Natural Solution for Toothache Found

Dentists Be Damned

This eBook teaches you all the remedies and tricks that you need to know to Never visit the dentist again, and still have the most perfect mouth full of the teeth that you know of. This book contains a toothache remedy that will treat the root of the problem, how to restore your gums to full health, a supplement that makes plaque fall off your teeth in no time, and a solution that can stop cavities Forever. This book doesn't just teach you how to get rid of some pain, it teaches you how to Eliminate the source of pain once and for all. After taking to heart the information in this book, trips to the dentist will become a thing of the past. Alice Barnes has taken her 15 years of tooth research and compiled it all in this eBook for you. And when you order, you get two free eBooks! You will also receive How to Prevent and Cure Canker Sores, and How to Get Rid of Bad Breath. All of these resources will keep you OUT of dentists' offices as long as you live! Continue reading...

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New Methods of Detection of Caries

The Diagnosis of Caries Simply looking at a tooth to determine whether caries is present is an inaccurate technique, although the exact sensitivity and specificity depends upon the experience of the dentist (Huysmans et al. 1998). The diagnosis of caries is one of the most difficult clinical assessments that the dentist must perform (Fig. 1.1a,b). For the best results, the teeth should be dried, and when good illumination is used a carious occlusal lesion affecting the outer half of the enamel will appear white and opaque. The anatomy of the occlusal fissure is often invaginated to form an expanded hidden chamber that is easily colonized by bacteria and then can become carious. However, when the walls of the fissure have incipient caries, the lesion is easily missed by the examining dentist. Where the occlusal demineralization progresses to affect the outer third of the dentin, an obvious white-spot lesion is visible without drying the surface. Frank cavitation of the enamel surface...

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. 4.1 Routine operative dentistry should always be completed prior to advanced procedures. Operative intervention allows the assessment of the extent of caries prior to crown preparation Fig. 4.1 Routine operative dentistry should always be completed prior to advanced procedures. Operative intervention...

New Developments in Caries Removal and Restoration

Apply Sodium Fluoride Tooth

Caries Removal There have been several recent developments with regard to methods of caries removal, and new laser, air abrasion, and chemomechanical methods have been introduced, as well as improvements in the more traditional bur technology. Laser and air-abrasion machine technologies do not contact the tooth, and as such they are much less likely than the traditional dental bur to become contaminated and cause cross-infection. Single-use dental burs prevent cross-infection, but their cost can be prohibitive. Cleaning dental burs using only autoclaving does not result in satisfactory decontamination, and a presterilization cleaning must be implemented. Manual cleaning of burs with a bur brush may produce a variable quality of presterilization cleaning, is laborious and time-consuming, and support staff may suffer puncture wounds of their skin. Washer disinfectors are very effective for presterilization cleaning of contaminated burs (Whitworth et al. 2004), but these machines are...

Dental Pain Page the Tooth Fairy

Dental pain can be a troubling ordeal. If your teeth are in pain, you can scarcely take a comfortable breath. Your dentist should be consulted to help you discover the source of your pain. Acupuncture and acupressure have been shown to be effective in the treatment of alleviating toothaches and postoperative dental pain. I frequently treat patients after they've had oral surgery or teeth pulled (even all four wisdom teeth ). With the help of acupuncture, the pain and swelling go down much more quickly Patients are able to return to work or regular household life much faster and with greater comfort In ib 1997 consensus statement on the efficacy of acupuncture, the National Institutes of Health (NIH) identified acupuncture as an effective treatment for post-op dental pain. In ib 1997 consensus statement on the efficacy of acupuncture, the National Institutes of Health (NIH) identified acupuncture as an effective treatment for post-op dental pain.

Nursing Bottle Caries Clinical Summary

The etiology of dental caries is multifactorial with an interplay between microflora (plaque colonized with Streptococcus mutans), substrate (fermentable carbohydrates from breast milk, formula, or juice), and host (saliva and teeth). Nursing or milk bottle caries results from prolonged and frequent night time breastfeeding or sleeping with a bottle containing milk or sugar-containing juices. The sugars are fermented by the bacteria in plaque, lowering the pH in the mouth and resulting in demineralization of the tooth enamel. The condition generally occurs before 18 months of age and is more prevalent in medically underserved children. Upper central incisors are most commonly involved. Dental referral is

Whos the Person Giving My Anesthesia Do Credentials Matter

Out of the approximately 40 million patients who received anesthesia in the United States in the past year, a physician specializing in anesthesiology administered less than half of those anesthetics. More than 3 million procedures were performed in doctors' and dentists' offices in 2000. Studies indicate that a physician specializing in anesthesiology was present in the office surgery suite during surgery in less than one-third of these cases.1 The Others frequently have had no formal anesthesia training. The average amount of formal training in anesthesia administration of nurses, dental hygienists, and technicians who administer anesthesia is zero. The average amount of formal training in anesthesia administration of nonanesthesiologist physicians is zero. Although dentists may choose to take a few weeks or months of training in the administration of sedative medications and nitrous oxide in dental school, their average amount of time spent in formal training in anesthesia...

Concepts of Disease in East Asia

Disease thus first appears in China embodied in dangerous others, as a menace from without. After the Shang dynasty, the focus of concern would broaden and shift from disgruntled ancestors to parasites and poisons, demons and witchcraft spells. But whomever or whatever the Chinese accused of inspiring sickness, the defining feature of the earliest conceptions of disease was their independence from a conception of the body. In other words, the peculiarities of an individual's somatic condition were no more relevant to understanding a fever or a toothache than they were for explaining why one's crops were destroyed in a storm. The fact that an affliction happened to attack the body was incidental. The vengeful spirits that brought sickness could just as easily have inflicted drought and famine.

Evidence Based Prevention Definitions

Prevention is often categorized as primary, secondary, and tertiary prevention. Primary prevention is defined as interventions that reduce the risk of disease occurrence in otherwise healthy individuals. Counseling patients to avoid smoking and prescribing fluoride to children to prevent cavities are examples of primary prevention. Secondary prevention includes screening to identify risk factors for disease or the early detection of a disease among asymptomatic and at-risk individuals. Evaluating and treating abnormal blood pressure in adults is an effective way to identify individuals at risk for heart disease and provides an opportunity to intervene before the disease occurs. Screening for colon cancer using colonoscopy to detect precancerous polyps and then removing the polyps is another example of secondary prevention. Individuals who receive primary or secondary prevention services have no obvious signs of illness in clinical terms, they are asymptomatic.

Posterior Resin Composite Restorations

Small pits and fissures with minima caries can be treated very conservatively and restored directly with good esthetics using composite resin. In addition, the remaining fissures can be protected with a resin sealant. The main contraindication to restoring the tooth with composite resin is an inability to isolate the tooth from salivary contamination, which would prevent the composite forming an effective bond to the tooth structure. The wear resistance of posterior composites has improved so that these materials have wear that is comparable to that of amalgam (Mair 1995). Wear is of little concern with these minimal restorations, as occlusal forces are also directed to the adjacent enamel. The modern small-particle composites have an improved abrasion resistance and can be polished easily. The major advantage of adhesive resin composite restorations is their conservative nature. Amalgam preparations require removing sufficient tooth substance to obtain adequate retention to resist...

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...

