HISTORY OF DENTISTRY

Since prehistoric times when people have had problems with their teeth, there were always
other people to help them.

The earliest history of treating tooth related problems goes back to 7000 BC, where the Indus
Valley Civilization gave us evidence of treating the mouth for tooth decay.
The earliest dental filling, made of beeswax, was discovered in Slovenia and dates from 6500
BC. The first explanation of tooth decay cause was noted by the Sumerians around 5000 BC.
The hypothesis was that tooth decay was caused by a tooth worm.
A Sumerian text gives the first written reference to dental decay and it dates from 5000 BC.
Ancient Egyptian papers describe substances to be mixed and applied to the teeth to relieve
pain.

Early signs of dental prosthetic and surgery were discovered in the remains of some ancient
Egyptians. Hippocrates and Aristotle described not only the eruption pattern of teeth but
treatment of decayed teeth and gums, extraction of teeth with forceps, and stabilization of
loose teeth and fractured jaws by wires. The first use of dental appliances or bridges comes
from the Etruscans 700 BC.

Even through the 19th century dentistry was not a profession. Minor dental proce- dures
were performed by barbers. They usually practiced the extraction of teeth. The barber dentists
pulled teeth to treat decay. Besides, they filled cavities and made false teeth out of human
teeth and cow bone. Instruments for dental extractions were invent- ed several centuries ago.
In the 14th century, Guy de Chauliac was the first to use dental pelican to perform dental
extractions. In medieval times people believed in traditional remedies. In Germany you were
supposed to kiss a donkey to cure your toothache.
By 17th-century French physician Pierre Fauchard started dentistry as a science, and is
known as «the father of modern dentistry». The basic oral anatomy and func tions, signs and
symptoms of oral pathology, operative methods for removing decay and restoring teeth,
periodontal disease, orthodontics, replacement of missing teeth. And tooth transplantation
were described in his book «The Surgeon Dentist». The sci- entists consider this book the first
complete scientific description of dentistry. PierreFauchard developed the extensive use of
dental prosthesis, the application of dental fillings for the treatment of dental caries. He stated
that sugar derivative acids includ- ing tartaric acid are responsible for dental decay.
Dentistry was a painful procedure for many years. In the 1790s, a British chem- ist initiated
the experiments on the use of nitrous oxide for pain relief. He called it «laughing gas.» The
«laughing gas» became very popular during the next 50 years, and is still used in dental
practice. 1790 was noted as a remarkable year in dentistry. The first dental foot engine was
constructed by John Greenwood. There was also the first specialized dental chair invented. In
1905, a German chemist discovered procaine; he named it Novocain which started the era of
«painless dentistry.»
 In 1957, John Borden invented a high-speed dental drill, which shortened the time of tooth
preparation for a filling.
Both with Novocain and high speed drill dentistry entered the modern ages.

DENTAL SPECIALITIES
Dentistry has progressed significantly in recent centuries. And if you have a problem with teeth
you may go and see your dentist.
If a general dentist can't cope with your problem, he will refer you to practitioners in one of the
following specialties: conservative dentistry, endodontics, oral and maxillofacial surgery,
orthodontics, prosthodontics, periodontology, paedodontics and oral pathology.

A conservative dentist deals with treatment and prevention of caries and restores carious or
broken teeth conservatively using filling materials. An endodontist treats oral conditions due to
a disease or injury of the dental pulp.
These diseases are: pulpitis, periapical abscesses, non-vital teeth or exposed pulp.
One of the endodontic procedures is root canal treatment (RCT)

An oral surgeon treats and surgically corrects diseases, injuries and defects of the mouth and
jaws. He performs complicated extractions, correction of cleft palate, removal of cysts and
tumours, deals with impacted teeth and retained roots of the teeth as well as inserts implants.
An orthodontist deals with various forms of malocclusion, and misalignment of the teeth
(crowding, overlapping, overbite) and designs corrective and supportive devices in the form of
dental braces, fixed and removable appliances.
A paedodontist provides dental care for children and deals with mixed dentition, prevention of
dental caries, and promotes proper oral hygiene in young patients, prevents caries by the
application of fissure sealants and varnishes. Besides, the paediatric dentist also treats mentally
retarded, non-cooperative or handicapped children.
A periodontist diagnoses and treats the tissues supporting and surrounding the teeth, including
gingivitis and periodontitis, removes calculus from teeth, provides instruction on how to
maintain oral hygiene to avoid such gingival conditions.
A prosthodontist constructs artificial appliances designed to restore and maintain the oral
function by replacing missing teeth or other oral structures with crowns, bridges, complete and
partial dentures, laminate veneers, post-and-cores. An oral pathologist examines oral tissues
for some abnormalities using clinical, radiographic, or other laboratory procedures necessary to
make a diagnosis to provide treatment or advice regarding the treatment of such abnormalities.
A public health dentist is responsible for the dental health needs of entire communities. He
designs and administers large-scale prevention and dental care programmes. Public health
dentists work with local and state health departments to improve oral health, teach in dental
schools and conduct research with preventive measures. They are also involved in initiating and
implementing community fluoridation programmes.
DENTAL TEAM

In the British practice a dental surgeon has a degree of a Bachelor of Dental Surgery and his
duty is to diagnose, perform, and monitor the dental care of patients.
Auxiliary personnel includes: a receptionist, a dental surgery assistant (DSA), a dental hygienist
and a dental laboratory technician.

