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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? 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: 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. 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). 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. 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 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. 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