STOMATOLOGY

Stomatology is the branch of medicine or dentistry concerned with the

structures, functions, and diseases of the mouth.
Collins Dictionary.
Stomatology is increasingly called oral medicine in current usage.
Oral medicine, or stomatology, treat the variety of diseases that affect both the
skin and the oral mucous membranes. Some of these diseases, such as pemphigus
vulgaris, can develop their first manifestations in the mouth and can be life
threatening. Oral cancer also has a high mortality rate, partly because it grows in
such close proximity to so many vital structures and readily involves them.
Definition of common terms.
Caries
Commonly used tem for tooth decay.
Cavity
Decay on tooth caused by caries; also referred to as carious lesion.
Cusp
The pointed portion of the tooth.
Decay
The lay term for carious lesions in a tooth; decomposition of tooth structure.
Dentin
The part of the tooth that is beneath the enamel and cementum.
Dry mouth
The condition of not having enough saliva to keep the mouth wet. If it goes
untreated, severe dry mouth can lead to increased level of tooth decay and
infections of the mouth.
Enamel
Hard calcified tissue covering dentin of the crown of tooth.
Erosion
Wearing down of tooth structure, caused by chemicals (acids).
Gingiva
Soft tissues overlying the crowns of unerupted teeth and encircling the necks of
those that have erupted.
Gingivitis
Inflammation of gingival tissue without loss of connective tissue.
Jaw
A common name for either the mandible or maxilla.
Labial
Pertaining to or around the lip.
Lesion
An injury or wound; area of diseased tissue.
Malignant
Having the properties of dysplasia, invasion, and metastasis.
Oral
Pertaining to the mouth.
Palate
The hard and soft tissues forming the roof of the mouth that separates the oral
and nasal cavities.
Periodontal
Pertaining to the supporting and surrounding tissues of the teeth.
Periodontal Abscess
An infection in the gum pocket that can destroy hard and soft tissues.
Periodontitis
Inflammation and loss of connective tissue of the supporting and surrounding
structure of teeth with loss of attachment.
Plaque
A soft sticky substance that accumulate on teeth composed largely of bacteria
and bacterial derivatives.
Scaling
Removal of plaque, calculus, and stain from teeth.
Submandibular glands
Walnut-sized major salivary glands located beneath the tongue.

Basic notions of care in stomatology

Basic dental care involves brushing and flossing your teeth regularly, seeing your
dentist for regular checkups and cleanings, and eating a mouth-healthy diet,
which means eating plenty of whole grain foods, vegetables and fruits, and
protein foods.
Why is basic dental care important?
Practicing basic dental care:
 Prevents tooth decay.
 Prevents gum (periodontal) disease, which can damage gum tissue and the
bones that support teeth, and in the long term can lead to the loss of teeth.
 Shortens time with the dentist and makes the trip more pleasant.
 Saves money. By preventing tooth decay and gum disease, you can reduce
the need for fillings and other costly procedures.
 Helps prevent bad breath. Brushing and flossing rid your mouth of the
bacteria that cause bad breath.
 Helps keep teeth white by preventing staining from food, drinks, and
tobacco.
 Improves overall health.
  Makes it possible for your teeth to last a lifetime.

Ways to avoid dental problems

Keeping your teeth and gums healthy requires good nutrition and regular
brushing and flossing.
 Brush your teeth twice a day (in the morning and before bed) and floss
once day. This removes plaque, which can lead to damaged teeth, gums,
and surrounding bone.
 Use toothpaste that contains fluoride, which helps prevent tooth decay and
cavities.
 Avoid foods that contain a lot of sugar. Sugar helps plaque grow.
 Avoid using tobacco products, which can cause gum disease and oral
cancer. Exposure to tobacco smoke (second-hand smoke) may also cause
gum disease as well as other health problems.
 Practice tongue cleaning. You can use a tongue cleaner or a soft-bristle
toothbrush, stroking in a back-to-front direction.
 Schedule regular trips to the dentist based on how often you need
examinations and cleaning.

What conditions are linked to oral health?

Research shows that gingivitis and periodontitis can contribute to certain health
conditions including cardiovascular disease, stroke, endocarditis (infection of the
inner lining of the heart), pneumonia, and pregnancy complications such as
premature birth and low birth weight.
Conversely, there are certain health conditions that can have a negative impact
on your teeth and gums, including diabetes, osteoporosis, HIV/AIDS, and
Alzheimer’s disease.
Signs of poor oral hygiene
There are several warning signs that could indicate oral health problems. The
most common signs of poor oral hygiene include:
  Bleeding gums
 Tooth decay
 Chronic bad breath
 Loose teeth
 Gum recession
 Mouth sores that don’t go away
 Toothache
 Swelling of the jaw
 Gingivostomatitis (an infection of the mouth caused by certain bacteria and
viruses)

Structure of the oral cavity

The oral cavity is bounded by the teeth, tongue, hard palate, and soft palate.
These structures make up the mouth and play a key role in the first step of
digestion: ingestion. The oral cavity is the point of entry into the gastrointestinal
system but also acts as an alternative respiratory pathway in case the nose gets
blocked and helps produce and modify sound when you speak or sing.
The oral cavity is formed by the arch of the hard and soft palates above, the teeth
and cheeks laterally and the tongue on the floor of the mouth.
>insert diagram<

