Treating gum disease with homemade remedies

Freedom From Dental Disease

The Primary Care Oral Health Action Pack can Favorably change the way you look at your oral health and what affects it. Increase your knowledge of YOUR teeth and gums, YOUR entire oral environment and yes, your SMILE! Reveal the TRUE CAUSE of cavities, decay of bone and tissue and disclose the proper biological balance. Put YOU in command over this contagious, yet EASILY preventable disease which runs rampant thoughout our population. Allow you to TAKE ACTION to restoring your teeth and gums to optimum health while preventing further decay and damage, as well as preventing any potentially related problems such as heart disease, diabetes, and so on. How to Become Dentally Self Sufficient. Research Advocates OraMedics The science behind the program! The 7 Factors Transcript - Dr. Nara's Last speech before the World Health Federation. Read more here...

Freedom From Dental Disease Summary


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Periodontal Disease Pyorrhea

The word pyorrhea comes from the Greek pyon ( pus ) and rhoia ( to flow ), a graphic description of the disease in which an outflowing of pus proceeds from the gingival (gum) tissues of the oral cavity. The term pyorrhea has been used in Europe since the mid-1500s and in America since the late 1800s. In 1937, however, the term was abandoned in favor of periodontal disease. Periodontal disease means any ailment of the supporting structures of the teeth, including gingiva, periodontal ligament, and alveolar bone. In simplest terms, periodontal disease can be divided into two distinct, but not mutually exclusive, disease processes. The first involves inflammation of gingival tissues, called gingivitis, and the second, a destructive loss of bone and connective tissue attachment termed periodontitis.

Gingivitis and gingival index

The presence and degree of gingivitis (Fig. 26.9) is assessed based on a combination of redness and swelling, as well as presence or absence of bleeding on gentle probing of the gingival sulcus. Various indices can be used to give a numerical value to the degree of gingival inflammation present. In the clinical situation, a simple bleeding index is the most useful. Using this method, a periodontal probe is gently inserted into the gingival sulcus at several locations around the whole circumference of each tooth and the tooth is given a score of 0 if there is no bleeding and a score of 1 if the probing elicits bleeding.

Recurrent Caries and Periodontal Disease

Interproximal Caries

The patient must have satisfactory oral hygiene before commencing tooth preparation for advanced restorative procedures, otherwise failure is inevitable. The teeth should be examined and the extent of caries and existing restorations noted. The plaque accumulation in the stagnation area around an interproximal caries lesion is often associated with gingivitis (Fig. 4.1). Placing a well-contoured temporary restoration to resolve the gingival inflammation is often a necessary first step (Fig. 4.2). The tooth should undergo a thorough visual examination (Fig. 4.3). A radiographic examination is necessary to ascertain the extent of recurrent caries prior to crown preparation (Fig. 4.4). Fig. 4.2 Interproximal caries lesion may be associated with gingivitis, and a well-contoured temporary restoration can allow healing. This facilitates impression taking for crowns and allows careful planning of the crown margin

Trench Mouth Acute Necrotizing Ulcerative Gingivitis Clinical Summary

Painful severely edematous interdental papillae are characteristic of trench mouth, or acute necrotizing ulcerative gingivitis (ANUG). Other associated features include the presence of ulcers with an overlying grayish pseudomembrane and a punched out appearance. The inflamed gingival tissue is friable, necrotic, and represents an acute destructive disease process of the periodontium. Fever, malaise, and regional lymphadenopathy are commonly associated signs. Patients may also complain of foul breath and a strong metallic taste. Poor oral hygiene, emotional stress, smoking, and immunocompromised states (eg, HIV, steroid use, diabetes) all predispose for ANUG. Anaerobic Fusobacterium and spirochetes are the predominant bacterial organisms involved. The anterior incisor and posterior molar gingival regions are the most commonly affected oral tissue. Acute herpetic, gonococcal, or streptococcal gingivostomatitis, aphthous stomatitis, desquamative gingivitis, and chronic periodontal...