Associated Neurological Findings

Applying small drops of sweet, sour, bitter, and salty tasting stimuli (with water rinses between applications) to the fungiform papillae on the front of the tongue (which are innervated by the chorda tympani division of CN VII) and on the circumvallate papillae at the rear of the tongue (CN IX) can be useful in identifying regional deficits and damage to specific nerves involved in taste perception. Iatrogenic factors, such as tonsillectomy, can damage CN IX fibers and produce taste distortions, whereas alterations in CN VII function (i.e., the chorda tympani nerve) can be caused by middle ear infections. Local factors (e.g., dryness, inflammation, edema, atrophy, abnormal surface texture, leukoplakia, erythoplasia, exudate, erosion, and ulceration) can influence taste function through a variety of means (e.g., gastric reflux), as can poor oral health and the use of smokeless tobacco. y

Preventive Resin Restorations

These restorations are indicated when occlusal caries has involved a minimal amount of dentin. The technique involves isolating the tooth using a rubber dam. The fissure is investigated using a no. 0.5 round diamond bur, to a depth of about 1 mm. When this initial phase of cavity preparation is complete, the extent of caries can be assessed more easily and a decision taken as to whether to extend the cavity to the enamel-dentin junction. Any caries is removed with a small, no. round bur. Overhanging enamel is left in situ as the adhesive resin composite will provide strength to the tooth. The enamel and dentin are etched, washed, and dried (but the dentin remains moist and glistening). The enamel dentin bonding agent (primers and adhesives) is applied with a small applicator. The bonding agent is polymerized for about 10s. Composite resin is then applied incrementally and light-cured. The remaining etched fissures and the composite resin can be sealed with a thin layer of fissure...

Posterior Composite Resin Restoration

Following the application of local anesthesia, the tooth is isolated with a rubber dam. The larger class I tooth preparation has an initial depth of about 1.5mm, just penetrating into the dentin. The caries is removed from the enamel-dentin junction. Small class I cavities will have sufficient retention and resistance form from the adhesive restoration so that occlusally converging walls and flat pulpal floors may not be necessary, but where the restoration becomes more extensive then these features should be incorporated. Beveled occlusal margins are contraindicated because the thin margin of composite resin is easily lost during function, leaving a margin that quickly becomes stained. However, buccal and lingual grooves, where the occlusal contacts are lighter, can be given a 0.5-mm-wide bevel.

Direct Composite Resin Restorations

Once the caries has been removed, the remaining areas of the occlusal surface can be treated conservatively or with fissure sealants. Where necessary, calcium hydroxide can be used to protect the deepest areas of the cavity preparation, but this material has no adhesive properties. The enamel is etched for about 15s, the dentin is etched for 10s, and the etchant is washed off. The enamel surface is dried and the dentin moistened with a damp cotton wool pad. Overdrying etched dentin causes collapse of the exposed collagen fibers. The primer is applied and dried gently. The dentin surface should appear shiny. The adhesive bonding agent is applied and light-cured before applying the composite resin. The polymer chains of the polymerized resin wrap around the collagen fibers, providing the basis for the retention of the restoration. Lining materials such as flowable composite liners or resin-modified glass ionomers can provide a stress-absorbing layer immediately beneath the composite...

Nursing and the new managerialism

I believe that doctors and other professional people in the NHS are trained to take professional decisions off their own bat, and do not need the torrent of advice to which in recent years they have been subjected. It is doctors, dentists and nurses and their colleagues in the other health professions who provide the care and cure of patients, and promote the health of the people. It is the purpose of management to support them in giving that service.

Sinusitis Clinical Summary

Maxillary sinusitis is the most common form of sinusitis and is associated with paranasal facial pain, maxillary dental pain, purulent rhinorrhea, retroocular pain, and conjunctivitis. Ethmoid sinusitis is more common in children and produces a low-grade fever and periorbital pain. Frontal sinusitis can cause a severe headache above the eyes, which is exacerbated by leaning forward a low-grade fever upper lid edema and rhinorrhea. Sphenoid sinusitis is fortunately rare and patients classically complain of a vertex

Studies of Direct Resin Composite Restoration Survival

Van Nieuwenhuysen et al. (2003) found that composite resin was an unsuitable material with which to restore extensive cavity preparations in molar and premolar teeth. All retreatment was classed as failure, which resulted in a Kaplan-Meier median survival time of 7.8 years for resin restorations. This is in comparison to extensive amalgam restorations, which have been shown to be much more successful. However, extensive composite resin or amalgam restorations are cost-effective and can be easily repaired. The decision to repair an existing restoration rather than replace it should follow only after careful discussion of the treatment options with the patient. But the extent of active dentinal caries under a large restoration and the size of the new restoration can be difficult to predict.

Reasons for Failure of Extensive Direct Composite Resin Restorations

In smaller posterior restorations, discoloration of the margin and secondary caries are significant causes of failure, perhaps due to poor adaptation and gap formation at insertion and polymerization of the composite resin. But the success rate of these smaller restorations rival those of amalgam, especially where the composite resins have been placed under ideal conditions in university settings (Wilson et al. 1991). The success of posterior composite restorations is maximized where the external surface is surrounded by enamel and direct occlusal forces are avoided (Ferracane, 1992).

Adding value to milk through the use of milk protein genomics

Ideally, a milk enriched in peptides promoting immune function, controlling blood pressure, acting as a bacteriostat and minimizing oxidative stress and cancer risk, while at the same time relieving depression and preventing dental caries, would seem to have the makings of a highly valuable functional food. Combining this with an enrichment with n-3 fatty acids thought to increase insulin sensitivity and therefore prevent diabetes, together with certain milk carbohydrates capable of improving cognition, adds greatly to a product that already acts as a rich source of amino acids and energy to promote normal growth processes. Manipulation of these proteins in milk will inevitably occur in the factory and potentially in the cow. The challenge remains to turn this speculation into commercial reality for the benefit of societies in both the developed world and the developing world.

The Sandwich Technique

In the open-sandwich technique, glass ionomer restorative material forms the interproximal box of class II cavities and is extended occlusally from the gingival margin to just short of the contact point. Composite resin has better mechanical properties than glass ionomer and forms a protective covering layer. The technique is indicated in those patients with a high caries rate who require large posterior tooth restorations. The fluoride release by the glass ionomer is intended to prevent secondary caries by remineralizing the surrounding tooth. In addition, by reducing the bulk of composite resin that must be used, the polymerization shrinkage is also reduced. The technique has been modified to replace the glass ionomer with resin modified glass ionomers (such as Vitremer Core Buildup Restorative System, 3M Dental Products, St. Paul, MN, USA), which also release fluoride but have superior mechanical properties to traditional glass ionomer. Vitremer Core Buildup has a dual curing...

Modern Provisionalization in Esthetic Implantology

The prosthesis is totally tooth-supported and retained by acid etching the adjacent teeth and cementing using composite resin. However, adhesive bridges require greater clinical skills than do conventional bridges, and there is the possibility of recurrent dental caries occurring around the margins and line angles. Debonding tendency occurs with a frequency as high as 25 to 31 (Williams et al. 1989), which requires the recementation every time it occurs. This provisional method can be used when patients are extremely concerned with their social appearance or their work includes speaking in front of the media, so they cannot afford any movable devices in their mouth (See Figure 2.44).

Whos Administering Twilight Anesthesia

In the office-based surgery suite, the nurse circulating in the operating suite most commonly administers the sedation. In many cases, surgeons will administer the sedation themselves.2 Some surgeons and dentists will use the term twilight anesthesia as a euphemism for general anesthesia to avoid medical mal

Anesthesia in the Office

Intravenous sedative medication to the patient, and more than one-third said they administered the medication themselves.3 Many dentists and surgeons are directing the anesthesia administration by an office employee while they are also performing the procedure. In anesthesia circles, this is known as anesthesia by proxy. Sometimes the proxy is an RN, and sometimes the proxy is a dental hygienist with no medical training whatsoever. These anesthesia proxies administer potent anesthesia drugs of which they have little knowledge, and they are often incompetent in managing the life-threatening complications that arise from their use. Many anesthesia proxies are not trained in ACLS and are not certi-fiably competent in rescuing the patient from an untoward event.4 Patient monitoring standards in the office appear to be more cavalier than those required in the hospital setting. In a survey given to aesthetic surgeons, 5 percent reported they did not monitor blood pressure, 7 percent did not...

