Oral Health Tips for Smokers

Oral Health Tips for Smokers

* Seek out resources for assistance: www.cancer.org, www.hazelton.org, www.smokefree.gov, www.pointperio.com.
* Schedule an exam with your physician to identify the right smoking cessation program. Inquire about a counseling service, nicotine patch or gum, nasal inhalers and sprays or non-nicotine prescription medications.
* Schedule a professional dental cleaning and oral health checkup. Inform your dentist that you are a smoker and ask to be screened for periodontal disease and other smoking-related conditions.
* Be certain to maintain a proper dental hygiene home program. Smokers have special dental hygiene needs. For example, smokers usually require professional cleaning more often than non-smokers. Treat yourself to a new tongue cleaner, dental floss and mouthwash.
* Initiate a stress reduction program such as an exercise regimen, Pilates or a yoga class.

Smokers’ Challenges & Solutions

The challenge in quitting smoking lies in both the physical and emotional dependency caused by the nicotine in cigarettes. Nicotine is a drug equally addictive to other narcotics. The physical withdrawal from cigarettes may include headaches, nausea, cold sweats, and tremors. The emotional symptoms may include depression, irritability, nervousness, fatigue, and a lack of concentration.

find a local dentistSince withdrawal from smoking can be one of the most difficult challenges to overcome, the healthcare community has developed a wealth of solutions to assist you. There are state-sponsored “quit smoking” hotlines, prescription medications, and over-the-counter drugs designed to help you through the withdrawal period.

There are behavioral modification programs that can be accessed through state sponsored “quit smoking” hotlines. You may have access to one-on-one therapy offered by private psychologists, therapists, counselors or in some cases, through prescription medication companies. In the end, the advantages of quitting are far greater than the risks associated with smoking.

Whose Oral Health is Affected by Poor Nutritional Habits?

Whose Oral Health is Affected by Poor Nutritional Habits?

Minerals and Nutrients Necessary for Oral Health

The number of people consuming sugar-filled sodas, sweetened fruit drinks and snacks that contain little, if any, nutritional value is skyrocketing among the general population.

Eating patterns and food choices, particularly among children and teens, are important factors that affect how quickly tooth decay develops. Dentists believe that children who consume too much soda are more prone to tooth decay and serious ailments, such as diabetes and osteoporosis, later in life. However, foods high in carbohydrates, as well as some fruits, juices and sodas, peanut butter, crackers and potato chips, also contribute to cavities in children.

The elderly, individuals on restrictive diets and those undergoing medical treatment may be too isolated, weak or lack the appetite, time, resources or money to eat nutritionally balanced meals at a time when it is especially vital. As a result, these individuals may be afflicted by tooth loss, pain or a joint dysfunction such as temporomandibular joint (TMJ) disorder, all of which can impair an individual's ability to taste, bite, chew and swallow foods.

People who are severely underweight or overweight (struggling with obesity), who have recently lost weight and/or are malnourished or take medications (steroids, immunosuppressants, chemotherapeutic agents, etc.), may have a poor nutritional state that could negatively impact their dental caries rate, also.

If you or someone you know is experiencing any of these circumstances, talk to your dentist about solutions and remedies to the situation. It is important to keep all members of your healthcare team informed and up-to-date about your medical history, lifestyle and eating habits so they can work together to identify, prevent and/or control oral and medical health risks.

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Nutrition affects teeth during development. Poor nutrition may exacerbate periodontal disease, a leading cause of tooth loss in adults, as well as other oral infectious diseases. Although poor nutrition does not cause gum disease directly, many researchers think the disease progresses faster and more severely in people with poor nutritional habits.

Therefore, getting the proper amount of vitamins, minerals, fats and protein is essential for the growth and regeneration of normal tissues, as well as your body's ability to fight infections. Carbohydrates, fat and protein supply the energy your body needs for tissue maintenance and repair. Along with vitamin C, vitamins A, E, B, K and D are essential for healing and a quicker recovery time. For example, vitamin A significantly contributes to healing by reducing the inflammatory period of tissue repair.

Important minerals and nutrients your body needs to stay healthy include the following:

Calcium:
Your teeth and jaws are made mostly of calcium. Without enough calcium in your diet, you may develop gum disease and tooth decay. Calcium is found in many foods and liquids, such as milk and dairy products, beans, broccoli, nuts and oysters.

Iron:
Iron deficiency can cause tongue inflammation and mouth sores. Iron is found in foods such as red meat, bran cereals and some nuts and spices.

Vitamin B3 (niacin):
A lack of vitamin B3 can cause bad breath and canker sores. To boost your B3 levels, eat chicken and fish.

Vitamins B12 and B2 (riboflavin):
Mouth sores can develop when you do not get enough Vitamins B12 and B2. Red meat, chicken, liver, pork and fish, as well as dairy products like milk, yogurt and cheese, are good sources of vitamin B12. Vitamin B2 is found in foods like pasta, bagels, spinach and almonds.

Vitamin C:
Vitamin C deficiency may lead to bleeding gums and loose teeth. Sweet potatoes, raw red peppers and oranges are great sources of vitamin C.

Vitamin D:
Vitamin D helps your body absorb calcium, which helps build strong bones and teeth. A diet lacking or low in vitamin D can lead to burning mouth syndrome. Symptoms of this condition include a burning mouth sensation, a metallic or bitter taste in your mouth and mouth dryness. To increase your vitamin D intake, drink milk, and eat egg yolks and fish. Limited amounts of sunshine help the body to produce Vitamin D.

Preventive Dentistry Strategies

Preventive Dentistry Strategies

Preventive oral care strategies for children and adults include a number of in-office and home care activities, including:

At-home oral hygiene.
The most important prevention technique is brushing and flossing at least twice a day (or after every meal) to remove dental plaque, a film-like coating that forms on your teeth. If not removed, plaque can build up and produce dental tartar, a hardened, sticky substance with acid-producing bacteria that cause tooth decay and lead to gum disease.

Fluoride use.
Fluoride strengthens teeth and prevents tooth decay. Fluoride treatments are provided in dental offices, and dentists recommend using fluoride toothpastes and mouth rinses at home. Public water fluoridation – ranked as one of the 20th century's 10 great public health achievements – provides a major source of fluoride.

Diet.
A balanced diet is a dental health essential. Foods with sugars and carbohydrates feed the bacteria that produce dental plaque, while calcium-poor diets increase your chances of developing gum (periodontal) disease and jaw deterioration.

Regular dental visits.
Since most dental conditions are painless at first, if you don't regularly visit your dentist, you may not be aware of dental problems until they cause significant damage. For best results, schedule regular dental check-ups every six months; more often if you're at higher risk for oral diseases. Your dentist should also perform oral cancer screenings to check for signs of abnormal tissues. Especially for children, checking oral growth and development (including an assessment for caries development) should be part of dental evaluations.

Dental cleanings and screenings. A dental cleaning (prophylaxis) is recommended every six months to remove dental plaque and stains you're unable to remove yourself, as well as to check for signs of tooth decay.

X-rays.
X-rays enable dentists to look for signs of dental problems that are not visible to the naked eye, such as cavities between teeth and problems below the gum line.

Mouth guards.
Mouth guards – particularly a custom-made mouth guard prescribed by your dentist to provide a better fit – can be worn during sports activities to protect against broken teeth. Mouth guards also are used to treat teeth grinding (bruxism), which can wear down teeth and contribute to temporomandibular joint (TMJ) disorder.