Common pathologies of the teeth and oral cavity

Key facts
 Oral diseases, while largely preventable, pose a major health burden for
many countries and affect people throughout their lifetime, causing pain,
discomfort, disfigurement and even death.
 It is estimated that oral diseases affect nearly 3.5 billion people.
 Untreated dental caries in permanent teeth is the most common health
condition according to the Global Burden of Disease 2019.
 Treatment for oral health conditions is costly and usually not part of
universal health coverage.
  Most low- and middle-income countries are unable to provide services to
prevent and treat oral health conditions.
 Oral conditions are caused by a variety of modifiable risk factors, including
sugar consumption, tobacco use, alcohol use and poor hygiene, their
underlying social and commercial determinants.
Oral health – WHO

The mouth is one of the most important part of the body. It has many different
functions including;
 Take in food and drink
 Breathe in air
 Start digestion
 Speak and sing
 Show emotion by smiling and pouting
Any problem that affects the mouth and make it hard to eat, drink, or even smile.
Some common pathologies of the mouth include:

DENTAL CARIES

Dental caries (Cavity) is a chronic infection resulting from tooth-adherent

cariogenic bacteria, primarily Streptococcus mutans, which metabolize sugars to
produce acid, demineralizing the tooth structure over time. This activity describes
the evaluation and management of dental caries and highlights the role of the
interprofessional team in evaluating and treating patients with dental caries.
The term “dental caries” was first reported in literature approximately around
1634, and it originates from the Latin word “caries”, which stands for decay. The
term was initially used to describe holes in the teeth. Dental caries is reported to
be one of the oldest and most common diseases found in humans.
Etiology
Dental caries is the term that refers both to the disease and resulting lesion.
Cavities are caused by tooth decay, a process that occurs over time. Here’s how
tooth decay develops:
 Plague forms. Dental plaque is a clear sticky film that coats the teeth. It’s
due to eating a lot of sugars and starches and failing to clean the teeth well.
Bacteria quickly begin feeding on them and form plaque. Plaque that stays
on the teeth can harden under or above the gum line into tartar (calculus).
Tartar makes plaque more difficult to remove and creates a shield for
bacteria.
 Plaque attacks. The acid in the plaque removes minerals in the tooth’s
hard, outer enamel. This erosion causes tiny openings or holes in the
enamel – the first stage of cavities. Once areas of enamel are worn away,
the bacteria and acid can reach the next layer of the tooth, called dentin.
This layer is softer than enamel and less resistant to acids. Dentin has tiny
tubes that directly communicate with the nerve of the tooth causing
sensitivity.
 Destruction continues. As tooth decay develops, the bacteria and acid
continue their march through the teeth, moving next to the inner tooth
material (pulp) that contains nerves and blood vessels. The pulp becomes
swollen and irritated from the bacteria. Because there is no place for the
swelling to expand inside of the tooth, the nerve becomes pressed, causing
pain. Discomfort can even extend outside of the tooth root to the bone.

Symptoms
The signs and symptoms of caries vary, depending on their extent and
location. When a cavity is just beginning, there may not be any symptoms at
all. As the decay gets larger, it may cause signs and symptoms such as:
 Toothache, spontaneous pain or pain that occurs without any apparent
cause.
 Tooth sensitivity
  Mild to sharp pain when eating or drinking something sweet, hot or
cold.
 Visible holes or pits in teeth
 Brown, black or white staining on any surface of a tooth.
 Pain when biting.

Prevention/ health education

Good oral and dental hygiene can help avoid cavities and tooth decay. Here are
some tips to help prevent cavities:
 Brush with fluoride toothpaste after eating or drinking. Brush teeth at
least twice a day and ideally after every meal. Floss between the teeth.
 Rinse your mouth. If your dentist feels you have a high risk of developing
cavities, he or she may recommend that you use a mouth rinse with
fluoride.
 Visit your dentist regularly. Get professional teeth cleanings and regular
oral exams which can help prevent problems or catch them early.
 Consider dental sealants. A sealant is a protective plastic coating applied
the chewing surface of back teeth. It seals off grooves and crannies that
tend to collect food, protecting tooth enamel from plaque and acid. The
Centers for Disease Control and Prevention (CDC) recommends sealants for
all school-age children. Sealants may last for several years before they need
to be replaced, but they need to be checked regularly.
 Drink some tap water. Most public water supplies have added fluoride,
which can help reduce tooth decay significantly.
 Avoid frequent snacking and sipping. Whenever you eat or drink beverages
other than water, you help your mouth bacteria create acids that can
destroy tooth enamel. If you snack or drink throughout the day, your teeth
are under constant attack.
 Eat tooth-healthy foods. Some food and beverages are better for your
teeth than others. Avoid foods that get stuck in grooves and pits of the
teeth for long periods, or brush soon after eating them. However, foods
such as fresh fruits and vegetables increase saliva flow, and unsweetened
coffee, tea and sugar-free gum help wash away food particles.
  Consider fluoride treatment. If you aren’t getting enough fluoride through
fluorinated drinking water and other sources, your dentist my recommend
periodic fluoride treatment.
 Ask about antibacterial treatments. If you are especially vulnerable to
tooth decay, for example because of a medical condition, your dentist may
recommend special antibacterial mouth rinses or other treatments to help
cut down on harmful bacteria in your mouth.
 Combined treatments. Chewing xylitol-based gum along with prescription
fluoride and antibacterial rinse can help reduce the risk of cavities.

Diagnosis
A dentist can usually detect tooth decay by:
 Asking about tooth pain sensitivity.
 Examining your mouth and teeth.
 Probing your teeth with dental instruments to check for soft areas.
 Looking at dental X-rays, which can show the extent of cavities and decay.