New Developments in Crown Provision

After several crown preparations and the insult from caries, teeth often approach the end of their treatment cycle lacking a retentive coronal tooth structure. Pins can be used on posterior teeth to retain a core such as amalgam, but they may perforate the pulp or periodontal ligament and cause microcracks in an already weakened tooth. Elective devitalization of the tooth and the fitting of a post and core are possible, but this necessitates further tooth removal. Post and core restorations have a poor prognosis where endodontic therapy has caused problems such as excessive tapering of the root canal and perforation of the root canal. With severe endodontic complications, consideration should be given to extracting the tooth and providing an implant-retained crown, which research has shown to be very successful.

Multiple body parts II body parts receive different interventions

A different situation is that in which different parts of the body are randomized to different interventions. 'Split-mouth' designs in oral health are of this sort, in which different areas of the mouth are assigned different interventions. These trials have similarities to cross-over trials whereas in cross-over trials individuals receive multiple treatments at different times, in these trials they receive multiple treatments at different sites. See methods described in Chapter 16 (Section 16.4). It is important to distinguish these studies from those in which participants receive the same intervention at multiple sites (Section 9.3.7).

Nutrition And Dysphagia

Dysphagia occurs in approximately one-third of patients with serious TBI, eventually in up to one-half of patients with MS, in nearly all patients with ALS, and in people with myasthe-nia gravis that affects oral muscles, the velopha-ryngeal port, and the pharynx. Aspiration is also common in people with Parkinson's disease. Fatigability may impede swallowing in any patient with a neurologic disease, but is especially apt to affect people with myasthenia. Oral secretions colonized by bacterial pathogens in dental plaque, caries, and periodontal tissue, as well as reflux of gastric fluids put patients at risk for aspiration pneumonia.

Clinical Trials In Dentistry

CARIES PREVENTION AND TREATMENT STUDIES The aims for these prevention studies are to investigate the effectiveness of different ways of preventing dental caries. These include different methods of strengthening the teeth (such as the use of fluorides in different forms), modification of diet (such as the use of sugar substitutes), or modification of health behaviours (such as tooth brushing techniques and habits, oral education programmes). The target populations for these studies are mainly children, the elderly and special needs groups. Most of the clinical trials are phase I or phase II types. For those studies investigating the effectiveness of different forms of fluorides (in the form of toothpaste, topical fluorides, sealant), randomisation of the assignment of groups with different regimes (including the control group) can be done at the individual level with parallel design. In a study to compare the effectiveness of two toothpastes with different concentration of fluoride to...

Interproximal enamel reduction

Fluoridated prophylaxis paste is used while slenderizing is performed (Fig 17-1 b). The paste increases the life of the abrasive instrument because the paste becomes a part of the abrasive surface. When the diamond disk is used, the paste creates a smoother enamel surface. A rough surface could collect bacteria, which might cause interproximal caries. Treating the newly exposed enamel with fluoride gel is important because the fluoride-rich enamel has been removed. Having performed this procedure on several thousand patients as well as myself, I have never seen interproximal caries develop.

Impact Of Trials On Dental Practice

DIET AND DENTAL CARIES Evidence of the role of diet, particularly sugars, in relation to dental caries has largely been collated from animal experiences or in vitro studies. Human studies have largely been of the observational type world-wide epidemiological studies, 'before and after' studies, and studies among people with both high and low sugar consumption. Very few interventional studies on human subjects have been conducted,4'60 and are unlikely to be undertaken in the future given the difficulties of placing groups of people on rigid dietary regimes for long periods of time and because of ethical issues. The main conclusion of studies relating to sugar and dental caries has been that (1) consumption of sugar, even at high levels, is associated with only a small increase in caries increment if the sugar is taken up to four times a day and none between meals (2) consumption of sugar both between meals and at meals is associated with a marked increase in caries increment.61'62...

Risk assessment in tooth extraction

Clinical examination will reveal gross caries, which can make forceps placement very difficult. Imbrication or crowding can make forceps placement and delivery of the tooth difficult. Wear facets, indicating increased occlusal load, increase supporting bone strength making extractions more difficult.

Abd El Salam El Askary

Reasons for tooth extraction include, but are not limited to, insufficient crown-to-root ratios, remaining root length, periodontal attachment levels, periodontal health of teeth adjacent to the proposed implant sites, severe subgingival caries, root fractures with large endodontic posts, root resorption, teeth with deep furcation involvement that is being considered as an abutment for fixed partial dentures, and questionable teeth in need of endodontic retreatment. Usually teeth requiring root amputations, hemi-sections, or advanced peri-odontal procedures have questionable prognosis, and patients should be given the implant option and information on long-term success rates before these procedures are implemented. Similarly, nonvital teeth fractured at the gingival margin with roots shorter than 13 mm should be considered for implants. However, clinicians are urged to remember that dental implants are a method for restoring missing teeth, not the teeth that are not yet missing.

Radiographic assessment

The crown of the impacted tooth should also be examined for evidence of caries, as caries will tend to weaken it and make fracture more likely on elevation. Paradoxically, a carious crown is also more difficult to section and split than an intact crown. The size, number and shape of the roots, and how they relate to each other, is fundamental to the assessment of difficulty in removal. Fused roots tapering to the apex present little difficulty in elevation and removal compared to converging or diverging roots with apical dilacerations.

The Permanent Maxillary Incisors

A linguogingival groove is a more common finding in maxillary lateral incisors than in central incisors. A lingual pit, near the center of this groove, is also more common, and when present, is a potential site for caries. Another groove, which is sometimes found on the lateral, but very rarely on the central incisor, is the linguogingival fissure. This groove usually originates in the lingual pit and extends cervically, and slightly distally, onto the cingulum. It might be helpful to think of the linguogingival fissure as running in a more or less vertical direction, while the linguogingival groove extends in a roughly horizontal direction.

Call Your Dentist

Possible causes Tooth decay or a dental abscess, in which a collection of pus forms in or beneath a tooth as a result of an infection, may cause constant toothache. action Try using a toothpaste for sensitive teeth. If there is no improvement in your symptoms within 2 weeks or if the symptoms get worse, consult your dentist.

Clinical Procedures for Restoration of Cervical Lesions

Releases fluoride, although whether the fluoride release results in a significant clinical caries-inhibitive effect is not known. After completion of the cavity preparation, a GC Cavity Conditioner (containing 20 polyacrylic acid and 3 aluminum chloride) is applied to the moist dentin for 10 s to remove the smear layer. It has been shown recently that if the smear layer is allowed to remain, it may hydrolyze over time, allowing bacterial penetration and mi-croleakage. The capsules are activated by pushing the plunger and triturating them for 10 s. Once the cement is mixed it is applied to the moist cavity. The incorporation of air bubbles must be avoided. The material is contoured with a plastic matrix strip and light-cured for 20 s, which will polymerize the material to a depth of 2 mm. If the cavity depth is greater than this, a layering technique must be used. Excess material is removed by polishing with a superfine diamond bur and polishing strips and discs. GC Fuji Varnish is...

New Developments in Direct Posterior Resin Composites

Using modern adhesive systems, tooth removal is primarily limited to removing caries. Overhanging enamel margins are retained as they will be strengthened by adhesive bonding. Manufacturers are investing considerable effort in developing simplified adhesive and resin-composite restorative systems with the minimum of office steps and the widest range of applications. An example of a single-step adhesive is iBond (Heraeus Kultzer, NY, USA). Three consecutive layers of iBond are applied generously to the clean, dry cavity. The adhesive is gently massaged for 30s, dried gently with air, and then polymerized for 20 s. Venus (Heraeus Kultzer) is applied to the cavity using an incremental technique and each addition is polymerized for 20 s. Venus is a typical hybrid resin-composite material with submicron barium glass filler particles (average particle size of 0.7pm) and is suitable for onlay and inlay applications, as well as direct composite veneers.

