SMILE AND CHEW

Oral Pathology

2014-06-21T21:32:00.001+03:00

Comming Soon..!!

Bulimia and teeth

2010-12-03T15:54:00.000+03:00

Bulimia nervosa (usually referred to just as bulimia) is an eating disorder. The term bulimia nervosa means 'the nervous hunger of an ox'. The condition was first recognised as an eating disorder in 1979.

it can affect both men and women but, women are 10 times more likely to develop bulimia than men. However, bulimia is becoming more common in boys and men.

Recent studies suggest that around 8 in every 100 women will have bulimia at some point in their lives. The condition can occur at any age but it often starts around the age of 19. Bulimia can affect children, but this is extremely rare.

Dental problems

Persistent vomiting can cause your stomach acids to damage the enamel on your teeth, which may lead to tooth decay. Excessive vomiting can also cause bad breath and a sore throat.

Oral thrush

2010-12-03T15:40:00.000+03:00

is a fungal infection in the mouth, caused by the yeast fungus candida albicans. It is common in healthy babies under two years old.
The main symptom is one or more white spots or patches in your baby's mouth, although some infants may not have any symptoms.
Babies rarely have oral thrush in their first week of life. It is most common in babies around four weeks old. Older babies can get it too, but this is less common.
Some babies can have repeated infections.
Oral thrush in babies is not usually linked with other illnesses or conditions. It may not bother your baby, but if their mouth is sore they may be reluctant to feed.

Breastfeeding advice

Breastfeeding mothers may have a thrush infection on their nipples and/or within their milk ducts. This can cause painful, cracked nipples and can make breastfeeding painful. If you think you have a thrush infection on your nipples, see your doctor as soon as possible.

Symptoms

Not all infants with oral thrush will have symptoms.
Whitish patches
In babies, symptoms of oral thrush can include one or more white spots or patches in and around the baby's mouth.
The patches in your baby's mouth may look yellow or cream-coloure, like curd or cottage cheese. They can also join together to make larger plaques.

also found in :

on your baby's gums
on the roof of their mouth
inside their cheeks

You can easily rub the patches off. The tissue underneath will be red and raw. It may also bleed a little.
The patches may not seem to bother your baby. But if they are sore, your baby may be reluctant to feed.

Other symptoms

Other signs and symptoms of oral thrush in babies are:

a whitish sheen to their saliva
fussiness at the breast (keeps detaching from the breast)
refusing the breast
clicking sounds during feeding
poor weight gain
nappy rash

Some babies may dribble more saliva than normal if they have an oral thrush infection.

Causes

Oral thrush is caused by a yeast fungus called candida albicans. Healthy people have this fungus in their mouths and it does not normally cause problems.
However, if the level of fungus overgrowth, the mucosa in your baby's mouth can become infected.

Immature immune system

Oral thrush may occur in babies because their immune systems take time to mature, making them less able to resist infection.
Oral thrush is more common in premature babies (babies born before 37 weeks of pregnancy) because:

their immune systems are not very strong
they have not had as many of their mother's antibodies passed to them

Antibiotics

Oral thrush infections can also happen after treatment with antibiotics. This is because antibiotics reduce the levels of healthy bacteria in your baby's mouth, which allows fungus levels to increase.
If you are breastfeeding and have been taking antibiotics for an infection, your own levels of healthy bacteria can be affected, making you or your baby more prone to a thrush infection.
In babies, oral thrush is not usually due to poor hygiene.

Diagnosis

Your doctor will look in your baby's mouth and will be able to diagnose oral thrush based on the visible symptoms.
Taking swabs does not help with diagnosis as healthy babies carry the fungus in their mouths.

Treatment

Mild oral thrush infections in babies can often clear up after a few days without treatment. However, if you are concerned, visit your doctor.

Antifungal medicine

If your doctor decides that your baby needs treatment, they will probably prescribe an antifungal medicine called miconazole, which kills the fungus in your baby's mouth.
The dose of miconazole will vary depending on your baby's age. Your doctor will be able to recommend the correct dosage for your baby and advise you how long to use the treatment.
In 2008, the manufacturers of miconazole recommended that the gel no longer be used in babies younger than four months, because of the risks of choking if it is not applied carefully.
If the infection has not cleared after seven days, visit your doctor again. They may continue treatment with miconazole for a further seven days, or they may prescribe another antifungal medicine called nystatin.

