Dental Care

Dental Care Tips For Healthy Teeth and Gums

2013-03-27T21:58:00.000+08:00

With proper care, your teeth and gums can stay healthy throughout your life. The healthier your teeth and gums are, the less risk you have for tooth decay and gum disease. You can keep your teeth and gums healthy. Most problems with teeth and gums can be prevented by taking these steps:

Do a white-teeth diet

What goes in shows up on your teeth. So if you’re drinking a lot of red wine and black tea, or smoking cigarettes, expect the results to show up as not-so-pearly whites. Other culprits include colas, gravies and dark juices. The bottom line: if it’s dark before you put it in your mouth, it will probably stain your teeth. Step one: brush your teeth immediately after having foods that stain. Step two: regularly use a good bleaching agent, either from the pharmacy or your dentist. Step three: be conscious of tooth-staining foods and drinks, and have them only when a toothbrush is around. If not, have an apple for dessert.

Brush your teeth

It’s also important to brush your teeth in the morning and before going to bed. Brushing removes plaque, a film of bacteria that clings to teeth. When bacteria in plaque come into contact with food, they produce acids. These acids lead to cavities. To brush:

Place a pea-sized dab of fluoride toothpaste on the head of the toothbrush. (Use a soft toothbrush.)
Place the toothbrush against the teeth at a 45-degree angle to the gum line.
Move the brush across the teeth using a small circular motion. Continue with this motion cleaning one tooth at a time. Keep the tips of the bristles against the gum line. Avoid pressing so hard that the bristles lie flat against the teeth. (Only the tips of the toothbrush clean the teeth.) Let the bristles reach into spaces between teeth.
Brush across the top of the chewing surfaces of the teeth. Make sure the bristles get into the groves and crevices.
Use the same small circular motion to clean the backside of the upper and lower teeth -- the side that faces the tongue.
To clean the inside of the bottom front teeth, angle the head in an up-and-down position toward the bottom inside of the mouth and move the toothbrush in a small circle.
For the inside of the top front teeth, angle the brush in an up-and-down position with the tip of the head pointing towards the roof of the mouth. Move the toothbrush in a small circle.
Give your tongue a few gentle brush strokes, brushing from the back of your tongue forward. Do not scrub. This helps remove bacteria and freshens your breath.
After brushing your teeth for two to three minutes, rinse your mouth with water.

Watch out for plaque.

Plaque (“plak”) is a sticky substance that forms on your teeth. When plaque stays on your teeth too long, it can lead to tooth decay (cavities) and gum disease. Tooth decay and gum disease are the main causes of tooth loss.

Taking care of your teeth and gums is especially important if you:

Have diabetes
Have cancer
Are an older adult
Are pregnant

Drink a cup of tea everyday

Flavonoids and other ingredients in tea seem to prevent harmful bacteria from sticking to teeth, and also block production of a type of sugar that contributes to cavities. Tea also contains high amounts of fluoride.

Replace your brush

Replace your toothbrush with a new one every 3 to 4 months. Otherwise, you’re just transferring bacteria to your mouth.

Visit Your Dentist Regularly

Visit your dentist or dental therapist regularly. They have special equipment and techniques for cleaning your teeth, and it’s cheaper to get problems fixed early.

Floss daily to keep your gums healthy

Floss once a day. Flossing gets rid of food and plaque between the teeth, where your toothbrush cannot reach. If plaque stays between teeth, it can harden into tartar, which must be removed by a dentist. To floss:

Remove about an 18-inch strip of floss from the dispenser.
Wind the floss around the middle fingers of each hand, leaving a 1-inch section open for flossing. Floss the top teeth first, then the bottom.
Place the floss in your mouth and use your index fingers to push the floss between the teeth. Be careful not to push too hard and injure the gums.
Move the floss up and down against the tooth and up and around the gum line. The floss should form a C-shape around the tooth as you floss.
Floss between each tooth as well as behind the back teeth.
Use a clean section of floss as needed and take up used floss by winding it around the fingers.

Grip your toothbrush like a pencil

Does your toothbrush look as if it’s been used to clean the car? If so, you’re probably brushing too hard. Contrary to what some scrub-happy people think, brushing with force is not the best way to remove plaque. The best way is to place your toothbrush at a 45 degree angle against your gums and gently move it in a circular motion, rather than a back-and-forth motion. Grip the toothbrush like a pencil so you won’t scrub too hard.

Keep teeth for eating

Keep a bottle opener and a small pair of scissors in your bag or desk drawer. If you have the right gadgets to hand, you won’t be tempted to use your teeth as tools, which can damage them. In fact, never, ever use your teeth as tools for anything except eating.

Mumps

2013-03-19T00:34:00.003+08:00

Mumps (acute viral sialadenitis: epidemic parotitis) is an acute infectious disease which affects principally the major salivary salivary glands.

Mumps

Aetiopathogenesis

Mumps is caused by an RNA paramyxovirus transmitted by direct contact or by droplet spread from saliva but some Coxsackie, ECHO- and other viruses occasionally cause similar features.

Clinical Features

A longish incubation period of 2–3 weeks is followed by an acute onset of

painful salivary swelling (parotitis) usually bilaterally, although in the early stages only one parotid gland may appear to be involved ( Fig. 2.7.34 ). In approximately 10% of cases the submandibular glands are also affected and rarely these may be the only glands involved. The salivary swelling persists for about 7 days and then gradually subsides. The most obvious intraoral feature is swelling and redness at the duct orifice of the affected gland (papillitis)
trismus
fever
malaise.

Mumps less commonly and mainly in adults has extrasalivary manifestations which can include:

orchitis (ensuing infertility is rare)
pancreatitis
meningoencephalitis
oophoritis and thyroiditis (ensuing infertility is rare)
glomerulonephritis—especially in immunocompromised persons.

Diagnosis

The diagnosis is on clinical grounds but confirmation, if needed, is by demonstrating a four–fold rise in serum antibody titres to mumps S and V antigens between acute serum and convalescent serum taken 3 weeks later.

A similar clinical picture can arise with radioactive iodine therapy (‘iodine mumps’), as salivary gland swelling and possible xerostomia that lasts for about 7 days. Rarely these features persist and cause
permanent loss of function of one or more gland.

Management

No specific antiviral agents are available. Treatment is, therefore, symptomatic involving

analgesics
adequate hydration
reducing the fever.

Reference : Scull C, et al. 2010. Oral and Maxillofacial Disease. Vol. 4th Ed. Informa Healthcare. UK

10 Tips to Stop Grinding Your Teeth at Night

2013-03-19T00:06:00.000+08:00

In many cases, bruxism is mild and no treatment is necessary for occasional teeth grinding. However, if there is evidence of damage caused by bruxism (worn or broken teeth, broken dental restorations, jaw pain etc) or your dentist evaluates that there is increased risk of these problems in the future, your dentist will suggest a bruxism treatment plan.

Treatment Option for Teeth Grinding

Manage Your Stress

Since stress is a large factor in bruxism, take proactive measures to deal with your daily stressors. Whether it be exercise, 20 minutes of meditation, a weekly massage, journaling, changing your perception of stressful situations, or therapy, commit to incorporating one stress-reducing strategy every day.

Dental approaches

If you or your child has bruxism, your doctor may suggest a mouth guard or protective dental appliance (splint) to prevent damage to the teeth.

Wear a nightguard

The most common treatment suggested by dentists to cure bruxism is a custom-made specially-fitted dental night guard that is worn during sleep to prevent unconscious teeth grinding.

A dental night guard is a thin horseshoe-shaped appliance made of hard plastic. The night guard fits between your upper and lower teeth, to prevent further dental damage to teeth by absorbing the force of clenching or grinding. Besides of preventing the two sets of teeth from grinding against each other, night guards also aid in changing the patient's behavior.

Your dentist can make you a custom-fitted night guard by taking accurate impressions of your upper and lower teeth, that are used to create a model of how your teeth fit together. Based on this model the dentist forms a customized heat-processed hard plastic nightguard. Over-the-counter mouth guards are also available and they're less expensive than custom guards, but may not be as comfortable and effective as one custom-made for you. It is very important for the success of the bruxism treatment that the night guard fits perfectly.

Another type of appliance used for the treatment of bruxism is the NTI Tension Suppression System. The NTI device is much easier to wear as it gets attached to the front two teeth only, keeping the back teeth (molars) completely separated. The purpose of a night guard or NTI is to stop this destruction of tooth structure right away and reduce jaw clenching and teeth grinding.

Normally you need to wear the night guard each night for it to work properly. It takes a few nights to get adjusted to, but most people who use night guards for teeth grinding quickly get used to them.

Relax Your Jaw Muscles

Even if you feel like you are getting a good handle on your stress, your subconscious may still incite your jaw to clench. The website Bruxism101.com recommends relaxing your jaw throughout the day and make facial relaxation a habit. Set your watch or cell phone to beep every hour to check your facial tension and practice loosening your jaw.

Hypnosis

Hypnosis has also been used with success in some individuals to cure bruxism.

Change Your Sleep Position

A supine position with good neck support allows the lower jaw to rest and relax. Changing your sleep position combined with the use of a night guard for teeth grinding can significantly help in the treatment of bruxism.

Medication

In general, medications aren't very effective for treatment of bruxism. In some cases, your doctor may suggest taking a muscle relaxant before bedtime. If you develop bruxism as a side effect of an antidepressant medication, your doctor may change your medication or prescribe another medication to counteract your bruxism. OnabotulinumtoxinA (Botox) injections may help some people with severe bruxism who haven't responded to other treatments. However, more research is needed, as this treatment hasn't been thoroughly studied.

