Toothache Alternative Medicine

Dentists Be Damned

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

Dentists Be Damned Summary


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Total Dental Health

Total Dental Health is a natural program aimed at preventing and reversing severe periodontal disease. Total Dental Health was created with the aim of ensuring people get healthy within a few days. It is an E-book that has a comprehensive, natural and easy plan to ward off periodontitis as well as fight it. Total Dental Health was designed to help people by pointing out methods that will be useful in having a great oral health. The plan is so comprehensive that the users will have no need for any external guide in the usage of the book. Moreover, it has food plans that had been tested by a lot of people and has been discovered to has a great effect in fighting teeth diseases or gum bleeding such as gingivitis. The food plan is such that the author has used it to point out foods to eat and those to avoid. Not limited to adults, Total Dental Health is well-equipped to help children in preventing teeth problems that might later cause pain and embarrassment. With its unique natural methods, the user gets the chance to spend less as opposed to when he/she visits a dentist More here...

Total Dental Health Summary

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Author: Mike
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Price: $7.00

Caries Control For The Periodontal Patient

Dental caries, particularly root caries, can be a problem tor periodontal patients because of attachment loss associated with the disease process and periodontal therapeutic procedures. Root caries develops through a process similar to coronal caries, involving the alternating cycle of demineralization and remineralization of the surfaces.I4M The process requires the fermentation of carbohydrates in the plaque by oral bacteria, resulting in loss of mineral from the root surface. Lactobacilli and Streptococci species are involved in the root caries process, similar to coronal caries.17 The major difference is the amount of organic material in the root surfaces is greater than in enamel, so once the demineralization has occurred, the organic matrix mostly collagen is exposed. Organic material is then further broken down by bacterial enzymes, resulting in destruction of the root surface.4 Fluoride works primarily by topical effects to prevent and reverse the caries process, whether in...

Dental Decay

Formation of healthy teeth is supported by proper diet during childhood - ample protein, calcium, phosphate, and vitamins C and D are particularly important. Diet is also important in the prevention of dental caries. Repeated exposure of the teeth to sugar by frequent snacking on sugary foods and drinks will substantially increase risk of dental caries. Resistance to dental caries is increased if the diet contains optimum amounts of fluoride. Fluoride is incorporated into the crystals that form the tooth enamel, making them more resistant to acid. In many areas, fluoridation of the water or salt supply provides children with ample fluoride. In areas where the flu-

Diet Caries

Sucrose is extremely cariogenic, whereas lactose (milk sugar) and fructose are less likely to cause caries. Unlike sugars, fats and protein cannot be used by bacteria to produce acid. Moreover, fats can coat the teeth and form a protective layer, whereas proteins increase the buffering capacity of the saliva. Milk products or cheese rather than sugary foods at the end of meals can reduce acid formation and help prevent tooth decay. Optimum nutrition during childhood can encourage formation of thick, acid-resistant enamel. The teeth gradually form and calcify from birth through the teen years, and a generous dietary supply of protein, calcium, fluoride, and vitamins C and D are important. Fluoride, incorporated into the enamel structure, sharply increases resistance of enamel to acid (see Fig. 5.3). Insufficient fluoride leaves teeth vulnerable to tooth decay. Low-level fluoride supplementation has great benefits adding trace amounts of fluoride to the water or salt supply can reduce...

Late Effects In Survivors

As noted earlier, patients who survive the first five years after HCT are likely to survive long-term with mortality rates eventually approaching that of the general population (5). However, some survivors experience late complications of HCT. Baker et al. (67) studied the long-term risks and benefits of HCT for CML. Two hundred forty-eight recipient of HCT for CML who had survived at least two years post-HCT were compared to 317 normal siblings. Subjects completed a 238-item survey on medical late effects. When compared with sibling controls, survivors had higher risks of ocular, oral health, endocrine, gastrointestinal, musculo-skeletal, neurosensory, and neuromotor impairments. Multivariate analysis of the allograft recipients identified chronic GVHD as a major risk factor for hypothyroid-ism, osteoporosis, cardiopulmonary, neurosensory, and neuromotor impairments. These data show the need for continued monitoring and medical intervention in these patients. The CIBMTR and EBMT...