Prevention

If your baby uses a dummy, sterilise all their dummies regularly, as well as any toys designed to be put in their mouth, such as teething rings.
If you bottle feed your baby, sterilise the bottles and other feeding equipment regularly, especially the teats.

Some doctors also suggest giving your baby a drink of sterilised water after a feed, to rinse away any milk left in their mouth.

SMILE AND CHEW: First Aid Advice For avulsed Permanent Tooth

2010-11-27T01:25:00.000+03:00

SMILE AND CHEW: First Aid Advice For avulsed Permanent Tooth: "First Aid Advice For avulsed Permanent ToothTo save the tooth, it must be reimplanted (2 hours is the outer limit for survival). Right aw..."

SMILE AND CHEW: THE AIMS

2010-11-27T01:24:00.000+03:00

SMILE AND CHEW: THE AIMS: "This blog is aiming for medical goal concerning the dental one & the relative fields, so the contributions of the experienced practitioner ..."

Pregnancy and dentistry

2010-11-26T23:43:00.001+03:00

Pregnancy and dentistry

During pregnancy, many women experience increased sensitivity and swelling of thegingiva.Pregnancy causes an alteration in the estrogen and progesterone levels (10 times) that, when coupled with plaque that is present in the mouth can cause an exaggerated form of gingivitis . In some cases, the infected gum can form a benign growth called a pregnancy tumor or pyogenic granuloma (10%). The pregnancy tumor does not usually require treatment, and heals after the child is born. Professional dental cleanings twice during your pregnancy, as well as frequent brushing teeth (three times a day) and flossing, will greatly reduce gum swelling, sensitivity, and the risk of developing a pregnancy tumor, Pregnant women usually complain about dry mouth or xerostomia so as she would be advised to drink water a lot.

Most dental treatments can be safely completed during pregnancy., routine checkup X-rays are usually avoided during pregnancy if the pregnant has received routine dental care and is in good dental health. If the pregnant is in pain, dental X-rays can be safely taken, but I advise using two lead aprons to shield the radiation. Dental anesthetics at regular doses are not harmful to the unborn child. Some obstetricians advise dentists to use anesthetics without epinephrine during pregnancy.

Most antibiotics used by dentists during pregnancy do not put the unborn child at risk. Acceptable antibiotic medications include penicillin, amoxicillin, and clindamycin. Dentists should avoid prescribing tetracycline and narcotic pain medication, and not recommend over the counter pain relievers such as aspirin, and ibuprofen . Dental pain should be treated with acetaminophen in most cases.

The best time for dental treatment during pregnancy is in the second trimester because during the last half of the third trimester, there will be risks for premature delivery since the uterus is sensitive to outside forces. Elective dental treatment such as cosmetic dentistry & exodontia and should be postponed until after the child is born, If dental treatment is absolutely necessary to alleviate pain, prevent infection, decrease your stress levels, or decrease the stress levels of your foetus then go ahead. Always consult your obstetrician if you have any questions about medications or treatment provided by you Pregnancy and your oral health.

# lose a tooth for every child is a myth. Previous theories said that if the developing foetus is not getting enough calcium, it will absorb the calcium from the mother’s teeth. This theory is not correct. As long as your brush twice everyday and floss everyday, you will reduce your chances of cavities during your pregnancy.

# Pregnant women should avoid lying on their backs for extended periods of time because this will put pressure on large blood vessels. This can cause changes in blood circulation.

Porcelain Veneers (porcelain laminates)

2010-11-24T22:02:00.001+03:00

Porcelain Veneers (porcelain laminates)

they are thin porcelain ceramic “covers” that can be cemented to teeth. They are a 1/2mm thick or less and they have a beautiful, natural, semi-translucent appearance. They are very simple to apply and they became widely popular because more people are seeking for “perfect smile.”

Some cases indicated for P.V. :

1. permanently discolored teeth

2. crooked teeth

3. oddly shaped teeth

4. unnaturally colored fillings

5. broken or chipped teeth

6. gaps between teeth

Porcelain veneers are considered permanent restorative dental work. They should last 10 to 15 years or longer. Plastic veneers usually do not last as long and are not as aesthetically pleasing. Porcelain veneers can be damaged if a person with veneers uses their teeth to perform unusual tasks that put tensile pressure on the teeth, such as using the teeth to open bottles or hard nut shells. People who excessively clench or grind their teeth may need a night guard to help protect the teeth and veneers.

