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oral surgery Return to the top

Oral Surgery is a recognized international specialty in dentistry. It includes the diagnosis, surgical and related treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the head, mouth, teeth, gums, jaws and neck.[1] It involves, but is not limited to: dental implants, wisdom teeth removal, apicoectomy, TMJ disorder, facial trauma, corrective jaw surgery, oral pathology, osseous tissue surgery, anesthesia and bone grafts. Unlike in the United States, in some areas of the world it is separate from Oral and Maxillofacial surgery (OMS, OMFS, or "Maxfacs"), which is a unique specialty usually requiring both medical and dental qualifications of 8-10 years of education after college. Oral surgery as a specialty is defined in Europe as a dental specialty[2]. It requires 3 years of further university training after a formal qualification in dentistry. The Directive 2001/19/EC also distinguishes Oral Surgery from other evidence of formal qualifications in specialized Medicine, such as oral and maxillofacial surgery, which requires both medical and dental training in the European Union. However, it is important to note that, in the United States, there is no such equivalent dental specialist to the European "oral surgeon". Based on the scope of practice in the United States, "oral surgeons" are those who, internationally, would be more appropriately described as "oral and maxillofacial surgeons". In 2007, the United Kingdom's General Dental Council transferred dentists on the specialist list in Surgical Dentistry to a reconfigured Oral Surgery list.

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ho·lis·tic    /hoʊˈlɪstɪk/ Show Spelled[hoh-lis-tik] Show IPA –adjective 1. incorporating the concept of holism in theory or practice: holistic psychology. 2. identifying with principles of holism in a system of therapeutics, esp. one considered outside the mainstream of scientific medicine, as naturopathy or chiropractic, and usually involving nutritional measures. Use holistic in a Sentence See images of holistic Search holistic on the Web Origin: 1926; hol(ism) + -istic —Related forms ho·lis·ti·cal·ly, adverb —Can be confused:  holistic, wholistic. Dictionary.com Unabridged Based on the Random House Dictionary, © Random House, Inc. 2011. Cite This Source | Link To holistic World English Dictionary holistic (həʊˈlɪstɪk) [Click for IPA pronunciation guide] — adj 1. of or relating to a doctrine of holism 2. of or relating to the the medical consideration of the complete person, physically and psychologically, in the treatment of a disease ho'listically — adv Collins English Dictionary - Complete & Unabridged 10th Edition 2009 © William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009 Cite This Source Word Origin & History holistic 1926, coined, along with holism, by Gen. J.C. Smuts (1870-1950), from Gk. holos "whole" (see safe (adj.)). In reference to the theory that regards nature as consisting of wholes. Holistic medicine is first attested 1960. Online Etymology Dictionary, © 2010 Douglas Harper Cite This Source Medical Dictionary ho·lis·tic definition Pronunciation: /hō-ˈlis-tik/ Function: adj 1 : of or relating to holism 2 : relating to or concerned with wholes or with complete systems rather than with the analysis of, treatment of, or dissection into parts < holistic medicine attempts to treat both the mind and the body> ho·lis·ti·cal·ly Pronunciation: /-ti-k(ə-)lē/ Function: adv Merriam-Webster's Me

History The term holism was introduced by the South African statesman Jan Smuts in his 1926 book, Holism and Evolution.[1] Smuts defined holism as "The tendency in nature to form wholes that are greater than the sum of the parts through creative evolution."[2] The idea has ancient roots. Examples of holism can be found throughout human history and in the most diverse socio-cultural contexts, as has been confirmed by many ethnological studies. The French Protestant missionary, Maurice Leenhardt coined the term cosmomorphism to indicate the state of perfect symbiosis with the surrounding environment which characterized the culture of the Melanesians of New Caledonia. For these people, an isolated individual is totally indeterminate, indistinct and featureless until he can find his position within the natural and social world in which he is inserted. The confines between the self and the world are annulled to the point that the material body itself is no guarantee of the sort of recognition of identity which is typical of our own culture. In the late 1990s the term holistic evolved into the term wholistic in order to clarify the concept even further. For example schools refer to wholistic learning styles and medicine refers to the wholistic model that considers the mind, body, spirit in diagnosis and treatment. [edit] In science Main article: Holism in science In the latter half of the 20th century, holism led to systems thinking and its derivatives, like the sciences of chaos and complexity. Systems in biology, psychology, or sociology are frequently so complex that their behavior is, or appears, "new" or "emergent": it cannot be deduced from the properties of the elements alone.[3] Holism has thus been used as a catchword. This contributed to the resistance encountered by the scientific interpretation of holism, which insists that there are ontological reasons that prevent reductive models in principle from providing efficient algorithms for prediction of system behavior in certain classes of systems. Scientific holism holds that the behavior of a system cannot be perfectly predicted, no matter how much data is available. Natural systems can produce surprisingly unexpected behavior, and it is suspected that behavior of such systems might be computationally irreducible, which means it would not be possible to even approximate the system state without a full simulation of all the events occurring in the system. Key properties of the higher level behavior of certain classes of systems may be mediated by rare "surprises" in the behavior of their elements due to the principle of interconnectivity, thus evading predictions except by brute force simulation. Stephen Wolfram has provided such examples with simple cellular automata, whose behavior is in most cases equally simple, but on rare occasions highly unpredictable.[4] Complexity theory (also called "science of complexity"), is a contemporary heir of systems thinking. It comprises both computational and holistic, relational approaches towards understanding complex adaptive systems and, especially in the latter, its methods can be seen as the polar opposite to reductive methods. General theories of complexity have been proposed, and numerous complexity institutes and departments have sprung up around the world. The Santa Fe Institute is arguably the most famous of them. [edit] In anthropology There is an ongoing dispute as to whether anthropology is intrinsically holistic. Supporters of this concept consider anthropology holistic in two senses. First, it is concerned with all human beings across times and places, and with all dimensions of humanity (evolutionary, biophysical, sociopolitical, economic, cultural, psychological, etc.). Further, many academic programs following this approach take a "four-field" approach to anthropology that encompasses physical anthropology, archeology, linguistics, and cultural anthropology or social anthropology.[5] Some leading anthropologists disagree, and consider anthropological holism to be an artifact from 19th century social evolutionary thought that inappropriately imposes scientific positivism upon cultural anthropology.[6] The term "holism" is additionally used within social and cultural anthropology to refer to an analysis of a society as a whole which refuses to break society into component parts. One definition says: "as a methodological ideal, holism implies ... that one does not permit oneself to believe that our own established institutional boundaries (e.g. between politics, sexuality, religion, economics) necessarily may be found also in foreign societies."[7] [edit] In business A holistic brand (also holistic branding) is considering the entire brand or image of the company. For example a universal brand image across all countries, including everything from advertising styles to the stationery the company has made, to the company colours. [edit] In ecology Ecology is the leading and most important approach to holism, as it tries to include biological, chemical, physical and economic views in a given area. The complexity grows with the area, so that it is necessary to reduce the characteristic of the view in other ways, for example to a specific time of duration. John Muir, Scots born early conservationist,[8] wrote "When we try to pick out anything by itself we find it hitched to everything else in the Universe". More information is to be found in the field of systems ecology, a cross-disciplinary field influenced by general systems theory. see Holistic Community. [edit] In economics With roots in Schumpeter, the evolutionary approach might be considered the holist theory in economics. They share certain language from the biological evolutionary approach. They take into account how the innovation system evolves over time. Knowledge and know-how, know-who, know-what and know-why are part of the whole business economics. Knowledge can also be tacit, as described by Michael Polanyi. These models are open, and consider that it is hard to predict exactly the impact of a policy measure. They are also less mathematical. [edit] In philosophy Main articles: Semantic holism and confirmation holism In philosophy, any doctrine that emphasizes the priority of a whole over its parts is holism. Some suggest that such a definition owes its origins to a non-holistic view of language and places it in the reductivist camp. Alternately, a 'holistic' definition of holism denies the necessity of a division between the function of separate parts and the workings of the 'whole'. It suggests that the key recognisable characteristic of a concept of holism is a sense of the fundamental truth of any particular experience. This exists in contradistinction to what is perceived as the reductivist reliance on inductive method as the key to verification of its concept of how the parts function within the whole. In the philosophy of language this becomes the claim, called semantic holism, that the meaning of an individual word or sentence can only be understood in terms of its relations to a larger body of language, even a whole theory or a whole language. In the philosophy of mind, a mental state may be identified only in terms of its relations with others. This is often referred to as content holism or holism of the mental. Epistemological and confirmation holism are mainstream ideas in contemporary philosophy. Ontological holism was espoused by David Bohm in his theory on The Implicate Order. [edit] In sociology Main article: Gemeinschaft and Gesellschaft Émile Durkheim developed a concept of holism which he set as opposite to the notion that a society was nothing more than a simple collection of individuals. In more recent times, Louis Dumont [9] has contrasted "holism" to "individualism" as two different forms of societies. According to him, modern humans live in an individualist society, whereas ancient Greek society, for example, could be qualified as "holistic", because the individual found identity in the whole society. Thus, the individual was ready to sacrifice himself or herself for his or her community, as his or her life without the polis had no sense whatsoever. Martin Luther King Jr had a holistic view of social justice. In Letter from Birmingham Jail he famously said: "Injustice anywhere is a threat to justice everywhere". Scholars such as David Bohm [10] and M. I. Sanduk [11] consider the society through the Plasma Physics. From physics point of view, the interaction of individuals within a group may lead a continuous model. Therefore for M. I. Sanduk “The nature of fluidity of plasma (ionized gas) arises from the interaction of its free interactive charges, so the society may behave as a fluid owing to the free interactive individuals. This fluid model may explain many social phenomena like social instability, diffusion, flow, viscosity...So the society behaves as a sort of intellectual fluid”. [edit] In psychology of perception A major holist movement in the early twentieth century was gestalt psychology. The claim was that perception is not an aggregation of atomic sense data but a field, in which there is a figure and a ground. Background has holistic effects on the perceived figure. Gestalt psychologists included Wolfgang Koehler, Max Wertheimer, Kurt Koffka. Koehler claimed the perceptual fields corresponded to electrical fields in the brain. Karl Lashley did experiments with gold foil pieces inserted in monkey brains purporting to show that such fields did not exist. However, many of the perceptual illusions and visual phenomena exhibited by the gestaltists were taken over (often without credit) by later perceptual psychologists. Gestalt psychology had influence on Fritz Perls' gestalt therapy, although some old-line gestaltists opposed the association with counter-cultural and New Age trends later associated with gestalt therapy. Gestalt theory was also influential on phenomenology. Aron Gurwitsch wrote on the role of the field of consciousness in gestalt theory in relation to phenomenology. Maurice Merleau-Ponty made much use of holistic psychologists such as work of Kurt Goldstein in his "Phenomenology of Perception." [edit] In teleological psychology Alfred Adler believed that the individual (an integrated whole expressed through a self-consistent unity of thinking, feeling, and action, moving toward an unconscious, fictional final goal), must be understood within the larger wholes of society, from the groups to which he belongs (starting with his face-to-face relationships), to the larger whole of mankind. The recognition of our social embeddedness and the need for developing an interest in the welfare of others, as well as a respect for nature, is at the heart of Adler's philosophy of living and principles of psychotherapy. Edgar Morin, the French philosopher and sociobiologist, can be considered a holist based on the transdisciplinary nature of his work. Mel Levine, M.D., author of A Mind at a Time,[12] and co-founder (with Charles R. Schwab) of the not-for-profit organization All Kinds of Minds, can be considered a holist based on his view of the 'whole child' as a product of many systems and his work supporting the educational needs of children through the management of a child's educational profile as a whole rather than isolated weaknesses in that profile. [edit] In theological anthropology In theological anthropology, which belongs to theology and not to anthropology, holism is the belief that the nature of humans consists of an ultimately divisible union of components such as body, soul and spirit. [edit] In theology Holistic concepts are strongly represented within the thoughts expressed within Logos (per Heraclitus), Panentheism and Pantheism. [edit] In neurology A lively debate has run since the end of the 19th century regarding the functional organization of the brain. The holistic tradition (e.g., Pierre Marie) maintained that the brain was a homogeneous organ with no specific subparts whereas the localizationists (e.g., Paul Broca) argued that the brain was organized in functionally distinct cortical areas which were each specialized to process a given type of information or implement specific mental operations. The controversy was epitomized with the existence of a language area in the brain, nowadays known as the Broca's area.[13] Although Broca's view has gained acceptance, the issue isn't settled insofar as the brain as a whole is a highly connected organ at every level from the individual neuron to the hemispheres. [edit] Applications [edit] Architecture Architecture is often argued by design academics and those practicing in design to be a holistic enterprise.[14] Used in this context, holism tends to imply an all-inclusive design perspective. This trait is considered exclusive to architecture, distinct from other professions involved in design projects. [edit] Education reform The Taxonomy of Educational Objectives identifies many levels of cognitive functioning, which can be used to create a more holistic education. In authentic assessment, rather than using computers to score multiple choice tests, a standards based assessment uses trained scorers to score open-response items using holistic scoring methods.[15] In projects such as the North Carolina Writing Project, scorers are instructed not to count errors, or count numbers of points or supporting statements. The scorer is instead instructed to judge holistically whether "as a whole" is it more a "2" or a "3". Critics question whether such a process can be as objective as computer scoring, and the degree to which such scoring methods can result in different scores from different scorers. [edit] Medicine Holism appears in psychosomatic medicine. In the 1970s the holistic approach was considered one possible way to conceptualize psychosomatic phenomena. Instead of charting one-way causal links from psyche to soma, or vice-versa, it aimed at a systemic model, where multiple biological, psychological and social factors were seen as interlinked. Other, alternative approaches at that time were psychosomatic and somatopsychic approaches, which concentrated on causal links only from psyche to soma, or from soma to psyche, respectively.[16] At present it is commonplace in psychosomatic medicine to state that psyche and soma cannot really be separated for practical or theoretical purposes.[citation needed] A disturbance on any level - somatic, psychic, or social - will radiate to all the other levels, too. In this sense, psychosomatic thinking is similar to the biopsychosocial model of medicine.[citation needed] Alternative medicine practitioners adopt a holistic approach to healing.

Holism (from ὅλος holos, a Greek word meaning all, whole, entire, total) is the idea that all the properties of a given system (physical, biological, chemical, social, economic, mental, linguistic, etc.) cannot be determined or explained by its component parts alone. Instead, the system as a whole determines in an important way how the parts behave. The general principle of holism was concisely summarized by Aristotle in the Metaphysics: "The whole is different from the sum of its parts" (1045a10). Reductionism is sometimes seen as the opposite of holism. Reductionism in science says that a complex system can be explained by reduction to its fundamental parts. For example, that the processes of biology can be reduced to chemistry and the laws of chemistry explained by physics. Contents [hide] * 1 History * 2 In science o 2.1 In anthropology o 2.2 In business o 2.3 In ecology o 2.4 In economics o 2.5 In philosophy o 2.6 In sociology o 2.7 In psychology of perception o 2.8 In teleological psychology o 2.9 In theological anthropology o 2.10 In theology o 2.11 In neurology * 3 Applications o 3.1 Architecture o 3.2 Education reform o 3.3 Medicine * 4 See also * 5 Notes * 6 References * 7 Further reading * 8 External links [edit] History The term holism was introduced by the South African statesman Jan Smuts in his 1926 book, Holism and Evolution.[1] Smuts defined holism as "The tendency in nature to form wholes that are greater than the sum of the parts through creative evolution."[2] The idea has ancient roots. Examples of holism can be found throughout human history and in the most diverse socio-cultural contexts, as has been confirmed by many ethnological studies. The French Protestant missionary, Maurice Leenhardt coined the term cosmomorphism to indicate the state of perfect symbiosis with the surrounding environment which characterized the culture of the Melanesians of New Caledonia. For these people, an isolated individual is totally indeterminate, indistinct and featureless until he can find his position within the natural and social world in which he is inserted. The confines between the self and the world are annulled to the point that the material body itself is no guarantee of the sort of recognition of identity which is typical of our own culture. In the late 1990s the term holistic evolved into the term wholistic in order to clarify the concept even further. For example schools refer to wholistic learning styles and medicine refers to the wholistic model that considers the mind, body, spirit in diagnosis and treatment. [edit] In science Main article: Holism in science In the latter half of the 20th century, holism led to systems thinking and its derivatives, like the sciences of chaos and complexity. Systems in biology, psychology, or sociology are frequently so complex that their behavior is, or appears, "new" or "emergent": it cannot be deduced from the properties of the elements alone.[3] Holism has thus been used as a catchword. This contributed to the resistance encountered by the scientific interpretation of holism, which insists that there are ontological reasons that prevent reductive models in principle from providing efficient algorithms for prediction of system behavior in certain classes of systems. Scientific holism holds that the behavior of a system cannot be perfectly predicted, no matter how much data is available. Natural systems can produce surprisingly unexpected behavior, and it is suspected that behavior of such systems might be computationally irreducible, which means it would not be possible to even approximate the system state without a full simulation of all the events occurring in the system. Key properties of the higher level behavior of certain classes of systems may be mediated by rare "surprises" in the behavior of their elements due to the principle of interconnectivity, thus evading predictions except by brute force simulation. Stephen Wolfram has provided such examples with simple cellular automata, whose behavior is in most cases equally simple, but on rare occasions highly unpredictable.[4] Complexity theory (also called "science of complexity"), is a contemporary heir of systems thinking. It comprises both computational and holistic, relational approaches towards understanding complex adaptive systems and, especially in the latter, its methods can be seen as the polar opposite to reductive methods. General theories of complexity have been proposed, and numerous complexity institutes and departments have sprung up around the world. The Santa Fe Institute is arguably the most famous of them. [edit] In anthropology There is an ongoing dispute as to whether anthropology is intrinsically holistic. Supporters of this concept consider anthropology holistic in two senses. First, it is concerned with all human beings across times and places, and with all dimensions of humanity (evolutionary, biophysical, sociopolitical, economic, cultural, psychological, etc.). Further, many academic programs following this approach take a "four-field" approach to anthropology that encompasses physical anthropology, archeology, linguistics, and cultural anthropology or social anthropology.[5] Some leading anthropologists disagree, and consider anthropological holism to be an artifact from 19th century social evolutionary thought that inappropriately imposes scientific positivism upon cultural anthropology.[6] The term "holism" is additionally used within social and cultural anthropology to refer to an analysis of a society as a whole which refuses to break society into component parts. One definition says: "as a methodological ideal, holism implies ... that one does not permit oneself to believe that our own established institutional boundaries (e.g. between politics, sexuality, religion, economics) necessarily may be found also in foreign societies."[7] [edit] In business A holistic brand (also holistic branding) is considering the entire brand or image of the company. For example a universal brand image across all countries, including everything from advertising styles to the stationery the company has made, to the company colours. [edit] In ecology Ecology is the leading and most important approach to holism, as it tries to include biological, chemical, physical and economic views in a given area. The complexity grows with the area, so that it is necessary to reduce the characteristic of the view in other ways, for example to a specific time of duration. John Muir, Scots born early conservationist,[8] wrote "When we try to pick out anything by itself we find it hitched to everything else in the Universe". More information is to be found in the field of systems ecology, a cross-disciplinary field influenced by general systems theory. see Holistic Community. [edit] In economics With roots in Schumpeter, the evolutionary approach might be considered the holist theory in economics. They share certain language from the biological evolutionary approach. They take into account how the innovation system evolves over time. Knowledge and know-how, know-who, know-what and know-why are part of the whole business economics. Knowledge can also be tacit, as described by Michael Polanyi. These models are open, and consider that it is hard to predict exactly the impact of a policy measure. They are also less mathematical. [edit] In philosophy Main articles: Semantic holism and confirmation holism In philosophy, any doctrine that emphasizes the priority of a whole over its parts is holism. Some suggest that such a definition owes its origins to a non-holistic view of language and places it in the reductivist camp. Alternately, a 'holistic' definition of holism denies the necessity of a division between the function of separate parts and the workings of the 'whole'. It suggests that the key recognisable characteristic of a concept of holism is a sense of the fundamental truth of any particular experience. This exists in contradistinction to what is perceived as the reductivist reliance on inductive method as the key to verification of its concept of how the parts function within the whole. In the philosophy of language this becomes the claim, called semantic holism, that the meaning of an individual word or sentence can only be understood in terms of its relations to a larger body of language, even a whole theory or a whole language. In the philosophy of mind, a mental state may be identified only in terms of its relations with others. This is often referred to as content holism or holism of the mental. Epistemological and confirmation holism are mainstream ideas in contemporary philosophy. Ontological holism was espoused by David Bohm in his theory on The Implicate Order. [edit] In sociology Main article: Gemeinschaft and Gesellschaft Émile Durkheim developed a concept of holism which he set as opposite to the notion that a society was nothing more than a simple collection of individuals. In more recent times, Louis Dumont [9] has contrasted "holism" to "individualism" as two different forms of societies. According to him, modern humans live in an individualist society, whereas ancient Greek society, for example, could be qualified as "holistic", because the individual found identity in the whole society. Thus, the individual was ready to sacrifice himself or herself for his or her community, as his or her life without the polis had no sense whatsoever. Martin Luther King Jr had a holistic view of social justice. In Letter from Birmingham Jail he famously said: "Injustice anywhere is a threat to justice everywhere". Scholars such as David Bohm [10] and M. I. Sanduk [11] consider the society through the Plasma Physics. From physics point of view, the interaction of individuals within a group may lead a continuous model. Therefore for M. I. Sanduk “The nature of fluidity of plasma (ionized gas) arises from the interaction of its free interactive charges, so the society may behave as a fluid owing to the free interactive individuals. This fluid model may explain many social phenomena like social instability, diffusion, flow, viscosity...So the society behaves as a sort of intellectual fluid”. [edit] In psychology of perception A major holist movement in the early twentieth century was gestalt psychology. The claim was that perception is not an aggregation of atomic sense data but a field, in which there is a figure and a ground. Background has holistic effects on the perceived figure. Gestalt psychologists included Wolfgang Koehler, Max Wertheimer, Kurt Koffka. Koehler claimed the perceptual fields corresponded to electrical fields in the brain. Karl Lashley did experiments with gold foil pieces inserted in monkey brains purporting to show that such fields did not exist. However, many of the perceptual illusions and visual phenomena exhibited by the gestaltists were taken over (often without credit) by later perceptual psychologists. Gestalt psychology had influence on Fritz Perls' gestalt therapy, although some old-line gestaltists opposed the association with counter-cultural and New Age trends later associated with gestalt therapy. Gestalt theory was also influential on phenomenology. Aron Gurwitsch wrote on the role of the field of consciousness in gestalt theory in relation to phenomenology. Maurice Merleau-Ponty made much use of holistic psychologists such as work of Kurt Goldstein in his "Phenomenology of Perception." [edit] In teleological psychology Alfred Adler believed that the individual (an integrated whole expressed through a self-consistent unity of thinking, feeling, and action, moving toward an unconscious, fictional final goal), must be understood within the larger wholes of society, from the groups to which he belongs (starting with his face-to-face relationships), to the larger whole of mankind. The recognition of our social embeddedness and the need for developing an interest in the welfare of others, as well as a respect for nature, is at the heart of Adler's philosophy of living and principles of psychotherapy. Edgar Morin, the French philosopher and sociobiologist, can be considered a holist based on the transdisciplinary nature of his work. Mel Levine, M.D., author of A Mind at a Time,[12] and co-founder (with Charles R. Schwab) of the not-for-profit organization All Kinds of Minds, can be considered a holist based on his view of the 'whole child' as a product of many systems and his work supporting the educational needs of children through the management of a child's educational profile as a whole rather than isolated weaknesses in that profile. [edit] In theological anthropology In theological anthropology, which belongs to theology and not to anthropology, holism is the belief that the nature of humans consists of an ultimately divisible union of components such as body, soul and spirit. [edit] In theology Holistic concepts are strongly represented within the thoughts expressed within Logos (per Heraclitus), Panentheism and Pantheism. [edit] In neurology A lively debate has run since the end of the 19th century regarding the functional organization of the brain. The holistic tradition (e.g., Pierre Marie) maintained that the brain was a homogeneous organ with no specific subparts whereas the localizationists (e.g., Paul Broca) argued that the brain was organized in functionally distinct cortical areas which were each specialized to process a given type of information or implement specific mental operations. The controversy was epitomized with the existence of a language area in the brain, nowadays known as the Broca's area.[13] Although Broca's view has gained acceptance, the issue isn't settled insofar as the brain as a whole is a highly connected organ at every level from the individual neuron to the hemispheres. [edit] Applications [edit] Architecture Architecture is often argued by design academics and those practicing in design to be a holistic enterprise.[14] Used in this context, holism tends to imply an all-inclusive design perspective. This trait is considered exclusive to architecture, distinct from other professions involved in design projects. [edit] Education reform The Taxonomy of Educational Objectives identifies many levels of cognitive functioning, which can be used to create a more holistic education. In authentic assessment, rather than using computers to score multiple choice tests, a standards based assessment uses trained scorers to score open-response items using holistic scoring methods.[15] In projects such as the North Carolina Writing Project, scorers are instructed not to count errors, or count numbers of points or supporting statements. The scorer is instead instructed to judge holistically whether "as a whole" is it more a "2" or a "3". Critics question whether such a process can be as objective as computer scoring, and the degree to which such scoring methods can result in different scores from different scorers. [edit] Medicine Holism appears in psychosomatic medicine. In the 1970s the holistic approach was considered one possible way to conceptualize psychosomatic phenomena. Instead of charting one-way causal links from psyche to soma, or vice-versa, it aimed at a systemic model, where multiple biological, psychological and social factors were seen as interlinked. Other, alternative approaches at that time were psychosomatic and somatopsychic approaches, which concentrated on causal links only from psyche to soma, or from soma to psyche, respectively.[16] At present it is commonplace in psychosomatic medicine to state that psyche and soma cannot really be separated for practical or theoretical purposes.[citation needed] A disturbance on any level - somatic, psychic, or social - will radiate to all the other levels, too. In this sense, psychosomatic thinking is similar to the biopsychosocial model of medicine.[citation needed] Alternative medicine practitioners adopt a holistic approach to healing. [edit] See also * Buckminster Fuller * Christopher Alexander * Confirmation holism * David Bohm * Emergence * Emergentism * Gaia hypothesis * Gestalt psychology * Gestalt therapy * Gross National Happiness * Holarchy * Holism in ecological anthropology * Holistic health * Holon (philosophy) * Howard T. Odum * Jan Smuts * Janus * Kurt Goldstein * Logical holism * Ontology * Organicism * Herbert Simon * Polytely * Panarchy * Synergetics * Synergy * Systems theory * Willard Van Orman Quine [edit] Notes 1. ^ According to the Oxford English Dictionary 2. ^ cf. Henri Bergson. 3. ^ Bertalanffy 1968, p.54. 4. ^ S. Wolfram, Cellular automata as models of complexity, Nature 311, 419 - 424 (1984) 5. ^ Shore, Bradd (1999) Strange Fate of Holism. Anthropology News 40(9): 4-5. 6. ^ Segal, Daniel A.; Sylvia J. Yanagisako (eds.), James Clifford, Ian Hodder, Rena Lederman, Michael Silverstein (2005). Unwrapping the Sacred Bundle: Reflections on the Disciplining of Anthropology. Duke University Press. http://www.dukeupress.edu/cgibin/forwardsql/search.cgi?template0=nomatch.htm&template2=books/book_detail_page.htm&user_id=11016434335&Bmain.Btitle_option=1&Bmain.Btitle=Unwrapping+the+Sacred+Bundle. 7. ^ anthrobase definition of holism 8. ^ Reconnecting with John Muir By Terry Gifford, University of Georgia, 2006 9. ^ Louis Dumont, 1984 10. ^ Wilkins, M., (1986) Oral history interviews with David Bohm, 16 tapes, undated transcript (AIP and Birkbeck college Library, London), 253-254. 11. ^ M. I. Sanduk, Does Society Exhibit Same Behaviour of Plasma Fluid? http://philpapers.org/rec/DSE 12. ^ (Simon & Schuster, 2002) 13. ^ 'Does Broca's area exist?': Christofredo Jakob's 1906 response to Pierre Marie's holistic stance. Kyrana Tsapkini, Ana B. Vivas, Lazaros C. Triarhou. Brain and Language, Volume 105, Issue 3, June 2008, Pages 211-219, http://dx.doi.org/10.1016/j.bandl.2007.07.124 14. ^ Holm, Ivar (2006). Ideas and Beliefs in Architecture: How attitudes, orientations, and underlying assumptions shape the built environment. Oslo School of Architecture and Design. ISBN 82-547-0174-1. 15. ^ Rubrics (Authentic Assessment Toolbox) "So, when might you use a holistic rubric? Holistic rubrics tend to be used when a quick or gross judgment needs to be made" [1] 16. ^ Lipowski, 1977. [edit] References * Ludwig von Bertalanffy,1971 General System Theory. Foundations Development Applications. Allen Lane (1968) * Bohm, D. (1980) Wholeness and the Implicate Order. London: Routledge. ISBN 0-7100-0971-2 * Leenhardt, M. 1947 Do Kamo. La personne et le mythe dans le monde mélanésien. Gallimard. Paris. * Lipowski, Z.J.: "Psychosomatic medicine in seventies". Am. J. Psych. 134:3:233-244 * Jan C. Smuts, 1926 Holism and Evolution MacMillan, Compass/Viking Press 1961 reprint: ISBN 0-598-63750-8, Greenwood Press 1973 reprint: ISBN 0-8371-6556-3, Sierra Sunrise 1999 (mildly edited): ISBN 1-887263-14-4 [edit] Further reading * Dusek, Val, The Holistic Inspirations of Physics: An Underground History of Electromagnetic Theory Rutgers University Press, Brunswick NJ, 1999. * Fodor, Jerry, and Ernst Lepore, Holism: A Shopper's Guide Wiley. New York. 1992 * Hayek, F.A. von. The Counter-revolution of Science. Studies on the abuse of reason. Free Press. New York. 1957. * Mandelbaum, M. Societal Facts in Gardner 1959. * Phillips, D.C. Holistic Thought in Social Science. Stanford University Press. Stanford. 1976. * Dreyfus, H.L. Holism and Hermeneutics in The Review of Metaphysics. 34. pp. 3–23. * James, S. The Content of Social Explanation. Cambridge University Press. Cambridge, 1984. * Harrington, A. Reenchanted Science: Holism in German Culture from Wilhelm II to Hitler. Princeton University Press. 1996. * Lopez, F. Il pensiero olistico di Ippocrate, vol. I-IIA, Ed. Pubblisfera, Cosenza Italy 2004-2008. [edit] External links Look up holism in Wiktionary, the free dictionary. * Brief explanation of Koestler's derivation of "holon" * Holism in nature – and coevolution in ecosystems * Stanford Encyclopedia of Philosophy article: "Holism and Nonseparability in Physics" * James Schombert of University of Oregon Physics Dept on quantum holism * Theory of sociological holism from "World of Wholeness" [show]v · d · eStandards-based education reform Theorists William Spady • Jean Piaget • Benjamin Bloom • Marc Tucker • Maria Montessori • Constance Kamii • Rheta DeVries • Betty Zan Theories Outcome-based education • Cognitive load • Standards-based education reform • Developmentally Appropriate Practice • Holism • Constructivism • Block scheduling • Holistic grading • Active learning • Problem-based learning • Discovery learning • Inquiry-based learning • Inventive spelling • Open-space school • Small schools movement • Inclusion Values Excellence and equity • Achievement gap Learning standards National Science Education Standards • National Reading Panel • No Child Left Behind Act • Adequate Yearly Progress • Goals 2000 • School-to-work transition • Principles and Standards for School Mathematics • National Skill Standards Board Standards-based assessment Authentic assessment • Criterion-referenced test • Norm-referenced test • Standards-based assessment • High school graduation examination Standardized tests List of standardized tests in the United States • Standardized testing and public policy Standardized curriculum Decodable text • Guided reading • Phonics • Whole language • Traditional education • Traditional mathematics • Direct instruction • Rote learning • Grades • Lecture • Tracking (education) • Standard algorithms [show]v · d · eEpistemology Related articles Outline of epistemology · Alethiology · Formal epistemology · Meta-epistemology · Philosophy of perception · Philosophy of science · Faith and rationality · Social epistemology Concepts in epistemology Knowledge · Justification · Belief · Perception · A priori knowledge · Induction · Other minds · Analytic-synthetic distinction · Causality · Common sense · Descriptive knowledge · Gettier problem · Objectivity · Analysis · Proposition · Regress argument · Simplicity · Speculative reason · Truth · more... 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Quine · Bertrand Russell · Ludwig Wittgenstein · Vienna Circle Portal · Category · Task Force · Stubs · Discussion [show]v · d · eAnalytic philosophy Contemporary philosophy ( analytic · continental ) Related articles Ordinary language philosophy · Philosophical logic · Philosophy of language · Philosophy of science · Postanalytic philosophy · more... Concepts in analytic philosophy Analysis · Analytic-synthetic distinction · Denotation · Definite description · Meaning · Sense data · Sense and Reference · Paradox of analysis Theories in analytic philosophy Deflationism · Direct reference theory · Empiricism · Holism · Logical atomism · Logical positivism · Naturalism · Naturalized epistemology · Neutral monism · Particularism · Pragmatism · Reductionism · Scientism · Skepticism · Verificationism · more... Analytic philosophers J. L. Austin · Australian Realists · Alfred Ayer · Berlin Circle · G. E. M. Anscombe · C. D. Broad · Rudolf Carnap · Patricia Churchland · Daniel Dennett · Michael Dummett · Gottlob Frege · Paul Grice · Saul Kripke · Carl Hempel · G. E. Moore · Hilary Putnam · W.V.O. Quine · Bertrand Russell · Gilbert Ryle · Peter Singer · Peter Strawson · Vienna Circle · John Wisdom · Ludwig Wittgenstein · more ... Portal · Category · Task Force · Stubs · Discussion Retrieved from "http://en.wikipedia.org/wiki/Holism" Categories: Holism | Justification | Philosophy of science | Communalism | Political philosophy | New Thought movement | Social theories | Philosophical theories

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osmetics are substances used to enhance the appearance or odor of the human body. Cosmetics include skin-care creams, lotions, powders, perfumes, lipsticks, fingernail and toe nail polish, eye and facial makeup, towelettes, permanent waves, colored contact lenses, hair colors, hair sprays and gels, deodorants, hand sanitizer, baby products, bath oils, bubble baths, bath salts, butters and many other types of products. A subset of cosmetics is called "make-up," which refers primarily to colored products intended to alter the user’s appearance. Many manufacturers distinguish between decorative cosmetics and care cosmetics. The word cosmetics derives from the Greek κοσμητική τέχνη (kosmetikē tekhnē), meaning "art of dress and ornament", from κοσμητικός (kosmētikos), "skilled in ordering or arranging"[1] and that from κόσμος (kosmos), meaning amongst others "order" and "ornament".[2] The manufacture of cosmetics is currently dominated by a small number of multinational corporations that originated in the early 20th century, but the distribution and sale of cosmetics is spread among a wide range of different businesses. The U.S. Food and Drug Administration (FDA) which regulates cosmetics in the United States[3] defines cosmetics as: "intended to be applied to the human body for cleansing, beautifying, promoting attractiveness, or altering the appearance without affecting the body's structure or functions." This broad definition includes, as well, any material intended for use as a component of a cosmetic product. The FDA specifically excludes soap from this category.[4] Contents [hide] * 1 History * 2 Criticism and controversy * 3 Makeup types * 4 Skin care products * 5 Ingredients o 5.1 Organic and natural ingredients * 6 Cosmetic industry * 7 Cosmetic careers * 8 See also * 9 References * 10 Further reading [edit] History Nefertiti bust with eye liner applied Main article: History of cosmetics The first archaeological evidence of cosmetics usage was found in Egypt around 3500 BC during the Ancient Egypt times with some of royalty owning make-up, such as Nefertiti, Nefertari, mask of Tutankhamun, etc. The Ancient Greeks and Romans also used cosmetics.[5][6] The Romans and Ancient Egyptians used cosmetics containing poisonous mercury and often lead. The ancient kingdom of Israel was influenced by cosmetics as recorded in the Old Testament—2 Kings 9:30 where Jezebel painted her eyelids—approximately 840 BC. The Biblical book of Esther describes various beauty treatments as well. In the Middle Ages, although its use was frowned upon by Church leaders, many women still wore cosmetics. A popular fad for women during the Middle Ages was to have a pale-skinned complexion, which was achieved through either applying pastes of lead, chalk, or flour, or by bloodletting. Women would also put white lead pigment that was known as "ceruse" on their faces to appear to have pale skin.[7] Cosmetic use was frowned upon at many points in Western history. For example, in the 19th century, make-up was used primarily by prostitutes, and Queen Victoria publicly declared makeup improper, vulgar, and acceptable only for use by actors.[8] Adolf Hitler told women that face painting was for clowns and not for the women of the master race.[citation needed] Women in the 19th century liked to be thought of as fragile ladies. They compared themselves to delicate flowers and emphasised their delicacy and femininity. They aimed always to look pale and interesting. Sometimes ladies discreetly used a little rouge on the cheeks, and used "belladonna" to dilate their eyes to make their eyes stand out more. Make-up was frowned upon in general especially during the 1870s when social etiquette became more rigid. Actresses however were allowed to use make up and famous beauties such as Sarah Bernhardt and Lillie Langtry could be powdered. Most cosmetic products available were still either chemically dubious, or found in the kitchen amid food colorings, berries and beetroot. By the middle of the 20th century, cosmetics were in widespread use by women in nearly all industrial societies around the world. Cosmetics have been in use for thousands of years. The absence of regulation of the manufacture and use of cosmetics has led to negative side effects, deformities, blindness, and even death through the ages. Examples of this were the prevalent use of ceruse (white lead), to cover the face during the Renaissance, and blindness caused by the mascara Lash Lure during the early 20th century. The worldwide annual expenditures for cosmetics today is estimated at $19 billion.[9] Of the major firms, the largest is L'Oréal, which was founded by Eugene Schueller in 1909 as the French Harmless Hair Colouring Company (now owned by Liliane Bettencourt 26% and Nestlé 28%; the remaining 46% is traded publicly). The market was developed in the USA during the 1910s by Elizabeth Arden, Helena Rubinstein, and Max Factor. These firms were joined by Revlon just before World War II and Estée Lauder just after. Beauty products are now widely available from dedicated internet-only retailers,[10] who have more recently been joined online by established outlets, including the major department stores and traditional bricks and mortar beauty retailers. Like most industries, cosmetic companies resist regulation by government agencies like the FDA, and have lobbied against this throughout the years. The FDA does not have to approve or review the cosmetics, or what goes in them before they are sold to the consumers. The FDA only regulates against the colors that can be used in the cosmetics and hair dyes. The cosmetic companies do not have to report any injuries from the products; they also only have voluntary recalls on products.[11] [edit] Criticism and controversy Further information: Campaign for Safe Cosmetics and Testing cosmetics on animals During the 20th century, the popularity of cosmetics has increased rapidly.[citation needed] Cosmetics are used by girls at an increasingly young age, especially in the United States. Due to the fast-decreasing age of make-up users, many companies, from high-street brands like Rimmel to higher-end products like Estee Lauder, have catered to this expanding market by introducing more flavored lipsticks and glosses, cosmetics packaged in glittery, sparkly packaging and marketing and advertising using young models.[citation needed] The social consequences of younger and younger beautification has had much attention in the media over the last few years. Criticism of cosmetics has come from a variety of sources including some feminists, Islamists, Christianists, animal rights activists, authors and public interest groups. There is a growing awareness and preference for cosmetics that are without any supposedly toxic ingredients, especially those derived from petroleum, sodium lauryl sulfate (SLS), and parabens.[12] Numerous published reports have raised concern over the safety of a few surfactants. SLS causes a number of skin issues including dermatitis.[13][14][15][16][17] Parabens can cause skin irritation and contact dermatitis in individuals with paraben allergies, a small percentage of the general population.[18] Animal experiments have shown that parabens have a weak estrogenic activity, acting as xenoestrogens.[19] Prolonged use of makeup has also been linked to thinning eyelashes.[20] Synthetic fragrances are widely used in consumer products. Studies concluded from patch testing show synthetic fragrances are made of many ingredients which cause allergic reactions.[21] Cosmetics companies have been criticised for making pseudoscientific claims about their products which are misleading or unsupported by scientific evidence.[22][23] [edit] Makeup types * Lipstick, lip gloss, lip liner, lip plumper, lip balm, lip conditioner, lip primer, and lip boosters.[3] * Foundation, used to smooth out the face and cover spots or uneven skin coloration. Usually a liquid, cream, or powder.[3] Foundation primer can be applied before to get a smoother finish. * Powder, used to set the foundation, giving a matte finish, and also to conceal small flaws or blemishes. * Rouge, blush or blusher, cheek coloring used to bring out the color in the cheeks and make the cheekbones appear more defined. This comes in powder, cream, and liquid forms.[3] * Bronzer, used to give skin a bit of color by adding a golden or bronze glow.[3] * Mascara is used to darken, lengthen, and thicken the eyelashes. It is available in natural colors such as brown and black, but also comes in bolder colors such as blue, pink, or purple. There are many different formulas, including waterproof for those prone to allergies or sudden tears. Often used after an eyelash curler and mascara primer.[3] Eye shadow being applied Broadway actor Jim Brochu applies make-up before the opening night of a play. The chin mask known as chutti for Kathakali, a performing art in Kerala, India is considered the thickest makeup applied for any artform. * Eyelid glue, eye liner, eye shadow, eye shimmer, and glitter eye pencils as well as different color pencils used to color and emphasize the eyelids (larger eyes give a more youthful appearance).[3] * Eyebrow pencils, creams, waxes, gels and powders are used to color and define the brows.[3] * Nail polish, used to color the fingernails and toenails.[3] * Concealer, Makeup used to cover any imperfections of the skin. Cosmetics can also be described by the form of the product, as well as the area for application. Cosmetics can be liquid or cream emulsions; powders, both pressed and loose; dispersions; and anhydrous creams or sticks. Lip stain is a cosmetic product that contains either water or a gel base. To help the product stay on the lips, many stains may contain alcohol. These lip coloring products are available in a variety of formulas, colors, and application types. The idea behind lip stains is to temporarily saturate the lips with color with a dye, rather than applying a colored wax to the lips to color them. A lip stain is usually designed to be waterproof so that the color will be long lasting, and once the stain dries, it should not smear, stain, wear unevenly, or transfer to the teeth. A lip stain may come in a bottle with an applicator which is used to brush the stain onto the lips, and it can also come in a small jar, with users applying the stain with a finger or a cosmetic brush. Make-up remover is the product used to remove the make-up products applied on the skin. It is used for cleaning the skin for other procedures, like applying any type of lotion at evening before the person go to sleep. [edit] Skin care products Also included in the general category of cosmetics are skin care products. These include creams and lotions to moisturize the face and body which are often formulated for different skin types per range, sunscreens to protect the skin from UV radiation and damage, skin lighteners, and treatment products to repair or hide skin imperfections (acne, wrinkles, dark circles under eyes, etc.), tanning oils to brown the skin. [edit] Ingredients Main article: Ingredients of cosmetics While there is assurance from the largest cosmetic companies that ingredients have passed quality tests and official regulations, and are therefore generally safe to use, there is a growing preference for cosmetics that are without any "synthetic" ingredients, especially those derived from petroleum. Once a niche market, handmade and certified organic products are becoming more mainstream. Ingredients' listings in cosmetics are highly regulated in many countries. The testing of cosmetic products on animals is a subject of some controversy. It is now illegal in the United Kingdom, the Netherlands, and Belgium, and a ban across the European Union is due to come into effect in 2009. [edit] Organic and natural ingredients Even though many cosmetic products are regulated, there are still health concerns regarding the presence of harmful chemicals within these products.[citation needed] Aside from color additives, cosmetic products and their ingredients are not subject to FDA regulation prior to their release into the market. It is only when a product is found to violate Federal Food, Drug, and Cosmetic Act (FD&C Act) and Fair Packaging and Labeling Act (FPLA) after its release that the FDA may start taking action against this violation.[24] With many new products released into the market every season, it is hard to keep track of the safety of every product. Some products carry carcinogenic contaminant 1,4- dioxane. Many cosmetic companies are coming out with "All natural" and organic products. All natural products contain mineral and plant ingredients and organic products are made with organic agricultural products. Products who claim they are organic are not, unless they are certified "USDA Organic."[25][26] See also: natural skin care [edit] Cosmetic industry The cosmetic industry is a profitable business for most manufacturers of cosmetic products. By cosmetic products, we understand anything that is intended for personal care such as skin lotions or sun lotions, makeup and other such products meant to emphasize one's look. Given the technological development and the improvement of the manufacturing process of cosmetics and not least due to the constantly increasing demand of such products, this industry reported an important growth in terms of profit. The cosmetic industry has not only grown only in the United States, but also in various parts of the world which have become famous for their cosmetic precuts. Some of these include France, Germany, Italy and Japan. It has been estimated that in Germany, the cosmetic industry generated sales of EUR 12.6 billion at retail sales, in 2008 [27] which made of German cosmetic industry the 3rd in the world, after Japan and the United States. Also, it has been shown that in the same country, this industry has grown with nearly 5 percent in one year, from 2007 to 2008. The exports of Germany in this industry reached in 2008 EUR 5.8 billion whereas the imports of cosmetics totaled EUR 3 billion.[27] The main countries that export cosmetics to Germany are France, Switzerland, the United States and Italy and they mainly consist of makeup and fragrances or perfumes for women. After the United States, Japan is the second largest market for cosmetics in the world, a market worth about JPY 1.4 trillion per year.[28] The worldwide cosmetics and perfume industry currently generates an estimated annual turnover of US$170 billion (according to Eurostaf - May 2007). Europe is the leading market, representing approximately €63 billion, while sales in France reached €6.5 billion in 2006, according to FIPAR (Fédération des Industries de la Parfumerie - the French federation for the perfume industry).[29] France is another country in which the cosmetic industry plays an important role, both nationally and internationally. Most products on whose label it is stated "Made in France" are valued on the international market. According to data from 2008, the cosmetic industry has risen constantly in France, for 40 consecutive years. In 2006, this industrial sector reached a record level of EUR 6.5 billion. Famous cosmetic brands produced in France include Vichy, Yves Saint Laurent, Yves Rocher and many others. The Italian cosmetic industry is also an important player in the European cosmetic market. Although not as large as in other European countries, the cosmetic industry in Italy was estimated to reach EUR 9 billion in 2007.[30] The Italian cosmetic industry is however dominated by hair and body products and not makeup as in many other European countries. In Italy, hair and body products make up approximately 30% of the cosmetic market. Makeup and facial care however are the first cosmetic products to be exported in the United States. Due to the popularity of cosmetics, especially fragrances and perfumes, many designers who are not necessarily involved in the cosmetic industry came up with different perfumes carrying their names. Moreover, most actors and singers also have their own perfume line (such as Celine Dion). The designer perfumes are, like any other designer products, the most expensive in the industry as the consumer pays not only for the product but also for the brand. Famous Italian fragrances are produced by Giorgio Armani, Dolce and Gabbana and so on. The European Commission and the U.S. Food and Drug Administration (FDA) are the two bodies making legislation in what concerns cosmetic industry and its various aspects within the European Union, respectively in the United States. In the European Union, the circulation of cosmetic products and their safety are law subjects since 1976. One of the newest amendments of the directive concerning cosmetic industry comes as a result of the attempt to ban animal testing. Therefore, testing cosmetic products on animals is illegal in the European Union from September 2004 and testing separate ingredients of such products on animals is also prohibited by law starting with March 2009.[31] The FDA joined with thirteen other Federal agencies in forming the Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM) in 1997 which is an attempt to ban animal testing and find other methods to test the cosmetic products.[32] The cosmetic industry worldwide seems to be continuously developing, now more than ever with the advent of the Internet companies. Many famous companies sell their cosmetic products online also in countries in which they do not have representatives.[33] [edit] Cosmetic careers A professional make-up artist servicing a client An account executive is responsible for visiting all department and specialty store counter sales and doors. They explain new products and "gifts with purchase" (free items given out upon purchase of a certain cosmetics item that costs more than a set amount). A beauty adviser provides product advice based on the client's skin care and makeup requirements. Beauty advisers can become certified through the Anti-Aging Beauty Institute. Supermodel Alek Wek receiving make-up from a professional. A cosmetician is a professional who provides facial and body treatments for clients. The term cosmetologist is sometimes used interchangeably with this term, but most commonly refers to a certified professional. A freelance makeup artist provides clients with beauty advice and cosmetics assistance—usually paid by the cosmetic company by the hour. Professionals in cosmetics marketing careers manage research focus groups, promote the desired brand image, and provide other marketing services (sales forecasting, allocation to different retailers, etc.). Those involved in cosmetics product development design, create and refine cosmetics products. Some positions that fall under this category include chemists, quality assurance and packaging people. Many involved within the cosmetics industry often specialize in a certain area of cosmetics such as special effects makeup or makeup techniques specific to the film, media and fashion sectors. [edit] See also * Airbrush makeup * Testing cosmetics on animals * Body art * Body hygiene kit * Cosmeceutical * Cosmetic surgery * Cosmetic, Toiletry, and Fragrance Association * Cosmetology * DEA list of chemicals * Federal Food, Drug, and Cosmetic Act * Henna * List of cosmetic ingredients * Make-up artist * Moulage * Permanent makeup * Personal care * Pharmaceuticals and personal care products in the environment * Society of Cosmetic Chemists [edit] References 1. ^ κοσμητικός, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus 2. ^ κόσμος, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus 3. ^ a b c d e f g h i Reed, Sandra I. US Department of Health and Human Services. "Cosmetics and Your Health." 2004. May 14, 2007. [1] 4. ^ Lewis, Carol. FDA. "Clearing up Cosmetic Confusion." The marketing industry is now targeting young girls to wear 'super cool lip gloss' and 'fairy glitter eye shadow', by throwing them in with toys in a box and claiming that 'girls will be girls', are they truly being girls or another plastic? 5. ^ Lesley Adkins, Roy A. Adkins, Handbook to life in Ancient Greece, Oxford University Press, 1998 6. ^ Bruno Burlando, Luisella Verotta, Laura Cornara, and Elisa Bottini-Massa, Herbal Principles in Cosmetics, CRC Press, 2010 7. ^ Rao,prathiba, cosmetics and personal care products, vol 1, pp 380-382,Elsevier inc, 1998 8. ^ Pallingston, J (1998). Lipstick: A Celebration of the World's Favorite Cosmetic. St. Martin's Press. ISBN 0312199147. 9. ^ "As Consumerism Spreads, Earth Suffers, Study Says". National Geographic: pp. 2. http://news.nationalgeographic.com/news/2004/01/0111_040112_consumerism_2.html. Retrieved 2007-08-21. 10. ^ "Lessons from categorising the entire beauty products sector (Part 1)". pp. 1. http://www.beautynow.co.uk/blog/beauty-products-part-1-522.html. Retrieved 2009-09-28. 11. ^ "cosmetics and your health." womensheatlh.gov.nd.web.4 nov 2004 12. ^ "Signers of the Compact for Safe Cosmetics". Campaign for Safe Cosmetics. Archived from the original on 2007-06-09. http://web.archive.org/web/20070609155356/http://www.safecosmetics.org/companies/signers.cfm. Retrieved 2007-07-05. 13. ^ Agner T (1991). "Susceptibility of atopic dermatitis patients to irritant dermatitis caused by sodium lauryl sulphate". Acta Derm. Venereol. 71 (4): 296–300. PMID 1681644. 14. ^ Nassif A, Chan SC, Storrs FJ, Hanifin JM (November 1994). "Abnormal skin irritancy in atopic dermatitis and in atopy without dermatitis". Arch Dermatol 130 (11): 1402–7. doi:10.1001/archderm.130.11.1402. PMID 7979441. http://www.jem.org/cgi/content/full/195/7/855. 15. ^ Marrakchi S, Maibach HI (2006). "Sodium lauryl sulfate-induced irritation in the human face: regional and age-related differences". Skin Pharmacol Physiol 19 (3): 177–80. doi:10.1159/000093112. PMID 16679819. 16. ^ CIR publication. Final Report on the Safety Assessment of Sodium Lauryl Sulfate and Ammonium Lauryl Sulfate. Journal of the American College of Toxicology. 1983 Vol. 2 (No. 7) pages 127–181. 17. ^ Löffler H, Effendy I (May 1999). "Skin susceptibility of atopic individuals". Contact Derm. 40 (5): 239–42. doi:10.1111/j.1600-0536.1999.tb06056.x. PMID 10344477. 18. ^ Nagel JE, Fuscaldo JT, Fireman P (April 1977). "Paraben allergy". JAMA 237 (15): 1594–5. doi:10.1001/jama.237.15.1594. PMID 576658. 19. ^ Byford JR, Shaw LE, Drew MG, Pope GS, Sauer MJ, Darbre PD (January 2002). "Oestrogenic activity of parabens in MCF7 human breast cancer cells". J. Steroid Biochem. Mol. Biol. 80 (1): 49–60. doi:10.1016/S0960-0760(01)00174-1. PMID 11867263. http://linkinghub.elsevier.com/retrieve/pii/S0960076001001741. 20. ^ Towards Beautiful Eyes – Solutions for Thinning Lashes and Dark Patches, Kamau Austin. 21. ^ Frosch PJ, Pilz B, Andersen KE, et al. (November 1995). "Patch testing with fragrances: results of a multicenter study of the European Environmental and Contact Dermatitis Research Group with 48 frequently used constituents of perfumes". Contact Derm. 33 (5): 333–42. doi:10.1111/j.1600-0536.1995.tb02048.x. PMID 8565489. 22. ^ http://news.scotsman.com/latestnews/-Pseudo-science-can39t-cover.3606975.jp 23. ^ http://www.badscience.net/category/cosmetics/ 24. ^ http://www.cfsan.fda.gov/~dms/cos-206.html 25. ^ Singer, Natasha. "Natural, Organic Beauty." New York Times. 1 Nov. 2007. 18 Mar. 2008 26. ^ <http://www.nytimes.com/2007/11/01/fashion/01skin.html?_r=1&oref=slogin> 27. ^ a b "Cosmetic Industry". http://www.german-business-portal.info/GBP/Navigation/en/Business-Location/Manufacturing%20Industries/cosmetics-industry,did=326082.html. Retrieved 2010-08-04. 28. ^ "Blueprint for a Cosmetics Empire". http://www.japaninc.com/article.php?articleID=1390. Retrieved 2010-08-04. 29. ^ "France continues to lead the way in cosmetics". http://www.clickpress.com/releases/Detailed/82987005cp.shtml. Retrieved 2010-08-04. 30. ^ "Cosmetics - Europe (Italy) 2008 Marketing Research". http://researchwikis.com/Cosmetics_-_Europe_%28Italy%29_2008_Marketing_Research. Retrieved 2010-08-04. 31. ^ "Regulatory context". http://ec.europa.eu/consumers/sectors/cosmetics/animal-testing/index_en.htm. Retrieved 2010-08-04. 32. ^ "Animal Testing". http://www.fda.gov/Cosmetics/ProductandIngredientSafety/ProductTesting/ucm072268.htm. Retrieved 2010-08-04. 33. ^ "Buy Cosmetics Online". http://www.cosmeticindustry.org/buy.html. Retrieved 2010-08-04. [edit] Further reading Wikimedia Commons has media related to: Cosmetics * Winter, Ruth (2005) [2005] (in English). A Consumer's Dictionary of Cosmetic Ingredients: Complete Information About the Harmful and Desirable Ingredients in Cosmetics (Paperback). USA: Three Rivers Press. ISBN 1400052335. * Begoun, Paula (2003) [2003] (in English). Don't Go to the Cosmetics Counter Without Me(Paperback). USA: Beginning Press. ISBN 1877988308. * Carrasco, Francisco (2009) [2009] (in Spanish). Diccionario de Ingredientes Cosmeticos(Paperback). Spain: www.imagenpersonal.net. ISBN 9788461349791. [hide]v · d · eCosmetics Products Lips Lip gloss · Lip liner · Lip plumper · Lipstick Face Concealer · Foundation · Face powder · Rouge · Bindi · Thanaka · Tilaka · Cleanser-Toner-Moisturizer Eyes Eye liner · Eye shadow · Kohl · Mascara Other Shampoo-Conditioner-Styling cream · Nail polish · Anti-aging cream · Body powder · Cold cream · Sindoor Cosmetics.JPG Ingredients International Nomenclature of Cosmetic Ingredients · List of ingredients Related topics Cosmetic advertising · Beauty salon · Spa · Cosmetology · History of cosmetics Treatments Cosmetic surgery · Botox · Facial · Bleaching · Manicure · Pedicure · Hair removal (Waxing-Threading-Shaving) · Hair styling [show] Major brands Ahava · Almay · Artistry · Aveda · Avon · Bath & Body Works · Biotherm · Bobbi Brown · The Body Shop · Bonne Bell · Burt's Bees · Cargo · Carol's Daughter · Clarins · Clinique · CoverGirl · Creme 21 · Daigaku Honyaku Center · Dr. Hauschka · Eden Allure · Elizabeth Arden · Estée Lauder · Fabergé · Hard Candy · Helena Rubinstein · Kanebo Ltd. · Kao Corporation · Kevyn Aucoin · Kiehl's · La Mer · Lancôme · Laneige · Laura Mercier · Laura Mercier Cosmetics · Lise Watier · L'Oréal · L'occitane · Lush · MAC Cosmetics · Mary Kay · Max Factor · Maybelline · ModelCo · NARS · Natura · Natural Wonder · Neal's Yard Remedies · Neutrogena · Nexxus · Nivea · O Boticário · Oriflame · Origins · Paula Begoun · Red Earth · Revlon · Richard Hudnut · Rimmel · Sephora · Shiseido · Shu Uemura · SK-II · Stila · Ulta · Ultima II · Urban Decay · Vichy · Victoria's Secret · Vie at Home · Wella · Yves Rocher Categories Companies · People · History Retrieved from "http://en.wikipedia.org/wiki/Cosmetics" Categories: Cosmetics | Skin care | Greek loanwords Hidden categories: All articles with unsourced statements | Articles with unsourced statements from November 2007 | Articles with unsourced statements from September 2008 | Articles with unsourced statements from August 2008 Personal tools * Log in / create account Namespaces * Article * Discussion Variants Views * Read * Edit * View history Actions Search Search Navigation * Main page * Contents * Featured content * Current events * Random article * Donate to Wikipedia Interaction * Help * About Wikipedia * Community portal * Recent changes * Contact Wikipedia Toolbox * What links here * Related changes * Upload file * Special pages * Permanent link * Cite this page Print/export * Create a book * Download as PDF * Printable version Languages * العربية * Български * Català * Česky * Dansk * Deitsch * Deutsch * Español * Esperanto * Euskara * فارسی * Français * Gaeilge * ગુજરાતી * 한국어 * हिन्दी * Hrvatski * Bahasa Indonesia * Italiano * עברית * ಕನ್ನಡ * Latina * Lietuvių * Македонски * മലയാളം * Nederlands * 日本語 * ‪Norsk (bokmål)‬ * Олык Марий * Polski * Português * Română * Русский * Simple English * Српски / Srpski * Suomi * Svenska * Tagalog * தமிழ் * ไทย * Türkçe * Українська * اردو * 中文 * This page was last modified on 24 January 2011 at 13:59. * Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. 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Cosmetics are substances used to enhance the appearance or odor of the human body. Cosmetics include skin-care creams, lotions, powders, perfumes, lipsticks, fingernail and toe nail polish, eye and facial makeup, towelettes, permanent waves, colored contact lenses, hair colors, hair sprays and gels, deodorants, hand sanitizer, baby products, bath oils, bubble baths, bath salts, butters and many other types of products. A subset of cosmetics is called "make-up," which refers primarily to colored products intended to alter the user’s appearance. Many manufacturers distinguish between decorative cosmetics and care cosmetics. The manufacture of cosmetics is currently dominated by a small number of multinational corporations that originated in the early 20th century, but the distribution and sale of cosmetics is spread among a wide range of different businesses. The U.S. Food and Drug Administration (FDA) which regulates cosmetics in the United States[1] defines cosmetics as: "intended to be applied to the human body for cleansing, beautifying, promoting attractiveness, or altering the appearance without affecting the body's structure or functions." This broad definition includes, as well, any material intended for use as a component of a cosmetic product. The FDA specifically excludes soap from this category.[2] Contents [hide] * 1 History * 2 Criticism and controversy * 3 Makeup types * 4 Skin Care Products * 5 Ingredients o 5.1 Organic and natural ingredients * 6 Cosmetic industry * 7 Cosmetic careers * 8 See also * 9 References * 10 Further reading [edit] History Nefertiti bust with eye liner applied Main article: History of cosmetics The first archaeological evidence of cosmetics usage was found in Egypt around 3500 BC during the Ancient Egypt times with some of royalty owning make-up, such as Nefertiti, Nefertari, mask of Tutankhamun, etc. The Ancient Greeks and Romans[citation needed] also used cosmetics. The Romans and Ancient Egyptians used cosmetics containing poisonous mercury and often lead. The ancient kingdom of Israel was influenced by cosmetics as recorded in the Old Testament—2 Kings 9:30 where Jezebel painted her eyelids—approximately 840 BC. The Biblical book of Esther describes various beauty treatments as well. In the Middle Ages, although its use was frowned upon by Church leaders, many women still wore cosmetics. A popular fad for women during the Middle Ages was to have a pale-skinned complexion, which was achieved through either applying pastes of lead, chalk, or flour, or by bloodletting. Women would also put white lead pigment that was known as "ceruse" on their faces to appear to have pale skin.[3] Cosmetic use was frowned upon at many points in Western history. For example, in the 19th century, make-up was used primarily by prostitutes, and Queen Victoria publicly declared makeup improper, vulgar, and acceptable only for use by actors.[4] Adolf Hitler told women that face painting was for clowns and not for the women of the master race.[citation needed] Women in the 19th century liked to be thought of as fragile ladies. They compared themselves to delicate flowers and emphasised their delicacy and femininity. They aimed always to look pale and interesting. Sometimes ladies discreetly used a little rouge on the cheeks, and used "belladonna" to dilate their eyes to make their eyes stand out more. Make-up was frowned upon in general especially during the 1870s when social etiquette became more rigid. Actresses however were allowed to use make up and famous beauties such as Sarah Bernhardt and Lillie Langtry could be powdered. Most cosmetic products available were still either chemically dubious, or found in the kitchen amid food colorings, berries and beetroot. By the middle of the 20th century, cosmetics were in widespread use by women in nearly all industrial societies around the world. Cosmetics have been in use for thousands of years. The absence of regulation of the manufacture and use of cosmetics has led to negative side effects, deformities, blindness, and even death through the ages. Examples of this were the prevalent use of ceruse (white lead), to cover the face during the Renaissance, and blindness caused by the mascara Lash Lure during the early 20th century. The worldwide annual expenditures for cosmetics today is estimated at $19 billion.[5] Of the major firms, the largest is L'Oréal, which was founded by Eugene Schueller in 1909 as the French Harmless Hair Colouring Company (now owned by Liliane Bettencourt 26% and Nestlé 28%; the remaining 46% is traded publicly). The market was developed in the USA during the 1910s by Elizabeth Arden, Helena Rubinstein, and Max Factor. These firms were joined by Revlon just before World War II and Estée Lauder just after. Beauty products are now widely available from dedicated internet-only retailers,[6] who have more recently been joined online by established outlets, including the major department stores and traditional bricks and mortar beauty retailers. Like most industries, cosmetic companies resist regulation by government agencies like the FDA, and have lobbied against this throughout the years. The FDA does not have to approve or review the cosmetics, or what goes in them before they are sold to the consumers. The FDA only regulates against the colors that can be used in the cosmetics and hair dyes. The cosmetic companies do not have to report any injuries from the products; they also only have voluntary recalls on products.[7] [edit] Criticism and controversy Further information: Campaign for Safe Cosmetics and Testing cosmetics on animals During the 20th century, the popularity of cosmetics has increased rapidly.[citation needed] Cosmetics are used by girls at an increasingly young age, especially in the United States. Due to the fast-decreasing age of make-up users, many companies, from high-street brands like Rimmel to higher-end products like Estee Lauder, have catered to this expanding market by introducing more flavored lipsticks and glosses, cosmetics packaged in glittery, sparkly packaging and marketing and advertising using young models.[citation needed] The social consequences of younger and younger beautification has had much attention in the media over the last few years. Criticism of cosmetics has come from a variety of sources including some feminists, Islamists, Christianists, animal rights activists, authors and public interest groups. There is a growing awareness and preference for cosmetics that are without any supposedly toxic ingredients, especially those derived from petroleum, sodium lauryl sulfate (SLS), and parabens.[8] Numerous published reports have raised concern over the safety of a few surfactants. SLS causes a number of skin issues including dermatitis.[9][10][11][12][13] Parabens can cause skin irritation and contact dermatitis in individuals with paraben allergies, a small percentage of the general population.[14] Animal experiments have shown that parabens have a weak estrogenic activity, acting as xenoestrogens.[15] Prolonged use of makeup has also been linked to thinning eyelashes.[16] Synthetic fragrances are widely used in consumer products. Studies concluded from patch testing show synthetic fragrances are made of many ingredients which cause allergic reactions.[17] Cosmetics companies have been criticised for making pseudoscientific claims about their products which are misleading or unsupported by scientific evidence.[18][19] [edit] Makeup types * Lipstick, lip gloss, lip liner, lip plumper, lip balm, lip conditioner, lip primer, and lip boosters.[1] * Foundation, used to smooth out the face and cover spots or uneven skin coloration. Usually a liquid, cream, or powder.[1] Foundation primer can be applied before to get a smoother finish. * Powder, used to set the foundation, giving a matte finish, and also to conceal small flaws or blemishes. * Rouge, blush or blusher, cheek coloring used to bring out the color in the cheeks and make the cheekbones appear more defined. This comes in powder, cream, and liquid forms.[1] * Bronzer, used to give skin a bit of color by adding a golden or bronze glow.[1] * Mascara is used to darken, lengthen, and thicken the eyelashes. It is available in natural colors such as brown and black, but also comes in bolder colors such as blue, pink, or purple. There are many different formulas, including waterproof for those prone to allergies or sudden tears. Often used after an eyelash curler and mascara primer.[1] Eye shadow being applied Broadway actor Jim Brochu applies make-up before the opening night of a play. The chin mask known as chutti for Kathakali, a performing art in Kerala, India is considered the thickest makeup applied for any artform. * Eyelid glue, eye liner, eye shadow, eye shimmer, and glitter eye pencils as well as different color pencils used to color and emphasize the eyelids (larger eyes give a more youthful appearance).[1] * Eyebrow pencils, creams, waxes, gels and powders are used to color and define the brows.[1] * Nail polish, used to color the fingernails and toenails.[1] * Concealer, Makeup used to cover any imperfections of the skin. Cosmetics can also be described by the form of the product, as well as the area for application. Cosmetics can be liquid or cream emulsions; powders, both pressed and loose; dispersions; and anhydrous creams or sticks. Lip stain is a cosmetic product that contains either water or a gel base. To help the product stay on the lips, many stains may contain alcohol. These lip coloring products are available in a variety of formulas, colors, and application types. The idea behind lip stains is to temporarily saturate the lips with color with a dye, rather than applying a colored wax to the lips to color them. A lip stain is usually designed to be waterproof so that the color will be long lasting, and once the stain dries, it should not smear, stain, wear unevenly, or transfer to the teeth. A lip stain may come in a bottle with an applicator which is used to brush the stain onto the lips, and it can also come in a small jar, with users applying the stain with a finger or a cosmetic brush. Make-up remover is the product used to remove the make-up products applied on the skin. It is used for cleaning the skin for other procedures, like applying any type of lotion at evening before the person go to sleep. [edit] Skin Care Products Also included in the general category of cosmetics are skin care products. These include creams and lotions to moisturize the face and body which are often formulated for different skin types per range, sunscreens to protect the skin from UV radiation and damage, skin lighteners for a whiter skin, and treatment products to repair or hide skin imperfections (acne, wrinkles, dark circles under eyes, etc.), tanning oils to brown the skin. [edit] Ingredients Main article: Ingredients of cosmetics While there is assurance from the largest cosmetic companies that ingredients have passed quality tests and official regulations, and are therefore generally safe to use, there is a growing preference for cosmetics that are without any "synthetic" ingredients, especially those derived from petroleum. Once a niche market, handmade and certified organic products are becoming more mainstream. Ingredients' listings in cosmetics are highly regulated in many countries. The testing of cosmetic products on animals is a subject of some controversy. It is now illegal in the United Kingdom, the Netherlands, and Belgium, and a ban across the European Union is due to come into effect in 2009. [edit] Organic and natural ingredients Even though many cosmetic products are regulated, there are still health concerns regarding the presence of harmful chemicals within these products.[citation needed] Aside from color additives, cosmetic products and their ingredients are not subject to FDA regulation prior to their release into the market. It is only when a product is found to violate Federal Food, Drug, and Cosmetic Act (FD&C Act) and Fair Packaging and Labeling Act (FPLA) after its release that the FDA may start taking action against this violation.[20] With many new products released into the market every season, it is hard to keep track of the safety of every product. Some products carry carcinogenic contaminant 1,4- dioxane. Many cosmetic companies are coming out with "All natural" and organic products. All natural products contain mineral and plant ingredients and organic products are made with organic agricultural products. Products who claim they are organic are not, unless they are certified "USDA Organic."[21][22] See also: natural skin care [edit] Cosmetic industry The cosmetic industry is a profitable business for most manufacturers of cosmetic products. By cosmetic products, we understand anything that is intended for personal care such as skin lotions or sun lotions, makeup and other such products meant to emphasize one's look. Given the technological development and the improvement of the manufacturing process of cosmetics and not least due to the constantly increasing demand of such products, this industry reported an important growth in terms of profit. The cosmetic industry has not only grown only in the United States, but also in various parts of the world which have become famous for their cosmetic precuts. Some of these include France, Germany, Italy and Japan. It has been estimated that in Germany, the cosmetic industry generated sales of EUR 12.6 billion at retail sales, in 2008 [23] which made of German cosmetic industry the 3rd in the world, after Japan and the United States. Also, it has been shown that in the same country, this industry has grown with nearly 5 percent in one year, from 2007 to 2008. The exports of Germany in this industry reached in 2008 EUR 5.8 billion whereas the imports of cosmetics totaled EUR 3 billion.[23] The main countries that export cosmetics to Germany are France, Switzerland, the United States and Italy and they mainly consist of makeup and fragrances or perfumes for women. After the United States, Japan is the second largest market for cosmetics in the world, a market worth about JPY 1.4 trillion per year.[24] The worldwide cosmetics and perfume industry currently generates an estimated annual turnover of US$170 billion (according to Eurostaf - May 2007). Europe is the leading market, representing approximately €63 billion, while sales in France reached €6.5 billion in 2006, according to FIPAR (Fédération des Industries de la Parfumerie - the French federation for the perfume industry).[25] France is another country in which the cosmetic industry plays an important role, both nationally and internationally. Most products on whose label it is stated "Made in France" are valued on the international market. According to data from 2008, the cosmetic industry has risen constantly in France, for 40 consecutive years. In 2006, this industrial sector reached a record level of EUR 6.5 billion. Famous cosmetic brands produced in France include Vichy, Yves Saint Laurent, Yves Rocher and many others. The Italian cosmetic industry is also an important player in the European cosmetic market. Although not as large as in other European countries, the cosmetic industry in Italy was estimated to reach EUR 9 billion in 2007.[26] The Italian cosmetic industry is however dominated by hair and body products and not makeup as in many other European countries. In Italy, hair and body products make up approximately 30% of the cosmetic market. Makeup and facial care however are the first cosmetic products to be exported in the United States. Due to the popularity of cosmetics, especially fragrances and perfumes, many designers who are not necessarily involved in the cosmetic industry came up with different perfumes carrying their names. Moreover, most actors and singers also have their own perfume line (such as Celine Dion). The designer perfumes are, like any other designer products, the most expensive in the industry as the consumer pays not only for the product but also for the brand. Famous Italian fragrances are produced by Giorgio Armani, Dolce and Gabbana and so on. The European Commission and the FDA are the two bodies making legislation in what concerns cosmetic industry and its various aspects within the European Union, respectively in the United States. In the European Union, the circulation of cosmetic products and their safety are law subjects since 1976. One of the newest amendments of the directive concerning cosmetic industry comes as a result of the attempt to ban animal testing. Therefore, testing cosmetic products on animals is illegal in the European Union from September 2004 and testing separate ingredients of such products on animals is also prohibited by law starting with March 2009.[27] The FDA joined with thirteen other Federal agencies in forming the Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM) in 1997 which is an attempt to ban animal testing and find other methods to test the cosmetic products.[28] The cosmetic industry worldwide seems to be continuously developing, now more than ever with the advent of the Internet companies. Many famous companies sell their cosmetic products online also in countries in which they do not have representatives.[29] [edit] Cosmetic careers A professional make-up artist servicing a client An account executive is responsible for visiting all department and specialty store counter sales and doors. They explain new products and "gifts with purchase" (free items given out upon purchase of a certain cosmetics item that costs more than a set amount). A beauty adviser provides product advice based on the client's skin care and makeup requirements. Beauty advisers can become certified through the Anti-Aging Beauty Institute. Supermodel Alek Wek receiving make-up from a professional. A cosmetician is a professional who provides facial and body treatments for clients. The term cosmetologist is sometimes used interchangeably with this term, but most commonly refers to a certified professional. A freelance makeup artist provides clients with beauty advice and cosmetics assistance—usually paid by the cosmetic company by the hour. Professionals in cosmetics marketing careers manage research focus groups, promote the desired brand image, and provide other marketing services (sales forecasting, allocation to different retailers, etc.). Those involved in cosmetics product development design, create and refine cosmetics products. Some positions that fall under this category include chemists, quality assurance and packaging people. Many involved within the cosmetics industry often specialize in a certain area of cosmetics such as special effects makeup or makeup techniques specific to the film, media and fashion sectors.

crown lengthening Return to the top

Crown lengthening is a surgical procedure performed by a dentist to expose a greater amount of tooth structure for the purpose of subsequently restoring the tooth prosthetically.[1] This is done by incising the gingival tissue around a tooth and, after temporarily displacing the soft tissue, predictably removing a given height of alveolar bone from the circumference of the tooth or teeth being operated on. While many general dentists perform this procedure, they frequently refer such cases to periodontists. Contents [hide] * 1 Biomechanical considerations o 1.1 Biologic width o 1.2 Ferrule effect o 1.3 Crown-to-root ratio o 1.4 Treatment planning * 2 References [edit] Biomechanical considerations [edit] Biologic width The gingival sulcus (G) is a little crevice that lies between the enamel of the tooth crown (A) and the sulcular epithelium. At the base of this crevice lies the junctional epithelium, which adheres via hemidesmosomes to the surface of the tooth, and from the base of the crevice to the height of the alveolar bone (C) is approximately 2 mm, known as the biologic width. The biologic width is patient specific and may vary anywhere from 0.75-4.3 mm. Biologic width is the distance established by "the junctional epithelium and connective tissue attachment to the root surface" of a tooth.[1] This distance is important to consider when fabricating dental restorations, because they must respect the natural architecture of the gingival attachment if harmful consequences are to be avoided. This distance is 2.04 mm (on average), of which 1.07 mm is occupied by the connective tissue attachment and another approximate 0.97 mm being occupied by the junctional epithelium.[1] Because it is impossible to perfectly restore a tooth to the precise coronal edge of the junctional epithelium, the roughly 1 mm depth of the sulcus is often included together with the biologic width when leaving a certain amount of tooth structure remaining, thus establishing a margin of safety. When restorations do not take these considerations into account and violate biologic width, three things tend to occur: * chronic pain * chronic inflammation of the gingiva * unpredictable loss of alveolar bone [edit] Ferrule effect In addition to removing 2 mm of bone to establish a proper biologic width, another 2 mm should be removed to reveal enough tooth structure to allow for a 2 mm ferrule.[2] A ferrule, in respect to teeth, is a band that encircles the external dimension of residual tooth structure, not unlike the metal bands that exist around a barrel. Sufficient vertical height of tooth structure that will be grasped by the future crown is necessary to allow for a ferrule effect of the future prosthetic crown; it has been shown to significantly reduce the incidence of fracture in the endodontically treated tooth.[3] Because beveled tooth structure is not parallel to the vertical axis of the tooth, it does not properly contribute to ferrule height; thus, a desire to bevel the crown margin by 1 mm would require an additional 1 mm of bone removal in the crown lengthening procedure.[4] Frequently, however, restorations are performed without such a bevel. These two X-ray films depict the teeth of the upper right quadrant. In the upper film, there is a tooth, #5, with a large, defective DO composite restoration. The lower film depicts the ideal bone level after a crown lengthening procedure has been completed, as well as the margin of the prosthetic crown in relation to the reduced height of bone. Note that this is a dramatization of the procedure: the lower film is a digital manipulation of the upper film, and not an actual film of the teeth after a crown lengthening procedure and crown cementation have been performed. Some recent studies suggest that, while ferrule is certainly desirable, it should not be provided at the expense of the remaining tooth/root structure.[5] On the other hand, it has also been shown that the "difference between an effective, long-term restoration and a failure can be as small as 1 mm of additional tooth structure that, when encased by a ferrule, provides great protection. When such a long-lasting, functional restoration cannot be predictably created, tooth extraction should be considered."[6] [edit] Crown-to-root ratio The alveolar bone surrounding one tooth will naturally surround an adjacent tooth, and removing bone for a crown lengthening procedure will effectively damage the bony support of adjacent teeth to some inevitable extent, as well as unfavorably increase the crown-to-root ratio. Additionally, once bone is removed, it is almost impossible to regain it to previous levels, and in case a patient would like to have an implant placed in the future, there might not be enough bone in the region once a crown lengthening procedure has been completed. Thus, it would be prudent for patients to thoroughly discuss all of their treatment planning options with their dentist before undergoing an irreversible procedure such as crown lengthening. [edit] Treatment planning Crown lengthening is often done in conjunction with a few other expensive and time-consuming procedures of which the combined goal is to improve the prosthetic forecast of a tooth. If a tooth, because of its relative lack of solid tooth structure, also requires a post and core, and thus, endodontic treatment, the total combined time, effort and cost of the various procedures, as well as the impaired prognosis due to the combined inherent failure rates of each procedure, might combine to make it reasonable to have the tooth extracted. If the patient and the extraction site make for eligible candidates, it might be possible to have an implant placed and restored with more esthetic, timely, inexpensive and reliable results. It is important to consider the many options available during the treatment planning stages of dental care. A better alternative to surgical crown lengthening is orthodontic forced eruption, it is simple, it is non-invasive, does not remove or damage the bone and cost effective. The tooth is extruded a couple of millimeters with simple bracketing of adjacent teeth and using light forces this will only take a couple of months. A simple fiberotomy is performed after crown lengthening and is easily performed by the general dentist. In many cases such as this one shown, surgery and extraction may be avoided if patient is treated orthodontically rather than periodontally.

