BAD BREATH:-
Many people worry about bad breath, either their own or someone else’s. The advertising media have made much of the social stigma arising from ‘offensive breath’ to their own advantage. Bad breath or halitosis may indicate a dental problem, but this may not always be the case.
CAUSES
The odour may be caused by factors in the mouth or by changes occurring in other parts of the body.
Local factors:
· Decaying food particles on or between the teeth
· A coated tongue covered by growing microorganism.
· Unclean dentures
· Smell of tobacco
· Alcohol
· Gum diseases with pus production involved
· Healing wounds after a surgery or extraction causes arising away from the mouth.
· Head cold with infected nasal air passages
· Acute inflammation of air spaces present within the facial
bones (often filled with a great deal of pus )
· Tonsillitis.
· Many waste products are broken down from food and drink
are excreted through the lungs and this applies to alcoholic
drinks as well as pungent foods like onion, garlic etc.
· Diabetes in which the patient has a sweet acetone breath.
Bad breath is not a disease; it is rather a symptom, which indicates the presence of disease either within the mouth or away from the mouth. Odours, which may appear unpleasant to many, may not be the same to some e.g. People in the Mediterranean area are accustomed to the scent of garlic, a scent which many people around the world find obnoxious.
SWOLLEN GUMS:-
Change of gums from a thin, well-adapted, continuous covering around the teeth to a thick swollen red mass, may not only appear unsightly, but also acts as a platform for further destruction of healthy teeth and supporting bone.
CAUSES
1. Most common cause is infection of the “gingiva”, by a thin covering of food and bacteria on the tooth surface called “Plaque”. The bacterial content of this plaque trigger a response from the gingiva, which results in a swelling. The swelling is caused by accumulation of white blood cells and fluids, which in turn counteracts the action of the bacteria.
2. Due to certain normal condition such as pregnancy and puberty, there is swelling of the gingiva seen. This swelling is an abnormal response to the normal bacteria present in the mouth. The abnormal response is a result of hormonal changes or variation seen during the above-mentioned conditions.
3. Certain disease or deficiency condition may also result in swollen gingiva
E.g.
- Vitamin C deficiency.
- Leukemia
- Tumors or abnormal growth on the gingiva, which may
be harmless or, can be cancerous.
4. Certain drugs used by the patient may result in increased size of the gingiva as a side effect.
E.g. 1. Phentoin used in epileptic Fits. 2. Nifidipine used for blood pressure.
SYMPTOMS
1. Pain may or may not be present.
2. If the cause is infection then, the initial stage is
indicated by the presence of bright red gingiva.
- As the infection progresses the color changes from red to bluish red to deep blue.
3. The gingiva becomes soft and spongy; rarely it may become thickened due to formation of scar tissue.
4. Bleeding of the gingiva is another common symptom in the advanced stage.
5. Swelling caused by the drugs is usually very hard and thick. The gingiva will become swollen even after treatment of the swelling. The swelling occurs only when the drug is administered for a certain period of time.
DIAGNOSIS
The sight of the gingiva itself is sufficient to diagnose the condition.
Bleeding of the gums is seen, when a sharp thin metal instrument is passed along the margin connecting the tooth and the gingiva. This bleeding indicates inflammation.
--Gingival fluid measurement tests:
In this test, the increase in amount of gingival fluid is measured which is usually not seen in a healthy gingiva.
Gingiva fluid is a fluid produced by the gingiva in the space between the teeth and the gingiva called gingival sulcus.
Special instrument and techniques are required to measure the minute increase in the amount of gingival flood. This is a specialized test for confirming swelling due to infection.
TREATMENT
- In case of swelling due to inflammation, good care of the
teeth and the gums by proper and timely brushing and
usage of mouth washes can reduce the swelling.
- If collection of plaque or food debris is in large amount
then professional help is required to remove the deposits,
which are firmly stuck to the teeth.
- If swelling is due to drugs, stoppage of the drug
automatically causes a reduction of swelling.
- In case of swelling due to general illness correction of the
health problem . Usually results in an improvement.
- If swelling is a tumor then surgical removal is the only
answer.
- Incase if thick fibrous growth of gingiva a treatment
called gingevectomy.
MORE INFORMATION
Gingiva can sometimes swell at such a fast rate that it may cover most surfaces of the teeth. In such cases surgical procedure to reshape the gingiva to normal size and shape is available.
FAQ’s
Can a swollen gum cause any discomfort?
It is usually associated with a mild constant gnawing pain, or may cause no pain at all The swelling may hamper the normal brushing, resulting in the increased accumulation of bacteria and hence cause more inflammation and destruction of gum tissue.
GLOSSARY
Gingiva: A soft tissue layer covering the bone supporting the teeth.
Plaque: Thin layer of food debris and bacteria, which covers the tooth surface
BLEEDING GUMS:-
Bleeding gums is among the common conditions affecting the oral cavity. The Chinese might have noticed bleeding gums as early as 2500 BC. They termed the associated diseases as “Ya-Kon” which means diseases of soft tissue surrounding the teeth. This problem still continues to affect us even with so many modern facilities available in the field of oral care.
--what are the causes for bleeding gums?
1. Long standing information for gums: Poor maintenance of the teeth, such as inadequate brushing or failure to rinse the mouth after meals results in a thin layer of food and bacteria covering the tooth surface. This bacterium is the chief culprit behind the inflammation. The gums during the stage of infection become soft, spongy and swollen. Trauma to the gums by hard brushing or tooth picking with sharp objects result in gingival bleeding.
2. Bleeding can also be due to injury of the gums by any sharp food item e.g., fish bone.
3. Hot food and chemicals can end up burning the gums, further resulting in bleeding. For e.g. Some people still follow the practice of placing pain relieving tablets on the gum adjacent to the painful tooth, which invariably causes burns.
4. Certain rapidly spreading infections can damage the blood vessels of the gums resulting in bleeding. One such disease is ANUG.
5. Deficiency of Vitamin C causes problems with the blood vessels, hence causing bleeding in the gums. Ancient sailors were known to suffer from this problem until some one came up with the bright idea of stocking the ships with oranges during travel. As we know oranges are a rich source of Vitamin C.
6. Certain general illness of the body can also precipitate gingival bleeding.
They are the following.
a. Allergic reaction.
b. Increase in number of cells called platelets. These are
cells, which join together to form a plate that blocks the
bleeding from an injured vessel.
c. Failure in Blood clotting mechanism due to deficiency of a
few important components.
d. Cancerous condition called leukemia.
e. Certain drugs such as aspirin and anti-coagulants, which
prevent the normal clotting mechanism of the blood.
--How does the condition present itself?
Bleeding of the gums may occur with or without associated pain .The pain if present is usually dull in nature. Bleeding is usually noticed during brushing, or in the saliva,while spitting.
Eating of any coarse food items may induce bleeding.
--How it is diagnosed?
The dentist, using an instrument called probe, diagnoses this condition. This instrument is a sharp thin metal which , when passed along the margin between the tooth and the gum causes spontaneous bleeding. Blood tests taken show any problems with the clotting mechanism, if present.
--How are bleeding gums treated?
If long standing inflammation is the cause of bleeding then removal of the source of bacteria will result in improvement of the situation. If the source is mild to moderate in collection. Proper maintenance of the teeth by the patient is more than sufficient. If the source is moderate to severe in collection then professional help is required. Serious systemic problems might have to be treated to correct bleeding from these diseases.
MORE INFORMATION
Bleeding gums are indication of a slowly progressing disease of the gums, which may further involve the bone supporting the tooth and ultimately result in tooth loss.
FAQ
--Is bleeding of the gum a serious problem?
Yes, bleeding gums is a serious problem. It is either indicating the beginning of the destructive process involving the supporting tissue around the tooth or some serious underlying systemic problems, which could be fatal.
--Is there any medication for bleeding gums?
Liquid solutions are available across the counter, which can be self administered by patient. When applied over the gums it either stops or reduces bleeding. But long lasting result s are obtained only by treating the cause.
GLOSSARY
Leukemia - Cancer of a certain type of white blood cells.
Oral hygiene - Proper care of the teeth and its associated structures.
ANUG- It is a rapidly spreading destructing disease of the gum
DENTAL ABSCESS:-
WHAT IS AN ABSCESS?
An abscess is the collection of pus following any infection, occurring within the body. When pus accumulates in relation to a tooth it is known as dental abscess. It can occur following an infection around the root of a tooth, in the gums or within the jawbone.
CAUSES
1. The most common cause is tooth decay. Tooth decay is a slowly progressing infection destroying the tooth and its contents. This infection descends down from the pulp to the tip of the roots and spreads into the surrounding bone. The pus formed is a result of this infection.
2. Injury to a tooth from a fall or blow can also result in a dental abscess.
3. Bacteria or food particles trapped within the gums or between the tooth and the gum can cause an infection resulting in an abscess. Medical problems such as diabetes can result in frequent occurrence of dental abscess.
SYMPTOMS
1. Pain associated with or without chewing
2. Redness and swelling in relation to the concerned area
3. Difficulty in swallowing
4. Foul tasting discharge within the mouth
5. Foul breath
6. Fever
WHAT HAPPENS IF THE ABSCESS IS NOT TREATED?
If left untreated the bag of pus break's open into the mouth or the face causing recurrent discharge of pus. This can result in foul breath, foul taste or an ugly scar on the face.
At times the infection spreads within the face and the neck region resulting in certain life threatening conditions.
HOW IS THE DENTAL ABSCESS TREATED?
The main principle of treatment is to drain the accumulated pus and remove the source of infection. This can either be done through the tooth by doing a Root canal treatment or via the gums by incising and draining the abscess. This is followed by a complete course of antibiotics and pain relievers. If the infection still persists the patient is referred to an oral surgeon for the surgical removal of the infected area.
WHAT CAN BE DONE TO PREVENT THE SPREAD OF A DENTAL ABSCESS?
The best way to prevent an abscess is to visit your dentist twice a year. At these appointments, your dentist will:
1. X-ray your teeth once a year to check for decay between
the teeth and to evaluate the health of your jaw bone.
2. Examine your teeth and mouth.
3. Remove any plaque and tartar that have built up on your
teeth.
4. Teach you how to care for your teeth and maintain good
oral health.5. Alert you to any problem areas.