The Procedure:

At the initial office visit once a decision is made to use porcelain veneers, the dentist may do some simple contouring of the teeth and then take an impression of the teeth. A half-millimeter or less (about 0.3 to 0.5 millimeter - the thickness of a fingernail) of the tooth may be removed to make room for the veneers. This procedure can be done with or without anesthetic, as per the patient’s needs. While waiting for the veneers to be made, the teeth may be more sensitive to hot and cold than normal. The impressions are sent to a dental lab that makes the porcelain veneers in about a week. On the second visit, the veneers are applied using a light-sensitive resin and white light. Another visit to the dentist about a week after having the veneers placed will ensure everything is going according to plan.

Determining if Veneers are Right for You

You may not be a candidate for porcelain veneers if you have active decay or weakened/compromised front teeth. Further, if you are a habitual teeth-clencher or teeth-grinder, your dentist may advise against getting veneers. Veneers can be applied by any properly trained cosmetic dentist. Contact a dentist’s office of your choice for a visit to see if veneers are a good choice for you

Some cases indicated for P.V. :

1. permanently discolored teeth
2.   crooked teeth
3.    oddly shaped teeth
4.   unnaturally colored fillings
5.   broken or chipped teeth
6.    gaps between teeth

The Procedure :

Determining if Veneers are Right for You :

Brushing and flossing techniques

2010-11-24T10:21:00.000+03:00

smoking

2010-11-24T01:32:00.000+03:00

smoking effect on dental health :

Smoking cause a lot of ill-effects on our general and oral health.

Discoloration of tooth

Smoking causes tooth stains on the teeth.These tooth stains are due to the nicotine and tar present in the cigarettes.Staining of tooth ranges from yellow to dark brown and these stains are difficult to remove by normal brushing.

Bad Breath

Smokers are at a greater risk of developing bad breath than non smokers.The nicotine and tar content gives rise to a typical bad breath known as smokers breath.smoking causes dry mouth which is a leading cause of Halitosis (bad breath).

Tooth decay

Smoking leads to teeth staining and accumulation of plaque which eventually leads to dental caries.

Gum Disease

Due to the accumulation of plaque and tartar caused by smoking, it finally leads to gum disease.Normal functioning of cells in the gum tissue also affects badly due to smoking because of lack of oxygen in the bloodstream.A recent study reveals that smokers are 4 times vulnerable to gum disease than non-smokers.

Tooth loss

Advanced gum disease (Periodontitis) is the leading cause of tooth loss in adults.

Oral Cancer

A major bad effect of smoking is oral cancer. Nearly 90% of all Oral Cancer patients are smokers.

Other bad effects of smoking

Mouth Sores
Hairy tongue
Sinusitis
Smokers lip
Jaw bone loss
Altered sense of taste and smell
Shifting teeth
Delayed wound healing

The studies shows that the body’s resistant power to diseases will also weaken due to years of smoking.

sterilization of turbines and dental handpieces

2010-11-23T20:37:00.000+03:00

Cleaning, lubrication and sterilization of turbines and dental handpieces:

Turbines and dental handpieces are very delicate instruments,Maintenance of turbines and dental handpieces requires special attention.

Manufacturer's instructions for cleaning, lubrication, and sterilization should be followed closely and to ensure both the effectiveness of the process and the longevity of handpieces.
Over time, the internal channels of turbines and handpieces will become coated with a so-called biofilm, consisting of organic material and different types of microorganism. The biofilm will also
harbour particles that have been retracted into the internal parts of the instruments from the oral
cavity. These particles consist of ground enamel, dentin, amalgam, composite…

If cleaning/disinfection and lubrication are not carried out regularly between every patient when
the rotating instruments have been used, the deposit accumulated inside the instruments will have a devastating effect on the function of all internal moving parts.

Dental handpieces, triplex (three-way) syringes and ultrasonic scalers also require particular attention when it comes to infection control. In dentistry most drilling procedures require water
for flushing and cooling.

Three-way syringes, rotating instruments and ultrasonic scalers generate very fine aerosols which the patient may inhale during treatment. The aerosol and the microorganisms this may contain can thus enter deep into the patient’s respiratory tract.

