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Tooth loss, more reasons to take care of your gums




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.

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President’s efforts require parliamentary support



President Ranil Wickremesinghe

By Jehan Perera

With less than a year and half to the presidential elections, President Ranil Wickremesinghe has a tight deadline to meet if he is to attain his aspirations for the country.  His visit last week to Japan where he sought to renew ties which had made it Sri Lanka’s largest aid donor for decades, was reported to be highly successful.  During his visit, the President had apologized to the Japanese government leaders regarding the cancellation of the Light Rail Transit project which was subsequently delivered by Japan to Bangladesh.   The completion of the elevated railroad would have significantly reduced Colombo’s traffic jams. The disastrous mistake the previous government made in crudely cancelling the project unilaterally and without rational reason lost Sri Lanka the goodwill of Japan which will not be easy to get back.  Getting Japan back as a donor partner would be a great boon.  Overcoming the serious economic crisis that besets the country and its people would require a massive infusion of foreign assistance if the period of recovery is to be kept short and not prolonged indefinitely.

President Wickremesinghe’s leadership is also being credited with the structural economic reforms that the country is undertaking with regard to revenue generation and cost cutting.  Undertaking economic reforms that would streamline the economy has been a long term desire on the part of the President and seen during his past stints as Prime Minister.  During the period 2001 to 2004, when he effectively led the government as Prime Minister and entered into the ceasefire agreement with the LTTE, he tried to implement the same set of economic reforms.  Both of these radical measures proved to be too much for the population to bear and he suffered defeat at the elections that followed. Typically, the reform measures he presents is based on the “trickle down” theory, which, in highly corrupt polities, like Sri Lanka, means that the poor have to be content with the crumbs falling off the table. Once again, and unfazed, he is taking up the challenge of taking up unpopular economic measures, such as cutting subsidies, increasing taxes and privatizing state owned enterprises.

As part of the IMF recovery plan for the country, the government, under his leadership, is putting in place anti-corruption legislation that is required by the IMF.  It appears that this legislation, which is still in its draft form, is being pushed more by the President than by the government.  This was evident when a civil society group, led by the anti-corruption watchdog Transparency International, held a meeting for parliamentarians of all parties within the parliamentary complex.  The attendance from the government side was limited, though the Opposition participated in strength.  The top leadership of most of the Opposition parties, was in attendance, especially the largest Opposition party, the SJB, whose leader Sajith Premadasa also made an appearance.  They gave an inkling of the change of faces that needs to accompany any “system change.” The consensus of the discussion was that the draft legislation was a positive addition to the fight against corruption.


The situation on the ground, in terms of implementation of the laws pertaining to good governance and accountability, continue to be highly unsatisfactory.  The protest movement that was in evidence a year ago, gave its attention to issues of corruption and economic mismanagement for the reason that it had led to the economic collapse of the country that affected the entirety of its population. Both corruption and economic mismanagement had been facilitated by the concentration of political power in the executive.  One of President Wickremesinghe’s first actions was to give astute political leadership to the passage of the 21st Amendment which sought to restore the independence of key state institutions necessary for a check and balance function.  The most important aspect of the 21st Amendment is to protect those who are in charge of oversight bodies from interference by the political authority.

 A notable feature of the present is that the parliamentary majority has shown itself to be willing to follow President Wickremesinghe’s lead when it comes to putting frameworks of good governance and accountability in place for the future.  But when it comes to implementing them in the present, the ruling party, in particular, works in its own self-interest and to protect its own.  Unfortunately, there are a growing number of instances in which it can be seen that the parliamentary majority, led by the ruling party, continues to flout the spirit of the law and practices of good governance.  This was seen in the manner in which the Chairman of the Public Utilities Commission was forced out of his position through a majority vote in Parliament.  Regrettably, the protections afforded by the 21st Amendment could not protect the Chairman of the regulatory authority who opposed the electricity price hikes that led to the price hike to the poorest being up to 500 percent, while to the super rich and companies it was only 50 percent.