Orthodontics. A bad bite (malocclusion) can impair eating and speaking, and crooked teeth are hard to keep clean. Correcting an improper bite with orthodontics that may include the use of dental braces or clear teeth aligners (invisible braces), such as Invisalign or Invisalign Teen, limits the possibility of future dental problems.

Sealants. Sealants are thin composite coatings placed on the chewing surfaces of back permanent teeth to protect your child from tooth decay.

Avoid smoking and drinking.
Smoking, chewing tobacco and alcohol consumption can negatively affect your oral health. Apart from dry mouth, tooth discoloration and plaque buildup, smoking causes gum disease, tooth loss and even oral cancer.

Oral health management.
Consistent dental care for chronic dental diseases/conditions is essential for arresting or reversing their harmful effects.

Patient education.
Patients who understand the outcome of poor dental health are likelier to see their dentist for preventive dentistry treatments. Instilling excellent oral hygiene habits significantly helps ensure a lifetime of dental health.Preventive Dentistry Strategies

Nutritional Tips for Good Oral Health

Nutritional Tips for Good Oral Health

* Maintain a healthy and balanced diet centered on moderation and variety. Select foods from each of the five major food groups (breads, cereals and other grain products; fruits; vegetables; meat, poultry, fish and beans; and milk and dairy products).
* Keep a food diary for a week. Record every item you eat and drink, especially ones that contain sugar. Compare your dietary entries to the food pyramid recommendations of the U.S. Department of Agriculture (USDA) by visiting mypyramid.gov.
* Avoid “fad diets” that limit or eliminate entire food groups, which usually result in vitamin or mineral deficiencies.
* Drink plenty of water. This keeps your mouth moist and helps to wash away loose food particles.
* Limit the number of snacks between meals. Remember that each time you eat foods that contain sugar, your teeth are bombarded with acids for 20 minutes or more.
* Keep your consumption of foods containing free sugars to a maximum of four times a day.
* If you must snack, opt for healthy foods that are low in sugar and do not stick to your teeth. Cheese, raw vegetables, nuts, plain yogurt or a piece of fruit are good choices.
* find a local dentistWhen you eat fermentable carbohydrates like crackers, cookies and chips, eat them as part of your meal, instead of by themselves. Combinations of foods neutralize acids in the mouth and inhibit tooth decay.
* Drinking soda at meal times is less harmful to your teeth than drinking it alone; continuously sipping soda over time is more harmful than drinking the entire can of soda at once. To help reduce the amount of soda that comes into direct contact with your teeth, try drinking with a straw.

consultation with a cosmetic dentist

consultation with a cosmetic

Your initial consultation with a cosmetic dentist is an opportunity for you to learn about the practice that you've narrowed down your search to, as well as discuss what you like and don't like about your smile. It's also an opportunity for you and the cosmetic dentist to establish realistic expectations for your cosmetic dental treatment.

Consultations for cosmetic dentistry treatments typically include records gathering. Because these records are important for developing a unique and precise cosmetic dental treatment plan that will satisfy your needs, a significant amount of time may be spent for this purpose. Records gathering involves, but is not limited to:

* A comprehensive intraoral examination and inspection of any existing dental work.
* Intraoral photographs
* Radiographs (x-rays)
* Impressions of your upper and lower teeth (models and study casts will be made later).
* Looking through smile design books that show an assortment of before and after photographs of different cosmetic dental procedures.
* Reviewing different tooth shapes and sizes to see what appeals to you.
* Discussing tooth color
* Using a computer monitor, reviewing your smile tooth by tooth with the cosmetic dentist so you can thoroughly understand what can be changed and how.

Your consultation may also include a meeting with a patient coordinator. The patient coordinator's role in the cosmetic dental practice is to help you with scheduling appointments and follow-up care.

You may also meet with the practice's office manager to discuss the types of financing or payment options available to help you manage the cost of your cosmetic dentistry treatment – dental insurance does not typically provide coverage for cosmetic treatment. If not, remember to ask about what the financing options are. While payment plans are available through a number of dental loan providers, your cosmetic dentist may offer in-house payment options as well.


Considerations for the Consultation

Cosmetic dentistry results may vary and are dependent on the skill of your dentist. Finding a qualified cosmetic dentist therefore requires careful consideration, even during the consultation stages of treatment.

During your consultation, make note of how you feel about the practice's ambiance. Specifically, are you comfortable with the cosmetic dentist's chair-side manner? Is the staff friendly, welcoming and quick to address your concerns? Since cosmetic dentistry treatment can take time, it is important to establish a rapport with all individuals involved.

If the cosmetic dentist provides you with a diagnosis and treatment plan during the consultation, it is important that he or she share that information with you in detail. Make sure that you understand your diagnosis and any viable treatment alternatives. Make sure that you feel completely comfortable with the level of detail and thoroughness of the explanations you are given so that you can make an educated decision about your cosmetic dental treatment.

Likewise, when providing you with a treatment plan, the cosmetic dentist should be able to tell you about the type of materials that will be used in the fabrication of your restorations. Be sure to ask about how long the results are expected to last and the type of maintenance required in order to sustain the benefit of the procedures. For example, teeth whitening must be repeated every three to six months – depending upon the procedure you choose – in order to maintain the benefits. Similarly, you may be required to wear a protective mouth guard at night to help maintain your veneers.
find a local dentist

Since most cosmetic dentistry procedures include restorations made in a dental laboratory, ask about the dental laboratory technician your dentist plans to involve in your treatment plan. Is the laboratory technician or ceramist a Certified Dental Technician or an accredited member of the AACD? Has the dentist worked with this laboratory technician for many years and/or on similar cases in the past?

When you select a cosmetic dentist, you are selecting a dental professional who will help you change your appearance by changing the look of your teeth and your smile. It is a very personal and important choice. Most procedures are not reversible, so you will want to take your time, ensure that you feel comfortable with the dentist, and that you feel confident with his/her skills and capabilities. When you do, you will likely be happy and completely satisfied with the results that are achieved with the cosmetic dentistry treatment you receive

DENTAL CROWN

DENTAL CROWN

The cost of a depends on several factors, including the technical demands of the treatment, the training and expertise of the dentist, the training and expertise of the dental technologist, and the location of the dentist.

Dental Crowns may range in price from $1,000 to $3,500 and last between 10 and 15 years or longer, though results vary depending upon your unique considerations. In esthetically-demanding situations, it can be helpful to ask the treating dentist for clinical photographs of treatment they have provided in the past to visualize the expertise and skill of the dental team being selected.
Selecting a Crown Dentist

Both the dentist and the laboratory technologist play a role in the design and treatment outcome of a crown. Art and science are important factors in designing the proper anatomical features of the crown to provide the best possible fit in the mouth.

Some of the technologies and material choices for today's crowns are fairly new, making it important to know how much experience the dentist has with the equipment used in the procedure. General dentists, family dentists, cosmetic dentists and prosthodontists may perform all treatment options; however, the level of expertise varies among dentists. For example, prosthodontists receive an additional two- to three-years of training focused on understanding complex tooth and bone structures, which may be applicable to your case.
Prolonging the Life of the Crown

The longevity of the full coverage crown is determined by the precision of its fit to the underlying tooth. The fit of a crown can vary tremendously and requires attention to detail by the providing dentist. An ill-fitted dental crown can house bacteria that may build into more serious tooth decay in years to come.

It is also important that the tooth be in a healthy state to ensure its longevity. In all cases, your dentist will evaluate the gums and supporting bone structure to ensure these supporting tissues are in a healthy state. This protects the tooth and minimizes the potential for eventual gum recession that exposes the crown margin.

what type of Braces do you want ?

what type of braces do you want ?