ppo Return to the top

In health insurance in the United States, a preferred provider organization (or "PPO", sometimes referred to as a participating provider organization or preferred provider option) is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients. Contents [hide] * 1 Overview * 2 PPO * 3 EPO * 4 See also * 5 References * 6 External links [edit] Overview A preferred provider organization is a subscription-based medical care arrangement. A membership allows a substantial discount below the regularly charged rates of the designated professionals partnered with the organization. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network (unlike the usual insurance with premiums and corresponding payments paid either in full or partially by the insurance provider to the medical doctor). They negotiate with providers to set fee schedules, and handle disputes between insurers and providers. PPOs can also contract with one another to strengthen their position in certain geographic areas without forming new relationships directly with providers. This will be mutually beneficial in theory, as the insurer will be billed at a reduced rate when its insureds utilize the services of the "preferred" provider and the provider will see an increase in its business as almost all and or insureds in the organization will use only providers who are members. PPOs have gained popularity in the past decade because, although they tend to have slightly higher premiums than HMOs and other more restrictive plans, they offer patients more flexibility overall.[1] [edit] PPO Other features of a preferred provider organization generally include utilization review, where representatives of the insurer or administrator review the records of treatments provided to verify that they are appropriate for the condition being treated rather than largely or solely being performed to increase the amount of reimbursement due. Another near-universal feature is a pre-certification requirement, in which scheduled (non-emergency) hospital admissions and, in some instances outpatient surgery as well, must have prior approval of the insurer and often undergo "utilization review" in advance. [edit] EPO An exclusive provider organization (EPO) is a type of managed care plan that combines features of HMOs and PPOs. It is referred to as exclusive because the employers agree not to contract with any other plan.

wisdom tooth Return to the top

A wisdom tooth, in humans, is any of the usually four third molars, including mandibular third molar and maxillary third molar. Wisdom teeth usually appear between the ages of 17 and 25.[1] Most adults have four wisdom teeth, but it is possible to have more, in which case they are called supernumerary teeth. Wisdom teeth commonly affect other teeth as they develop, becoming impacted or "coming in sideways". They are often extracted when this occurs. About 35% of the population does not develop wisdom teeth at all.[2] Contents [hide] * 1 Impaction * 2 Partial eruption * 3 Extraction * 4 Post-extraction problems o 4.1 Bleeding and oozing o 4.2 Dry socket o 4.3 Swelling o 4.4 Nerve injury * 5 Treatment controversy o 5.1 Scientific trials o 5.2 Recommendations * 6 Vestigiality and variation * 7 Potential uses for extracted teeth * 8 Etymology o 8.1 Different terms in other languages * 9 See also * 10 References * 11 External links [edit] Impaction The upper left (picture right) and upper right (picture left) wisdom tooth are distoangularly impacted. The lower left wisdom tooth is horizontally impacted. The lower right wisdom tooth is vertically impacted (unidentifiable in orthopantomogram). Impacted wisdom teeth fall into one of several categories: * Mesioangular impaction is the most common form (44%), and means the tooth is angled forward, towards the front of the mouth. * Vertical impaction (38%) occurs when the formed tooth does not erupt fully through the gum line. * Distoangular impaction (6%) means the tooth is angled backward, towards the rear of the mouth. * Horizontal impaction (3%) is the least common form, which occurs when the tooth is angled fully ninety degrees sideways, growing into the roots of the second molar.[citation needed] Typically mesioangular impactions are the most difficult to extract in the maxilla and easiest to extract in the mandible, while distoangular impactions are the easiest to extract in the maxilla and most difficult to extract in the mandible. Frequently, a fully erupted upper wisdom tooth requires bone removal if the tooth does not yield easily to forceps or elevators. Failure to remove distal or buccal bone while removing one of these teeth can cause the entire maxillary tuberosity to be fractured off, thereby tearing out the floor of the maxillary sinus.[citation needed] Impacted wisdom teeth may also be categorized on whether they are still completely encased in the jawbone. If it is completely encased in the jawbone, it is a bony impaction. If the wisdom tooth has erupted out of the jawbone but not through the gumline, it is called a soft tissue impaction. In a small portion of patients, cysts and tumors occur around impacted wisdom teeth, requiring surgical extraction. Estimates of the incidence of cysts around impacted teeth vary from 0.001% to 11%, with a higher incidence in older patients, suggesting that the chance of a cyst or tumor increases the longer an impaction exists. Only 1-2% of impactions result in malignant tumors.[3] The oldest known impacted wisdom tooth belonged to a European woman of the Magdalenian period (18,000 - 10,000 BC).[4] [edit] Partial eruption Sometimes the wisdom tooth fails to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, forming a soft tissue flap or lid around the tooth called an operculum. Teeth covered by an operculum can be difficult to clean with a toothbrush. Additional cleaning techniques can include using a needle-less plastic syringe to vigorously wash the tooth with moderately pressured water or to softly wash it with hydrogen peroxide. However, debris and bacteria can easily accumulate under an operculum, which may cause pericoronitis, a common infection problem in young adults with partial impactions that is often exacerbated by occlusion with opposing third or second molars. Common symptoms include a swelling and redness of the gum around the eruption site, difficulty in opening the mouth, a bad odor or taste in the mouth, and pain in the general area which may also run down the entire lower jaw or possibly the neck. Untreated pericoronitis can progress to a much more severe infection. If the operculum does not disappear, recommended treatment is extraction of the wisdom tooth. An alternative treatment involving removal of the operculum, called operculectomy, has been advocated. There is a high risk of permanent or temporary numbness of the tongue due to damage of the nerve with this treatment and it is no longer recommended as a standard treatment in oral surgery. [edit] Extraction A wisdom tooth protrudes outwards from the gumline at the back of the lower teeth. A dental officer and his assistant remove the mandibular third molar of a patient. An extracted mandibular third molar that was horizontally impacted. An upper and lower right wisdom tooth extracted during the same session under local anesthetics. Main article: Dental extraction Wisdom teeth are extracted for two general reasons: either the wisdom teeth have already become impacted, or the wisdom teeth could potentially become problematic if not extracted. Potential problems caused by the presence of properly grown-in wisdom teeth include infections caused by food particles easily trapped in the jaw area behind the wisdom teeth where regular brushing and flossing is difficult and ineffective. Such infections may be frequent, and cause considerable pain and medical danger. Other reasons wisdom teeth are removed include misalignment which rubs up against the tongue or cheek causing pain, potential crowding or malocclusion of the remaining teeth (a result of there being not enough room on the jaw or in the mouth), as well as orthodontics.[5] [edit] Post-extraction problems This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2010) There are several problems that might occur after the extraction(s) have been completed. Some of these problems are unavoidable and natural, while others are under the control of the patient. The suggestions contained in the sections below are general guidelines that a patient will be expected to abide by, but the patient should follow all directions that are given by the surgeon in addition to the following guidelines. Above all, the patient must not disregard the given instructions; doing so is extremely dangerous and could result in any number of problems ranging in severity from being merely inconvenient (dry socket) to potentially life-threatening (serious infection of the extraction sites). Cyst around right lower wisdom tooth. [edit] Bleeding and oozing Bleeding and oozing is inevitable and should be expected to last up to three days (although by day three it should be less noticeable). Rinsing the mouth during this period is counter-productive, as the bleeding stops when the blood forms clots at the extraction sites, and rinsing out the mouth will most likely dislodge the clots. The end result will be a delay in healing time and a prolonged period of bleeding. Gauze pads should be placed at the extraction sites, and then should be bitten down on with firm and even pressure. This will help to stop the bleeding, but should not be overdone as it is possible to irritate the extraction sites and prolong the bleeding or remove the clot. The bleeding should decrease gradually and noticeably upon changing the gauze. If the bleeding lasts for more than a day without decreasing despite having followed the surgeon's directions, the surgeon should be contacted as soon as possible. This is not supposed to happen under normal circumstances and signals that a serious problem is present. A wet tea bag can replace the gauze pads. Tannin contained in tea can help reduce the bleeding.[6] Due to the blood clots that form in the exposed sockets as well as the abundant bacterial flora in the mouth, an offensive smell may be noticeable a short time after surgery. The persistent odor often is accompanied by an equally rancid-tasting fluid seeping from the wounds. These symptoms will diminish over an indeterminate amount of time, although one to two weeks is normal. While not a cause for great concern, a post-operative appointment with one's surgeon seven to ten days after surgery is highly recommended to make sure that the healing process has no complications and that the wounds are relatively clean. If infection does enter the socket, a qualified dental professional can gently plunge a plastic syringe (without the hypodermic needle) full of a mixture of equal parts hydrogen peroxide and water or chlorohexidine gluconate, which also comes in the form of a mouth wash, into the sockets to remove any food or bacteria that may collect in the back of the mouth. This is less likely if the person has his/her wisdom teeth removed at an early age. [edit] Dry socket Main article: Alveolar osteitis A dry socket is a painful inflammation[dubious – discuss] of the alveolar bone (not an infection); it occurs when the blood clots at an extraction site are dislodged, fall out prematurely, or fail to form. It is still not known how they form or why they form. In some cases, this is beyond the control of the patient. However, in other cases this happens because the patient has disregarded the instructions given by the surgeon. Smoking, blowing one's nose, spitting, or drinking with a straw in disregard to the surgeon's instructions can cause this, along with other activities that change the pressure inside of the mouth, such as sneezing or playing a musical instrument. The risk of developing a dry socket is greater in smokers, in diabetics, if the patient has had a previous dry socket, in the lower jaw, and following complicated extractions. The extraction site will become irritated and painful, due to inflammation of the bone lining the tooth socket (osteitis). The symptoms are made worse when food debris is trapped in the tooth socket. The patient should contact their surgeon if they suspect that they have a case of dry socket. The surgeon may elect to clean the socket under local anesthetic to cause another blood clot to form or prescribe medication in topical form (e.g. Alvogel) to apply to the affected site. A non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen may be prescribed by the surgeon for pain relief. Generally dry sockets are self limiting and heal in a couple of weeks without treatment. [edit] Swelling Swelling should not be confused with dry socket, although painful swelling should be expected and is a sign that the healing process is progressing normally. There is no general duration for this problem; the severity and duration of the swelling vary from case to case. The surgeon will tell the patient how long they should expect swelling to last, including when to expect the swelling to peak and when the swelling will start to subside. If the swelling does not begin to subside when it is supposed to, the patient should contact his or her surgeon immediately. While the swelling will generally not disappear completely for several days after it peaks, swelling that does not begin to subside or gets worse may be an indication of infection. Swelling that re-appears after a few weeks is an indication of infection caused by a bone or tooth fragment still in the wound and should be treated immediately. [edit] Nerve injury Mandibular division of trigeminal nerve, seen from the middle line. Nerve injury is primarily an issue with extraction of third molars, but can occur with the extraction of any tooth should the nerve be near the surgical site. Two nerves are typically of concern and are found in duplicate (on the left and right side): * The inferior alveolar nerve, which enters the mandible at the mandibular foramen and exits the mandible at the sides of the chin from the mental foramen. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch, as well as sense of touch to the right or left half of the chin and lower lip. * The lingual nerve, which branches off the mandibular branches of the trigeminal nerve and courses just inside the jaw bone, entering the tongue and supplying sense of touch and taste to the right and left half of the anterior 2/3 of the tongue as well as the lingual gingiva (i.e. the gums on the inside surface of the dental arch). Such injuries can occur while lifting teeth (typically the inferior alveolar) but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary.[7] Depending on the type of injury (i.e. Seddon classification: neuropraxia, axonotmesis, and neurotmesis) they can be prolonged or permanent. [edit] Treatment controversy Preventive removal of the third molars is a common practice in developed countries and is usually recommended by dentists. According to Pediatric Dentistry: Infancy Through Adolescence, 4th Edition: Evaluation of third molars is usually completed during mid- to late adolescence. Parents commonly ask about treating these teeth. The reasons for extraction of third molars include impaction or failure to erupt; potential or existing pathosis such as cysts or ameloblastoma; decay; posteruption malposition; nonfunction as a result of an absent opposing tooth; difficulty with hygiene; and recurrent pericoronitis. If any of these are considerations, third molars should be removed during adolescence.... The evaluation of developing third molars in adolescent athletes is of particular importance. Not only can an athletic season suddenly be interrupted by the annoying and often painful eruption of third molars with associated acute pericoronitis, but mandibular fractures in the gonial angle region of developing third molars can also occur in adolescent athletes.[5] Several dental textbooks encourage the removal of third molars. From Contemporary Oral and Maxillofacial Surgery, 5th Edition: As a general rule, all impacted teeth should be removed unless removal is contraindicated. Extraction should be performed as soon as the dentist determines that the tooth is impacted. Removal of impacted teeth becomes more difficult with advancing age. The dentist should typically not recommend that impacted teeth be left in place until they cause difficulty. If the tooth is left in place until problems arise, the patient may experience an increased incidence of local tissue morbidity, loss of or damage to adjacent teeth and bone, and potential injury to adjacent vital structures. Additionally, if removal of impacted teeth is deferred until they cause problems later in life, surgery is more likely to be complicated and hazardous because the patient may have compromising systemic diseases and the surrounding bone becomes more dense. A fundamental precept of the philosophy of dentistry is that problems should be prevented. Preventive dentistry dictates that impacted teeth are to be removed before complications arise unless removal will cause more serious problems.[8] The rationale of prophetically removing third molars prior to their complete root formation is that the likelihood of nerve damage or other complications is extremely low. This is not the case however with symptomatic removal of a third molar after root formation is complete and more intimate with the inferior alveolar nerve and as the mandible becomes more dense with age.[9] However, studies have shown that dentists graduated from different countries—or even from different dental schools in the same country[10]—may have different clinical decisions regarding third molar removal for the same clinical condition. For example, dentists graduated from Israeli dental schools may recommend more often for the removal of asymptomatic impacted third molar than dentists graduated from Latin-American or Eastern European dental schools.[11] [edit] Scientific trials In 2006, the Cochrane Collaboration published a systematic review of randomized controlled trials in order to evaluate the effect of preventive removal of asymptomatic wisdom teeth.[12] The authors found no evidence to either support or refute this practice. There was reliable evidence showing that preventative removal did not reduce or prevent late incisor crowding. The authors of the review suggested that the number of surgical procedures could be reduced by 60% or more. Likewise, ClinicalEvidence published a summary largely based on the Cochrane review that concluded prophylactic extraction is "likely to be ineffective or harmful."[13] It advised against extracting asymptomatic, disease-free wisdom teeth because of the risk of damage to the inferior alveolar nerve. Some evidence not from randomized trials suggests that the extraction of the asymptomatic tooth may be beneficial if caries are present in the adjacent second molar, or if periodontal pockets are present distal to the second molar.[citation needed] It may be argued, however, that these meta-analyses are inappropriate in that the lack of randomized control trials is likely the result of the expense and impracticality of studying diseases already strongly linked to third molar tissues. For example odontogenic cysts arising from the third molar follicle and odontogenic tumors from the third molar epithelium are relatively rare and can take decades to develop, making controlled trials extremely expensive and challenging (especially high loss to follow up).[citation needed] The American Association of Oral and Maxillofacial Surgeons has published an extensive White Paper on Third Molar Data summarizing the most current research into the subject of third molar extraction.[14] It states that, "The presence of visible third molars is associated with elevated levels of periodontitis . . . which involves adjacent teeth and is progressive and only partially responsive to therapy."[14] In developed countries, the presence of wisdom teeth is associated with substandard dental care, leading to an increased likelihood of periodontitis, which may be caused by a lack of dental care rather than the presence of wisdom teeth. Periodontal bacteria causes gum disease, and may travel through the blood stream, resulting in systemic infections associated with the heart, kidneys and other organs. Further, studies have found such bacteria in amniotic fluid and is considered a factor in low birth weight infants.[15] [edit] Recommendations In the U.K., the National Institute for Health and Clinical Excellence, which appraises the cost-effectiveness of treatments for the National Health Service, has argued that there is no evidence that removing disease-free impacted wisdom teeth is beneficial, and recommends against removal to avoid the various risks and discomforts of the procedure.[16] The American Association of Oral and Maxillofacial Surgeons recommends that third molars be removed in patients who, in the opinion of their family dentists, suffer from periodontal infections where the probing depth exceeds 3 mm. It argues that it is advisable to have the third molars of such patients removed in young adulthood to avoid the complications that may occur when third molars have grown to maturity. In these cases, there is a greater likelihood of nerve damage and other potential concerns.[14] The American Public Health Association recommends against prophylactic removal of asymptomatic, non-pathological wisdom teeth, including wisdom teeth that are impacted,[17] on the basis that the removal of third molars (wisdom teeth), like the removal of any teeth, should be based on evidence of diagnosed pathology or demonstrable need, rather than anticipated future pathology. The APHA's position is based on scientific research that documents the risks of injury to the nerves of the jaw that can cause permanent numbness of the lip and tongue, damage to the temporomandibular (jaw) joint and adjacent teeth. [edit] Vestigiality and variation See also: Human vestigiality Wisdom teeth are vestigial third molars that human ancestors used to help in grinding down plant tissue. The common postulation is that the skulls of human ancestors had larger jaws with more teeth, which were possibly used to help chew down foliage to compensate for a lack of ability to efficiently digest the cellulose that makes up a plant cell wall. As human diets changed, smaller jaws gradually evolved, yet the third molars, or "wisdom teeth", still commonly develop in human mouths.[18] Agenesis of wisdom teeth in human populations ranges from practically zero in Tasmanians to nearly 100% in indigenous Mexicans.[19] The difference is related to the PAX9 gene (and perhaps other genes).[20] [edit] Potential uses for extracted teeth In August 2008, it was revealed that scientists in Japan were able to successfully harvest stem cells from wisdom teeth.[21] This discovery is of great clinical importance, as wisdom tooth extractions are a relatively common type of oral surgery. Patients who have their wisdom teeth removed are currently able to opt to have stem cells from those teeth isolated and saved, in case they should ever need the cells. [edit] Etymology They are generally thought to be called wisdom teeth because they appear so late – much later than the other teeth, at an age where people are presumably "wiser" than as a child, when the other teeth erupt.[22] [edit] Different terms in other languages Some languages use a different term for the same teeth, for example: * In Arabic, it is called (Dors el Aql) or (ضرس العقل) meaning "tooth of maturity" or "the adulthood tooth". * In Dutch, the name is "verstandskies", a literal translation to English would be wisdomtooth, but "verstands" could also mean "standing far away", referring to the fact that wisdom teeth are at the most distant position in one's mouth. The English word "wisdom tooth" may thus be based on a mistranslation of the Dutch word "verstandskies". * Turkish refers directly to the age at which wisdom teeth appear and calls it 20 yaş dişi (20th year tooth). * In Korean, its name is Sa-rang-nee (사랑니, love teeth) referring to the young age and the pain of the first love. * In Japanese, its name is Oyashirazu (親知らず), literally meaning "unknown to the parents," from the idea that they erupt after a child has moved away. * The Indonesian term gigi bungsu for the last teeth a person cuts refers to bungsu, meaning "youngest child", because the teeth erupt so much later than the others, implying that the teeth are "younger" than the rest. * In Thailand, the wisdom tooth is described fan-khut (ฟันคุด) "huddling tooth" due to its shortage of space. * In Spanish, their name is "Muelas del Juicio", a close equivalent to wisdom teeth: ("Juicio" meaning: good judgment, reason, sense). * In India, in its Hindi speaking states, they are called "Akkal daant" ("akkal" means wisdom and "daant" means tooth) which refers to the tooth erupting at an age when a person is wiser. Alternately it may also refer to the wisdom of sexual awareness of a person when the tooth erupts in the late teens and thus is also linked with a person starting to develop sexual feelings. [edit] See also * Dentistry * Dental hygienist * Oral and maxillofacial surgery * Toothache

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A dental extraction (also referred to as exodontia) is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to prevent restoration. Extractions of impacted or problematic wisdom teeth are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment. Contents [hide] * 1 History * 2 Reasons for tooth extraction * 3 Types of extraction * 4 Post-extraction healing * 5 Complications * 6 See also * 7 References [edit] History Historically, dental extractions have been used to treat a variety of illnesses, as well as a method of torture to obtain forced confessions. Before the discovery of antibiotics, chronic tooth infections were often linked to a variety of health problems, and therefore removal of a diseased tooth was a common treatment for various medical conditions. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican, which was used through the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century. As dental extractions can vary tremendously in difficulty, depending on the patient and the tooth, a wide variety of instruments exist to address specific situations. [edit] Reasons for tooth extraction The most common reason for extraction is tooth damage due to breakage or decay. There are additional reasons for tooth extraction: * Severe tooth decay or infection. Despite the reduction in worldwide prevalence of dental caries, still it is the most common reason for extraction of (non-third molar) teeth with up to two thirds of extractions.[1] * Extra teeth which are blocking other teeth from coming in. * Severe gum disease which may affect the supporting tissues and bone structures of teeth. * In preparation for orthodontic treatment (braces) * Teeth in the fracture line * Fractured teeth * Insufficient space for wisdom teeth (impacted third molars). Although many dentists remove asymptomatic impacted third molars,[2][3] American as well as British Health Authorities recommended against this routine procedure, unless there are evidences for disease in the impacted tooth or the near environment.[4] The American Public Health Association, for example, adopted a policy, Opposition to Prophylactic Removal of Third Molars (Wisdom Teeth) because of the large number of injuries resulting from unnecessary extractions.[5] * Receiving radiation to the head and neck may require extraction of teeth in the field of radiation. * Deliberate, medically unnecessary, extraction as a particularly dreadful form of physical torture. [edit] Types of extraction An extracted 3rd molar that was horizontally impacted. Extractions are often categorized as "simple" or "surgical". Simple extractions are performed on teeth that are visible in the mouth, usually under local anaesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the Periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Typically, when teeth are removed with forceps, slow, steady pressure is applied with controlled force. Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding bone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal. Surgical extractions are usually performed under a general anaesthetic. 2 extracted teeth from a 14 year old male, compared against a £1 coin, which has a diameter of 22.50 millimetres (0.89 inches). [edit] Post-extraction healing Following extraction of a tooth, a blood clot forms in the socket, usually within an hour. Bleeding is common in this first hour, but its likelihood decreases quickly as time passes, and is unusual after 24 hours. The raw open wound overlying the dental socket takes about 1 week to heal. Thereafter, the socket will gradually fill in with soft gum tissue over a period of about one to two months. Final closure of the socket with bony remodeling can take six months or more. [edit] Complications Example of post-operative swelling following third molar (wisdom teeth) extractions. Example of alveolar osteitis (dry socket) following lower third molar (wisdom tooth) extraction; six days post-surgery. 1. Infection: although rare[citation needed], it does occur. The dentist may opt to prescribe antibiotics pre- and/or post-operatively if they determine the patient to be at risk. 2. Prolonged bleeding: The dentist has a variety of means at their disposal to address bleeding; however, it is important to note that small amounts of blood mixed in the saliva after extractions are normal, even up to 72 hours after extraction. Usually, however, bleeding will almost completely stop within eight hours of the surgery, with only minuscule amounts of blood mixed with saliva coming from the wound. A gauze compress will significantly reduce bleeding over a period of a few hours. 3. Swelling: Often dictated by the amount of surgery performed to extract a tooth (e.g. surgical insult to the tissues both hard and soft surrounding a tooth). Generally, when a surgical flap must be elevated (i.e. and the periosteum covering the bone is thus injured), minor to moderate swelling will occur. A poorly-cut soft tissue flap, for instance, where the periosteum is torn off rather than cleanly elevated off the underlying bone, will often increase such swelling. Similarly, when bone must be removed using a drill, more swelling is likely to occur. 4. Sinus exposure and oral-antral communication: This can occur when extracting upper molars (and in some patients, upper premolars). The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The doctor typically mentions this risk to patients, based on evaluation of radiographs showing the relationship of the tooth to the sinus. It is important to note that the sinus cavity is lined with a membrane called the Sniderian membrane, which may or may not be perforated. If this membrane is exposed after an extraction, but remains intact, a "sinus exposed" has occurred. If the membrane is perforated, however, it is a "sinus communication". These two conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain primary closure—depending on the size of the exposure as well as the likelihood of the patient to heal. In both cases, a resorbable material called "gelfoam" is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period. 5. Nerve injury: This is primarily an issue with extraction of third molars, but can occur with the extraction of any tooth should the nerve be close to the surgical site. Two nerves are typically of concern, and are found in duplicate (one left and one right): 1. the inferior alveolar nerve, which enters the mandible at the mandibular foramen and exits the mandible at the sides of the chin from the mental foramen. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch, as well as sense of touch to the right or left half of the chin and lower lip. 2. The lingual nerve (one right and one left), which branches off the mandibular branches of the trigeminal nerve and courses just inside the jaw bone, entering the tongue and supplying sense of touch and taste to the right and left half of the anterior 2/3 of the tongue as well as the lingual gingiva (i.e. the gums on the inside surface of the dental arch). Such injuries can occur while lifting teeth (typically the inferior alveolar), but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary, but depending on the type of injury (i.e. Seddon classification: neuropraxia, axonotmesis, & neurotmesis), can be prolonged or even permanent. 6. Displacement of tooth or part of tooth into the maxillary sinus (upper teeth only). In such cases, almost always the tooth or tooth fragment must be retrieved. In some cases, the sinus cavity can be irrigated with saline (antral lavage) and the tooth fragment may be brought back to the site of the opening through which it entered the sinus, and may be retrievable. At other times, a window must be made into the sinus in the Canine fossa--a procedure referred to as "Caldwell luc". 7. Dry socket (Alveolar osteitis) is a painful phenomenon that most commonly occurs a few days following the removal of mandibular (lower) wisdom teeth. It is commonly believed[weasel words] that it occurs because the blood clot within the healing tooth extraction site is disrupted. More likely,[citation needed] alveolar osteitis is a phenomenon of painful inflammation within the empty tooth socket because of the relatively poor blood supply to this area of the mandible (which explains why dry socket is usually not experienced in other parts of the jaws). Inflamed alveolar bone, unprotected and exposed to the oral environment after tooth extraction, can become packed with food and debris. A dry socket typically causes a sharp and sudden increase in pain commencing 2–5 days following the extraction of a mandibular molar, most commonly the third molar. This is often extremely unpleasant for the patient; the only symptom of dry socket is pain, which often radiates up and down the head and neck. A dry socket is not an infection, and is not directly associated with swelling because it occurs entirely within bone — it is a phenomenon of inflammation within the bony lining of an empty tooth socket. Because dry socket is not an infection, the use of antibiotics has no effect on its rate of occurrence. The risk factor for alveolar osteitis can dramatically increase with smoking after an extraction. 8. Bone fragments Particularly when extraction of molars is involved, it is not uncommon for the bones which formerly supported the tooth to shift and in some cases to erupt through the gums, presenting protruding sharp edges which can irritate the tongue and cause discomfort. This is distinguished from a similar phenomena where broken fragments of bone or tooth left over from the extraction can also protrude through the gums. In the latter case, the fragments will usually work their way out on their own. In the former case, the protrusions can either be snipped off by the dentist, or eventually the exposed bone will erode away on its own.

ppo preferred Return to the top

In health insurance in the United States, a preferred provider organization (or "PPO", sometimes referred to as a participating provider organization or preferred provider option) is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients. Contents [hide] * 1 Overview * 2 PPO * 3 EPO * 4 See also * 5 References * 6 External links [edit] Overview A preferred provider organization is a subscription-based medical care arrangement. A membership allows a substantial discount below the regularly charged rates of the designated professionals partnered with the organization. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network (unlike the usual insurance with premiums and corresponding payments paid either in full or partially by the insurance provider to the medical doctor). They negotiate with providers to set fee schedules, and handle disputes between insurers and providers. PPOs can also contract with one another to strengthen their position in certain geographic areas without forming new relationships directly with providers. This will be mutually beneficial in theory, as the insurer will be billed at a reduced rate when its insureds utilize the services of the "preferred" provider and the provider will see an increase in its business as almost all and or insureds in the organization will use only providers who are members. PPOs have gained popularity in the past decade because, although they tend to have slightly higher premiums than HMOs and other more restrictive plans, they offer patients more flexibility overall.[1] [edit] PPO Other features of a preferred provider organization generally include utilization review, where representatives of the insurer or administrator review the records of treatments provided to verify that they are appropriate for the condition being treated rather than largely or solely being performed to increase the amount of reimbursement due. Another near-universal feature is a pre-certification requirement, in which scheduled (non-emergency) hospital admissions and, in some instances outpatient surgery as well, must have prior approval of the insurer and often undergo "utilization review" in advance. [edit] EPO An exclusive provider organization (EPO) is a type of managed care plan that combines features of HMOs and PPOs. It is referred to as exclusive because the employers agree not to contract with any other plan.

In health insurance in the United States, a preferred provider organization (or "PPO", sometimes referred to as a participating provider organization or preferred provider option) is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients. Contents [hide] * 1 Overview * 2 PPO * 3 EPO * 4 See also * 5 References * 6 External links [edit] Overview A preferred provider organization is a subscription-based medical care arrangement. A membership allows a substantial discount below the regularly charged rates of the designated professionals partnered with the organization. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network (unlike the usual insurance with premiums and corresponding payments paid either in full or partially by the insurance provider to the medical doctor). They negotiate with providers to set fee schedules, and handle disputes between insurers and providers. PPOs can also contract with one another to strengthen their position in certain geographic areas without forming new relationships directly with providers. This will be mutually beneficial in theory, as the insurer will be billed at a reduced rate when its insureds utilize the services of the "preferred" provider and the provider will see an increase in its business as almost all and or insureds in the organization will use only providers who are members. PPOs have gained popularity in the past decade because, although they tend to have slightly higher premiums than HMOs and other more restrictive plans, they offer patients more flexibility overall.[1] [edit] PPO Other features of a preferred provider organization generally include utilization review, where representatives of the insurer or administrator review the records of treatments provided to verify that they are appropriate for the condition being treated rather than largely or solely being performed to increase the amount of reimbursement due. Another near-universal feature is a pre-certification requirement, in which scheduled (non-emergency) hospital admissions and, in some instances outpatient surgery as well, must have prior approval of the insurer and often undergo "utilization review" in advance. [edit] EPO An exclusive provider organization (EPO) is a type of managed care plan that combines features of HMOs and PPOs. It is referred to as exclusive because the employers agree not to contract with any other plan. [edit] See also * Managed care * Health maintenance organization * Point of service plan * Independent practice association * Dental plan * Single-payer health care

novocaine Return to the top

Procaine is a local anesthetic drug of the amino ester group. It is used primarily to reduce the pain of intramuscular injection of penicillin, and it was also used in dentistry. Owing to the ubiquity of the trade name Novocain, in some regions procaine is referred to generically as novocaine. It acts mainly by being a sodium channel blocker.[1] Procaine was first synthesized in 1905,[2] shortly after amylocaine, and is the oldest man-made local anesthetic still in clinical use. It was created by the German chemist Alfred Einhorn who gave the chemical the trade name Novocaine, from the Latin nov- (meaning new) and -caine, a common ending for alkaloids used as anesthetics. It was introduced into medical use by surgeon Heinrich Braun. Procaine application before removal of a decayed tooth Procaine is used less frequently today since more effective (and hypoallergenic) alternatives such as lidocaine (Xylocaine) exist. Prior to the discovery of procaine, cocaine was the most commonly used local anesthetic. Like other local anesthetics (with the exception of cocaine), mepivacaine, and prilocaine, procaine is a vasodilator, and is often coadministered with epinephrine for the purpose of vasoconstriction. Vasoconstriction helps to reduce bleeding and prevents the drug from reaching systemic circulation in large amounts. Also unlike cocaine, procaine does not have the euphoric and addictive qualities that put it at risk for abuse. Procaine, an ester anesthetic, is metabolized in the plasma by the enzyme pseudocholinesterase through hydrolysis into para-amino benzoic acid (PABA), which is then excreted by the kidneys into the urine. Allergic reactions to procaine are usually not in response to procaine itself, but to PABA. About 1 in 3000 people have an atypical form of pseudocholinesterase, which does not hydrolyze ester anesthetics such as procaine, resulting in a prolonged period of high levels of the anesthetic in the blood and increased toxicity. Procaine is the primary ingredient in the controversial preparation Gerovital H3 by Ana Aslan (Romania), which is claimed by its advocates to remedy many effects of aging. The mainstream medical view is that these claims were seriously studied and discredited in the 1960s. 1% Procaine injection has been recommended for the treatment of extravasation complications associated with venipuncture (along with moist heat, ASA, steroids, antibiotics). It has likewise been recommended for treatment of inadvertent intra-arterial injections (10mL of 1% procaine) as it helps relieve pain and vascular spasm.

braces Return to the top

Dental braces (also known as orthodontic braces, or simply braces) are devices used in the orthodontic industry that help align and straighten teeth and help to position them with regard to a person’s bite, while also working to improve dental health. They are often used to correct under bites, as well as, malocclusions[1] , overbites, cross bites, open bites, deep bites, crooked teeth, and various other flaws of the teeth and jaw. Braces can be either cosmetic or structural. Dental braces or orthodontic braces are often used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws. While they are mainly used on children and teenagers, adults are also big contributors to this type of market including people seen on television, such as actors, Tom Cruise, Katherine Heigl, and R&B singer Fantasia. Contents [hide] * 1 History o 1.1 Ancient Times o 1.2 18th century o 1.3 19th century o 1.4 20th century * 2 How braces work * 3 Types of braces * 4 Procedure * 5 Post-treatment o 5.1 Retainers o 5.2 Pre-Finisher * 6 Complications and risks * 7 Treatment time and cost * 8 References [edit] History [edit] Ancient Times Braces date all the way back to ancient times according to many scholars and historians, and existed around the time 500-300BC. Many experts say that around 400-500BC, Hippocrates and Aristotle contemplated about ways to straightened teeth and to fix various dental conditions. Archaeologists have come to discover numerous mummified ancient individuals with the appearance of metal bands wrapped around their teeth. It has been perceived that catgut, which is a type of cord that is made from the natural fibers of an animal’s intestines, did the work that is done by today’s orthodontic wire used to close gaps in the teeth and mouth[2] . Meanwhile in Greece during the so-called Golden Age, the Etruscans, seen as the early Romans, were burying their dead with dental appliances in place that were used to maintain space and prevent collapse of the teeth during after life. Although there is no date documented, this process was most likely before the start of our era. An unknown researcher found a Roman tomb with a number of teeth bound with gold wire documented as a ligature wire, which is a small elastic wire that is used to affix the arch wire to the bracket. In the early years of our era, a philosopher and physician, Aurelius Cornelius Celsus, first recorded the treatment of teeth by finger pressure[3] . Unfortunately, due to lack of evidence, the poor preservation of bodies, and primitive technology, not much research was done on dental braces until around the 17th century, although dentistry as a profession was making great advancements. [edit] 18th century There are many orthodontic scholars who could be considered as the “Father of Orthodontics” who lived in the 17th, 18th, and even early 19th centuries. Dentists were continuously thinking of ways to correct bad bites. In 1728, French dentist Pierre Fauchard, who took orthodontics out of the Dark Ages, published an entire book called the “The Surgeon Dentist” on methods of straightening teeth. Fauchard, in his practice, used a device called a “Bandeau,” which is a horseshoe-shaped piece of precious metal that helped expand the arch. Years later in 1757, another French dentist, Ettienne Bourdet, who was also dentist to the King of France, followed Fauchard's book with “The Dentist’s Art,” which also dedicated a chapter to tooth alignment and application. He perfected the “Bandeau” and was the first dentist on record to recommend extraction of the premolar teeth to alleviate crowding and to improve jaw growth. [edit] 19th century Although teeth straightening and pulling was used to improve alignment of remaining teeth and had been practiced since early times, orthodontics, as a science of its own, did not really exist until the mid-19th century. Some important dentists helped to advance dental braces with specific instruments and tools that allowed braces to be improved. In 1819, Delabarre introduced the wire crib, which marked the birth of contemporary orthodontics and gum elastics were first employed by Maynard in 1843. Tucker was the first to cut rubber bands from rubber tubing in 1850, but this was nothing compared to advances in orthodontics in the 20th Century. Norman W. Kingsley who was a dentist, writer, artist, and sculptor in 1858 wrote the first article on orthodontics and in 1880, his book, “Treatise on Oral Deformities", was published. Also a dentist named J. N. Farrar is credited for writing two volumes entitled, "A Treatise on the Irregularities of the Teeth and Their Corrections". Farrar was very good at designing brace appliances and he was the first to suggest the use of mild force at timed intervals to move teeth. [edit] 20th century In the early 20th century America, Edward H. Angle devise the first simple classification system for malocclusions, such as Class I, Class II, and so on. His classification system is still used today was a way for dentists to describe how crooked teeth are (what way teeth are pointing) and how teeth fit together. Angle contributed greatly to the design of orthodontic and dental appliances, making many simplifications. He founded the first school and college of orthodontics, organized the American Society of Orthodontia in 1901 which became the American Association of Orthodontists (AAO) in the 1930s, and founded the first orthodontic journal in 1907. Other innovations in orthodontics in the late 19th and early 20th centuries included the first textbook on orthodontics for childern, published by J.J. Guilford in 1889, and the use of rubber elastics, pioneered by Calvin S. Case, along with H. A. Baker. [edit] How braces work The application of braces moves the teeth as a result of force and pressure on the teeth. There are four basic elements that are needed in order to help move the teeth. In the case of traditional metal or wire braces, one uses brackets, bonding material, arch wire, and ligature elastic, also called an “O-ring”[4] to help align the teeth. The teeth move when the arch wire puts pressure on the brackets and teeth. Sometimes springs or rubber bands are used to put more force in a specific direction. Braces have constant pressure, which over time, move teeth into their proper positions. Occasionally adults may need to wear headgear to keep certain teeth from moving. When braces put pressure on your teeth, the periodontal membrane stretches on one side and is compressed on the other. This movement needs to be done slowly otherwise the patient risks losing his or her teeth. This is why braces are commonly worn for approximately two and a half years and adjustments are only made every three or four weeks. This process loosens the tooth and then new bone grows in to support the tooth in its new position which is technically called bone remodeling. Bone remodeling is a biomechanical process responsible for making bones stronger in response to sustained load-bearing activity and weaker in the absence of carrying a load. Bones are made of cells called osteoclasts and osteoblasts. Two different kinds of bone resorption are possible which are called direct resorption, starting from the lining cells of the alveolar bone, and indirect or retrograde resorption, which takes place when the periodontal ligament has become subjected to an excessive amount and duration of compressive stress[5] . Another important factor associated with tooth movement is bone deposition. Bone deposition occurs in the distracted periodontal ligament and without bone deposition, the tooth will loosen and voids will occur distal to the direction of tooth movement[6] . A tooth will usually move about a millimeter per month during orthodontic movement, but there is high individual variability. Orthodontic mechanics can vary in efficiency, which partly explains the wide range of response to orthodontic treatment. [edit] Types of braces Modern orthodontists can offer many types and varieties of braces: * Traditional braces are stainless steel, sometimes in combination with nickel titanium, and are the most widely used. These include conventional braces, which require ties to hold the archwire in place, and newer self-tying (or self-ligating) brackets. Self-ligating brackets may reduce friction between the wire and the slot of the bracket, which in turn might be of therapeutic benefit.[7] * "Clear" braces serve as a cosmetic alternative to traditional metal braces by blending in more with the natural color of the teeth or having a less conspicuous or hidden appearance. Typically, these brackets are made of ceramic or plastic materials and function in a similar manner to traditional metal brackets. Clear elastic ties and white metal ties are available to be used with these clear braces to help keep the appliances less conspicuous. Clear braces have a higher component of friction and tend to be more brittle than metal braces. This can make removing the appliances at the end of treatment more difficult and time consuming.[citation needed] * Gold-plated stainless steel braces are often employed for patients allergic to nickel (a basic and important component of stainless steel), but may also be chosen because some people simply prefer the look of gold over the traditional silver-colored braces. * Lingual braces (Incognito Braces) are custom made fixed braces bonded to the back of the teeth making them invisible to other people. In lingual braces the brackets are cemented onto the backside of the teeth making them invisible while in standard braces the brackets are cemented onto the front side of the teeth. Hence, lingual braces are a cosmetic alternative to those who do not wish to have the unaesthetic metal look but wish to improve their smile. * Titanium braces resemble stainless steel braces but are lighter and just as strong. People with allergies to the nickel in steel often choose titanium braces, but they are more expensive than stainless steel braces. Traditional braces are mostly used in treating children, as well as, adults. They consist of a small bracket that is glued to the front of each tooth and the molars are adjusted with a band that encircles the tooth. An advantage is one can eat and drink while wearing the brace but a disadvantage is that one must give up certain foods and eating habits while wearing them, such as, chewing gum and potato chips. Another disadvantage is they have to be periodically tightened by your orthodontist causing increased amounts of discomfort. * Progressive, clear removable aligners (examples of which are Invisalign , Originator, ClearCorrect) may be used to gradually move teeth into their final positions. Aligners are generally not used for complex orthodontic cases, such as when extractions, jaw surgery, or palate expansion are necessary. These braces are the most recent type of braces. Many orthodontists do not use these braces because they feel they do not produce the best corrective results compared to traditional braces, but opinions differ. These are good choices for people who have slight orthodontic problems, but can also be used in severe cases. The main attraction of these braces is they are virtually invisible making them hardly noticeable on the teeth. They work to gradually move the teeth into their right position just like traditional braces, but without the constant help of wires that need tightening. They do require an improvement in the amount of oral hygiene because they have to be removed to eat and one must brush and floss after every meal. * For less difficult cases spring aligners are also an option that can cost much less than braces or Invisalign (one example is NightShiftOrtho) and still align primarily the front six top and bottom teeth. * Smart brackets are the latest concept under investigation. The smart bracket contains a microchip that measures the forces that act on the bracket and subsequently, the tooth interface . The aim of these braces is to reduce the duration of orthodontic therapy and the related expenses and discomfort to the individual. * A-braces [8] are another new concept in dental appliances. In the shape of a capital letter A, A-braces are applied, adjusted, removed and completely controlled by the user. At the ends of the A's arms are angled knobbed bits that the user bites down over. The width between the bits is adjusted by turning the crossbar, housed across the arms. A user never has to experience pain because the pressure is so easy to control. A-braces may serve as self-adjustable retainers and palate expanders.[citation needed] [edit] Procedure A patient's teeth are prepared for application of braces. Orthodontic services may be provided by any licensed dentist trained in orthodontics. In North America most orthodontic treatment is done by orthodontists, dentists in diagnosis and treatment of malocclusions—malalignments of the teeth, jaws, or both. A dentist must complete 2–3 years of additional post-doctoral training to earn a specialty certificate in orthodontics. There are many general practitioners who also provide orthodontic services. The first step is to determine whether braces are suitable for the patient. The doctor consults with the patient and inspects the teeth visually. If braces are appropriate, a records appointment is set up where X-rays, molds, and impressions are made. These records are analyzed to determine the problems and proper course of action. Typical treatment times vary from six months to two and a half years depending on the complexity and types of problems. Orthognathic surgery may be required in extreme cases. About 2 weeks before the braces are applied brackets are required to spread apart back teeth in order confirm enough space for the bands. Teeth to be braced will have an adhesive applied to help the cement bond to the surface of the tooth. In most cases the teeth will be banded and then brackets will be added. A bracket will be applied with dental cement, and then cured with light until hardened. This process usually takes a few seconds per tooth. If required, orthodontic spacers may be inserted between the molars to make room for molar bands to be placed at a later date. Molar bands are required to ensure brackets will stick. Bands are also utilized when dental fillings or other dental work make securing a bracket to a tooth infeasible. An archwire will be threaded between the brackets and affixed with elastic or metal ligatures. Elastics are available in a wide variety of colors. Archwires are bent, shaped, and tightened frequently to achieve the desired results. Brackets with hooks can be placed, or hooks can be created and affixed to the archwire to affix the elastic to. The placement and configuration of the elastics will depend on the course of treatment and the individual patient. Elastics are made in different diameters, colors, sizes, and strengths. Modern orthodontics makes frequent use of nickel-titanium archwires and temperature-sensitive materials. When cold, the archwire is limp and flexible, easily threaded between brackets of any configuration. Once heated to body temperature, the archwire will stiffen and seek to retain its shape, creating constant light force on the teeth. When applying another type of dental brace, such as Invisalign, the process is quite different but there are similarities like the initial steps of molding the teeth before application. With Invisalign, impressions of the patient's teeth are sent for evaluation. After viewing and determining the best course of action for the patient, their series of trays are created. The patients dentist or orthodontist receives the trays which fit to the patients mouth almost like a protective mouthpiece. There are some forms of braces in which the brackets are placed in a special form which are customized to the patients mouth. This reduces the application time for the traditional type of braces. The form contains the metal brackets which are placed in the patients mouth like a mouth guard, drastically reducing the application time. Dental braces, with a transparent power chain, removed after completion of treatment. In many cases there is insufficient space in the mouth for all the teeth to fit properly. There are two main procedures to make room in these cases. One is extraction: teeth are removed to create more space. The second is expansion: the palate or arch is made larger by using a palatal expander.Expanders can be used with both children and adults. Since the bones of adults are already fused, expanding the palate is not possible without surgery to unfuse them. An expander can be used on an adult without surgery, but to expand the dental arch, and not the palate. Each month or two, the braces must be adjusted. This helps shift the teeth into the correct position. When they get adjusted the orthodontist takes off the colored rubber bands keeping the wire in place. The wire is then taken out, and may be replaced or modified. When the wire has been placed back into the mouth, the patient may choose a color for the new rubber bands, which are then fixed to the metal brackets. The adjusting process may cause some discomfort, which is normal. [edit] Post-treatment In order to avoid the teeth moving back to their original position, retainers may be worn once the treatment with braces is complete. Patients may need post-orthodontic surgery, such as a fiberotomy or alternatively a gum lift, to prepare their teeth for retainer use and improve the gumline contours after the braces come off. [edit] Retainers Main article: Retainer (orthodontic device) In order to prevent the teeth moving back to their original position, retainers may be worn once the treatment with braces is complete for the patient depending on their specific needs. If the patient does not wear the braces appropriately for the right amount of time, the teeth will move towards their previous position. For regular traditional braces Hawley retainers are used. They are made of metal hooks that surround the teeth and are enclosed by an acrylic plate shaped to fit the patient’s palate. For invisalign braces an Essix retainer is used. They are similar to the regular invisalign braces and is a clear plastic tray that is form fitted to the teeth that stays in place. There is also a bonded retainer where a wire is permanently bonded to the lingual side of the teeth, usually the lower teeth only. Doctors will refuse to remove this retainer; it requires a special orthodontic appointment to have it removed. [edit] Pre-Finisher The Pre Finisher is molded to the patient’s teeth by use of extreme pressure to the appliance by the person’s jaw. The product is then worn a certain amount of time with the user applying force to the appliance in their mouth for 10 to 15 seconds at a time. The goal of the process is to increase the exercise time in applying the force to the appliance. If a person’s teeth are not ready for a proper retainer the orthodontist may prescribe the use of a pre formed finishing appliance such as the Pre Finisher. This appliance fixes gaps between the teeth, small spaces between the upper and lower jaw, and other minor smaller problems that could lead to. [edit] Complications and risks Plaque forms easily when food is retained in and around braces. It is important to maintain proper oral hygiene by brushing and flossing thoroughly when wearing braces to prevent tooth decay, decalcification, or unpleasant color changes to the teeth. There is a small chance of allergic reaction to the elastics or to the metal used in braces. In even rarer cases, latex allergy may result in anaphylaxis. Latex-free elastics and alternative metals can be used instead. It is important for those who believe that they are allergic to their braces to notify the orthodontist immediately. Mouth sores may be triggered by irritation from components of the braces. Many products can increase comfort, including oral rinses, dental wax or dental silicone, and products to help heal sores. Braces can also be damaged if proper care is not taken. It is important to wear a mouth guard to prevent breakage and/or mouth injury when playing sports. Certain sticky or hard foods such as taffy, raw carrots, hard pretzels, and toffee should be avoided because they can damage braces. Frequent damage to braces can prolong treatment. Some orthodontists recommend sugar-free chewing gum in the belief that it may expedite treatment and relieve soreness; other orthodontists object to gum chewing because it is sticky and may therefore damage the braces. In the course of treatment orthodontic brackets may pop off due to the forces involved, or due to cement weakening over time. The orthodontist should be contacted immediately for advice if this occurs. In most cases the bracket is replaced. When teeth move, the end of the arch wire may become displaced, causing it to poke the back of the patient's cheek. Dental wax can be applied to cushion the protruding wire. The orthodontist must be called immediately to have it clipped, or a painful mouth ulcer may form. If the wire is causing severe pain, it may be necessary to carefully bend the edge of the wire in with a spoon or other piece of equipment (e.g. tweezers) until the wire can be clipped by an orthodontist. Patients with periodontal disease usually must obtain periodontal treatment before getting braces. A deep cleaning is performed, and further treatment may be required before beginning orthodontic treatment. Bone loss due to periodontal disease may lead to tooth loss during treatment. In some cases, teeth may be loose for a prolonged period of time. One may be able to wiggle one's teeth for a year or two after treatment or longer. The dental displacement obtained with the orthodontic appliance determines in most cases some degree of root resorption. Only in a few cases is this side effect large enough to be considered real clinical damage to the tooth. In rare cases, the teeth may fall out or have to be extracted due to root resorption.[9][10] Pain and discomfort are common after adjustment and may cause difficulty eating for a time, often a couple days. During this period, eating soft foods can help avoid additional pressure on teeth. Removal of the cemented brackets can also be painful. The cement must be chipped and scraped off which can cause severe pain in patients with sensitive teeth. Often molar bands have been installed for an extended period of time and they may be embedded in the gums at the time of removal. The metallic look may not be desirable to some people, although transparent varieties are available. According to a survey published in the American Journal of Orthodontics and Dentofacial Orthopedics, dental braces with no visible metal were considered the most attractive. Braces that combine clear ceramic brackets with thin metal or clear wires were a less desirable option, and braces with metal brackets and metal wires were rated as the least aesthetic combination.[11] [edit] Treatment time and cost Typical treatment time is from six months to six years, depending on the severity of the case, location, age, etc., although research has shown that the average duration is 1 year and 4 months.[citation needed] Treatment can be accelerated using novel planning, unorthodox treatment goals[citation needed] and positioning techniques. The typical cost of braces ranges widely in various regions. The cost depends on whether both arches are being treated and the length of treatment. Typical orthodontic treatment comprises metal braces on both arches for 12 to 24 months. The 2007 orthodontic practice study done by the Journal of Clinical Orthodontics showed the United States national average cost of braces for comprehensive orthodontic treatment to be $2,000 for children and $5,354 for adults.[citation needed] Some cases in the United Kingdom cost £3,500, although they can much of the time be provided free on the NHS, providing the patient is under 18, a student up to 19, a pregnant woman, a nursing mother or living on a low income.[12] In some European countries (e.g. Norway, Finland, Sweden, Slovenia, Slovakia, Germany, Croatia or Denmark) orthodontic treatment is available without charge to patients under 18 (or for treatment to start at 16, such as Republic of Ireland and the UK) as benefits for orthodontic treatment are provided under government-run health care systems. However, in the UK, the National Health Service will not pay for braces if the teeth do not a have protrusion of over 5mm; if there is not a protrusion, it is classed as cosmetic. In some countries (e.g. Ireland), adults can also get treatment at a discounted rate, or claim tax relief after paying a full cost with a private practitioner. In India this treatment can cost anywhere between INR 10000 to INR 80000. The cost also depends on the type of braces, the type of city the patient is in and on the orthodontist's skill and experience. In Saudi Arabia the price of treatment ranges between 3500SR to 15000SR.

crowns Return to the top

crown is a type of dental restoration which completely caps or encircles a tooth or dental implant. Crowns are often needed when a large cavity threatens the ongoing health of a tooth[1]. They are typically bonded to the tooth using a dental cement. Crowns can be made from many materials, which are usually fabricated using indirect methods. Crowns are often used to improve the strength or appearance of teeth. While unarguably beneficial to dental health, the procedure and materials can be relatively expensive[2]. The most common method of crowning a tooth involves using a dental impression of a prepared tooth by a dentist to fabricate the crown outside of the mouth. The crown can then be inserted at a subsequent dental appointment. Using this indirect method of tooth restoration allows use of strong restorative materials requiring time consuming fabrication methods requiring intense heat, such as casting metal or firing porcelain which would not be possible to complete inside the mouth. Because of the expansion properties, the relatively similar material costs, and the aesthetic benefits, many patients choose to have their crown fabricated with gold[3]. As new technology and materials science has evolved, computers are increasingly becoming a part of crown and bridge fabrication, such as in CAD/CAM Dentistry. Contents [hide] * 1 Other reasons to restore with a crown o 1.1 Implants o 1.2 Endodontically treated teeth o 1.3 Surveyed crown o 1.4 Aesthetics * 2 Tooth preparation o 2.1 Dimensions of preparation o 2.2 Taper o 2.3 Margin o 2.4 Ferrule effect * 3 Adequate and appropriate restoration of tooth structure * 4 3/4 and 7/8 crowns * 5 All-ceramic restorations * 6 Longevity * 7 Advantages and disadvantages * 8 Types and materials o 8.1 Metal-containing restorations + 8.1.1 Full gold crown o 8.2 Porcelain-fused-to-metal crowns o 8.3 Restorations without Metal + 8.3.1 Chairside CAD/CAM Dentistry + 8.3.2 Empress + 8.3.3 In-ceram + 8.3.4 Procera * 9 See also * 10 References * 11 External links [edit] Other reasons to restore with a crown There are additional situations in which a crown would be the restoration of choice. [edit] Implants Dental implants are placed into either the maxilla or mandible as an alternative to partial or complete edentulism. Once placed and properly integrated into the bone, implants may then be fitted with a number of different prostheses: * crowns or bridges * precision attachments for either removable partial dentures, complete dentures or a hybrid sort of prosthetic appliance. [edit] Endodontically treated teeth When teeth undergo endodontic treatment, or root canal therapy, they are devitalized when the nerve and blood supply are cut off and the space which they previously filled, known as the "pulp chamber" and "root canal", are thoroughly cleansed and filled with various materials to prevent future invasion by bacteria. Although there may very well be enough tooth structure remaining after root canal therapy is provided for a particular tooth to restore the tooth with an intracoronal restoration, this is not suggested in most teeth. The vitality of a tooth is remarkable in its ability to provide the tooth with the strength and durability it needs to function in mastication. The living tooth structure is surprisingly resilient and can sustain considerable abuse without fracturing. Consequently, after root canal therapy is performed, a tooth becomes extremely brittle and is significantly weaker than its vital neighbors. Fractures of endodontically treated teeth increase considerably in the posterior dentition when cuspal protection is not provided by a crown.[4] The average person can exert 150-200 lbs. of muscular force on their posterior teeth, which is approximately nine times the amount of force that can be exerted in the anterior. If the effective posterior contact area on a restoration is 0.1 mm², over 1 million PSI of stress is placed on the restoration. Therefore, posterior teeth (i.e. molars and premolars) should in almost all situations be crowned after undergoing root canal therapy to provide for proper protection against fracture (mandibular premolars, being very similar in crown morphology to canines, may in some cases be protected with intracoronal restorations). Should an endodontically treated tooth not be properly protected, there is a chance of it succumbing to breakage from normal functional forces. This fracture may well be difficult to treat, such as a "vertical root fracture" . Anterior teeth (i.e. incisors and canines), which are exposed to significantly lower functional forces, may effectively be treated with intracoronal restorations following root canal therapy if there is enough tooth structure remaining after the procedure. [edit] Surveyed crown Another situation in which a crown is the restoration of choice is when a tooth is intended as an abutment tooth for a removable partial denture, but is initially unfavorable for such a task. If the abutment teeth onto which the RPD is supposed to clasp do not possess the proper dimensions or features required, these aspects can be built into what is known as a surveyed crown. [edit] Aesthetics A fourth situation in which a crown would be the restoration of choice is when a patient desires to have his or her smile aesthetically improved but when partial coverage (i.e., a veneer/laminate) is not an option for one or more reasons. If the patient's occlusion does not permit for a mildly-retentive restoration, or if there is too much decay or a fracture within the tooth structure, a porcelain or composite veneer may not be placed with any adequate guarantee for its durability. Similarly, a "bruxer" (someone who clenches or grinds their teeth) may produce enough force to repeatedly dislodge or irreversibly abrade any veneer a dentist can plan for. In such a case, full coverage crowns can alter the size, shape or shade of a patient's teeth while protecting against failure of the restoration. Makeover shows such as Extreme Makeover make extensive use of crowns, as the time-frame of the makeover is too short to allow up to 18 months for orthodontic treatment for problems that might otherwise be corrected more conservatively. [edit] Tooth preparation A full-arch vinylpolysiloxane impression of the teeth prepared for the 5-unit PFM bridge shown in the photographs below. The salmon-colored impression material used near the crown preparations is of a lower viscosity than the blue, allowing for the capture of greater detail. Preparation of a tooth for a crown involves the irreversible removal of a significant amount of tooth structure. All restorations possess compromised structural and functional integrity when compared to healthy, natural tooth structure. Thus, if not indicated as desirable by an oral health-care professional, the crowning of a tooth would most likely be contraindicated. It should be evident, though, that dentists trained at different institutions in different eras and in different countries might very well possess different methods of treatment planning and case selection, resulting in somewhat diverse recommendations for treatment. Traditionally more than one visit is required to complete crown and bridge work, and the additional time required for the procedure can be a disadvantage; the increased benefits of such a restoration, however, will generally offset these considerations. [edit] Dimensions of preparation When preparing a tooth for a traditional crown, the enamel may be totally removed and the finished preparation should, thus, exist primarily in dentin. As elaborated on below, the amount of tooth structure required to be removed will depend on the material(s) being used to restore the tooth. If the tooth is to be restored with a full gold crown, the restoration need only be .5 mm in thickness (as gold is very strong), and therefore, a minimum of only .5 mm of space needs to be made for the crown to be placed. If porcelain is to be applied to the gold crown, an additional minimum of 1 mm of tooth structure needs to be removed to allow for a sufficient thickness of the porcelain to be applied, thus bringing the total tooth reduction to minimally 1.5 mm. If there is not enough tooth structure to properly retain the traditional prosthetic crown, the tooth requires a build-up material. This can be accomplished with a pin-retained direct restoration, such as amalgam or a composite resin, or in more severe cases, may require a post and core. Should the tooth require a post and core, endodontic therapy would then be indicated, as the post descends into the devitalized root canal for added retention. If the tooth, because of its relative lack of exposed tooth structure, also requires crown lengthening, the total combined time, effort and cost of the various procedures, together with the decreased prognosis because of the combined inherent failure rates of each procedure, might make it more reasonable to have the tooth extracted and opt to have an implant placed. In recent years, the technological advances afforded by CAD/CAM Dentistry offer viable alternatives to the traditional crown restoration in many cases. [5][6] Where the traditional indirectly fabricated crown requires a tremendous amount of surface area to retain the normal crown, potentially resulting in the loss of healthy, natural tooth structure for this purpose, the all-porcelain CAD/CAM crown can be predictably used with significantly less surface area. As a matter of fact, the more enamel that is retained, the greater the likelihood of a successful outcome. As long as the thickness of porcelain on the top, chewing portion of the crown is 1.5mm thick or greater, the restoration can be expected to be successful. The side walls which are normally totally sacrificed in the traditional crown are generally left far more intact with the CAD/CAM option. In regards to post & core buildups, these are generally contraindicated in CAD/CAM crowns as the resin bonding materials do best bonding the etched porcelain interface to the etched enamel/dentin interfaces of the natural tooth itself. The crownlay is also an excellent alternative to the post & core buildup when restoring a root canal treated tooth. [edit] Taper The prepared tooth also needs to possess 3 to 5 degrees of taper to allow for the restoration to be properly placed on the tooth. The taper should not exceed 20 degrees. Fundamentally, there can be no undercuts on the surface of the prepared tooth, as the restoration will not be able to be removed from the die, let alone fit on the tooth (see explanation of lost-wax technique below to understand of the processes involved in crown fabrication). At the same time, too much taper will severely limit the grip that the crown has on the prepared tooth, thus contributing to failure of the restoration. Generally, 6º of taper around the entire circumference of the prepared tooth, giving a combined taper of 12º at any given sagittal section through the prepared tooth, is appropriate to both allow the crown to fit yet provide enough grip. [edit] Margin The most coronal position of untouched tooth structure (that is, the continual line of original, undrilled tooth structure at or near the gum line) is referred to as the margin. This margin will be the future continual line of tooth-to-restoration contact, and should be a smooth, well-defined delineation so that the restoration, no matter how it is fabricated, can be properly adapted and not allow for any openings visible to the naked eye, however slight. An acceptable distance from tooth margin to restoration margin is anywhere from 40-100 μm[citation needed]. However, the R.V. Tucker method of gold inlay and onlay restoration produces tooth-to-restoration adaptation of potentially only 2 μm[citation needed], confirmed by scanning electron microscopy; this is less than the diameter of a single bacterium. Naturally, the tooth-to-restoration margin is an unsightly thing to have exposed on the visible surface of a tooth when the tooth exists in the aesthetic zone of the smile. In these areas, the dentist would like to place the margin as far apical (towards the root tip of the tooth) as possible, even below the gum line. While there is no issue, per se, with placing the margin at the gumline, problems may arise when placing the margin too subgingivally (below the gumline). First, there might be issues in terms of capturing the margin in an impression to make the stone model of the prepared tooth (see stone model replication of tooth in photographs, above). Secondly, there is the seriously important issue of biologic width. Biologic width is the mandatory distance to be left between the height of the alveolar bone and the margin of the restoration, and if this distance is violated because the margin is placed too subgingivally, serious repercussions may follow. In situations where the margin cannot be placed apically enough to provide for proper retention of the prosthetic crown on the prepared tooth structure, the tooth or teeth involved should undergo a crown lengthening procedure. The natural tooth's crown (A) meets the root (B) at the cementoenamel junction, and it is roughly at this point that the gingival attachment begins at the base of the gingival sulcus (G). The margin of the prosthetic crown may not violate the 2 mm of biologic width from the base of this sulcus to the height of the alveolar bone (C) if complications are to be avoided. There are a number of different types of margins that can be placed for restoration with a crown. There is the chamfer, which is popular with full gold restorations, which effectively removed the smallest amount of tooth structure. There is also a shoulder, which, while removing slightly more tooth structure, serves to allow for a thickness of the restoration material, necessary when applying porcelain to a PFM coping or when restoring with an all-ceramic crown (see below for elaboration on various types of crowns and their materials). When using a shoulder preparation, the dentist is urged to add a bevel; the shoulder-bevel margin serves to effectively decrease the tooth-to-restoration distance upon final cementation of the restoration. [edit] Ferrule effect A very important consideration when restoring with a crown is the incorporation of the ferrule effect. As with the bristles of a broom, which are grasped by a ferrule when attached to the broomstick, the crown should envelop a certain height of tooth structure to properly protect the tooth from fracture after being prepared for a crown. This has been established through multiple experiments as a mandatory continuous circumferential height of 2 mm; any less provides for a significantly higher failure rate of endodontically-treated crown-restored teeth. When a tooth is not endodontically treated, the remaining tooth structure will invariably provide the 2 mm height necessary for a ferrule, but endodontically treated teeth are notoriously decayed and are often missing significant solid tooth structure. Because they are weaker after the additional removal of tooth structure that occurs during a root canal procedure, endodontically treated teeth require proper protection against vertical root fracture. Contrary to what some dentists believe, a bevel is not at all suitable for implementing the ferrule effect, and beveled tooth structure may not be included in the 2 mms of required tooth structure for a ferrule. Some have speculated that a shoulder preparation on an all ceramic crown that will be bonded in place may have the same effect as a ferrule. [edit] Adequate and appropriate restoration of tooth structure As crowns are fabricated indirectly (outside of the mouth) free of the encumbrances of saliva, blood, and tight quarters, they can be made to fit more precisely than restorative materials placed directly (inside the mouth). In regards to marginal adaptations (the circumferential seal which keeps bacteria out), anatomically correct contacts (touching adjacent teeth properly so food will not be retained), and proper morphology, the indirect fabrication of the restorations are unprecedented. Indirectly fabricated crowns may be fabricated one of two ways. In the traditional sense, the tooth in question is prepared, a mold is taken, a temporary crown is placed and then the patient leaves. The mold is then sent to a dental laboratory whereby a model is constructed from the mold, and a crown is created on the model (usually out of porcelain, ceramic, gold, or porcelain/ceramic fused to metal) to replace the missing tooth structure. The patient returns to the dental office a week or two later and then the temporary is removed and the crown is fitted and cemented in place. Alternatively, a crown may be indirectly fabricated utilizing technology and techniques relating to CAD/CAM Dentistry, whereby the tooth is prepared and computer software is used to create a virtual restoration which is milled on the spot and bonded permanently in place an hour or two later. [edit] 3/4 and 7/8 crowns There are even restorations that fall between an onlay and a full crown when it comes to preservation of natural tooth structure. In the past, it was somewhat common to find dentists who prepared teeth for 3/4 and 7/8 crowns. Such restorations would generally be fabricated for maxillary second premolars or first molars, which might only be slightly visible when a patient smiled. Thus, the dentist would preserve healthy natural tooth structure that existed on the mesiobuccal corner of the tooth for aesthetic purposes, the remainder of the tooth would be enclosed in restorative material. Even when porcelain-fused-to-metal and all-ceramic crowns were developed, preserving any amount of tooth structure adds to the overall strength of the tooth. As one can imagine, though, those dentists who took issue with the increased marginal length of the onlay restoration would surely take issue with the purported advantages of increased remaining tooth structure when it translated into the enormously increased marginal length of a 3/4 or 7/8 crown.

floss Return to the top

Dental floss is either a bundle of thin nylon filaments or a plastic (Teflon or polyethylene) ribbon used to remove food and dental plaque from teeth. The floss is gently inserted between the teeth and scraped along the teeth sides, especially close to the gums. Dental floss may be flavored or unflavored, and waxed or unwaxed. An alternative tool to achieve the same effect is the interdental brush. Contents [hide] * 1 History * 2 Use * 3 Directions * 4 Vibration * 5 Benefits * 6 Floss threader * 7 See also * 8 References * 9 External links [edit] History Dental floss Levi Spear Parmly, a dentist from New Orleans, is credited with inventing the first form of dental floss. He recommended that people should clean their teeth with silk floss in 1815.[1] Dental floss was still unavailable to the consumer until the Codman and Shurtleft company started producing human-usable unwaxed silk floss in 1882. In 1898, the Johnson & Johnson Corporation received the first patent for dental floss. Other early brands included Red Cross, Salter Sill Co. and Brunswick. A character is depicted using dental floss in James Joyce's famous novel Ulysses (serialised 1918-1920) and is an early mention of the practice in literary fiction. The adoption of floss was poor before World War II. It was around this time, however, that Dr. Charles C. Bass developed nylon floss. Nylon floss was found to be better than silk because of its greater abrasion resistance and elasticity. In response to environmental concerns, dental floss made from biodegradable materials is now available. Dentists and dental hygienists urge the daily oral hygiene regimen of toothbrushing and flossing. Nearly all Americans brush their teeth. However, studies have found that only 10 to 40% of Americans report flossing on a daily basis.[2] [edit] Use Dental floss is commonly supplied in plastic dispensers that contain 10 to 50 meters of floss. After pulling out the desired amount, the floss is pulled against a small protected blade in the dispenser to sever it. Dental floss is held between the fingers. The floss is guided between each tooth and under the gumline to remove particles of food stuck between teeth and dento-bacterial plaque that adhere to such dental surfaces. Ideally using a C-shape, the floss is curved around a tooth and placed under the gumline, and then moved away from the gumline, the floss scrapes the side of each tooth, and can also clean the front or back of the tooth. Gently moving the floss from below the gumline to away from the gumline removes dento-bacterial plaque attached to teeth surfaces above and below the gumline. A clean section of floss can be used to clean each tooth to avoid transmitting plaque bacteria from one tooth to another. There are many different kinds of dental floss commonly available. The most important variable is thickness. If the floss is too thick for the space between a pair of teeth then it will be difficult or impossible to get the floss down between the teeth. On the other hand, if the floss is too thin, it may be too weak and break. Different floss will suit different mouths, and even different parts of one mouth. This is because some teeth have a smaller gap between them than others. It's possible that thicker floss does a better job of scraping bacterial plaque off teeth, given that there is space enough between the teeth to use it. When a piece of hard food is tightly wedged between the teeth, one may need to switch to thinner floss, because thick floss cannot get past the food. It is possible to split some kinds of dental floss lengthwise generating a pair of thinner pieces that are much weaker but sometimes usable. This is possible because some kinds of dental floss are made of many very thin strands that are not woven together but rather run more or less in parallel. This can also be useful if the dental floss you have is too thick for you, for any other reason, and you do not have access to any other, for example when travelling in a foreign country. F-shaped and Y-shaped dental floss wands Ergonomic flosser with swiveling, disposable heads Specialized plastic wands, or floss picks, have been produced to hold the floss. These may be attached to or separate from a floss dispenser. While not pinching the finger, using a wand may be awkward and also make it difficult to floss at all the angles possible with a finger. At the same time, the enhanced reach can make flossing the back teeth easier. These types of flossers may be missing the area under the gum line that needs to be flossed. Ergonomic flossers with improved handle for better grip and swiveling floss heads allow easy access to any pair of teeth in the mouth, to the front teeth as well as to the rear teeth. Also their floss heads feature a lateral flexibility that enables improved control for the dental floss to hug the sides of the teeth and clean under the gum line without the danger of hurting the gums. Occasional flossing and/or improper flossing can typically lead to bleeding gums. The main cause of the bleeding is inflammation of the gingival tissue due to gingivitis. [edit] Directions The American Dental Association advises to floss thoroughly once or more per day. While they do not make a recommendation regarding the order of brushing and flossing, flossing prior to brushing allows for fluoride from the toothpaste to reach between the teeth.[3] Overly vigorous or incorrect flossing can result in gum tissue damage. For proper flossing, the Association advises to curve the floss against the side of the tooth in a 'C' shape, and then to wipe the tooth from under the gumline (very gently) to the tip two or three times, repeated on adjacent and subsequent teeth. [edit] Vibration Some power flossers use vibration which transfers through the floss, originating from the ends. This is likely inspired by the similar use of vibration of the bristles in modern electric toothbrushes. As the vibration causes subtle movement, the floss will find the path of least resistance when pressed down. The movement would also help in temporarily separating tooth and gum for floss to get through. This allows easier penetration under the gumline, with less force applied to push into the gap between teeth. With less force applied, more control of flossing is possible. In normal flossing, pressure may be applied until the floss 'pops' through the teeth, and the momentum can carry on and painfully impact the gum tissue. With more control, this can be reduced or avoided completely. Many consider vibrations to be soothing; it is a common technique in massage and orthopedic devices. Much like electric toothbrushes are soothing to the teeth and gums, vibrating floss can soothe and massage the gumline. Cuts become less likely as the floss will not press against as isolated an area, and less pressure is applied. Any abrasions to the gum would be more evenly distributed, leading to more equal adaptation of the tissue.[citation needed] [edit] Benefits Flossing in combination with toothbrushing can prevent gum disease,[4] halitosis,[5] and dental caries.[6][7] Regular flossing is also linked to reduced incidence of heart disease.[8] Flossing is correlated with greater longevity, potentially as a result of the prevention of gum inflammation.[9][10] [edit] Floss threader A Floss Threader A floss threader is loop of fiber (similar to fishing line) used to thread floss into small places around teeth. Threaders are sometimes required to floss with dental braces, fix retainers, bridges, and crowns. [edit] See also * Floss pick * Interdental brush * Tongue cleaner * Crest Glide

root canal Return to the top

A root canal is the space within the root of a tooth. It is part of a naturally occurring space within a tooth that consists of the pulp chamber (within the coronal part of the tooth), the main canal(s), and more intricate anatomical branches that may connect the root canals to each other or to the surface of the root. The smaller branches, referred to as accessory canals, are most frequently found near the root end (apex) but may be encountered anywhere along the root length. There may be one or two main canals within each root. Some teeth have more variable internal anatomy than others. This space is filled with a highly vascularized, loose connective tissue, the dental pulp. The dental pulp is the tissue of which the dentin portion of the tooth is composed. The dental pulp helps complete formation of the secondary teeth (adult teeth) one to two years after eruption into the mouth. The dental pulp also nourishes and hydrates the tooth structure which makes the tooth more resilient, less brittle and less prone to fracture from chewing hard foods. Additionally, the dental pulp provides a hot and cold sensory function. Root canal is also a colloquial term for a dental operation, endodontic therapy, wherein the pulp is cleaned out, the space disinfected and then filled. Contents [hide] * 1 Tooth structure * 2 See also * 3 Notes * 4 External links [edit] Tooth structure At the center of a tooth is a hollow area that houses soft tissue, known as pulp or nerve. This hollow area contains a relatively wide space in the coronal portion of the tooth called the pulp chamber. This chamber is connected to the tip of the root via narrow canal(s); hence, the term "root canal". Human teeth normally have one to four canals, with teeth toward the back of the mouth having more. These canals run through the center of the roots like pencil lead through the length of a pencil. The pulp receives nutrition through the blood vessels and sensory nerves carry signals back to the brain. For many people who experience tooth pain or discomfort, a root canal may be recommended, and a qualified dentist or more preferably an endodontist (root canal therapy specialist) should be consulted in a timely manner.