6. Recommend any needed treatments.
RECEDING GUMS:-
--Do your teeth appear longer than usual?
Are you teeth sensitive when you drink anything hot or cold? . If yes, you might actually be the victim of receding gums. A condition normally seen occurring with age, but can also occurs in younger individuals.
CAUSES
1. Age: Gradual changes of the gingiva due to minor trauma and infection over the years can lead to down ward displacement of the gingiva.
2. Faulty brushing techniques may also result in receding gums.
3. Abnormally tilted teeth.
4. Strong band of muscles in the mouth may be attached to the gingiva, the constant contraction of which may result in receding gums. e.g. A small strip of muscle band is present between & above the two upper central anterior teeth. If this strip of muscle is too thick it can cause an upward displacement of the gingiva resulting in exposure of the roots of the teeth.
SYMPTOMS
An unsightly smile due to exposure of the roots of the teeth as a result of downward displacement of gingiva.
- Sensitivity of the teeth to hot or cold food items.
- Food getting stuck between the roots of adjacent
teeth.
DIAGNOSIS
The level of the gingival in relation to the tooth diagnoses this condition. If the level of gingiva is below the line, which separates the crown of the tooth from the root, it is diagnosed as gingival recession.
TREATMENT
Treatment of this condition is by a small surgical procedure. The displaced gingival is repositioned by detaching the gingival and tying it up at the optimal level. - But before this surgery all the regular procedure to create a healthy gingival is undertaken such as regular brushing, scaling, root planning, gum surgeries etc.,
MORE INFORMATION
When more amount of tooth surface is exposed to the saliva in the oral cavity, the rate of tooth to decay is also high. Thus covering of the teeth by the gingiva is very essential.
FAQ
Can receding gum occurring in relation to all the teeth in the mouth be treated?
Receding gum can be treated in relation to a few teeth, but treatment of all the teeth is not possible. But prior treatment will definitely improve the condition and prevent further occurrence.
GLOSSARY
Gingiva - soft thin tissue covering the bone supporting the teeth.
THUMB SUCKING:-
Thumb sucking in children has always caused embarrassment to many parents. The parents were more concerned over the social embarrassment caused by this habit rather than the actual physical damage caused by it.
This silly habit as it appears to many parents not only causes abnormally arranged teeth but also implicates the mental state of the child.
CAUSES
Thumb sucking can either be a non-compulsive act or a compulsive oral habit.
Non-Compulsive act:
As children grow, they pick up or drop habits depending on its acceptability. These habits are usually called non-compulsive habits or acts. Thumb sucking can be one such habit, which can be seen from birth to the age of 16. On an average most of the children stop this habit by the age 4. There are some children, however, who can continue the habit to as late as 12-15 years. In these children, thumb sucking is usually a way to relieve the frustration of hunger.
Compulsive Act:
Thumb sucking can be called compulsive when it has acquired a fixation in the child to the extent that he retreats to the practice of this habit when ever his security is threatened by events, which occur in his world. Unlike the non-compulsive habit, the child tends to suffer from increased anxiety when he attempts to correct the habit. The habit becomes his safety valve to release emotional pressure, whenever it becomes, too much to cope with. Lack of love and affection by the parents towards the child plays a major role in making the child emotionally insecure and thus making him resort to habits like thumb sucking.
SYMPTOMS
- If the habit is discontinued before the permanent teeth eruption, it can be considered harmless.
- Continuous thumb sucking leads to many ill effects. The main symptoms of this problem is shown by the teeth and they are:
- Displacement of the child’s permanent teeth due to the
uneven forces placed on the teeth by the thumb.
- The upper and lower front teeth may not approximate with each other.
- The upper front teeth may flare out.
- The open bite or lack of approximation of upper and lower front teeth may result in speech difficulties during pronunciation.
-As a result of the flared out or
protruding front teeth the child may end up fracturing these teeth more often.
- Protruding and uneven teeth change the facial appearance. This can cause an inferiority complex in the young mind.
DIAGNOSIS
Any child above the age of 4 with protruding anterior teeth may be affected by thumb sucking. A detailed history about the habit is very helpful. The frequency and duration of this habit can help in evaluating the extent of the habit.
The thumb used by the child normally appears to be very clean compared to the other finger.
TREATMENT
It can be treated by psychological methods also.
1. Psychological Method:-
The child is guided by the dentist and parent to consciously put an end to the thumb sucking habit over a period. This is possible only if the child is psychologically willing and wants to stop the habit.
Children often combine thumb-sucking habit with other secondary habits such as hair pulling or nose probing.
Frequently making the secondary habit impossible to perform can break the primary habit.
It is very important not to criticise the child. The child needs a lot of support and affection. He should be told about the ill effects of sucking the thumb to reinforce his determination to stop thumb sucking.
2. Extra oral method:-
The other simple methods are:
-Painting the child’s thumb or finger with an unpleasant tasting substance.
-Tapping the thumb with plaster so as to prevent thumb sucking.
-The above-mentioned methods will succeed depending upon the attitude of the parent. The parents should in someway reward the child for “growing out of the habit” during the procedure both by their action and by a small token prize.
-This will make a deep impression on the child and orient him towards completely breaking of the habit. The parent should also be warned that there is always the possibility that a more deleterious habit will spring up in its place if the present one is suppressed.
3. Intra oral methods:--
This is done by fabricating appliances, which are then fitted into the mouth of the child by the dentist. They are normally viewed as punishment devices by the child there by sometime producing severe emotional disturbances. If the appliances are going to convert a happy youngster into a nervous child overnight, it is not worth it.
MORE INFORMATION
There are other oral habits, which should be brought to the notice of the child’s dentist. These habits are lip sucking, tongue thrusting, nail biting, mouth breathing and bruxism.
All the above-mentioned habits will definitely takes its toll on the teeth. Therefore, early identification and treatment of these habits are necessary to ensure a good set of teeth and a lovely smile.
FAQ’s
Is thumb sucking a natural habit?
Yes, thumb sucking a natural habit until the age of 4. Continuation of the habit beyond the age of 6 will result in mal-alignment of teeth. Most children will give up this habit by themselves, but in cases where this doesn’t occur a dentist should be consulted.
Is there any other effect of thumb sucking other than that on the teeth?
Sucking on a dirty finger can make the child prone to infection, as during this stage children normally tend to play with sand or dirt.
GLOSSARY
Bruxism- Grinding of teeth.
TOOTH DISCOLORATION:
Poetry compares teeth to pearls. But teeth unlike pearls, are exposed to a variety of elements in day-to-day life. All these exposures are bound to take its toll on teeth color. They are also called the sentries of the digestive system.
CAUSES
The tooth discolouration can either be on the tooth surface (extrinsic) or be present within the substance of the tooth(intrinsic).
1. Intrinsic causes
In a tooth with an intact blood and nerve supply, the causes are:--
Hereditary disorders.
Tetracycline medication.
Excessive fluoride intake in drinking water.
High fevers associated with early childhood disease.
The loss of blood supply and nerve supply can by itself cause discoloration of the tooth.
2. Extrinsic causes
Stains from tobacco smoking.
Bacteria producing colored pigments.
A salivary protein layer covering the tooth surface.
The tinted remnants of a certain membrane seen on the teeth surface as the teeth, initially erupt out into the mouth.
Tooth decay or a broken down filling.
SYMPTOMS
Intrinsic causes are usually seen at the time of teeth eruption.
- In hereditary conditions like erythroblastosisfetalis and porphyria the teeth are colored in a brownish blue and a brownish red respectively.
- Tetracycline administration durin pregnancy can lead to discoloration of teeth as the tooth erupts in the newborn.
- Depending on the severity, discoloration can range from yellow -orange in mild cases and bluish gray in the most severe cases.
- Flurosis is a condition seen in places with increased fluoride content in the drinking water. Beyond a certain level, fluoride can cause yellow staining of teeth.
- High fever due to childhood infections can lead to areas of poor calcification within the teeth resulting in the appearance of prominent white spots.
Extrinsic stains can be classified based on color of the stain into:
- Brown stains: It is caused by a thin translucent, bacteria free layer covering the teeth. It is seen in individuals who do not brush their teeth adequately, or in those who use toothpaste with inadequate action.
- Tobacco stains: Dark brown or black surface accompanied by brown discoloration of the tooth
substance is seen. These stains results from coal tar combustion present in the tobacco and also due to the diffusion of tobacco juices into the substance of the teeth.
- Green stains: Green to greenish yellow stains, sometimes of considerable thickness is seen in
children. It is usually seen in upper anterior teeth and has been attributed to florescent bacteria and fungi.
- Orange stains : Occurs in front teeth, and is caused by color producing bacteria.
- Metallic stains: Caused by metals and metallic salts, which may be introduced into the oral cavity by metal-containing dust inhaled by industrial workers.
Examples of stains caused by various metals are:
Copper dust
Greenish Stain
Iron
Brown Stain
Silver
Black Stain
Mercury
Greenish Black
DIAGNOSIS
Diagnosis is made based on the color of the stain. If the stain still remains after meticulous cleaning of the teeth by the dentist, it is understood that the stain is present within the substance of the tooth. A careful history taking can be useful in differentiating between an internal stain and an external stain.
TREATMENT
- Many people have definite aesthetic problem from internal or external stains, where as others worry needlessly about the overall color of their teeth. In the latter instance the dentist must decide if the color of the teeth can be improved enough to justify treatment even though the patient insists on having something done. For e.g. person with light complexion may believe that their teeth are too dark when actually they are normal in color. A Sun tan, darker makeup or a darker lipstick will usually make teeth appear much whiter by increasing the contrast between the teeth and thesurrounding facial features
- Most external stains can be removed by thorough cleaning of teeth, with an instrument called “ ultrasonic scaler”.
This instrument removes most of the stains caused by tobacco, food debris or bacteria. If a broken down filling or a cavity is the cause, filling the defect will improve the discoloration. Discoloration resistant to cleaning can be corrected or greatly improved through conservative procedures such as Bleaching, Micro abrasion or Veneering.
- Stains caused by tetracycline medications are usually much difficult to treat, and might require a radical approach.
MORE INFORMATION
- Most bleaching techniques are some form of derivative of hydrogen peroxide in different concentrations and are applied by different application techniques.
- The lightening of the color of the tooth through application of a chemical agent, which tends to decolorize the pigmentation present on the tooth, is referred to as bleaching.
- Bleaching technique may be classified as to whether they involve a living tooth or a tooth with no blood and nerve supply. The procedure can be carried out within the dental clinic or by the patient at his residence.
- Bleaching generally has an approximate life span of 1 – 3 years, although this change may be permanent in some situations.
FAQ’s
Is there anyway of preventing stains from smoking?
Yes, there is a way. Quit smoking, because there are no cigarettes available in the market, which do not cause staining. Usage of filters could reduce staining to a certain extent.
GLOSSARY
Micro abrasions: It is a method of elimination of discoloration when the stained areas in abraded away. This technique does result in the physical removal as tooth substance and therefore are indicated only for stains that do not extend beyond a few tenths of a millimeter in depth.
TOOTH MOBILITY:-
Mobility of teeth is caused by disease or injury to the gum and the bone which supports the teeth.
CAUSES
1. Infection: when there is accumulation of food debris and bacteria on the tooth. There is inflammation of gingival. Infection is the main cause of inflammation. Inflammation from the gingiva spread to the fibrous tissue between the teeth and bone and finally it hits the bone. Inflammation and destruction of bone affects the foundation on which the teeth stands causing tooth mobility.
2. Increased amount and uneven forces during chewing when transmitted to the teeth, causes tooth mobility.
3. A tumor of the bone, which causes destruction to the bony architecture, results in tooth mobility.
4. Blunt injury to the tooth structure can also cause looseness of teeth.
SYMPTOMS
1. Patient complains of discomfort while chewing of food.
2. Pain may accompany the mobility of teeth
3. The tissues around a mobile tooth are invariable red, swollen and damaged.
DIAGNOSIS
- Certain amount of tooth movement is always present. This movement is felt when the teeth are clenched.
- Mild moderate movement of teeth is usually diagnosed by manually pushing the tooth in question on either side with the help of probing instruments. Fingers are never a reliable source for the diagnosis for such movements.
TREATMENT
Cleaning the mobile tooth of all bacterial sources may reduce mobility to a certain extent.
- Teeth which are mobile by just a millimeter are so can be splinted to the adjacent teeth.
- Teeth which are loose and which move in all direction may have to be extracted.
MORE INFORMATION
Splinting is usually done using a thin steel wire, here the mobile teeth is bond to the adjacent stable teeth in a specific pattern, so as to attain maximum stabilization of the loose tooth. This procedure might be slightly pain full. New methods have been devised to completely eliminate pain.
FAQ
What level of teeth mobility can be stabilized?
Mobility of 1mm can be treated successfully, but anything beyond this level reduces the chances of success. Also teeth loosened due to trauma have a better chance of success than teeth loosened due to infection.
Is splinting painful?
This procedure is normally done under local anesthesia; hence pain will not be a problem.
GLOSSARY
Splinting: stabilization of the mobile tooth by drawing support from the strong adjacent teeth.
ORAL CANCER:-
- Cancerous growth occurring within the structures of the oral cavity is known as Oral Cancer The oral cavity includes the mouth and all the structures within it ,such as the tongue, teeth ,gums ,lower jaw etc
- Cancer is an abnormal disorganized growth of cells in the tissue of a person . Cancer cells keep on multiplying without paying head to the body’s command to stop. This abnormal growth of cells destroys the normal structure and the function of the affected tissue and the body in general .
- Among other cancers oral cancer is one of the most common causes of death. In male, oral cancer represents 4% of total body cancer and in female; it is 2% of all cancers. Majority of the oral cancers affect the outer layer of mucous membrane covering the oral cavity.
Causes:
Cancer in the mouth does not occur overnight. It occurs as a series changes within the tissue , which eventually promotes the development of cancer.
The factors involved are:
1. Tobacco
2. Alcohol
3. Syphilis (a sexually transmitted disease caused by a bacteria)
4. Nutritional deficiencies.
5. Virus infection
6. Sunlight
7. Other miscellaneous factors such as trauma, heat, and irritation from sharp teeth, poorly restored fillings and ill-fitting dentures.
Signs and Symptoms:-
Oral cancer may initially present without any symptoms. Patients are most often identified only after a significant progression of the disease. Discomfort is the most common symptoms that compels a patient to seek medical care.
Patient may present with any of the following symptom:
· Awareness of a mass present or growing within the Oral Cavity.
· Difficulty in swallowing.
· Toothache.
· Pain in the ear.
· Limited mouth opening.
· Excessive bleeding which is not seen that commonly.
· A non-healing ulcer in the oral cavity.
· Swelling on the gums interfering with the seating of the dentures in the mouth.
Majority of oral cancers involve the tongue, the posterior region of the oral cavity and the floor of the mouth. The lips, gums, the under surface of the tongue and the palate (bones separating the mouth from the floor of the nose) are less frequently involved.
Warning signs of Oral Cancer:-
Certain pre-cancerous lesions occurring in the oral cavity may indicate the person’s susceptibility to cancer. These lesions can be in the form of white patches in the mucous membrane covering the oral cavity and along the lateral border of the tongue, which cannot be removed by rubbing the affected area.
· Red patches seen on the mucous membrane lining the mouth and the tongue.
· Increase in fibrous content of the mucous membrane lining the cheek, which presents itself as thick fibrous bands running along the inner aspect of the cheek. Commonly seen in betel nut chewers this condition results in inability to open the mouth.
All the above lesions will cause a burning sensation when consuming spicy food.
DIAGNOSIS:-
1. Thorough examination of the oral cavity and the neck region conducted without neglecting any area may show hard lumps of tissues, which may indicate cancer. The patient is assessed for any suspicious tissue changes, which may include a white, red or a mixed white or red lesion.
2. Imaging the lesion using x-ray films, CT scan and advanced diagnostic techniques such as MRI helps in defining the location and extent of the cancerous growth.
3. Microscopic examination of a tissue specimen from the suspected lesion is the best method to confirm or rule out oral cancer. It gives the exact type and nature of cancer.
TREATMENT:-
- The principle objective is to cure the patient of cancer. The choice of treatment depends upon factors such as cancer cell type, amount of changes in the cell, size and location of the cancerous growth.
- Surgery or radiation is used with curative intent in treatment of cancer. Chemotherapy (Medicines) is used as an additional form of treatment. In early lesion either surgery or radiation as a form of treatment would suffice. But in an advanced condition, a combination of both surgery and radiation is required.
- There is rarely a second chance available for cure. Hence the initial approach of treatment is critical. The survival rates after early detection and treatment of cancer have been noted to be 70%. Chemotherapy (Medicines) is a weak substitute for the above-mentioned treatment.
More Information:-
Tobacco utilization either in the form of smoking or chewing is an important factor in the development of oral cancer. About 97% of oral cancer victims are known to be associated with tobacco either in the form of smoking or chewing. Pipe smoking and cigar smoking have been known to increase the risk levels by a few folds. Among the various habits associated with tobacco, tobacco chewing is known to cause oral cancer more rapidly than any of the other habits. This is because of the direct and repeated contact of the tobacco with the mucous membrane of the oral cavity.
FAQs:
--Do all betel nut or tobacco chewers get oral cancer?
Betel nut and tobacco chewers are definitely more prone to oral cancer than those who do not have this habit, but there are also other factors such as genetics, diet, environment and the person’s immune system.
--Will stopping the habit improve the condition?
There are certain lesions seen frequently in the mouth of betel nut and tobacco chewers. These lesions precede oral cancer. If these preceding lesions are identified in time, then stopping the habit will definitely improve the lesion or maybe even cure it.
--Is pain an early sign of Cancer?
Not always. Pain is usually a late symptom of cancer. People often think that persistent pain such as headache or constant pain in the region of the face means cancer, but this is rarely the case. However pain should not be ignored.
--What are the side effects of treatment?
There are side effects to all forms of treatments involving oral cancer.
--Surgery
If the lesion is small then there are usually no side effects, but if the lesion is large the it may require the removal of the affected structure resulting in the speech defects difficulty in swallowing and also facial deformities. These conditions can rehabilitated by speech therapy and by physiotherapy.
--Radiation therapy
During and after radiation therapy the patient develops mouth sores. The patient also suffers from reduced secretion of saliva, which causes difficulty in swallowing and makes the patient more prone to teeth decay and other forms of infection.
--Chemotherapy
Side effects depend on the kind of drug used. The usual side effects are loss of hair, ulcers in the mouth and in the stomach, reduced resistance to infection, loss of appetite, nausea, vomiting, and lack of energy.
GLOSSARY CT SCAN
It is an advanced diagnostic technique using x-rays to three dimensionally identify the site and extent of a lesion.
MRI: It is more advanced technique, which uses magnetic force to diagnose both bony and soft tissue lesions.
FIBROUS DYSPLASIA OF THE BONE:-
About Fibrous dysplasia of the bone:
Fibrous dysplasia (FD) of the bone is a peculiar condition that affects either all bones or a single bone in the body.
Most cases are diagnosed in adolescence and young adulthood and remain unchanged throughout life. The initial manifestations of fibrous dysplasia are most commonly found in persons aged 3-15 years. In the past, many conditions that could not be satisfactorily explained have been included under this disease. The bone in this condition is fibrous or plastic in quality and is defective in form as well.
TYPES
Fibrous dysplasia of the bone is divided into two types:
1· Monostotic fibrous dysplasia
2· Polystotic fibrous dysplasia
In monostotic type only one bone is involved, and hence the prognosis of this type is definitely better. In polystotic type, more than one bone or a group of bones is involved, and the prognosis is poorer.
Monostotic Fibrous dysplasia of the bone:
This condition affects mostly people in the age group 10-30. It involves excessive growth of hard fibrous tissue that replaces normal bone tissue in a single bone. Approximately 70-80% of FD cases are monostotic, occurring most frequently in the rib (28%), femur (23%), tibia, craniofacial bones (10-25%), and humerus. With monostotic disease, patients as old as 20 or 30 years are asymptomatic.
The cause of this condition is unknown although several theories have been proposed. One theory attributes this disease to abnormal activity in the bone forming tissues prior to birth. Another theory says any localized infection or trauma gives rise to this disease. In some cases, Monostotic FD of the bone has occurred as an autosomal recessive trait.
