Oral Health

What is Health? According to the World Health Organisation (WHO), Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

What is Oral Health? According to the WHO, Oral health is a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity. Risk factors for oral diseases include unhealthy diet, tobacco use, harmful alcohol use, and poor oral hygiene.

What is Dentistry? The branch of medicine that deals with the prevention, diagnosis and treatment of diseases of the teeth, gums, and other structures of the oral cavity.

Specialties in Dentistry Endodontics - Endodontics is the branch of dentistry which is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Oral and Maxillofacial Surgery - Oral and maxillofacial surgery is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

Specialties in Dentistry Orthodontics and Dentofacial orthopedics- Orthodontics and dentofacial orthopedics is the dental specialty that includes the diagnosis, prevention, interception, and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures. Pediatric Dentistry - Pediatric Dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

Specialties in Dentistry Periodontics - Periodontics is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. Prosthodontics - Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes.

Dental Anatomy and Physiology

The Dentitions The term dentition is used to describe the natural teeth in the jawbones. Primary dentition is the first set of 20 primary teeth. Also referred to as “baby teeth” or “deciduous teeth” Permanent dentition refers to the 32 secondary or “adult” teeth. Mixed dentition occurs when both primary and permanent teeth are present, usually between the ages of 6 to 12.

Types of Teeth The functions of teeth vary, depending on their individual shape and size and their location in the jaws. The three basic food processing functions of the teeth are cutting, holding or grasping, and grinding. Incisors are single-rooted teeth with a relatively sharp thin edge referred to as the incisal edge. Located in the front of the mouth, they are designed to cut food without the application of heavy forces. Central (front teeth) and lateral (distal to the centrals) teeth are incisors.

Canines, also known as cuspids, are located at the corner of the arch Canines, also known as cuspids, are located at the corner of the arch. They are designed for cutting and tearing foods, which require the application of force. Premolars are a cross between canines and molars. An older term for premolar is bicuspid. The pointed cusps hold and grind the food. They have a broader surface for chewing food. There are two sets of premolars in the permanent dentition and NO premolars in the primary dentition.

Molars are much larger than premolars Molars are much larger than premolars. The molars have more cusps than other teeth that are used to chew or grind up food. There are two sets of molars in the primary dentition and three sets of molars in the permanent dentition.

Begin to form during the first trimester of pregnancy Primary (deciduous) Consists of 20 teeth Begin to form during the first trimester of pregnancy Typically begin erupting at around 6 months Most children have a complete primary dentition by 3 years of age 1. Oral Health for Children: Patient Education Insert. Compend Cont Educ Dent.

Secondary (permanent) Consists of 32 teeth in most cases Incisors Canine (Cuspid) Premolars Molars Maxilla Secondary (permanent) Consists of 32 teeth in most cases Begin to erupt around 6 years of age Most permanent teeth have erupted by age 12 Third molars (wisdom teeth) are the exception; often do not appear until late teens or early 20s Mandible

Identifying Teeth Classification of Teeth: Incisors (central and lateral) Canines (cuspids) Premolars (bicuspids) Molars Incisor Canine Premolar Molar

Dental arches The maxillary arch (upper arch), actually part of the skull, is fixed and not capable of movement. The teeth in the upper arch are set in the maxilla, the maxillary bone. The mandibular arch (lower arch) is capable of movement through the action of the temporomandibular joint (TMJ). The mandible, the mandibular bone supports the teeth in the lower arch.

Quadrants An imaginary midline divides each arch into a left half and a right half. When the maxillary and mandibular arches are each divided into halves the resulting four sections are called quadrants, as follows: Maxillary right quadrant Maxillary left quadrant Mandibular right quadrant Mandibular left quadrant

Tooth Numbering

Directions of the Oral Cavity Anterior means toward the front of the mouth. Posterior means toward the back of the mouth. Medial means toward the middle or toward the middle of the arch. Lateral means toward the side or toward the outside of the mouth.

Mesial means toward the mid-line of the dental arch. Distal means away from the mid-line of the dental arch.

Structure of a tooth

The 4 main dental tissues: Enamel The 4 main dental tissues: Dental Pulp Dentin Enamel Dentin Cementum Dental Pulp Cementum

Dental Tissues—Enamel Structure Highly calcified and hardest tissue in the body Crystalline in nature Enamel rods Insensitive—no nerves Acid-soluble—will demineralize at a pH of 5.5 and lower Cannot be renewed Darkens with age as enamel is lost Fluoride and saliva can help with remineralization

Dental Tissues—Enamel Enamel can be lost by: Physical mechanism Abrasion (mechanical wear) Attrition (tooth-to-tooth contact) Abfraction (lesions) Chemical dissolution Erosion by extrinsic acids (from diet) Erosion by intrinsic acids (from the oral cavity/digestive tract) Multifactorial etiology Combination of physical and chemical factors

Dental Tissues—Dentin Softer than enamel Susceptible to tooth wear (physical or chemical) Does not have a nerve supply but can be sensitive Is produced throughout life Three classifications Primary Secondary Tertiary Will demineralize at a pH of 6.5 and lower

Dental Tissues—Dentin Three classifications: Primary dentin forms the initial shape of the tooth. Secondary dentin is deposited after the formation of the primary dentin on all internal aspects of the pulp cavity. Tertiary dentin, or “reparative dentin” is formed by replacement odontoblasts in response to moderate-level irritants such as attrition, abrasion, erosion, trauma, moderate-rate dental caries, and some operative procedures.