Treatment
Regular checkups can identify cavities and other dental conditions before they
cause troubling symptoms and lead to more serious problems. The sooner you
seek care, the better your chances of reversing the earliest stages of tooth decay
and delaying its progression. If a cavity is treated before it starts causing pain, you
probably won’t need extensive treatment.
Treatment on cavities depends on how severe they are and your particular
situation. Treatment options include:
Fluoride treatments. If your cavity just started, a fluoride treatment may
help restore your tooth’s enamel and can sometimes reverse a cavity in the
very early stages. Professional fluoride treatments contain more fluoride
than the amount found in tap water, toothpaste and mouth rinses. Fluoride
treatments may be liquid, gel, foam or varnish that’s brushed onto your
teeth or placed in a small tray that fits over teeth.
 Fillings. Fillings, also called restorations, are the main treatment option
when decay has progressed beyond the earliest stage. Fillings are made of
various materials, such as tooth-colored composite resins, porcelain or
dental amalgam that is a combination of several materials.
Crowns. For extensive decay or weakened teeth, you may need a crown, a
custom-fitted covering that replaces your tooth’s entire natural crown. The
dentist drills away all the decayed area and enough of the rest of the tooth
to ensure a good fit. Crowns may be made of gold, high strength porcelain,
resin or other materials.
Root canals. When decay reaches the inner material of the tooth (pulp),
you may need a root canal. This is a treatment to repair and save a badly
damaged or infected tooth instead of removing it. The diseased tooth pulp
is removed. Medication is sometimes put into the root canal to clear any
infection. Then the pulp is replaced with a filling.
Tooth extractions. Some teeth become so severely decayed that they
cannot be restored and must be removed. Having a tooth pulled out can
leave a gap that allows your other teeth to shift. A bridge or dental implant
can be placed to replace the missing tooth.

Nursing care
Assessment
1. Assess the patient’s oral hygiene practices. Assess the teeth, gums,
mucous membranes, and tongue for color, moisture, texture, irritation, and
infection
Rationale: oral hygiene information provides direction on possible
etiological factors and guidance for subsequent education.
2. Assess the patient’s nutritional status
Rationale: Poor food choices contribute to dentition problems. Poor
dentition can affect food consumption.
3. Assess for complaints of toothache.
Rationale: Dental caries and abscess development is common and painful.
4. Assess the patient’s ability to complete regular oral care.
Rationale: Patient may need assistance in completing oral care.
 5. Assess to what extent fear of dentists plays a role in avoidance of dental
care.
Rationale: Patient might have had an unpleasant experience in the past and
may be expecting the dental appointment to be uncomfortable. Providing
accurate information may help reduce fear.
6. Assess for financial problems to accessing and maintaining improved
dental care.
Rationale: Patients may be proud to ask for assistance or may be unaware
of social services available to them.
Nursing interventions
1. Provide a mouth care routine including tooth brushing at regular intervals
with a soft-bristle toothbrush and fluoride toothpaste.
Rationale: cleaning of teeth with a toothbrush and fluoride-containing
toothpaste prevents the build-up of plaque.
2. Teach gentle flossing of teeth with suitable dental floss.
Rationale: flossing promotes gum health and prevents the build-up of
plaque.
3. Instruct the patient to rinse the mouth with warm saline or antiplaque
mouth rinse.
Rationale: these measures help promote oral hygiene.
4. Assist the patient in performing oral hygiene after every meal and as often
as needed,
Rationale: regular brushing of teeth especially after meals is vital to prevent
build-up of bacteria.
5. Encourage patient to avoid high-sugar foods.
Rationale: high sugar foods may promote tooth decay.
6. Instruct patient to obtain regular dental checkups and follow-ups.
Rationale: regular dental checkups helps with early identification of
problems.
7. Educate patient on importance of oral hygiene.
Rationale: right knowledge helps prevent possible dental problems.
8. Educate patient on importance of maintaining a healthy diet despite dental
problems.
Rationale: adequate nutrition is vital to healthy teeth and body.
DENTAL ABSCESS

Also known as Tooth Abscess, a dental abscess is a pocket of pus that’s

caused by bacteria infection. The abscess can occur at different areas near
the tooth for different reasons. A periapical abscess occurs at the tip of the
root. A periodontal abscess occurs in the gums at the side of a tooth root. A
periapical tooth abscess usually occurs as a result of an untreated dental
cavity, an injury or prior dental intervention. The resulting infection with
irritation and swelling can cause an abscess at the tip of the root.

Dentists will treat a tooth abscess by draining it and getting rid of the
infection. They may be able to save the tooth with root canal treatment but
in some cases, the tooth may need to be extracted. Leaving a tooth abscess
untreated can lead to serious, even life-threatening complications.

Symptoms

Signs and symptoms of tooth abscess include;

