Treating gum disease with homemade remedies

Freedom From Dental Disease

The Primary Care Oral Health Action Pack can Favorably change the way you look at your oral health and what affects it. Increase your knowledge of YOUR teeth and gums, YOUR entire oral environment and yes, your SMILE! Reveal the TRUE CAUSE of cavities, decay of bone and tissue and disclose the proper biological balance. Put YOU in command over this contagious, yet EASILY preventable disease which runs rampant thoughout our population. Allow you to TAKE ACTION to restoring your teeth and gums to optimum health while preventing further decay and damage, as well as preventing any potentially related problems such as heart disease, diabetes, and so on. How to Become Dentally Self Sufficient. Research Advocates OraMedics The science behind the program! The 7 Factors Transcript - Dr. Nara's Last speech before the World Health Federation. Read more here...

Freedom From Dental Disease Summary

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What You Should Know About Gum Disease

These books encapsulate my personal experience with fighting gum disease, described as follows: My gums bled during dental cleanings. I had pockets depths of 4 and 5mms and one 6mm pocket. My dentist told me I had moderate gum (periodontal) disease. She and / or the hygienist also told me that the ONLY thing that would help me was a Scaling and Root Planing Treatment - Otherwise knowns as a SRP or Deep Cleaning. After applying the information I learned on my own and the tools that I employed the results were that my pocket depths returned to normal. There was no more bleeding during dental cleanings, brushing or flossing. I was told that I no longer needed the Deep Cleaning or SRP treatment and that whatever I was doing, I should keep it up.

What You Should Know About Gum Disease Summary

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Section P Periodontal Disease Chapter 126

Periodontal Disease, Vascular Inflammation, and Dysfunction Microvascular Dysfunction and Atherosclerosis Closing the Loop on RAGE, Periodontal Disease, and Vascular Inflammation The Possible Roles of Vascular Endothelial Growth Factor in Periodontal Disease 857 Synthesis and Regulation of VEGF Role in Disease Processes Role in Periodontal Disease Therapeutic Applications Future Perspectives

Acute Necrotising Ulcerative Gingivitis

Acute necrotising ulcerative gingivitis (Vincent disease, trench mouth) is a relatively common oral disease. Although it is generally accepted that bacteria play a pivotal role in the development of the disease, a specific causal agent has not been established. In the past the Gramnegative anaerobes designated as Treponema vincentii and Fusobacterium nucleatum were strongly implicated and Treponema denticola 165 and Prevotella intermedia are some of the current candidate organisms.

Periodontal Disease Vascular Inflammation and Dysfunction

Periodontal diseases are chronic infections affecting the supporting structures of teeth. Several cross-sectional, case-control, and longitudinal studies have reported an increased risk for vascular disease and related clinical events in individuals with periodontal disease. In these studies the risk was independent of other known risk factors, including smoking, diabetes, and the blood lipid profile 1 . Multiple pathogenic mechanisms likely underlie these observations, including, at least in part, direct infection of the vasculature by oral pathogenic bacteria, and or generalized inflammation secondary to lipopolysaccharide or other bacterial products that engage host defense mechanisms. Indeed, more recent evidence has indicated that patients with severe periodontal disease have increased serum levels of CRP, IL-1, and IL-6, hyperfibrinogenemia, and moderate leukocytosis compared to unaffected controls 2 . The findings above have been extended, as a relationship between periodontal...

Individual Differences in Response to Ligatureinduced Periodontitis

The Animal Model of Periodontitis Ligature-induced periodontitis is a disease model that fulfils several important criteria first, it is sensitive to individual differences of HPA axis reactivity. Second, it should involve innate immune functions being most sensitive to alterations of the stress responsiveness. Third, it should be relevant to human disease. The disease is a locally restricted destructive inflammatory process triggered by Gram-negative oral microorganisms that colonize tooth surfaces (dental plaque) in the gingival sulci. The disease is characterized by breakdown of the tooth-supporting tissues (the periodon-tium), which may lead to tooth loss in the most severe cases. Periodontal disease represents a major health problem with an incompletely understood pathomechanism. A high incidence of periodontal disease is associated with genetics, increased age, negative life events and depression, heavy smoking, and poorly controlled diabetes mellitus. Until now, it is...