Thanks to today’s technology, patients now have more options when it comes to wearing braces. While regular metal braces are still widely used, clear braces are becoming increasingly popular along with new self-ligating high-tech braces. Removable appliances can still be used for mild cases of misaligned teeth.


Metal Braces

The most common type. Today’s metal braces are smaller, more comfortable and more attractive.

Clear Braces

Made of transparant materials, most popular with adult patients, due to their esthetic appeal. Drawbacks are that they are more fragile and less efficient.


Damon Braces

The new self-ligating high-tech braces eliminate the need for elastic o-rings thus more hygienic. Damon braces are more comfortable, move teeth faster and require fewer control visits for the patients.

Lingual Braces

Custom made and bonded to the back of the teeth making it invisible to others. Very complicated and can be uncomfortable

Removable Appliances

Usually used in children with mixed dentition and mild cases. Treatment effect is highly dependent upon patients cooperativeness in using the appliance. Can be used as an adjunct to fixed appliance.

What are the causes of Chest Pain?

What are the causes of chest pain?

Chest pain is one of the most common complaints that will bring a patient to the Emergency Department. Seeking immediate care may be lifesaving, and considerable public education has been undertaken to get patients to access medical care when chest pain strikes. While the patient may be worried about a heart attack, there are many other causes of pain in the chest that the healthcare provider will need to consider. Some diagnoses are life threatening, while others are less dangerous.

Deciding the cause of chest pain is sometimes very difficult and may require blood tests, x-rays, CT scans and other tests to sort out the diagnosis. Often though, a careful history taken by the healthcare provider may be all that is needed to find the answer.

Teeth Whitening ...

Do you sometimes ask yourself why are you so unfortunate for having such yellow teeth? Are you always shy to go out because you don't want people to notice your yellow teeth because you feel that you might feel more terrible about yourself? Having yellow teeth can be such an awful thing. However, you shouldn't dwell on the fact that you have yellow teeth because you can still do something to make your teeth look whiter than ever. Remember that anything is possible if you believe you can do the things that you need to do.


There are actually hundreds of possible and guaranteed ways that can help you make your teeth look whiter than ever. Besides brushing your teeth each and every meal, you can as well have the biggest chance to have pearly whites if you will consider using the best teeth whitening gel that you can easily order online.

You don't need to worry so much about your yellow teeth because there are hundreds of guaranteed ways that can help you have whiter teeth very soon. Remember that as much as possible, you need to avoid drinking coffee, soda or tea because these drinks will only give you yellow teeth. So besides brushing your teeth after each meal and using the best teeth whitening gel, you must as well try your best to avoid drinking beverages that have artificial colors in it.

Remember that if you're going to brush your teeth right after each meal and if you're going to use the best teeth whitening gel and you won't drink coffee, soda or tea anymore, it won't take long until you're going to make your teeth look whiter than ever. You don't really need to go to the dentist's clinic just to have professional results of having whiter teeth because in simple ways you can as well achieve effective results that will definitely change the color of your teeth for the better.

You deserve to feel so much better about yourself that's why you shouldn't think twice about doing things that can make you have whiter teeth than ever. I wish you all the best and good luck!

Dental plaque identification

Dental Plaque Identification at Home

The home dental plaque identification test identifies plaque, a sticky substance that collects around and between teeth. The test helps show how well you are brushing and flossing your teeth.

Plaque is the major cause of tooth decay and gum disease (gingivitis). It is hard to see with the naked eye because it is whitish colored, like teeth.

How the Test is Performed

There are two ways to perform this test. One method uses special tablets that contain a red dye that stains the plaque. One tablet is chewed thoroughly, moving the mixture of saliva and dye over the teeth and gums for about 30 seconds. The mouth is then rinsed with water and the teeth are examined to identify pink-stained areas (unremoved plaque). A small dental mirror may help to check all areas.

The second method uses a plaque light. A special fluorescent solution is swirled around the mouth. The mouth is rinsed gently with water, and the teeth and gums are examined while shining an ultraviolet plaque light into the mouth. The advantage of this method is that it leaves no pink stains in the mouth.

In the office, dentists are often able to detect plaque through a thorough examination with dental instruments.

Normal Results

No plaque or food debris will be seen on the teeth.


What Abnormal Results Mean

The tablets will stain areas of plaque dark-red.

The plaque light solution will color the plaque a brilliant orange-yellow.

The colored areas show where the brushing and flossing have missed. These areas need to be brushed again to get rid of the stained plaque.

Considerations

The tablets may cause a temporary pink coloring of the lips and cheeks. They may color the mouth and tongue red. Dentists suggest using them at night so that the color will be gone by morning.

Osteomyelitis

Osteomyelitis

Osteomyelitis is an acute or chronic bone infection.

Causes

Bone infection can be caused by bacteria or fungi.

* Infection may also spread to a bone from infected skin, muscles, or tendons next to the bone, as in osteomyelitis that occurs under a chronic skin ulcer (sore).
* The infection that causes osteomyelitis can also start in another part of the body and spread to the bone through the blood.
* A current or past injury may have made the affected bone more likely to develop the infection. A bone infection can also start after bone surgery, especially if the surgery is done after an injury or if metal rods or plates are placed in the bone.

In children, the long bones are usually affected. In adults, the feet, spine bones (vertebrae), and the hips (pelvis) are most commonly affected.

Risk factors are recent trauma, diabetes, hemodialysis, poor blood supply, and IV drug abuse. People who have had their spleen removed are also at higher risk for osteomyelitis.


Symptoms

* Bone pain
* Fever
* General discomfort, uneasiness, or ill-feeling (malaise)
* Local swelling, redness, and warmth
* Nausea

Additional symptoms that may be associated with this disease:

* Chills
* Excessive sweating
* Low back pain
* Swelling of the ankles, feet, and legs

Treatment

The objective of treatment is to eliminate the infection and prevent it from getting worse.

Antibiotics will be given to destroy the bacteria that are causing the infection. You may be given more than one antibiotic at a time. Often, the antibiotics are given through an IV (intravenously, meaning through a vein) rather than by mouth. Antibiotics are taken for at least 4-6 weeks, sometimes longer.

Surgery may be needed to remove dead bone tissue if you have an infection that does not go away. If there are metal plates near the infection, they may be removed. The open space left by the removed bone tissue may be filled with bone graft or packing material that promotes the growth of new bone tissue.

Infection of an orthopedic prosthesis may require surgical removal of the prosthesis and infected tissue surrounding the area. A new prosthesis may be implanted in the same operation or delayed until the infection has gone away.

If the patient has diabetes, it will need to be well controlled. If there are problems with blood supply, surgery to improve blood flow may be needed.

Periodontitis is inflammation and infection of the ligaments and bones that support the teeth

Periodontitis

Periodontitis is inflammation and infection of the ligaments and bones that support the teeth

Causes

Periodontitis occurs when inflammation or infection of the gums (gingivitis) is untreated or treatment is delayed. Infection and inflammation spreads from the gums (gingiva) to the ligaments and bone that support the teeth. Loss of support causes the teeth to become loose and eventually fall out. Periodontitis is the primary cause of tooth loss in adults. This disorder is uncommon in childhood but increases during adolescence.

Plaque and tartar accumulate at the base of the teeth. Inflammation causes a pocket to develop between the gums and the teeth, which fills with plaque and tartar. Soft tissue swelling traps the plaque in the pocket. Continued inflammation eventually causes destruction of the tissues and bone surrounding the tooth. Because plaque contains bacteria, infection is likely and a tooth abscess may also develop, which increases the rate of bone destruction.