A receptionist is a person who creates the image of the practice. He greets and assists the
patients giving information about schedule visits, filling patient's information.
A dental surgery assistant is responsible for preparing patients pre- and postoperatively. He
should make patients to feel as comfortable as possible in the dental chair to be prepared for
dental treatment.
Typical day duties of the dental assistant:
•to hand instruments and materials to the dentist
•to keep patient's mouth dry
•to clean, sterilize and disinfect instruments and equipment

• to prepare tray setups for dental procedure

•to prepare materials for taking impressions and restorations
•to remove sutures
•to apply anesthetics to the gums

•to make temporary crowns

•to take radiographs and process the film
A dental hygienist provides clinical and educational services in private dental offices, schools
industrial plants and public health organizations. He performs oral prophylaxis, conducts caries
screening and teaches oral health care. Dental hygienists clean teeth and examine oral areas,
head and neck for the signs of oral diseases.
A dental technician constructs and repairs appliances such as crowns, bridges, dentures, and
orthodontic appliances. Dental laboratory technicians work under the supervision of a dentist.

PEDIATRIC DENTISTRY

Pediatric dentistry is the branch of dentistry dealing with children from birth through
adolescence. Pediatric dentists are supposed to promote the dental health of children and
educate their parents. The first visit to a dentist should be paid within six months after the
eruption of the first tooth. It is necessary to establish a long-term friendly relationship between
the dentist and the patient. The early oral examination helps to detect the early stages of tooth
decay because it is essential to maintain oral health, change habits, and provide proper
treatment. In addition, parents get the information on preventative home care
(brushing/flossing/fluorides), finger, thumb, and pacifier habits, recommendations on
preventing oral injuries, diet modification, and growth and development of teeth.
The job is done by highly trained dental assistants, dental hygienist, and lab technicians. A
dentist provides safe and effective dental services. His responsibility is to control every
procedure and prevent potential risks including infection, nerve damage, bleeding, and pain.
Responsibilities of a dentist are:
• Diagnosing oral diseases.

•Promoting oral health such as professional cleaning, fluoride application and disease
prevention.
•Treatment planning to maintain or restore the oral health of their patients.

•Interpreting results of X-ray and laboratory tests.

•Safe administration of anesthetics.
•Monitoring growth and development of the teeth and jaws.
•Performing surgical procedures on the teeth, bone and soft tissues of the oral cavity.
•Filling of decaying teeth.

•Treatment of dental injuries, including fractured, displaced, and knocked out teeth.
Tooth decay prevention is their major concern. Pediatric dentists examine the gums and
evaluate throat muscles and nervous system organs including the head, neck and jaw, the
tongue, and salivary glands. They are supposed to reveal lumps, swellings, ulcers,
discolorations. Pediatric dentists are responsible for carrying out biopsies and tests.
Communication remains an important aspect for a pediatric dentist because it helps to
establish friendly and effective relationship between the dentist and the parents based on
mutual trust and confidence.

PEDIATRIC DENTISTS
Pediatric dentists are dedicated to the oral health of children from infancy through the teen years. They
have the experience and qualifications to care for a child's teeth, gums, and mouth throughout the
various stages of childhood.

Children begin to get their baby teeth during the first 6 months of life. By age 6 or 7 years they start to
lose their first set of teeth, which eventually are replaced by secondary, permanent teeth. Without
proper dental care, children face possible oral decay and disease that can cause a lifetime of pain and
complications. Today, early childhood dental caries - an infectious disease is 5 times more common in
children than asthma and 7 times more common than hay fever.

Pediatric dentists should complete at least four years of dental school and two additional years of
residency training in dentistry for infants, children, teens, and children with special needs

Pediatric dentists provide comprehensive oral health care that includes the following:

•Infant oral health exams, which include risk assessment for caries in mother and child.

•Preventive dental care including cleaning and fluoride treatment, as well as nutrition and diet
recommendations.

•Habit counselling (for example, pacifier use and thumb sucking).

•Early assessment and treatment for straightening teeth and correcting an improper bite (orthodontics).

•Repair of tooth cavities or defects.

• Diagnosis of oral conditions associated with diseases such as diabetes, congenital heart defect,
asthma, hay fever, and attention deficit/hyperactivity disorder.

•Management of gum diseases and conditions including ulcers, short frenulae, mucoceles, and pediatric
periodontal disease.

•Care for dental injuries (for example, fractured, displaced, or knocked-out teeth).

Children are not just small adults. They are not always able to be patient and cooperative during a
dental examination. Pediatric dentists know how to examine and treat children in ways that make them
comfortable. In addition, pediatric dentists use specially designed equipment in offices that are arranged
and decorated with children in mind.

A pediatric dentist offers a wide range of treatment options, as well as expertise and training to care for
the child's teeth, gums, and mouth. When your pediatrician suggests that your child should receive a
dental exam, you can be assured that a pediatric dentist will provide the best possible care. Regular
pediatric check-ups should begin after your child's first birthday. During a pediatric dental check-up, one
of our skilled pediatric dental specialists will thoroughly examine your child's teeth and gums for signs of
decay or disease.

ORTHODONTIA

A special field of dentistry is orthodontia, also known as orthodontics and dentofacial orthopedics. An
orthodontist undergoes special training in a dental school or college after they have graduated in
dentistry. Edward Angle and Norman William Kingsley pioneered the establishment of orthodontics as a
specialty. Orthodontist deals with the diagnosis, prevention and correction of malpositioned teeth and
the jaws.

