DEATH BY A THOUSAND CUTS

Death by a thousand cuts was a form of torture used by the chinese as capital punishment for serious crimes in the last part of the nineteenth century. The idea was to prolong the suffering of the condemned for as long as possible with small wounds before the person finally died. Although you could say that the last cut was the one that killed the person, really it was a combination of all the previous injuries.

Today we use “Death by a thousand cuts” as a metaphor for minor progressive changes that by themselves may go unnoticed but when put together have a significant negative impact .

A tooth breaks down in a gradual process. Most of the times when a patient comes with a broken tooth, their complaint is “I was just eating a piece of bread” or  I was eating a fry, it wasn’t even hard”. The truth is that it wasn’t the last bite that broke the tooth, the tooth had been gradually getting worse and worse over time without even being noticed.

In dental practice we routinely identify injuries caused by sudden trauma, that is when someone sustains a sudden impact that causes obvious damage. A punch in the mouth that knocks a tooth out is what we would consider Macro-trauma. But the consequences of micro-trauma often fly under the radar. Micro-trauma is caused by a continuous negative event. Such is the case of excessive compression of the teeth from grinding. When teeth are pressed together, that force is transferred to the root and the support structures of the tooth. When pressure is held down, we pinch the membrane that attaches the tooth to the jaw, we create a slowing down of the circulation that comes to the tooth through a tiny opening at the end of the root. With limited blood supply and poor oxygen reaching the tooth and its surrounding tissues, there are biologic changes that ultimately result in tissue destruction. Much like if you were to leave a tourniquet in one of your limbs for too long, that part of your body would wither and die; when you pinch blood supply to the teeth and gums, they become oxygen deprived and die. This ultimately results in receding gums, loose and shifting teeth, nerve death, root fractures and potential tooth loss.

Other conditions that develop in a slow, progressive way are Cavities and Gum Disease. Cavities normally take a long time to develop. It usually takes years of neglect and continuous consumption of foods that cause acid erosion of the enamel. Every time you consume a product like soda or sour candy, it’s like dunking your teeth in a bath of acid, your enamel starts getting weak and porous, after you’re done eating, saliva bathes the teeth diluting the acid and replenishing the enamel surface with minerals. The problem is when the consumption of acidic foods is too frequent and in intervals that don’t allow adequate time for the tooth structure to recover completely before the next meal. Then the process becomes progressively worse until it reaches a point where there is irreversible tissue breakdown and a cavity develops.

Of course, if you have poor saliva production this will accelerate the breakdown process. There is poor saliva production when someone is on cancer treatment, or when a combination of medications is used to treat a medical problem like High Blood Pressure or Chronic Allergies. 

Gum disease is yet another example of slow tissue destruction that in most cases happens without obvious indications of harm. In the case of gum disease, it is actually your own defense system causing breakdown. When oral hygiene is inadequate, tartar and plaque build up collect around the gum causing swelling. In order to destroy the irritation caused by tartar, your own body sends killer cells to attack and destroy bacteria and their byproducts. The bone and gums that hold your teeth are casualties of the biologic warfare taking place around the roots of your teeth. By the time you notice the tooth has become loose, more than half of the bone around the tooth is gone.

Some dental conditions can go unnoticed for years since in most cases the symptoms are mild and many dental practitioners neglect to screen patients periodically. The mouth is a continuously changing environment that requires periodic supervision.

The good news is that minor changes in your lifestyle can make a big difference. It is not the deep cleaning that will cure gum problems, it is mundane daily rituals like brushing and flossing. It is not the crown that will prevent tooth wear and fracture, it is being consistent with the use a of a protective nightguard device. Minor consistent actions that have a big impact.

Other factors that may cause or aggravate the development of dental problems include, diet, stress and certain medical conditions. 

If you have any questions about this or any other dental subjects you can write to bresamiledesign@gmail.com or call (626)810-5000 in West Covina or (714)529-2626 in the city of Brea.