Childhood periodontal diseases

Periodontal diseases can be grouped broadly into gingivitis and periodonti-tis, and each can be further divided according to the disease characteristics (e.g., chronic, aggressive) and the contributing factors, including related systemic conditions and disorders 39 . On the basis of histopathology, gingivitis is characterized by inflammation confined to the gingiva, and peri-odontitis denotes destruction of periodontal tissues that involve the gingiva, the periodontal ligament, root cementum and the supporting bone (alveolar bone) (Fig. 1). From the epidemiological aspect, gingivitis is more prevalent in childhood than periodontitis. The periodontal diseases are well recognized to be initiated by some selected microorganisms, so-called periodontopathic microorganisms, in subgingival plaque and or supragingival plaque adjacent to gingival crevice. It is also evident that the onset and progress of these inflammatory diseases are based on the balance between the periodontopathic...

Toothpaste That Targets Gingivitis

As of 2002, only one toothpaste on the U.S. market has been allowed by the U.S. Food and Drug Administration to claim antigingivitis properties. The toothpaste, a multicare product that is meant to fight plaque and cavities as well as gingivitis, targets the gum disease with a combination of sodium fluoride, triclosan, and a copolymer. Triclosan is an antibacterial agent often found in soaps and deodorants. As an ingredient in toothpaste, it inhibits the growth of bacteria in plaque. Bacteria in plaque can produce harmful acids, toxins, and enzymes that damage surrounding gum tissues. The redness, swelling, tenderness, and bleeding of gums that result from plaque buildup are the symptoms of gingivitis. The copolymer Gantrez extends the life of the triclosan so that it remains on teeth and gums for approximately 12 hours after brushing, giving long-life protection against gingivitis.

Role in Periodontal Disease

During the progression of periodontal disease, the periodontal vasculature is profoundly affected and there is evidence that inflamed tissue enhances the expression of inflammatory mediators, which in their turn may promote angiogenesis. It has been found that there are greater amounts of VEGF in gingival crevicular fluid collected from clinically diseased sites than in fluid from healthy sites. VEGF production in gingival fibroblasts and periodontal ligament fibroblasts may enhance vascular permeability and the accumulation of inflammatory cells, which is similar to the inflammatory phase of periodontal disease. Therefore, VEGF may be associated with the etiology of periodontal disease, particularly specific to the gingiva, which is characterized by swelling, edema, gingival exudation, and heavy neovascularization. Porphyromonas gingivalis and Actinobacillus actino-mycetemcomitans are major etiologic agents of periodontal disease. They contain a number of cell surface bioactive...

Chronic Marginal Gingivitis and Localised Gingival Fibrous Hyperplasia

Chronic marginal gingivitis of variable degree is so common as to be almost universal. It represents a response of the gingival tissues to accumulation of dental microbial plaque around the teeth. If left untreated the inflammation can become more severe and extend into the underlying periodontal tissues causing loss of peri-odontal ligament attachment and a pocket develops between the tooth and the overlying gingiva exacerbating the tendency for plaque accumulation. Eventually, there is progressive resorption of the supporting alveolar bone leading to loosening or loss of the tooth. Chronic marginal gingivitis is characterised microscopically by mild vascular hyperaemia and dense chronic inflammatory infiltration. The crevicular epithelium is ulcerated and may become hyperplastic with thin, irregular and anastomosing processes extending into the gingival connective tissue. There may be consid

Gingivitis

Gingivitis is an inflammation of the gums and periodentitis is the inflammation of the gums and surrounding tissues that can eventually result in loss of bone support. Symptoms are gums that are red, swollen, and bleed easily. They often recede and bad breath may be present. A good diet and proper oral hygiene are essential in preventing gum disease. Sugar significantly increases plaque formation while adversely affecting white blood cell function. Toothpaste or mouthwash containing sanguinarine, an alkaloid from the herb bloodroot, helps prevent plaque formation and has anti-inflammatory and antimicrobial properties. Centella extract, 30 mg twice daily, a triter-penoid from gota kola, has effective wound healing properties especially effective for severe gum disease and after surgery.

