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
South’s ‘structural deficiencies’ and the onset of crippled growth

The perceptive commentator seeking to make some sense of social and economic developments within most Southern countries today has no choice but to revisit, as it were, that classic on post-colonial societies, ‘The Wretched of the Earth’ by Frantz Fanon. Decades after the South’s initial decolonization experience this work by the Algerian political scientist of repute remains profoundly relevant.
The fact that the Algeria of today is seeking accountability from its former colonizer, France, for the injustices visited on it during the decades of colonial rule enhances the value and continuing topicality of Frantz’s thinking and findings. The fact that the majority of the people of most decolonized states are continuing to be disempowered and deprived of development should doubly underline the significance of ‘The Wretched of the Earth’ as a landmark in the discourse on Southern questions. The world would be erring badly if it dismisses this evergreen on decolonization and its pains as in any way outdated.
Developments in contemporary China help to throw into relief some of the internal ‘structural deficiencies’ that have come to characterize most Southern societies in current times. However, these and many more ‘structural faults’ came to the attention of the likes of Fanon decades back.
It is with considerable reservations on their truthfulness that a commentator would need to read reports from the US’ Office of the Director of National Intelligence (ODNI) on developments in China, but one cannot approach with the same skepticism revelations on China by well-known media institutions such as Bloomberg News.
While an ODNI report quoted in this newspaper on March 25th, 2025, elaborated on the vast wealth believed to have been amassed by China’s contemporary rulers and their families over the years, Bloomberg News in a more studied manner said in 2012, among other things, on the same subject that, ‘Xi’s extended family had amassed assets totaling approximately $376 million, encompassing investments in sectors like rare earth minerals and real estate. However, no direct links were established between these assets and Xi or his immediate family.’
Such processes that are said to have taken hold in China in post- Mao times in particular are more or less true of most former colonies of the South. A clear case in point is Sri Lanka. More than 75 years into ‘independence’ the latter is yet to bring to book those sections of its ruling class that have grown enormously rich on ill-gotten gains. It seems that, as matters stand, these sections would never be held accountable for their unbounded financial avarice.
The mentioned processes of exploitation of a country’s wealth, explain in considerable measure, the continuing underdevelopment of the South. However, Fanon foresaw all these ills and more about the South long ago. In ‘The Wretched of the Earth’ he speaks insightfully about the ruling classes of the decolonized world, who, having got into the boots of the departing colonizers, left no stone unturned to appropriate the wealth of their countries by devious means and thereby grow into the stratum described as ‘the stinking rich.’
This is another dimension to the process referred to as ‘the development of underdevelopment.’ The process could also be described as ‘How the Other Half Dies’. The latter is the title of another evergreen piece of research of the seventies on the South’s development debacles by reputed researcher Susan George.
Now that the Non-aligned Movement is receiving some attention locally it would be apt to revisit as it were these development debacles that are continuing to bedevil the South. Among other things, NAM emerged as a voice of the world’s poor. In fact in the seventies it was referred to as ‘The trade union of the poor.’ Accordingly, it had a strong developmental focus.
Besides the traditional aims of NAM, such as the need for the South to keep an ‘equidistance’ between the superpowers in the conduct of its affairs, the ruling strata of developing countries were also expected to deliver to their peoples equitable development. This was a foremost dimension in the liberation of the South. That is, economic growth needed to be accompanied by re-distributive justice. In the absence of these key conditions no development could be said to have occurred.
Basing ourselves on these yardsticks of development, it could be said that Southern rulers have failed their peoples right through these decades of decolonization. Those countries which have claimed to be socialistic or centrally planned should come in for the harshest criticism. Accordingly, a central aim of NAM has gone largely unachieved.
It does not follow from the foregoing that NAM has failed completely. It is just that those who have been charged with achieving NAM’s central aims have allowed the Movement to go into decline. All evidence points to the fact that they have allowed themselves to be carried away by the elusive charms of the market economy, which three decades ago, came to be favoured over central planning as an essential of development by the South’s ruling strata.
However, now with the returning to power in the US of Donald Trump and the political Right, the affairs of the South could, in a sense, be described as having come full circle. The downgrading of USAID, for instance, and the consequent scaling down of numerous forms of assistance to the South could be expected to aggravate the development ills of the hemisphere. For instance, the latter would need to brace for stepped-up unemployment, poverty and social discontent.
The South could be said to have arrived at a juncture where it would need to seek ways of collectively advancing its best interests once again with little or no dependence on external assistance. Now is the time for Southern organizations such as NAM to come to the forefront of the affairs of the South. Sheer necessity should compel the hemisphere to think and act collectively.
Accordingly, the possibility of South-South cooperation should be explored anew and the relevant institutional and policy framework needs to be created to take on the relevant challenges.
It is not the case that these challenges ceased to exist over the past few decades. Rather it is a case of these obligations being ignored by the South’s ruling strata in the belief that externally imposed solutions to the South’s development questions would prove successful. Besides, these classes were governed by self- interest.
It is pressure by the people that would enable their rulers to see the error of their ways. An obligation is cast on social democratic forces or the Centre-Left to come to center stage and take on this challenge of raising the political awareness of the people.
Features
Pilot error?