Robert Azzi Dds And American Accademy Of Periodontology

Periodontal Microsurgery Tibbett

Clinical Associate Professor, Department of Oral Health Care Delivery, Baltimore College of Dental Surgerv Dental School, University of Maryland at Baltimore, Baltimore, Maryland Chief, Professional Development and Research, Dental Care Clinical Center, Veterans Administration Maryland Healthcare System, Perry Point, Maryland Department of Periodontology, l astman Dental Institute for Oral Health Clare Sciences, University of London, London, Lngland Karen F. Novak, DDS, MS, PhD Associate Professor, Department of Periodontics, ( enter for Oral Health Research, Universityof Kentucky. Lexington, Kentucky M. John Novak, BDS, LDS, MS, PhD Professor, Department of Periodontics Associate Director, Center for Oral Health Research, University ot Kentucky, Lexington. Kentucky It is our hope that this new edition will continue to be as useful to dentists, periodontists, and students as the previous editions and it will contribute to the continuous progress of our profession.

Pulmonary Disease Periodontal Disease And Acute Respiratory Infections

On the converse side of the relationship between systemic health and oral health that is, the potential effects of periodontal disease on 1 wide range of organ systems. Ibis field of periodontal medicine addresses the important questions Clan bacterial infection of the periodontium, commonly known as periodontitis, have an effect remote from the oral cavity Is periodontal infection a risk factor for systemic diseases or conditions that affect human health

Use in Prevention and Therapy

Optimum fluoride intake sharply reduces the prevalence and severity of dental caries.2'4 Low-level fluoride supplementation (through water, salt, or supplements) can reduce risk of caries in children by more than two-thirds.4 In areas where water or salt is fluoridated, supplementation by other means, such as fluoride mouthwashes or tablets, is unnecessary.

N M OBrien and T P OConnor

Dental caries involves metabolism of sugars by oral microorganisms including Streptococcus mutans to acids that gradually dissolve tooth enamel. It is now recognised that a number of dietary factors and nutrient interactions can modify the expression of dental caries. The cariogenic potential of food is influenced by its composition, texture, solubility, retentiveness and ability to stimulate saliva flow. A considerable body of research has been conducted on the cariostatic effects of cheese. Early work demonstrated that the incorporation of dairy products into the diet greatly decreased the development of dental caries in rats. Later work indicated that if enamel is treated with milk in vitro and subsequently washed, the solubility of the enamel is greatly reduced. This effect was attributed to the high levels of calcium and phosphate in milk or to the protective effects of casein. It has also been reported that both casein and whey proteins significantly reduced the extent of...

Relationship to Systemic Disease

A recent review of the literature conducted by I.oesche indicates poor oral health has been associated with medical conditions such as aspiration pneumonia and cardiovascular disease. In particular, periodontal disease can be associated with coronary heart disease and cerebrovascular accidents.1 In addition, the Surgeon General's Report on Oral Health emphasizes that animal and population-based studies demonstrate an association between periodontal disease and diabetes, cardiovascular disease, and stroke.22

Classification Of Periodontal Instruments

Explorers are used to locate calculus deposits and caries. Si tiling, root planing, and curettage instruments are used lor removal of plaque and calcified deposits from the crown and root of a tooth, removal of altered cemen-tum from the subgingival root surface, and debridement of the soft tissue lining the pocket. Scaling and curettage instruments are classified as follows

Periodontal Disease And Mortality

Cardiac Tn1

In examining research that suggests oral health status as a possible risk factor for systemic conditions, it is important to recognize when other known risk factors for those systemic conditions have been accounted for in the analysis. Host susceptibility factors that place individuals at risk for periodontitis may also place them at risk for systemic diseases such .is cardiovascular disease. In that case, the association may actually be between the risk factors, rather than between the diseases themselves, lor example, periodontitis and cardiovascular disease share risk factors like smoking, age, race, male gender, and stress. Genetic risk factors may also be shared.57 in the VA Dental Longitudinal Study, smoking was an independent risk factor for mortality. When examining the data to determine it periodontal status was a risk factor, smoking status and other known risk factors for mortality were removed from the equation to allow independent evaluation of periodontal status. In...

