Mental health articles

Treatment of Oral Diseases

Surgical Treatments

Oral cancer is among the conditionstreated by surgical intervention.Curative treatment is usually initiated by radical surgicalremoval of the tumor. Radical in this casemeans thatall cancerous tissue can be removed. Surgical treatmentcan be supplemented by radiotherapy and chemotherapy.However, in some cases a curative approach isnot possible without destruction of vital organs, thuspalliative treatment with partial tumor removal (sizereduction) followed by chemo- or radiotherapy canbe carried out. The ultimate goal in the latter case isto restore the quality of life of the patient. Dependingon the amount of oral and maxillofacial structuresthat are destroyed by cancer or ablative surgery, manysuch patients require reconstruction. Surgical reconstructionmay also be required after maxillofacial traumadue to accidents. Bony structures can often be repositionedafter trauma, however in some cases and afterremoval of parts of the jawbone due to tumor surgery,bone grafts can be used to replace missing bone. Otherprocedures are various types of flap surgeries or skingrafting to repair soft tissue lesions. In some cases,maxillofacial prostheses are required and delivered byprosthodontists. Other procedures provided by oral surgeonsinclude the surgical removal of teeth includingwisdom teeth. For these procedures, a surgical incisionis made to lift a mucosal flap to enable access to the jawbone.Variable amounts of bone are then removed byosteotomy to get access to the structure to be removed.Wisdom teeth or residual roots can then be removedand the wound is closed by sutures. _ Dental implantsare another treatment often provided by oral surgeons.These artificial tooth roots are usually made from titaniumand used to replace missing teeth or to stabilizedentures.

Operative Dentistry

Dental caries often results inlarge primary structural defects of one or multipleteeth. High and low speed motors are used to excavatethe decayed enamel and dentine together with diamondand round burs. The resulting defects can berestored either by direct or indirect restorations. Foranterior teeth (incisors and canines), direct restorationsare made from tooth-colored resin composite materials.These can also be used for smaller fillings of posteriorteeth (premolars and molars). _ Composite fillingsare bonded to the remaining enamel and dentin using an etching and bonding technique. For posterior teeth,amalgam has been used as a standard filling material;it as been used less in the past years due to controversiesabout its biocompatibility. Instead, gold _inlays or_onlays (partial crowns) can be made. If a more estheticallypleasing restoration is desired, inlays or onlayscan be made from ceramic. If caries leads to an inflammationof the dental pulp, an endodontic or _root canaltreatment is carried out. The dental pulp is removedcompletely and the space is filled with a root fillingmaterial.

Dental trauma is often caused by accidents in road trafficor households. Fractured tooth fragments can eitherbe reattached using the bonding technique. If fragmentsare lost, the tooth can be restored with a resin compositefilling. Larger defects may require a crown restoration.Traumatized teeth which have been partially or fullyavulsed can often be splinted to adjacent teeth if thealveolus is intact. Primary healing of the traumatizedperiodontal and gingival tissues is often achieved, however,an endodontic treatment may be necessary. Theprognosis of avulsed teeth is uncertain. If the integrityof the tooth as a whole is compromised beyond the lossof the clinical crown it usually cannot be replanted andthe resulting gap will have to be closed using prostheticrestorations.

Prosthodontics

 If larger portions of dental hardtissues are missing they need to be replaced byprosthodontic means. Fixed prosthodontic (Shillingburg1997) rehabilitations include full _ crowns. Forposterior teeth, metal crowns are common whereas foranterior teeth, mainly tooth-colored crowns are used(porcelain fused to metal, all-ceramic) so that toothshape and color are mimicked.

Small numbers of missing teeth can be replaced using_fixed dental prostheses (fixed partial dentures; FPDs).As long as the gap is enclosed by teeth, these canbe used as abutment teeth for fixed bridgework. Themissing tooth itself is replaced by a pontic. Multiplegaps can be restored with multiple pontics, however,as a general rule, no more than three adjacent missingteeth should be restored using FPDs. Single or multiplemissing units can also be replaced using _ dental implants.After the surgical placement of the jawanchoredtitanium screw and a healing phase, the finalprosthodontic restoration is made and attached to theimplant using a screw or cement joint. In most cases,fixed restorations will not only restore chewing andspeech function but also restore the esthetic appearanceso that the rehabilitation will not be detected by theuntrained eye.

Multiple missing teeth often cannot be restored byfixed restorations anymore, unless multiple implantsare placed. Thus, _ partial removable dental prostheses(removable partial dentures; RPD)are required to rehabilitate patients suffering from partialedentulism. Such partial dentures consist of a basewhich is usually made from denture base resin (polymethylmethacrylate).The base is completed with industriallyprefabricated denture teeth, the actual replacementsfor the missing natural teeth. Final RPDs oftenhave a reinforcing metal substructure. The metal baseextends to the attachments which are used to retainthe denture in the patient’s mouth. Attachments can beclasps which partially circumvent the remaining teeth;in addition, so called _precision attachments or _telescopiccrowns (telescopic copings, double crowns) areused as attachments. Removable dentures can be wornat all times, but have to be removed by the patient forcleaning.

If all teeth are missing, _ complete removable dentalprosthesesare used to replace all of the missingteeth. Similar to partial dentures, a denture basemade of pink acrylic resin is combined with dentureteeth to make a complete denture. These dentures relyon the anatomy of the jawbone and the mucosal tissuesfor retention. Jawbone will be reduced by resorptionover time, thus denture retention will decrease overtime. Dental implants can be usedto improve retention and regain support of partial andcomplete dentures.

Periodontics

 Gingivitis and _ periodontitis makeup for the second large entity of bacterial oral disease.Treatments for gingivitis and periodontitis includeclosed and open debridement of the root surfaces of theaffected teeth. Surgical treatments comprise but are notlimited to open flap surgery to gain access to cleaningsites and guided tissue regeneration to recreate periodontalattachment of the tooth to the jawbone.

Orthodontics

Orthodontic diagnosis and treatmentsare mostly provided in specialist settings. Rotated, inclined or malpositioned teeth are moved using minimalforces applied by removable or fixed orthodonticdevices. Skeletal dysgnathy is mostly treated surgicallythrough repositioning of the mandible and/or maxillawithin the skull bone.

Tags: oral diseases, treatment