 Severe, constant, throbbing toothache that can spread to the
jawbone, neck or ear.
 Pain or discomfort with hot or cold temperatures.
 Pain or discomfort with the pressure of chewing or biting.
 Fever
 Swelling in the face, cheek or neck that may lead to difficulty
swallowing or breathing.
 Tender swollen lymph nodes under the jaw or in the neck.
 Foul mouth odor
 Sudden rush of foul-smelling and foul-tasting, salty fluid in the mouth
and pain relief, if the abscess ruptures.
Causes
A periapical tooth abscess occurs when bacteria invade the dental pulp. The pulp
is the innermost part of the tooth that contains blood vessels, nerves and
connective tissue.
Bacteria enter through either a dental cavity or a chip or crack in the tooth and
spread all the way down to the root. The bacterial infection can cause swelling
and inflammation at the tip of the root.
Risk factors
These factors may increase the risk of tooth abscess
Poor dental habits and care
A diet high in sugar
Dry mouth; having a dry mouth can increase the risk of tooth decay. Dry
mouth is often due to side effects of certain medications or issues relating
to aging.
Complications
A tooth abscess won’t go away without treatment. If the abscess ruptures, the
pain may improve a lot, but treatment is still imperative.
If the abscess doesn’t drain, the infection may spread to the jaw and to other
areas of the head and neck. If the tooth is located near the maxillary sinus and
opening can develop between the tooth abscess and the sinus. This can cause an
infection in the sinus cavity which can eventually lead to sepsis which is life-
threatening.
If the patient has a weakened immune system and the tooth abscess is left
untreated, the risk of spreading infection is even more.
Prevention
Avoiding tooth decay is essential to preventing a tooth abscess. Respect all
measures of prevention of tooth decay:
 Drink water that contains fluoride
 Brush teeth for two minutes at least twice a day with a fluoride toothpaste.
 Use dental floss to clean between the teeth at least once a day.
  Replace your toothbrush every 3 to 4 months, or whenever the bristles are
frayed.
 Eat healthy food, limiting sugary items and between-meal snacks.
 Visit a dentist regularly for checkups and professional cleanings.
 Consider using an antiseptic or a fluoride mouth rinse to add an extra layer
of protection against tooth decay.

Diagnosis
In addition to examining the teeth and the area around it, the dentist may;
o Tap on the teeth. A tooth that has an abscess at its root is generally
sensitive to touch or pressure.
o Recommend an X-ray of the aching tooth which can help identify an
abscess. It will also help determine whether the infection has spread,
causing abscesses in other areas.
o Recommend a CT scan to determine whether the infection has spread to
other areas within the neck and how severe it is.
Treatment
The goal of treatment is to get rid of the infection. To do this, the dentist may:
 Incise and drain the abscess. By making a small cut into the abscess,
allowing the pus to drain out. The dentist then washes the area with saline.
Occasionally, a small rubber drain is placed to keep the area open for
drainage while the swelling regresses.
 Do a root canal. This can help get rid of the infection and save the tooth.
 Extract the affected tooth. If the affected tooth can’t be saved, extraction
will be done to get rid of the infection.
 Prescribe antibiotics. If the infection is limited to the abscessed area,
antibiotics may not be necessary. But if the infection has spread to nearby
teeth, the jaw or other areas, the dentist will likely prescribe antibiotics to
stop if from spreading further. Antibiotics will also be important in a patient
with a weakened immune system.
 GINGIVITIS
Overview
Gingivitis is a common mild form of gum disease (periodontal disease) that causes
irritation, redness and swelling of the gingiva (the part of the gum around the
base of the teeth). It is important to take gingivitis seriously and treat it promptly
as it can lead to a more serious gum disease called periodontitis and tooth loss.
Gingivitis occurs in 3 out of 4 Americans during their lifetime, but with proper
dental care early on, it can be reversed.
Key points
 Bacteria buildup around the teeth is the most common cause of gingivitis.
 The main symptom of gingivitis is red, puffy gums that may bleed when
brushing teeth.
 Gingivitis often resolves with good oral hygiene.
Etiology
Gingivitis is caused by the buildup of plaque on the teeth and gums. The bacteria
found in plaque produce toxins that can irritate the gums and cause them to
become inflamed and may even lead to bleeding. Gingivitis is actually the number
one cause of bleeding gums in adults.
Other factors might increase your risk of gingivitis. These are:
 Smoking/tobacco use is one of the greatest risk factors associated with
gum disease and can lower the chances for successful treatment. Research
shows that smokers are seven times more likely to suffer from gum disease
than people who don’t smoke.
 Poor oral hygiene such as not brushing or flossing regularly is one of the
several easily avoided causes of gingivitis.
 Stress is another one of many causes of gingivitis. Constant stress can
weaken your immune system and negatively impact your ability to fight
infection, including gum disease.
 Hormonal changes including puberty, menopause, and pregnancy can
cause increase sensitivity and inflammation in the gums.
  Some diseases. Cancer, diabetes and HIV are linked to a higher risk of
gingivitis.
 Drugs. Medications that reduce saliva production can impact a person’s
oral health. Dilantin, an epilepsy medication, and angina drugs can also
cause abnormal growth of gum tissue, increasing the risk of inflammation.

Signs and symptoms

The signs and symptoms of gingivitis might include:
Gum inflammation and discoloration
Tender gums that may be painful to touch
Bleeding from the gums when brushing or flossing
Halitosis
Receding gums
Soft gums
However, in mild cases of gingivitis, there may be no discomfort or noticeable
symptoms.
Diagnosis
A dentist or oral hygienist will check for symptoms, such as plaque and tartar in
the oral cavity.
Treatment
If diagnosis happens early and treatment is prompt and proper, a person may be
able to treat gingivitis at home with good oral hygiene.
However, if symptoms do not resolve, or the condition affects a person’s quality
of life, they should seek professional help.
Treatment often involves care by a dental professional and follow-up procedures
carried out by the patient at home. A dental professional may initially carry out
scaling. This is so that they can remove excess plaque and tartar. Once scaling is
done, the dental professional will explain the importance of oral hygiene and how
to brush and floss effectively.
Prevention
Gingivitis can be prevented by practicing regular, good oral hygiene. This includes:
 Brushing teeth at least twice a day
 Flossing teeth at least once a day
 Regularly rinsing the mouth with an antiseptic mouthwash.
Complications
Treating gingivitis and following the dental health professional’s instructions can
typically prevent complications.
However, gum disease can spread and affect tissue, teeth and bones if left
untreated.
Complications include:
 Abscess or infection in the gingiva or jaw bone
 Periodontitis which is a more serious condition that can lead to loss of
bone and teeth.
 Recurrent gingivitis
 Trench mouth, where bacterial infection leads to ulceration of gums.