Focal Infection Theory Revisited

Recent research in the area ol periodontal medicine marks a resurgence in the concept ol focal inlection. In 1 WO, William Hunter, a British physician, first developed the idea that oral microorganisms were responsible for a wide range ol systemic conditions that were not easily recognized as being infectious in nature ' 1 and claimed that restoration of carious teeth rattier than extraction resulted in trapping of infectious agents under restorations. In addition to caries, pulpal necrosis, and periapical abscesses, Hunter also identified gingivitis and periodontitis as foci of infection. He advocated extraction of teeth with these conditions to eliminate the source of sepsis. Hunter believed that teeth were liable to septic infection primarily due in their structure and their relationship to alveolar bone. He stated that the degree of systemic effec t produced by oral sepsis depended on the virulence of the oral infection and the degree of resistance of the individual. He also felt...

Chemical Plaque Control

Mechanical plaque removal remains the primary method used to prevent dental diseases and maintain oral health. However, an improved understanding of the infectious nature of dental diseases has dramatically revitalized interest in chemical methods of plaque control. Mechanical plaque control is necessary and not replaceable by chemical plaque control. I'luoride toothpastes are an essential part of any long-term plaque control program. Appropriate topical preparations of fluoride such as mouthrinses and higher concentration gels should be used as needed for caries control. I he addition of antimicrobial mouthrinses will likely reduce gingivitis in periodontal patients. ( hlorhexidine rinses are very effective agents and can be used to augment plaque control during Phase 1 therapy, for patients with recurrent problems, for ineffective plaque control for any reason, for some uncommon oral mucous membrane diseases, and for use after periodontal or oral surgery. Fssential oil mouthrinses...

Functional Anatomy Of

N understanding of the principles of occlusion and the relationship to oral health and disease is nccessar) for all dental clinicians. Unfortunately, 110 other discipline in dentistry has been so complicated by confusion and controversy. Historically, occlusal relationships have been considered largely from a morphologic rather than a biologic perspective. This approach has led to an overemphasis on occlusal scheme and jaw position without adequate consideration of the functional status of the patient's entire masticatory system.

Dental And Medical Assessments Review of Dental History

Older adults are high users ol prescription and over-the-counter medications. Table 39-2 lists the top 20 dnigs prescribed in the U.S. in 1998. Many medications used by older adults can have a negative impact on oral health, lb obtain a complete list of prescription and over-the-counter medications, ask patients to bring each medication bottle or package to the dental office. This helps not only obtain a complete medication list but The American Society of Anesthesiologists established a useful tool to predict risk of surgical mortality.416 The tool (Box 39-1) stratifies patients into five categories, adjusts for age by not allowing an older adult to be assigned into Class I. and has been validated for patients aged 80 + years. I bis classification system was originally designed to assess surgical risk under general anesthesia however, il is also currently used to assess risk before diagnostic testing and outpatient surgery. Dentists can use this tool for patient assessment before...

Gingivectomy Before And After

Periodontitis Before And After

Step Remove the excised pocket wall, clean the area, and closely examine the root surface. I he most apical one consists ot a bandlike light zone where the tissues were attached, and coronally to it some calculus remnants, root caries, or root resorption may be found, (inundation tissue may be seen on the excised soft tissue (Fig. 58-6).

Role Of Cas In The Alimentary Tract

CA VI is produced by the serous acinar cells of the parotid and submandibular glands (Kadoya et al. 1987 Parkkila et al. 1990), and its secretion is controlled by the autonomic nervous system (Fernley 1991). Functionally, CA VI probably accelerates neutralization of the protons produced by cariogenic bacteria, thus protecting teeth from caries (Kivela et al. 1999). CA VI has also been linked to the neutralization processes in the upper gastrointestinal tract (Parkkila et al. 1997) and pancreas (Fujikawa-Adachi et al. 1999a). A novel role for CA VI was also suggested when Thatcher et al. (1998) linked CA VI to taste function. Henkin et al. (1999) proposed that CA VI might function as a trophic factor for the taste bud stem cells. Recently, Karhumaa et al. (2001) reported the presence of CA VI in milk. Interestingly, the CA VI concentration in human colostral milk was ca. eight times higher than in mature milk and saliva. CA VI concentrations in newborn saliva are much lower than in...

