Download - MODULE 1 Content
-
8/12/2019 MODULE 1 Content
1/33
1
CHAPTER I
INTRODUCTION
1.1 Background
Dental and oral health is something that should be viewed upon as something
of a significant matter, as they contribute to a persons overall health. Dental and
oral problems could lead to unwanted pain and it can even interfere with ones
social life. Pain in the teeth can be caused by a number of different factors, such
as lack of hygiene in the oral cavity, lack of visits to the dentist, and lack of
knowledge that can lead to bad habits. These factors are usually common among
teenagers, especially teenage boys, who usually have plenty to do and have a high
curiosity on things that can be detrimental to their health.
Dental pain can be caused by several reasons, such as sensitive teeth (dentine
hypersensitivity) and dental caries. Dental pain can usually be attributed to a sharp
and painful feeling in the oral cavity that may be constant or not, sometimes the
victim suffers from a fever or a headache that may be caused by the everlasting
pain. Dental pain could be made worse due to complications in the periodontal
tissue, periodontal issues can include gingivitis and periodontitis. Bad breath, or
halitosis may also occur due to poor oral hygiene. All of these complications that
happen within the oral cavity can easily be avoided just by taking simple
measures that can maintain the homeostasis within the oral cavity.
Diseases in the mouth area can also have an effect on someones social life,
especially on a teens social life. Teenagers can be attributed with wanting a lot of
friends, but when dental and oral problems occur, these problems can inhibit the
teens social interaction. Problems that can be seen on a teen with poor oral
hygiene is the yellowing of teeth or usually called tooth discoloration, and bad
breath or sometimes called halitosis. These two problems can cause the teenager
to have a low-self esteem since he or she will be shunned by his friends for having
these dental/oral problems.
-
8/12/2019 MODULE 1 Content
2/33
2
There are also habits that can exacerbate a persons overall dental/oral health.
These so called bad habits can be lacking the common decency to have an
occasional check-up to the dentist and picking up life-threatening choices, such as
smoking. Teenagers whom are ignorant of their dental/oral health will usually not
bother going to the dentist, this causes them to lack knowledge of what is going
on within their own mouth. The teenager could have a high buildup of plaque,
which is usually a source of many dental problems, and not even know it since he
does not check-up with the dentist regularly. Smoking also worsens dental/oral
health in that in can cause discoloration of the tooth, halitosis, and even receding
gums due to alveolar bone loss.
1.2 The Purpose of Discussion
The purpose of this discussion is to know what happens in the oral cavity
of the 19 year old smoker boy whom feels pain when he consumes hot or cold
drinks and/or hot or cold foods, also with all the boys friends avoiding him
whenever he talks. The boy is also afraid of visiting the dentist, so he never or
barely checks his oral hygine.
-
8/12/2019 MODULE 1 Content
3/33
3
CHAPTER II
REVIEW OF LITERATURE
2.1 Nineteen Years Old Boy
Adolescence is the most critical time period for the human development.
At this time, both teenage boys and girls experience growth in the form of
physical and psychological changes. Adolescents also experience emotional
changes which is apparent in the form attitude and behavior. Personality
development during this period is affected by their parents and familys
environment, as well as the schoolsenvironment. Other influences can stem from
the rapid advances in information technology, both print and electronic media.
Insight and knowledge of these things will affect the process of searching for
these teenagers identity. Most women (95% of total population) reached puberty
between the ages of 9-16 years, while the majority of men (95% of total
population) reached puberty between the ages of 10-19 years (Brooks-Gunn &
Reiter, 1990).
2.1.1 Physical Changes of BoysMen have testosterone which helps the growth of hairs around the armpits,
male genitals, and the face (beard, moustache, goatee, etc), and also changes in
their voices, acne formation, and sperm production at certain times that can come
out as a wet dream. Other changes include:
Weight and height increase Start to sweat more Skin becomes oily, sometimes with pimples and acne Hands, feet, arms, and legs become larger Hair grows under arms, pubic areas, legs, chest, and face Voice will break and deepen Shoulders and chest broaden Penis and testes continue to enlarge and lengthen Perspiration increases and body odor may appear
-
8/12/2019 MODULE 1 Content
4/33
4
2.1.2 Psychological Changes in BoysBeside physical changes, boys also experience the psychological changes,
such as:
Showing strong feelings Thinking more about right and wrong things Capable of thinking rationally and more complex Attracted or having relationship with girls Having mood swings Parents are no longer welcome to accompany in public More self-conscious
2.1.3 Social Changes in BoysThese changes occur as a consequence of the effect of increasing maturity
and the way of thinking and acting upon others or the environment. However,
these changes are sometimes plunged in the wrong direction.1
Some social changes experienced by men:
Searching for identity Boys will usually have more freedom than girls Looking for new experiences, especially when it turns to be a trend
(Smoking, taking drugs, etc.)
Seeking more independence Take and do risky or challenging things
2.1.4 Mens Periodontal HealthMens periodontal health may be poorer than that of women due to their
lack of action when it comes to oral hygiene. Research published in the Journal of
Periodontology found that women are almost twice as likely as men to have
received a regular dental check-up in the past year, and women were more likely
than men to schedule suggested treatment following those dental check-ups.
Furthermore, men have worse indicators of periodontal health than women,
including higher incidence of dental plaque, tartar, and bleeding on probing. This
may be because women are three times more likely to floss every day than men2
-
8/12/2019 MODULE 1 Content
5/33
5
2.2 Smoking Habit
2.2.1 Tobacco Smoking
Figure 2.2.1
It is well known that tobacco contributes to the development of health
problem, including oral health. Tobacco contains chemicals that are harmful to the
human body and the smoking or chewing of tobacco is the cause of 8090% of
oral cancers. Other oral consequences of tobacco consumption include increased
risk of periodontal disease, bad breath, tooth discoloration, an increased buildup
of dental plaque, and delayed healing following tooth extraction, periodontaltreatment or oral surgery. Smoking is a risk factor for several types of diseases,
both locally and systemic. Tar, nicotine, and carbon monoxide are three kinds of
the most dangerous chemicals in cigarette smoke. Tobacco usage produces
harmful effects on every structure in the mouth such as staining teeth and slowing
down dental restoration (healing), tooth decay, periodontal disease, hairy tongue,
taste derangement, halitosis, premalignant lesion, oral cancer etc. The
pathogenesis of these oral lesion most likely result from the many irritants of the
tobacco, and also carcinogens from burning tobacco, but also arrive from the
drying of the mucosa by the high intra oral temperature, pH change, alteration in
immune response or altered resistance to infection. Most of these lesions are
reversible after tobacco cessation. 5
Smoking can cause a decrease in the acidity of saliva, lower buffering
capacity, also reduction of saliva which results in the increase of streptococcus
cariogenic that may increase the incidence of dental caries. Smoking not only
-
8/12/2019 MODULE 1 Content
6/33
6
causes systemic effects, but also can cause pathological conditions in the oral
cavity. Teeth and soft tissue in the oral cavity, are parts that can be damaged by
smoking. Periodontal disease, caries, tooth loss, gingival recession, pre-cancerous
lesions, oral cancer, as well as implant failure, are cases that can arise from
habitual smoking. The emergence of a variety of local and systemic pathological
conditions in the oral cavity are caused by the decrease in the function of the
molecule, including saliva.5
2.2.2. Oral Cavity
The oral cavity is the easiest area that can be exposed by the effects of
smoking, because it is the site of absorption of the main results of the burning
cigarette. Toxic components in cigarettes can irritate the soft tissues of the oral
cavity, cause mucosal infection, cause dry socket, cause slow-healing wounds,
weaken the ability of phagocytosis, suppress the proliferation of osteoblasts, and
can also reduce the intake of blood flow to the gingiva.6
2.2.3. Tooth Staining
Smoking can cause an external tooth discoloration. At first, this stain was
initially thought to be due of nicotine reaction. But actually, this was the effects oftobacco combustion products called tar. Nicotine itself is colorless and soluble.