Dental Disease

Other areas of the mouth can be affected by disease. Gums may become inflamed due to irritation from plaque or infection, resulting in periodontal disease and resorption of alveolar bone. The subsequent exposure of tooth roots with alveolar recession can result in root caries and tooth loss. Supporting bony tissues of the jaw are subject to inflammation just as bone is in other parts of the body. In an archeological context, the dental pathologies most commonly seen are caries, periodontal disease, dental abscess, antemortem tooth loss, dental attrition, and enamel hypoplasia. Unfortunately, there are two major difficulties in extracting meaningful


Gingivitis is by definition reversible (Fig. 26.9). Removal or adequate reduction of plaque will restore inflamed gingivae to health. Once clinically healthy gingivae have been achieved these can be maintained by daily removal or reduction of the accumulation of plaque. In short, the treatment of gingivitis is to restore the inflamed tissues to clinical health and then to maintain clinically healthy gingivae, thus preventing periodontitis (Fig. 26.15). The purpose of the professional periodontal therapy in the gingivitis patient is removal of


Untreated gingivitis may progress to periodontitis. Periodontitis is irreversible. It is important to remember that periodontitis is a site-specific disease, i.e. it may affect one or more sites of one or several teeth (Fig. 26.16). The aim of treatment is to prevent development of new lesions at other sites and to prevent further tissue destruction at sites that are already affected.

Accuracy of Screening Tests

Several screening mechanisms exist for CHD electrocardiogram (ECG), exercise testing, and electron beam computed tomography (EBCT) for coronary calcium. The sensitivity of resting ECG abnormalities for CHD is low. The sensitivity of an exercise test ranges from 10 to 70 and the predictive value from 2.2 to 24 . False-positive results are more likely for young persons and women (Pignone et al., 2003). Evidence is limited on the use of nontraditional risk factors in CHD assessment, including ankle-brachial index (ABI), leukocyte count, fasting glucose level, periodontal disease, carotid intimal medial thickening, EBCT, homocysteine level, lipoprotein(a) level, and high-sensitivity C-reactive protein (hs-CRP) level. Screening for cerebrovascular disease with an ultrasound of the carotid artery to detect significant stenosis has a reported sensitivity of 86 to 90 and specificity of 87 to 94 (Wolff, 2007).

Complications Associated with Endotracheal Intubation

Most often there are no complications associated with the placement and use of an endotracheal tube. Sometimes during insertion of the endotracheal tube, you may have minor trauma to your lip (fat lip) or teeth (chipped tooth). If you have preexisting dental disease, unusual airway anatomy, or you bite down hard while the endotracheal tube is in place, you could suffer more extensive dental damage, such as a dislodged tooth. Sore throat is probably the most common complaint. Typically, this is mild and resolves itself within twelve to twenty-four hours without any therapy. Vocal-cord damage is very uncommon, and if it does occur, it usually resolves spontaneously over a matter of days or weeks. The endotracheal tube can be an airway irritant to you if you have significant

General Considerations

There has been an increasing interest throughout the world in the use of natural ingredients for health, especially tea. Tea is the world's second most popular beverage after water. Green tea accounts for approximately 20 of all tea consumed. It has been claimed that overall health of the body, especially the oral cavity, can be maintained by the consumption of green tea. Green tea is not fermented therefore, it contains polyphenols that are inactivated in the fermentation process of black tea production. Green tea has been consumed in East Asia, where its benefits have been claimed for centuries. Green tea polyphenols possess antioxidant and antiviral properties that account for its benefits these benefits have been touted to include lowering blood pressure, lowering cholesterol, stabilizing blood glucose, inhibiting bacterial growth, and blocking many carcinogenic agents. Polyphenols have been shown to inhibit the growth of Streptococcus mutans, the major etiologic bacterium...

Soft Tissue Biocharacterization and Influence

With thick flat tissue biotype, marginal inflammation is described in its acute form as marginal redness or magenta-cyanotic in appearance. With chronic inflammation, marginal gingivitis is present with gingiva coloration ranging from red to magenta. The gingiva may range from a normal shape to a boggy, enlarged shape. As inflammation persists, periodontal pocketing tends to occur. In regions with a relatively thick bulk of bone, the pocket formation occurs in conjunction with infrabony defects (See Figure 2.27). The thick flat tissue type is ideal for placing dental implants and restoring it with high esthetic predictability. Here the gingival and osseous scalloping is normally parallel to the cementoenamel junction (CEJ) (Gargiulo et al. 1961). The minimal undulation of the CEJ between adjacent teeth, which predictably follows the natural contour of the alveolar crest, makes the gingival tissues more stable. Consequently, this type of periodon-tium is less likely to exhibit soft...

Head and Neck Diseases

Some Ayurvedic diseases of the mouth would seem to have a recognizably modern counterpart, among them (1) neoplasms of the lip (when the latter is described with raised areas of flesh that ultimately ulcerate) and (2) herpes labialis, with varicolored multiple small swellings. A condition in which the gums became spongy, retreated, and bled easily may have indicated scurvy, whereas another in which the gums and dental roots bled easily and gave off a purulent exudate may have been pyorrhea or periodontitis. Mahashaushira was a grave and painful condition in which teeth became loose in the gums, and the palate and the cheek were ulcerated. This seems to have been either cancrum oris or buccal carcinoma.