SYMPTOMS
The first sign of the disease is a painless bulging in the affected jaw. As the lesion is constantly expanding, they could lose their balance of contacting the teeth in the opposite jaw, and as a result, there may be disturbance in the teeth as well. . When Fibrous dysplasia occurs in the upper jaw of the maxilla, Monostotic FD is a serious condition. The lesion extends into the maxillary sinus, and on the face. At times it may extend to the base of the skull and obstruct vital nerves, causing irreparable damage.
TREATMENT
The treatment of Monostotic FD of the bone is usually radical surgery. This surgery mutilates the entire bone involved, sometimes necessitating block resection as well. In some cases, this condition could lead to osteosarcoma or cancer of the bone.
Polyostotic fibrous dysplasia:-
This condition affects a number of bones in the body, mostly the long bones. About 20-30% of FD cases are polyostotic. Two thirds of patients exhibit symptoms before the age of 10. Polyostotic FD frequently involves the skull and facial bones, pelvis, spine, and shoulder girdle. The sites of involvement are the femur (91%), tibia (81%), pelvis (78%), ribs, skull and facial bones (50%), upper extremities, lumbar spine, clavicle, and cervical spine, in decreasing order of frequency.
SYMPTOMS
- There is a thickening of the long bones and the patient usually complains of persistent bone pain.
- Often, the initial symptom is pain in the involved limb and, spontaneous fracture, or both. Leg-length discrepancy is present to varying degrees in 70% of patients with limb involvement. The weight bearing bones become bowed due to weakening of the structural integrity of the bone.
- The bones of the face and the skull are involved in a majority of the cases and sometimes are unilateral in distribution. If this happens, there is an obvious deformity of the face.
- Sometimes brown lesions called the "cafe-au-lait" spots are present on the skin. Vaginal bleeding is another feature of this condition. Teeth do not erupt into the oral cavity on time. Several hormonal disturbances are also commonly seen. The thyroid, parathyroid and the pituitary as well as the ovary are involved.
TREATMENT
Mild cases are satisfactorily treated with surgery. But in severe cases, radiation therapy has been tried with limited success. The lesions have a high potential to turn malignant.
FAQs
--What is Fibrous Dysplasia (FD)?
Fibrous dysplasia (FD) is a disease of the bones characterized by abnormal growth areas or lesions in one or more bones. FD can occur in any bone, including the skull, legs, arms, and the ribs.
--Which doctor do I consult about FD?
A bone specialist is to be consulted.
--What is McCune-Albright Syndrome?
McCune-Albright Syndrome is named after the two physicians who described it over 50 years ago. About 10 % of those with polyostotic FD have some associated endocrine (hormonal) problems including early puberty and areas of increased skin pigmentation called cafe-au-lait marks. These birthmarks have irregular borders, again primarily on one side of the body. The combination of polyostotic fibrous dysplasia, endocrine disorders, and café-au-lait marks is called McCune Albright Syndrome (MAS).
--Is FD hereditary?
No. FD is not hereditary.
--Why does one get FD?
The cause of FD is still unknown. The gene responsible for FD appears to be especially susceptible to mutations. Though rare, FD occurs in males and females and in people of all races across the globe. It is possible that the mutation occurs randomly.
--Is FD cancer?
FD is not cancer. Many people use to term "lesion" to mean any defect to avoid confusion of FD with malignant bone tumors. However, an FD bone lesion can turn cancerous; but this is very rare—in less than 1 % of FD cases.
--Is there a permanent cure for FD?
In general, FD cannot be cured today, unless it is only one lesion in one bone that can be completely eliminated by surgery. There are often unidentified FD cells in several bones and all cannot be eliminated by surgery. Some drug treatments can significantly diminish bone pain in long bones and cause some good bone to fill in the defects. Bisphosphonate drugs such as alendronate (Fosamax) that is used for treating osteoporosis or pamidronate (Aredia) have helped some people. However, these drugs do not work for all FD patients. Research is in progress to find other possible treatments.
DEVELOPMENTAL DISTURBANCES OF THE TONGUE:
About Tongue
The tongue is an important organ that occupies a large area in the oral cavity covering the floor of the mouth. It is below the palate, and is surrounded by teeth on either side. Together with the palate, it performs the function of swallowing. It is rightly said that the tongue is a gateway to the esophagus. A host of things can go wrong with the formation of the tongue, since it develops from multiple sources, rather than a single progenitor process. Most of the developmental disturbances of the tongue are related to its size and shape, though structural defects also exist.
Defects related to the size of the tongue:-
Microglossia:
This is a condition where the size of the tongue is abnormally small. Cases of complete absence of the tongue have been reported. Fortunately, it is a rare condition. Obviously, a tiny tongue will pose many difficulties related to speech and swallowing. There is no treatment for this condition, and the affected person will have to train their tongue to the best of their abilities.
Macroglossia:
This is a much more common condition than microglossia, where the tongue is highly enlarged. An enlarged tongue may be congenital, when it is associated with generalized muscular hypertrophy or hemi hypertrophy. Secondary macroglossia is that condition that occurs in conjunction with some other conditions like a tumor of the tongue, hemangioma and acromegaly. Acromegaly is a hormonal disturbance where growth hormone is secreted in excess of the requirements of the body. The reason behind the enlargement of the tongue in this case is related to the relaxation of the muscles that support the lower jaw, and there is no support to keep the tongue in position.
As a rule, macroglossia causes disturbances in the teeth as well. Due to the continuous pressure exerted by the heavy tongue, teeth begin to move away and the tongue occupies these spaces between the teeth, giving it a scalloped appearance. Macroglossia is a prominent feature in Beckwith's hypoglycemic syndrome, where neonatal hypoglycemic predominates along with umbilical hernia and post-natal gigantism. The treatment of macroglossia involves the removal of the cause that gives rise to this condition. At times, surgical stripping of the tongue to reduce the heavy musculature is also warranted.
Ankyloglossia:
Ankyloglossia occurs as a result of the fusion of the lingual frenum to the floor of the mouth. However, complete fusion rarely occurs; a partial ankyloglossia or "tongue-tie" is a much more common condition. This leads to a myriad of speech problems such as lisping and stuttering. The treatment is to surgically sever the connection between the frenum and the floor of the mouth.
Fissured Tongue:
This condition is also referred to as scrotal tongue since the tongue often resembles the scrotum in this state. Here a transverse groove is present on the tongue from which numerous smaller grooves radiate all over the surface of the tongue. The condition is usually painless and the only problem is with the food debris gets stuck in the grooves. These have to be cleaned by gauze or a toothbrush.
Median Rhomboid Glossitis:
This condition is a classic developmental disorder of the tongue. It is a failure of the developmental apparatus during the organogenesis of the fetus. A structure called "tuberculum impar" is supposed to withdraw when the two halves of the tongue come close to each other during development. When this does not happen, the structure gets trapped in between the two halves of the tongue, thereby creating an area, which looks like a bald patch on it. Median Rhomboid Glossitis has also been strongly linked with the fungal infection caused by Candida albicans, where the tongue has an ovoid patch just before the entry into the esophagus. Sometimes a flat-raised area can also be discerned. This condition is reportedly thrice as common in men as in women. The exact cause for this occurrence is not known, although hormonal links have been suggested.There is no known treatment for MRG, though doctors have tried to administer anti-fungal agents with mixed results.
Cleft tongue:
Cleft tongue is a condition where the tongue has a cleft running right across it horizontally or vertically, although reported cases have had vertical clefts. Complete clefting is extremely rare, and occurs as a result of lack of developmental forces to push both halves of the tongue towards each other. Partial clefting presents as a deep groove in the middle of the tongue and is a common feature in the oro-facial-digital syndrome. Cleft tongue is of little importance other than causing difficulty in eating as food gets stuck in the cleft.
Benign Migratory Glossitis:
This condition is also called a Geographic Tongue due to the behavior of the lesions, which tend to "migrate" from one area of the tongue to another. The exact cause for the condition remains unknown, although it tends to occur with more intensity in cases of emotional stress. Females are twice as affected as males, but no racial differences have been observed. The lesions here are yellowish-white or deep red in color depending on the papillae that are affected.
The area of the lesion loses its epithelial lining, making hot foods seem hotter. The areas of desquamation (epithelium peel-off) persist for a while, regress spontaneously, but reappear over time. Patients with this condition are usually asymptomatic and the lesions themselves are an incidental finding during routine check-up. Again there is no known treatment for the disease, but some doctors have reported moderate success with vitamins and mineral supplements.
Hairy Tongue:
This is a condition characterized by the hypertrophy of the filiform papillae of the tongue as well as desquamation of the area where this occurs. If the papillae become stained with tobacco, they appear black in color and look like hair on the tongue. The tongue could also appear yellowish-white if foodstuff is trapped within these papillae. Anemia and gastric troubles are said to have a significant bearing on the development of this condition. Antibiotics like penicillin and Aureomycin are also responsible for the staining of the papillae. Smoking remains the biggest cause for the occurrence of the condition. Sometimes, head and neck irradiation after cancer may also produce this condition. The only treatment of the condition is to keep the tongue as clean as possible by using a toothbrush.
FAQs
--My tongue burns whenever I take chilli-hot food. What is the cause and treatment of this problem?
Burning sensation on the tongue could be due to some drugs commonly taken for diabetes and hypertension. More often, it is a result of sloughing away of the epithelial lining of the tongue. If this is the case, you should avoid taking chilli-hot food till it regenerates.
--I have a large tongue. What are the chances of getting it surgically reduced?
A large tongue develops primarily due to hormonal disturbances. Make sure that this is not the case before opting for surgery. Otherwise the chances of surgical reduction are excellent.
--My son has a lisp when he speaks and I have noticed that his tongue has limited movement. What should be done?
The boy is suffering from a condition called Ankyloglossia, more commonly tongue-tie. A simple surgical procedure should take care of the problem. Please consult your doctor as well as an oral surgeon for the needful
--I have just recovered from a bout of malaria and find that food does not taste the same. What should I do?
The loss of taste is temporary and has come about because of the strong drugs that you have taken. The tongue will recover over time and the taste apparatus should be all right in a fortnight’s time.
