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.
Features
Viktor Orban, Benjamin Netanyahu and Donald Trump: The Terrible Threes of the 21st Century
In the autumn of 1956, Hungary staged the first uprising against the 20th century Soviet behemoth. Seventy years later, in the spring of 2026 Hungary has delivered the first electoral thrashing against 21st century right wing populism in Europe. The 1956 uprising was crushed after seven days. But the opposition scored a landslide victory in Hungary’s parliamentary election held on Sunday, April 12 and. Viktor Orban, Prime Minister since 2010 and the architect of what he proudly called “the illiberal state”, was resoundingly defeated. Orban who has been a pain in the neck for the European Union was a close ally of US President Donald Trump and Israeli Prime Minister Benjamin Netanyahu.
Trump even dispatched his Vice President JD Vance to Budapest to campaign for Orban. After Orban’s defeat, Trump and his MAGA followers may be having nightmares about the US midterm elections in November. Similarly, Orban’s defeat has reportedly caused “great concern in the halls of power in Jerusalem.” Netanyahu has lost his only ally in the European Union and the opposition victory in Hungary does not augur well for his own electoral prospects in the Israeli elections due in October.
Ceasefire Hopes
Trump and Netanyahu have bigger things to worry about in the Middle East and among their own political bases. Trump is going bonkers, blasphemously imitating Christ and badmouthing the Pope, launching a blockade in the Strait of Hormuz and strong arming more talks in Islamabad. Netanyahu has been forced to sit on his hands, pausing his fight against Iran while pursuing peace talks with Lebanon. The leaders and diplomats from Pakistan, Egypt and Turkey are shuttling around drumming up support for another round of talks in Islamabad and a prolonged extension of the ceasefire.
Further talks in Islamabad and potential extension of the ceasefire received a new boost by Trump’s announcement of a new 10-day ceasefire between Israel and Lebanon. The background to this development appears to be Iran’s insistence on having this secondary ceasefire, and Trump insisting on ceasefire abidance by Hezbollah in return for his ordering Netanyahu to stop his brutal ‘lawn mowing’ in Lebanon. All of this might seem to augur well for a potential extension of the primary ceasefire between the US and Iran. There are also reports of the narrowing of gap between the two parties – involving a potential moratorium on Iran’s uranium enrichment, the opening of the Strait of Hormuz, and Iran’s access to its frozen assets estimated to be $100 billion.
Meanwhile the IMF has released its latest World Economic Outlook with a grim forecast. “Once again, says the report, “the global economy is threatened with being thrown off the course – this time by the outbreak of war in the Middle East.” Before the war, the IMF was expected to upgrade its growth forecasts for the global economy. Now it is going to be weaker growth and higher inflation with oil price optimistically stabilizing around $100 a barrel in 2026 and $75 a barrel in 2027. In a worst case scenario, if the oil prices were to hit $110 in 2026 and $125 in 2027, growth everywhere will further weaken and inflation will go further up in countries big and small.
In a joint statement on the Middle East, the Finance Ministers of the United Kingdom, Australia, Japan, Sweden, Netherlands, Finland, Spain, Norway, Republic of Ireland, Poland and New Zealand have called on the IMF and World Bank “to provide a coordinated emergency support offer for countries in need, tailored to country circumstances and drawing on the full range and flexibility of their tool kits.” They have also welcomed “advice on domestic responses that are temporary, targeted, and effective, and encourage work to identify steps needed to protect long-term growth.”
Subversion from the Right
The two men, Trump and Netanyahu, who started the war and precipitated the current crisis are not being held accountable by anyone and they are still free to do what they want and as they please. The third man, Victor Orban, who did not have anything to do with the war but extended wholehearted ideological and political support as a faithful apprentice to the two older sorcerers, has been democratically defeated. Together, they formed the terrible threes of the 21st century, spearheading a subversion from the right of the emerging liberal status quo of the post Cold War world. Orban’s defeat is a significant setback to the illiberal right, but it is not the end of it.
