Diabetes and Dentistry

Hi everyone,

Apologies again for this late post - I have been ultra busy lately! This entry is about diabetes and dentistry and how one affects the other. Issues such as this are important for people who suffer from the disease and also drug developers and manufacturers who need to take into account problems such as side effects in different individuals.

The importance of dental care with diabetes

- Diabetes is a disease which can affect the whole body, including the mouth
- Diabetics face a higher than normal risk of oral health problems due to poorly controlled blood sugars
- The less well controlled the blood sugar, the more likely oral health problems are to arise – this is because uncontrolled diabetes impairs white blood cells, which are the body’s main defence against bacterial infections that can occur in the mouth

Dental Problems which diabetics are more at risk of developing

- Dry mouth, xerostomia (dry mouth due to lack of saliva) and salivary gland dysfunction
- Caries
- Increased susceptibility to bacterial, viral and fungal (including oral candidiasis - thrush) infections
- Periodontitis (untreated gum disease) and loss of teeth
- Burning mouth syndrome
- Gingivitis (gum disease)

Dry Mouth

- Uncontrolled diabetes can decrease saliva flow and thus result in dry mouth which can further lead to sores, ulcers, infections and tooth decay
- Dry mouth can cause difficulties in tasting, chewing, swallowing and speaking
- It can also increase chances of developing dental decay and other infections in the mouth
- Dry mouth may be a sign of some diseases and conditions
- It may also be cause by certain medications or medical treatments
- Symptoms include: A sticky and dry feeling in the mouth, trouble chewing, swaalowing, tasting or speaking, a burning feeling in the mouth, a dry throat, cracked lips, a dry, togh tongue, mouth sores and infections and decay when there is not an adequate supply of saliva (this causes the rate of tooth decay to increase rapidly)

Dry mouth – Treatment

- High fluoride toothpaste such as Colgate prevident 5000+ in order to help reduce decay
- Biotene – an oral rinse used to relieve symptoms of dry mouth
- Salagen (Pilocarpine) – These pills have been shown to provide significantly increased saliva flow whilst relieving dry mouth BUT Salagen may cause fluctuations in blood pressure so will need to be taken under the supervision of a doctor
- Chewing gum and sour candy in particular products with Xylitol (natural sugar alternative) – chewing this type of gum for five minutes after every meal has been shown to reduce the incidence of tooth decay by up to 62%

Salivary Gland Dysfunction

- The average person creates about 1 litre of saliva per day
- If saliva production is reduced, an individual’s oral bacteria level can increase 10 fold (compared to normal levels)
- In patients with diabetes; there may be xerostomia (dry mouth)and SGD which may be due to polyuria (excessive production of urine) or an underlying metabolic or endocrine problem
- When the normal environment of the oral cavity is altered due to a decrease n salivary flow/change in salivary composition, a healthy mouth can become susceptible to dental caries and tooth deterioration

Dental caries – AKA: Cavities

- Occur when teeth are frequently exposed to foods containing carbohydrates such as starches and sugars
- Such cavities have been identified as bacterial infections
- Bacteria inhabit the plaque and form up to 500 different products including acid
- Plaque interacts with food deposits on the teeth to produce acid which slowly dissolves the calcium in teeth – with regard to the fact that enamel is 97% calcium, this acid causes teeth to decay and may cause gum disease and bad breath
- When a substantial amount of calcium has dissolved from the surface of a tooth, the surface may break and form a hole – this is the basis for the formation of a cavity – an active lesion can be diagnosed based upon colour, surface texture and x-rays (e.g. white spots can be active lesions if they are not glossy and feel rough
- An area of decay may take from 6 months to 8years to dissolve the tooth enamel – a “cavity” is caused when the outer layer collapses and produces a whole which cannot repair itself

Decay which is unique to adults

- Root cavities: As people age, their gums can recede and leave parts of the teeth exposed – tooth roots become exposed and may decay easily – many people over 60 have root cavities as a result of gum disease
- It has been found that gum recession occurs more frequently in moderate and poorly controlled diabetic patients (this is due to plaque responding differently and creating more harmful products in the gums)
- Repeated decay around existing fillings: Decay can form around existing fillings and crowns as these areas aren’t as smooth as a natural tooth surface and can decay easier
- Cavities due to dry mouth

Bacterial, Viral and Fungal infections

- Thrush (oral candidiasis) is an infection caused by a fungus that grows in the mouth and people with diabetes are at risk of thrush because the fungus thrives on high glucose levels in saliva
- Smoking, taking antibiotics often and wearing dentures (especially ones which are worn constantly) may lead to thrush although medication is available to treat this infection
- Good diabetic control, not smoking and removing and cleaning dentures daily can help prevent thrush 