The practice of flushing by running the turbines between patients should be discouraged. In
order to remove over 99% of the contaminant from the air chamber, a turbine have to run for
more than 4-7 min depending on the type of the handpiece. In order to remove all infective
matter after use, these instruments must be cleaned and disinfected internally and externally
after every patient.

Adequate external cleaning and disinfection can be achieved in a washer-disinfector
complemented by some form of internal cleaning and disinfection. Internal cleaning of
handpieces is best done with the aid of specially designed cleaning apparatus which as well as
cleaning also lubricates the handpiece.

Careful evaluation of autoclave process:

To achieve sterility of dental handpieces, three-way syringes and ultrasonic scalers they must
be treated in an autoclave with preevacuation which effectively evacuates air from inside the
instruments before the sterilization process begins.

Quality of lubricants:

The choice of lubricant is also very essential for proper maintenance of the rotating instruments.
it's must be environmentally friendly as well as non-toxic and non-allergenic,smell- taste free, have a good wetting capacity and be safe to use in conjunction with autoclaving of the rotating
instruments – steam sterilization at 135°C.
.

Dental phobia

2010-11-23T00:18:00.000+03:00

Dental phobia

Dental phobia is traditionally defined as an irrational and exaggerated fear of dentists and dental procedures. Some controversy exists with regards to whether the fear is "irrational", as dental phobia is most commonly caused by previous bad experiences.
there appear to be more types of dental phobia like:

needle phobia.
fear of dentists" & "fear of specific dental procedures"

Dental phobia may better be defined as an extreme and persistent fear which results in the individual's avoidance of attending a dentist at all costs, unless possibly when a physical problem becomes overwhelming. Even thinking or hearing about going to the dentist will cause marked psychological distress, and the phobia may interfere with social functioning.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), dental phobia (which may also be referred to as odontophobia, dentophobia, dentist phobia, or dental anxiety) is one of the specific phobias. The diagnostic criteria of specific phobia include

a marked and persistent fear of the specific object or situation that is excessive or unreasonable,
an immediate anxiety response upon exposure to the feared stimulus, which may take the form of a panic attack,
recognition that the fear is excessive or unreasonable,
avoidance of the anxiety-producing situation,
the phobia interferes with normal functioning or causes marked distress.

Dental phobia is most commonly caused by traumatic dental experiences, although there can be other causes as well. Children are often influenced by their parents' fears and attitudes towards dental treatment. Dental phobia may involve fear of dentists, dental procedures, a specific fear of needles, teeth, or objects and situations which remind the sufferer of the phobic situation. The dentist's drill is often a major factor in these fears

DENTAL PAIN

2010-11-23T00:03:00.000+03:00

DENTAL PAIN

toothache, also known as odontalgia or as odontalgy, is an aching pain in or around a tooth. In most cases toothaches are caused by problems in the tooth or jaw, such as cavities, gum disease, the emergence of wisdom teeth, a cracked tooth, infected dental pulp (necessitating root canal treatment or extraction of the tooth), jaw disease, or exposed tooth root.
Causes of a toothache may also be a symptom of diseases of the heart, such as angina or a myocardial infarction, due to referred pain.
After having one or more teeth extracted a condition known as dry socket can develop, leading to extreme pain. The severity of a toothache can range from a mild discomfort to excruciating pain, which can be experienced either chronically or sporadically. This pain can often be aggravated somewhat by chewing or by hot or cold temperatures.
An oral examination complete with X-rays can help discover the cause. Severe pain may be considered a dental emergency. A special condition is barodontalgia, a dental pain evoked upon changes in barometric pressure, in otherwise asymptomatic but diseased teeth.
Atypical odontalgia is a form of toothache present in apparently normal teeth. The pain, generally dull, often moves from one tooth to another for a period of 4 months to several years. This is most commonly reported by middle-aged women. The cause of atypical odontalgia is not yet clear

Toothaches are sometimes caused by an irritation of the pulp, known as pulpitis. This can be either reversible or irreversible. Irreversible pulpitis can be identified by sensitivity and pain lasting longer than fifteen seconds, although an exception to this may exist if the tooth has been recently operated on. Teeth affected by irreversible pulpitis will need either a root canal or an extraction.

dental emergency

2010-11-22T16:56:00.000+03:00

The best method to prevent a dental emergency is to properly protect your child.

dentists are recommending that children engaged in sports should wear mouth guards. they are made of plastic and cover the lower teeth.Not only do mouth guards protect teeth but they also protect lips, gums, and cheeks.