The three emerged in the specific historical contexts of their own polities that are both vastly different and yet share powerful ingredients that have proved to be politically potent. The broader context has been the end of the Cold War and the removal of the perceived external threat which opened up the domestic political space in the US, for locking horns over primarily cultural standpoints and climate politics. This era began with the Clinton presidency in 1992 and the election of Barack Obama 16 years later, in 2008, created the illusion of a post-racial America.
In reality, the right was able to push back – first with the younger Bush presidency (2000-2008) pursuing compassionate conservatism, and later with the foray of Trump (2016-2020) threatening to end what he called the “American Carnage.” Of the 32 years since the election of Bill Clinton, Democrats have controlled the White House for 20 years over five presidential terms (Clinton – two, Obama – two, and Biden -one), while the Republicans won three terms (Bush – two, Trump – one) spanning 12 years.
Trump has since won a second term for another four years, but already in his five+ years in office he has issued executive orders to roll back almost all of the liberal advancements in the realms of civil rights, equality, diversity and inclusion. All that the celebrated acronym DEI (Diversity, Equality and Inclusion) stands for has been executively ordered to be banished from the state, its agencies and its programs.
In Europe, the European Union became the champion and bulwark of liberalism and subsidiarity, which in turn provoked the rise of right wing populism in every member country. Brexit was the loudest manifestation against what was considered to be EU’s overreach, but after Britain’s bitter Brexit experience the populists in the European countries gave up on demanding their own exit and limited themselves to fighting the EU from their national bases.
Viktor Orban became the face and voice of anti-EU nationalists. But he and his political party, the Christian Nationalist Fidesz – Hungarian Civic Alliance, are not the only one. Nigel Farage’s Reform UK in Britain and Marine Le Pen’s National Rally Party in France are becoming real electoral contenders, while right wing presidents have been elected in Argentina and Chile.
The rise and fall of Viktor Orban
Of the three terribles, Orban is the youngest but with the longest involvement in politics. Born in 1963, Viktor Orban became a political activist as a 15-year old high schooler, becoming secretary of a Young Communist League local. He continued his activism while studying law in Budapest, visiting Poland and writing his thesis on the Polish Solidarity movement, giving lectures in West Germany and the US as a potential future Hungarian leader, and undertaking research on European civil society at Pembroke College, Oxford.
At the age of 26, Orban gained national prominence with a speech he delivered on June 16, 1989 in Budapest’s Heroes’ Square to mark the reburial of Imre Nagy and other Hungarians killed in the 1956 uprising. Imre Nagy was the leader of the 1956 Hungarian uprising against the puppet Soviet Union outpost in Budapest.
To digress and make a local connection – the pages of Sri Lanka’s parliamentary Hansard of 1956, contain an impressive record of the political debate in Sri Lanka over the events in Hungary. The LSSP’s Colvin R de Silva eloquently led the Trotskyite prosecution of the Soviet invasion of Hungary and the suppression of its freedoms. Pieter Keuneman of the Communist Party used his wit and debating skills to defend the indefensible. GG Ponnambalam, the unrepentant anti-communist, used the opportunity to take swipes on both sides. Finally, for the government, Prime Minister SWRD Bandaranaike deployed his own oratorical skills to empathize with the uprising without condemning the USSR. The four men were Sri Lanka’s foremost verbal gladiators and they used the occasion to put on quite a display of their talents.
Back to Hungary, where Orban began his political vocation identifying himself with Imre Nagy and demanding the withdrawal of the Soviet army from Hungary and calling for free elections in that country to elect a new government. That same year in 1989, Fidesz was recognized as a political party; Orban became its leader four years later in 1993 and led the party and its allies to their first victory and formed a new government in 1998. At age 35 Orban became the second youngest Prime Minister in Hungary’s history.
During his first term, Orban started well on the economy, reducing inflation and the budget deficit, was welcomed to the White House by President George W. Bush, and led Hungary to join NATO overruling Russian objections. But the slide into authoritarianism and corruption was just as quick, including the attempt to replace the two-thirds parliamentary majority requirement by a simple majority. By the end of the term the ruling coalition disintegrated and Orban lost the 2002 election and became the leader of the opposition over the next two terms till 2010.