The stain is easily cleaned by a dentist because it just being in the outer surface of
the teeth. But to a person who smokes cigarettes for a very long time, the stain
could sink in the deeper part of the enamel layer and can be hard to clean
permanently. 5
Figure 2.2.3
There are three main types of tooth discoloration:
1. Extrinsic discoloration, This occurs when the outer layer of the tooth(the enamel) is stained. Coffee, wine, cola or other drinks or foods can
stain teeth. Smoking also causes extrinsic stains.
-
8/12/2019 MODULE 1 Content
7/33
7
2. Intrinsic discoloration, This is when the inner structure of the tooth(the dentin) darkens or gets a yellow tint. The person can get this type
of discoloration if:
The person had too much exposure to fluoride during earlychildhood.
The persons mother used tetracycline antibiotics during the secondhalf of pregnancy.
The person used tetracycline antibiotics when you were 8 years oldor younger.
The person had trauma that affected a tooth when you were ayoung child. A fall, for example, may damage the developing
permanent tooth.
The person had trauma in a permanent tooth, and internal bleedingdiscolored the tooth.
The person were born with a rare condition called dentinogenesisimperfecta. This causes gray, amber or purple discolorations.
3. Age-related discoloration, This is a combination of extrinsic andintrinsic factors. Dentin naturally yellows over time. The enamel that
covers the teeth gets thinner with age, which allows the dentin to show
through. Foods and smoking also can stain teeth as people get older.
Finally, chips or other injuries can discolor a tooth, especially when
the pulp has been damaged.
2.2.4. Periodontal and Gum Disease
Oral soft tissue abnormalities can happen due to toxic components and
carcinogenic agent contained in cigarette smoke, these abnormalities include
erythroplakia, leukoplakia, smokers keratosis, squamous cell carcinoma, and
verrucous carcinoma. Smoker's keratosis is a white patch in the roof of the mouth
(palate) of someone who is a smoker, these usually comes about from chronic
contact with tobacco smoke. Smoking can stimulate melanocytes to produce
melanin oral mucosa redundant. Melanin is then deposited on the basal cell layer
of the mucosa, resulting in brown pigmentation of the buccal mucosa and gingiva,
-
8/12/2019 MODULE 1 Content
8/33
8
known as smokers melanosis. Other pathological conditions in the oral cavity
often found in smokers are root caries, halitosis, periimplantitis, impairment of
taste, staining of the teeth or restorations, as well as periodontal disease.
Periodontal diseases include the accumulation of plaque and calculus, periodontal
pockets, gingival inflammation, gingival recession, and alveolar bone loss. Side
effects of tobacco to periodontal tissue are related to the quantity of cigarette
consumption per day and duration of smoking. Epidemiological study has proved
that smoking is the main factor of periodontal disease.
Figure 2.2.4
Nicotine, as the result of cigarette combustion causes the abnormal
condition of the blood vessel called vasoconstriction, although some form of
vasoconstriction appear normally on the human body, vasoconstriction due to
nicotine can be permanent. Blood vessels act as a nutrient and oxygen transporter,
which is mainly responsible for wound healing process. Nicotine also causes the
formation of periodontal pocket, reduces saliva production, causes halitosis, and
can increase the risk of gingivitis. Periodontal tissue disease due to smoking
begins with the accumulation of plaque on the teeth and gingiva. Tar buildup on
the teeth, in addition to causing aesthetic problems, also causes tooth surface to
become rough, making it easy for plaque to cling on. The accumulation of plaque
on the gingival margin, exacerbated by conditions of poor oral hygiene, and the
change of gingival vascularization caused by smoking causes gingival
inflammation. Untreated gingivitis, can progress to periodontitis as a result of
bacterial invasion of chronic plaque below the gingival margin, followed by
accumulation of chronic inflammatory cells, causing loss of collagen in the
-
8/12/2019 MODULE 1 Content
9/33
9
gingival connective tissue exposed. The loss of gingival attachment to the tooth,
causes gingival recession, resulting in root caries risk. Alveolar bone and tooth
loss is the most severe condition of periodontitis.
2.2.5 Tongue
Figure 2.2.5
Smoking also stimulates the filliformis papillae to become longer. The
combustion of cigarette produce a brown colored substance which is easily
deposited on the tongue papillae, that is why it is harder for smokers to taste
sweet, bitter, and also salty foods because of the sensoric nerve ending
dysfunction of the taste buds. This condition is called by black hairy tongue.
Black hairy tongue is only found on the top of the tongue, and it usually starts in
the back and progresses towards the tip of the tongue as it grows. The treatment of
hairy tongue is variable. In many cases, simply brushing the tongue with a
toothbrush or using a commercially available tongue scraper is sufficient to
remove elongated filiform papillae and retard the growth of additional ones.ue is
perfectly harmless and only temporary.4
2.2.6. Delayed Wound Healing
Wounds result from many things such as burns, surgery, scraping your
knee, or infections.When a wound occurs, the immune system sends out many
healing factors through the blood vessels to the wound to help it heal. Oxygen we
breath is also sent to the wound through our blood vessels to help the wound heal.
