A question of health

GUM TRANSPLANTS

GUM TRANSPLANTS

I am a 57-year-old male and my dentist has recommended a gum transplant for some of my lower set of teeth. I have no inflammation or other symptoms but I am informed that the receding gum line will get worse, and the teeth could fall out. Can you advise if the transplant, which involves taking roof-of-mouth tissue for the graft, is necessary and has proved to be successful?

I am not a dentist or oral surgeon, so I can only tell you what I have discovered by doing some research into gum transplants on your behalf. Taking some tissue from the roof of the mouth to treat receding gums is a recognised surgical technique that has been used for many years. It is important to distinguish between gum recession that is caused by infection and inflammation - periodontitis - and gum recession that seems to be caused by thin, fragile tissues. Surgical treatments such as tissue transplants are much more likely to be successful when the cause is not infection. It sounds as though your dentist is proposing a free gingival graft. A thin layer of gum tissue is taken from the roof of the mouth and transplanted to another part of the mouth. If successful, this tough new gum tissue will either prevent further gum recession, or cover the roots of the teeth that have been exposed by previous recession. I cannot say whether the transplant is necessary. You may want to get a second opinion from a specialist periodontist. There are other specialist treatments for gum recession that are equally effective.

HIGH CHOLESTEROL

I was recently prescribed atorvastatin for high cholesterol levels (6.8). I experienced bad muscle pains in my legs. I looked up statins and cholesterol on the internet and found sites questioning the accepted wisdom that high cholesterol is bad. My problem is that I am now worried by both my high cholesterol level and by the prospect of taking statins. I'm sure I am not the only one who is faced by this dilemma.

It is important to remember that a raised cholesterol level is not a disease in itself. It is one of a number of risk factors that may increase the chance that you will develop heart disease or have a heart attack. Many people who have heart attacks do not have high cholesterol levels. And having a high cholesterol level does not mean that you will have any heart problems at all. The only sensible approach to the problem is to take a level-headed look at all of your risk factors. If you smoke, if you have high blood pressure, if you take no exercise, or if you have diabetes, these are going to be much more important things to work on than your cholesterol levels. Statins such as atorvastatin are effective in reducing cholesterol levels. If you are a 50-year-old smoker who does not have diabetes, has normal blood pressure and a cholesterol level of 6.8, your risk of dying from a heart attack or stroke in the next five years is about 2 per cent. If you stop smoking, you can halve this risk to about 1 per cent. If you continue smoking, but reduce your cholesterol level to 5.0 you can reduce your risk to about 1.4 per cent. If you stop smoking and lower your cholesterol level, your risk will be about 0.7 per cent. This illustrates that all of the risk factors are important, but stopping smoking is much more effective than lowering cholesterol levels. You can do these calculations for yourself on the web at www.riskscore.org.uk.

HURTING HANDS

I had polio 40 years ago and my hands are suffering as a result of using elbow crutches for all that time. A physiotherapist recommended that I take glucosamine, in the hope that it will help my damaged hands. I would like to be able to read some authoritative research or assessment of this substance, as I am not one for taking expensive food supplements. A friend in France tells me that her rheumatic dog has been put on glucosamine by the local vet.

There is a substantial body of research evidence showing that glucosamine (with or without another substance called chondroitin sulphate) can help people with osteoarthritis. It does not help everyone, and it is not a miracle cure, but it seems to be safe and effective. If the pain in your hands is not due to osteoarthritis of the hand joints, I think glucosamine is unlikely to help you. One problem in assessing glucosamine is that there are dozens of preparations on the market, and they are all slightly different. One point in favour of glucosamine is that it has few side effects, unlike other more traditional treatments for arthritis. If you do try glucosamine, choose a low cost product. A high price is no guarantee of purity or effectiveness.

HAVE YOUR SAY: READERS WRITE

TJ got side-effects when she took quinine for her cramps:

I took quinine for years until I became concerned that I may have had some side-effects relating to vision, so I went on the hunt for an alternative. I came up with calcium (600 mg) and magnesium (250 mg) supplements, taken at night, which have been more successful than quinine. Separate tablets rather than combined seemed more effective, although I'm not sure why.

Send questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions