Download Dental Plaque Diseases

DUMITRACHE
SFEATCU
MIHAELA ADINA
IONELA RUXANDRA
RANGA
ROXANA CRISTINA
ORAL HEATH EDUCATION GUIDE FOR
ADOLESCENTS
Coordinator:
Dumitrache Mihaela Adina
Authors:
Dumitrache Mihaela Adina
Assoc. Professor, Oral Health and Community Dentistry Department, Faculty of
Dentistry, U.M.P. ,,Carol Davila”, Bucharest
Sfeatcu Ionela Ruxandra
Lecturer, Oral Health and Community Dentistry Department, Faculty of
Dentistry, U.M.P. ,,Carol Davila”, Bucharest
Ranga Roxana Cristina
Lecturer, Preventive Dentistry Department, Faculty of Dentistry,
U.M.P. ,,Carol Davila”, Bucharest
Collaborators:
Borontiș Grigore
President of ,,Asociația Tineri pentru Educație și Societate”
Lambescu Dan Gabriel
Assistant Professor, Oral Health and Community Dentistry Department, Faculty of Dentistry,
U.M.P. ,,Carol Davila”, Bucharest
Acknowledgements: This book was published with the support of European Commission, through the National
Agency for Community Programs in Education and Vocational Training, Erasmus + Youth Community Project type
Oral health -based Learning Model "Com4you" no. 2014-2-RO01-KA205-013237.
CONTENT
Chapter I. Oral health – Why is it important..................................................................
Chapter II. Dental Decay and Gingivitis.........................................................................
Chapter III. Removing dental plaque by tooth brushing and auxiliary tools..........................
Chapter IV. The role of diet in the development of dental caries................................................
Chapter V. The Effects of Eating Disorders on the Oral Health..............
V.1. Dental erosion.................................................................................................
V.2. Bulimia..............................................................................................................
Chapter VI. Oral Soft Tissues Injuries …………………………………….
Chapter VII. The Effects of Alcohol and Tobacco on Oral Health …………………………
Chapter VIII. Methods of preventing oral diseases in dental office........................................
VIII.1. Role of fluoride in dental caries preventing ………………………………………
VIII.2. Dental Sealants ………………………………………………
VIII.3. Role of regular dental check-ups ………………………………………..
I.
Oral health – Why is it important?
Certainly each of us have heard about how important it is to stay healthy for a better
development of our body.
What does it mean ”oral health” for each of you?
Most often, the answer that each of us will provide will be reflected by a healthy
smile.
Fig. 1. The importance of oral health (from 1)
Let's look at what might happen if we neglect it...
The lack of oral hygiene can lead
to dental caries and gingivitis
Pain
Lower results at school, absenteeism
Poor diet and appearance
General health problems in long term (fig. 2).
Fig. 2. Consequences of the lack of oral hygiene (from 1)
Loss of teeth
How can you realize that your teeth are in distress?
Tabel 1. Signs and symptoms of oral disease
SYMPTOMS
Masticatory difficulties
Poor dental hygiene because of pain
Halitosis (Foul smelling breathing)
Absence of smilling
Sad face
Refusal to eat
Persistent pain
Tearful wailing
Brown strains on teeth
Dental caries
Swollen lips
Gingival inflamation, bleeding after brushing
Calculus
SIGNS
Low school activities involvment
Low self esteem
Sometimes hyperactive
Hand over the mouth
What can you do?
1. Ask dentist's help! An initial consultation can establish the problems that you are
experiencing.
2. Regular dental check-up (every 6 month).
3. Brush your teeth daily, in the morning and in the evening.
4. Use dental floss, mouthwash, as your dentist advices you
5. Be careful with your diet: rich in vitamins and minerals, poor in hydrocarbons and sweet
acid drinks.
DENTITION
People have two types of teeth (two rows of teeth): deciduous teeth (primary teeth - that
are changing) and permanent dentition (teeth which are permanent - no change anymore). The
teeth are placed on dental arches: maxillary (upper) and mandible (lower).
Primary teeth (children’s teeth) are in number of 20 and change completely up to age 13.
They are divided into:
•
•
•
•
•
Central incisors
Lateral incisor
Canine
First molar
Second molar
The 5 teeth are symmetrical on the maxillary (upper arch), 10 teeth in total. The same
number and the same order is on the mandible too (lower arch) (fig. 3).
Fig. 3. Deciduous dentition (from 2)
Permanent teeth appear after the age of 6, with the advent of the "6-year molar."