Orban returned to power with a two-thirds majority in 2010 and immediately introduced a new constitution that set the stage for ushering in the illiberal state. What had been previously a communist state now became a Christian state where ‘traditional values’ of gender rights, sexuality, and exclusive nationalism were constitutionally enshrined. The electoral system was changed reducing the number parliamentarians from 386 to 199 – with 103 of them directly elected and 93 assigned proportionately. Orban went on to win three more elections over 16 years – in 2014, 2018 and 2022 – each with a two-thirds majority, and used the time and power to transform Hungary into a conservative fortress in Europe.
The new constitution and its frequent amendments were used to centralize legislative and executive power, curb civil liberties, restrict freedom of speech and the media, and to weaken the constitutional court and judiciary. It was his opposition to non-white immigration that made him “the talisman of Europe’s mainstream right”. He described immigration as the West’s answer to its declining population and flatly rejected it as a solution for Hungary. Instead, he told his compatriots, “we need Hungarian children.” His ‘Orbanomics’ policies restricted abortion and encouraged family formation – forgiving student debt for female students having or adopting children, life-long tax holiday for women with four or more children, and sponsoring fixed-rate mortgages for married couples.
Orban wanted to make Hungary an “ideological center for … an international conservative movement”. Orban heaped praise on Jair Bolsonaro for making Brazil the best example of a “modern Christian democracy.” He endorsed Trump in every one of Trump’s three presidential elections, the only European leader to do so. In return, Orban has been described by US MAGA ideologue Steve Bannon as “Trump before Trump.” Orban’s attack on universities for being the citadels of liberalism have found their echoes in Trump’s America and Modi’s India.
For all his efforts in making Hungary a conservative ideological centre, Viktor Orban’s undoing came about because of Hungary’s growing economic crises and the depth of corruption and systemic nepotism that engulfed the government. The economy has tanked over the last three years with rising prices and the national debt reaching 75% of the GDP – the highest among East European countries. Orban’s critics have exposed and the people have experienced systemic corruption that enabled the siphoning of public wealth into private accounts, the creation of a ‘neo-feudal capitalist class’, and the enrichment of family and friends. Orban’s corruption became the central plank of the opposition platform that Peter Magyar and his Tisza Party presented to the voters and caused his ouster after 16 years.
The Prime Minister elect is not a dyed in the wool liberal, but a member of a conservative Budapest family, and a politician cut from the old Orban cloth. Magyar (literally meaning “Hungarian”) was once a “powerful insider” in the Fidesz government – notably active in foreign affairs, while his ex-wife was once the Minister of Justice in Orban’s cabinet. Mr. Magyar may not fully roll back all of Orban’s illiberalism, but he has committed himself to eliminating corruption, increasing social welfare spending, limiting the prime ministerial tenure to two terms, and being more pro-European, EU and NATO.
EU and European leaders have openly welcomed the change in Hungary, and may be looking for the new government to change Orban’s vetoing of a number of EU initiatives, especially those involving assistance to Ukraine. In return, the new government in Hungary will be expecting the unfreezing of as much as $33 billion funds that the EU extraordinarily chose to freeze as punishment for Orban’s illiberal initiatives in Hungary. For Trump and Netanyahu, the defeat of Viktor Orban removes their only ally and supporter in all of Europe.
by Rajan Philips
Features
ICONS:A Dialogue Across Centuries
Sky Gallery of the Fareed Uduman Art Forum is dedicated to bringing audiences, cultures, and time periods together through meaningful and accessible art experiences to create the closest possible encounters with the world’s greatest paintings. Previous exhibitions include, Gustav Klimt, Frida Kahlo, Paul Gauguin, Vincent Van Gogh, Salvador Dali.
ICONS is conceived as “a dialogue across centuries” bringing together over a dozen artistic geniuses whose works span the Renaissance to the modern era. These works at their original scales of creation changes the conversation. You can finally stand in front of a life-size Vermeer or a monumental Monet and feel the dialogue between artists who never met but shaped each other across time. Each exhibit is meticulously presented on canvas, hand-framed, and finished at the exact dimensions of the original masterpieces, preserving the integrity of composition, texture, brushwork, color and scale.
