© T Lane © Faculty of Dentistry, The University of Hong Kong Page 1 of 4

“Write Expressions” Quiz from Expressions 2011 issue 1

Answers and Commentary:

Sentences that contain spelling mistakes, or correctly spelt but wrongly used words,

will obscure your message, create confusion, and reduce your credibility as a

professional or scientist. Writing clearly and correctly is especially important for

messages intended for the general public. To revise the sentences in this issue’s Write

Expressions, we can first look at the individual words and then at the overall meaning.

Some suggestions for improvements follow; you may have thought of other

improvements too.

(1) Keeping teeth and gums healthy neccesitates a regular and through oral hygeine regime. (a) neccesitates necessitates; to remember the spelling of necessary and necessitate

(double “s” but single “c”), you could make up a sentence like this: Never Eat Chocolate, Eat Sausage Sandwiches instead… . Depending on your taste, it could be strawberry strudel rather than curry, or sardine salad rather than cabbage.

(b) hygeine hygiene; the rhyme “i before e, except after c” may be useful here (hence, niece, believe, and sieve but ceiling and receive, although we also have protein, seize, and leisure).

(c) through thorough is the correct word here.

(d) regime regimen; in modern usage, regime is a political system, and regimen is a recommended programme of health care, drug treatment, diet, exercise, etc (and regiment is a military unit). It may be useful to think of the word “medication” to remember regimen.

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The “corrected” sentence is thus: “Keeping teeth and gums healthy necessitates a regular and thorough oral hygiene regimen”. To make it sound less formal, we could use everyday words and revise it as: “Keeping teeth and gums healthy needs a regular and thorough mouth cleaning (or cleansing) routine”. The purpose of the sentence is to explain that one process depends on another, and that people have to actively do something throughout life to maintain oral health. Hence, a more direct version as a statement of fact, and with clarification of the actor in the sentence, could be: “People need to keep their teeth and gums healthy by routinely cleaning them well” (but not “People need to routinely clean their teeth and gums well to keep them healthy” because “them” is ambiguous and could confusingly refer to people or teeth and gums). Alternatively, as a recommendation, it could read: “You need to routinely clean your teeth and gums well to keep them healthy” or “You need to keep your teeth and gums healthy by routinely cleaning them well”.

(2) Bacteria very easily infect peoples’ teeth and gums irregardless of their age. (a) peoples’ people’s; the plural of person is people (or sometimes persons), so the

possessive is people’s.

(b) irregardless regardless; although “irregardless” exists as an (incorrect) word in speech, probably as a blend of regardless and irrespective, it is a double-negative and dictionaries advise the use of regardless in writing instead.

(c) easily readily or quickly; the degree of difficulty faced by the bacterial cells is probably not really the issue.

(d) infect colonise, or attach to and grow on, or form biofilms on, or live on, or establish communities on, etc. An infection is a disease state implying an advanced stage of bacterial multiplication (and contamination or invasion). Bacteria do not initially enter teeth but attach to the surface, feeding off our food and drink from our meals; their waste products are acids, which gradually dissolve the teeth and eventually allow the bacteria to enter. Similarly, bacteria growing on or near gums initially cause gum redness, tenderness, and swelling (inflammation) owing to the body’s response to substances the bacteria make. Instead of infect, we need another term to describe how, within minutes after toothbrushing, free-floating bacteria in the mouth quickly stick to the surfaces of the mouth, multiply, and live in complex communities (biofilms), ready to feed when we feed. In addition, bacterial communities are actually a mix of “harmless” (commensal) and “harmful” (pathogenic) bacteria in balance with each other until certain conditions trigger an imbalance (similarly, the human gut contains beneficial bacteria but their presence is not necessarily an infection; yet, under certain conditions, harmful bacteria outgrow the beneficial ones and cause disease). Hence colonise or recolonise may be a better word. A word related to infect is infest, but that is usually used to describe being over-run by higher organisms such as insects.

(e) their age age; the possessive pronoun “their” could refer to bacteria, people, or teeth and gums, but really refers to the people, so the sentence needs recasting. Alternatively, “their” can be omitted and a preceding comma can be added so that the reader can assume “age” refers to the people.

The “corrected” sentence is thus: “Bacteria very quickly colonise people’s teeth and gums, regardless of age”, or it could be clarified as: “Bacteria very quickly colonise the teeth and gums of people, regardless of their age”, or “Bacteria very quickly colonise the teeth and gums of people of all ages”, or “Bacteria very quickly colonise the teeth and gums of young and old alike”. If the function of the sentence is to warn the public, then “you” could be used and some elaboration added to illustrate everyday relevance, such as “No matter how old or young you are, bacteria very quickly grow back on teeth and gums after you have cleaned them”.

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(3) When biofilm sufferers firstly practice flossing, they may aggravate gums, gum

bleeding is suspicious for gingivitis.

(a) biofilm sufferers people. Biofilms are multiple layers of micro-organisms living on moist

surfaces such as the inside of the mouth (but also elsewhere in the environment such as pipes and rocks); hence, to be more precise, the sentence is about oral biofilms. People might suffer from disease, pain, infection, or advanced effects of biofilms, but not really from the presence of oral biofilms—that is, biofilms are not a disease or a disease name. Furthermore, we all have oral biofilms and they mostly do not cause suffering/pain/symptoms, which is why many people develop gum disease and tooth decay without knowing it. Hence, it is better to avoid the term suffer unless it is literally meant, or if emotional effect is intended; here, “people with oral biofilms” is better, but since we all have them, just “people” is clear enough.

(b) firstly first; adverbs do not always have to end in “-ly” and first is correct here to mean the first time, or first few times.