When the wound healing process is complete, the new skin and/or scar tissue
functions as a new covering to protect us from future injuries.5
Research shows that smoking can also cause vasoconstriction of blood
vessels. This may be influenced by the degree of inhalation of cigarette smoke and
-
8/12/2019 MODULE 1 Content
10/33
10
nicotine absorption into the tissues. Vasoconstriction of blood vessels can reduce
blood flow and gingival sulcus fluid, resulting in reduced supply of oxygen and
nutrients to the tissues, carbon monoxide in cigarettes can increase blood pressure
that will have an effect on hemoglobin switching systems. Carbon monoxide have
an affinity with hemoglobin around two hundred times stronger than the affinity
of oxygen to hemoglobin, this can inhibit wound healing.5
2.2.7. Oral Cancer
The changing condition in the mouth cavity is caused by the toxic
contained within tobacco or because of constant irritation that comes from the
burning of tobacco products that cause drying of the oral mucosa, intra oral
temperature increases, change in pH in the mouth, change in the immune
response, or change in resistance to infection, especially viral and fungal
infections. Irritation from tobacco smoke invade mucosal epithelial cells that
increased cellular activity, keratotic changes, the epithelium becomes thicker
white and gray on the mucosa of the mouth buccal. Smoking is a predisposing
factor, can increase the likelihood of oral cancer about 2-4 times. Tar carcinogenic
substance chronic irritation causes changes in the basic structure of early oral
mucosal epithelium, such as desquamation, atrophy, keratosis, and can even cause
epithelial dysplasia that have a malignancy. Oral cancer begins with mucosal
changes that are not accompanied by pain. 4,5
Figure 2.2.7
When signs and symptoms do appear, the typically include:
Patches on the lining of the mouth or tongue, usually red or red andwhite in color.
Mouth ulcers that do not go away. A sore that does not heal.
-
8/12/2019 MODULE 1 Content
11/33
11
A swelling in the mouth that persists for over three weeks. A lump or thickening of the skin or lining of the mouth. Pain when swallowing. Loosening teeth (tooth) for no clear reason. Dentures don't fit properly. Jaw pain. Jaw stiffness. Sore throat. A sensation that something is stuck in your throat. Painful tongue. A hoarse voice. Pain in the neck that does not go away.
2.3 Toothache
A toothache, also known as odontalgia or, less frequently, as odontalgy is
a painful feeling in or around the tooth.8It can be caused by a number of factors,
such as:
Tooth decay Abscess tooth Fractured tooth Damaged filling Infected gums Sensitive teeth
In most cases, a toothache is caused mostly by problems within the jaw.
2.3.1 Toothache SymptomsSymptoms of toothache may include the following:
Tooth pain that may be sharp, throbbing, or constant. In some people,pain results when pressure is applied to the tooth (i.e, Sensitive Teeth)
Swelling around the tooth A Fever or a headache Foul tasting drainage from the infected tooth
-
8/12/2019 MODULE 1 Content
12/33
12
Because the symptoms of a toothache may resemble other medical
conditions or dental problems, it can be difficult to diagnose the cause without a
complete evaluation by a dentist.
Figure 2.3.1 A person with a toothache
2.3.2 PlaquePlaque is a soft, sticky film that builds up on your teeth and contains
millions of bacteria. The bacteria in plaque cause tooth decay and gum disease if
they are not removed regularly through brushing and flossing.9
When you eat, the bacteria in plaque use the sugars in your food to
produce acids that eat away at the tooth enamel. Repeated attacks cause the
enamel to break down, eventually resulting in a cavity (or hole) in the tooth
surface.Plaque that is not removed daily by brushing and flossing between teeth
can eventually harden into tartar. Brushing and flossing become more difficult as
tartar collects at the gum line. As the tartar, plaque and bacteria continue to
increase, the gum tissue can become red, swollen and possibly bleed when you
brush your teeth. This is called gingivitis, an early stage of gum (periodontal)
disease.
If plaque is allowed to remain on your teeth and harden, bigger problems
to ones oral health can arise; this can happen after just 26 hours. When this
happens, the plaque hardens into tartar, or dental calculus. Because it has
mineralized onto your teeth, tartar is far more difficult to remove than
plaque.Once tartar forms on teeth, it may be more difficult to brush and floss it off
the teeth effectively. If this is the case, the acids released by the bacteria in your
mouth are more likely to break down tooth enamel. That leads to cavities and
-
8/12/2019 MODULE 1 Content
13/33
13
tooth decay. The CDC estimates that more than 90% of adults over the age of 40
have some form of tooth decay.
Tartar that develops above the gum line can be especially serious. That's
because the bacteria it harbors may irritate and damage gums. Over time, this
inflammation can lead to progressivegum disease.Gum disease can have serious
consequences if left untreated. According to the CDC, between 5% and 11% of
adults are affected by advanced gum disease.9
Since plaque is constantly growing in your mouth, the best way to remove
it and to prevent tartar build-up is to brush and floss ones teeth every day.
Dental plaque is usually broadly classified as supra-gingival plaque, even
though it can be divided into two categories; these two categories are, as
mentioned before, supra-gingival plaque and sub-gingival plaque. Supra-gingival
plaque is found at or above the gingival margin; the supra-gingival plaque in
direct contact with the gingival margin is referred to as marginal plaque. Sub-
gingival plaque is found below the gingival margin, between the tooth and the
gingival sulcular tissue.10
The different regions of plaque are significant to different processes
associated with diseases of the teeth and periodontium. For example, marginal
plaque can lead to gingivitis. Supra-gingival plaque and tooth-associated sub-
gingival plaque are critical in calculus formation and root caries. Sub-gingival
plaque can lead to soft tissue destruction which will eventually lead to different
forms of periodontitis.7
According to a study done by the Forsyth Institute in Boston,
Porphyromonasgingivalis, Bacteroidesforsythus and Treponemadenticola could
be detected in supragingival plaque samples of both healthy and periodontitis
subjects. Actinomyces species were the dominant taxa in both supra- and
subgingival plaque from healthy and periodontitis subjects.11Actinomyces species
accounted for 63.2%, of supragingival and 47.2% of subgingival plaque in healthy
subjects and 48.% and 37.8% in periodontitis subjects respectively. Increased
proportions of P. gingivalis, B. forsythus, and species of Prevotella,
http://www.webmd.com/oral-health/tc/gum-disease-topic-overviewhttp://www.webmd.com/oral-health/tc/gum-disease-topic-overview -
8/12/2019 MODULE 1 Content
14/33
14
Fusobacterium, Campylobacter and Treponema were detected subgingivally in the
periodontitis subjects. P. gingivalis, B. forsythus and T. denticola were
significantly more prevalent in both supra- and subgingival plaque samples from
periodontitis subjects.The main differences between supra and subgingival plaque
as well as between health and disease were in the proportions and to some extent
levels of Actinomyces, "orange" and "red" complex species.11
2.3.3 Tooth Decay (Dental Caries)
Tooth decay is the process that results in acavity (dental caries). It occurs
when bacteria in your mouth make acids that eat away at a tooth. If not treated,
tooth decay cancause pain,infection, and tooth loss.