children Return to the top

Biologically, a child (plural: children) is generally a human between the stages of birth and puberty. The legal definition of "child" generally refers to a minor, otherwise known as a person younger than the age of majority. "Child" may also describe a relationship with a parent or authority figure, or signify group membership in a clan, tribe, or religion; it can also signify being strongly affected by a specific time, place, or circumstance, as in "a child of nature" or "a child of the Sixties."[1] Contents [hide] * 1 Legal, biological, and social definitions o 1.1 As a non-adult * 2 Attitudes toward children * 3 Age of responsibility * 4 Socialization of the child * 5 Child mortality * 6 See also * 7 References [edit] Legal, biological, and social definitions Population aged under 15 years in 2005 The United Nations Convention on the Rights of the Child defines a child as "a human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier."[2] Ratified by 192 of 194 member countries. Biologically, a child is anyone between birth and puberty or in the developmental stage of childhood, between infancy and adulthood. Children generally have fewer rights than adults and are classed as not able to make serious decisions, and legally must always be under the care of a responsible adult. [edit] As a non-adult Recognition of childhood as a state different from adulthood began to emerge in the 16th and 17th centuries. Society began to relate to the child not as a miniature adult but as a person of a lower level of maturity needing adult protection, love and nurturing. This change can be traced in painting: In the Middle Ages, children were portrayed in art as miniature adults with no childish characteristics. In the 16th century, images of children began to acquire a distinct childish appearance. From the late 17th century onwards, children were shown playing. Toys and literature for children also began to develop at this time.[3] Peruvian school children in Lima [edit] Attitudes toward children Social attitudes toward children differ around the world in various cultures. These attitudes have changed over time. A 1988 study on European attitudes toward the centrality of children found that Italy was more child-centric and Holland less child-centric, with other countries, such as Austria, Great Britain, Ireland and West Germany falling in between.[4] [edit] Age of responsibility The age at which children are considered responsible for their own actions (e.g., marriage, voting, etc.) has also changed over time, and this is reflected in the way they are treated in courts of law. In Roman times, children were regarded as not culpable for crimes, a position later adopted by the Church. In the nineteenth century, children younger than seven years old were believed incapable of crime. Children from the age of seven forward were considered responsible for their actions. Therefore, they could face criminal charges, be sent to adult prison, and be punished like adults by whipping, branding or hanging.[5] Surveys have found that at least 25 countries around the world have no specified age for compulsory education. Minimum employment age and marriage age also vary. In at least 125 countries, children aged 7–15 may be taken to court and risk imprisonment for criminal acts. In some countries, children are legally obliged to go to school until they are 14 or 15 years old, but may also work before that age. A child's right to education is threatened by early marriage, child labour and imprisonment.[6] Further information: Age of consent, Age of majority, Age of criminal responsibility, and Marriageable age [edit] Socialization of the child Children in Namibia All children go through stages of social development. An infant or very young child will play alone happily. If another child wanders onto the scene, he or she may be physically attacked or pushed out of the way. Next, the child is able to play with another child, gradually learning to share and take turns. Eventually the group grows larger, to three or four children. By the time a child enters kindergarten, he or she is usually able to join in and enjoy group experiences.[7] Children with ADHD and learning disabilities may need extra help in developing social skills. The impulsive characteristics of an ADHD child may lead to poor peer relationships. Children with poor attention spans may not tune in to social cues in their environment, making it difficult for them to learn social skills through experience.[7] [edit] Child mortality According to population health experts, child mortality rates have fallen sharply since the 1990s. Deaths of children under the age of five are down by 42% in the United States, while Serbia and Malaysia have cut their rates by nearly 70%.[8] [edit] See also Listen to this article (info/dl) Play sound This audio file was created from a revision of Child dated 2008-06-24, and does not reflect subsequent edits to the article. (Audio help) More spoken articles Sound-icon.svg * Child (hieroglyph) * Childhood * Advertising to children * Age of consent * Child development * Children Youth and Environments Journal * Defense of infancy * List of youth topics * Youth rights * List of terms of endearment * Children's clothing

toothpaste Return to the top

Toothpaste is a paste or gel dentifrice used with a toothbrush as an accessory to clean and maintain the aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it serves as an abrasive that aids in removing the dental plaque and food from the teeth, assists in suppressing halitosis, and delivers active ingredients such as fluoride or xylitol to help prevent tooth and gum disease (gingivitis).[1] Most of the cleaning is achieved by the mechanical action of the toothbrush, and not by the toothpaste. Salt and Baking soda are among materials that can be substituted for commercial toothpaste. Toothpaste is not intended to be swallowed. Contents [hide] * 1 Ingredients o 1.1 Abrasives o 1.2 Fluorides o 1.3 Surfactants o 1.4 Other components + 1.4.1 Antibacterial agents + 1.4.2 Flavorants + 1.4.3 Remineralizers + 1.4.4 Miscellaneous components * 2 Safety o 2.1 Fluoride o 2.2 Triclosan o 2.3 Diethylene glycol o 2.4 Miscellaneous issues and debates + 2.4.1 Alteration of taste perception * 3 Other types of toothpaste o 3.1 Whitening toothpastes o 3.2 Herbal and "natural" toothpastes * 4 History o 4.1 Early toothpastes o 4.2 Tooth powder o 4.3 Modern toothpaste o 4.4 Striped toothpaste * 5 See also * 6 Notes * 7 External links [edit] Ingredients In addition to 20-42% water, toothpastes are derived from a variety of components, including three main ones: abrasives, fluoride, and detergents. [edit] Abrasives Abrasives constitute at least 50% of a typical toothpaste. These insoluble particles help remove plaque from the teeth. The removal of plaque and calculus prevents caries and periodontal disease. Representative abrasives include particles of aluminum hydroxide (Al(OH)3), calcium carbonate (CaCO3), various calcium hydrogen phosphates, various silicas and zeolites, and hydroxyapatite (Ca5(PO4)3OH). Abrasives, like the dental polishing agents used in dentists' offices, also cause a small amount of enamel erosion which is termed "polishing" action. Some brands contain powdered white mica which acts as a mild abrasive, and also adds a cosmetically-pleasing glittery shimmer to the paste. The polishing of teeth removes stains from tooth surfaces, but has not been shown to improve dental health over and above the effects of the removal of plaque and calculus.[2] [edit] Fluorides Fluoride in various forms is the most popular active ingredient in toothpaste to prevent cavities. Although it occurs in small amounts in plants, animals, and some natural water sources, the additional fluoride has beneficial effects on the formation of dental enamel and bones. Sodium fluoride (NaF) is the most common source of fluoride but stannous fluoride (SnF2), Olaflur (an organic salt of fluoride), and sodium monofluorophosphate (Na2PO3F) are also used. Much of the toothpaste sold in the United States has 1000 to 1100 parts per million fluoride. In the UK, the fluoride content is often higher, a NaF of 0.32% w/w (1,450 ppm fluoride) is not uncommon. [edit] Surfactants Many, although not all, toothpastes contain sodium lauryl sulfate (SLS) or related surfactants (detergents). SLS is found in many other personal care products as well, such as shampoo, and is mainly a foaming agent, which enables uniform distribution of toothpaste, improving its cleansing power.[2] [edit] Other components [edit] Antibacterial agents Triclosan, an antibacterial agent, is a common toothpaste ingredient in the UK. Triclosan or zinc chloride prevent gingivitis and, according to the American Dental Association, helps reduce tartar and bad breath.[1][3] [edit] Flavorants Toothpaste comes in a variety of colorings, and flavors intended to encourage use of the product. Three most common flavorants are peppermint, spearmint, and wintergreen. Toothpaste flavored with peppermint-anise oil is popular in the Mediteranian region. These flavors are provided by the respective oils, e.g. peppermint oil.[2] More exotic flavors include anise, apricot, bubblegum, cinnamon, fennel, lavender, neem, ginger, vanilla, lemon, orange, and pine. More unusual flavors have been used, e.g. peanut butter, iced tea, and even whisky. Unflavored toothpaste exist. [edit] Remineralizers Hydroxyapatite nanocrystals and calcium phosphate are included in some formulations for remineralization,[4] i.e. the reformation of enamel. Toothpaste is sold in many brands [edit] Miscellaneous components Agents are added to suppress the tendency of toothpaste to dry into a powder. Included are various sugar alcohols such as glycerol, sorbitol, xylitol, or related derivatives, such as 1,2-propylene glycol and polyethyleneglycol.[5] Strontium chloride or potassium nitrate are included in some toothpastes to reduce sensitivity. Sodium polyphosphate is added to minimize the formation of tartar. [edit] Safety [edit] Fluoride Although water fluoridation has been praised as one of the top medical achievements of the 20th century,[6] fluoride-containing toothpaste can be acutely toxic if swallowed in large amounts.[7][8] The risk of using fluoride is low enough that the use of 'full-strength' toothpaste (1350-1500ppm fluoride) is advised for all ages (although smaller volumes are used for young children; a 'smear' of toothpaste until 3 years).[8] Several non-fluoride toothpastes are available. [edit] Triclosan Reports have suggested that triclosan, an active ingredient in many toothpastes, can combine with chlorine in tap water to form chloroform ,[9] which the United States Environmental Protection Agency classifies as a probable human carcinogen. An animal study revealed that the chemical might modify hormone regulation, and many other lab researches proved that bacteria might be able to develop resistance to triclosan in a way, which can help them to resist antibiotics also.[10] [edit] Diethylene glycol The inclusion of sweet-tasting but toxic diethylene glycol in Chinese-made toothpaste led to a multi-nation and multi-brand toothpaste recall in 2007.[11] The world outcry made Chinese officials ban the practice of using diethylene glycol in toothpaste.[12] [edit] Miscellaneous issues and debates With the exception of toothpaste intended to be used on pets such as dogs and cats, and toothpaste used by astronauts, most toothpaste is not intended to be swallowed, and doing so may cause nausea or diarrhea. 'Tartar fighting' toothpastes have been debated.[13] Case reports of plasma cell gingivitis have been reported with the use of herbal toothpaste containing cinnamon.[14] SLS has been proposed increase the frequency of mouth ulcers in some people as it can dry out the protective layer of oral tissues causing the underlying tissues to become damaged.[15] [edit] Alteration of taste perception After using toothpaste, orange juice and other juices have an unpleasant taste. This effect is attributed to products of the chemical reaction between stannous fluoride in toothpaste and the acetic acid in the juices.[16] Sodium lauryl sulfate alters taste perception. It can break down phospholipids that inhibit taste receptors for bitterness, giving food a bitter taste. It is also thought to inhibit sweet receptors. In contrast, apples are known to taste more pleasant after using toothpaste.[17] Distinguishing between the hypotheses that the bitter taste of orange juice results from stannous fluoride or from sodium lauryl sulfate is still an unresolved issue and it is thought that the menthol added for flavor may also take part in the alteration of taste perception when binding to lingual cold receptors. [edit] Other types of toothpaste [edit] Whitening toothpastes Many toothpastes make whitening claims. Some of these toothpastes contain peroxide, the same ingredient found in tooth bleaching gels. The abrasive in these toothpaste remove the stains, not the peroxide. Whitening toothpaste cannot alter the natural color of teeth or reverse discoloration by penetrating surface stains or decay. To remove surface stains, whitening toothpaste may include abrasives and additives such as sodium tripolyphosphate. When used twice a day, whitening toothpaste typically takes two to four weeks to make teeth appear less yellow. Whitening toothpaste is generally safe for daily use, but excessive use might damage tooth enamel. Teeth whitening gels represent an alternative.[citation needed] [edit] Herbal and "natural" toothpastes Herbal toothpaste from Croatia Herbal toothpastes are made from natural ingredients and some are even certified as organic. Many consumers have started to switch over to natural toothpastes in order to avoid synthetic and artificial flavors that are commonly found in regular toothpastes.[18] Due to the increased demand of natural products, most of the toothpaste manufacturers now produce herbal toothpastes. This type of toothpaste does not contain dyes or artificial flavors. Many herbal toothpastes do not contain fluoride or sodium laurel sulfate. The ingredients found in natural toothpastes vary widely but often include baking soda, aloe, eucalyptus oil, myrrh, plant extract (strawberry extract), and essential oils. In addition to the commercially available products, it is possible to make ones own toothpaste using similar ingredients. When using a toothpaste that has not been proven to be efficient in preventing periodontal diseases it is particularly important to have regular dental checkups. [edit] History [edit] Early toothpastes Toothpastes or powders came into general use in the 19th century. The Greeks, and then the Romans, improved the recipes for toothpaste by adding abrasives such as crushed bones and oyster shells.[19] In the 9th century, the Persian musician and fashion designer Ziryab invented a type of toothpaste, which he popularized throughout Islamic Spain.[20] The exact ingredients of this toothpaste are unknown,[21] but it was reported to have been both "functional and pleasant to taste".[20] It is not known whether these early toothpastes were used alone, were to be rubbed onto the teeth with rags, or were to be used with early toothbrushes, such as neem-tree twigs and miswak. Washington Sheffield made the original collapsible toothpaste tubes lead.[22][23] [edit] Tooth powder Tooth powders for use with toothbrushes came into general use in the 19th century in Britain. Most were homemade, with chalk, pulverized brick, or salt as ingredients. An 1866 Home Encyclopedia recommended pulverized charcoal, and cautioned that many patented tooth powders that were commercially marketed did more harm than good. [edit] Modern toothpaste Modern toothpaste gel An 18th century American and British toothpaste recipe called for burnt bread. Another formula around this time called for dragon's blood (a resin), cinnamon, and burnt alum.[24] By 1900, a paste made of hydrogen peroxide and baking soda was recommended for use with toothbrushes. Pre-mixed toothpastes were first marketed in the 19th century, but did not surpass the popularity of tooth-powder until World War I. In 1892, Dr. Washington Sheffield of New London, Connecticut, manufactured toothpaste into a collapsible tube, Dr. Sheffield's Creme Dentifrice. He had the idea after his son traveled to Paris and saw painters using paint from tubes. In New York City in 1896, Colgate & Company Dental Cream was packaged in collapsible tubes imitating Sheffield. Fluoride was first added to toothpastes in 1914, and was initially criticized by the American Dental Association (ADA) in 1937. Fluoride toothpastes developed in the 1950s received the ADA's approval. To develop the first ADA-approved fluoride toothpaste, Procter & Gamble started a research program in the early 1940s. In 1950, Procter & Gamble developed a joint research project team headed by Dr. Joseph Muhler at Indiana University to study new toothpaste with fluoride. In 1955, Procter & Gamble's Crest launched its first clinically proven fluoride-containing toothpaste. On August 1, 1960, the ADA reported that "Crest has been shown to be an effective anticavity (decay preventative) dentifrice that can be of significant value when used in a conscientiously applied program of oral hygiene and regular professional care." The amount of fluoride in toothpastes varies from country to country. In 2006 appeared in Europe the first toothpaste containing synthetic hydroxylapatite as an alternative to fluoride for the remineralization and reparation of tooth enamel. The "biomimetic hydroxylapatite" is intended to protect the teeth by creating a new layer of synthetic enamel around the tooth instead of hardening the existing layer with fluoride that chemically changes it into Fluorapatite.[citation needed] In June, 2007, the US Food and Drug Administration and similar agencies in Panama, Puerto Rico and Australia advised consumers to avoid certain brands of toothpaste manufactured in China, after some were found to contain the poisonous diethylene glycol, also called diglycol or labeled as "DEG" on the tube.[25] [edit] Striped toothpaste The red area represents the material used for stripes, and the rest is the main toothpaste material. The two materials are not in separate compartments; they are sufficiently viscous that they will not mix. Applying pressure to the tube causes the main material to issue out through the pipe. Simultaneously, some of the pressure is forwarded to the stripe-material, which is then pressed onto the main material through holes in the pipe. Striped toothpaste was invented by a New Yorker named Leonard Lawrence Marraffino in 1955. The patent (US patent 2,789,731, issued 1957) was subsequently sold to Unilever, who marketed the novelty under the 'Stripe' brand-name in the early 1960s. This was followed by the introduction of the 'Signal' brand in Europe in 1965 (UK patent 813,514). Although 'Stripe' was initially very successful, it never again achieved the 8% market share that it cornered during its second year. Marraffino's design, which remains in use for single-color stripes, is simple. The main material, usually white, sits at the crimp end of the toothpaste tube and makes up most of its bulk. A thin pipe, through which that carrier material will flow, descends from the nozzle to it. The stripe-material (this was red in 'Stripe') fills the gap between the carrier material and the top of the tube. The two materials are not in separate compartments. The two materials are sufficiently viscous that they will not mix. When pressure is applied to the toothpaste tube, the main material squeezes down the thin pipe to the nozzle. Simultaneously, the pressure applied to the main material causes pressure to be forwarded to the stripe material, which then issues out through small holes (in the side of the pipe) onto the main carrier material as it is passing those holes. In 1990 Colgate-Palmolive was granted a patent (USPTO 4,969,767) for two differently-colored stripes. In this scheme, the inner pipe has a cone-shaped plastic guard around it, and about half way up its length. Between the guard and the nozzle-end of the tube is then a space for the material for one color, which then issues out of holes in the pipe. On the other side of the guard is space for second stripe-material, which has its own set of holes. Striped toothpaste should not be confused with layered toothpaste. Layered toothpaste requires a multi-chamber design (e.g. USPTO 5,020,694), in which two or three layers then extrude out of the nozzle. This scheme, like that of pump dispensers (USPTO 4,461,403), is more complicated (and thus, more expensive to manufacture) than either the Marraffino design or the Colgate design. [edit] See also * Tooth whitening * Dental floss * Fluoride therapy * Creamy snuff * Oral hygiene

laser dentistry Return to the top

A dental laser is a type of laser designed specifically for use in oral surgery or dentistry. In the United States, the use of lasers on the gums was first approved by the Food and Drug Administration in the early 1990s, and use on hard tissue like teeth or the bone of the mandible gained approval in 1996.[1] Several variants of dental laser are in use, with the most common being diode lasers, carbon dioxide lasers, and yttrium aluminium garnet laser. Different lasers use different wavelengths and these mean they are better suited for different applications. For example, diode lasers in the 810–900 nm range are well absorbed by red coloured tissues such as the gingivae increasingly being used in place of electrosurgery and standard surgery for soft tissue applications such as tissue contouring and gingivectomy Use of the dental laser remains limited, with cost and effectiveness being the primary barriers. The cost of a dental laser ranges from $8,000 to $50,000, where a pneumatic dental drill costs between $200 and $500. The lasers are also incapable of performing some routine dental operations.[2] Dental lasers are not without their benefits, though, as the use of a laser can decrease morbidity after surgery, and reduces the need for anesthetics. Because of the cauterisation of tissue there will be little bleeding following soft tissue procedures, and some of the risks of alternative electrosurgery procedures are avoided.

pediatrics Return to the top

Pediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. The age limit of such patients ranges from birth to 18. In countries where the age of majority is 18, this age limit may be from birth to age 17 (such as in Canada). A medical practitioner who specializes in this area is known as a pediatrician. The word pediatrics and its cognates mean healer of children; they derive from two Greek words: παῖς (pais = child) and ἰατρός (iatros = doctor or healer). In Commonwealth countries, the respective spellings paediatrics and paediatrician are usually preferred. There may be a slight semantic difference: in the USA, a pediatrician (US spelling) is often a primary care physician who specializes in children, whereas in the Commonwealth a paediatrician (British spelling) generally is a medical specialist not in primary general practice. For further detail, see discussion on the broad and narrow meanings. Contents [hide] * 1 History * 2 Differences between adult and pediatric medicine * 3 Training of Pediatricians * 4 Social role of pediatric specialists * 5 See also * 6 References * 7 Further reading * 8 External links [edit] History Pediatrics is a relatively new medical specialty, developing only in the mid-19th century. Arthur Jacobi (1830–1919) is known as the father of pediatrics because of his many contributions to the field.[1] Soraneus in Greece in the 2nd century AD wrote the first known manuscript devoted to pediatrics.[2] Rhazes (865–925) in Persia wrote The Diseases of Children, the first book to deal with pediatrics as an independent field of medicine.[3][unreliable source?] The first printed book to be devoted especially to children's diseases was in Italian (1472) by Bagallarder's Little Book on Disease in Children.[2] In Europe in the Enfants-Trouvés (1674–1838) in Paris (French = Hospice for Found-Children, i.e., foundlings). There was a gradual move to found separate institutions specifically for ill children, partly to avoid exposing them to adults in adult hospitals.[4][5] In the Western world, the first generally accepted pediatric hospital is the Hôpital des Enfants Malades (French = Hospital for Sick Children), which opened in Paris in June 1802, on the site of a previous orphanage.[6] From its beginning, this famous hospital accepted patients up to the age of fifteen years,[4] and it continues to this day as the pediatric division of the Necker-Enfants Malades Hospital, created in 1920 by merger with the physically contiguous Necker Hospital, founded in 1778 for adults. This example was only gradually followed in other European countries. The Charité (a hospital founded in 1710) in Berlin established a separate Paediatric Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now Wrocław), both in 1837. The English-speaking world waited until 1852 for its first pediatric hospital, the Hospital for Sick Children, Great Ormond Street, some fifty years after the founding of its namesake in Paris.[6] In the USA, the first similar institutions were the Children's Hospital of Philadelphia, which opened in 1855, and then Boston Children's Hospital (1869).[7] [edit] Differences between adult and pediatric medicine Pediatrics differs from adult medicine in many respects.[8] The obvious body size differences are paralleled by maturational changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and developmental issues are of greater concern to pediatricians than they often are to adult physicians. Treating a child is not like treating a miniature adult. A major difference between pediatrics and adult medicine is that children are minors and, in most jurisdictions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility and informed consent must always be considered in every pediatric procedure. In a sense, pediatricians often have to treat the parents and sometimes, the family, rather than just the child. Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances. [edit] Training of Pediatricians The training of pediatrician varies considerably across the world. Depending on jurisdiction and university, a medical degree course may be either undergraduate-entry or graduate-entry. The former commonly takes five or six years, and has been usual in the Commonwealth. Entrants to graduate-entry courses (as in the USA), usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Medical graduates hold a degree specific to the country and university in and from which they graduated. This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for "internship" or "conditional registration". Within the United States, the term physician also describes holders of the Doctor of Osteopathic medicine (D.O.) degree. For further information on osteopathic medicine, see the entry on the comparison of MD and DO in the US. Pediatricians must undertake further training in their chosen field. This may take from four to eight or more years, (depending on jurisdiction and the degree of specialization). The post-graduate training for a primary care physician, including primary care pediatricians, is generally not as lengthy as for a hospital-based medical specialist. In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in some jurisdictions, specialization in pediatrics may begin before completion of this degree. In some jurisdictions, pediatric training is begun immediately following completion of entry-level training. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing pediatric (or any other) specialization. Specialist training is often largely under the control of pediatric organizations (see below) rather than universities, with varying degrees of government input, depending on jurisdiction. [edit] Social role of pediatric specialists Like other medical practitioners, pediatricians are traditionally considered to be members of a learned profession, because of the extensive training requirements, and also because of the occupation's special ethical and legal duties. Pediatricians commonly enjoy high social status, often combined with expectations of a high and stable income and job security. However, pediatric medical practitioners in general often work long and inflexible hours, with shifts at unsociable times, and may earn less than other professionals whose education is of comparable length.[9] Neonatologists or general pediatricians in hospital practice are often on call at unsociable times for perinatal problems in particular—such as for Cesarean section or other high risk births, and for the care of ill newborn infants

periodontitis Return to the top

Periodontitis is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth. Periodontitis is caused by microorganisms that adhere to and grow on the tooth's surfaces, along with an overly aggressive immune response against these microorganisms. A diagnosis of periodontitis is established by inspecting the soft gum tissues around the teeth with a probe (i.e. a clinical exam) and by evaluating the patient's x-ray films (i.e. a radiographic exam), to determine the amount of bone loss around the teeth.[1] Specialists in the treatment of periodontitis are periodontists; their field is known as "periodontology" or "periodontics". The word "periodontitis" comes from peri ("around"), odont ("tooth") and -itis ("inflammation"). Contents [hide] * 1 Classification o 1.1 Extent o 1.2 Severity * 2 Signs and symptoms o 2.1 Effects outside the mouth * 3 Causes * 4 Prevention * 5 Management o 5.1 Initial therapy o 5.2 Reevaluation o 5.3 Surgery o 5.4 Maintenance o 5.5 Alternative treatments * 6 Prognosis * 7 Epidemiology * 8 In other animals * 9 See also * 10 Further reading * 11 Footnotes * 12 External links [edit] Classification The 1999 classification system for periodontal diseases and conditions listed seven major categories of periodontal diseases,[2] of which the last six are termed destructive periodontal disease because they are essentially irreversible. The seven categories are as follows: 1. Gingivitis 2. Chronic periodontitis 3. Aggressive periodontitis 4. Periodontitis as a manifestation of systemic disease 5. Necrotizing ulcerative gingivitis/periodontitis 6. Abscesses of the periodontium 7. Combined periodontic-endodontic lesions Moreover, terminology expressing both the extent and severity of periodontal diseases are appended to the terms above to denote the specific diagnosis of a particular patient or group of patients. [edit] Extent The extent of disease refers to the proportion of the dentition affected by the disease in terms of percentage of sites. Sites are defined as the positions at which probing measurements are taken around each tooth and, generally, six probing sites around each tooth are recorded, as follows: 1. mesiobuccal 2. mid-buccal 3. distobuccal 4. mesiolingual 5. mid-lingual 6. distolingual If up to 30% of sites in the mouth are affected, the manifestation is classification as localized; for more than 30%, the term generalized is used. [edit] Severity The severity of disease refers to the amount of periodontal ligament fibers that have been lost, termed clinical attachment loss. According to the American Academy of Periodontology, the classification of severity is as follows:[3] * Mild: 1–2 mm of attachment loss * Moderate: 3–4 mm of attachment loss * Severe: ≥ 5 mm of attachment loss [edit] Signs and symptoms Periodontitis manifesting as painful, red, swollen gums, with abundant plaque. In the early stages, periodontitis has very few symptoms and in many individuals the disease has progressed significantly before they seek treatment. Symptoms may include the following: * Redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food (e.g. apples) (though this may occur even in gingivitis, where there is no attachment loss) * Gum swelling that recurs * Halitosis, or bad breath, and a persistent metallic taste in the mouth * Gingival recession, resulting in apparent lengthening of teeth. (This may also be caused by heavy handed brushing or with a stiff tooth brush.) * Deep pockets between the teeth and the gums (pockets are sites where the attachment has been gradually destroyed by collagen-destroying enzymes, known as collagenases) * Loose teeth, in the later stages (though this may occur for other reasons as well) Patients should realize that the gingival inflammation and bone destruction are largely painless. Hence, people may wrongly assume that painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing periodontitis in that patient. [edit] Effects outside the mouth Periodontitis has been linked to increased inflammation in the body such as indicated by raised levels of C-reactive protein and Interleukin-6.[4][5][6][7] It is through this linked to increased risk of stroke,[8][9] myocardial infarction,[10] and atherosclerosis.[11][12][13][14][15][16][17] It also linked in those over 60 years of age to impairments in delayed memory and calculation abilities.[18][19] [edit] Causes Periodontitis is an inflammation of the periodontium, i.e., the tissues that support the teeth. The periodontium consists of four tissues: * gingiva, or gum tissue; * cementum, or outer layer of the roots of teeth; * alveolar bone, or the bony sockets into which the teeth are anchored; * periodontal ligaments (PDLs), which are the connective tissue fibers that run between the cementum and the alveolar bone. This X-ray film displays two lone-standing mandibular teeth, the lower left first premolar and canine, exhibiting severe bone loss of 30–50%. Widening of the periodontal ligament surrounding the premolar is due to secondary occlusal trauma. The primary etiology (cause) of gingivitis is poor oral hygiene which leads to the accumulation of a mycotic [20][21][22][23] and bacterial matrix at the gum line, called dental plaque. Other contributors are poor nutrition and underlying medical issues such as diabetes.[24] New finger nick tests have been approved by the Food and Drug Administration in the US, and are being used in dental offices to identify and screen patients for possible contributory causes of gum disease such as diabetes. In some people, gingivitis progresses to periodontitis - with the destruction of the gingival fibers, the gum tissues separate from the tooth and deepened sulcus, called a periodontal pocket. Subgingival microorganism (those that exist under the gum line) colonize the periodontal pockets and cause further inflammation in the gum tissues and progressive bone loss. Examples of secondary etiology are those things that, by definition, cause microbic plaque accumulation, such as restoration overhangs and root proximity. The excess restorative material that exceeds the natural contours of restored teeth, such as these, are termed "overhangs", and serve to trap microbic plaque, potentially leading to localized periodontitis. Smoking is another factor that increases the occurrence of periodontitis, directly or indirectly,[25][26][27] and may interfere with or adversely affect its treatment.[28][29][30] If left undisturbed, microbic plaque calcifies to form calculus, which is commonly called tartar. Calculus above and below the gum line must be removed completely by the dental hygienist or dentist to treat gingivitis and periodontitis. Although the primary cause of both gingivitis and periodontitis is the microbic plaque that adheres to the tooth surface, there are many other modifying factors. A very strong risk factor is one's genetic susceptibility. Several conditions and diseases, including Down syndrome, diabetes, and other diseases that affect one's resistance to infection also increase susceptibility to periodontitis. Another factor that makes periodontitis a difficult disease to study is that human host response can also affect the alveolar bone resorption. Host response to the bacterial-mycotic insult is mainly determined by genetics; however, immune development may play some role in susceptibility. According to some researches periodontitis may be associated with higher stress.[31] [edit] Prevention Daily oral hygiene measures to prevent periodontal disease include: * Brushing properly on a regular basis (at least twice daily), with the patient attempting to direct the toothbrush bristles underneath the gum-line, to help disrupt the bacterial-mycotic growth and formation of subgingival plaque. * Flossing daily and using interdental brushes (if there is a sufficiently large space between teeth), as well as cleaning behind the last tooth, the third molar, in each quarter. * Using an antiseptic mouthwash. Chlorhexidine gluconate based mouthwash in combination with careful oral hygiene may cure gingivitis, although they cannot reverse any attachment loss due to periodontitis. * Using a 'soft' tooth brush to prevent damage to tooth enamel and sensitive gums. * Using periodontal trays to maintain dentist-prescribed medications at the source of the disease. The use of trays allows the medication to stay in place long enough to penetrate the biofilms where the microorganism are found. * Regular dental check-ups and professional teeth cleaning as required. Dental check-ups serve to monitor the person's oral hygiene methods and levels of attachment around teeth, identify any early signs of periodontitis, and monitor response to treatment. Typically dental hygienists (or dentists) use special instruments to clean (debride) teeth below the gumline and disrupt any plaque growing below the gumline. This is a standard treatment to prevent any further progress of established periodontitis. Studies show that after such a professional cleaning (periodontal debridement), microbic plaque tend to grow back to pre-cleaning levels after about 3–4 months. Hence, in theory, cleanings every 3–4 months might be expected to also prevent the initial onset of periodontitis. However, analysis of published research has reported little evidence either to support this or the intervals at which this should occur. [32] Instead, it is advocated that the interval between dental check-ups should be determined specifically for each patient between every 3 to 24 months.[33][34] Nonetheless, the continued stabilization of a patient's periodontal state depends largely, if not primarily, on the patient's oral hygiene at home as well as on the go. Without daily oral hygiene, periodontal disease will not be overcome, especially if the patient has a history of extensive periodontal disease. Periodontal disease and tooth loss are associated with an increased risk of cancer.[35] A contributing cause may be low selenium in the diet: "Results showed that selenium has the strongest association with gum disease, with low levels increasing the risk by 13 fold." [36] [edit] Management This section from a panoramic X-ray film depicts the teeth of the lower left quadrant, exhibiting generalized severe bone loss of 30–80%. The red line depicts the existing bone level, whereas the yellow line depicts where the gingiva was originally (1–2 mm above the bone), prior to the patient developing periodontal disease. The pink arrow, on the right, points to a furcation involvement, or the loss of enough bone to reveal the location at which the individual roots of a molar begin to branch from the single root trunk; this is a sign of advanced periodontal disease. The blue arrow, in the middle, shows up to 80% bone loss on tooth #21, and clinically, this tooth exhibited gross mobility. Finally, the peach oval, to the left, highlights the aggressive nature with which periodontal disease generally affects mandibular incisors. Because their roots are generally situated very close to each other, with minimal interproximal bone, and because of their location in the mouth, where plaque and calculus accumulation is greatest because of the pooling of saliva, mandibular anteriors suffer excessively. The split in the red line depicts varying densities of bone that contribute to a vague region of definitive bone height. The cornerstone of successful periodontal treatment starts with establishing excellent oral hygiene. This includes twice daily brushing with daily flossing. Also the use of an interdental brush (called a Proxi-brush) is helpful if space between the teeth allows. For smaller spaces a product called "Soft Picks" are an excellent manual cleaning device. Persons with dexterity problems such as arthritis may find oral hygiene to be difficult and may require more frequent professional care and/or the use of a powered tooth brush. Persons with periodontitis must realize that it is a chronic inflammatory disease and a lifelong regimen of excellent hygiene and professional maintenance care with a dentist/hygienist or periodontist is required to maintain affected teeth. [edit] Initial therapy Removal of microbic plaque and calculus is necessary to establish periodontal health. The first step in the treatment of periodontitis involves non-surgical cleaning below the gumline with a procedure called scaling and debridement. In the past, Root Planing was used (removal of cemental layer as well as calculus). This procedure involves use of specialized curettes to mechanically remove plaque and calculus from below the gumline, and may require multiple visits and local anesthesia to adequately complete. In addition to initial scaling and root planing, it may also be necessary to adjust the occlusion (bite) to prevent excessive force on teeth that have reduced bone support. Also it may be necessary to complete any other dental needs such as replacement of rough, plaque retentive restorations, closure of open contacts between teeth, and any other requirements diagnosed at the initial evaluation. [edit] Reevaluation Multiple clinical studies have shown that non-surgical scaling and root planing is usually successful if the periodontal pockets are shallower than 4–5 mm (See articles by Stambaugh RV, Int J Periodontics Rest Dent, 1981 or Waerhaug J, J Periodontol, 1978).[37][38][39] It is necessary for the dentist or hygienist to perform a reevaluation 4–6 weeks after the initial scaling and root planing, to determine if the treatment was successful in reducing pocket depths and eliminating inflammation. Pocket depths which remain after initial therapy of greater than 5-6mm with bleeding upon probing are indicate continued active disease and will very likely show further bone loss over time. This is especially true in molar tooth sites where furcations (areas between the roots) have been exposed. [edit] Surgery If non-surgical therapy is found to have been unsuccessful in managing signs of disease activity, periodontal surgery may be needed to stop progressive bone loss and regenerate lost bone where possible. There are many surgical approaches used in treatment of advanced periodontitis, including open flap debridement, osseous surgery, as well as guided tissue regeneration and bone grafting. The goal of periodontal surgery is access for definitive calculus removal and surgical management of bony irregularities which have resulted from the disease process to reduce pockets as much as possible. Long-term studies have shown that in moderate to advanced periodontitis, surgically treated cases often have less further breakdown over time and when coupled with a regular post-treatment maintenance regimen are successful in nearly halting tooth loss in nearly 85% of patients.[40][41] [edit] Maintenance Once successful periodontal treatment has been completed, with or without surgery, an ongoing regimen of "periodontal maintenance" is required. This involves regular checkups and detailed cleanings every three months to prevent re-population of periodontitis-causing microorganism, and to closely monitor affected teeth so that early treatment can be rendered if disease recurs. Usually periodontal disease exist due to poor plaque control, therefore if the brushing techniques are not modified, a periodontal recurrence is probable. [edit] Alternative treatments Periodontitis has an inescapable relationship with subgingival calculus (tartar). The first step in any procedure is to eliminate calculus under the gum line, as it houses destructive anaerobic microorganisms that consume bone, gum and cementum (connective tissue) for food. Most alternative “at-home” gum disease treatments involve injecting anti-microbial solutions, such as hydrogen peroxide, into periodontal pockets via slender applicators or oral irrigators. This process disrupts anaerobic microorganism colonies and is effective at reducing infections and inflammation when used daily. A number of potions and elixirs that are functionally equivalent to hydrogen peroxide are commercially available but at substantially higher cost. However, such treatments do not address calculus formations, and so are short-lived, as anaerobic microorganism colonies quickly regenerate in and around calculus. In a new field of study, calculus formations are addressed on a more fundamental level. At the heart of the formation of subgingival calculus, growing plaque formations starve out the lowest members of the community, which calcify into calcium phosphate salts of the same shape and size of the original, organic bacilli[citation needed]. Calcium phosphate salts (unlike calcium phosphate; the primary component in teeth) are ionic and adhere to tooth surfaces via electrostatic attraction[citation needed]. Smaller, free-floating calcium phosphate salt particles are equally attracted to the same areas, as are additional calcified microorganism, growing calculus formations as unorganized, yet strong, “brick and mortar” matrices[citation needed]. The microscopic voids in calculus formations house new anaerobic microorganism, as does the top “diseased layer”[citation needed]. Because the root cause of subgingival calculus development is ionic attraction, it was hypothesized that the introduction of oppositely charged particles around the formations may chelate calcium phosphate salt components away from the matrix, thus reducing the size of subgingival calculus formations[original research?]. To accomplish this, a sequestering agent solution consisting partly of sodium tripolyphosphate (STPP) and sodium fluoride (charge -1) was tested on a patient with burnished and new subgingival calculus at a depth of 6 mm[original research?]. The patient delivered the solution using an oral irrigator, once a day, for 60 days. The results were the successful elimination of all calculus formations studied.[42][unreliable medical source?] This test was conducted using a subgingival endoscopic camera (perioscope) by an independent periodontist[original research?]. The promise of this new, alternative treatment is to keep subgingival calculus at bay, in concert with traditional periodontal treatments. In this way, periodontitis may be controlled by the patient, and complete restoration of dental health can be a collaborative effort between the patient and the dental professional[original research?]. Additionally, Periodontitis can be treated in a noninvasive manner by means of Periostat (subantimicrobial dose of doxycycline), an FDA-approved, orally-administered drug that has been shown to reduce bone loss. Its mechanism of action in part involves inhibition of Matrix metalloproteinases (such as collagenase), which degrade the extracellular matrix under inflammatory conditions. This ultimately can lead to reduction of aveolar bone-loss in patients with periodontal disease (as well as patients without periodontitis). [edit] Prognosis Dentists and dental hygienists measure periodontal disease using a device called a periodontal probe. This is a thin "measuring stick" that is gently placed into the space between the gums and the teeth, and slipped below the gum-line. If the probe can slip more than 3 millimeters below the gum-line, the patient is said to have a gingival pocket if no migration of the epithelial attachment has occurred or a periodontal pocket if apical migration has occurred. This is somewhat of a misnomer, as any depth is in essence a pocket, which in turn is defined by its depth, i.e., a 2 mm pocket or a 6 mm pocket. However, it is generally accepted that pockets are self-cleansable (at home, by the patient, with a toothbrush) if they are 3 mm or less in depth. This is important because if there is a pocket which is deeper than 3 mm around the tooth, at-home care will not be sufficient to cleanse the pocket, and professional care should be sought. When the pocket depths reach 6 and 7 mm in depth, the hand instruments and cavitrons used by the dental professionals may not reach deeply enough into the pocket to clean out the microbic plaque that cause gingival inflammation. In such a situation the bone or the gums around that tooth should be surgically altered or it will always have inflammation which will likely result in more bone loss around that tooth. An additional way to stop the inflammation would be for the patient to receive subgingival antibiotics (such as minocycline) or undergo some form of gingival surgery to access the depths of the pockets and perhaps even change the pocket depths so that they become 3 mm or less in depth and can once again be properly cleaned by the patient at home with his or her toothbrush. If a patient has 7 mm or deeper pockets around their teeth, then they would likely risk eventual tooth loss over the years. If this periodontal condition is not identified and the patient remains unaware of the progressive nature of the disease then, years later, they may be surprised that some teeth will gradually become loose and may need to be extracted, sometimes due to a severe infection or even pain. According to the Sri Lankan tea labourer study, in the absence of any oral hygiene activity, approximately 10% will suffer from severe periodontal disease with rapid loss of attachment (>2 mm/year). 80% will suffer from moderate loss (1–2 mm/year) and the remaining 10% will not suffer any loss.[43][44] [edit] Epidemiology Disability-adjusted life year for peridontal disease per 100,000 inhabitants in 2004.[45] no data less than 3.5 3.5-4 4-4.5 4.5-5 5-5.5 5.5-6 6-6.5 6.5-7 7-7.5 7.5-8 8-8.5 more than 8.5 Periodontitis is very common, and is widely regarded as the second most common disease worldwide, after dental decay, and in the United States has a prevalence of 30–50% of the population, but only about 10% have severe forms. Like other conditions that are intimately related to access to hygiene and basic medical monitoring and care, periodontitis tends to be more common in economically disadvantaged populations or regions. Its occurrence decreases with higher standard of living. In Israeli population, individuals of Yemenite, North-African, South Asian, or Mediterranean origin have higher prevalence of periodontal disease than individuals from European descent.[46] Presumably, individuals living in East Asia (e.g. Japan, South Korea and Taiwan) have the lowest incident of periodontal disease in the world. [edit] In other animals Periodontal disease is the most common disease found in dogs and affects more than 80% of dogs aged three years or older. The prevalence of periodontal disease in dogs increases with age but decreases with increasing body weight; i.e., toy and miniature breeds are more severely affected. Systemic disease may develop because the gums are very vascular (have a good blood supply). The blood stream carries these anaerobic microorganisms, and they are filtered out by the kidneys and liver, where they may colonize and create microabscesses. The microorganisms traveling through the blood may also attach to the heart valves, causing vegetative endocarditis (infected heart valves). Additional diseases that may result from periodontitis includes chronic bronchitis and pulmonary fibrosis.[47] [edit] See also * Periodontist * chronic periodontitis * Actinomyces naeslundii, a kind of bacterium * Candida albicans, a kind of micetum * Calculus (dental), tartar * Campylobacter, a kind of bacterium * Dental plaque, bacterial biofilm that clings to teeth * Epidemiology of periodontal diseases * Halitosis, bad breath due to oral bacteria * Oral hygiene, how to promote good health of the mouth * Edentulism, condition of one or more missing teeth * Gingivitis, inflammation of the gums * Gum graft, a type of gum surgery, to replace lost gum tissue * Head and neck anatomy, biological composition above the shoulders * Osteoimmunology, studies the immune system with respect to bones * Oral microbiology, study of the microorganisms of the oral cavity * LANAP, Laser Assisted New Attachement Procedure * Tooth loss * Dental Implant

nitrous oxide Return to the top

Nitrous oxide, commonly known as laughing gas or sweet air,[1] is a chemical compound with the formula N2O. It is an oxide of nitrogen. At room temperature, it is a colorless non-flammable gas, with a slightly sweet odor and taste. It is used in surgery and dentistry for its anesthetic and analgesic effects. It is known as "laughing gas" due to the euphoric effects of inhaling it, a property that has led to its recreational use as a dissociative anesthetic. It is also used as an oxidizer in rocketry and in motor racing to increase the power output of engines. At elevated temperatures, nitrous oxide is a powerful oxidizer similar to molecular oxygen. Nitrous oxide gives rise to NO on reaction with oxygen atoms, and this NO in turn reacts with ozone. As a result, it is the main naturally occurring regulator of stratospheric ozone. It is also a major greenhouse gas and air pollutant. Considered over a 100 year period, it has 298 times more impact per unit weight than carbon dioxide.[2] Contents [hide] * 1 History o 1.1 Early use (1794-1843) o 1.2 Anesthetic use * 2 Production o 2.1 Other routes * 3 Applications o 3.1 Rocket motors o 3.2 Internal combustion engine o 3.3 Aerosol propellant o 3.4 In medicine o 3.5 Recreational use * 4 Neuropharmacology o 4.1 Anxiolytic effect o 4.2 Analgesic effect o 4.3 Euphoric effect o 4.4 Neurotoxicity * 5 Safety o 5.1 Chemical/physical o 5.2 Biological o 5.3 Environmental * 6 Legality * 7 See also * 8 References * 9 External links [edit] History The gas was first synthesized by English natural philosopher and chemist Joseph Priestley in 1772, who called it phlogisticated nitrous air (see phlogiston).[3] Priestley published his discovery in the book Experiments and Observations on Different Kinds of Air (1775), where he described how to produce the preparation of "nitrous air diminished", by heating iron filings dampened with nitric acid.[4] [edit] Early use (1794-1843) The first important use of nitrous oxide was made possible by Thomas Beddoes and the renowned engineer James Watt, who worked together to publish the book Considerations on the Medical Use and on the Production of Factitious Airs (1794). This book was important for two reasons. First, James Watt had invented a novel machine to produce "Factitious Airs" (i.e. nitrous oxide) and a novel "breathing apparatus" to inhale the gas. Second, the book also presented the new medical theories by Thomas Beddoes, that tuberculosis and other lung diseases could be treated by inhalation of "Factitious Airs"[5] (the word factitious means "artificial"). The machine to produce "Factitious Airs" comprised three parts: A furnace to burn the needed material, a vessel with water where the produced gas passed through in a spiral pipe (in order for impurities to be "washed off"), and finally the gas cylinder with a gasometer where the produced air could be tapped into portable air bags (made of airtight oily silk). The breathing apparatus comprised one of the portable air bags connected with a tube to a mouthpiece. With this new equipment being engineered and produced already in 1794, the way was now paved for clinical trials, which began when Thomas Beddoes in 1798 established the "Pneumatic Institution for Relieving Diseases by Medical Airs" in Clifton (Bristol). In the basement of the building, a large scale machine was producing the gases under the supervision of a young Humphry Davy, who was encouraged to experiment with new gases for patients to inhale.[5] The first important work of Davy was to examine the nitrous oxide, with the results being published in his book: Researches, Chemical and Philosophical (1800). In that publication, Davy notes the analgesic effect of nitrous oxide at page 465 and its potential to be used for surgical operations at page 556.[6] Despite the valuable finding made by Davy, that inhalation of nitrous oxide could relieve a conscious person from pain, another 44 years would elapse before doctors attempted to use it for anaesthesia. The use of nitrous oxide as a recreational drug at "laughing gas parties", primarily arranged for the British upper class, became an immediate success beginning in 1799. While the effects of the gas generally make the user feel stuporous, dreamy and sedated, some people also "get the giggles" in a state of euphoria, and erupt in laughter and overall amusement.[7] [edit] Anesthetic use Further information: Nitrous oxide and oxygen The first time nitrous oxide was used as anesthetic drug in the treatment of a patient was when dentist Horace Wells, with assistance by Gardner Quincy Colton and John Mankey Riggs, demonstrated insensitivity to pain from a dental extraction on December 11, 1844.[8] In the following weeks, Wells treated the first 12-15 patients with nitrous oxide in Hartford, and according to his own record only failed in two cases.[9] In spite of these convincing results being reported by Wells to the medical society in Boston already in December 1844, this new method was not immediately adopted by other dentists. The reason for this was most likely that Wells, in January 1845 at his first public demonstration towards the medical faculty in Boston, had been partly unsuccessful, leaving his colleagues doubtful regarding its efficacy and safety.[10] The method did not come into general use until 1863, when Gardner Quincy Colton successfully started to use it in all his "Colton Dental Association" clinics, that he just had established in New Haven and New York City.[5] Over the following three years, Colton and his associates successfully administered nitrous oxide to more than 25,000 patients.[11] With its efficacy and safety now demonstrated by large numbers, the usage of nitrous oxide rapidly became the preferred anesthetic method in dentistry. Because the gas is mild enough to keep a patient in a conscious and conversational state, and yet in most cases strong enough to suppress the pain caused by dental work, it remains the preferred gas anesthetic in today's dentistry. In hospitals, nitrous oxide was however found not to be a strong enough anesthetic for the use in large operations. Being a stronger and more potent anesthetic, sulfuric ether was instead demonstrated and accepted for use in October 1846, along with chloroform in 1847.[5] When Joseph Thomas Clover invented the "gas-ether inhaler" in 1876, it however became a common practice at hospitals to initiate all anesthetic treatments with a mild flow of nitrous oxide, and then gradually increase the anaesthesia with the stronger ether/chloroform. Clover's gas-ether inhaler was designed to supply the patient with nitrous oxide and ether at the same time, with the exact mixture being controlled by the operator of the device. It remained in use by many hospitals until the 1930s.[11] Although hospitals today are using a more advanced anaesthetic machine, these machines still use the same principle launched with Clover's gas-ether inhaler: To initiate the anesthesia with nitrous oxide, before the administration of a more powerful anesthetic. [edit] Production Nitrous oxide production Nitrous oxide is most commonly prepared by careful heating of ammonium nitrate, which decomposes into nitrous oxide and water vapor.[12] The addition of various phosphates favors formation of a purer gas at slightly lower temperatures. One of the earliest commercial producers was George Poe in Trenton, New Jersey.[13] NH4NO3 (s) → 2 H2O (g) + N2O (g) This reaction occurs between 170 and 240 °C, temperatures where ammonium nitrate is a moderately sensitive explosive and a very powerful oxidizer. Above 240 °C the exothermic reaction may accelerate to the point of detonation, so the mixture must be cooled to avoid such a disaster. Superheated steam is used to reach reaction temperature in some turnkey production plants.[14] Downstream, the hot, corrosive mixture of gases must be cooled to condense the steam, and filtered to remove higher oxides of nitrogen. Ammonium nitrate smoke, as an extremely persistent colloid, will also have to be removed. The cleanup is often done in a train of 3 gas washes; namely base, acid and base again. Any significant amounts of nitric oxide (NO) may not necessarily be absorbed directly by the base (sodium hydroxide) washes. The nitric oxide impurity is sometimes chelated out with ferrous sulfate, reduced with iron metal, or oxidised and absorbed in base as a higher oxide. The first base wash may (or may not) react out much of the ammonium nitrate smoke. However, this reaction generates ammonia gas, which may have to be absorbed in the acid wash. [edit] Other routes The direct oxidation of ammonia may someday rival the ammonium nitrate pyrolysis synthesis of nitrous oxide mentioned above. This capital-intensive process, which originates in Japan, uses a manganese dioxide-bismuth oxide catalyst:[15] 2 NH3 + 2 O2 → N2O + 3 H2O Higher oxides of nitrogen are formed as impurities. In comparison, uncatalyzed ammonia oxidation (i.e. combustion or explosion) goes primarily to N2 and H2O. Nitrous oxide can be made by heating a solution of sulfamic acid and nitric acid. Many gases are made this way in Bulgaria.[citation needed][16] HNO3 + NH2SO3H → N2O + H2SO4 + H2O There is no explosive hazard in this reaction if the mixing rate is controlled. However, as usual, toxic higher oxides of nitrogen are formed. Nitrous oxide is produced in large volumes as a by-product in the synthesis of adipic acid; one of the two reactants used in nylon manufacture.[17][18] This might become a major commercial source, but will require the removal of higher oxides of nitrogen and organic impurities. Currently much of the gas is decomposed before release for environmental protection. Greener processes may prevail that substitute hydrogen peroxide for nitric acid oxidation; hence no generation of oxide of nitrogen by-products. Hydroxylammonium chloride can react with sodium nitrite to produce N2O as well: NH3OH+Cl− + NaNO2 → N2O + NaCl + 2 H2O If the nitrite is added to the hydroxylamine solution, the only remaining byproduct is salt water. However, if the hydroxylamine solution is added to the nitrite solution (nitrite is in excess), then toxic higher oxides of nitrogen are also formed. Also, HNO3 can be reduced to N2O by SnCl2 and HCl mixture: 2 HNO3 + 8 HCl + 4 SnCl2 → 5 H2O + 4 SnCl4 + N2O [edit] Applications [edit] Rocket motors Nitrous oxide can be used as an oxidizer in a rocket motor. This has the advantages over other oxidizers in that it is non-toxic and, due to its stability at room temperature, easy to store and relatively safe to carry on a flight. As a secondary benefit it can be readily decomposed to form breathing air. Its high density and low storage pressure enable it to be highly competitive with stored high-pressure gas systems. In a 1914 patent, American rocket pioneer Robert Goddard suggested nitrous oxide and gasoline as possible propellants for a liquid-fueled rocket. Nitrous oxide has been the oxidizer of choice in several hybrid rocket designs (using solid fuel with a liquid or gaseous oxidizer). The combination of nitrous oxide with hydroxyl-terminated polybutadiene fuel has been used by SpaceShipOne and others. It is also notably used in amateur and high power rocketry with various plastics as the fuel. Nitrous oxide can also be used in a monopropellant rocket. In the presence of a heated catalyst, N2O will decompose exothermically into nitrogen and oxygen, at a temperature of approximately 1300 °C. Because of the large heat release, the catalytic action rapidly becomes secondary as thermal autodecomposition becomes dominant. In a vacuum thruster, this can provide a monopropellant specific impulse (Isp) of as much as 180 s. While noticeably less than the Isp available from hydrazine thrusters (monopropellant or bipropellant with nitrogen tetroxide), the decreased toxicity makes nitrous oxide an option worth investigating. Specific impulse (Isp) can be improved by blending a hydrocarbon fuel with the nitrous oxide inside the same storage tank, becoming a nitrous oxide fuel blend (NOFB) monopropellant. This storage mixture does not incur the danger of spontaneous ignition, since N2O is chemically stable. When the nitrous oxide decomposes by a heated catalyst, high temperature oxygen is released and rapidly ignites the hydrocarbon fuel-blend. NOFB monopropellants are capable of I sp greater than 300 seconds, while avoiding the toxicity associated with hypergolic propulsion systems.[19][20] The low freezing point of NOFB eases thermal management compared to hydrazine and dinitrogen tetroxide—a valuable property for space storable propellants. [edit] Internal combustion engine Main article: Nitrous In vehicle racing, nitrous oxide (often referred to as just "nitrous" or "NOS") allows the engine to burn more fuel and air, resulting in a more powerful combustion. The gas itself is not flammable, but it delivers more oxygen than atmospheric air by breaking down at elevated temperatures. Nitrous oxide is stored as a compressed liquid; the evaporation and expansion of liquid nitrous oxide in the intake manifold causes a large drop in intake charge temperature, resulting in a denser charge, further allowing more air/fuel mixture to enter the cylinder. Nitrous oxide is sometimes injected into (or prior to) the intake manifold, whereas other systems directly inject right before the cylinder (direct port injection) to increase power. The technique was used during World War II by Luftwaffe aircraft with the GM-1 system to boost the power output of aircraft engines. Originally meant to provide the Luftwaffe standard aircraft with superior high-altitude performance, technological considerations limited its use to extremely high altitudes. Accordingly, it was only used by specialized planes like high-altitude reconnaissance aircraft, high-speed bombers, and high-altitude interceptor aircraft. One of the major problems of using nitrous oxide in a reciprocating engine is that it can produce enough power to damage or destroy the engine. Very large power increases are possible, and if the mechanical structure of the engine is not properly reinforced, the engine may be severely damaged or destroyed during this kind of operation. It is very important with nitrous oxide augmentation of internal combustion engines to maintain proper operating temperatures and fuel levels to prevent "preignition", or "detonation" (sometimes referred to as "knocking" or "pinging"). Most problems that are associated with nitrous do not come from mechanical failure due to the power increases. Since nitrous allows a much denser charge into the cylinder it dramatically increases cylinder pressures. The increased pressure and temperature can cause problems such as melting the piston or valves. It may also crack or warp the piston or head and cause preignition due to uneven heating. Automotive-grade liquid nitrous oxide differs slightly from medical-grade nitrous oxide. A small amount of sulfur dioxide is added to prevent substance abuse.[21] [edit] Aerosol propellant An 8 g canister of nitrous oxide intended for use as a whipped cream aerating agent The gas is approved for use as a food additive (also known as E942), specifically as an aerosol spray propellant. Its most common uses in this context are in aerosol whipped cream canisters, cooking sprays, and as an inert gas used to displace oxygen, to inhibit bacterial growth, when filling packages of potato chips and other similar snack foods. The gas is extremely soluble in fatty compounds. In aerosol whipped cream, it is dissolved in the fatty cream until it leaves the can, when it becomes gaseous and thus creates foam. Used in this way, it produces whipped cream four times the volume of the liquid, whereas whipping air into cream only produces twice the volume. If air were used as a propellant, oxygen would accelerate rancidification of the butterfat; nitrous oxide inhibits such degradation. Carbon dioxide cannot be used for whipped cream because it is acidic in water, which would curdle the cream and give it a seltzer-like 'sparkling' sensation. However, the whipped cream produced with nitrous oxide is unstable and will return to a more or less liquid state within half an hour to one hour. Thus, the method is not suitable for decorating food that will not be immediately served. Similarly, cooking spray, which is made from various types of oils combined with lecithin (an emulsifier), may use nitrous oxide as a propellant; other propellants used in cooking spray include food-grade alcohol and propane. Users of nitrous oxide often obtain it from whipped cream dispensers that use nitrous oxide as a propellant (see above section), for recreational use as a euphoria-inducing inhalant drug. It is not harmful in small doses, but risks due to lack of oxygen do exist (see Recreational use below). Outside of its use as a propellant, in 2010, Monster Energy, a company specializing in high-potency energy drinks, introduced a line of drinks under the brand "Nitrous Monster" that includes nitrous oxide in the carbonation.[citation needed] [edit] In medicine Further information: Nitrous oxide and oxygen Medical grade N2O tanks used in dentistry. Nitrous oxide has been used for anesthesia in dentistry since December 1844, where Horace Wells made the first 12-15 dental operations with the gas in Hartford. Its debut as a generally accepted method however came in 1863, when Gardner Quincy Colton introduced it more broadly at all the Colton Dental Association clinics, that he founded in New Haven and New York city.[5] The first devices used in dentistry to administer the gas, known as Nitrous Oxide inhalers, were designed in a very simple way with the gas stored and breathed through a breathing bag made of rubber cloth, without a scavenger system and flowmeter, and with no addition of oxygen/air.[11] Today these simple and somewhat unreliable inhalers, of course have been replaced by the more modern relative analgesia machine, which is an automated machine designed to deliver a precisely dosed and breath-actuated flow of nitrous oxide mixed with oxygen, for the patient to inhale safely. The machine used in dentistry is designed as a more simplified version of the larger anaesthetic machine used by hospitals, as it doesn't feature the additional anaesthetic vaporiser and medical ventilator. The purpose of the machine allows for a more simple design, as it only delivers a mixture of nitrous oxide and oxygen for the patient to inhale, in order to depress the feeling of pain -while keeping the patient in a conscious state. The relative analgesia machine typically feature a constant-supply flowmeter, which allow the proportion of nitrous oxide and the combined gas flow rate to be individually adjusted. The gas is administered by dentists through a demand-valve inhaler over the nose, which will only release gas when the patient inhales through the nose. Because nitrous oxide is minimally metabolized in humans (with a rate of 0.004%), it retains its potency when exhaled into the room by the patient, and can pose an intoxicating and prolonged exposure hazard to the clinic staff if the room is poorly ventilated. Where nitrous oxide is administered, a continuous-flow fresh-air ventilation system or nitrous scavenger system is used to prevent a waste-gas buildup. Hospitals are administering nitrous oxide as one of the anesthetic drugs delivered by anaesthetic machines. Nitrous oxide is a weak general anesthetic, and so is generally not used alone in general anesthesia. In general anesthesia it is used as a carrier gas in a 2:1 ratio with oxygen for more powerful general anesthetic drugs such as sevoflurane or desflurane. It has a MAC (minimum alveolar concentration) of 105% and a blood:gas partition coefficient of 0.46. When nitrous oxide is inhaled as the only anesthetic drug, it is normally administered as a mixture with 30% gas and 70% oxygen.[22] The medical grade gas tanks, with the tradename Entonox and Nitronox contain a mixture with 50%, but this will normally be diluted to a lower percentage upon the operational delivery to the patient. Inhalation of nitrous oxide is frequently used to relieve pain associated with childbirth, trauma, oral surgery, and acute coronary syndrome (includes heart attacks). Its use for acute coronary syndrome is of unknown benefit.[23] In Britain, Entonox and Nitronox are commonly used by ambulance crews (including unregistered practitioners) as a rapid and highly effective analgesic gas. Nitrous oxide has been shown to be effective in treating a number of addictions including alcohol withdrawa

tooth loss Return to the top

Tooth loss From Wikipedia, the free encyclopedia Jump to: navigation, search A young boy after losing two baby teeth, exfoliated in response to the permanent teeth beneath, which will erupt through the gums to take their place. Tooth loss is when one or more teeth come loose and fall out. Tooth loss is normal for deciduous teeth (baby teeth), when they are replaced by a person's adult teeth. Otherwise, losing teeth is undesirable and is the result of injury or disease, such as mouth trauma, tooth injury, tooth decay, and gum disease. The condition of being toothless or missing one or more teeth, is called edentulism. Contents [hide] * 1 Prevention of tooth loss * 2 Missing tooth replacement * 3 Research in tooth regeneration * 4 See also * 5 References * 6 External links [edit] Prevention of tooth loss Tooth loss due to tooth decay and gum disease may be prevented by practicing good oral hygiene, and regular check-ups (twice per year) at the dentist's office. In contact sports, risk of mouth trauma and tooth injury is reduced by wearing mouthguards and helmets with a facemask (e.g., football helmet, and goalie mask). [edit] Missing tooth replacement There are three basic ways to replace a missing tooth or teeth, including a fixed dental bridge, dentures, and dental implants. [edit] Research in tooth regeneration Researchers in Japan have successfully regrown fully functional teeth in mice. Epithelial and mesenchymal cells were extracted from the mice, cultured to produce a tooth "germ," and the germ was then implanted into the bone at the space of a missing tooth. A tooth of the correct external and internal structure, hardness, strength and sensitivity later erupted in the space, eventually meeting the opposing tooth in a manner similar to an original natural tooth. This technique may be a possible future treatment for replacement of missing teeth.[1] [edit] See also * Teeth cleaning o Tooth brushing o Flossing o Tongue Cleaning * Dental surgery * Wisdom tooth * Dental Implant * Periodontist

oral cancer Return to the top

Oral cancer is a subtype of head and neck cancer, is any cancerous tissue growth located in the oral cavity.[1] It may arise as a primary lesion originating in any of the oral tissues, by metastasis from a distant site of origin, or by extension from a neighboring anatomic structure, such as the nasal cavity or the maxillary sinus. Oral cancers may originate in any of the tissues of the mouth, and may be of varied histologic types: teratoma, adenocarcinoma derived from a major or minor salivary gland, lymphoma from tonsillar or other lymphoid tissue, or melanoma from the pigment producing cells of the oral mucosa. There are several types of oral cancers, but around 90% are squamous cell carcinomas[2], originating in the tissues that line the mouth and lips. Oral or mouth cancer most commonly involves the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth). Most oral cancers look very similar under the microscope and are called squamous cell carcinoma. These are malignant and tend to spread rapidly. Contents [hide] * 1 Signs and symptoms * 2 Causes o 2.1 Tobacco o 2.2 Alcohol o 2.3 Human papillomavirus * 3 Diagnosis * 4 Management * 5 Prognosis * 6 Epidemiology * 7 See also * 8 References * 9 External links [edit] Signs and symptoms Skin lesion, lump, or ulcer: * On the tongue, lip, or other mouth areas * Usually small * Most often pale colored, may be dark or discolored * Early sign may be a white patch (leukoplakia) or a red patch (erythroplakia) on the soft tissues of the mouth * Usually painless initially * May develop a burning sensation or pain when the tumor is advanced Additional symptoms that may be associated with this disease: * Tongue problems * Swallowing difficulty * Mouth sores that do not resolve in 14 days * Pain and paraesthesia are late symptoms. [edit] Causes All cancers are diseases in the cancer cells. Oncogenes are activated as a result of mutation of the DNA. The exact cause is often unknown. Regardless of the cause, treatment is the same: surgery, radiation with or without chemotherapy. Risk factors that predispose a person to oral cancer have been identified in epidemiological studies. India being member of International Cancer Genome Consortium is leading efforts to map oral cancer's complete genome. In many Asian cultures chewing betel, paan and Areca is known to be a strong risk factor for developing oral cancer. In India where such practices are common, oral cancer represents up to 40% of all cancers, compared to just 4% in the UK. Some oral cancers begin as leukoplakia a white patch (lesion), red patches, (erythroplakia) or non healing sores that have existed for more than 14 days. In the US oral cancer accounts for about 8 percent of all malignant growths. Men are affected twice as often as women, particularly men older than 40/60. In Indian subcontinent Oral submucous fibrosis is very common. This condition is characterized by limited opening of mouth and burning sensation on eating of spicy food. This is a progressive lesion in which the opening of the mouth becomes progressively limited, and later on even normal eating becomes difficult. It occurs almost exclusively in India and Indian communities living abroad. [edit] Tobacco Smoking and other tobacco use are associated with about 75 percent of oral cancer cases, caused by irritation of the mucous membranes of the mouth from smoke and heat of cigarettes, cigars, and pipes. Tobacco contains over 60 known carcinogens, and the combustion of it, and by products from this process, is the primary mode of involvement. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes. [edit] Alcohol Alcohol use is another high-risk activity associated with oral cancer. There is known to be a very strong synergistic effect on oral cancer risk when a person is both a heavy smoker and drinker. The risk is greatly increased compared to a heavy smoker, or a heavy drinker alone. Recent studies in Australia, Brazil and Germany point to alcohol-containing mouthwashes as also being etiologic agents in the oral cancer risk family. Constant exposure to these alcohol containing rinses, even in the absence of smoking and drinking, lead to significant increases in the development of oral cancer. A 2008 study suggests that acetaldehyde (a break-down product of alcohol) is implicated in oral cancer.[3][4] [edit] Human papillomavirus Main article: HPV-positive oropharyngeal cancer Infection with human papillomavirus (HPV), particularly type 16 (there are over 120 types), is a known risk factor and independent causative factor for oral cancer. (Gilsion et al. Johns Hopkins) A fast growing segment of those diagnosed does not present with the historic stereotypical demographics. Historically that has been people over 50, blacks over whites 2 to 1, males over females 3 to 1, and 75% of the time people who have used tobacco products or are heavy users of alcohol. This new and rapidly growing sub population between 20 and 50 years old is predominantly non smoking, white, and males slightly outnumber females. Recent research from Johns Hopkins indicates that HPV is the primary risk factor in this new population of oral cancer victims. HPV16 (along with HPV18) is the same virus responsible for the vast majority of all cervical cancers and is the most common sexually transmitted infection in the US. Oral cancer in this group tends to favor the tonsil and tonsillar pillars, base of the tongue, and the oropharnyx. Recent data suggest that individuals that come to the disease from this particular etiology have some slight survival advantage. [edit] Diagnosis An examination of the mouth by the health care provider or dentist shows a visible and/or palpable (can be felt) lesion of the lip, tongue, or other mouth area. As the tumor enlarges, it may become an ulcer and bleed. Speech/talking difficulties, chewing problems, or swallowing difficulties may develop. A feeding tube is often necessary to maintain adequate nutrition. This can sometimes become permanent as eating difficulties can include the inability to swallow even a sip of water. There are a variety of screening devices that may assist dentists in detecting oral cancer, including the Velscope, Vizilite Plus and the identafi 3000. While a dentist, physician or other health professional may suspect a particular lesion is malignant, there is no way to tell by looking alone - since benign and malignant lesions may look identical to the eye. A non-invasive brush biopsy (BrushTest) can be performed to rule out the presence of dysplasia (pre-cancer) and cancer on areas of the mouth that exhibit an unexplained color variation or lesion. The only definitive method for determining if cancerous or precancerous cells are present is through biopsy and microscopic evaluation of the cells in the removed sample. A tissue biopsy, whether of the tongue or other oral tissues and microscopic examination of the lesion confirm the diagnosis of oral cancer or precancer. [edit] Management Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough, and if surgery is likely to result in a functionally satisfactory result. Radiation therapy with or without chemo is often used in conjunction with surgery, or as the definitive radical treatment, especially if the tumour is inoperable. Surgeries for oral cancers include * Maxillectomy (can be done with or without Orbital exenteration) * Mandibulectomy (removal of the mandible or lower jaw or part of it) * Glossectomy (tongue removal, can be total, hemi or partial) * Radical neck dissection * Moh's procedure or CCPDMA * Combinational e.g. glossectomy and laryngectomy done together. * Feeding tube to sustain nutrition. Owing to the vital nature of the structures in the head and neck area, surgery for larger cancers is technically demanding. Reconstructive surgery may be required to give an acceptable cosmetic and functional result. Bone grafts and surgical flaps such as the radial forearm flap are used to help rebuild the structures removed during excision of the cancer. An oral prothesis may also be required. Most oral cancer patients depend on a feeding tube for their hydration and nutrition. Some will also get a port for the chemo to be delivered. Many oral cancer patients are disfigured and suffer from many long term after effects. The after effects often include fatigue, speech problems, trouble maintaining weight, thyroid issues, swallowing difficulties, inability to swallow, memory loss, weakness, dizziness, high frequency hearing loss and sinus damage. Survival rates for oral cancer depend on the precise site, and the stage of the cancer at diagnosis. Overall, survival is around 50% at five years when all stages of initial diagnosis are considered. Survival rates for stage 1 cancers are 90%, hence the emphasis on early detection to increase survival outcome for patients. Following treatment, rehabilitation may be necessary to improve movement, chewing, swallowing, and speech. speech and language pathologists may be involved at this stage. Chemotherapy is useful in oral cancers when used in combination with other treatment modalities such as radiation therapy. It is not used alone as a monotherapy. When cure is unlikely it can also be used to extend life and can be considered palliative but not curative care. Biological agents, such as Cetuximab have recently been shown to be effective in the treatment of squamous cell head and neck cancers, and are likely to have an increasing role in the future management of this condition when used in conjunction with other treatments. Treatment of oral cancer will usually be by a multidisciplinary team, with treatment professionals from the realms of radiation, surgery, chemotherapy, nutrition, dental professionals, and even psychology all possibly involved with diagnosis, treatment, rehabilitation, and patient care. The Oral Cancer Foundation is a website devoted to in depth medical information about all oral cancers including treatment, side effects and even lists of the nation's best cancer treatment centers. The Oral Cancer Foundation has a forum where patients and their caregivers assist each other. It is monitored by the founder and administrators who ensure accurate up to date information is exchanged. This website has the most comprehensive amount of information devoted to oral cancer. [edit] Prognosis * Postoperative disfigurement of the face, head and neck * Complications of radiation therapy, including dry mouth and difficulty swallowing * Other metastasis (spread) of the cancer * Significant weight loss [edit] Epidemiology Age-standardized death from oro-pharyngeal per 100,000 inhabitants in 2004.[5] no data less than 2 2-4 4-6 6-8 8-10 10-12 12-14 14-16 16-18 18-20 20-25 more than 25 In 2008, in the United States alone, about 34,000 individuals were diagnosed with oral cancer. 66% of the time these will be found as late stage three and four disease. Low public awareness of the disease is a significant factor, but these cancers could be found at early highly survivable stages through a simple, painless, 5 minute examination by a trained medical or dental professional.