(c) practice practise. In US English, practice is a noun and verb; in UK English, practice is the noun and practise is the verb. You can use the last three letters of “practice” to remember this: “ice” is a noun. However, “practise flossing” is ambiguous because it could mean learning to floss or just the action of flossing; since the word “first” already implies the start of a new routine, “practise” could be deleted and the clause rephrased.

(d) aggravate gums irritate? Although aggravate and exacerbate mean to make a problem worse and usually refers to existing diseases or conditions, gums themselves cannot be made “worse”, so irritate may be a better verb. However, although flossing or brushing incorrectly may indeed irritate gums, the sentence is actually about effects of biofilms and that bleeding is a warning sign of early gum disease known as gingivitis. The gist of the sentence is that people usually do not know they have gum disease until they see signs such as gum bleeding during flossing. In this context, we can assume that the gums are already irritated by biofilm bacteria, and hence swollen, tender, and prone to bleeding, so aggravate is a suitable verb, but the state of the gums needs to be clarified.

(e) is suspicious for is suggestive of, or is a sign of or suggests; clinical findings might arouse suspicion in general if a diagnosis is unclear, but, in the context of this sentence, the symptoms indicate or suggest a diagnosis, which should be confirmed and followed up by a dentist. Because gum bleeding can be a sign of other diseases, the modal verb “may” is also needed.

The sentence also has a comma splice: the last comma has been incorrectly used instead of a full-

stop (period) or a semi-colon. The “corrected” sentence is thus: “When people first floss, they may

aggravate gums (that are) already affected (or irritated) by bacteria in plaque. Gum bleeding may

be suggestive of gingivitis.” The two thoughts are not quite linked, however. To complete the flow of

logic for the reader, we need to link flossing of already-irritated gums to bleeding and then to

gingivitis. Depending on the context, it may not be necessary to restrict the message to the first use

of floss. We might also want to address the reader as “you” for increased engagement and explain

what the implications are, in a Problem-Solution relationship. A possible revision is: “Because your

gums get irritated by bacteria from plaque, they may sometimes bleed when you floss. Gum

bleeding may be a sign of early gum disease (gingivitis), which can lead to more serious gum

disease (periodontitis) and eventually to tooth loss. Fortunately, gingivitis is reversible with routine

and thorough brushing and flossing. It is best to talk to your dentist about proper brushing and

flossing techniques and to arrange regular dental check-ups.”

(4) A systemic review has recently proved that oral biofilms bacteria can enter into

blood, where they cause systematic infections.

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(a) systemic systematic; a review that includes a methodical and comprehensive analysis of

the existing literature is a systematic review, because it was done in a systematic rather than haphazard or biased way.

(b) recently (proved) recent systematic review, or recently published systematic review; the proving was not recent: the publication of the review was.

(c) proved concluded, found, revealed, shown, etc; although the past participle of prove is either proved or proven, it implies something definitive. The review (secondary) study is likely to be observational (following the natural course of events) rather than experimental (controlling test conditions and measuring effects), and data are likely to be mostly qualitative and descriptive. Even if it were a quantitative hypothesis-testing study that pooled and analysed data from primary studies (that is, a meta-analysis), the result would merely represent support for one hypothesis or another, with a certain degree of confidence. A neutral reporting verb would therefore be more appropriate. Moreover, it is unclear if the finding is about the blood entry or about infections; to clarify how the rest of the sentence relates to this verb, the sentence needs recasting.

(d) oral biofilms bacteria bacteria from oral biofilms. It looks as if an apostrophe is missing (oral biofilms’ bacteria) or the “s” should be deleted because plurals lose their “s” when used like an adjective to premodify another noun (oral biofilm bacteria), but it is better to put the head noun first followed by a prepositional phrase to clarify the relationship between the terms.

(e) enter into blood enter the blood circulation; enter does not take a preposition (unless when used in a special way, such as “enter into a contract”; however “gain entry into” is OK) and blood is too vague and sounds like the substance in general, similar to saying “salt dissolves in water”. The definite article is needed (the blood); or, to link the phrase to the rest of sentence on distant infections, the blood circulation or the bloodstream is really meant.

(f) where by which, or through which; the blood or the blood circulation is not the place where the infections occur (although at a certain concentration of bacteria in the blood, the state may be classified as septicaemia)—rather, the blood is the carriage system by which bacteria reach distant organs.

(g) cause may cause, or might cause; the evidence, as appraised in a recent systematic review, is so far circumstantial (see reference below), and a possible association or link is not the same as direct cause-and-effect.

(h) systematic infections systemic infection; systemic means throughout a system—here, the whole body—meaning that bacteria from the mouth may be able to spread to the rest of the body. The word infection needs to be singular since it is a general term for any infection elsewhere in the body; it could be plural if more than one infection site is specifically meant. Alternatively, the phrase could be clarified, in terms of infections in multiple distant sites.

The “corrected” sentence is thus: “A recent systematic review has concluded that bacteria from oral biofilms can enter the blood circulation, through which they might cause systemic infection”. It could also be clarified as: “A recent systematic review has concluded that bacteria from oral biofilms can enter the blood circulation and may be associated with systemic infection”, or “A recent systematic review has concluded that bacteria from oral biofilms can enter the blood circulation and might cause infections in distant organs”, or “A recent systematic review has concluded that bacteria from oral biofilms might cause infections in distant organs by spreading through the blood circulation”. It would be good to include the reference too: Parahitiyawa NB, Jin LJ, Leung WK, Yam WC, Samaranayake LP. Microbiology of odontogenic bacteremia: beyond endocarditis. Clin Microbiol Rev 2009;22:46-64. However, an additional clarification is needed that the review was about possible infections apart from those of the heart.