In any permanent dentition there are 32 teeth, on each half arch the following teeth may
be found:
•
•
•
•
•
•
•
•
Central incisors
Lateral incisor
Canine
First premolar
Second premolar
First molar (6 years molar) - it is also called so because the age around where
appears
Second molar (12 years molar)
Third molar (wisdom tooth) - appears after 18 years
Fig. 4. Permanent dentition (from 3)
Tooth structure
A tooth consists of enamel, dentin, cementum and pulp tissue.
Fig. 5. Tooth structure (from 4)
The portion of the tooth exposed to the oral cavity is known as the dental crown, and the
portion below the dental crown is known as the tooth root.
The dental pulp cavity exists in the center of the tooth, through which the dental pulp, called
the nerve, runs. In order to receive an impact on the tooth and to absorb and alleviate the
force on the jaw, the surface of the tooth root area (cementum) and the alveolar bone are
connected by a fibrous tissue called the periodontal ligament.
The tooth is supported by the tissue consisting of the alveolar bone, gums and the periodontal
ligament.
Enamel = The hardest bodily tissue covering the surface of the dental crown. Enamel is the
hardest substance in the body. It is as hard as crystal (7 on the Mohs scale of mineral
hardness).
Dentin = The tissue that forms the tooth from the dental crown to the tooth root, situated
inside the enamel and cementum. It is softer than the enamel. A small tube filled with tissue
fluid, called the dentinal tubule, runs inside the dentin. Forms the bulk of the tooth and can be
sensitive if the protection of the enamel is lost.
Cementum = The tissue covering the surface of the tooth root. It connects the alveolar bone
with the tooth by the periodontal ligament. Its hardness is similar to bone.
Dental pulp: Soft tissue containing the blood and nerve supply to the tooth. The pulp extends
from the crown to the tip of the root, supplying nutrients to the dentin.
Periodontal ligament = Tissue consisting mainly of the fibrous tissue that connects the tooth
root and the alveolar bone. It prevents force applied to the tooth from being directly imposed
on the alveolar bone while chewing food.
Alveolar bone = Provides a socket to surround and support the roots of the teeth.
Gingiva = The soft tissue covering the alveolar bone. It is generally called “gum”.
What is the periodontium?
The periodontium represents the specialized tissues that both surround and support the
teeth, maintaining them in the maxillary and mandibular bones. It consists of superficial
periodontium and deep periodontium.
Superficial periodontium is made of attached gingiva, free gingiva, and interdental
gingival (fig. 6).
1- Free gingiva
2- Interdental gingiva
3- Attached gingiva
Fig. 6. Structure of superficial periodontium (from 5)
How do you recognise a healthy gingiva?
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It has light pink colour with some variations between human races;
Attached on tooth;
Interdental papilla between teeth.
Deep periodontium consists of periodontal ligaments, an elastic fiber network, which
connects the root to the bone.
Teeth functions
1. Chewing role (food eating)
It is the main function of the teeth. Teeth are part of the digestive system.
Chewing is the first stage of digestion and plays a very important role. Without teeth,
digestion process is much more difficult which leads to important disorders of food absorption
(lack of essentials elements - vitamins, calcium and other minerals). Also unmixed food
swallowing can cause digestive system diseases (gastritis, ulcer).
Depending on their position in the mouth, teeth play a role in biting, tearing or chewing
food.
The incisors have biting role of the food (fig. 7).
Fig. 7. Incisors role (from 6)
The canines have the role in tearing the food.
Fig. 8. The role of canines (from 7)
The molars have the role in chewing and grinding food.
Fig. 9. Molars role (from 8)
2. Aesthetic role
Teeth, especially those situated in front of the mouth, have a strong aesthetic role.
Fig. 10. The importance of teeth in aesthetic (from 9)
(from
Fig. 11. The importance of teeth in aesthetic
10
)
The position, shape and color of the teeth play a pronounced role in defining
individual personality.
Fig. 12. The appearance of harmonious dentures (from 11)
3. Phonetic role
Teeth, particularly incisors play an important role in the pronunciation of consonants (S,
Z, D, T, V, and F). When we lack teeth (especially if it's front teeth), speaking and
pronunciation will suffer.
Fig.13. Pronouncing the word “THE” in English language (from 12)
II.
Dental Decay and Gingivitis, so called “Dental Plaque Diseases”
Dental decay is a disease of crown and root (hard tissue) of a tooth caused by dental
microbial plaque.
Cavities that destroy teeth contain a lot of bacteria which develop and produce acids due to a
poor oral
hygiene (lack of tooth brushing) together with sugar and carbohydrates from our diet
followed by
acid demineralization (fig. 14).
Fig. 14. Process of dental caries development
Dental plaque
It occurs when we don’t
brush our teeth and then the
microorganisms feed with
food scraps
Fig. 15. Microscopic aspect of dental microbial plaque (from 13)
How can you recognize dental microbial plaque?