PERIODONTITIS

Periodontitis is a serious infection of the gums caused by chronic accumulation of

bacteria on the teeth and gums. As periodontitis progresses, bones and teeth can
be damaged. However, if periodontitis is treated early, and proper oral hygiene is
maintained, the damage can be stopped.
Stages of periodontitis
Periodontitis starts as inflammation and gets worse over time.
 Inflammation (gingivitis). Periodontitis begins with inflammation in the
gums called gingivitis. One of the first signs of gingivitis is bleeding from the
gums during brushing or flossing of the teeth. There is also plaque
deposition. Plaque is buildup of bacteria and food debris on the teeth.
 Although bacteria are always present in the mouth, they only become
harmful when conditions allow them to increase dramatically.
 Early periodontal disease. In the early stages of periodontitis, gums recede,
or pull away, from the teeth and small pockets form between gums and
teeth. The pockets harbor harmful bacteria. The immune system tries to
fight the infection, and gum tissue starts to recede. There is bleeding during
brushing and flossing, and possibly some bone loss.
 Moderate periodontal disease. If left to progress to moderate periodontal
disease, you might experience bleeding and pain around the teeth and gum
recession. Teeth begin to lose bone support and become loose. The
infection can lead to an inflammatory response throughout the body.
 Advanced periodontal disease. In advanced disease, the connective tissue
that hold the teeth in place begin to deteriorate. The gums, bones, and
other tissue that support the teeth are destroyed. There is severe pain
while chewing, severe bad breath, and a foul taste in the mouth. There’s
also loss of teeth.
Symptoms
The symptoms depend on the stage of the disease, but generally include:
 Gums that brush upon brushing or flossing of teeth
 Bad breath
 Changes in position of teeth or loose teeth
 Receding gums
 Red, tender, swollen gums
 Buildup of plaque or tartar on the teeth
 Pain when chewing
 Tooth loss
 Foul taste in the mouth
 Inflammatory response throughout the body.
Etiology
Healthy people normally have hundreds of different types of bacteria in their
mouth. Most of them are completely harmless. When dental hygiene is poor:
1 The bacteria in the mouth multiply and form dental plaque
 2 If plaque is not removed, overtime bacteria deposit mineral within the
plaque
3 This mineral deposit is known as tartar, which will encourage more
bacterial growth toward the root of the tooth.
4 The body’s immune response to this bacteria growth leads to inflammation
in the gums.
5 The attachment of the gum to the root of a tooth is disrupted overtime,
and a periodontal pocket may form between the gum and the root.
6 Harmful anaerobic bacteria colonize in the pocket and multiply, releasing
toxins that can damage gums, teeth, and supporting bone structures.
Additionally, certain factors put one at a higher risk of periodontitis, including:
 Smoking, which is one of the biggest risk factors for periodontitis
 Type 2 diabetes
 Obesity
 Hormonal changes in women which can make the gums more sensitive.
 Conditions that impact the immune system, like HIV or leukemia.
 Medications that reduce the flow of saliva in the mouth.
 Genetics
 Poor nutrition, including deficiency in vitamin C.
Diagnosis
Periodontitis can be detected at an early stage during a routine dental
examination.
The dentist may use a tiny ruler called probe to measure any pockets on the
gums.
Dental X-rays may also be used.
Complications
If left untreated, periodontitis can cause tooth loss. The bacteria responsible for
periodontitis can enter the bloodstream through the gum tissue, possibly
affecting other parts of the body. For example, periodontitis is linked with
respiratory disease, rheumatoid arthritis, coronary artery disease and problems
controlling blood sugar in diabetes.
 MOUTH ULCER
Mouth ulcers are small sores that form around the gums, lips, inner cheeks or
palate. They are usually yellow or red, and can be quite painful. They can be
triggered by several different factors, including minor injuries, hormonal changes,
and emotional stress. Mouth ulcers aren’t contagious and they go away on their
own, but there are treatments to help ease pain and discomfort. Mouth ulcers
may also be called aphthous ulcers or canker sores.
Mouth ulcers are different from cold sores in that they form inside the mouth and
are due to irritation, injury, vitamin deficiencies or other factors. Cold sores on
the other hand appears on the lips and are caused by a virus, and unlike mouth
sores, are contagious.
Mouth ulcers can affect people of all ages. Most of the time, having a mouth ulcer
is more of an inconvenience than a serious medical concern. While mouth ulcers
themselves are not considered dangerous, they have been linked to serious
health conditions, including diabetes, immune disorders, inflammatory bowel
disease, HIV and AIDS amongst others.
Symptoms
Mouth ulcers are easy to spot. They are typically white, yellow or gray in the
center and red around the edges. Other symptoms could include swelling around
the ulcer, increased soreness when brushing the teeth, pain that worsens when
eating spicy, salty or sour foods.
Management and treatment
While most mouth ulcers heal on their own, topical treatments may be prescribed
to ease discomfort and reduce the risk of complications. Common mouth ulcer
treatments include antiseptic gels, steroid ointments or medicated mouth rinses.
Home remedies include over-the-counter topical anesthetics, drinking plenty of