Another definition of tooth decay is an infection, bacterial in origin, that
causes demineralization of the hard tissues of the teeth; these include the enamel,
dentin, and cementum. It is usually a result of the production of acid by bacterial
fermentation of food debris accumulated on the tooth surface.7
Dental caries can come about in different ways, a persons mouth provides
a vast ecology for bacteria to thrive, bacteria which combine with small food
particles and saliva to form a sticky film known as plaque, which builds up on
your teeth just minutes after brushing; bacteria in plaque survives by digesting the
foods we eat, specifically the ones that are broken down into simple sugars
(monosaccharides). When a person consumes food and drink that are high in
carbohydrates (sugary or starchy), the bacteria in plaque turn the carbohydrates
into energy they need, producing acid at the same time. Over time, the acid in
plaque begins to break down the surface of your tooth. The plaque will first start
to erode the enamel. Over time, a small hole known as a cavity can develop on the
surface.11 This will cause a toothache.Once cavities have formed in the enamel,
the plaque and bacteria can reach the dentine; as the dentine is softer than the
enamel, the process of tooth decay speeds up as shown in figure 2.3.2.
http://www.webmd.com/hw-popup/cavitieshttp://www.webmd.com/pain-management/guide/pain-management-overview-factshttp://www.nhs.uk/conditions/toothache/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/toothache/Pages/Introduction.aspxhttp://www.webmd.com/pain-management/guide/pain-management-overview-factshttp://www.webmd.com/hw-popup/cavities -
8/12/2019 MODULE 1 Content
15/33
15
Figure 2.3.2
Without treatment, plaque and bacteria will enter the pulp. At this stage,
your nerves will be exposed to bacteria, making your tooth very painful. The
bacteria can also infect tissue within the pulp, causing pulpitis. Pulpitis is the
inflammation ofdental pulp tissue. The pulp contains the blood vessels the nerves
and connective tissue inside a tooth and provides the tooths blood and nutrients.
Pulpitis is mainly caused by bacteria infection which itself is a secondary
development of caries (tooth decay). It manifests itself in the form of a toothache.
Increased sensitivity tostimuli,specifically hot and cold, is a common symptom
of pulpitis. A prolonged throbbingpain may be associated with the
disease. However, pulpitis can also occur without any pain.12 When pulpitis
becomes worse, a necrotic pulp may form as seen in figure 2.3.3. Necrotic pulp is
a finding in dentistry to describedental pulp within atooth which has
becomenecrotic.It is a finding of interest todentists as the process of pulp death
may be painful causing, a toothache. Sequelae of a necrotic pulp includeacute
apical periodontitis,dental abscess orradicular cyst and discoloration of the tooth
that may requiretooth bleaching. Tests for a necrotic pulp include:vitality
testing using athermal test or anelectric pulp tester. Discoloration may be
visually obvious, or more subtle. Treatment usually involvesendodontics or
extraction.
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Dental_pulphttp://en.wikipedia.org/wiki/Toothachehttp://en.wikipedia.org/wiki/Stimulus_(physiology)http://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Dental_pulphttp://en.wikipedia.org/wiki/Toothhttp://en.wikipedia.org/wiki/Necrotichttp://en.wikipedia.org/wiki/Dentistshttp://en.wikipedia.org/wiki/Toothachehttp://en.wikipedia.org/w/index.php?title=Acute_apical_periodontitis&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Acute_apical_periodontitis&action=edit&redlink=1http://en.wikipedia.org/wiki/Dental_abscesshttp://en.wikipedia.org/wiki/Radicular_cysthttp://en.wikipedia.org/wiki/Tooth_bleachinghttp://en.wikipedia.org/w/index.php?title=Vitality_testing&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Vitality_testing&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Thermal_test&action=edit&redlink=1http://en.wikipedia.org/wiki/Electric_pulp_testhttp://en.wikipedia.org/wiki/Endodonticshttp://en.wikipedia.org/wiki/Endodonticshttp://en.wikipedia.org/wiki/Electric_pulp_testhttp://en.wikipedia.org/w/index.php?title=Thermal_test&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Vitality_testing&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Vitality_testing&action=edit&redlink=1http://en.wikipedia.org/wiki/Tooth_bleachinghttp://en.wikipedia.org/wiki/Radicular_cysthttp://en.wikipedia.org/wiki/Dental_abscesshttp://en.wikipedia.org/w/index.php?title=Acute_apical_periodontitis&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Acute_apical_periodontitis&action=edit&redlink=1http://en.wikipedia.org/wiki/Toothachehttp://en.wikipedia.org/wiki/Dentistshttp://en.wikipedia.org/wiki/Necrotichttp://en.wikipedia.org/wiki/Toothhttp://en.wikipedia.org/wiki/Dental_pulphttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Stimulus_(physiology)http://en.wikipedia.org/wiki/Toothachehttp://en.wikipedia.org/wiki/Dental_pulphttp://en.wikipedia.org/wiki/Inflammation -
8/12/2019 MODULE 1 Content
16/33
16
Figure 2.3.3
Tooth decay typically occurs in teeth at the back of your mouth, known as
molars and premolars. These are large flat teeth used to chew food. Due to their
size and shape, it is easy for particles of food to get stuck on and in between these
teeth. They are also harder to clean properly. It is more common for a front tooth
to be affected by tooth decay when it is touching another tooth alongside it.10
Factors that increase your risk of tooth decay include diet, poor oral
hygiene, smoking, and dry mouth. A diet that is high in carbohydrates increases
the risk of tooth decay. Poor oral hygiene also exacerbates tooth decay as plaque
develops and is not taken care of by brushing or flossing. Smoking interferes withthe production of saliva, saliva helps balance the effects of the acid produced by
plaque, wash away the bacteria in plaque, and also neutralizes the acid caused by
plaque. Smoking also contributes to dry mouth, people with dry mouth produces
lower levels of saliva. (Jamie Alexander, 2012)
2.3.4 Symptoms and Treatments of Tooth DecayAs we mentioned before, tooth decay is caused by the acids produced by
plaque, acids that can erode tooth enamel, dentin, and cementum. The symptoms
that are associated with tooth decay usually do not occur until a cavity forms or a
tooth becomes infected.14 When these occur, symptoms can include:
Toothache, which is the most common symptom. An infection or irritation ofthe toothpulp usually causes the pain.
Bad breath or a foul taste in the mouth. White, gray, brown, or black spots on the teeth.
http://www.webmd.com/hw-popup/pulp-dentalhttp://www.webmd.com/oral-health/guide/webmd-medical-reference-collaboration-cleveland-clinic-dental-health-bad-breathhttp://www.webmd.com/oral-health/guide/webmd-medical-reference-collaboration-cleveland-clinic-dental-health-bad-breathhttp://www.webmd.com/hw-popup/pulp-dental -
8/12/2019 MODULE 1 Content
17/33
17
Loosefillings. Abroken tooth or a tooth that is sensitive to pressure.