You can see it by visual inspection as an adherent film to the teeth or after coloring it
with disclosing agents by the dentist.
Fig. 16. Visible dental plaque (personal collection) Fig. 17. Colored microbial plaque (personal collection)
Dental calculus is a mineralized dental microbial plaque, a solid deposit which can be seen by
visual inspection (fig. 18). It can be removed only by the dentist or dental hygienist (fig. 19).
Fig. 18. Calculus
(from 14)
Fig. 19. The appearance of teeth after scaling (from 14)
Gingivitis is a disease of smooth tissue caused also by dental microbial plaque which was
not removed by regularly and correctly tooth brushing (fig. 20, 22) and due to presence of
calculus (fig. 18). Gingival inflammation can occur frequently in patients with fixed orthodontic
appliances and with improper oral hygiene (fig. 19).
Other factors that may influence the risk of tooth decay and gum inflammation are:
Orthodontic appliances have
There are categories of foods that are not
a good effect on aligning the
good for oral health and should be
teeth, but we don’t have to
avoided, if it’s possible, namely: sweets,
forget that they gather the
flour and sticky products, that can fix to
food scraps and bacteria if
the teeth and if they are not removed, they
they are not removed by
could lead to gum disease and more.
brushing and other additional
There are products that are able protect
methods and can lead to
the gums such as the hard ones, fibers
of the gums and
Smoking is very harmful notdamages
only
ones, rich in vitamins.
for the effect of staining the teeth teeth staining.
and mouth odor that it produces,
but also by reducing the blood
flow in the gums and in this way
Fig. 20 și Fig. 21. Gingiva aspect before and after treatment (from 15)
Fig. 22. Gingivitis - patient with braces (from 16)
What are the symptoms of gingivitis? The color of the gums is changing in red. The gum can
be increased, softer or firmer.
Gingivitis
Bleeding
when
brushing
,
chewing.
Gingivita
Burning
feel
The color of the
gums is changing in
red. The gum can be
increased, softer
firmer
or
Mild pain
when
chewing
or
brushing.
Note that gingivitis is a reversible gum injury turning into initial shape and color if the teeth are
daily well brushed and the calculus is removed every 6 months in the dental office!
III.
Removing microbial dental plaque by tooth brushing and auxiliary
tools
Toothbrushes are available in many different kinds of shapes and size, with nylon bristles
which do not impregnate with microorganisms, dry quickly and sometimes have wear indicators.
(fig. 23).
Fig. 23. Types of manual toothbrushes (from 17)
Manual brushing technique:

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You will choose a brush with medium hair consistency.
The toothbrush will be oriented parallel on the bucal tooth surface, at a 45 degree angle
with the filaments directed toward the root of the tooth in touch with the gums and the
dental surface.
You will then roll the brush over the teeth from the gums to the inferior part of the tooth.
Repeat 8 to 10 times the rolling movements for every group of 2-3 teeth from the
posterior side (molars) all the way to the opposite posterior side on the maxilla or the
mandible.
It is important not to start from the same side each time for a better cleaning.
The oral side of the posterior teeth will be brushed the same way, until you reach the
premolars and the incisors.


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The oral side of the premolars and the incisors will be brushed using anterior and
posterior movements with the brush oriented perpendicular to the dental surface for a
better removal of the dental plaque.
The occlusal side of the molars and premolars will be brushed using 8 to 10 circular
movements.
At the end you will use bucal-oral movement to brush the distal part of the last molars.
Fig. 24. Correct brushing movements (from 18, 19)
Remember! An efficient toothbrushing means to be repeated twice a day, in the morning before
or after breakfast and in the evening, before going to bed.

How long does the tooth brushing last? A normal brushing last between 3 to 5 minutes
for both dental archways.
And something about electric tooth brushing…
Removal of dental plaque from interdental and subgingival surfaces is possible due to a
smaller head of the tip and to high frequency vibrations which have a ventilation effect.
However, it is necessary to get training on brushing technique from the dentist, for a better
efficiency of electric toothbrushing. Disadvantages: the technique can be a little difficult at the
beginning and is more expensive than a manual toothbrush.
Fig. 25. Electrical toothbrush (from 20)
Electric toothbrushes are especially indicated for people with reduced dexterity and
disabilities, or any individual who prefers such a toothbrush, being easier for brushing (fig. 25).

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
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Tooth pastes which can be used are of different types such as (fig. 26):
For decay prevention, with fluoride;
Antiplaque toothpastes (with clorhexidine, triclosan etc)
Anticalculus
Desensitizing toothpastes
Cosmetic toothpastes, for whitening teeth.