Many people worry about bad breath, either their own or someone else’s. The advertising media have made much of the social stigma arising from ‘offensive breath’ to their own advantage. Bad breath or halitosis may indicate a dental problem, but this may not always be the case.
CAUSES
The odour may be caused by factors in the mouth or by changes occurring in other parts of the body.
Local factors:
· Decaying food particles on or between the teeth
· A coated tongue covered by growing microorganism.
· Unclean dentures
· Smell of tobacco
· Alcohol
· Gum diseases with pus production involved
· Healing wounds after a surgery or extraction causes arising away from the mouth.
· Head cold with infected nasal air passages
· Acute inflammation of air spaces present within the facial
bones (often filled with a great deal of pus )
· Tonsillitis.
· Many waste products are broken down from food and drink
are excreted through the lungs and this applies to alcoholic
drinks as well as pungent foods like onion, garlic etc.
· Diabetes in which the patient has a sweet acetone breath.
Bad breath is not a disease; it is rather a symptom, which indicates the presence of disease either within the mouth or away from the mouth. Odours, which may appear unpleasant to many, may not be the same to some e.g. People in the Mediterranean area are accustomed to the scent of garlic, a scent which many people around the world find obnoxious.
SWOLLEN GUMS:-
Change of gums from a thin, well-adapted, continuous covering around the teeth to a thick swollen red mass, may not only appear unsightly, but also acts as a platform for further destruction of healthy teeth and supporting bone.
CAUSES
1. Most common cause is infection of the “gingiva”, by a thin covering of food and bacteria on the tooth surface called “Plaque”. The bacterial content of this plaque trigger a response from the gingiva, which results in a swelling. The swelling is caused by accumulation of white blood cells and fluids, which in turn counteracts the action of the bacteria.
2. Due to certain normal condition such as pregnancy and puberty, there is swelling of the gingiva seen. This swelling is an abnormal response to the normal bacteria present in the mouth. The abnormal response is a result of hormonal changes or variation seen during the above-mentioned conditions.
3. Certain disease or deficiency condition may also result in swollen gingiva
E.g.
- Vitamin C deficiency.
- Leukemia
- Tumors or abnormal growth on the gingiva, which may
be harmless or, can be cancerous.
4. Certain drugs used by the patient may result in increased size of the gingiva as a side effect.
E.g. 1. Phentoin used in epileptic Fits. 2. Nifidipine used for blood pressure.
SYMPTOMS
1. Pain may or may not be present.
2. If the cause is infection then, the initial stage is
indicated by the presence of bright red gingiva.
- As the infection progresses the color changes from red to bluish red to deep blue.
3. The gingiva becomes soft and spongy; rarely it may become thickened due to formation of scar tissue.
4. Bleeding of the gingiva is another common symptom in the advanced stage.
5. Swelling caused by the drugs is usually very hard and thick. The gingiva will become swollen even after treatment of the swelling. The swelling occurs only when the drug is administered for a certain period of time.
DIAGNOSIS
The sight of the gingiva itself is sufficient to diagnose the condition.
Bleeding of the gums is seen, when a sharp thin metal instrument is passed along the margin connecting the tooth and the gingiva. This bleeding indicates inflammation.
--Gingival fluid measurement tests:
In this test, the increase in amount of gingival fluid is measured which is usually not seen in a healthy gingiva.
Gingiva fluid is a fluid produced by the gingiva in the space between the teeth and the gingiva called gingival sulcus.
Special instrument and techniques are required to measure the minute increase in the amount of gingival flood. This is a specialized test for confirming swelling due to infection.
TREATMENT
- In case of swelling due to inflammation, good care of the
teeth and the gums by proper and timely brushing and
usage of mouth washes can reduce the swelling.
- If collection of plaque or food debris is in large amount
then professional help is required to remove the deposits,
which are firmly stuck to the teeth.
- If swelling is due to drugs, stoppage of the drug
automatically causes a reduction of swelling.
- In case of swelling due to general illness correction of the
health problem . Usually results in an improvement.
- If swelling is a tumor then surgical removal is the only
answer.
- Incase if thick fibrous growth of gingiva a treatment
called gingevectomy.
MORE INFORMATION
Gingiva can sometimes swell at such a fast rate that it may cover most surfaces of the teeth. In such cases surgical procedure to reshape the gingiva to normal size and shape is available.
FAQ’s
Can a swollen gum cause any discomfort?
It is usually associated with a mild constant gnawing pain, or may cause no pain at all The swelling may hamper the normal brushing, resulting in the increased accumulation of bacteria and hence cause more inflammation and destruction of gum tissue.
GLOSSARY
Gingiva: A soft tissue layer covering the bone supporting the teeth.
Plaque: Thin layer of food debris and bacteria, which covers the tooth surface
BLEEDING GUMS:-
Bleeding gums is among the common conditions affecting the oral cavity. The Chinese might have noticed bleeding gums as early as 2500 BC. They termed the associated diseases as “Ya-Kon” which means diseases of soft tissue surrounding the teeth. This problem still continues to affect us even with so many modern facilities available in the field of oral care.
--what are the causes for bleeding gums?
1. Long standing information for gums: Poor maintenance of the teeth, such as inadequate brushing or failure to rinse the mouth after meals results in a thin layer of food and bacteria covering the tooth surface. This bacterium is the chief culprit behind the inflammation. The gums during the stage of infection become soft, spongy and swollen. Trauma to the gums by hard brushing or tooth picking with sharp objects result in gingival bleeding.
2. Bleeding can also be due to injury of the gums by any sharp food item e.g., fish bone.
3. Hot food and chemicals can end up burning the gums, further resulting in bleeding. For e.g. Some people still follow the practice of placing pain relieving tablets on the gum adjacent to the painful tooth, which invariably causes burns.
4. Certain rapidly spreading infections can damage the blood vessels of the gums resulting in bleeding. One such disease is ANUG.
5. Deficiency of Vitamin C causes problems with the blood vessels, hence causing bleeding in the gums. Ancient sailors were known to suffer from this problem until some one came up with the bright idea of stocking the ships with oranges during travel. As we know oranges are a rich source of Vitamin C.
6. Certain general illness of the body can also precipitate gingival bleeding.
They are the following.
a. Allergic reaction.
b. Increase in number of cells called platelets. These are
cells, which join together to form a plate that blocks the
bleeding from an injured vessel.
c. Failure in Blood clotting mechanism due to deficiency of a
few important components.
d. Cancerous condition called leukemia.
e. Certain drugs such as aspirin and anti-coagulants, which
prevent the normal clotting mechanism of the blood.
--How does the condition present itself?
Bleeding of the gums may occur with or without associated pain .The pain if present is usually dull in nature. Bleeding is usually noticed during brushing, or in the saliva,while spitting.
Eating of any coarse food items may induce bleeding.
--How it is diagnosed?
The dentist, using an instrument called probe, diagnoses this condition. This instrument is a sharp thin metal which , when passed along the margin between the tooth and the gum causes spontaneous bleeding. Blood tests taken show any problems with the clotting mechanism, if present.
--How are bleeding gums treated?
If long standing inflammation is the cause of bleeding then removal of the source of bacteria will result in improvement of the situation. If the source is mild to moderate in collection. Proper maintenance of the teeth by the patient is more than sufficient. If the source is moderate to severe in collection then professional help is required. Serious systemic problems might have to be treated to correct bleeding from these diseases.
MORE INFORMATION
Bleeding gums are indication of a slowly progressing disease of the gums, which may further involve the bone supporting the tooth and ultimately result in tooth loss.
FAQ
--Is bleeding of the gum a serious problem?
Yes, bleeding gums is a serious problem. It is either indicating the beginning of the destructive process involving the supporting tissue around the tooth or some serious underlying systemic problems, which could be fatal.
--Is there any medication for bleeding gums?
Liquid solutions are available across the counter, which can be self administered by patient. When applied over the gums it either stops or reduces bleeding. But long lasting result s are obtained only by treating the cause.
GLOSSARY
Leukemia - Cancer of a certain type of white blood cells.
Oral hygiene - Proper care of the teeth and its associated structures.
ANUG- It is a rapidly spreading destructing disease of the gum
DENTAL ABSCESS:-
WHAT IS AN ABSCESS?
An abscess is the collection of pus following any infection, occurring within the body. When pus accumulates in relation to a tooth it is known as dental abscess. It can occur following an infection around the root of a tooth, in the gums or within the jawbone.
CAUSES
1. The most common cause is tooth decay. Tooth decay is a slowly progressing infection destroying the tooth and its contents. This infection descends down from the pulp to the tip of the roots and spreads into the surrounding bone. The pus formed is a result of this infection.
2. Injury to a tooth from a fall or blow can also result in a dental abscess.
3. Bacteria or food particles trapped within the gums or between the tooth and the gum can cause an infection resulting in an abscess. Medical problems such as diabetes can result in frequent occurrence of dental abscess.
SYMPTOMS
1. Pain associated with or without chewing
2. Redness and swelling in relation to the concerned area
3. Difficulty in swallowing
4. Foul tasting discharge within the mouth
5. Foul breath
6. Fever
WHAT HAPPENS IF THE ABSCESS IS NOT TREATED?
If left untreated the bag of pus break's open into the mouth or the face causing recurrent discharge of pus. This can result in foul breath, foul taste or an ugly scar on the face.
At times the infection spreads within the face and the neck region resulting in certain life threatening conditions.
HOW IS THE DENTAL ABSCESS TREATED?
The main principle of treatment is to drain the accumulated pus and remove the source of infection. This can either be done through the tooth by doing a Root canal treatment or via the gums by incising and draining the abscess. This is followed by a complete course of antibiotics and pain relievers. If the infection still persists the patient is referred to an oral surgeon for the surgical removal of the infected area.
WHAT CAN BE DONE TO PREVENT THE SPREAD OF A DENTAL ABSCESS?
The best way to prevent an abscess is to visit your dentist twice a year. At these appointments, your dentist will:
1. X-ray your teeth once a year to check for decay between
the teeth and to evaluate the health of your jaw bone.
2. Examine your teeth and mouth.
3. Remove any plaque and tartar that have built up on your
teeth.
4. Teach you how to care for your teeth and maintain good
oral health.5. Alert you to any problem areas.
