Features
Tooth loss, more reasons to take care of your gums
By PROF DR DASAN SWAMINATHAN
Red, puffy and bleeding gums is a common complaint from patients visiting the dentist. Gums should never bleed even when you brush or use dental floss. If your gums bleed even sometimes, something is wrong. Gums should never be red or swollen.
World Health Organization sources have indicated that a significant proportion of adult populations suffer from some form of periodontal disease, or more commonly known as “gum disease”, and it has even overtaken dental caries as the main cause of tooth loss.
More than 60% of adults in Malaysia tend to suffer from some form of periodontal disease. It is also the main cause of tooth loss amongst our adult population. Oral health professionals in Malaysia are now spending more time treating this disease than before.
The modern era is characterised by longevity and better health, but unfortunately, many adults continue to suffer from periodontal disease, leading to early loss of teeth, and jeopardizing quality of life.
Every day, a sticky, almost invisible film forms on tooth surfaces, which is derived from salivary glycoproteins. If not removed by proper oral hygiene, it matures into what is called plaque, (also called plaque biofilm or oral biofilm), and this biofilm is the primary aetiology of periodontal disease.
If you do not remove this plaque biofilm, it will be contaminated by bacteria, which are found in abundance in the oral cavity. It is said that there are more than 650 species of bacteria present in our mouths, and some of these bacteria can lead to periodontal disease if it multiplies outside the normal range.
Plaque biofilm can be seen particularly at the gingival margins. The bacteria within the plaque biofilm produces toxins that make the gums red, swollen and bleed easily.
This inflammation is the start of periodontal disease.
The toxins produced by the bacterial plaque biofilm not only cause inflammation of the gingival tissue, but also cause destruction of the alveolar bone, which holds the root of our teeth.
When sufficient bone has been lost, the tooth loosens. Finally, when deprived of most of the periodontal ligament and supporting bone, the tooth becomes so loose that it either falls off or has be extracted.
Our immune system, which has a role in targeting the bacteria within the plaque biofilm, can also contribute to the destruction of the tooth-supporting tissue, which will eventually lead to tooth loss.
There are several local and systemic contributing factors that can lead to the initiation and progression of the disease.
Symptoms of gum disease are bleeding gums, migration of teeth, receding gums, mouth malodour (halitosis), taste disturbances and tooth loss as the disease progresses.
Signs of gum disease include inflamed gingiva (gums) and the space between the neck of the tooth and soft tissue known as sulcus becoming deeper, resulting in a term called periodontal pocketing (which harbours multiple anaerobic bacteria causing the destruction of the supporting structures).
There will be radiographic changes indicating the destruction of alveolar bone.
Periodontal disease in the early stages, only involving the supra gingival area, is called chronic gingivitis, and when it proceeds to the roots of teeth via periodontal pocketing, and affects the supporting structures of teeth like the periodontal ligament and alveolar bone, it is called chronic periodontitis.
Gingivitis is reversible if early treatment is sought, but periodontitis is irreversible, and treatment only prevents more damage.
It is unfortunate that what is lost due to the disease (especially bone) is hard to gain back, even with sophisticated dental treatments.
No early signs
In its early stages, periodontal disease is almost painless, and this will prevent many individuals from seeking dental help and intervention.
You may not notice the gradual onset of puffiness of your gingiva or pay attention to occasional bleeding when brushing.
Four out of five teenagers and adults have some form of periodontal disease, and most do not even know it.
That is why people lose more teeth from periodontal disease than from all other reasons combined.
But the good news is that most periodontal disease can be prevented, or treated in its early stages.
Most people have varying resistance to the disease at different times in their lives. For example, a person’s immune system may be normal for years, and then when immunity diminishes, it can cause the “resting” periodontal disease to flare up.
No one knows why our resistance to the disease varies.
Periodontal disease can have an active phase where the disease progresses rapidly, and a “quiet phase” where the disease practically “hibernates” for a certain period of time.