Background to Nonmedical Prescribing

As discussed, doctors have traditionally been the prescribers of medicines, and, in the UK, the Medicines Act, 1968, limited the legal right to prescribe medicines to doctors, dentists and veterinary surgeons. However, in 1986, the UK Government's Cumberledge Report - Neighbourhood Nursing - A Focus for Care identified the potential of non-medical prescribing. This report advocated prescribing by community nurses within their sphere of competence, and led to the establishment of

Ankylosis and submerged deciduous teeth

Submerged deciduous molars are also a result of ankylosis. Some children have submerged teeth in several areas, the cause of which is often unknown. It has been suggested that there is a lack of growth potential in these areas. The ankylosed tooth remains static while alveolar bone growth continues, so that it may become completely buried. The adjacent permanent teeth erupt and often the submerged tooth becomes impacted between them. The submerging tooth is prone to caries and eruption of the permanent successor is prevented. Removal becomes more difficult as they become more deeply embedded so it is better to extract them early. area by a mouth gag during dental extraction or other surgical procedures under general anaesthesia is a possibility, as is primary failure of eruption. Surgical exposure is sometimes successful if there is soft tissue obstruction or a small odontome preventing eruption, but results are poor if there is true ankylosis or long delay after normal eruption time....

Distribution Incidence and Epidemiology

Many individuals in the older population have had fewer teeth extracted as a consequence of a lower caries (cavities) incidence, which is a result of fluoride use, improvements in dental care, and better public health education. Paradoxically, this increase in the retention rate of teeth in the aging population provides an increase in the number of teeth at risk to the development of periodontitis. The only improvement that has been noted since the 1970s has been a slight reduction in the incidence and severity of gingivitis among the under-35 age group.

History and Geography

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.

Ceramic Inlay and Onlay Restorations

Kelly and Smales (2004) have shown that the traditional cast gold onlay is one of the least cost-effective, indirect posterior restorative options, and indirect porcelain onlays are likely to prove to be no more cost-effective. When dentists are undergoing treatment themselves, most still prefer traditional gold and amalgam restorations rather than the esthetic alternatives (Rosenstiel et al. 2004). In trying to assess the longevity of ceramic restorations, most studies have been short term and performed in a university setting where time pressures on the operator are less. Some concern has been expressed about the progressive wear of the composite luting agent giving rise to marginal discoloration and secondary caries. A highly filled, viscous luting cement is recommended because it is associated with lower polymerization stress and microleakage (Hahn et al. 2001). Bulk fracture of some of the ceramic materials due to the inherent brittleness of the material has also been observed,...

Garattini MC Meazzini

It is a well known fact, to the international scientific community that orthodontic treatment can be performed only when the hard and soft tissues of the oral cavity are in perfectly good health. In other words, a patient candidate to orthodontic treatment must not present caries or other periodontal diseases of any sort. In the case of such a disease, the patient must first undergo treatment to solve these problems, then maintain a suitable state of health of the tissues, by means of scrupulous oral hygiene, before starting any orthodontic treatment. Otherwise it is impossible to start any orthodontic treatment due to the serious complications that might arise. Orthodontic therapy is an elective therapy. Pathological situations where emergency treatment may be called for are inexistent in the orthodontic field. There are also systemic diseases where orthodontic treatment is contraindicated. After recording the patient's case history and clinical examination, we are in a position to...

Is Suicidal Behavior More Common in Creative People

Artists as an occupational group in general and certain subgroups of artists in particular, for instance writers and poets as well as female artists, have higher suicide rates. Steven Stack in an analysis of suicide rates among occupational groups in the US (based on the standard federal occupational codes) found that artists, along with doctors, dentists, mathematicians, and scientists, were an occupational group with an increased suicide risk, even after controlling for age, gender, marital status, and race. Artists were twice as likely to die from suicide than the rest of the working-age population, probably due to high prevalence of psychiatric disorders and high occupational stress linked to their profession. In the early 1990s, the suicide rate in the United States for artists in general (33 suicides per 100 000 artists) was almost three times the national average, and suicide rates for subcategories of artists ranged from 23 per 100 000 for actors and directors to 44 per 100...

Streptococcal Diseases

Group D streptococci, normal residents of the human body, can produce endocarditis in people with deformed heart valves. Some streptococci cannot be so readily grouped, such as Streptococcus viridans. These can also cause endocarditis, and they play a role in the formation of dental caries.

Toxicity Amelioration

One of the greatest concerns for patients with head and neck cancer is the adverse effects secondary to chemotherapy and or radiotherapy exposure. Improvements in local control and survival with newer combined modality approaches often come at the expense of more side effects, especially xerostomia and mucositis. Xerostomia contributes to a higher incidence of abnormalities of speech, oral cavity infections, and dental caries.45 Complications secondary to the mucositis include local pain, malnutrition, gastrostomy tube placement, and a higher incidence of aerodigestive tract infections. Therefore, potential approaches to prevent these treatment-related toxicities are of great interest.

Immediate extraction complications

This may be unavoidable if the tooth is weakened either by caries or a large restoration. However, the forceps may have been applied improperly to the crown instead of to the root mass, or the long axis of the beaks of the forceps may not have been along that of the tooth. Sometimes, crown fracture arises from the use of forceps whose beaks are too broad (see Ch. 25) or as a result of the operator trying to 'hurry' the operation. The management of this complication is to remove all debris from the oral cavity and review the clinical situation. Surgical extraction of the remaining fragment may then be necessary (see Ch. 23). the root in the antrum and the operator should then raise a buccal flap from the mesial and distal margins of the socket. Access to the antrum should then be increased by bone removal with bone nibblers and drills. The root can then be removed from the antrum by a variety of techniques including suction, the use of small caries excavators or direct removal by...

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).

The Written Physical Examination

Left Lower Abdominal Tenderness

Throat Lips slightly cyanotic without lesions patient wears an upper denture buccal mucosa pink without injection all lower teeth are present and are in fair condition no obvious caries gingivae normal tongue midline without fasciculations no lesions seen or palpated on tongue mild injection of posterior pharynx with yellowish-white discharge present on posterior pharynx and tonsils tonsils minimally enlarged uvula elevates in midline gag reflex intact. Throat Lips cyanotic all teeth present except for all third molars, which have been extracted occlusion normal no caries seen gingivae normal tongue midline with markedly dilated tortuous veins on undersurface no fasciculations of tongue noted posterior pharynx appears within normal limits uvula midline and elevates normally gag reflex intact.

Patient Education Home Care Instructions Fluoride Application

Osteoradionecrosis

Lack of fluoride compliancy. Figure 20-3. Advanced caries. Lack of fluoride compliancy. Patients should be monitored weekly during their radiation therapy for compliance with fluoride application and oral hygiene. Monitoring should continue on a monthly basis for the first 6 months post-treatment. The frequency of these visits is necessary because of the quick-acting nature of radiation caries, and the sequence establishes a pattern for continuity of care, possibly reducing the frequency and severity of oral complications from cancer therapy. Several long-term oral complications can result from head and neck radiation therapy. Many of these adversely affect the patient's quality of life, of which xerostomia is probably the most prevalent and disabling major sequela of the irradiated oral cavity.11 Radiotherapy causes loss of parenchyma and atrophy of glandular elements with development of fibrosis, and lack of saliva production. Severity depends on total...