Unwind Before You Go to Bed

Give yourself a half hour or even an hour before falling asleep to put work or some other chronic stressor out of your mind. Take a long bath or do light yoga to loosen your mind and your body. And if the news tends to rile you or causes anxiety, don't watch TV before hitting the hay.

Orthodontic Treatment

It may help if your bruxism seems to be associated with dental problems. In severe cases — when tooth wear has led to sensitivity or the inability to chew properly — your dentist may need to use overlays or crowns to entirely reshape the chewing surfaces of your teeth. Reconstructive treatment can be quite extensive and although it will correct the wear, it may not stop the bruxism.

Splints

Splints are usually constructed of hard acrylic and fit over your upper or lower teeth. Some dentists may make them right in the office, while others may send them to a laboratory to be made.

Behaviour Therapy

Biofeedback is one of the modern methods for bruxism treatment. Behavior therapy is a form of complementary and alternative medicine that uses a variety of monitoring procedures and equipment to teach the bruxism patient to control involuntary body responses.

During a biofeedback session, electrical sensors are applied that measure the amount of muscle activity of the mouth and jaw, and then feed the information back to the patient via auditory and visual cues, such as a beeping sound or a flashing light. This feedback, is indicating to the patient when abnormal muscle activity is taking place so that the behavior can be changed and finally stop the teeth grinding habit.

Apply Heat

Applying a warm, wet washcloth to the side of your face can help relax muscles sore from clenching.

Do Your Research

Knowledge is power, so talk to your dentist about bruxism and read any materials he or she provides, and do your own investigating.

Bruxism (Teeth Grinding)

2013-03-14T09:51:00.000+08:00

Sleep should be a calm, peaceful endeavour. But for people with sleep bruxism - tooth-grinding or clenching at night - sleep can become a noisy, gnashing, and not-so-restful situation.

Sleep bruxism, also known as nocturnal tooth grinding, is the medical term for clenching or grinding teeth during sleep. A type of movement disorder that occurs during sleep, bruxism is a common condition - one survey estimates that 8% of adults grind their teeth at night and a study shows that more than a third of parents report symptoms of bruxism in their children. Occasional bruxism may not be harmful but when it occurs regularly, it may be associated with moderate to severe dental damage, facial pain, and disturbed sleep.

Although teeth grinding can be caused by stress and anxiety, it often occurs during sleep and is more likely caused by an abnormal bite or missing or crooked teeth.

People who have sleep bruxism can also suffer headaches, earaches, jaw pain, jaw joint disorders and damaged teeth. Sleep bruxism may also be linked with other medical conditions and have an impact on quality of life. If you feel you may suffer from sleep bruxism, talk to your doctor about ways to treat it and see Treatment and Coping.

10 Tips To Prevent Bad Breath

2013-03-14T09:28:00.002+08:00

Is your breath smelling more funky than fresh? Chances are, you’ve got a plethora of odor-producing bacteria having a field day in your mouth—particularly on the back of your tongue—which is the most common cause of bad breath.

Are you desperately looking for some magical tricks that can prevent bad breath and give a feeling of freshness? To cure bad breath, you must have tried so many remedies, but maybe nothing worked so far. Try some of the marvelous tips given below, which can give an everlasting relief from this medical disorder:

Clean your tongue. Along with brushing and flossing twice a day, also use a tongue scraper, available at most drugstores, or brush your tongue. That’s because your tongue has millions of filaments that can trap food particles and bacteria, leading to oral odor.
Drinking plenty of water. Bad breath occurs because of anaerobic bacteria that break down sugar and protein into volatile sulphur compounds (VSCs). These broken compounds create foul smells that can cause bad breath. In general, anaerobic bacteria require dry conditions to thrive speedily. Drinking plenty of water changes the environment required for the growth and development of the anaerobic bacteria. Water helps to dilute the concentration of volatile sulphur compounds. To prevent bad breath, you must carry a bottle of water everywhere.
Chew sugarless gum. Surprising as it sounds, saliva is the best defense against bad breath. A common cause of halitosis is dry mouth, which can be triggered by certain medications and health problems. If you’re wondering why morning breath can be smelly, that’s because saliva flow is lower during sleep. Chewing gum counteracts these problems by stimulating salivation. What’s more, gum containing the sugar substitute xylitol may help reduce cavity-causing bacteria, a recent study suggests.
Avoid using commercial mouthwashes. Dry mouth is an ideal condition for the growth of anaerobic bacteria. Most of commercial mouthwashes contain unnecessary ingredients such as flavor and color to lure many customers. In addition, the presence of alcohol enhances the harmful effect of anaerobic bacteria. Continuous use of such mouthwashes can create chronic bad breath, which is difficult to treat. At times, commercial mouthwashes have various health hazards.
Scent your breath with cinnamon. Unlike other flavorings, such as mint, which only mask bad breath, cinnamon appears to have odor-combating compounds, with a study presented at the annual meeting of International Association for Dental Research reporting that the cinnamon-flavored gum, Big Red, seems to reduce odor-causing bacteria. In the study, people who chewed the gum had a more than 50 percent drop in bacteria levels.
Fresh fruits and green vegetables. Eat fruits and vegetables, such as apple, celery, cucumber and carrot, which are natural mouth cleaners. These natural products can remove food and plaque particles that stay between teeth and gum while eating. Such a type of cleaning process is called auto-floss. It hampers the growth of anaerobia bacteria by increasing saliva in the mouth. In addition, these foods can also improve oral health. Therefore, you should increase regular consumption of fruits and vegetables.
Pay attention to your diet. An unfortunate side effect of a low-carb diet, such as the Atkins plan, can be “dragon breath” due to ketosis (the fat-burning state that is one of the goals of this type of diet). The only cure is increasing carbs, though chewing mint leaves or parsley can temporarily mask the problem. Also watch out for other foods that can trigger mouth odor, such as coffee, alcohol, and such obvious culprits as onions and garlic.
Natural antibiotic. Nature is a huge treasury, especially notable natural herbs such as parsley, aloe vera and olive is easily available anywhere. Chewing parsley can effectively reduce bad breath as well as detoxify the mouth. These herbs are a rich source of chlorophyll, which sweetens the mouth. Not only this, they also enhance saliva which can prevent dry mouth. Make your own mouthwash with aloe vera, which is easily available in your herbal store. After brushing teeth, use two tablespoons of diluted aloe vera with a glass of water. Use the solution to gargle your mouth regularly.
Rule out medical problems. 90 percent of the time, halitosis is triggered by microbes in the mouth. Common dental causes include cavities, gum disease (which may not cause any obvious symptoms other than bad breath), and faulty tooth restorations that have become a breeding ground for bacteria. However, if you have good oral health—and persistent halitosis—check with your doctor, since such illnesses as respiratory tract infections, diabetes, acid reflux disease, liver disease and even cancer, in rare cases, can also cause mouth odor, cautions Dr. Mitchell. One of the best ways to protect your oral health—and keep your breath fresh—is to avoid tobacco use, which greatly increases risk for gum disease and oral cancer.
Consult an oral care expert. Bad breath might be because of oral diseases such as Candida infection and gum disease. If you have any of these diseases, you must see a dentist. In case of halitosis, you should immediately consult an oral care provider. At times, you should avoid improper mercury fillings by dentist. Otherwise, such things can affect your oral health.

Are Daily Habits Damaging Your Teeth?

2013-02-22T00:16:00.001+08:00

Some of the habits developed by children and adult alike over time may cause damage to the teeth that will not immediately show or manifest but will build up over the years, which will be harmful to their overall dental health in the long run. Here is a list of practices you may want to avoid.

Eating Sugary Foods

Sugar is a tooth’s worst enemy , and the longer it stays in your mouth, the worse it is. It is said that all types of sugar can cause tooth decay. Bacteria use the energy in the sugar and then make acids which attack teeth and tooth enamel. This then causes tooth decay, which is also known as dental caries. If we have a large amount of sugary foods and drinks in our diet, our mouth will be acidic and will take about 20-30 minutes to return to its normal pH level. Think about the last time you had a bunch of gummy candy—how much time did you have to spend picking little bits out from your teeth? Jelly and gummy candies are harder to wash away, which mean the sugar in them just hangs around your teeth, feeding the acid-causing bacteria that live in your mouth. Because of this, it is important to avoid sugary foods that stick to the teeth longer than other foods and bathe them in sugar, like jelly beans and other candies.

Drinking soft drinks and alcohol

Soft drinks have emerged as one of the most significant dietary sources of tooth decay, affecting people of all ages. Prolonged exposure to soft drinks can lead to significant enamel loss. Some research suggests it may be just as corrosive to teeth as drinking battery fluid, and this can occur as soon as the first three minutes of consumption. This is caused by a combination of mostly three factors, one is the sugar (which is really a minor factor compared to the others) then comes the phosphoric acid present in some soft drinks and finally the staining effect that they can have on your teeth.

Alcohol, similarly to soda, is also extremely acidic and can erode the teeth. This can lead to cavities, long term tooth decay and increase the risk of periodontal disease. Alcohol abuse can also damage the soft tissue and decreases the natural saliva in the mouth, without natural saliva, the mouth becomes dry, making it easier for bacteria and infection to stay in the mouth.

So what can you do to prevent this? The most obvious answer is to reduce or altogether stop consuming soft drinks or alcohol. Substitute with fresh fruit juices or just have milk or better yet, water.

Using teeth as tools

We’ve all been there –When you use your teeth to snap off bottle caps, remove clothing tags, or open plastic bags. Stop immediately using your teeth as tools. Teeth should not be used as can openers, scissors, pliers, or knives because they aren’t tools. While it’s definitely an immediate solution it is far from a good one! This common habit may cause micro-cracks that may eventually lead to more serious dental problems in time. Stick with scissors, openers or knives next time you need to open something.