Periapical Abscesses

- A dental abscess is an infection of the mouth, face, jaw or throat that begins as a tooth infection or cavity
- These infections can be caused by poor dental health and can result from lack of proper and timely dental care, they may also occur in people who have other conditions that weaken the immune system (such as diabetes, chemotherapy cancer care)
- Dental abscesses can also be triggered by minor trauma in the oral cavity

Periodontitis

- Diabetics are more prone to the development of gum disease (periodontal disease) from gingivitis that is caused by the presence of bacteria in plaque
- Plaque is the white sticky film that accumulates on teeth below and above the gum line that may harden into a rough yellow or brown deposit called tartar or calculus
- Without regular dental checkups periodontal disease may result if gingivitis is left untreated
- It could also cause inflammation and destruction of tissues surrounding and supporting teeth, gums, bone and fibres which hold the gums to the teeth
- Gum infections can make it difficult to control blood sugar and severe infections can cause teeth to loosen or fall out
- PERIODONTAL OR GUM DISEASE IS THE MAIN CAUSE OF TOOTH LOSS IN ADULTS!!!
- Simple things which help prevent periodontal disease:
* Changes in diet and exercise
* Brushing teeth after every meal
* Flossing daily
* Using a tongue scraper to scrape the tongue
* Being aware of blood sugar levels and informing medical and dental professionals of any changes in the oral cavity such as white patches in the mouth

Lichen Planus

- This is a relatively common disease of unknown cause – may be due to an allergic or immune reaction
- This disorder has been known to develop after exposure to potential allergens such as medications, dyes and other substances
- Generally considered to involve a hypersensitivity reaction on microscopic level
- Appears as lacy white matches on the inside of the cheeks or on the tongue
- The link with diabetes and oral lichen planus is suggests that it is an adverse effect of the drug therapy used to treat diabetes
- Mild symptoms should be examined regularly so as to see if any further treatment is required (such treatments may include corticosteroids, medicated mouth wash or immunosuppressant medications)

Burning mouth syndrome (BMS)

- Patients usually show no clinically detectable lesions although symptoms of pain and burning may be intense
- BMS is a complex condition in which a burning pain occurs on the tongue or lips, or over a widespread area involving the whole mouth without any obvious reasoning
- Symptoms of BMS include: A burning sensation in the tongue, lips, gums, palate or throat (as if the patient had been burned with a hot liquid). Other symptoms include dry mouth, sore mouth, tingling/numb sensation in the mouth or tip of tongue and a bitter r metallic taste
- BMS may be caused by: Dry mouth, oral thrush, depression, heartburn, bruxism, diabetes, menopause, some medications and allergies
- Treatment is available when doctors understand the underlying cause of the condition – if this doesn’t happen, oral thrush medications, vitamins or antidepressants may be prescribed, as such medications have proved effective in treating BMS  

Gingivitis

- Characterised by inflamed and bleeding gums – it can be a precursor to chronic periodontitis and do needs to be treated
- Gingivitis results from bacterial plaque accumulation at the gum margin and in the sulcus between the margin and the tooth
- Thickening of blood vessels is a complication of diabetes that may increase the risk of gum disease – diabetes causes blood thickening which slows the flow of nutrients to the mouth and therefore slows the removal of harmful substances from the mouth
- High glucose levels in the mouth fluids may help germs grow and set the stage for gum disease
- Smoking increases the risk of gum disease – A 45 year old diabetic smoker is 20 times more likely to develop gum disease (and consequently bone and tooth loss) than a 45 year old without such risk factors
- Simple lifestyle changes can be made as mentioned above under ‘Periodontitis’

When is the best time for diabetic patients to receive dental care?

- Dental procedures should be as short and stress free as possible
- Morning appointments are preferred as blood glucose levels tend to be better controlled at this time of day
- Take medications as directed when you schedule an appointment
- Test blood sugar levels and take blood pressure and take these results with you to your appointment
- Keep your dentist informed of any changes in your health regularly and visit the dentist every 3-4 months
- Postpone non-emergency dental procedures if the blood sugar is not in good control (NOTE: Abscesses should be treated right away)
- Be aware that healing time will generally take longer in diabetic patients      

I hope that you have found this post interesting and I know that many of you will be able to relate to the issues raised as you may suffer or know someone who suffers from diabetes.

All the best

Zahra :) x x x

Yahoo: 'Cut the cost of a healthy mouth!'