Fig. 26. Tooth paste (from 21)
To find out what type of toothpaste you should use, depending on your oral problems, ask your
dentist!
Auxiliary methods for dental plaque removal
Dental microbial plaque control is made mostly by tooth brushing and is completed by auxiliary
methods such as flossing, using inter-dental toothbrushes etc., especially in areas between teeth,
hardly approachable only with toothbrush.
1 DENTAL FLOSS
Suitable for removing dental plaque from the sides of the tooth is indicated to be used before
brushing.
Fig.
27.
technique (from 22)
Flossing
Be careful to avoid injuring your gums!
Follow these instructions for using dental floss (waxed or un-waxed) (fig. 27):
 Insert carefully the floss between two teeth using a back and forth motion;
 Gently bring the floss to the gum line, but don't force it under the gums;
 Curve the floss around the edge of your tooth in the shape of the letter "C" and slide it up and
down the side of each tooth;
 Repeat this process between all your teeth, and remember to floss the back sides of your back
teeth;
 You can also use a floss holder, is much easier.
2. INTERDENTAL TOOTHBRUSHES
Indicated for broader clean between the teeth (fig. 29) and for fixed orthodontic appliances,
only according with dentist instructions (fig. 30).
Fig. 29. Types of interdental toothbrushes (from 23)
Fig. 30. Using the interdental toothbrushes (from 24)
How to use interdental toothbrush?
 Insert the interdental toothbrush between interdental spaces and then it is carried back
and forth movements;
 To learn correct technique, ask your dentist, who will adapt the technique to your
situation.
How often do we use it ? ONCE A DAY!
3. ORAL IRRIGATOR (DENTAL WATER JET)
Are used to remove plaque and food debris, to massage the gum, especially if you wear
braces, all recommended by your dentist (fig. 31).
Fig. 31. Type of oral irrigator (from 25)
4. MOUTH WASHES
It cannot replace dental brushing, only completes it!
Do not choose for yourselves the type of mouthwash, but only if you are instructed by
your dentist!
How to use mouth water? After the dental brushing dispense approximately 20 ml of mouth
wash with the cover including the jug and rinse mouth for 30 seconds minimum, then spit.
Do not swallow!
Fig. 32. The dosage of mouthwash (from 26)
5. CHEWING GUM
You can chew sugar free gum between tooth brushings or meals no more than 20 minutes. It
stimulates salivary secretion and self cleaning of the teeth.
6. TONGUE SCRAPER
It is recommended to clean your tongue during daily tooth brushing (fig. 33). Tongue scraper can
be placed at the end of the toothbrush handle.
Fig. 33. Tongue scraper technique (from 27)
The oral halitosis is caused by dental microbial plaque from the tongue that is why it has to be
cleaned daily!
REMEMBER! Dental floss, mouthwashes, inter-dental brushes, oral irrigators do not
replace tooth brushing but complete it!
IV.
The role of diet in the development of dental caries
Tooth decay is caused primarily by abnormal accumulation of an increased number of bacteria in
the oral cavity that have not been removed by a regular cleaning and sugars in our diets that will
allow these bacteria the secretion of acids which will cause demineralization of the tooth.
We analyze here the issues that diet plays a leading role in decay.
1. Which food promote tooth decay? Those containing sugar and starch:
*Sweets candy
*Cookies
*Cereal bars
*Drops
*Pastry cream
*Jam
*Biscuits
*Soda drinks
* Honey
*Chips
* Ice cream
*Yogurt with fruits
2. The remaining foods that contain sugar do not play any role in decay?
Dairy Products -Teeth are essentially formed of calcium and phosphorus. These two elements are
found in dairy products. Through their consumption during the formation of teeth allows calcium
and phosphorus loading to the tooth which will make it more resistant to acid attacks bacteria
and protects against cavities (fig. 34).
Products with increased lipid fat content – do not participate in the formation of dental caries,
contrary, play a role of bioprotective film for teeth and prevent adhering dental bacteria on the
tooth surfaces.
Fruits and vegetables - main contribution of vitamins and minerals that allow maintaining
healthy mouth mucosa and preventing bacterial action. Fruits and vegetables countries and/or
raw allow oral cavity and teeth cleaning: after their consumption saliva increases and leads to
dissolution and (partial) removal of dental microbial plaque (fig. 34).
Fig. 34. Food which protects teeth from decay (from 28)
3. Frequency of food intake plays a role in the formation of cavities?
The way in which sugars are consumed plays a more important role in the formation of cavities
than the consumed amount.
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Frequent intakes. Those who take frequent snacks between meals and those who used to
drink sodas or beverages with high sugar content, are likely to develop tooth decay.