Preface to the First Edition

Veterinarians, and public health workers interested in understanding the application of basic biology to virtually all immunological or infection-mediated disease processes of external mucosal surfaces. This handbook will be of particular importance to students of medicine and pediatrics, including individuals studying gastroenterology and pul-monology, ophthalmology, gynecology, infectious disease, otolaryngology, periodontal disease, sexually transmitted disease, and especially mucosal immunology.

Juxtaoral Organ of Chievitz

Primary herpes infection (primary herpetic gingivo-stomatitis) is characterised by widespread vesicular lesions of the oral mucosa 183 . Any site may be involved, but the hard palate and the dorsum of the tongue are the most common locations. The vesicles quickly rupture to leave shallow, painful, sharply demarcated ulcers that are 1-2 mm in diameter and have an erythematous halo. Ulcers frequently coalesce to form more irregular lesions. Gingivitis is a very characteristic feature of primary herpes. The gingivae are swollen and often strikingly erythematous, even in the absence of frank ulceration. There is often conspicuous cervical lymphade-nopathy, together with mild fever and malaise. Oral lesions usually resolve spontaneously within 1-2 weeks. About a third of patients infected with Herpes simplex, either clinically or sub-clinically, are susceptible to recurrent infections.

Wegeners Granulomatosis

A rare, but particularly characteristic oral feature is so-called strawberry gums, which is considered to be virtually pathognomonic of Wegener's granulomatosis 111, 124 . There is a localised or generalised prolifera-tive gingivitis with a mottled, purplish-red granular surface, which resembles an over-ripe strawberry. Disease localised to the gingiva tends to be fairly low-grade. Involvement of the underlying bone, however, may cause the related teeth to loosen or exfoliate.

Immediate Questions

Any feeding difficulties In an infant, choking, slow feeding, tiring with feeding, poor suck, vomiting, or regurgitation suggests GI, cardiac, or neurologic disorder. In a toddler or older child with decreased appetite, consider dental disease, constipation, chronic illness, or apathy.

Peripheral Giant Cell Granuloma Giant Cell Epulis

Pyogenic granulomas are most common on the gingivae and less frequently in other intraoral sites, particularly the lip and tongue. They form solitary, soft, red and friable nodules that bleed readily. They frequently ulcerate and are covered by a fibrinous slough. Gingival lesions may be seen in pregnancy and appear to be a focal exacerbation of pregnancy gingivitis 113 . Pregnancy epuli-des (pregnancy tumour) usually manifest towards the end of the first trimester. They have a strong tendency to recur if removed before parturition and may show partial or complete spontaneous resolution if left following delivery. Occasionally, similar lesions are seen in other parts of the mouth during pregnancy, particularly the dorsum of the tongue, and they are termed granuloma gravidarum 52 .

Physical Examination See Also Chapter

A complete physical exam with vital signs, weight and neck circumference should be performed on every patient. Included in this evaluation is a detailed head and neck examination. Specific attention is focused in the regions that have been well described as potential sites of upper airway obstruction, such as the nose, palate, and base of tongue (20-25). Nasal obstruction can occur as a result of alar collapse, septal deviation, and turbinate hypertrophy or sinonasal masses. These can be identified on anterior rhinoscopy. The oral cavity should be examined for dental occlusion, periodontal disease and any lesions, including torus mandibulae or torus palatinus. Examination of the oropharyngeal and hypopharyngeal regions includes a description of the tonsils, palate, lateral pharyngeal walls, and tongue base. A variety of grading systems, such as Mallampati's, have been developed to establish a standard of describing the degree of obstruction caused by these structures (26,27). However,...

Duration and modification of empirical antibiotics

Full medical examination, repeated cultures, and chest radiography should be performed. Metronidazole should be added in cases of severe mucositis, necrotizing gingivitis, perianal tenderness, and acute abdominal pain. However, in the absence of any clues to the etiology of persistent fever, antifungal treatment should be commenced (Fig 1).