The second incident, in the same week, has been the apprehension of a parliamentarian at the airport for gold smuggling who was let off with a fine that was much less than the fine provided for by law for such offenses.  The parliamentarian himself has shown no remorse whatsoever and on the contrary has argued with considerable gumption that he is a victim of injustice as he did not pack his own bag and it was done by another.  The very same day that he paid his fine and was released by the Customs he went to Parliament, as if he had no problems. Opposition parliamentarians have urged that the parliamentarian, caught gold smuggling, should resign, but so far to no avail.  The question is whether he will be held accountable for the discredit he has brought upon himself, his political party, Parliament and the country or whether he will be judged to be no worse than many of his peers and the matter put aside.


The third incident, in the same week, is that of a foreign national who entered the country, on a forged passport, and was apprehended, at the airport, by Immigration officers.  They were instructed by a government minister to release the foreign person on the grounds that he was a businessman who had come to invest in the country.  However, when the incident was reported in the media, the government decided to deport him and said it will take action against the Immigration officers who had followed illegal orders in releasing him.  The media reported that no inquiry will be held against the Minister for influencing the Immigration officials to release the arrested foreign national as anybody could make a request like that but that an inquiry should be held against the Immigration officials for obeying the wrong instructions.

President Wickremesinghe has won many plaudits for his willingness to take up the challenge of rescuing the country from the abyss when he accepted former President Gotabaya Rajapaksa’s offer to become Prime Minister. It has now become clear that the President is determined to set laws and frameworks for the future. Unfortunately, it appears that the implementation of good governance practices and accountability is simply impossible in a context in which the parliamentary majority is not willing to follow them.  As a result, the crackdown on corruption and abuse of power that was hoped for when President Wickremesinghe took over has not manifested itself on the ground.

There is still little or no evidence that President Wickremesinghe is able or willing to take action against those within his government who violate the laws and frameworks of good governance that he is setting for the future of the country.  Up to now, the President has only been able to use the security forces and the parliamentary majority to crack down on the protest movement which demanded an end to corruption and accountability for abuse of power. If this situation continues, the President will lose both credibility and authority while those who engage in corruption and abuse of power will once again entrench themselves and become impossible to dislodge to the detriment of the national interest.  There is a need for all in the polity, both government and opposition, to strengthen the hand of the President to make a break with the past so that the resources of the country will be used for the common good rather than end up in private pockets.

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Sri Lanka’s ignorance matches that of US – II



LTTE training forcibly recruited civilians

Human Rights and war crimes:

By Daya Gamage
Foreign Service National Political Specialist (ret.)
US Department of State

(Continued from yesterday)

It is essential to note the most fundamental divide in the country is between rural and urban populations. Sri Lanka’s economy has always been essentially agricultural and even today some 77 percent of the population lives in rural districts. The ratio of Sinhalese to Tamils living in rural districts nationally approximates their ratio in the population at large.  Rural areas include Tamil-majority parts of Vanni (Mannar, Mullaitivu and Vavuniya Districts) and the Kilinochchi District in the Northern Province.  Similarly, such Sinhalese-majority districts as Monaragala and Badulla in the southern province of Uva, and Hambantota in the south are mostly rural.  During the colonial period and until the early 1970s the economic and political elites of Sri Lanka were almost exclusively a subset of the approximately 19 percent of the population living in urban areas.

These areas were privileged in terms of better economic infrastructure, better health and other government services, and better educational and employment opportunities.  These advantages were shared by all communities living in the cities: Sinhalese, Tamils and Muslims, who coexisted and cooperated in general harmony.  Again, all three ethnic communities in the rural sector face inadequate educational facilities, less economic infrastructure and employment opportunities.

Post-Independence dilemma

Post-independence leaders faced a prickly dilemma: the economic development and broadened enfranchisement demanded by democratic politics required that more resources and opportunities be shared with the countryside, which would dilute the power and privileges of the 19 percent. All sections of the educated urban class were threatened by this, and none more than urban Tamils.  Not surprisingly, political leaders reacted to this broadening competition for national resources by reaching out to their ethnic constituencies for support in defending their privileges.

Let’s turn to war crimes and human rights violations the 18 May 2023 US House of Representative Resolution and the Canadian prime minister were referring to. The data and facts given below could be new to policymakers and lawmakers in Sri Lanka as well as to their counterparts in Washington. I say this because there was no evidence that Sri Lanka ever presented these factual data to the West. If the policymakers and lawmakers in Washington were aware of the following data the Resolution would have taken a different tone.