Cervical Line Curvatures

The epithelial attachment is the actual attachment of the soft tissue of the mouth to the tooth. The epithelial attachment can be distinguished from the previously described periodontal ligament even though both structures are components of the tooth's attachment apparatus. The epithelial attachment serves as the connection for the soft (gingival) tissue and is limited in comparative area (but not importance), while the periodontal ligament provides the attachment of the hard tissue (bone) to the tooth's root structure, and is much more extensive in area. Since there is usually a sulcus between the gingival margin and the epithelial attachment, these two entities are not normally located at the same level on the tooth. However, like the gingival margin, the epithelial attachment may be variable in its location, and has a tendency to migrate apically during a person's lifetime, especially in the presence of periodontal disease. The epithelial attachment is normally found close to the...

Cross Section Of A Tooth

Daily care is vital to maintain dental health. You need to limit your intake of foods and drinks containing sugar because these contribute to tooth decay. You should also brush and floss your teeth regularly to prevent food particles from building up on your teeth and so reduce the risk of tooth decay and gum disease.

Examination under general anaesthesia

Gingivitis and gingival index Identify the presence of periodontal disease, i.e. gingivitis and periodontitis Differentiate between gingivitis - inflammation of the gingiva - and periodontitis - inflammation of the periodontal tissues, resulting in loss of attachment and eventually tooth loss Assess the extent of tissue destruction where there is periodontitis.

Periodontalclinical attachment level

Periodontal probing depth is not necessarily correlated with severity of attachment loss. As already mentioned, gingival hyperplasia may contribute to a deep pocket or a pseudopocket if there is no attachment loss, while gingival recession may result in the absence of a pocket but also minimal remaining attachment. Periodontal attachment level records the distance from the cemento-enamel junction or from a fixed point on the tooth to the base or apical extension of the pathological pocket. It is thus a more accurate assessment of tissue loss in periodontitis. PAL is either directly measured with a periodontal probe or it is calculated, e.g. PPD + gingival recession.

Professional periodontal therapy

It is important to remember that periodontitis is a site-specific disease. Depicted is a lower first molar with periodontitis (destruction of periodontal ligament, bone loss and gingival recession) affecting the buccal surface of the distal root. The rest of the tooth shows no evidence of periodontitis (normal PPD and no gingival recession) Fig. 26.16 Periodontitis. It is important to remember that periodontitis is a site-specific disease. Depicted is a lower first molar with periodontitis (destruction of periodontal ligament, bone loss and gingival recession) affecting the buccal surface of the distal root. The rest of the tooth shows no evidence of periodontitis (normal PPD and no gingival recession)

Subgingival scaling and root planing

The procedure for closed subgingival debridement is shown in Figure 26.20. It is often a lengthy procedure. It must be emphasized that removing subgingival plaque, calculus and debris as well as the superficial layer of toxin-laden cemen-tum and restoring the root surfaces to smoothness is a most important step. Removing only the supragingival debris at a periodontitis site does not have any therapeutic benefit. It will not prevent disease progression, as the cause of the disease - subgingival plaque - is still present.

Maintenance of oral hygiene home care

The benefit of any professional periodontal therapy is shortlived unless maintained by effective home care. In fact, if no home care is instituted after professional periodontal therapy, then plaque will rapidly reform and disease will progress. It has been shown that 3 months after periodontal therapy, gingivitis scores are equivalent to those recorded prior to therapy if no home care is instituted (Gorrel & Bierer 1999). The cause (dental plaque) and effects (discomfort, pain, chronic focus of infection, loss of teeth and possibility of systemic complications) of periodontal disease must be thoroughly explained to the pet owner. The owner must be made aware that home care is the most essential component in both preventing and treating periodontal disease. The responsibility of maintaining oral hygiene, i.e. keeping plaque accumulation to a level compatible with periodontal health rests with the owner of the pet. Once instituted, home care regimens need continuous monitoring and...

Tissue Engineering in Maxillofacial Surgery

Roughly 20,000 organ transplants, 500,000 joint replacements, and literally millions of dental-oral-craniofacial procedures ranging from tooth restorations to major reconstruction of facial hard and soft tissues are performed annually. According to the National Institute of Dental and Craniofacial Research, 86 of adults over 70 years have at least moderate periodontitis and more than one-quarter have lost their teeth, which has serious repercussions on health and quality of life (Albandar and Kingman 1999).