Dental Tissues—Dentin (Tubules) Pulp Dentinal tubules connect the dentin and the pulp (innermost part of the tooth, circumscribed by the dentin and lined with a layer of odontoblast cells) Tubules contain fluid and nerve fibers External stimuli cause movement of the dentinal fluid, a hydrodynamic movement, which can result in short, sharp pain episodes Tubule Odontoblast Cell Nerve Fibers Fluid

Dental Tissue—Cementum Thin layer of mineralized tissue covering the dentin Softer than enamel and dentin Anchors the tooth to the alveolar bone along with the periodontal ligament Not sensitive

Dental Tissue—Dental Pulp Innermost part of the tooth A soft tissue rich with blood vessels and nerves Responsible for nourishing the tooth The pulp in the crown of the tooth is known as the coronal pulp Pulp canals traverse the root of the tooth Typically sensitive to extreme thermal stimulation (hot or cold)

Dental Tissue—Dental Pulp Pulpitis is inflammation or infection of the dental pulp, causing extreme sensitivity and/or pain. Pulpitis may be reversible (treated with restorative procedures) or irreversible (necessitating root canal). Untreated pulpitis can lead to pulpal necrosis necessitating root canal or extraction.

Periodontal Tissues Gingiva Alveolar Bone Periodontal Ligament Cementum Gingiva Periodontal Ligament Alveolar bone Cementum

Oral Cavity Demineralization: mineral salts dissolve into the surrounding salivary fluid: enamel at approximate pH of 5.5 or lower dentin at approximate pH of 6.5 or lower erosion or caries can occur

Oral Cavity Remineralization: pH comes back to neutral (7) saliva-rich calcium and phosphates minerals penetrate the damaged enamel surface and repair it: enamel pH is above 5.5 dentin pH is above 6.5

ORAL HYGIENE AND DENTAL CARE

Did you know ? Approx. 90%of systemic disease have links to oral health. People who have periodontal disease double their risk to fatal heart attack. Infection in mouth increases risk of respiratory infection. Diabetics with periodontal disease have more difficulty in controlling blood sugar level.

TOOTH DECAY [CARIES] Broadly caries are of 3 types 1. Pit and Fissure caries. 2. Smooth surface caries. 3. Cervical caries.

Mechanism of tooth decay. Bacteria in the presence of sugary substances produce acid that causes demineralization of teeth.

Enamel is affected first, as decay continues it reaches to dentin and then to pulp. Saved by filling. Needs RCT

GINGIVITIS gingival tissue. Bleeding gums. Factors may also be Inflammation of the gingival tissue. Bleeding gums. Factors may also be hormonal, drug induced.

PERIODONTITIS Infected gum recedes. Pockets become infected. Bone loss starts. Periodontal disease causes 70% of tooth loss. It affects 3 out of 4 people .

Causes of periodontal disease. Lack of daily ,complete oral hygiene. Broken fillings/teeth. Misaligned/crowded teeth. A poorly balanced diet. Systemic disease. Drugs[xerostomia]

Symptoms of periodontal disease. Red ,puffy gums. Gum tenderness[pain] Gum that bleed during brushing. Persistent bad breath.[halitosis] Shifted/loosened teeth. Pus.

DISEASES IN CHILDHOOD Caries. Malocclusion Mouth breathing. Tongue thrusting. Finger/Thumb sucking.

Thumb Sucking Normal tendency. Bad habit. (up till 18 months)

DISEASES IN ADULT Caries. Periodontal disease. Edentulism. Ulcers. Cancer. Bruxuism . Staining of teeth.

PREVENTION CARIES- Reduce sugar intake. Brushing twice a day. Flossing once daily. Use of mouthwash. Healthy snack habit. Proper brushing method

Prevention of gingivitis. Maintain good oral hygiene. Cleaning of teeth. Interruption of bad habit.[smoking , mouth breathing.] Proper brushing technique .

Prevention of periodontitis. Scaling. Maintenance of oral hygiene. Flap operation. Bone grafting.

Replacement of tooth loss. EDENTULISM- Loss of one or more teeth. Restore it by- RPD[Removal partial denture.] FPD[Fixed partial denture.] CD[Complete denture.] Implant

A lifetime of proper hygiene improves quality of life

FOOD FACTS Learn how to read labels on food products

Tooth brushing and Mouth Care

Type of toothbrush – Soft to Medium bristles with small head. How often should I replace my toothbrush? When it begins to wear or every three months , whichever comes first. How important is the toothpaste? According to the need and choice.

Mouth Care Involves the teeth, gums, palate and tongue Patients should be encouraged to: Brush teeth, at least twice daily or after meals (45minutes to 1hr) Use toothpaste that contains fluoride Floss after meals Moisturize and lubricate lips and mucosa as needed .

Tooth brushing Techniques There are several different acceptable tooth brushing methods because each patient has different needs. Not one method is perfect for all patients. Some patients may use more than one method.

Toothbrush Methods The important thing is to brush thoroughly for at least two minutes each time and two times a day….

Quote from Soupy Sales “Be true to your teeth or they will be false to you”

Prepare Your Toothbrush

Start in the Back

Roll Away

Work in a Clockwise Direction

Brushing the Back Surface of the Upper Front Teeth

Brushing the Back of the Lower Front Teeth

Brush the Biting Surface

Brush Your Tongue and the Inside of Your Cheeks

Dental Chart

Fluorosis Dental fluorosis is a developmental disturbance of dental enamel caused by excessive exposure to high concentrations of fluoride during tooth development.

Tetracycline stains

Arrested Caries This is a carious lesion that has become inactive and has stopped progressing; they may exhibit changes in color and consistency. This occurs when the carious process starts but remineralisation exceeds deminersalisation and the process stops.

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