Eating before bedtime. It is advised not to eat before bed - without milk, juice or other
sugary drinks. Food and beverage consumption just before bedtime results in stagnation
on teeth for several hours, becoming food for bacteria responsible for tooth decay.
Recommendations:
brush your teeth after meals and snacks (if possible) or rinse your mouth with water
or chew gum!!!
eat sweets only on tables, not bitten or drink sugary drinks throughout the day !!!
allow teeth in fasting hours between meals!!!
4. Consistency of the food is important for tooth decay?
Food sweet sticky as chocolate, toffees, biscuits and pastries are cariogenic, given that without their
removal by brushing them stay longer in the mouth and the teeth than other foods with stiffer fibres such
as fruits and vegetables, the latter quickly removed from the mouth (fig. 35)
Fig. 35. Sticky food (from 29)
Some remarks about the important nutrients for oral health
FATS

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Makes around the particles of carbohydrate protective sleeves, partially preventing their
metabolism;
Accelerates the passage of carbohydrates in the oral cavity;
It forms a protective seal around hard dental structures;
A number of fatty acids prevents it from multiplying and developing bacteria that play a
role in dental caries;
Lipids is 30% of the caloric diet, or about 1.2 g/kg/day;
Food sources of lipids can be of origin: Animal: lard, butter, whole milk, cottage cheese,
cheese, fatty meat, fish, eggs; Plant: sunflower oil, soybeans, corn germ, olive;
margarine.
PROTEIN
 Protect against tooth decay by forming a film on the tooth surface, isolating it from
attack of demineralized acids;
 The plant proteins interferes with the growth of microorganisms on the surface of the
tooth;
 An insufficient amount of protein leads to increased susceptibility of tooth to decay,
decreasing production of saliva and of cells involved in defense;
 Main sources of protein are the meat, fish and their derivatives; egg; dairy; vegetables
and fruits especially nuts and oilseeds; cereals.
VITAMINS
VITAMIN
:
It has a role in the development of bone and teeth, skin and mucosa integrity and proper
conduct of the defense system.
VITAMIN
:
It has a role in the absorption of calcium and phosphorus necesarry for teeth and bone
mineralization
VITAMIN
:
It has a role in wound healing and increasing the resistance to infection.
CALCIUM:
 It has a role in the contraction of muscles, blood clotting, bone and teeth calcification;
 Insufficient intake : incomplete mineralization of bones, the risk of bone fractures;
 Dietary sources: milk, oranges, green leafy vegetable.
PHOUSPHOURs:
 It has a role in strengthening bones and dental tissues, contraction of muscles.
MAGNESIUM:
It has a role in the strength and integrity of bone and muscle contraction.
FLUORIDE:
 Plays a role in the prevention of dental caries;
 Insufficient intake increases the incidence of dental caries;
 Dietary sources: water fluoridation, tea, toothpaste, algae.
Mineral deficiency produces gum diseases, altered taste, reduce bone and teeth
mineralisation, delay healing of wounds, alteration of development of the enamel.
-
King Philip of Macedonia compelled his family members to eat an apple after every meal, to
keep teeth healthy.
- Due to increased consumption of fat food the Eskimos do not have caries.
- Chocolate with high cocoa content is less harmful than those with lower content.
- Wholemeal bread is less cariogenic than white bread.
V.
The Effects of Eating Disorders on the Oral Health
V.1. Dental erosion = it is a loss of minerals from the enamel which occurs in contact with acids
and when the pH of the mouth decreases (fig. 36 și 37).
Fig. 36 și 37. Clinical aspects of dental erosion (from 30, 31)
Favorable factors of erosion
Diet
Environment
Drugs
Chronic vomiting
Chronic vomiting
Acid food
Industrial acid
Aspirin
Anorexia
Alcoholism
Wine
Chemichal
reagents
Vitamin C
Bulimia
Digestive system
diseases
Carbonated
drinks
Alcoholism
Citrus
Digestive system
diseases
Preventive measures:

avoid direct contact of teeth with acidic products (using straw)

minimizing the consumption and frequency of cariogenic food and fizzy drinks

consuming sugar-free chewing gum than 20 minutes after meals

avoid washing teeth immediately after consuming acidic food or drinks, must wait at least an hour
until the tooth enamel is recovering after acid attack
 using tooth paste with fluoride
 dental check-ul at six months

rinsing after each meal rich in acidic foods, so it will remove the acid in the mouth
V.2. Bulimia is an eating behavior disorder characterized by uncontrollable eating in
large quantities. The sequence occurs as follows: feed intake is suppressed for a certain period of
time, excessive eating followed by feelings of guilt and personal decay.