Project Title Efficacy Of Bupropion For Treating Spit Tobacco Users

Summary Although overall rates of cigarette smoking have declined over the past 40 years, the use of spit tobacco (ST) has tripled. The use of ST can lead to nicotine addiction and physical dependence. ST use is known to increase the risk of periodontal disease and oral cancer. Moreover, ST use increases the risk for cancer of the esophagus, larynx, stomach and pancreas and the risk of cardiovascular disease. Effective interventions are needed to assist ST users to stop. Bupropion, a monocyclic anti-depressant that inhibits the neuronal re-uptake of norepinephrine and dopamine and may also selectively inhibit neuronal nicotinic receptors, has demonstrated efficacy for smoking cessation. In a placebo-controlled pilot study, we have shown possible treatment effects of sustained release bupropion (SR) in ST user. Our aims are 1) To evaluate the efficacy of a 12-week course of bupropion SR rates of abstinence from all tobacco use 2) To evaluate the efficacy of a 12-week course of...

Project Title General Clinical Research Centerforsyth Dental Instit

Summary (provided by applicant) The BIDMC's GCRC proposes to form a satellite with the Forsyth Dental Institute (FDI), a world class center for clinical investigation of oral disease. This proposal describes a spectrum of investigations involving treatment of periodontal diseases, development of a vaccine for dental caries, testing of mercury amalgam toxicity and investigation of oral cancer. Sixteen projects are described that will be conducted at the Satellite Center that include microbiology, microbial genomics, microbial taxonomy, immunology and toxicology as these studies relate to conditions of oral health and disease and microbial biofilms. The proposed Satellite Center will include a Dental Clinic Core, a Laboratory Core and Biostatistics Informatics support. Specific areas of investigation in this application include 1) comparison of conventional and antibacterial_supplemented treatments of periodontal disease 2) investigation of means to prevent periodontal disease 3)...

Anaerobic Gram Negative Cocci and Rods

Anaerobic gram-negative rods are called Bacteroides and are members of the Bacteriodaceae family of bacteria that live in the intestinal tract of humans. Bacteroides can cause peritonitis, which is inflammation of the peritoneum due to infection. Another kind of anaerobic gram-negative rod is Fusobacterium. These are long slender rods that live in the gingival crevices of teeth and cause gingivitis, which is a gum infection.

Perianal or periodontal

Both are common sites of infection in neutropenic patients. Perianal lesions may become secondarily infected if skin abraded. Add metronidazole 500mg IV tds to standard therapy. Painful SC abscesses may form and may require surgical incision. Gum disease and localized tooth infections abscesses are frequently seen. Add metronidazole to therapy as above, arrange OPG and dental review as surgical intervention may be required in non-responders. If possible, best delayed until neutrophil recovery in most cases then do electively before next course of chemotherapy.

Cellular Targets of Cigarette Smoke Induced Microvascular Dysfunction

The organism undergoes an inflammatory-type response with every cigarette smoked. This is caused either by combustion products, reactive oxygen species, and other compounds that are inhaled with the cigarette smoke, or by reactive oxygen species and inflammatory mediators released from the organism in response to cigarette smoking (particularly from phagocytic cells that are sequestered in the pulmonary microcirculation in response to cigarette smoke). This is most obviously reflected in an activation of white blood cells. Although leukocyte adhesion and emigration are involved in host defense and phagocytosis and thus serve a beneficial role during a well-contained inflammatory response, leukocytes may also turn against the host and contribute to tissue damage, characterized by the breakdown of capillary perfusion, the loss of endothelial integrity, and the extravasation of fluid and macromolecules into the interstitial space 6 . A feature common to the pathomechanisms of most...

Early Life Stress Increases Disease Susceptibility in Adulthood

Early life stress modulates neural and neuroendocrine mechanisms in host defence and autoimmunity, thereby predisposing to adult disease susceptibility. Here, we reported on opposing effects of MD and HA on a diversity of diseases like asthma, multiple sclerosis, and periodontitis. Summarizing, MD increases, whereas HA decreases, disease susceptibility to all investigated disease models. Furthermore, HA prolongs the pain threshold, decreases anxiety-like behavior, and improves motor function and explorative behaviors, whereas MD induces more or less opposite-like effects. Denenberg and Karas (1959) summarized different experiments and stated that handled animals weighed most, learned best, and lived longest. The question is, how are these effects mediated First, postnatal handling and maternal deprivation have been shown to program adult HPA responsiveness (Ladd et al., 2000). However, based on our data, we are tempted to conclude that the demonstrated effects are far beyond...