Treatment


The goal of treatment is to reduce inflammation, eliminate pockets if present, and address any underlying causes. Rough surfaces of teeth or dental appliances should be repaired. General illness or other conditions should be treated.

It is important to have the teeth cleaned thoroughly. This may involve use of various instruments or devices to loosen and remove deposits from the teeth (scaling). Meticulous home oral hygiene is necessary after professional tooth cleaning to limit further destruction. The dentist or hygienist will demonstrate brushing and flossing techniques. It is often recommended that patients with periodontitis have professional tooth cleaning more frequently than twice a year.

Surgery may be necessary. Deep pockets in the gums may need to be opened and cleaned. Loose teeth may need to be supported. Your dentist may need to remove a tooth or teeth so that the problem doesn't get worse and spread to

The mouth

Oral cavity

The mouth, also called the (oral cavity) or buccal cavity is the entranceway into the digestive system containing both primary and accessory organs of digestion.

The mouth is designed to support chewing, (mastication) and swallowing, (deglutition), and speech (phonation).

Two rows of teeth are supported by facial bones of the skull, the maxilla above and the mandible below.

Teeth are surrounded by gingiva, or gums, part of the periodontium, support tissue of oral cavity protection.

In addition to the teeth, other structures that aid chewing are the lips, cheeks, tongue, hard palate, soft palate, and floor of the mouth.

Teeth

Humans normally will produce two sets of teeth called primary dentition, or deciduous teeth, and secondary dentition, or permanent teeth.

A tooth is the toughest known substance in the body exceeding bones in density and strength. Tooth enamel lends great strength to the tooth structure. The formation of a developing tooth includes the process of dentin formation, (see: Dentinogenesis) and enamel formation, (see: amelogenesis). As the tooth breaks through the gum into the mouth, the process is called eruption. The formation of teeth begins in early fetal development and goes through six stages:

* (1) initiation stage, 6th - 7th week
* (2) bud stage, 8th wk
* (3) cap stage, 9th-10 wk
* (4) bell stage, 11th-12th wk
* (5) apposition
* (6) maturation stage

Tooth enamel is white initially but is susceptible to stains from coffee and cigarette usage. A tooth sits in a specialized socket called gomphosis. The tooth is held in location by a periodontal ligament, with the assistance of cementum.

The white visible part of a tooth is called the crown. The rounded upper projections of the back teeth are cusps. The hard white exterior covering of the tooth is the enamel. As the tooth tapers below the gumline, the neck is formed. Below the neck, holding the tooth into the bone, is the root of the tooth. The inner portions of the tooth consist of the dentin, a bonelike tissue, and the pulp. The pulp is a soft tissue area containing the nerve and blood vessels to nourish and protect the tooth, located within the pulp cavity.

There are various tooth shapes for different jobs. For example, when chewing, the upper teeth work together with the lower teeth of the same shape to bite, chew, and tear food. The names of these teeth are:

* (1) Incisors, there are eight incisors located in the front of the mouth (four on the top and four on the bottom). They have sharp, chisel-shaped crowns that cut food.
* (2) Cuspids (or canine tooth), the four cuspids are next to each incisor. Cuspids have a pointed edge to tear food.
* (3) Premolars (or bicuspids), the four pairs of molars are located next to the cuspids. They crush and tear food.
* (4) Molars, there are twelve molars, in sets of three, at the back of the mouth. They have wide surfaces that help to grind food.

Adults have 32 permanent teeth, and children have 20 deciduous teeth.

Salivary glands

There are three sets of salivary glands: the parotid, the submandibular and the sublingual glands. The (exocrine) glands secrete saliva for proper mixing of food and provides enzymes to start chemical digestion.

Saliva also helps to hold together the formed bolus which is swallowed after chewing.

Saliva is composed of primarily of water, ions, salivary amylase, lysozymes, and trace amounts of urea.

Periodontium

The periodontium includes all of the support membranes of the dental structures surround and support the teeth such as the gums and the attachment surfaces and membranes.

This includes epithelial tissues (epithelium), connective tissues, (ligaments and bone), muscle tissue and nervous tissue.

Tongue

The tongue is a specialized skeletal muscle that is specially adapted for the activities of speech, chewing, developing gustatory sense (taste) and swallowing.

It is attached to the hyoid bone.

Terms meaning tongue include "glosso" and "lingual."

Mucosa

The protective tissues of the oral cavity are continuous with the digestive tract are called mucosa or mucous membranes.

They line the oral, nasal, and external auditory meatus, (ear), providing lubrication and protection against pathogens.

This is a stratified squamous epithelium containing about three layers of cells.

The lips are also protected by specialized sensory cells called Meissner's corpuscles.

The cells of the inner oral cavity are called the buccal mucosa.

Problems with complete dentures

Problems with complete dentures

Problems with dentures include the fact that patients are not used to having something in their mouth that is not food. The brain senses this appliance as "food" and sends messages to the salivary glands to produce more saliva and to secrete it at a higher rate. This will only happen in the first 12 to 24 hours, after which, the salivary glands return to their normal output. New dentures can also be the cause of sore spots as they compress the soft tissues mucosa (denture bearing soft tissue). A few denture adjustments for the days following insertion of the dentures can take care of this issue. Gagging is another problem encountered by a minority of patients. At times, this may be due to a denture that is too loose, too thick or extended too far posteriorly onto the soft palate. At times, gagging may also be attributed to psychological denial of the denture. (Psychological gagging is the most difficult to treat since it is out of the dentist's control. In such cases, an implant supported palateless denture may have to be constructed or a hypnotist may need to be consulted). Sometimes there could be a gingivitis under the full dentures, which is caused by accumulation of dental plaque.

One of the most common problems for new full upper denture wearers is the loss of taste.

Another problem with dentures is keeping them in place. There are three rules governing the existence of removable oral appliances: support, stability and retention.

Prosthodontic principles of dentures

Support
Support is the principle that describes how well the underlying mucosa (oral tissues, including gums and the vestibules) keeps the denture from moving vertically towards the arch in question, and thus being excessively depressed and moving deeper into the arch. For the mandibular arch, this function is provided by the gingiva (gums) and the buccal shelf (region extending laterally (beside) from the posterior (back) ridges), whereas in the maxillary arch, the palate joins in to help support the denture. The larger the denture flanges (part of the denture that extends into the vestibule), the better the support.

Stability
Stability is the principle that describes how well the denture base is prevented from moving in the horizontal plane, and thus from sliding side to side or front and back. The more the denture base (pink material) runs in smooth and continuous contact with the edentulous ridge (the hill upon which the teeth used to reside, but now consists of only residual alveolar bone with overlying mucosa), the better the stability. Of course, the higher and broader the ridge, the better the stability will be, but this is usually just a result of patient anatomy, barring surgical intervention (bone grafts, etc.).

Retention
Retention is the principle that describes how well the denture is prevented from moving vertically in the opposite direction of insertion. The better the topographical mimicry of the intaglio (interior) surface of the denture base to the surface of the underlying mucosa, the better the retention will be (in removable partial dentures, the clasps are a major provider of retention), as surface tension, suction and just plain old friction will aid in keeping the denture base from breaking intimate contact with the mucosal surface. It is important to note that the most critical element in the retentive design of a full maxillary denture is a complete and total border seal (complete peripheral seal) in order to achieve 'suction'. The border seal is composed of the edges of the anterior and lateral aspects AND the posterior palatal seal. The posterior palatal seal design is accomplished by covering the entire hard palate and extending not beyond the soft palate and ending 1–2 mm from the vibrating line.