Restorative Implications Of Endodontic Therapy

Ultimately, most root canal-treated teeth require restorations. Although the initial success rate for endodontics is quite high 46 the long-term retention and function is dependent on, to .1 great extent, the ability to adequately restore the tooth. Restoration is complicated by the extent of crown loss from caries, fracture, and the size and placement of the access to the pulp chamber.1* Additional factors ire the type of restoration to be used, the configuration and number of the pulp canals, root form, and the need for a post and core. M ' Although severely decayed and or fractured teeth can often be successfully treated cndodontically, such teeth may require periodontal surgery and yel he difficult or impossible to restore. Complex interdisciplinary treatment should be confined to teeth that are of critical importance to the overall treatment plan after clue consideration ol alternate treatment methods. 7. Brannstrom M. I.intl PO Pulpal response to early dental caries. J Dent Res...

Methods Of Osseous Resective Surgery

Vertical Grooving Periodontal Surgery

Fig. 62-7 Reduction of bony ledges and exposure of caries by osteoplasty. A, Buccal preoperative photograph showing two crowns, exostoses, and caries B, Hap reflected to reveal caries on both molars at the restoration margins, interdental cratcring, and a facial exostosis C, Postosseous surgery the bulk of the bony removal was by osteoplasty with minor ostedomy between the two molars The caries is now exposed and the crowns lengthened for restoration. D, Six weeks postoperative photograph The plaque control is deficient but the teeth should be readily restorable at this time (Courtesy Dr Joseph Schwartz, Portland, Ore.) Fig. 62-7 Reduction of bony ledges and exposure of caries by osteoplasty. A, Buccal preoperative photograph showing two crowns, exostoses, and caries B, Hap reflected to reveal caries on both molars at the restoration margins, interdental cratcring, and a facial exostosis C, Postosseous surgery the bulk of the bony removal was by osteoplasty with minor ostedomy between...

Treatment Of Furcation Defects

Odontoplasty Osteoplasty

I itj 6 Treatment ol a grade II furcation by osteoplasty and odontoplasty. A, This mandibular first molar has been treated by endodontics and an area of caries in the furcation repaired. A class II furcation is present. B, five year postoperative picture of ihe results of flap debridement, osteoplasty, and severe odonto plasty. Note the adaptation ol the gingiva into the furcation area. (Courtesy Dr. Ronald Rott Sacramento, Calif.) I itj 6 Treatment ol a grade II furcation by osteoplasty and odontoplasty. A, This mandibular first molar has been treated by endodontics and an area of caries in the furcation repaired. A class II furcation is present. B, five year postoperative picture of ihe results of flap debridement, osteoplasty, and severe odonto plasty. Note the adaptation ol the gingiva into the furcation area. (Courtesy Dr. Ronald Rott Sacramento, Calif.)

Complete Hydrolysis Fructose Syrups

Fructose syrups are widely utilized in the food industry in that they are sweeter than sucrose, thus allowing less sugar to be used to achieve a given level of sweetness (i.e., fructose is 1.2 times sweeter than sucrose on a weight basis (Shallenberger, 1993)). In addition, fructose metabolism in humans is not insulin dependent, and it produces less tooth decay than other sugars (Roch-Norlund et al., 1972). Currently, much of the fructose used by the food industry is produced from corn starch, a glucose polymer, via hydrolysis followed by isomerization. The fructose content is around 42 but can be increased to 95 by chromatographic separation of the residual glucose and further isomerization.

Referral Of Patients To The Periodontist

For various reasons, an ever-greater number ol periodontal maintenance patients are expected in future years. I he number of caries per capita has dwindled since the mid-1970s by about 50 , and some evidence suggests that this decline will continue.1 As more people retain their teeth throughout their lifetimes and the proportion ol older people in the population increases,

Online Dental Education

Dental education has used the Internet tor continuing education courses originating in universities, professional organizations, and private companies. Periodontics has always been prominent in these endeavors, and in 1999 periodontal online courses were the largest subject group in dentistry. Some ol the earliest educational sites in periodontics were the site established at the University ol l.und by Dr. Roll Attstrom anil associates (this site is now called Peruulontulogy rum Sweden iiiul Denmark and comes from the ( enter for Oral Health Sciences at Malmo University and the School of Dentistry at Copenhagen at h111 wwvv.odont.ku.dJs l ask jicriodon11 lgy nutin.html) and the UCIA Periodontics Information ( enter supported by the Tarrson I ndovved Chair in Periodontics at la.cdu pii Commercial companies were also involved in the beginning offerings of online courses, with periodontal programs tor dentists, dental hygienists, and periodontists. Colgate offers access to...