The pain may become worse, when someone:
Eat sweets. Eat hot or cold foods or drink hot, cold, or acidic liquids, such as citrus
drinks.
Chew food or gum. Breathe in cold air. Brush your teeth.
Treatment for tooth decay depends on how bad it is. One may be able to
reverse slight tooth decay by using fluoride. To fix cavities caused by mild tooth
decay, a dentist will fill the cavities with another substance (fillings)as seen in
figure 2.3.4. For more severe tooth decay, one may need acrown orroot canal.In
extreme cases, your dentist may have to remove the tooth.
Figure 2.3.4
2.3.5 Sensitive Teeth: Causes and TreatmentsSensitive teeth, or dentine hypersensitivity is similar to tooth decay in that
the victim feels pain, but it is different because the pain only arises when pressure
is applied to the sensitive tooth/teeth (e.g hot/cold food and drinks). Although it
can be said that tooth decay increases the sensitivity of the decayed tooth to its
surroundings. Sensitive teeth usually occurs when the enamel is eroded, thus
exposing the dentin, or because the roots of the tooth are exposed, which also
http://www.webmd.com/hw-popup/dental-filling-restorationhttp://www.webmd.com/oral-health/guide/repairing-a-chipped-or-broken-toothhttp://www.webmd.com/hw-popup/dental-filling-restorationhttp://www.webmd.com/hw-popup/crownhttp://www.webmd.com/hw-popup/root-canal-treatmenthttp://www.webmd.com/hw-popup/root-canal-treatmenthttp://www.webmd.com/hw-popup/crownhttp://www.webmd.com/hw-popup/dental-filling-restorationhttp://www.webmd.com/oral-health/guide/repairing-a-chipped-or-broken-toothhttp://www.webmd.com/hw-popup/dental-filling-restoration -
8/12/2019 MODULE 1 Content
18/33
18
expose the dentin. The reason for this can be numerous, enamel can be eroded
from too much bleaching; roots can be exposed by overaggressive brushing, gum
recession, and periodontal disease.13
A layer of enamel, the strongest substance in the body, protects the crowns
of the healthy teeth. A layer called cementum protects the roots of the tooth under
the gum line. Underneath the enamel and the cementum is dentin, a part of the
tooth that is less dense than enamel or cementum.
The dentin contains microscopic tubules. When the dentin loses its
protective covering, the tubules allow heat and cold or acidic or sticky foods to
stimulate the nerves and cells inside the tooth as seen is figure 2.3.5. This causes
hypersensitivity and occasional discomfort when you chew, drink cold or hot
liquids, or when you breathe through your mouth.
Figure 2.3.5
Periodontal disease an infection of the gums and bone that support the
teeth also may be responsible. If periodontal disease is left untreated, gum
tissues can separate from the teeth and form spaces called pockets that provide a
home for bacteria. Periodontal disease can progress until the bone and other tooth-
supporting tissues are destroyed, leaving the root surfaces of teeth exposed.
Regular dental checkups are important so that tooth decay, periodontal disease
and other problems may be detected and treated in the early stages.13
-
8/12/2019 MODULE 1 Content
19/33
19
Sensitive teeth can be treated. Depending on the cause, dentists may
suggest that patients try desensitizing toothpaste, which contains compounds that
help block sensation traveling from the tooth surface to the nerve. Desensitizing
toothpaste usually requires several applications before the sensitivity is reduced.
If the desensitizing toothpaste does not ease the patients discomfort,
dentists may also suggest in office treatments. A fluoride gel or special
desensitizing agents may be applied to the sensitive areas of the affected teeth.
When these measures do not correct the problem, your dentist may recommend
other treatments, such as a filling, a crown, an inlay or bonding to correct a flaw
or decay that results in sensitivity. The type of treatment will depend on what is
causing the sensitivity.
If gum tissue has been lost from the root due to gum recession, a dentist
may recommend a surgical gum graft (figure 2.3.6) to cover the root, protect the
tooth and reduce sensitivity. In cases in which hypersensitivity is severe and
persistent and cannot be treated by other means, your dentist may recommend
endodontic (root canal) treatment to eliminate the problem
Figure 2.3.6
2.3.6 Periodontal Disease (Gingivitis and Periodontitis)Gingivitis,also generally calledgum disease or periodontal disease, begins
with bacterial growth in your mouth and may end -- if not properly treated -- with
tooth loss due to destruction of the tissue that surrounds your teeth.15
http://www.webmd.com/oral-health/guide/gingivitis-periodontal-diseasehttp://www.webmd.com/oral-health/tc/gum-disease-topic-overviewhttp://www.webmd.com/oral-health/tc/gum-disease-topic-overviewhttp://www.webmd.com/oral-health/guide/gingivitis-periodontal-disease -
8/12/2019 MODULE 1 Content
20/33
20
Gingivitis (gum inflammation) usually precedes periodontitis (gum
disease). However, it is important to know that not all gingivitis progresses to
periodontitis.16
In the early stage of gingivitis, bacteria inplaquebuilds up, causing the
gums to become inflamed and to easily bleed during tooth brushing. Although the
gums may be irritated, the teeth are still firmly planted in their sockets. No
irreversible bone or other tissue damage has occurred at this stage. The longer
plaque and tartar are on teeth, the more harmful they become. Gingivitis is a mild
form of gum disease that can usually be reversed with daily brushing and flossing,
and regular cleaning by a dentist or dental hygienist. This form of gum disease
does not include any loss of bone and tissue that hold teeth in place.16
Figure 2.3.7
When gingivitis is left untreated, it can advance to periodontitis as seen in
figure 2.3.7. In a person with periodontitis, the inner layer of the gum and bone
pull away from the teeth and form pockets. These small spaces between teeth and
gums collect debris and can become infected. The body's immune system fights
the bacteria as the plaque spreads and grows below the gum line.
Toxins or poisons -- produced by the bacteria in plaque as well as the
body's natural response enzymes involved in fighting infections -- start to break
down the bone and connective tissue that hold teeth in place. As the disease
progresses, the pockets deepen and more gum tissue and bone are destroyed. If
http://www.webmd.com/oral-health/guide/plaque-and-your-teethhttp://www.webmd.com/oral-health/guide/plaque-and-your-teeth -
8/12/2019 MODULE 1 Content
21/33
21
not treated, the bones, gums, and tissue that support the teeth are destroyed. The
teeth may eventually become loose and have to be removed .Gum disease is the
leading cause of tooth loss in adults.
Plaque is the primary cause of gum disease.15 However, other factors can
contribute to periodontal disease. These include:
Hormonal changes, such as those occurring duringpregnancy,puberty,menopause, and monthlymenstruation,make gums more sensitive, which
makes it easier for gingivitis to develop.