As mentioned above, implant technology can vastly improve the patient's denture-wearing experience by increasing stability and saving his or her bone from wearing away. Implant can also help with the retention factor. Instead of merely placing the implants to serve as blocking mechanism against the denture pushing on the alveolar bone, small retentive appliances can be attached to the implants that can then snap into a modified denture base to allow for tremendously increased retention. Options available include a metal Hader bar or precision balls attachments, among other things.


Complications and recommendations

The fabrication of a set of complete dentures is a challenge for any denturist, including those who are experienced. There are many axioms in the production of dentures that must be understood, of which ignorance of one axiom can lead to failure of the denture case. In the vast majority of cases, complete dentures should be comfortable soon after insertion, although almost always at least two adjustment visits will be necessary to remove sore spots. One of the most critical aspects of dentures is that the impression of the denture must be perfectly made and used with perfect technique to make a model of the patient's edentulous (toothless) gums. The denturist must use a process called border molding to ensure that the denture flanges are properly extended. An endless array of never-ending problems with denture may occur if the final impression of the denture is not made properly. It takes considerable patience and experience for a denturist to know how to make a denture, and for this reason it may be in the patient's best interest to seek a specialist, either a Denturist or a Prosthodontist, to make the denture. A general dentist may do a good job, but only if he or she is meticulous and usually he or she must be experienced.

The maxillary denture (the top denture) is usually relatively straightforward to manufacture so that it is stable without slippage. The lower full denture tends to be the most

-_ lower full denture should or must be supported by 2-4 implants placed in the lower jaw for support. A lower denture supported by 2-4 implants is a far superior product than a lower denture without implants, held in place with weak lower mouth muscles. It is routine to be able to bite into an apple or corn-on-the-cob with a lower denture anchored by implants. Without implants, it is quite difficult or even impossible to do so.

Some patients who believe they have "bad teeth" may think it is in their best interests to have all their teeth extracted and full dentures placed. However, statistics show that the majority of patients who actually receive this treatment wind up regretting they did so. This is because full dentures have only 10% of the chewing power of natural teeth, and it is difficult to get them fitted satisfactorily, particularly in the mandibular arch. Even if a patient retains one tooth, that will contribute to the denture's stability. However, retention of just one or two teeth in the upper jaw does not contribute much to the overall stability of a denture, since a full upper denture tends to be very stable, in contrast to a full lower denture. It is thus advised that patients keep their natural teeth as long as possible, especially their lower teeth.

The oral cavity

Oral bacteria

Oral bacteria include streptococci, lactobacilli, staphylococci, corynebacteria, and various anaerobes in particular bacteroides. The oral cavity of the new-born baby does not contain bacteria but rapidly becomes colonized with bacteria such as Streptococcus salivarius. With the appearance of the teeth during the first year colonization by Streptococcus mutans and Streptococcus sanguis occurs as these organisms colonise the dental surface and gingiva. Other strains of streptococci adhere strongly to the gums and cheeks but not to the teeth. The gingival crevice area (supporting structures of the teeth) provides a habitat for a variety of anaerobic species. Bacteroides and spirochetes colonize the mouth around puberty.

Treponema denticola

The levels of oral spirochetes are elevated in patients with periodontal diseases. Among this group, Treponema denticola is the most studied and is considered as one of the main etiological bacteria of periodontitis. Treponema denticola is a motile and highly proteolytic bacterium.

Fusospirochetes

Spirochetes and fusi-form bacilli live as normal flora in the mouth, but in the case of bleeding in the oral cavity, the bacteria can cause infection and diseases to oral cavity: 1/ Acute necrotizing ulcerative gingivitis (ANUG) 2/ Vincent angina with a membrane covering the throat area

Veillonella

Veillonella are gram-negative anaerobic cocci. It is thought that this species thrives in the acidic environment of caries and is thought to slow the development of dental caries. It converts the acidic products of other species to less acidic products.

Porphyromonas gingivalis

Porphyromonas gingivalis is a Gram-negative oral anaerobe strongly associated with chronic adult periodontitis. The bacterium produces a number of well-characterized virulence factors and can be manipulated genetically. The availability of the genome sequence is aiding our understanding of the biology of P. gingivalis and how it interacts with the environment, other bacteria and the human host.

Aggregatibacter actinomycetemcomitans

Aggregatibacter actinomycetemcomitans is considered an oral pathogen due to its virulence factors, its association with localized aggressive periodontitis in young adolescents, and studies indicating that it can cause bone loss.

Lactobacillus

Some Lactobacillus species have been associated with dental caries although these bacteria are normally symbiotic in humans and are found in the gut flora.

Destruction of enamel

Destruction of enamel

The high mineral content of enamel, which makes this tissue the hardest in the human body, also makes it susceptible to a demineralization process which often occurs as dental caries, otherwise known as cavities.[16] Demineralization occurs for several reasons, but the most important cause of tooth decay is the ingestion of sugars. Tooth cavities are caused when acids dissolve tooth enamel:

Ca10(PO4)6(OH)2(s) + 8H+(aq) → 10Ca2+(aq) + 6HPO42-(aq) + 2H2O(l)

Sugars from candies, soft drinks, and even fruit juices play a significant role in tooth decay, and consequently in enamel destruction. The mouth contains a great number and variety of bacteria, and when sucrose, the most common of sugars, coats the surface of the mouth, some intraoral bacteria interact with it and form lactic acid, which decreases the pH in the mouth.Then, the hydroxylapatite crystals of enamel demineralize, allowing for greater bacterial invasion deeper into the tooth. The most important bacterium involved with tooth decay is Streptococcus mutans, but the number and type of bacteria varies with the progress of tooth destruction.

Furthermore, tooth morphology dictates that the most common site for the initiation of dental caries is in the deep grooves, pits, and fissures of enamel. This is expected because these locations are impossible to reach with a toothbrush and allow for bacteria to reside there. When demineralization of enamel occurs, a dentist can use a sharp instrument, such as a dental explorer, and "feel a stick" at the location of the decay. As enamel continues to become less mineralized and is unable to prevent the encroachment of bacteria, the underlying dentin becomes affected as well. When dentin, which normally supports enamel, is destroyed by a physiologic condition or by decay, enamel is unable to compensate for its brittleness and breaks away from the tooth easily.

The extent to which tooth decay is likely, known as cariogenicity, depends on factors such as how long the sugar remains in the mouth. Contrary to common belief, it is not the amount of sugar ingested but the frequency of sugar ingestion that is the most important factor in the causation of tooth decay.[28] When the pH in the mouth initially decreases from the ingestion of sugars, the enamel is demineralized and left vulnerable for about 30 minutes. Eating a greater quantity of sugar in one sitting does not increase the time of demineralization. Similarly, eating a lesser quantity of sugar in one sitting does not decrease the time of demineralization. Thus, eating a great quantity of sugar at one time in the day is less detrimental than is a very small quantity ingested in many intervals throughout the day. For example, in terms of oral health, it is better to eat a single dessert at dinner time than to snack on a bag of candy throughout the day.

In addition to bacterial invasion, enamel is also susceptible to other destructive forces. Bruxism, also known as clenching of or grinding on teeth, destroys enamel very quickly. The wear rate of enamel, called attrition, is 8 micrometers a year from normal factors. A common misconception is that enamel wears away mostly from chewing, but actually teeth rarely touch during chewing. Furthermore, normal tooth contact is compensated physiologically by the periodontal ligaments (pdl) and the arrangement of dental occlusion. The truly destructive forces are the parafunctional movements, as found in bruxism, which can cause irreversible damage to the enamel.