Some experts feel that the immune system of the host plays a major role in these cyclic changes in the progression of the disease.
Periodontal disease and
systemic disorders
Ongoing research and scientific papers over the last decade have linked periodontal disease to systemic conditions like diabetes mellitus, atherosclerosis, cardiovascular diseases, strokes, osteoarthritis, respiratory tract and lung infections, obesity and renal disorders.
These conditions are considered as systemic host-mediating factors that can contribute to the progression of periodontal disease.
Research has now shown that diabetics are more susceptible to gum disease, and gum disease in turn has been implicated in poor glycaemic control in these individuals.
Even some cancers are linked to periodontal disease, and recently, Alzheimer’s disease has also been mentioned.
The exact mechanism whereby this association occurs is still being debated, but it has been suggested that the by-products of periodontal pathogens and the host immune response to this bacterial infection may play a contributory role.
Research and clinical trials conducted at Universiti Malaya’s Faculty of Dentistry on the association of periodontal disease and systemic conditions like diabetes and obesity have shown that there is a link. More research is being carried out to determine this link.
Findings from such research will make the prevention and management of periodontal disease even more important for our patients.
Management of periodontal disease
Periodontal disease is very unpredictable. We think that the disease is caused by a group of bacteria present in our mouth and not by any one particular microorganism.
Thus, it is difficult to develop a vaccine for the disease as several species of microorganisms may be involved in the initiation and progression of the disease.
The main clinical periodontal parameters that dentists assess are the plaque and bleeding scores, and periodontal pocket depths, before we can embark on any non-surgical or surgical interventions.
This will give us information on the stage of disease progression. Radiographic evaluation of the hard structures can also be done to evaluate, among other findings, the alveolar bone levels.
The management of periodontal disease will consist of removing the bacterial plaque biofilm from the mouth, along with any deposits in the supra-gingival and sub-gingival parts of the teeth, and making the roots of the teeth as clean as possible by a procedure known as scaling and root planning/debridement.
Scaling and root planning/debridement aims to reduce the bacterial load in the mouth by removing deposits that are contaminated by bacteria.
Local contributing factors like overhanging restorations, ill-fitting prosthesis, carious lesions and malocclusion can act as traps for bacterial plaque biofilm and have to be addressed.
The bacterial plaque biofilm can become calcified (if not removed regularly) into hardened calculus (tartar). Calculus can also harbour plaque biofim due to its rough surface, and its removal has to be done professionally because of its tenacity.
The systemic host-mediating factors may require referral to our medical colleagues, if the patient is not under medical care.
To maintain this lowered level of bacterial load, it is imperative that patients practise proper oral hygiene. Oral hygiene education has now become an important and integral aspect of periodontal therapy, and should be reinforced at every visit and review.
Mouth rinses like chlorhexidine, which have antibacterial effects, can be used as an adjunct to mechanical oral hygiene methods like tooth brushing and flossing.
These mouth rinses are especially useful in individuals with poor manual dexterity, such as patients who have had a stroke.
It is also useful in patients who have undergone periodontal and maxillofacial surgery to look after their oral hygiene during the post-surgical phase.
I would advocate antimicrobial mouth rinses for any individual who has issues maintaining their mechanical plaque control.
The prevention of periodontal disease is literally in our hands, and together with oral health professionals, we can try and identify the disease early and prevent it from causing damage to tooth-supporting tissue, thus, preventing tooth loss and improving our quality of life.
We should make regular visits to the dentist and we should treat oral health as an important aspect of our lives. (The Star/ANN)
Prof Dr Dasan Swaminathan is a specialist periodontist. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice.
by Dr Gotabhya Ranasinghe
Senior Consultant Cardiologist
National Hospital Sri Lanka
When we sought a meeting with Hon Dr. Ramesh Pathirana, Minister of Health, he graciously cleared his busy schedule to accommodate us. Renowned for his attentive listening and deep understanding, Minister Pathirana is dedicated to advancing the health sector. His openness and transparency exemplify the qualities of an exemplary politician and minister.