Holding or Chewing on a pen, glasses, pencil or other solid and hard objects in your mouth can also cause your teeth to crack or break. Biting your nails, can also cause splinters or cracks in your teeth.

Brushing teeth immediately after meal

Many people brush more than the recommended number of times per day - especially after a rich meal. But research shows that brushing too soon after meals and drinks, especially those that are acidic, can do more harm than good. If you brush too soon after eating you haven’t given the enamel enough time to re-mineralize and you might actually be brushing your enamel away. The scientists found an increase in dentin loss when brushing in the 20 minutes after drinking soda. But there was considerably less wear when brushing took place 30 or 60 minutes afterward. Waiting to brush for at least 30 minutes gives your mouth time to produce enough saliva to neutralize the acidity. This saliva helps your teeth to harden and absorb more calcium, which then acts like a coat of armour.

Smoking

Most of us know that smoking is bad for our health, but did you know that smoking is also a major contributor to many dental problems? Smoking can lead to tooth staining, gum disease, tooth loss and in more severe cases mouth cancer.

Using the Wrong Equipment

Don’t use paperclip, toothpick, or piece of paper to get something out from your teeth. Using these objects may lead to gum and tooth damage. Toothpicks are the least favoured way of cleaning food stuck between teeth – the best solution for cleaning in between your teeth is floss or an interdental brush.

Grinding Your Teeth

Teeth grinding (bruxism) is involuntary clenching, grinding and gnashing of the teeth. Bruxism can be a physical expression of stress; for example, susceptible people may tend to grind their teeth when they are angry, concentrating hard on a particular task or feeling anxious. The problem with bruxism, as the habit of grinding and clenching is called, is the wear and tear on your teeth. When you grind your teeth, you can wear away tooth enamel. This can lead to sensitive teeth and tooth decay, and it can also cause damage to expensive dental work. Finally, grinding taxes the muscles and joints of the temporomandibular (jaw).

Oral Disease: Herpes Labialis

2013-02-21T19:47:00.001+08:00

What Causes Herpes Labialis?

Herpes simplex virus (HSV), after primary oral or perioral infection, remains latent in the trigeminal ganglion. HSV moves down the trigeminal nerve to produce mucocutaneous lesions if reactivated by factors such as:

fever
sunlight
trauma or
immunosuppression.

Labial or perioral herpes labialis (cold sores) affect up to 15% of the normal population.

What are the Symptoms?

Lesions are seen typically at the mucocutaneous junction, starting as macules which rapidly become papular, vesicular, then pustular over a few days and crust and heal usually without scarring. Any mucocutaneous site can be affected, including the anterior nares.

Patients with T-cell immune defects in particular are predisposed to recurrent herpes with widespread and persistent lesions. Haemorrhage into lesions produces a deceptive appearance in a leukaemic or other patient with thrombocytopenia.

Impetigo can mimic (or complicate) herpes labialis.

How is Herpes Labialis Diagnosed?

Differential diagnosis of herpes labialis is mainly from primary HSV infection, herpes zoster, impetigo or carcinoma (rarely). Diagnosis is largely clinical, though polymerase chain reaction DNA detection, immunodetection, electron microscopy or viral culture is occasionally needed.

How is Herpes Labialis Treated?

Most patients will have spontaneous remission within 1 week to 10 days but, as the condition is both uncomfortable and unsightly, antiviral treatment is indicated from as early in the disease as possible. Penciclovir 1% cream applied in the prodrome may help abort or control lesions in healthy patients,
and appears more effective than aciclovir 5% cream.

Systemic antivirals (aciclovir, valaciclovir and famciclovir) may be needed for more severe cases, especially immunocompromised patients, in whom the lesions may otherwise spread or persist. Antiviral resistance is becoming a significant problem to immunocompromised persons, especially those with severe immune defects: alternative therapies then include foscarnet, n -docosanol, idoxuridine or tromantadine hydrochloride.

Reference : Scully R. 2010. Oral and Maxillofacial Disease. Informa Healthcare. UK

Familial Adenomatous Polyposis (FAP)

2013-02-21T19:28:00.000+08:00

What is FAP?

FAP—an autosomal dominant condition caused by mutation in the APC tumour suppressor gene on chromosome 5—is characterized by the development during the second decade of life of hundreds of adenomas in the colon and rectum. These eventually cause rectal bleeding or anaemia, or develop into cancer.

A less aggressive variant—termed attenuated FAP, is characterized by fewer colorectal adenomatous polyps (usually 10–100), a later age of denoma appearance and a lower cancer risk.

What are the Symptoms of FAP?

FAP is initially symptomless but later gastrointestinal features appear. Extraintestinal manifestations may include osteomas, dental anomalies (unerupted teeth, agenesis of one or more teeth, supernumerary teeth, dentigerous cysts and odontomas), congenital hypertrophy of retinal pigment epithelium, desmoid tumours and extracolonic cancers (thyroid, liver, bile ducts and central nervous system).

Where there are skull and mandible osteomas, dental abnormalities and fibromas on scalp, shoulders, arms and back, the term Gardner syndrome is employed.

How is FAP Diagnosed?

Clinical plus imaging and colonic polyp biopsy.

How is FAP Treated?

The intestinal polyps have a 100% risk of undergoing malignant transformation: therefore, the early identification of disease and colectomy is critical.

Reference: Scully C. 2010. Oral and Maxillofacial Disease. Vol. 4th Ed. Informa Healthcare. UK.

Dental Anasthesia: Posterior Superior Alveolar Nerve Block

2013-02-21T15:47:00.001+08:00

The posterior superior alveolar (PSA) nerve is a branch of the maxillary division of the trigeminal nerve. It parts from the main trunk in the pterygopalatine fossa, passes inferiorly along the posterior wall of the maxilla, and enters the bone about 1 cm superior and posterior to the third molar tooth. The PSA nerve supplies the buccal gingivae, periodontium, and alveolus associated with the upper molar teeth. It provides innervation to the pulps of all the upper molar teeth with the possible exception of the mesiobuccal pulp of the first molar, which is supplied by the middle superior alveolar (MSA) nerve in approximately 50% of individuals.

Branches of the maxillary nerve

Injection for the PSA nerve block is performed in a highly vascular area, and formation of a hematoma is a recognized side effect, especially when the needle is advanced more than 15 mm. Immediate hemorrhage is controlled by pressure, but postinjection trismus may last for weeks. Antibiotic therapy should be prescribed if the hematoma is large.

Technique: Posterior Superior Alveolar Nerve Block

Use a short or long needle, no less than 27 gauge.
Instruct the patient to open the mouth only slightly, and move the lower jaw over to side of injection.
Retract the lip and cheek with the thumb or first finger of left hand.
Insert the needle at the height of the maxillary buccal sulcus at distal aspect of second
molar.
Advance the needle posteriorly, superiorly, and medially (at 45-degree angle to each plane) to a depth 15 mm.
Perform aspiration.
Inject 1.5 ml of solution slowly.
If bone is contacted before a depth of 1.5 ml achieved, alter the angle of approach by
withdrawing slightly and positioning the syringe medially.

Normal orientation of needle for posterior superior alveolar nerve block. From Jastak JT, Yagiela JA, Donaldson D: Local anesthesia of the oral cavity, Philadelphia, 1995, Saunders.

Palpation of zygomatic process in posterior superior alveolar nerve block. Point of needle insertion lies within mucosal pocket posterior to palpating finger.

Source : Dionne RA. 2002. Management of Pain and Anxiety in the Dental Office. W.B. Saunders. Philadelphia

How Hypnosis Can Manage Pain and Anxiety in the Dental Office

2013-02-21T15:26:00.002+08:00

Hypnosis is a formalized method of applying the techniques of attention modification, paced breathing, and muscle relaxation. It has been employed in dentistry for more than 100 years. Highly regarded courses in hypnosis for clinicians are available on a regional basis from the American Society of Clinical Hypnosis. The courses are graded from beginner to advanced. A beginner’s course will equip the clinician with skills that can be used the next day in practice. A hypnosis course is an easy way to practice talking to patients about a more comfortable way to experience dental treatment.

The process of helping a patient reach a hypnotic state is called induction, as described in the following example:

The patient should be relaxed and sitting up.

Dentist: Please make yourself comfortable. You must be comfortable to get relaxed.
Do you feel comfortable now?

Patient: Yes.

Dentist: Now raise your arms over your head and then just let them drop into your lap. Good. You may have felt a moment of relaxation when you did that. Your whole body relaxed briefly. Please try it again. You may begin to sense that when you relax that your limbs get heavy. This heaviness is part of relaxation. Now try breathing slowly.
Take a deep breath, hold your breath as you are comfortable, and let it out slowly. Each time you breathe in and out, you will get more and more relaxed. You may want to close your eyes.

The dentist can count while giving breathing and suggestions for relaxation as follows:

Dentist: I would like you to tighten your arm and hand muscles; make them stiff out in front of you. Now as I count, I want you to imagine first tightening and then loosening the muscles. One, feel the muscles of your hands tighten and your arms stiffen. Two, make them really tight. Three, now begin to loosen them a little. Take a deep breath and let it out slowly. Four, imagine your muscles getting heavy and much looser. Take another breath. Five, your arms may not feel so heavy that they begin to fall into your lap.

Once a patient becomes comfortable, the dental work can be started. The dentist should alert the patient about an upcoming noise, bump, or other action. Throughout the procedure the dentist can continue to encourage the patient to maintain the relaxed quiet state.