fillings Return to the top

A dental restoration or dental filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. The structural loss typically results from caries or external trauma. It is also lost intentionally during tooth preparation to improve the aesthetics or the physical integrity of the intended restorative material. Dental restoration also refers to the replacement of missing tooth structure that is supported by dental implants. Dental restorations can be divided into two broad types: direct restorations and indirect restorations. All dental restorations can be further classified by their location and size. A root canal filling is a restorative technique used to fill the space where the dental pulp normally resides. Contents [hide] * 1 Tooth preparation * 2 Direct restorations * 3 Indirect restorations * 4 Restoration classifications * 5 Materials used in dental restorations o 5.1 Metals and metallic alloys o 5.2 Tooth colored + 5.2.1 Composite resin + 5.2.2 Glass ionomer cement + 5.2.3 Porcelain (ceramics) o 5.3 Comparison * 6 Restoration of dental implants * 7 See also * 8 References * 9 External links [edit] Tooth preparation Tooth #3, the upper right first molar, with the beginning of an MO preparation. Looking into the preparation, the white, outer enamel appears intact, while the yellow, underlying dentin appears recessed. This is because the dentin was decayed and was thus removed. This portion of the enamel is now unsupported, and should be removed to prevent future fracture. Restoring a tooth to good form and function requires two steps, (1) preparing the tooth for placement of restorative material or materials, and (2) placement of restorative material or materials. The process of preparation usually involves cutting the tooth with special dental burrs, to make space for the planned restorative materials, and to remove any dental decay or portions of the tooth that are structurally unsound. If permanent restoration can not be carried out immediately after tooth preparation, temporary restoration may be performed. The prepared tooth, ready for placement of restorative materials, is generally called a tooth preparation. Materials used may be gold, amalgam, dental composites, resin-reinforced glass ionomers, porcelain or any number of other materials. Preparations may be intracoronal or extracoronal. * Intracoronal preparations are those preparations which serve to hold restorative material within the confines of the structure of the crown of a tooth. Examples include all classes of cavity preparations for composite or amalgam, as well as those for gold and porcelain inlays. Intracoronal preparations are also made as female recipients to receive the male components of Removable partial dentures. * Extracoronal preparations are those preparations which serve as a core or base upon which or around which restorative material will be placed to bring the tooth back into a functional or aesthetic structure. Examples include crowns and onlays, as well as veneers. In preparing a tooth for a restoration, a number of considerations will come into play to determine the type and extent of the preparation. The most important factor to consider is decay. For the most part, the extent of the decay will define the extent of the preparation, and in turn, the subsequent method and appropriate materials for restoration. Another consideration is unsupported tooth structure. In the photo at right, unsupported enamel can be seen where the underlying dentin was removed because of infiltrative decay. When preparing the tooth to receive a restoration, unsupported enamel is removed to allow for a more predictable restoration. While enamel is the hardest substance in the human body, it is particularly brittle, and unsupported enamel fractures easily. [edit] Direct restorations This technique involves placing a soft or malleable filling into the prepared tooth and building up the tooth before the material sets hard. The advantage of direct restorations is that they usually set quickly and can be placed in a single procedure. Since the material is required to set while in contact with the tooth, limited energy can be passed to the tooth from the setting process without damaging it. Where strength is required, especially as the fillings become larger, indirect restorations may be the best choice. [edit] Indirect restorations This technique of fabricating the restoration outside of the mouth using the dental impressions of the prepared tooth. Common indirect restorations include inlays and onlays, crowns, bridges, and veneers. Usually a dental technician fabricates the indirect restoration from records the dentist has provided of the prepared tooth. The finished restoration is usually bonded permanently with a dental cement. It is often done in two separate visits to the dentist. Common indirect restorations are done using gold or ceramics. While the indirect restoration is being prepared, a provisory/temporary restoration is sometimes used to cover the prepared part of the tooth, which can help maintain the surrounding dental tissues. Removable dental prostheses (mainly dentures) are considered by some to be a form of indirect dental restoration, as they are made to replace missing teeth. There are numerous types of precision attachments (also known as combined restorations) to aid removable prosthetic attachment to teeth, including magnets, clips, hooks and implants which could be seen as a form of dental restoration. The CEREC method is a chairside CAD/CAM restorative procedure. An optical impression of the prepared tooth is taken using a camera. Next, the specific software takes the digital picture and converts it into a 3D virtual model on the computer screen. A ceramic block that matches the tooth shade is placed in the milling machine. An all-ceramic, tooth-colored restoration is finished and ready to bond in place. Another fabrication method is to import STL and native dental CAD files into CAD/CAM software products that guide the user through the manufacturing process. The software can select the tools, machining sequences and cutting conditions optimized for particular types of materials, such as titanium and zirconium, and for particular prostheses, such as copings and bridges. In some cases, the intricate nature of some implants requires the use of 5-axis machining methods to reach every part of the job.[1] [edit] Restoration classifications GV Black Classification of Restorations Greene Vardiman Black classified the fillings depending on their size and location.[2] * Class I Caries affecting pit and fissure, on occlusal, buccal, and lingual surfaces of posterior teeth, and Lingual of anterior teeth. * Class II Caries affecting proximal surfaces of molars and premolars. * Class III Caries affecting proximal surfaces of centrals, laterals, and cuspids. * Class IV Caries affecting proximal including incisal edges of anterior teeth. * Class V Caries affecting gingival 1/3 of facial or lingual surfaces of anterior or posterior teeth. * Class VI Caries affecting cusp tips of molars, premolars, and cuspids. [edit] Materials used in dental restorations Main article: Dental restorative materials [edit] Metals and metallic alloys Amalgam filling These metals are mostly used for making crowns, bridges and dentures. Pure titanium could be successfully incorporated into bone. It is biocompatible and stable. Precious metallic alloys * gold (high purity: 99.7%) * gold alloys (with high gold content) * gold-platina alloy * silver-palladium alloy * titanium Base metallic alloys * cobalt-chromium alloy * nickel-chrome alloy Amalgam * Silver amalgam Amalgam is widely used for direct fillings, mainly for posterior teeth, and completed in single appointment. Cast gold is used for indirect restorations. Amalgam leaches tiny amounts of mercury and while some concerns have been raised, there is currently no evidence that any of this mercury remains in the body nor that dangerous levels are ever reached [3]. Direct Gold * Gold Although rarely used, due to expense and specialized training requirements, gold foil can be used for direct dental restorations. [edit] Tooth colored Dental composites are also called white fillings, used in direct fillings. Crowns and in-lays can be made in the laboratory from dental composites. These materials are similar to those used in direct fillings and are tooth coloured. Their strength and durability is not as high as porcelain or metal restorations and they are more prone to wear and discolouration. [edit] Composite resin Dental composites, also called white fillings, are a group of restorative materials used in dentistry. As with other composite materials, a dental composite typically consists of a resin-based matrix, such as a bisphenol A-glycidyl methacrylate (BISMA) resin like urethane dimethacrylate (UDMA), and an inorganic filler such as silicon dioxide silica. Compositions vary widely, with proprietary mixes of resins forming the matrix, as well as engineered filler glasses and glass ceramics. The filler gives the composite wear resistance and translucency. A coupling agent such as silane is used to enhance the bond between these two components. An initiator package begins the polymerization reaction of the resins when external energy (light/heat, etc.) is applied. A catalyst package can control its speed. This is not recommended for molars. After tooth preparation, a thin glue or bonding material layer is applied. Composites are then filled layer by layer and photo-polymerising each using light.[4] At the end the surface will be shaped and polished. [edit] Glass ionomer cement A glass ionomer cement (GIC) is one of a class of materials commonly used in dentistry as filling materials and luting cements. These materials are based on the reaction of silicate glass powder and polyalkeonic acid. These tooth-coloured materials were introduced in 1972 for use as restorative materials for anterior teeth (particularly for eroded areas, Class III and V cavities). As they bond chemically to dental hard tissues and release fluoride for a relatively long period, modern-day applications of GICs have expanded. The desirable properties of glass ionomer cements make them useful materials in the restoration of carious lesions in low-stress areas such as smooth-surface and small anterior proximal cavities in primary teeth. Results from clinical studies also support the use of conventional glass ionomer restorations in primary molars. They need not be put in layer by layer, like in composite fillings. [edit] Porcelain (ceramics) Full-porcelain (ceramic) dental materials include porcelain, ceramic or glasslike fillings and crowns (a.k.a jacket crown, as a metal-free option). They are used as in-lays, on-lays, crowns, and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. Full-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel. Another type is known as porcelain-fused-to-metal, which is used to provide strength to a crown or bridge. These restorations are very strong, durable and resistant to wear, because the combination of porcelain and metal creates a stronger restoration than porcelain used alone. One of the advantages of computerized dentistry (CAD/CAM technologies) is that it enabled the application of zirconium-oxide (ZrO2). The introduction of this material in restorative and prosthetic dentistry is most likely the decisive step toward the use of full ceramics without limitation. With the exception of zirconium-oxide, existing ceramics systems lack reliable potential for the various indications for bridges without size limitations. Zirconium-oxide with its high strength and comparatively higher fracture toughness seems to buck this trend. With a three-point bending strength exceeding 900 megapascals, zirconium-oxide can be used in virtually every full ceramic prosthetic solution, including bridges, implant supra structures and root dowel pins. Previous attempts to extend its application to dentistry were thwarted by the fact that this material could not be processed using traditional methods used in dentistry. The arrival of computerized dentistry enables the economically prudent use of zirconium-oxide in such elements as base structures such as copings and bridges and implant supra structures. Special requirements apply to dental materials implanted for longer than a period of thirty days. Several technical requirements include high strength, corrosion resistance and defect-free producibility at a reasonable price. Ever more stringent requirements are being placed on the aesthetics of teeth. Metals and porcelain are currently the materials of choice for crowns and bridges. The demand for full ceramic solutions, however, continues to grow. Consequently, industry and science are increasingly compelled to develop full ceramic systems. In introducing full ceramic restorations, such as base structures made of sintered ceramics, computerized dentistry plays a key role. [edit] Comparison * Composites and Amalgam are used mainly for direct restoration. Composites can be made of color matching the tooth, and surface can be polished after filling. * Amalgam fillings expand with age, possibly cracking the tooth and requiring repair and filling replacement. But chance of leakage of filling is less. * Composite fillings shrink with age and may pull away from the tooth allowing leakage. If leakage is not noticed early recurrent decay may occur. * Fillings have a finite lifespan: an average of 12.8 years for amalgam and 7.8 years for composite resins.[5] Fillings fail because of changes in the filling, tooth or the bond between them. Secondary caries formation can also affect the structural integrity the original filling. Fillings are recommended for small to medium sized restorations. * Porcelain and Gold are used for indirect restorations like crowns and partial coverage crowns (onlays). Some types of porcelains are hard, but can cause wear on opposing teeth. They are brittle and are not always recommended for molar restorations. A new material called lithium disilicate (ips.emax) is indicated for use on molars for crowns and onlays now because it is fracture resistant compared to other porcelains used for dental restorations.[6] [edit] Restoration of dental implants Main article: Dental implant Dental implants, are anchors placed in bone, usually made from titanium or titanium alloy. They can support dental restorations which replace missing teeth. Some restorative applications include supporting crowns, bridges, or dental prostheses. [edit] See also * Dental restorative materials the materials used for fillings * CEREC * Fixed prosthodontics * Dental treatment * Dental dam * Gold teeth * CAD/CAM Dentistry * Treatment of knocked-out (avulsed) teeth

retainer Return to the top

retainers are custom-made devices, made usually of wires or clear plastic, that hold teeth in position after surgery or any method of realigning teeth. They are most often used before or after dental braces to hold teeth in position while assisting the adjustment of the surrounding gums to changes in the bone. Most patients are required to wear their retainer(s) every night at first, with many also being directed to wear them during the day - at least initially. There are three types of retainers typically prescribed by orthodontists and dentists: Hawley, Essix, and Bonded (Fixed) retainers. Contents [hide] * 1 Hawley retainer * 2 Vacuum-formed (Essix) retainer * 3 Fixed retainers * 4 References [edit] Hawley retainer The underneath surface of an upper Wrap Around Hawley retainer resting on top of a retainer case The best-known type is the Hawley retainer, which includes a metal wire that surrounds the teeth and keeps them in place. Named for its inventor, Dr. Charles Hawley, the labial wire, or Hawley bow, incorporates 2 omega loops for adjustment. It is anchored in an acrylic arch that sits in the palate (roof of the mouth). The advantage of this type of retainer is that the metal wires can be adjusted to finish treatment and continue moving teeth as needed.[1] Recently, a more aesthetic version of the Hawley retainer has been developed.[citation needed] For this alternative, the front metal wire is replaced with a clear wire called the ASTICS. This retainer is intended to be adjustable in a similar manner to the traditional Hawley retainer, which is not practical with vacuum-formed retainers. [edit] Vacuum-formed (Essix) retainer Another common type is the vacuum formed retainer (VFR). This is a polypropylene or polyvinylchloride (PVC) material, typically .020" or .030" thick. Essix is a brand name many dental offices are familiar with. This clear or transparent retainer fits over the entire arch of teeth or only from canine to canine (clip on retainer) and is produced from a mold. It is similar in appearance to Invisalign trays, though the latter are not considered "retainers". VFRs, if worn 24 hours per day, do not allow the upper and lower teeth to touch because plastic covers the chewing surfaces of the teeth. Some orthodontists feel that it is important for the top and bottom chewing surfaces to meet to allow for "favorable settling" to occur. VFRs are less expensive, less conspicuous, and easier to wear than Hawley retainers. However, for patients with disorders such as Bruxism, VFRs are prone to rapid breakage and deterioration, especially if the material is PVC, a short chain molecule. This breaks down swiftly as compared to polypropylene, a long chain molecule. Most removable retainers are supplied with a retainer case for protection. During the first few days of retainer use, many people experience extra saliva in their mouth. This is natural and is due to the presence of a new object inside the mouth and consequent stimulation of the salivary glands. It may be difficult to speak for a while after getting a retainer, but this speech difficulty should go away over time as one gets used to wearing it. [edit] Fixed retainers An entirely different category of orthodontic retainers are fixed retainers. A fixed retainer typically consists of a passive wire bonded to the tongue-side of the (usually, depending on the patient's bite, only lower) incisors. Unlike the previously-mentioned retainer types, fixed retainers cannot be removed by the patient. Some doctors prescribe fixed retainers regularly, especially where active orthodontic treatments have effected great changes in the bite and there is a high risk for reversal of these changes. While the device is usually required until a year after wisdom teeth have been extracted it is often kept in place for life. Fixed retainers may lead to tartar build-up or gingivitis due to the difficulty of flossing while wearing these retainers. As with dental braces, patients often must use floss threaders to pass dental floss through the small space between the retainer and the teeth

oral hygiene Return to the top

Oral hygiene is the practice of keeping the mouth and teeth clean to prevent dental problems and bad breath. Contents [hide] * 1 Teeth cleaning o 1.1 Plaque o 1.2 Flossing * 2 Tongue cleaning * 3 Gum care * 4 Oral irrigation * 5 Food and drink o 5.1 Beneficial foods o 5.2 Detrimental foods * 6 Other * 7 Oral hygiene and systemic diseases * 8 See also * 9 References * 10 External links [edit] Teeth cleaning See also: Tooth brushing Teeth cleaning is the removal of dental plaque and tartar from teeth to prevent cavities, gingivitis, and gum disease. Severe gum disease causes at least one-third of adult tooth loss. Tooth Decay is the most common global disease affecting every family. Over 80% of cavities occur inside pits and fissures on chewing surfaces where brushing cannot reach food left trapped after every meal or snack and saliva or fluoride have no access to neutralise acid and remineralise demineralised tooth. Fissure sealants dentists apply over grooves in chewing surfaces of back teeth, block food being trapped and halt the decay process. An elastomer strip has been shown to force sealant deeper inside opposing chewing surfaces at the same time and can also force fluoride toothpaste inside chewing surfaces before brushing to remineralise demineralised teeth. Since before recorded history, a variety of oral hygiene measures have been used for teeth cleaning. This has been verified by various excavations done all over the world, in which chewsticks, tree twigs, bird feathers, animal bones and porcupine quills were recovered. Many people used different forms of teeth cleaning tools. Indian medicine (Ayurveda) has used the neem tree (a.k.a. daatun) and its products to create teeth cleaning twigs and similar products for millennia. A person chews one end of the neem twig until it somewhat resembles the bristles of a toothbrush, and then uses it to brush the teeth. In the Muslim world, the miswak, or siwak, made from a twig or root with antiseptic properties has been widely used since the Islamic Golden Age. Rubbing baking soda or chalk against the teeth was also common. Generally, dentists recommend that teeth be cleaned professionally at least twice per year. Professional cleaning includes tooth scaling, tooth polishing, and, if too much tartar has built up, debridement. This is usually followed by a fluoride treatment. Between cleanings by a dental hygienist, good oral hygiene is essential for preventing tartar build-up which causes the problems mentioned above. This is done by carefully and frequently brushing with a toothbrush and the use of dental floss to prevent accumulation of plaque on the teeth.[1] [edit] Plaque Plaque is a yellow sticky film that forms on the teeth and gums. The bacteria in plaque release acid that attacks tooth enamel. Tooth decay can occur after repeated attacks. Some food causes plaque bacteria that produce acids. Thorough daily brushing and flossing can prevent tartar from forming on the teeth. Plaque can also cause irritation to the gums, making them red, tender, or bleeding easily. In some cases, the gums pull away from the teeth, leaving cavities inhabited by bacteria and pus. If this is not treated, bones around the teeth can be destroyed. Teeth may become loose or have to be removed as with periodontal (gum) disease in mostly adults. Eating a balanced diet and limiting snacks can prevent tooth decay and periodontal disease. Nutritious foods such as raw vegetables, plain yogurt, cheese, or a piece of fruit are considered good snack foods to grab.[2] [edit] Flossing The use of dental floss is an important element of oral hygiene, since it removes the plaque and the decaying food remaining stuck between the teeth. This food decay and plaque cause irritation to the gums, allowing the gum tissue to bleed more easily. Acid forming foods left on teeth also demineralise teeth eventually causing cavities. Flossing for a proper inter-dental cleaning is recommended at least once per day, preferably before bedtime, to help prevent receding gums, gum disease, and cavities between the teeth. A dental hygienist demonstrates dental flossing. It is recommended to use enough floss to enable easy use, usually ten or more inches with three to four inches of taut floss to put between teeth. Floss is then wrapped around the middle finger and/or index finger, and supported with the thumb on each hand. It is then held tightly to make taut, and then gently moved up and down between each tooth. It is important to floss under visible areas by curving the floss around each tooth instead of moving up and down on gums, which are much more sensitive than teeth. However, bleeding gums are normal upon first usage of floss, and will harden with use.[3] One should use an unused section of the floss when moving around different teeth. Removing floss from between teeth requires using the same back-and-forth motion as flossing, but gently bringing the floss up and out of gaps between teeth. [edit] Tongue cleaning Cleaning the tongue as part of daily oral hygiene is essential, since it removes the white/yellow bad-breath-generating coating of bacteria, decaying food particles, fungi (such as Candida), and dead cells from the dorsal area of the tongue. Tongue cleaning also removes some of the bacteria species which generate tooth decay and gum problems. [edit] Gum care Massaging gums with toothbrush bristles is generally recommended for good oral health. Flossing is recommended at least once per day, preferably before bed, to help prevent receding gums, gum disease, and cavities between the teeth. [edit] Oral irrigation Some dental professionals recommend oral irrigation as a way to clean teeth and gums.[4] Oral irrigators reach 3–4 mm under the gum line. Oral irrigators use a pressured, directed stream of water to disrupt plaque and bacteria. [edit] Food and drink Foods that help muscles and bones also help teeth and gums. Breads and cereals are rich in vitamin B while fruits and vegetables contain vitamin C, both of which contribute to healthy gum tissue.(8) Lean meat, fish, and poultry provide magnesium and zinc for teeth. Some people recommend that teeth be brushed after every meal and at bedtime, and flossed at least once per day, preferably at night before sleep. For some people, flossing might be recommended after every meal. [edit] Beneficial foods Some foods may protect against cavities. Fluoride is a primary protector against dental cavities. Fluoride makes the surface of teeth more resistant to acids during the process of remineralisation. Drinking fluoridated water is recommended by some dental professionals while others say that using toothpaste alone is enough. Milk and cheese are also rich in calcium and phosphate, and may also encourage remineralisation. All foods increase saliva production, and since saliva contains buffer chemicals this helps to stabilize the pH to near 7 (neutral) in the mouth. Foods high in fiber may also help to increase the flow of saliva. Sugar-free chewing gum stimulates saliva production, and helps to clean the surface of the teeth.(8) According to World Dental,[5] these are the top ten beneficial foods for teeth. 1. Green tea contains polyphenol antioxidant plant compounds that reduce plaque and help reduce cavities and gum disease. Tea may help reduce bad breath. Tooth enamel is strengthened because green tea contains fluoride which promotes healthy teeth. 2. Milk and yogurt are good for teeth because they contain low acidity, which means that wearing of teeth is less. They are also low in decay-inducing sugar. Milk is a good source of calcium, the main component of teeth and bones. 3. Cheese contains calcium and phosphate, which helps balance pH in the mouth,[citation needed] preserves (and rebuilds) tooth enamel, produces saliva, and kills bacteria[citation needed] that cause cavities and disease. 4. Fruits such as apples, strawberries and kiwis contain Vitamin C. This vitamin is considered the element that holds cells together. If this vitamin is neglected, gum cells can break down, making gums tender and susceptible to disease. 5. Vegetables: Vitamin A, found in pumpkins, carrots, sweet potatoes and broccoli, is necessary for the formation of tooth enamel. Crunchy vegetables may also help clean gums. 6. Onions contain antibacterial sulfur compounds. Tests show that onions kill various types of bacteria,[citation needed] especially when eaten raw. 7. Celery protects teeth by producing saliva which neutralizes bacteria that cause cavities. It also massages the teeth and gums. 8. Sesame seeds reduce plaque and help build tooth enamel.[citation needed] They are also very high in calcium. 9. Animal food: beef, chicken, turkey, and eggs contain phosphorus which, with calcium, is one of the two most vital minerals of teeth and bone. 10. Water cleans the mouth and produces saliva that deposits essential minerals into the teeth. It keeps teeth hydrated[clarification needed] and washes away particles from the teeth. [edit] Detrimental foods Sugars are commonly associated with dental cavities. Other carbohydrates, especially cooked starches, e.g. crisps/potato chips, may also damage teeth, although to a lesser degree since starch has to be converted by enzymes in saliva first. Sucrose (table sugar) is most commonly associated with cavities. The amount of sugar consumed at any one time is less important than how often food and drinks that contain sugar are consumed. The more frequently sugars are consumed, the greater the time during which the tooth is exposed to low pH levels, at which point demineralisation occurs (below 5.5 for most people). It is important therefore to try to encourage infrequent consumption of food and drinks containing sugar so that teeth have a chance to be repaired by remineralisation and fluoride. Limiting sugar-containing foods and drinks to meal times is one way to reduce the incidence of cavities. Sugars from fruit and fruit juices, e.g., glucose, fructose, and maltose seem equally likely to cause cavities.[citation needed] Acids contained in fruit juice, vinegar and soft drinks lower the pH level of the oral cavity which causes the enamel to demineralize. Drinking drinks such as orange juice or cola throughout the day raises the risk of dental cavities tremendously. Another factor which affects the risk of developing cavities is the stickiness of foods. Some foods or sweets may stick to the teeth and so reduce the pH in the mouth for an extended time, particularly if they are sugary. It is important that teeth be cleaned at least twice a day, preferably with a toothbrush and fluoride toothpaste, to remove any food sticking to the teeth. Regular brushing and the use of dental floss also removes the dental plaque coating the tooth surface. Chewing gum assists oral irrigation between and around the teeth, cleaning and removing particles, but for teeth in poor condition it may damage or remove loose fillings as well. [edit] Other Smoking and chewing tobacco are both strongly linked with multiple dental diseases.[6] Regular vomiting, as seen in bulimia nervosa, also causes significant damage. Mouthwash or mouth rinse improve oral hygiene. Dental chewing gums claim to improve dental health. Retainers can be cleaned in mouthwash or denture cleaning fluid.[7] Dental braces may be recommended by a dentist for best oral hygiene and health. Dentures, retainers, and other appliances must be kept extremely clean. This includes regular brushing and may include soaking them in a cleansing solution. Wikimedia Commons has media related to: oral hygiene [edit] Oral hygiene and systemic diseases Several recent clinical studies show a direct link between poor oral hygiene (oral bacteria & oral infections) and serious systemic diseases, such as:[8][9] * Cardiovascular Disease (Heart attack and Stroke) * Bacterial Pneumonia * Low Birth Weight/Extreme High Birth Weight * Diabetes complications * Osteoporosis [edit] See also * Receding gums * Periodontology * List of oral health and dental topics * List of basic dentistry topics * Halitosis * Toothbrush * Tongue cleaner * Dental floss * American Dental Hygienists' Association

teeth whitening Return to the top

Dental bleaching, also known as tooth whitening, is a common procedure in general dentistry but most especially in the field of cosmetic dentistry. A child's deciduous teeth are generally whiter than the adult teeth that follow. As a person ages the adult teeth often become darker due to changes in the mineral structure of the tooth, as the enamel becomes less porous[citation needed]. Teeth can also become stained by bacterial pigments, foodstuffs and tobacco. Certain antibiotic medications (like tetracycline) can also cause teeth stains or a reduction in the brilliance of the enamel.[1] There are many methods to whiten teeth: bleaching strips, bleaching pen, bleaching gel, laser bleaching, and natural bleaching. Traditionally, at-home whitening involves applying bleaching gel to the teeth using thin guard trays. At-home whitening can also be done by applying small strips that go over the front teeth. Oxidizing agents such as hydrogen peroxide or carbamide peroxide are used to lighten the shade of the tooth. The oxidizing agent penetrates the porosities in the rod-like crystal structure of enamel and oxidizes interprismatic stain deposits; over a period of time, the dentin layer, lying underneath the enamel, is also bleached. Power bleaching uses light energy to accelerate the process of bleaching in a dental office. The effects of bleaching can last for several months, but may vary depending on the lifestyle of the patient. Factors that decrease whitening include smoking and the ingestion of dark colored liquids like coffee, tea and red wine. Internal staining of dentine can discolor the teeth from inside out. Internal bleaching can remedy this. If heavy staining or tetracycline damage is present on a patient's teeth, and whitening is ineffective, there are other methods of whitening teeth. Bonding, when a thin coating of composite material is applied to the front of a person's teeth and then cured with a blue light can be performed to mask the staining. A veneer can also mask tooth discoloration. Contents [hide] * 1 Methods * 2 Risks * 3 Internal bleaching * 4 Agents * 5 References [edit] Methods According to the American Dentist Association there are different options to whiten one's teeth that include: in-office bleaching, which is applied by a professional dentist; at-home bleaching, which is to be used at home by the patient; over-the-counter, which is applied by patients; and options called non-dental, which are offered at mall kiosks, spas, salons, or other similar places). Whitening products intended for home use include gels, chewing gums, rinses, toothpastes, among others.[2] The ADA has published a list of accepted over-the-counter whitening products to help people choose appropriate whitening products.[3] The ADA recommends to have one's teeth checked by a dentist before undergoing any whitening method. The dentist should examine the patient thoroughly: take a health and dental history (including allergies and sensitivities), observe hard and soft tissues, placement and conditions of restorations, and sometimes x-rays to determine the nature and depth of possible irregularities. There are two main methods of gel bleaching—one performed with high-concentration gel, and another with low-concentration agents. High-concentration bleaching can be accomplished either in the dental office, or at home. Performing the procedure at home is accomplished using high-concentration carbamide peroxide, which is readily available online or in dental stores and is much more cost-effective than the in-office procedure. Whitening is performed by applying a high concentration of oxidizing agent to the teeth with thin plastic trays for a short period of time, which produces quick results. The application trays ideally should be well-fitted to retain the bleaching gel, ensuring even and full tooth exposure to the gel. Trays will typically stay on the teeth for about 15–20 minutes. Trays are then removed and the procedure is repeated up to two more times. Most in-office bleaching procedures use a light-cured protective layer that is carefully painted on the gums and papilla (the tips of the gums between the teeth) to reduce the risk of chemical burns to the soft tissues. The bleaching agent is either carbamide peroxide, which breaks down in the mouth to form hydrogen peroxide, or hydrogen peroxide itself. The bleaching gel typically contains between 10% and 44% carbamide peroxide (15% is recommended),[by whom?] which is roughly equivalent to a 3-10% hydrogen peroxide concentration. Low-concentration whitening is far less effective, and is generally only performed at home. Low-concentration whitening involves purchasing a thin mouthguard or strip that holds a relatively low concentration of oxidizing agent next to the teeth for as long as several hours a day for a period of 5 to 14 days. Results can vary, depending on which application is chosen, with some people achieving whiter teeth in a few days, and others seeing very little results or no results at all. Whitening is potentially better at a dentist because the strip or mouth-guard does not completely conform to the shape of the teeth, sometimes leaving the tips of the teeth (near the gumline) unbleached. The bleaching agent is typically less than 10% hydrogen peroxide equivalent, so irritation to the soft tissue around teeth is minimized. Dentists as well as some dental laboratories can fabricate custom fitted whitening trays that will greatly improve the results achieved with an over-the-counter whitening method. A typical course of bleaching can produce dramatic improvements in the cosmetic appearance of most stained teeth; however, some stains do not respond to bleaching. Tetracycline staining may require prolonged bleaching, as it takes longer for the bleach to reach the dentine layer. Case studies have been performed on people with tetracycline stained teeth. They used custom bleaching trays every night for 6 months and saw dramatic results and improvement. White-spot decalcifications may also be highlighted and become more noticeable directly following a whiting process, but usually calm back down with the other parts of the teeth becoming more white. The white spots become less noticeable, with the other parts of the teeth becoming more white. Bleaching is not recommended if teeth have decay or infected gums. It is also least effective when the original tooth color is grayish and may require custom bleaching trays. Bleaching is most effective with yellow discolored teeth. However, whitener does not work where bonding has been used and neither is it effective on tooth-color filling. Other options to deal with such cases are the porcelain veneers or dental bonding.[4] Although there is a wide range of whitening products and techniques available, the results after using them may vary from very positive results to almost non-existent results. The whitening shade guides are used to measure tooth color with Vitapan Classic Shade Guide being the most widely used with 16 shades. These shades determine the effectiveness of the whitening procedure, which may vary from two to seven shades.[5] Power or light-accelerated bleaching, sometimes colloquially referred to as laser bleaching, uses light energy to accelerate the process of bleaching in a dental office. Different types of energy can be used in this procedure, with the most common being halogen, LED, or plasma arc. Clinical trials have demonstrated that among these three options, halogen light is the best source for producing optimal treatment results.[6] The ideal source of energy should be high energy to excite the peroxide molecules without overheating the pulp of the tooth.[7] Lights are typically within the blue light spectrum as this has been found to contain the most effective wavelengths for initiating the hydrogen peroxide reaction. A power bleaching treatment typically involves isolation of soft tissue with a resin-based, light-curable barrier, application of a professional dental-grade hydrogen peroxide whitening gel (25-38% hydrogen peroxide), and exposure to the light source for 6–15 minutes. Recent technical advances have minimized heat and ultraviolet emissions, allowing a less time-intensive patient preparation procedure. Most power teeth whitening treatments can be done in approximately 30 minutes to one hour, in a single visit to a dental physician. Treatment times and recommendations are dependent on the condition of a person’s teeth at time of treatment. It should be noted that the use in cosmetic dentistry, of concentrations above 0.1% of Hydrogen Peroxide are illegal in the UK, but almost all teeth whitening methods use many times this concentration. [edit] Risks Side effects of teeth bleaching include: * Chemical burns from gel bleaching (if a high-concentration oxidizing agent contacts unprotected tissues, which may bleach or discolor mucous membranes), sensitive teeth * Overbleaching (known in the profession as "over-white teeth") aka "Hyperodonto-oxidation" * Rebound, or teeth losing the bleached effect, particularly with the intensive treatments (products that provide a large change in tooth colour over a very short treatment period, e.g., 1 hour) * Pain if you have "sensitive teeth" caused by open dentinal tubules. A recent study by Kugel et al. showed that nearly half the initial change in color provided by an intensive in-office treatment (i.e., 1 hour treatment in a dentist's chair) may be lost in seven days.[8] Rebound is experienced when a large proportion of the tooth whitening has come from tooth dehydration (also a significant factor in causing sensitivity).[9] As the tooth rehydrates, tooth color 'rebounds' back toward where it started.[10] Home tooth bleaching treatments can very slightly reduce tooth enamel.[11] There have been long term Tetracycline studies done where patients received high concentration bleach, over night, for 6 months. These studies show that even over long term exposure, the amount of reduction in tooth enamel is insignificant.[citation needed] The side effects that occur most often are a temporary increase in tooth sensitivity and mild irritation of the soft tissues of the mouth, particularly the gums.[12] Tooth sensitivity often occurs during early stages of the bleaching treatment. Tissue irritation most commonly results from an ill-fitting mouthpiece tray rather than the tooth-bleaching agent. Both of these conditions usually are temporary and disappear within 1 to 3 days of stopping or completing treatment. Individuals with sensitive teeth and gums, receding gums and/or defective restorations should consult with their dentist prior to using a tooth whitening system. People who are sensitive to hydrogen peroxide (the whitening agent) should not try a bleaching product without first consulting a dentist. Also, prolonged exposure to bleaching agents may damage tooth enamel. This is especially the case with home remedy whitening products that contain fruit acids. Bleaching is not recommended in children under the age of 16. This is because the pulp chamber, or nerve of the tooth, is enlarged until this age. Tooth whitening under this condition could irritate the pulp or cause it to become sensitive. Tooth whitening is also not recommended in pregnant or lactating women. Tooth whitening does not usually change the color of fillings and other restorative materials. It does not affect porcelain, other ceramics, or dental gold. However, it can slightly affect restorations made with composite materials, cements and dental amalgams. Tooth whitening can restore color of fillings, porcelain, and other ceramics when they become stained by foods, drinks, and smoking, among other activities.[citation needed] Although some over-the-counter bleaching products contain carbamide peroxide, most of them are H2O2 based, which has the potential to interact with DNA. Therefore, there is some concern with H2O2 carcinogenicity and non-carcinogenicity. However, there is no sufficient research in this sense. What the studies have been able to show is that H2O2 is both an irritant and cytotoxic. Clinical studies have found a higher occurrence of gingival irritation when patients use bleaching materials with higher peroxide concentrations.[2] [edit] Internal bleaching Internal bleaching procedures are performed on devitalized teeth that have undergone endodontic therapy (a.k.a. "Root Canal") but are discolored due to internal staining of the tooth structure by blood and other fluids that leached in. Unlike external bleaching, which brightens teeth from the outside in, internal bleaching brightens teeth from the inside out. Bleaching the tooth internally involves drilling a hole to the pulp chamber, cleaning, sealing, and filling the root canal with a rubber-like substance, and placing a peroxide gel into the pulp chamber so the gel can work directly inside the tooth on the dentin layer.[citation needed] In this variation of whitening the peroxide is sealed within the tooth over a period of some days and replaced as needed, the so called "walking bleach" technique.[citation needed] [edit] Agents Various chemical and physical agents can be used to whiten teeth. Toothpaste typically has small particles of silica, aluminum oxide, calcium carbonate, or calcium phosphate to grind off stains formed by colored molecules that have adsorbed onto the teeth from food. Unlike bleaches, whitening toothpaste does not alter the intrinsic color of teeth. Bleaching solutions contain peroxide, which bleaches the tooth enamel to change its color.[13] Off-the-shelf products typically rely on a carbamide peroxide solution varying in concentration from 10% to 44%. Bleaching solutions may be applied directly to the teeth, embedded in a plastic strip that is placed on the teeth or use a gel held in place by a mouthguard. The FDA of America only approve gels that are under 6% Hydrogen peroxide or 16% or under of Carbamide Peroxide. The Scientific Committee for Consumer Protection of the EU also consider gels containing higher dose than mentioned above to be unsafe. Some of the kits on the market are therefore not considered safe.

impacted teeth Return to the top

Impacted and embedded teeth are the two main types of unerupted teeth found in the mouth, and can sometimes be confused with each other. In cases of both impacted and embedded teeth, the teeth remain below the surface of the gum and sometimes bone, rather than erupting into an exposed position within the mouth; however, the reason for the failure to erupt differs. Impacted teeth result from a situation in which an unerupted tooth is wedged against another tooth or teeth or otherwise directed so that it cannot erupt normally. In contrast, an embedded tooth is an unerupted tooth that is covered, usually completely, with bone. The former is "physically" blocked in its path of eruption, while the latter is compromised by its lack of eruptive force often without known etiology. Certain systemic and local pathologic conditions may be associated with both (i.e., cleidocranial dysostosis). [edit] Impaction classifications There are numerous classification systems used to identify the specific manner in which a tooth is impacted. One of the most simple distinctions made is whether a tooth is impacted completely within bone or whether it has broken through the bony cortex and is partially or completely covered in gingival tissue; the former would be termed bony impaction, while the latter would be termed soft-tissue impaction, and both classifications may present as partial or complete.[1] Mandibular third molars are the most commonly found unerupted teeth, while maxillary third molars are second most common.

teeth cleaning Return to the top

Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities (dental caries), gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened deposits not removed by routine cleaning. Contents [hide] * 1 Brushing, scrubbing and flossing o 1.1 Brushing o 1.2 Flossing and interdental cleaning o 1.3 Scrubbing * 2 Professional teeth cleaning * 3 Complications * 4 References * 5 External links [edit] Brushing, scrubbing and flossing Main articles: Tooth brushing and Dental floss [edit] Brushing Careful and frequent brushing with a toothbrush helps to prevent build-up of plaque bacteria on the teeth.[1] These bacteria metabolize carbohydrates from food and excrete acid which demineralizes tooth enamel, which may eventually decay teeth, causing toothache and cavities and requiring dental treatment, often involving fillings. Dental calculus (tartar, hardened plaque) buildup on teeth, usually opposite salivary ducts, is due to minerals deposited on resident plaque. Frequent brushing and swishing saliva around helps prevent these deposits. Fluoride-containing or anti-plaque (tartar control) toothpastes may mitigate production of plaque and calculus[citation needed]. Early toothbrushing utilized powdered pumice stone as a polishing agent. Later, flavored powders were mixed with the powered pumice to make a more pleasant-tasting toothpowder. In the late 1920s powdered pumice was mixed with a flavored paste to make toothpaste, with no added treatment agents as found in toothpastes today. Electric toothbrushes were developed, and initially recommended for people with strength or dexterity problems in their hands, but they have come into widespread general use. The effectiveness of electric toothbrushes at reducing plaque formation and gingivitis is about the same as conventional toothbrushes[2] Toothbrushing cannot reach or force toothpaste inside pits and fissures in chewing surfaces[citation needed], where over 80% of cavities occur. A new toothbrush design is needed to force fluoride toothpaste inside pits and fissures to neutralise acid and remineralise demineralised tooth enamel[citation needed]. [edit] Flossing and interdental cleaning In addition to brushing, cleaning between teeth may help to prevent build-up of plaque bacteria on the teeth. This may be done with dental floss or interdental brushes. 80% of cavities occur in the grooves, or pits and fissures, of the chewing surfaces of the teeth.[3] Special appliances or tools may be used to supplement toothbrushing and interdental cleaning. These include special toothpicks, oral irrigators, and other devices. [edit] Scrubbing Teeth can be cleaned by scrubbing with a twig instead of a toothbrush. Plant sap in the twig takes the place of toothpaste. In many parts of the world teeth cleaning twigs are used. In the Muslim world the miswak or siwak is made from twigs or roots that are said to have an antiseptic effect when used for cleaning teeth[citation needed]. [edit] Professional teeth cleaning Dental hygienist polishing a patient's teeth See also: Dental surgery Teeth cleaning (prophylaxis) by a dental hygienist removes tartar (mineralized plaque) that may develop even with careful brushing and flossing, especially in areas that are difficult to reach in routine toothbrushing. Professional cleaning includes tooth scaling and tooth polishing and debridement if too much tartar has accumulated. This involves the use of various instruments or devices to loosen and remove deposits from the teeth. Most dental hygienists recommend having the teeth professionally cleaned at least once every year or two.[4] More frequent cleaning and examination may be necessary during treatment of dental and other oral disorders. Routine examination of the teeth is recommended at least every year. This may include yearly, select dental X-rays. See also dental plaque identification procedure and removal. Between cleanings by a dental hygienist, good oral hygiene helps to prevent cavities, tartar build-up, and gum disease. [edit] Complications Overly vigorous or incorrectly performed brushing or flossing may cause injury to the gingiva (gums). Improper or over-vigorous brushing may cause sore gums, damage to tooth enamel, gingivitis, and bleeding gums. Dentists and dental hygienists can instruct and demonstrate proper brushing or flossing techniques.[5]

pediatric dentistry Return to the top

Pediatric Dentistry (formerly Pedodontics/Paedodontics) is the branch of dentistry dealing with children from birth through adolescence. It is one of the Specialties recognized by the American Dental Association, Royal College of Dentists of Canada, and Royal Australasian College of Dental Surgeons. This discipline focuses intimately on pediatric/adolescent growth and development, disease causality and prevention, child psychology and management, and all aspects of the highly-specialized Pediatric restorative techniques and modalities. Some Pediatric Dentists also specialize in the care of "special needs" patients, such as people with cerebral palsy, mental retardation and autism. Pediatric Dentists require an extra two to three years of post-doctoral dental training after attaining their dental degree. They are then eligible for board certification by the American Board of Pediatric Dentistry (Diplomate ABPD) or Fellowship with either the Royal College of Dentists of Canada ( FRCDC (Paed) ), or Royal Australasian College of Dental Surgeons ( FRACDS (Paed) ). Most states (excluding Texas) and provinces require a Specialty Permit or License in order to limit professional practice to Pediatric Dentistry or to represent oneself as a Pediatric Dentist. Differentiating itself from general dentistry, Pediatric Dentistry emphasizes the establishment of trust and confidence in children with their dentists. Consequently, one of the main components of pediatric training is child psychology. This manifests itself in special office designs, different communication styles and an emphasis on teaching preventative dental habits to children in an effort to make dental visits enjoyable. Pediatric Dentistry places special importance in preventing tooth decay. Studies show that poor oral health care in children can lead to impaired school performance and poor social relationships. Therefore, Pediatric Dentists give advice on how to make teeth strong the importance of developing healthy eating habits and other ways to prevent disease from occurring. Additionally, Pediatric Dentists work toward the maintenance of primary teeth (baby teeth) until they are naturally lost. This is due to the importance they serve in permitting children to chew properly and therefore maintain good nutrition, their role in speech development, and the maintenance of space for the eventual eruption of the permanent teeth. The role of the Pediatric Dentist changes as children enter adolescence. Recognizing the growing importance of appearance and self-image in their patients, Pediatric Dentists work to ensure that adolescents’ dental needs are met. Preventative dental health care is emphasized and when necessary information is provided to adolescents about subjects such as wisdom teeth tobacco use, sealants and oral piercing. Pediatric Dentists promote the dental health of children as well as serve as educational resources for parents. It is recommended by the American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) that a dental visit should occur within six months after the presence of the first tooth or by a child’s first birthday. It is important to establish a Dental Home for a child. This is because early oral examination aids in the detection of the early stages of tooth decay. Early detection is essential to maintain oral health, modify aberrant habits, and treat as needed and as simply as possible. Additionally, parents are given a program of preventative home care (brushing/flossing/fluorides), a caries risk assessment, information on finger, thumb, and pacifier habits, advice on preventing injuries to the mouth and teeth of children, diet counseling, and information on growth and development.

porcelain Return to the top

porcelain - 4 dictionary results Affordable Smile MakeOver No shots. No drilling. No adhesives The Painless Way to a Great Smile! www.SnapOnSmile.com Learn Chinese easily Free course,Free videos,Free audios Making Chinese easily for learning. www.Chinese.cn Porcelain Repair Products Repair Chips, Scratches & More. Colors To Match Any Brand. Buy Now! Sponsored Results www.Find-A-Fix.com por·ce·lain    /ˈpɔrsəlɪn, ˈpoʊr-; ˈpɔrslɪn, ˈpoʊrs-/ Show Spelled[pawr-suh-lin, pohr-; pawrs-lin, pohrs-] Show IPA –noun 1. a strong, vitreous, translucent ceramic material, biscuit-fired at a low temperature, the glaze then fired at a very high temperature. 2. ware made from this. Use porcelain in a Sentence See images of porcelain Search porcelain on the Web Origin: 1520–30; < F porcelaine < It porcellana orig., a type of cowry shell, appar. likened to the vulva of a sow, n. use of fem. of porcellano of a young sow, equiv. to porcell ( a ), dim. of porca sow ( see pork, -elle) + -ano -an —Related forms por·ce·la·ne·ous, por·cel·la·ne·ous  /ˌpɔrsəˈleɪniəs, ˌpoʊr-/ Show Spelled[pawr-suh-ley-nee-uhs, pohr-] Show IPA, adjective Dictionary.com Unabridged Based on the Random House Dictionary, © Random House, Inc. 2011. Cite This Source | Link To porcelain Figurines Browse Dozens of Stores Online. Find Top Brands Home Décor. Buy Now www.Glimspe.com Montgy Porcelain Veneers Call Today & Enhance Your Smile with Our Cosmetic Dental Veneers. Sponsored Results www.LeighAnneNevinsDmd.com World English Dictionary porcelain (ˈpɔːslɪn, -leɪn, ˈpɔːsə-) [Click for IPA pronunciation guide] — n 1. a more or less translucent ceramic material, the principal ingredients being kaolin and petuntse (hard paste) or other clays, ground glassy substances, soapstone, bone ash, etc 2. an object made of this or such objects collectively 3. ( modifier ) of, relating to, or made from this material: a porcelain cup [C16: from French porcelaine, from Italian porcellana cowrie shell, porcelain (from its shell-like finish), literally: relating to a sow (from the resemblance between a cowrie shell and a sow's vulva), from porcella little sow, from porca sow, from Latin; see pork ] porcellaneous — adj Collins English Dictionary - Complete & Unabridged 10th Edition 2009 © William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009 Cite This Source Word Origin & History porcelain c.1530, from M.Fr. porcelaine, from It. porcellana "porcelain" (13c.), lit. "cowrie shell," the chinaware so called from resemblance to the shiny surface of the shells. The shell's name in It. is from porcella "young sow," fem. of L. porcellus "young pig," dim. of porculus "piglet," dim. of porcus "pig." Supposedly the shells were so called because the shape of the orifice reminded someone of the vaginas of pigs. Online Etymology Dictionary, © 2010 Douglas Harper Cite This Source Medical Dictionary por·ce·lain definition Pronunciation: /ˈpōr-s(ə-)lən, ˈpȯr-/ Function: n : a hard, fine-grained, nonporous, and usually translucent and white ceramic ware that consists essentially of kaolin, quartz, and feldspar and that has many uses in dentistry Merriam-Webster's Medical Dictionary, © 2007 Merriam-Webster, Inc. Cite This Source Famous Quotations porcelain "And like that game with which the Japanese amuse themse..." "Daughters are the seed of occupations, Of asperiti..." "Time goes, you say? Ah, no! Alas, Time stays, we g..." "As a bathtub lined with white porcelain, When the ..." "It is only following out nature. As a child, I never ca..."

"Fine China" redirects here. For the band, see Fine China (band). This article is about the ceramic material. For other uses, see Porcelain (disambiguation). Question book-new.svg This article needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (February 2008) Northern Song celadon porcelain, 10th century, China. Soft-paste porcelain Swan tureen, 1752-6, Chelsea. Flower centerpiece, 18th century, Spain. Porcelain is a ceramic material made by heating raw materials, generally including clay in the form of kaolin, in a kiln to temperatures between 1,200 °C (2,192 °F) and 1,400 °C (2,552 °F). The toughness, strength, and translucence of porcelain arise mainly from the formation of glass and the mineral mullite within the fired body at these high temperatures. Porcelain derives its present name from old Italian porcellana (cowrie shell) because of its resemblance to the translucent surface of the shell.[1] Porcelain can informally be referred to as "china" in some English-speaking countries, as China was the birth place of porcelain making.[2] Properties associated with porcelain include low permeability and elasticity; considerable strength, hardness, glassiness, brittleness, whiteness, translucence, and resonance; and a high resistance to chemical attack and thermal shock. For the purposes of trade, the Combined Nomenclature of the European Communities defines porcelain as being "completely vitrified, hard, impermeable (even before glazing), white or artificially coloured, translucent (except when of considerable thickness) and resonant." However, the term porcelain lacks a universal definition and has "been applied in a very unsystematic fashion to substances of diverse kinds which have only certain surface-qualities in common" (Burton 1906). Porcelain is used to make table, kitchen, sanitary, and decorative wares; objects of fine art; and tiles. Its high resistance to the passage of electricity makes porcelain an excellent insulator. Dental porcelain is used to make false teeth, caps, crowns and veneers. Contents [hide] * 1 Scope, materials and methods o 1.1 Scope o 1.2 Materials o 1.3 Methods * 2 Categories of porcelain o 2.1 Hard paste o 2.2 Soft paste o 2.3 Bone china * 3 History o 3.1 Chinese porcelain o 3.2 European porcelain + 3.2.1 Meissen + 3.2.2 Soft paste porcelain + 3.2.3 Other developments * 4 As an electric insulating material * 5 As a building material o 5.1 Types porcelain * 6 See also * 7 References * 8 External links [edit] Scope, materials and methods [edit] Scope The most common uses of porcelain are the creation of artistic objects and the production of more utilitarian wares. It is difficult to distinguish between stoneware and porcelain because this depends upon how the terms are defined. A useful working definition of porcelain might include a broad range of ceramic wares, including some that could be classified as a stoneware. [edit] Materials Further information: Pottery Chinese porcelain from the reign of the Qianlong Emperor (1735-1796) Clay is generally thought to be the primary material from which porcelain is made, even though clay minerals might account for only a small proportion of the whole. The word "paste" is an old term for both the unfired and fired material. A more common terminology these days for the unfired material is "body", for example, when buying materials a potter might order an amount of porcelain body from a vendor. The composition of porcelain is highly variable, but the clay mineral kaolinite is often a significant component. Other materials can include feldspar, ball clay, glass, bone ash, steatite, quartz, petuntse and alabaster; further information on these formulations is given at "soft-paste porcelain". The clays used are often described as being long or short, depending on their plasticity. Long clays are cohesive (sticky) and have high plasticity; short clays are less cohesive and have lower plasticity. In soil mechanics, plasticity is determined by measuring the increase in content of water required to change a clay from a solid state bordering on the plastic, to a plastic state bordering on the liquid, though the term is also used less formally to describe the facility with which a clay may be worked. Clays used for porcelain are generally of lower plasticity and are shorter than many other pottery clays. They wet very quickly, meaning that small changes in the content of water can produce large changes in workability. Thus, the range of water content within which these clays can be worked is very narrow and the loss or gain of water during storage and throwing or forming must be carefully controlled to keep the clay from becoming too wet or too dry to manipulate. [edit] Methods This section may require cleanup to meet Wikipedia's quality standards. Please improve this section if you can. The talk page may contain suggestions. (February 2008) Korean celadon incense burner from the Goryeo period The following section provides background information on the methods used to form, decorate, finish, glaze, and fire ceramic wares. Forming. is described in the Wikipedia articles Pottery and Ceramic forming techniques. Glazing. Unlike their lower-fired counterparts, porcelain wares do not need glazing to render them impermeable to liquids and for the most part are glazed for decorative purposes and to make them resistant to dirt and staining. Great detail is given in the glaze article. Many types of glaze, such as the iron-containing glaze used on the celadon wares of Longquan, were designed specifically for their striking effects on porcelain. Decoration. Porcelain wares may be decorated under the glaze using pigments that include cobalt and copper or over the glaze using coloured enamels. Like many earlier wares, modern porcelains are often bisque-fired at around 1,000 degrees Celsius, coated with glaze and then sent for a second glaze-firing at a temperature of about 1,300 degrees Celsius or greater. Another early method is once-fired where the glaze is applied to the unfired body and the two fired together in a single operation. A porcelain doll from the Czech Republic Firing. In this process, green (unfired) ceramic wares are heated to high temperatures in a kiln to permanently set their shapes. Porcelain is fired at a higher temperature than earthenware so that the body can vitrify and become non-porous. [edit] Categories of porcelain Porcelain can be divided into the three main categories: hard-paste, soft-paste, and bone, depending on the composition of the paste, the material used to form the body of a porcelain object. [edit] Hard paste Main article Hard-paste porcelain Some of the earliest European porcelains were produced at the Meissen factory in the early 18th century; they were formed from a paste composed of kaolinite, quartz, and alabaster and fired at temperatures in excess of 1,350 °C (2,462 °F), producing a porcelain of great hardness and strength. Later, the composition of the Meissen hard paste was changed and the alabaster was replaced by feldspar, allowing the pieces to be fired at lower temperatures. Kaolinite, feldspar and quartz (or other forms of silica) continue to provide the basic ingredients for most continental European hard-paste porcelains. [edit] Soft paste Main article Soft-paste porcelain Its history dates from the early attempts by European potters to replicate Chinese porcelain by using mixtures of china clay and ground-up glass or frit; soapstone and lime were known to have also been included in some compositions. As these early formulations suffered from high pyroplastic deformation, or slumping in the kiln at raised temperature, they were uneconomic to produce. Formulations were later developed based on kaolin, quartz, feldspars, nepheline syenite and other feldspathic rocks. These were technically superior and continue in production. [edit] Bone china Main article Bone China Although originally developed in England to compete with imported porcelain, Bone china is now made worldwide. It has been suggested[by whom?]that a misunderstanding of an account of porcelain manufacture in China given by a Jesuit missionary was responsible for the first attempts to use bone-ash as an ingredient of Western porcelain (in China, china clay was sometimes described as forming the bones of the paste, while the flesh was provided by refined porcelain stone)[citation needed]. For whatever reason, when it was first tried it was found that adding bone-ash to the paste produced a white, strong, translucent porcelain. Traditionally English bone china was made from two parts of bone-ash, one part of china clay kaolin and one part china stone (a feldspathic rock), although this has largely been replaced by feldspars from non-UK sources.[3] [edit] History [edit] Chinese porcelain Main article: Chinese ceramics See also: List of Chinese inventions A Chinese porcelain-ware displaying battles between dragons, Kangxi era (1662-1722), Qing Dynasty. Porcelain is generally believed to have originated in China. Although proto-porcelain wares exist dating from the Shang Dynasty about 1600 BCE, by the Eastern Han Dynasty (100-200 BCE) high firing glazed ceramic wares had developed into porcelain, and porcelain manufactured during the Tang Dynasty period (618–906) was exported to the Islamic world, where it was highly prized.[4] Early porcelain of this type includes the tri-color glazed porcelain, or sancai wares. Historian S.A.M. Adshead writes that true porcelain items in the restrictive sense that we know them today could be found in dynasties after the Tang,[5] during the Song, Yuan, Ming, and Qing Dynasties. By the Sui (about 580 AD) and Tang (about 620 AD) dynasties, porcelain had become widely produced. Eventually, porcelain and the expertise required to create it began to spread into other areas; by the seventeenth century, it was being exported to Europe. Korean and Japanese porcelain also have long histories and distinct artistic traditions. [edit] European porcelain Letter of Francois Xavier d'Entrecolles about Chinese porcelain manufactuting techniques, 1712, published by du Halde in 1735. These exported Chinese porcelains of the seventeenth and eighteenth centuries were held in such great esteem in Europe that in the English language china became a commonly–used synonym for the Franco-Italian term porcelain. Apart from copying Chinese porclelain in faience (tin glazed earthenware), the soft-paste Medici porcelain in 16th-century Florence was the first real European attempt to reproduce it, with little success. The European search for the secret of porcelain manufacture ended in 1708 with the discovery by Ehrenfried Walther von Tschirnhaus and Johann Friedrich Böttger of a combination of ingredients, including Colditz clay (a source of kaolinite), calcined alabaster, and quartz, that produced a hard, white, translucent porcelain. It appears that in this discovery technology transfer from East Asia played little part. The Chinese manufacturing secrets for porcelain manufacturing were revealed by the Jesuit Father Francois Xavier d'Entrecolles in 1712, and openly published in 1735. [edit] Meissen Meissen porcelain - 19th Century pair of candelabras and a clock. Tschirnhaus and Böttger were employed by Augustus the Strong and worked at Dresden and Meissen in the German state of Saxony. Tschirnhaus had a wide knowledge of European science and had been involved in the European quest to perfect porcelain manufacture when in 1705 Böttger was appointed to assist him in this task. Böttger had originally been trained as a pharmacist; after he turned to alchemical research, it was his claim that he knew the secret of transmuting dross into gold that attracted the attention of Augustus. Imprisoned by Augustus as an incentive to hasten his research, Böttger was obliged to work with other alchemists in the futile search for transmutation and was eventually assigned to assist Tschirnhaus. One of the first results of the collaboration between the two was the development of a red stoneware that resembled the red stoneware of Yixing. A workshop note records that the first specimen of hard, white European porcelain was produced in January 1708. At the time, the research was still being supervised by Tschirnhaus; however, he died in October of that year. It was left to Böttger to report to Augustus in March 1709 that he could make true white porcelain. For this reason, credit for the European discovery of porcelain is traditionally ascribed to him rather than Tschirnhaus.[6] The Meissen factory was established in 1710 after the development of a kiln and a glaze suitable for use with Böttger's porcelain, which required firing at temperatures greater than 1,350 °C (2,462 °F) to achieve translucence. Meissen porcelain was once-fired, or green-fired. It was noted for its great resistance to thermal shock; a visitor to the factory in Böttger's time reported having seen a white-hot teapot being removed from the kiln and dropped into cold water without damage. Evidence to support this widely disbelieved story was given in the 1980s when the procedure was repeated in an experiment at the Massachusetts Institute of Technology.[citation needed] [edit] Soft paste porcelain Main article: Soft-paste porcelain Saint-Cloud manufactory soft porcelain bowl, with blue decoration under glaze, 1700-1710. The pastes produced by combining clay and powdered glass (frit) were called Frittenporzellan in Germany and frita in Spain. In France they were known as pâte tendre and in England as "soft-paste";[7] they appear to have been given this name because they do not easily retain their shape in the wet state, or because they tend to slump in the kiln under high temperature, or because the body and the glaze can be easily scratched. Experiments at Rouen produced the earliest soft-paste in France, but the first important French porcelain was made at the Saint-Cloud factory before 1702. Soft-paste factories were established with the Chantilly manufactory in 1730 and at Mennecy in 1750. The Vincennes porcelain factory was established in 1740, moving to larger premises at Sèvres[8] in 1756. Vincennes soft-paste was whiter and freer of imperfections than any of its French rivals, which put Vincennes/Sèvres porcelain in the leading position in France and throughout the whole of Europe in the second half of the 18th century.[9] The first soft-paste in England was demonstrated by Thomas Briand to the Royal Society in 1742 and is believed to have been based on the Saint-Cloud formula. In 1749, Thomas Frye took out a patent on a porcelain containing bone ash. This was the first bone china, subsequently perfected by Josiah Spode. In the fifteen years after Briand's demonstration, half a dozen factories were founded in England to make soft-paste table-wares and figures: * Chelsea 1743 [10][11] * Bow 1745.[12][13][14] * St James's 1748 [14][15] * Bristol porcelain 1748 * Longton Hall 1750 [16] * Derby 1757 [17][18] * Lowestoft porcelain 1757 [19][20] [edit] Other developments William Cookworthy discovered deposits of china clay in Cornwall, making a considerable contribution to the development of porcelain and other whiteware ceramics in the United Kingdom. Cookworthy's factory at Plymouth, established in 1768, used Cornish china clay and china stone to make porcelain with a body composition similar to that of the Chinese porcelains of the early eighteenth century. [edit] As an electric insulating material porcelain insulator for medium high voltage Porcelain is an excellent insulator for use at high voltage, especially in outdoor applications. Examples are: terminals for High voltage cables, bushings of power transformers, insulation of high frequency antennas and many other cases. [edit] As a building material Dakin Building, Brisbane, California using porcelain panels Demonstration of the translucent quality of much porcelain. Porcelain can be used as a building material, usually in the form of tiles or large rectangular panels. Modern porcelain tiles are generally produced to a number of recognised international standards and definitions.[21][22] Manufacturers are found across the world[23] with Italy being the global leader, producing over 380 million square metres in 2006.[24] Historic examples of rooms decorated entirely in porcelain tiles can be found in several European palaces including ones at Capodimonte, Naples, the Royal Palace of Madrid and the nearby Royal Palace of Aranjuez.[25] and the Porcelain Tower of Nanjing in China. More recent noteworthy examples include The Dakin Building in Brisbane, California and the Gulf Building in Houston, Texas which, when constructed in 1929, had a 70-foot-long (21 m) porcelain logo on its exterior.[26] A more detailed description of the history, manufacture and properties of porcelain tiles is given in the article “Porcelain Tile: The Revolution Is Only Beginning.”[26] [edit] Types porcelain * Austria o Augarten porcelain * Denmark o Bing & Grøndahl o Royal Copenhagen * Finland o Arabia * France o Rouen porcelain (1673–1696) o Nevers porcelain o Saint-Cloud porcelain (1693–1766) o Chantilly porcelain (1730–1800) o Vincennes porcelain (1740–1756) o Mennecy-Villeroy porcelain (1745-) o Sèvres porcelain (1756–present) o Limoges porcelain (1771–present) o Revol porcelain (1789–present) o Haviland porcelain * Germany o Barbara Flügel o Arzberg porcelain o Frankenthal Porcelain o Fürstenberg China o Hutschenreuther of Selb o Meissen porcelain o Nymphenburg Porcelain Manufactory o Rosenthal o Villeroy & Boch * Hungary o Alföldi o Herend Porcelain o Hollóházi o Zsolnay * Japan o Noritake * Norway o Porsgrund * Poland o Chodzież o Ćmielów o Horodnica o Wałbrzych * Romania o Apulum SA * Italy o Capodimonte porcelain o Majello Capodimonte * Portugal o Vista Alegre * Russia o Gzhel o Lomonosov * Spain o Lladró * Turkey o Kutahya Porselen * Lithuania o JIESIA (1938-present) * United Kingdom o Belleek o Chelsea porcelain factory o Coalport o Davenport o Goss crested china o Josiah Spode o Josiah Wedgwood o Liverpool porcelain o Mintons Ltd o New Hall porcelain o Plymouth Porcelain o Rockingham Pottery o Royal Crown Derby o Royal Doulton o Royal Worcester * United States o Blue Ridge o Lenox o Lotus Ware * Brazil o Porcelana Schmidt * Iran o Zarin porcelain [edit] See also * Stoneware * Pottery * Lithophane * Sea pottery [edit] References 1. ^ Oxford English Dictionary: "The ceramic material was apparently so named on account of the resemblance of its translucent surface to the nacreous shell of the mollusc. [...] The cowrie was probably originally so named on account of the resemblance of the fissure of its shell to a vulva (it is unclear whether the reference is spec. to the vulva of a sow)." 2. ^ OED, "China"; An Introduction to Pottery. 2nd edition. Rado P. Institute of Ceramic / Pergamon Press. 1988. Usage of "china" in this sense is inconsistent, & it may be used of other types of ceramics also. 3. ^ Changes & Developments Of Non-plastic Raw Materials. Sugden A. International Ceramics Issue 2 2001. 4. ^ "Porcelain". Columbia Encyclopedia Sixth Edition. 2008. http://www.encyclopedia.com/doc/1E1-porcelai.html. Retrieved 2008-06-27. 5. ^ Adshead, S.A.M. (2004). T'ang China: The Rise of the East in World History. New York: Palgrave Macmillan. ISBN 1-4039-3456-8 (hardback). Page 80 & 83. 6. ^ Gleeson, Janet. The Arcanum, an accurate historic novel on the greed, obsession, murder and betrayal that led to the creation of Meissen porcelain. Bantam Books, London, 1998. 7. ^ Honey, W.B., European Ceramic Art, Faber and Faber, 1952, p.533 8. ^ Metropolitan Museum of Art 9. ^ Metropolitan Museum of Art 10. ^ ‘Science Of Early English Porcelain.’ I.C. Freestone. Sixth Conference and Exhibition of the European Ceramic Society. Vol.1 Brighton, 20–24 June 1999, p.11-17 11. ^ ‘The Sites Of The Chelsea Porcelain Factory.’ E.Adams. Ceramics (1), 55, 1986. 12. ^ [1] 13. ^ [2] 14. ^ a b [3] 15. ^ [4] 16. ^ ‘Ceramic Figureheads. Pt. 3. William Littler And The Origins Of Porcelain In Staffordshire.’ Cookson Mon. Bull. Ceram. Ind. (550), 1986. 17. ^ [5] 18. ^ History of Royal Crown Derby Co Ltd, from "British Potters and Potteries Today", publ 1956 19. ^ 'The Lowestoft Porcelain Factory, and the Chinese Porcelain Made for the European Market during the Eighteenth Century.' L. Solon. The Burlington Magazine. No. 6. Vol.II. August 1906. 20. ^ [6] 21. ^ “New American Standard Defines Polished Porcelain By The Porcelain Tile Certification Agency.” Tile Today No.56, 2007. 22. ^ Porcelain tile as defined in ASTM C242 - 01(2007) Standard Terminology of Ceramic Whitewares and Related Products published by ASTM International. 23. ^ ’Manufacturers Of Porcelain Tiles’ Ceram.World Rev. 6, No.19, 1996 … ‘The main manufacturers of porcelain tiles in Italy, Europe, Asia, Africa, Oceania and the Americas are listed.’ 24. ^ ”Italian Porcelain Tile Production At The Top” Ind.Ceram. 27, No.2, 2007. 25. ^ Porcelain Room, Aranjuez Comprehensive but shaky video 26. ^ a b “Porcelain Tile: The Revolution Is Only Beginning.” Tile Decorative Surf. 42, No.11, 1992. * Combined Nomenclature of the European Communities - EC Commission in Luxembourg, 1987 . * Burton, William. Porcelain, its Nature, Art and Manufacture. Batsford, London, 1906.

aetna Return to the top

Aetna, Inc. (NYSE: AET) is an American health insurance company, providing a range of traditional and consumer directed health care insurance products and related services, including medical, pharmaceutical, dental, behavioral health, group life, long-term care, and disability plans, and medical management capabilities. Aetna is a member of the Fortune 100. Contents [hide] * 1 Operations o 1.1 Members * 2 Lobbying and Campaign Contributions * 3 Quality of Care * 4 Current Leadership * 5 History o 5.1 Timeline + 5.1.1 1810s + 5.1.2 1850s + 5.1.3 1860s + 5.1.4 1870s + 5.1.5 1880s + 5.1.6 1890s + 5.1.7 1900s + 5.1.8 1910s + 5.1.9 1960s + 5.1.10 1990s + 5.1.11 2000s o 5.2 2009 o 5.3 2010 * 6 Fines, Lawsuits and Settlements o 6.1 1999 o 6.2 2000 o 6.3 2001 o 6.4 2002 o 6.5 2003 o 6.6 2007 o 6.7 2009 o 6.8 2010 * 7 Life insurance policies on slaves * 8 See also * 9 References * 10 External links [edit] Operations In 2005, the company had $1.1 billion in earnings. Aetna's 2007 revenue, reported in 2008, was $27.6 billion. Aetna's 2008 revenue, reported in 2009, was $31 billion. [edit] Members Aetna provides health care, dental, pharmacy, group life, disability, and long-term care insurance and employee benefits, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare. Membership numbers: (as of March 31, 2008) * 17.467 million — medical members * 14.166 million — dental members * 10.951 million — pharmacy members * 13.609 million — group insurance members * 843,000+ — health-care professionals * 490,000+ — primary-care doctors and specialists * 4,919 — hospitals [edit] Lobbying and Campaign Contributions Aetna has spent more than $2.0 million in 2009 on lobbying.[3] The company spent $809,793 between January, 2009 and the end of March, 2009—up 41 percent from the same period in 2008.[4] Aetna's campaign contributions include more than $110,000 to US Senator Joe Lieberman (ID-CT) in 2009.[5] From 2005 through 2009, Aetna contributed $56,250 to Senator Max Baucus (D-MT), chairman of the Senate Finance Committee, making Aetna the senator's seventh highest contributor over that time period.[6] [edit] Quality of Care In the California Health Care Quality Report Card 2009 Edition, Aetna received 2 out of 4 stars in both Meeting National Standards of Care and How Members Rate Their HMO, for a rating of "Fair" (out of "Poor," "Fair," "Good," or "Excellent").[7] In the California Health Care Quality Report Card 2010 Edition, Aetna received 3 out of 4 stars in both Meeting National Standards of Care and How Members Rate Their HMO, for a rating of "Good" (out of "Poor," "Fair," "Good," or "Excellent").[8] [edit] Current Leadership * Ron Williams - Chairman and CEO * Mark Bertolini - President * Meg McCarthy - Senior Vice President and Chief Information Officer * Joseph Zubretsky - Chief Financial Officer [edit] History Aetna is the direct descendant of Aetna (Fire) Insurance Company, of Hartford, Connecticut.[9][10] The name was meant to invoke Mount Etna, at the time Europe's most active volcano.[11] [edit] Timeline [edit] 1810s * 1819 Henry Leavitt Ellsworth, Yale graduate and attorney, becomes second president of Aetna (Fire) Insurance Company, succeeding Thomas K. Brace. Ellsworth, who later became the first U.S. Patent Commissioner, served as Aetna's president for two years until 1821, when he resigned, but Ellsworth continued as a director for another 16 years. Ellsworth's brother, William Wolcott Ellsworth, also served as a director, as well as the company's first General Counsel.[12] The Aetna building in Hartford [edit] 1850s * 1850 Aetna began operation of an Annuity Fund to sell life insurance, choosing Hartford, Connecticut judge Eliphalet Adams Bulkeley, who was a general counsel to the company and on its board of directors, to head it.[11] At the time, some church leaders and others believed life insurance was sinful.[10] * 1853 The Annuity department separated from Aetna Insurance to be incorporated as the Aetna Life Insurance Company, with Eliphalet Bulkeley as president.[11] * 1854 Aetna hired its first full-time employee, Thomas O. Enders, later to become company president.[11] * 1857 Aetna moved to new offices on Hungerford and Cone Streets in Hartford. The Panic of 1857 struck Hartford and the nation, causing the closing of all but one bank and many other businesses. Eliphalet Bulkeley blocked a move to liquidate the company during the economic downturn.[10][11] * The Aetna Insurance Company issued life insurance policies on an undetermined number of African-American slaves, naming their owners as beneficiaries.[13] [edit] 1860s * 1861 Aetna began offering participating life insurance policies which paid dividends to policyholders just as the mutual life insurance policies did. Aetna launched its new product with a promotional effort including higher commissions for its agents while most companies were cutting back due to the outbreak of the American Civil War and the consequent loss of premium payments from Southern policyholders. However, the death toll of the war coupled with the booming wartime economy caused an expansion of the life insurance business to match Aetna's expansion.[10][11] * 1865 By 1864 Aetna had increased its volume of business by 600% over 1861 and its annual premium income ninefold, exceeding one million dollars. As a result, Aetna possessed the financial stability and resources it needed to meet the stringent regulatory requirements placed on life insurance companies in Massachusetts and New York; by 1865 the company was authorized to begin soliciting business in these states.[11] * 1867 Company income rose from $78,000 in 1861 to $5,129,000 by 1867. Aetna moved to its third home office at 670 Main Street, Hartford. By 1924, Aetna had 94 million dollars, 43% of its assets, invested in farm mortgages.[11] * 1868 Aetna altered its business practices, hiring its first actuary and abandoning the half-note premium system in favor of an all-cash premium plan. [edit] 1870s * 1872 Eliphalet A. Bulkeley died and Thomas O. Enders became president.[11] * 1878 Aetna increased its capitalization from $150,000 to $750,000.[11] * 1879 Enders' failing health forced him to resign and Eliphalet Bulkeley's son Morgan G. Bulkeley replaced him.[11] [edit] 1880s * 1888 Aetna outgrew its old offices on 670 Main Street in Hartford and purchased its fourth home office, next door at 650 Main Street; the first building Aetna actually owned, and Aetna's home office for the next 42 years.[11] [edit] 1890s * 1891 Aetna issued its first accident policy, purchased by Morgan Bulkeley himself.[11] * 1892 Aetna held its first general agents conference in Chicago.[11] * 1899 Aetna became one of the first publicly held insurance companies to enter the health insurance field.[11] [edit] 1900s * 1902 Aetna created an Accident and Liability department to offer employers' liability and workmen's collective insurance, in reaction to the growing strength of the Progressive social reform movement. This would become the cornerstone of the Aetna Accident and Liability Company.[11] * 1903 An Engineering and Inspection Division was created to improve workplace safety.[11] * 1904 Aetna introduced its first corporate seal, conveying Aetna's status as the largest life insurer in the world writing accident, health and liability coverage; the logo portrayed the company's home office bursting out from within a globe, with large block typeface spelling out Aetna's ranking.[11] * 1907 Aetna created a casualty subsidiary to handle items such as automobile property coverage; Aetna soon began aggressively expanding into related lines such as collision and damage. This business developed into the Aetna Casualty and Surety Company.[11] * 1908 Aetna hired its first home office female employee (Julia Kinghorn, telephone switchboard operator), the first of what has become more than two-thirds of Aetna’s employees.[11] [edit] 1910s * 1910 Under the management of E. E. Cammack, Aetna began using Hollerith punched cards machines for tabulating and hired 35 women to input mortality statistics on keypunch machines, the company's first female home office clerks.[11] * 1911 Aetna began its first national advertising campaign. The same year, Aetna formed a bond department to market fidelity and surety coverages.[11] * 1912 Aetna introduced the first combination automobile policy, with several separate types of coverage combined into one contract. Several Aetna insureds were killed on the RMS Titanic.[11] * 1913 Aetna formed its second affiliate, the Automobile Insurance Company, to write fire insurance on cars. This soon expanded to include windstorm, tornado, leasehold, and ocean and inland marine insurance. Aetna formed a Group department to sell group life insurance, one of the first insurers to do so; the first step towards Aetna’s current health care business.[11] [edit] 1960s * 1960 Aetna expanded outside the U.S., buying a Canadian company, Excelsior Life Insurance Company. In 1968, it bought a majority interest in Producer's and Citizen's Cooperative Assurance Company, of Sydney, Australia. In 1981, it bought a 40 percent interest in two Chilean companies, and soon thereafter invested in ventures in England, Spain, Hong Kong, Taiwan, Indonesia and Korea. [edit] 1990s * Between 1996 and 1999, Aetna initiated a series of company acquisitions. In 1998, Aetna bought NYLCare Health Plans for $1.05 billion, adding 2.2 million members. The next year, it bought Prudential HealthCare for $1 billion, making it the largest provider of health benefits in the U.S., with more than 21 million members. The company spent more than $20 million that it received in fees and premiums from customers to revamp its computer systems, enabling the company to identify and discontinue unprofitable accounts. With this new and extensive information about policyholders, new management, and a shift in strategy, Aetna sharply raised premiums on less profitable accounts. Within a few years, Aetna shed 8 million covered lives due to premiums that customers could no longer afford.[14] [edit] 2000s * 2000 Aetna hired John W. Rowe as CEO and executive chairman. Rowe cut approximately 15,000 jobs and raised insurance premiums by 16 percent per year. He also shrunk Aetna's customer base from 19 million members to 13 million by abandoning unprofitable markets, including almost half of the counties nationwide in which it offered Medicare products.[15][16] * 2000 Aetna sold its financial services and international businesses to ING for $7.7 billion, spun off its health business to its shareholders, thus focusing its business as an independent health and group benefits company. * 2006 John Rowe ended his 65 months as CEO and executive chairman of Aetna; during his tenure, the former Harvard geriatrician earned $225,000 a day (including Sundays and holidays).[17] * 2007 Aetna chief medical officer Troy Brennan told the Aetna Investor Conference that, "The (U.S.) healthcare system is not timely." He cited "recent statistics from the Institution of Healthcare Improvement… that people are waiting an average of about 70 days to try to see a provider. And in many circumstances people initially diagnosed with cancer are waiting over a month, which is intolerable."[18] * 2007 Aetna acquired plan operator Schaller Anderson in July, signaling a push into the growing business of running plans for Medicaid and the State Children's Health Insurance Program.[19] * 2008 Aetna CEO Ron Williams received $38.12 million in compensation - the highest annual compensation in the insurance sector and the 22nd-highest compensation of all American CEOs.[20][21] * 2008 Aetna began offering pet health insurance in Alabama, District of Columbia, Idaho, Iowa, Montana, North Dakota and Texas, with plans to quickly expand to all 50 states. “As the new underwriter for Pets Best policies, we look forward to working closely with Pets Best and the AVMA GHLIT to extend the reach of the pet insurance industry to bring trusted, affordable pet health insurance products to pet owners nationwide,” said Gretchen Spann, Aetna’s head of pet insurance.[22] * 2008 Aetna's 2008 revenue, excluding net realized capital losses, increased 14 percent over 2007 to $31.6 billion.[23] [edit] 2009 * Through June 30, Aetna took in $14 billion in premiums: $10.7 billion of that amount from employers and employees, $2.9 billion more from Medicare recipients who bought a supplemental insurance plan to cover the gaps in what Medicare covers, and another $400 million for handling Medicaid claims. Aetna reported that it paid out $11.9 billion in health care reimbursements and $2.3 billion in administrative expenses (20 percent).[24] * On September 22, more than 200 people gathered in front of Aetna's Hartford headquarters to call for a public health insurance option they said is essential to true national health care reform. The insurance industry, including Aetna, has opposed a public option.[25] * On October 2, Connecticut Attorney General Richard Blumenthal and Healthcare Advocate Kevin P. Lembo asked Aetna and four other insurance companies for information the companies may have sent policyholders regarding the impact of proposed legislation on Medicare Advantage and prescription drug programs. According to Blumenthal, some insurance companies have exaggerated or stretched the impact of health care reform.[26] * On October 27, Aetna stock values shot up when U.S. Senator Joe Lieberman of Connecticut broke with the Democratic caucus that he is a member of and vowed to join a Republican-led filibuster if the public option was not removed from the Senate's health care reform bill.[27] * On October 30, Aetna reported a third quarter profit increase of 18 percent.[28] * On November 3, US Senator Tom Harkin, chairman of the Committee on Health, Education, Labor and Pensions, launched an investigation into health insurance pricing, asking Aetna and three other major insurers to justify their pricing practices. The investigation began after small business owners testified before Harkin's committee that skyrocketing health care premiums were severely hurting their livelihoods.[29] * On November 19, Aetna announced the layoff off some 3.5% of its work force—625 employees now and a similar number of reductions early next year. The current cuts include 160 jobs in Connecticut.[30][31] "Streamlining our business now will enable us to improve our competitiveness and redirect resources to areas with a greater potential for future growth," said Aetna CEO Ron Williams.[32] During the third quarter of 2009, Aetna earned $326.2 million, or 73 cents per share. That represents an increase from $277.3 million, or 58 cents per share, in the same quarter last year.[33] * On November 30, Aetna CEO Ron Williams told analysts that Aetna would increase prices in 2010 and force 600,000 to 650,000 Aetna customers to drop their coverage.[34] Aetna President Mark Bertolini justified the move as "ensuring that each customer is priced to an appropriate margin."[35] Aetna chief executive Ronald Williams owns 7.6 million Aetna stock and options. * On December 7, Aetna filed a $4.9 billion correction to its 2008 health insurance regulatory filings. The new filings show that Aetna spends less on small business health care than previously reported. “Health insurance companies have a duty to provide accurate financial information both to consumers and to their regulators about how much money they actually spend on health care and how much they spend on profits, on executive salaries, and on figuring out how to deny care to people when they really need it,” said Senator Jay Rockefeller, Chairman of the U.S. Senate Committee on Commerce, Science, and Transportation. “Unfortunately, it looks like Aetna and other health insurers haven’t been taking this duty very seriously. I’m disappointed that my Committee had to launch a full-scale congressional investigation to get these companies to meet their basic reporting obligations.”[36] * On December 14, Aetna stocks rose dramatically after U.S. Senator Joe Lieberman of Connecticut threatened to filibuster the Senate health care reform bill if it included a Medicare buy-in proposal.[37][38] * December 29: Aetna chief executive Ron Williams owns approximately 7.6 million Aetna stock and options. The price gain for Aetna stocks of $8.50 from October lows to December 29 adds at least $37 million in value to Williams' holdings.[39] [edit] 2010 * On January 19, Aetna stocks rose $1.23 to $32.59, due to the possibility that a Republican candidate could win a previously Democratic U.S. Senate seat in Massachusetts. Such a victory could deprive Democrats of the 60-vote majority they need in the Senate to stop a potential filibuster of the national healthcare reform bill.[40] * On February 3, Aetna laid off more than 100 Connecticut workers. This follows the lay off of 160 Connecticut Aetna employees in November, 2009.[41] * On February 6, Aetna reported 2009 fourth-quarter net income of $165.9 million, or 38 cents per share, on $8.69 billion in revenue.[42] * On April 30, Aetna announced a 29 percent increase in net income for the first quarter of 2010 compared with the same quarter a year ago, as the insurer benefited from higher investment income.[43] * In April, Aetna notified policyholders that it was in a contract dispute with Continuum Health Partners and that its contract with Continuum Health Partners would lapse as of June 5, 2010. Continuum Health Partners comprises five major New York City hospitals: Beth Israel Medical Center, Roosevelt Hospital, St. Luke's Hospital, Long Island College Hospital and New York Eye and Ear Infirmary. The June 5th date passed and the contract lapsed, an outcome that could mean much higher costs for thousands of New Yorkers.[44] Aetna is obligated in its contract with doctors to retain those doctors in-network for a policyholder for a period of a year or until the expiration date of the policyholder's contract, whichever comes first. Aetna did not inform policyholders of this fact. Continuum Health provided a form to policyholders to make this request.[45] U.S. Senator Kirsten Gillibrand has asked executives of Aetna and Continuum Health Parnters to re-enter negotiations, saying, "I urge you to re-enter negotiations on a new three-year agreement for reimbursement rates, for the sake of the patients that need health coverage."[46] In July, the Faculty Union of Pratt Institute, United Federation of College Teachers Local 1460, prepared a letter to Aetna expressing their unhappiness over the termination of the contract.[47] * In June, Crystal Run Healthcare, a 170-doctor group practice in Orange County, New York and Sullivan County, New York, announced that it would terminate its contract with Aetna on July 31, 2011.[48][49] Crystal Run stated that, "Aetna proposes to pay us significantly less than other commercial health care plans with whom we contract. Despite good faith efforts, we cannot come to an agreement at this time. We want to afford every opportunity to our patients to make informed choices regarding their health care coverage." Aetna replied, "It is extraordinary that a responsible physician group would alarm patients in this manner more than a year before there could be any impact to those patients."[50] * On July 27, Aetna reported that its second-quarter profit rose 42 percent, as the percentage of premiums the company spent on medical care fell versus a year ago. The insurer earned $491 million, or $1.14 a share, in the three months ended June 30. That compares with net income of $346.6 million, or 77 cents a share, in the same period last year.[51] * On September 9, Aetna announced that it would demolish its 1,300,000-square-foot (121,000 m2) structure in Middletown, Connecticut that once housed approximately 5,000 Aetna employees on a 261-acre (1.06 km2) campus. Aetna has not said exactly how it will redevelop the site, although a data center currently located there will remain regardless of future plans.[52] [edit] Fines, Lawsuits and Settlements [edit] 1999 * A jury in California awarded $116 million in punitive damages for "malice, oppression and fraud" to a patient's widow who contended he died after a subsidiary of Aetna delayed approving treatment for stomach cancer that its own doctors had recommended. Lawyers on both sides called it the largest such verdict against a health maintenance organization. In 2001 a settlement was reached.[53][54][55] [edit] 2000 * The U.S. Court of Appeals affirmed a $1,855,000 federal jury award for Brokerage Concepts Inc. (BCI) against Aetna U.S. Healthcare (formerly U.S. Healthcare), its Pennsylvania subsidiary, and one of its former senior executives, Richard Wolfson. In its suit, BCI accused Aetna U.S. Healthcare of tortious interference with contractual relations. BCI alleged the managed-care company used its economic power in the business of prescription drug sales to coerce one BCI's clients, the "I Got It at Gary's" pharmacy chain, into using another Aetna U.S. Healthcare subsidiary, Corporate Health Administrators, as its health benefits management firm. According to the suit, Aetna U.S. Healthcare threatened to drop "I Got it at Gary's" from its pharmacy network if the company didn't switch to Corporate Health Administrators.[56] [edit] 2001 * The Maryland Insurance Commissioner ordered five Maryland health plans to pay a total of $1.4 million in penalties for failing to comply with the state's claims payment practices; Aetna was cited twice and ordered to pay the largest fine of $850,000.[57] * The State of Texas fined Aetna $1.15 million for failing to promptly pay doctors and hospitals for services. Texas Insurance Commissioner Jose Montemayor also ordered Aetna to pay restitution to physicians and health care providers who did not receive timely payment for claims.[58] [edit] 2002 * The New York Department of Insurance fined Aetna US Healthcare and UnitedHealthcare a total of $2.5 million, citing a litany of bungled claims, improper treatment denials, unlicensed health insurance agents, and poorly performing claims processors using out-of-date software.[59] * Aetna agreed to streamline communications, reduce administrative complexity, and improve the quality of the health care system, ending litigation between Aetna and 700,000 physicians and medical societies. The physicians' lawsuit, settled for $470 million, charged Aetna with systematically reducing payments to physicians and overriding their treatment decisions.[60] [edit] 2003 * Aetna and the American Dental Association (ADA) announced a class-action settlement by dentists who accused Aetna of interfering with dental procedures to cut costs and forcing dentists to comply with excessive paperwork. The settlement called for Aetna to pay $4 million to 40,000 to 50,000 dentists and $1 million to the ADA Foundation, a charitable group.[61] * Georgia Insurance Commissioner John W. Oxendine fined Aetna's Prudential Health Plan $100,000 for violating Georgia's prompt pay law by delaying claims payments. Aetna companies had been fined four previous times by Oxendine's office, in 2000 and again in 2002, for a total of $411,200.[62] [edit] 2007 * The New Jersey Department of Banking and Insurance filed an administrative order levying a $9.5 million fine against Aetna for refusing to appropriately cover certain services provided by out-of-network providers—including emergency treatment--in violation of New Jersey rules and regulations.[63] [edit] 2009 * Former Aetna employee Cornelius Allison of Darby, Pa., filed suit against Aetna in U.S. District Court in Pennsylvania after hackers gained access to a company Web site holding personal data for 450,000 current and former employees as well as job applicants. The suit charged Aetna with negligence, breach of contract, negligent misrepresentation and invasion of privacy.[64] * The Arizona Department of Insurance fined Aetna Life Insurance Company and Aetna Health, Inc. after examination of their practices exposed multiple violations of Arizona insurance laws. The department found that Aetna violated significant state laws governing important areas of health insurance operations, including Aetna's: failure to provide policyholders with information about their rights on appeals of medical claims or services denials; failure to acknowledge receipt of policyholder appeals; failure to notify policyholders about appeal decisions/outcomes; and, in some appeals involving the denial of services for potentially life threatening conditions, failure to inform policyholders of their decision within the required, expedited time frames.[65] [edit] 2010 * Aetna paid a $750,000 fine as part of a settlement with the New York Insurance Department related to the company administering an affordable healthcare plan for the state. Aetna's violations included failing to provide a required 30-day notice of rate increases to about 946 members in 2007, failing to provide notice to 1,406 terminated workers of their rights to convert to another policy, failing to report enrollment data from May 2007 through August 2008, and failing to respond to Insurance Department requests for data in March 2008.[66] [edit] Life insurance policies on slaves In 2000 Deadria Farmer-Paellmann, head of the nonprofit Restitution Study Group of Hoboken, New Jersey, disclosed that from approximately 1853 to approximately 1860 Aetna had issued life insurance policies to slaveowners covering the lives of their slaves.[67] Aetna acknowledged that concrete evidence exists for Aetna issuing coverage for the lives of slaves and released a public apology.[68] The US Department of Commerce has determined that in modern US dollars - calculated for inflation and interest - slavery generated trillions of dollars for the US economy.[69] In 2002, Farmer-Paellmann brought suit against Aetna and two other companies in federal court asking for reparations for the descendants of slaves. The lawsuit said Aetna, CSX and Fleet were "unjustly enriched" by "a system that enslaved, tortured, starved and exploited human beings." It argued that African-Americans are still suffering the effects of 2½ centuries of enslavement followed by more than a century of institutionalized racism. The complaint blamed slavery for present-day disparities between blacks and whites in income, education, literacy, health, life expectancy and crime.[13] This suit was denied, and the denial largely upheld on appeal.[70][71] In 2006, Farmer-Paellmann announced a nationwide boycott of Aetna over the issue of reparations for its policies covering slaves. Aetna stated that its commitment to diversity in the workplace and its investment of over 36 million dollars in such areas as education, health, economic development, community partnerships, and minority-owned business initiatives in the African-American community is more effective at aiding descendants of slaves and African-Americans in general than making restitutions for Aetna's life insurance policies on slaves.[72][73][74][75][76][77] [edit] See also Connecticut portal Companies portal * Drivotrainer * Health care reform in the United States * Health insurance * Life insurance * Managed health care * Medicare Advantage * Pet insurance * Public health insurance option * Reparations for slavery