Distribution Incidence and Epidemiology

Epidemiological research during the past 25 years indicates that periodontal disease is one of the most common diseases affecting humankind. There is a direct cause-and-effect relationship between the bac Periodontal disease is a widespread chronic disease and remains as the primary reason for the loss of teeth in the adult population throughout the world. In fact, virtually all individuals in any population exhibit manifestations of the disease. The prevalence and severity of periodontal disease increase with advancing age, tend to be greater in nonwhites than whites, and are greater for males in both races. There appears to be a trend toward an increase in the prevalence and severity of periodontal disease in the over-35 age group. This increase is most pronounced in the lower socioeconomic groups and is highly correlated with differing levels of personal and professional oral hygiene care. Many individuals in the older population have had fewer teeth extracted as a consequence of a...

Clinical Manifestations and Pathology

The pathogenesis of periodontal disease must be considered in four stages colonization, invasion, destruction, and healing. During colonization, plaque accumulates on the teeth and microbial growth ensues. If the plaque is not removed through adequate oral hygiene, the formation of calculus may begin, and the early stages of microbial invasion into the adjacent gingival tissues commence. Clinical signs may consist of gingival tissues that are tender, swollen, and red. This tissue may bleed upon probing or during brushing. However, periodontal disease usually progresses over the course of many years, and discomfort is a rarity. It is because of this asymptomatic evolution that persistent bacterial invasion and local irritation can progress into the destructive phase of the disease in which loss of connective tissue and loss of alveolar bone take place. Signs and symptoms of the destructive stage can include pocketing around the tooth within the gingival crevice, gingival recession, sup...

History and Geography

Although periodontology has been practiced as a specialty only during this century, the recognition of periodontal disease in various forms has persisted for millennia. The condition of the dental structures of teeth and bone of our ancestors has been revealed through examination and radiographs of skulls discovered in archaeological excavations. There is evidence that periodontal disease existed in some of the earliest members of humankind. Egyptian mummies show signs of dental caries and periodontal disease as well as primitive, yet valiant, attempts at repairing these dental pathoses. Indeed, it is believed that the Papyrus of Ebers, which was written around 1550 B.C. by Egyptians, and describes various conditions of the oral cavity, is the earliest written record of dentistry as a distinctive branch of the healing arts. The Greek historian Herodotus described Egypt as being the home of medical specialties, including dentistry. Pliny, a Roman, published his book Natural History in...

Treatment Complications in the Esthetic Zone

Adell and others (1981) stated that marginal bone height depends on both proper marginal stress distribution and adequate function of the marginal soft tissue. They also listed several factors that contribute to marginal bone loss, including (1) surgical trauma, such as detachment of the periosteum and damage caused during drilling, (2) improper stress distribution caused by defective prosthetic design and occlusal trauma, (3) physiological ridge resorption, and (4) gingivitis, which, if allowed to progress, will lead to the ingression of bacteria and their toxins to the underlying osseous structure.

Essential Oils Used In Treating Diseases In Animals

Bad breath as a result of gum disease and bacterial buildup on the teeth of pets can be treated by brushing their teeth with a mixture of a couple of tablespoons of baking soda, 1 drop of clove oil and 1 drop of aniseed oil. Lavender, myrrh, and clove oils can also be directly applied to their gums.

Syndromes of Lesions Involving Peripheral Branches of Cranial Nerve V

The numb chin syndrome (mental neuropathy) often reflects a bony lesion affecting the mental foramen through which V3 passes to innervate the chin and mandible.y , y Patients often report numbness or pain on one or both sides of the chin, which may extend to the lip or submandibular region. Frequent causes include granulomatous diseases such histiocytosis X primary bony malignancies such as osteosarcoma, fibrosarcoma, and plasmacytoma and metastatic lesions from lung, breast, and prostate carcinomay as well as lymphoma (especially Burkitt's lymphoma). Development of a numb chin in a patient with cancer in remission may indicate relapse. Nonmalignant etiologies include collagen vascular disorders, trauma, periodontal disease, benign bony cyst, focal idiopathic osteolysis (Gorham's disease),y and sickle cell disease. A variant of the numb chin syndrome is the numb cheek syndrome, which results from a bony lesion affecting the infraorbital foramen or the maxillary sinus and trigeminal...