Etiologic Factors Of Pulpal Disease

Lhe major causes of pulpal inflammation are 1) instrumentation during periodontal, restorative or prosthetic dentistry 2) the progression of denial caries and 3) direct. local trauma such as tooth fracture, lhe extent of inflammation of the pulp and the signs and symptoms that result vary with the severity of the insult and the ability of the host to ameliorate- the inflammation that results. Of these, dental caries is lhe most common cause of pulpal disease. Bacteria are present in carious enamel and dentin. Although the numbers of bacteria may di minish in lhe deepest layers of the dentin, the ability of microorganisms and their by-products to penetrate through the dentinal tubules and to provoke pulpal inflammation is well documented. Direct exposure of the pulp by caries'1 or sealing infected pulps may alter the process of infection it the pulp is unable to eliminate the bacteria. The dynamics of the pulpal reaction is dictated by the virulence of the bacteria, the host response,...

Furcation Involvement

Root Canal Root Amputation

Teeth tor which there is no more predictable or cost-effective method of therapy. Examples are teeth with furcation defects that have been treated successfully with endodontics but now present with .1 vertical root fracture, advanced bone loss or caries on bone root. 4. leeth in patients with good oral hygiene and low activity for caries are suitable candidates. Patients unable or unwilling to perform good oral hygiene and preventive measures are not suitable candidates for root resection or hemisection. Root-resected teeth require endodontic treatment and commonly require cast restorations.

Periodontal Disease And Stroke

In case-control studies, poor denial health was a significant risk factor for cerebrovascular ischemia. In one study, bleeding on probing, suppuration, subgingival calculus, and the number of periodontal or periapical lesions were significantly greater in male stroke patients than in controls.7 Overall, 25 of all stroke patients had significant dental infections compared with only 2.5 of controls. Ibis study supports an association between poor oral health and stroke in men under age SO. In the other study, men and women age 50 and older who had a stroke had significantly more severe periodontitis and more periapical lesions than did nonstroke control subjects. Poor dental health was an independent risk factor for stroke. In a longitudinal study over IS years, subjects with greater than 20 mean radiographic bone loss at baseline were almost three times as likely to have a stroke than were subjects with less than 20 hone loss. Periodontitis was a greater risk factor for stroke than was...

The Toothbrush Powered Toothbrushes Dentifrices

CARIES CONTROL FOR THE PERIODONTAL PATIENT CHEMICAL PLAQUE CONTROL Chlorhexidine Essential Oil Mouthrinse Other Products Recommendations DISCLOSING AGENTS FREQUENCY OF PLAQUE REMOVAL The dental profession relies on mechanical plaque control (i.e., daily cleaning with a toothbrush and other oral hygiene aids) as the most dependable way of achieving oral health benefits for all dental patients including periodontal patients. Plaque growth occurs within hours and must be completely removed at the very least every 48 hours in periociontally healthy subjects to prevent inflammation.110 Toothbrushing is a completely accepted part ol dailx life and good oral hygiene practice. However. plaque control by toothbrushing alone is not sufficient to control gingival and periodontal diseases because periodontal lesions are predominantly interdental.** It has been demonstrated in health) subjects that plaque formation begins on the interproximal surfaces where the toothbrush does not reach. Masses of...

The Difference between the Diet of Our Distant Ancestors and Our Diet Today

In the industrialized countries diets have changed remarkably over the past 100 years. This dietary shift, combined with an increasingly sedentary lifestyle, is a major cause of many common diseases-heart disease, osteoporosis, tooth decay, high blood pressure, and diabetes. These disorders, so prevalent now, were rare before the 20th century. For thousands of years, humans adapted to and thrived on a diet radically different from today's diet.19,20 Looking at the diet of our ancestors provides an insight into what foods and nutrients humans were genetically designed to consume for good health.

Respondent Aggression

When two organisms are placed in the same setting and painful stimuli are delivered, the organisms may attack one another (Ulrich, Wolff, & Azrin, 1964). The fighting generated by this circumstance is called respondent aggression (or pain-elicited aggression) because it follows the presentation of aversive events. Attack occurs even though neither individual is responsible for the delivery of the painful stimuli. Ulrich and Azrin (1962) placed two rats in an operant chamber and noted that the animals showed no signs of aggression. However, when the rats were shocked, they turned and attacked each other. Elicited aggression has been documented in several species including humans (Azrin, Hutchinson, & Hake, 1963 Hutchinson, 1977), and it has been found with painful stimuli other than electric shock (Azrin, Hake, & Hutchinson, 1965). Most people recognize that they are more prone to aggression when exposed to painful stimuli. When feeling good you may never shout at your boyfriend, but...