smile Return to the top

A smile is a facial expression formed by flexing the muscles near both ends of the mouth.[1] The smile can also be found around the eyes (See 'Duchenne smile' below). Among humans, it is customarily an expression denoting pleasure, happiness, or amusement, but can also be an involuntary expression of anxiety, in which case it is known as a grimace. Cross-cultural studies have shown that smiling is a means of communicating emotions throughout the world.[2] But there are large difference between different cultures.[3] A smile can be spontaneous or artificial (when people feel obliged to smile). Happiness is most often the motivating cause of a smile. Among animals, the exposure of teeth, which may bear a resemblance to a smile, is often used as a threat or warning display—known as a snarl—or a sign of submission. In chimpanzees, it can also be a sign of fear. The study of smiles is a part of gelotology, psychology, and linguistics, comprising various theories of affect, humor, and laughter.[4] Contents [hide] * 1 Dimples * 2 Duchenne smile * 3 Pan American Smile * 4 See also * 5 References * 6 Further reading * 7 External links [edit] Dimples A man smiling, with dimples. Cheek dimples are visible indentations of the epidermis, caused by underlying flesh, which form on some people's cheeks, especially when they smile. Dimples are genetically inherited and are a dominant trait.[5] A rarer form is the single dimple, which occurs on one side of the face only. Anatomically, dimples may be caused by variations in the structure of the facial muscle known as zygomaticus major. Specifically, the presence of a double or bifid zygomaticus major muscle may explain the formation of cheek dimples.[6] This bifid variation of the muscle originates as a single structure from the zygomatic bone. As it travels anteriorly, it then divides with a superior bundle that inserts in the typical position above the corner of the mouth. An inferior bundle inserts below the corner of the mouth. Dimples are also visable on some people's buttocks. [edit] Duchenne smile Although many different types of smiles have been identified and studied, researchers (e.g. Freitas-Magalhaes) have devoted particular attention to an anatomical distinction first recognized by French physician Guillaume Duchenne. While conducting research on the physiology of facial expressions in the mid-19th century, Duchenne identified two distinct types of smiles. A Duchenne smile involves contraction of both the zygomatic major muscle (which raises the corners of the mouth) and the orbicularis oculi muscle (which raises the cheeks and forms crow's feet around the eyes). A non-Duchenne smile involves only the zygomatic major muscle.[7] Many researchers believe that Duchenne smiles indicate genuine spontaneous emotions since most people cannot voluntarily contract the outer portion of the orbicularis oculi muscle.[8] [edit] Pan American Smile The Pan-Am smile is the name given to a "fake smile", in which only the zygomatic major muscle is voluntarily contracted to show politeness. It is named after the airline Pan American World Airways, whose flight attendants would always flash every jet-setter the same, faked smile. [9] [edit] See also * Emoticon * Emotion * Emotional labor * Facial Action Coding System * Frown * Facial expression * Laughter * Smiley * Social psychology * World Smile Day [edit] References 1. ^ Freitas-Magalhães, A., & Castro, E. (2009). The Neuropsychophysiological Construction of the Human Smile. In A. Freitas-Magalhães (Ed.), Emotional Expression: The Brain and The Face (pp.1-18). Porto: University Fernando Pessoa Press. ISBN 978-989-643-034-4. 2. ^ Carroll E. Izard (1971). The Face of Emotion, New York: Appleton-Century-Croft. 3. ^ http://www.articlealley.com/article_112402_35.html 4. ^ Freitas-Magalhães, A. (2006). The Psychology of Human Smile. Oporto: University Fernando Pessoa Press. 5. ^ Singapore Science Centre: ScienceNet|Life Sciences|Genetics/ Reproduction 6. ^ http://www3.interscience.wiley.com/cgi-bin/abstract/78395/ 7. ^ Duchenne, Guillaume (1990). The Mechanism of Human Facial Expression. New York: Cambridge University Press. (Original work published 1862). 8. ^ Ekman, P., Friesen, W. V., and O'Sullivan, M. (1988). "Smiles when lying". Journal of Personality and Social Psychology, 54, pp. 414–420. 9. ^ Harlow, John (February 20, 2005). "The smile that says where you’re from". The Sunday Times. http://www.timesonline.co.uk/tol/news/uk/article516707.ece. Retrieved 18 January 2011. [edit] Further reading * Conniff, R. (2007). What's behind a smile? Smithsonian Magazine, 38,46-53. * Miller, Professor George A., et al. Overview for "smile." Retrieved 12 December 2003 from this page. * Ottenheimer, H.J. (2006). The anthropology of language: An introduction to linguistic anthropology. Belmont, CA: Thomson Wadsworh. * Ekman, P., Davidson, R.J., & Friesen, W.V. (1990). The Duchenne smile: Emotional expression and brain psysiology II. Journal of Personality and Social Psychology, 58, 342-353. Cited in: Russell and Fernandez-Dols, eds. (1997). * Russell and Fernandez-Dols, eds. (1997). The Psychology of Facial Expression. Cambridge. ISBN 0521587964. * Messinger, D. & Fogel, A. (2007). The interactive development of social smiling. In Robert Kail (ed.), Advances in Child Development and Behavior, 35, 327-366. Oxford: Elsevier. Retrieved 25 June 2010 from [1] [edit] External links Wikimedia Commons has media related to: Smile * BBC News: Scanner shows unborn babies smile [hide]v · d · ePsychological manipulation Positive reinforcement Attention · Flattery · Giving gifts · Giving money · Grooming (adult · child) · Ingratiation · Love bombing · Praise · Seduction · Smiling · Superficial charm · Superficial sympathy Negative reinforcement Anger · Character assassination · Crying · Emotional blackmail · Frowning · Glaring · Guilt trip · Inattention · Intimidation · Nagging · Nit-picking criticism · Passive aggression · Punishment · Relational aggression · Shaming · Silent treatment · Sulking · Swearing · Threats · Victim blaming · Victim playing · Yelling Other techniques Deception · Denial · Deprogramming · Disinformation · Distortion · Diversion · Evasion · Exaggeration · Gaslighting · Indoctrination · Lying · Minimisation · Rationalization (making excuses) · Lowballing · Sullivan Nod · Bait-and-switch · Trojan Horse (business) · Pride-and-ego down · Good Cop/Bad Cop · Reid Technique · Setting up to fail Contexts Abuse · Advertising · Bullying · Confidence trick · Media manipulation · Mind control · Mobbing · Propaganda · Scapegoating · Smear campaign · Spin · Whispering campaign · Salesmanship · Interrogation Related topics Assertiveness · Blame · Dumbing down · Enabling · Impression management · Fallacy · Narcissism · Personal boundaries · Personality disorders · Persuasion · Projection · Psychopathy · Self-esteem · Sheeple · Sycophancy · Vulnerabilities · Weasel words · Whistleblowing

inlays Return to the top

Inlays An impression of preparation for restoration with a DO gold inlay on tooth #5. The "DO" designation indicates that the gold serves as a restoration for the distal and occlusal surfaces of the tooth. This tooth was prepared and the inlay will be fabricated according to the R.V. Tucker method of gold inlay preparation. Notice how the line angles of the impression for the inlay are very sharp and precise; this is achieved using carbon-tipped stainless steel instruments. The salmon-colored polyvinylsiloxane impression material is less viscous than the blue and is able to capture better detail for the tooth being restored. Sometimes, a tooth is treatment planned to be restored with an intracoronal restoration, but the decay or fracture is so extensive that a direct restoration, such as amalgam or composite, would compromise the structural integrity of the restored tooth by possibly undermining the remaining tooth structure or providing substandard opposition to occlusal (i.e. biting) forces. In such situations, an indirect gold or porcelain inlay restoration may be indicated. The following documents the indirect (out of the mouth) fabrication of a gold inlay. When an inlay is used, the tooth-to-restoration margin may be finished and polished to such a super-fine line of contact that recurrent decay will be all but impossible. It is for this reason that some dentists recommend inlays as the restoration of choice for pretty much any and all filling situations. While these restorations might be ten times the price of direct restorations, the superiority of an inlay as a restoration in terms of resistance to occlusal forces, protection against recurrent decay, precision of fabrication, marginal integrity, proper contouring for gingival (tissue) health, ease of cleansing and many other aspects of restorative quality offers an excellent alternative to the direct restoration. For this reason, some patients request inlay restorations so they can benefit from its wide range of advantages even when an amalgam or composite will suffice. The only true disadvantage of an inlay is the higher cost. An MO gold inlay on tooth #3, the "MO" designation indicating that the gold serves as a restoration for the mesial and occlusal surfaces of the tooth. This tooth was also restored according to the R.V. Tucker method. Notice how the gold appears to flow into the tooth structure, almost perfectly mimicking the natural contours and even allowing the specular reflection to continue over the margin from tooth to gold. [edit] Onlays Additionally, when decay or fracture incorporate areas of a tooth that make amalgam or composite restorations essentially inadequate, such as cuspal fracture or remaining tooth structure that undermines perimeter walls of a tooth, an "onlay" might be indicated. Similar to an inlay, an onlay is an indirect restoration which incorporates a cusp or cusps by covering or onlaying the missing cusps. All of the benefits of an inlay are present in the onlay restoration. The onlay allows for conservation of tooth structure when the only other alternative is to totally eliminate cusps and perimeter walls for restoration with a crown. Just as inlays, onlays are fabricated outside of the mouth and are typically made out of gold or porcelain. Gold restorations have been around for many years and have an excellent track record. In recent years, newer types of porcelains have been developed that seem to rival the longevity of the gold. Either way, if the onlay or inlay is made in a dental laboratory, a temporary is fabricated while the restoration is custom made for the patient. A return visit is then required to deliver the final prosthesis. Inlays and onlays may also be fabricated out of porcelain and delivered the same day utilizing techniques and technologies relating to CAD/CAM Dentistry. [2][3]

invisalign Return to the top

Invisalign is a series of clear, removable teeth aligners that both orthodontists and dentists use as an alternative to traditional metal dental braces. As of April 2008, more than 730,000 patients have completed or are currently in treatment.[1] Invisalign is designed, manufactured, and marketed by Santa Clara-based medical-device company Align Technology, Inc. Align says that over 35,790 doctors are trained to provide Invisalign treatment in the U.S., with 48,130 doctors worldwide.[1] As of January 29, 2008, Align Technology has 1,307 employees worldwide, and has manufactured more than 32 million aligners. The company has 133 patents.[citation needed] Align Technology was in a legal battle with the makers of a competing product, OrthoClear, from early 2005 until September 2006.[2] Zia Chisti, one of the founders of Align, had started OrthoClear to compete against Invisalign. In a complaint filed with the United States International Trade Commission (ITC) on January 11, 2006, Align alleged that OrthoClear utilized Align's trade secrets and infringed twelve Align patents, comprising more than 200 patent claims, in the production of OrthoClear aligners at a facility in Lahore, Pakistan. On September 27, 2006, Align Technology settled its litigation with OrthoClear. OrthoClear has stopped accepting new cases and discontinued its aligner business worldwide. Align acquired all disputed intellectual property. Contrary to some reports, Align did not purchase OrthoClear.[2] Align Technology is also defending a class action suit on behalf of dentists and orthodontists who were suddenly dropped as approved Invisalign prescribers because they failed to meet a never-before-mentioned quota requirement. After prescribing doctors paid thousands of dollars each for Invisalign training, Align Technology unilaterally implemented a requirement that every prescriber start at least 10 new cases a year. The doctors are seeking a refund of the training cost because the training has no utility except in the prescription of Invisalign products.[3] Contents [hide] * 1 Advantages and disadvantages o 1.1 Advantages o 1.2 Disadvantages o 1.3 Scientific studies * 2 Pricing * 3 Treatment * 4 References * 5 Further reading * 6 External links [edit] Advantages and disadvantages [edit] Advantages The most obvious advantage of the treatment is cosmetic: the aligners are completely transparent, therefore far more difficult to detect than traditional wire and bracket braces. This makes the method particularly popular among adults who want to straighten their teeth without the look of traditional metal braces, which are commonly worn by children and adolescents. In addition, the aligners are marketed as being more comfortable than braces.[4] Due to the removable nature of the device, food can be consumed without the encumbrance of metallic braces. Clinically, aligners avoid many of the side effects of traditional fixed appliances,[5] for example the effects on the gums and supporting tissues.[6] Almost all types of orthodontic treatment will cause the roots of teeth to shorten (root resorption) for most patients,[7] and demineralisation or tooth decay occurs in up to 50% of patients[8] because they cannot be removed for eating and cleaning, and because they prevent accurate x-rays from being taken. Patients "graduate" to a new set of aligners in their treatment series approximately every two weeks. The aligners give less force per week and less pain than do fixed appliances (traditional metal braces). Fixed appliances are adjusted approximately every six weeks and apply greater forces.[9] Aligners should be removed to eat, drink, to clean the teeth, or to have them checked by the clinician. Because you remove the aligners, you are not limited to what you eat. (It is acceptable to wear aligners while drinking water.) Computerized treatment planning is compulsory as part of the Invisalign protocol. As with other forms of orthodontic treatments that incorporate a computerized plan, this allows the prospective patient to review the projected smile design, learn how long the treatment is likely to take, compare different plans, and make a more educated decision about whether or not to use Invisalign. Invisalign treatments have been claimed to be quicker than traditional orthodontics. A large-scale study of 408 patients with traditional appliances in Indiana took an average of 35.92 months with a maximum of 96 months,[10] while Invisalign takes between 12–18 months.[5][11] In a much smaller study[12] Invisalign was shown to be faster and achieve straighter teeth than alternatives but relapsed to ultimately get similar results to the traditional appliances examined. The study was considered by the authors, however, to be too small for many conclusions to be statistically significant. Furthermore, this general concept that Invisalign is faster has been challenged by the Invisalign review which points out that there are other brace appliance systems that take half the time, for example by incorporating surgery or temporary implants that insert into the patient's bone, to accelerate the procedure.[13] [edit] Disadvantages Invisalign does not require a cephalometric radiograph, which places huge limitations every step of the way from proper treatment planning through final results. Orthodontists use this type of x-ray to treatment plan the final angulation of the teeth keeping in mind the patients facial profile. Invisalign does not take this into account and does not require a cephalometric radiograph. Invisalign claims to be less painful than conventional braces. This is arguably the most deceptive marketing claim because Invisalign exerts uncontrollable and extremely uncomfortable force loads on teeth. These high force loads damage surrounding bone and show increased risk of root resorption of the teeth. This really hurts and is an inefficient, unpredictable,painful, and biologically damaging way to move teeth. The product also has other disadvantages: the very fact that the aligners are removable means they are not continually correcting the teeth. Unlike traditional fixed braces, they are largely dependent on a patient's habits and their consistency in wearing the aligners. The success of the Invisalign aligners is based on a patient's commitment to wear the aligners for a minimum of 20–22 hours per day, only removing them when they are eating, drinking, or brushing their teeth. The system is also somewhat expensive, as conceded by the Align company,[14] and can be more expensive than traditional wire and bracket systems. The aligners must be removed before eating, an advantage and disadvantage depending upon the person. They and the teeth should be cleaned before re-inserting them afterwards. Because the aligners are removed for eating, they could be lost. Invisalign recommends that the patient keep the previous aligners in case this happens. However, Invisalign provides two plastic containers to keep the braces in, so they are safe and can't be lost or damaged. Certain teeth are slightly problematic for Invisalign aligners to rotate. Some lower premolars with their rounded shape can be difficult for the aligners to grasp and apply a rotational force to. Unlike traditional braces, if a patient grinds or clenches her or his teeth during the day or while sleeping, the aligners can become damaged. In practice, however, this problem is very rare and a new aligner can be ordered. Also, similar to traditional metal braces, aligners may cause a slight lisp at the beginning of treatment. This usually disappears as the patient becomes used to the treatment. The aligners are constructed of implantable-grade polyurethane, and the Align company has acknowledged that, though extremely rare, there may be cases of allergic and toxic sensitivity reactions to Invisalign.[14] Minor symptoms such as sore throat, cough, and nausea have been reported. In more serious cases, the FDA has received reports of systemic swelling or throat pain that has extended to the upper chest and wind passages requiring emergency medical treatment and discontinuation of the Invisalign treatment.[citation needed] While the Invisalign company provides no information except the MSDS (material safety data sheet) directly to patients or orthodontists, working through the patient's orthodontist Invisalign will make the aligners with several different materials to attempt to reduce toxic or allergic sensitivity. Should the treatment go off track, or patients fail to keep the aligners in for the required length of time, then the next aligner in the series will not fit, and a new set of impressions and aligners will be necessary, adding to the cost.[11] [edit] Scientific studies From the American Journal of Orthodontics and Dentofacial Orthopedics. Invisalign is an inferior treatment compared to conventional braces and has inferior treatment outcomes. Introduction: This treatment-outcome assessment objectively compares Invisalign (Align Technology, Santa Clara, Calif) treatment with braces. Methods: This study, a retrospective cohort analysis, was conducted in New York, NY, in 2004. Records from 2 groups of 48 patients (Invisalign and braces groups) were evaluated by using methods from the American Board of Orthodontics Phase III examination. The discrepancy index was used to analyze pretreatment records to control for initial severity of malocclusion. The objective grading system (OGS) was used to systematically grade posttreatment records. Statistical analyses evaluated treatment outcome, duration, and strengths and weaknesses of Invisalign compared with braces. 'Results: The Invisalign group lost 13 OGS points more than the braces group on average, and the OGS passing rate for Invisalign was 27% lower than that for braces. Invisalign scores were consistently lower than braces scores for buccolingual inclination, occlusal contacts, occlusal relationships, and overjet. Invisalign’s OGS scores were negatively correlated to initial overjet, occlusion, and buccal posterior crossibite.' Invisalign patients finished 4 months sooner than those with fixed appliances on average. P < .05 was used to determine statistically significant differences. Conclusions: According to the OGS, Invisalign did not treat malocclusions as well as braces in this sample. Invisalign was especially deficient in its ability to correct large anteroposterior discrepancies and occlusal contacts. The strengths of Invisalign were its ability to close spaces and correct anterior rotations and marginal ridge heights. This study might help clinicians to determine which patients are best suited for Invisalign treatment. In a systematic review of the literature, published in the Journal of the American Dental Association in 2005,[15] Drs. Manual Lagravere and Carlos Flores-Mir were unable to draw strong conclusions about the effectiveness of the Invisalign system. They pointed to the need for randomized clinical trials.[15] Since this paper, more studies about the clinical effectiveness have been published; for example in the UK, Dr Paul Humber has analyzed 100 back-to-back Invisalign cases. Assessing the patients after two sets of aligners, he found that 94% of the dentitions had achieved the objectives set.[5] In the USA, Akhlaghi and colleagues compared treatment with the invisalign system with treatment with conventional braces and concluded that "conventional fixed appliances achieved better results in the treatment of Class I mild crowding malocclusions".[16] In a comparison of outcomes between the two approaches, Kuncio et al.[12] reported that the Invisalign group displayed greater relapse saying "the mean alignment of the Invisalign group was superior to the Braces group before and after the retention phase, but these differences were not statistically significant. Therefore, even though the Invisalign cases relapsed more, they appear to have the same, if not better, overall alignment scores." In a larger study[17] Djeu and colleagues had similar findings to Akhlaghi above and concluded that "Invisalign was especially deficient in its ability to correct large anteroposterior discrepancies and occlusal contacts". They felt that "The strengths of Invisalign were its ability to close spaces and correct anterior rotations and marginal ridge heights." They added "Invisalign patients finished 4 months sooner than those with fixed appliances on average." Furthermore, work at NYU/Buffalo University by Dr Omar Fetouh in 2009,[18] where 67 patients were studied, half of whom were treated with Invislaign and half with traditional braces. All cases had difficulty Index 'DI' less than 5 and were treated non extraction. The posttreatment results were graded using the ABO Objective Grading System. The results show that there was no statistical significant differences between the scores of both groups in treatment Alignment(p=0.059), Occlusal Relationship (p=0.223) and interproximal contacts. The Invisalign group had higher scores in Marginal Ridges, Bucco-lingual inclination, Occlusal contacts, and Overjet than Braces group. The study concluded that " Invisalign can treat mild cases of malocclusion (DI <5)as efficently, if not better, as braces." [edit] Pricing The treatment price is often more than traditional braces. Treatment price is set by the dentist or orthodontist, although the cost of treatment varies considerably by doctor. Doctor fees are usually determined by complexity and length of treatment. In the U.S., treatments range in price from $3,000 to $9,000, depending on geographic location. For example, in northwest Ohio, the case of a patient with a mild overbite and several teeth that needed to be turned cost $5,580.00 in 2008 (for a 13-month treatment). Braces would have cost $5,225.00 (if the express treatment were available, it would have been $4,300). It is important to remember that costs vary from case to case. In Europe, the treatment price ranges from €3,000 to €7,800, depending on case complexity and length. [edit] Treatment An orthodontist, or general dentist, begins by taking dental impressions, x-rays and photographs of the patient's teeth and sending them to Align Technology. It is not recommended to see a General Dentist because they have limited knowledge about orthodontics. The impressions are put through a CT scan from which a computer creates a three-dimensional model. The information is sent to Costa Rica and is manipulated by non-dentist and non-orthodontist lay persons who individualize the teeth in the computer model and move them to their final position as prescribed by the orthodontist. Many times however the technician moves the teeth to where he or she sees fit and sends them through to be processed without regard to what the orthodontist has prescribed. Custom software then simulates the movement of the teeth in stages. The orthodontist reviews the simulation online using Align Technology's ClinCheck via a web browser and approves or modifies the treatment. Once approved, a plastic resin aligner is manufactured for each stage of the computer simulation and shipped to the orthodontist.[19] Attachments, also called buttons are sometimes bonded to teeth that need to be rotated or moved more than other teeth. Patients can expect as many as fourteen attachments. They are tooth-colored and made of a glass-like substance. Elastic wear (rubber bands) are also used to move the teeth forward or back relative to the jaw, thus accomplishing anterior or posterior corrections. Reproximation, (also called Interproximal Reduction or IPR and colloquially, fileing or drilling), is sometimes used at the contacts between teeth to allow for a better fit. [20] [5] Average treatment time is about one year,[5] again depending on the complexity of the treatment. Simple treatments (minor crowding, minor spacing) may be as short as twenty weeks—this is known as the "Invisalign Express" program. Although the aligners are removable, they must be worn at least 20 to 22 hours per day to avoid delaying the treatment process. If they are not worn consistently, treatment time will increase. After the regular aligner or braces treatment is complete, retainers composed of a similar plastic material are usually required to be worn, at least at night. Like other orthodontic systems, the patient has some flexibility. The final position of the teeth is not completely determined by the last aligner. If the patient wants to change the end position because the actual position is not optimal, new aligners are ordered, which are usually included in the originally quoted cost, called a 'Refinement.'

orthodontist Return to the top

Orthodontics (from Greek orthos "straight or proper"; and odous "tooth") is the first specialty of dentistry that is concerned with the study and treatment of malocclusions (improper bites), which may be a result of tooth irregularity, disproportionate jaw relationships, or both. Orthodontic treatment can focus on dental displacement only, or can deal with the control and modification of facial growth. In the latter case it is better defined as "dentofacial orthopaedics". Orthodontic treatment can be carried out for purely aesthetic reasons with regards to improving the general appearance of patients' teeth. However, there are orthodontists who work on reconstructing the entire face rather than focusing exclusively on teeth. Edward Angle was the first orthodontist—the first dentist to limit his practice to orthodontics only. He is considered the "Father of Modern Orthodontics." Contents [hide] * 1 Methods * 2 Diagnosis and treatment planning * 3 Training o 3.1 United States of America o 3.2 Europe o 3.3 Canada o 3.4 India * 4 References [edit] Methods For comprehensive orthodontic treatment, most commonly, metal wires (Juste) are inserted into orthodontic brackets (see dental braces), which can be made from stainless steel or a more aesthetic ceramic material. The wires interact with the brackets to move teeth into the desired positions. Other methods may include invisalign. Invisalign consists of clear plastic aligners that allow you to realign your teeth without others seeing how your teeth are moving. Dental braces, with a powerchain, removed after completion of treatment. Additional components—including removable appliances ("plates"), headgear, expansion appliances, and many other devices—may also be used to move teeth and jaw bones. Functional appliances, for example, are used in growing patients (age 5 to 14) with the aim of modifying the jaw dimensions and relationship if these are altered. This therapy, termed Dentofacial Orthopedics, is frequently followed by fixed multibracket therapy ("full braces") to align the teeth and refine the occlusion. Hawley retainers are the most common type of retainers. This picture shows retainers for the top and bottom of the mouth. Orthodontics is the study of dentistry that is concerned with the treatment of improper bites, and crooked teeth. Orthodontic treatment can help fix your teeth and set them in the right place. Orthodontists usually use braces and retainers to set your teeth. [2] There are, however, orthodontists who work on reconstructing the entire face rather than focusing exclusively on teeth. After a course of active orthodontic treatment, patients will typically wear retainers, which maintain the teeth in their improved positions while surrounding bone reforms around them. The retainers are generally worn full-time for a short period, perhaps six months to a year, then part-time (typically, nightly during sleep) for as long as the orthodontist recommends. It is possible for the teeth to stay aligned without regular retainer wear. However, there are many reasons teeth will crowd as a person ages, whether or not the individual ever experienced orthodontic treatment; thus there is no guarantee that teeth will stay aligned without retention. For this reason, many orthodontists prescribe part-time retainer wear for many years after orthodontic treatment. [edit] Diagnosis and treatment planning In diagnosis and treatment planning, the orthodontist must (1) recognize the various characteristics of a malocclusion or dentofacial deformity; (2) define the nature of the problem, including the etiology if possible;(3) design a treatment strategy based on the specific needs and desires of the individual; and (4) present the treatment strategy to the patient in such a way that the patient fully understands the ramifications of his/her decision.[3] The New York Times has recently written that Orthodontists are using Cone Beam CT too much in the diagnosis and treatment of orthodontic patients, leading to an unecessary increased risk of cancer.[4] [edit] Training Orthodontics was the first recognised specialty field within dentistry. Many countries have their own systems for training and registering orthodontic specialists. A two to three year period of full-time post-graduate study is required for a dentist to qualify as an orthodontist. [edit] United States of America The applicant must have completed or be a full-time student/resident in an advanced education program in orthodontics and dentofacial orthopedics which is approved by the Commission on Dental Accreditation of the ADA. The "Advanced Standing Student - Standard #5," as recognized by the Commission of Dental Education, is eligible to make application upon the completion of their program. The applicant will submit with the application either a copy of the graduate orthodontic degree/certificate or a letter from the Program Director verifying the applicant's status. [5] Certification Process 1. Application 2. Written Examination 3. Clinical Examination 4. Annual Fee [edit] Europe In the United Kingdom, this training period lasts three years, after completion of a membership from a Royal College. A further two years is then completed to train to consultant level, after which a fellowship examination from the Royal College is sat. In other parts of Europe, a similar pattern is followed. It is always worth contacting the professional body responsible for registering orthodontists to ensure that the orthodontist you wish to consult is a recognised specialist. [edit] Canada A number of dental schools and hospitals offer advanced education in the specialty of Orthodontics to dentists seeking postgraduate education. The courses range from two to three years (with the majority being 3 years) of full-time classes in the theoretical and practical aspects of orthodontics together with clinical experience. Generally, admission is based on an application process followed by an extensive interviewing process by the institution, in order to select the best candidates. Candidates usually have to contact the individual school directly for the application process. [edit] India In India, many dental colleges affiliated to universities offer orthodontics as specialisation in Master of Dental Surgery ( M.D.S ) programme.The minimum qualification for M.D.S is Bachelor of Dental Surgery ( B.D.S ). The present course for MDS in Orthodontics stands at 3 years in all dental colleges in India which are recognised by the Dental Council of India. The Indian Orthodontic Society was established in 1965. The Academy Of Fixed Orthodontics [1](AFO), established in 2008, represents GP's and members from other dental specialties who practices orthodontics. AFO offers certification courses in Fixed Orthodontics for General Practitioners in Dentistry. Indian Orthodontic Society, the official body of orthodontists in India doesnt recognise non orthodontists who have taken certificate courses from non recognized bodies as Orthodontists. Only orthodontists who have done masters in orthodontics from recognised schools are allowed as members of Indian Orthodontic Society. russian orthodontic degree is recognised by dental council of india according new gazette by government.one should pass screening test to get registered

white fillings Return to the top

Dental composite From Wikipedia, the free encyclopedia (Redirected from White filling) Jump to: navigation, search Question book-new.svg This article needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (May 2007) Question book-new.svg This article needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (November 2010) Dental composites. Dental composite resins are types of synthetic resins which are used in dentistry as restorative material or adhesives. Synthetic resins evolved as restorative materials since they were insoluble, aesthetic, and insensitive to dehydration and were inexpensive. It is easy to manipulate them as well. Composite resins are most commonly composed of Bis-GMA monomers or some Bis-GMA analog, a filler material such as silica and in most current applications, a photoinitiator. Dimethacrylates are also commonly added to achieve certain physical properties such as flowability. Further tailoring of physical properties is achieved by formulating unique concentrations of each constituent.Unlike Amalgam which essentially just fills a hole, composite cavity restorations when used with dentin and enamel bonding techniques restore the tooth back to near its original physical integrity. Contents [hide] * 1 History of use * 2 Composition * 3 Advantages * 4 Disadvantages * 5 Direct dental composites * 6 Indirect dental composites * 7 Composite shrinkage * 8 See also * 9 References [edit] History of use File:Polymerizationslampe an 20090930 03.JPG Polymerization hardening lamp used on a composite dental filling. Initially, composite restorations in dentistry were very prone to leakage and breakage due to weak compressive strength. In the 1990s and 2000s, composites were greatly improved and are said to have a compression strength sufficient for use in posterior teeth. Today's composite resins have low polymerization shrinkage and low coefficients of thermal shrinkage, which allows them to be placed in bulk while maintaining good adaptation to cavity walls. The placement of composite requires meticulous attention to procedure or it may fail prematurely. The tooth must be kept perfectly dry during placement or the resin will likely fail to adhere to the tooth. Composites are placed while still in a soft, dough-like state, but when exposed to light of a certain blue wavelength, they polymerize and harden into the solid filling. It is challenging to harden all of the composite, since the light often does not penetrate more than 2–3 mm into the composite. If too thick an amount of composite is placed in the tooth, the composite will remain partially soft, and this soft unpolymerized composite could ultimately irritate or kill the tooth's nerve. The dentist should place composite in a deep filling in numerous increments, curing each 2–3 mm section fully before adding the next. In addition, the clinician must be careful to adjust the bite of the composite filling, which can be tricky to do. If the filling is too high, even by a subtle amount, that could lead to chewing sensitivity on the tooth. A properly placed composite is comfortable, aesthetically pleasing, strong and durable, and could last 10 years or more. (By most North American insurance companies 2 years minimum) The most desirable finish surface for a composite resin can be provided by aluminum oxide disks. Classically, Class III composite preparations were required to have retention points placed entirely in dentin. A syringe was used for placing composite resin because the possibility of trapping air in a restoration was minimized. Modern techniques vary, but conventional wisdom states that because there have been great increases in bonding strength due to the use of dentin primers in the late 1990s, physical retention is not needed except for the most extreme of cases. Primers allow the dentin's collagen fibers to be "sandwiched" into the resin, resulting in a superior physical and chemical bond of the filling to the tooth. Indeed, composite usage was highly controversial in the dental field until primer technology was standardized in the mid to late 1990s. The enamel margin of a composite resin preparation should be beveled in order to improve aesthetics and expose the ends of the enamel rods for acid attack. The correct technique of enamel etching prior to placement of a composite resin restoration includes etching with 30%-50% phosphoric acid and rinsing thoroughly with water and drying with air only. In preparing a cavity for restoration with composite resin combined with an acid etch technique, all enamel cavosurface angles should be obtuse angles. Contraindications for composite include varnish and zinc oxide-eugenol. Composite resins for Class IIs were not indicated because of excessive occlusal wear in the 1980s and early 1990s. Modern bonding techniques and the increasing unpopularity of amalgam filling material have made composites more attractive for Class II restorations. Opinions vary, but composite is regarded as having adequate longevity and wear characteristics to be used for permanent Class II restorations (although amalgam has proved to last considerably longer and have reduced leakage and sensitivity when compared to Class II composite restorations). [edit] Composition Dental composite resin. As with other composite materials, a dental composite typically consists of a resin-based oligomer matrix, such as a bisphenol A-glycidyl methacrylate (BISGMA) or urethane dimethacrylate (UDMA), and an inorganic filler such as silicon dioxide (silica). Compositions vary widely, with proprietary mixes of resins forming the matrix, as well as engineered filler glasses and glass ceramics. The filler gives the composite wear resistance and translucency. A coupling agent such as silane is used to enhance the bond between these two components. An initiator package (such as: camphorquinone (CQ), phenylpropanedione (PPD) or lucirin (TPO)) begins the polymerization reaction of the resins when external energy (light/heat, etc.) is applied. A catalyst package can control its speed. [edit] Advantages The main advantage of a direct dental composite over traditional materials such as amalgam is improved aesthetics. Composites can be made in a wide range of tooth colors allowing near invisible restoration of teeth. Composites are glued into teeth and this strengthens the tooth's structure. The discovery of acid etching (producing enamel irregularities ranging from 5-30 micrometers in depth) of teeth to allow a micromechanical bond to the tooth allows good adhesion of the restoration to the tooth. This means that unlike silver filling there is no need for the dentist to create retentive features destroying healthy tooth. The acid-etch adhesion prevents micro leakage; however, all white fillings will eventually leak slightly. Very high bond strengths to tooth structure, both enamel and dentin, can be achieved with the current generation of dentin bonding agents. [edit] Disadvantages Composite resin restorations have several disadvantages: They are technique-sensitive meaning that without meticulous placement they may fail prematurely. They take up to 50% longer to place than amalgam fillings and are thus more expensive. In addition clinical survival of composite restorations placed in posterior teeth has been shown to be significantly lower than amalgam restorations.[1] Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial. [2] [edit] Direct dental composites Direct dental composites are placed by the dentist in a clinical setting. Polymerization is accomplished typically with a hand held curing light that emits specific wavelengths keyed to the initiator and catalyst packages involved. When using a curing light, remember that the light should be held as close to the resin surface as possible, a shield should be placed between the light tip and the operator's eyes, and that curing time should be increased for darker resin shades. Light cured resins provide denser restorations than self-cured resins because no mixing is required that might introduce air bubble porosity. Direct dental composites can be used for: * Filling gaps (diastemas) between teeth using a shell-like veneer or * Minor reshaping of teeth * Partial crowns on single teeth [edit] Indirect dental composites This type of composite is cured outside the mouth, in a processing unit that is capable of delivering higher intensities and levels of energy than handheld lights can. Indirect composites can have higher filler levels, and are cured for longer times. As a result, they have higher levels and depths of cure than direct composites. For example, an entire crown can be cured in a single process cycle in an extra-oral curing unit, compared to a millimeter layer of a filling. As a result, full crowns and even bridges (replacing multiple teeth) can be fabricated with these systems. A stronger, tougher and more durable product is likely. Indirect dental composites can be used for: * Filling cavities in teeth, as fillings, inlays and/or onlays * Filling gaps (diastemas) between teeth using a shell-like veneer or * Reshaping of teeth * Full or partial crowns on single teeth * And even bridges spanning 2-3 teeth [edit] Composite shrinkage Composite resins have a notorious reputation for shrinking upon curing, however, uses as a dental restorative material focus on low shrinkage composites. Composite shrinkage can be reduced by altering the molecular and bulk composition of the resin. For example, UltraSeal XT Plus uses Bis-GMA without dimethacrylate and was found to have a shrinkage of 5.63%, 30 minutes after curing. On the other hand, this same study found that Heliomolar, which uses Bis-GMA, UDMA and decandiol dimethacrylate, had a shrinkage of 2.00%, 30 minutes after curing.[3] In the field of dental restorative materials, reduction of composite shrinkage is a "hot topic".[according to whom?] Soon to be introduced are patent pending, is a safe, non-leaching antimicrobial agent which minimizes recurrent decay of the tooth and reduces the harmful effects of micro-organisms and which some may cause gingivitis and periodonttitis (periodontal disease).[citation needed] [edit] See also * Dental restorative materials

toothache Return to the top

A toothache, also known as odontalgia or, less frequently, as odontalgy, is an aching pain in or around a tooth. In most cases toothaches are caused by problems in the tooth or jaw, such as cavities, gum disease, the emergence of wisdom teeth, a marginally cracked tooth, infected dental pulp (necessitating root canal treatment or extraction of the tooth), jaw disease, or exposed tooth root. Causes of a toothache may also be a symptom of diseases of the heart, such as angina or a myocardial infarction, due to referred pain. After having one or more teeth extracted a condition known as dry socket can develop, leading to extreme pain. The severity of a toothache can range from a mild discomfort to excruciating pain (more common in the second molars, especially on the left mandible), which can be experienced either chronically or sporadically. This pain can often be aggravated somewhat by chewing or by hot or cold temperature. An oral examination complete with X-rays can help discover the cause. Severe pain may be considered a dental emergency. A special condition is barodontalgia, a dental pain evoked upon changes in barometric pressure, in otherwise asymptomatic but diseased teeth.[1][2] Atypical odontalgia is a form of toothache present in apparently normal teeth. The pain, generally dull, often moves from one tooth to another for a period of 4 months to several years. The cause of atypical odontalgia is not yet clear, although some form of nerve deafferentation is plausible. Toothaches are sometimes caused by an irritation of the pulp, known as pulpitis. This can be either reversible or irreversible. Irreversible pulpitis can be identified by sensitivity and pain lasting longer than fifteen seconds, although an exception to this may exist if the tooth has been recently operated on. Teeth affected by irreversible pulpitis will need either a root canal or an extraction.[3] Some causes of toothache are the more obvious culprits such as a cracked tooth, filling or veneer, dental caries from eating acidic, sweet foods that corrode the fillings and the tooth’s protective enamel layer. This corrosion is caused from the bacteria that are present on the teeth which break down the sugars in refined foods and then excrete them in the form of acids, which then eat away at the protective enamel of the tooth, causing a cavity, infection and eventually toothache.

anesthesia Return to the top

Anesthesia, or anaesthesia (see spelling differences; from Greek αν-, an-, "without"; and αἴσθησις, aisthēsis, "sensation"), traditionally meant the condition of having sensation (including the feeling of pain) blocked or temporarily taken away. It is a pharmacologically induced and reversible state of amnesia, analgesia, loss of responsiveness, loss of skeletal muscle reflexes or decreased stress response, or all simultaneously. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. An alternative definition is a "reversible lack of awareness," including a total lack of awareness (e.g. a general anesthetic) or a lack of awareness of a part of the body such as a spinal anesthetic. The word anesthesia was coined by Oliver Wendell Holmes, Sr. in 1846.[1] Types of anesthesia include local anesthesia, regional anesthesia, general anesthesia, and dissociative anesthesia. Local anesthesia inhibits sensory perception within a specific location on the body, such as a tooth or the urinary bladder. Regional anesthesia renders a larger area of the body insensate by blocking transmission of nerve impulses between a part of the body and the spinal cord. Two frequently used types of regional anesthesia are spinal anesthesia and epidural anesthesia. General anesthesia refers to inhibition of sensory, motor and sympathetic nerve transmission at the level of the brain, resulting in unconsciousness and lack of sensation.[2] Dissociative anesthesia uses agents that inhibit transmission of nerve impulses between higher centers of the brain (such as the cerebral cortex) and the lower centers, such as those found within the limbic system. Contents [hide] * 1 History o 1.1 Plant derivatives o 1.2 Early inhalational anesthetics o 1.3 Non-pharmacological methods * 2 Anesthesia providers o 2.1 Physicians o 2.2 Nurse anesthetists o 2.3 Anesthesiologist assistants o 2.4 Operating department practitioners o 2.5 Veterinary anesthetists/anesthesiologists * 3 Other personnel * 4 Anesthetic agents * 5 Anesthetic equipment * 6 Anesthetic monitoring * 7 Anesthesia record * 8 See also * 9 References * 10 External links [edit] History Main article: History of general anesthesia [edit] Plant derivatives Throughout Europe, Asia, and the Americas a variety of Solanum species containing potent tropane alkaloids were used, such as mandrake, henbane, Datura metel, and Datura inoxia. Ancient Greek and Roman medical texts by Hippocrates, Theophrastus, Aulus Cornelius Celsus, Pedanius Dioscorides, and Pliny the Elder discussed the use of opium and Solanum species. In 13th century Italy, Theodoric Borgognoni used similar mixtures along with opiates to induce unconsciousness, and treatment with the combined alkaloids proved a mainstay of anesthesia until the nineteenth century. In the Americas coca was also an important anesthetic used in trephining operations. Incan shamans chewed coca leaves and performed operations on the skull while spitting into the wounds they had inflicted to anesthetize the site.[citation needed] Alcohol was also used, its vasodilatory properties being unknown. Ancient herbal anesthetics have variously been called soporifics, anodynes, and narcotics, depending on whether the emphasis is on producing unconsciousness or relieving pain. The use of herbal anesthesia had a crucial drawback compared to modern practice—as lamented by Fallopius, "When soporifics are weak, they are useless, and when strong, they kill." To overcome this, production was typically standardized as much as feasible, with production occurring from specific locations (such as opium from the fields of Thebes in ancient Egypt). Anesthetics were sometimes administered in the "spongia somnifera", a sponge into which a large quantity of drug was allowed to dry, from which a saturated solution could be trickled into the nose of the patient. At least in more recent centuries, trade was often highly standardized, with the drying and packing of opium in standard chests, for example. In the 19th century, varying aconitum alkaloids from a variety of species were standardized by testing with guinea pigs. Trumping this method was the discovery of morphine, a purified alkaloid that could be injected by hypodermic needle for a consistent dosage. The enthusiastic reception of morphine led to the foundation of the modern pharmaceutical industry.[citation needed] The first effective local anesthetic was cocaine. Isolated in 1859, it was first used by Karl Koller, at the suggestion of Sigmund Freud, in eye surgery in 1884.[1] German surgeon August Bier (1861–1949) was the first to use cocaine for intrathecal anesthesia in 1898.[3] Romanian surgeon Nicolae Racoviceanu-Piteşti (1860–1942) was the first to use opioids for intrathecal analgesia; he presented his experience in Paris in 1901.[3] A number of newer local anesthetic agents, many of them derivatives of cocaine, were synthesized in the 20th century, including eucaine (1900), amylocaine (1904), procaine (1905), and lidocaine (1943). [edit] Early inhalational anesthetics Further information: Inhalational anaesthetic Anesthesia pioneer Crawford W. Long Contemporary re-enactment of Morton's October 16, 1846, ether operation; daguerrotype by Southworth & Hawes On 16 October 1846 William Thomas Green Morton, a Boston dentist was invited to the Massachusetts General Hospital to demonstrate his new technique for painless surgery. After Morton had induced anesthesia by administration of diethyl ether by inhalation, surgeon John Collins Warren removed a tumor from the neck of Edward Gilbert Abbott. This first public demonstration of ether anesthesia occurred in the surgical amphitheater now called the Ether Dome. The previously skeptical Dr. Warren was impressed and stated "Gentlemen, this is no humbug." In a letter to Morton shortly thereafter, physician and writer Oliver Wendell Holmes, Sr. proposed naming the state produced "anesthesia", and the procedure an "anesthetic".[4] Morton at first attempted to hide the actual nature of his anesthetic substance, referring to it as Letheon. He received a US patent for his substance, but news of the successful anesthetic spread quickly by late 1846. Respected surgeons in Europe including Liston, Dieffenbach, Pirogov, and Syme, quickly undertook numerous operations with ether. An American-born physician, Boott, encouraged London dentist James Robinson to perform a dental procedure on a Miss Lonsdale. This was the first case of an operator-anesthetist. On the same day, 19 December 1846, in Dumfries Royal Infirmary, Scotland, a Dr. Scott used ether for a surgical procedure.[citation needed] The first use of anesthesia in the Southern Hemisphere took place in Launceston, Tasmania, that same year. Drawbacks with ether such as excessive vomiting and its flammability led to its replacement in England with chloroform. Discovered in 1831, the use of chloroform in anesthesia is linked to James Young Simpson, who, in a wide-ranging study of organic compounds, found chloroform's efficacy on 4 November 1847. Its use spread quickly and gained royal approval in 1853 when John Snow gave it to Queen Victoria during the birth of Prince Leopold. Unfortunately, chloroform is not as safe an agent as ether, especially when administered by an untrained practitioner (medical students, nurses, and occasionally members of the public were often pressed into giving anesthetics at this time). This led to many deaths from the use of chloroform that (with hindsight) might have been preventable. The first fatality directly attributed to chloroform anesthesia was recorded on 28 January 1848 after the death of Hannah Greener.[citation needed] John Snow of London published articles from May 1848 onwards "On Narcotism by the Inhalation of Vapours" in the London Medical Gazette. Snow also involved himself in the production of equipment needed for the administration of inhalational anesthetics. [edit] Non-pharmacological methods This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (September 2010) There is a long history of the use of hypnotism as an anesthetic techniques. Chilling tissue (e.g. with a mixture of salt and ice or a spray of diethyl ether or ethyl chloride) can temporarily inhibit the ability of nerve fibers (axons) to conduct sensation. The hypocapnia that results from hyperventilation can temporarily inhibit the conscious perception of sensory stimuli, including pain (see Lamaze technique). These techniques are seldom employed in modern anesthetic practice. [edit] Anesthesia providers Physicians specializing in perioperative care, development of an anesthetic plan, and the administration of anesthetics are known in the United States as anesthesiologists and in the United Kingdom and Canada as anaesthetists or anaesthesiologists. All anesthetics in the UK, Australia, New Zealand, Hong Kong and Japan are administered by physicians. Nurse anesthetists also administer anesthesia in 109 nations.[5] In the US, 35% of anesthetics are provided by physicians in solo practice, about 55% are provided by anesthesia care teams (ACTs) with anesthesiologists medically directing anesthesiologist assistants or certified registered nurse anesthetists (CRNAs), and about 10% are provided by CRNAs in solo practice.[6][7][8][9][10] [edit] Physicians Main article: Anesthesiologist Anesthesia students training with a patient simulator In the strict sense, the term anesthetist refers to any individual who administers anesthesia. However, in the US the term is most commonly employed to refer to registered nurses who have completed specialized education and training in anesthesia to become certified registered nurse anesthetists (CRNAs). In the US and Canada, medical doctors who specialize in anesthesiology are called anesthesiologists. Such physicians in the United Kingdom (UK), Australia and New Zealand are called anaesthetists or anaesthesiologists. In the US, a physician specializing in anesthesiology typically completes 4 years of college, 4 years of medical school, and four years of postgraduate medical training or residency [11] According to the American Society of Anesthesiologists, anesthesiologists provide or participate in more than 90 percent of the 40 million anesthetics delivered annually.[12] In the UK, this training lasts a minimum of seven years after the awarding of a medical degree and two years of basic residency, and takes place under the supervision of the Royal College of Anaesthetists.[citation needed] In Australia and New Zealand, it lasts five years after the awarding of a medical degree and two years of basic residency, under the supervision of the Australian and New Zealand College of Anaesthetists.[citation needed] Other countries have similar systems, including Ireland (the Faculty of Anaesthetists of the Royal College of Surgeons in Ireland), Canada and South Africa (the College of Anaesthetists of South Africa). In the US, satisfactory completion of the written and oral Board examinations allows an anesthesiologist to be called a "Diplomate" of the American Board of Anesthesiology (or of the American Osteopathic Board of Anesthesiology, for osteopathic physicians). This is often referred to colloquially as being "Board Certified". In the UK, Fellowship of the Royal College of Anaesthetists (FRCA) is conferred upon medical doctors following satisfactory completion of the written and oral parts of the Royal College's examination. The role of the anesthesiologist is no longer limited to the operation itself — Many anesthesiologists function as perioperative physicians, ensuring optimal analgesia and maintenance of physiologic homeostasis throughout the preoperative, intraoperative, and postoperative periods. Anesthesiologists may elect to subspecialize in anesthesia for particular types of surgery (cardiothoracic, obstetrical, neurosurgical, pediatric), regional anesthesia, acute or chronic pain medicine, or Intensive Care Medicine. Anesthesia providers are often trained using full scale human simulators. The field was an early adopter of this technology and has used it to train students and practitioners at all levels for the past several decades. Notable centers in the United States can be found at the Johns Hopkins Medicine Simulation Center,[13] Harvard's Center for Medical Simulation,[14] Stanford,[15] The Mount Sinai School of Medicine HELPS Center in New York,[16] and Duke University.[17] [edit] Nurse anesthetists Main article: Nurse anesthetist In the United States, advanced practice nurses specializing in the provision of anesthesia care are known as Certified Registered Nurse anesthetists (CRNAs). According to the American Association of Nurse Anesthetists, the 39,000 CRNAs in the US administer approximately 30 million anesthetics each year, roughly two thirds of the US total.[18] 34% of nurse anesthetists practice in communities of less than 50,000. CRNAs start school with a bachelors degree and at least 1 year of acute care nursing experience,[19] and gain a masters degree in nurse anesthesia before passing the mandatory Certification Exam. Masters-level CRNA training programs range in length from 24 to 36 months. CRNAs may work with podiatrists, dentists, anesthesiologists, surgeons, obstetricians and other professionals requiring their services. CRNAs administer anesthesia in all types of surgical cases, and are able to apply all the accepted anesthetic techniques—general, regional, local, or sedation. Many states place restrictions on practice, and hospitals often regulate what CRNAs and other midlevel providers can or can not do based on local laws, provider training and experience, and hospital and physician preferences.[20] In the United States, the Centers for Medicare and Medicaid Services (CMS), a federal agency within the United States Department of Health and Human Services, determines the conditions for payment for all anesthesia services provided under the Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP) programs. For the purposes of payment for anesthesiology services, CMS defines an anesthesia practitioner as a physician who performs the anesthesia service alone, a CRNA who is not medically directed, or a CRNA or AA who is medically directed.[21] Under the QZ Anesthesia Claims Modifier, CMS allows payment to a CRNA for anesthesiology services provided under these programs without medical direction by a physician.[21] Furthermore, under CMS regulations, anesthesia must be administered only by: * a qualified doctor of medicine or osteopathic medicine, dentist, oral surgeon, or podiatrist; * a CRNA who, unless exempted, is under the supervision of the operating practitioner or of an anesthesiologist; * an anesthesiologist's assistant who is under the supervision of an anesthesiologist.[22] The aforementioned exemption for CRNAs is the State exemption (also referred to as an "opt-out"). Under the State exemption, if the State in which the hospital is located submits a letter to CMS requesting exemption from physician supervision of CRNAs, and that letter has been signed by the Governor of that State, then hospitals within that State may be exempted from the requirement for physician supervision of CRNAs.[22] In 2001, CMS established this exemption for CRNAs from the physician supervision requirement by recognizing a Governor's written request to CMS attesting that it is in the best interests of the State's citizens to exercise this exemption.[23] As of July 2009, fifteen states (California, Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, South Dakota, Wisconsin and Montana) have chosen to opt-out of the CRNA physician supervision regulation.[23] [edit] Anesthesiologist assistants In the United States, anesthesiologist assistants (AAs) are graduate-level trained specialists who have undertaken specialized education and training to provide anesthesia care under the direction of an anesthesiologist. AAs typically hold a masters degree and practice under anesthesiologist supervision in 18 states through licensing, certification or physician delegation.[24] In the UK, a similar group of assistants are currently being evaluated. They are referred to as "physician assistant (anaesthesia)" (PAA). Their background can be nursing, operating department practice, another of the allied medical professions, or even one of the natural sciences.[citation needed] Training is in the form of a postgraduate diploma and takes 27 months to complete.[citation needed] [edit] Operating department practitioners Main article: Operating Department Practitioners This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (September 2010) In the United Kingdom, operating department practitioners provide assistance and support to the anesthetist or anesthesiologist. They can also assist the surgeon with surgical procedures and provide postoperative care to patients emerging from anesthesia. ODPs can be found in the operating department, accident and emergency department, intensive care unit, high dependency unit and in radiology, cardiology and endoscopy suites which require anesthesia support. They may also work with organ transplantation teams, as well as provide pre-hospital care to trauma victims. They are state-registered in the UK. The ODP is a mid-level practitioner of perioperative medicine. ODPs also function as lecturers and trainers in cardiopulmonary resuscitation, and work in management positions in operating departments. [edit] Veterinary anesthetists/anesthesiologists Main article: Veterinary anesthesia This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (September 2010) Much of the equipment and drugs utilized by veterinary anesthetists is similar or identical to that used in anesthesia for human patients. There are vast differences in the physiology of different animal species, which may influence the choice of anesthetic agents and delivery systems in organisms ranging in diversity from (for example) annelids to elephants. For many wild animals, anesthetic drugs must often be delivered from a distance by means of remote projector systems ("dart guns") before the animal can even be approached. Large domestic livestock can often be anesthetized for certain types of surgery in the standing position using only local anesthetics and sedative drugs. While most clinical veterinarians and veterinary technicians routinely function as anesthetists in the course of their professional duties, veterinary anesthesiologists in the U.S. are veterinarians who have completed a three year residency in anesthesia and have qualified for certification by the American College of Veterinary Anesthesiologists. [edit] Other personnel Further information: Anaesthetic technician, Biomedical Equipment Technician, and Surgical technologist Anesthesia technicians are specially trained biomedical technicians. They do not administer anesthesia, but rather they assist anesthesia providers similar to the way in which scrub technicians assist surgeons. Commonly these services are collectively called perioperative services, and thus the term perioperative service technician (PST) is used interchangeably with anesthesia technician. In the United States, an anesthesia technician can become a Certified Anesthesia Technician (Cer.A.T.), followed by becoming a Certified Anesthesia Technologist (Cer.A.T.T.) through American Society of Anesthesia Technologists & Technicians (ASATT).[25] In New Zealand, an anesthetic technician completes a course of study recognized by the New Zealand Anaesthetic Technicians Society.[26] [edit] Anesthetic agents Further information: Anesthetic, General anaesthetic, Inhalational anaesthetic, and Local anesthetic An anesthetic agent is a drug that brings about a state of anesthesia. A wide variety of drugs are used in modern anesthetic practice. Many are rarely used outside of anesthesia, although others are used commonly by all disciplines. Anesthetics are categorized in to two categories: general anesthetics cause a reversible loss of consciousness (general anesthesia), while local anesthetics cause reversible local anesthesia and a loss of nociception. [edit] Anesthetic equipment Main article: Anaesthetic equipment In modern anesthesia, a wide variety of medical equipment is desirable depending on the necessity for portable field use, surgical operations or intensive care support. Anesthesia practitioners must possess a comprehensive and intricate knowledge of the production and use of various medical gases, anesthetic agents and vapors, medical breathing circuits and the variety of anesthetic machines (including vaporizers, ventilators and pressure gauges) and their corresponding safety features, hazards and limitations of each piece of equipment, for the safe, clinical competence and practical application for day to day practice. The risk of transmission of infection by anesthetic equipment has been a problem since the beginnings of anesthesia. Although most equipment that comes into contact with patients is disposable, there is still a risk of contamination from the anesthetic machine itself[27] or because of bacterial passage through protective filters.[28] [edit] Anesthetic monitoring This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (September 2010) Patients under general anesthesia must undergo continuous physiological monitoring to ensure safety. In the US, the American Society of Anesthesiologists have established mininum monitoring guidelines for patients receiving general anesthesia, regional anesthesia, or sedation. This includes electrocardiography (ECG), heart rate, blood pressure, inspired and expired gases, oxygen saturation of the blood (pulse oximetry), and temperature.[29] In the UK the Association of Anaesthetists (AAGBI) have set minimum monitoring guidelines for general and regional anesthesia. For minor surgery, this generally includes monitoring of heart rate, oxygen saturation, blood pressure, and inspired and expired concentrations for oxygen, carbon dioxide, and inhalational anesthetic agents. For more invasive surgery, monitoring may also include temperature, urine output, blood pressure, central venous pressure, pulmonary artery pressure and pulmonary artery occlusion pressure, cardiac output, cerebral activity, and neuromuscular function. In addition, the operating room environment must be monitored for ambient temperature and humidity, as well as for accumulation of exhaled inhalational anesthetic agents, which might be deleterious to the health of operating room personnel. [edit] Anesthesia record The anesthesia record is the medical and legal documentation of events during an anesthetic.[30] It reflects a detailed and continuous account of drugs, fluids, and blood products administered and procedures undertaken, and also includes the observation of cardiovascular responses, estimated blood loss, urine output and data from physiologic monitors (see "Anesthetic monitoring" section above) during the course of an anesthetic. Traditionally handwritten on paper, the anesthesia record is increasingly being replaced by an electronic record as part of an Anesthesia Information Management System (AIMS), especially since 2007.[31] An AIMS is any information system that is used as an automated electronic anesthesia record keeper (i.e., connection to patient physiologic monitors and/or the anesthetic machine) and which also may allow the collection and analysis of anesthesia-related perioperative patient data gathered from monitors and/or the anesthesia machine. These systems typically run on medical-grade hardware in the operating room. AIMS can be stand-alone systems or integrated modules of a hospital information system. AIMS have several benefits to the anesthesia departments as well to the hospital administration as documented in the scientific literature: * Reducing anesthesia-related drug costs[32] * Increased anesthesia billing and capture of anesthesia-related charges[33] * Increased hospital reimbursement through improved hospital coding[34][35] * Improvement of the data quality of the intraoperative anesthesia record[36][37] * Support training and education of the anesthesia workforce[38] * Support of clinical decision-making[39] * Support of patient care and safety[40] * Enhancement of clinical studies[41] * Enhancement of clinical quality improvement programs[42] * Support of clinical risk management[43] * Monitoring for diversion of controlled substances[44] [edit] See also * Allergic reactions during anesthesia * Anesthesia awareness * ASA physical status classification system * Cardiothoracic anesthesiology * Geriatric anesthesia * Intraoperative neurophysiological monitoring * The Helsinki Declaration for Patient Safety in Anaesthesiology * Patient safety * Perioperative mortality * Second gas effect

flap surgery Return to the top

Pharyngeal flap surgery is a procedure to correct the airflow during speech. The procedure is common among people with cleft palate and some types of dysarthria. Contents [hide] * 1 Pharyngeal flap procedures * 2 Candidacy * 3 Complications * 4 Outcomes * 5 See also * 6 External links [edit] Pharyngeal flap procedures Posterior pharyngeal flap surgery is the most commonly used operation to restore velopharyngeal competence (i.e., develop a functional seal between the nasal cavity and the oral cavity), and therefore correct hypernasality and nasal air escape (Ysunza et al., 2002). Posterior pharyngeal flaps can be based superiorly or inferiorly and the velum can be split transversely or along the midline (Lideman-Boshki et al., 2005). Centrally positioned, superior based flaps continue to be the most popular pharyngeal flap choice, yet inferior based flaps are easier for the surgeon to perform. Compared to superiorly based flaps, inferiorly based flaps are limited in regard to the size of velopharyngeal opening that can be covered (Peterson-Falzone et al., 2001). Pharyngoplasties correcting hypernasal speech can be traced back as far as the 19th century when Passavant first explored palatopexy in a 23 year old female (Hall et al., 1991). In 1876, Schoenborn also attempted to reduce the amount of air entering the nasal cavity by developing the first true inferior based pharyngeal flap surgery, where a flap of tissue was sutured into the velum and attached to the lower end of the posterior pharyngeal wall. Modifying his technique, Schoenborn published a superior based pharyngeal flap surgery in 1886, where the flap of tissue attached to the upper end of the posterior pharyngeal wall. In 1928, Rosenthal used an inferiorly based posterior pharyngeal flap in combination with a modified von Langenbeck palatoplasty in primary surgery for cleft palate repair. Taking a different approach, Padgett (1930) utilized a superiorly based flap for cleft palate patients whose primary surgical repair had been unsuccessful (Sloan, 2000). By the 1950s, posterior pharyngeal flap surgery became widely adopted in the correction of VPI (Peterson-Falzone et al., 2001). In the 1970s, Hogan and Shprintzen advanced posterior pharyngeal flaps, leading to an increased success rate in the elimination of VPI. Hogan (1973) proposed a ‘lateral portal control’ flap to modulate the postoperative port size. In this flap, lateral ports exist on both sides of the pharyngeal flap to assist in drainage, nasal breathing, and nasal resonance. Using the pressure-flow studies of Warren and colleagues as a basis for lateral port size, Hogan placed a 4 mm diameter catheter through the lateral ports on either side of the flap to tailor the port size to the perception of nasal resonance (Sloan, 2000). Consistent with Warren’s aerodynamic data, Hogan advocated that the velopharyngeal opening be no greater than 4 mm in diameter because a larger gap would most likely result in hypernasal speech (Peterson-Falzone et al., 2001). In 1979, Shprintzen advocated ‘tailor-made’ flaps, with the width of the flap determined by the degree of preoperative lateral pharyngeal wall adduction. According to Shprintzen, the base of the pharyngeal flap should be positioned at the site with the greatest level of lateral pharyngeal wall movement. In addition, Shprintzen recommends that a narrower flap be used with pronounced lateral pharyngeal wall movement, while a wider flap should be used with limited lateral pharyngeal wall movement (Sloan, 2000) Use of a narrow flap in individuals with limited preoperative lateral pharyngeal wall movement has the potential to increase lateral pharyngeal wall movement postoperatively (Karling et al., 1999). [edit] Candidacy Pharyngeal flap surgery may be recommended to resolve velopharyngeal incompetence after patients prove unable to achieve significant speech improvements through speech therapy alone. Other requirements to qualify for the surgery include a short and immobile or easily fatigued palate (Mazaheri et al., 1994). The patient’s pattern of VP closure is one aspect that is taken take into consideration by doctors in deciding whether pharyngeal flap surgery is the appropriate method of treatment (Armour et al., 2005). A variety of closure patterns have been found, and the pattern varies person to person. When planning pharyngeal flap surgery, it is imperative for the doctor to match the postoperative structure to the preoperative movements in order for an adequate seal to be achieved (Ysunza et al., 2002). Research has found that pharyngeal flap surgery has been most effective for those with a sagittal closure pattern (good lateral wall movement but poor velar movement (Armour et al., 2005). Pharyngeal flap surgery is not recommended for everyone and alternative treatment methods are available. One alternative is the use of a prosthesis. In some instances, a prosthesis is capable of stimulating pharyngeal wall movement, thus aiding in VP closure. Most often, prostheses have been recommended for use in young children (Mazaheri et al., 1994). Currently, no accurate method is available to determine whether a pharyngeal flap or an alternative method will have better results for eliminating velopharnygeal incompetence. Pharyngeal flap surgery has been completed in both children and adults. When younger children undergo the surgery, fewer speech impairments tend to occur. A possible explanation is that the earlier the surgery, the less likely the child will have developed compensatory strategies to overcome the velopharyngeal incompetence (Armour et al., 2005). However, with thorough preoperative planning, pharyngeal flap surgery can be just as effective in eliminating VPI in adults as it is in children (Hall et al., 1991). [edit] Complications The most common complications of pharyngeal flap surgery include airway obstruction and sleep apnea (Pena, 2000). Snoring has also been noted as a possible negative outcome of the surgery (Sloan, 2000). As a result of flap surgery, the airway is compromised in several ways. Some of the issues associated with this compromise include: narrowing of the nasal and oral airway secondary to edema, impeding of the nasopharynx by the flap itself, anatomical changes in which the oropharynx becomes smaller, and decreased respiratory drive following anesthesia. There is also a correlation between the individuals who have this surgery and the presence of other craniofacial and neurological conditions. These factors together may lead to the above complications (Pena, 2000). Postoperative airway obstruction may range from mild stridor events to severe blockage of the airway resulting in intubation or tracheostomy. All patients should be closely monitored following surgery due to the possible damage to the newly repaired palate or even the risk of death. In the literature, airway obstruction following pharyngeal flap surgery using the Wardill-Kilner and von Langenbeck techniques are well documented. It has been concluded that individuals with Franceschetti syndrome or Pierre Robin sequence are at increased risk for developing airway obstruction following pharyngoplasty due to their shallow nasopharyngeal airway and inadequate maxillofacial growth at the time of the surgery. It is also believed that prolonged duration of the surgical procedure may be directly correlated with an increased incidence of airway obstruction. Age does not seem to influence the risk. Factors that increase the risk of airway obstruction include associated congenital anomalies and a history of airway problems (Anthony & Sloan, 2002). Sleep apnea can be categorized as obstructive sleep apnea (OSA) or central sleep apnea. The potential health risks of OSA are severe and therefore even a small percentage of incidence is considered significant. Obstructive sleep apnea symptoms must be carefully assessed following pharyngeal flap surgery (Ysunza). This condition was found to be more commonly linked to posterior pharyngeal flap surgery, however, pharyngeal flaps are considered to be more valuable in correcting velopharyngeal function than other treatment options, especially in severe cases of VPI (Sloan, 2000). It has also been reported that large tonsils have been found in a high percentage of OSA cases. Large tonsils may be shifted posteriorly, under the ports of the flap. In superiorly-based pharyngeal flaps, tonsils are a likely contributor to OSA. Surgical procedures such as uvulopalatopharyngoplasties and tonsillectomies may be required to resolve the OSA. Consequently, tonsillar tissue is an important area of pre-operative assessment (Ysunza et al., 1993). [edit] Outcomes Pharyngeal flap surgery may be able to improve speech performance in children or adults with a cleft palate who have velopharyngeal insufficiency. In fact, there is a high success rate for improvement of speech following pharyngeal flap surgery. However, surgery does not guarantee perfect or 100% intelligible speech. In addition to speech improvements, pharyngeal flap surgery may help eliminate hypernasality, nasal turbulence, and facial grimacing (Tonz et al., 2002). Often, speech improvements are not obvious immediately following the surgery. Speech improvements are more prevalent after one year post surgery and usually continue for several years. The outcomes of pharyngeal flap surgery vary among each individual in regards to improvements in hyponasality, hypernasality, nasal turbulence, voice quality, articulation, and intelligibility (Tonz et al., 2002; Liedman-Boshki et al., 2005). Patients who undergo pharyngeal flap surgery encounter the risk of never breathing through their nose again, which could create abnormal speech (i.e., denasal resonance) (Witt et al., 1998). It is estimated that around 20-30% of patients with clefts develop hypernasal speech after pharyngeal flap surgery (Heliovaara et al., 2003). The percentage reported for individuals developing hypernasal speech is debated by researchers. It is possible that hypernasality can be a side effect of pharyngeal flap surgery, however hyponasal speech occurs more frequently after a successful surgery (Liedman-Boshki et al., 2005). It is also possible that pharyngeal flap surgery will be unsuccessful. Some patients may even require secondary surgery for velopharyngeal insufficiency. It is common that individuals who have to undergo a second surgery could develop secondary speech problems, more specifically compensatory articulation and resonance disorders. Problems occurring post secondary surgery are often more difficult to extinguish (Tonz et al., 2002). As previously mentioned, one problem that may occur after surgery is hypernasality. This is caused when a narrow flap and inadequate lateral pharyngeal wall movement prohibit lateral port closure during phonation. There are several other reasons surgery may fail the first time, including a poorly designed flap such as one that is too narrow, postoperative scar (contracture of the flap), or inappropriate patient selection. Also, the flap may be too wide and occlude the lateral ports. There are higher rates of surgical failure in children with a history of perinatal upper airway obstruction, such as those with Robin sequence (Witt et al., 1998). The type of cleft, as well as the type of flap used (superiorly or inferiorly-based) does not seem to make a difference in postoperative speech outcomes. It has been reported that different types of flaps give different speech configurations, however the results showed equally good outcomes for postoperative speech, regardless of the type of flap used. Therefore, it is imperative that the surgeon selects the right type of flap for each individual (Liedman-Boshki et al., 2005). Overall, speech should improve after pharyngeal flap surgery. It is important to remember that improvement is variable and individuals react differently to surgery. Changes in speech do not always occur immediately after surgery, but this does not mean improvements will not be made. Lastly, speech problems such as compensatory articulation strategies do not often extinguish on their own. A speech language pathologist is usually involved both before and after pharyngeal flap surgery to monitor and help improve speech difficulties.