6. Recommend any needed treatments.
RECEDING GUMS:-
--Do your teeth appear longer than usual?
Are you teeth sensitive when you drink anything hot or cold? . If yes, you might actually be the victim of receding gums. A condition normally seen occurring with age, but can also occurs in younger individuals.
CAUSES
1. Age: Gradual changes of the gingiva due to minor trauma and infection over the years can lead to down ward displacement of the gingiva.
2. Faulty brushing techniques may also result in receding gums.
3. Abnormally tilted teeth.
4. Strong band of muscles in the mouth may be attached to the gingiva, the constant contraction of which may result in receding gums. e.g. A small strip of muscle band is present between & above the two upper central anterior teeth. If this strip of muscle is too thick it can cause an upward displacement of the gingiva resulting in exposure of the roots of the teeth.
SYMPTOMS
An unsightly smile due to exposure of the roots of the teeth as a result of downward displacement of gingiva.
- Sensitivity of the teeth to hot or cold food items.
- Food getting stuck between the roots of adjacent
teeth.
DIAGNOSIS
The level of the gingival in relation to the tooth diagnoses this condition. If the level of gingiva is below the line, which separates the crown of the tooth from the root, it is diagnosed as gingival recession.
TREATMENT
Treatment of this condition is by a small surgical procedure. The displaced gingival is repositioned by detaching the gingival and tying it up at the optimal level. - But before this surgery all the regular procedure to create a healthy gingival is undertaken such as regular brushing, scaling, root planning, gum surgeries etc.,
MORE INFORMATION
When more amount of tooth surface is exposed to the saliva in the oral cavity, the rate of tooth to decay is also high. Thus covering of the teeth by the gingiva is very essential.
FAQ
Can receding gum occurring in relation to all the teeth in the mouth be treated?
Receding gum can be treated in relation to a few teeth, but treatment of all the teeth is not possible. But prior treatment will definitely improve the condition and prevent further occurrence.
GLOSSARY
Gingiva - soft thin tissue covering the bone supporting the teeth.
THUMB SUCKING:-
Thumb sucking in children has always caused embarrassment to many parents. The parents were more concerned over the social embarrassment caused by this habit rather than the actual physical damage caused by it.
This silly habit as it appears to many parents not only causes abnormally arranged teeth but also implicates the mental state of the child.
CAUSES
Thumb sucking can either be a non-compulsive act or a compulsive oral habit.
Non-Compulsive act:
As children grow, they pick up or drop habits depending on its acceptability. These habits are usually called non-compulsive habits or acts. Thumb sucking can be one such habit, which can be seen from birth to the age of 16. On an average most of the children stop this habit by the age 4. There are some children, however, who can continue the habit to as late as 12-15 years. In these children, thumb sucking is usually a way to relieve the frustration of hunger.
Compulsive Act:
Thumb sucking can be called compulsive when it has acquired a fixation in the child to the extent that he retreats to the practice of this habit when ever his security is threatened by events, which occur in his world. Unlike the non-compulsive habit, the child tends to suffer from increased anxiety when he attempts to correct the habit. The habit becomes his safety valve to release emotional pressure, whenever it becomes, too much to cope with. Lack of love and affection by the parents towards the child plays a major role in making the child emotionally insecure and thus making him resort to habits like thumb sucking.
SYMPTOMS
- If the habit is discontinued before the permanent teeth eruption, it can be considered harmless.
- Continuous thumb sucking leads to many ill effects. The main symptoms of this problem is shown by the teeth and they are:
- Displacement of the child’s permanent teeth due to the
uneven forces placed on the teeth by the thumb.
- The upper and lower front teeth may not approximate with each other.
- The upper front teeth may flare out.
- The open bite or lack of approximation of upper and lower front teeth may result in speech difficulties during pronunciation.
-As a result of the flared out or
protruding front teeth the child may end up fracturing these teeth more often.
- Protruding and uneven teeth change the facial appearance. This can cause an inferiority complex in the young mind.
DIAGNOSIS
Any child above the age of 4 with protruding anterior teeth may be affected by thumb sucking. A detailed history about the habit is very helpful. The frequency and duration of this habit can help in evaluating the extent of the habit.
The thumb used by the child normally appears to be very clean compared to the other finger.
TREATMENT
It can be treated by psychological methods also.
1. Psychological Method:-
The child is guided by the dentist and parent to consciously put an end to the thumb sucking habit over a period. This is possible only if the child is psychologically willing and wants to stop the habit.
Children often combine thumb-sucking habit with other secondary habits such as hair pulling or nose probing.
Frequently making the secondary habit impossible to perform can break the primary habit.
It is very important not to criticise the child. The child needs a lot of support and affection. He should be told about the ill effects of sucking the thumb to reinforce his determination to stop thumb sucking.
2. Extra oral method:-
The other simple methods are:
-Painting the child’s thumb or finger with an unpleasant tasting substance.
-Tapping the thumb with plaster so as to prevent thumb sucking.
-The above-mentioned methods will succeed depending upon the attitude of the parent. The parents should in someway reward the child for “growing out of the habit” during the procedure both by their action and by a small token prize.
-This will make a deep impression on the child and orient him towards completely breaking of the habit. The parent should also be warned that there is always the possibility that a more deleterious habit will spring up in its place if the present one is suppressed.
3. Intra oral methods:--
This is done by fabricating appliances, which are then fitted into the mouth of the child by the dentist. They are normally viewed as punishment devices by the child there by sometime producing severe emotional disturbances. If the appliances are going to convert a happy youngster into a nervous child overnight, it is not worth it.
MORE INFORMATION
There are other oral habits, which should be brought to the notice of the child’s dentist. These habits are lip sucking, tongue thrusting, nail biting, mouth breathing and bruxism.
All the above-mentioned habits will definitely takes its toll on the teeth. Therefore, early identification and treatment of these habits are necessary to ensure a good set of teeth and a lovely smile.
FAQ’s
Is thumb sucking a natural habit?
Yes, thumb sucking a natural habit until the age of 4. Continuation of the habit beyond the age of 6 will result in mal-alignment of teeth. Most children will give up this habit by themselves, but in cases where this doesn’t occur a dentist should be consulted.
Is there any other effect of thumb sucking other than that on the teeth?
Sucking on a dirty finger can make the child prone to infection, as during this stage children normally tend to play with sand or dirt.
GLOSSARY
Bruxism- Grinding of teeth.
TOOTH DISCOLORATION:
Poetry compares teeth to pearls. But teeth unlike pearls, are exposed to a variety of elements in day-to-day life. All these exposures are bound to take its toll on teeth color. They are also called the sentries of the digestive system.
CAUSES
The tooth discolouration can either be on the tooth surface (extrinsic) or be present within the substance of the tooth(intrinsic).
1. Intrinsic causes
In a tooth with an intact blood and nerve supply, the causes are:--
Hereditary disorders.
Tetracycline medication.
Excessive fluoride intake in drinking water.
High fevers associated with early childhood disease.
The loss of blood supply and nerve supply can by itself cause discoloration of the tooth.
2. Extrinsic causes
Stains from tobacco smoking.
Bacteria producing colored pigments.
A salivary protein layer covering the tooth surface.
The tinted remnants of a certain membrane seen on the teeth surface as the teeth, initially erupt out into the mouth.
Tooth decay or a broken down filling.
SYMPTOMS
Intrinsic causes are usually seen at the time of teeth eruption.
- In hereditary conditions like erythroblastosisfetalis and porphyria the teeth are colored in a brownish blue and a brownish red respectively.
- Tetracycline administration durin pregnancy can lead to discoloration of teeth as the tooth erupts in the newborn.
- Depending on the severity, discoloration can range from yellow -orange in mild cases and bluish gray in the most severe cases.
- Flurosis is a condition seen in places with increased fluoride content in the drinking water. Beyond a certain level, fluoride can cause yellow staining of teeth.
- High fever due to childhood infections can lead to areas of poor calcification within the teeth resulting in the appearance of prominent white spots.
Extrinsic stains can be classified based on color of the stain into:
- Brown stains: It is caused by a thin translucent, bacteria free layer covering the teeth. It is seen in individuals who do not brush their teeth adequately, or in those who use toothpaste with inadequate action.
- Tobacco stains: Dark brown or black surface accompanied by brown discoloration of the tooth
substance is seen. These stains results from coal tar combustion present in the tobacco and also due to the diffusion of tobacco juices into the substance of the teeth.
- Green stains: Green to greenish yellow stains, sometimes of considerable thickness is seen in
children. It is usually seen in upper anterior teeth and has been attributed to florescent bacteria and fungi.
- Orange stains : Occurs in front teeth, and is caused by color producing bacteria.
- Metallic stains: Caused by metals and metallic salts, which may be introduced into the oral cavity by metal-containing dust inhaled by industrial workers.
Examples of stains caused by various metals are:
Copper dust
Greenish Stain
Iron
Brown Stain
Silver
Black Stain
Mercury
Greenish Black
DIAGNOSIS
Diagnosis is made based on the color of the stain. If the stain still remains after meticulous cleaning of the teeth by the dentist, it is understood that the stain is present within the substance of the tooth. A careful history taking can be useful in differentiating between an internal stain and an external stain.
TREATMENT
- Many people have definite aesthetic problem from internal or external stains, where as others worry needlessly about the overall color of their teeth. In the latter instance the dentist must decide if the color of the teeth can be improved enough to justify treatment even though the patient insists on having something done. For e.g. person with light complexion may believe that their teeth are too dark when actually they are normal in color. A Sun tan, darker makeup or a darker lipstick will usually make teeth appear much whiter by increasing the contrast between the teeth and thesurrounding facial features
- Most external stains can be removed by thorough cleaning of teeth, with an instrument called “ ultrasonic scaler”.
This instrument removes most of the stains caused by tobacco, food debris or bacteria. If a broken down filling or a cavity is the cause, filling the defect will improve the discoloration. Discoloration resistant to cleaning can be corrected or greatly improved through conservative procedures such as Bleaching, Micro abrasion or Veneering.
- Stains caused by tetracycline medications are usually much difficult to treat, and might require a radical approach.
MORE INFORMATION
- Most bleaching techniques are some form of derivative of hydrogen peroxide in different concentrations and are applied by different application techniques.