Sufferers are trying to overcome these feelings in different ways. The most common form
is induced vomiting. Starvation, use of laxatives, enemas, diuretics and excessive exercise are
also common to avoid weight gain.
Bulimic behavior is often installed during adolescence, the average age of onset is 18
years and most commonly occurs in girls.
The bulimic behavior is not concerned as long as it remains occasionally, as happens for
example in pregnant women.
In the most severe cases, bulimic vomiting is accompanied by dehydration and may cause
potassium loss (which is manifested by weakness and by cramps), esophageal lesions and dental
acidity caused by gastric fluid regurgitated.
Damage to enamel (the protective layer of the tooth) by wearing is called erosion.
The teeth surfaces are gradually affected. Initially, the surfaces of upper teeth concerning the
palate (fig. 38), then teeth edge that bite the food (incisal edge) and finally all teeth (fig. 39).
This form is typical of developing lesions consistent with head position upon vomiting.
Highly directional flow of vomiting, which has an average pH of 3.8, determines the place and
degree of corrosion on teeth.
Lower teeth (lower) are initially less affected because tongue has a protective role.
The enamel thinning or disappearance can cause pain, especially when the persons eats hot,
cold, sweet and sour food.
Fig. 38. Aspect of oral erosion (from 32)
Fig. 39. Dental erosion (from 33)
Increases the risk of tooth decay and dental structure is less protected once the enamel
become thinner (fig. 40).
Fig. 40. Enamel affected by erosion (from 34)
VI. Oral Soft Tissues Injuries
 Saburral Tongue is a white-yellow tongue due to a large amount of dental microbial
plaque on the surface because of a poor dental hygiene (fig. 41).
Fig. 41. Aspect of saburral tongue (from 35)
Usually your tongue is pink colored and has a smooth surface (fig. 42).
Fig. 42. Aspect of normal tongue (from 36)
 Geographical tongue și fissured tongue are common, benign conditions. The first
presents various red areas surrounded by a white border also emphasized (fig. 43), and
for the second are observed on the tongue numerous grooves edges, more or less deep
(fig. 44).There is no treatment just a good oral hygiene.

Fig. 43. Aspect of geographical tongue (from 37) Fig. 44. Aspect of fissured tongue (from 38)
A large amount of bacteria can survive in the fissures, so pay attention on proper oral
hygiene!
 Oral candidiasis (candidosis) is a fungal infection of the mouth este o afecțiune micotică
caused by a group of yeasts called Candida. The main causes are: antibiotics; oral
contraceptives; medicines that lower the body's defense capability; corticosteroids (fig.
45).
Fig. 45. Aspect of tongue with candiosis (from 39)
It is compulsory to present to the dentist who will decide the treatment to be followed.
 Mouth aphthae apapear on soft mucosa (lip, cheek, tongue) from several possible causes:
a weakened immune system, stress, unbalanced diet, smoking, certain medications,
different trauma to the mouth, autoimmune diseases, menstruation (fig. 46).
Fig. 46. Aspect of aphthae (from 40)
The wound starts out as a small red bulge that gives out a burning sensation for about a
day. The sores are covered by a white or yellow membrane, bordered by a red circle. Canker
sores usually heal in two weeks without scars.
Labial herpes is an infectious disease caused by herpes simplex virus, highly
contagious!
The herpes virus can be transmitted through direct contact, through kissing an infected
person or by commonly using the same silverware, towels or shaving blades during the periods
that the virus is active.
Fig. 47. Aspect of herpes (from 41)
Warning symptoms include:
 Itching of the lips or skin around mouth
 Burning near the lips or mouth area
 Tingling near the lips or mouth area
Afterwards, oral herpes start off as painful blisters that break and after which it will ooze (it is
of this moment that herpes becomes contagious). After a time the opened wound will start
covering up with a yellow crust, which will eventually fall off, revealing the newly healed skin
from underneath. The ulcerations persist about 7 to 10 days after which it heals without scars.
After the wound is healed, the virus either enters a state of “hibernation” or it can reaper in
different periods of time.
Oral herpes can be treated with special ointments or creams recommended by the doctor.
Preventive measures:



Avoid contact with saliva, skin or mucous membrane in people who have the virus.
Avoid direct contact. Wash your hands with soap and water immediately after touching
the lesions.
If you know that a person has herpes, not lent glasses, creams, make-up, lip balm,
lipstick, razor, tweezers!
REMEMBER!
Oral mucosal diseases can lead to complications, so any abnormal situation should lead us the
dentist!
 The Effects of Oral Piercings on the Oral health
Fig. 48. Oral piercings (from 42)
Very common among teenagers as an expression of the desire to impress others, oral
piercings can be applied on lips, tongue, etc. (Fig. 48). Often draw unwanted complications
(fig. 49-52).