The history of orthodontics has been related to the history of dentistry for over 2000 years. Dentistry
originated as a branch of medicine. Malocclusion is not considered a disease, but abnormal alignment of
the teeth of upper and lower jaws. The incidence of malocclusion varies. Orthodontic treatment indices
classify malocclusions in terms of severity. Nearly 30% of the global population encounter malocclusion
problems that can be corrected by orthodontic treatment.

In addition to focusing on dental displacement, orthodontic treatment deals with the control and
modification of facial growth. This type of therapy is defined as dentofacial orthopedics. In case of
severe malocclusions a combination of orthodontics jaw surgery is required.

In diagnosis and treatment planning, the orthodontist must (1) recognize the various characteristics of a
malocclusion or dentofacial deformity; (2) define the nature of the problem, including the etiology if
possible; (3) design a treatment strategy based on the specific needs and desires of the individual; and
(4) present the treatment strategy to the patient in such a way that the patient fully understands it.

TEETH
Teeth are any of the hard, resistant structures occurring on the jaws. They are used for biting
and masticating food - the first step in the digestion. Teeth also help us say certain sounds.
A tooth consists of a crown and one or several roots. The crown is visible above the gum. The
root supports the tooth in the jawbone. The periodontal ligament attaches the root to the
alveolar processes of the jaws. The root is enclosed in the gum tissue. The shape of the crown
and root depends on the individual.
Permanent teeth have identical general structure and are composed of three layers. An outer
inorganic layer of enamel is the most solid tissue in the body covering the entire tooth crown.
The middle layer of the tooth is composed of dentine, which is less hard than enamel and
similar to bone. The dentine is the inner part of the tooth nourished by the pulp. The pulp
contains cells, tiny blood vessels, and a nerve and is located in the centre of the tooth. The root
canal extends through the whole inner portion of the tooth and gets general nutrition through
the apical foramina at the end of the roots. The root of the tooth is covered by cementum. The
latter, together with periodontal ligaments, alveolar bone, and gingiva (gums) compose the
periodontium -the supporting structure of a tooth.
People have two sets of teeth in their lives, the primary teeth (also called the baby, milk or
deciduous teeth) and the permanent teeth (also called the adult or secondary teeth). Most
babies are born with no visible teeth- the teeth are forming inside the gums. The 20 primary
teeth (four incisors, two canines, and four molars in each jaw) begin to erupt about six months
after birth. The primary dentition is complete by age 3. Primary teeth are smaller and whiter,
have more pointed cusps and larger pulp chambers as well as more delicate roots than
permanent teeth. Shedding usually begins about age 5 or 6 and by age 14 old primary teeth
completely fall out and are replaced by 32 permanent teeth. The permanent dentition is made
up of four incisors. two canines, four premolars, and six molars in each jaw
Incisors are frontal teeth adapted for biting, tearing, cutting and chopping A canine or cuspid
tooth is adjacent to the incisors on each side. It has the function of tearing food.
The basic function of premolars and molars is to break up food particles. Premolars are
responsible for both crushing and grinding the food. Premolars are known as bicuspids. The
molars are involved in grinding and chewing food. The wisdom tooth can be of various size and
number of roots. Incisors, canines, and premolars have one root whereas premolars have two
or three.

WISDOM TEETH
With age comes wisdom. Specifically, wisdom teeth.
Human mouth goes through many changes during lifetime. One major dental milestone that
usually takes place between the ages of 17 and 24 is the appearance of the third molars.
Eruption outside of this age range is not uncommon. Historically these teeth have been called
wisdom teeth because they come through at a more mature age
If there is not enough room for the teeth, or they are not aligned properly, they may never
fully erupt. People usually have four: upper left, upper right, lower left. and lower right. If they
don't, it's doe to their genetic makeup. It's been estimated that about 25% of people are lacking
one or more.
In dental terminology, an "impacted" tooth refers to one that has failed to fully erupt (emerge
into its expected position). This failure to erupt properly might occur because

• There is not enough room in the person's jaw to accommodate the tooth.
• The tooth's eruption path is obstructed by other teeth.
• Because the angulation of the tooth is improper.

Depending on the inclination of the impacted wisdom tooth to the long axis of the adjacent
molar, they differentiate horizontal, vertical, mesial, and distal impaction The reason why some
wisdom teeth are impacted is not an easy question to ar
A primary cause simply seems to be a condition of inadequate jawbone space behind a person's
second molar. Why this lack of space exists is not fully understood. There does, however, seem
to be a correlation between large tooth star and/or the presence ef generalized tooth crowding
and having impacted wisdom teeth.
The dietary changes adopted by modern man have been theorized as playing a tele in the
incidence of the third molar impaction. It has also been argued that the course nature of stone-
age man's diet, as compared to modern man's relatively wt dirt, probably required more
chewing muscle activity. This activity could have Otimulated greater jawbone growth, thus
providing more space for wisdom teeth
Deciduous teeth or primary teeth fall out at the age of. They are replaced by the permanent
teeth. The primary teeth help a child learn to chew and speak. The duous and the permanent
teeth differ by their composition, structure, and number.
The enamel of the deciduous teeth is thinner. Therefore, the primary teeth are usually whiter
than the permanent teeth and more vulnerable to the primary tooth decay that can be
provoked by sugar intake and inadequate fluoride treatment.
The shape of the teeth is also different. The front permanent teeth usually have small bumps
on the top, known as mamelons. The mamelons wear off over time, if the teeth fit together
evenly. A dentist can also file the mamelons off to make sure the teeth look even
The roots of the deciduous teeth are thinner and shorter than the roots id the permanent
teeth. It allows them to dissolve when it's time for the tooth to fall out as well as ensures some
space for the permanent teeth to form beneath them.