- The lightening of the color of the tooth through application of a chemical agent, which tends to decolorize the pigmentation present on the tooth, is referred to as bleaching.
- Bleaching technique may be classified as to whether they involve a living tooth or a tooth with no blood and nerve supply. The procedure can be carried out within the dental clinic or by the patient at his residence.
- Bleaching generally has an approximate life span of 1 – 3 years, although this change may be permanent in some situations.
FAQ’s
Is there anyway of preventing stains from smoking?
Yes, there is a way. Quit smoking, because there are no cigarettes available in the market, which do not cause staining. Usage of filters could reduce staining to a certain extent.
GLOSSARY
Micro abrasions: It is a method of elimination of discoloration when the stained areas in abraded away. This technique does result in the physical removal as tooth substance and therefore are indicated only for stains that do not extend beyond a few tenths of a millimeter in depth.
TOOTH MOBILITY:-
Mobility of teeth is caused by disease or injury to the gum and the bone which supports the teeth.
CAUSES
1. Infection: when there is accumulation of food debris and bacteria on the tooth. There is inflammation of gingival. Infection is the main cause of inflammation. Inflammation from the gingiva spread to the fibrous tissue between the teeth and bone and finally it hits the bone. Inflammation and destruction of bone affects the foundation on which the teeth stands causing tooth mobility.
2. Increased amount and uneven forces during chewing when transmitted to the teeth, causes tooth mobility.
3. A tumor of the bone, which causes destruction to the bony architecture, results in tooth mobility.
4. Blunt injury to the tooth structure can also cause looseness of teeth.
SYMPTOMS
1. Patient complains of discomfort while chewing of food.
2. Pain may accompany the mobility of teeth
3. The tissues around a mobile tooth are invariable red, swollen and damaged.
DIAGNOSIS
- Certain amount of tooth movement is always present. This movement is felt when the teeth are clenched.
- Mild moderate movement of teeth is usually diagnosed by manually pushing the tooth in question on either side with the help of probing instruments. Fingers are never a reliable source for the diagnosis for such movements.
TREATMENT
Cleaning the mobile tooth of all bacterial sources may reduce mobility to a certain extent.
- Teeth which are mobile by just a millimeter are so can be splinted to the adjacent teeth.
- Teeth which are loose and which move in all direction may have to be extracted.
MORE INFORMATION
Splinting is usually done using a thin steel wire, here the mobile teeth is bond to the adjacent stable teeth in a specific pattern, so as to attain maximum stabilization of the loose tooth. This procedure might be slightly pain full. New methods have been devised to completely eliminate pain.
FAQ
What level of teeth mobility can be stabilized?
Mobility of 1mm can be treated successfully, but anything beyond this level reduces the chances of success. Also teeth loosened due to trauma have a better chance of success than teeth loosened due to infection.
Is splinting painful?
This procedure is normally done under local anesthesia; hence pain will not be a problem.
GLOSSARY
Splinting: stabilization of the mobile tooth by drawing support from the strong adjacent teeth.
ORAL CANCER:-
- Cancerous growth occurring within the structures of the oral cavity is known as Oral Cancer The oral cavity includes the mouth and all the structures within it ,such as the tongue, teeth ,gums ,lower jaw etc
- Cancer is an abnormal disorganized growth of cells in the tissue of a person . Cancer cells keep on multiplying without paying head to the body’s command to stop. This abnormal growth of cells destroys the normal structure and the function of the affected tissue and the body in general .
- Among other cancers oral cancer is one of the most common causes of death. In male, oral cancer represents 4% of total body cancer and in female; it is 2% of all cancers. Majority of the oral cancers affect the outer layer of mucous membrane covering the oral cavity.
Causes:
Cancer in the mouth does not occur overnight. It occurs as a series changes within the tissue , which eventually promotes the development of cancer.
The factors involved are:
1. Tobacco
2. Alcohol
3. Syphilis (a sexually transmitted disease caused by a bacteria)
4. Nutritional deficiencies.
5. Virus infection
6. Sunlight
7. Other miscellaneous factors such as trauma, heat, and irritation from sharp teeth, poorly restored fillings and ill-fitting dentures.
Signs and Symptoms:-
Oral cancer may initially present without any symptoms. Patients are most often identified only after a significant progression of the disease. Discomfort is the most common symptoms that compels a patient to seek medical care.
Patient may present with any of the following symptom:
· Awareness of a mass present or growing within the Oral Cavity.
· Difficulty in swallowing.
· Toothache.
· Pain in the ear.
· Limited mouth opening.
· Excessive bleeding which is not seen that commonly.
· A non-healing ulcer in the oral cavity.
· Swelling on the gums interfering with the seating of the dentures in the mouth.
Majority of oral cancers involve the tongue, the posterior region of the oral cavity and the floor of the mouth. The lips, gums, the under surface of the tongue and the palate (bones separating the mouth from the floor of the nose) are less frequently involved.
Warning signs of Oral Cancer:-
Certain pre-cancerous lesions occurring in the oral cavity may indicate the person’s susceptibility to cancer. These lesions can be in the form of white patches in the mucous membrane covering the oral cavity and along the lateral border of the tongue, which cannot be removed by rubbing the affected area.
· Red patches seen on the mucous membrane lining the mouth and the tongue.
· Increase in fibrous content of the mucous membrane lining the cheek, which presents itself as thick fibrous bands running along the inner aspect of the cheek. Commonly seen in betel nut chewers this condition results in inability to open the mouth.
All the above lesions will cause a burning sensation when consuming spicy food.
DIAGNOSIS:-
1. Thorough examination of the oral cavity and the neck region conducted without neglecting any area may show hard lumps of tissues, which may indicate cancer. The patient is assessed for any suspicious tissue changes, which may include a white, red or a mixed white or red lesion.
2. Imaging the lesion using x-ray films, CT scan and advanced diagnostic techniques such as MRI helps in defining the location and extent of the cancerous growth.
3. Microscopic examination of a tissue specimen from the suspected lesion is the best method to confirm or rule out oral cancer. It gives the exact type and nature of cancer.
TREATMENT:-
- The principle objective is to cure the patient of cancer. The choice of treatment depends upon factors such as cancer cell type, amount of changes in the cell, size and location of the cancerous growth.
- Surgery or radiation is used with curative intent in treatment of cancer. Chemotherapy (Medicines) is used as an additional form of treatment. In early lesion either surgery or radiation as a form of treatment would suffice. But in an advanced condition, a combination of both surgery and radiation is required.
- There is rarely a second chance available for cure. Hence the initial approach of treatment is critical. The survival rates after early detection and treatment of cancer have been noted to be 70%. Chemotherapy (Medicines) is a weak substitute for the above-mentioned treatment.
More Information:-
Tobacco utilization either in the form of smoking or chewing is an important factor in the development of oral cancer. About 97% of oral cancer victims are known to be associated with tobacco either in the form of smoking or chewing. Pipe smoking and cigar smoking have been known to increase the risk levels by a few folds. Among the various habits associated with tobacco, tobacco chewing is known to cause oral cancer more rapidly than any of the other habits. This is because of the direct and repeated contact of the tobacco with the mucous membrane of the oral cavity.
FAQs:
--Do all betel nut or tobacco chewers get oral cancer?
Betel nut and tobacco chewers are definitely more prone to oral cancer than those who do not have this habit, but there are also other factors such as genetics, diet, environment and the person’s immune system.
--Will stopping the habit improve the condition?
There are certain lesions seen frequently in the mouth of betel nut and tobacco chewers. These lesions precede oral cancer. If these preceding lesions are identified in time, then stopping the habit will definitely improve the lesion or maybe even cure it.
--Is pain an early sign of Cancer?
Not always. Pain is usually a late symptom of cancer. People often think that persistent pain such as headache or constant pain in the region of the face means cancer, but this is rarely the case. However pain should not be ignored.
--What are the side effects of treatment?
There are side effects to all forms of treatments involving oral cancer.
--Surgery
If the lesion is small then there are usually no side effects, but if the lesion is large the it may require the removal of the affected structure resulting in the speech defects difficulty in swallowing and also facial deformities. These conditions can rehabilitated by speech therapy and by physiotherapy.
--Radiation therapy
During and after radiation therapy the patient develops mouth sores. The patient also suffers from reduced secretion of saliva, which causes difficulty in swallowing and makes the patient more prone to teeth decay and other forms of infection.
--Chemotherapy
Side effects depend on the kind of drug used. The usual side effects are loss of hair, ulcers in the mouth and in the stomach, reduced resistance to infection, loss of appetite, nausea, vomiting, and lack of energy.
GLOSSARY CT SCAN
It is an advanced diagnostic technique using x-rays to three dimensionally identify the site and extent of a lesion.
MRI: It is more advanced technique, which uses magnetic force to diagnose both bony and soft tissue lesions.
FIBROUS DYSPLASIA OF THE BONE:-
About Fibrous dysplasia of the bone:
Fibrous dysplasia (FD) of the bone is a peculiar condition that affects either all bones or a single bone in the body.
Most cases are diagnosed in adolescence and young adulthood and remain unchanged throughout life. The initial manifestations of fibrous dysplasia are most commonly found in persons aged 3-15 years. In the past, many conditions that could not be satisfactorily explained have been included under this disease. The bone in this condition is fibrous or plastic in quality and is defective in form as well.
TYPES
Fibrous dysplasia of the bone is divided into two types:
1· Monostotic fibrous dysplasia
2· Polystotic fibrous dysplasia
In monostotic type only one bone is involved, and hence the prognosis of this type is definitely better. In polystotic type, more than one bone or a group of bones is involved, and the prognosis is poorer.
Monostotic Fibrous dysplasia of the bone:
This condition affects mostly people in the age group 10-30. It involves excessive growth of hard fibrous tissue that replaces normal bone tissue in a single bone. Approximately 70-80% of FD cases are monostotic, occurring most frequently in the rib (28%), femur (23%), tibia, craniofacial bones (10-25%), and humerus. With monostotic disease, patients as old as 20 or 30 years are asymptomatic.
The cause of this condition is unknown although several theories have been proposed. One theory attributes this disease to abnormal activity in the bone forming tissues prior to birth. Another theory says any localized infection or trauma gives rise to this disease. In some cases, Monostotic FD of the bone has occurred as an autosomal recessive trait.