Prevention and Treatment

Careful flossing and toothbrushing can prevent periodontal disease, especially if combined with twice yearly polishing and removal of calculus at a dental office. Periodontal disease can be treated in its earlier stages by cleaning out the inflamed gingival crevice and removing plaque and calculus. In advanced cases, surgery is usually required to expose and clean the roots of the teeth. Trench mouth (figure 24.6), also known as Vincent's disease, or acute necrotizing ulcerative gingivitis (ANUG), is a severe, acute condition distinct from other forms of periodontitis. The disease was rampant among soldiers living in trenches during World War I because they were unable to attend to mouth care thus its name.

Other Systemic Diseases and Acceleration of Microvascular Dysfunction and Atherosclerosis

A common systemic disease linked to acceleration of vascular pathology and exaggerated periodontal disease is diabetes. Diabetes is a heterogeneous group of disorders affecting millions of people in the United States. Worldwide, the incidence of diabetes is burgeoning. Multiple sequelae of this disorder lead to a wide range of complications in target tissues such as the retina, kidney, peripheral nerves, and micro- and macrovasculature. Multiple epi-demiologic studies have definitively linked the incidence and severity of atherosclerosis to diabetes. What is the link to oral pathology Epidemiologic studies have strongly suggested that diabetes increases the prevalence and severity of periodontitis. Our laboratory developed a murine model with which to test these concepts. Oral anal inoculation with P gingivalis of mice rendered diabetic with streptozotocin enhanced alveolar bone loss in hyperglycemic animals, in parallel with increased expression of inflammatory and gelatinolytic...

Essay 10 Dental Issues before and after Organ Transplantation

Despite the dramatic reduction in dental disease over the past three decades, resulting principally from fluoridation of public water supplies and increased public education, the mouth remains the most commonly infected site in the body. Almost all adults have some subacute, asymptomatic source of oral infection, arising most frequently as a result of chronic periodontal disease. Added to this is the fact that less than half the population chooses to receive regular maintenance care and instead seek treatment only episodically when pain or other acute symptoms force them to see a dentist. This means that a vast amount of untreated, often asymptomatic dental pathology exists in the population at large. For patients in robust health even well established, chronic oral infections can be tolerated with few, minor systemic symptoms. This, however, is not true of organ transplant patients who following successful immunosuppression can quickly and easily be overwhelmed by a fulminating...

Dermatitis Herpetiformis

Linear IgA disease is a rather poorly defined heterogeneous group of mucocutaneous blistering disorders that closely resemble mucous membrane pemphigoid clinically and microscopically 160, 191 . Like pemphigoid, the eyes may be involved. Linear IgA disease in adults has been separated from similar conditions in childhood such as bullous dermatosis of childhood and childhood cicatricial pemphigoid. Cutaneous linear IgA disease of adults has a strong association with a history of bowel disease. This association is much less clear in patients with oral lesions. However, patients with oral linear IgA disease appear to have a higher risk of severe ocular lesions. Some cases of oral lesions have been associated with drugs 51 . The condition is more common in women than men and it usually presents as a desquamative gingivitis with, or without, ulceration.

Clinical Practice Issues Indications and Contraindications

Not all patients are suitable candidates for the use of oral appliances. This treatment modality has no known role in treating central sleep apnea or hypoventilation states. Some case reports have shown OSA being worsened by oral appliance therapy (59,60), and this together with the known potential for a placebo reponse (12,13), highlights the need for objective assessment of treatment response. Caution is warranted in patients with TMJ problems, and it may be advisable to seek expert dental specialist assessment prior to initiation of treatment. Insufficient number of teeth to permit adequate retention of the appliance may preclude treatment. It is commonly accepted that 10 teeth on each dental arch would represent the minimum number required (61). Less teeth will increase the partition of the pressure on each tooth and will cause more dental side effects. Similarly, the presence of periodontal disease may promote excessive tooth movement with an oral appliance. These cases may...