Clinicopathologic Correlations


Benign mucous membrane pemphigoid, or cicatricial pemphigoid, is a chronic mucocutaneous bullous disease of elderly people in which the lesions are commonly limited to the oral cavity and conjunctiva. Subepidermal bullae, up to 2 cm in size, and autoantibodies to the basement membrane are present erosion may be present as well. Skin involvement is rare and usually not severe. Nikolsky's sign, in which the bulla or external layer of mucous membrane or skin is easily separated from the underlying tissue by slight friction, is usually positive. Figure 12-46 depictds benign mucous membrane pemphigoid. Note the denudation of the gingivae. Figure 12-47 depicts cicatricial pemphigoid. The most common oral finding is patchy, desqua-mative gingivitis, as seen in this figure. always painful. Figure 12-48 depicts pemphigus vulgaris the desquamative gingivitis is visible. Another case of pemphigus vulgaris is seen in Figure 12-49. Note the large and confluent ulcerations, which were painful, on...

Diseases in the Prehistoric Period

There is also evidence for a range of dental pathology, including caries, periodontal disease, abscesses (periapical and alveolar), and excessive tooth wear, sometimes with pulpal involvement (Pietrusewsky 1974,1982, 1982-3 Houghton and Warrachai 1984). Evidence for caries, periodontal disease, and abscesses has also been found in human remains from sites at Talaud Island in North Sulawesi, and Gua Cha in the Central Malay Peninsula (Bulbeck 1982).

Notion Of Bucco-dental Superinfections Activity of Listerine against Plaque and or Gingivitis Activity of Listerine against Plaque and or Gingivitis After the assessment for the presence of gingivitis and target pathogens (Porphyromonas gingivalis, Fusobacterium nucleatum, and Veillonella sp.) and total anaerobes, 37 patients undertook a twice daily mouthrinse with Listerine for 14 days. After a washout period, the study was conducted again using a flavored hydroalcoholic placebo. The results of this randomized, doubleblind, crossover study showed that the essential oil rinse significantly lowered the number of all target pathogens by 66.3-79.2 , as compared to the control (Fine et al., 2007). The buccodental conditions of 26 French children were documented by measuring the percentage of dental surface free of plaque, gum inflammation, and the papillary bleeding index (PBI). After 7 days of rinsing with the mouthwash for 2 min, the test group was found to have a reduction of dental plaque in 69 of cases...

Patient Education Home Care Instructions Fluoride Application


Osteoradionecrosis (ORN) is a relatively uncommon clinical condition. However, its risk increases if the radiation dosage is greater than 6,500 cGy to any portion of the mandible13 (Figure 20-4). The maxilla is rarely affected due to its inherent rich blood supply. Radiotherapy causes endothelial damage to blood vessels within the mandible, causing fibrosis and ischemia, increasing the risk of necrosis of hypovascular or avascular bone when exposed to the insult of bacterial infection. It can be devastating and may even develop many years after completion of radiation therapy. As many as 30 percent of cases of ORN are reported to be of a spontaneous origin. However, most reports in the literature focus on caries and extraction sites as precipitating factors. Acute and chronic periodontal disease and mandibu-lotomy sites can also be a focus of origin for ORN. Traditional and conservative treatment of ORN consists of antibiotics (when symptoms are present), surgical debridement and...

Development of the Teeth

Dwarfed roots - This condition exists when normal sized crowns have abnormally short roots. The crowns of these teeth are also abnormal in contour, exhibiting a greater incisocervical convexity of the labial surface. Normally, dwarfed roots are found only in the anterior teeth, most commonly the maxillary central incisors. The condition is quite often bilateral. It is also thought to have a hereditary etiology. These teeth may be lost at an early age simply because of passive eruption, or periodontal disease. This anomaly should not be confused with the shortened roots and blunted apices of teeth, occasionally observed radiographically following orthodontic treatment, and caused by excessive pressures during tooth movement. 13. Enamel pearls - Also known as enamelomas, or enamel drops, they are found attached to the root surfaces of teeth, in the form of small, spherical nodules of enamel surrounding a dentin core. Their specific site is usually in the furcation area of molars....

Sahin To Parel Distance

Host responses in periodontal diseases Current concepts. J Periodontol, 63, pp. 333-338. Gouvoussis, J., D. Sindhusake, and S. Yeung. 1995. Cross infection from periodontitis sites to failing implant sites in the same mouth. Int J Oral Maxillofac Implants, 12, pp. 666-673.