Illnesses may affect the condition of your gums. This includes diseasessuch ascancerorHIV that interfere with the immune system.
Becausediabetes affects the body's ability to use blood sugar, patients with
this disease are at higher risk of developing infections, including
periodontal disease and cavities.
Bad habits such assmoking make it harder for gum tissue to repair itself. Poor oral hygiene habits such as not brushing and flossing on a daily basis,
make it easier for gingivitis to develop.
Family history of dental disease can be a contributing factor for thedevelopment of gingivitis.
Gum disease may progress painlessly, producing few obvious signs, even in
the late stages of the disease. Although the symptoms of periodontal disease often
are subtle, the condition is not entirely without warning signs. Certain symptoms
may point to some form of the disease. The symptoms of gum disease include:
Gums that bleed during and after tooth brushing Red, swollen, or tender gums Persistentbad breath or bad taste in the mouth Receding gums Formation of deep pockets between teeth and gums Loose or shifting teeth
Even if the symptoms are unnoticeable, some form of gum disease. In some
people, gum disease may affect only certain teeth, such as the molars. Only a
http://www.webmd.com/baby/default.htmhttp://children.webmd.com/tc/growth-and-development-ages-11-to-14-years-what-to-expecthttp://women.webmd.com/tc/normal-menstrual-cycle-topic-overviewhttp://www.webmd.com/cancer/http://www.webmd.com/cancer/http://www.webmd.com/hiv-aids/default.htmhttp://diabetes.webmd.com/default.htmhttp://www.webmd.com/smoking-cessation/default.htmhttp://www.webmd.com/oral-health/guide/bad-breathhttp://www.webmd.com/oral-health/guide/bad-breathhttp://www.webmd.com/smoking-cessation/default.htmhttp://diabetes.webmd.com/default.htmhttp://www.webmd.com/hiv-aids/default.htmhttp://www.webmd.com/cancer/http://women.webmd.com/tc/normal-menstrual-cycle-topic-overviewhttp://children.webmd.com/tc/growth-and-development-ages-11-to-14-years-what-to-expecthttp://www.webmd.com/baby/default.htm -
8/12/2019 MODULE 1 Content
22/33
22
dentist or a periodontist can recognize and determine the progression of gum
disease.
2.4 Halitosis2.4.1. Introduction
Halitosis, oral malodor or fetor oris, commonly known as 'bad breath' is
defined as an unpleasant smell on the breath when the patient breathes out or
speaks, or when he or she wakes up in the morning. 17 Halitosis term originates
from the Latin "halitus" meaning "breath" and the Greek "osis" meaning
"abnormal" or "diseased".
The unpleasant smell of the breath mainly originates from VSCs,
especially hydrogen sulfide ( ), methylmercaptan ( ), and the most
important is dimethyl sulfide [ ]. However, when the saliva dries out on
the mucosal surfaces, other compounds in mouth air may also play role a role, for
example diamines (putrescine & cadaverine), indole, skatole, and volatile organic
acids (butyric or propionic acid). Most of these compunds are results from the
proteolytic degradation by oral microorganisms of peptides present in saliva.
Sulfur-containing or non-sulfur-containing amino acids, shed epithelium, food
debris, gingival crevicular fluid (GFC), interdental plaque, postnasal drip, and
blood. In particular, usually gram negative -- anaerobic bacteria poses such
preteolytic activity)
2.4.2. The Category of Halitosis
Halitosis can be divided into three categories, there are true halitosis,
pseudohalitosis, and halitophobia18
1. True halitosisReal halitosis can be further subdivided into physiological and
pathological halitosis. Physiologic halitosis includes halitosis caused by dietary
components, deleterious habits, morning breath, secondary to xerostomia caused
by physiologic factors. Pathologic halitosis occurs secondary to pathologic
conditions or oral tissues like gingival and periodontal diseases like periodontitis,
acute necrotizing ulcerative gingivitis, residual post-operative blood, debris under
dental appliances, ulcerative lesions of the oral cavity, Halitosis may be associated
-
8/12/2019 MODULE 1 Content
23/33
23
with a coated tongue, may occur due to xerostomia secondary to salivary gland
diseases, tonsilloliths.
2.
PseudohalitosisPatients who suffer from pseudohalitosis complain of the existence of
halitosis even though it is not perceived by others. This condition can be managed
effectively by counseling (using literature support, education and explanation of
examination results) and simple oral hygiene measures.
3. HalitophobiaSome individuals continue to insist that they have halitosis even after they
have been treated for genuine halitosis or pseudo-halitosis. Such individuals are
categorized as halitophobic. Halitophobia may be considered when no physical or
social evidence exists to suggest that halitosis is.20
2.4.3 The Causes of Halitosis
The cause of halitosis are diveded into physiologic halitosis and pathologic
halitosis. Physiologic halitosis caused by:
a. Lack of salivary flow during sleepSaliva is very important to maintain the freshness of your breath.
Production of saliva decreases during sleep, this may cause dry mouth and
bad breath.
b. The food
Oral malodor can occur due to the influence of food. Some types of foods
that can cause bad breath (Halitosis), which are sulfur-containing foods
-
8/12/2019 MODULE 1 Content
24/33
24
such as garlic, cabbage, broccoli and food that smells like MLA, in Curry,
and durian.
c.
Drinks or alcohol
Alcohol can reduce saliva production and also irritate the mouth tissue,
eventually making the drinker get aggravating bad breath.
d. Smoking habitSmoking may aggravate the health status of oral hygiene that can trigger
the onset of gingivitis and can result in the occurrence of bad breath.
e. Women in Menstrual periodMenstruation (menses) can make women experience bad breath (halitosis)
due to the reduction of saliva secretion in the mouth.
Pathologic halitosis can be caused by:
a. Poor Oral HygienePoor oral hygiene can trigger the onset of halitosis, leftover foods stuck on
the teeth can be very hard to clean, especially when using braces.
b. PlaquesPlaque is a soft deposits consisting of a collection of bacteria that breeds
on a matrix that is formed and attached tightly on the surface of the teeth,
plaque forms when someone ignores his or her dental/oral health.
c. Caries that leads to necrosisDental caries is a disease that may be caused by the interaction between 4
factors, there are: Hosts, Agent, Environment and Time, all of these
factors damage the hard tissue of teeth, namely the enamel, dentin and
-
8/12/2019 MODULE 1 Content
25/33
25
cementum. Caries may erode into the central of connective tissue core of a
tooth or dental pulp.causing necrosis of the pulp and infection.26 This
condition leads to gangren gass release that smells like corpse.