People typically have 20 primary teeth and 32 permanent teeth, including four wisdom teeth.
Part of the reason for the difference in number is that a child's mouth is much smaller than an
adult's Children don't have enough space for eight to 12 molars in the back of the mouth. As
the child grows older, the jaw develops making the room for the additional permanent teeth.

People are often wrong when they think that the primary teeth don't need care or protection.
However, it is important to provide regular and delicate care for the primary teeth as you
would care for the permanent set of teeth. If the teeth are lost or extracted early, they can't act
as space holders and may not leave enough room for the permanent teeth. A child might also
have occlusal problems later.

ORAL HEALTH
Good dental or oral care maintains not only healthy teeth, gums and tongue, but also the whole
body. Oral problems, including bad breath, dry mouth, canker or cold sores, tooth decay, or
thrush are all preventable with proper care.

Good oral health involves more than just brushing. To keep teeth and mouth healthy for a
lifetime of use, there are important and interconnected aspects that everyone should know.
o Motivation and understanding one's oral health needs. Many patients find oral hygiene
aids inconvenient and difficult to use, so motivation must be at a high level. A doctor
has to interest patients in cleaning their teeth by helping them to understand how
important it is and how they will benefit. A patient has to talk with his dentist (other
oral health care specialist, or hygienist) about any special conditions in his mouth and
any ways in which his health conditions affect the teeth or oral health. For example,
cancer treatments, pregnancy, heart diseases, diabetes, dental appliances (dentures,
braces) can all impact one's oral health and may necessitate a change in the oral care.
o Brushing. People have to brush their teeth at least twice a day, morning and night.
Toothbrushes have bristles ranging from soft to hard, so people have to choose the one
that feels comfortable. There are different techniques of brushing - Stillman's, Charter's,
and Bass brushing methods as well as more ordinary circular/roll or side-to-side ones.
There are also interdental (used where there are large areas; the brush is put back and
 forth between the space) and interspace brushing methods (used for irregular teeth but
will not clean right between the teeth).
.
Interdental cleaning. A doctor has to show patients how to clean the difficult-to-reach spaces
between the teeth. Patients can use interdental wooden sticks (require large spaces between
the teeth and are not very efficient in removing plaque), dental floss or tape (used when teeth
are close together, especially in younger patients, but may cause damage to the gum if used
incorrectly), and interdental or interspace brushes.
• Mouthwashing. After every brushing, a patient has to rinse the mouth. After eating, bacteria
accumulate in the mouth; this, in turn, can cause plaque, which if not removed, combines with
sugars and forms acids destroying enamel. In order to prevent this, good antiseptic mouthwash
has to be used after every meal. Mouth rinses should not be a replacement for brushing or
flossing, though, but as an added hygiene tool. If brushing or rinsing is not available, chewing
sugarless gum may help.
.
Diet. Only good oral hygiene is not enough to prevent dental and periodontal diseases. Having a
healthy well-balanced diet rich in vitamins and minerals (e.g.. calcium, potassium, phosphorus,
iodine, zinc) and reducing the consumption of sugars and starches (e.g., cakes, candies, ice
cream, soft drinks, potato chips) are important in keeping teeth healthy.
• Fluoride. Toothpastes and mouthwashes should contain fluoride which strengthens the teeth
and prevents tooth decay. Using fluoride supplements where drinking water contains small
amount of fluoride plays a significant role in preventing oral diseases.

•Regular check-ups. The standard recommendation is to visit a dentist twice a year for check-
ups and cleanings.
Early demineralization of the tooth can be healed by taking the above steps, but larger cavities
usually need to be filled. Filling teeth does not prevent dental decay.
The whole cycle of decay will start again unless the hygiene is kept, diet controlled, and a
fluoride toothpaste and mouthwash used.

TOOTHBRUSHING TECHNIQUES
There are four brushing methods that dental professionals encourage their patients to use,
each addressing different oral health concerns. They're unlike the conventional
'scrubbing, also known as side-to-side method that most patients use which is damaging to
their tooth and gum structure. Instead of harming, these professional brushing methods
actually help to promote the health of the teeth and gums:
Stillman's Brushing Method
Indications for use: for patients with gingivitis; to remove plaque from above the gum line.
Method/Technique: the bristles are held at a 45° angle toward the gum line. Half of the bristles
should be covering the gums, and the other half of the bristles should be on the tooth surface.
By making short and light horizontal movements, the plaque is removed from above the gum
line. These motions help to remove plaque and stimulate the gums. Only small groups of teeth
can be done at a time. Once an area is complete, move onto the next set of teeth.
Bass (Sulcular) Brushing Method
Indications for use: for patients with periodontitis; to remove plaque from below the gum line.
Method/Technique: like Stillman's, the bristles are held at a 45° angle toward the gum line.
Very slight pressure and vibratory motions are made so that the bristles go slightly beneath the
gum line. Only small groups of teeth can be done at a time. Once an area is complete, move
onto the next set of teeth.
Both Stillman's and Bass brushing methods can be 'modified' by gently sweeping the bristles
away from the gums after performing the instructed brushing method.
Charter's Brushing Method
Indications for use: for patients with orthodontic braces.
Method/Technique: with the bristles positioned at a 45° angle, direct them so that they remove
plaque from above the brackets and arch wire, then direct them so that the bristles remove
plaque from below the brackets and arch wire. This will ensure that plaque is removed from all
surfaces of the braces.
Circular (Roll) Brushing Method
Indications for use: for young patients; patients with poor manual dexterity; in combination
with any other brushing method; for healthy patients instead of
"scrubbing" method.
Method/Technique: the bristles are held at a 45° angle toward the gum line. Make small and
light circular shaped brush strokes overlapping each tooth surface until all surfaces are reached.
For all of these brushing methods, continue to brush the chewing surfaces, as well as the back
of the bottom and front teeth, and the tongue by lightly scrubbing up and down, being careful
not to damage any of the tissues. Also, remember to brush using a soft bristled toothbrush!