Angular Cheilitis Early Hiv Symptom

Stages Infection

Alteration of taste, gingival pain, malaise, fever, and halitosis. As the disease progresses, a whitish pseudomembrane develops along the gingival margins, with ulceration and blunting of the interdental papillae. Acute necrotizing gingivitis, pictured in Figure 12-57, may be an early feature of HIV infection. Acute necrotizing gingivitis (see Fig. 12-57)

Structure and Physiology

Loss of teeth from dental caries or periodontal disease is common. Gingival recession may produce problems with dentures and a malalignment of bite. Atrophic changes in the salivary glands cause dryness of the mouth, known as xerostomia, a common complaint among the elderly.

Periodontal probing depth

Fig. 26.9 Gingivitis is inflammation of the gingiva, which manifests as reddening, swelling and often bleeding of the gingival margin Fig. 26.9 Gingivitis is inflammation of the gingiva, which manifests as reddening, swelling and often bleeding of the gingival margin at the base of the sulcus. The depth from the free gingival margin to the base of the sulcus is measured in millimetres at several locations around the whole circumference of the tooth (Fig. 26.10). The probe is moved gently horizontally, walking along the floor of the sulcus. The gingival sulcus is 1-3 mm deep in the dog and 0.5-1 mm in the cat. Measurements in excess of these values usually indicate the presence of periodontitis the periodontal ligament has been destroyed and alveolar bone resorbed, thus allowing the probe to be inserted to a greater depth. The term used to describe this situation is periodontal pocketing. All sites with periodontal pocketing should be accurately recorded. Gingival inflammation...

Clinical Trials Methods

Receiving all the treatment modalities at the different parts of the mouth concurrently, the study period of the investigation could be shorter. The study period could then be of the same duration as if the parallel design was used, but the number of subjects used could be reduced. In an investigation of the efficiency of split-mouth design compared to whole-mouth design (with the use of parallel study design), it was concluded that when disease characteristics are symmetrically distributed over the within-patient experimental units, the split-mouth design could provide moderate to large gains in relative efficiency. For periodontal disease, division of the mouth into two experimental units, either left and right or upper and lower sides, provided the greatest symmetry of the disease characteristics.22 Besides the distribution of the disease, one should also consider the carry-across effects arising from the split-mouth designs. Carry-across effects occur where treatment performed in...

Criteria for removal of wisdom teeth

Unbeatable pulpal or periapical pathology periodontal disease Cystic change Periodontal disease As a result of the unsatisfactory relationship between the second and third molars, the area is prone to periodontal disease, which may compromise the second molar. This can be improved by the removal of the third molar.

Inlay Tissue Grafting

Connective Tissue Graft Around Implant

Minor- to moderate-size edentulous alveolar ridge defects can lead to critical esthetic problems when an anterior fixed prosthesis is to be fabricated, particularly with esthetically conscious patients. In the case of alveolar ridge deformity, the standard pontic size and shape will not maintain a normal and harmonious relationship with the underlying environment, so modifications are necessary. The most common causes of alveolar ridge deformities include developmental defects, advanced periodontal disease, postextraction bone resorption, traumatic removal of teeth, and surgical injury. Reconstructive periodontal procedures permit the restoration of the hard and soft tissues of the alveolar ridge to their former dimensions and allow the clinician to provide improved esthetic results. These procedures can be applied with dental implant treatment with predictable results.

Chronic infections and stroke

As with atherosclerosis, the contribution of chronic bacterial infections to the etiology of stroke is unclear. Some studies found an increased risk of stroke in patients with elevated antibody titers suggesting previous C. pneumoniae infection, H. pylori gastritis, and periodontal disease (caused by a great variety of bacteria). For these pathogens conflicting information has been published 6, 7 and randomized interventional trials, for example, aiming at the eradication of C. pneumonia by macrolide therapy, failed to reduce the incidence of vascular events 8, 9 .

Category C Severely Symptomatic

History should be obtained including a review of risk factors for HIV-1 exposure, drug and alcohol history, sexual history, travel history, and medical history. A complete baseline physical examination should be performed. Focused follow- up examinations are then recommended with attention directed to findings that indicate disease progression such as general appearance and weight loss, dermatological conditions (seborrheic dermatitis, folliculitis, dermatophytosis, Kaposi's sarcoma, bacillary angiomatosis), oral lesions (candidiasis, hairy leukoplakia, aphthous ulcers, periodontal disease), localized lymphadenopathy, splenomegaly and signs or symptoms of neurological neuropsychiatric involvement (mood or affective disorders, psychomotor slowing, abnormal eye movements, hyperreflexia, change of gait).