Hey everyone,

I'm currently in the process of writing my next blog entry about diabetes and dentistry. Meanwhile, here's an interesting article I read on yahoo regarding dentistry within the current economic situation. Worth a read - especially if you're looking to lessen the price of your dental treatment! ;)

http://uk.finance.yahoo.com/news/Cut-cost-healthy-mouth-yahoofinanceuk-3770746570.html

Zahra :)

Forensic Dentistry

Hey everyone,

This entry is about the forensic strand of dentistry. In many TV programmes and series we often find that police identify suspects based on ‘dental records’. During one of my work experience placements, the clinic manager also informed me of the importance of such records within the law and police records. This entry aims to provide a clearer view to what is actually involved in particular in this process.

First a few key phrases….

Forensic Science: The application of science to those criminal and civil laws that are enforced by police agencies in a criminal justice system.
Forensic Anthropology: Identifies human skeletal remains. Also tries to reconstruct from remains, the physical appearance of the deceased.
Forensic Odontology: Identifies the person by their teeth or bite marks.

Determination of sex

- In males, crests and ridges are more pronounced in males (A, B, C)
- In males, the chin is significantly more square (E)
- In males, the jaw and mastoid process is wide and robust (I, E)
- In males the forehead slopes more (F)

Determination of race

- The cranium is the only reliable bone to tell the general race category
- Nasal index: The ratio of the width of the nose, multiplied by 100
- Nasal Spine: Feel the base of the nasal cavity, on either side of the nasal spine and you will find sharp ridges, rounded ridges or no ridges at all 
- Shape of eye orbits: Round or square
- Mongoloid (Asian and Native American decent) – wider cheekbones, concave incisors and a great width between eyes
- Negrid (African and West Indian decent) – prominent ridges and wider nasal opening
- Caucasian – most features are narrow 

Facial reconstruction

- These were developed for a variety of reasons including criminal investigations, historically valuable remains, remains of humans and prehistoric hominids
- In order to help determine facial features, the following clues from the skull may be used: brow ridge, distance between the eye orbits, shape of nasal chamber, shape and projection of nasal bones, the form of the chin and the overall profile of the facial bones
- 2D reconstructions are hand-drawn facial mages based on skull photos and are usually produced with the cooperation between and artist and forensic anthropologist
- 3D reconstructions are sculptures created with modelling clay which usually require both and artist and forensic anthropologist. Computer programmes may be used to manoeuvre scanned photographs of remains and facial features and reconstruction includes building muscles
- During reconstruction certain rules need to be taken into concentration, for example the fact that ears are usually the same length as the nose although elderly people usually have longer ears 
   
Computer superimposition

- Superimposing photographs of individual believed to be the owner of skeletal remains over x-ray of the unidentified skull
- If x-ray and photograph are from the same individual, the anatomical features of the face should align accurately

Forensic Odontology

- Identification of bite marks on victim
- Comparison of bite marks with teeth of suspect
- Identification of unknown bodies through dental records
- Age estimations of skeletal remains
- Victim identification through DNA analysis

Why teeth?

- Every human body ages in a similar manner, the teeth also follow a semi-standardized pattern and such quantitative measures help to establish the relative age of the individual
- Each human has an individual set of teeth which can be traced back to established dental records to find missing individuals
- Teeth are made of enamel and so can withstand trauma (decomposition, heat degradation, water immersion and desiccation) better than other tissues in the body
- Teeth are a source of DNA as dental pulp or crushed tooth can provide nuclear/mitochondrial DNA to help identify an individual
- Individual characteristics include: Size, shape and placement of tooth, shape of root, quantity of teeth and combinations of dental work (Crowns, Extractions, Bridges, Fillings, Root canals)

Identification through teeth

- Dental treatment: The quality of the dental treatment, the metals and techniques used could indicate which country the individual is from (or where they had the dental treatment)
- Dental records: Records such as old models can be used to compare the suspected victim with unidentified remains
- X-ray evaluation: Ante and post mortem dental x-rays can be compared

Bite marks

- These are impressions from teeth found on skin or items left at a scene which usually outline teeth placement
- They can be classified into 2 groups:
1) Cameron and Sims Classification – Agents (Humans or Animals) and Materials ( Skin, body tissue, food or other materials)
2) Mac Donald’s Classifications – Tooth pressure marks, tongue pressure marks or tooth scrape marks
- Bite marks are photographed with a scale, casts of impression are taken, cats of suspects teeth are taken and a comparison between suspect cast and bite mark is made
- Physical characteristics of bite marks include distance from cuspid to cuspid, tooth alignment, tooth width, thickness and spacing, missing teeth, wear patterns such as chips and grinding and dental history such as fillings, crown etc.
- Computer Odontology: This is a 3D bite mark analysis whereby 3D scans of dental casts are used to generate overlays using various pressure and deviation and the overlays are compared with the photograph of the bite marks