Often, hypnosis sessions end by the clinician giving the patient posthypnotic suggestions, which usually take the form of praising the patient for doing well and suggesting that the feeling of calm and painlessness of the session will continue in the period after treatment. The patient should be told that practice at home improves the effectiveness of hypnosis.

Source: Dionne RA. 2002. Management of Pain and Anxiety In The Dental Office. W.B. Saunders. Philadelphia

Hypodontia

2013-02-17T23:56:00.000+08:00

Hypodontia (oligodontia), the congenital absence of teeth, represented by the loss of one or two teeth with no apparent associated abnormalities is not uncommon. The most common teeth to be missing are the last in each series. Most surveys, however, show that one or more third molars are missing in approximately one-quarter of the population. A study carried out in an English population and excluding the third molars has shown that the teeth most likely to be missing are the lower second premolars (40.9%) followed by the upper lateral incisors (23.5%) and by the upper second premolars (20.9 %).

The pattern of missing teeth does, however, vary from population to population. A common finding in hypodontia is the presence of small and conically shaped teeth replacing normal units of the dentition . Hypodontia in the primary dentition is a relatively rare occurrence.

The congenital absence of teeth associated with abnormalities of the bone or ectodermal appendages is relatively rare. The dysplasia involved may be attributed to ectodermally derived structures or to more complex syndromes in which there are both dermal and bony abnormalities.

Hairy Tongue

2013-02-17T23:50:00.001+08:00

Hairy tongue (lingua villosa) is a commonly observed condition of defective desquamation of the filiform papillae that results from a variety of precipitating factors. In hairy tongue the lesion does not consist simply of a coating on the surface of the tongue but represents an elongation of the filiform papillae, often to many times their original length. With this elongation the papillae often take on a dark colour, black or brown being common. The mechanism for the formation of these coloured hairy tongues is quite unknown, there apparently being many initiating factors. For instance, hairy tongue frequently follows a course of antibiotic therapy and may resolve quite rapidly on completion of treatment. Other hairy tongues apparently appear completely spontaneously and no cause is ever found for them. Equally doubtful is the source of the pigment involved. It is usual to relate this to pigment-producing organisms entrapped within the papillae but, in fact, no such organisms have ever been demonstrated. In the past, the presence of hairy tongue was often ascribed to candidal infection but, again, it has never been shown that there is any true association between candidosis and the production of the elongated papillae.

Treatment of hairy tongue is remarkably difficult. Those cases associated with antibiotic therapy frequently, but not invariably, resolve when the medication is finished. The use of effervescent and mucus-solvent mouthwashes may be helpful in reducing secondary irritation and thereby producing suitable conditions for the resolution of the abnormality but, again, the results are variable. The authors have used chemical cauterization, with trichloracetic acid, to treat hairy tongue, but only small areas can be managed at a time, because of discomfort afterwards. Long-term results of this chemical counterization were disappointing. "Sucking a dry peach stone" has been advocated for the management of hairy tongue but this approach does seem to be potentially hazardous! Some patients with this condition use tongue scrapers or brush their tongue vigorously but these measures are rarely effective.

Source :
Field A. 2003. Tyldesley's Oral Medicine. Vol. 5th Ed. Oxford University Press. UK
http://emedicine.medscape.com/article/1075886-overview
http://www.youtube.com/watch?v=S1lyFPUIkfE

Tooth decay

2013-02-15T19:14:00.000+08:00

What is tooth decay?

Dental caries or tooth decay is one of the most common chronic diseases in the world and affects people of all ages. It is an infectious disease that can be transmitted from one person to another. Cavities are the end result of the disease. The good news is, caries disease is preventable and if treated early, can be treated and controlled. Early caries lesions can even be reversed.

Early signs of tooth decay

Early tooth decay can be hard to spot, especially if you don’t have special training.

The first sign of tooth decay is when the upper incisors develop a dull, white band along the gum line (the area at the base of the tooth, near the gums). You might see brown spots on the teeth, and the gums might be red and swollen. In more advanced stages of tooth decay, blackened areas show up on the teeth, with the gums still looking red and swollen.

Stages of tooth decay

Preventing tooth decay with good dental care

Regular dental checks and visits to the dentist, brushing and flossing are essential steps towards preventing tooth decay. You can read more about dental care for your child in the following articles:

Dental care for newborns
Dental care for babies
Dental care for toddlers
Dental care for preschoolers
Dental care for school-age children.

Preventing tooth decay with healthy eating and drinking

Teeth cleaning alone isn’t a guarantee against tooth decay. The types of food and drink you give your child can affect the development of tooth decay.

Babies under 4-6 months

Newborns and young babies only need breastmilk or formula. When your baby is old enough to drink something other than milk, water is the best option.

Babies over 6-8 months

When your baby is 6-8 months, she can start to use a cup for drinking. A bottle isn’t necessary after 12 months of age. Avoid giving your baby sweetened milk, fruit juice or cordials. These will increase the risk of tooth decay.

Older babies, children and teenagers

Children need a wide variety of healthy foods and snacks. Foods and drinks that are low in sugar are best. Avoid giving your children sweet biscuits or cakes as treats. If your child does eat something sweet, drinking a glass of water or eating a ‘tooth-friendly food’ afterwards can reduce the amount of acid on his teeth.

‘Tooth-friendly foods’ are foods that are low in sugar, promote chewing and get your child’s saliva going. Some good examples of tooth-friendly foods include cheese and chopped vegetables such as carrot and celery.

The longer food and drink stays in your child’s mouth, the more chance there is for acid to develop and cause damage to tooth enamel. This means that nibbling foods and sipping drinks over longer periods of time is more likely to cause tooth decay.

You can discourage your child from long periods of eating or drinking by:

establishing regular snack and meal times, rather than all-day grazing
making sure your child eats and drinks in one place only – for example, at the table
putting food away when snack time or mealtime is over
encouraging your child to drink tap water if she’s thirsty (if you don’t have juice, cordial or soft drink in the fridge or cupboard, you won’t have to watch what your child drinks as carefully)
giving your child sweet foods as part of a meal rather than as a snack.

Other ways to avoid tooth decay

Good family dental health

The germs that cause tooth decay can be transmitted between people. This means it’s important for the whole family to keep their teeth healthy and clean.

If all the family members’ toothbrushes are kept in the same place, make sure the brushes don’t touch – this reduces the risk that decay-causing germs will travel between brushes and into mouths. And when it comes to toothbrushes, there’s no sharing! One for each family member is best.

Bottle-feeding and breastfeeding

Settling babies to sleep with bottles of milk can lead to early childhood tooth decay, particularly if it happens often. The problem is that the milk contains natural sugars, which can build up around baby’s teeth at night. The germs on the teeth can turn the sugars into acids, which eat away at the enamel of the baby teeth.

It’s recommended that you don’t settle your baby in bed with a bottle of milk. If your baby needs extra fluids, give him a quick drink of cooled boiled water before you put him into bed.

In general, if you’re bottle-feeding, take the bottle away when your baby’s finished. Likewise, if you’re breastfeeding, take baby off the breast when he’s had enough. Simple measures like these can help prevent early childhood tooth decay.

Asthma inhalers or puffers

These are a vital part of some children’s asthma management plans, but the powder in some puffers is acidic and can damage tooth enamel. This could lead to tooth decay over time if it isn’t balanced with good oral hygiene.

To avoid tooth decay, rinse your child’s mouth with water immediately after each use of the puffer. Ensure that your child’s teeth are cleaned twice a day with toothpaste. But don’t brush teeth straight after using the puffer – allow 30–60 minutes before brushing.

Other medications

Some medicines can affect your child’s oral health because of their sugar content. Check the label of any medication for any hidden sugars, particularly if your child’s going to be taking the medication for a long period of time.

Saliva helps clean and protect your child’s teeth – without saliva, tooth decay and other oral health problems can become more common. But some medications can reduce saliva production, leaving your child with a dry mouth. Talk to your doctor or pharmacist about the effects of the medication on saliva and teeth. Older children and teenagers could try chewing sugar-free gum. It stimulates saliva flow and helps to protect teeth from decay.

You can also encourage your child to rinse her mouth with water immediately after taking medication, and to brush with fluoride toothpaste one hour after.

Sports drinks

Sports drinks can erode your child’s teeth, particularly if your child drinks them regularly.

It’s best for your child to drink sports drinks only sometimes, and to drink plenty of water instead. When he does drink sports drinks, it’s a good idea for him to rinse with water straight away and to brush his teeth with a fluoride toothpaste about an hour after.

Source :
http://www.ndc.com.sg
http://raisingchildren.net.au

Sensitive Teeth: Why are My Teeth Sensitive and What can I do About It?

2013-02-14T18:48:00.001+08:00

If a taste of ice cream or a sip of coffee is sometimes painful or if brushing or flossing makes you wince occasionally, you may have a common problem called "sensitive teeth." Some of the cause include tooth decay, cracked tooth, worn tooth enamel, worn fillings and tooth roots that are exposed as a result of aggressive tooth brushing, gum recession and periodontal (gum disease).

Symptoms of Sensitive Teeth

A layer of enamel, the strongest substance in the body, protects the crown of healthy teeth. A layer called
cementum protects the tooth root under the gum line. Underneath the enamel and the cementum is dentin, a part of the tooth that is less dense than enamel or cementum.

The dentin contains microscopic tubules (small hollow tubes or canals). When the dentin loses its protective covering, the tubules allow heat and cold or acidic or sticky foods to stimulate the nerves and cells inside the tooth. This may cause hypersensitivity and occasional discomfort when you chew, drink cold or hot liquids, when you breathe through your mouth.

