Dental Health
How to clean the sides of teeth 
Dr H.S. Chawla

The tooth has five surfaces. Out of these five, two surfaces — the outer buccal (facing the cheeks) and the inner (the lingual/palatal and the chewing/occlusal surfaces) get cleaned with normal tooth brushing. The sides — the contacting surfaces between the adjacent teeth — do not get cleaned with routine tooth-brushing. These surfaces, also called proximal surfaces, need special cleaning aids.

This question arises if your near and dear ones, who are not doing so, continue to have good teeth. I would hasten to add that if they have good teeth today, it does not imply that they would enjoy healthy teeth for the rest of their lives. The time-frame to get the disease depends on your innate immunity. With the passage of time, sooner or later, you are bound to get bad teeth and gums if you are neglecting the sides of the teeth.

Proximal surfaces carry the maximum bacterial load — dental plaque. It has been seen in clinical practice that gum disease invariably begins from this area. Dental cavities on the proximal surfaces of teeth are also not uncommon. So, it is of paramount importance that you start cleaning the sides of the teeth right away, if you don’t already do so.

There is no rationale to neglect the sides of your teeth. In fact, the surfaces of teeth other than the sides (the proximal surfaces) get partly cleaned from the friction created by chewing food, particularly fibrous items. The sides of teeth, which are 45 per cent of the total 128 tooth surfaces in an individual with 28 teeth, totally escape the friction from the chewing of food. Regular tooth brushing do not reach these surfaces of teeth.

How to clean the proximal sides

The main armaments for cleaning these surfaces are a dental floss and an inter-dental brush. Both these items are available in the market. In children and adults, the use of dental floss is generally preferred over the inter-dental brush. This is because the spaces between the teeth at this stage are very narrow and completely filled with gums, and it is difficult to pass an inter-dental brush through these spaces.

Dental floss

The intent of flossing is to take off the dental plaque (which is the aggregation of bacteria on teeth) from the side surfaces of the teeth and not to remove food particles. For this purpose, about 6 inches of floss is taken out of the dental floss container and each free end is wound around the fingers of each hand so that an inch and a half is left. This remaining stretch of the floss is passed below each contact point of the teeth with tiny see-saw movements.

Care is taken to land the floss at the inter-dental area softly and not with a thud to protect the gums from any injury from sharp movements. After this step, the stretch of the floss is firmly rubbed from the gum upwards (gum downwards for the upper teeth), five to six times, first on one surface and then on the other proximal surface of the teeth. Likewise, it is repeated for all the inter-proximal areas.

The teeth are narrower at their necks towards the gums; so, with the recession of bone and gums with age, inter-dental areas gradually get wider. Even at this stage, an inter-dental brush may still not pass into the inter-dental areas. Therefore, as an alternative to the interdental brush, a knot can be made on the floss, and passed back and forth over the inter-dental surfaces, the sides of teeth can be cleaned off the dental plaque.

To facilitate flossing, the floss is also available pre-mounted on disposable prongs. Separate Y-shaped floss handles are also available on which dental floss can be wound up for easy manoeuverability. These items are particularly helpful for people who lack manual dexterity.

Interdental brushes

The inter-dental brush is a miniature bottle brush. These are available in different sizes — extra fine, fine, medium and big and also with straight and tapering brush head. Such a brush is gently inserted from the labial/cheek sides of the teeth in a way that it does not injure the gum. For this, a mild bend is needed be given to the wire supporting the bristles of the inter-dental brush, from gum upwards for the lower teeth and gum downwards for the upper teeth. After an insertion into the inter-dental space, the inter-dental brush is rubbed with a to-and-fro movement, five-seven times, on each inter-proximal surface.

Inter-dental brushing, apart from cleaning the sides of teeth, also keratinizes the inter-dental gum as it automatically rubs on this part of the gum. The keratinization is, indeed, very important for the health of the gums. The main shortcoming of interdental brushing is that it does not clean the contacting areas of the sides of the teeth. For this, dental flossing is required

The recommendation is to use the dental floss during early life when the inter-dental spaces are tight and both the dental floss and the inter-dental brush later when the inter-dental areas widen with age. This is the only way to ensure healthy teeth and gums. Remember, the routine brushing of the teeth alone is inadequate.

The writer, Chief Consultant, SukhIqbal Dental Center, Chandigarh, is a former Professor and Head, Oral Health Sciences Centre, PGI, Chandigarh. Email: chawlahs@gmail.com

EYESIGHT
Refresh your eyes during exams
Dr Mahipal S. Sachdev

Healthy vision is the most important tool that a student needs in order to succeed in school/college. Here are some very simple ways to reduce eye strain and improve efficiency for studies:

Palming: One should sit comfortably and rub one’s hands together to make them warm. Keep the eyes closed and cover them lightly with your cupped palms. Don’t apply any pressure on your eyeballs. Place your palms in a manner so that the eyes are covered properly. Make sure that there are no gaps between the fingers so that no light rays enter the eyes. Do deep breathing slowly. Relax like that for three-five minutes and then uncover the eyes. Repeat the palming for three minutes or more.