These are some of activities often cause dental injuries :

1. Trips and Falling into furniture and down stairs often causes dental injury. This occur when children are first learning to stand using furniture to maintain balance.

2. Water Fountains - Often kids injure teeth by ramming them into the spout of water fountains as they drink. Sometimes kids behind them accidentally bump into them causing them to injure their teeth.

3. Forks and Spoons - Believe it or not, some injuries are self-inflicted when people, not paying attention, crack or chip their teeth with spoons or forks as they eat

4. Bottle Caps - Tell your child to never open a bottle cap by using their teeth.

First Aid Advice For avulsed Permanent Tooth

2010-11-22T10:42:00.000+03:00

First Aid Advice For avulsed Permanent Tooth

To save the tooth, it must be reimplanted (2 hours is the outer limit for survival). Right away is best. If more than 30 minutes away from dental or medical care, replace the tooth in the socket before coming in. Use the following technique
Rinse off the tooth with saliva or water (do not scrub it).
Replace it in the socket facing the correct way.
Press down on the tooth with your thumb until the crown is level with the adjacent tooth.
Have your child bite down on a piece of cloth to stabilize the tooth until you can reach your dentist.

Baby teeth can't be re-implanted.

Types of Tooth Injuries

Loosened tooth - may bleed a little from the gums. Usually tightens up on its own.
Displaced tooth (usually pushed inward)
Chipped or fractured tooth
Avulsed tooth - a dental emergency for permanent teeth

Transporting an avulsed Permanent Tooth

If unable to put the tooth back in its socket,do this:
It is very important to keep the tooth moist
Transport the tooth in a cup of cold milk or saliva (inside the child's mouth) (EXCEPTION: Age less than 12 years old) or cup containing child's saliva ( spit)

Major Causes of Halitosis (bad breath)

2010-11-22T02:05:00.000+03:00

Major Causes of Halitosis (bad breath)

breath odor is terms used to describe noticeably unpleasant odors exhaled in breathing.” Acute bad breath is a very common problem caused by such things as oral dryness, stress, hunger, eating certain foods such as garlic and onions, smoking, and poor oral care. Morning breath is a typical example of transient bad breath. However, Chronic bad breath is a far more serious condition affecting one quarter of the population in different capacities.

Dry mouth causes bad breath and odor to come out of the mouth . During sleep, the tongue and mouth gets dried up due to lack of saliva. As saliva starts increasing in levels, the degree of bad breath comes down.

Halitosis is caused by the presence of a huge colony of oral bacteria. The anaerobic respiration of these bacteria will pile residual compounds containing sulfides and ammonia.

Most of the treatment available is mostly asymptotic and are limited to controlling bad breath by mouth and breath fresheners.

Many species of these bacteria are usually found on the back of the tongue, where they find protection and security from normal mouth activity. The rough edges of our tongue usually harbor millions of these harmful bacteria, which create toxins by digesting debris, dead cells, and other residues. These toxins are harmful in creating a bad odor in the breath.

Other causes of chronic bad breath may be periodontitis (gum disease), diabetes, sinusitis, kidney failure, tonsilloliths, gastroesophageal reflux disorder , and a wide variety of prescription drugs.

Brushing disadvantage

2010-11-22T01:45:00.000+03:00

Brushing disadvantage :
Do not brush your teeth right after drinking soda, Because carbonated drinks are highly acidic and have the potential to damage a tooth's enamel.

what is dry socket

2010-11-22T01:38:00.000+03:00

what is dry socket ?

localized osteitis is a condition which affects patients undergo tooth extraction. This painful event can be avoided in majoirty of cases by proper understanding.

This condition occurs after tooth extraction, particularly after traumatic extraction, resulting in a dry appearance of the exposed bone in the socket, due to loss of the blood clot. It is basically a focal osteomyelitis without suppuration and is accompanied by severe pain (alveolalgia) and foul odor. It is also called alveolar osteitis and alveolitis sicca dolorosa.

Affected person complains of unbearable pain and sensitivity of intake of food or drinks.