Other nonbacterial processes of enamel destruction include abrasion (involving foreign elements, such as toothbrushes), erosion (involving chemical processes, such as lemon juice), and possibly abfraction (involving compressive and tensile forces).

Though enamel is described as tough, it has a similar brittleness to glass making it unlike other natural crack-resistant laminate structures such as shell and nacre potentially vulnerable to fracture. In spite of this it can withstand the bite forces as high as 1,000 N many times a day during chewing. This resistance is due in part to the microstructure of enamel which contains processes, enamel tufts, that stabilize the growth of such fractures at the dentinoenamel junction.The configuration of the tooth also acts to reduce the tensile stresses that cause fractures during biting.

oral health

Oral hygiene and fluoride

Considering the vulnerability of enamel to demineralization and the daily menace of sugar ingestion, prevention of tooth decay is the best way to maintain the health of teeth. Most countries have wide use of toothbrushes, which can reduce the number of bacteria and food particles on enamel. Some isolated societies do not have access to toothbrushes, but it is common for those people to use other objects, such as sticks, to clean their teeth. In between two adjacent teeth, floss is used to wipe the enamel surfaces free of plaque and food particles to discourage bacterial growth. Although neither floss nor toothbrushes can penetrate the deep grooves and pits of enamel, good general oral health habits can usually prevent enough bacterial growth to keep tooth decay from starting.
Common dentistry trays filled with fluoride foam

These methods of oral hygiene have been helped greatly by the use of fluoride. Fluoride can be found in many locations naturally, such as the ocean and other water sources. Naturally occurring calcium fluoride is not the same as sodium fluoride, a byproduct of the fertilizer industry and the fluoride that is added to drinking water. The recommended dosage of fluoride in drinking water depends on air temperature; in the U.S. it ranges from 0.7 to 1.2 mg/L (milligrams per liter). Fluoride catalyzes the diffusion of calcium and phosphate into the tooth surface, which in turn remineralizes the crystalline structures in a dental cavity. The remineralized tooth surfaces contain fluoridated hydroxyapatite and fluorapatite, which resist acid attack much better than the original tooth did. Fluoride therapy is used to help prevent dental decay.

Many groups of people have spoken out against fluoridated drinking water. One example used by these advocates is the damage fluoride can do as fluorosis. Fluorosis is a condition resulting from the overexposure to fluoride, especially between the ages of 6 months to 5 years, and appears as mottled enamel. Consequently the teeth look unsightly, although the incidence of dental decay in those teeth is very small. It is important, however, to note that all substances, even beneficial ones, are detrimental when taken in extreme doses. Where fluoride is found naturally in high concentrations, filters are often used to decrease the amount of fluoride in water. For this reason, codes have been developed by dental professionals to limit the amount of fluoride a person should take. These codes are supported by the American Dental Association and the American Academy of Pediatric Dentistry. The acute toxic dose of fluoride is ~5 mg/kg of body weight. Furthermore, whereas topical fluoride, found in toothpaste and mouthwashes, does not cause fluorosis, its effects are also less pervasive and not as long-lasting as those of systemic fluoride, such as when drinking fluorinated water.[37] For instance, all of a tooth's enamel gains the benefits of fluoride when it is ingested systemically, through fluoridated water or salt fluoridation (a common alternative in Europe). Only some of the outer surfaces of enamel can be reached by topical fluoride. Thus, despite fluoridation's detractors, most dental health care professionals and organizations agree that the inclusion of fluoride in public water has been one of the most effective methods of decreasing the prevalence of tooth decay.

Teeth cleaning

Brushing, scrubbing and flossing

Careful and frequent brushing with a toothbrush helps to prevent build-up of plaque bacteria on the teeth.[1] These bacteria metabolize carbohydrates in our meals or snacks and excrete acid which demineralizes tooth enamel, eventually leading to tooth decay and toothache if acid episodes are frequent or are not prevented. Calculus (dental) or tartar buildup on teeth usually opposite salivary ducts is because of calcium deposits in resident plaque. Frequent brushing and swishing saliva around helps prevent these deposits. Cavities can be costly, in terms of the monetary cost to drill out the cavities and insert dental fillings, and in terms of the tissue already damaged. Fluoride- containing, or anti-plaque (tartar control) toothpastes may be recommended by the dentist.

Early toothbrushing utilized powdered pumice stone as a polishing agent. Later, flavored powders were mixed with the powered pumice to develop a more tasty toothpowder. In the late 1920's, powdered pumice was mixed with a flavored paste to make toothpaste, with no added treatment agents as found in toothpastes today.

Flossing

In addition to brushing, the use of dental floss too may help to prevent build-up of plaque bacteria on the teeth.

Almost all cavities occur where food is trapped between teeth and inside deep pits and fissures in grooves on chewing surfaces, where the brush, toothpaste, mouthwash, saliva, and chewing gum cannot reach.

Special appliances or tools may be recommended to supplement (but not to replace) toothbrushing and flossing. These include special toothpicks, oral irrigators, or other devices. Initially electric toothbrushes were only recommended for persons who have problems with strength or dexterity of their hands, but many dentists are now recommending them to many other patients to improve their home dental care.

Scrubbing

Unlike tooth brushing, scrubbing can also be done using a twig. With this approach, no brush is used but the twig itself is used to clean the teeth. Plant sap present within the twig make the use of additional tooth paste unneeded. In many parts of the world Teeth cleaning twigs are used. In the Muslim world the miswak or siwak is made from twigs or roots that are alleged to have an antiseptic effect when applied as a toothbrush.

Professional teeth cleaning

Regular teeth cleaning (Prophylaxis) by a dental hygienist is recommended to remove tartar (mineralized plaque) that may develop even with careful brushing and flossing, especially in areas that are difficult for a patient to reach on his own at home. Professional cleaning includes tooth scaling and tooth polishing and debridement if too much tartar has accumulated. This involves the use of various instruments or devices to loosen and remove deposits from the teeth.

Most dental hygienists recommend having the teeth professionally cleaned at least once every 12 to 24 months. More frequent cleaning and examination may be necessary during the treatment of many of the dental/oral disorders. Routine examination of the teeth is recommended at least every year. This may include yearly, select dental X-rays. See also dental plaque identification procedure and removal.

However, in between cleanings by a dental hygienist, good oral hygiene is essential for preventing cavities, tartar build-up, and gum disease.

Complications

Overly vigorous or incorrectly performed brushing or flossing may result in injury to the gingiva (gums). Some results of improper or over vigorous brushing may include: worn-out bristles, unusually sore gums, damage to enamel of teeth, gingivitis and bleeding gums.

One should always call the dentist or dental hygienist if instructions or demonstration of proper brushing or flossing techniques is needed, or to schedule routine dental cleaning and examination.