Dr. Palitha Mahipala, the current Health Secretary, demonstrates both commendable enthusiasm and unwavering support. This combination of attributes makes him a highly compatible colleague for the esteemed Minister of Health.
Our discussion centered on a project that has been in the works for the past 30 years, one that no other minister had managed to advance.
Minister Pathirana, however, recognized the project’s significance and its potential to revolutionize care for heart patients.
The project involves the construction of a state-of-the-art facility at the premises of the National Hospital Colombo. The project’s location within the premises of the National Hospital underscores its importance and relevance to the healthcare infrastructure of the nation.
This facility will include a cardiology building and a tertiary care center, equipped with the latest technology to handle and treat all types of heart-related conditions and surgeries.
Securing funding was a major milestone for this initiative. Minister Pathirana successfully obtained approval for a $40 billion loan from the Asian Development Bank. With the funding in place, the foundation stone is scheduled to be laid in September this year, and construction will begin in January 2025.
This project guarantees a consistent and uninterrupted supply of stents and related medications for heart patients. As a result, patients will have timely access to essential medical supplies during their treatment and recovery. By securing these critical resources, the project aims to enhance patient outcomes, minimize treatment delays, and maintain the highest standards of cardiac care.
Upon its fruition, this monumental building will serve as a beacon of hope and healing, symbolizing the unwavering dedication to improving patient outcomes and fostering a healthier society.We anticipate a future marked by significant progress and positive outcomes in Sri Lanka’s cardiovascular treatment landscape within the foreseeable timeframe.
by Fr. Emmanuel Fernando, OMI
Jesuit Fr. Aloysius Pieris (affectionately called Fr. Aloy) celebrated his 90th birthday on April 9, 2024 and I, as the editor of our Oblate Journal, THE MISSIONARY OBLATE had gone to press by that time. Immediately I decided to publish an article, appreciating the untiring selfless services he continues to offer for inter-Faith dialogue, the renewal of the Catholic Church, his concern for the poor and the suffering Sri Lankan masses and to me, the present writer.
It was in 1988, when I was appointed Director of the Oblate Scholastics at Ampitiya by the then Oblate Provincial Fr. Anselm Silva, that I came to know Fr. Aloy more closely. Knowing well his expertise in matters spiritual, theological, Indological and pastoral, and with the collaborative spirit of my companion-formators, our Oblate Scholastics were sent to Tulana, the Research and Encounter Centre, Kelaniya, of which he is the Founder-Director, for ‘exposure-programmes’ on matters spiritual, biblical, theological and pastoral. Some of these dimensions according to my view and that of my companion-formators, were not available at the National Seminary, Ampitiya.
Ever since that time, our Oblate formators/ accompaniers at the Oblate Scholasticate, Ampitiya , have continued to send our Oblate Scholastics to Tulana Centre for deepening their insights and convictions regarding matters needed to serve the people in today’s context. Fr. Aloy also had tried very enthusiastically with the Oblate team headed by Frs. Oswald Firth and Clement Waidyasekara to begin a Theologate, directed by the Religious Congregations in Sri Lanka, for the contextual formation/ accompaniment of their members. It should very well be a desired goal of the Leaders / Provincials of the Religious Congregations.
Besides being a formator/accompanier at the Oblate Scholasticate, I was entrusted also with the task of editing and publishing our Oblate journal, ‘The Missionary Oblate’. To maintain the quality of the journal I continue to depend on Fr. Aloy for his thought-provoking and stimulating articles on Biblical Spirituality, Biblical Theology and Ecclesiology. I am very grateful to him for his generous assistance. Of late, his writings on renewal of the Church, initiated by Pope St. John XX111 and continued by Pope Francis through the Synodal path, published in our Oblate journal, enable our readers to focus their attention also on the needed renewal in the Catholic Church in Sri Lanka. Fr. Aloy appreciated very much the Synodal path adopted by the Jesuit Pope Francis for the renewal of the Church, rooted very much on prayerful discernment. In my Religious and presbyteral life, Fr.Aloy continues to be my spiritual animator / guide and ongoing formator / acccompanier.