Proper oral hygiene is an important step in preventing tooth decay, periodontal disease and pain from sensitive teeth. If you brush your teeth incorrectly or brush too aggressively, you may injure your gums and expose tooth roots.

Periodontal disease-an infection of the gums and bone that support the teeth- also may be responsible. If periodontal disease is left untreated, gum tissues can separate from the teeth and form spaces called pockets that provide a home for bacteria. Periodontal disease can progress until the bone and other tooth supporting tissues are destroyed, leaving the root surfaces of teeth exposed. Regular dental checkups are important so that decay, periodontal disease and other problems may be detected and treated in the early stages.

Treatment

Sensitive teeth can be treated. Depending on the cause, your dentist may suggest that you try desensitizing toothpaste, which contains compounds that help block sensation traveling from the tooth surface to the nerve. Desensitizing toothpaste usually requires several applications before the sensitifity is reduced. When choosing toothpaste or any other dental care products, look for those that display the American Dental Association's Seal of Acceptance-your assurance that products have met ADA criteria for safety and effectiveness.

If the desensitizing toothpaste does not ease your discomfort, your dentist may suggest in-office treatments. A fluoride gel or special desensitizing agents may be applied to the sensitive areas of the affected teeth. When these measures do not correct the problem, your dentist may recommend other treatments, such as filling, a crown, an inlay or bonding to correct a flaw or decay that results in sensitivity. The type of treatment will depend on what is causing the sensitivity.

If gum tissue has been lost from the root (gum recession), your dentist may recommend a surgical gum graft to cover the root, protect the tooth and reduce the sensitivity. In cases in which hypersensitivity is severe and persistent and cannot be treated by other means your dentist may recommend endodontic (root canal) treatment to eliminate the problem.

Reference : Sensitive teeth causes and treatment. JADA, vol 134, December 2003.

Six Techniques for Managing Behaviour in Pediatric Dentistry

2013-02-14T18:05:00.000+08:00

Voice control

Voice control is a controlled alteration of voice volume, tone, or pace to influence and direct the patient's behaviour.

Objectives:
(i) To gain the patient's attention and compliance.
(ii) To avert negative or avoidance behaviour.
(iii) To establish appropriate adult-child roles.

Indications: May be used with any patient.

Contraindications: None.

Non-verbal communication

Non-verbal communication is the reinforcement and guidance of behaviour through appropriate contact, posture, and facial expression.

Objectives:
(i) To enhance the effectiveness of other communicative management techniques.
(ii) To gain or maintain the patient's attention and compliance.

Indications: May be used with any patient.

Contraindications: None.

Tell-show-do

Tell-show-do is a technique of behaviour shaping used with both verbal and non-verbal communication.

Objectives:
(i) To teach the patient important aspects of the dental visit and familiarize the patient with the dental setting.
(ii) To shape the patient's response to procedures through desensitization and well-described expectations.

Indications: May be used with any patient.

Contraindications: None.

Positive reinforcement

Positive reinforcement is the process of establishing desirable patient behaviour through appropriate feedback.

Objectives:
(i) To reinforce desired behaviour.

Contraindications: None.

Indications: May be useful for any patient.

Parental presence/absence

Parental presence/absence involves either allowing or removing the parent(s) from the dental surgery in order to gain cooperation.

Objectives:
(i) To gain the patient's attention and compliance.
(ii) To avert negative or avoidance behaviours.
(iii) To establish appropriate adult-child roles.
(iv) To enhance the communication environment.

Indications: May be used with any patient.

Contraindications: None.

Hand over mouth exercise

Hand over mouth exercise is a technique for managing unsuitable behaviour that cannot be modified by the more straightforward techniques. It is often used with inhalation sedation (conscious sedation).

Objectives:
(i) To redirect the child's attention, enable communication with the dentist so that appropriate behavioural expectations can be explained.
(ii) To extinguish excessive avoidance behaviour and help the child regain self-control.
(iii) To ensure the child's safety in the delivery of quality dental treatment.
(iv) To reduce the need for sedation or general anaesthesia.

Indications:
(i) A healthy child who is able to understand and co-operate, but who exhibits obstreperous or hysterical avoidance behaviours.

Contraindications:
(i) In children who, due to age, disability, medication, or emotional immaturity are unable to verbally communicate, understand, and co-operate.
(ii) Any child with an airway obstruction.

Other techniques such as sedation in all its forms and general anaesthesia are described elsewhere.

Painful Socket (Dry Socket)

2013-02-13T03:01:00.004+08:00

Dry socket, the most common postoperative complication from tooth extractions is characterized by the partial or total premature loss of a blood clot that forms after extraction, exposed bone and nerves to outside, results in severe pain and delay the healing process.

In normal condition, after extraction, blood clot forms inside a socket (a hole in the bone where the tooth has been removed) and the healing process begins. During the first 24 hours, a fibrin-covered clot adheres to the socket bone. Within 3-4 days, fibroblasts form and the clot is stabilized. The clot is slowly replaced by granulation tissue. In approximately 1 month, the socket is filled with new bone.

In dry socket, the clot dislodges or dissolves too soon (few days after extraction), leaves the bone and nerve exposed to outside environment which then leads to severe pain and halitosis. Dry socket is not an infection, therefore antibiotics is not indicated unless secondary bacterial infection begins at a later time.

The incidence of dry socket has ranged from 1% to 4% of extractions; 45% occurs in mandibular third molars (lower wisdom teeth) and ten times greater in the lower teeth than the upper teeth.In general, the healing process takes place in 3-4 weeks.

Contributing factors of Dry socket:

Smoking increases risk 2-5 times
Taking oral contraceptives increases risk 2-5 times. Try to schedule during the last week of the cycle, during that time the estrogen level are inactive
Trauma during extraction, difficult extraction
Wisdom tooth extraction especially impacted teeth
History of dry socket, previous pericoronitis or ulcerative gingivitis (appropriate antibiotic prophylaxis should be administered prior to wisdom tooth extraction)
Rinsing too soon or too vigorously; causing the clot to dislodge from the wound
Using straw after extraction
Ignore home care instruction provided by the dentist
Poor oral hygiene
Taking Immunosuppressant drugs: Corticosteroids such as prednisolone (Deltasone, Orasone), Mycopehnolate (CellCept), Cyclosporine (Sandimmune, Neoral), Azathioprine (Imuran)
Recent history of Acute Ulcerative Gingivitis (Trench Mouth), Pericoronitis (infection around the crown of the tooth) associated with the extracted tooth
In the age group of 40-50 years old. Female are prone to dry socket than male.
Presence of local bacteria infection such as ulcerative gingivitis
Trauma from surgery or existing inflammation - generally occurs as early as the second day after extraction. According to Birn's theory, trauma from surgery or existing inflammation causes bone and adjacent tissue to release stable tissue activators, which convert plasminogen in the blood clot to plasmin. Plasmin is a fibrinolytic agent which dissolves the blood clot.

How to prevent dry socket

Pre-operative oral hygiene - have your teeth cleaned before extraction to reduce plaque and bacteria
Use mouthwash with 0.12% chlorhexidine digluconate just before surgery and as irrigation after extraction reduce risk in some patients
Stop smoking prior to surgery and 72 hours after extraction
Avoid vigorous mouth rinse for the first 24 hours after extraction
Use gentle toothbrush and gentle mouth rinse with 0.12% chlorhexidine digluconate for at least a week after extraction
Follow the dentist instruction and see the dentist immediately if the pain increase after few days or bad taste coming out from the wound
For women who use oral contraceptives; schedule surgery when you get the the lowest dose of estrogen, during days 23 through 28 of the tablet cycle, the hormone can interfere with blood clotting
Avoid smoking, the action of smoking can dislodge the clotting and contaminate the wound
Avoid using straw for drinking, the suction will interfere or dislodge blood clotting
For women, schedule extractions during the last week the menstrual cycle, estrogen level is lower during that time

How can you tell if you have dry socket

The pain at the socket which is improving during the first few days after extraction abruptly reversing to excruciating sharp shooting pain. If the extracted tooth is in lower jaw, pain is so intense sometimes it can radiate to the ear.
The normal post extraction blood clot is absent from the socket
The socket is empty, bone is covered by a yellow-gray of necrotic tissue
Swelling of gum tissue around the socket
You may have bad breath (Halitosis) and bad taste in your mouth
Inability to open your mouth normally (Trismus). Trismus develop between 10-40 days after extraction
Swelling of regional lymph nodes at the affected side
Fever, headache, insomnia and dizziness

You might not feel all these symptoms at the same time.