On the morning of 21 March, 2025, a Chinese-built K-8 jet trainer aircraft of the Sri Lanka Air Force (SLAF) crashed at Wariyapola. Fortunately, the two pilots ejected from the aircraft and parachuted down to safety.
A team of seven has been appointed to investigate the accident. Their task is to find the ‘cause behind the cause’, or the root cause. Ejecting from an aircraft usually has physical and psychological repercussions. The crew involved in the crash are the best witnesses, and they must be well rested and ready for the accident inquiry. It is vital that a non-punitive atmosphere must prevail. If the pilots believe that they are under threat of punishment, they will try to withhold vital information and not reveal the truth behind what happened, prompting their decision to abandon the stricken aircraft. In the interest of fairness, the crew must have a professional colleague to represent them at the Inquiry.
2000 years ago, the Roman philosopher Cicero said that “To err is human.” Alexander Pope said, “To err is human. To forgive, divine.” Yet in a Royal Air Force (RAF) hangar in the UK Force (RAF) hangs a sign declaring: “To err is human. To forgive is not RAF policy” These are the two extremes.
Over the years, behavioural scientists have observed that errors and intelligence are two sides of the same coin. In other words, an intelligent human being is liable to make errors. They went on to label these acts of omission and commission as ‘Slips, Lapses, Mistakes and Violations’.
To illustrate the point in a motoring context, if one was restricted to driving at a speed limit of 100 kph along an expressway and the speed crept up to 120 kph, then it is a ‘Slip’ on one’s part. If you forgot to fasten the seatbelt, it is a ‘Lapse’. While driving along a two-lane road, if a driver thinks in his/her judgement that the way is clear and tries to overtake slower traffic on the road, using the opposite lane, then encounters unanticipated opposite traffic and is forced to get back to the correct lane, that is a ‘Mistake’. Finally, if a double line is crossed while overtaking, while aware that the law is being broken, that is labelled as a ‘Violation’. In theory, all of the above could be applied to flying as well.
In the mid-Seventies, Elwyn Edwards and Frank Hawkins proposed that good interaction between Software (paperwork), Hardware (the aircraft and other machines), Liveware (human element) and the (working) environment are the essentials in safe flight operations. Labelled the ‘SHELL’ concept, it was adopted by the International Civil Aviation Organisation. (ICAO). (See Diagram 01)
In diagram 01, two ‘L’s depict the ‘Liveware’, inside and outside an aircraft flightdeck. The ‘L’ at the centre is the pilot in command (PIC), who should know his/her strengths and weaknesses, know the same of his/her crew, aircraft, and their mission, and, above all, be continuously evaluating the risks.
Finally, Prof. James Reason proposed the Swiss Cheese Theory of Accident Causation. (See Diagram 02)
From this diagram we see that built in defences in a system are like slices of Swiss cheese. There are pre-existing holes at random which, unfortunately, may align and allow the crew at the ‘sharp end’ to carry out a procedure unchecked.
Although it is easy and self-satisfying to blame a crew, or an individual, at an official accident investigation, what should be asked, instead, is why or how the system failed them? Furthermore, a ‘just culture’ must prevail.
The PIC and crew are the last line of defence in air safety and accident prevention. (See Diagram 3)
A daily newspaper reported that it is now left to be seen whether the crash on 21 March was due to mechanical failure or pilot error. Why is it that when a judge makes a wrong judgement it is termed ‘Miscarriage of Justice’ or when a Surgeon loses a patient on the operating table it is ‘Surgical Misadventure’, but when a pilot makes an honest error, it is called ‘Pilot Error’? I believe it should be termed ‘Human Condition’.
Even before the accident investigation had started, on 23 March, 2025, Minister of Civil Aviation, Bimal Ratnayake, went on record saying that the Ministry of Defence had told him the accident was due to an ‘athweradda’ (error). This kind of premature declaration is a definite ‘no-no’ and breach of protocol. The Minister should not be pre-empting the accident enquiry’s findings and commenting on a subject not under his purview. Everyone concerned should wait for the accident report from the SLAF expert panel before commenting.
God bless the PIC and crew!
– Ad Astrian
Features
Thai scene … in Colombo!

Yes, it’s happening tomorrow, Friday (28th), and Saturday (29th,) and what makes this scene extra special is that you don’t need to rush and pack your travelling bags and fork out a tidy sum for your airfare to Thailand.
The Thai Street Food Festival, taking place at Siam Nivasa, 43, Dr. CWW Kannangara Mawatha, Colombo 7, will not only give you a taste of Thai delicacies but also Thai culture, Thai music, and Thai dancing.
This event is being organised by the Thai Community, in Sri Lanka, in collaboration with the Royal Thai Embassy in Colombo.
The Thai Community has been very active and they make every effort to promote Amazing Thailand, to Sri Lankans, in every possible way they can.
Regarding the happening, taking place tomorrow, and on Saturday, they say they are thrilled to give Sri Lankans the vibrant Thai Street Food Festival.

Explaining how Thai souvenirs are turned out
I’m told that his event is part of a series of activities, put together by the Royal Thai Embassy, to commemorate 70 years of diplomatic relations between Thailand and Sri Lanka.
At the Thai Street Food Festival, starting at 5.00 pm., you could immerse yourself in lively Thai culture, savour delicious Thai dishes, prepared by Colombo’s top-notch restaurants, enjoy live music, captivate dance performances, and explore Thai Community members offering a feast of food and beverages … all connected with Amazing Thailand.

Some of the EXCO members of the Thai Community, in Sri Lanka,
with the Ambassador for Thailand
I’m sure most of my readers would have been to Thailand (I’ve been there 24 times) and experienced what Amazing Thailand has to offer visitors … cultural richness, culinary delights and unique experiences.
Well, if you haven’t been to Thailand, as yet, this is the opportunity for you to experience a little bit of Thailand … right here in Colombo; and for those who have experienced the real Thailand, the Thai Street Food Festival will bring back those happy times … all over again!
Remember, ENTRANCE IS FREE.
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