Fig. 49. Complications of oral piercings (from 43)
Fig. 50. Forked tongue (from 44)
Fig. 51. Tongue infection
(from 45)
Fig. 52. Piercing infection
on the lower lip (from 46)
Safety Measures
Reffering to the body piercer
Reffering to the piercing
The piercer should have a body
piercing artist license
The piercer should be experienced,
look presentable and have a
professional attitude
He/she should work in a clean
environment, in accordance with the
hygiene standards established by law.
He/she should use safe methods and
avoid cross infection (from one person
to another, using contaminated
instruments)
The piercer should own a sterilizer
The shape should be adequate for a specific
area
The dimensions should also be adequate
He/she should use sterile jewelry,
needles and instruments
The piercer should give information
and guidelines before and after
inserting the piercing
The tongue piercing should have balls
made of plastic (not metal) to reduce the
risk of gum and teeth injury
The piercing should be constantly checked
so that swallowing, unscrewing or
aspiration(when an object is breathed into
the lungs) can be avoided
Choosing a small ball for the ventral
surface of the tongue so that the sublingual
surface won’t be traumatized
Developing some harmful habits like
constantly moving the tongue piercing on
the surface of teeth and gum can cause
damage, therefore this sort of tics should
be controlled
If the person being pierced is allergic to
some materials, the piercer will avoid using
piercings that contain those allergens (e.g.
allergies to some metals)
If the piercing is being removed, before
reinsertion it must be disinfected
The piercer should also offer the client
written instructions that can be kept
and consulted if necessary
The piercer should be open to clarify Some materials can alter the taste. If this
any problems or questions that can kind of dysfunction appears, the removal of
appear, so that complications can be piercing is recommended.
avoided
Recommendations
-
Avoid alcohol mouthwash and spicy/hot/sticky/hard foods;
Avoid smoking;
Brush your teeth after every meal and rinse with alcohol free mouthwash;
Use a soft toothbrush;
Eat soft foods;
-
Contact your dentist if you notice changes like:
 Yellow or green coloration of the tissue surrounding the piercing;
 Scar tissue or indurate tissue around the piercing that looks darker than
the rest of the tissue;
 Red, swollen, painful area around the piercing;
 Elevated lesion containing pus (abscess) around the piercing;
 Bleeding after the initial healing of the piercing hole;
 Low-grade fever that persists a few days after inserting the piercing.
VII. The Effects of Alcohol and Tobacco on Oral Health
A.
Tobacco
4000 harmful chemicals
40 are carcinogenic
A cigarette contains:
Nicotine – a natural liquid substance produced by tobacco plant which gives addiction;
Tar – a substance which sticks on the lungs
Carbon Oxide – a poisonous gas
Nicotine is a very powerful drug which rapidly spreads in the brain and in the central nervous
sistem.
Nicotine
Oral and nasal mucoasa
Blood (10 seconds)
Brain
Which are the effects of smoking on oral mucosa? Smokers are more likely expose to oral
cancer than everyone else, 70% of cases being among them. A smoker is 6, 85 times more
exposed to oral cancer than no smokers.
Do you know how the oral health is affected on smokers? Oral health is affected by:
-
-
Leukoplakia which is represented by firmly attached white patches on the mucous
membranes of the oral cavity; there are up to 20% chances to transform into oral
cancer.
Nicotinic stomatitis (smoker's palate), a lesion of the palatal mucosa produced by the
concentrated heat stream of smoke from tobacco (fig. 53);
Fig. 53. Nicotinic stomatitis (from 47)
-
Periodontal disease - gums pull away from the teeth and form spaces (called
“pockets”) that become infected and the teeth may be lost. It has 4 times more risk on
smokers (fig. 54);
Fig. 54. Periodontal disease at a smoker (from 48)
-
Dental caries are
three times more frequent on smokers because of large amount of dental microbial
plaque and a decreased saliva flow rate.
(fig. 55).
Fig. 55. Smoker with dental caries (from 49)
-
Taste and smell disturbances which make the smoker to neglect meals and not to be
aware of odour of his/hers clothes, mouth, hair.
B. Which are the risks of drinking alcohol on oral health?
Alcohol increases oral, larynx, esophagus, pharynx cancer from 2 to 5 times, especially in
association with smoking and lack of oral hygiene!
Dental alveolar disharmony is when teeth do not fit with jaws - teeth or jaws are too
large too small and they grow when teeth are crowded or too small for jaws are too high, and
they grow with spaces between them.