Injection Snoreplasty

Palatal injection sclerotherapy (injection snoreplasty) was introduced as an inexpensive, minimally invasive office procedure that treats palatal flutter snoring. Essentially, a sclerotherapy agent is injected into the submucosal layer of the soft palate to promote fibrosis and scarring (106). Several different sclerotherapy agents have been employed to stiffen the soft palate. The two most commonly used agents are 3 sodium tetradecyl sulfate (sotradecol) and 50 ethanol (107). The average number of injections required to achieve adequate reduction in snoring was 1.2 injections per patient. Exclusion criteria for this modality include comorbid diseases that interfere with wound healing (uncontrolled diabetes, uncontrolled hypothyroidism, and periodontal disease), marked tonsillar hypertrophy, previous surgical procedures for snoring, and significant OSA. Complete cessation or a significant reduction in snoring was reported by 92 of patients or bed partners. However, the rate of snoring...

Pretransplant Treatment

Ideally, before transplantation, all active dental disease should be treated and acute and chronic infection eradicated. Impacted, periodontally involved and unrestorable teeth should be extracted. Nonvital teeth and those with periapical pathology should be endodontically treated or if a predictably successful outcome cannot be guaranteed, then extracted. Meticulous oral hygiene regimes should be established, taught and constantly reinforced for all patients.

Consequences of Cigarette Smoke Induced Microvascular Dysfunction

Most smoke-related diseases point toward effects on the microcirculation. For one, the development of pulmonary emphysema occurs at the microcirculatory level of the delicate alveolar membranes, presumably due to a dysbalance between aggressive factors such as tissue degrading mediators and reactive oxygen species released from smoke-activated neutrophils (i.e., elastase, hydrolytic enzymes) and protective factors such as a-1 antiprotease, which are inactivated by cigarette smoke. Also, the association of cigarette smoking and chronic inflammatory conditions such as periodontal disease is a largely microcirculatory phenomenon that involves phagocyte dysfunction and other pathomech-anisms. Another important problem related to cigarette smoking-induced microcirculatory dysfunction is of major concern to plastic surgeons. There is an impressive literature on the adverse effects of cigarette smoking on the outcome after surgical interventions, such as (i) a significantly higher incidence...

Neutropenia

Defined as a neutrophil count < 2.0 x 109 L. The risk of infective complications is closely related to the absolute neutrophil count. More severe when neutropenia is due to impaired production from chemotherapy or marrow failure rather than to peripheral destruction or maturation arrest where there is often a cellular marrow with early neutrophil precursors and normal monocyte counts. Type of infection determined by the degree and duration of neutropenia. Ongoing chemotherapy further increases the risk of serious bacterial and fungal opportunistic infection and the presence of an indwelling intravenous catheter increases the incidence of infection with coagulase-negative staphylococci and other skin commensals. Patients with chronic immune neutropenia may develop recurrent stomatitis, gingivitis, oral ulceration, sinusitis and peri-anal infection.

Biguanides

Chlorhexidine, the most effective of a group of chemicals called biguanides, is extensively used in antiseptic products. It adheres to and persists on skin and mucous membranes, is of relatively low toxicity, and destroys a wide range of microbes, including vegetative bacteria, fungi, and some enveloped viruses. Chlorhexidine is an ingredient in a multitude of products including antiseptic skin creams, disinfectants, and mouthwash-es. In the 1990s the FDA approved the use of chlorhexidine-impregnated catheters and implanted surgical mesh. Even tiny chips have been developed that can be inserted into periodon-tal pockets, where they slowly release chlorhexidine to treat periodontal gum disease. Adverse side effects of chlorhexidine are rare, but severe allergic reactions have been reported.

Overview

Sugar abuse is also an important factor causing many people to be seriously overweight. Periodontitis, or gum disease, has also been shown to be independently associated with a greater incidence of heart disease. Saito et al. showed that obesity appears to increase the risk of having this kind of gum disease.2 It would appear that at least one way in which sugar can affect the incidence of heart disease is in its ability to cause the obesity that is positively associated with the periodontitis.