What the dentist may do

The dentist may irrigate a socket and clean food particles from the socket and induce bleeding leading to clot formation
Pack the socket with dry socket paste to relieve pain, prevent food debris to accumulate in the socket and protect the exposed bone. The dry socket paste consists of Eugenol, Guaiacol (antiseptic, anesthetic), and Chlorobutanol in anhydrous form (antibacterial and antifungal). The dressing need to changed every few days (24-48 hours) for 1 week, or sooner if the pain diminished. The pain will improve within an hour after applying the dressing. This treatment doesn't promote healing process, instead it will slow down the healing process. Once the pain is tolerable, the treatment is discontinued. Adverse reaction of Eugenol are hypersensitivity, irritation and cytotoxic when contacts with soft tissue.
If there is clinical signs of infection, such as fever, suppuration, the dentist may prescribe Amoxicillin 1,500 mg/day; for patients allergic to Amoxicillin, the dentist may prescribe Clindamycin 1,200 mg/day
Instruct you to gentle rinse your mouth with warm salt water or other medicated mouth rinse such as 0.12% Chlorhexidine 3 times daily for 7 days.
If the pain persist after 48 hours, return to the dentist

What to do at home

Use syringe with warm salt water to clean the wound or just gently switch your mouth with warm salt water, listerine or 0.12% chlorhexidine digluconate (prescribed by the dentist) to remove food debris
Use Clove oil (from over-the-counter), add few drops in cotton pellet or gauze (cut into small size to fit the socket), and carefully apply to the wound using tweezers; place another regular size gauze over and bite down to hold the gauze in place. This method has been successfully alleviate pain within an hour in most cases. Care must be taken to apply only to the socket area and not to other soft tissue to prevent unnecessary burn sensation. Change to new dressing when it no longer help relieving pain. Note: Use only as needed for pain, prolong use of clove oil can delay the healing process. Stop using clove oil as soon as pain subsides. Other products that contain oil of clove (Eugenol) are Red Cross toothache kits.
First twenty four hours after extraction; rinse your mouth gently with warm water after each meal
Eat only soft food such as soup
To relieve pain with pain pills, use non-steroid anti-inflammatory drugs:

Mild pain

Acetaminophen (Paracetamol; Tylenol) 0.5 - 1g taken every 4 - 6 hours (maximum dose 4000 mg/day). Avoid using this drug if you have liver disease or history of alcoholis. Other name brands are: Aceta, Anacin, Dapacin, Fem-Etts, Genapap, Genebs, Mapap, Maranox, MedaCap, MedaTab, Panadol, Tapanol and some more name brands.

Ibuprofen (advil, motrin, mediprin, nurofen, cuprofen) 200 – 400mg taken every 4 - 6 hours

Moderate pain

Acetaminophen (Paracetamol, Tylenol) 0.5 - 1g + Ibuprofen 200 – 400mg taken every 4 - 6 hour.

Codeine + Ibuprofen 2 tablets every 8 hours (brand names include Nurofen Plus and Solpaflex)

Codeine + Acetaminophen (Paracetamol, Tylenol) 2 tablets every 8 hours (brand names include Solpadeine, Paracodol, Solpadol and Kapake)
Alternating between 1000 mg of Acetaminophen (paracetamol); 2 extra-strength Tylenol (not to exceed 4,000 mg of Tylenol or 8 extra strength Tylenol) in one day, and 400 mg of ibuprofen; 2 tabs of Advil, every 4 hours. Do not use this regimen if you have history of peptic ulcer, liver disease, hypertension. Do not take more than few days.

Severe pain

6. To relieve swelling;

First 24 hours after extraction;

Apply ice pack or cold towel place outside of your face in the area of extraction alternately 15-20 minutes on and 15-20 minutes off for 6 hours or till bedtime.

More than 24 hours after extraction;

Apply moist heat (wet towel put in microwave for 10-20 seconds or dip towel in hot water) place outside of your face in the area of extraction alternately 10-15 minutes on and 10-15 minutes off.
This routine should be used in all extraction

Source : http://www.toothnature.com/2011/05/dry-socket.html

After a Tooth Extraction: How to Take a Proper Care of Your Mouth

2013-02-13T02:44:00.000+08:00

After an extraction, it's important for a blood clot to form to stop the bleeding and begin the healing process. That's why your dentist will ask you to bite on a gauze pad for 30 to 45 minutes after an extraction. If bleeding or oozing continues after you remove the gauze pad, place another gauze pad on the area and bite firmly for another 30 minutes. You may have to do this several times.

After the blood clot forms, it's important to protect it, especially for the next 24 hours. It's important to not:

smoke and chew tobacco
drinking alcohol
suck through a straw
rinse your mouth vigorously
clean the teeth next to the extraction site

These activities could dislodge the clot and slow down healing.

Limit yourself to calm activities for the first 24 hours. This keeps your blood pressure lower, reduces bleeding, and helps the healing process.

After the tooth is extracted, you may feel some pain and have some swelling. You can use an ice bag (20 minutes on, 20 minutes off) to keep this to a minimum. The swelling usually starts to go down after 48 hours.

To control discomfort, take pain medication as recommended. Don't take medication on an empty stomach or nausea may result. If antibiotics are prescribed, continue to take them for the indicated length of time, even if all symptoms and signs of infection are gone. Also:

Drink lots of fluids.
Eat only soft, nutritious foods on the day of the extraction.
Don't use alcoholic beverages.
Avoid hot and spicy foods.

You can begin eating normally the next day, or if not by then, as soon as it's comfortable. Gently rinse your mouth with warm salt water three times a day (put a teaspoon of salt in a cup of warm water, and then gently rinse, swish, and spit). Also, rinse gently after meals. This helps keep food out of the extraction site.

It's very important to resume your normal dental routine after 24 hours. This should include brushing your teeth and tongue and flossing at least once a day. This will speed healing and help keep your breath and mouth fresh. Call your dental office right away if you have heavy bleeding, severe pain, continued swelling after two or three days, or a reaction to the medication. After a few days, you'll be feeling fine and can resume your normal activities.

Dry socket is an infection in your tooth socket after a tooth is extracted. The condition usually develops when a blood clot fails to form in the socket, or if the blood clot comes loose. Dry socket occurs in approximately 5 percent of all tooth extractions.

Normally, the blood clot that forms after a tooth is removed promotes healing, laying the foundation for the growth of new bone tissue. When dry socket occurs, this blood clot is lost and the infected, inflamed socket appears empty - hence the name. Nerves are exposed, and sometimes the bone is visible in the empty socket.

You may not have symptoms until 3 to 5 days after the extraction. Then, the condition will manifest itself as severe pain that doesn't subside, often accompanied by what feels like an earache. You may also have an unpleasant taste in your mouth, and bad breath. Call your dentist right away if you notice any symptoms of dry socket. Treatment for dry socket typically includes a gentle rinsing of the socket and dressing the socket with sedative medication.

Article Source: http://EzineArticles.com/348305

Topical Therapy for Lesions of The Oral Mucosa

2013-02-13T02:26:00.002+08:00

Topical therapy has several advantages over the systemic administration of drugs. Side-effects, although not eliminated, are usually reduced and local application allows for maximum concentration of the drug at the site of the lesion. Agents tend to be more effective if they can be retained locally for as long as possible.

Covering agents

A number of gels and pastes are available to provide mechanical protection of ulcerative areas in the mouth. Agents such as carmellose gelatin gel may also be used as carriers for more active substances such as steroids or antifungal agents. A number of preparations of this kind are commercially available and others can be made up by a pharmacist. Unfortunately, patients often report difficulty applying these pastes, particularly at the back of the mouth.

Topical antiseptics

Chlorhexidine has antibacterial and some anticandidal activity and is currently the most effective antiplaque agent. Chlorhexidine can be used as a mouthwash, spray, or gel to control secondary infection in mucosal ulceration and as an adjunct, or short-term alternative, to toothbrushing and other oral hygiene measures. However, it frequently stains teeth brown and may cause discoloration of the tongue. Staining of the teeth is reversible but can be a problem with long-term use. Some patients do not like the taste of chlorhexidine and occasionally it causes idiosyncratic mucosal irritation. Parotid swelling has been reported in a few cases following use of chlorhexidine.

Topical analgesics

A topical analgesic preparation such as benzydamine (Difflam®) may provide temporary symptomatic relief for erosive and ulcerative oral lesions and enable the patient to eat and drink. Topical anaesthetic agents such as lidocaine gel (or rinse) can also be used for short-term symptomatic relief but should be prescribed with caution since secondary trauma could easily be painlessly effected during the period of anaesthesia. A further precaution to be taken includes the avoidance of preparations of sufficient strength to affect the laryngeal reflexes. Lidocaine rinses should not be used for long periods of time because of the possibility of systemic absorption and side-effects. In spite of these difficulties, it is, from time to time, justifiable to prescribe treatment of this kind. Local anaesthetics are also included in some throat lozenges and mouth ulcer pastilles (or paste) on sale to the public. Many contain sugar, however, and patients should be warned about their cariogenic potential.

Topical antibiotics

There are inherent disadvantages associated with the use of topical antibiotics because of the possibilities of selection for resistant strains and of inducing hypersensitivity reactions in the patient. The value of topical antibiotics outweighs such risks in some cases. Tetracycline (or chlortetracycline) is a useful topical antibiotic. As a 2 per cent solution, it is often effective in reducing secondary infection (and thus the discomfort) in cases of aphthous stomatitis, primary herpetic stomatitis, erosive lichen planus, and other severe ulcerative conditions. Interestingly, (chlor)tetracycline mouthwashes are particularly effective in reducing the discomfort of herpetiform aphthous stomatitis. Use of topical antibiotics cannot normally be accepted as long-term treatment for recurrent conditions and it is best regarded as treatment reserved for acute episodes. The mouthwash may be made by the patient dissolving the contents of a 250 mg tetracycline capsule in 10 ml of water to give a 2 per cent solution. It may be more effective to have the solution accurately made up by the pharmacist, including 10 per cent of glycerol as a demulcent.

If the treatment is not unduly prolonged, there is minimal trouble from overgrowth of resistant organisms in the mouth, although a candidal infection may occur and must be appropriately dealt with.

Many of patients have oral lesions that are persistent and severe. In such cases, the prolonged use of antibiotic-based mouthwashes is clinically justified, particularly in the chlortetracycline-triamcinolone combination that is used in such conditions as pemphigus and major erosive lichen planus.