Identification from dental DNA

- Teeth are an excellent source of DNA as they can resist extreme conditions
- If the individual’s ante mortem sample Is unavailable, the DNA pattern from the teeth can be compared to a parent or a sibling
- The best source of dental DNA is pulpal tissue
- Cryogenic grinding may be used to extract DNA whereby the whole tooth is cooled to extremely low temperatures and then mechanically grinded to a fine powder thus resulting is the tooth being completely crushed
- Another method is the drilling of the root canals, scraping the pulpal area with a medical needle and subsequently flushing the tissue debris

Using the Palatal Rugae in identification

- Useful in cases where patients are edentulous (lack teeth)
- Rugae patterns are considered unique to an individual
- Rugae patterns on the descendant’s maxilla or maxillary dentures may be compared to old dentures that may be recovered from the descendents residence or plaster model from the dental office

Lip prints identification

- Examination of lip print-cheiloscopy
- Grooves are heritable and individualistic so material evidence left at a crime scene may be used similar to finger prints
- Lip prints are classified as:
1) Simple wrinkles – straight line, curved line, angled line, sine shaped curve
2) Compound wrinkles – bifurcated, trifurcated, anomalous
- Invisible prints can be lifted using materials such as aluminium powder, magnetic powder
- One disadvantage may be that trauma and surgical treatment can affect the size and shape of the lip
- Another disadvantage is that the zone of transition close to vermilian border is extremely mobile so prints produced may differ depending on direction and amount of pressure applied

Case Study 1

- Investigators were unable to identify and so requested a post-mortem dental profile
- The skeletal pattern and dental characteristics suggested the following: Caucasian male, aged 25-35 years at death, moderate adult periodontitis (gum disease), nicotine stains, lack of recent dental treatment and previous treatment to Canadian standards
- Using this information, a facial reproduction was reproduced by a forensic artist

- Subsequently, the body was identified as that of a 28 year-old missing white male smoker

Case study 2

- Circumstantial evidence established the probable identity of a found human skull
- Ante mortem dental records were not available for comparison
- Medical records revealed the availability of a cervical smear
- Partial degradation of DNA from teeth produced a profile at eight genetic loci
- These were compared with the DNA profile obtained from the Pap smear and established that the samples originated from the same source     

Conclusion

- Dental practitioners should be aware of the forensic application of dentistry
- Dental records can be used to provide patients with optimal dental service but can also be beneficial to legal authorities during an identification process – therefore it is important that all forms of dental treatment should be recorded and kept safe
- Dentists should also be aware and detect signs of violence appearing on their patients – this should be done by being aware of the criteria of abusive injuries and the reporting mechanisms to ensure a correct response by the concerned authorities.

Zahra :)

Bibliography: The information on this entry was produced from http://www.smile-mag.com/art_files/Forensic_Odontology.pdf and a downloaded PDF file. No copyright intended by any means.

The Amazing Human Body

Hey everyone,

Again, I have to apologise as I have been extremely busy with university applications and school, so I haven't been able to blog recently.

I just wanted to share the following video which we watched in class this week. It shoes protein synthesis in real time. I find this absolutely amazing - the complexity of the human body!!! I hope you enjoy it as much as I have done!

Zahra :)

Careers in Dental care

Hi everyone,

I know it's been ages since I've last blogged...I've been pretty busy! But hopefully I'll be able to make up for it in the next few days! :)

Dentistry is an interdisciplinary field to work in. This means that various subject fields are combined whereby different professionals work together to provide people with service. In this case this service is dental care. There are many different individuals who work together within a dental team. Such individuals include, but are not limited to, Dental Technicians, Dental Hygienists, Dental Practice Managers, Dental Nurses and Dentists. Each of these individuals play a key role in the dental team and it is therefore necessary for such individuals to have excellent team working skills. The following link provides you with a handy booklet regarding careers in dental care. This booklet has been produced by the NHS and no copyright is intended by any means. http://www.4shared.com/document/MJFw-Rq0/Careers_in_Dental_Care.html

Personally, I have decided to study to become a Dentist. In order to do this within the UK, there are two main routes which can be followed.

