Oral Health PDF

– Any change in the colour and/or translucency Definition of a tooth due to any cause  – Restorative filling material – Drugs Causes – Pulpal necrosis – hemorrhage Fluorosis Restorative filling (amalgam) Pulpal necrosis...

– Any change in the colour and/or translucency Definition of a tooth due to any cause  – Restorative filling material – Drugs Causes – Pulpal necrosis – hemorrhage Fluorosis Restorative filling (amalgam) Pulpal necrosis Smoking Hemorrhage Tetracycline  – Discoloration is one of the major reasons why patient may seek dental treatment – Negatively influence the quality of life as it affects the Facts aesthetic immediately – An understanding of the etiology of tooth discoloration is very important for proper diagnosis and then the suitable treatment plan  – Based on location or etiology Classification Diagnosis Treatments Micro abrasion Conservative method 25-200µm of outer layer of enamel Mild acid solution used Macroabrasion Removal localized stains It is indicated in deeper stains Micro Vs Macro- abrasion  – A veneer is a layer of material placed over Veneers a tooth. Veneers can improve the aesthetics of a smile and protect the tooth's surface from damage Veneers  – Ceramic crowns are prosthetic replacements which are permanently fixated onto the Ceramic Crowns prepared teeth or dental implants with the aim of restoring the lost function and aesthetics of teeth. Ceramic Crowns  The bleaching agents that are most commonly used for whitening of root-filled teeth are hydrogen peroxide, carbamide Bleaching peroxide, and sodium perborate. Hydrogen peroxide is the active ingredient in currently used tooth bleaching materials = Whitening 1. External 2. Internal  – Internal tooth bleaching is a completely different process that requires access inside the Internal tooth. This type of bleaching is done when a bleaching particular tooth is darkened or discolored; this usually occurs when the nerve inside the tooth has died due to either infection or trauma.  –Applied to the external surface of the tooth, it is accomplished in a two External different ways: Bleaching – Home bleach – Laser (Zoom)Bleaching External Bleaching Before…After  WHAT IS FLUORIDE? Fluoride is a natural inorganic, monatomic anion mineral with the chemical formula F⁻ , whose salts are typically white or colorless, that builds strong teeth and prevents cavities. Fluoride is a mineral in your bones and teeth Fluoride is also found naturally in the following: Water Soil Plants Rocks Air  What are the benefits of Fluoride? Improves dental health and prevents decay Restores minerals to tooth surfaces where bacterial acids may attack enamel. Inhibits the growth of harmful oral bacteria and further prevent cavities. v“Fluoride cannot remove decay create a stronger outer surface to your teeth, so it can help stop the decay from penetrating into the deeper parts of teeth vFluoride is especially helpful in individuals at high risk of developing dental caries  What are the benefits of Fluoride? v Fluoride benefits both children and adults v The earlier children are exposed to fluoride, the less likely they are to develop cavities v Studies found a 43% reduction in cavities in children and adolescents who received fluoride treatments for one year v Fluoridated water reduced cavities by 40 to 60 percent  How Fluoride is supplied? In local drinking water supply and in many over-the-counter (OTC) products, including: Toothpaste Mouth rinses Supplements (Gel, varnish….etc)  Sources of Dietary Fluoride? Common sources of dietary fluoride include: Tea Water Food cooked in water Fish Infant formula Grape juice Some vegetables and fruits  Mechanism of action? Fluoride helps to: Rebuild (remineralize) weakened tooth enamel Slow down the loss of minerals from tooth enamel Reverse early signs of tooth decay Prevent the growth of harmful oral bacteria  Optimum amount of fluoride needed? A professional fluoride treatment at your dentist’s office every 3, 6, or 12 months, depending on your oral health. Dentist may prescribe a special fluoride rinse or gel to use regularly at home for caries-high risk patients.  Optimum dose of fluoride? Optimal fluoride intake comes from food, water, and supplements. Optimum concentration in drinking water in moderate climate is 0.7-1 mg/L [part per million (ppm)] The following recommended daily amounts of fluoride: < 6 months: None Ø 6 months-3 years of age: 0.1 to 1.5 milligrams (mg) Ø 4 - 6 years of age: 1 to 2.5 mg Ø 7 - 10 years of age: 1.5 to 2.5 mg Ø Adolescents and adults: 1.5 to 4 mg  Fluoride for Children? Under 3 years: Brush their teeth with close supervision. Apply only a thin layer of fluoride toothpaste to their toothbrush. The toothpaste should be no bigger than a grain of rice. 3-6 years: Pea size tooth paste is recommended. Watch children to ensure they spit toothpaste out while brushing.  Side effect of overdose? Fluoride poisoning is very rare today, but overexposure may harm developing bones and teeth in small children. Ø Too much fluoride can cause: Dental Fluorosis: White specks on mature teeth and staining and pitting on teeth Problems with bone homeostasis Skeletal fluorosis:Very dense bones that aren’t very strong  Side effect of overdose? Acute toxicity, due to overdose by taking supplement pills, can cause: Nausea Diarrhea Tiredness Excessive sweating v It can even lead to death. Always keep fluoride supplements out of reach of children. Dental Fluorosis  The ability to chew and swallow is so critical function that is required to obtain essential nutrients for the body Oral health plays a significant role in A balanced diet is so essential for the assuring adequate nutritional status body’s immune system to fight infections. A well- balanced diet may benefit oral health 1- Calcium u Calcium is so essential for healthy bones, teeth, muscle contractions u calcium has a significant role in building the density at the alveolar bone u women and men are twice as likely to have periodontal diseases if their calcium intake is insufficient. u Researches have shown that patients who consumed less than the recommended 60 mg per day : (about one orange): at nearly one-and-a- half times the risk of developing severe gingivitis 2- Vitamin C u vitamin C which has a significant role in maintaining and repairing healthy connective tissue along with its antioxidant properties u known as a powerful scavenger of reactive oxygen species, which form part of the body's antioxidant defense system u vitamin C (among other important vitamins) are essential to maintaining healthy gums. u Daily intake from 60-70 mg  FACTS u Dairy products provide calcium and vitamin D for strengthening teeth and bones. u B vitamins for growth and iron for healthy blood, which in turn contributes to healthy gum tissue supplied by Breads and cereals. u Some foods tend to be stick to the teeth, such as chips, food’s characteristics affect the time that it remains in the mouth. u Starches can cause caries, too. Starches in general— from bread to crackers to sugars from fruit, milk, honey, corn sweeteners, and refined sugar—can all produce the acids that damage teeth. FACTS u Incorporate balance and variety in food choice u Clean teeth with fluoride toothpaste at least twice a day. u Floss regularly, or use an interdental brush (particularly useful for braces, bridges, or hard-to-reach places). u Visit the dentist regularly. u Limit eating occasions to regular meals and no more than two to three snacking occasions daily.  Nail Biting Definition: Onychophagia, or onychophagy, is considered a pathological oral habit characterized by chronic, seemingly uncontrollable nail biting that is destructive to fingernails, the surrounding tissue and teeth. Causes: Higher level of anxiety Symptoms: Distressful feelings of unease and tension, damage to nails and fingers, oral injuries and dental problems Onset: usually begins in early childhood, most common during adloscence, and may continue through adulthood, although the behavior often decreases or stops with age.  Nail Biting Oral manifestations: Chipping of teeth, overloading of jaw musculature that may lead to jaw dysfunction Treatment: Ø Bitter-tasting nail polishes Ø Barrier-type interventions: gloves or bite-plate Ø In sever cases emotional factors should be removed  Cheek Biting Definition: is considered to be a body-focused repetitive behavior (BFRB) similar to hair pulling or nail biting. It can be an anxiety-related problem. BFRB become disorder when affect quality of life, damage or distress. Can be related to mental health and psychological disorders Causes: Ø Reaction to stress and boredom Ø Coping method for emotional overload Ø Malalignment of teeth Ø Malpositioned wisdom teeth Ø Inappropriately contoured posterior crowns  Cheek Biting Oral manifestations: Injury to the mucosa, corrugated mucosa, ulcers, pain and discomfort Cheek biting and oral cancer: biting may not directly cause oral cancer but it aggravates, promotes and progress existing precancerous or cancerous lesions Treatment: Ø Orthodontic alignment of teeth Ø Replacement of faulty crowns Ø Chewing gum to replace the habit Ø Mouthguard Ø Lower stress level by cognitive behavioral therapy  Thumb Sucking Definition: repeated and forceful sucking of the thumb with associated strong buccal and lip contraction Causes: Ø Emotional Theory: Freudian based emotional disturbance stemmed from satisfaction from feeding period and thus elicit pleasure by sucking finger as a continuum behavior Ø The learned behavior theory: an innate urge in infants and that finger sucking is an outlet for an excess sucking urge which is an innate behavior that becomes a habit  Thumb Sucking Complications: Ø Digit sucking is a habit that is considered to be normal up to the age of 2–4 years Ø If stopped at age of 4 and changes will be reversed Ø Maxilla: narrowing of arch, proclination of anterior teeth, posterior cross bite, increased horizontal overlap, in some cases anterior open bite Ø Mandible: Retroclination of anterior teeth Ø Speech problems Ø Mouth breathing as a consequence of open bite Ø In severe cases digital deformity and callus Ø Feeling of shame and social stigma Ø Incompetent lips Ø Lower lip placed behind upper incisors  Thumb Sucking Management: Ø Treatment for thumb sucking should not be pursued before the child is 4 years of age. Ø Different approaches 1. Psychological Approach and Behavior Modification 1.Screening of patient for underlying psychological disturbance 2.Parents should provide adequate positive reinforcement. 2. Reminder Therapy 3. Reward Therapy 4. Appliance Therapy  Thumb Sucking Management: Reminder Therapy v For the child who wants to quit but needs help. v Reminders that are introduced with an explanation to the child can be useful. v One of the simplest approaches is to secure an adhesive bandage with waterproof tape on the finger that is sucked. v The “reminder” must be neutral and not perceived as any form of punishment  Thumb Sucking Management: Reward Therapy A deal is made up between the child and the parent or between the child and the dentist. It simply states that the child will receive a reward if he/she discontinued the habit within a specified period of time.  Thumb Sucking Management: Appliance Therapy 1- Removable appliances: consist of palatal wire assembly embedded in removable acrylic appliance Quad helix 2- Fixed appliances: consist of maxillary lingual arch with cribs or rake soldered or inserted in lingual sheath in anterior region. Most common appliances used are Quad helix, palatal crib.  Mouth Breathing Definition: Habitual respiration through the mouth instead of the nose Types: 1- Obstructive: Nasal obstruction 2- Habitual: Mouth breathing though obstruction removed 3- Anatomical: Short upper lip  Mouth Breathing Causes: Developmental and morphologic anomalies like abnormal development of nasal cavity, nasal turbinates and short upper lip. Partial nasal obstruction due to deviated nasal septum, Localized benign tumors. Infection and inflammation of nasal mucosa Traumatic injuries to the nasal cavity Genetic pattern— ectomorphic children having a genetic type of tapering face and naso-pharynx are prone to nasal obstruction.  Mouth Breathing Effects of mouth breathing: Lip incompetence Increase in the height of the lower third of the face due to low position of the tongue in the mouth floor Dark circles Narrow nostrils Dental crowding Proclination and spacing of maxillary anteriors The lower lip is heavy and everted High arched palate and gummy smile associated with malocclusion of class II High prevalence of posterior cross-bite and anterior open-bite Anterior marginal gingivitis called mouth breathing gingivitis is seen. Mouth Breathing  Mouth Breathing Management Remove underlying cause Myfunctional therapy: Lip exercise by stretching upper lip to seal the mouth, hold pencil between lips at daytime, tape lips together at night, deep breathing exercise. Oral screen: The oral screen is a device used to retrain the lips: 1. Corrects simple labioversion of the maxillary anterior teeth 2. Habit correcting appliance as it helps retrain and strengthen lip action It should not be used if the child has nasorespiratory distress or nasal obstruction.  