water, practicing good oral hygiene, rinsing the mouth with warm saline water a
few times each day and avoiding hot and spicy foods until the ulcer heals.
Prevention
*Discuss.
 ORAL CANCER
Mouth cancer refers to cancer that develops in any of the parts that make up the
mouth (oral cavity). Mouth cancer can occur on the lips, gums, tongue, inner
lining of the cheeks, roof of the mouth, floor of the mouth.
Cancer that occurs on the inside of the mouth is sometimes called oral cancer or
oral cavity cancer.
Mouth cancer is one of the several types of cancers grouped in a category called
head and neck cancers. Mouth cancers and other head and neck cancers are often
treated similarly.
About 50,000 people in the U.S. get oral cancer each year, 70% of them men.
Oral cancers are most often discovered after they’ve spread to the lymph nodes
of the neck. Early detection is key to surviving oral cancer.
Risk factors for developing oral cancer
One of the biggest risk factors for oral cancer is tobacco use. This includes
smoking cigarettes, cigars, and pipes, as well as chewing tobacco.
People who consume large amounts of alcohol and tobacco are at an even
greater risk, especially when both products are used on a regular basis.
Other risk factors include:
 Human papillomavirus (HPV) infection
 Chronic facial sun exposure
 A previous diagnosis of oral cancer
 A family history of oral or other types of cancer
 A weakened immune system
 Poor nutrition
 Being male. Men are twice as likely to get oral cancer as women.
Symptoms
Symptoms of oral cancer includes:
 A sore on the mouth or lip that won’t heal
 A mass or growth anywhere in the mouth
  Bleeding from the mouth
 Loose teeth
 Pain or difficulty swallowing
 A lump in the neck
 An earache that won’t go away
 Dramatic weight loss
 Lower lip, face, neck, or chin numbness
 White, red and white, or red patches in or on the mouth or lips
 A sore throat
 Jaw pain or stiffness
 Tongue pain
Diagnosis
First by physical examination. This includes closely examining the roof and floor of
the mouth, the back of the throat, tongue, and cheeks, and the lymph nodes in
the neck.
If any tumors, growths, or suspicious lesions are found, a biopsy is performed and
sent for studies.
In addition, the doctor may also perform one or more of the following tests:
X-rays to see if cancer cells have spread to the jaw, chest, or lungs
CT scan to reveal any tumors in the mouth, throat, neck, lungs, or
elsewhere in the body.
PET scan to determine if the cancer has traveled to lymph nodes or other
organs
MRI scan to show a more accurate image of the head and neck, and
determine the extent or stage of the cancer
An endoscopy to examine the nasal passages, sinuses, inner throat,
windpipe, and trachea.
Stages of oral cancer
There are four stages of oral cancer.
 Stage 1: the tumor is 2cm or smaller, and the cancer hasn’t spread to the
lymph nodes.
  Stage 2: the tumor is between 2-4cm, and cancer cells haven’t spread to
the lymph nodes
 Stage 3: the tumor is either larger than 4cm and hasn’t spread to the lymph
nodes, or is any size and has spread to one lymph node, but not to other
parts of the body.
 Stage 4: tumors are any size and the cancer cells have spread to nearby
tissues, the lymph nodes, or other parts of the body.
According to the National Cancer Institute, the five-year survival rates for oral
cavity and pharynx cancers are as follows:
 83 percent, for localized cancer (that hasn’t spread)
 64 percent, for cancer that’s spread to nearby lymph nodes
 38 percent, for cancer that’s spread to other parts of the body.
Overall, 60 percent of all people with oral cancer will survive for five years or
more. The earlier the stage at diagnosis, the higher the chance of survival after
treatment. This makes timely diagnosis and treatment all the more important.
Treatment
Treatment for oral cancer will vary depending on the type, location, and stage of
the cancer at diagnosis.
o Surgery: treatment for early stages usually involves surgery to remove the
tumor and cancerous lymph nodes.
o Radiation therapy: radiation therapy is another option. This involves aiming
radiation beams at the tumor once or twice a day, five days a week, for two
to eight weeks. Treatment for advanced stages will usually involve a
combination of chemotherapy and radiation therapy.
o Chemotherapy: chemotherapy is a treatment with drugs that kill cancer
cells. The medicine is given either orally or intravenously.
o Targeted therapy: targeted therapy drugs bind to specific proteins on
cancer cells and interfere with their growth
o Nutrition: nutrition is also an important part of oral cancer treatment.
Many treatments make it difficult or painful to eat and swallow, and poor
appetite and weight loss are common. Getting the advice of a nutritionist
can help plan a food menu that will be gentle on the mouth and throat, and
 will provide the body with the calories, vitamins and minerals it needs to
heal.
o Keeping the mouth healthy: keeping the mouth healthy during cancer
treatment is a crucial part of treatment. Make sure to keep the mouth
moist and teeth and gums clean.
Outlook
The outlook for oral cancers depends on the specific type and stage of cancer at
diagnosis. It also depends on the patient’s general health, age, and tolerance and
response to treatment. Early diagnosis is critical because treating stage 1 and
stage 2 cancers may be less invasive and have a higher chance of successful
treatment.
After treatment, frequent checkups are necessary to ascertain recovery. This
usually consist of physical exams, blood tests, X-rays, and CT scans.