DENTAL PLAQUE
Plaque is very personal. It forms from countless combinations of foods, individual acid and
moisture levels in a person's mouth, and internal and exterior bacteria from any number of
sources. Back molars, the ridges along dental work, and the lower faces of teeth near the gum
line are places where plaque accumulates the most, and these areas often are harder to get to
with a quick brushing. Tooth decay and bad breath are some obvious signs that plaque bacteria
are thriving in a mouth, but these problems develop long after plaque has started to form.
You can't see plaque with the naked eye until decay from plaque forms, but you can feel the
sticky film, note some dull sliminess and just know it's there if you've missed some
appointments with the toothbrush. You can use disclosing tablet, which releases a safe dye that
mixes with saliva and attaches itself to areas covered with plaque bacteria. Some dental
professionals use the tablets to teach young children where they need to steer their
toothbrushes, and adults can use the dye after brushing to see what areas they may be missing.
Removing plaque is important for oral health. The scientists state that bacteria and acids erode
tooth enamel, and contribute to cavities formation. Additionally, plaque can lead to gum
diseases. Soft plaque, if not removed after eating, can harden making toothbrushing more
difficult and less effective at the gum line. Tartar or calculus can irritate gums and cause
 bleeding and swollen gums associated with gingivitis. Gums can recede and create pockets for
further accumulation of plaque debris.
Removing the plaque can prevent many of the issues. The best advice for fighting plaque
includes brushing teeth after meals and daily flossing. Toothbrushing reduces the build-up of
bacteria. Interdental cleaning, which includes flossing and using toothpicks, is one of the most
effective ways to keep plaque from forming between teeth and at the gum line. Alcohol-free,
fluoride and anti-bacterial rinses can help remove particles and plaque, as well as freshen
breath
Sealants, made from a plastic material, are applied to the teeth to fill in crevices and form a
layer that protects tooth enamel from decay.
Regular professional cleanings and check-ups are important for keeping teeth and gums
healthy. If plaque hardens, toothbrushing is not helpful. Ultrasonic and scaling tools help
remove tartar deposits. Cleaning and removing plaque prevent tooth decay and gum disease
and removes stains.
All of these dental procedures prove effective if accompanied by a healthy diet and after-meal
cleaning. Highly acidic foods and products rich in carbohydrates eat away tooth enamel.
Therefore, brushing thoroughly and flossing regularly can help keep the mouth clean and
healthy.
The scientific investigations suggest that as early as 5000 B.C. people were searching for the
source of tooth decay that was later reported as 'tooth warms: In ancient times, people could
not explain the origin of dental problems. They were unable to recognize tooth decay at the
initial stage. There were no dental clinics or dental colleges providing dental training or dental
treatment. A lack of knowledge resulted in the mvth that cavities formed due to the harmful
action of tooth worms occupying the teeth.
Many people believed that the tooth worm settled on the surface of the tooth to multiply and
create holes. It caused a toothache and the pain subsided once the worm had a rest. No one
could describe the creature. It has taken many different forms over the years.
It is widely known that worms are not the cause of plaque formation and tooth decay. In 1674
Antonie van Leeuwenhoek found worm-like, active bacteria while studying samples from inside
his own mouth under his microscope. His informal studies led to more scientific research into
bacteria and the products of their living.
Ancestors of those same bacterial worms are alive and undergoing mutational changes in the
21" century. People worldwide still wish to get rid of them. Nowadays, it's well-known that
dental plaque, typically the precursor to tooth decay, contains more than 600 different
microorganisms, while Syreptococcus mutans being the primary causal agent and the
pathogenic species responsible for dental caries specifically in the initiation and development
stages. S. mutans is naturally present in the human oral microbiota, along with at least 25 other
species of oral streptococci.

DENTAL HISTORY TAKING

It is said that over 80 % of diagnoses are made on history alone, a further 5-10%
on examination and the remainder on investigation. It is clear that history and
examination skills remain at the very core of clinical practice.

History taking or medical record, or interview, being the initial step of clinical
 examination, is an integral part of any diagnosing and treatment. Its aim is toobtain
invaluable information about patient's health, complaints, and troubles in order
ot establish aprovisional or differential diagnosis. It is a planned doctor-patient
conversation which enables patient to describe his sufferings, feelings and fears.

History taking includes the following:

• General information or demographic data including social and family historv;
• Presenting complaints;
• Dental history;

• Medical history (current and past ones).

Demographic data are used to identify the patient and his clinical record. The
minimum data required include the following: name, marital status, date of birth,
occupation, lifestyle, current address and contact telephonenumbers.