2.4.4. Plaque and Halitosis
Figure 2.5.4
Halitosis usually starts with plaque formation in teeth. Plaque formation is
divided into three stages: pellicle formation, bacterial adhesion (colonization) and
hardening. Pellicle formed when plaque, food debris and bacteria gather together.
The first stage of the plaque formation is pellicles attachment on the tooth
enamel. Pellicle is thin layer of saliva protein that attach immediately after we
brush our teeth. Pellicle has a role to protect email from acid activity. But, pellicle
makes the surface of tooth sticky, so the bacteria are easily attached to the tooth
especially the Streptococcus mutans bacterium and aldo Streptococcus sangius.
These bacteria produce a substance that stimulates the other free bacteria that
gather in the tooth. If plaque is not cleaned, it will accumulate, harden, and then
become tartar.
Even though what triggers bad breath is not clear, yet, most of the smell
comes from the food debris in the mouth. Actually in everybodys mouth well
always find bacteria, but, if the bacteria multiply in a large scale, it is a problem.
Most of these bacteria live between the teeth and are united with plaque and
caries, and also in the back of tongue. The bacteria produce toxins or poisons, by
outlining the leftovers and dead cells which are present in the mouth. These toxins
cause bad breath during exhale as the result of metabolism by anaerobic
-
8/12/2019 MODULE 1 Content
26/33
26
decomposition of food waste. And this decomposition produces sulfide and
ammonia compounds.
2.4.5 The Reduction of Saliva and HalitosisSaliva is a clear, watery liquid made by several glands in your mouth area.
Saliva is an important part of a healthy body. Saliva is mostly made of water and
it also contains important substances that ones body needs to digest food and
keep his or herteeth strong.28Saliva is important because it:
Keeps the mouth moist and comfortable Helps chew, taste, and swallow
Fights bacteria in plaque and preventsbad breath Has proteins and minerals that protect tooth enamel, preventtooth
decay and also prevents gum disease
Helps keepdentures securely in placeThe glands that make saliva are called salivary glands. The salivary glands
sit inside each cheek (Parotid Gland), at the bottom of your mouth (Sub-lingualis
Gland), and near your front teeth by the jaw bone (Sub-Mandibularis gland).
There are six major salivary glands and hundreds of minor ones. Saliva moves
through tubes called salivary ducts. Normally, the body is always making saliva,
up to 2 to 4 pints a day. Usually, the body makes the most saliva in the late
afternoon. It makes the least amount at night.
Certain diseases and medicines can affect how much saliva we can make.
If we do not make enough saliva, our mouth can become quite dry. This condition
is called dry mouth (xerostomia). Dry mouth causes the gums,tongue,and other
tissues in the mouth to become swollen and uncomfortable. Anaerobic bacteria
thrive in this type of setting. A high amount of anaerobic bacteria can leads to
halitosis.28Dry mouth also makes us more likely to develop rapid tooth decay and
gum (periodontal) disease. That's because saliva helps clear food particles from
our teeth. This helps reduce your risk forcavities.
http://www.webmd.com/oral-health/picture-of-the-teethhttp://www.webmd.com/oral-health/guide/bad-breathhttp://www.webmd.com/oral-health/tc/tooth-decay-topic-overviewhttp://www.webmd.com/oral-health/tc/tooth-decay-topic-overviewhttp://www.webmd.com/oral-health/dental-health-dentureshttp://www.webmd.com/oral-health/picture-of-the-tonguehttp://www.webmd.com/oral-health/guide/dental-health-cavitieshttp://www.webmd.com/oral-health/guide/dental-health-cavitieshttp://www.webmd.com/oral-health/picture-of-the-tonguehttp://www.webmd.com/oral-health/dental-health-dentureshttp://www.webmd.com/oral-health/tc/tooth-decay-topic-overviewhttp://www.webmd.com/oral-health/tc/tooth-decay-topic-overviewhttp://www.webmd.com/oral-health/guide/bad-breathhttp://www.webmd.com/oral-health/picture-of-the-teeth -
8/12/2019 MODULE 1 Content
27/33
27
Dry mouth is common in older adults, although the reasons are unclear.
Diseases that affect the whole body (systemic disorders), poornutrition,and the
use of certaindrugs are thought to play a key role.28
Too little saliva and dry mouth can be caused by:
Certain diseases such asHIV/AIDS, Sjogren's syndrome,diabetes, andParkinson's
Blockage in one or more tubes that drain saliva (salivary duct obstruction) Chemotherapy andradiation therapy Dehydration "Fight or flight" stress response Structural problem with a salivary duct Smoking cigarettes
2.5 Rarely Visit The Dentist
Dental fear and anxiety (DFA) refers to the fear of and anxiety towards
going to the dentist. It exists in a considerable proportion of children.24 Dental
fear and anxiety are major contributors to the reluctance of people across the
world to obtain dental services. The cost in human terms as a result of this fear
and anxiety is staggering: pain, swelling, lack of function, lack of esthetics,
missed time from work (and its attendant cost to business), lack of proper
nutrition, and medical complications arising from dental problems to name just a
few issues. While dental fear and anxiety are two of the foremost challenges
clinicians face in treating patients, strategies for managing fearful patients are not
widely agreed upon or considered standard, certainly not scientifically proven.
Understanding the root causes of dental fear with a view toward providing
management strategies short of sedation and general anesthesia has proven
elusive. In other words, there are no universally agreed upon and taught standards
that scientists are aware of for management of dental fear and anxiety short of
pharmacological means. This study was undertaken to statistically compare the
perceptions of doctors and patients with regard to very specific factors that might
cause dental fear and anxiety in adolescents and is a major dilemma in pediatric
dental practice.25
http://www.webmd.com/diet/old-diet-tochttp://www.webmd.com/drugs/index-drugs.aspxhttp://www.webmd.com/hiv-aids/default.htmhttp://diabetes.webmd.com/default.htmhttp://www.webmd.com/cancer/questions-answers-chemotherapyhttp://www.webmd.com/cancer/what-to-expect-from-radiation-therapyhttp://www.webmd.com/a-to-z-guides/dehydration-adultshttp://www.webmd.com/smoking-cessation/default.htmhttp://www.webmd.com/smoking-cessation/default.htmhttp://www.webmd.com/a-to-z-guides/dehydration-adultshttp://www.webmd.com/cancer/what-to-expect-from-radiation-therapyhttp://www.webmd.com/cancer/questions-answers-chemotherapyhttp://diabetes.webmd.com/default.htmhttp://www.webmd.com/hiv-aids/default.htmhttp://www.webmd.com/drugs/index-drugs.aspxhttp://www.webmd.com/diet/old-diet-toc -
8/12/2019 MODULE 1 Content
28/33
28
Fear of and anxiety towards going to dentists (ie, dental fear and anxiety,
DFA) are major problems for a sizeable proportion of children and adolescents.