Topical corticosteroids

One of the most important factors to be considered when using topical steroids is the degree of suppression of adrenal function that may occur when these drugs are administered. The degree of adrenal suppression varies not only from steroid to steroid and according to the method of use, but there is also considerable individual variation. For instance, a dose of systemic prednisolone that may apparently cause no side-effects in one patient may render another markedly Cushingoid. It is the author practice to use high-concentration, locally applied steroids to replace systemic medication wherever possible. Excessive use of topical steroid preparations can, however, result in a significant amount of systemic absorption. Application of more potent topical steroids also increases the likelihood of a superimposed oral candidiasis and some oral physicians advocate the concomitant use of a prophylactic, topical antifungal agent.

Source : Field A. 2003. Tyldesley's Oral Medicine. Vol 5th Ed. Oxford University Press. UK

Submandibular Gland Resection

2013-02-12T22:58:00.001+08:00

EMBRYOLOGY

The paired submandibular glands develop from the buds in the floor of the primitive mouth that grow on the lateral aspect of the tongue. The buds initially give rise to cords that canalize into ducts, and their ends differentiate into the acinar structures.

ANATOMY

The submandibular gland is located in the floor of the mouth and consists of a larger superficial part that communicates with a smaller deep part around the posterior border of the mylohyoid. The superficial part primarily lies within the digastric triangle and is bounded superomedially by the mylohyoid muscle, superolaterally by the mandible, and inferiorly by the skin platysma and investing layer of the deep cervical fascia. The facial artery is related to the posterior surface of the submandibular gland.

The deep part of the submandibular gland is located in the interval between the mylohyoid and the hyoglossus muscle. Emerging from the deep part of the gland is the submandibular duct (Wharton’s duct), which opens at the base of the frenulum in the floor of the mouth. Other important structures that lie in the vicinity of the deep part of the submandibular gland are the lingual nerve, the submandibular ganglion superiorly, and the hypoglossal nerve inferiorly.

The blood supply of the submandibular gland is through branches of the facial and lingual arteries, and the venous drainage follows the respective facial and lingual veins. The parasympathetic secretomotor supply is from the superior salivary nucleus of the seventh cranial nerve. These fibers reach the submandibular ganglion via the chorda tympani and submandibular ganglion.

PREOPERATIVE PREPARATION

Apart from basic investigations, the imaging studies of the submandibular gland, particularly plain radiograph of the floor of the mouth, sialogram for recurrent submandibular gland enlargement, or computed tomography of the neck for a solitary mass within the submandibular gland, are reviewed. Although indication for resection of the submandibular gland is usually based on clinical suspicion, results of fine-needle aspiration cytology, if performed, should be reviewed. Preoperatively the surgeon must determine by physical examination whether the hypoglossal, lingual, and marginal mandibular branches of the facial nerve are intact. Informed consent is obtained after the patient is informed about the risks of damage to the hypoglossal nerve, the lingual nerve, and the marginal mandibular branch of the facial nerve.

OPERATIVE PROCEDURE

POSITION

The patient undergoes general anesthesia with endotracheal intubation, but anesthesiologists must refrain from using paralyzing agents because these may make the use of the nerve stimulator ineffective. The patient is placed in a supine position with a shoulder roll to extend the neck. The head is turned away from the affected side and elevated to a 45-degree position to reduce venous congestion. The operative area is prepped and draped. The face is left exposed by placing a transparent dressing to allow facial movements to be observed during facial nerve stimulation.

INCISION

Fig. 1

An incision about 2 cm below and parallel to the body of the mandible is marked with an indelible pen ( Fig. 1). The skin is infiltrated with 1% lidocaine with epinephrine to avoid bleeding from the skin. The skin is incised with a no. 15 scalpel.

EXPOSURE AND OPERATIVE TECHNIQUE

The dermis is divided with cutting electrocautery down to the level of the platysma. In line with the incision, the platysma is also divided, and then superior and inferior flaps are created in the subplatysmal plane. Superiorly, the surgeon should be cognizant of the presence of the marginal mandibular branch of the facial nerve. The facial artery and vein will be encountered running deep to this nerve, and they are divided and ligated. In fact, retracting these vessels upward will protect the marginal mandibular branch of the facial nerve during subsequent dissection (Hayes-Martin maneuver). The superior border of the gland is freed from the body of the mandible.

Dissection now proceeds toward the posterior aspect of the gland, and the posterior/common facial vein is exposed, isolated, divided, and ligated. Posteriorly, the gland is carefully elevated off the surface of the sternocleidomastoid muscle. Retracting the anterior border of the sternocleidomastoid muscle will expose the tortuous facial artery, which is ligated again. The superficial part of the submandibular gland is elevated from the underlying mylohyoid muscle. The posterior border of the mylohyoid muscle is identified and then retracted anteriorly with a loop retractor. This should expose the deep part of the submandibular gland and the important adjacent structures ( Fig. 2 ). These include the lingual nerve above and the hypoglossal nerve below.

Fig. 2

Superiorly the branches from the lingual nerve to the submandibular ganglion are seen and divided. This allows the lingual nerve to retract superiorly and thus avoids injury. Next, the hypoglossal nerve, which will be seen emerging from beneath the anterior belly of the digastric muscle, is identified. The gland now remains attached only by its submandibular duct (Wharton’s duct), lying between the lingual and hypoglossal nerves. The submandibular duct is clamped, divided, and ligated with 2-0 absorbable sutures. The operative area is inspected for hemostasis, and the retracted marginal mandibular nerve is returned to its normal position.

CLOSURE

A 7-mm Jackson-Pratt drain is placed in the operative field. The platysma is approximated, with care taken not to entrap the already preserved marginal mandibular nerve. The skin is closed with 5-0 absorbable sutures.

Source : Khatri, VP. 2003. Khatri : Operative Surgery Manual. Vol. 1st Ed. Elsevier. USA

Video : http://www.youtube.com/watch?v=T6jmyRAmTBA

Caring For Dentures

2013-02-12T22:30:00.004+08:00

Taking proper care of your dentures is important for keeping them in proper shape and also to keep your mouth healthy. Maintaining and keeping your dentures hygienic does not require any special attention. Once you receive your dentures, your dentist will tell you that they need regular cleaning and care. Here is a step-by-step procedure to keep your dentures clean and healthy.

Cleaning at night:

Dentures should be cleaned regularly at night without fail. Cleaning should be done carefully and with proper attention. Dentures seldom get spoiled in a day but damage slowly over time when proper care is not given regularly.

• Before you start the cleaning routine, make sure that you have taken appropriate steps to prevent damage to your dentures. Dentures are made of ceramic which is brittle. They can break easily if dropped. Before you clean, place a folded soft towel underneath or fill your sink with water. This will prevent any damage if you drop them accidentally.

• The first cleaning step is to rinse your denture thoroughly with water and run your fingers along the inside edges to remove any large pieces of debris or other substances. Rinse them under a full tap to wash away debris.

• Next is brushing. For dentures always use a soft bristled brush. Hard bristles can wear down dentures quickly. Do not use toothbrushes. Although they may seem to clean well, toothbrushes can damage dentures over time. Buy a proper denture brush and use it properly. Gently brush all surfaces taking care that the plastic and bend attachments don’t get damaged.

In addition to removing food debris and bacteria, brushing also prevents stains from developing on denture surfaces. People who skip brushing may find permanent stains develop on their dentures.

• Once you are done brushing, rinse the denture thoroughly with water. Fill a glass half with denture solution. It is common practice to use water instead of denture solution. Although apparently this does not cause any damage, water contains microorganisms which may deteriorate parts of the denture. It is recommended that you use a good denture solution instead.

Tips for care:

• Never wrap your denture in paper towel as it may accidentally get thrown away. Always have proper accessories for cleaning and storing your dentures.

• Do not use household cleaners, dish washing liquid or any other solution apart from special denture cleaning solutions. Domestic cleaners contain chemicals that can damage or deform your dentures. Never use bleach because it can cause discoloration of the pink plastic. Liquid hand soap is safe to use. However, it gives the dentures a slippery feel which some people find annoying.

• Keep dentures away from reach of children and pets. In fact, do not allow adults to touch them either. Having other people handle your dentures is unhygienic and may cause disease.

• Do not use hot water for cleaning dentures as this can damage the plastic parts.

• Always use solutions and equipment that has been approved by the American Dental Association (ADA). This ensures that the products you are using are safe and effective for your purpose.

Type of Dental Braces

2013-02-12T22:06:00.000+08:00

Dental braces are no longer for teenagers only. An increasing number of adults are choosing braces to straighten their teeth. According to the American Association of Orthodontists, about 22 percent of braces wearers are adults. You can select from these four types of braces to acquire that perfect smile.

Metal braces

The most inexpensive type of braces for adults are the traditional, stainless-steel versions. Obviously, the drawback to wearing these is how visible they are. Metal braces hold a thin wire held in place with rubber bands to put pressure on the teeth and move them to the desired place.

Metal braces can irritate gums and cheeks at first. Once you have them on, you have to watch what you eat, avoiding things that can stick to the braces, such as caramel or gum. You also have to avoid eating hard food, which can move or dislodge the braces.

Ceramic braces

Ceramic braces cost more than stainless-steel versions because they blend in with the teeth and aren't as visible. Also, you can choose between clear elastic ties or white metal ties to hold the braces in place.

Though the braces themselves won't stain, the ties will easily, especially if you consume items that typically stain teeth, such as coffee. Your orthodontist will swap out the ties every time he or she adjusts the braces, which is usually every month.

Ceramic braces are more sensitive and can easily break or chip, so they require more maintenance and more time to install than metal braces, which increases the treatment time and cost.

Lingual braces

Lingual braces are customized to bond and hide behind the teeth to remain invisible, but they cost more than metal or ceramic braces because the process is more complicated. They require a skillful orthodontist to install them, and not every orthodontist knows how to do it.