INFECTIONS OF THE ORAL CAVITY

The oral cavity harbors a diverse microbial flora that under normal conditions
resides in homeostasis. The imbalance of this flora or the colonization with new
microorganisms from a viral, fungal, or bacterial origin can infect the oral cavity
and its mucosa.
Primary bacterial infections of the oral mucosa seldom arise because of the oral
epithelium’s protective role over the underlying tissues, the saliva’s antibacterial
characteristics, and the immune response of phagocytes. However, if the oral
mucosa is disrupted due to poor oral hygiene, trauma, alcohol misuse, smoking,
or any other stimuli, the risk of primary bacterial infection goes up.
Immunocompromised patients such as those with HIV, cancer, or undergoing
prolonged corticosteroid therapy are at increased risk.
We will discuss the buccal aspects of the most common bacterial infections with
oral mucosa involvement including sexually transmitted diseases: syphilis and
gonorrhea; a granulomatous disease: tuberculosis: and a condition most
commonly affecting young children: scarlet fever.
SYPHILIS
Syphilis is caused by a spirochete known as Treponema pallidum that can be
sexually transmitted (vaginal, anal, or oral contact) or passed through the
placenta, causing congenital syphilis.
Approximately 4 to 12% of syphilis patients will present with oral manifestations
and are usually diagnosed in the second phase of the disease.
The oral manifestation of syphilis is usually the first sign of the disease. The initial
oral lesion characteristic of primary syphilis known as chancre, appears at the site
of inoculation about two weeks after the exposure. The most common locations
are the buccal mucosa, tongue and lips.
The chancre usually presents as a solitary, painless, round and indurated nodule
with firm margins accompanied by regional lymphadenopathy. The chancre
begins as a macule that evolves into a papule. The papule may erode and
transform into an ulcer of around 0.5 to 1.5 cm in diameter. Lack of pain
characterizes the syphilitic lesion and prompts to differentiate it from a squamous
cell carcinoma.
Secondary syphilis is a highly contagious stage that appears 2 to 8 weeks after the
primary chancre emerges. Unlike primary syphilis, oral lesions in the secondary
stage of the disease are multiple and painful. Patients also report sore throats.
Tertiary syphilis is a destructive stage that manifests months or years after the
initial infection in patients who have not received effective treatment during the
primary and secondary stages of the disease. Oral manifestation of this stage
include a chronic granulomatous lesion usually located on the hard palate, which
may perforate into the nasal septum.
When pregnant women transmit syphilis to their children, various developmental
defects commonly arise, including dental abnormalities. Hutchinson’s incisors are
characteristic of congenital syphilis patients, small, widely spaced, and peg-
shaped incisors, which are semi translucent instead of ivory, with a screwdriver-
shaped incisal edge. Another dental abnormality that may be seen is Moon
molars or mulberry molars, where molar anatomy is replaced by small, dome-
shaped teeth, with dental cusps set closer together.
Syphilis can be screened through serological tests such as the venereal disease
research laboratory (VDRL) and rapid plasma reagin (RPR) tests. Spirochetes can
be detected in chancres in primary syphilis using dark-field microscopy. However,
dark-field microscopy should be avoided for oral lesions because the treponemal
organism is part of the normal oral flora and could lead to false-positive results.
Everyone presenting with signs and symptoms of syphilis should also be tested for
other sexually transmitted diseases. Additionally, to prevent congenital syphilis,
pregnant women should be screened during their first trimester.
The chancre and oral lesions in primary syphilis are self-limiting and heal without
scar in three to six weeks. A single dose of long-acting benzathine penicillin G (2.4
million units) intramuscular is the drug of choice if primary regions persist and for
secondary syphilis. Tertiary syphilis is also treated with intramuscular benzathine
penicillin G once weekly for three to four weeks. Patients who are allergic to
penicillin are alternatively treated with doxycycline, tetracycline, or ceftriaxone.
Patients diagnosed with syphilis, even if receiving treatment, should abstain from
any sexual activity to prevent the spread of the disease. In addition, the sexual
partners of a syphilis partners should be notified, tested, and treated accordingly.
Post-treatment follow-up is required once every three months for a year using
blood tests to ensure the effectiveness of treatment.
The prognosis of oral lesions is reasonably good for patients who seek care
immediately. Without the proper treatment, such oral lesions could become
recurrent, take longer to heal, or even progress to precancerous or cancerous
lesions.
GONORRHEA
Gonorrhea is a sexually transmitted disease caused by gram-negative cocci called
Neisseria gonorrhoeae. N. gonorrhoeae mainly affects mucous membranes
causing urethritis in men and cervicitis in women.
Oral or pharyngeal gonorrhea, though uncommon, is more prevalent in females
or in men who have sex with men (MSM). Oropharyngeal gonorrhea is known to
be rare because the saliva is a hostile environment for N. gonorrhoeae. The
disease may be transmitted through oral sex and kissing, even in an asymptomatic
infected person.
High sensitivity and specificity are reported with light microscopy for symptomatic
males with urethral discharge; however, light microscopy has a lower sensitivity
for diagnosing pharyngeal gonorrhea.
Transmission of gonorrhea to the oral cavity and pharynx is more common via
oral-penile contact.
Oral gonorrhea presents symptomless in many cases, but a persistent sore throat
is the most predominant kind when symptomatic. Other possible signs include
acute ulceration, diffuse oropharyngeal erythema, edematous tissues that bleed
easily, and flu-like symptoms.
Oropharyngeal gonorrhea can be treated with a single oral dose of 400mg of
cefixime.
TUBERCULOSIS
Tuberculosis is a granulomatous disease caused by aerobic acid-fast bacilli,
Mycobacterium tuberculosis, triggering a primary pulmonary infection. Oral
tuberculosis results from a secondary infection via blood dissemination.
Oral tuberculosis lesions are more commonly located in the posterior aspect of
the dorsum of the tongue, followed by the buccal mucosa, gingiva, lips, and the
floor of the mouth.
Primary oral tuberculosis manifests as a single painful, necrotic ulcer. The ulcer
can last more than 2 to 3 weeks. Primary lesions are also associated with the
spread of the disease to cervical lymph nodes that present as enlarged and
painful. Tuberculosis osteomyelitis may also appear as lesions within the jaw.
Secondary tuberculosis present as slowly growing, irregular, and painful oral
ulcers. Like primary lesions, secondary lesions are usually exposed to mechanical
trauma. Other systemic symptoms that may accompany a patient with
tuberculosis are fever, chronic cough, sputum production, hemoptysis, night
sweats, weight loss, and appetite loss.
If tuberculosis is suspected, different tests are available, including tissue histology,
tuberculin skin test, acid-fast bacillus microbial staining, and culture. A biopsy of
any unresolved ulcer is mandatory to confirm the diagnosis of tuberculosis and
rule out carcinoma.
A combination of isoniazid, rifampin, pyrazinamide, and ethambutol is used to
treat tuberculosis. Patients should also be isolated during their treatment course
to prevent the further spread of the disease.