Levi Spear Parmly

William Hunter Focal Infection Theory

Ot dentists, some of whom emigrated to America and practiced in the early years of the Republic. Some of (ieorge Washington's dentures were made with springs similar to those in the design illustrated by Fauchard. All aspects of dental practice are presented in his book (i.e., restorative dentistry, prosthodontics, oral surgery, periodontics, and orthodontics). Preventive dentistry is described in Chapter 4 ( The Regimen and Care Required for the Preservation of the Teeth ) and in Chapter 5 ( How to Keep the Teeth White and Strengthen the Gums ). Fauchard wrote that confections and sweets destroy the teeth by sticking to their surfaces and producing an acid. He described in detail his periodontal instru A contemporary of Hunter, Thomas Berdmore (1740-85), was considered the outstanding dentist in England and was known as Dentist to His Majesty (i.e., King George III). He published the Treatise in the Disorders ami Deformities of the Teeth ami Gums in 1770. with several chapters...


Fluoride is naturally found in minute amounts in all foods. Although fluoride was once considered an essential nutrient, it is no longer considered essential but rather beneficial for human health. Its benefits are a sharp reduction in prevalence and severity of dental caries in both children and adults when an optimum dose is ingested (about 0.05 mg kg body weight day).1 However, the range of fluoride intake compatible with human health is narrow toxicity may appear at levels of intake only two to five times the dose needed to help prevent dental caries.2,3


Dental Treatment Dentate Status Periodontal Status Caries Status Dental Visits Xerostomia Candidiasis DENTAL AND MEDICAL ASSESSMENTS Review of Dental History The focus of this chapter is to provide the reader with information on the interrelationship between aging and oral health, with emphasis on periodontal health.

Box 391

A common goal for all older adults is to decrease bacteria through oral hygiene and mechanical debridement. Clinical trials involving older adults show that the development or progression of periodontal disease can be prevented or arrested by the control of plaque. For certain patients, topical antibiotic therapy may complement repeated subgingival instrumentation during supportive care. Oral hygiene maintenance should also focus on root surfaces susceptible to caries. 24


Patients with refractory periodontitis, when transferred to maintenance care, must have a stable periodontal status, similar to the situation presented in Fig. 40-4, Box4. The maintenance visit should consist of examination and evaluation of the patient's current oral health thorough root debridement, followed by prophylaxis and a review of oral hygiene instructions. When signs of disease recur, monitoring with bacterial testing is recommended.

Hutchinson Teeth

Bobby Pin Notching Dentistry

Dental Caries Dental caries is first visible as a chalky white area in the enamel surface of a tooth. This area may then turn brown or black, become soft, and cavitate. Special dental techniques, including x-rays, are necessary for early detection. (Sources of photos Pregnancy Tumor, Dental Caries From Langlais RP, Miller CS Color Atlas of Common Oral Diseases. Philadelphia, Lea & Febiger 1992. LJsed with permission Kaposi's Sarcoma in AIDS Kelley WN (ed) Textbook of Internal Medicine, 2nd ed. Philadelphia, JB Lippincott, 1992 Lead Line Courtesy of Dr. R. A. Cawson, from Cawson RA Oral Pathology, 1st ed. London, LJK, Gower Medical Publishing, 1987.)


Throughout a woman's life cycle, hormonal influences affect therapeutic decision making in periodontics. Historically, therapies have been gender biased. However, the advent of new research has provided keener appreciation of the unique systemic influences on oral, periodontal, and implant tissues. Oral health care professionals have greater awareness and capabilities of dealing with hormonal influences associated with the reproductive process. Periodontal and oral tissue responses may be altered, creating diagnostic and therapeutic dilemmas. Therefore it is imperative that the clinician recognize, customize, and appropriately alter periodontal therapy according to the individual woman's needs based on the stage of her life cycle.