Accreditation Commission for Acupuncture and Oriental Medicine AGAOM

Immune systems, 151 nausea, 149-150 pain, 150-151 carpal tunnel syndrome, 75-77 CFIDS, 221 childbirth, 160-162 constipation, 188-189 coughing, 126 cupping, 43 dental pain, 62-64 depression, 208-209 dianhea, 190 151-153 chemotherapy, 149-150 herbal medicines, 153-154 immune systems, 151 pain, 150-151 CFIDS, 221 childbirth, 160-162 choosing, 243-244 constipation, 187-189 cystitis, 181-184 dental pain, 62-64 depression, 208-209 diagnosis acupressure, 4, 9-10, 19, 21-24, 27-29, 74, 86, 128-131, 239-241 acu-points, 5-7, 63-64, 238 allergies, 116-117 anxiety 210-211 arthritis, 78-79 asthma, 118-120 back pain, 82-85 bladder infections, 182-184 bronchitis, 121 bursitis, shoulders, 70-71 cancer, 151-153 carpal tunnel syndrome, 76-77 colds, 124-125 constipation, 188-189 dental pain, 62-64 diarrhea, 190 dysmenorrhea, 169-170 eczema, 196-197 elbow pressure, 30-31 electrical currents, 8 endometriosis, 177-179 facelifts, 199-200 feet, reflexology, 24-25 finger pressure, 30 foot pressure, 31-32...

Development of the Teeth

Amelogenesis imperfecta - This type of enamel dysplasia has an hereditary cause. The defect may range from an almost complete absence of enamel, to enamel that was deposited, but failed to fully mature, depending on the stage at which the disturbance occurred. The crowns of teeth with this abnormality are subject to rampant caries, as well as excessive attrition. For this reason, these teeth are rarely seen as late as adult life. They are also an esthetic consideration, since the crowns exhibit a surface roughness. The incidence of this dysplasia has been reported as about one in 14,000. c. Dental fluorosis (Mottled enamel) - The intake of excessively high levels of fluoride ion during the enamel calcification period is responsible for this type of enamel dysplasia. It is considered to be a hypocalcification problem, since sufficient enamel matrix is normally present. The clinical appearance originally reveals chalky white bands or areas, which usually become pigmented in a brown...

Clinical Appearance of Attrition

Tooth Erosion Cupping

Fig. 5.2 Rapid attrition removes the caries-prone fissure system and early caries Fig. 5.2 Rapid attrition removes the caries-prone fissure system and early caries The incidence of occlusal caries in teeth undergoing rapid attrition is low because there is no caries-prone fissure system and early caries is abraded away (Fig. 5.2). In interproximal areas of teeth, caries can initiate and spread unhindered by the occlusal attrition.

Schwannomas of the Jugular Foramen Nerves

The most common symptom reported was hearing loss. Besides paresis of the nerves, patients can have vagoglos-sopharyngeal pain. Dysphagia, dysphonia, and persistent toothache have been reported. Schwannomas of the jugular foramen may mimic the clinical signs of glomus jugulare tumors in every aspect. Keye classified these tumors into three groups (1) type A is confined to the intracranial compartment (2) type B invades mainly the bone and (3) type C is primarily extracranial.7

Sinus Disease Symptoms

The symptoms of sinus disease are similar to the symptoms of nasal disease. Fever, malaise, cough, nasal congestion, maxillary toothache, purulent nasal discharge, headache, and little improvement of symptoms with decongestants increase the likelihood of sinus disease. Pain, often made worse by bending forward, is an important symptom. Pain from localized sinus disease is usually present in the area overlying the involved sinus. The only exception is sphenoid sinus disease, which is felt diffusely. Maxillary sinus pain is felt behind the eye and near the second premolar and first and second molar teeth. Frontal sinus pain is localized to above the eye. Ethmoid sinus pain is usually periorbital. Sometimes sinus pain can be referred to another area. In addition to pain, ocular abnormalities may also be present with diseases of the sinuses. The accuracy of the symptoms and signs of sinusitis has been evaluated. Colored nasal discharge, cough, and sneezing were the symptoms with the...

Clinical Manifestations Of Sjogrens Syndrome

The accelerated development of dental caries is also noted. Enlargement of the lacrimal glands is uncommon. Even when the salivary glands are not enlarged, they always exhibit lymphohistiocyte-mediated acinar destruction (Marx 1995). When enlarged, however, they show features of the benign lymphoepithelial lesion (BLL) in almost all cases. These lesions may occur in patients who do not have Sjogren's syndrome. Furthermore, they may undergo malignant transformation to lymphomas in patients with or without Sjogren's syndrome (Figure 6.2). This concept, as well as the entity Mikulicz's disease, is clearly worthy of additional discussion.

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.

Berkowitzs reformulation of his reformulation the neoassociationist model of anger

As can be seen from the figure, Berkowitz's reformulation begins with what he describes as an aversive event. This term is all-encompassing it includes people who feel bad because they have a toothache, are very hot, are exposed to foul smells or unpleasant noises, or who are just very sad or depressed. Berkowitz argues that a process of preliminary cognitive appraisal labels these events as aversive and that this leads to the generation of negative affect. This negative affect generated by the aversive event's occurrence Berkowitz cites numerous research findings in support of his model and many of these seek to show that the presence of aversive events of various kinds loud noises, heat, toothache, having your arm in an uncomfortable position, and so on increase the thoughts, feelings, and motor reactions usually associated with anger (Berkowitz & Harmon-Jones, 2004). Berkowitz's model can account for much of these research data as well as other findings. For example, the studies...

Hereditary and Congenital Conditions

Shingles Eye Swollen Shut

Aplasia of one or all of the major salivary glands is a rare condition that may present with severe xerostomia, rampant caries, candidiasis, pharyngitis, and laryngitis. In addition, dental chipping (Mandel 2006) and recurrent herpes labialis (Heath, McCleod, and Pearce 2006) have been described as presenting signs of salivary gland aplasia. The condition may occur as part of a recognized syndrome, associated with other congenital anomalies, or as an isolated phenomena. Aplasia of the lacrimal and salivary glands (ALSG) presenting with irritable eyes and xerostomia is an autosomal dominant condition that appears to be related to mutations in FGF10 (Entesarium, Dalqvist, and Shashi et al. 2007). In lacrimo-auriculo-dento-digital syndrome (LADD), agenesis of salivary glands as well as lacrimal glands can be seen and is an autosomal dominant condition with variable expressivity (Inan, Yilmaz, and Demir et al. 2006). A case of subman-dibular agenesis with parotid gland hypoplasia in...

Acupuncture Yoga and Homeopathic Remedies

Excellent reviews of acupuncture's theory, efficacy, and practice (Kaptchuk, 2002 Nielsen and Hammerschlag, 2004) cite the 1997 NIH Consensus Development Panel findings on acupuncture. After reviewing all available evidence from RCTs up to 1997, the panel concluded that clear evidence shows that acupuncture is efficacious for adult postoperative and chemotherapy nausea and vomiting and for postoperative dental pain. The panel also reported that acupuncture should be considered a useful adjunct for addiction, stroke rehabilitation, osteoarthritis, headache, low back pain, tennis elbow, menstrual cramps, carpal tunnel, and fibromyal-gia (NIH, 1998).

Clinical Trials Methods

Crossover design will not be applicable if the treatment has protracted 'carry-over' effect, i.e. the effect of the treatment is not reversible. In this situation, either parallel or split-mouth design should be adopted. For example in the case of dental caries, since most carious lesions occur in the pit and fissure on the occlusal surfaces of the posterior teeth, the effectiveness of sealing these pits and fissures in order to prevent dental caries is studied. In studies for comparing the effectiveness of fissure sealant compared to non-sealed teeth or sealant with different active ingredients to prevent caries, crossover design is not applicable as once the teeth are sealed, the process is not reversible. Thus for these studies, either parallel design or split-mouth design would be used. In the setting of parallel design, subjects are assigned to different concurrent test groups while in the setting of split-mouth design, different teeth of the same group of subjects are assigned...

