Q: My gum bleeds after brushing, is it a sign of low calcium or a dental problem?

A: Gums can bleed after brushing due to a number of reasons. Gingivitis is the most common cause of gum bleeding. Here gums become infected followed by chronic inflammation.

Failure to brush teeth after food, brushing inadequately, eating lots of candy and sticky substances are some of the reasons that result into residual particles of food sticking between teeth.

Bacteria are attracted by this food which lodges in the gaps resulting into formation of plague.Chronic inflammation occurs in the adjoining part of gums due to the chronic infection, which leads to swelling of gums and bleeding after brushing.

People with reduced immunity like those living with uncontrolled diabetes, HIV infection, and cancer are more susceptible to such infections.

Use of toothbrushes with hard bristles also leads to bleeding from gums after brushing but may also be a sign of vitamin C. deficiency. Use of drugs like aspirin can also lead to bleeding from gums.

Disorders of bleeding and clotting can lead to bleeding from anywhere in the body including the gums. Liver and kidney diseases lead to deficiency of clotting factors and this can manifest as bleeding.

To solve this problem, it is vital to improve oral hygiene. One should always try to brush teeth after eating. If not possible, try to rinse the mouth adequately with water. It is better to avoid excess consumption of candy, cakes and sodas.

Keeping a chewing gum in mouth for a long time is also not a good practice for health of gums and teeth. Regular flossing of the teeth also helps in removing any residual food particles and keeping teeth and surrounding gums clean and germ free. Toothbrush used should not have hard bristles or be changed as soon as bristles start getting worn off. Eating crunchy fruits like apple after food is also helpful in removing residual food particles.

Fruits rich in vitamin C. like oranges and guavas help in preventing vitamin C deficiency. Use of antiseptic mouth washes helps to reduce the infection and ongoing inflammation inside the mouth.

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Q: I am 4 months pregnant but for the past one week, I did not feel anything moving in my tummy, should I be worried?

A: Is it your first pregnancy? Usually fetal movements are perceived from about 18 -20 weeks of pregnancy. It is anything like a discrete kick, flutter, swish or roll.

These are the first signs of growing fetal life and indicate integrity of the neurological and musculoskeletal system of the intra uterine fetus.

The frequency of movements increases as the baby grows, Gradually by 2nd trimester of pregnancy, the fetal movements acquire a diurnal pattern, akin to biological rhythm of the body in an adult. There may be maximum movements during afternoon and evening.

In between the movements, there is gap due to sleep of the fetus. Change in frequency and pattern of the fetal movements is a sign of growing neurological system of the fetus. There may be from 16 to about 75 times movement per day.

A multiparous woman(one who has had other children before), may perceive fetal movements much early in pregnancy, whereas one who is pregnant for the first time may feel them much later say even after 20 weeks.

It is said that these movements are felt best in lying down position as compared to sitting position. Minimum movements may be perceived while standing. This could be one reason, why women who work outside and remain busy do not sometimes feel fetal movements very well.

However, absence of fetal movements is not a good sign. It can be due to anterior location of the placenta. Other intrauterine abnormalities like polyhdroamnios, oligohydramnios (abnormalities of amniotic fluid) can cause abnormal or reduced fetal movements.

Smoking and alcohol, uncontrolled hypertension or diabetes can also adversely affect fetal growth and movements. It can also be due to hormonal imbalance.

Intrauterine death is the most dreaded reason of absent fetal movements. It is advisable to consult a gynecologist urgently. Clinical examination and ultrasound can help determine the status of the fetus as well as placenta such that any problem detected can be treated early.

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Q: Whenever I finish eating food these days, I feel nausea. Someone advised me to de-worm.  What could be the source of this nausea?

A: Worm infestation is one of the reasons for nausea after eating. But it can be due to several other reasons as well.

Nausea may be part of dyspepsia. There maybe or may not be associated symptoms like vomiting, burning pain in upper tummy and or chest or bloating sensation of stomach. Remaining without food for a long time and then overeating is one common cause for dyspepsia.

Taking very spicy food, use of alcohol or caffeine, eating late in the night, taking a heavy meal in the night are other common causes for dyspepsia. It can also be due to chronic constipation. If bowels are not evacuated regularly, colon tends to be loaded. Eating food tends to increase burden on the gut causing nausea.

Infections of the gut, whether bacterial, viral or protozoal or even by worms can cause nausea as one of the manifestations. There may be other features as well like diarrhoea, cramp like pain in abdomen and fever. Poor food and hand hygiene is the most common cause for these Infections.

A simple stool examination can be used to detect these symptoms to identify the infecting microbe. The good thing is that these infections are curable but tend to reoccur if hygiene is compromised.

Although not necessarily limited to these, other conditions which can result into nausea include chronic inflammation of inner lining of stomach or peptic ulcer, chronic diseases like tuberculosis of intestines or cancer of the stomach.

Taking frequent small meals helps in the digestion of food and prevents nausea. Adequate amount of fiber in the food prevents constipation, drinking adequate amount of water is also useful in this regard. Evening meals should be preferably light and taken much before sleeping time. Alcohol and excess of coffee should be avoided.