Dry socket usually develops after 3 to 5post surgical days. The pathogenesis of dry socket (also called fibrinolytic alveolitis) is a subject of debate with two main opinions. The first one is based on the presumption that there is a absolute absence of blood clot. According to the second opinion there is initial blood clot formation, which subsequently gets lysed leaving behind an empty socket. Streptococci have been implicated as causative organisms, but lysis might occur without bacterial presence also.

The following factors are considered important in causation of dry socket:

Insufficient blood supply to the alveolus.
Preexisting infection. (Granuloma, periodontal or pericoronal infection)
Use of large amounts of local Anesthetic, leading to vasoconstriction.
Post operative bleeding.
Trauma to alveolus during extraction.
Infection during or after extraction.
Root/bone fragments or foreign bodies left in the socket.
Excessive irrigation and curettage.
Fibrolytic or proteolytic activity in the clot.
Loss of clot due to patient's negligence
Patient actions like sucking liquids, sneezing, coughing, rinsing water post extraction
Predisposing factors in patient, eg smoking, poor general health

Dry socket is more often seen in the mandibular molars particularly the third molars. This condition is associated with excruciating pain, foul breath, unpleasant taste, empty socket and gingival inflammation and Lymphadinopathy.

Prophylactic packing of alveolus with medicated dressing and advising patient to use 0.2% chlorhexidine mouth rinse may be helpful to avoid dry socket in suspect cases.

Treatment of dry socket is mainly done to control pain by analgesics, advice warm saline rinse to remove food debris, dressing the cavity to protect & heal the socket. In early stages just initiating fresh bleeding in the socket and giving a pack will resolve this condition.

Zinc oxide dressings also have been advised, commercial dressings are also available in international market ex. Alvogyl

causes of teeth staining

2010-11-22T01:26:00.000+03:00

causes of teeth staining :

I. intrinsic :

1. Fluorosis staining.
2. Tetracycline staining.
3. pulp necrosis.
4. heredity and dental history.
5. Iatrogenic discoloration.(amalgam, gutta perch, formpcresol.....etc.
6. aging.
7. Discoloration from systemic conditions :
Dentinogenesis imperfecta, jaundice. Bleaching procedures

II. Extrinsic stains:

1. smoking.
2. chewing tobacoo.
3.Coffee and tea.

other types for teeth whitening

2010-11-22T01:05:00.000+03:00

* other types for teeth whitening :

Bonding- A composite resin that is molded onto the tooth to change its color and to reshape it. The resin material can stain and chip with the passage of time.
Porcelain veneers- Shell like porcelain facings are bonded onto stained teeth. They are used to whiten, reshape, or lengthen teeth and require at least two appointments.
Whitening tooth pastes- these effectively keep the teeth cleaner and therefore looking whiter. Some of them may be more abrasive than others. The stronger tooth pastes rely more on abrasion to remove external stains than changing the color of teeth.

THE AIMS

2010-11-21T02:15:00.002+03:00

This blog is aiming for medical goal concerning the dental one & the relative fields, so the contributions of the experienced practitioner with ideas, thoughts , advices and complications which are the dentist is always facing them on daily practice including the questions of the patients .

So we are looking forward to enrich the site with helpful information .

-teeth whitening , advantages & disadvantages?

teeth whitening is a process of getting a brighter color by using LASER device with an acidic gel(peroxide 35%) applied on the teeth.

Laser teeth whitening is a quick, painless procedure for teeth that have become stained by coffee, tea,smoking,aging and injury.

teeth can be whitened on Vita scale up to 10 shades lighter

Removing dental calculus and plaque is most performed before Laser whitening.

Depending on the look you desire, you may need to be keep the gel on longer. If your teeth are fairly close to your desired color, then you will only need to be in the chair for a short period. Typically, it takes about an hour to accomplish a whiter smile.

-Advantage:

You need just one visit to see a visible difference in the color of your teeth.

-Disadvantage:

-The cost

-Teeth sensitivity & gum. This is because of the bleach used to whiten the teeth, in general this is a short term problem could be minimized with Potassium Nitrate tooth paste.

Whitening could be done in office technique (30-60min) & home bleaching kit with custom tray fabrication (depends on the kit brand).

Bleaching can be done to 11 - 18 years old with no side effect other than those seen in general population.

You can rub the teeth with lemon or with Baking powder to get brighter look.