Mouth Breathing Management Rapid maxillary expansion: Increase nasal air flow and decrease nasal air resistance Aimed at widening of the arch Increase in intranasal space occurs due to outer walls of nasal cavity moving apart  Tongue Thrust Definition: Forward movement of the tongue tip between the teeth to meet the lower lip during swallowing and in sounds of speech, so that the tongue becomes interdental. It is an oral habit pattern related to the persistence of an infantile swallow pattern during childhood and adolescence  Tongue Thrust Types: 1- Simple anterior tongue thrust: anterior open bite with normal contacts in posterior teeth 2- Posterior (lateral)tongue thrust: Posterior open bite with tongue thrusting laterally 3- Complex tongue thrust: Teeth are apart and buccal Simple anterior tongue thrust occlusion is deranged. Posterior (lateral)tongue thrust  Tongue Thrust Causes: Retained infantile swallow Upper respiratory tract infection, mouth breathing, chronic tonsillitis, and Allergy. Hereditary inherited hyperactivity of orbicularis oris muscle Induced by other habits such as thumb and finger sucking Congenital macroglossia (Large tongue) Adaptive tongue thrust is forward movement during swallowing to help establish an anterior lip.  Tongue Thrust Intraoral Features Proclined, spaced and sometimes flared upper anterior resulting in increased overjet Retroclined or proclined lower anterior depending upon the type of tongue thrust Presence of an anterior open bite Presence of posterior cross bites The simple tongue thrust is characterized good intercuspation of posterior teeth in contrast to complex tongue thrust Difficulty with speech, especially the S and Z sounds  Tongue Thrust Extraoral Features 1. Usually dolichocephalic face (Long face) 2. Increased lower anterior facial height 3. Incompetent lips 4. Expression less face as the mandible is stabilized by facial muscles instead of masticatory muscles during deglutition A model of King Tutankhamun facial reconstructions from CT scans of King Tutankhamun's mummy  Tongue Thrust Treatment Myofunctional exercise: Child is asked to place the tip of tongue in rugae area for 5 min and then swallow, whistling, reciting the count from 60-69, gargling and yawning Speech therapy: It is not indicated before the age of 8 yrs; to pronounce words beginning with s and repeat s; multiplication table of 6 Appliance therapy: Tongue-thrusting device; Palatal crib Orhodontic treatment Surgical treatment: For reduction of lymphoid tissue size improves abnormality to tongue thrust. orthognathic surgical procedure for correction of skeletal malformation. z Missing teeth…Loosing teeth § Edentulism (Toothless) : is defined as the absence or complete loss of all natural dentition (teeth). Is the condition of being toothless to at least some degree; it is the result of tooth loss §. Loss of some teeth results in partial edentulism (One or more teeth are missing but never all.) § Whereas loss of all teeth results in complete edentulism.  z Dentate Complete edentulism Partial edentulism z Missing tooth vs Missing parts of the tooth z Reasons for missing teeth § Cavities § Gum disease § Periodontal disease ; as the destruction of these structures worsens, the teeth become loose and fall out. § Amongst the elderly, old fillings, dry mouth, gum recession, and plaque may all play a role in edentulism. § Accidents § Trauma § Cancer z Importance of replacing missing teeth § Function (mastication, speech, swallowing) § Aesthetic (facial profile, lip contour) § Psychological (life style, well being) z  z Treatment options for missing teeth Dental Prosthesis Fixed Removable Maxillofacial Partial Complete Intra-oral Post core, Single Implants Dentures Dentures (obturators) Extra-oral inlays, crowns& retained onlays, Bridges prosthesis veneers Factors on deciding on the treatment plan z § Medical history; diabetes, cardiovascular diseases, handicap § Histological factors; bone level, mucosa, saliva…. § Cost § Allergy to certain materials § Skilled dental team § Available resources and equipments § Age z § Single damaged crown Single crown § Large filling is contraindicated § Root is sound and exists § Different materials like; metal ceramic, zirconia crowns, preesed ceramic, metal crown. z Crown Materials used in crown restoration z Highly damaged crown but root is there  z Post and core § post and core crown is a type of dental restoration required where there is an inadequate amount of sound tooth tissue remaining to retain a conventional crown. A post is cemented into a prepared root