Convergence exercise: Hold a pencil in front of you at arm’s length. Move your arm slowly to your nose and follow the pencil with your eyes until you can’t keep it in focus. Repeat 10 times. This will strengthen the eye muscles responsible for convergence.

Change of focus: Focus on a distant object for a few seconds and slowly refocus your eyes on a nearby object at arm’s length. Focus for many seconds and go back to the distant object. Do this five times. Taking short breaks while working on the computer to stare out to the distance object also relieves some eye-strain.

Maintain good room illumination/lighting: Eye-strain is often caused by reading excessively in dim light. While reading, your room should be well lit and the source of light should be at your back. When you use a computer, the ambient light should be half that used in most offices. Position your monitor so that windows are to the side of it, instead of in front or back.

Minimise glare: Glare on walls and finished surfaces as well as reflections on the computer screen itself can also cause eyestrain. You may want to install an anti-glare screen on your monitor. Again, when outside light cannot be reduced, use a computer hood. Have an anti-reflective coating applied to your glasses. This will prevent glare and reflections on the backside of your lenses from reaching your eyes.

Blink frequently: Blink 10 times every 30 minutes by closing your eyes as if falling asleep (very slowly).

Take frequent breaks (Rule of 20): Follow 20-20-20 rule. Take a 20-second break and look 20 feet away every 20 minutes.

Correct posture: While studying and using your computer adjust your work station and chair to the correct height.

Persistent eye-strain could be there due to refractive error. In that case, vision testing refraction is required. If refractive error is detected, then consistent use of glasses is recommended.

Don’t do the exercises with your contact lenses on. Do not apply pressure on your eyes. In case, eye-strain persists, please consult your eye specialist.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: drmahipal@gmail.com

Ayurveda & You
Tips for managing indigestion
Dr R. Vatsyayan

Called ‘ajeerna’ in ayurvedic parlance, indigestion is commonly described as discomfort in one’s belly mostly after food consumption. Though one of the common health disorders, indigestion is triggered by a number of factors which include adopting indiscretion in dietary habits, consuming too much fatty, heavy, spicy and greasy food, overeating and eating at wrong timings or when the previous meal is not digested properly.

Similarly, taking food items which are processed and incompatible to each other, consuming excess of tea, coffee and alcohol, use of medicines like painkillers and emotional stress also disturb normal digestive functioning. Certain organic defects like poor oral hygiene, inflammation of the stomach and pancreas, gallstones and intestinal infections can also give rise to indigestion-like conditions.

According to Ayurveda, indigestion can be summed up into four types. The first one correlates to increased mucous contents and lessening of digestive acids in the stomach. The second one is caused by erratic secretions of digestive enzymes leading to belching, acidity and sourness. The third form is marked by a sense of fullness in the abdomen caused by improper emptying of the stomach. The fourth one is a temporary or normal stage till food is in the process of proper digestion.

A person suffering from indigestion complains of varied symptoms which include fullness and discomfort in the abdomen accompanied by gas, belching and feeling of nausea. Acidity or heartburn occurs if food is too spicy and fried in nature. In the case of chronic indigestion, loss of appetite, diarrhoea, constipation or malabsorption-type symptoms are seen. In elderly persons, the weakening of the digestive fire or ‘jatharagni’ makes it difficult to digest even simple food and they constantly complain of poor appetite, dyspepsia and various other symptoms.

In all types of indigestion, fasting for at least one mealtime is necessary. After this when the patient feels hungry, he should be given limewater, boiled vegetables or their soup. Taking a fresh piece of ginger sprinkled with table salt just before the meals rekindles the appetite. Drinking buttermilk mixed with a pinch of roasted cumin powder after breakfast or lunch improves digestion. For chronic cases of gas formation and indigestion, taking one to two gram powder of dry mint leaves, dry ginger, coriander seeds, cumin, fennel and rock salt (all in equal qunatities) is a good home remedy.

Classic Ayurveda offers a number of medicines which can effectively combat indigestion.

PS: The present-day fast lifestyle is largely responsible for the increasing number of gastroenterological problems. The ancient masters in general advise a light and easily digestible diet. In fact, adopting complete dietary discipline like eating when the previous meal has been digested and keeping the quantity, quality and compatibility of food items in mind supported by a regulated but an active lifestyle is the core of good health.

The writer is a Ludhiana-based senior ayurvedic physician. E mail - yourhealth@ rediffmail.com