dental bridge Return to the top

A bridge, also known as a fixed partial denture, is a dental restoration used to replace a missing tooth by joining permanently to adjacent teeth or dental implants. There are different types of bridges, depending on how they are fabricated and the way they anchor to the adjacent teeth. Conventionally, bridges are made using the indirect method of restoration however, bridges can be fabricated directly in the mouth using such materials as composite resin. A bridge is fabricated by reducing the teeth on either side of the missing tooth or teeth by a preparation pattern determined by the location of the teeth and by the material from which the bridge is fabricated. In other words, the abutment teeth are reduced in size to accommodate the material to be used to restore the size and shape of the original teeth in a correct alignment and contact with the opposing teeth. The dimensions of the bridge are defined by Ante's Law: "The root surface area of the abutment teeth has to equal or surpass that of the teeth being replaced with pontics" [1]. The materials used for the bridges include gold, porcelain fused to metal, or in the correct situation porcelain alone. The amount and type of reduction done to the abutment teeth varies slightly with the different materials used. The recipient of such a bridge must be careful to clean well under this prosthesis. When restoring an edentulous space with a fixed partial denture that will crown the teeth adjacent to the space and bridge the gap with a pontic, or "dummy tooth", the restoration is referred to as a bridge. Besides all of the preceding information that concerns single-unit crowns, bridges possess a few additional considerations when it comes to case selection and treatment planning, tooth preparation and restoration fabrication. Contents [hide] * 1 Case selection and treatment planning * 2 Tooth preparation * 3 Restoration fabrication * 4 See also * 5 References [edit] Case selection and treatment planning When a single tooth requires a crown, the prosthetic crown will in most instances rest upon whatever tooth structure was originally supporting the crown of the natural tooth. However, when restoring an edentulous area with a bridge, the bridge is almost always restoring more teeth than there are root structures to support. For instance, in the photo at right, the 5-unit bridge will only be supported on three abutment teeth. To determine whether or not the abutment teeth can support a bridge without failure from lack of support from remaining root structures, the dentist employs Ante's rule—which states that the roots of abutment teeth must have a combined surface area in three dimensions that is more than that of the missing root structures of the teeth replaced with a bridge. When the situation yields a poor prognosis for proper support, double abutments may be required to properly conform to Ante's rule. When a posterior tooth intended for an abutment tooth already possesses an intracoronal restoration, it might be better to make that bridge abutment into an inlay or an onlay, instead of a crown. However, this may concentrate the torque of the masticatory forces onto a less enveloping restoration, thus making the bridge more prone to failure. In some situations, a cantilever bridge may be constructed to restore an edentulous area that only has adequate teeth for abutments either mesially or distally. This must also conform to Ante's rule but, because there are only abutments on one side, a modification to the rule must be applied, and these bridges possess double abutments in the majority of cases, and the occlusal surface area of the pontic is generally decreased by making the pontic smaller than the original tooth. [edit] Tooth preparation As with preparations for single-unit crowns, the preparations for multiple-unit bridges must also possess proper taper to facilitate the insertion of the prosthesis onto the teeth. However, there is an added dimension when it comes to bridges, because the bridge must be able to fit onto the abutment teeth simultaneously. Thus, the taper of the abutment teeth must match, to properly seat the bridge. This is known as requiring parallelism among the abutments. When this is not possible, due to severe tipping of one of more of the abutments, for example, an attachment may be useful, as in the photo at right, so that one of the abutments may be cemented first, and the other abutment, attached to the pontic, can then be inserted, with an arm on the pontic slipping into a groove on the cemented crown to achieve a span across the edentulous area. [edit] Restoration fabrication Full dental bridge being machined using WorkNC Dental CAD/CAM software. As with single-unit crowns, bridges may be fabricated using the lost-wax technique if the restoration is to be either a multiple-unit FGC or PFM. Another fabrication technique is to use CAD/CAM software to machine the bridge[2]. As mentioned above, there are special considerations when preparing for a multiple-unit restoration in that the relationship between the two or more abutments must be maintained in the restoration. That is, there must be proper parallelism for the bridge to seat properly on the margins. Sometimes, the bridge does not seat, but the dentist is unsure whether or not it is only because the spatial relationship of the two or more abutments is incorrect, or whether the abutments do not actually fit the preparations. The only way to determine this is to section the bridge and try in each abutment by itself. If they all fit individually, it must have simply been that the spatial relationship was incorrect, and the abutment that was sectioned from the pontic must now be reattached to the pontic according to the newly confirmed spatial relationship. This is accomplished with a solder index. The proximal surfaces of the sectioned units (that is, the adjacent surfaces of the metal at the cut) are roughened and the relationship is preserved with a material that will hold on to both sides, such as GC pattern resin. With the two bridge abutments individually seated on their prepared abutment teeth, the resin is applied to the location of the sectioning to reestablish a proper spatial relationship between the two pieces. This can then be sent to the lab where the two pieces will be soldered and returned for another try-in or final cementation. [edit] See also * Dental restoration * Fixed prosthodontics * Resin retained bridge

retainers Return to the top

retainers are custom-made devices, made usually of wires or clear plastic, that hold teeth in position after surgery or any method of realigning teeth. They are most often used before or after dental braces to hold teeth in position while assisting the adjustment of the surrounding gums to changes in the bone. Most patients are required to wear their retainer(s) every night at first, with many also being directed to wear them during the day - at least initially. There are three types of retainers typically prescribed by orthodontists and dentists: Hawley, Essix, and Bonded (Fixed) retainers. Contents [hide] * 1 Hawley retainer * 2 Vacuum-formed (Essix) retainer * 3 Fixed retainers * 4 References [edit] Hawley retainer The underneath surface of an upper Wrap Around Hawley retainer resting on top of a retainer case The best-known type is the Hawley retainer, which includes a metal wire that surrounds the teeth and keeps them in place. Named for its inventor, Dr. Charles Hawley, the labial wire, or Hawley bow, incorporates 2 omega loops for adjustment. It is anchored in an acrylic arch that sits in the palate (roof of the mouth). The advantage of this type of retainer is that the metal wires can be adjusted to finish treatment and continue moving teeth as needed.[1] Recently, a more aesthetic version of the Hawley retainer has been developed.[citation needed] For this alternative, the front metal wire is replaced with a clear wire called the ASTICS. This retainer is intended to be adjustable in a similar manner to the traditional Hawley retainer, which is not practical with vacuum-formed retainers. [edit] Vacuum-formed (Essix) retainer Another common type is the vacuum formed retainer (VFR). This is a polypropylene or polyvinylchloride (PVC) material, typically .020" or .030" thick. Essix is a brand name many dental offices are familiar with. This clear or transparent retainer fits over the entire arch of teeth or only from canine to canine (clip on retainer) and is produced from a mold. It is similar in appearance to Invisalign trays, though the latter are not considered "retainers". VFRs, if worn 24 hours per day, do not allow the upper and lower teeth to touch because plastic covers the chewing surfaces of the teeth. Some orthodontists feel that it is important for the top and bottom chewing surfaces to meet to allow for "favorable settling" to occur. VFRs are less expensive, less conspicuous, and easier to wear than Hawley retainers. However, for patients with disorders such as Bruxism, VFRs are prone to rapid breakage and deterioration, especially if the material is PVC, a short chain molecule. This breaks down swiftly as compared to polypropylene, a long chain molecule. Most removable retainers are supplied with a retainer case for protection. During the first few days of retainer use, many people experience extra saliva in their mouth. This is natural and is due to the presence of a new object inside the mouth and consequent stimulation of the salivary glands. It may be difficult to speak for a while after getting a retainer, but this speech difficulty should go away over time as one gets used to wearing it. [edit] Fixed retainers An entirely different category of orthodontic retainers are fixed retainers. A fixed retainer typically consists of a passive wire bonded to the tongue-side of the (usually, depending on the patient's bite, only lower) incisors. Unlike the previously-mentioned retainer types, fixed retainers cannot be removed by the patient. Some doctors prescribe fixed retainers regularly, especially where active orthodontic treatments have effected great changes in the bite and there is a high risk for reversal of these changes. While the device is usually required until a year after wisdom teeth have been extracted it is often kept in place for life. Fixed retainers may lead to tartar build-up or gingivitis due to the difficulty of flossing while wearing these retainers. As with dental braces, patients often must use floss threaders to pass dental floss through the small space between the retainer and the teeth

Orthodontic retainers are custom-made devices, made usually of wires or clear plastic, that hold teeth in position after surgery or any method of realigning teeth. They are most often used before or after dental braces to hold teeth in position while assisting the adjustment of the surrounding gums to changes in the bone. Most patients are required to wear their retainer(s) every night at first, with many also being directed to wear them during the day - at least initially. There are three types of retainers typically prescribed by orthodontists and dentists: Hawley, Essix, and Bonded (Fixed) retainers. Contents [hide] * 1 Hawley retainer * 2 Vacuum-formed (Essix) retainer * 3 Fixed retainers * 4 References [edit] Hawley retainer The underneath surface of an upper Wrap Around Hawley retainer resting on top of a retainer case The best-known type is the Hawley retainer, which includes a metal wire that surrounds the teeth and keeps them in place. Named for its inventor, Dr. Charles Hawley, the labial wire, or Hawley bow, incorporates 2 omega loops for adjustment. It is anchored in an acrylic arch that sits in the palate (roof of the mouth). The advantage of this type of retainer is that the metal wires can be adjusted to finish treatment and continue moving teeth as needed.[1] Recently, a more aesthetic version of the Hawley retainer has been developed.[citation needed] For this alternative, the front metal wire is replaced with a clear wire called the ASTICS. This retainer is intended to be adjustable in a similar manner to the traditional Hawley retainer, which is not practical with vacuum-formed retainers. [edit] Vacuum-formed (Essix) retainer Another common type is the vacuum formed retainer (VFR). This is a polypropylene or polyvinylchloride (PVC) material, typically .020" or .030" thick. Essix is a brand name many dental offices are familiar with. This clear or transparent retainer fits over the entire arch of teeth or only from canine to canine (clip on retainer) and is produced from a mold. It is similar in appearance to Invisalign trays, though the latter are not considered "retainers". VFRs, if worn 24 hours per day, do not allow the upper and lower teeth to touch because plastic covers the chewing surfaces of the teeth. Some orthodontists feel that it is important for the top and bottom chewing surfaces to meet to allow for "favorable settling" to occur. VFRs are less expensive, less conspicuous, and easier to wear than Hawley retainers. However, for patients with disorders such as Bruxism, VFRs are prone to rapid breakage and deterioration, especially if the material is PVC, a short chain molecule. This breaks down swiftly as compared to polypropylene, a long chain molecule. Most removable retainers are supplied with a retainer case for protection. During the first few days of retainer use, many people experience extra saliva in their mouth. This is natural and is due to the presence of a new object inside the mouth and consequent stimulation of the salivary glands. It may be difficult to speak for a while after getting a retainer, but this speech difficulty should go away over time as one gets used to wearing it. [edit] Fixed retainers An entirely different category of orthodontic retainers are fixed retainers. A fixed retainer typically consists of a passive wire bonded to the tongue-side of the (usually, depending on the patient's bite, only lower) incisors. Unlike the previously-mentioned retainer types, fixed retainers cannot be removed by the patient. Some doctors prescribe fixed retainers regularly, especially where active orthodontic treatments have effected great changes in the bite and there is a high risk for reversal of these changes. While the device is usually required until a year after wisdom teeth have been extracted it is often kept in place for life. Fixed retainers may lead to tartar build-up or gingivitis due to the difficulty of flossing while wearing these retainers. As with dental braces, patients often must use floss threaders to pass dental floss through the small space between the retainer and the teeth.

tooth abscess Return to the top

A tooth abscess or root abscess is pus enclosed in the tissues of the jaw bone at the tip of an infected tooth. Usually the abscess originates from a bacterial infection that has accumulated in the soft pulp of the tooth. Abscesses typically originate from dead pulp tissue, usually caused by untreated tooth decay, cracked teeth or extensive periodontal disease. A failed root canal treatment may also create a similar abscess. It may also develop from bacteria entering a tooth filling and multiplying. Pus may also develop. There are three types of dental abscess. A gingival abscess involves only the gum tissue, without affecting either the tooth or the periodontal ligament. A periapical abscess starts in the dental pulp. A periodontal abscess begins in the supporting bone and tissue structures of the teeth. Contents [hide] * 1 Presentation and symptoms * 2 Treatment * 3 Untreated consequences * 4 See also * 5 References * 6 External links [edit] Presentation and symptoms The pain is continuous and may be described as gnawing, sharp, shooting, or throbbing. Putting pressure or warmth on the tooth may induce extreme pain. There may be a swelling present at either the base of the tooth, the gum, and/or the cheek, which can be alleviated by applying ice packs. An acute abscess may be painless but still have a swelling present on the gum. It is important to get anything that presents like this checked by a dental professional as it may become chronic later. In some cases, a tooth abscess may perforate bone and start draining into the surrounding tissues creating local facial swelling. In some cases, the lymph glands in the neck will become swollen and tender in response to the infection. It may even feel like a migraine as the pain can transfer from the infected area. The pain does not normally transfer across the face, only upwards or downwards as the nerves that serve each side of the face are separate. Severe aching and discomfort on the side of the face where the tooth is infected is also fairly common, with the tooth itself becoming unbearable to touch. [edit] Treatment Successful treatment of a dental abscess centers on the reduction and elimination of the offending organisms. If the tooth can be restored, root canal therapy can be performed. Nonrestorable teeth must be extracted, followed by curettage of all apical soft tissue. Unless they are symptomatic, teeth treated with root canal therapy should be evaluated at 1- and 2-years intervals to rule out possible lesional enlargement and to ensure appropriate healing. Abscesses may fail to heal for several reasons: * Cyst formation * Inadequate root canal therapy * Vertical root fractures * Foreign material in the lesion * Associated periodontal disease * Penetration of the maxillary sinus Following conventional, adequate root canal therapy, abscesses that do not heal or enlarge are often treated with surgery and filling the root tips; and will require a biopsy to evaluate the diagnosis.[1] [edit] Untreated consequences If left untreated, a severe tooth abscess may become large enough to perforate bone and extend into the soft tissue eventually becoming osteomyelitis and cellulitis respectively. From there it follows the path of least resistance and may spread either internally or externally. The path of the infection is influenced by such things as the location of the infected tooth and the thickness of the bone, muscle and fascia attachments. External drainage may begin as a boil which bursts allowing pus drainage from the abscess, intraorally (usually through the gum) or extra orally. Chronic drainage will allow an epithelial lining to form in this communication to form a pus draining canal (fistula). Sometimes this type of drainage will immediately relieve some of the painful symptoms associated with the pressure. Internal drainage is of more concern as growing infection makes space within the tissues surrounding the infection. Severe complications requiring immediate hospitalization include Ludwig's angina, which is a combination of growing infection and cellulitis which closes the airway space causing suffocation in extreme cases. Also infection can spread down the tissue spaces to the mediastinum which has significant consequences on the vital organs such as the heart. Another complication, usually from upper teeth, is a risk of septicaemia (infection of the blood), from connecting into blood vessels, brain abscess, (extremely rare) or meningitis, (also rare). Depending on the severity of the infection, the sufferer may feel only mildly ill, or may in extreme cases require hospital care. Treat with antibiotics (possibly amoxil) to get on top of the bacteria.[citation needed] An old name for this ailment is 'Gumboil' and could well have been fatal for sufferers in the years before antibiotics, especially considering the lack of emphasis on oral hygiene and the crudity of dentistry in Victorian times.[2]

family Return to the top

fam·i·ly    /ˈfæməli, ˈfæmli/ Show Spelled [fam-uh-lee, fam-lee] Show IPA noun, plural -lies, adjective –noun 1. a. a basic social unit consisting of parents and their children, considered as a group, whether dwelling together or not: the traditional family. b. a social unit consisting of one or more adults together with the children they care for: a single-parent family. 2. the children of one person or one couple collectively: We want a large family. 3. the spouse and children of one person: We're taking the family on vacation next week. 4. any group of persons closely related by blood, as parents, children, uncles, aunts, and cousins: to marry into a socially prominent family. 5. all those persons considered as descendants of a common progenitor. 6. Chiefly British . approved lineage, esp. noble, titled, famous, or wealthy ancestry: young men of family. 7. a group of persons who form a household under one head, including parents, children, and servants. 8. the staff, or body of assistants, of an official: the office family. 9. a group of related things or people: the family of romantic poets; the halogen family of elements. 10. a group of people who are generally not blood relations but who share common attitudes, interests, or goals and, frequently, live together: Many hippie communes of the sixties regarded themselves as families. 11. a group of products or product models made by the same manufacturer or producer. 12. Biology . the usual major subdivision of an order or suborder in the classification of plants, animals, fungi, etc., usually consisting of several genera. 13. Slang . a unit of the Mafia or Cosa Nostra operating in one area under a local leader. 14. Linguistics . the largest category into which languages related by common origin can be classified with certainty: Indo-European, Sino-Tibetan, and Austronesian are the most widely spoken families of languages. Compare stock ( def. 12 ) , subfamily ( def. 2 ) . 15. Mathematics . a. a given class of solutions of the same basic equation, differing from one another only by the different values assigned to the constants in the equation. b. a class of functions or the like defined by an expression containing a parameter. c. a set. –adjective 16. of, pertaining to, or characteristic of a family: a family trait. 17. belonging to or used by a family: a family automobile; a family room. 18. suitable or appropriate for adults and children: a family amusement park. 19. not containing obscene language: a family newspaper. —Idiom 20. in a / thefamily way, pregnant. Use family in a Sentence See images of family Search family on the Web Origin: 1350–1400; ME familie < L familia a household, the slaves of a household, equiv. to famul ( us ) servant, slave + -ia -y3 —Related forms an·ti·fam·i·ly, adjective in·ter·fam·i·ly, adjective —Usage note See collective noun. Dictionary.com Unabridged Based on the Random House Dictionary, © Random House, Inc. 2011. Cite This Source | Link To family Explore the Visual Thesaurus » Related Words for : family home, house, household, menage, family unit View more related words » Clinical Depression Definition Symptoms, causes, treatments of Clinical Depression Definition. myOptumHealth.com Master's in Nursing Earn a Nursing Degree Online. Get Info About Georgetown Programs. Sponsored Results Online.Nursing.Georgetown.edu World English Dictionary family (ˈfæmɪlɪ, ˈfæmlɪ) [Click for IPA pronunciation guide] — n , pl -lies 1. a. a primary social group consisting of parents and their offspring, the principal function of which is provision for its members b. ( as modifier ): family quarrels ; a family unit 2. one's wife or husband and one's children 3. one's children, as distinguished from one's husband or wife 4. Compare extended family a group of persons related by blood; a group descended from a common ancestor 5. all the persons living together in one household 6. any group of related things or beings, esp when scientifically categorized 7. biology any of the taxonomic groups into which an order is divided and which contains one or more genera. Felidae (cat family) and Canidae (dog family) are two families of the order Carnivora 8. ecology a group of organisms of the same species living together in a community 9. a group of historically related languages assumed to derive from one original language 10. chiefly ( US ) an independent local group of the Mafia 11. maths a group of curves or surfaces whose equations differ from a given equation only in the values assigned to one or more constants in each curve: a family of concentric circles 12. physics the isotopes, collectively, that comprise a radioactive series 13. informal in the family way pregnant [C15: from Latin familia a household, servants of the house, from famulus servant] Collins English Dictionary - Complete & Unabridged 10th Edition 2009 © William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009 Cite This Source Word Origin & History family c.1400, "servants of a household," from L. familia "household," including relatives and servants, from famulus "servant," of unknown origin. The classical L. sense recorded in Eng. from 1545; the main modern sense of "those connected by blood" (whether living together or not) is first attested 1667. Replaced O.E. hiwscipe. Buzzword family values first recorded 1966. Phrase in a family way "pregnant" is from 1796. Family circle is 1809; family man, one devoted to wife and children, is 1856 (earlier it meant "thief," 1788, from family in slang sense of "the fraternity of thieves"). Online Etymology Dictionary, © 2010 Douglas Harper Cite This Source Medical Dictionary fam·i·ly definition Pronunciation: /ˈfam-(ə-)lē/ Function: n pl -lies ; 1 : the basic unit in society traditionally consisting of two parents rearing their children also : any of various social units differing from but regarded as equivalent to the traditional family single-parent family > 2 : a group of related plants or animals forming a category ranking above a genus and below an order and usually comprising several to many genera family Function: adj Merriam-Webster's Medical Dictionary, © 2007 Merriam-Webster, Inc. Cite This Source family fam·i·ly (fām'ə-lē, fām'lē) n. 1. A group of blood relatives, especially parents and their children. 2. A taxonomic category of related organisms ranking below an order and above a genus. The American Heritage® Stedman's Medical Dictionary Copyright © 2002, 2001, 1995 by Houghton Mifflin Company. Published by Houghton Mifflin Company. Cite This Source Science Dictionary family (fām'ə-lē) Pronunciation Key A group of organisms ranking above a genus and below an order. The names of families end in -ae, a plural ending in Latin. In the animal kingdom, family names end in -idae, as in Canidae (dogs and their kin), while those in the plant kingdom usually end in -aceae, as in Rosaceae (roses and their kin). See Table at taxonomy. The American Heritage® Science Dictionary Copyright © 2002. Published by Houghton Mifflin. All rights reserved. Cite This Source Legal Dictionary Main Entry: fam·i·ly Pronunciation: 'fam-lE, 'fa-m&- Function: noun Inflected Form: plural -lies 1 : a group of individuals related by blood, marriage, or adoption 2 : a group of usually related individuals who live together under common household authority and esp. who have reciprocal duties to each other NOTE: The interpretation of the word family in a law context depends upon the area of the law concerned (as contract or zoning law), the purpose of the document (as a statute or contract) in which it is used, and the facts of the case. Often for zoning purposes, the occupants of a group home are considered a family if the organization is like that of a family or if the home is going to be a permanent rather than a transitional residence for the occupants. — fa·mil·ial /f&-'mil-y&l/ adjective Merriam-Webster's Dictionary of Law, © 1996 Merriam-Webster, Inc. Cite This Source Cultural Dictionary family definition In biology, the classification lower than an order and higher than a genus. Lions, tigers, cheetahs, and house cats belong to the same biological family. Human beings belong to the biological family of hominids. ( See Linnean classification.) The American Heritage® New Dictionary of Cultural Literacy, Third Edition Copyright © 2005 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved. Cite This Source Idioms & Phrases family see in a family way; run in the blood (family). The American Heritage® Dictionary of Idioms by Christine Ammer. Copyright © 1997. Published by Houghton Mifflin. Cite This Source Famous Quotations family "Q: What would have made a family and career easier for ..." "Pessimists say that the family is eroding. Optimists sa..." "I come from a long line of male chauvinists in a very t..." "The naturalistic literature of this country has reached..." "... the aspiring immigrant ... is not content to progre..." More Quotes

coral gables Return to the top

Coral Gables is a city in Miami-Dade County, Florida, southwest of Downtown Miami, in the United States. The city is home to the University of Miami. The population was 42,249 at the 2000 census. According to U.S Census estimates in 2005, the city had a population of 42,871.[3] Coral Gables is served by the Miami Metrorail at three stations: Douglas Road Station, University Station, and South Miami Station. Douglas Road Station directly serves the Village of Merrick Park and Coconut Grove, as well as Miracle Mile via the Coral Gables Trolley. University Station serves the University of Miami and the BankUnited Center, and the South Miami Station serves the Shops at Sunset Place and the surrounding South Miami neighborhood. Contents [hide] * 1 History * 2 Geography o 2.1 Surrounding areas * 3 Demographics * 4 Coral Gables today * 5 Media * 6 Economy * 7 Diplomatic missions * 8 Education o 8.1 University of Miami o 8.2 Primary and secondary schools + 8.2.1 Public schools + 8.2.2 Private schools o 8.3 Public libraries * 9 Notable residents * 10 Places of interest * 11 Gallery * 12 Sister cities * 13 References * 14 External links [edit] History Further information: History of Miami, Florida Coral Gables was one of the first planned communities, and prefigured the development of the gated community and the homeowners association. It is famous for its strict zoning regulations.[4] The city was developed by George Edgar Merrick during the Florida land boom of the 1920s. The city's architecture is almost entirely Mediterranean Revival Style. By 1926, the city covered 10,000 acres (40 km2), had netted $150 million in sales with over $100 million spent on development.[5] Merrick designed the downtown commercial district to be only four blocks wide and more than two miles (3 km) long. The main artery bisected the business district. Merrick could boast that every business in Coral Gables was less than a two-block walk. The city used to have an old electric trolley system which was replaced by the popularity of modern automobiles, but now a new free circulator trolley system, initiated in November, 2003, runs down Ponce de León Boulevard. In 1925, roughly simultaneous to the founding of Coral Gables, the city was selected as the home to the University of Miami, which was constructed that year on 240 acres (0.97 km2) of land just west of U.S. Route 1, approximately two miles south of downtown Coral Gables. During World War II, the Pan America Airline leased its Coral Gables-based airport and hangar facilities with the US Navy. Many Navy pilots and mechanics were trained and housed in Coral Gables. [edit] Geography Coral Gables is located at 25°43′42″N 80°16′16″W / 25.728228°N 80.270986°W / 25.728228; -80.270986..[6] According to the United States Census Bureau, the city has a total area of 96.2 km2 (37.2 mi2). 34.0 km2 (13.1 mi2) of it is land and 62.2 km2 (24.0 mi2) of it (64.64%) is water. [edit] Surrounding areas * Miami, Unincorporated Miami-Dade County * Unincorporated Miami-Dade County Flagami (Miami) Up arrow left.svg Up-1.svg Up arrow right.svg Miami * West Miami, Coral Terrace, South Miami, Pinecrest, Palmetto Bay Left.svg Right.svg {Coral Way, Coconut Grove (Miami)}, Biscayne Bay * Palmetto Bay Down arrow left.svg Down arrow.svg Down arrow right.svg Biscayne Bay * Palmetto Bay, Biscayne Bay [edit] Demographics Alhambra Circle is Coral Gables' primary financial street with numerous high-rise office buildings As of the census[1] of 2000, there were 42,249 people, 16,793 households, and 10,243 families residing in the city. The population density was 1,242.4/km2 (3,216.9/mi2). There were 17,849 housing units at an average density of 524.9/km2 (1,359.1/mi2). The racial makeup of the city was 91.83% White (47.7% were Non-Hispanic Whites,)[7] 3.30% African American, 0.13% Native American, 1.68% Asian, 0.04% Pacific Islander, 1.49% from other races, and 1.54% from two or more races. Hispanic or Latino of any race were 46.64% of the population. There were 16,793 households out of which 24.2% had children under the age of 18 living with them, 49.2% were married couples living together, 9.1% had a female householder with no husband present, and 39.0% were non-families. 31.5% of all households were made up of individuals and 9.8% had someone living alone who was 65 years of age or older. The average household size was 2.31 and the average family size was 2.92. In the city the population was spread out with 17.4% under the age of 18, 13.9% from 18 to 24, 29.0% from 25 to 44, 23.9% from 45 to 64, and 15.8% who were 65 years of age or older. The median age was 38 years. For every 100 females there were 87.6 males. For every 100 females age 18 and over, there were 85.6 males. According to a 2007 estimate,[8] the median income for a household in the city was $78,157, and the median income for a family was $121,651. Males had a median income of $66,178 versus $39,444 for females. The per capita income for the city was $46,163. About 4.3% of families and 6.9% of the population were below the poverty line, including 5.6% of those under age 18 and 6.0% of those age 65 or over. In 2000, Spanish was spoken as a first language by 51.05% of residents, while English was the first language of 43.82%, French 1.08%, Portuguese 0.79%, and Italian 0.72% of the population.[9] As of 2000, Coral Gables had the eighteenth highest percentage of Cuban residents in the US, with 28.72% of the populace.[10] It also had the sixty-fourth highest percentage of Colombian residents in the US, at 2.27% of the city's population,[11] and the sixteenth highest percentage of Venezuelan residents in the US, at 1.17% of its population.[12] [edit] Coral Gables today Coral Way, one of the many scenic roads through the Gables Coral Gables is currently known as a pedestrian-friendly destination. Located four miles from Miami International Airport, the "City Beautiful" has around 140 dining establishments and gourmet shops, and many notable international retailers. Among the landmarks in Coral Gables are the Venetian Pool, Douglas Entrance, the Biltmore Hotel, and many fine residences. [edit] Media Coral Gables is covered by several local and regional radio and television stations. Coral Gables is also covered by several weekly newspapers, but has only two newspapers with the city's namesake and main focus. The Coral Gables Gazette is the only award winning FPA (Florida Press Association) weekly newspaper serving Coral Gables. Covering local government, news, sports as well as community events. The Gazette is also the oldest weekly newspaper in Coral Gables. The Gables other newspaper, The Coral Gables News Tribune, is published twice monthly and is part of Miami's Community Newspapers, the Voice of the Community. At the University of Miami in Coral Gables, The Miami Hurricane, the official student newspaper, is published twice weekly. Portions of the 1995 film Fair Game were filmed in Coral Gables.[13] [edit] Economy Major Coral Gables intersection at Coral Way (Miracle Mile) and Ponce de Leon Boulevard * The University of Miami has been the largest employer in Coral Gables since the city's beginning.[14] * Intelsat has its Latin American headquarters in Suite 1100 at One Alhambra Plaza.[15] * Fresh Del Monte Produce has its headquarters in Coral Gables.[16] * ExxonMobil has marine fuels operations in Suite 900 at One Alhambra Plaza in Coral Gables.[17] * Aeroméxico operates a ticket office in Suite 102 at Two Alhambra Plaza.[18] * American Airlines maintains the Ponce de Leon Travel Center at 901 Ponce De Leon Boulevard.[19] * MoneyGram has its Miami Office in Coral Gables.[20] * Dolphin Entertainment is an independent film studio that is located in Coral Gables [21] By 2006 Burger King had announced that it planned to move its headquarters to a proposed office building in Coral Gables.[22] By 2007 Burger King instead renewed the lease in its existing headquarters for 15 years. Burger King planned to consolidate employees working at an area near Miami International Airport and at a Dadeland Mall-area facility into the current headquarters by June of that year. Instead Bacardi USA leased the headquarter complex, a 15-story building. Bacardi consolidated employees from seven separate buildings in South Florida.[23] [edit] Diplomatic missions Several countries operate consulates in Coral Gables. They include Colombia,[24] El Salvador,[25] Italy,[26] Spain,[27] and Uruguay.[28] In addition the Taipei Economic and Cultural Office in Miami, of the Republic of China, is located in Suite 610 at 2333 Ponce De Leon Boulevard.[29] [edit] Education University of Miami Coral Gables High School [edit] University of Miami Main article: University of Miami Coral Gables is the location of the University of Miami, a university ranked in the top tier of national universities,[30] with particular national status in the fields of business, law, marine science, medicine, and music.[31][32] [edit] Primary and secondary schools [edit] Public schools Coral Gables schools are part of the Miami-Dade School District, which serves almost all of metropolitan Miami. The district has one high school in Coral Gables, Coral Gables High School, which educates students in grades nine through 12. George Washington Carver Middle School (Miami, Florida) is located in Coral Gables. An existing school was moved to the current location on Grand Avenue on land donated by George Merrick. When Carver died in 1942 the school was renamed in his honor.[33] [edit] Private schools The management offices of Gulliver Schools are located in Coral Gables.[34] Gulliver Academy, a PreK-8 school that is a member of Gulliver Schools, is within Coral Gables.[35] [edit] Public libraries Miami-Dade Public Library System operates the Coral Gables Branch.[36] [edit] Notable residents See also: List of University of Miami alumni * Dave Barry, Pulitzer Prize-winning humor columnist[37] * Bruce Berkowitz, mutual fund manager[38] * Hélio Castroneves, race car driver * Maxine Clark, the founder of Build-a-Bear Workshop * Colleen Corby, model * Gail Edwards, actress, It's a Living, Blossom, Full House. * José José, pop singer.[39] * Soia Mentschikoff, law professor * Marilyn Milian, judge, The People's Court[40] * Jonathan Vilma, professional football player, New Orleans Saints[41] [edit] Places of interest * Biltmore Hotel * Coral Gables Museum * Coral Way scenic drive * DeSoto Fountain * Miracle Mile * Fairchild Tropical Botanic Garden * John C. Gifford Arboretum * Jerry Herman Ring Theatre * Lowe Art Museum * Montgomery Botanical Center * University of Miami * Venetian Pool * Village of Merrick Park [edit] Gallery Miracle Mile in Downtown Coral Gables Miracle Theater on Miracle Mile Typical residential street in Coral Gables DeSoto Fountain Coral Gables City Hall with its statue of Merrick Venetian Pool is a Coral Gables public swimming pool Giralda Avenue in Coral Gables Village of Merrick Park Alhambra Water Tower The famous Coral Gables Biltmore Hotel Miracle Theater on Miracle Mile Gardens at Merrick Park Ponce de Leon Boulevard Downtown Coral Gables along Alhambra Circle [edit] Sister cities See also: List of sister cities in Florida Coral Gables has seven sister cities, according to the Coral Gables website[42]: * France Aix-en-Provence, France * Colombia Cartagena, Colombia * Spain Granada, Spain * Ecuador Quito, Ecuador * Italy Pisa, Italy * Spain El Puerto de Santa Maria, Spain * Guatemala La Antigua, Guatemala [edit] References 1. ^ a b "American FactFinder". United States Census Bureau. http://factfinder.census.gov. Retrieved 2008-01-31. 2. ^ "US Board on Geographic Names". United States Geological Survey. 2007-10-25. http://geonames.usgs.gov. Retrieved 2008-01-31. 3. ^ http://www.census.gov/popest/cities/tables/SUB-EST2005-04-12.csv 4. ^ "Court Decision". http://www.3dca.flcourts.org/opinions/3D05-2845.pdf. Retrieved October 13, 2010. 5. ^ Williams, Linda K. & George, Paul S.. "South Florida: A Brief History". Historical Museum of Southern Florida. http://www.hmsf.org/history/south-florida-brief-history.htm. Retrieved September 4, 2009. 6. ^ "US Gazetteer files: 2000 and 1990". United States Census Bureau. 2005-05-03. http://www.census.gov/geo/www/gazetteer/gazette.html. Retrieved 2008-01-31. 7. ^ "Demographics of Coral Gables, Florida". MuniNetGuide.com. http://www.muninetguide.com/states/florida/municipality/Coral_Gables.php. Retrieved 2007-11-02. 8. ^ factfinder.census.gov 9. ^ "MLA Data Center Results of Coral Gables, Florida". Modern Language Association. http://www.mla.org/map_data_results&state_id=12&county_id=&mode=place&zip=&place_id=14250&cty_id=&ll=&a=&ea=&order=r. Retrieved 2007-11-02. 10. ^ "Ancestry Map of Cuban Communities". Epodunk.com. http://www.epodunk.com/ancestry/Cuban.html. Retrieved 2007-11-02. 11. ^ "Ancestry Map of Colombian Communities". Epodunk.com. http://www.epodunk.com/ancestry/Colombian.html. Retrieved 2007-11-02. 12. ^ "Ancestry Map of Venezuelan Communities". Epodunk.com. http://www.epodunk.com/ancestry/Venezuelan.html. Retrieved 2007-11-02. 13. ^ Fair Game (1995) - Filming locations 14. ^ http://www.coralgables.com/CGWeb/dep_dev_topemp.htm 15. ^ "Corporate web site." Retrieved on October 18, 2010. 16. ^ Walker, Elaine. "Machines to sell food that's good for you." Miami Herald. Saturday September 26, 2009. Retrieved on October 2, 2009. 17. ^ "Contact us marine." ExxonMobil. Retrieved on January 26, 2009. 18. ^ "Florida - Ticket Offices." Aeroméxico. Retrieved on January 28, 2009. 19. ^ "Miami And Coral Gables, Florida Travel Center." American Airlines. Retrieved on April 9, 2009. 20. ^ "Other Locations." MoneyGram. Retrieved on May 11, 2010. 21. ^ "[www.dolphinentertainment.com Welcome to Dolphin Entertainment]." Dolphin Entertainment. Retrieved on June 13, 2009. 22. ^ Beaird, Daniel. "OFFICE MARKET UPDATE Vacancies drop as job growth remains steady." Southeast Real Estate Business. August 2006. Retrieved on October 2, 2009. 23. ^ "Bacardi U.S.A. to take over BK's planned Coral Gables headquarters." South Florida Business Journal. Tuesday May 8, 2007. Retrieved on October 2, 2009. 24. ^ "Contáctenos." Consulate-General of Colombia in Miami. Retrieved on January 30, 2009. 25. ^ "Norte América." Consulate-General of El Salvador in Miami. Retrieved on January 31, 2009. 26. ^ "Welcome to the web site of the Consulate General of Italy in Miami." Consulate-General of Italy in Miami. Retrieved on January 30, 2009. 27. ^ Home page. Consulate-General of Spain in Miami. Retrieved on January 30, 2009. 28. ^ "Consular in US." Embassy of Uruguay Washington D.C. Retrieved on January 30, 2009. 29. ^ "Contact Us." Taipei Economic and Cultural Office in Miami. Retrieved on January 30, 2009. 30. ^ "Best Colleges 2010: University of Miami". U.S. News & World Report. http://colleges.usnews.rankingsandreviews.com/best-colleges/coral-gables-fl/university-of-miami-1536. Retrieved 2009-10-08. 31. ^ UM Featured in 2007 Edition of the Princeton Review Annual College Guide - "The Best 361 Colleges" | University of Miami 32. ^ About the University of Miami | University of Miami 33. ^ "GWC web site." Retrieved on September 12, 2010. 34. ^ "About Our Campuses." Gulliver Schools. Retrieved on September 28, 2009. 35. ^ "Gulliver Academy." Gulliver Schools. Retrieved on September 28, 2009. 36. ^ "Coral Gables." Miami-Dade Public Library System. Retrieved on September 28, 2009. 37. ^ Lewine, Edward (April 28, 2010). "Dave Barry's Fun House". The New York Times. http://www.nytimes.com/2010/05/02/magazine/02fob-domains-t.html. 38. ^ "Bruce Berkowitz: The megamind of Miami". http://finance.fortune.cnn.com/2010/12/10/bruce-berkowitz-the-megamind-of-miami. 39. ^ http://www.peopleenespanol.com/pespanol/articles/0,22490,1647703,00.html 40. ^ [1] 41. ^ Jonathan Vilma at New Orleans Saints web site. 42. ^ "City of Coral Gables website." Retrieved on 20 October 2010.

geriatrics Return to the top

Geriatrics is a sub-specialty of internal medicine that focuses on health care of elderly people.[1] It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or physician who specializes in the care of elderly people. Rather, this decision is determined by the individual patient's needs, and the availability of a specialist. Geriatrics, the care of aged people, differs from gerontology, which is the study of the aging process itself. The term geriatrics comes from the Greek geron meaning "old man" and iatros meaning "healer". However, geriatrics is sometimes called medical gerontology. Contents [hide] * 1 Scope o 1.1 Differences between adult and geriatric medicine o 1.2 Increased complexity o 1.3 Geriatric giants o 1.4 Practical concerns * 2 Subspecialties and related services o 2.1 Medical o 2.2 Surgical o 2.3 Other geriatrics subspecialties * 3 History * 4 Geriatricians' training o 4.1 Minimum Geriatric Competencies * 5 Research o 5.1 Hospital Elder Life Program o 5.2 Pharmacology * 6 Ethical and medico-legal issues * 7 See also * 8 References * 9 Further reading * 10 External links [edit] Scope [edit] Differences between adult and geriatric medicine Geriatrics differs from standard adult medicine because it focuses on the unique needs of the elderly person. The aged body is different physiologically from the younger adult body, and during old age, the decline of various organ systems becomes manifest. Previous health issues and lifestyle choices produce a different constellation of diseases and symptoms in different people. The appearance of symptoms depends on the remaining healthy reserves in the organs. Smokers, for example, consume their respiratory system reserve early and rapidly. Geriatricians distinguish between diseases and the effects of normal ageing. For example, renal impairment may be a part of ageing, but renal failure and urinary incontinence are not. Geriatricians aim to treat any diseases that are present and to decrease the effects of aging on the body. [edit] Increased complexity The decline in physiological reserve in organs makes the elderly develop some kinds of diseases and have more complications from mild problems (such as dehydration from a mild gastroenteritis). Multiple problems may compound: A mild fever in elderly persons may cause confusion, which may lead to a fall and to a fracture of the neck of the femur ("breaking her/his hip"). Elderly people require specific attention to medications. Elderly people particularly are subjected to polypharmacy (taking multiple medications). Some elderly people have multiple medical disorders; some have self-prescribed many herbal medications and over-the-counter drugs; some adult physicians prescribe medications to their specialty without reviewing other medications used by the elder patient. This polypharmacy may result in many drug interactions and may cause some adverse drug reactions. Drugs are excreted mostly by the kidneys or the liver, either of which may be impaired in the elderly, and as a result the medication might need adjustment to avoid overwhelming the kidneys or liver. The presentation of disease in elderly persons may be vague and non-specific, or it may include delirium or falls. (Pneumonia, for example, may present with low-grade fever, dehydration, confusion or falls, rather than the high fever and cough seen in middle-aged adults.) Some elderly people may find it hard to describe their symptoms in words, especially if the disease is causing confusion, or if they have cognitive impairment. Delirium in the elderly may be caused by a minor problem such as constipation or by something as serious and life-threatening as a heart attack. Many of these problems are treatable, if the root cause can be discovered. [edit] Geriatric giants The so-called geriatric giants are the major categories of impairment that appear in elderly people, especially as they begin to fail. These include immobility, instability, incontinence and impaired intellect/memory. Impaired vision and hearing loss are common chronic problems among older people. Hearing problems can lead to social isolation, depression, and dependence as the person is no longer able to talk to other people, receive information over the telephone, or engage in simple transactions, such as talking to a person at a bank or store. Vision problems lead to falls from tripping over unseen objects, medicine being taken incorrectly because the written instructions could not be read, and finances being mismanaged. [edit] Practical concerns Functional abilities, independence and quality of life issues are of great concern to geriatricians and their patients. Elderly people generally want to live independently as long as possible, which requires them to be able to engage in self-care and other activities of daily living. A geriatrician may be able to provide information about elder care options, and refers people to home care services, skilled nursing facilities, assisted living facilities, and hospice as appropriate. Frail elderly people may choose to decline some kinds of medical care, because the risk-benefit ratio is different. For example, frail elderly women routinely stop screening mammograms, because breast cancer is typically a slowly growing disease that would cause them no pain, impairment or loss of life before they would die of other causes. Frail people are also at significant risk of post-surgical complications and the need for extended care, and an accurate prediction—based on validated measures, rather than how old the patient's face looks—can help older patients make fully informed choices about their options. Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories.[2] One frailty scale uses five items: unintentional weight loss, muscle weakness, exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes.[2] Frail elderly patients (score of 4 or 5) who were living at home before the surgery have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people. [edit] Subspecialties and related services Some diseases commonly seen in elderly are rare in adults, e.g., dementia, delirium, falls. As societies aged, many specialized geriatric- and geriatrics-related services emerged[3][4] including: [edit] Medical * Geriatric psychiatry or psychogeriatrics (focus on dementia, delirium, depression and other psychiatric disorders). * Cardiogeriatrics (focus on cardiac diseases of elderly) * Geriatric nephrology (focus on kidney diseases of elderly) * Geriatric dentistry (focus on dental disorders of elderly) * Geriatric Rehabilitation (focus on physical therapy in elderly) * Geriatric oncology (focus on tumors in elderly) * Geriatric rheumatology (focus on joints and soft tissue disorders in elderly) * Geriatric neurology (focus on neurologic disorders in elderly) * Geriatric diagnostic imaging * Geriatrics dermatology (focus on skin disorders in elderly) * Geriatric subspeciality medical clinics (As Geriatric Anticoagulation Clinic Geriatric Assessment Clinic, Falls and Balance Clinic, Continence Clinic, Palliative Care Clinic, Elderly Pain Clinic, Cognition and Memory Disorders Clinic) * Geriatric emergency medicine * Geriatric Physical Examination of interest especially to Physicians & Physician Assistants. * Geriatric public health or Preventive Geriatrics (focuses on geriatrics public health issues including disease prevention and health promotion in elderly) * Geriatric pharmacotherapy [edit] Surgical * Orthogeriatrics (close cooperation with orthopedic surgery and a focus on osteoporosis and rehabilitation). * Geriatric Cardiothoracic Surgery * Geriatric urology * Geriatric otolaryngology * Geriatric General Surgery * Geriatric trauma * Geriatric gynecology * Geriatric ophthalmology [edit] Other geriatrics subspecialties * Geriatric anesthesia (focuses on anesthesia & perioperative care of elderly) * Geriatric intensive-care unit: (a special type of intensive care unit dedicated to critically-ill elderly) * Geriatric nursing (focuses on nursing of elderly patients and the aged). * Geriatric nutrition * Geriatric Occupational Therapy (part of Geriatric Rehabilitation) * Geriatric Pain Management * Geriatric Physical Therapy * Geriatric podiatry * Geriatric psychology [edit] History Text document with red question mark.svg This section may contain inappropriate or misinterpreted citations that do not verify the text. Please help improve this article by checking for inaccuracies. (help, talk, get involved!) (September 2010) The Canon of Medicine, written by Abu Ali Ibn Sina (Avicenna) in 1025, was the first book to offer instruction in the care of the aged, foreshadowing modern gerontology and geriatrics. In a chapter entitled "Regimen of Old Age", Avicenna was concerned with how "old folk need plenty of sleep" and how their bodies should be anointed with oil, and recommended exercises such as walking or horse-riding. Thesis III of the Canon discussed the diet suitable for old people, and dedicated several sections to elderly patients who become constipated.[5][6][7] The famous Arabic physician, Ibn Al-Jazzar Al-Qayrawani (Algizar, circa 898-980), also wrote a special book on the medicine and health of the elderly, entitled Kitab Tibb al-Machayikh[8] or Teb al-Mashaikh wa hefz sehatahom.[9] He also wrote a book on sleep disorders and another one on forgetfulness and how to strengthen memory, entitled Kitab al-Nissian wa Toroq Taqwiati Adhakira,[10][11][12] and a treatise on causes of mortality entitled Rissala Fi Asbab al-Wafah.[8] Another Arabic physician in the 9th century, Ishaq ibn Hunayn (died 910), the son of Hunayn Ibn Ishaq, wrote a Treatise on Drugs for Forgetfulness (Risalah al-Shafiyah fi adwiyat al-nisyan).[13] The first modern geriatric hospital was founded in Belgrade, Serbia in 1881 by doctor Laza Lazarević.[14] The term geriatrics was proposed in 1909 by Dr. Ignatz Leo Nascher, former Chief of Clinic in the Mount Sinai Hospital Outpatient Department (New York City) and a "Father" of geriatrics in the United States. Modern geriatrics in the United Kingdom really began with the "Mother" of Geriatrics, Dr. Marjorie Warren. Warren emphasized that rehabilitation was essential to the care of older people. Using her experiences as a physician in a London Workhouse infirmary, she believed that merely keeping older people fed until they died was not enough; they needed diagnosis, treatment, care, and support. She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment. The practice of geriatrics in the UK is also one with a rich multi-disciplinary history. It values all the professions, not just medicine, for their contributions in optimizing the well-being and independence of older people. Another "hero" of British Geriatrics is Bernard Isaacs, who described the "giants" of geriatrics mentioned above: immobility and instability, incontinence, and impaired intellect.[15] Isaacs asserted that, if examined closely enough, all common problems with older people relate back to one or more of these giants. The care of older people in the UK has been advanced by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention.[16] [edit] Geriatricians' training In the United States, geriatricians are primary-care physicians who are board-certified in either family medicine or internal medicine and who have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine. In the United Kingdom, most geriatricians are hospital physicians, whereas some focus on community geriatrics. While originally a distinct clinical specialty, it has been integrated as a specialisation of general medicine since the late 1970s.[17] Most geriatricians are, therefore, accredited for both. In contrast to the United States, geriatric medicine is a major specialty in the United Kingdom; geriatricians are the single most numerous internal medicine specialists. [edit] Minimum Geriatric Competencies In July 2007, the Association of American Medical Colleges (AAMC) and the John A. Hartford Foundation hosted a National Consensus Conference on Competencies in Geriatric Education where a consensus was reached on minimum competencies (learning outcomes) that graduating medical student needed to assure competent care by new interns to older patients. Twenty-six (26) Minimum Geriatric Competencies in eight content domains were endorsed by the American Geriatrics Society (AGS), the American Medical Association (AMA), and the Association of Directors of Geriatric Academic Programs (ADGAP). The domains are: cognitive and behavioral disorders; medication management; self-care capacity; falls, balance, gait disorders; atypical presentation of disease; palliative care; hospital care for elders, and health care planning and promotion. Each content domain specifies three or more observable, measurable competencies. The competencies list is available on the Portal of Geriatric Online Education (POGOe) at: http://www.pogoe.org/Minimum_Geriatric_Competencies. [edit] Research [edit] Hospital Elder Life Program Perhaps the most pressing issue facing geriatrics is the treatment and prevention of delirium. This is a condition in which hospitalized elderly patients become confused and disoriented when confronted with the uncertainty and confusion of a hospital stay. The health of the patient will decline as a result of delirium and can increase the length of hospitalization and lead to other health complications. The treatment of delirium involves keeping the patient mentally stimulated and oriented to reality, as well as providing specialized care in order to ensure that her/his needs are being met. The Hospital Elder Life Program (HELP) is an innovative model of hospital care created by Sharon Inouye, MD, MPH and her colleagues at the Yale University School of Medicine. It is designed to prevent delirium and functional decline among elderly individuals in the hospital inpatient setting. HELP uses a core team of interdisciplinary staff and targeted intervention protocols to improve patients' outcomes and to provide cost-effective care. Unique to the program is the use of specially trained volunteers who carry out the majority of the non-clinical interventions. In up to 40% of the cases, incident delirium can be prevented. To that end, HELP promotes interventions designed to maintain cognitive and physical functioning of older adults throughout the hospitalization, maximize patients' independence at discharge, assist with the transition from hospital to home and prevent unplanned hospital readmissions. Customized interventions include daily visitors; therapeutic activities to provide mental stimulation; daily exercise and walking assistance; sleep enhancement; nutritional support and hearing and vision protocols. HELP has been replicated in over 63 hospitals across the world. Although the majority of the sites are based in the United States located in 25 different states, there is a growing international presence. International sites include: Australia, Canada, the Netherlands, Taiwan and the United Kingdom. HELP is protected by copyright held by Sharon Inouye MD, MPH. The Dissemination Team including Dr. Inouye are located at Hebrew SeniorLife at the Institute for Aging Research in Boston, MA. [edit] Pharmacology Pharmacological constitution and regimen for older people is an important topic, one that is related to changing and differing physiology and psychology. Changes in physiology with aging may alter the absorption, the effectiveness and the side effect profile of many drugs. These changes may occur in oral protective reflexes (dryness of the mouth caused by diminished salivary glands), in the gastrointestinal system (such as with delayed emptying of solids and liquids possibly restricting speed of absorption), and in the distribution of drugs with changes in body fat and muscle and drug elimination. Psychological considerations include the fact that elderly persons (in particular, those experiencing substantial memory loss or other types of cognitive impairment) are unlikely to be able to adequately monitor and adhere to their own scheduled pharmacological administration. One study (Hutchinson et al., 2006) found that 25% of participants studied admitted to skipping doses or cutting them in half. Self-reported noncompliance with adherence to a medication schedule was reported by a striking one-third of the participants. Further development of methods that might possibly help monitor and regulate dosage administration and scheduling is an area that deserves attention. Another important area is the potential for improper administration and use of potentially inappropriate medications, and the possibility of errors that could result in dangerous drug interactions. Polypharmacy is often a predictive factor (Cannon et al., 2006). Research done on home/community health care found that "nearly 1 of 3 medical regimens contain a potential medication error" (Choi et al., 2006). [edit] Ethical and medico-legal issues Elderly persons sometimes cannot make decisions for themselves. They may have previously prepared a power of attorney and advance directives to provide guidance if they are unable to understand what is happening to them, whether this is due to long-term dementia or to a short-term, correctable problem, such as delirium from a fever. Geriatricians must respect the patients' privacy while seeing that they receive appropriate and necessary services. More than most specialties, they must consider whether the patient has the legal responsibility and competence to understand the facts and make decisions. They must support informed consent and resist the temptation manipulate the patient by withholding information, such as the dismal prognosis for a condition or the likelihood of recovering from surgery at home. Elder abuse is the physical, financial, emotional, sexual, or other type of abuse of an older dependent abuse. Adequate training, services, and support can reduce the likelihood of elder abuse, and proper attention can often identify it. For elderly people who are unable to care for themselves, geriatricians may recommend legal guardianship or conservatorship to care for the person or the estate. * End of life issues & Do Not Resuscitate (DNR) orders. * Euthanasia. [edit] See also * Aging in Place * Aging-associated diseases * Alliance for Aging Research * Commission for Certification in Geriatric Pharmacy * Elderly care * Gero-Informatics * Nosokinetics * Life extension * Geriatric medicine in Egypt * Physical & Occupational Therapy in Geriatrics (journal)

tooth whitening Return to the top

Dental bleaching, also known as tooth whitening, is a common procedure in general dentistry but most especially in the field of cosmetic dentistry. A child's deciduous teeth are generally whiter than the adult teeth that follow. As a person ages the adult teeth often become darker due to changes in the mineral structure of the tooth, as the enamel becomes less porous[citation needed]. Teeth can also become stained by bacterial pigments, foodstuffs and tobacco. Certain antibiotic medications (like tetracycline) can also cause teeth stains or a reduction in the brilliance of the enamel.[1] There are many methods to whiten teeth: bleaching strips, bleaching pen, bleaching gel, laser bleaching, and natural bleaching. Traditionally, at-home whitening involves applying bleaching gel to the teeth using thin guard trays. At-home whitening can also be done by applying small strips that go over the front teeth. Oxidizing agents such as hydrogen peroxide or carbamide peroxide are used to lighten the shade of the tooth. The oxidizing agent penetrates the porosities in the rod-like crystal structure of enamel and oxidizes interprismatic stain deposits; over a period of time, the dentin layer, lying underneath the enamel, is also bleached. Power bleaching uses light energy to accelerate the process of bleaching in a dental office. The effects of bleaching can last for several months, but may vary depending on the lifestyle of the patient. Factors that decrease whitening include smoking and the ingestion of dark colored liquids like coffee, tea and red wine. Internal staining of dentine can discolor the teeth from inside out. Internal bleaching can remedy this. If heavy staining or tetracycline damage is present on a patient's teeth, and whitening is ineffective, there are other methods of whitening teeth. Bonding, when a thin coating of composite material is applied to the front of a person's teeth and then cured with a blue light can be performed to mask the staining. A veneer can also mask tooth discoloration. Contents [hide] * 1 Methods * 2 Risks * 3 Internal bleaching * 4 Agents * 5 References [edit] Methods According to the American Dentist Association there are different options to whiten one's teeth that include: in-office bleaching, which is applied by a professional dentist; at-home bleaching, which is to be used at home by the patient; over-the-counter, which is applied by patients; and options called non-dental, which are offered at mall kiosks, spas, salons, or other similar places). Whitening products intended for home use include gels, chewing gums, rinses, toothpastes, among others.[2] The ADA has published a list of accepted over-the-counter whitening products to help people choose appropriate whitening products.[3] The ADA recommends to have one's teeth checked by a dentist before undergoing any whitening method. The dentist should examine the patient thoroughly: take a health and dental history (including allergies and sensitivities), observe hard and soft tissues, placement and conditions of restorations, and sometimes x-rays to determine the nature and depth of possible irregularities. There are two main methods of gel bleaching—one performed with high-concentration gel, and another with low-concentration agents. High-concentration bleaching can be accomplished either in the dental office, or at home. Performing the procedure at home is accomplished using high-concentration carbamide peroxide, which is readily available online or in dental stores and is much more cost-effective than the in-office procedure. Whitening is performed by applying a high concentration of oxidizing agent to the teeth with thin plastic trays for a short period of time, which produces quick results. The application trays ideally should be well-fitted to retain the bleaching gel, ensuring even and full tooth exposure to the gel. Trays will typically stay on the teeth for about 15–20 minutes. Trays are then removed and the procedure is repeated up to two more times. Most in-office bleaching procedures use a light-cured protective layer that is carefully painted on the gums and papilla (the tips of the gums between the teeth) to reduce the risk of chemical burns to the soft tissues. The bleaching agent is either carbamide peroxide, which breaks down in the mouth to form hydrogen peroxide, or hydrogen peroxide itself. The bleaching gel typically contains between 10% and 44% carbamide peroxide (15% is recommended),[by whom?] which is roughly equivalent to a 3-10% hydrogen peroxide concentration. Low-concentration whitening is far less effective, and is generally only performed at home. Low-concentration whitening involves purchasing a thin mouthguard or strip that holds a relatively low concentration of oxidizing agent next to the teeth for as long as several hours a day for a period of 5 to 14 days. Results can vary, depending on which application is chosen, with some people achieving whiter teeth in a few days, and others seeing very little results or no results at all. Whitening is potentially better at a dentist because the strip or mouth-guard does not completely conform to the shape of the teeth, sometimes leaving the tips of the teeth (near the gumline) unbleached. The bleaching agent is typically less than 10% hydrogen peroxide equivalent, so irritation to the soft tissue around teeth is minimized. Dentists as well as some dental laboratories can fabricate custom fitted whitening trays that will greatly improve the results achieved with an over-the-counter whitening method. A typical course of bleaching can produce dramatic improvements in the cosmetic appearance of most stained teeth; however, some stains do not respond to bleaching. Tetracycline staining may require prolonged bleaching, as it takes longer for the bleach to reach the dentine layer. Case studies have been performed on people with tetracycline stained teeth. They used custom bleaching trays every night for 6 months and saw dramatic results and improvement. White-spot decalcifications may also be highlighted and become more noticeable directly following a whiting process, but usually calm back down with the other parts of the teeth becoming more white. The white spots become less noticeable, with the other parts of the teeth becoming more white. Bleaching is not recommended if teeth have decay or infected gums. It is also least effective when the original tooth color is grayish and may require custom bleaching trays. Bleaching is most effective with yellow discolored teeth. However, whitener does not work where bonding has been used and neither is it effective on tooth-color filling. Other options to deal with such cases are the porcelain veneers or dental bonding.[4] Although there is a wide range of whitening products and techniques available, the results after using them may vary from very positive results to almost non-existent results. The whitening shade guides are used to measure tooth color with Vitapan Classic Shade Guide being the most widely used with 16 shades. These shades determine the effectiveness of the whitening procedure, which may vary from two to seven shades.[5] Power or light-accelerated bleaching, sometimes colloquially referred to as laser bleaching, uses light energy to accelerate the process of bleaching in a dental office. Different types of energy can be used in this procedure, with the most common being halogen, LED, or plasma arc. Clinical trials have demonstrated that among these three options, halogen light is the best source for producing optimal treatment results.[6] The ideal source of energy should be high energy to excite the peroxide molecules without overheating the pulp of the tooth.[7] Lights are typically within the blue light spectrum as this has been found to contain the most effective wavelengths for initiating the hydrogen peroxide reaction. A power bleaching treatment typically involves isolation of soft tissue with a resin-based, light-curable barrier, application of a professional dental-grade hydrogen peroxide whitening gel (25-38% hydrogen peroxide), and exposure to the light source for 6–15 minutes. Recent technical advances have minimized heat and ultraviolet emissions, allowing a less time-intensive patient preparation procedure. Most power teeth whitening treatments can be done in approximately 30 minutes to one hour, in a single visit to a dental physician. Treatment times and recommendations are dependent on the condition of a person’s teeth at time of treatment. It should be noted that the use in cosmetic dentistry, of concentrations above 0.1% of Hydrogen Peroxide are illegal in the UK, but almost all teeth whitening methods use many times this concentration. [edit] Risks Side effects of teeth bleaching include: * Chemical burns from gel bleaching (if a high-concentration oxidizing agent contacts unprotected tissues, which may bleach or discolor mucous membranes), sensitive teeth * Overbleaching (known in the profession as "over-white teeth") aka "Hyperodonto-oxidation" * Rebound, or teeth losing the bleached effect, particularly with the intensive treatments (products that provide a large change in tooth colour over a very short treatment period, e.g., 1 hour) * Pain if you have "sensitive teeth" caused by open dentinal tubules. A recent study by Kugel et al. showed that nearly half the initial change in color provided by an intensive in-office treatment (i.e., 1 hour treatment in a dentist's chair) may be lost in seven days.[8] Rebound is experienced when a large proportion of the tooth whitening has come from tooth dehydration (also a significant factor in causing sensitivity).[9] As the tooth rehydrates, tooth color 'rebounds' back toward where it started.[10] Home tooth bleaching treatments can very slightly reduce tooth enamel.[11] There have been long term Tetracycline studies done where patients received high concentration bleach, over night, for 6 months. These studies show that even over long term exposure, the amount of reduction in tooth enamel is insignificant.[citation needed] The side effects that occur most often are a temporary increase in tooth sensitivity and mild irritation of the soft tissues of the mouth, particularly the gums.[12] Tooth sensitivity often occurs during early stages of the bleaching treatment. Tissue irritation most commonly results from an ill-fitting mouthpiece tray rather than the tooth-bleaching agent. Both of these conditions usually are temporary and disappear within 1 to 3 days of stopping or completing treatment. Individuals with sensitive teeth and gums, receding gums and/or defective restorations should consult with their dentist prior to using a tooth whitening system. People who are sensitive to hydrogen peroxide (the whitening agent) should not try a bleaching product without first consulting a dentist. Also, prolonged exposure to bleaching agents may damage tooth enamel. This is especially the case with home remedy whitening products that contain fruit acids. Bleaching is not recommended in children under the age of 16. This is because the pulp chamber, or nerve of the tooth, is enlarged until this age. Tooth whitening under this condition could irritate the pulp or cause it to become sensitive. Tooth whitening is also not recommended in pregnant or lactating women. Tooth whitening does not usually change the color of fillings and other restorative materials. It does not affect porcelain, other ceramics, or dental gold. However, it can slightly affect restorations made with composite materials, cements and dental amalgams. Tooth whitening can restore color of fillings, porcelain, and other ceramics when they become stained by foods, drinks, and smoking, among other activities.[citation needed] Although some over-the-counter bleaching products contain carbamide peroxide, most of them are H2O2 based, which has the potential to interact with DNA. Therefore, there is some concern with H2O2 carcinogenicity and non-carcinogenicity. However, there is no sufficient research in this sense. What the studies have been able to show is that H2O2 is both an irritant and cytotoxic. Clinical studies have found a higher occurrence of gingival irritation when patients use bleaching materials with higher peroxide concentrations.[2] [edit] Internal bleaching Internal bleaching procedures are performed on devitalized teeth that have undergone endodontic therapy (a.k.a. "Root Canal") but are discolored due to internal staining of the tooth structure by blood and other fluids that leached in. Unlike external bleaching, which brightens teeth from the outside in, internal bleaching brightens teeth from the inside out. Bleaching the tooth internally involves drilling a hole to the pulp chamber, cleaning, sealing, and filling the root canal with a rubber-like substance, and placing a peroxide gel into the pulp chamber so the gel can work directly inside the tooth on the dentin layer.[citation needed] In this variation of whitening the peroxide is sealed within the tooth over a period of some days and replaced as needed, the so called "walking bleach" technique.[citation needed] [edit] Agents Various chemical and physical agents can be used to whiten teeth. Toothpaste typically has small particles of silica, aluminum oxide, calcium carbonate, or calcium phosphate to grind off stains formed by colored molecules that have adsorbed onto the teeth from food. Unlike bleaches, whitening toothpaste does not alter the intrinsic color of teeth. Bleaching solutions contain peroxide, which bleaches the tooth enamel to change its color.[13] Off-the-shelf products typically rely on a carbamide peroxide solution varying in concentration from 10% to 44%. Bleaching solutions may be applied directly to the teeth, embedded in a plastic strip that is placed on the teeth or use a gel held in place by a mouthguard. The FDA of America only approve gels that are under 6% Hydrogen peroxide or 16% or under of Carbamide Peroxide. The Scientific Committee for Consumer Protection of the EU also consider gels containing higher dose than mentioned above to be unsafe. Some of the kits on the market are therefore not considered safe

gums Return to the top

The gingiva (sing. and plur.: gingiva), or gums, consists of the mucosal tissue that lies over the alveolar bone. Contents [hide] * 1 General description * 2 Macroscopic features of gingiva o 2.1 Marginal gingiva o 2.2 Attached gingiva o 2.3 Interdental gingiva * 3 Diseases of the gingiva * 4 Characteristics of healthy gingiva o 4.1 Color o 4.2 Contour o 4.3 Texture o 4.4 Reaction to disturbance * 5 Additional images * 6 See also * 7 References * 8 External links * 9 Further reading [edit] General description Gingiva are part of the soft tissue lining of the mouth. They surround the teeth and provide a seal around them. Compared with the soft tissue linings of the lips and cheeks, most of the gingiva are tightly bound to the underlying bone which helps resist the friction of food passing over them. Healthy gingiva is usually coral pink, but may contain physiologic pigmentation. Changes in color, particularly increased redness, together with edema and an increased tendency to bleed, suggest an inflammation that is possibly due to the accumulation of bacterial plaque. A diagram of the periodontium. A, crown of the tooth, covered by enamel. B, root of the tooth, covered by cementum. C, alveolar bone. D, subepithelial connective tissue. E, oral epithelium. F, free gingival margin. G, gingival sulcus. H, principle gingival fibers. I, alveolar crest fibers of the PDL. J, horizontal fibers of the PDL. K, oblique fibers of the PDL. [edit] Macroscopic features of gingiva The gingiva is divided anatomically into marginal, attached and interdental areas. [edit] Marginal gingiva The marginal gingiva is the terminal edge of gingiva surrounding the teeth in collar like fashion. In about half of individuals, it is demarcated from the adjacent, attached gingiva by a shallow linear depression, the free gingival groove. Usually about 1 mm wide, it forms the soft tissue wall of the gingival sulcus. The marginal gingiva is supported and stabilized by the gingival fibers. [edit] Attached gingiva The attached gingiva is continuous with the marginal gingiva. It is firm, resilient, and tightly bound to the underlying periosteum of alveolar bone. The facial aspect of the attached gingiva extends to the relatively loose and movable alveolar mucosa, from which it is demarcated by the mucogingival junction. Attached gingiva may present with surface stippling. [edit] Interdental gingiva The interdental gingiva occupies the gingival embrasure, which is the interproximal space beneath the area of tooth contact. The interdental gingiva can be pyramidal or have a "col" shape.Attached gingiva is resistant to masticatory forces and always keratinised. [edit] Diseases of the gingiva The gingival cavity microecosystem, fueled by food residues and saliva, can support the growth of many microorganisms, of which some can be injurious to health. Improper or insufficient oral hygiene can thus lead to many gingival and periodontal disorders, including gingivitis or pyorrhea, which are major causes for tooth failure. Recent studies have also shown that Anabolic steroids are also closely associated with gingival enlargement requiring a gingivectomy for many cases. Gingival recession is when there is lateral movement of the gingival margin away from the tooth surface.[1] It may indicate an underlying inflammation such as periodontitis[2] or pyorrhea,[2] a pocket formation, dry mouth[2] or displacement of the marginal gingivae away from the tooth by mechanical (such as brushing),[2] chemical, or surgical means.[3] Gingival retraction, in turn, may expose the dental neck and leave it vulnerable to the action of external stimuli, and may cause root sensitivity.[2] [edit] Characteristics of healthy gingiva [edit] Color Healthy gingiva usually has a color that has been described as "coral pink." Other colors like red, white, and blue can signify inflammation (gingivitis) or pathology. Although the text book color of gingiva is "coral pink", normal racial pigmentation makes the gingiva appear darker. Because the color of gingiva varies due to racial pigmentation, uniformity of color is more important than the underlying color itself. [edit] Contour Healthy gingiva has a smooth arcuate or scalloped appearance around each tooth. Healthy gingiva fills and fits each interdental space, unlike the swollen gingiva papilla seen in gingivitis or the empty interdental embrasure seen in periodontal disease. Healthy gums hold tight to each tooth in that the gingival surface narrows to "knife-edge" thin at the free gingival margin. On the other hand, inflamed gums have a "puffy" or "rolled" margin. [edit] Texture Healthy gingiva has a firm texture that is resistant to movement, and the surface texture often exhibits surface stippling. Unhealthy gingiva, on the other hand, is often swollen and mushy. [edit] Reaction to disturbance Healthy gums usually have no reaction to normal disturbance such as brushing or periodontal probing. Unhealthy gums on the other hand will show bleeding on probing (BOP) and/or purulent exudate (pus). [edit] Additional images Mouth (oral cavity) Mouth [edit] See also * Gum graft * Head and neck anatomy * Periodontitis

dentures Return to the top

Dentures are prosthetic devices constructed to replace missing teeth, and which are supported by surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable, however there are many different denture designs, some which rely on bonding or clasping onto teeth or dental implants. There are two main categories of dentures, depending on whether they are used to replace missing teeth on the mandibular arch or the maxillary arch. Contents [hide] * 1 Causes of tooth loss * 2 Advantages * 3 Types of dentures o 3.1 Removable partial dentures o 3.2 Complete dentures * 4 History * 5 Fabrication of Complete Dentures * 6 Problems with complete dentures * 7 Prosthodontic principles of dentures o 7.1 Support o 7.2 Stability o 7.3 Retention o 7.4 Complications and recommendations * 8 References [edit] Causes of tooth loss Patients can become entirely edentulous (without teeth) due to many reasons, the most prevalent being removal because of dental disease typically relating to oral flora control, i.e. periodontal disease and tooth decay. Other reasons include tooth developmental defects caused by severe malnutrition, genetic defects such as Dentinogenesis imperfecta, trauma, or drug use. [edit] Advantages Dentures can help patients in a number of ways: 1. Mastication - chewing ability is improved by replacing edentulous areas with denture teeth. 2. Aesthetics - the presence of teeth provide a natural facial appearance, and wearing a denture to replace missing teeth provides support for the lips and cheeks and corrects the collapsed appearance that occurs after losing teeth. 3. Phonetics - by replacing missing teeth, especially the anteriors, patients are better able to speak by improving pronunciation of those words containing sibilants or fricatives. 4. Self-Esteem - Patients feel better about themselves. [edit] Types of dentures [edit] Removable partial dentures Removable partial dentures are for patients who are missing some of their teeth on a particular arch. Fixed partial dentures, also known as "crown and bridge", are made from crowns that are fitted on the remaining teeth to act as abutments and pontics made from materials to resemble the missing teeth. Fixed bridges are more expensive than removable appliances but are more stable. [edit] Complete dentures Conversely, complete dentures or full dentures are worn by patients who are missing all of the teeth in a single arch (i.e. the maxillary (upper) or mandibular (lower) arch). [edit] History Around 700BC, Etruscans in northern Italy made dentures out of human or other animal teeth. These deteriorated quickly but, being easy to produce, were popular until the mid 19th century.[1] The oldest useful complete denture appeared in Japan, and has been traced to the ganjyoji temple in Kii Province, Japan.[2]。It was a wooden denture made of Buxus microphylla, and used by Nakaoka Tei (–20 April 1538). This wooden denture had almost the same shape as modern dentures retained by suction. It also shaped to cover each condition of teeth loss. Wooden dentures were used in Japan up until the Meiji period. London's Peter de la Roche is believed to be one of the first 'Operators for the Teeth', men who fashioned themselves as specialists in dental work. Often these men were professional goldsmiths, ivory turners or students of barber-surgeons.[3] The first porcelain dentures were made around 1770 by Alexis Duchâteau. In 1791 the first British patent was granted to Nicholas Dubois De Chemant, previous assistant to Duchateau, for "De Chemant's Specification", "a composition for the purpose of making of artificial teeth either single double or in rows or in complete sets and also springs for fastening or affixing the same in a more easy and effectual manner than any hitherto discovered which said teeth may be made of any shade or colour, which they will retain for any length of time and will consequently more perfectly resemble the natural teeth." He began selling his wares in 1792 with most of his porcelain paste supplied by Wedgwood.[citation needed] Perhaps the most famous early denture user was George Washington. He was fitted with them no later than 1764. President Washington's dentures are part of a new display on exhibit at Mount Vernon. Despite the rumors, the famous dentures are not made of wood; instead they are made of hippopotamus ivory.[citation needed] In London in 1820, Claudius Ash, a goldsmith by trade, began manufacturing high-quality porcelain dentures mounted on 18-carat gold plates. Later dentures were made of Vulcanite from the 1850s on, a form of hardened rubber (Claudius Ash’s company was the leading European manufacturer of dental Vulcanite) into which porcelain teeth were set, and then, in the 20th century, acrylic resin and other plastics.[4] In Britain in 1968 79% of those aged 65–74 had no natural teeth, by 1998 this proportion had fallen to 36%.[citation needed] [edit] Fabrication of Complete Dentures Modern dentures are most often fabricated in a commercial Dental Laboratory using a combination of a tissue shaded powder polymethylmethacrylate acrylic for the tissue shaded aspect, and commercially produced acrylic teeth available in hundreds of shapes and tooth colors. The process of fabricating a denture usually begins with a dental impression of the maxilla or mandible. This impression is used to create a stone model that represents the arch. A wax rim is fabricated to assist the dentist or denturist with establishing the vertical dimension of occlusion. After this a bite registration is created to marry the position of one arch to the other. Once the relative position of each arch to the other is known, the wax rim can be used as a base to place the selected denture teeth in correct position. This arrangement of teeth is tried in to the mouth so that adjustments can be made to the Occlusion. After the occlusion has been verified by the doctor with the patient, and all phonetic requirements are met, the denture is processed. Processing a denture is usually performed in a lost-wax process whereby the form of the final denture, including the acrylic denture teeth, is invested in stone. This investment is then heated, and the wax is remove through a sprue when it melts. The remaining cavity is then either filled by forced injection or pouring of the uncured denture acrylic. After a curing period, the stone investement is removed, the acrylic is polished, and the denture is complete. [edit] Problems with complete dentures This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2007) Problems with dentures include the fact that patients are not used to having something in their mouth that is not food. The brain senses this appliance as "food" and sends messages to the salivary glands to produce more saliva and to secrete it at a higher rate. This will only happen in the first 12 to 24 hours, after which the salivary glands return to their normal output. New dentures can also be the cause of sore spots as they compress the soft tissues mucosa (denture bearing soft tissue). A few denture adjustments for the days following insertion of the dentures can take care of this issue. Gagging is another problem encountered by a minority of patients. At times, this may be due to a denture that is too loose, too thick or extended too far posteriorly onto the soft palate. At times, gagging may also be attributed to psychological denial of the denture. (Psychological gagging is the most difficult to treat since it is out of the dentist's control. In such cases, an implant supported palateless denture may have to be constructed or a hypnotist may need to be consulted). Sometimes there could be a gingivitis under the full dentures, which is caused by accumulation of dental plaque. One of the most common problems for new full upper denture wearers is the loss of taste. Another problem with dentures is keeping them in place. There are three rules governing the existence of removable oral appliances: support, stability and retention. [edit] Prosthodontic principles of dentures [edit] Support Support is the principle that describes how well the underlying mucosa (oral tissues, including gums and the vestibules) keeps the denture from moving vertically towards the arch in question, and thus being excessively depressed and moving deeper into the arch. For the mandibular arch, this function is provided by the gingiva (gums) and the buccal shelf (region extending laterally (beside) from the posterior (back) ridges), whereas in the maxillary arch, the palate joins in to help support the denture. The larger the denture flanges (part of the denture that extends into the vestibule), the better the support. This last sentence requires comment and correction, it reveals some misunderstanding by the author as flanges usually provide stability and not support. Indeed, long flanges beyond the functional depth of the sulcus are a common error in denture construction, often (but not always) leading to movement in function. [edit] Stability Stability is the principle that describes how well the denture base is prevented from moving in the horizontal plane, and thus from sliding side to side or front and back. The more the denture base (pink material) runs in smooth and continuous contact with the edentulous ridge (the hill upon which the teeth used to reside, but now consists of only residual alveolar bone with overlying mucosa), the better the stability. Of course, the higher and broader the ridge, the better the stability will be, but this is usually just a result of patient anatomy, barring surgical intervention (bone grafts, etc.). [edit] Retention Retention is the principle that describes how well the denture is prevented from moving vertically in the opposite direction of insertion. The better the topographical mimicry of the intaglio (interior) surface of the denture base to the surface of the underlying mucosa, the better the retention will be (in removable partial dentures, the clasps are a major provider of retention), as surface tension, suction and just plain old friction will aid in keeping the denture base from breaking intimate contact with the mucosal surface. It is important to note that the most critical element in the retentive design of a full maxillary denture is a complete and total border seal (complete peripheral seal) in order to achieve 'suction'. The border seal is composed of the edges of the anterior and lateral aspects AND the posterior palatal seal. The posterior palatal seal design is accomplished by covering the entire hard palate and extending not beyond the soft palate and ending 1–2 mm from the vibrating line. As mentioned above, implant technology can vastly improve the patient's denture-wearing experience by increasing stability and saving his or her bone from wearing away. Implant can also help with the retention factor. Instead of merely placing the implants to serve as blocking mechanism against the denture pushing on the alveolar bone, small retentive appliances can be attached to the implants that can then snap into a modified denture base to allow for tremendously increased retention. Options available include a metal Hader bar or precision balls attachments, among other things. [edit] Complications and recommendations The fabrication of a set of complete dentures is a challenge for any Dentist/Denturist, including those who are experienced. There are many axioms in the production of dentures that must be understood; ignorance of one axiom can lead to failure of the denture case. In the vast majority of cases, complete dentures should be comfortable soon after insertion, although almost always at least two adjustment visits will be necessary to remove sore spots. One of the most critical aspects of dentures is that the impression of the denture must be perfectly made and used with perfect technique to make a model of the patient's edentulous (toothless) gums. The dentist must use a process called border molding to ensure that the denture flanges are properly extended. An array of problems may occur if the final impression of the denture is not made properly. It takes considerable patience and experience for a dentist to know how to make a denture, and for this reason it may be in the patient's best interest to seek a specialist, either a Prosthodontist or perhaps even a Denturist, to make the denture. A general dentist may do a good job, but only if he or she is meticulous and usually he or she must be experienced. The maxillary denture (the top denture) is usually relatively straightforward to manufacture so that it is stable without slippage. A lower full denture should or must be supported by 2-4 implants placed in the lower jaw for support. A lower denture supported by 2-4 implants is a far superior product than a lower denture without implants, because 1) It is much more difficult to get adequate suction on the lower jaw. 2) The functioning of the tongue tends to break that suction, and 3) Without teeth the ridge tends to resorb and provides the denture less and less stability over time. It is routine to be able to bite into an apple or corn-on-the-cob with a lower denture anchored by implants. Without implants, it is quite difficult or even impossible to do so. In any case, implant supported dentures provide several advantages over conventional dentures.[5] They offer improved comfort due to less irritation of the gums, confidence due to less risk of slipping out, and appearance due to less plastic required for retention purposes. Patients with implant supported dentures have increased chewing efficacy and can speak more clearly. Some patients who believe they have "bad teeth" may think it is in their best interests to have all their teeth extracted and full dentures placed. However, statistics show that the majority of patients who actually receive this treatment wind up regretting they did so. This is because full dentures have only 10% of the chewing power of natural teeth, and it is difficult to get them fitted satisfactorily, particularly in the mandibular arch. Even if a patient retains one tooth, that will contribute to the denture's stability. However, retention of just one or two teeth in the upper jaw does not contribute much to the overall stability of a denture, since a full upper denture tends to be very stable, in contrast to a full lower denture. It is thus advised that patients keep their natural teeth as long as possible, especially their lower teeth.