Lichen Planus

Sometimes involvement of the gingiva may be the predominant or only manifestation of lichen planus. As such, it needs to be distinguished from a variety of other inflammatory gingival conditions. The most common appearance is gingival atrophy and the epithelial thinning leads to a shiny, red, smooth appearance. This is known clinically as desquamative gingivitis. It is important to appreciate that desquamative gingivitis is a clinical, descriptive term and not a diagnosis. Diseases other than lichen planus that can produce this appearance include mucous membrane pemphigoid, pemphigus and a condition called plasma cell gingivitis that is probably allergy based. Unlike marginal gingivitis, the inflammation can extend onto the alveolar mucosa, but in the absence of secondary plaque accumulation there is usually sparing of the marginal gingiva and interdental papillae. The condition may be generalised or only patch-ily distributed. Also, for unknown reasons, it is rare on the lingual and...

M J Tenerelli

There was a time when toothpaste cleaned your teeth and mouthwash freshened your breath, and that was that. Not anymore. Today, oral care products promise at least two, if not three or four, different ways to bolster your oral health and beautify your face. Toothpastes that clean also battle gum disease and turn pearly whites whiter. Mouthwash fights plaque as well as halitosis. These innovations in oral care products are a direct response to the busy modern consumer, who wants one product to do effectively as many things as possible. While toothpastes and mouthwash share some basic ingredients, the special extra functions they endeavor to provide call for different and specific ingredients for each formulation.

Oral Health

Diabetes adversely affects oral health, increasing the risk of gingivitis and other oral infections. Gingivitis is a major cause of tooth loss and pain that can affect oral intake. Saliva flow protects against dental caries but age, drugs and diseases can reduce this. Poor oral and dental health is linked with chewing difficulties that can cause malnutrition, poor general health and reduced quality of life (45,46).

Figure 421

The dental plaque above the gingival margin of the tooth is designated as supragingival, and the dental plaque below the gingival margin (i.e., in the gingival sulcus or pocket) is called subgingival. Gingivitis can be experimentally induced in an uninflamed periodontium by allowing the unimpeded accumulation of supragingi-val plaque and is reversed completely by the thorough and complete removal of supragingival plaque. Gingivitis is due principally to the accumulation and retention of plaque at or near the gingival margin. The accumulation of supragingival plaque is also a prime influence in the development of subgingival plaque. As undisturbed plaque matures, it changes in composition and becomes more complex. A bacterial succession occurs whereby microorganisms associated with gingival health, that is, gram-positive rods and cocci, are replaced by microorganisms associated with gingivitis, that is, gram-negative rods and cocci, as well as spiral organisms and spirochetes. As a...

Essential Oils

Essential oils may reduce plaque levels by inhibiting bacterial enzymes and by reducing pathogenicity of plaque via reduction of the amount of endotoxin the alcohol is probably responsible for denaturing bacterial cell walls. The substantivity of Listerine appears to be quite low, and therefore, it must be used at least twice a day to be effective. A variety of clinical studies have demonstrated that Listerine is capable of reducing plaque and gingivitis over extended periods however, the degree of reduction is variable. Listerine will reduce plaque and gingivitis anywhere from 14.9 to 20.8 and 6.5 to 27.7 , respectively (Table 42.1). Adverse reactions include a bitter taste and burning sensation in the oral cavity. Regular use of high-alcohol rinses can aggravate existing oral lesions and desiccate mucous membranes. In addition to Listerine, a huge number of American Dental Society (ADA) approved generic equivalents available over the counter.

Fluorides

Ing water (1 mg L), tablets (0.25-1 mg), drops (0.125-0.5 mg), topical application by mouthwashes (200-1,000 mg L), gels for home use (900 mg kg) and professional use (9,000-19,000 mg kg), and dentifrices (1,000 mg kg). In contrast to the efficacy of fluorides in preventing carious lesions, these formulations have relatively poor antibacterial properties (Table 42.1).The weak therapeutic benefit of fluorides on gingivitis is due to a modest inhibition of glycolysis in plaque bacteria. Sodium fluoride, monofluorophosphate, and stannous fluoride are the compounds used in topically applied agents.

Toothpaste

The FDA approved Colgate Total, the first toothpaste containing an antibacterial agent (0.3 Triclosan) and the first dentifrice clinically proven to help fight gum disease (gingivitis) in adults (the clinical study did not involve children). Colgate conducted studies that showed that Total (in combination with chloride) reduced plaque by 11.9 in the first trial and 9.3 in the second. This equates to a reduction in gum disease by 19.3 and 29.0 , respectively. It is not fully understood how Triclosan works in your mouth. Triclosan is considered to be a drug, and all new toothpastes containing it must be approved by the FDA.