Cutting the Wires Nerve Blocks and Neurosurgery Temporary Nerve Blocks

Nerve blocks can be as simple as the shot of novocaine dentists use to numb a tooth. By injecting a drug near the path of a nerve, you can block the transmission of painful signals before they reach the spinal cord and brain. Such blocks are used for minor surgery and sometimes for chronic pain, such as from a back injury. An epidural nerve block, used commonly for labor pain, provides more extensive pain relief because the anesthetic (numbing medicine) is injected into the epidural space, a compartment that surrounds the spinal cord. These local anesthetic blocks are considered temporary nerve blocks because numbness lasts for only several hours. For cancer pain, which often is progressive and unrelenting, temporary or local anesthetic blocks are usually used for secondary pain that is only indirectly related to the cancer itself or to diagnose or test the use of a more lasting nerve block, rather than for therapeutic use.

Decision Making in Esthetic Implantology Cases

These variations are probably due to differences in clinical performance, precision of the bridge fabrication, and the type of metal alloy used. Conventional single-tooth replacement with fixed partial dentures involves several biological and technical risks, such as endodon-tic complications, secondary caries, difficult access for plaque control resulting in periodontal complications, loss of retention, and fractures of abutment teeth. The main reason for failure of conventional bridges is attributed to endodontic failure of the abutment teeth after an unknown period of time (Meyenberg and Imoberdof 1997). The extensive destruction of the abutment teeth through tooth preparation for conventional bridges is now considered to be a clinical drawback, especially when the teeth are sound. The immense loss of tooth structure during tooth preparation can be the actual reason for unsatisfactory results that result from this treatment option. option. Adhesive bridges were originally...

Criteria for removal of wisdom teeth

Infection pericoronitis untreatabte caries Untreatable caries, pulpal or periapical pathology Another common indication for removal of wisdom teeth is the development of caries either in the wisdom tooth itself or in the adjacent second molar. This occurs because the patient is unable to clean the distal aspect of the second molar or the area around the wisdom tooth, which is often partially erupted. This leads to the accumulation of food debris and plaque and then caries of the adjacent tooth surfaces. This may lead to untreatable pulpal or periapical pathology. Restorative dentists can request the removal of unerupted third molar teeth to facilitate denture design or the accurate placement of implants.

The Pulp Tissue and Pulp Cavity

Equine Dental Pulp Anatomy

Formation of dentin The dentinogenesis process is a function of the odontoblasts, which are cells that differentiate from the peripheral portion of the pulp. The primary dentin is normally laid down only during the period of tooth formation and ends when root development is complete. All dentin production does not necessarily cease following tooth maturation, however. The pulp is still capable of initiating the formation of secondary dentin at any time during the rest of its life, in both primary and permanent teeth. There are two types of secondary dentin, reparative and physiological, which differ from each other histologically, and from primary dentin both macroscopically (mainly color) and microscopically. Reparative dentin forms in response to acute or chronic irritants such as caries, thermal and functional trauma, and mechanical causes. In reality, this is a defensive and protective mechanism. Physiological secondary dentin may be deposited in a rather consistent and uniform...

Tunnel And Slot Preparation

1 New Methods of Detection of Caries 1 1.1 The Diagnosis of 1.1.5 Radiology of Dental 1.1.7 Modern Caries Detection and Management 12 2 New Developments in Caries Removal and Restoration . . . 17 2.1 Caries 2.1.8 Caries-Detector 2.2 Restoration Following Caries Detection 26 2.2.2 Caries as a 2.2.3 Preventing Dental 2.2.4 When Should Caries Be 2.2.6 Ozone Therapy for the Treatment of Caries 32 4.1.1 Recurrent Caries and Periodontal Disease 67

Transcutaneous Electrical Nerve Stimulation

That ordinarily occurs via the smaller-diameter nerve fibers. TENS has been demonstrated via meta-analysis to be an effective treatment for adult chronic musculoskeletal pain (Johnson and Martinson 2007). A placebo-controlled trial provided support for TENS for children experiencing procedural pain (Lander and Fowler-Kerry 1993). Research also supports the effectiveness of TENS for pediat-ric dental pain (Baghdadi 1999 Modaresi et al. 1996). Published case reports (e.g., Kesler et al. 1988 Van Epps et al. 2007) have described its efficacy, including for neuropathic pain.

Professional healthcare

Most disorders can be diagnosed and treated by general practitioners (GPs). GP practices provide a range of services, including antenatal care and clinics for immunizations and for minor surgery such as wart removal. Some large practices also have other healthcare providers including practice nurses, dentists, physiotherapists, and some practitioners of complementary therapy, such as osteopaths. In addition, the NHS helpline, NHS Direct, provides advice on health by telephone or on the internet (see useful addresses, p.311).

Traditional Visual Radiograph Comparison Subjective

Forensic dentists have assisted medical examiners and coroners in unidentified-body cases for many years. In the United States, two cases are cited as the beginning of American forensic odontology the 1776 identification by the silversmith and dentist Paul Revere of Major General Joseph Warren after his death at These early cases did not involve radiography but subjective recognition of dental restorations or prostheses fabricated by the dentists involved. Dental radiography did not become widespread until the middle 20th century but has now become the standard of care in North America and in most of the developed world. Dentists use radiographs to diagnose pathologic and developmental problems, to aid in treatment procedures, and to confirm both appropriate treatment and good dental health. Consequently, experienced dentists develop skill at recognizing both biologic and restorative features in those images. This recognition is the basis for most dental identifications and is...

Surgery On The Middle Third Of The Face

Anesthesia of the maxillary nerve and its subdivisions is indicated for dental pain management and surgical procedures. By using techniques of local infiltration, nerve blocks, and field blocks, these areas can quite easily be anesthetized. The following blocks can be performed on the maxillary nerve and its following branches (1) supraperiosteal, (2) infraorbital, (3) nasopalatine, (4) greater palatine, and (5) posterosuperior alveolar.

Surgery On The Lower Third Of The Face

Surgery of the lower third of the face requires a block of the mandibular nerve. Mandibular nerve block can be done anywhere from the foramen ovale to the mental foramen for surgery of the mandible, lower teeth, or superficial operations of the mandibular region. This block is useful for minor reduction of mandibular fractures or extraction of teeth. Dentists prefer intraoral routes, whereas anesthesiologists commonly use the extraoral route at the coronoid notch.

Postoperative Analgesia

It is usual to give postoperative analgesics during outpatient dental extraction procedures. The amount of pain experienced postoperatively varies with the number of teeth extracted and the difficulty encountered in extraction. If there has been a difficult extraction of a tooth that has produced trauma to the gums, there is considerably more pain than simple extraction of, for example, a single upper incisor. Postoperative analgesia is provided usually with non-steroidal anti-inflammatory agents (NSAIDs) given orally in recovery or in the early postoperative period. The use of NSAIDs is ideal for postoperative dental pain, as some of the pain originates from the tissue swelling and these agents act in part by decreasing swelling. More recently, the use of a suppository which is inserted during anaesthesia has been described. Drugs given in this manner include paracetamol and diclofenac. It is appropriate to discuss the use of analgesic suppositories with the patient and or the...

Nonpharmacologic Therapy

Lifestyle modifications should be started early and continued throughout treatment. They may improve ADL, gait, balance, and mental health. The most common interventions include maintaining good nutrition, physical condition, and social interactions. Patients should avoid medications that block central dopamine (e.g., antipsychotics), as they may worsen PD symptoms.1,19 A multidisciplinary approach using the expertise of nutritionists, speech therapists, physical therapists, occupational therapists, and social workers may optimize care, but may not be covered by insurance. Patients should maintain regular visits with their optometrist ophthalmologist and dentist. PD medications decrease saliva flow, increasing the risk of dental caries.