Historical Context

Sophia's upbringing directly influenced Hawthorne's themes. Her father, Dr. Nathaniel Peabody, grew the purple wildflower Solanum dulcamara in his Salem garden, using it for tooth pain relief. From her early childhood Sophia kept records on the garden. Her father, despite his homeopathic tendencies, made her the object of some experiments, as Dr. Rappaccini did with Beatrice. He dosed her with paregoric (opium), laudanum, and mercury, and Hawthorne, to his horror, later found it necessary to cure his wife of these addictions. Another incident central to Hawthorne's theme was the bitter medical rivalry between two famous regional doctors, Dr. Oliver Wendell Holmes and Dr. Robert Wesselhoeft. In 1842 at the prestigious Boston Society for the Diffusion of Useful Knowledge, Holmes accused Wesselhoeft of quackery and ran him out of town, denouncing his delusional use of homeopathy (a water cure) and calling him an empiric with fantastic theories. In addition, Wesselhoeft's brother,...

Undercontoured Teeth

Early Lateral Tonge Canser

Fig. 11-7 Calculus A, Calculus attached to pellicle on enamel surface (e). rhe enartiel was removed in the preparation ol the specimen. Also note calculus attached to dentin and associated penetration of dental tubules (arrows). B, Interproximal area with early and advanced root caries of adjacent teeth and with calculus attached to carious surfaces (atrows).

Occlusal Therapy

The purpose of occlusal therapy is to establish stable functional relationships favorable to the oral health of the patient, including the periodontium. A variety of procedures could contribute to this objective interoc-dusal appliance therapy, occlusal adjustment, restorative procedures, orthodontic tooth movement, and orthognathic surgery.


4 American Dental Assoc iation, Council on ccess, Prevention, and Interpersonal Relations Women's Oral Health Issues. Dec. 1995. t hicago, ADA, 1995. 56. Muramatsu lakaesu Y Oral health stains related to subgingival bacterial flora and sex hormones in saliva during pregnane v . Bull Ibkyo Dent i ollege 1094 35(,'3) I .39 67. Paganini-Hill A Benefits ol estrogen replacement thcrapv on oral health the leisure world cohort. Arch Intern Med 1005 155 2.325. 95. Zachariascn RD Ovarian hormones and oral health pregnanes- gingivitis (ompend t ontin I'.duc Dent 1989 10(9) 508,

Periodontal Surgery

Posterior Iliac Crest

I he delect is debrided of ill granulation tissue and the root surface is planed to remove til remnants of plaque, accretions and other root surface alterations (grooves, notches, caries) employing ultrasonic sonic, hand, and or rotary instrumentation. Odontoplast) and or osteoplasty are performed il required lor adequate access to the detect including intraradicular or furcation fundus concavities and or reduction of enamel projections.

Hard Tissue Adhesive

As previously noted, prostheses can be attached to calcified tissues (bone, tooth enamel, dentin) by gross mechanical interlocking to machined surfaces. Thus, room temperature-polymerizing methyl methacrylate (Fig. 7) systems are used to fix orthopedic implants (e.g., acrylic bone cement, see Chapter 7.7) and for dental restorations. The former, in a closed system, has been relatively successful. However, conditions are much more stringent in the mouth because of the changing environment, thermomechanical stresses on the bond, and the presence of oral bacteria that result in renewed tooth decay. Thus, considerable development of new dental cements and adhesive systems has occurred in recent years in attempts to provide a leakproof bond to attach fillings, crowns, and veneers to the tooth (Fig. 8).

Tooth Mortality

Of the patients showed any further loss ol periodontal support. No teeth were extracted in the 5-year iosttreatment period, it should be pointed out that the patients in this stuch were selected because ol their capacity to meet high requirements ol plaque control alter repeated instruction in oral hygiene techniques. This fact does not detract from the validity of the study but tends to show the etiologic importance ol bacterial plaque. The results indicate that periodontal surgery coupled with a detailed plaque control program not only temporarily cures the disease but also reduces lurther progression of periodontal breakdown, even in patients with severely reduced periodontal support. After 14 years, hi of the original patients were still in the study.11 Recurrence of destructive periodontal disease in isolated sites ol the dentition resulted in loss ol a certain number of teeth during the observation period d ig. 77-( ). In the 6 to 10 years after active therapy, one tooth in each...