Fig. 56. Aspect of dental-alveolar disharmony and orthodontic appliances (from 50)
Physiognomy is affected, tooth decay can occur due to incorrectly performed hygiene,
gingivitis etc.These problems can be solved by orthodontic treatment so that orthodontic
specialist will take the most appropriate treatment decision (fig. 56).
VIII. Methods of preventing oral diseases in dental office
Short description of the mechanism of production of dental caries: The enamel is
disposed outside of the tooth (wrapping virtually all the tooth’s crown) that is why it is subject to
harmful factors found, normally, in the oral cavity: microbes, food scraps, sugars which, together
contribute to the formation of the dental plaque (this is deposited on the teeth and cause damage /
destruction of enamel by releasing acids).
The acids produced by the dental plaque determine what is called enamel
demineralization (loss of structure/thickness of the component chemical elements - mainly in
calcium and phosphorus) which sets the beginning of tooth decay.
In absence of an appropriate treatment for caries evolve and progresses to the tooth’s loss! (fig.
57).
Stages of dental caries development
Fig. 57. Stages
development (from 51)
of
dental
caries
Fig. 58. Demineralization and remineralization process (from 52)
Fluoride causes the formation of fluorapatite and fluorine hydroxyapatite at the enamel
surface which are more resistant to acid attack than hydroxyapatite (under these chemical
compound are, normally, calcium and phosphorus present in the enamel structure). The process
is called remineralization and determines the occurrence of a more resistant tooth structure to
tooth decay (fig. 58 și 59).
Fig. 59. Tooth remineralization when sucrose is absent. Repair enamel with hydroxyapatite and
fluorapatite (from 53)
VIII.1. Why is fluoride important?
•
•
•
Helps to prevent the formation of tooth decay
It can block early signs of tooth decay development
Used regularly it strengthens tooth structure providing resistance to decay.
How does fluoride protect teeth?
Its main function is to strengthen the tooth enamel.
To protect teeth, sources of fluoride can be managed professionally, in the dental office (by
applying varnishes or gels with fluoride), recommended for administration at home (from
toothpastes, mouthwashes, gels for selfaplications) or assimilated from diet (fig. 60 și 61).
Fig. 60. Main sourcesof fluoride (from 54)
Fig. 61. Local fluoridation (from 55)
Ask your dentist for more information and instructions about personal fluoridation!
VIII.2. Dental Sealants
Dental sealants are coatings that are usually placed on the chewing (occlusal) surface of
the permanent back teeth (the molars and premolars) to help protect them from decay.
The first dental sealant to be placed is usually on the fissure of the first permanent molar
tooth, once the chewing surface of the tooth has erupted completely beyond the gum or during
first 2 years after eruption (fig. 62).
Basically, the tooth is protected against harmful factors in the mouth at a time when it is
in danger of decay.
Fig. 62. Sealed surfaces of molars (from 56)
Is Better to Prevent Than to Cure?
Regular visits to the dental office help us to identify easier the signs of dental lesions so
preventive measures regarding teeth and gums can be taken.
Calculus and dental microbial plaque are the main risk factors which can be controlled by
professional brushing and scaling in the dental office.
Local fluoridation and sealants are methods for preventing tooth decay among risk group.
Does prevention save time?
As the dental caries and gingivitis are detected sooner by the dentist, the treatment will be
more simple and painless. Regular dental check-ups can diagnose diseases in their early stages
and treatment is more easily achieved and also easily supported by the patient.
Early detection of tooth decay in early stages such as demineralization favors the
remineralization of the enamel that is why we talk about reversible stage of decay.
But left untreated, later reaches the dentin and afterwards touch the tooth pulp. In this
situation it is necessary to conduct a comprehensive treatment: canals (endodontic) treatment +
coronal filling. Tooth becomes unrecoverable, extraction being necessary.
If the gum is affected mild to moderate non surgical treatments may be applied, gum
returning to normal.
VIII.3. Early detection of disease through regular dental check-ups helps avoid
complications. If a decayed tooth is not identified and treated in time, it can go through different
stages of complications from abscess pain and even loss.
In many cases, gum diseases remain asymptomatic until they reach an advanced stage.
Gingival support structures can be destroyed, and the teeth become mobile. Following the
appearance of purulent formations, it can destroy the bone that supports the teeth, leading to
tooth loss.
In addition to the time you save regularly coming for control, you should know that a seal
is not painful, and costs less than a canal treatment or a tooth crown cover. Similarly, cleanings
and scaling are much more tolerable than surgery.
During dental visits, not only teeth aim condition, but the entire oral cavity. There are
signs at this level that lead us to a general medical condition such as nutritional deficiency,
stress, eating disorders, etc.
In conclusion, no more excuses and make an appointment to your dentist!
Fig. 63. Planning schedules (from 57)
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