female Return to the top

Female (♀) is the sex of an organism, or a part of an organism, which produces non-mobile ova (egg cells). Contents [hide] * 1 Defining characteristics * 2 Etymology and usage * 3 Mammalian female * 4 Symbol * 5 Sex determination o 5.1 Genetic determination o 5.2 Environmental determination * 6 See also * 7 Sources * 8 References [edit] Defining characteristics The ova are defined as the larger gametes in a heterogamous reproduction system, while the smaller, usually motile gamete, the spermatozoon, is produced by the male. A female individual cannot reproduce sexually without access to the gametes of a male (an exception is parthenogenesis). Some organisms can reproduce both sexually and asexually. There is no single genetic mechanism behind sex differences in different species and the existence of two sexes seems to have evolved multiple times independently in different evolutionary lineages. The repeated pattern is sexual reproduction in isogamous species with two or more mating types with gametes of identical form and behavior (but different at the molecular level) to anisogamous species with gametes of male and female types to oogamous species in which the female gamete is very much larger than the male and has no ability to move. There is an argument that this pattern was driven by the physical constraints on the mechanisms by which two gametes get together as required for sexual reproduction.[1] Other than the defining difference in the type of gamete produced, differences between males and females in one lineage cannot always be predicted by differences in another. The concept is not limited to animals; egg cells are produced by chytrids, diatoms, water moulds and land plants, among others. In land plants, female and male designate not only the egg- and sperm-producing organisms and structures, but also the structures of the sporophytes that give rise to male and female plants. [edit] Etymology and usage The word female comes from the Latin femella, the diminutive form of femina, meaning "woman," which is not actually related to the word "male." In the late 14th century, the English spelling was altered so that the word paralleled the spelling of "male."[2] [edit] Mammalian female The distinguishing characteristic of the class Mammalia is the presence of mammary glands. The mammary glands are modified sweat glands that produce milk, which is used to feed the young during the period of time shortly after birth. Only mammals have the capacity to produce milk. The presence of mammary glands is most obvious on humans, due to the tendency of the female human body to store large amounts of fatty tissue near the nipples, resulting in prominent breasts, although today some human females also surgically augment their breast size. However, mammary glands are present in all mammals, although they are vestigial in the male of the species. The mammalian female is characterized by having two copies of the X chromosome as opposed to the male which carries only one X and one smaller Y chromosome. To compensate for the difference in size, one of the female's X chromosomes is randomly inactivated in each cell. In birds, by contrast, it is the female who is heterozygous and carries a Z and a W chromosome whilst the male carries two Z chromosomes. Mammalian females are characterized in that they all bear live young (with the rare exception of monotremes, which lay eggs). This is not totally unique, as some animals, such as guppies have analogous reproductive structures. In addition, some other non-mammalian animals, such as sharks, whose eggs hatch inside their bodies also have the appearance of bearing live young. [edit] Symbol A common symbol used to represent the female sex is ♀ (Unicode: U+2640 Alt codes: Alt+12), a circle with a small cross underneath. According to Schott[3], the most established view is that the male and female symbols "are derived from contractions in Greek script of the Greek names of these planets, namely Thouros (Mars) and Phosphoros (Venus). These derivations have been traced by Renkama[4] who illustrated how Greek letters can be transformed into the graphic male and female symbols still recognised today." Thouros was abbreviated by θρ, and Phosphoros by Φκ, which were contracted into the modern symbols. [edit] Sex determination Main article: Sex-determination system The sex of a particular organism may be determined by a number of factors. These may be genetic or environmental, or may naturally change during the course of an organism's life. Although most species with male and female sexes have individuals that are either male or female, hermaphroditic animals have both male and female reproductive organs. [edit] Genetic determination Most mammals, including humans, are genetically determined as such by the XY sex-determination system where males have an XY (as opposed to XX) sex chromosome. During reproduction, a male can give either an X sperm or a Y sperm, while a female can only give an X egg. A Y sperm and an X egg produce a boy, while an X sperm and an X egg produce a girl. The ZW sex-determination system, where males have a ZZ (as opposed to ZW) sex chromosome may be found in birds and some insects and other organisms. Members of Hymenoptera, such as ants and bees, are determined by haplodiploidy, where most males are haploid and females and some sterile males are diploid. [edit] Environmental determination Some species develop into one sex or the other depending on local environmental conditions, e.g. many crocodilians' sex is influenced by the temperature of their eggs. Other species (such as the goby) are capable of transforming, as adults, from one sex to the other in response to local reproductive conditions (such as a shortage of males). In humans and most mammals, sex is determined chromosomally—a Y sperm will produce a male offspring and an X sperm a female. [edit] See also Look up female in Wiktionary, the free dictionary. Wikimedia Commons has media related to: Females * Dakini * Femininity * Feminine side * Gestation * Girl * Lactation * Male * Transwoman * Transman * Woman * Womyn

plaque Return to the top

Dental plaque is a biofilm, usually colorless, that develops naturally on the teeth. It is formed, as in any biofilm, by colonizing bacteria trying to attach itself to a smooth surface (of a tooth)[1]. It has been also speculated that plaque forms part of the defense systems of the host by helping to prevent colonization by microorganisms which may be pathogenic[2]. The film is soft enough to come off by using finger nail. It starts to harden within 48 hours; in about 10 days the plaque becomes dental calculus (tartar), rock-hard and difficult to remove[3]. Dental plaque can give rise to dental caries (tooth decay)—the localised destruction of the tissues of the tooth by acid produced from the bacterial degradation of fermentable sugars[2]—and periodontal problems such as gingivitis and chronic periodontitis. Contents [hide] * 1 Plaque formation * 2 Components of plaque * 3 See also * 4 References [edit] Plaque formation Microscopic view of some of the bacteria of which plaque is composed. Numbered ticks are 10 µm apart. The mechanisms of plaque formation include[2] * Absorption of proteins and bacteria to form a film on the tooth surface. * The effect of van der Waals and electrostatic forces between microbial surfaces and the film to create reversible adhesion to the teeth. * Irreversible adhesion due to intermolecular interactions between cell surfaces and the pellicle. * Secondary colonisers attach to primary colonisers by intermolecular interaction. * The cells divide and generate a biofilm. [edit] Components of plaque Plaque consists of microorganisms and extracellular matrix. The microorganisms that form the biofilm are mainly Streptococcus mutans and anaerobes, with the composition varying by location in the mouth. Examples of such anaerobes include fusobacterium and actinobacteria. The extracellular matrix contains proteins, long chain polysaccharides and lipids. The microorganisms present in dental plaque are all naturally present in the oral cavity, and are normally harmless. However, failure to remove plaque by regular tooth brushing means that they are allowed to build up in a thick layer. Those microorganisms nearest the tooth surface convert to anaerobic respiration; it is in this state that they start to produce acids. * Acids released from dental plaque lead to demineralization of the adjacent tooth surface, and consequently to dental caries. Saliva is also unable to penetrate the build-up of plaque and thus cannot act to neutralize the acid produced by the bacteria and remineralize the tooth surface. * They also cause irritation of the gums around the teeth that could lead to gingivitis, periodontal disease and tooth loss. * Plaque build up can also become mineralized and form calculus (tartar).

fluoride Return to the top

Fluoride is the anion F−, the reduced form of fluorine when as an ion and when bonded to another element. Both organofluorine compounds and inorganic fluorine compounds containing are called fluorides.[1] Fluoride, like other halides, is a monovalent ion (−1 charge). Its compounds often have properties that are distinct relative to other halides. Structurally, and to some extent chemically, the fluoride ion resembles the hydroxide ion. Fluorine-containing compounds range from potent toxins such as sarin to life-saving pharmaceuticals such as efavirenz, and from inert materials such as calcium fluoride to the highly reactive sulfur tetrafluoride. The range of fluorine-containing compounds is vast because fluorine is capable of forming compounds with all the elements except helium and neon.[2][3] Compounds containing fluoride anions and in many cases those containing covalent bonds to fluorine are called fluorides. Contents [hide] * 1 Occurrence o 1.1 Natural occurrence * 2 Applications o 2.1 Pesticides o 2.2 Organic synthesis o 2.3 Inorganic fluorides o 2.4 Fluoropolymers o 2.5 Cavity prevention o 2.6 Biomedical applications * 3 Toxicology * 4 See also * 5 References * 6 External links [edit] Occurrence The mineral fluorite, a common mineral and chief source of fluoride for commercial applications. Solutions of inorganic fluorides in water contain F− and bifluoride HF2−.[4] Few inorganic fluorides are soluble in water without undergoing significant hydrolysis. Examples of inorganic fluorides include hydrofluoric acid (HF), sodium fluoride (NaF), and uranium hexafluoride (UF6). In terms of its reactivity, fluoride differs significantly from chloride and other halides, and is more strongly solvated due to its smaller radius/charge ratio. Its closest chemical relative is hydroxide. The Si-F linkage is one of the strongest single bonds. In contrast, other silyl halides are easily hydrolyzed. [edit] Natural occurrence Many fluoride minerals are known, but of paramount commercial importance are fluorite and fluorapatite.[5] Fluoride is found naturally in low concentration in drinking water and foods. Water with underground sources is more likely to have higher levels of fluoride, whereas the concentration in seawater averages 1.3 parts per million (ppm).[6] Fresh water supplies generally contain between 0.01–0.3 ppm, whereas the ocean contains between 1.2 and 1.5 ppm.[7] [edit] Applications Fluorides are pervasive in modern technology. Hydrofluoric acid is the fluoride synthesized on the largest scale. It is produced by treating fluoride minerals with sulfuric acid. Hydrofluoric acid and its anhydrous form hydrogen fluoride are used in the production of fluorocarbons and aluminium fluorides. Hydrofluoric acid has a variety of specialized applications, including its ability to dissolve glass.[5] [edit] Pesticides Sulfuryl fluoride is used as a pesticide and fumigant on agricultural crops. On in 2010 the United States Environmental Protection Agency proposed to withdraw the use of Sulfuryl fluoride on food. Sulfuryl fluoride breaks down in to fluoride once sprayed on food.[8][9] Cryolite is a pesticide that leaves fluoride on agricultural commodities.[10][11] [edit] Organic synthesis Fluoride reagents are significant in synthetic organic chemistry. Due to the affinity of silicon for fluoride, and the ability of silicon to expand its coordination number, silyl ether protecting groups can be easily removed by the fluoride sources such as sodium fluoride and tetra-n-butylammonium fluoride (TBAF). [edit] Inorganic fluorides Sulfur hexafluoride is an inert, nontoxic insulator that is used in electrical transformers. Uranium hexafluoride is used in the separation of isotopes of uranium between the fissile isotope U-235 and the non-fissile isotope U-238 in preparation of nuclear reactor fuel and atomic bombs. The volatility of fluorides of uranium and other elements may also be used for nuclear fuel reprocessing. PTFE is often used to coat non-stick frying pans as it is not water-wettable and possesses high heat resistance. [edit] Fluoropolymers Fluoropolymers such as polytetrafluoroethylene, Teflon, are used as chemically inert and biocompatible materials for a variety of applications, including as surgical implants such as coronary bypass grafts,[12] and a replacement for soft tissue in cosmetic and reconstructive surgery.[13] These compounds are also commonly used as non-stick surfaces in cookware and bakeware, and the fluoropolymer fabric Gore-Tex used in breathable garments for outdoor use. [edit] Cavity prevention Main article: water fluoridation Fluoride-containing compounds are used in topical and systemic fluoride therapy for preventing tooth decay. They are used for water fluoridation and in many products associated with oral hygiene.[14] Originally, sodium fluoride was used to fluoridate water; however, hexafluorosilicic acid (H2SiF6) and its salt sodium hexafluorosilicate (Na2SiF6) are more commonly used additives, especially in the United States. The fluoridation of water is known to prevent tooth decay[15][16] and is considered by the U.S. Centers for Disease Control and Prevention as "one of 10 great public health achievements of the 20th century".[17][18] In some countries where large, centralized water systems are uncommon, fluoride is delivered to the populace by fluoridating table salt. Fluoridation of water is not without critics, however (see Water fluoridation controversy).[19] Structure of halothane. [edit] Biomedical applications Positron emission tomography is commonly carried out using fluoride-containing pharmaceuticals such as fluorodeoxyglucose, which is labelled with the radioactive isotope fluorine-18, which emits positrons when it decays into 18O. Numerous drugs contain fluorine including antipsychotics such as fluphenazine, HIV protease inhibitors such as tipranavir, antibiotics such as ofloxacin and trovafloxacin, and anesthetics such as halothane.[20] Fluorine is incorporated in the drug structures to reduce drug metabolism, as the strong C-F bond resists deactivation in the liver by cytochrome P450 oxidases.[21] Fluoride salts are commonly used to inhibit the activity of phosphatases, such as serine/threonine phosphatases.[22] Fluoride mimics the nucleophilic hydroxyl ion in these enzymes' active sites.[23] Beryllium fluoride and aluminium fluoride are also used as phosphatase inhibitors, since these compounds are structural mimics of the phosphate group and can act as analogues of the transition state of the reaction.[24][25] [edit] Toxicology Main article: Fluoride poisoning Reaction of the irreversible inhibitor diisopropylfluorophosphate with a serine protease Fluoride-containing compounds are so diverse that it is not possible to generalize on their toxicity, which depends on their reactivity and structure, and in the case of salts, their solubility and ability to release fluoride ions. Soluble fluoride salts, of which NaF is the most common, are mildly toxic but have resulted in both accidental and suicidal deaths from acute poisoning.[5] While the minimum fatal dose in humans is not known, a case of a fatal poisoning of an adult with 4 grams of NaF is documented.[26] For Sodium fluorosilicate (Na2SiF6), the median lethal dose (LD50) orally in rats is 0.125 g/kg, corresponding to 12.5 g for a 100 kg adult.[27] The fatal period ranges from 5 min to 12 hours.[26] The mechanism of toxicity involves the combination of the fluoride anion with the calcium ions in the blood to form insoluble calcium fluoride, resulting in hypocalcemia; calcium is indispensable for the function of the nervous system, and the condition can be fatal. Treatment may involve oral administration of dilute calcium hydroxide or calcium chloride to prevent further absorption, and injection of calcium gluconate to increase the calcium levels in the blood.[26] Hydrogen fluoride is more dangerous than salts such as NaF because it is corrosive and volatile, and can result in fatal exposure through inhalation or upon contact with the skin; calcium gluconate gel is the usual antidote.[28] In the higher doses used to treat osteoporosis, sodium fluoride can cause pain in the legs and incomplete stress fractures when the doses are too high; it also irritates the stomach, sometimes so severely as to cause ulcers. Slow-release and enteric-coated versions of sodium fluoride do not have gastric side effects in any significant way, and have milder and less frequent complications in the bones.[29] In the lower doses used for water fluoridation, the only clear adverse effect is dental fluorosis, which can alter the appearance of children's teeth during tooth development; this is mostly mild and is unlikely to represent any real effect on aesthetic appearance or on public health.[30] [edit] See also * Fluoride deficiency * Sodium monofluorophosphate * Total ionic strength adjustment buffer

cavities Return to the top

Dental caries, also known as tooth decay or a cavity, is a disease where bacterial processes damage hard tooth structure (enamel, dentin, and cementum).[1] These tissues progressively break down, producing dental caries (cavities, holes in the teeth). Two groups of bacteria are responsible for initiating caries: Streptococcus mutans and Lactobacillus. If left untreated, the disease can lead to pain, tooth loss, infection, and, in severe cases, death.[2] Today, caries remains one of the most common diseases throughout the world. Cariology is the study of dental caries. The presentation of caries is highly variable; however, the risk factors and stages of development are similar. Initially, it may appear as a small chalky area that may eventually develop into a large cavitation. Sometimes caries may be directly visible, however other methods of detection such as radiographs are used for less visible areas of teeth and to judge the extent of destruction. Tooth decay is caused by specific types of acid-producing bacteria that cause damage in the presence of fermentable carbohydrates such as sucrose, fructose, and glucose.[3][4][5] The mineral content of teeth is sensitive to increases in acidity from the production of lactic acid. Specifically, a tooth (which is primarily mineral in content) is in a constant state of back-and-forth demineralization and remineralization between the tooth and surrounding saliva. When the pH at the surface of the tooth drops below 5.5, demineralization proceeds faster than remineralization (meaning that there is a net loss of mineral structure on the tooth's surface). This results in the ensuing decay. Depending on the extent of tooth destruction, various treatments can be used to restore teeth to proper form, function, and aesthetics, but there is no known method to regenerate large amounts of tooth structure, though stem cell related research suggests one possibility. Instead, dental health organizations advocate preventive and prophylactic measures, such as regular oral hygiene and dietary modifications, to avoid dental caries.[6] Contents [hide] * 1 Classification o 1.1 Location + 1.1.1 Pit and fissure caries (class I dental caries) + 1.1.2 Smooth-surface caries + 1.1.3 Other general descriptions o 1.2 Etiology o 1.3 Rate of progression o 1.4 Affected hard tissue * 2 Signs and symptoms * 3 Causes o 3.1 Teeth o 3.2 Bacteria o 3.3 Fermentable carbohydrates o 3.4 Time o 3.5 Other risk factors * 4 Pathophysiology o 4.1 Enamel o 4.2 Dentin + 4.2.1 Sclerotic dentin + 4.2.2 Tertiary dentin * 5 Diagnosis * 6 Treatment o 6.1 Medicinal plants in the treatment of dental caries * 7 Prevention o 7.1 Oral hygiene o 7.2 Dietary modification o 7.3 Other preventive measures * 8 Epidemiology * 9 History * 10 See also * 11 Footnotes and sources * 12 References * 13 External links [edit] Classification Caries can be classified by location, etiology, rate of progression, and affected hard tissues.[7] These forms of classification can be used to characterize a particular case of tooth decay in order to more accurately represent the condition to others and also indicate the severity of tooth destruction. G.V. Black Classification of Restorations [edit] Location Generally, there are two types of caries when separated by location: caries found on smooth surfaces and caries found in pits and fissures.[8] The location, development, and progression of smooth-surface caries differ from those of pit and fissure caries. G.V. Black created a classification system that is widely used and based on the location of the caries on the tooth. The original classification distinguished caries into five groups, indicated by the word "Class", and a Roman numeral. Pit and fissure caries is indicated as Class I; smooth surface caries is further divided into Class II, Class III, Class IV, and Class V.[9] A Class VI was added onto Black's Classification of Caries Lesions and also represents a smooth-surface carious lessson. The pits and fissures of teeth provide a location for caries formation. [edit] Pit and fissure caries (class I dental caries) Pits and fissures are anatomic landmarks on a tooth where the enamel folds inward. Fissures are formed during the development of grooves but the enamel in the area is not fully fused. As a result, a deep linear depression forms in the enamel's surface structure, which forms a location for dental caries to develop and flourish. Fissures are mostly located on the occlusal (chewing) surfaces of posterior (rear) teeth and palatal surfaces of maxillary anterior (front) teeth. Pits are small, pinpoint depressions that are most commonly found at the ends or cross-sections of grooves.[10] In particular, buccal pits are found on the facial surfaces of molars. For all types of pits and fissures, the deep infolding of enamel makes oral hygiene along these surfaces difficult, allowing dental caries to develop more commonly in these areas. The occlusal surfaces of teeth represent 12.5% of all tooth surfaces but are the location of over 50% of all dental caries.[11] Among children, pit and fissure caries represent 90% of all dental caries. Pit and fissure caries can sometimes be difficult to detect. As the decay progresses, caries in enamel nearest the surface of the tooth spreads gradually deeper. Once the caries reaches the dentin at the dentino-enamel junction (DEJ), the decay quickly spreads laterally. Within the dentin, the decay follows a triangle pattern that points to the tooth's pulp. This pattern of decay is typically described as two triangles (one triangle in enamel, and another in dentin) with their bases conjoined to each other at the DEJ. This base-to-base pattern is typical of pit and fissure caries, unlike smooth-surface caries (where base and apex of the two triangles join). [edit] Smooth-surface caries There are three types of smooth-surface caries. Proximal caries, also called interproximal caries, form on the smooth surfaces between adjacent teeth. Root caries form on the root surfaces of teeth. The third type of smooth-surface caries occur on any other smooth tooth surface. In this radiograph, the dark spots in the adjacent teeth show proximal caries. Proximal caries are the most difficult type to detect.[12] Frequently, this type of caries cannot be detected visually or manually with a dental explorer. Proximal caries form cervically (toward the roots of a tooth) just under the contact between two teeth. As a result, radiographs are needed for early discovery of proximal caries.[13] Under Black's classification system, proximal caries on posterior teeth (premolars and molars) are designated as Class II caries.[14] Proximal caries on anterior teeth (incisors and canines) are indicated as Class III if the incisal edge (chewing surface) is not included and Class IV if the incisal edge is included. Root caries, which are sometimes described as a category of smooth-surfaces caries, are the third most common type of caries and usually occur when the root surfaces have been exposed due to gingival recession. When the gingiva is healthy, root caries is unlikely to develop because the root surfaces are not as accessible to bacterial plaque. The root surface is more vulnerable to the demineralization process than enamel because cementum begins to demineralize at 6.7 pH, which is higher than enamel's critical pH.[15] Regardless, it is easier to arrest the progression of root caries than enamel caries because roots have a greater reuptake of fluoride than enamel. Root caries are most likely to be found on facial surfaces, then interproximal surfaces, then lingual surfaces. Mandibular molars are the most common location to find root caries, followed by mandibular premolars, maxillary anteriors, maxillary posteriors, and mandibular anteriors. Lesions on other smooth surfaces of teeth are also possible. Since these occur in all smooth surface areas of enamel except for interproximal areas, these types of caries are easily detected and are associated with high levels of plaque and diets promoting caries formation.[12] Under Black's classification system, caries near the gingiva on the facial or lingual surfaces is designated Class V.[14] Class VI is reserved for caries confined to cusp tips on posterior teeth or incisal edges of anterior teeth. [edit] Other general descriptions Besides the two previously mentioned categories, carious lesions can be described further by their location on a particular surface of a tooth. Caries on a tooth's surface that are nearest the cheeks or lips are called "facial caries", and caries on surfaces facing the tongue are known as "lingual caries". Facial caries can be subdivided into buccal (when found on the surfaces of posterior teeth nearest the cheeks) and labial (when found on the surfaces of anterior teeth nearest the lips). Lingual caries can also be described as palatal when found on the lingual surfaces of maxillary teeth because they are located beside the hard palate. Caries near a tooth's cervix—the location where the crown of a tooth and its roots meet—are referred to as cervical caries. Occlusal caries are found on the chewing surfaces of posterior teeth. Incisal caries are caries found on the chewing surfaces of anterior teeth. Caries can also be described as "mesial" or "distal." Mesial signifies a location on a tooth closer to the median line of the face, which is located on a vertical axis between the eyes, down the nose, and between the contact of the central incisors. Locations on a tooth further away from the median line are described as distal. [edit] Etiology Rampant caries. In some instances, caries are described in other ways that might indicate the cause. "Baby bottle caries", "early childhood caries", or "baby bottle tooth decay" is a pattern of decay found in young children with their deciduous (baby) teeth. The teeth most likely affected are the maxillary anterior teeth, but all teeth can be affected.[16] The name for this type of caries comes from the fact that the decay usually is a result of allowing children to fall asleep with sweetened liquids in their bottles or feeding children sweetened liquids multiple times during the day. Another pattern of decay is "rampant caries", which signifies advanced or severe decay on multiple surfaces of many teeth.[17] Rampant caries may be seen in individuals with xerostomia, poor oral hygiene, stimulant use (due to drug-induced dry mouth[18]), and/or large sugar intake. If rampant caries is a result of previous radiation to the head and neck, it may be described as radiation-induced caries. Problems can also be caused by the self destruction of roots and whole tooth resorption when new teeth erupt or later from unknown causes. Dr. Miller stated in 1887 that "Dental decay is chemico-parasitic process consisting of two stages, the decalcification of enamel, which results in its total destruction and the decalcification of dentin as a preliminary stage followed by dissolution of the softened residue." In his hypothesis, Dr.Miller assigned essential roles to three factors: 1. Carbohydrate substrate. 2. Acid which caused dissolution of tooth minerals. 3. Oral micro organisms which produce acid and also cause proteolysis. [edit] Rate of progression Temporal descriptions can be applied to caries to indicate the progression rate and previous history. "Acute" signifies a quickly developing condition, whereas "chronic" describes a condition which has taken an extended time to develop where thousands of meals and snacks, many causing some acid demineralisation that is not remineralized and eventually results in cavities. Fluoride treatment can help recalcification of tooth enamel. Recurrent caries, also described as secondary, are caries that appears at a location with a previous history of caries. This is frequently found on the margins of fillings and other dental restorations. On the other hand, incipient caries describes decay at a location that has not experienced previous decay. Arrested caries describes a lesion on a tooth which was previously demineralized but was remineralized before causing a cavitation. Using fluoride treatments can help with recalcification. [edit] Affected hard tissue Depending on which hard tissues are affected, it is possible to describe caries as involving enamel, dentin, or cementum. Early in its development, caries may affect only enamel. Once the extent of decay reaches the deeper layer of dentin, "dentinal caries" is used. Since cementum is the hard tissue that covers the roots of teeth, it is not often affected by decay unless the roots of teeth are exposed to the mouth. Although the term "cementum caries" may be used to describe the decay on roots of teeth, very rarely does caries affect the cementum alone. Roots have a very thin layer of cementum over a large layer of dentin, and thus most caries affecting cementum also affects dentin. [edit] Signs and symptoms The tip of a dental explorer, which is used for caries diagnosis. A person experiencing caries may not be aware of the disease.[19] The earliest sign of a new carious lesion is the appearance of a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel. This is referred to as incipient decay. As the lesion continues to demineralize, it can turn brown but will eventually turn into a cavitation ("cavity"). Before the cavity forms, the process is reversible, but once a cavity forms, the lost tooth structure cannot be regenerated.[citation needed] A lesion which appears brown and shiny suggests dental caries were once present but the demineralization process has stopped, leaving a stain. A brown spot which is dull in appearance is probably a sign of active caries. As the enamel and dentin are destroyed, the cavity becomes more noticeable. The affected areas of the tooth change color and become soft to the touch. Once the decay passes through enamel, the dentinal tubules, which have passages to the nerve of the tooth, become exposed and causes pain in the tooth. The pain may worsen with exposure to heat, cold, or sweet foods and drinks.[1] Dental caries can also cause bad breath and foul tastes.[20] In highly progressed cases, infection can spread from the tooth to the surrounding soft tissues. Complications such as cavernous sinus thrombosis and Ludwig's angina can be life-threatening.[21][22][23] [edit] Causes There are four main criteria required for caries formation: a tooth surface (enamel or dentin); caries-causing bacteria; fermentable carbohydrates (such as sucrose); and time.[24] The caries process does not have an inevitable outcome, and different individuals will be susceptible to different degrees depending on the shape of their teeth, oral hygiene habits, and the buffering capacity of their saliva. Dental caries can occur on any surface of a tooth which is exposed to the oral cavity, but not the structures which are retained within the bone.[25] [edit] Teeth There are certain diseases and disorders affecting teeth which may leave an individual at a greater risk for caries. Amelogenesis imperfecta, which occurs between 1 in 718 and 1 in 14,000 individuals, is a disease in which the enamel does not fully form or forms in insufficient amounts and can fall off a tooth.[26] In both cases, teeth may be left more vulnerable to decay because the enamel is not able to protect the tooth.[27] In most people, disorders or diseases affecting teeth are not the primary cause of dental caries. Ninety-six percent of tooth enamel is composed of minerals.[28] These minerals, especially hydroxyapatite, will become soluble when exposed to acidic environments. Enamel begins to demineralize at a pH of 5.5.[29] Dentin and cementum are more susceptible to caries than enamel because they have lower mineral content.[30] Thus, when root surfaces of teeth are exposed from gingival recession or periodontal disease, caries can develop more readily. Even in a healthy oral environment, however, the tooth is susceptible to dental caries. The anatomy of teeth may affect the likelihood of caries formation. Where the deep grooves of teeth are more numerous and exaggerated, pit and fissure caries are more likely to develop. Also, caries are more likely to develop when food is trapped between teeth. A gram stain image of Streptococcus mutans. [edit] Bacteria The mouth contains a wide variety of oral bacteria, but only a few specific species of bacteria are believed to cause dental caries: Streptococcus mutans and Lactobacilli among them.[3][5] Lactobacillus acidophilus, Actinomyces viscosus, Nocardia spp., and Streptococcus mutans are most closely associated with caries, particularly root caries. Bacteria collect around the teeth and gums in a sticky, creamy-coloured mass called plaque, which serves as a biofilm. Some sites collect plaque more commonly than others. The grooves on the biting surfaces of molar and premolar teeth provide microscopic retention, as does the point of contact between teeth. Plaque may also collect along the gingiva. [edit] Fermentable carbohydrates Bacteria in a person's mouth convert glucose, fructose, and most commonly sucrose (table sugar) into acids such as lactic acid through a glycolytic process called fermentation.[4] If left in contact with the tooth, these acids may cause demineralization, which is the dissolution of its mineral content. The process is dynamic, however, as remineralization can also occur if the acid is neutralized by saliva or mouthwash. Fluoride toothpaste or dental varnish may aid remineralization.[31] If demineralization continues over time, enough mineral content may be lost so that the soft organic material left behind disintegrates, forming a cavity or hole. The impact such sugars have on the progress of dental caries is called cariogenicity. Sucrose, although a bound glucose and fructose unit, is in fact more cariogenic than a mixture of equal parts of glucose and fructose. This is due to the bacteria utilising the energy in the saccharide bond between the glucose and fructose subunits. S.mutans adheres to the biofilm on the tooth by converting sucrose into an extremely adhesive substance called dextran polysaccharide by the enzyme dextransucranase.[32] [edit] Time The frequency of which teeth are exposed to cariogenic (acidic) environments affects the likelihood of caries development.[33] After meals or snacks, the bacteria in the mouth metabolize sugar, resulting in an acidic by-product which decreases pH. As time progresses, the pH returns to normal due to the buffering capacity of saliva and the dissolved mineral content of tooth surfaces. During every exposure to the acidic environment, portions of the inorganic mineral content at the surface of teeth dissolves and can remain dissolved for two hours.[34] Since teeth are vulnerable during these acidic periods, the development of dental caries relies heavily on the frequency of acid exposure. The carious process can begin within days of a tooth erupting into the mouth if the diet is sufficiently rich in suitable carbohydrates. Evidence suggests that the introduction of fluoride treatments have slowed the process.[35] Proximal caries take an average of four years to pass through enamel in permanent teeth. Because the cementum enveloping the root surface is not nearly as durable as the enamel encasing the crown, root caries tends to progress much more rapidly than decay on other surfaces. The progression and loss of mineralization on the root surface is 2.5 times faster than caries in enamel. In very severe cases where oral hygiene is very poor and where the diet is very rich in fermentable carbohydrates, caries may cause cavities within months of tooth eruption. This can occur, for example, when children continuously drink sugary drinks from baby bottles. [edit] Other risk factors Reduced saliva is associated with increased caries since the buffering capability of saliva is not present to counterbalance the acidic environment created by certain foods. As result, medical conditions that reduce the amount of saliva produced by salivary glands, particularly the submandibular gland and parotid gland, are likely to lead to widespread tooth decay. Examples include Sjögren's syndrome, diabetes mellitus, diabetes insipidus, and sarcoidosis.[36] Medications, such as antihistamines and antidepressants, can also impair salivary flow. Stimulants, most notoriously methylamphetamine, also occlude the flow of saliva to an extreme degree. Abusers of stimulants tend to have poor oral hygiene. Tetrahydrocannabinol, the active chemical substance in cannabis, also causes a nearly complete occlusion of salivation, known colloquially as "cotton mouth". Moreover, sixty-three percent of the most commonly prescribed medications in the United States list dry mouth as a known side effect.[36] Radiation therapy of the head and neck may also damage the cells in salivary glands, increasing the likelihood of caries formation.[37] The use of tobacco may also increase the risk for caries formation. Some brands of smokeless tobacco contain high sugar content, increasing susceptibility to caries.[38] Tobacco use is a significant risk factor for periodontal disease, which can cause the gingiva to recede.[39] As the gingiva loses attachment to the teeth, the root surface becomes more visible in the mouth. If this occurs, root caries is a concern since the cementum covering the roots of teeth is more easily demineralized by acids than enamel.[15] Currently, there is not enough evidence to support a causal relationship between smoking and coronal caries, but evidence does suggest a relationship between smoking and root-surface caries.[40] Intrauterine and neonatal lead exposure promote tooth decay.[41][42][43][44][45][46][47] Besides lead, all atoms with electrical charge and ionic radius similar to bivalent calcium,[48] such as cadmium, mimic the calcium ion and therefore exposure may promote tooth decay.[49] Salivary and dietary iodine seems to play an important role in pathogenesis of dental caries and in salivary glands physiology. Saliva is rich in peroxidase enzymes and has high secretion of iodides. Iodine is able to penetrate directly through intact enamel in dentine, pulp and periodontal tissues and according to some researchers it is able to prevent some dental pathologies directly with antibacterial action, and also indirectly with an antioxidant mechanism. - Venturi S, Venturi M. (2009). Iodine in evolution of salivary glands and in oral health. Nutr Health. 2009;20(2):119-34. - Banerjee, R.K. and Datta, A.G. (1986). Salivary peroxidases. Mol Cell Biochem, 70, 21-9. - Hardgrove, T.A.: ADA Booklet (1939). “Dental Caries” published in 1939 by the American Dental Association (ADA). (Lynch, Kettering, Gies, eds.). - Bartelstone, H. J. (1951). Radioiodine penetration through intact enamel with uptake by bloodstream and thyroid gland. J Dent Res., 5, 728–33. - Bartelstone, H.J., Mandel, I.D., Oshry, E. and Seidlin, S.M. (1947). Use of Radioactive Iodine as a Tracer in the Study of the Physiology of Teeth. Science, 106, 132. [edit] Pathophysiology The progression of pit and fissure caries resembles two triangles with their bases meeting along the junction of enamel and dentin. [edit] Enamel Enamel is a highly mineralized acellular tissue, and caries act upon it through a chemical process brought on by the acidic environment produced by bacteria. As the bacteria consume the sugar and use it for their own energy, they produce lactic acid. The effects of this process include the demineralization of crystals in the enamel, caused by acids, over time until the bacteria physically penetrate the dentin. Enamel rods, which are the basic unit of the enamel structure, run perpendicularly from the surface of the tooth to the dentin. Since demineralization of enamel by caries generally follows the direction of the enamel rods, the different triangular patterns between pit and fissure and smooth-surface caries develop in the enamel because the orientation of enamel rods are different in the two areas of the tooth.[50] As the enamel loses minerals, and dental caries progresses, the enamel develop several distinct zones, visible under a light microscope. From the deepest layer of the enamel to the enamel surface, the identified areas are the: translucent zone, dark zones, body of the lesion, and surface zone.[51] The translucent zone is the first visible sign of caries and coincides with a one to two percent loss of minerals.[52] A slight remineralization of enamel occurs in the dark zone, which serves as an example of how the development of dental caries is an active process with alternating changes.[53] The area of greatest demineralization and destruction is in the body of the lesion itself. The surface zone remains relatively mineralized and is present until the loss of tooth structure results in a cavitation. [edit] Dentin Unlike enamel, the dentin reacts to the progression of dental caries. After tooth formation, the ameloblasts, which produce enamel, are destroyed once enamel formation is complete and thus cannot later regenerate enamel after its destruction. On the other hand, dentin is produced continuously throughout life by odontoblasts, which reside at the border between the pulp and dentin. Since odontoblasts are present, a stimulus, such as caries, can trigger a biologic response. These defense mechanisms include the formation of sclerotic and tertiary dentin.[54] In dentin from the deepest layer to the enamel, the distinct areas affected by caries are the translucent zone, the zone of destruction, and the zone of bacterial penetration.[50] The translucent zone represents the advancing front of the carious process and is where the initial demineralization begins. The zones of bacterial penetration and destruction are the locations of invading bacteria and ultimately the decomposition of dentin. The faster spread of caries through dentin creates this triangular appearance in smooth surface caries. [edit] Sclerotic dentin The structure of dentin is an arrangement of microscopic channels, called dentinal tubules, which radiate outward from the pulp chamber to the exterior cementum or enamel border.[55] The diameter of the dentinal tubules is largest near the pulp (about 2.5 μm) and smallest (about 900 nm) at the junction of dentin and enamel.[56] The carious process continues through the dentinal tubules, which are responsible for the triangular patterns resulting from the progression of caries deep into the tooth. The tubules also allow caries to progress faster. In response, the fluid inside the tubules bring immunoglobulins from the immune system to fight the bacterial infection. At the same time, there is an increase of mineralization of the surrounding tubules.[57] This results in a constriction of the tubules, which is an attempt to slow the bacterial progression. In addition, as the acid from the bacteria demineralizes the hydroxyapatite crystals, calcium and phosphorus are released, allowing for the precipitation of more crystals which fall deeper into the dentinal tubule. These crystals form a barrier and slow the advancement of caries. After these protective responses, the dentin is considered sclerotic. Fluids within dentinal tubules are believed to be the mechanism by which pain receptors are triggered within the pulp of the tooth.[58] Since sclerotic dentin prevents the passage of such fluids, pain that would otherwise serve as a warning of the invading bacteria may not develop at first. Consequently, dental caries may progress for a long period of time without any sensitivity of the tooth, allowing for greater loss of tooth structure. [edit] Tertiary dentin In response to dental caries, there may be production of more dentin toward the direction of the pulp. This new dentin is referred to as tertiary dentin.[56] Tertiary dentin is produced to protect the pulp for as long as possible from the advancing bacteria. As more tertiary dentin is produced, the size of the pulp decreases. This type of dentin has been subdivided according to the presence or absence of the original odontoblasts.[59] If the odontoblasts survive long enough to react to the dental caries, then the dentin produced is called "reactionary" dentin. If the odontoblasts are killed, the dentin produced is called "reparative" dentin. In the case of reparative dentin, other cells are needed to assume the role of the destroyed odontoblasts. Growth factors, especially TGF-β,[59] are thought to initiate the production of reparative dentin by fibroblasts and mesenchymal cells of the pulp.[60] Reparative dentin is produced at an average of 1.5 μm/day, but can be increased to 3.5 μm/day. The resulting dentin contains irregularly shaped dentinal tubules which may not line up with existing dentinal tubules. This diminishes the ability for dental caries to progress within the dentinal tubules. [edit] Diagnosis (A) A small spot of decay visible on the surface of a tooth. (B) The radiograph reveals an extensive region of demineralization within the dentin (arrows). (C) A hole is discovered on the side of the tooth at the beginning of decay removal. (D) All decay removed. Primary diagnosis involves inspection of all visible tooth surfaces using a good light source, dental mirror and explorer. Dental radiographs (X-rays) may show dental caries before it is otherwise visible, particularly caries between the teeth. Large dental caries are often apparent to the naked eye, but smaller lesions can be difficult to identify. Visual and tactile inspection along with radiographs are employed frequently among dentists, particularly to diagnose pit and fissure caries.[61] Early, uncavitated caries is often diagnosed by blowing air across the suspect surface, which removes moisture and changes the optical properties of the unmineralized enamel. Some dental researchers have cautioned against the use of dental explorers to find caries.[12] In cases where a small area of tooth has begun demineralizing but has not yet cavitated, the pressure from the dental explorer could cause a cavity. Since the carious process is reversible before a cavity is present, it may be possible to arrest the caries with fluoride and remineralize the tooth surface. When a cavity is present, a restoration will be needed to replace the lost tooth structure. At times, pit and fissure caries may be difficult to detect. Bacteria can penetrate the enamel to reach dentin, but then the outer surface may remineralize, especially if fluoride is present.[62] These caries, sometimes referred to as "hidden caries", will still be visible on x-ray radiographs, but visual examination of the tooth would show the enamel intact or minimally perforated. [edit] Treatment An amalgam used as a restorative material in a tooth. See also: Dental restoration and Tooth extraction Destroyed tooth structure does not fully regenerate, although remineralization of very small carious lesions may occur if dental hygiene is kept at optimal level.[1] For the small lesions, topical fluoride is sometimes used to encourage remineralization. For larger lesions, the progression of dental caries can be stopped by treatment. The goal of treatment is to preserve tooth structures and prevent further destruction of the tooth. Generally, early treatment is less painful and less expensive than treatment of extensive decay. Anesthetics—local, nitrous oxide ("laughing gas"), or other prescription medications—may be required in some cases to relieve pain during or following treatment or to relieve anxiety during treatment.[63] A dental handpiece ("drill") is used to remove large portions of decayed material from a tooth. A spoon, a dental instrument used to remove decay carefully, is sometimes employed when the decay in dentin reaches near the pulp.[64] Once the decay is removed, the missing tooth structure requires a dental restoration of some sort to return the tooth to functionality and aesthetic condition. Restorative materials include dental amalgam, composite resin, porcelain, and gold.[65] Composite resin and porcelain can be made to match the color of a patient's natural teeth and are thus used more frequently when aesthetics are a concern. Composite restorations are not as strong as dental amalgam and gold; some dentists consider the latter as the only advisable restoration for posterior areas where chewing forces are great.[66] When the decay is too extensive, there may not be enough tooth structure remaining to allow a restorative material to be placed within the tooth. Thus, a crown may be needed. This restoration appears similar to a cap and is fitted over the remainder of the natural crown of the tooth. Crowns are often made of gold, porcelain, or porcelain fused to metal. A tooth with extensive caries eventually requiring extraction. In certain cases, endodontic therapy may be necessary for the restoration of a tooth.[67] Endodontic therapy, also known as a "root canal", is recommended if the pulp in a tooth dies from infection by decay-causing bacteria or from trauma. During a root canal, the pulp of the tooth, including the nerve and vascular tissues, is removed along with decayed portions of the tooth. The canals are instrumented with endodontic files to clean and shape them, and they are then usually filled with a rubber-like material called gutta percha.[68] The tooth is filled and a crown can be placed. Upon completion of a root canal, the tooth is now non-vital, as it is devoid of any living tissue. An extraction can also serve as treatment for dental caries. The removal of the decayed tooth is performed if the tooth is too far destroyed from the decay process to effectively restore the tooth. Extractions are sometimes considered if the tooth lacks an opposing tooth or will probably cause further problems in the future, as may be the case for wisdom teeth.[69] Extractions may also be preferred by patients unable or unwilling to undergo the expense or difficulties in restoring the tooth. [edit] Medicinal plants in the treatment of dental caries [70] S. No↓ Botanical Name↓ Part used↓ Inhibition Organisms↓ 1. Acacia leucophloea Bark Streptococcus mutans 2. Albizia lebbeck Bark Streptococcus mutans 3. Abies canadensis Whole plant Streptococcus mutans 4. Aristolochia cymbifera Whole plant Streptococcus mutans 5. Annona senegalensis Whole plant Streptococcus mutans 6. Albizia julibrissin Whole plant Streptococcus mutans 7. Allium sativum Bulbs Streptococcus mutans 8. Anacyclus pyrethrum Root Streptococcus mutans 9. Areca catechu Nuts Streptococcus mutans 10. Breynia nivosus Whole plant Streptococcus mutans 14. Citrus medica Roots Streptococcus mutans 15. Coptidis rhizoma Whole plant Streptococcus mutans 16. Caesalpinia martius Fruits Streptococcus mutans, Streptococcus oralis, Lactobacillus casei 17. Cocos nucifera Whole plant Streptococcus mutans 18. Caesalpinia pyramidalis Whole plant Streptococcus mutans 19. Chelidonium majus Whole plant Streptococcus mutans 20. Drosera peltata Whole plant Streptococcus mutans, Streptococcus sobrinus 21. Embelia ribes Fruit Streptococcus mutans 22. Erythrina variegata Root Streptococcus mutans, Streptococcus sanguis 23. Euclea natalensis Whole plant Streptococcus mutans 24. Fiscus microcarpa Aerial part Streptococcus mutans 25. Gymnema Sylvester Leaves,Roots Streptococcus mutans 27. Glycyrrhiza glabra Root Streptococcus mutans 28. Hamamelis virginiana Leaves Preveotella spp., Actinomyces odontolitycus 29. Harungana madagascariensis Leaves Actinomyces, Fusobacterium, Lactobacillus, Prevotella, Propioni bacterium, Streptococcus spp. 30. Helichrysum italicum Whole plant Streptococcus mutans, Streptococcus sanguis, Streptococcus sobrinus 31. Ginkgo biloba Whole plant Streptococcus mutans 32. Juniperus virginiana Whole plant Streptococcus mutans 33. Kaemperia pandurata Dried rhizomes, root Streptococcus mutans 34. Legenaria sicerania Leaves Streptococcus mutans 35. Mentha arvensis Leaves Streptococcus mutans 36. Mikania lavigata Aerial parts Streptococcus mutans, Streptococcus sobrinus 37. Mikania glomerata Whole plant Streptococcus cricetus 38. Melissa officinalis Whole plant Streptococcus mutans, Streptococcus sanguis 39. Magnolia grandiflora Whole plant Streptococcus mutans, Streptococcus sanguis 40. Melissa officinalis Whole plant Streptococcus mutans, Streptococcus sanguis 41. Magnolia grandiflora Whole plant Streptococcus mutans, Streptococcus sanguis 42. Nicotiana tabacum leaves Streptococcus mutans 43. Physalis angulata Flower Streptococcus mutans 44. Pinus virginiana Whole plant Streptococcus mutans 45. Pistacia lentiscus mastic gum Porphyromonas gingivalis 46. Pistacia vera Whole plant oral Streptococci 47. Piper cubeba Whole plant periodontal pathogens 48. Polygonum cuspidatum Root Streptococcus mutans, Streptococcus sobrinus 49. Rheedia brasiliensis Fruit Streptococcus mutans 50. Rhus corriaria Whole plant Streptococcus mutans, Streptococcus sanguis 51. Rhus corriaria Whole plant Streptococcus mutans, Streptococcus sanguis 52. Rosmarinus officinalis Whole plant Streptococcus mutans 53. Quercus infectoria Gall Streptococcus mutans 54. Rhus corriaria Whole plant Streptococcus mutans, Streptococcus sanguis 55. Syzygium cumini Bark Streptococcus mutans 56. Sassafras albidum Whole plant Streptococcus mutans 57. Solanum xathaocarpum Whole plant Streptococcus mutans 58. Syzygium aromaticum Dried flower Staphylococcus aureus 59. Thymus vulgaris Whole plant Streptococcus mutans, Streptococcus sanguis 60. Tanacetum vulgare Whole plant Staphylococcus aureus 61. Thuja plicata Whole plant Staphylococcus aureus 62. Ziziphus joazeiro Whole plant Staphylococcus aureus [edit] Prevention Toothbrushes are commonly used to clean teeth. [edit] Oral hygiene Personal hygiene care consists of proper brushing and flossing daily.[6] The purpose of oral hygiene is to minimize any etiologic agents of disease in the mouth. The primary focus of brushing and flossing is to remove and prevent the formation of plaque. Plaque consists mostly of bacteria.[71] As the amount of bacterial plaque increases, the tooth is more vulnerable to dental caries when carbohydrates in the food are left on teeth after every meal or snack. A toothbrush can be used to remove plaque on accessible surfaces, but not between teeth or inside pits and fissures on chewing surfaces. When used correctly, dental floss removes plaque from areas which could otherwise develop proximal caries. Other adjunct hygiene aids include interdental brushes, water picks, and mouthwashes. However oral hygiene is probably more effective at preventing gum disease than tooth decay. Food is forced inside pits and fissures under chewing pressure, leading to carbohydrate fueled acid demineralisation where the brush, fluoride toothpaste and saliva have no access to remove trapped food, neutralise acid or remineralise demineralised tooth like on other more accessible tooth surfaces food to be trapped. (Occlusal caries accounts for between 80 and 90 percent of caries in children (Weintraub, 2001). Chewing fibre like celery after eating, forces saliva inside trapped food to dilute any carbohydrate like sugar, neutralise acid and remineralise demineralised tooth. (The teeth at highest risk for carious lesions are the first and second permanent molars.) Professional hygiene care consists of regular dental examinations and cleanings. Sometimes, complete plaque removal is difficult, and a dentist or dental hygienist may be needed. Along with oral hygiene, radiographs may be taken at dental visits to detect possible dental caries development in high risk areas of the mouth. [edit] Dietary modification For dental health, frequency of sugar intake is more important than the amount of sugar consumed.[33] In the presence of sugar and other carbohydrates, bacteria in the mouth produce acids which can demineralize enamel, dentin, and cementum. The more frequently teeth are exposed to this environment, the more likely dental caries are to occur. Therefore, minimizing snacking is recommended, since snacking creates a continual supply of nutrition for acid-creating bacteria in the mouth. Also, chewy and sticky foods (such as dried fruit or candy) tend to adhere to teeth longer, and consequently are best eaten as part of a meal. Brushing the teeth after meals is recommended. For children, the American Dental Association and the European Academy of Paediatric Dentistry recommend limiting the frequency of consumption of drinks with sugar, and not giving baby bottles to infants during sleep.[72][73] Mothers are also recommended to avoid sharing utensils and cups with their infants to prevent transferring bacteria from the mother's mouth.[74] It has been found that milk and certain kinds of cheese like Cheddar can help counter tooth decay if eaten soon after the consumption of foods potentially harmful to teeth.[33] Also, chewing gum containing xylitol (a sugar alcohol) is widely used to protect teeth in some countries, being especially popular in the Finnish candy industry.[75] Xylitol's effect on reducing plaque is probably due to bacteria's inability to utilize it like other sugars.[76] Chewing and stimulation of flavour receptors on the tongue are also known to increase the production and release of saliva, which contains natural buffers to prevent the lowering of pH in the mouth to the point where enamel may become demineralised.[77] Common dentistry trays used to deliver fluoride. [edit] Other preventive measures The use of dental sealants is a means of prevention. A sealant is a thin plastic-like coating applied to the chewing surfaces of the molars. This coating prevents food being trapped inside pits and fissures in grooves under chewing pressure so resident plaque bacteria are deprived of carbohydrate that they change to acid demineralisation and thus prevents the formation of pit and fissure caries, the most common form of dental caries. Sealants are usually applied on the teeth of children, shortly after the molars erupt. Older people may also benefit from the use of tooth sealants, but their dental history and likelihood of caries formation are usually taken into consideration. Calcium, as found in food such as milk and green vegetables, are often recommended to protect against dental caries. It has been demonstrated that calcium and fluoride supplements decrease the incidence of dental caries. Fluoride helps prevent decay of a tooth by binding to the hydroxyapatite crystals in enamel.[78] The incorporated calcium makes enamel more resistant to demineralization and, thus, resistant to decay.[79] Topical fluoride is also recommended to protect the surface of the teeth. This may include a fluoride toothpaste or mouthwash. Many dentists include application of topical fluoride solutions as part of routine visits. This article may contain promotional material and other spam. Please remove any content which is not encyclopedic, and any promotional external links in accordance with Wikipedia:External links. (You can help!) (June 2010) Ambox scales.svg This article has been nominated to be checked for its neutrality. Discussion of this nomination can be found on the talk page. (June 2010) Other products with little or less supportive scientific evidence for effectiveness for the purpose of remineralization include DCPD, ACP, calcium compounds, fluoride, and Enamelon. Remineralization can also be performed professionally at the dentist. Furthermore, recent research shows that low intensity laser radiation of argon ion lasers may prevent the susceptibility for enamel caries and white spot lesions.[80] As bacteria are a major factor contributing to poor oral health, there is currently research to find a vaccine for dental caries. As of 2004, such a vaccine has been successfully tested on animals,[81] and is in clinical trials for humans as of May 2006.[82] Chewing gum after eating promotes the flow of saliva which naturally reduces the acidic pH environment and promotes remineralization. Xylitol lollies and gum also inhibit the growth of Streptococcus mutans. [edit] Epidemiology Disability-adjusted life year for dental caries per 100,000 inhabitants in 2004.[83] no data less than 50 50-60 60-70 70-80 80-90 90-100 100-115 115-130 130-138 138-140 140-142 more than 142 Worldwide, most children and an estimated ninety percent of adults have experienced caries, with the disease most prevalent in Asian and Latin American countries and least prevalent in African countries.[84] In the United States, dental caries is the most common chronic childhood disease, being at least five times more common than asthma.[85] It is the primary pathological cause of tooth loss in children.[86] Between twenty-nine and fifty-nine percent of adults over the age of fifty experience caries.[87] The number of cases has decreased in some developed countries, and this decline is usually attributed to increasingly better oral hygiene practices and preventive measures such as fluoride treatment.[88] Nonetheless, countries that have experienced an overall decrease in cases of tooth decay continue to have a disparity in the distribution of the disease.[87] Among children in the United States and Europe, twenty percent of the population endures sixty to eighty percent of cases of dental caries.[89] A similarly skewed distribution of the disease is found throughout the world with some children having none or very few caries and others having a high number.[87] Australia, Nepal, and Sweden have a low incidence of cases of dental caries among children, whereas cases are more numerous in Costa Rica and Slovakia.[90] The classic "DMF" (decay/missing/filled) index is one of the most common methods for assessing caries prevalence as well as dental treatment needs among populations. This index is based on in-field clinical examination of individuals by using a probe, mirror and cotton rolls. Because the DMF index is done without X-ray imaging, it underestimates real caries prevalence and treatment needs.[62] [edit] History An image from 1300s (A.D.) England depicting a dentist extracting a tooth with forceps. There is a long history of dental caries. Over a million years ago, hominids such as Australopithecus suffered from cavities.[91] The largest increases in the prevalence of caries have been associated with dietary changes.[91][92] Archaeological evidence shows that tooth decay is an ancient disease dating far into prehistory. Skulls dating from a million years ago through the neolithic period show signs of caries, excepting those from the Paleolithic and Mesolithic ages.[91] The increase of caries during the neolithic period may be attributed to the increased consumption of plant foods containing carbohydrates.[93] The beginning of rice cultivation in South Asia is also believed to have caused an increase in caries. A Sumerian text from 5000 BC describes a "tooth worm" as the cause of caries.[94] Evidence of this belief has also been found in India, Egypt, Japan, and China.[92] Unearthed ancient skulls show evidence of primitive dental work. In Pakistan, teeth dating from around 5500 BC to 7000 BC show nearly perfect holes from primitive dental drills.[95] The Ebers Papyrus, an Egyptian text from 1550 BC, mentions diseases of teeth.[94] During the Sargonid dynasty of Assyria during 668 to 626 BC, writings from the king's physician specify the need to extract a tooth due to spreading inflammation.[92] In the Roman Empire, wider consumption of cooked foods led to a small increase in caries prevalence.[89] The Greco-Roman civilization, in addition to the Egyptian, had treatments for pain resulting from caries.[92] The rate of caries remained low through the Bronze Age and Iron Age, but sharply increased during the Middle Ages.[91] Periodic increases in caries prevalence had been small in comparison to the 1000 AD increase, when sugar cane became more accessible to the Western world. Treatment consisted mainly of herbal remedies and charms, but sometimes also included bloodletting.[96] The barber surgeons of the time provided services that included tooth extractions.[92] Learning their training from apprenticeships, these health providers were quite successful in ending tooth pain and likely prevented systemic spread of infections in many cases. Among Roman Catholics, prayers to Saint Apollonia, the patroness of dentistry, were meant to heal pain derived from tooth infection.[97] There is also evidence of caries increase in North American Indians after contact with colonizing Europeans. Before colonization, North American Indians subsisted on hunter-gatherer diets, but afterwards there was a greater reliance on maize agriculture, which made these groups more susceptible to caries.[91] In the medieval Islamic world, Muslim physicians such as al-Gazzar and Avicenna (in The Canon of Medicine) provided the earliest known treatments for caries, though they also believed that it was caused by tooth worms as the ancients had. This was eventually proven false in 1200 by another Muslim dentist named Gaubari, who in his Book of the Elite concerning the unmasking of mysteries and tearing of veils, was the first to reject the idea of caries being caused by tooth worms, and he stated that tooth worms in fact do not even exist. The theory of the tooth worm was thus no longer accepted in the Islamic medical community from the 13th century onwards.[98] During the European Age of Enlightenment, the belief that a "tooth worm" caused caries was also no longer accepted in the European medical community.[99] Pierre Fauchard, known as the father of modern dentistry, was one of the first to reject the idea that worms caused tooth decay and noted that sugar was detrimental to the teeth and gingiva.[100] In 1850, another sharp increase in the prevalence of caries occurred and is believed to be a result of widespread diet changes.[92] Prior to this time, cervical caries was the most frequent type of caries, but increased availability of sugar cane, refined flour, bread, and sweetened tea corresponded with a greater number of pit and fissure caries. In the 1890s, W.D. Miller conducted a series of studies that led him to propose an explanation for dental caries that was influential for current theories. He found that bacteria inhabited the mouth and that they produced acids which dissolved tooth structures when in the presence of fermentable carbohydrates.[101] This explanation is known as the chemoparasitic caries theory.[102] Miller's contribution, along with the research on plaque by G.V. Black and J.L. Williams, served as the foundation for the current explanation of the etiology of caries.[92] Several of the specific strains of bacteria were identified in 1921 by Fernando E. Rodriguez Vargas. [edit] See also * Feline odontoclastic resorptive lesion * Acid erosion * Oral microbiology

air abrasion Return to the top

Dental drill From Wikipedia, the free encyclopedia (Redirected from Air abrasion (dental)) Jump to: navigation, search A high-speed dental handpiece. A dental drill (or dentist's drill) is a small, high-speed drill used in dentistry to remove decayed tooth material prior to the insertion of a dental filling. Dental drills are used in the treatment of dental caries. The term "dental drill" is considered the more colloquial form of the term "dental handpiece," although it can also be construed as to include the power source for one or more handpieces, a "dental engine." "Handpiece" and "engine" are more generic and euphemistic terms for generic dental tools. Modern dental drills can rotate at up to 400,000 rpm,[1] and generally use hard metal alloy bits (actually small rotary files) known as 'burs'. Dental burs come in a great variety of shapes designed for specific applications. They are often made of steel with a tungsten carbide coating, or of tungsten carbide entirely. The bur may also have a diamond coating. Dental drills, which have a distinctive, shrill sound, are often a prominent factor in many people's fear of dentistry. Contents [hide] * 1 History * 2 Dental bur * 3 Alternatives * 4 Other uses * 5 References * 6 External links [edit] History Foot-powered dental drill The Indus Valley Civilization has yielded evidence of dentistry being practiced as far back as 7000 BC.[2] This earliest form of dentistry involved curing tooth related disorders with bow drills operated, perhaps, by skilled bead craftsmen.[3] The reconstruction of this ancient form of dentistry showed that the methods used were reliable and effective.[4] Cavities of 3.5 mm depth with concentric groovings indicate use of a drill tool. The age of the teeth has been estimated at 9000 years. In later times, mechanical hand drills were used. Like most hand drills, they were quite slow, with speeds of up to 15 rpm. In 1864, British dentist George Fellows Harrington invented a clockwork dental drill named Erado. The device was much faster than earlier drills, but also very noisy. In 1868, American dentist George F. Green came up with a pneumatic dental drill powered with pedal-operated bellows. James B. Morrison devised a pedal-powered burr drill in 1871. The first electric dental drill was patented in 1875 by Dr. Green, a development that revolutionized dentistry. By 1914, electric dental drills could reach speeds of up to 3000 rpm. A second wave of rapid development occurred in the 1950s and 60s, including the development of the air turbine drill. The modern incarnation of the dental drill is the air turbine handpiece, developed by John Patrick Walsh (later knighted) and members of the staff of the Dominion Physical Laboratory (DPL) Wellington , New Zealand. The first official application for a provisional patent for the handpiece was granted in October 1949. This handpiece was driven by compressed air. The final model is held by the Commonwealth Inventions development Board in Canada. The New Zealand patent number is No/104611. The patent was granted in November to John Patrick Walsh who conceived the idea of the contra angle air-turbine handpiece after he had used a small commercial-type air grinder as a straight handpiece. Dr. John Borden developed it in America and it was first commercially manufactured and distributed by the DENTSPLY Company as the Borden Airotor in 1957. Current iterations can operate at up to 800,000 rpm, however, most common is a 400,000 rpm "high speed" handpiece for precision work complemented with a "low speed" handpiece operating at a speed that is dictated by a micromotor which creates the momentum (max up to 40,000 rpm) for applications requiring higher torque than a high-speed handpiece can deliver. [5] [edit] Dental bur A collection of various burs used in dentistry. A dental bur is a type of drill bit used in a handpiece (commonly called a dental drill). The burs are usually made of tungsten carbide or diamond. The three parts to a bur are the head, the neck, and the shank.[6] The head of the bur contains the blades which produce the cutting action. These blades may be positioned at different angles in order to change the property of the bur. More obtuse angles will produce a negative rake angle which increases the strength and longevity of the bur. More acute angles will produce a positive rake angle which has a sharper blade, but which dulls more quickly. There are various shapes of burs that include round, inverted cone, straight fissure, tapered fissure, and pear-shaped burs. Additional cuts across the blades of burs were added to increase cutting efficiency, but their benefit has been minimized with the advent of high-speed handpieces.[6] These extra cuts are called crosscuts. Due to the wide array of different burs, numbering systems to categorize burs are used and include a US numbering system and a numbering system used by the International Organisation for Standardisation (ISO). [edit] Alternatives Starting in the 1990s, a number of alternatives to conventional rotary dental drills have been developed. These include laser ablation systems and air abrasion devices (essentially miniature sand blasters). [edit] Other uses Dental drills and drill bits are commonly used by jewellers and hobbyists for high-precision drilling work.

gingivitis Return to the top

Gingivitis ("inflammation of the gum tissue") is a term used to describe non-destructive periodontal disease.[1] The most common form of gingivitis is in response to bacterial biofilms (also called plaque) adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease. In the absence of treatment, gingivitis may progress to periodontitis, which is a destructive form of periodontal disease.[2] While in some sites or individuals, gingivitis never progresses to periodontitis,[3] data indicates that periodontitis is always preceded by gingivitis.[4] Contents [hide] * 1 Classification * 2 Signs and symptoms * 3 Cause * 4 Diagnosis * 5 Prevention o 5.1 Treatment * 6 Complications * 7 See also * 8 References * 9 External links [edit] Classification As defined by the 1999 World Workshop in Clinical Periodontics, there are two primary categories of gingival diseases, each with numerous subgroups:[5] 1. Dental plaque-induced gingival diseases 1. Gingivitis associated with plaque only 2. Gingival diseases modified by systemic factors 3. Gingival diseases modified by medications 4. Gingival diseases modified by malnutrition 2. Non-plaque-induced gingival lesions 1. Gingival diseases of specific bacterial origin 2. Gingival diseases of viral origin 3. Gingival diseases of fungal origin 4. Gingival diseases of genetic origin 5. Gingival manifestations of systemic conditions 6. Traumatic lesions 7. Foreign body reactions 8. Not otherwise specified [edit] Signs and symptoms The symptoms of gingivitis are somewhat non-specific and manifest in the gum tissue as the classic signs of inflammation: * Swollen gums * Bright red or purple gums * Gums that are tender or painful to the touch Additionally, the stippling that normally exists on the gum tissue of some individuals will often disappear and the gums may appear shiny when the gum tissue becomes swollen and stretched over the inflamed underlying connective tissue. The accumulation may also emit an unpleasant odor. When the gingiva are swollen, the epithelial lining of the gingival crevice becomes ulcerated and the gums will bleed more easily with even gentle brushing, and especially when flossing. [edit] Cause Because plaque-induced gingivitis is by far the most common form of gingival diseases, the following sections will deal primarily with this condition. The etiology, or cause, of plaque-induced gingivitis is bacterial plaque, which acts to initiate the body's host response. This, in turn, can lead to destruction of the gingival tissues, which may progress to destruction of the periodontal attachment apparatus.[6] The plaque accumulates in the small gaps between teeth, in the gingival grooves and in areas known as plaque traps: locations that serve to accumulate and maintain plaque. Examples of plaque traps include bulky and overhanging restorative margins, claps of removable partial dentures and calculus (tartar) that forms on teeth. Although these accumulations may be tiny, the bacteria in them produce chemicals, such as degrative enzymes, and toxins, such as lipopolysaccharide (LPS, otherwise known as endotoxin) or lipoteichoic acid (LTA), that promote an inflammatory response in the gum tissue. This inflammation can cause an enlargement of the gingiva and subsequent pseudopocket formation. [edit] Diagnosis It is recommended that a dental hygienist or dentist be seen after the signs of gingivitis appear. A dental hygienist or dentist will check for the symptoms of gingivitis, and may also examine the amount of plaque in the oral cavity. A dental hygienist or dentist will also look for signs of periodontitis using X-rays or periodontal probing as well as other methods. If gingivitis is not responsive to treatment, referral to a periodontist (a specialist in diseases of the gingiva and bone around teeth and dental implants) for further treatment may be necessary. [edit] Prevention OTC anti-gingivitis mouthwash containing chlorhexidine from Mexico. Gingivitis can be prevented through regular oral hygiene that includes daily brushing and flossing. Interdental brushes are also useful in cleaning the teeth from plaque. Hydrogen peroxide, saline, alcohol or chlorhexidine mouth washes may also be employed. In a recent clinical study, the beneficial effect of hydrogen peroxide on gingivitis has been highlighted. Rigorous plaque control programs along with periodontal scaling and curettage also have proved to be helpful, although according to the American Dental Association, periodontal scaling and root planing are considered as a treatment to periodontal disease, not as a preventive treatment for periodontal disease.[7] In a 1997 review of effectiveness data the FDA found clear evidence which showed that toothpaste containing triclosan was effective in preventing gingivitis.[8] In many countries, such as the United States, mouthwashes containing chlorhexidine are available only by prescription. Researchers analyzed government data on calcium consumption and periodontal disease indicators in nearly 13,000 U.S. adults. They found that men and women who had calcium intakes of fewer than 500 milligrams, or about half the recommended dietary allowance, were almost twice as likely to have gum disease, as measured by the loss of attachment of the gums from the teeth. The association was particularly evident for people in their 20s and 30s.[9] Preventing gum disease may also benefit a healthy heart. According to physicians with The Institute for Good Medicine at the Pennsylvania Medical Society, good oral health can reduce risk of cardiac events. Poor oral health can lead to infections that can travel within the bloodstream.[10] [edit] Treatment The focus of treatment for gingivitis is removal of the etiologic (causative) agent, plaque. Therapy is aimed at the reduction of oral bacteria, and may take the form of regular periodic visits to a dental professional together with adequate oral hygiene home care. Thus, several of the methods used in the prevention of gingivitis can also be used for the treatment of manifest gingivitis, such as scaling, root planing, curettage, mouth washes containing chlorhexidine or hydrogen peroxide, and flossing. Interdental brushes also help remove any causative agents. Recent scientific studies have also shown the beneficial effects of mouthwashes with essential oils. [edit] Complications * Tooth loss * Recurrence of gingivitis * Periodontitis * Infection or abscess of the gingiva or the jaw bones * Trench mouth (bacterial infection and ulceration of the gums) [edit] See also * Periodontist * Periodontitis

blue cross Return to the top

The Blue Cross Blue Shield Association (BCBSA) is a federation of 39 separate health insurance organizations and companies in the United States. Combined, they directly or indirectly provide health insurance to over 100 million Americans.[3] The history of Blue Cross dates back to 1929, while the history of Blue Shield dates to 1939. The Blue Cross Association dates back to 1960, while its Blue Shield counterpart was actually created in 1948. The two organizations merged in 1982, forming the current association. The company has its headquarters in the Michigan Plaza complex in the Chicago Loop area of Chicago, Illinois.[4] Contents [hide] * 1 History * 2 Current organization * 3 List of Blue Cross and Blue Shield companies o 3.1 Publicly traded companies o 3.2 Multi-state private companies o 3.3 Single-state or regional companies o 3.4 Puerto Rico * 4 Details on specific organizations o 4.1 Idaho o 4.2 North Carolina o 4.3 Pennsylvania * 5 References * 6 External links [edit] History Further information: History of insurance Health care in the United States Public health care * Federal Employees Health Benefits Program * Indian Health Service * Medicaid * Medicare * Military Health System / TRICARE * State Children's Health Insurance Program (SCHIP) * Veterans Health Administration Private health coverage * Health insurance in the United States * Consumer-driven health care o Flexible spending account (FSA) o Health reimbursement account o Health savings account o High-deductible health plan (HDHP) o Medical savings account * Managed care * Health maintenance organization (HMO) * Preferred provider organization (PPO) * Medical underwriting Health care law * Emergency Medical Treatment and Active Labor Act (1986) * Health Insurance Portability and Accountability Act (1996) * Medicare Prescription Drug, Improvement, and Modernization Act (2003) * Patient Safety and Quality Improvement Act (2005) * Patient Protection and Affordable Care Act (2010) State/municipal level reform * Fair Share Health Care Act * Healthy Howard * Healthy San Francisco * Massachusetts health care reform * Oregon Health Plan This box: view · talk · edit Blue Cross and Blue Shield developed separately, with Blue Cross plans providing coverage for hospital services, while Blue Shield covered physicians' services.[5] Blue Cross is a name used by an association of health insurance plans throughout the United States. Its predecessor was developed in 1929, by Justin Ford Kimball, at Baylor University in Dallas, Texas.[6] The first plan guaranteed teachers 21 days of hospital care for $6 a year, and was later extended to other employee groups in Dallas, and then nationally.[6] The American Hospital Association (AHA) adopted the Blue Cross symbol in 1939 as the emblem for plans meeting certain standards. In 1960 the AHA commission was superseded by the Blue Cross Association. Affiliation with the AHA was severed in 1972. The Blue Shield concept was developed at the beginning of the 20th century by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians.[7] The first official Blue Shield Plan was founded in California in 1939. In 1948 the symbol was informally adopted by nine plans called the Associated Medical Care Plan, and was later renamed the National Association of Blue Shield Plans. In 1982 Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association.[8] Prior to the Tax Reform Act of 1986, organizations administering Blue Cross Blue Shield were tax exempt under 501(c)(4) as social welfare plans. However, the Tax Reform Act of 1986 revoked that exemption because the plans sold commercial-type insurance. They became 501(m) organizations, subject to federal taxation but entitled to "special tax benefits"[9] under IRC 833. In 1994, the Blue Cross Blue Shield Association changed to allow its licensees to be for-profit corporations.[5] Some plans[specify] are still considered not-for-profit at the state level. [edit] Current organization Question book-new.svg This section needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (August 2009) Blue Cross and/or Blue Shield insurance companies are franchisees, independent of the association (and traditionally each other), offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state. They also act as administrators of Medicare in many states or regions of the U.S.[10], and provide coverage to state government employees as well as to the federal government employees under a nationwide option of the Federal Employees Health Benefit Plan.[11] The 14-state WellPoint is the largest Blue Cross Blue Shield member, and is a publicly traded company. Other multi-state organizations include CareFirst in the Mid-Atlantic and The Regence Group in the Pacific Northwest. The largest non-investor owned member is Health Care Service Corporation,[citation needed] which operates four Blue Cross and Blue Shield Plans in the Midwest and Southwest (Illinois, Oklahoma, Texas, and New Mexico). [edit] List of Blue Cross and Blue Shield companies [edit] Publicly traded companies * Anthem for-profit (WellPoint) o Anthem Blue Cross Blue Shield + Colorado + Connecticut + Indiana + Kentucky + Maine + Missouri + Nevada + New Hampshire + Ohio + Parts of Virginia + Wisconsin o Anthem Blue Cross + California o Blue Cross Blue Shield of Georgia o Empire Blue Cross and Blue Shield (New York) [edit] Multi-state private companies * CareFirst o District of Columbia o Maryland o Parts of Virginia * Health Care Service Corporation o Blue Cross Blue Shield of Illinois o Blue Cross Blue Shield of New Mexico o Blue Cross Blue Shield of Oklahoma o Blue Cross Blue Shield of Texas * Highmark o Highmark Blue Cross Blue Shield (Western Pennsylvania) o Highmark Blue Shield (Eastern & Central Pennsylvania) o Mountain State Blue Cross and Blue Shield (West Virginia) * Premera o Premera Blue Cross Blue Shield of Alaska o Premera Blue Cross (Washington) * The Regence Group o Regence Blue Shield of Idaho o Regence Blue Cross Blue Shield of Oregon o Regence Blue Cross Blue Shield of Utah o Regence Blue Shield (Washington) * Wellmark Blue Cross Blue Shield o Iowa o South Dakota [edit] Single-state or regional companies * Blue Cross Blue Shield of Alabama * Blue Cross Blue Shield of Arizona * Arkansas Blue Cross Blue Shield * Blue Shield of California * Blue Cross Blue Shield of Delaware * Blue Cross Blue Shield of Florida * Hawaii Medical Service Association * Blue Cross of Idaho * Blue Cross Blue Shield of Kansas * Blue Cross Blue Shield of Louisiana * Blue Cross Blue Shield of Massachusetts * Blue Cross Blue Shield of Michigan * Blue Cross Blue Shield of Minnesota * Blue Cross Blue Shield of Mississippi * Blue Cross Blue Shield of Kansas City (Missouri) * Blue Cross Blue Shield of Montana * Blue Cross Blue Shield of Nebraska * Horizon Blue Cross Blue Shield of New Jersey * Excellus Blue Cross Blue Shield (Central New York) * Blue Shield of Northeastern New York * Blue Cross Blue Shield of Western New York * Blue Cross Nevada * Blue Cross Blue Shield of North Carolina * Blue Cross Blue Shield of North Dakota * Blue Cross of Northeastern Pennsylvania * Capital Blue Cross (Central Pennsylvania) * Independence Blue Cross (Philadelphia, Southeastern Pennsylvania) * Blue Cross Blue Shield of Rhode Island * Blue Cross Blue Shield of South Carolina * Blue Cross Blue Shield of Tennessee * Blue Cross Blue Shield of Vermont * Blue Cross Blue Shield of Wyoming [edit] Puerto Rico * Triple-S Management Corporation (Blue Cross & Blue Shield)