Fr. Aloysius Pieris, BA Hons (Lond), LPh (SHC, India), STL (PFT, Naples), PhD (SLU/VC), ThD (Tilburg), D.Ltt (KU), has been one of the eminent Asian theologians well recognized internationally and one who has lectured and held visiting chairs in many universities both in the West and in the East. Many members of Religious Congregations from Asian countries have benefited from his lectures and guidance in the East Asian Pastoral Institute (EAPI) in Manila, Philippines. He had been a Theologian consulted by the Federation of Asian Bishops’ Conferences for many years. During his professorship at the Gregorian University in Rome, he was called to be a member of a special group of advisers on other religions consulted by Pope Paul VI.
Fr. Aloy is the author of more than 30 books and well over 500 Research Papers. Some of his books and articles have been translated and published in several countries. Among those books, one can find the following: 1) The Genesis of an Asian Theology of Liberation (An Autobiographical Excursus on the Art of Theologising in Asia, 2) An Asian Theology of Liberation, 3) Providential Timeliness of Vatican 11 (a long-overdue halt to a scandalous millennium, 4) Give Vatican 11 a chance, 5) Leadership in the Church, 6) Relishing our faith in working for justice (Themes for study and discussion), 7) A Message meant mainly, not exclusively for Jesuits (Background information necessary for helping Francis renew the Church), 8) Lent in Lanka (Reflections and Resolutions, 9) Love meets wisdom (A Christian Experience of Buddhism, 10) Fire and Water 11) God’s Reign for God’s poor, 12) Our Unhiddden Agenda (How we Jesuits work, pray and form our men). He is also the Editor of two journals, Vagdevi, Journal of Religious Reflection and Dialogue, New Series.
Fr. Aloy has a BA in Pali and Sanskrit from the University of London and a Ph.D in Buddhist Philosophy from the University of Sri Lankan, Vidyodaya Campus. On Nov. 23, 2019, he was awarded the prestigious honorary Doctorate of Literature (D.Litt) by the Chancellor of the University of Kelaniya, the Most Venerable Welamitiyawe Dharmakirthi Sri Kusala Dhamma Thera.
Fr. Aloy continues to be a promoter of Gospel values and virtues. Justice as a constitutive dimension of love and social concern for the downtrodden masses are very much noted in his life and work. He had very much appreciated the commitment of the late Fr. Joseph (Joe) Fernando, the National Director of the Social and Economic Centre (SEDEC) for the poor.
In Sri Lanka, a few religious Congregations – the Good Shepherd Sisters, the Christian Brothers, the Marist Brothers and the Oblates – have invited him to animate their members especially during their Provincial Congresses, Chapters and International Conferences. The mainline Christian Churches also have sought his advice and followed his seminars. I, for one, regret very much, that the Sri Lankan authorities of the Catholic Church –today’s Hierarchy—- have not sought Fr.
Aloy’s expertise for the renewal of the Catholic Church in Sri Lanka and thus have not benefited from the immense store of wisdom and insight that he can offer to our local Church while the Sri Lankan bishops who governed the Catholic church in the immediate aftermath of the Second Vatican Council (Edmund Fernando OMI, Anthony de Saram, Leo Nanayakkara OSB, Frank Marcus Fernando, Paul Perera,) visited him and consulted him on many matters. Among the Tamil Bishops, Bishop Rayappu Joseph was keeping close contact with him and Bishop J. Deogupillai hosted him and his team visiting him after the horrible Black July massacre of Tamils.