Presenting complaints. Patients visiting dentist often complain of pain. In order to

establish adiagnosis, it si important to obtain as far as possible aclear description of
the pain. nI this case, SOCRATES may help remember the main questions ot be asked:
S- site of pain (Ask the patient to demonstrate the place of maximum pain.);

O- onset(Was it gradual or sudden? When did ti start? sI the pain affected or

initiated by hot or cold stimuli?);
C - character (Get the patient to describe the pain, e.g. dull ache, sharp, throbbing or shooting.);
R - radiation (Ask the patient if the pain spreads anywhere);
A- associations (Are there anyassociated symptoms such as swelling, numbness or pain elsewhere?);

T - timing (Is the pain intermittent or constant? How frequent is it? How long does it last?);
E- exacerbating and alleviating factors (Is there anything that makes the pain better or worse?);
S - severity (How intense is it? Does the pain keep the patient awake at night or wake them from sleep?
What treatments has the patient tried and were they effective?). tI is worth asking the patient about the
effectiveness of pain-killers or other medications.
Dental history. It requires data about dental visits, their regularity and frequency, reasons of visits, and
previous treatments. Doctor should also ask about oral hygiene, all complaints not related to the current
one, presence or absence of all natural or artificial teeth, past dental or maxillofacial traumas, etc.

Past and current medical history. An accurate medical history may reveal conditions relevant to diagnosis
of the presenting complaint, for example oral lesions in a patient taking non-steroidal anti-inflammatory
drugs. Patients taking any anticoagulants or having blood clotting problems require special consideration.
Pregnancy might be a contraindication for some diagnostic procedures (e.g., X-ray) and using anesthesia.
 Having completed history taking, usually a provisional diagnosis is established. After that the doctor has
to perform the next stage of clinical examination, which is physical examination including visual inspection,
palpation, percussion, probing, pulp vitality tests and others. The examination is divided into an extraoral
examination (it includes visual examination of the head and neck with a special focus on swellings or
deformity, asymmetry of the face, abnormal colour or scars on the skin or lips), followed by intraoral
examination. The latter starts with checking oral hygiene and soft tissues condition. The entire oral mucosa
should be carefully inspected, any ulcer of>3 weeks' duration requires further investigation. Periodontal
condition can be assessed rapidly, using a periodontal probe, pockets >5mm indicate the need for a more
thorough assessment. Doctor has to examine each tooth in turn for caries and examine the integrity of any
restorations present. Occlusion should bechecked as well. This should involve not only getting the patient
to close together and examining the relationship between the arches, but also looking at the path of
closure for any obvious prematurities and displacements. The evidence of toothwear might also be
important.
Afterwards, if it is necessary, the doctor may refer his patient to undergo instrumental (X-ray, CT, MRI,
etc.) and laboratory (different blood tests or tissue histology tests) examinations. Only having obtained all
the necessary information,accurate final diagnosis can be established and proper treatment chosen.

COMMON MEDICAL AND DENTAL EMERGENCIES IN

DENTISTRY
An emergency condition in dentistry is an unexpected event that can include accidental or
wilful bodily injury, central nervous system stimulation and depression, respiratory and
circulatory disturbances, as well as allergic reactions. Prompt management is essential for both
medical and dental emergencies. Consequently, dentists and their staff should be prepared to
recognize, respond and effectively deal with emergency conditions. Some medical emergencies
may take place in a dental clinic during dental treatment. Fainting is the most common cause of
sudden loss of consciousness. It is normally associated with syncope due to anxiety, fear,
fatigue, pain, and the sight of blood or surgical instruments. Symptoms observed before
fainting include clammy skin, pallor, bradycardia and low pulse volume followed by tachycardia
and loss of consciousness. This medical emergency is usually managed by placing the patient
supine with the head lower than the legs to increase blood flow to the brain. In addition,
fainting may be a result of a medical condition such as hypotension, seizure, hypoglycemia,
hyperventilation, allergy, a stroke, or myocardial infarction. If these medical conditions occur
dentists should seek medical support by calling immediately for an ambulance.

Anaphylactic shock is a severe, life-threatening allergic reaction. Causative agents of

anaphylactic shock include latex, penicillin, several drugs such as cephalosporins and NSAIDS
(non-steroidal anti-inflammatory drugs). It should be noted that a true allergic reaction to an
injected local anesthetic has a very low incidence in dentistry.

Signs and symptoms observed during anaphylactic shock are facial swelling and flushing,
itching, cold clammyskin, wheezing, dyspnea, abdominal pain, cyanosis with a rapid and weak
pulse, hypotension. It is recommended to lay the patient flat and raise their legs, give oxygen,
administer epinephrine and antihistamine. Then, the patient should be transported to a nearby
hospital.
Prolonged and uncontrolled bleeding is referred to as haemorrhage. Major haemorrhages are
not common in oral surgery except in patients who have bleeding or clotting disorders, or those
who are on anticoagulants. In patients with mild or severe bleeding disorders, the goal is to
minimize the risk by restoring hemostatic system to acceptable levels and maintaining
hemostasis by local and adjunctive methods. In patients with drug induced coagulopathies,
drugs may be stopped or the doses modified. However, uncontrolled and persistent bleeding
can occur in some healthy patients after dental extraction. In this case, a dentist should apply a
gelatine thrombin sponge or insert sutures.
Patients may face some types of dental emergencies outside a dental clinic due to a quick
exacerbation of dental issues.
Lost filling. In this case advice your patient to rinse out the tooth cavity with warm water and
press a cotton ball firmly into it or use an over-the-counter dental cement. It is the best to seek
medical attention as soon as possible.
Loss of a crown or cap. Missing crown may trigger pain during eating when food gets in the
exposed area. If a crown or cap is displaced placing dental wax or a temporary cap can help
ease sensitivity.
Severe toothache. If a severe toothache happens, recommend your patients to immediately
rinse their mouth out with warm water and place a cold compress against their cheek for 20
minutes to alleviate swelling. Remove the compress and let the area warm up and then reapply
the cold compress. Pain medication should not be used directly against the gum. It may inflame
the gum and do more damage to the teeth. An immediate visit to a dentist is necessary to
check for a bacterial infection.