canal, which retains a core restoration, which retains the final crown. § The role of the post is firstly to retain a core restoration and crown, and secondly to redistribute stresses down onto the root, thereby reducing the risk of coronal fracture. z z z Missing tooth § Missing tooth=no crown + no root § Extracted teeth § Congenitally missed teeth § One or more missing teeth z Anterior or posterior single or multiple  z Fixed bridges § A fixed bridge; bridges the gap between one or more missing teeth. § Once the bridge is in place, however, a fixed dental bridge looks, feels and functions like natural teeth, does not require removal for cleaning and is typically much more cost effective than a dental tooth implant. § Metal ceramic bridge, free metal ceramic, CAD/CAM Zirconia ceramic z  z Dental implant § A dental implant is a surgical procedure in which a replacement tooth root is placed and fused with the jawbone. § Advantages: While dental implants work well when replacing a single tooth, they may not be the best option for multiple teeth replacement. That said, dental implants provide the look and feel of natural teeth and can last for years, if not decades, without needing to be repaired or replaced. § Disadvantages: However, since a dental implant requires surgery and typically cost more than bridges or dentures, they aren’t right for everyone. z  z Removable partial denture § A removable partial denture consists of replacement teeth for a small section of missing teeth and look and function as normal. § While a removable partial denture is great for chewing and aesthetic appeal, they are far less durable than a tooth implant or bridge and can become uncomfortable when worn for an extended amount of time. § But they are typically the least expensive tooth replacement option available and are easy to repair if any damage occurs. z  z Complete removable denture § Unlike a removable partial denture, where only a section of missing teeth is replaced, a removable complete denture is used to replace all missing teeth. § While a removable complete denture is both aesthetic and functional, they can be uncomfortable and aren’t to be worn for 24 hours a day. § z z Overdentures =Implant+ denture z Overdentures =Implant+ denture § Retentive § Expensive § Hygienic § Complicated  Forms of Smoking Forms of tobacco include: Smoking forms: Cigarette, Cigar, Pipe, Hookah. Smokeless forms: Snuff and chewing tobacco like Khat chewing  Effects of Smoking Bad breath Tooth staining and discoloration Salivary gland openings inflammation on the roof of the mouth Increased plaque and calculus deposition on teeth Increased bone loss Increased risk of precancerous lesions such leukoplakia, white and red patches in the mouth  Effects of Smoking Increased risk of gingival and periodontal diseases Delayed healing process following tooth extraction, periodontal treatment, or oral surgery Lower success rate of dental implants procedures Increased risk of developing oral cancer Increased risk of dental caries Increased risk of tooth loss Tooth abrasion and erosion  Staining of Teeth Usually brown/black extrinsic stains Extent depends on duration, frequency and oral hygiene Smokers have twice as much staining as non- smokers Caused by tar and nicotine Chewable smoking cause staining too. Betel nut cause red staining Khat Chewing  Bad Breath Smoking can affect your sense of taste and smell The tar from cigarette smoke causes bad breath and can discolor your tongue. Remove these stains with a professional cleaning in the dentist's office and practicing good oral hygiene.  Dental Caries Smoking cause gingival recession and consequently root caries Increased risk of caries: reduce buffering effect of saliva and increase number of bacteria that cause caries such as S.Mutans Lower salivary activity Smoker have poorer oral hygiene Fewer visits to dentists Lesser overall health standard compared to non- smokers Caries in smokers is usually cervical, interproximal and root caries  Tooth Abrasion and Erosion Holding Pipe cause notching of incisal edges and cusp tips Long-term tobacco chewers demonstrate excessive tooth wear caused by gritty materials remaining in processed tobacco Chemical dissolution of enamel has been reported  Effect on Gingiva and Periodontium Gingival bleeding is less in smokers due to vasoconstrictive effect of nicotine Smoking interferes with normal function of gingival tissue Smoking affect the immune response