Sri Lanka-Singapore Free Trade Agreement
By Gomi Senadhira
senadhiragomi@gmail.com
“You might tell fairy tales, but the progress of a country cannot be achieved through such narratives. A country cannot be developed by making false promises. The country moved backward because of the electoral promises made by political parties throughout time. We have witnessed that the ultimate result of this is the country becoming bankrupt. Unfortunately, many segments of the population have not come to realize this yet.” – President Ranil Wickremesinghe, 2024 Budget speech
Any Sri Lankan would agree with the above words of President Wickremesinghe on the false promises our politicians and officials make and the fairy tales they narrate which bankrupted this country. So, to understand this, let’s look at one such fairy tale with lots of false promises; Ranil Wickremesinghe’s greatest achievement in the area of international trade and investment promotion during the Yahapalana period, Sri Lanka-Singapore Free Trade Agreement (SLSFTA).
It is appropriate and timely to do it now as Finance Minister Wickremesinghe has just presented to parliament a bill on the National Policy on Economic Transformation which includes the establishment of an Office for International Trade and the Sri Lanka Institute of Economics and International Trade.
Was SLSFTA a “Cleverly negotiated Free Trade Agreement” as stated by the (former) Minister of Development Strategies and International Trade Malik Samarawickrama during the Parliamentary Debate on the SLSFTA in July 2018, or a colossal blunder covered up with lies, false promises, and fairy tales? After SLSFTA was signed there were a number of fairy tales published on this agreement by the Ministry of Development Strategies and International, Institute of Policy Studies, and others.
However, for this article, I would like to limit my comments to the speech by Minister Samarawickrama during the Parliamentary Debate, and the two most important areas in the agreement which were covered up with lies, fairy tales, and false promises, namely: revenue loss for Sri Lanka and Investment from Singapore. On the other important area, “Waste products dumping” I do not want to comment here as I have written extensively on the issue.
1. The revenue loss
During the Parliamentary Debate in July 2018, Minister Samarawickrama stated “…. let me reiterate that this FTA with Singapore has been very cleverly negotiated by us…. The liberalisation programme under this FTA has been carefully designed to have the least impact on domestic industry and revenue collection. We have included all revenue sensitive items in the negative list of items which will not be subject to removal of tariff. Therefore, 97.8% revenue from Customs duty is protected. Our tariff liberalisation will take place over a period of 12-15 years! In fact, the revenue earned through tariffs on goods imported from Singapore last year was Rs. 35 billion.
The revenue loss for over the next 15 years due to the FTA is only Rs. 733 million– which when annualised, on average, is just Rs. 51 million. That is just 0.14% per year! So anyone who claims the Singapore FTA causes revenue loss to the Government cannot do basic arithmetic! Mr. Speaker, in conclusion, I call on my fellow members of this House – don’t mislead the public with baseless criticism that is not grounded in facts. Don’t look at petty politics and use these issues for your own political survival.”
I was surprised to read the minister’s speech because an article published in January 2018 in “The Straits Times“, based on information released by the Singaporean Negotiators stated, “…. With the FTA, tariff savings for Singapore exports are estimated to hit $10 million annually“.
As the annual tariff savings (that is the revenue loss for Sri Lanka) calculated by the Singaporean Negotiators, Singaporean $ 10 million (Sri Lankan rupees 1,200 million in 2018) was way above the rupees’ 733 million revenue loss for 15 years estimated by the Sri Lankan negotiators, it was clear to any observer that one of the parties to the agreement had not done the basic arithmetic!
Six years later, according to a report published by “The Morning” newspaper, speaking at the Committee on Public Finance (COPF) on 7th May 2024, Mr Samarawickrama’s chief trade negotiator K.J. Weerasinghehad had admitted “…. that forecasted revenue loss for the Government of Sri Lanka through the Singapore FTA is Rs. 450 million in 2023 and Rs. 1.3 billion in 2024.”