teeth Return to the top

Teeth (singular tooth) are small, calcified, whitish structures found in the jaws (or mouths) of many vertebrates that are used to break down food. Some animals, particularly carnivores, also use teeth for hunting or for defensive purposes. The roots of teeth are covered by gums. Teeth are not made of bone, but rather of multiple tissues of varying density and hardness. Teeth are among the most distinctive (and long-lasting) features of mammal species. Paleontologists use teeth to identify fossil species and determine their relationships. The shape of the animal's teeth are related to its diet. For example, plant matter is hard to digest, so herbivores have many molars for chewing and grinding. Carnivores, on the other hand, need canines to kill prey and to tear meat. Mammals are diphyodont, meaning that they develop two sets of teeth. In humans, the first set (the "baby," "milk," "primary" or "deciduous" set) normally starts to appear at about six months of age, although some babies are born with one or more visible teeth, known as neonatal teeth. Normal tooth eruption at about six months is known as teething and can be painful. Some animals develop only one set of teeth (monophyodont) while others develop many sets (polyphyodont). Sharks, for example, grow a new set of teeth every two weeks to replace worn teeth. Rodent incisors grow and wear away continually through gnawing, which helps maintain relatively constant length. The industry of the beaver is due in part to this qualification. Many rodents such as voles (but not mice) and guinea pigs, as well as rabbits, have continuously growing molars in addition to incisors.[1][2] Contents [hide] * 1 Mammals o 1.1 Aardvark o 1.2 Cetaceans o 1.3 Primates o 1.4 Horse o 1.5 Proboscideans o 1.6 Rabbit o 1.7 Rodent o 1.8 Manatees o 1.9 Walrus o 1.10 Dogs * 2 Fish * 3 Reptiles * 4 Fossilization and taphonomy * 5 References * 6 External links Mammals Main article: Mammal tooth Aardvark In Aardvarks, teeth lack enamel and have many pulp tubules, hence the name of the order Tubulidentata. Cetaceans Toothed whales is a suborder of the cetaceans characterized by having teeth. The teeth differ considerably between the species. They may be numerous, with some dolphins bearing over 100 teeth in their jaws. On the other hand, the narwhals have a giant unicorn-like tusk, which is a tooth containing millions of sensory pathways and used for sensing during feeding, navigation and mating. It is the most neurologically complex tooth known. Beaked whales are almost toothless, with only bizarre teeth found in males. These teeth may be used for feeding but also for demonstrating aggression and showmanship. Primates Main article: Human tooth Horse Main article: Horse teeth An adult horse has between 36 and 44 teeth. All horses have twelve premolars, twelve molars, and twelve incisors.[3] Generally, all male equines also have four canine teeth (called tushes) between the molars and incisors. However, few female horses (less than 28%) have canines, and those that do usually have only one or two, which many times are only partially erupted.[4] A few horses have one to four wolf teeth, which are vestigial premolars, with most of those having only one or two. They are equally common in male and female horses and much more likely to be on the upper jaw. If present these can cause problems as they can interfere with the horse's bit contact. Therefore, wolf teeth are commonly removed.[3] Horse teeth can be used to estimate the animal's age. Between birth and five years, age can be closely estimated by observing the eruption pattern on milk teeth and then permanent teeth. By age five, all permanent teeth have usually erupted. The horse is then said to have a "full" mouth. After the age of five, age can only be conjectured by study of the wear patterns on the incisors, shape, the angle at which the incisors meet, and other factors. The wear of teeth may also be affected by diet, natural abnormalities, and cribbing. Two horses of the same age may have different wear patterns. A horse's incisors, premolars, and molars, once fully developed, continue to erupt as the grinding surface is worn down through chewing. A young adult horse will have teeth which are 4.5-5 inches long, with the majority of the crown remaining below the gumline in the dental socket. The rest of the tooth will slowly emerge from the jaw, erupting about 1/8" each year, as the horse ages. When the animal reaches old age, the crowns of the teeth are very short and the teeth are often lost altogether. Very old horses, if lacking molars, may need to have their fodder ground up and soaked in water to create a soft mush for them to eat in order to obtain adequate nutrition. Proboscideans Section through the ivory tusk of a mammoth Elephants' tusks are specialized incisors for digging food up and fighting. Some of elephant teeth are similar to those in manatees, and it is notable that elephants are believed to have undergone an aquatic phase in their evolution. Elephants have four molars, one on each side of the upper and lower jaw. Until age 40, these are replaced by larger molars. The new molars shift forward from the back of the jaw as the old wear down. The final set of molars last for about twenty years.[5] Rabbit Rabbits and other Lagomorphs usually shed their deciduous teeth before (or very shortly after) their birth, and are usually born with their permanent teeth. [6] The teeth of rabbits complement their diet, which consist of a wide range of vegetation. Since many of the foods are abrasive enough to cause attrition, rabbit teeth grow continuously throughout life.[7] Rabbits have a total of 6 incisors, three upper premolars, three upper molars, two lower premolars, and two lower molars on each side. There are no canines. Three to four millimeters of tooth is worn away by incisors every week, whereas the posterior teeth require a month to wear away the same amount.[8] Anatomy of rabbit teeth The incisors and cheek teeth of rabbits are called aradicular hypsodont teeth. This is sometimes referred to as an elodent dentition. These teeth grow or erupt continuously. The growth or eruption is held in balance by dental abrasion from chewing a diet high in fiber. Rodent Rodents' incisors grow continuously throughout their lives, a process known as aradicular. Unlike humans whose ameloblasts die after tooth development, rodents continually produce enamel and must wear down their teeth by gnawing on various materials.[9] These teeth are used for cutting wood, biting through the skin of fruit, or for defense. The teeth have enamel on the outside and exposed dentin on the inside, so they self-sharpen during gnawing. On the other hand, continually growing molars are found in some rodent species, such as the sibling vole and the guinea pig.[10][11] There is variation in the dentition of the rodents, but generally, rodents lack canines and premolars, and have a space between their incisors and molars, called the diastema region. Manatees Mandibular molars of manatees develop separately from the jaw and are encased in a bony shell separated by soft tissue. Walrus Walrus tusks are canine teeth that grow continuously throughout life.[12] Dogs In dogs, the teeth are less likely than humans to form dental cavities because of the very high pH of dog saliva, which prevents enamel from demineralizing.[13] Fish See also: Shark tooth Fish, such as sharks, may go through many teeth in their lifetime. The multiple replacement of teeth is known as polyphydontia. Reptiles The teeth of reptiles are replaced constantly during their life. Juvenile crocodilians replace teeth with larger ones at a rate as high as 1 new tooth per socket every month. Once adult, tooth replacement rates can slow to two years and even longer. Over all, crocodilians may use 3,000 teeth from birth to death. New teeth are created within old teeth. Fossilization and taphonomy Because teeth are very resistant, often preserved when bones are not,[14] and reflect the diet of the host organism, they are very valuable to archaeologists and palaeontologists. Early fish such as the thelodonts had teeth for scales, suggesting that the origin of teeth was scales which were retained in the mouth. Fish as early as the late Cambrian had dentine in their exoskeleton, which may have functioned in defense or for sensing their environment.[15] Dentine can be as hard as the rest of teeth, and is composed of collagen fibres, reinforced with hydroxyapatite.[15] Decalcification removes the enamel from teeth and leaves only the organic interior intact, which comprises dentine and cementine.[16] Enamel is quickly decalcified in acids,[17] perhaps by dissolution by plant acids or via diagenetic solutions, or in the stomachs of vertebrate predators.[16] Enamel can be lost by abrasion or spalling,[16] and is lost before dentine or bone are destroyed by the fossilisation process.[17] In such a case, the 'skeleton' of the teeth would consist of the dentine, with a hollow pulp cavity.[16] The organic part of dentine, conversely, is destroyed by alkalis.[17]

halitosis Return to the top

Halitosis is a term used to describe noticeably unpleasant odors exhaled in breathing. Halitosis has a significant impact — personally and socially — on those who suffer from it or believe they do (halitophobia), and is estimated to be the third-most-frequent reason for seeking dental aid, following tooth decay and periodontal disease.[1] Contents [hide] * 1 General * 2 Cause o 2.1 Tongue + 2.1.1 Cleaning the tongue o 2.2 Mouth o 2.3 Gum disease o 2.4 Nose o 2.5 Tonsils o 2.6 Esophagus o 2.7 Stomach o 2.8 Systemic diseases o 2.9 Halitophobia (delusion halitosis) * 3 Diagnosis o 3.1 Self diagnosis o 3.2 Professional diagnosis * 4 Management o 4.1 Mouthwashes o 4.2 Traditional remedies * 5 Society and culture * 6 Research * 7 See also * 8 References [edit] General In most cases (85–90%), bad breath originates in the mouth itself.[2] The intensity of bad breath differs during the day, due to eating certain foods (such as garlic, onions, meat, fish, and cheese), obesity, smoking, and alcohol consumption.[3][4] Since the mouth is exposed to less oxygen and is inactive during the night, the odor is usually worse upon awakening ("morning breath"). Bad breath may be transient, often disappearing following eating, brushing one's teeth, flossing, or rinsing with specialized mouthwash. Bad breath may also be persistent (chronic bad breath), which is a more serious condition, affecting some 25% of the population in varying degrees.[5] It can negatively affect the individual's personal, social, and business relationships, leading to poor self-esteem and increased stress. The term halitosis dates from the 1870s, combining the Latin halitus, meaning 'breath', with the Greek suffix osis often used to describe a medical condition, e.g., "cirrhosis of the liver". Bad breath is not, however, a modern affliction. Records mentioning bad breath have been discovered dating to 1550 B.C. A mouthwash of wine and herbs was one recommended way of solving the problem[citation needed]. [edit] Cause [edit] Tongue The most common location for mouth-related halitosis is the tongue. Tongue bacteria produce malodorous compounds and fatty acids, and account for 80 to 90 percent of all cases of mouth-related bad breath.[6] Large quantities of naturally-occurring bacteria are often found on the posterior dorsum of the tongue, where they are relatively undisturbed by normal activity. This part of the tongue is relatively dry and poorly cleansed, and bacterial populations can thrive on remnants of food deposits, dead epithelial cells, and postnasal drip. The convoluted microbial structure of the tongue dorsum provides an ideal habitat for anaerobic bacteria, which flourish under a continually-forming tongue coating of food debris, dead cells, postnasal drip and overlying bacteria, living and dead. When left on the tongue, the anaerobic respiration of such bacteria can yield either the putrescent smell of indole, skatole, polyamines, or the "rotten egg" smell of volatile sulfur compounds (VSCs) such as hydrogen sulfide, methyl mercaptan, Allyl methyl sulfide, and dimethyl sulfide. [edit] Cleaning the tongue The most widely-known reason to clean the tongue is for the control of bad breath. Methods used against bad breath, such as mints, mouth sprays, mouthwash or gum, may only temporarily mask the odors created by the bacteria on the tongue, but cannot cure bad breath because they do not remove the source of the bad breath. In order to prevent the production of the sulfur-containing compounds mentioned above, the bacteria on the tongue must be removed, as must the decaying food debris present on the rear areas of the tongue. Most people who clean their tongue use a tongue cleaner (tongue scraper), or a toothbrush. [edit] Mouth There are over 600 types of bacteria found in the average mouth. Several dozen of these can produce high levels of foul odors when incubated in the laboratory. The odors are produced mainly due to the breakdown of proteins into individual amino acids, followed by the further breakdown of certain amino acids to produce detectable foul gases. For example, the breakdown of cysteine and methionine produce hydrogen sulfide and methyl mercaptan, respectively. Volatile sulfur compounds have been shown to be statistically associated with oral malodor levels, and usually decrease following successful treatment.[7] Other parts of the mouth may also contribute to the overall odor, but are not as common as the back of the tongue. These locations are, in order of descending prevalence: inter-dental and sub-gingival niches, faulty dental work, food-impaction areas in-between the teeth, abscesses, and unclean dentures.[8] Oral based lesions caused by viral infections like Herpes Simplex and HPV may also contribute to bad breath.[9] [edit] Gum disease There is some controversy over the role of periodontal diseases in causing bad breath. While bacteria growing below the gumline (subgingival dental plaque) have a foul smell upon removal, several studies reported no statistical correlation between malodor and periodontal parameters.[10][11] [edit] Nose The second major source of bad breath is the nose. In this occurrence, the air exiting the nostrils has a pungent odor that differs from the oral odor. Nasal odor may be due to sinus infections or foreign bodies.[7][8] [edit] Tonsils In general, putrefaction from the tonsils is considered a minor cause of bad breath, contributing to some 3–5% of cases. Approximately 7% of the population suffer from small bits of calcified matter in tonsillar crypts called tonsilloliths that smell extremely foul when released and can cause bad breath.[7][12] [edit] Esophagus The Cardia, which is the valve between the stomach and the esophagus, may not close properly due to a Hiatal Hernia or GERD, allowing acid to enter the esophagus and gases escape to the mouth.[13] A Zenker's diverticulum may also result in halitosis due to aging food retained in the esophagus. [edit] Stomach The stomach is considered by most researchers as a very uncommon source of bad breath (except in belching). The esophagus is a closed and collapsed tube, and continuous flow (as opposed to a simple burp) of gas or putrid substances from the stomach indicates a health problem—such as reflux serious enough to be bringing up stomach contents or a fistula between the stomach and the esophagus—which will demonstrate more serious manifestations than just foul odor.[2] In the case of allyl methyl sulfide (the byproduct of garlic's digestion), odor does not come from the stomach, since it does not get metabolized there.[14] [edit] Systemic diseases There are a few systemic (non-oral) medical conditions that may cause foul breath odor, but these are extremely infrequent in the general population. Such conditions are:[15][16] 1. Fetor hepaticus: an example of a rare type of bad breath caused by chronic liver failure. 2. Lower respiratory tract infections (bronchial and lung infections). 3. Renal infections and renal failure. 4. Carcinoma. 5. Trimethylaminuria ("fish odor syndrome"). 6. Diabetes mellitus. 7. Metabolic dysfunction.[17] Individuals afflicted by the above conditions often show additional, more diagnostically conclusive symptoms than bad breath. People troubled by bad breath should not conclude that they suffer from these conditions or disease. [edit] Halitophobia (delusion halitosis) Some one quarter of the patients seeking professional advice on bad breath suffer from a highly exaggerated concern of having bad breath, known as halitophobia, delusional halitosis, or as a manifestation of Olfactory Reference Syndrome. These patients are sure that they have bad breath, although many have not asked anyone for an objective opinion. Halitophobia may severely affect the lives of some 0.5–1.0% of the adult population.[18] [edit] Diagnosis [edit] Self diagnosis Scientists have long thought that smelling one's own breath odor is often difficult due to acclimatization, although many people with bad breath are able to detect it in others. Research has suggested that self-evaluation of halitosis is not easy because of preconceived notions of how bad we think it should be. Some people assume that they have bad breath because of bad taste (metallic, sour, fecal, etc.), however bad taste is considered a poor indicator.[19][20] For these reasons, the simplest and most effective way to know whether one has bad breath is to ask a trusted adult family member or very close friend ("confidant"). If the confidant confirms that there is a breath problem, he or she can help determine whether it is coming from the mouth or the nose, and whether a particular treatment is effective or not.[21] One popular home method to determine the presence of bad breath is to lick the back of the wrist, let the saliva dry for a minute or two, and smell the result. This test results in overestimation, as concluded from research, and should be avoided.[2] A better way would be to lightly scrape the posterior back of the tongue with a plastic disposable spoon and to smell the drying residue. Home tests that use a chemical reaction to test for the presence of polyamines and sulfur compounds on tongue swabs are now available, but there are few studies showing how well they actually detect the odor. Furthermore, since breath odor changes in intensity throughout the day depending on many factors, multiple testing sessions may be necessary. [edit] Professional diagnosis If bad breath is persistent, and all other medical and dental factors have been ruled out, specialized testing and treatment is required. Hundreds of dental offices and commercial breath clinics now claim to diagnose and treat bad breath. They often use some of several laboratory methods for diagnosis of bad breath: 1. Halimeter: a portable sulfide monitor used to test for levels of sulfur emissions (to be specific, hydrogen sulfide) in the mouth air. When used properly, this device can be very effective at determining levels of certain VSC-producing bacteria. However, it has drawbacks in clinical applications. For example, other common sulfides (such as mercaptan) are not recorded as easily and can be misrepresented in test results. Certain foods such as garlic and onions produce sulfur in the breath for as long as 48 hours and can result in false readings. The Halimeter is also very sensitive to alcohol, so one should avoid drinking alcohol or using alcohol-containing mouthwashes for at least 12 hours prior to being tested. This analog machine loses sensitivity over time and requires periodic recalibration to remain accurate.[22] 2. Gas chromatography: portable machines, such as the OralChroma, are currently being introduced.[23] This technology is specifically designed to digitally measure molecular levels of the three major VSCs in a sample of mouth air (hydrogen sulfide, methyl mercaptan, and dimethyl sulfide). It is accurate in measuring the sulfur components of the breath and produces visual results in graph form via computer interface.[24] 3. BANA test: this test is directed to find the salivary levels of an enzyme indicating the presence of certain halitosis-related bacteria.[25] 4. β-galactosidase test: salivary levels of this enzyme were found to be correlated with oral malodor.[26] Although such instrumentation and examinations are widely used in breath clinics, the most important measurement of bad breath (the gold standard) is the actual sniffing and scoring of the level and type of the odor carried out by trained experts ("organoleptic measurements"). The level of odor is usually assessed on a six-point intensity scale.[1][7][27] [edit] Management At the current time, chronic halitosis is not very well understood by most physicians and dentists, so effective treatment is not always easy to find. Five strategies may be suggested: 1. Gently cleaning the tongue surface twice daily is the most effective way to keep bad breath in control; that can be achieved using a tooth brush, tongue cleaner or tongue brush/scraper to wipe off the bacterial biofilm, debris, and mucus. An inverted teaspoon may also do the job. Scraping or otherwise damaging the tongue should be avoided, and scraping of the V-shaped row of taste buds found at the extreme back of the tongue should also be avoided. Brushing a small amount of antibacterial mouth rinse or tongue gel onto the tongue surface will further inhibit bacterial action.[2] 2. Eating a healthy breakfast with rough foods helps clean the very back of the tongue.[16] 3. Chewing gum: Since dry-mouth can increase bacterial buildup and cause or worsen bad breath, chewing sugarless gum can help with the production of saliva, and thereby help to reduce bad breath. Chewing may help particularly when the mouth is dry, or when one cannot perform oral hygiene procedures after meals (especially those meals rich in protein). This aids in provision of saliva, which washes away oral bacteria, has antibacterial properties and promotes mechanical activity which helps cleanse the mouth. Some chewing gums contain special anti-odor ingredients. Chewing on fennel seeds, cinnamon sticks, mastic gum, or fresh parsley are common folk remedies. 4. Gargling right before bedtime with an effective mouthwash (see below). Several types of commercial mouthwashes have been shown to reduce malodor for hours in peer-reviewed scientific studies. Mouthwashes may contain active ingredients that are inactivated by the soap present in most toothpastes. Thus it is recommended to refrain from using mouthwash directly after toothbrushing with paste (also see mouthwashes, below).[28] 5. Maintaining proper oral hygiene, including daily tongue cleaning, brushing, flossing, and periodic visits to dentists and hygienists. Flossing is particularly important in removing rotting food debris and bacterial plaque from between the teeth, especially at the gumline. Dentures should be properly cleaned and soaked overnight in antibacterial solution (unless otherwise advised by your dentist).[8] [edit] Mouthwashes Before discussing them, it is important to note that there has not been a single documented medical case of successfully cured chronic halitosis using any of the currently available mouthwashes. However a 2008 systematic review determined the efficacy of antibacterial mouthrinses for treating bad breath.[29] Mouthwashes often contain antibacterial agents including cetylpyridinium chloride, chlorhexidine (which can cause temporary staining of the teeth)[30], zinc gluconate, essential oils, and chlorine dioxide. Zinc and chlorhexidine provide strong synergistic effect.[31][32] They may also contain alcohol, which is a drying agent. Other solutions rely on odor eliminators like oxidizers to eliminate existing bad breath on a short-term basis. A relatively new approach for home-care of bad breath is by oil-containing mouthwashes. The use of essential oils has been studied,[33] was found effective and is being used in several commercial mouthwashes, as well as the use of two-phase (oil:water) mouthwashes, which have been found to be effective in reducing oral malodor.[34] also advances in oral science has made advice websites available world wide. [edit] Traditional remedies According to traditional Ayurvedic medicine, chewing areca nut and betel leaf is an excellent remedy against bad breath. In South Asia, it was a custom to chew areca or betel nut and betel leaf among lovers because of the breath-freshening and stimulant drug properties of the mixture. Both the nut and the leaf are mild stimulants and can be addictive with repeated use. The betel nut will also cause tooth decay and dye one's teeth bright red when chewed. Both areca nut and the betel leaf chewing however are recognised risk factors for squamous cell carcinoma. Their use is not recommended. [edit] Society and culture Bad breath often evokes a reaction characteristic of disgust among those who interact with bad breath sufferers. This is a natural defensive reaction designed to protect the body from potential sources of disease:[opinion] The major chemical compounds of bad breath are the same as those emitted by rotting food (Putrescine), feces (Skatole), and even dead bodies (Cadaverine), all potential sources of disease and infection. When the brain detects these compounds, it protects the body by forcing physical recoil (which moves the body away), scrunching up the nose (which constricts the nasal passages, and prevents further intake of noxious odors), and by causing gagging (which stops anything being swallowed). It may also produce nausea and vomiting, which ejects anything that has already been swallowed. Although these reactions are involuntary, they are often misinterpreted as a personal judgement on the sufferer, and can severely damage personal relationships. [edit] Research In 1996, the International Society for Breath Odor Research (ISBOR) was formed to promote multidisciplinary research on all aspects of breath odors. The eighth international conference on breath odor took place in 2009 in Dortmund, Germany. [edit] See also * Periodontitis * Dental caries * Tooth abscess * Postnasal drip * Oral hygiene * Toothbrush * Tongue cleaner (scraper) * Mouthwash * Toothpaste * Trimethylaminuria

dentist Return to the top

A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis prevention and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services. The dental team includes dental assistants, dental hygienists, dental technicians, and in some states, dental therapists. Contents [hide] * 1 Training * 2 Responsibilities * 3 Specialties * 4 References [edit] Training All dentists in the U.S must graduate from an accredited university and complete required courses such as biology, general chemistry, organic chemistry, physics, and statistics/calculus. While most dental schools require at least a bachelors degree, a few schools may consider admitting exceptional students after only 3 years of college. To apply, students must take the DAT or Dental Admissions Test. Admission to dental school is competitive, and is generally determined based on factors such as GPA, DAT scores, recommendation letters, and extracurricular activities. To become a licensed dentist, one must then complete 4 years of dental school and successfully master all clinical competencies and national board exams. Many states require dentists to complete a post graduate residency program as well. In the US, a newly graduated dentist is then awarded the Doctor of Dental Surgery degree, or the Doctor of Dental Medicine degree depending on the dental school attended. Both degrees are the same. A newly graduated dentist can then pursue further specialty residency training ranging from 2 to 6 years. [edit] Responsibilities By nature of their general training, a licensed dentist can carry out the majority of dental treatments such as restorative (dental restorations, crowns, bridges), orthodontics(Braces, Invisalign), prosthetic (dentures), endodontic (root canal) therapy,periodontal (gum) therapy, and exodontia (extraction of teeth), as well as performing examinations, taking radiographs (x-rays) and diagnosis. Dentists can also prescribe medications such as antibiotics, fluorides, and Sedatives. Dentists need to take additional qualifications or training to carry out more complex treatments such as General anesthesia, oral and maxillofacial surgery, and implants. Whilst the majority of oral diseases are unique and self limiting, some conditions can indicate poor general health, and conditions such as osteoporosis, diabetes, and cancer. [edit] Specialties Main article: Specialty (dentistry) Official specialties * Dental public health - The study of dental epidemiology and social health policies. * Endodontics - Root canal therapy and study of diseases of the dental pulp. * Oral and maxillofacial pathology - The study, diagnosis, and sometimes the treatment of oral and maxillofacial related diseases. * Oral and maxillofacial radiology - The study and radiologic interpretation of oral and maxillofacial diseases. * Oral and maxillofacial surgery - Extractions, implants, and MaxilloFacial surgery. * Orthodontics and dentofacial orthopaedics - The straightening of teeth and modification of midface and mandibular growth. * Periodontics (also periodontology) - Study and treatment of diseases of the periodontium(Gums) (non-surgical and surgical) as well as placement and maintenance of dental implants * Pediatric dentistry (formerly pedodontics) - Dentistry for children * Prosthodontics - Dentures, bridges and the restoration of implants. Some prosthodontists further their training in "oral and maxillofacial prosthodontics", which is the discipline concerned with the replacement of missing facial structures, such as ears, eyes, noses, etc. Specialists in these fields are designated "registrable" (in the United States, "board eligible") and warrant exclusive titles such as orthodontist, oral and maxillofacial surgeon, endodontist, pediatric dentist, periodontist, or prosthodontist upon satisfying certain local (U.S., "Board Certified")

Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body.[1] Dentistry is widely considered necessary for complete overall health. Those who practice dentistry are known as dentists. The dentist's supporting team aids in providing oral health services, which includes dental assistants, dental hygienists, dental technicians, and dental therapists. Contents [hide] * 1 Overview o 1.1 Dental surgery and treatments o 1.2 Prevention * 2 Education and licensing * 3 Specialties * 4 History * 5 Priority patients * 6 Geography * 7 Organizations * 8 See also o 8.1 Lists * 9 References * 10 External links [edit] Overview Sagittal section of a tooth [edit] Dental surgery and treatments Dentistry usually encompasses very important practices related to the oral cavity. Oral diseases are major public health problems due to their high incidence and prevalence across the globe with the disadvantaged affected more than other socio-economic groups.[2] Although modern day dental practice centres around prevention, many treatments or interventions are still needed. The majority of dental treatments are carried out to prevent or treat the two most common oral diseases which are dental caries (tooth decay) and periodontal disease (gum disease or pyorrhea). Common treatments involve the restoration of teeth as a treatment for dental caries (fillings), extraction or surgical removal of teeth which cannot be restored, scaling of teeth to treat periodontal problems and endodontic root canal treatment to treat abscessed teeth. All dentists train for around 4 or 5 years at University and qualify as a 'dental surgeon'. By nature of their general training they can carry out the majority of dental treatments such as restorative (fillings, crowns, bridges), prosthetic (dentures), endodontic (root canal) therapy,periodontal (gum) therapy, and exodontia (extraction of teeth), as well as performing examinations, radiographs (x-rays) and diagnosis. Dentists can also prescribe certain medications such as antibiotics, fluorides, and sedatives but they are not able to prescribe the full range that physicians can. Dentists need to take additional qualifications or training to carry out more complex treatments such as sedation, oral and maxillofacial surgery, and implants. Whilst the majority of oral diseases are unique and self limiting, some can indicate poor general health,tumours,blood dyscrasias and abnormalities including genetic problems. [edit] Prevention Dentists also encourage prevention of dental caries through proper hygiene (tooth brushing and flossing), fluoride, and tooth polishing. Dental sealants are plastic materials applied to one or more teeth, for the intended purpose of preventing dental caries (cavities) or other forms of tooth decay. Recognized but less conventional preventive agents include xylitol, which is bacteriostatic,[3] casein derivatives,[4] and proprietary products such as Cavistat BasicMints.[5] [edit] Education and licensing Early dental chair in Pioneer West Museum in Shamrock, Texas The first dental school, Baltimore College of Dental Surgery, opened in Baltimore, Maryland, USA in 1840. Philadelphia Dental College was founded in 1863 and is the second in the United States. In 1907 Temple University accepted a bid to incorporate the school. Studies showed that dentists graduated from different countries,[6] or even from different dental schools in one country,[7] may have different clinical decisions for the same clinical condition. For example, dentists graduated from Israeli dental schools may recommend more often for the removal of asymptomatic impacted third molar (wisdom teeth) than dentists graduated from Latin American or Eastern European dental schools.[8] In the United Kingdom of Great Britain and Ireland, the 1878 British Dentists Act and 1879 Dentists Register limited the title of "dentist" and "dental surgeon" to qualified and registered practitioners.[9][10] However, others could legally describe themselves as "dental experts" or "dental consultants".[11] The practice of dentistry in the United Kingdom became fully regulated with the 1921 Dentists Act, which required the registration of anyone practicing dentistry.[12] The British Dental Association, formed in 1880 with Sir John Tomes as president, played a major role in prosecuting dentists practising illegally.[9] In Korea, Taiwan, Japan, Sweden, Germany, the United States, and Canada, a dentist is a healthcare professional qualified to practice dentistry after graduating with a degree of either Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD). This is equivalent to the Bachelor of Dental Surgery/Baccalaureus Dentalis Chirurgiae (BDS, BDent, BChD, BDSc) that is awarded in the UK and British Commonwealth countries. In most western countries, to become a qualified dentist one must usually complete at least four years of postgraduate study[citation needed]; within the European Union the education has to be at least five years. Dentists usually complete between five and eight years of post-secondary education before practising. Though not mandatory, many dentists choose to complete an internship or residency focusing on specific aspects of dental care after they have received their dental degree. [edit] Specialties Main article: Specialty (dentistry) The American Dental Association recognizes nine dental specialties: Public Health Dentistry, Endodontics, Oral & Maxillofacial Pathology, Oral & Maxillofacial Radiology, Oral & Maxillofacial Surgery (Oral Surgeon), Orthodontics, Pediatric Dentistry, Periodontics, Prosthodontics, and General Dentistry. [13][14] [edit] History Farmer at the dentist, Johann Liss, c. 1616-17. A modern Dentist's chair The Indus Valley Civilization has yielded evidence of dentistry being practiced as far back as 7000 BC.[15] This earliest form of dentistry involved curing tooth related disorders with bow drills operated, perhaps, by skilled bead craftsmen.[16] The reconstruction of this ancient form of dentistry showed that the methods used were reliable and effective.[17] A Sumerian text from 5000 BC describes a "tooth worm" as the cause of dental caries.[18] Evidence of this belief has also been found in ancient India, Egypt, Japan, and China. The legend of the worm is also found in the writings of Homer, and as late as the 14th century AD the surgeon Guy de Chauliac still promoted the belief that worms cause tooth decay.[19] The Edwin Smith Papyrus, written in the 17th century BC but which may reflect previous manuscripts from as early as 3000 BC, includes the treatment of several dental ailments.[20][21] In the 18th century BC, the Code of Hammurabi referenced dental extraction twice as it related to punishment.[22] Examination of the remains of some ancient Egyptians and Greco-Romans reveals early attempts at dental prosthetics and surgery.[23] Ancient Greek scholars Hippocrates and Aristotle wrote about dentistry, including the eruption pattern of teeth, treating decayed teeth and gum disease, extracting teeth with forceps, and using wires to stabilize loose teeth and fractured jaws.[24] Some say the first use of dental appliances or bridges comes from the Etruscans from as early as 700 BC.[25] Further research suggested that 3000 B.C. In ancient Egypt, Hesi-Re is the first named “dentist” (greatest of the teeth). The Egyptians bind replacement teeth together with gold wire. Roman medical writer Cornelius Celsus wrote extensively of oral diseases as well as dental treatments such as narcotic-containing emollients and astringents.[26][27] Historically, dental extractions have been used to treat a variety of illnesses. During the Middle Ages and throughout the 19th century, dentistry was not a profession in itself, and often dental procedures were performed by barbers or general physicians. Barbers usually limited their practice to extracting teeth which alleviated pain and associated chronic tooth infection. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican[28] (resembling a pelican's beak) which was used up until the late 18th century. The pelican was replaced by the dental key[28] which, in turn, was replaced by modern forceps in the 20th century.[citation needed] The first book focused solely on dentistry was the "Artzney Buchlein" in 1530,[29] and the first dental textbook written in English was called "Operator for the Teeth" by Charles Allen in 1685.[10] It was between 1650 and 1800 that the science of modern dentistry developed. It is said that the 17th century French physician Pierre Fauchard started dentistry science as we know it today, and he has been named "the father of modern dentistry".[30] Among many of his developments were the extensive use of dental prosthesis, the introduction of dental fillings as a treatment for dental caries and the statement that sugar derivative acids such as tartaric acid are responsible for dental decay. There has been a problem of quackery in the history of dentistry, and accusations of quackery among some dental practitioners persist today.[31] [edit] Priority patients UK NHS priority patients include patients with congenital abnormalities (such as cleft palates and hypodontia), patients who have suffered orofacial trauma and those being treated for cancer in the head and neck region. These are treated in a multidisciplinary team approach with other hospital based dental specialities orthodontics and maxillofacial surgery. Other priority patients include those with infections (either third molars or necrotic teeth which can often infect the brain) or avulsed permanent teeth, as well as patients with a history of smoking or smokeless tobacco with ulcers in the oral cavity also. [edit] Geography Main article: Dentistry throughout the world [edit] Organizations Main article: List of dental organizations [edit] See also Main articles: List of basic dentistry topics and Index of oral health and dental articles * Barodontalgia * Biodontics * Calculus * Crown * Dental amalgam * Dental brace * Dental cavities * Dental extraction * Dental fear * Dental implants * Dental laboratory * Dental notation * Dental restoration * Dentin * Eco-friendly dentistry * Fluoridation * Fluoride therapy * Gingivitis * Halitosis * Minimal intervention dentistry * Oral and maxillofacial surgery * Oral hygiene * Orthodontics * Patron Saint of dentistry (Saint Apollonia) * Special needs dentistry * Periodontitis * Plaque * Toothache * Xerostomia [edit] Lists DentistryLogo.png Dentistry portal Wikiversity At Wikiversity you can learn more and teach others about Dentistry at: The School of Dentistry * List of dentists * List of oral health and dental topics * List of dental schools in the United States

gum graft Return to the top

A gingival graft (also called gum graft or periodontal plastic surgery[1][2][3][4]) is a generic name for any of a number of surgical periodontal procedures whose combined aim is to cover an area of exposed tooth root surface with grafted oral tissue. The covering of exposed root surfaces accomplishes a number of objectives: the prevention of further root exposure, decreased or eliminated sensitivity, decreased susceptibility to root caries and improved cosmetic. These procedures are usually performed by a dental specialist in the field of gingival tissue, known as a periodontist, but may be performed by a general dentist having training in these procedures. Contents [hide] * 1 Specific procedures * 2 See also * 3 Sources * 4 References [edit] Specific procedures Coronally and apically positioned flaps , although technically not grafting procedures, are other forms of a pedicle grafts in that gingival tissue is freed up and moved either coronally or apically. This requires adequate thickness and width of gingival tissue at the base of the recession defect. A free gingival graft is a dental procedure where a small layer of tissue is removed from the palate of the patient's mouth and then relocated to the site of gum recession. It is sutured (stitched) into place and will serve to protect the exposed root as living tissue. The donor site will heal over a period of time without damage. This procedure is often used to increase the thickness of very thin gum tissue. A subepithelial connective tissue graft takes tissue from under healthy gum tissue in the palate, which may be placed at the area of gum recession. This procedure has the advantage of excellent predictability of root coverage [5], as well as decreased pain at the palatal donor site compared to the free gingival graft. The subepithelial connective tissue graft is a very common procedure for covering exposed roots. A lateral pedicle graft, or pedicle graft, takes tissue from the area immediately adjacent to the damaged gingiva. This is not always an option, as the constraint that there must be sufficient tissue immediately lateral to the area of interest is an onerous one. When this procedure is performed, the transplant tissue is cut away and rotated over the damaged area. This can place the donor area at risk of recession as well. An acellular dermal matrix (such as Alloderm) graft uses donated medically-processed human skin tissue as a source for the graft. The advantage of this procedure is no need for a palatal donor site, however some periodontists believe it may be less successful [6], while others believe it is equally successful as a subepithelial connective tissue graft. [7] Through the advent of micro-surgical procedures these procedures have become more predictable and comfortable for the patients. Gum grafts are usually performed by periodontists who are trained in these procedures. [edit] See also * Gum recession * Periodontal disease

sensitive teeth Return to the top

Dentine hypersensitivity is sensation felt when the nerves inside the dentin of the teeth are exposed to the environment. The sensation can range from irritation all the way to intense, shooting pain. This sensitivity can be caused by several factors, including wear, decaying teeth or exposed tooth roots. Dentine contains many thousands of microscopic tubular structures that radiate outwards from the pulp; these dentinal tubules are typically 0.5-2 microns in diameter. Changes in the flow of the plasma-like biological fluid present in the dentinal tubules can trigger mechanoreceptors present on nerves located at the pulpal aspect thereby eliciting a pain response. This hydrodynamic flow can be increased by cold, air pressure, drying, sugar, sour (dehydrating chemicals), or forces acting onto the tooth. Hot or cold food or drinks, and physical pressure are typical triggers in those individuals with teeth sensitivity. Treatment can consist of amorphous calcium and phosphate, NovaMin, potassium nitrate, strontium chloride, gluma, fluoride therapy, or calcium sodium phosphosilicate. Potassium nitrate is commonly used in toothpastes such as Sensodyne or Crest Sensitive as a remedy and is approved as a monographed drug by the FDA. Nonetheless, there remains some dispute about its effectiveness.[1] Strontium chloride and strontium acetate are used in Sensodyne Original and Sensodyne Mint toothpastes. The mode of action is linked to their ability to form mineralised deposits within the tubule lumen and on the surface of the exposed dentine that help prevent transmission of the applied stimulus. One cause of sensitive teeth can be traced to nocturnal gastroesophageal reflux disease (acid reflux). Stomach acid can reach the teeth and cause enamel loss and prevent re-mineralization.[2] Contents [hide] * 1 Prevalence * 2 Prevention * 3 Treatments o 3.1 At-home treatments o 3.2 In-office treatments o 3.3 Other procedures * 4 See also * 5 References * 6 External links [edit] Prevalence A study conducted at Queen's University, Belfast, determined that the prevalence of reported sensitivity was 57.2%. In most cases the incidence occurred in the 30-39 year age group. Although the majority of individuals reported that cold was the major stimulus for pain, other causes such as toothbrushing, hot, and sweet stimuli were reported as well. This study found the prevalence of dentine sensitivity to be much higher than in previous reports. These results suggest an increase in the levels of sensitivity within the general population.[3] [edit] Prevention Before the proper treatment for a patient is defined, it is important to first prevent, modify, eliminate or control etiologic factors such as plaque, improper toothbrushing, and a diet high in fermentable carbohydrates and/or acidic foods.[4] Some examples of acidic foods are fruits, fruit juices and wine whose acids can remove smear layers and open dentinal tubules. Toothbrushing with abrasive toothpaste may abrade the dentin surface which may open up dentinal tubules if combined with erosive agents. One recommendation for patients is to avoid toothbrushing for at least two to three hours after consuming the above mentioned acidic foods or drinks.[5] [edit] Treatments There are different options to treat dentine hypersensitivity that can be divided in at-home treatments, those the patient can apply, and in-office treatments, those applied by the dentist. [edit] At-home treatments At-home treatments include desensitizing toothpastes or dentifrices, potassium salts, mouthwashes and chewing gums. Desensitizing toothpastes containing potassium nitrate have been used since the 1980s while toothpastes with potassium chloride or potassium citrate have been available since at least 2000.[6] It is believed that potassium ions diffuse along the dentinal tubules to inactivate intradental nerves. However, as of 2000[update], this has not been confirmed in intact human teeth and the desensitizing mechanism of potassium-containing toothpastes remains uncertain.[7] Since 2000, several trials have shown that potassium-containing toothpastes can be effective in reducing dentine hypersensitivity, although rinsing the mouth after brushing may reduce their efficacy.[6] Studies have found that mouthwashes containing potassium salts and fluorides can reduce dentine hypersensitivity, although rarely to any significant degree.[6] As of 2006[update], no controlled study of the effects of chewing gum containing potassium chloride has been made, although it has been reported as significantly reducing dentine hypersensitivity.[6] [edit] In-office treatments In-office treatments might be much more complex and they may include the application of dental sealants, having fillings put over the exposed root that is causing the sensitivity, or a recommendation to wear a specially made night guard or retainer if the problems are a result of teeth grinding. [8] Other possible treatments include fluorides are also used because they decrease permeability of dentin in vitro. Also, potassium nitrate can be applied topically in an aqueous solution or an adhesive gel. Oxalate products are also used because they reduce dentin permeability and occlude tubules more consistently. However, while some studies have showed that oxalates reduced sensitivity, others reported that their effects did not differ significantly from those of a placebo. Nowadays, dentine hypersensitivity treatments use adhesives, which include varnishes, bonding agents and restorative materials because these materials offer improved desensitization. [9] [edit] Other procedures Other procedures include ionto-phoresis, usually used in conjunction with fluoride pastes or solutions. Another procedure is the use of low level laser therapy. A study involving 1102 teeth of 388 patients determined that when used with the correct irradiation parameters, LLLT was effective in treating dentinal hypersensitivity. This therapy quickly reduces pain and maintains a prolonged pain-free status in 91.27% of the cases. [10] [edit] See also * Tooth * Dental pulp * Toothpaste * Remineralization of teeth * Bioactive glass

veneers Return to the top

In dentistry, a veneer is a thin layer of restorative material placed over a tooth surface, either to improve the aesthetics of a tooth, or to protect a damaged tooth surface. There are two main types of material used to fabricate a veneer, composite and dental porcelain. A composite veneer may be directly placed (built-up in the mouth), or indirectly fabricated by a dental technician in a dental laboratory, and later bonded to the tooth, typically using a resin cement such as Panavia. In contrast, a porcelain veneer may only be indirectly fabricated. Contents [hide] * 1 History * 2 Indications * 3 Alternatives * 4 See also * 5 References [edit] History Veneers were invented by a California dentist named Charles Pincus [1]. At the time, they fell off in a very short time as they were held on by denture adhesive. They were, however, useful for temporarily changing the appearance of actors' teeth. Research started in 1982 by Simonsen and Calamia [2] revealed that porcelain could be etched with hydrofluoric acid, and bond strengths could be achieved between composite resins and porcelain that were predicted to be able to hold porcelain veneers on to the surface of a tooth permanently. This was confirmed by Calamia [3] in an article describing a technique for fabrication, and placement of Etched Bonded Porcelain Veneers using a refractory model technique and Horn [4] describing a platinum foil technique for veneer fabrication. Additional articles have proven the long-term reliability of this technique. [5][6][7][8][9][10][11][12][13] Today, with improved cements and bonding agents, they typically last 10-30 years. They may have to be replaced in this time due to cracking, leaking, chipping, discoloration, decay, shrinkage of the gum line and damage from injury or tooth grinding. The cost of veneers can vary depending on the experience and location of the dentist. In the US, costs range anywhere from $1000 a tooth upwards to $2500 a tooth as of 2009. Porcelain veneers are said to be somewhat more durable and less likely to stain than veneers made of composite.[citation needed][14], [edit] Indications Veneers are an important tool for the cosmetic dentist. A dentist may use one veneer to restore a single tooth that may have been fractured or discolored, or multiple teeth to create a "Hollywood" type of makeover. Many people have small teeth resulting in spaces that may not be easily closed by orthodontics. Some people have worn away the edges of their teeth resulting in a prematurely aged appearance, while others may have malpositioned teeth that appear crooked. Multiple veneers can close these spaces, lengthen teeth that have been shortened by wear, provide a uniform color, shape, and symmetry, and make the teeth appear straight[15]. The problem of overuse of porcelain veneers by certain cosmetic dentists has been profiled in the book, 'Confessions of a Former Cosmetic Dentist'. The author suggests that the use of veneers for 'instant orthodontics' or simulated straightening of the teeth is harmful, especially for younger people with healthy teeth. Many cosmetic dentists agree that porcelain veneers can be used improperly and can exploit patients. Recently, there has been a trend and demand for "no preparation" or minimal preparation veneers. Advances in dental porcelain technology can now allow dentists to create extremely thin porcelain veneers which eliminates (or reduces) the need for enamel removal. Examples of these types of porcelain veneers include Lumineers or UltraVeneers [16] [edit] Alternatives In the past, the only way to correct dental imperfections was to cover the tooth with a crown. Today, in most cases there are several alternatives: crown, composite resin bonding or porcelain veneer or even cosmetic contouring or orthodontics Non-permanent dental veneers are available. These dental veneers are molded to existing teeth and are removable and reusable and are made from a flexible resin material. Do it yourself at home kits are also available for the impression-taking process. Actual veneers are made in the lab and sent to the wearer through the mail. [edit] See also * Cosmetic dentistry * Crown (dentistry) * Dental restoration * CAD/CAM Dentistry

edentulism Return to the top

Edentulism is the condition of being toothless to at least some degree; it is the result of tooth loss. Loss of some teeth results in partial edentulism, while loss of all teeth results in complete edentulism. Organisms that never possessed teeth can also be described as edentulous, such as members of the former zoological classification order of Edentata, which included anteaters, sloths and armadillos, all of which possess no anterior teeth and either no or poorly-developed posterior teeth. Contents [hide] * 1 Signs and symptoms o 1.1 Facial support and aesthetics o 1.2 Vertical dimension of occlusion o 1.3 Pronunciation o 1.4 Preservation of alveolar ridge height o 1.5 Masticatory efficiency * 2 Cause * 3 Epidemiology * 4 References [edit] Signs and symptoms This X-ray film displays two lone-standing teeth, #21 and #22, as the remnants of a once full complement of 16 lower teeth. This case of partial edentulism is the result of periodontal disease, as is suggested by the substantial bone loss on the two remaining teeth. For people, the relevance and functionality of teeth can be easily taken for granted, but a closer examination of their considerable significance will demonstrate how they are actually very important. Among other things, teeth serve to: * support the lips and cheeks, providing for a fuller, more aesthetically pleasing appearance * maintain an individual's vertical dimension of occlusion * along with the tongue and lips, allow for the proper pronunciation of various sounds * preserve and maintain the height of the alveolar ridge * cut, grind, and otherwise chew food [edit] Facial support and aesthetics When an individual's mouth is at rest, the teeth in the opposing jaws are nearly touching; there is what is referred to as a freeway space of roughly 2–3 mm. However, this distance is partially maintained as a result of the teeth limiting any further closure past the point of maximum intercuspation. When there are no teeth present in the mouth, the natural vertical dimension of occlusion is lost and the mouth has a tendency to overclose. This causes the cheeks to exhibit a "sunken-in" appearance and wrinkle lines to form at the commisures. Additionally, the anterior teeth, when present, serve to properly support the lips and provide for certain aesthetic features, such as an acute nasiolabial angle. Loss of muscle tone and skin elasticity due to old age, when most individuals begin to experience edentulism, tend to further exacerbate this condition. The tongue, which consists of a very dynamic group of muscles, tends to fill the space it is allowed, and in the absence of teeth, will broaden out.[1] This makes it initially difficult to fabricate both complete dentures and removable partial dentures for patients exhibiting complete and partial edentulism, respectively; however, once the space is "taken back" by the prosthetic teeth, the tongue will return to a narrower body. [edit] Vertical dimension of occlusion As stated, the position of maximal closure in the presence of teeth is referred to as maximum intercuspation, and the vertical jaw relationship in this position is referred to as the vertical dimension of occlusion. With the loss of teeth, there is a decrease in this vertical dimension, as the mouth is allowed to overclose when there are no teeth present to block further upward movement of the mandible towards the maxilla. This may contribute, as explained above, to a sunken-in appearance of the cheeks, because there is now "too much" cheek than is needed to extend from the maxilla to the mandible when in an overclosed position. If this situation is left untreated for a many years, the muscles and tendons of the mandible and the TMJ may manifest with altered tone and elasticity. [edit] Pronunciation The teeth play a major role in speech. Some letter sounds require the lips and/or tongue to make contact with teeth for proper pronunciation of the sound, and lack of teeth will obviously affect the way in which an edentulous individual can pronounce these sounds. For example, the fricative consonant sounds of the English language s, z, x, d, n, l, j, t, th, ch and sh are achieved with tongue-to-tooth contact, and the fricative f and v are achieved through lip-to-tooth contact. These sounds are very difficult to properly enunciate for the edentulous individual. [edit] Preservation of alveolar ridge height This section's tone or style may not be appropriate for Wikipedia. Specific concerns may be found on the talk page. See Wikipedia's guide to writing better articles for suggestions. (August 2009) The green line indicates the faciolingual dimensions of a newly edentulous ridge, while the blue line indicates these dimensions after the occurrence of very severe resorption. The alveolar ridges are columns of bone that surround and anchor the teeth and run the entire length, mesiodistally, of both the maxillary and mandibular dental arches. The alveolar bone is unique in that it exists for the sake of the teeth that it retains; when the teeth are absent, the bone slowly resorbs. The maxilla resorbs in a superioposterior direction, and the mandible resorbs in an inferioanterior direction, thus eventually converting an individual's occlusal scheme from a Class I to a Class III. Loss of teeth alters the form of the alveolar bone in 91% of cases.[2] In addition to this resorption of bone in the vertical and anterioposterior dimensions, the alveolus also resorbs faciolingually, thus diminishing the width of the ridge. What initially began as a sort of tall, broad, bell curve-shaped ridge (in the faciolingual dimension) eventually becomes a short, narrow, stumpy sort of what doesn't even appear to be a ridge. Resorption is exacerbated by pressure on the bone; thus, long-term complete denture wearers will experience more drastic reductions to their ridges that non-denture wearers. Those individuals who do wear dentures can decrease the amount of bone loss by retaining some tooth roots in the form of overdenture abutments or have implants placed. Note that the depiction above shows a very excessive change and that this many take many years of denture wear to achieve. Ridge resorption may also alter the form of the ridges to less predictable shapes, such as bulbous ridges with undercuts or even sharp, thin, knife-edged ridges, depending of which of many possible factors influenced the resorption. Bone loss with missing teeth, partials and complete dentures is progressive. According to Wolff's law, bone is stimulated, strengthened and continually renewed directly by a tooth or an implant. Teeth and implants provide this direct stimulation which develops stronger bone around them. A 1970 research study of 1012 patients by Jozewicz showed denture wearers had a significantly higher rate of bone loss.[citation needed] Tallgren’s 25 year study in 1972 also showed denture wearers have continued bone loss over the years.[citation needed] The biting force on the gum tissue irritates the bone and it melts away with a decrease in volume and density. Carlsson’s 1967 study showed a dramatic bone loss during the first year after a tooth extraction which continues over the years, even without a denture or partial on it.[citation needed] The longer people are missing teeth, wear dentures or partials, the less bone they have in their jaws. This may result in decreased ability to chew food well, a decreased quality of life, social insecurity and decreasing esthetics because of a collapsing of the lower third of their face. The bone loss also results in a significant decrease in chewing force, prompting many denture and partial wearers to avoid certain kinds of food. Food collecting under the appliance takes their enjoyment out of eating so they make their grocery and restaurant choices by what they can eat. There are several reports that correlate the quality and length of peoples lives with their ability to chew.[citation needed] Dental implant studies from 1977 by Branemark and countless others show dental implants stop this progressive loss and stabilize the bone over the long term.[citation needed] Implanted teeth provide a stable, effective tooth replacement that feels natural. They also provide an improved ability to chew comfortably and for those missing many teeth an improved sense of well being. Dental implants have become the standard for replacing missing teeth in dentistry. [edit] Masticatory efficiency Physiologically, teeth provide for greater chewing ability. They allow us to masticate food thoroughly, increasing the surface area necessary to allow for the enzymes present in the saliva, as well as in the stomach and intestines, to digest our food. Chewing also allows food to be prepared into small boli that are more readily swallowed than haphazard chunks of considerable size. For those who are even partially endentulous, it may become extremely difficult to chew food efficiently enough to swallow comfortably, although this is entirely dependent upon which teeth are lost. When an individual loses enough posterior teeth to make it difficult to chew, he or she may need to cut their food into very small pieces and learn how to make use of their anterior teeth to chew. If enough posterior teeth are missing, this will not only affect their chewing abilities, but also their occlusion; posterior teeth, in a mutually protected occlusion, help to protect the anterior teeth and the vertical dimension of occlusion and, when missing, the anterior teeth begin to bear a greater amount of force for which they are structurally prepared. Thus, loss of posterior teeth will cause the anterior teeth to splay. This can be prevented by obtaining dental prostheses, such as removable partial dentures, bridges or implant-supported crowns. In addition to reestablishing a protected occlusion, these prostheses can greatly improve one's chewing abilities. As a consequence of a lack of certain nutrition due to altered eating habits, various health problems can occur, from the mild to the extreme. Lack of certain vitamins (A, E and C) and low levels of riboflavin and thyamin can produce a variety of conditions, ranging from constipation, weight loss, arthritis and rheumatism. There are more serious conditions such as heart disease and Parkinson's disease and even to the extreme, certain types of Cancer. Numerous studies linking edentulism with instances of disease and medical conditions have been reported. In a cross-sectional study, Hamasha and others found significant differences between edentulous and dentate individuals with respect to rates of atherosclerotic vascular disease, heart failure, ischemic heart disease and joint disease.[3] [edit] Cause The etiology, or cause of edentulism, can be multifaceted. While the extraction of non-restorable or non-strategic teeth by a dentist does contribute to edentulism, the predominant cause of tooth loss in developed countries is periodontal disease. While the teeth may remain completely decay-free, the bone surrounding and providing support to the teeth may reabsorb and disappear, giving rise to tooth mobility and eventual tooth loss. In the photo at right, tooth #21 (the lower left first premolar, to the right of #22, the lower left canine) exhibits 50% bone loss, presenting with a distal horizontal defect and a mesial vertical defect. Tooth #22 exhibits roughly 30% bone loss.

tooth brush Return to the top

The toothbrush is an oral hygiene instrument used to clean the teeth and gums that consists of a head of tightly clustered bristles mounted on a handle, which facilitates the cleansing of hard-to-reach areas of the mouth. Toothpaste, which often contains fluoride, is commonly used in conjunction with a toothbrush to increase the effectiveness of toothbrushing. Toothbrushes are available with different bristle textures, sizes and forms. Most dentists recommend using a toothbrush labelled "soft", since hard bristled toothbrushes can damage tooth enamel and irritate the gums.[1] Toothbrushes have usually been made from synthetic fibers since they were developed, although animal bristles are still sometimes used.[citation needed] Contents [hide] * 1 History * 2 See also * 3 References * 4 External links [edit] History A variety of oral hygiene measures have been used since before recorded history. This has been verified by various excavations done all over the world, in which chewsticks, tree twigs, bird feathers, animal bones and porcupine quills were recovered. The first toothbrush recorded in history was made in 3000 BC, a twig with a frayed end called a chewstick. Various forms of toothbrush have been used. Indian medicine (Ayurveda) used the twigs of the neem or banyan tree to make toothbrushes and other oral-hygiene-related products for millennia. The end of a neem twig is chewed until it is soft and splayed, and it is then used to brush the teeth. In the Muslim world, chewing miswak, or siwak, the roots or twigs of the Arak tree (Salvadora persica), which have antiseptic properties, is common practice. The usage of miswak dates back at least to the time of the Prophet Muhammad, who pioneered its use. Rubbing baking soda or chalk against the teeth has also been common practice in history. In 1223, Japanese Zen master Dōgen Kigen recorded on Shōbōgenzō that he saw monks in China clean their teeth with brushes made of horse-tail hairs attached to an ox-bone handle. A photo from 1899 showing the use of toothbrush. The earliest identified use of the word toothbrush in English was in the autobiography of Anthony Wood, who wrote in 1690 that he had bought a toothbrush off J. Barret.[2] William Addis of England is believed to have produced the first mass-produced toothbrush in 1780.[3][4] In 1770 he had been jailed for causing a riot; while in prison he decided that the method used to clean teeth – at the time rubbing a rag with soot and salt on the teeth – could be improved, so he took a small animal bone, drilled small holes in it, obtained some bristles from a guard, tied them in tufts, passed the tufts through the holes on the bone, and glued them. He soon became very wealthy. He died in 1808, and left the business to his eldest son, also called William; the company continues to this day[5]. By 1840 toothbrushes were being mass-produced in England, France, Germany, and Japan[5]. Pig bristle was used for cheaper toothbrushes, and badger hair for the more expensive ones[5]. The first patent for a toothbrush was by H. N. Wadsworth in 1857 (US Patent No. 18,653) in the United States, but mass production in the USA only started in 1885. The rather advanced design had a bone handle with holes bored into it for the Siberian boar hair bristles. Animal bristle was not an ideal material as it retains bacteria and does not dry well, and the bristles often fell out. In the USA brushing teeth did not become routine until after World War II, when American soldiers had to clean their teeth daily.[3] A child being shown how to use a toothbrush. Natural animal bristles were replaced by synthetic fibers, usually nylon, by DuPont in 1938. The first nylon bristle toothbrush, made with nylon yarn, went on sale on February 24, 1938. The first electric toothbrush, the Broxodent, was invented in Switzerland in 1954. In January 2003 the toothbrush was selected as the number one invention Americans could not live without according to the Lemelson-MIT Invention Index.[6] [edit] See also * Oral hygiene * Soladey-J3X, a toothbrush that doesn't required toothpaste[7] * Teeth cleaning twig * Dental floss * Toothpaste * Chewable toothbrush * Electric toothbrush * Ultrasonic cleaning * Miswak

acid erosion Return to the top

Acid erosion From Wikipedia, the free encyclopedia Jump to: navigation, search Acid erosion Classification and external resources ICD-10 K03.2 MeSH D014077 Acid erosion, also known as dental erosion, is the irreversible loss of tooth structure due to chemical dissolution by acids not of bacterial origin. Dental erosion is the most common chronic disease of children ages 5–17,[1] although it is only relatively recently that it has been recognised as a dental health problem.[2] There is generally widespread ignorance of the damaging effects of acid erosion; this is particularly the case with erosion due to fruit juices, because they tend to be seen as healthy.[3][4] Erosion is found initially in the enamel and, if unchecked, may proceed to the underlying dentin. Frequently consumed foods and drinks below pH 5.0–5.7 may intitiate dental erosion. The most common cause of erosion is by acidic foods and drinks. In general, foods and drinks with a pH below 5.0–5.7 have been known to trigger dental erosion effects.[5] Numerous clinical and laboratory reports link erosion to excessive consumption of drinks. Those thought to pose a risk are soft drinks and fruit drinks, fruit juices such as orange juice (which contain citric acid) and carbonated drinks such as colas (in which the carbonic acid is not the cause of erosion, but citric and phosphoric acid). Additionally, wine has been shown to erode teeth, with the pH of wine as low as 3.0–3.8.[5] Other possible sources of erosive acids are from exposure to chlorinated swimming pool water, and regurgitation of gastric acids. Contents [hide] * 1 Causes o 1.1 Extrinsic acidic sources o 1.2 Intrinsic acidic sources o 1.3 Behaviour * 2 Signs * 3 Prevention and management * 4 See also * 5 External links * 6 Further reading * 7 References [edit] Causes [edit] Extrinsic acidic sources Acidic drinks and foods lower the pH level of the mouth so consuming them causes the teeth to demineralise. Furthermore, sugars contained in food and drink also turn to acid, which further erodes the teeth.[6] Drinks low in pH levels that cause dental erosion include fruit juices, sports drinks, and carbonated drinks. Orange and apple juices are common culprits among fruit juices. Carbonated drinks such as Coca-Cola are also very acidic.[6] Frequency rather than total intake of acidic juices is seen as the greater factor in dental erosion; infants using feeding bottles containing fruit juices (especially when used as a comforter) are therefore at greater risk of acid erosion.[7] Saliva acts as a buffer, regulating the pH when acidic drinks are ingested. Drinks vary in their resistance to the buffering effect of saliva. Studies show that fruit juices are the most resistant to saliva's buffering effect, followed by, in order: fruit-based carbonated drinks and flavoured mineral waters, non-fruit-based carbonated drinks, sparkling mineral waters; Mineral water being the least resistant. Because of this, fruit juices in particular, may prolong the drop in pH levels.[8] A number of medications such as vitamin C, aspirin and some iron preparations are acidic and may contribute towards acid erosion.[7] [edit] Intrinsic acidic sources Dental erosion can occur by non-extrinsic factors too. Intrinsic dental erosion is known as perimolysis, whereby gastric acid from the stomach comes into contact with the teeth.[6] People with diseases such as anorexia nervosa, bulimia, and gastroesophageal reflux disease often suffer from this. GERD is quite common and an average of 7% of adults experience reflux daily.[6] The main cause of GERD is increased acid production by the stomach.[6] [edit] Behaviour Acid erosion often coexists with abrasion and attrition.[7] Abrasion is most often caused by brushing teeth too hard.[2] Throthing or swishing acidic drinks around the mouth increases the risk of acid erosion.[7] [edit] Signs There are many signs of dental erosion, including changes in appearance and sensitivity. One of the physical changes can be the color of teeth. There are two different colors teeth may turn if dental erosion is occurring, the first being a change of color that usually happens on the cutting edge of the central incisors. This causes the cutting edge of the tooth to become transparent.[9] A second sign is if the tooth has a yellowish tint. This occurs because the white enamel has eroded away to reveal the yellowish dentin.[9] A change in shape of the teeth is also a sign of dental erosion. Teeth will begin to appear with a broad rounded concavity, and the gaps between teeth will become larger. There can be evidence of wear on surfaces of teeth not expected to be in contact with one another.[9] If dental erosion occurs in children, a loss of enamel surface characteristics can occur. Amalgam restorations in the mouth may be clean and non-tarnished. Fillings may also appear to be rising out of the tooth, the appearance being caused when the tooth is eroded away leaving only the filling. The teeth may form divots on the chewing surfaces when dental erosion is occurring. This mainly happens on the first, second, and third molars. One of the most severe signs of dental erosion is cracking[10], where teeth begin to crack off and become coarse.[9] Other signs include pain when eating hot, cold, or sweet foods. This pain is due to the enamel having been eroded away, exposing the sensitive dentin.[11] [edit] Prevention and management Preventive and management strategies include the following:[12] * Treating the underlying medical disorder or disease. * Modifying the pH of the food or beverage contributing to the problem, or changing lifestyle to avoid the food or beverage. * Decrease abrasive forces. Use a soft bristled toothbrush and brush gently. No brushing immediately after consuming acidic food and drink as teeth will be softened. Leave at least half an hour of time space. Rinsing with water is better than brushing after consuming acidic foods and drinks.[6][7] * Drinking through a straw[13] * Using a remineralizing agent, such as sodium fluoride solution in the form of a fluoride mouthrinse, tablet, or lozenge, immediately before brushing teeth. * Applying fluoride gels or varnishes to the teeth. * Drinking milk or using other dairy products. * Using a neutralizing agent such as antacid tablets. * Dentine bonding agents applied to areas of exposed dentin[7] [edit] See also * Abrasion * Abfraction * Attrition * Bruxism

canker sore Return to the top

An aphthous ulcer (pronounced /ˈæpθəs/; AP-thəs) also known as a canker sore, is a type of mouth ulcer, appears as a painful open sore inside the mouth[1] or upper throat characterized by a break in the mucous membrane. Its cause is unknown, but they are not contagious.[2] The condition is also known as aphthous stomatitis, and alternatively as Sutton's Disease, especially in the case of major, multiple, or recurring ulcers. The term aphtha means ulcer; it has been used for many years to describe areas of ulceration on mucous membranes. Aphthous stomatitis is a condition which is characterized by recurrent discrete areas of ulceration which are almost always painful. Recurrent aphthous stomatitis (RAS) can be distinguished from other diseases with similar-appearing oral lesions, such as certain oral bacteria or herpes simplex, by their tendency to recur, and their multiplicity and chronicity. Recurrent aphthous stomatitis is one of the most common oral conditions. At least 10% of the population has it, and women are more often affected than men. About 30–40% of patients with recurrent aphthae report a family history.[3] Contents [hide] * 1 Classification o 1.1 Minor ulceration o 1.2 Major ulcerations o 1.3 Herpetiform ulcerations * 2 Signs and symptoms * 3 Causes * 4 Prevention o 4.1 Oral and dental measures o 4.2 Nutritional therapy * 5 Treatment * 6 Epidemiology * 7 References * 8 External links [edit] Classification Aphthous ulcers are classified according to the diameter of the lesion. [edit] Minor ulceration "Minor aphthous ulcers" indicate that the lesion size is between 3 mm (0.1 in)-10 mm (0.4 in). The appearance of the lesion is that of an erythematous halo with yellowish or grayish color. Pain that affects quality of life is the obvious characteristic of the lesion. When the ulcer is white or grayish, the ulcer will be extremely painful and the affected lip may swell. They may last about 2 weeks.[citation needed] [edit] Major ulcerations Major aphthous ulcers have the same appearance as minor ulcerations, but are greater than 10 mm in diameter and are extremely painful. They usually take more than a month to heal, and frequently leave a scar. These typically develop after puberty with frequent recurrences. They occur on movable non-keratinizing oral surfaces, but the ulcer borders may extend onto keratinized surfaces. [edit] Herpetiform ulcerations This is the most severe form. It occurs more frequently in females, and onset is often in adulthood. It is characterized by small, numerous, 1–3 mm lesions that form clusters. They typically heal in less than a month without scarring. Supportive treatment is almost always necessary.[4] [edit] Signs and symptoms Apthous ulcer Large aphthous ulcer on the lower lip Aphthous ulcers usually begin with a tingling or burning sensation at the site of the future aphthous ulcer. In a few days, they often progress to form a red spot or bump, followed by an open ulcer. The aphthous ulcer appears as a white or yellow oval with an inflamed red border. Sometimes a white circle or halo around the lesion can be observed. The gray-, white-, or yellow-colored area within the red boundary is due to the formation of layers of fibrin, a protein involved in the clotting of blood. The ulcer, which itself is often extremely painful, especially when agitated, may be accompanied by a painful swelling of the lymph nodes below the jaw, which can be mistaken for toothache; another symptom is fever. A sore on the gums may be accompanied by discomfort or pain in the teeth. [edit] Causes The exact cause of many aphthous ulcers is unknown but citrus fruits (e.g. oranges and lemons), physical trauma, stress, lack of sleep, sudden weight loss, food allergies, immune system reactions[5] and deficiencies in vitamin B12, iron, and folic acid[6] may contribute to their development. Nicorandil and certain types of chemotherapy are also linked to aphthous ulcers.[7] One recent study showed a strong correlation with allergies to cow's milk.[8] Aphthous ulcers are a major manifestation of Behçet disease,[9] and are also common in people with Crohn's disease.[10] Trauma to the mouth is the most common trigger.[11][12][13] Physical trauma, such as that caused by toothbrush abrasions, laceration with sharp or abrasive foods (such as toast, potato chips or other objects), accidental biting (particularly common with sharp canine teeth), after losing teeth, or dental braces can cause aphthous ulcers by breaking the mucous membrane. Other factors, such as chemical irritants or thermal injury, may also lead to the development of ulcers. Using a toothpaste without sodium lauryl sulfate (SLS) may reduce the frequency of aphthous ulcers[14][15][16][17] One smaller study found no connection between SLS in toothpaste and aphthous ulcers.[18][19] Celiac disease has been suggested as a cause of aphthous ulcers; small studies of patients (33% or 1 out of 3) with Celiac disease did demonstrate a conclusive link between the disease and aphthous ulcers vs control group (23%)[20][21] but some patients benefited from eliminating gluten from their diets.[20] There is no indication that aphthous ulcers are related to menstruation, pregnancy and menopause.[22] Smokers appear to be affected less often.[23] [edit] Prevention [edit] Oral and dental measures * Regular use of non-alcoholic mouthwash may help prevent or reduce the frequency of sores. In fact, informal studies suggest that mouthwash may help to temporarily relieve pain.[24] * In some cases, switching toothpastes can prevent aphthous ulcers from occurring with research looking at the role of sodium dodecyl sulfate (sometimes called sodium lauryl sulfate, or with the acronymes SDS or SLS), a detergent found in most toothpastes. Using toothpaste free of this compound has been found in several studies to help reduce the amount, size and recurrence of ulcers.[25][26][27] * Dental braces are a common physical trauma that can lead to aphthous ulcers and the dental bracket can be covered with wax to reduce abrasion of the mucosa. Avoidance of other types of physical and chemical trauma will prevent some ulcers, but since such trauma is usually accidental, this type of prevention is not usually practical. [edit] Nutritional therapy * Zinc deficiency has been reported in people with recurrent aphthous ulcers.[28] The few small studies looking into the role of zinc supplementation have mostly reported positive results particularly for those people with deficiency,[29] although some research has found no therapeutic effect.[30] [edit] Treatment A number of different treatments exist for apthous ulcers including: analgesics, anesthetics agents, antiseptics, anti-inflammatory agents, steroids, sucralfate, tetracycline suspension, and silver nitrate.[31] Amlexanox paste has been found to speed healing and alleviate pain.[32] Vitamin B12 has been found to be effective in treating recurrent aphthous ulcers, regardless of whether there is a vitamin deficiency present.[33] While dietary supplements of L-lysine can be effective in treating cold sores/herpetic lesions,[34] there is no evidence of an impact on canker sores. Suggestions to reduce the pain caused by an ulcer include: avoiding spicy food, rinsing with salt water or over-the-counter mouthwashes, proper oral hygiene and non-prescription local anesthetics.[35] Active ingredients in the latter generally include benzocaine,[36] benzydamine or choline salicylate.[37] Anesthetic mouthwashes containing benzydamine hydrochloride have not been shown to reduce the number of new ulcers or significantly reduce pain,[38] and evidence supporting the use of other topical anesthetics is very limited though some individuals may find them effective.[39] In general their role is limited; their duration of effectiveness is generally short and does not provide pain control throughout the day. Such medications may also cause complications in children.[40] Evidence is limited for the use of antimicrobial mouthwashes but suggests that they may reduce the painfulness and duration of ulcers and increase the number of days between ulcerations, without reducing the number of new ulcers.[41] Milk of magnesia is useful against aphthous ulcers when used topically.[42] Corticosteroid preparations containing hydrocortisone hemisuccinate or triamcinolone acetonide to control symptoms are effective in treating aphthous ulcers. [39][43][44] The application of silver nitrate will cauterize the sore; a single treatment decreases pain but does not affect healing time[45] though in children it can cause tooth discoloration if the teeth are still developing.[35] The use of tetracycline is controversial, as is treatment with levamisole, colchicine, gamma-globulin, dapsone, estrogen replacement and monoamine oxidase inhibitors.[36] While commonly used, Magic mouthwash, a combination of a number of ingredients including viscous lidocaine, benzocaine, milk of magnesia, kaolin-pectate, chlorhexidine, or diphenhydramine, has little evidence to support its use in the treatment of aphthous ulcers.[32][46] There is the hypothesis that pasteurized goat milk can help with disease symptoms. Currently, a clinical trial is conducted to check these claims.[47] [edit] Epidemiology Canker sores are a very common oral lesion. Epidemiological studies show an average prevalence between 15% and 30%.[48][49] Canker sores tend to afflict women more than men and people less than 45 years old. Canker sores occur most frequently among 16-25 year olds,[50] and they rarely occur in anyone over 55.[50] The frequency of canker sores varies from less than 4 episodes per year (85% of all cases) to more than one episode per month (10% of all cases) including people suffering from continuous RAS.[49]

crown Return to the top

A crown is the traditional symbolic form of headgear worn by a monarch or by a deity, for whom the crown traditionally represents power, legitimacy, immortality, righteousness, victory, triumph, resurrection, honour and glory of life after death. In art the crown may be shown being offered to those on Earth by angels. Apart from the traditional form, crowns also may be made of, for example, flowers, stars, oak leaves or thorns and be worn by others, representing what the coronation part aims to symbolize with the specific crown. They often contain jewels. Three distinct categories of crowns exist in those monarchies that use crowns or state regalia. Coronation - worn by monarchs when being crowned. State crown - worn by monarchs on other state occasions. (Note that similar headgear, worn by nobility and other high ranking people below the ruler, is in English called a coronet, however in many languages the same word is used, e.g., French couronne, German Krone, Dutch kroon); Consort crowns - worn by queens consort, signifying rank granted as a constitutional courtesy protocol. In Classical antiquity the crown (corona) that was sometimes awarded to people other than rulers, such as triumphal military generals or athletes, was actually a wreath or chaplet, or ribbonlike diadem. The precursor to the crown was the browband called the diadem, which had been worn by the Achaemenid Persian emperors, was adopted by Constantine I, and was worn by all subsequent rulers of the later Roman Empire. Numerous crowns of various forms were used in Antiquity, such as the White crown, Red Crown, combined Pschent crown and blue crown of Pharaonic Egypt. The corona radiata, the "radiant crown" known best on the Statue of Liberty, and perhaps worn by the Helios that was the Colossus of Rhodes, was worn by Roman emperors as part of the cult of Sol Invictus prior to the Roman Empire's conversion to Christianity. It was referred to as "the chaplet studded with sunbeams” by Lucian, about 180 AD (in Alexander the false prophet). Perhaps the oldest Christian crown in Europe is the Iron Crown of Lombardy, of Roman and Longobard age, later again used to crown modern Kings of Napoleonic and Austrian Italy, and to represent united Italy after 1860. In the Christian tradition of European cultures, where ecclesiastical sanction authenticates monarchic power, when a new monarch assumes the throne in a coronation ceremony, the crown is placed on the new monarch's head by a religious official. Some, though not all early Holy Roman Emperors travelled to Rome at some point in their careers to be crowned by the pope. Napoleon, according to legend, surprised Pius VII when he reached out and crowned himself, although in reality this order of ceremony had been pre-arranged. The Imperial crown of Japanese emperor Kōmei (1831 - 1867). Today, only the British Monarchy and Tongan Monarchy continue this tradition as the only remaining anointed and crowned monarchs, though many monarchies retain a crown as a national symbol in heraldry. The French Crown Jewels were sold in 1885 on the orders of the Third French Republic, with only a token number, with their precious stones replaced by glass, held on to for historic reasons and displayed by the Louvre. The Spanish Crown Jewels were destroyed in a major fire in the eighteenth century while the Irish Crown Jewels (actually merely the Sovereign's insignia of the Most Illustrious Order of St Patrick) were stolen from Dublin Castle in 1907. Heraldic crown of the Russian Empire Special headgear to designate rulers dates back to pre-history, and is found in many separate civilizations around the globe. Commonly, rare and precious materials are incorporated into the crown, but that is only essential for the notion of crown jewels. Gold and precious jewels are common in western and oriental crowns. In the Native American civilizations of the Pre-Columbian New World, rare feathers, such as that of the quetzal, often decorated crowns; so too in Polynesia (e.g. Hawaii). In other cultures no crown is used in the equivalent of coronation, but the head may still be otherwise symbolically adorned, as a royal tikka in the Hindu tradition of India. A crown is often an emblem of the monarchy, a monarch's government, or items endorsed by it. The word itself is used, particularly in Commonwealth countries, as an abstract name for the monarchy itself, as distinct from the individual who inhabits it (see The Crown). A specific type of crown (or coronet for lower ranks of peerage) is employed in heraldry under strict rules. Indeed some monarchies never had a physical crown, just a heraldic representation, as in the constitutional kingdom of Belgium, where no coronation ever took place; the royal installation is done by a solemn oath in parliament, wearing a military uniform: the King is not acknowledged as by divine right, but assumes the only hereditary public office in the service of the law; so he in turn will swear in all members of "his" federal government. Costume headgear imitating a monarch's crown is also called a crown. Such costume crowns may be worn by actors portraying a monarch, people at costume parties, or ritual "monarchs" such as the king of a Carnival krewe, or the person who found the trinket in a king cake. The Eastern Orthodox marriage service has a section called the crowning, wherein the bride and groom are crowned as "king" and "queen" of their future household. In Greek weddings, the crowns are diadems usually made of white flowers, synthetic or real, often adorned with silver or mother of pearl. They are placed on the heads of the newlyweds and are held together by a ribbon of white silk. They are then kept by the couple as a reminder of their special day. In Slavic weddings, the crowns are usually made of ornate metal, designed to resemble an imperial crown, and are held above the newlyweds heads by their best men. A parish usually owns one set to use for all the couples that are married there since these are much more expensive than Greek-style crowns. Children, mainly girls, sometimes connect flowers together in a chain, and wear the wreath as if it were a crown. Crowns are also often used as symbols of religious status or veneration, by divinities (or their representation such as a statue) or by their representatives, e.g. the Black Crown of the Karmapa Lama, sometimes used a model for wider use by devotees. A Crown of thorns according to the Bible, was placed on the head of Jesus before his crucifixion and has become a common symbol of martyrdom. Rapper Kanye West raised controversy when he appeared on the February 2006 cover of Rolling Stone wearing a crown of thorns. So did Madonna when she wore one on the opening night of her World Tour in May 2006. According to Roman Catholic tradition the Blessed Virgin Mary was crowned as Queen of Heaven after her assumption into heaven. She is often depicted wearing a crown, and statues of her in churches and shrines are ceremonially crowned during May. Because one or more crowns, alone or as part of a more elaborate design, often appear on coins, several monetary denominations came to be known as 'a crown' or the equivalent word in the local language, such as krone. This persists in the case of the national currencies of the Scandinavian countries and the Czech Republic. The crown of the United Kingdom became a commemorative coin and, as at a value of 25p was last minted in 1981, although the size was resurrected for 5 pound pieces. The generic term "crown sized" is frequently used for any coin roughly the size of an American silver dollar.

dental hygienist Return to the top

A dental hygienist is a licensed dental professional who specializes in preventive oral health, typically focusing on techniques in oral hygiene. Local dental regulations determine the scope of practice of dental hygienists. In most jurisdictions, hygienists work for a dentist, and some are licensed to administer local anesthesia. Common procedures performed by hygienists include cleanings known as prophylaxis, scaling and root planing for patients with periodontal disease, taking of prescribed radiographs, dental sealants, administration of fluoride, and providing instructions for proper oral hygiene and care.

implant Return to the top

Implant can refer to: Alien implants Brain implant Breast implant Buttock implant Cochlear implant Contraceptive implant Dental implant Extraocular implant Fetal tissue implant Implant (medicine) Implant (Scientology) Implant, The Implantation Microchip implant (animal) Implant (body modification) Microchip implant (human) Retinal implant Subdermal implant Transdermal implant

xrays Return to the top

• Coral Gables, Florida, United States of America
• Coral Terrace, Florida, United States of America
• Cutler, Florida, United States of America
• Doral, Florida, United States of America
• Fountainebleau, Florida, United States of America
• Fisher Island, Florida, United States of America
• Brownsville, Florida, United States of America
• Gladeview, Florida, United States of America
• Kendale Lakes, Florida, United States of America
• Kendall, Florida, United States of America
• Key Biscayne, Florida, United States of America
• Medley, Florida, United States of America
• Miami, Florida, United States of America
• Miami Beach, Florida, United States of America
• Miami Springs, Florida, United States of America
• North Bay Village, Florida, United States of America
• Olympia Heights, Florida, United States of America
• Pinecrest, Florida, United States of America
• Virginia Gardens, Florida, United States of America
• Richmond Heights, Florida, United States of America
• South Miami, Florida, United States of America
• Sweetwater, Florida, United States of America
• Tamiami, Florida, United States of America
• Westwood Lake, Florida, United States of America
• University Park, Florida, United States of America
• West Miami, Florida, United States of America
• Westchester, Florida, United States of America
• East Perrine, Florida, United States of America
• Glenvar Heights, Florida, United States of America
• Palmetto Estates, Florida, United States of America
• South Miami Heights, Florida, United States of America
• Sunset, Florida, United States of America
• The Crossings, Florida, United States of America
• Three Lakes, Florida, United States of America
• West Perrine, Florida, United States of America