Chipped or broken tooth. Patients must know that the first thing to do is to save the chipped or
fully dislodged tooth. Then, they should rinse the area inside their mouth as well as the tooth
that has been displaced with warm water. If there is bleeding, some gauze or cotton should be
applied to the area for five to 10 minutes. It is necessary to use a cold compress outside their
mouth until the swelling goes down. At the dentist's, clinical examination and radiography are
followed by fillings with or without root canal treatment or extraction.
Knocked-out tooth. The best chance of saving a tooth that has been fully removed from a
mouth is to visit a dentist within one hour. Until then, the tooth must be kept safely and moist
in a small container of milk or in water with some salt added.

DENTAL PHOBIA
A "phobia" is traditionally defined as an excessive, persistent, sometimes unreasonable, fear.
People can fear a specific situation, object or activity. Exposure to the feared stimulus promotes
an immediate anxiety response, which may take the form of a panic attack. The phobia causes a
lot of distress, and impacts on many aspects of daily life. A distinction has been made between
dental anxiety and dental phobia. Those with dental anxiety will have a sense of uneasiness
when it's time for their appointments. Dental phobia is an intense fear. The fight-or-flight
response occurs when just thinking about or being reminded of the threatening situation.
There are varying degrees of dental phobia. At the extreme, a person with dental phobia will
avoid dental care at all costs. Others may force themselves to go, but they may not sleep the
night before. Sometimes, people can get sick while they are in the reception room. People
develop dental phobias for many different reasons.
Pain: The fear of pain is most common in adults 24 years and older. This may be because their
early dental visits happened before many of the advances in "pain-free" dentistry. However,
pain caused by a dentist who is perceived as caring is less likely to result in psychological
trauma. Rather, it is pain inflicted by a dentist who is perceived as cold and controlling that has
a huge psychological impact.

Feelings of helplessness and loss of control: Many people develop phobias about situations in
which they feel they have no control. When they are in the dental chair, they have to stay still.
They may feel they can't see what's going on or predict what's going to hurt.
Embarrassment: The mouth is an intimate part of the body and dental treatments require
physical closeness. "The hygienist's or dentist's face may be a few inches away.
This can make people anxious and uncomfortable.
Negative past experiences or post-traumatic stress: This is characterized by intrusive thoughts
of the bad experience. Studies suggest that this is true for about
80-85% of dental phobias. This not only includes painful dental visits, but also psychological
behaviours such as insensitive, humiliating remarks made by a dentist.
Vicarious learning: If a parent is afraid of dentists, children may learn to be afraid as well.
Hearing other people's horror stories about visits to the dentists or the depiction of "the
dentist" in the media can have a similar effect.

Anyone can be affected by dental phobia. Some of the signs of dental phobia include: feeling
tense, having trouble sleeping, getting increasingly nervous, feeling like crying, increasing
anxiety at the sight of dental instruments or white-coated personnel in the dentist's office,
feeling physically ill at the thought of a dental visit, a panic attack, having trouble breathing.
As the solution to the patients fears today's dentistry offers sedation and anesthesia, as well as
highly trained, able to answer all questions and concerns, personable, kind and compassionate
dental specialists. The dental offices are especially designed to provide their patients with a
serene environment, in which all necessary work is performed without any bad memory of the
procedures, smells or unpleasant sounds.

ANAESTHESIA
The administration of local anesthesia, sedation and general anesthesia integral part of dental
practice.
Local anesthesia causes the temporary loss of sensation in some part of the body. It is
produced by a locally injected solution. It does not depress the level of consciousness. The
invention of local anesthetics with the development of nerve blockade injection techniques
marked a new era of patient comfort. Local anesthesia allows to perform extensive and invasive
dental procedures. Dental anesthetics form two groups: esters and amides. Esters are no longer
used as injectable anesthetics. However, benzocaine is used as a topical anesthetic. Amides are
used as injectable anesthetics in combination with lidocaine that is also known as a topical
anesthetic. Topical anesthetics numb the area to a depth of 2-3 mm and reduce the discomfort
of the initial penetration of the needle into the mucosa. Topical anesthetics are available in gel,
liquid, ointment, patch, and spray forms. Injectable local anesthetics create a chemical
roadblock between the source of pain and the brain by blocking the sodium channel of a nerve.
Local anesthetics are vasodilators and are absorbed into the circulation. Overdose with local
anesthetics can result in CNS depression, convulsions, elevated heart rate, and high blood
pressure. Vasoconstrictors are added to injectable local anesthetics to counteract the
vasodilatory action and prolong their action.