If these numbers are correct, as tariff liberalisation under the SLSFTA has just started, we will pass Rs 2 billion very soon. Then, the question is how Sri Lanka’s trade negotiators made such a colossal blunder. Didn’t they do their basic arithmetic? If they didn’t know how to do basic arithmetic they should have at least done their basic readings. For example, the headline of the article published in The Straits Times in January 2018 was “Singapore, Sri Lanka sign FTA, annual savings of $10m expected”.
Anyway, as Sri Lanka’s chief negotiator reiterated at the COPF meeting that “…. since 99% of the tariffs in Singapore have zero rates of duty, Sri Lanka has agreed on 80% tariff liberalisation over a period of 15 years while expecting Singapore investments to address the imbalance in trade,” let’s turn towards investment.
Investment from Singapore
In July 2018, speaking during the Parliamentary Debate on the FTA this is what Minister Malik Samarawickrama stated on investment from Singapore, “Already, thanks to this FTA, in just the past two-and-a-half months since the agreement came into effect we have received a proposal from Singapore for investment amounting to $ 14.8 billion in an oil refinery for export of petroleum products. In addition, we have proposals for a steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million), sugar refinery ($ 200 million). This adds up to more than $ 16.05 billion in the pipeline on these projects alone.
And all of these projects will create thousands of more jobs for our people. In principle approval has already been granted by the BOI and the investors are awaiting the release of land the environmental approvals to commence the project.
I request the Opposition and those with vested interests to change their narrow-minded thinking and join us to develop our country. We must always look at what is best for the whole community, not just the few who may oppose. We owe it to our people to courageously take decisions that will change their lives for the better.”
According to the media report I quoted earlier, speaking at the Committee on Public Finance (COPF) Chief Negotiator Weerasinghe has admitted that Sri Lanka was not happy with overall Singapore investments that have come in the past few years in return for the trade liberalisation under the Singapore-Sri Lanka Free Trade Agreement. He has added that between 2021 and 2023 the total investment from Singapore had been around $162 million!
What happened to those projects worth $16 billion negotiated, thanks to the SLSFTA, in just the two-and-a-half months after the agreement came into effect and approved by the BOI? I do not know about the steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million) and sugar refinery ($ 200 million).
However, story of the multibillion-dollar investment in the Petroleum Refinery unfolded in a manner that would qualify it as the best fairy tale with false promises presented by our politicians and the officials, prior to 2019 elections.
Though many Sri Lankans got to know, through the media which repeatedly highlighted a plethora of issues surrounding the project and the questionable credentials of the Singaporean investor, the construction work on the Mirrijiwela Oil Refinery along with the cement factory began on the24th of March 2019 with a bang and Minister Ranil Wickremesinghe and his ministers along with the foreign and local dignitaries laid the foundation stones.
That was few months before the 2019 Presidential elections. Inaugurating the construction work Prime Minister Ranil Wickremesinghe said the projects will create thousands of job opportunities in the area and surrounding districts.
The oil refinery, which was to be built over 200 acres of land, with the capacity to refine 200,000 barrels of crude oil per day, was to generate US$7 billion of exports and create 1,500 direct and 3,000 indirect jobs. The construction of the refinery was to be completed in 44 months. Four years later, in August 2023 the Cabinet of Ministers approved the proposal presented by President Ranil Wickremesinghe to cancel the agreement with the investors of the refinery as the project has not been implemented! Can they explain to the country how much money was wasted to produce that fairy tale?
It is obvious that the President, ministers, and officials had made huge blunders and had deliberately misled the public and the parliament on the revenue loss and potential investment from SLSFTA with fairy tales and false promises.
As the president himself said, a country cannot be developed by making false promises or with fairy tales and these false promises and fairy tales had bankrupted the country. “Unfortunately, many segments of the population have not come to realize this yet”.
(The writer, a specialist and an activist on trade and development issues . )
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