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.