Dental Infections

Another very significant source of dental infective toxicity comes from periodontal disease, or disease of the gums. Chronic gum disease can harbor the same types of bacteria that are seen with root canals, and the same types of extremely potent anaerobic bacterial toxins can result. Scannapieco and Genco outlined the evidence supporting the association between periodontal disease and both heart and lung disease.3 Beck et al. also demonstrated that periodontal disease is probably a significant risk factor for both heart attack and stroke.4 Interestingly, smoking, which has long been recognized as a risk factor for heart attack, is also the single best way to assure the eventual development of periodontal disease. Perhaps one of the main ways that smoking causes heart disease is by causing periodontal disease with all of its infective toxicity. Aside from avoiding smoking and taking large doses of vitamin C, the regular use of a dental water irrigation device with some hydrogen...

Microcheck 243

Periodontal disease is a chronic condition, caused by plaque at the gum margin, that can lead to loosening of teeth. Trench mouth is an acute illness with destruction of gingival tissue. Chronic infection by Helicobacter pylori is a key factor in the development of gastric and duodenal ulcers and gastric cancer.

ICDO code97343

Oral involvement occurs in 10 of patients with Langerhans cell histiocytosis (LCH). 78 of these patients have eosinophilic granulomas clinically, while the rest have multifocal multisystem disease 1021 . Common oral symptoms include swelling, pain, gingivitis, loose teeth and ulceration. The majority of patients with intraoral lesions have intraosseous lesions in the jaw bone, more commonly in the mandible. The intraoral soft tissues may be secondarily affected, especially the gingiva, but the palate, floor of mouth, buccal mucosa and tonsil can also be involved 1021, 2043 . In a minority of patients with intraoral soft tissue involvement, there is no

Percussion

Lateral Mirror Intraoral

FIG. 1-4 Percussion test to determine whether there is any apical periodontitis. If the patient has reported pain during mastication, the percussion test should be conducted very gently. A, First only the index finger should be used. The teeth should be percussed from a facial as well as an incisal direction. B, If the patient reports no tenderness when the teeth are percussed with the finger, a more definitive, sharper percussion can be conducted with the handle of the mouth mirror. FIG. 1-4 Percussion test to determine whether there is any apical periodontitis. If the patient has reported pain during mastication, the percussion test should be conducted very gently. A, First only the index finger should be used. The teeth should be percussed from a facial as well as an incisal direction. B, If the patient reports no tenderness when the teeth are percussed with the finger, a more definitive, sharper percussion can be conducted with the handle of the mouth mirror. The pressure exerted...

Crohns Disease

Oral lesions are relatively common in patients with Crohn's disease of the lower gastro-intestinal tract 57, 185 , but may be the presenting symptoms. They include swelling of the lips and cheeks (Fig. 3.17), recurrent aphthae, painful, indolent linear ulcers in the vestibular sul-ci, cobblestone thickening of the buccal mucosa, mucosal tags and hyperplastic, granular gingivitis 138 . The palate, tongue and pharynx, including the palatine ton

Figure 422

The previous routine treatment for cases of severe gingival disease consisted of calculus and plaque removal and oral hygiene instructions. Subsequent resolution of the gingival inflammation was largely dependent on daily plaque control by the patient. However, the use of a 0.1 to 0.2 chlorhexidine mouthwash supplementing daily plaque control will facilitate the patient's effort to fight new plaque formation and to resolve gingivitis. Consequently, use of chlorhexidine is indicated in the following situations in disinfection of the oral cavity before dental treatment as an adjunct during initial therapy, especially in cases of local and general aggressive periodontitis and in handicapped patients.

Future Directions

Today gingivitis and periodontitis are prevented principally through mechanical plaque control however, dentition free of supragingival and subgingival plaque is extremely difficult to accomplish and maintain. On an annual basis, Americans spend more than 750 million on oral rinsing agents, although few effective plaque-inhibiting oral rinses are available and many are associated with side effects that prohibit long-term use.

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