The prevalence of DFA in children and adolescents ranges from 5-20% in various
countries, with some cases being considered to be dental phobia (severe DFA).
Children and adolescents with DFA are often uncooperative during dental visits,
thus rendering treatment difficult or impossible. Such behavior compromises the
treatment outcome, creates occupational stress among dental staff, and is often a
cause of discord between dental professionals and patients or their parents. Fearful
children and adolescents may try every possible means to avoid or delay
treatment, resulting in deterioration of their oral health. Beyond its impacts on
dental care, DFA may also cause sleep disorders, affect ones daily life and have a
negative impact on ones psychosocial functioning. DFA acquired in childhood
may persist to adulthood and is a significant predictor for avoidance of dental
visits in adulthood. This pinpoints childhood as a critical stage for preventing and
intercepting DFA, thereby assisting people to protect their oral health in the long
term.24
Previous studies into DFA draw predominantly upon quantitative
instruments such as questionnaires and psychometric scales. The development of
these instruments, however, is largely based on professionals presumptions and
thus may not capture the whole spectrum of respondents perceptions and views.
Moreover, quantitative methods that focus on generating statistics and testing
hypotheses may not be able to uncover complex mechanisms. Qualitative research
approach is therefore considered an important complement to quantitative
methods, especially for gathering in-depth information on human behavior and
reasons for such a behavior. Although qualitative studies do not aim to providedata that are statistically extra-palatable to a wide population, they can delineate a
wide range of views and experiences in peoples own words and rich contexts.24
To children and adolescents, a visit to the dentist may represent a
tremendous challenge. Often seen in, their immediate physical reactions, such as
crying piteously, screaming forcefully, and shivering uncontrollably. On the other
hand, psychological responses to DFA appeared as an amalgamation of worry,
upset, panic, feeling of helplessness, insecurity, resentment, and hatred towards
-
8/12/2019 MODULE 1 Content
29/33
29
dentists. Some teenagers explicitly expressed worry and panic towards dental
treatments by making a video and publishing it on social media. And then, in
fearful pediatric patients often refused to sit in the dental chair or open their
mouths for oral examination. Parents and dental teams have to struggle to
convince or encourage them to cooperate.24
-
8/12/2019 MODULE 1 Content
30/33
30
CHAPTER III
MIND MAPPING
-
8/12/2019 MODULE 1 Content
31/33
31
CHAPTER IV
DISCUSSION
In the case that we have discussed, we know that this 19 old boy is a
smoker, he has bad breath when he talks with his friends and feels pain in few of
his teeth when he consumes cold/hot foods and beverages. He is also afraid to go
to the dentist. So we can conclude that this boy had little knowledge about dental
health education.
According to our group, there are 2 main problems in this case which
affect the condition of this boy. First is about his smoking habit; the materials
contained in cigarettes are harmful ingredients. Smoking cigarettes is detrimental
to dental/oral health, and also harmful to overall body health. The effect of the
materials contained within cigarettes is of many kinds, one of which is contained
in this issue.
Second is because of his fear about the dentist, we know that this boy is
rarely visiting the dentist. When he is rarely visiting the dentist, his teeth are
lacking the proper checkup that they should have gotten, which means he will
have a poor oral hygiene. Meanwhile, his knowledge about oral hygiene is alsovery miniscule. It will further aggravate his condition because he does not
maintain his dental problem.
From our discussion, we began by discussing about plaque. The plaque
formation is likely because of the tar from the cigarette that exacerbates the
buildup of plaque in his teeth and his poor oral hygiene; smoking also causes the
reduction of saliva production, which causes more plaque to form since saliva
washes away the bacteria within the plaque. In our group, we divided plaque
formation into 2 groups, which are periodontal disease-causing bacteria in plaque
and caries-causing bacteria in plaque.
Because of periodontal disease bacteria, plaque on teeth can accumulate
and become calculus (tartar). Since the boy rarely visits the dentist, the plaque
will likely accumulate even further. Bacteria in plaque can cause the gums to
inflame and bleed easily, thus leading to gingivitis. Since he is afraid to go to the
dentist, his gingivitis will become more severe because it is not treated; when
-
8/12/2019 MODULE 1 Content
32/33
32
gingivitis is not treated, it becomes a worse form of periodontal disease called
periodontitis. Periodontitis causes the roots of the teeth to be exposed. Because the
roots of the teeth do not contain any enamel, they are more susceptible to hot/cold
foods and beverages, this is what mainly causes the pain.
Periodontitis is a condition when the periodontal pocket gets deeper. Thus,
the food debris becomes harder to clean just by brushing the teeth daily. Gram
negative anaerobic bacteria breaks down the food debris that are left in
periodontal pocket and then release VSC as the result. In many cases, the
production of VSC in the mouth can be used as a unit of measurement for
halitosis. So, besides pain, periodontal disease can produce an unpleasant smell in
the mouth (halitosis).
The bacteria of caries such as streptococcus kariogenik, streptococcus
mutans, streptococcus sanguinis may lead to the formation of dental caries.
Dental caries is a chronic infectious disease affecting the mineralized tissues of
the teeth: enamel, dentine, and cementum. It occurs when microorganisms in
bacterial dental plaque metabolizes sugars, resulting in the production of acid. The
acid eats away at the hard tissues of the teeth (enamel, dentin, cementum), when
the decay reaches the pulp of a tooth, it will cause inflammation of the pulp called
pulpitis. Caries may erode into the central of connective tissue core of a tooth or
dental pulp, causing necrosis of the pulp and infection.26 This condition leads to
gangreene gas release, which smells like rotting corpse. So when the boy speaks
to his friend, they can smell this unpleasant smell. Thus, besides periodontitis,
dental caries is one of the factors that can cause bad breath or halitosis.
In early pulpitis, the pulp will react painfully to hot, cold, and sweet
stimuli but the pain does not last long and will cease whe the stimulus iswithdrawn.
So, the pain that happens to the boy is due to the exposure of the dentine
and also due to pulpitis. This pain occurs just when he consumes hot and cold
food or beverages. And the boys friends are avoiding him because of his bad
breath. The cause of his bad breath are necrosis and periodontitis that he suffered.
The most effective thing to be done by this boy is that he should not be
afraid of the dentist. When he is afraid to go to the dentist, he will not get the good
-
8/12/2019 MODULE 1 Content
33/33
dental care and good oral health that he should have gotten; he also will not know
about the overall condition of his mouth. When he is ignorant about his dental/oral
health, he will not look for any information that is beneficial to maintaining his
dental/oral health, his dental/oral health will be compromised. His smoking
activity will worsen his dental health. If he were to go to the dentist, he might
have gotten a lot of information about his dental/oral health. The costs of which
he pays would be even smaller if he diligently checks his teeth, rather than do a
treatment or treatments after a severe toothache.