The Present and the Past

May have been caused by dietary deficiency. The great number of dental caries, sore eyes, sore mouths, sore feet and legs, and skin lesions is suggestive of pellagra for it is suspected that the slave received an improperly balanced diet, particularly during the winter months and suffered greatly from cholera, pneumonia, dysentery . and probably to a lesser extent than his white master, from yellow fever and malaria.

Etiology and Epidemiology

Infection with the herpes simplex virus results from person-to-person contact. HSV-1 infections commonly are transmitted by oral secretions through kissing or the sharing of eating utensils, and thus herpetic infection can easily be spread within a family. Normally HSV-1 infections are painful and bothersome but have no serious consequences. An exception can be when the virus invades the cornea of the eye. Conjunctival or corneal herpes may produce scars that impair vision. It may occur among wrestlers from skin-to-skin contact. Another form of HSV-1 infection, called herpetic paronychia, may occur in dentists and in hospital personnel.

Clinical Manifestations Contemporaneous Observations

From the records we can see that the physician or surgeon was looking for a number of things to establish that his patient was scrofulous an itch and tumors in the glands, joints, and other tissues. As the disease progressed, the physician saw these tumors change into ulcers, which became deep and ultimately produced caries in the bones. Exploratory surgery was used to discover whether the last stage of the disease had been reached and what, accordingly, the prognosis was. Sometimes patients were sent home as incurable, sometimes they were treated in a hot room with mercury-sweats to unblock their glands and vessels of the impediment that was held to cause scrofula. Which of these many alternatives was used probably depended on where the doctor had been trained.

Mouth and Pharynx

I am going to count your teeth.'' Inspect the teeth for number and caries. The first lower molars erupt at about 1 year of age. These are followed by Figure 24-42 A, Milk caries. B, Periapical abcesses secondary to carious destruction. Figure 24-42 A, Milk caries. B, Periapical abcesses secondary to carious destruction. Multiple caries, especially of the upper incisors, are often an indication of milk caries, also known as nursing bottle caries. They are caused by the child's going to sleep with a bottle of milk or juice in the mouth. Cariogenic fluids such as milk or sweetened beverages that constantly bathe the teeth while the infant is asleep are the cause of nursing bottle carries. The interaction of Streptococcus mutans and other microorganisms in the mouth and fermentable carbohydrates results in acid demineralization of the susceptible tooth enamel. Untreated carious destruction progresses through the enamel, dentin, and pulp, producing...

Periapical Abscess Clinical Summary

Acute pain, swelling, and mild tooth elevation is characteristic of a periapical or dentoalveolar abscess. Exquisite sensitivity to percussion or chewing on the involved tooth is a common sign. The involved tooth may have had dental caries, a filling, or a root canal treatment. Periapical abscesses can enlarge

Gingival Abscess Periodontal Abscess Clinical Summary

In contrast, periapical abscesses are deep and not obvious on inspection. They usually present as tenderness to percussion or pain with chewing over the involved tooth. A parulis may also simulate a gingival abscess however, a parulis represents the cutaneous manifestation of a deeper periapical abscess. Unlike a parulis or periapical abscess, gingival abscesses are not usually associated with dental caries or fillings. Pericoronal abscesses tend to involve the gingiva overlying a partially erupted third molar.

Emergency Department Treatment And Disposition

Parental education and immediate referral to a dentist is necessary to prevent complications. If untreated, the caries may destroy the teeth and spread to contiguous tissues. These patients have a high risk for microbial invasion of the pulp and alveolar bone with the subsequent development of a dental abscess and facial cellulitis. In these cases, aggressive treatment with antibiotics (penicillin) and pain control, with prompt dental referral for definitive care, is necessary. Nursing Bottle Caries. Extensive tooth decay from sleeping with bottle containing milk or sugar-containing juices. (Photo contributor Lawrence B. Stack, MD.)

Who performs an impairment evaluation

Impairment evaluations should be performed only by professionals with a background in medical practice. Doctors of medicine and osteopathy are the logical choices. However, other professionals also possess such training and background and often perform impairment evaluations. Examples include chiropractic doctors, dentists, optometrists, psychologists, and physical therapists. Further, an impairment evaluation should be performed only by professionals qualified by training or experience to assess the organ system that needs to be evaluated. Ideally, a neurologist should evaluate neurologic impairment. However, many specialties cross boundaries so that an occupational medicine specialist or physiatrist will also be able to evaluate orthopaedic impairment, not just orthopedic surgeons.

What are the three most frequent routes by which bacterial infection spreads to the spinal column

The most common method for bacteria to spread to the spine is by the hematogenous route. Common sources of infection include infected catheters, urinary tract infection, dental caries, intravenous drug use, and skin infections. The second most common route is local extension from an adjacent soft tissue infection or paravertebral abscess. The third most common route is direct inoculation via trauma, puncture, or following spine surgery. The nucleus pulposus is relatively avascular, providing little or no immune response, and thus is rapidly destroyed by bacterial enzymes.

Side Effects of Antidepressants

Antimuscarinic cholinergic properties cause dry mouth, dental caries (due to dry mouth), blurred vision, constipation, sinus tachycardia, urinary retention, and memory loss and confusion. The most serious of these effects is the possibility of an anticholin-ergic delirium (atropine psychosis). This is usually associated with elevated plasma levels of TCA drugs but can be seen at therapeutic blood levels. Typical symptoms include impaired short-term memory, confusion, and peripheral signs of anticholiner-gic activity such as dry mouth, enlarged pupils, and dry skin. Older patients seem to

Specialty Team Coordination

The practice of head and neck oncology requires a comprehensive multidisciplinary team of specialists dedicated to the treatment of these diseases. This will include the surgical specialists (head and neck surgeons, plastic and reconstructive surgeons, dentists and oral surgeons, neurosurgeons), radiation oncologists, medical oncologists, pathologists, radiologists, nutritionists, oncology nurses, psychologists and social workers. It is imperative that there is excellent communication and close interaction among the various specialties starting early on in the evaluation and care of the patient.

Anatomy and Diagnosis

Esthesioneuroblastoma or olfactory neuroblastoma is a malignant tumor of the superior nasal vault that arises from the olfactory neuroepithelium and has a bimodal age distribution with peaks in the second and sixth decades.90 These rare tumors can cause vague symptoms that include epistaxis, nasal obstruction, and headache, with expansile and invasive growth leading to malar swelling, dental pain, proptosis, diplopia and increased intracranial pressure.19

Cadcam High Strength Ceramics

Shade Analysis And Communication

High strength CAD CAM materials are available in various types of ceramic (i.e., alumina and zirconia) to satisfy the strength and esthetic requirements anywhere in the mouth. They possess light transmission qualities greater than that of ceramometal restorations. However, optical properties vary familiarity with these materials is a must as CAD CAM has become increasingly popular and widely accepted among dentists and laboratory technicians alike. Reproduced by permission of Quintessence Publishing, copyright Quintessence. Figure 11.23. High strength CAD CAM materials are available in various types of ceramic (i.e., alumina and zirconia) to satisfy the strength and esthetic requirements anywhere in the mouth. They possess light transmission qualities greater than that of ceramometal restorations. However, optical properties vary familiarity with these materials is a must as CAD CAM has become increasingly popular and widely accepted among dentists and laboratory...

Dental Disease

Teeth and supporting tissues can be affected by many disease conditions. The size and shape of teeth can be affected by systemic diseases (e.g., infection and malnutrition) that occur during fetal, infant, and childhood dental development. Systemic diseases can also leave observable defects (hypoplasia) in the enamel. Tooth surfaces can be destroyed by bacteria, a process resulting in caries (Figure V.1.4). Caries can destroy the tooth to the point where the pulp cavity is exposed to infectious agents that can invade the bone and produce inflammation and abscess. Finally, teeth can be traumatized by gritty materials in food, by violence, and by the use of teeth as tools. 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...