SURGCAL PROCEDURES

surgical procedures

Treatments may be performed on the craniomaxillofacial complex: mouth, jaws, neck, face, skull, and include:

* Dentoalveolar surgery (surgery to remove impacted teeth, difficult tooth extractions, extractions on medically compromised patients, bone grafting or preprosthetic surgery to provide better anatomy for the placement of implants, dentures, or other dental prostheses)
* Diagnosis and treatment of benign pathology (cysts, tumors etc.)
* Diagnosis and treatment (ablative and reconstructive surgery, microsurgery) of malignant pathology (oral & head and neck cancer).
* Diagnosis and treatment of cutaneous malignancy (skin cancer), lip reconstruction
* Diagnosis and treatment of congenital craniofacial malformations such as cleft lip and palate and cranial vault malformations such as craniosynostosis, (craniofacial surgery)
* Diagnosis and treatment of chronic facial pain disorders
* Diagnosis and treatment of temporomandibular joint (TMJ) disorders
* Diagnosis and treatment of dysgnathia (incorrect bite), and orthognathic (literally "straight bite") reconstructive surgery, orthognathic surgery, maxillomandibular advancement, surgical correction of facial asymmetry.
* Diagnosis and treatment of soft and hard tissue trauma of the oral and maxillofacial region (jaw fractures, cheek bone fractures, nasal fractures, LeFort fracture, skull fractures and eye socket fractures).
* Splint and surgical treatment of sleep apnea, maxillomandibular advancement, genioplasty (in conjunction with sleep labs or physicians)
* Surgery to insert osseointegrated (bone fused) dental implants and Maxillofacial implants for attaching craniofacial prostheses and bone anchored hearing aids.
* Cosmetic surgery limited to the head and neck: (rhytidectomy/facelift, browlift, blepharoplasty/Asian blepharoplasty, otoplasty, rhinoplasty, septoplasty, cheek augmentation, chin augmentation, genioplasty, oculoplastics, neck liposuction, lip enhancement, injectable cosmetic treatments, botox, chemical peel etc.)

Diagnostic caries dentis

Diagnostic Methods
The EPC team evaluated the strength of the evidence describing the performance of diagnostic methods separately for cavitated lesions, lesions involving dentin, enamel lesions, and any lesions. They also separated the evaluations by the surface and tooth type involved. The team found 39 studies reporting 126 histologically validated assessments of diagnostic methods.

* There are few assessments of the performance of any diagnostic methods for primary or anterior teeth, and no assessments of performance on root surfaces. The strength of the evidence describing the performance of any diagnostic method for these teeth and surfaces is poor.
* Among studies assessing diagnostic performance for proximal and occlusal surfaces in posterior teeth, the team rated the strength of the evidence describing the performance of visual/tactile, fiberoptic transillumination (FOTI), and laser fluorescence methods as poor due to the small numbers of studies available.
* They also rated the strength of the evidence for radiographic, visual, and electrical conductance (EC) methods as poor for all types of lesions on posterior proximal and occlusal surfaces. However, these ratings were due less to inadequate numbers of assessments than to variation among reported results. In one instance, the quality of the available studies was the principal reason for the rating.
* For all but EC assessments, specificity of a diagnostic method was generally higher than sensitivity. Thus, false negative diagnoses are proportionally more apt to occur in the presence of disease than are false positive diagnoses in the absence of disease.
* The evidence did not support the superiority of either visual or visual/tactile methods. The number of available assessments was small and there was substantial variation among reports for each method.
* The evidence suggests, but is not conclusive, that some digital radiographic methods offer small gains in sensitivity compared to conventional film radiography on both proximal and occlusal surfaces.
* The evidence also suggests, but is not conclusive, that EC methods may offer heightened sensitivity on occlusal surfaces, but at the expense of specificity.
* The diagnostic performance literature is limited in terms of numbers of available assessments for most diagnostic techniques overall, and especially for primary teeth, anterior teeth and root surfaces, and for visual/tactile and FOTI methods. The literature is further limited by threats to both internal and external validity represented by incomplete descriptions of selection and diagnostic criteria and examiner reliability, the use of small numbers of examiners, nonrepresentative teeth, samples with high lesion prevalence, and a variety of reference standards of unknown reliability.

Management of Noncavitated Carious Lesions

The diagnosis of carious lesions

Dental caries, or cavities, is a chronic infectious disease experienced by more than 90 percent of adults in the United States. Recent changes in the epidemiology of dental caries have altered the presentation of the disease so that among children age 5 to 17 years, about 75 percent of the disease is now experienced in 25 percent of the population. Also, as understanding of the disease process has matured, the range of management strategies for dental caries has broadened.

Interventions to arrest or reverse the demineralization process that characterizes the development of a carious lesion are available, and several strategies for identifying those persons representing the quarter of the population who will experience an elevated incidence of dental caries have been reported.

The growing sophistication in available interventions for prevention and nonsurgical treatment of dental caries is matched by a similar increase in the available methods for diagnosis of carious lesions. The diagnosis of carious lesions has been primarily a visual process, based principally on clinical inspection and review of radiographs. Tactile information obtained through use of the dental explorer or "probe" has also been used in the diagnostic process. The development of some alternative diagnostic methods, such as fiber-optic transillumination (FOTI) and direct digital imaging, continue to rely on the dentist's interpretation of visual cues, while other emerging methods, such as electrical conductance (EC) and computer analysis of digitized radiographic images, offer the first "objective" assessments, where visual and tactile cues are either supplemented or supplanted by quantitative measurements.

This relatively recent growth in alternatives available for both diagnosis and management of dental caries has yet to be fully assimilated by dental practice. Thorough reviews of methods for diagnosis and management of dental caries should assist in that assimilation process.

TREATMENT OF PERIODONTITIS

Periodontitis is a form of gum disease. It is a chronic infection of the gums which is characterized by a loss of attachment between the tooth and the jawbone. It is the leading cause of tooth loss among adults in the United States.

Teeth are attached to the jaw by a series of very strong ligaments. The gums are also connected to the tooth by a complex series of microscopic fibers; and the gums lay over the tooth-bone attachment like a protective cover. Periodontitis begins in the shallow pocket where the tooth and gum meets, usually as a milder form of gum infection known as gingivitis. Bacteria can grow in this pocket, usually due to inadequate oral hygiene. The gum begins to pull away from the tooth deepening the pocket, making it harder to clean and encouraging the formation of tenacious tartar deposits below the gumline.

Over time this infection can cause inflammation in the bone, causing it to slowly disappear, undermining the attachment to the tooth. This loss of bone is what distinguishes periodontitis from gingivitis, where no bone loss occurs. After many years this can lead to tooth loss.

Diagnosis

Periodontal disease is diagnosed with a thorough periodontal exam. A small, blunt probe is used to measure the depth of the gum pockets around every tooth in the mouth. Measurements are taken at six sites on each tooth. This depth gives an objective gauge of the health of the gums. If the pockets bleed easily during probing this is noted as well. This bleeding is a sign of inflammation of the pocket. The appearance of the gums is noted; infected gums appear red and

puffy. The amount of tartar, or calculus, is determined. The mobility of all teeth is checked and the bite is evaluated. X-rays of all teeth are needed to evaluate the condition of the bone around each tooth and show calculus deposits below the gumline.

Treatment

It is important to realize that periodontitis is chronic, insidious, and episodic in nature....

Chronic- Periodontitis is typically a slow moving condition, taking many months or even years to develop. Once the disease develops and is diagnosed, it is never really cured. Instead it is managed, much like other chronic conditions like high blood pressure or diabetes.

Insidious- Periodontitis is usually silent until its later stages. That is, patients typically have no symptoms until the disease has progressed very far. It must be diagnosed through a thorough periodontal exam. Symptoms which do occur late in the disease are bleeding gums, sore or itchy gums, loose teeth, change in bite, bad breath, and acute gum abscesses.

Episodic- The actual disease activity of infection causing bone loss does not occur at all times in all places in the mouth. Instead, the active stages occur in an on/off fashion at various locations in the mouth. This can only be determined by accurate exams initially and at recall.

These above factors are important to understand the treatment of periodontitis. The goal is to control the current active infection and then closely monitor for signs of disease activity on a regular basis. Once susceptible to this disease it must be monitored for the rest of the patient's life. The ultimate goal is to prevent further bone loss and keep the teeth involved for as long as possible.