Smoking impairs blood flow to the gums Acute necrotizing ulcerative gingivitis (ANUG) is strongly associated with tobacco use 98% of ANUG patients are smokers ANUG affects teenagers and adults and associated ANUG with viral infection  Effect on Gingiva and Periodontium Smokers have deeper pockets, more attachment loss, more bone loss and more tooth mobility Smoker are 2.5-3.5 times at greater risk of severe periodontitis Cytotoxic effect of nicotine and other components are secreted in saliva and crevicular fluid Attachment of fibroblasts to cementum is altered Smokers response less favorable to periodontal therapy than non-smokers Smokers have less healing ability  Precancerous Oral Lesions I- Leukoplakia and erythroplakis Leukoplakia is unscrapable premalignant white lesion of oral mucosa Smokers have 6-fold increase in risk of developing leukoplakia Leukoplakia Erythroplakia: Unscrapable red lesion that can’t be defined as any other condition Annual cancer transformation rate of 5% Speckled (rough) erythroplakia has a cancer potential of at least 25% Speckled erythroplakia  Precancerous Oral Lesions II- Submucous Fibrosis Progressive stiffening of oral mucosa Difficulty in opening the mouth Cause by chewing mix betel leaf, areca nuts with their tobacco 8% malignant transformation in India  Oral Cancer 2-3% of all cancers Middle age and elderly Men more than women Risk increase with number of cigarettes and years of smoking Cessation of smoking decrease the risk Tobacco chewers also develop oral cancer Low grade malignancy at exact site of chewing: Verrucous carcinoma with low mortality rate  Oral Cancer Betel nut chewing may cause cancer Exposure to tobacco is responsible for 90% of oral cancer cases worldwide Free radicals from cigarettes smoking triggers this malignant transformation  Hairy Tongue Elongated filiform papillae mimicking hair on the dorsum of the tongue seen in heavy smokers  – Stained – discolored – worn – Chipped Problems – broken – misaligned – misshapen – or have gaps between them, – A “smile makeover” improves the appearance of your smile through one or more cosmetic dentistry procedures.  – Unlike restorative dental treatment, cosmetic dentistry is focused Restorative more on the cosmetic or aesthetic appeal of a patients smile than health. Therefore, cosmetic dentistry is more focused on VS improving the confidence of someone’s smile through techniques and procedures that will improve alignment, shape, cosmetic color and size of the teeth and mouth as well as the appearance of the gums and bite.  – Teeth Whitening Teeth whitening can be one of the simplest and least expensive ways to improve your smile. Teeth can be bleached with in-office products in your Types of dentist’s office or by buying a mold and gels from your dentist to bleach your cosmetic teeth at home. There are also whitening products available over procedures the counter at retail stores for convenient at-home whitening: whitening toothpastes, rinses, and whitestrips.  – Dental Veneers Types of Dental veneers are wafer-thin, custom- made shells of tooth-colored porcelain or cosmetic resin that cover the front surface of the teeth. changing the teeth color, shape, procedures size, or length. Veneers are often called “Hollywood teeth."  – Composite Bonding – Composite bonding refers to using material that resembles tooth enamel color. The dentist drills out the tooth decay then applies the composite onto Types of the tooth's surface, and then "sculpts" it into the right shape before curing it. This cosmetic procedure effectively covers the tooth's damage and gives the appearance of a procedures healthy tooth in its place. Bonding is one of the least expensive cosmetic dentistry procedures available to patients with tooth decay, chipped or cracked teeth, and worn-down edges.  – Botox and dermal fillers can help minimize TMJ and migraine symptoms, as well as reducing gummy smiles. While Botox and other dermal fillers are similar; Botox is derived from a neuromuscular toxin (botulinum), while most fillers are Hyaluronic acid, a naturally occurring nutrient that we lose as Dermal Filler we get older and Botox in Dentistry Dermal Filler and Botox in – Dentists are especially adept at treating these conditions with Dentistry Botox due to their extensive training and knowledge in oral and maxillofacial muscles. Dentists perform more injections in the oral and maxillofacial areas than any other medical practitioner