Diseases

The only complete extant medical book of the Koryo Era is the Hyang-yak kugup pang (Emergency remedies of folk medicine). This collection of simple relief measures and preparations was compiled during the reign of King Kojong, in 1236. It deals mainly with emergency measures such as employed in accidents injuries bites by insects, reptiles, and other animals drowning sunstroke food poisoning drunkenness and toothache. It describes, however, also symptoms of diseases and their treatment. This book may be considered to reflect the scholarly attitude toward health care because it

Human Face

Many attempts have been made to create a proportional relationship between dental anatomy and facial anatomy, concluding with a proportional relationship (Rufenacht 1990). Although these ratios have been practically applied in many cases, in reality they deviate in many other clinical instances, probably due to the unlimited variations of facial patterns. The orofacial complex still constitutes a prime challenge for both dentists and cosmetic surgeons. Many clinicians consider the facial complex as a separate entity from the dental complex, although they are closely linked. Whereas many dentists focus only on major esthetic reconstruction jobs related to the intraoral parameters, conversely, plastic surgeons focus only on the extraoral clinical parameters and the mere facial structure as a result, the overall cosmetic job incomplete for both parties. Therefore, combining the two entities in one treatment plan becomes a logical request. In addition, any treatment plan should achieve...

Teeth Morphology

Attempts to solve esthetic problems in this age of scientific revolution led dentists to seek an evidence-based concept. This search for esthetic success with dental restorations was led by Williams (1914) but involved many other ideas and authors as well (Wavrin 1920, Young 1954). While credit is often given to Williams, Hall (1886) was the first to describe what he believed was a correlation between face form and tooth form. He stated that three basic forms of teeth existed square, tapering, and ovoid (Stein 1936). The correlation succeeded due to its practicality and manufacturer support, and not because of any actual relationship (Young 1954).

Structural Factors

A wide range of structural problems can contribute to the development of a feeding disorder. Anatomical abnormalities of any of the structures involved in chewing, swallowing, and digesting can disrupt the process and cause significant problems. Abnormalities of the oral cavity such as cleft lip and palate, anomalies of the tongue (e.g., macroglossia, ankylo-glossia), and dental caries can increase the likelihood

Failure of Veneers

Porcelain veneers are successful esthetic restorations (see Table 4.2). Figure 4.16 illustrates the veneer restoration of the two upper central incisor teeth. Peumans et al. (1998) showed that 93 of restorations were excellent after 5 years, while failures were due to recurrent caries, fracture, microleak-age, or a pulpal reaction. Studies have shown that veneers do suffer large marginal gaps, probably due to poor location of the veneer onto the tooth during cementation and wear of the resin luting cement (Peumans et al. 2000). Marginal discrepancies may also occur due to the polymerization shrinkage of the luting resin cement. This can be minimized by using a highly filled resin. The commercially available luting cements differ considerably in their filler loading. Dentin exposure is inevitable in some cases, but the inability

Paranasal sinuses

Acute infective sinusitis is an almost universal occurrence during the common cold. This is due to rhinovirus infection and is usually a self-limiting condition needing only general supportive measures in the form of analgesics and nasal decongestants. Topical nasal decongestants (e.g. ephedrine) are preferred over systemic versions. Secondary bacterial infection of ethmoid, maxillary, frontal or, less frequently, sphenoid sinuses can occur following viral infection. Bacterial sinusitis is characterised by pain, which may be severe, and poorly localised (either to the forehead or malar region). There will be a swinging pyrexia with purulent rhinorrhea. Patients often complain of upper dental pain due to involvement of the maxillary sinus. Acute infective sinusitis is a common sequel to an upper respiratory tract infection and should be seen as a potentially serious condition. Treatment with local topical decongestants and systemic antibiotics is required and failure to improve within...

Current Issues

The first 'Cochrane Centre' was opened and funded in the UK in October 1992, to facilitate systematic reviews of randomised controlled trials across all areas of health care. Currently, there are 15 Cochrane Centres around the world. However, the Cochrane Centres are not directly responsible for preparing and maintaining systematic reviews. This is the responsibility of international collaborative review groups, which also maintain registers of systematic reviews currently being prepared or planned, so that unnecessary duplication of effort can be minimised and collaboration promoted. Currently there are about 50 review groups covering all of the important areas of health care and dentistry included in the Cochrane Oral Health Group (http www.cochrane-oral.man.ac.uk). The principal output of the collaboration is the Cochrane Reviews which are published electronically in successive issues of The Cochrane Database of Systematic Reviews. Ten Cochrane Reviews have been finished...

Consent

Although most dentists will not work on patients under general anaesthesia - most refer patients for general anaesthesia and so hence have the responsibilities of the referring dentist, detailed below - they do have continuing responsibility for their patients postoperatively and so must have detailed knowledge regarding their responsibilities surrounding such referrals. Operator dentists are required to ensure that the treatment to be undertaken is not beyond their level of expertise and knowledge and that the facility complies with General Dental Council requirements on anaesthetic and support staff, equipment and drugs and that there is a protocol in place for the care of the collapsed patient. Staff training in monitoring of the patient and in dealing with emergency situations is mandatory and should be undertaken regularly. Before embarking on the provision of care the operator should

Exclusions

Dry mouth can be relieved by sugarless mints or gum. Frequent sips of water are also helpful. Those with continued symptoms may be candidates to try artificial saliva solutions (Salivart, Mouth Kote). Meticulous dental care should be encouraged because caries can occur more frequently with reduced salivary flow. Secretagogues such as pilocarpine or cevimeline can be used, but adverse effects such as flushing, increased perspiration, and increased bowel or bladder motility might outweigh their benefits. Topical antifungal troches are useful for low-grade oral infections.

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...

Biological Dentistry

Biological dentists believe that the material used to fill cavities causes cancer, Alzheimer's disease, and almost all other chronic illnesses. Biological dentistry is the use of alternative (unproven) treatments for problems of the teeth, gums, jaws, and mouth as well as disorders throughout the body. Biological dentists believe that treating the mouth is a method of treating the body and curing its diseases. Examples of illnesses and problems that biological dentists aim to cure, in addition to cancer, include tinnitus (a ringing noise in the ear), vertigo, epilepsy, hearing loss, eye problems, sinusitis, joint pain, kidney problems, digestive disorders and heart disease. Along with mouth and dental work, biological dentists also use additional alternative treatments such as neural therapy, urging patients to avoid fluoridated water, oral acupuncture, cold laser surgery, homeopathy, and other unproven, unconventional techniques. These are briefly described below. Neural Therapy....

Management

Opening of the root canal can, in the early intrabony abscess, be sufficient in itself. When opened and pus is obtained, it is prudent not to close the canal immediately but allow sufficient time for adequate drainage to occur. This may take only 12-24 h but gross contamination and even caries within the root canal can occur if the tooth is left open for too long.

Medical history

It is important to ensure that the patient has a stable periodontal condition and low caries rate at the time of assessment, although many patients require implant treatment as a result of previous neglect. Mucosal disorders should be eliminated as far as possible. Bone quality and availability should be assessed (Table 37.6).

Conclusion

Noncarious tooth tissue loss provides a challenge of diagnosis and treatment for the dental surgeon. For example, some patients find it difficult to discuss their eating disorder problems, often denying that their diet or vomiting can be affecting their teeth. Oral health-care providers have a crucial role in the early identification of eating disorders and in the referral and management of these patients. Adhesive technology can be used to treat toothwear and should simplify treatment for this increasingly common problem, producing restorations with excellent appearance and functionality.

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