Early and usually transient side effects of 131I may include nausea, vomiting, sialoadenitis, xerostomia, loss of taste, thyroiditis (if a sizable thyroid remnant remains after surgery), and, rarely, bone marrow suppression (leukopenia and thrombocytopenia) 54 . Some of these early side effects may be minimized by having the patient drink lots of water after therapy and suck on tart candies, such as lemon drops, to promote salivary flow. The long-term consequences of 131I therapy in children remain an area of concern, particularly in individuals who receive high cumulative doses in early childhood. Much remains to be learned about possible late effects, which can include infertility (particularly in men), permanent damage to the salivary glands resulting in chronic xerostomia or salivary duct stones, excessive dental caries, reduced taste, pulmonary fibrosis (in those with diffuse pulmonary metastases), and the possibility of the development of other cancers (stomach, bladder,...

Phase I Therapy

Ihe specific goal of Phase I therapy is the control of active dental disease (see Chapters 47 and 4tt). Therefore when this phase ol therapy is completed, patients should be in a stale ol dental health with active caries no longer present and active destruction ol Ihe periodontium under control. This results in elimination ol the acute inflammatory response associated with periodontal destruction. I litis the status ol the gingival tissues should be such that lurlhcr restorative procedures of a more complex nature can be carried out without detrimental effects from unhealthy gingiva. Obtaining control of periodontal inflammation during Phase I therapy results in restorations ol a much higher quality than would be obtained if restoration were carried out in an environment of gingival intlammation. The presence of an acute inflammatory response in the gingiva causes ulceration of the epithelium that lines the gingival pocket and an increase in vascularity and edema of the tissues...

Goals of Therapy

A thorough oral examination will determine the patient's dental treatment needs. I he primary goals of dental therapy should be the restoration and maintenance of oral health, comfort, and function. t Ihe vers least, periodontal treatment goals should he directed toward control of FfiV-associated mucosal diseases such as chronic candidiasis and recurrent oral ulcerations. Acute periodontal and dental infections should he managed, and the patient should receive detailed instruct ons in performance of effective oral hygiene procedures.1 ( on-servative, nonsurgical periodontal therap should be a treatment option lor virtualh all HIV-positive patients, and performance ol elective surgical periodontal procedures to include implant placement has been reported. 1 Necrotizing ulcerative periodontitis (NUP) or necrotizing ulcerative stomatitis (Nt S) can be severely destructive to periodontal structures, bill a his.orv ol these conditions does not automatically dictate extraction ol involved...

Yvonne Holm

Ocimum suave is known under the names Chemwoken (Pokot), Mukandu (Kamba), Makanda kandu (Meru), Yoiyoiya Chesimia (Marakwet), Mkandu (Kikuyu), Sivai (Kipsigis) and Sunoni (Masai). The leaves are rubbed between palms and sniffed to treat a blocked nose and cough. The Meru prepare an infusion of the leaves for flu. Chewed leaves treat toothache, the juice is an anthelmintic in small children and roots boiled in soup treats chestache. It may be burnt at night to drive away insects (Githinji and Kokwaro 1993). In Tanzania O.suave have been claimed to have various medicinal activities, and extracts of the plant are used for treating coughs, eye and ear complaints, and abdominal pains (Chogo and Crank 1981).


Tetracyclines are selectively taken up in the teeth and growing bones of the fetus and of children, due to their chelating properties with calcium phosphate. This causes hypoplasia of dental enamel with pitting, cusp malformation, yellow or brown pigmentation and increased susceptibility to caries. After the fourteenth week of pregnancy and in the first few months of life even short courses can be damaging. Prevention of discolouration of the permanent front teeth requires that tetracyclines be avoided from the last 2 months of pregnancy to 4 years, and of other teeth to 8 years of age (or 12 years if the third molars are valued). Prolonged tetracycline therapy can also stain the fingernails at all ages.

Maintenance Program

Undisplaced Periodontal Flap

Periodontal care at each recall visit comprises three parts (Box 76-1). I he tirst part is concerned with examination and evaluation ol the patient's current oral health. I he second part includes the necessary maintenance treatment and oral hygiene reinforcement. I lie third part involves scheduling the patient for the next recall appointment, additional periodontal treatment, or restorative dental procedures. I he time required lor a recall visit for patients with multiple teeth in both arches is approximately I hour,4 which includes time tor greeting the patient, setting up. and cleaning up. Ihe recall examination is similar to the initial evaluation of the patient discussed in Chapter 30. However, because the patient is not new to the office, the dentist primarily looks for c hanges that have occurred since the last evaluation. Analysis of the current oral hygiene status ol the patient is essential Updating ol changes in the medical history and evaluation of restorations, caries,...

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