Also, lingual braces don't work well on small teeth and get in the way of the tongue, potentially causing speech problems and injuries, so you have to learn and practice speaking with them on.

Invisible braces

Invisible braces, such as Invisalign, cost more than any other types of braces because they are practically invisible. These braces are mainly for people without great teeth problems.

Instead of brackets mounted to the teeth, these braces are custom-fitted aligners (rubber trays) that you wear except when eating or brushing your teeth. The process involves using different aligners every two weeks to move the teeth gradually to the desired place.

These types of braces can be uncomfortable at first as the tray begins to put pressure on the teeth and you get used to them. You must also be disciplined because the success of these braces depends on you wearing the trays no less than 20 hours a day.

Source : http://www.angieslist.com/articles/4-types-dental-braces-adults.htm
Author : J.T Gonzales

Exfoliative cheilitis

2013-02-12T21:46:00.000+08:00

Exfoliative cheilitis is an uncommon condition affecting only the vermilion borders of the lips and characterized by the production of excessive amounts of keratin. This forms brown scales that may be spontaneously shed or may be removed by the patient. It has been suggested that this condition is exclusively seen in female patients, but several cases have recently been reported in males. The histology of the lesion is of a simple hyperparakeratosis and it is not considered to be a premalignant lesion.
There is no apparent systemic background to this condition but some patients report an association with stress, the degree of keratin formation apparently increasing at times of increased anxiety. All systemic investigations in these patients prove negative and all forms of treatment have as yet proved unhelpful. Local and systemic steroids, cautery, cryosurgery, and many other forms of treatment have been attempted without success. In those with an apparent anxiety-related condition, mild tranquillization has been reported as helpful, although the mechanism for this is far from clear. Antidepressant medication has also been prescribed for a few of these cases, with some degree of success. The author's experience with this condition is that affected individuals often appear to have a personality disorder. The extent to which there is a fictitious element involved is difficult to quantify. Most patients tend to peel off the exfoliating skin, but this could be a normal response under the circumstances. Eventually, this condition appears to resolve spontaneously but, while present, it is sufficient to cause the patient considerable distress.

How Important Good Oral Health During Pregnancy?

2013-02-12T21:37:00.001+08:00

It's no secret that pregnancy is an important time in a woman's life. While women often hear about how pregnancy causes physical changes that affect their hormone or appetite levels, these changes can have a great effect on their oral health as well. Despite the fact that good oral health is essential for the overall health of both mother and child, only 22 to 34 percent of women in the United States visit a dentist during pregnancy.

In fact, dental care during pregnancy is not only safe and effective, it's essential for combating the adverse effects of oral disease, according to an article published in the May/June 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD). Dentists have the ability to maintain the oral health of expectant mothers by treating the dental findings that are common during pregnancy.

"Hormonal changes during pregnancy can result in several changes in the mouth," says Homa Amini, DDS, co-author of the article. "Reports show that the most common oral disease is gingivitis, which has been reported in 30 to 100 percent of pregnancies."

Gingivitis, a buildup of plaque that causes inflammation of the gums, should be treated with a professional cleaning and proper toothbrushing and flossing. If left untreated, gingivitis can lead to periodontitis, a more serious form of gum disease. "Patients tend to delay the treatment of oral disease due to concerns for fetal safety; however, routine dental treatment can be performed safely at any time during pregnancy," says Dr. Amini. What's more, untreated dental disease can lead to pain, infections and unnecessary exposure to medications, any of which could harm the developing fetus. Poor oral health also can affect the nutritional intake of expectant mothers, which is essential for fetal growth and survival.

The hormonal fluctuations that result from pregnancy can produce benign pregnancy tumors in the mouth. These tumors usually appear after the first trimester and typically go away after delivery; however, surgical removal may be required when these tumors bleed, interfere with eating or do not resolve after delivery.
In addition to examining for oral disease, dentists may notice dental erosion -- the chemical or mechanochemical destruction of tooth material -- in pregnant women, due to increased acid in the mouth following morning sickness.
"To neutralize acid after vomiting, pregnant women should rinse the mouth with a mixture of a teaspoon of baking soda dissolved in a cup of water," says Patricia Meredith, DDS, FAGD, spokesperson for the AGD. "The teeth should be brushed only after the mouth has been rinsed and the acid has been neutralized to prevent further damage to the enamel."

Oral health assessment and treatment should be an essential part of prenatal care, as these steps allow the patient to receive ongoing advice concerning proper oral hygiene and infant oral health care.

Source : http://www.sciencedaily.com/releases/2010/05/100517132849.htm

Thumb Sucking: How to Help Your Child Stop the Habit

2013-02-12T21:22:00.001+08:00

Children suck their thumbs for a variety of reasons. For infants, it is a natural reflex that often begins in the womb. As babies grow, they learn a lot about their bodies and the world around them through sucking. They suck on their fingers, clothing, and toys. From this action they learn what is pleasing and what is uncomfortable. Sucking on an ice cube or cool teething ring feels good when those first teeth are trying to break through, but when the same teething child sucks on a hard plastic toy, she may experience discomfort.

Young children also use sucking to soothe and comfort themselves. Since the action is relaxing, it often induces sleep—which is why parents notice children sucking their thumbs when they are tired. In fact, many thumb suckers fall asleep more easily, are able to put themselves back to sleep quicker, and sleep through the night much earlier than their non-thumb sucking peers.

With all these positives, is there a point when parents should be concerned about thumb sucking? According to the American Dental Association (ADA), after a child's permanent teeth come in, thumb sucking can cause problems. It can interfere with proper mouth growth, teeth alignment, and cause changes to the roof of the mouth.

One factor that determines whether a child will have dental problems is the intensity with which she sucks. A child who just rests her thumb in her mouth or passively sucks on it is less likely to develop problems than a child who sucks her thumb in earnest. Parents whose children are vigorous thumb suckers should pay attention to any changes in their child's primary teeth and consult a dentist if any are noted.

The ADA recommends children give up thumb sucking by the time their permanent front teeth start coming in, which is typically around the age of five. But the good news is that the majority of children lose interest in thumb sucking long before this point. If your child is not one of them, you may have to intervene.

Studies of older thumb suckers show they have one thing in common: they were all encouraged by their parents, in one way or another, to stop sucking their thumbs at an early age. Here's how you can get your child on track.

Make Her Think it's Her Idea

Nagging your thumb sucker is no good for either of you. Instead, encourage her to realize how much she has grown and changed. Show her what she has left behind on her way to maturity. Point out that she no longer has use for diapers, bottles, or high chairs. Tell her how proud you are of that. Ask her what else she thinks she will give up. If she doesn't say thumb sucking, then you should suggest it.

Weaken the Habit

When you notice your child's thumb in his mouth, try to distract him. Engage him in an activity that requires he use both hands. Be especially prepared before nap and bedtime. Have him hold the book you are reading or hug a stuffed animal with each arm.

Help Her Notice

When your child wants to give up thumb sucking, tell her about a habit you gave up and how hard it was. Then decide on a secret signal between the two of you. When she unconsciously slips her thumb in her mouth—and she will—you can use the secret signal to help her realize what she is doing. By using a secret signal, you replace what could be a shameful situation with fun.

Use Authority

Comments from your child's pediatrician and dentist can work wonders. These authority figures have been a constant in his life. They can help him feel that he wants to stop sucking his thumb because he is growing up.

Consider Peer Pressure

Friends are very important to this age group. Having a sleepover with friends who do not suck their thumbs can be very helpful. If your child sucks her thumb and her friends mention it, this might be the motivation she needs to stop.

Resource :
1. http://www.babyzone.com/toddler/stop-thumb-sucking_72158
2. http://www.babyzone.com/toddler/stop-thumb-sucking_72158-page-2
Author : by Dr. Caron B. Goode

The Salivary Glands

2013-02-12T21:01:00.005+08:00

The parotid glands are the largest salivary glands. They are wedge-shaped and situated in front of the ear and behind the ramus of the mandible. The apex of the wedge is the deepest part of the gland. The peripheral branches of the facial nerve (CN VII) are intimately associated with the parotid gland. This relationship is inadvertently demonstrated when an inferior dental nerve anaesthetic block is administered incorrectly, and causes a temporary drooping of the upper eye lid.

Parotid saliva is transferred along the parotid duct into the oral cavity. The thick-walled parotid duct (Stenson's duct) emerges at the anterior border of the parotid gland and runs over the surface of the masseter before hooking medially over the anterior muscle border. The orifice of the duct is covered by a small flap of mucosa called the parotid papilla and this is situated opposite the maxillary second permanent molar.

The two submandibular glands are approximately half the size of the parotids. The superficial part of the submandibular gland is wedged between the body of the mandible and the mylohyoid muscle, with the smaller deep part hooking around the posterior border of the muscle to lie on the floor of the mouth above the mylohyoid. The submandibular (Wharton's) duct runs forward, along the floor of the mouth to open into the subligual papilla, just lateral to the lingual frenum. The secretions are a mixture of serous and mucous fluids.

The sublingual glands are the smallest of the three pairs of salivary glands and are located just below the floor of the mouth beneath the sublingual folds of mucous membrane. There are numerous sublingual ducts that open into the mouth along the sublingual folds. The secretions of these glands are predominantly mucous.

The minor salivary glands consist of numerous small mucosal glands situated on the tongue, palate, buccal and labial mucosa. They produce primarily a mucous secretion.

Reference: Field A. 2003. Tyldesley's Oral Medicine. Vol. 5th Ed. Oxford University Press. UK