Caring for the mouth after a tooth extraction

Control bleeding
To help control bleeding, bite firmly on the gauze placed by the dentist. The
pressure helps to form a blood clot in the tooth’s socket. If you have a lot of
bleeding, bite on a regular tea bag. The tannic acid in the tea aids forming a blood
clot. Bite on the gauze or tea bag until the bleeding stops.
Minimize pain
To lessen pain, take prescribed medicines as directed. Do not drive while taking
these pain medications as it may make you drowsy.
Reduce swelling
To reduce swelling, put an ice pack near the cheek near the extraction site. Apply
the ice pack for 10 minutes then remove for 5 minutes. Repeat as needed.
Get enough rest
Limit activities for the first 24 hours after an extraction. When lying down, elevate
the head slightly.
Do’s
Below are some things you should do to help your mouth heal.
 Do eat a diet of soft, healthy foods and snacks. Also drink plenty of liquids.
 Do brush your teeth gently. Avoid brushing around the extraction.
 Do keep the extraction site clean. After 12 hours you may be able to gently
rinse your mouth. Rinse 4 times a day with one teaspoon of salt in a glass of
water.
Don’ts
Below are some things to avoid while you’re healing.
  Don’t drink with a straw. Sucking on a straw might dislodge the blood clot.
 Don’t drink hot liquids. Hot liquids may increase swelling.
 Don’t smoke. Smoking may break down the blood clot which may cause a
painful tooth socket.
Call the dentist if;
 Pain becomes more severe the day after the extraction.
 Bleeding becomes hard to control.
 Swelling around the extraction site worsens.
 Itching or rashes occur after you take medicines.

Oral hygiene
Oral hygiene is the practice of keeping the mouth clean and disease-free. It
involves brushing and flossing of the teeth, and regular visits to the dentist for
dental X-rays, examinations and cleanings.
Good oral health helps you enjoy life. It lets you: speak clearly; taste, chew and
swallow nutritious foods; and show your feelings through facial expressions such
as smiling.
Brush your teeth. To keep your teeth healthy, it is important to remove dental
plaque; a sticky, colorless film of bacteria. Plaque buildup can cause tooth decay
and gum disease. Dental plaque is hard to see. You can see it more easily of you
stain it. After your brush your teeth, chew ‘disclosing tablets’, or brush with a
special disclosing toothpaste. The color will show you where there is still plaque,
and you can then brush those areas again to remove it.
Brushing tips:
 Use fluoride toothpaste. Fluoride is what protects teeth from tooth decay.
It prevents decay by strengthening the tooth’s hard outer surface, called
enamel.
 Angle the bristles towards the gum line, so they clean between the gums
and teeth.
 Brush gently using small, circular motions. Do not scrub hard back and
forth.
  Brush all sides of each tooth.
 Brush the tongue.
Floss to remove plaque and food particles, from between the teeth. Flossing tips:
 Use a string of floss about two feet long. Wrap it around the middle finger
of each hand.
 Grip the floss between the thumb and index finger of each hand
 Ease the floss gently between the teeth until it reaches the gum line. Curve
the floss like the letter ‘C’ around the side of each tooth. Slide the floss up
and down.
Some people find flossing difficult because of arthritis or other issues. If it’s too
hard to hold floss, try a wooden or plastic dental pick or any of these: floss
holder, water flosser or tiny interdental brushes.

Oral hygiene products

Here are eight basic dental care ‘tools’ for good oral hygiene and a nice smile;
Toothbrushes: always use a soft-bristled toothbrush (whether manual or
powered) and change once the bristles start becoming frayed.
Toothpaste: choose one with fluoride to strengthen the enamel and
prevent tooth decay. Many toothpastes also have ingredients that fight
tooth sensitivity, gingivitis, bad breath, or tartar. Toothpastes that have
additives, such as whitening agents, can break down tooth enamel. Ask
your dentist for recommendations on the best toothpaste for your
specific oral health needs.
Dental floss
Dental picks and sticks
Oral irrigators: this oral hygiene appliance shoots a steady stream of
water in your mouth to remove food from hard-to-reach places
between and around the teeth.
Teeth whiteners: teeth whiteners use peroxide to actually bleach teeth.
Mouthwash: different mouthwashes tackle different dental problems.
Some help remove plaque and prevent gingivitis; others contain fluoride
to help fight cavities. Some can control or mask bad breath.
Tongue scrappers: tongue scrappers can help lessen bad breath by
reducing the amount of bacteria that cause it. But your toothbrush can
do the job as well. Studies show that simply brushing the tongue can
reduce bad breath by 70 percent.