. A potent antioxidant and major player in the synthesis of collagen, vitamin C is essential for healthy gums. Many fruits and vegetables, including citrus fruits, berries, cantaloupe, broccoli and spinach, are rich sources of vitamin C, and most natural foods stores and pharmacies carry vitamin C supplements. Whether you get Vitamin C from food or supplements, many dentists suggest getting at least 1,000 milligrams of vitamin C a day to help treat and prevent periodontal disease.
• Grapefruit seed extract. This natural extract has proven antibiotic qualities. Some people suggest adding a drop to your regular toothpaste every time you brush. Look for grapefruit seed extract in natural foods stores or online.
• Cranberries. They're not just for Thanksgiving anymore. Long known as a treatment for urinary tract infections, cranberries and cranberry juice work by preventing bacteria from adhering to cells that line the bladder. Now it appears that cranberries may also keep bacteria from sticking to your teeth and gums. Unfortunately, most cranberry products have sugar added, which can undo the beneficial dental effects. Look for products sweetened with other fruits or fruit juices rather than with sugar. Suggested dose is 3 ounces of juice or six cranberry tablets daily. If you have a tendency to kidney stones or are taking the blood thinner warfarin, talk with your doctor before starting on a cranberry regimen.

RELATED
Web Resources
National Institute of Dental and Craniofacial Research
National Oral Health Information Clearinghouse
American Dental Association