At the heart of the exhibition is Jan van Eyck’s ‘Arnolfini Portrait’, a work that epitomizes the detail, symbolism, and human intimacy that have inspired generations of artists. Alongside it, visitors will encounter paintings that shaped the renaissance, impressionism, modernism, and the evolution of visual storytelling by Munch, Matisse, Monet, Degas, Da Vinci, Renoir, Vermeer, Rembrandt, Cézanne, Caravaggio, and more. The exhibition invites audiences to experience a rare conversation across centuries of artistic brilliance.
By bringing together works that are geographically and historically dispersed, ICONS creates a compelling space for comparison, reflection, and discovery. Visitors are invited to move beyond passive viewing into a more engaged encounter—tracing artistic influence, identifying stylistic shifts, and uncovering unexpected connections between artists who never shared the same physical space, yet remain deeply interconnected across time.
Designed and curated for both seasoned art enthusiasts and first-time visitors, ICONS offers an experience that is at once educational, immersive, and accessible—removing many of the traditional barriers associated with global museum-going.
Exhibition Details:
Dates: April 24 – May 3
Time: 10:00 AM – 5:00 PM (Monday – Sunday)
Venue: Sky Gallery Colombo 5
Features
Our Teardrop
BOOK REVIEW
Ranoukh Wijesinha (2026)
Published by Jam Fruit Tree Publications.
82 pages. Softcover. ISBN 978-624-6633-81-3
The author is a graduate teacher at St. Thomas’ College, Mount Lavinia; his alma mater. On leaving school he read for a Bachelor of Arts Degree in English Language and English Literature at the University of Nottingham (Malaysia). On graduating, in 2024, he went back to his old school to teach these same disciplines. There seems to be a historic logic to this as his grandfather, a notable Thomian of his day, also started his working career as a teacher at the College before moving on to the world of publishing; as a newspaper journalist and sub-editor.
On his maternal side, Wijesinha’s grandfather was an accomplished journalist, thespian and playwright of his day, and his mother is also a much sought after teacher of English and English Literature and, as acknowledged by him, his first, and foremost, English teacher.
Though there are some well-written, almost lyrical, pieces of prose in this publication, it is the poetry that dominates. Written with a sensitivity to people and events he has either observed himself, or as described to him by those who did, it also encompasses all genres of poetic verse, from the classical to the modern, including sonnets, acrostics, haiku to free and blank verse, the latter more in vogue today. All in all, it presents as a celebration of English poetry and its ability to, sometimes, express depth of thought and feeling far better than prose.
Dedicated to his mentor at St. Thomas’, his Drama and Singing Master had been a great influence on Wijesinha His sudden, premature, death understandably came as a shock to the still developing student under his tutelage. The poems “The Man who Made Me” and “The Curtain Called” best demonstrate this. In addition, it is apparent that Wijesinha has endured much mental trauma in his young life. Spending much time on his own, the questions these moments have raised are expressed in “When No One is Listening”, “There was a Time”, “Midnight Walks” and the prose “A Ramble through Colombo”.
However, the majority of the poems concern ‘Our Teardrop’, Sri Lanka, for whom the writer has a great love. He explores its history, its natural wonders, its people, its tragedies, its corruption and the hope that things will get better for all its people. “Bala’ and “Dicky” address a time of violence from days gone by when there were few glories, just victims. “Easter Sunday” brings this almost to the present time.
There also is humour. “Ado, Machang, Bro, Dude” celebrates his friends and friendships in a way that will reverberate with all the present and previous generations of those who are, or were once, in their late teens and early twenties.
There is little to criticise in this first of the writer’s forays into published works except, as referred to previously, to re-state that the prose quails in the face of the power of the poetry. It is all well written, filled with passion and compassion, and gives comfort that there still are young Sri Lankan writers who can be this brave, and write so powerfully, and profoundly, in English. It is hoped that this is just the first of many from the pen of this young writer.
L S M Pillai
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