SYMPTOMS
The first sign of the disease is a painless bulging in the affected jaw. As the lesion is constantly expanding, they could lose their balance of contacting the teeth in the opposite jaw, and as a result, there may be disturbance in the teeth as well. . When Fibrous dysplasia occurs in the upper jaw of the maxilla, Monostotic FD is a serious condition. The lesion extends into the maxillary sinus, and on the face. At times it may extend to the base of the skull and obstruct vital nerves, causing irreparable damage.
TREATMENT
The treatment of Monostotic FD of the bone is usually radical surgery. This surgery mutilates the entire bone involved, sometimes necessitating block resection as well. In some cases, this condition could lead to osteosarcoma or cancer of the bone.
Polyostotic fibrous dysplasia:-
This condition affects a number of bones in the body, mostly the long bones. About 20-30% of FD cases are polyostotic. Two thirds of patients exhibit symptoms before the age of 10. Polyostotic FD frequently involves the skull and facial bones, pelvis, spine, and shoulder girdle. The sites of involvement are the femur (91%), tibia (81%), pelvis (78%), ribs, skull and facial bones (50%), upper extremities, lumbar spine, clavicle, and cervical spine, in decreasing order of frequency.
SYMPTOMS
- There is a thickening of the long bones and the patient usually complains of persistent bone pain.
- Often, the initial symptom is pain in the involved limb and, spontaneous fracture, or both. Leg-length discrepancy is present to varying degrees in 70% of patients with limb involvement. The weight bearing bones become bowed due to weakening of the structural integrity of the bone.
- The bones of the face and the skull are involved in a majority of the cases and sometimes are unilateral in distribution. If this happens, there is an obvious deformity of the face.
- Sometimes brown lesions called the "cafe-au-lait" spots are present on the skin. Vaginal bleeding is another feature of this condition. Teeth do not erupt into the oral cavity on time. Several hormonal disturbances are also commonly seen. The thyroid, parathyroid and the pituitary as well as the ovary are involved.
TREATMENT
Mild cases are satisfactorily treated with surgery. But in severe cases, radiation therapy has been tried with limited success. The lesions have a high potential to turn malignant.
FAQs
--What is Fibrous Dysplasia (FD)?
Fibrous dysplasia (FD) is a disease of the bones characterized by abnormal growth areas or lesions in one or more bones. FD can occur in any bone, including the skull, legs, arms, and the ribs.
--Which doctor do I consult about FD?
A bone specialist is to be consulted.
--What is McCune-Albright Syndrome?
McCune-Albright Syndrome is named after the two physicians who described it over 50 years ago. About 10 % of those with polyostotic FD have some associated endocrine (hormonal) problems including early puberty and areas of increased skin pigmentation called cafe-au-lait marks. These birthmarks have irregular borders, again primarily on one side of the body. The combination of polyostotic fibrous dysplasia, endocrine disorders, and café-au-lait marks is called McCune Albright Syndrome (MAS).
--Is FD hereditary?
No. FD is not hereditary.
--Why does one get FD?
The cause of FD is still unknown. The gene responsible for FD appears to be especially susceptible to mutations. Though rare, FD occurs in males and females and in people of all races across the globe. It is possible that the mutation occurs randomly.
--Is FD cancer?
FD is not cancer. Many people use to term "lesion" to mean any defect to avoid confusion of FD with malignant bone tumors. However, an FD bone lesion can turn cancerous; but this is very rare—in less than 1 % of FD cases.
--Is there a permanent cure for FD?
In general, FD cannot be cured today, unless it is only one lesion in one bone that can be completely eliminated by surgery. There are often unidentified FD cells in several bones and all cannot be eliminated by surgery. Some drug treatments can significantly diminish bone pain in long bones and cause some good bone to fill in the defects. Bisphosphonate drugs such as alendronate (Fosamax) that is used for treating osteoporosis or pamidronate (Aredia) have helped some people. However, these drugs do not work for all FD patients. Research is in progress to find other possible treatments.
DEVELOPMENTAL DISTURBANCES OF THE TONGUE:
About Tongue
The tongue is an important organ that occupies a large area in the oral cavity covering the floor of the mouth. It is below the palate, and is surrounded by teeth on either side. Together with the palate, it performs the function of swallowing. It is rightly said that the tongue is a gateway to the esophagus. A host of things can go wrong with the formation of the tongue, since it develops from multiple sources, rather than a single progenitor process. Most of the developmental disturbances of the tongue are related to its size and shape, though structural defects also exist.
Defects related to the size of the tongue:-
Microglossia:
This is a condition where the size of the tongue is abnormally small. Cases of complete absence of the tongue have been reported. Fortunately, it is a rare condition. Obviously, a tiny tongue will pose many difficulties related to speech and swallowing. There is no treatment for this condition, and the affected person will have to train their tongue to the best of their abilities.
Macroglossia:
This is a much more common condition than microglossia, where the tongue is highly enlarged. An enlarged tongue may be congenital, when it is associated with generalized muscular hypertrophy or hemi hypertrophy. Secondary macroglossia is that condition that occurs in conjunction with some other conditions like a tumor of the tongue, hemangioma and acromegaly. Acromegaly is a hormonal disturbance where growth hormone is secreted in excess of the requirements of the body. The reason behind the enlargement of the tongue in this case is related to the relaxation of the muscles that support the lower jaw, and there is no support to keep the tongue in position.
As a rule, macroglossia causes disturbances in the teeth as well. Due to the continuous pressure exerted by the heavy tongue, teeth begin to move away and the tongue occupies these spaces between the teeth, giving it a scalloped appearance. Macroglossia is a prominent feature in Beckwith's hypoglycemic syndrome, where neonatal hypoglycemic predominates along with umbilical hernia and post-natal gigantism. The treatment of macroglossia involves the removal of the cause that gives rise to this condition. At times, surgical stripping of the tongue to reduce the heavy musculature is also warranted.
Ankyloglossia:
Ankyloglossia occurs as a result of the fusion of the lingual frenum to the floor of the mouth. However, complete fusion rarely occurs; a partial ankyloglossia or "tongue-tie" is a much more common condition. This leads to a myriad of speech problems such as lisping and stuttering. The treatment is to surgically sever the connection between the frenum and the floor of the mouth.
Fissured Tongue:
This condition is also referred to as scrotal tongue since the tongue often resembles the scrotum in this state. Here a transverse groove is present on the tongue from which numerous smaller grooves radiate all over the surface of the tongue. The condition is usually painless and the only problem is with the food debris gets stuck in the grooves. These have to be cleaned by gauze or a toothbrush.
Median Rhomboid Glossitis:
This condition is a classic developmental disorder of the tongue. It is a failure of the developmental apparatus during the organogenesis of the fetus. A structure called "tuberculum impar" is supposed to withdraw when the two halves of the tongue come close to each other during development. When this does not happen, the structure gets trapped in between the two halves of the tongue, thereby creating an area, which looks like a bald patch on it. Median Rhomboid Glossitis has also been strongly linked with the fungal infection caused by Candida albicans, where the tongue has an ovoid patch just before the entry into the esophagus. Sometimes a flat-raised area can also be discerned. This condition is reportedly thrice as common in men as in women. The exact cause for this occurrence is not known, although hormonal links have been suggested.There is no known treatment for MRG, though doctors have tried to administer anti-fungal agents with mixed results.
Cleft tongue:
Cleft tongue is a condition where the tongue has a cleft running right across it horizontally or vertically, although reported cases have had vertical clefts. Complete clefting is extremely rare, and occurs as a result of lack of developmental forces to push both halves of the tongue towards each other. Partial clefting presents as a deep groove in the middle of the tongue and is a common feature in the oro-facial-digital syndrome. Cleft tongue is of little importance other than causing difficulty in eating as food gets stuck in the cleft.
Benign Migratory Glossitis:
This condition is also called a Geographic Tongue due to the behavior of the lesions, which tend to "migrate" from one area of the tongue to another. The exact cause for the condition remains unknown, although it tends to occur with more intensity in cases of emotional stress. Females are twice as affected as males, but no racial differences have been observed. The lesions here are yellowish-white or deep red in color depending on the papillae that are affected.
The area of the lesion loses its epithelial lining, making hot foods seem hotter. The areas of desquamation (epithelium peel-off) persist for a while, regress spontaneously, but reappear over time. Patients with this condition are usually asymptomatic and the lesions themselves are an incidental finding during routine check-up. Again there is no known treatment for the disease, but some doctors have reported moderate success with vitamins and mineral supplements.
Hairy Tongue:
This is a condition characterized by the hypertrophy of the filiform papillae of the tongue as well as desquamation of the area where this occurs. If the papillae become stained with tobacco, they appear black in color and look like hair on the tongue. The tongue could also appear yellowish-white if foodstuff is trapped within these papillae. Anemia and gastric troubles are said to have a significant bearing on the development of this condition. Antibiotics like penicillin and Aureomycin are also responsible for the staining of the papillae. Smoking remains the biggest cause for the occurrence of the condition. Sometimes, head and neck irradiation after cancer may also produce this condition. The only treatment of the condition is to keep the tongue as clean as possible by using a toothbrush.
FAQs
--My tongue burns whenever I take chilli-hot food. What is the cause and treatment of this problem?
Burning sensation on the tongue could be due to some drugs commonly taken for diabetes and hypertension. More often, it is a result of sloughing away of the epithelial lining of the tongue. If this is the case, you should avoid taking chilli-hot food till it regenerates.
--I have a large tongue. What are the chances of getting it surgically reduced?
A large tongue develops primarily due to hormonal disturbances. Make sure that this is not the case before opting for surgery. Otherwise the chances of surgical reduction are excellent.
--My son has a lisp when he speaks and I have noticed that his tongue has limited movement. What should be done?
The boy is suffering from a condition called Ankyloglossia, more commonly tongue-tie. A simple surgical procedure should take care of the problem. Please consult your doctor as well as an oral surgeon for the needful
--I have just recovered from a bout of malaria and find that food does not taste the same. What should I do?
The loss of taste is temporary and has come about because of the strong drugs that you have taken. The tongue will recover over time and the taste apparatus should be all right in a fortnight’s time.
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