1) Undergraduate Dentistry - This usually involves a 5 year University course whereby students are taught a variety of modules within various fields of Dentistry. Depending on the University, teaching and assessment are carried out in different ways and it is therefore important to do prior research. In order to apply for an undergraduate Dentistry degree, you need to be undertaking some form of further education. In the UK this may be A-levels, BTEC, Highers, International Baccalaureate etc. Some universities also have a stated number of places available for international students. Either way, you would need to be studying science based subjects when applying to university. However, some universities do offer students a 'Foundation year'. This is for students who are not studying science based subjects but who would like to read Dentistry at university. It should be noted that such courses would take 6 years to complete. More detailed information is available on the University website or on the Universities and Colleges Admissions Service website (www.ucas.com). This is the site which most universities use to allocate their places.

2) Graduate Dentistry - Some universities offer graduates the opportunity to complete a 4 year Dentistry degree. Other universities may offer graduates the 5 year Dentistry degree. Most universities require the student to have undertaken a science-based undergraduate degree before applying for graduate Dentistry. Again, more detailed information can be found on the University website.

The UKCAT
Increasingly, Universities offering Dentistry degrees are asking students to take the United Kingdom Clinical Aptitude Test. This test currently involves 4 sub categories of Verbal reasoning, Quantitative reasoning, Abstract reasoning and Decision analysis. Further information, including the universities which currently require the UKCAT, can be found at www.ukcat.ac.uk. It has to be noted however, that the UKCAT can only be taken once per application cycle (per year) and has to be taken in the summer of the year before you plan to go to University.

This year I completed my AS grades in Chemistry, Biology, Maths, Psychology, General Studies and Critical Thinking. I have also recently completed the UKCAT, so I'd be more than happy to answer any questions which you may have. From September, I hope to continue studying Biology, Chemistry, Maths and General Studies to A2 level and I will hopefully be applying for Dentistry in October.

Zahra :)

Dispatches: The truth about your Dentist

Hey everyone,
Having heard about this program during my Exam Period in May/June I decided to watch it on 4od. I can say without a doubt that it is well worth watching for everyone! Please follow this link if you would like to watch this program: http://www.channel4.com/programmes/dispatches/episode-guide/series-91/episode-1 .

This program explores modern-day dentistry within the UK. It outlines the main problems with the current NHS Dental system and explores the reasoning behind how these problems have arisen.
The main issues which are presented in this program are summarised below:

• Why the NHS Dental services changed in 2006 - Due to a phenomenon called 'cheating' in which NHS Dentists would record more complex procedures for each patient whereas the actual treatment required was simpler and therefore cheaper. This would mean that the gross pay for the Dentist would increase. 
• Problems with the current NHS Dental system - Some dentists who are currently working within both NHS and Private Dentistry have exposed a new loophole within the NHS Dental service called 'gaming'. This happens when a Dentist takes on an NHS patient and offers them Private treatment which costs much more - However, many patients are not aware that many of these treatments are actually available on the NHS and so agree to paying the higher amounts. One such treatment is Root Canal and Crown which is explored in more detail within the program. 
• Dental goods from unregistered technicians - This is another loophole within the current NHS system, whereby dentists are buying items such as dentures, crowns etc. from unregistered dental laboratories/technicians. The problem with this is that although it may be cheaper for the dentist, the materials used are usually of a poor quality and are sometimes imported from abroad. Consequently, any dental goods made from such materials are subject to a higher level of damage and this in turn means that the patient has to pay to redo their treatment. 
• NHS dental treatment prices from Spring 2011 - Dental treatment under the NHS is split into 3 bands as outlined below: (Found on : http://www.nhs.uk/chq/Pages/1781.aspx?CategoryID=74&SubCategoryID=74 )
  There are three NHS charge bands.
  - Band 1: £17 includes an examination, diagnosis and advice. If necessary, it also includes X-rays, a scale and polish and planning for further treatment. - Band 2: £47 includes all treatment covered by Band 1, plus additional treatment, such as fillings, root canal treatment and removing teeth (extractions). - Band 3: £204 includes all treatment covered by Bands 1 and 2, plus more complex procedures, such as crowns, dentures and bridges.

I hope you find this as interesting as I did!

Zahra :) 

Introduction

Hi everyone,

My name is Zahra and I am an enthusiastic dentist-to-be! I hope to apply for university to study Dentistry in September and this is partially why I have set this blog up!

The main reason though, is because in my opinion Oral health is an extremely interesting field and I hope that through blogging my research findings, I will be able to extend my knowledge further and provide you with some fascinating information!

Through this blog, I also hope to record my journey through the world of Dentistry, from applying to Dental School to hopefully becoming a full-time Dentist.

I do hope that as many of you can join me on my journey...it will be great to have you on board!

Zahra :)

P.S: Here's a clip from Mr Bean which I'm sure many of you can relate to ;)