Treatment regimens are determined on an individualize basis. Most traditional treatments follow the same basic pattern. First the infection is disrupted by thorough cleaning below the gumline by the doctor or hygienist. This cleaning is called "scaling an root planing" and may take one to four or more appointments. Local anesthesia is often used for patient comfort. The goal is to remove the tartar and bacteria from the root surfaces to allow healing and reattachment of the gums. An individualized home care regimen is devised for the patient to control plaque. Plaque contains the bacteria which cause the disease and plaque hardens to become tartar. Controlling plaque levels through proper home care is critical to the success of the treatment.

The gums are given time to heal once scaling is done(2-4 weeks) and the mouth is reexamined to evaluate the success of the treatment and determine the need for further care. At this point laser treatments can be used to reduce localized pocketing. Laser treatments of pockets kills many of the offending bacteria, removes diseased tissue, and encourages gum reattachment to the teeth. This can often be done without scalpels, sutures, or the discomfort associated with traditional periodontal treatments.

A recall interval is determined. Regular recall visits are crucial for managing this disease over the long term. Frequent recall allows regular, early removal of tartar accumulations, disruption of bacteria in deeper pockets, and close monitoring of disease activity throughout the mouth. Any further treatment needs can be addressed as soon as possible.

WOMEN WITH PERIODONTAL DISEASE

A new study by NYU dental researchers has uncovered evidence that pregnant women with periodontal (gum) disease face an increased risk of developing gestational diabetes even if they don't smoke or drink, a finding that underscores how important it is for all expectant mothers – even those without other risk factors – to maintain good oral health.

The study, led by Dr. Ananda P. Dasanayake, Professor of Epidemiology & Health Promotion at New York University College of Dentistry in collaboration with the Faculty of Dental Sciences at the University of Peradeniya, Sri Lanka, eliminated smoking and alcohol use among a group of 190 pregnant women in the South Asian island nation of Sri Lanka, where a combination of cultural taboos and poverty deter the majority of women from smoking and drinking.

The findings support an earlier study led by Dr. Dasanayake that found evidence that pregnant women with periodontal disease are more likely to develop gestational diabetes than pregnant women with healthy gums.

That study, which followed 256 women at New York's Bellevue Hospital Center through their first six months of pregnancy, showed that 22 of the women developed gestational diabetes. Those women had significantly higher levels of periodontal bacteria and inflammation than the other women in the study. The findings were published in the April 2008 issue of the Journal of Dental Research.

More than one-third of the women in the new study, which was conducted over the course of one year, reported having bleeding gums when they brushed their teeth. The women were given a dental examination and a glucose challenge test, which is used specifically to screen for gestational diabetes.

How to Dental Medicine

PITTSBURGH, April 15 – Certain genetic variations may be linked to higher rates of tooth decay and aggressive periodontitis, according to two recently published papers by researchers at the University of Pittsburgh School of Dental Medicine and their collaborators.

Alexandre R. Vieira, D.D. S., Ph.D., senior author of both papers and an assistant professor of oral biology, and his colleagues at the School of Dental Medicine found that the rate of dental caries was influenced by individual variations, or polymorphisms, in a gene called beta defensin 1(DEFB1), which plays a key role in the first-line immune response against invading germs. The findings are available online in the Journal of Dental Research.

"We were able to use data gathered from our Dental Registry and DNA Repository, the only one of its kind in the world, to see if certain polymorphisms were associated with the development of caries," Dr. Vieira said. "This could help us find new ways to treat people who are particularly susceptible to tooth decay, a problem that afflicts millions of Americans."

For the study, the researchers analyzed nearly 300 anonymous dental records and accompanying saliva samples from the registry, assigning each case a DMFT score based on the presence of decayed teeth, missing teeth due to caries, and tooth fillings, as well as a DMFS score, based on decayed teeth, missing teeth, and filled surface of a tooth. In general, individuals with fewer caries have lower DMFT and DMFS scores.

Saliva samples contained one of three variants, dubbed G-20A, G-52A and C-44G, of the DEFB1 gene. Individuals who carried a G-20A copy had DMFT and DMFS scores that were five-times higher than for people who had other variants. The G-52A polymorphism was associated with lower DMFT scores.

"It's possible that these variations lead to differences in beta defensin's ability to inhibit bacterial colonization," Dr. Vieira said. "In the future, we might be able to test for these polymorphisms as clinical markers for caries risk."

In a second paper, published last week in PLoS One, Dr. Vieira, colleagues at Pitt and collaborators in Brazil studied saliva samples of 389 people in 55 families to look for genetic links to aggressive periodontitis, which is rapid and severe destruction of the gums and bone that starts at a young age and is thought to be more common in Africans and those of African descent. Brazil's population is composed primarily of Caucasians of Portuguese ancestry, Africans and native Indians.

They found hints of an association between the disease and the FAM5C gene. While further testing did not find any mutations or polymorphisms that bore out a relationship, other experiments showed elevated levels of FAM5C expression, or activation, in areas of diseased periodontal tissue compared to healthy tissue.

"The FAM5C gene recently was implicated in cardiovascular disease, in which inflammation plays a role, just as in periodontitis," Dr. Vieira said. "More research is needed to see if variation in the gene is associated with different activity profiles."

children problem

The question may be funny enough but not that funny to avoid answering it. As far as our visibility goes, our mouth may contain the teeth and the tongue but there is also the presence of many other things not visible to the naked eye. Diseases affecting the mouth and the throat are very common and it is mainly cavities and cancer that rule the chart. Children between the ages of 12-15 are the main sufferers of cavity. Cavity could cause severe pain, dysfunction, underweight and a very poor look on the face. Due to some of these diseases, some of the children may also tend to absent from school.

Cavity is not a disease that cannot be treated but the children coming from poor families face a tough time. Not just the children but also even the aged face this problem. People over the age of 60 tend to loose almost all their teeth. It not only spoils their look but also limits their intake of some nutritious food. This in turn affects their health.

Mouth and throat cancers is yet another problem. The main cause of this is too much of smoking and alcoholism. People who smoke a lot are prone to deadly diseases like periodontitis. Moreover, due to excessive smoking, medicines fail to show their reaction.

AIDS is a well heard of disease and is also a deadly one. Research says that this disease causes a serious damage to the mouth and the surrounding areas. The lips, tongue, cheeks and the gums are the worst affected by AIDS.

Many of the diseases of the mouth are also caused due to gallstones in the gallbladder and the liver. These stones cause a hindrance to the digestion of the food and the waste materials that are supposed to be eliminated from the body, remains back in the intestinal tract. Gallstones also slow down the secretion of bile, which in turn reduces appetite, and the secretion of saliva from the glands. If there is less saliva in the mouth, it causes a lot of problems. In extreme cases the tooth gets decayed and several other tooth problem also arises. Our mouth is very prone to bacterial and viral diseases and this is caused due to the waste in the mouth that decomposes leading to toxins in the body. The bacteria of the mouth are called the Thrush and the virus is called the Herpes. The weak and unhealthy cells of the body are the main targets of these bacterial and viral diseases.

Sometimes our mouth undergoes a bitter taste. This is caused due to the bile in the mouth, which drastically brings about a change in the pH- value of the saliva, which slows down, in fact destroys its cleansing abilities and leaves the mouth, to be affected by infection

The diseases that affect the mouth may sound deadly but it takes very little to enjoy a refreshing breath and have a broad smile on your face. It's never too late to take care of your mouth.