Diseases in the Pre Roman World

In samples of archeological human skeletons, approximately 15 percent show evidence of significant disease. The incidence of specific disease syndromes varies among geographic areas and cultures, as does the expression of diseases, but generally the most common pathological conditions seen in archeological human skeletons include trauma, infection, arthritis, and dental disease. These conditions will be the focus of our discussion. In addition, because of current interest, we will briefly discuss anemias and tumors. Most of the other general categories of disease (e.g., dysplasias and metabolic diseases) are represented by at least one syndrome that affects the skeleton, but archeological evidence for these syndromes tends to be rare. Differential diagnosis is often difficult, and low frequencies create severe limitations in reaching paleoepidemiological conclusions.

Tooth Subluxation Clinical Summary

Tooth subluxation refers to the loosening of a tooth in its alveolar socket. Traumatic oral injury is the most common etiology however, infection and periodontal disease may also produce loosening of teeth. Gingival lacerations and alveolar fractures are commonly associated with dental subluxations. Subluxated teeth are diagnosed by applying gentle pressure to the teeth with a tongue blade or fingertip. Movement, mild displacement, or blood along the crevice of the gingiva are signs of subluxation. Dental impaction and alveolar ridge fracture should be considered and ruled out clinically and radiographically.

Clinical Trials In Dentistry

TRIALS RELATED TO PERIODONTAL DISEASE In order to prevent periodontal disease, plaque removal and prevention of calculus deposit was one of the key concerns. Thus ways to improve toothbrushing (mechanical means to remove plaque) or the use of mouthrinse or toothpaste with active ingredients like chlorhex-idine and pyrophosphate ion (chemical means to remove plaque and to prevent calculus deposition) were investigated. Two main streams of therapy existed non-surgical and surgical therapy. The aims for these studies were to investigate the effectiveness of the treatment modalities in reducing the depth of the periodontal pocket or improving periodontal attachment level.

Canned or dry

Most dogs in the UK are fed a combination of canned and dry food (meat and mixer). Many dog owners may think that older dogs should have softer foods, but this can add to the problem of dental disease. Because of the increased incidence of dental disease in older dogs a complete dry food is recommended, together with regular home care, e.g. tooth-brushing. If the dog is used to a canned-only diet, gradual introduction of the dry product can usually be achieved by using it as if it were a mixer and slowly reducing the amount of canned food offered.

Daily Lives

Couples may find that epilepsy in one partner interferes with sex, intimacy, and sexuality. For example, having a seizure disorder may make a person feel unattractive and undesirable because of an altered self-image. Certain antiepileptic medications may cause cosmetic problems, such as coarsened skin, darkened facial hair, or periodontal disease, that may contribute to those negative feelings. Normal behavior during sexual activities, including abnormal breathing, altered facial expression, or stiffening of the body, may mimic seizure activity, causing patients or their partners to distance themselves or avoid sexual activity. Persons with epilepsy often worry about the possibility that they will have a seizure during sex. It is essential to address the impact of epilepsy on relationships and intimacy in counseling.

The dentition

The tooth is supported in its alveolar socket by a periodontal ligament, the fibres of which are embedded in the cementum of the root surface and the surrounding alveolar bone. A thin layer of dense bone encircles the tooth socket. Radiographically, this appears as a linear radio-opacity and is referred to as the lamina dura. The periodontal ligament appears as a uniform (0.4-1.9 mm), linear radio-lucency around the root. In the absence of periodontal disease, the alveolar bone should extend to a point 1.5 mm below the cemento-enamel junction.

Clinical assessment

Once the symptoms of pericoronitis have settled the patient needs to be assessed fully regarding the future management of the wisdom teeth. It is important to consider all four third molars as a unit and to make a decision on each of them. A general assessment of the mouth should be made, including caries activity and the level of periodontal disease. The patient's oral hygiene should be checked with particular reference to the accumulation of debris around the third molars. The eruption status of each of the four third molars is made using three categories -unerupted, partially erupted or fully erupted. Note should be taken of the patient's age because the management of third molars can be significantly influenced by this factor. It is also important to assess the surgical access to the third molar region by asking the patient to open widely and to note the space available between the distal aspect of the second molar and the vertical anterior border of the ascending ramus. This is...

