Ask the doctor: Why are my teeth starting to crumble?

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After a suspected heart attack ten years ago I have been trying to control my cholesterol through diet, and avoiding dairy foods and fatty meats. I have also been buying cholesterol-lowering products such as Benecol. However, I have recently found that my teeth are crumbling and breaking. Could my diet be the cause? I have started taking a calcium supplement but it doesn’t seem to help.

A. Hurst, Hampshire.

Once formed in childhood, teeth remain unchanged throughout our years

What a difficult situation you are in — you wisely recognise that your cholesterol must be controlled, yet you are worried that doing this has triggered your tooth damage.

We are all aware of the commonly held view that calcium-containing foods, such as dairy products, build strong teeth and bones. But this is not completely true — for teeth are different from bones. Whereas our bones are in a constant state of repair throughout life — with the body removing old cells and replacing them with new ones — teeth, once formed in childhood, remain unchanged throughout our years.

The die is cast in childhood — and it is the quality of your diet in those early years that dictates the strength of your teeth in adulthood. In addition to this, the simple passage of years can lead to teeth problems, with wear and tear and other factors such as gum disease contributing to tooth loss and damage.

This means that your crumbling, breaking teeth are not linked to avoiding dairy foods.

However, although calcium may not be crucial for teeth, it is vital for bones. This mineral, together with vitamin D, is key to preserving bone density and avoiding the bone-thinning condition, osteoporosis.

Thus, anyone who is restricting their dairy intake must try and get calcium from other sources, such as sardines (these have the added benefit of being good for your heart health) and pulses. And yoghurt doesn’t have to be completely off the menu — low-fat varieties contain more calcium than full fat.

And when it comes to reducing your cholesterol, you are doing exactly the right thing — reducing animal fat intake, whether it be from sources such as dairy foods or from red meat, and adding supplements such as stanols, from plants, as found in products like Benecol, can also be helpful. (These work by blocking the absorption of some of the cholesterol in the foods that you eat.)

CONTACT DR SCURR

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details.Dr Scurr cannot enter into personal correspondence.His replies cannot apply to individual cases and should be taken in a general context.

However, to prevent your arteries becoming clogged you need to take into account all factors — weight, blood pressure, and perhaps most importantly of all, the need for regular exercise. It is too easy to slip into the view that because you have suffered a heart scare then taking a daily walk might do more harm than good; in fact, the reverse is true — exercise is crucial to heart health.

Talk to your doctor about the possibility of a session or two with a dietician, who can advise you on how to proceed with your diet.

Avoid falling into the world of ‘nutritional medicine’ and vitamin supplements — these are nothing other than a substitute for what is really needed: weight control, regular exercise, and a carefully balanced nutritious dietary plan for the long term.

Could you tell me the symptoms of the muscle condition myasthenia gravis? At what age does this manifest itself, and what is the most effective approach to alleviate this disease?

E. Williams, Gwent.

This distressing condition is called an auto-immune disease, and occurs when the immune system mistakenly turns on the body and starts attacking healthy tissue.

In this condition, the immune system destroys key proteins at the junction between the nerve cells and the muscle, preventing nerve signals reaching the muscles. As a result, the key symptom is weakness and loss of strength. This is often more severe later in the day, or after exercise.

This weakness seems to mainly affect the eyes and the eyelids, for reasons that are still unknown, causing the lids to droop down.

Fifty per cent of patients suffer drooping eyelids, and over a year or two this may worsen and become associated with double vision as the muscles responsible for alignment of the eyes weaken.

In a smaller number of cases, the muscles that control breathing can be affected — a small proportion of patients experience difficulty in speaking or swallowing, or trouble in chewing food.

The condition is fairly rare, and for reasons that are still unclear women are three times more likely to develop it than men, and it seems to affect women under the age of 40 and men over the age of 60.

We are still unsure what causes it but one theory is that it is triggered by viral infection. The thymus gland has also been implicated — this small gland in the chest has a key role in ‘programming’ the cells of the immune system and telling them what to attack. The  majority of patients are found to have abnormalities of the thymus, and although the picture is not yet fully clear it appears that the thymus is pivotal in triggering the damaging immune response.

Although this was once a disabling and even fatal disorder, there is effective treatment. There are four main treatment strategies, depending on the severity of the disease.

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Medicines called acetylcholinesterase inhibitors, taken as daily pills, are very effective in controlling the symptoms (they help boost the signals between the nerves and the muscle) and may be all that is needed.

If this fails to control symptoms, drugs that suppress the immune system — and hence  the malfunctioning cells — may be necessary.

These include steroids or other immuno-suppressive agents such as azathioprine. They can cause remission in up to a half of patients within a month.

In rapidly progressive myasthenia, a speedier way of suppressing the immune damage is a technique called plasmapheresis, in which the antibodies are removed from the bloodstream.

Finally, there is surgical treatment. In some patients, removing the thymus resolves the disease. I hope this information has been of help.

By the way...

Call the matron — she knows what’s best

Nursing recruits are to spend a year working on the wards before they can start their studies, it’s just been announced. The idea is to give them a grounding in the fundamental basics of nursing — making beds, feeding patients, and the general aspects of caring for sick and disabled people.

The government plans to reform nurse training, with recruits spending a year working on the wards

You might think these are already part of nurse training, but apparently not. In fact, this ‘new’ idea was proposed in the Francis Report, the investigation into poor care at Stafford Hospital. The report identified the need for better bedside training of nurses, and proposed a three-month attachment for all new recruits.

The thinking is that this will help identify who might make a good nurse, or eliminate early on those who have no aptitude (or a poor attitude). On a whim, the powers-that-be have upped this to a one-year attachment. This is misguided, as it will vastly increase the proportion of untrained staff on the ward teams — and by whom, and how, will these recruits be governed and trained?

Staff on the wards are already completely overwhelmed with their workload, not to mention doing battle with the vast and increasing pressure of more red tape, and shrinking budgets.

In my 30 years as a doctor there has been change after change in nurse training and the nursing profession, and these changes exactly mirror the decline in standards. The Salmon Report, Project 2000, to name but a few of these changes, were all aimed at ‘fixing’ something that actually worked rather well.

When standards were higher, wards used to have a strict hierarchy, with matrons overseeing the nurses with a firm hand. These were then replaced with ward managers, and now when I visit my patients in hospital I have the greatest difficulty in working out whom to talk to, as the cleaners, the nurses and the ward clerks all look the same.

The old identifying uniforms have vanished, and when I asked a very senior nurse whom I have known for 40 years about this, she told me that she, too, has the same problem — and she is a senior adviser at government level.

Yes, hands-on training of nursing staff is essential, but let’s also allow hospital staff enough time to care for patients.

And perhaps try to learn some lessons from history. That means taking on board the views of those who remember the old order, which worked within a smoothly functioning system, before they have all gone.