The question of war crimes—and related charges of crimes against humanity and even of genocide—are a telling example of the frequent gulf between complex facts and simplistic popular beliefs that has distorted perceptions of the Sri Lankan civil war and, one would argue, US policy towards Sri Lanka. In a broader sense, this writer believes that the persistent fictions that have grown up around the separatist conflict are symptomatic of a larger problem in the crafting of policy toward countries that are insufficiently or incorrectly understood.

In the case of Sri Lanka, the tendency of international observers to rush to judgment— and censure—under worst-case assumptions is evidenced by the civilian fatalities figure cited extensively in print and public discourse. This figure of 40,000 is alleged to be the number of unarmed Tamils who were killed during the final stage of the war (January–May 2009). These deaths are blamed largely on the Sri Lankan military, which is accused of using excessive and indiscriminate force, and thereby of committing war crimes. The 40,000 figure became an item of international orthodoxy after it was mentioned in the report, often referred to as the Darusman Report, by an “unofficial” panel of experts appointed by U.N. Secretary-General Ban Ki-moon. The figure was arrived at by simply subtracting the number of internally displaced civilians who were administratively processed after the hostilities from the UN’s estimate of the number of civilians caught up in the final offensive.

To be precise, the March 2011 Darusman report conceded that “there is still no reliable figure for civilian deaths” but stated that the figure of 40,000 “cannot be ruled out” and needs further investigation.  The report did not refer to “credible evidence,” much less adduce any, using instead the vague expression “credible allegations.” This verdict was not voted upon or endorsed by the United Nations as an organisation, and despite its questionable logic and conflicting figures from other sources, the UN Secretary General pronounced the figure of 40,000 to be definitive. In a strange case of groupthink, most western governments and international NGOs have accepted it unquestioningly and wielded it rhetorically.

Disputed death count

The currency and obduracy of the death count, to which the Darusman Report gave birth, is all the more mystifying because it represents a major departure from calculations made not only by other reputable observers but even by UN staff on the ground in Sri Lanka. On March 9 (2009), the country team of the UN mission in Colombo briefed local diplomats for the first and only time on the civilian casualty figures it had collected from its Humanitarian Convoy.

 According to this briefing, 2,683 civilians had died between January 20 and March 7, and 7241 had been wounded. The UN country team did not indicate to the diplomats that the majority of these casualties were due to government shelling.  According to a cable from the US embassy in April 2009, the UN had estimated that from January 20 to April 6 civilian fatalities numbered 4,164, plus a further 10,002 wounded.  The International Crisis Group is quoted as reporting that “U.N. agencies, working closely with officials and aid workers located in the conflict zone, documented nearly 7,000 civilians killed from January to April 2009.

Those who compiled these internal numbers deemed them reliable to the extent they reflected actual conflict deaths but maintain it was a work in progress and incomplete.” Some three weeks before the end of the war, Reuters reported that “A UN working document, a copy of which was obtained by Reuters, says 6,432 civilians have been killed and 13,946 wounded in fighting since the end of January.” An unpublished report by the United Nations country team in Sri Lanka stated that from August 2008 to May 13, 2009 (five days before the war ended), the number of civilians killed was 7,721. Even if the UN Secretary General chose to ignore reporting from his own staff in the field, there were reports from other sources that should have tempered the figures adopted by other international organizations and governments with diplomatic representation in Colombo.

The International Committee of the Red Cross, the only outside agency present in the war zone during the final phase, used various statistical indicators to conclude that the total number of noncombatants killed was around 7,000.  Lord Naseby, a British parliamentarian and longtime advocate for Sri Lanka, announced in the House of Lords in November 2017 that he had managed to pry classified documents out of the Foreign Office through a freedom of information inquiry. These documents, which were dispatched from the British Defense Attaché in Colombo during the final days of the war, reported that about 7000 people had been killed.  Amnesty International wrote that . . . “derived independently from eyewitness testimony and information from aid workers [we estimate that] at least 10,000 civilians were killed.” This figure is in line with the estimate of an anthropologist working in Australia who questioned LTTE government servants and others who survived the final battles. This academician estimates that total fatalities from January 1 to May 19 ranged from 15,000 to 16,000, including some 5,000 Tiger dead. He cautions that any final figure must take into account the 600-900 deaths due to non-military causes that would be expected at standard death rates for a population of several hundred thousand over a period of five months, especially under very difficult conditions. He emphasizes that it was very difficult to distinguish civilians from combatants because the latter often did not wear uniforms.

According to some commentators, the prevalence and resilience of the 40,000-fatality figure can be attributed in significant measure to the publicity given to it by Gordon Weiss, an Australian journalist, who served as spokesperson for the UN mission in Sri Lanka from 2006 to 2009. In that official capacity Weiss reportedly used the fatality figure of 7,000 for 2009 and noted that, for the Sri Lankan Army, it made no tactical sense to kill civilians. Yet, in interviews to promote his popular book on the final days of the war, he used the unsubstantiated figure of 40,000, presumably for its shock value. When the book was published, the fatality figure had been reduced to 10,000.

ICRC figures 

On July 9, 2009, the US Ambassador-at-Large for War Crimes Issues, John Clint Williamson, met in Geneva with Jacques de Maio, Head of Operations for South Asia for the International Committee of the Red Cross. Williamson requested the meeting in order to collect information required for reporting to the US Congress. This information was invaluable because the ICRC was the only international organisation allowed by the GSL onto the northeastern battlefield for humanitarian work. In his diplomatic cable to Washington on that meeting, Williamson quoted de Maio as saying that “the Sri Lankan military was somewhat responsive to accusations of violations of international humanitarian law and was open to adapting its actions to reduce casualties.” The ambassador added that de Maio . . . “could cite examples of where the Army had stopped shelling when ICRC informed them it was killing civilians. In fact, the Army actually could have won the military battle faster with higher civilian casualties, yet chose a slower approach which led to a greater number of Sri Lankan military deaths …. On the LTTE, de Maio said that it had tried to keep civilians in the middle of a permanent state of violence. It saw the civilian population as a ‘protective asset’ and kept its fighters embedded amongst them.

De Maio said that the LTTE commanders’ objective had been to keep the distinction between civilian and military assets blurred.”  In April, as the fighting was nearing its climax, both the United Nations and the Group of Eight nations strongly condemned the LTTE for using civilians as human shields.

This writer can assure that the manuscript he is preparing with the retired Senior Foreign Service and Intelligence Officer of the Department of State Dr. Robert K. Boggs will disclose startling evidence of Washington’s foreign policy trajectory toward Sri Lanka, and how successive governments in Sri Lanka since 1980 – to date – displayed their utter ignorance that led to the infantile foreign policy approaches.

(The writer, Daya Gamage, is a retired Foreign Service National Political Specialist of the U.S. Department of State accredited to the Political Section of the American Embassy in Colombo, Sri Lanka)

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Excitement galore for Janaka



Janaka Palapathwala…a new identity soon!

Another artiste who is very much in the limelight, these days, is singer Janaka Palapathwala, who specializes in the golden hits of the past, made popular by Engelbert Humperdinck, Elvis, Tom Jones, Jim Reeves, and the like.

He has been seen crooning away at some of the prestigious events, in Colombo, and is now ready to entertain those who love the golden oldies…in Canada and the States.

Janaka, who plans to reveal a new identity soon, indicated to us that he is eagerly looking forward to this particular overseas tour as he has already been informed that the opener, on 3rd June, in Washington D.C., is a ‘sold out’ event.

“Summer Mega Blast’, on 3rd June, will have in attendance the band Binara & The Clan and DJ Shawn Groove.

Dynasty (Apple Green)…in action at ‘Memories Are Made Of This’

On 16th June, he will be in Toronto, Canada, for ‘Starlight Night’, with the band 7th String.

He has two dates in New York, on 24th June and 28th July (‘Welcome To My World’); Nebraska, 4th July (‘An Evening With Janaka’): Los Angeles, 15th July, and San Francisco, 22nd July.

Both the Los Angeles and San Francisco events are titled ‘Memories Are Made Of This’ and Janaka will perform, backed by the group Dynasty (Apple Green).

On his return home, he says he has to do the St. Peter’s College Welfare Society Dinner Dance, “Wild West’, scheduled for 26th July.

There will be plenty of action at this Peterite event, with the bands Misty, and Genesis, Shawn Groove, Frank David, Mazo, Ricardo Deen, Dinesh Subasinghe and Clifford Richards.

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