Sedation is most appropriate for people with dental fear but may also be used when the
patient has a low pain threshold, can't sit still in the dental chair, has very sensitive teeth or
needs extensive treatment. Sedation helps patients relax during dental procedures. Minimal
sedation is a minimally depressed level of consciousness produced by a pharmacological
method (inhalation of nitrous oxide or "laughing gas", pills). The patient's ability to respond to
tactile stimulation and verbal commands is maintained. Ventilatory and cardiovascular
functions are not affected. Moderate sedation is a drug-induced depression of consciousness
during which patients respond purposefully to verbal commands, either alone or accompanied
by light tactile stimulation, may slur their words when speaking and not remember much of the
procedure. Deep sedation is a drug-induced depression of consciousness during which patients
can be on the edge of consciousness or even unconscious. The ability to independently
maintain ventilatory function may be impaired.
General anesthesia is rarely used for dental treatment nowadays. One of the reasons for this is
that IV conscious sedation works so well for nearly everyone, and is extremely safe. Each
general anesthetic carries a certain amount of risk. This means that general anesthesia is only
performed in hospitals or specialist clinics where the necessary safety equipment is available.
Apart from the risk of serious complications, general anesthesia has a few major disadvantages:
-It depresses the cardiovascular and respiratory systems.
-Laboratory and instrumental tests are required.
-Very advanced training, an anesthesia team, and special equipment and facilities are needed.

-The patient can't drink or eat for 6 hours before the procedure. It's expensive.
-It does not reduce dental anxiety.
However, general anesthesia can be useful or even indicated for certain situations. When
conscious IV sedation doesn't work or oral maxillofacial surgery of certain type must be
conducted, general anesthesia is the best option.

DENTAL CARIES
Dental caries (tooth decay) is an infectious and communicable disease that causes
demineralization and dissolution of the dental tissues with the formation of a cavity. It is the
worldwide health concern, affecting humans of all ages. Dental caries is the single most
common chronic disease in children, however, due to recession of the gingival tissues, many
older adults experience root caries. Caries has afflicted humankind since the beginning of
recorded history. Since the late nineteenth century, dentists have been fighting tooth decay by
drilling out the decayed tooth structure and filling the tooth with a restorative material.
Although this treatment eliminates decay that is already present, it does nothing to lower levels
of bacteria in the mouth that may cause additional caries. The cause of caries is bacteria
breakdown of the hard tissues of the teeth (enamel, dentin and cementum). This occurs due to
acid made from food debris on sugar on the tooth surface. It is an ongoing process that begins
with the plaque, a colourless, soft, sticky layer of harmful bacteria (the mutans streptococci
(MS) (Streptococcus mutans) and the lactobacilli (LB)) that are responsible for caries. Plaque is
the most dangerous when bacteria group into colonies within 24 hours. After repeated attacks,
if the plaque is not removed, the enamel eventually breaks down and decays. Once that
happens the decay progresses inward to the centre of the tooth.
A decayed tooth is sensitive to heat, cold or sweets and brown spots signal a decayed area. The
tooth decay causes pain when chewing. The rate at which caries develops varies from person to
person and depends on many factors such as oral bacterial flora, dietary sugars, eating habits,
fluoride and salivary flow. There is general agreement among scientists that frequent
consumption of fermentable carbohydrate foods and drinks contribute to the development of
caries.
One of the most important factors in pathogenesis of caries is a high-carbohydrate diet, as well
as lack of fluoride, and chronic dryness of the mouth from the lack of saliva (xerostomia). Saliva
is like a miracle fluid that provides physical, chemical, and antibacterial protective measures for
the teeth. It can take months or even years for a carious lesion to develop. Carious lesions occur
when more minerals are lost (demineralization) from the enamel than are deposited
(remineralization). There are four different stages of dental caries. As caries progresses
through the stages, the damage to a tooth becomes worse.
● In stage one, acid created by bacteria in plaque begins to cause erosion of tooth enamel. The
formation of a tiny cavity in pits and fissures of tooth surfaces occurs. The small cavity is
painless and there are no noticeable symptoms.
● In stage two, the cavity gets deeper. It reaches the dentin under the enamel and starts to
spread. There will be some sensitivity to sweet, cold, or hot foods and beverages.
● In stage three, the cavity is advanced. The tooth begins to weaken due to the cavity
spreading. The tooth may show discoloration and the patient may begin to feel pain.
● In stage four, the tooth is very weak and fractures can develop. These fractures can cause a
tooth to break. Once this happens, a root canal may be needed to prevent infection of the
dental pulp.
Carious lesions can occur in four general areas of the tooth, as follows:
1) Pit-and-fissure caries occurs primarily on occlusal surfaces, on buccal and lingual grooves of
posterior teeth, and on lingual pits of the maxillary incisors.

2) Smooth surface caries occurs on enamel surfaces, including mesial, distal, facial, and lingual
susurfaces.
3) Root surface caries occurs on any surface of the exposed root.
4) Secondary caries, or recurrent caries, occurs on the tooth that surrounds a restoration.

If left untreated, dental decay reaches the pulp of the tooth and an abscess forms at the root
end causing pain. At this stage the root will need endodontic treatment; otherwise it must be
extracted. The purpose of treatment is to stop the loss of mineral so that the disease is cured.
Changing the microflora by topical fluorides, reducing the amount of dietary sugars, decreasing
the frequency of eating, use of fluorides or increasing the amount of salivary flow can help the
healing process.