Periodontal therapy

The management of periodontal disease is aimed at controlling the cause of the inflammation, i.e. dental plaque. Conservative or cause-related periodontal therapy consists of removal of plaque and calculus, and any other remedial procedures required, under general anaesthesia, in combination with daily maintenance of oral hygiene. In other words, the treatment of periodontal disease has two components Maintenance of oral hygiene is performed by the owner and is often called home care. Its effectiveness depends on the motivation and technical ability of the owner and the cooperation of the animal. If no home care is instituted, then plaque will rapidly reform after a professional periodontal therapy procedure and the disease will progress. Before any treatment is instituted, the owner must be made aware that home care is the most essential component in both preventing and treating periodontal disease. Whenever possible, it is useful to institute a home-care programme before any...


On occasion, pus associated with an impacted lower wisdom tooth will track buccally forwards above the buccinator attachment forming a sinus in the region of the first permanent molar. This may lead to some confusion as to the source of the infection and can lead to unnecessary removal of the first permanent molar. This condition is referred to as a migratory abscess. Pericoronitis can also be associated with acute ulcerative gingivitis causing marked halitosis and gingival sloughing and ulceration. Spread of infection can occur in various directions (Table 27.4), including laterally into cheek, or distobuccally under the masseter muscle to give rise to a submasseteric abscess characterised by profound trismus. It can also spread to the sublingual or submandibular region and also into the area around the tonsils and parapharyngeal space (see Ch. 33). Less commonly, it can ascend through the anterior pillar of fauces into soft palate causing marked dysphagia. Early and competent...

Trigeminal Neuralgia

Trigeminal neuralgia (TN) probably results from the focal demyelination of the trigeminal nerve or ganglia. y , '57' Symptomatic causes include intrinsic and extrinsic tumors near the gasserian ganglia and multiple sclerosis (MS) plaques located around the root entry zone of the trigeminal nerve. In the past, dental disease or dental procedures were thought to occasionally cause TN. However, the delineation of the syndrome of pretrigeminal neuralgia, which mimics dental illness, casts doubt on whether dental procedures can ever cause TN. y Most cases of so-called idiopathic TN may be due to pulsations of an aberrant vascular loop on the trigeminal nerve.y These pulsations induce a series of neural events that result in changes in wide dynamic range neurons in the trigeminal nucleus caudalis.

Inspect the Gingivae

Evidence of bleeding Is gingival inflammation present Is abnormal coloration present Erythroplakia is an area of mucous membrane on which there are granular, erythematous papules that bleed. Erythroplakia has a greater potential for malignancy than does leukoplakia. Figure 12-20 shows the mouth of a patient with erythroplakia of the gingiva (on the right) and inflammatory gingivitis (on the left).

Subject Index

Gallstones, 136 gangrene, 137 genetic disease, 139 gonorrhea, 151-152 leprosy, 194 measles, 213 ophthalmia, 232 periodontal disease, 246 pica, 248 genetic factors, (continued) in arthritis, 40, 141, 235 birth defects, 139-40 in bleeding disorders, 54-57 in breast cancer, 65-66 colorblindness, 140 in cystic fibrosis, 83 in diabetes mellitus, 89, 91 in diphtheria, 94 in Down syndrome, 96-98, 143 in heart disease, 160 in hemophilia, 140 history, 139-42 in Huntington's disease, 169 in hypertension, 169-71 in inflammatory bowel disease, 175-77 in lactose malabsorption, 183 molecular medicine and, 142-44 in multiple sclerosis, 222 in muscular dystrophies, 224-25 in Paget's disease of bone, 239-40 in polydactyly, 140 in sickle-cell anemia, 142, 298-300 in Tay-Sachs disease, 320-23 in trisomy, 96, 143 genital herpes, 161-62. See also herpes viruses geophagy, 247-49 German measles, 285-87 gestational diabetes, 88, 91 giant-cell tumor of bone, 239 giant intestinal fluke, 123 Giardia lamblia,...


The most important risk factor for the development of sinusitis is rhinitis (e.g., viral, allergic). Other risk factors include anatomic abnormalities (abnormality within the sinuses, septal deviation, choanal atresia, foreign body, adenoid hypertrophy), nasal polyps (which can also occur secondary to chronic sinusitis), conditions of local or systemic immunodeficiency, cystic fibrosis, primary ciliary dysfunction (Kartagener's syndrome), secondary ciliary dysfunction (cigarette smoking, nasal decongestant abuse, cocaine abuse), gastroesophageal reflux disease (GERD), systemic inflammatory conditions (sarcoidosis, Wegener's granulo-matosis), dental disease, and nasal or sinus tumors. Any of these conditions can mimic or cause rhinosinusitis. Further

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