All about Oral

jaws. To have a healthy mouth means brushing 2 or 3 times a day, flossing once a day and visiting a dentist every 3 to 4 months. Healthy teeth are very important ...

All About Oral Health: Dentistry for Individuals with Disabilities:

Consumer Caucus of the

New York State Developmental Disabilities Planning Council

Aldea LaParr Chairperson

This pamphlet is one in a series intended to help individuals with disabilities get the oral health care they need. It was developed for all individuals with disabilities, their caregivers, dental professionals, and medical professionals associated with good oral health care.

New York State Developmental Disabilities Planning Council 155 Washington Ave. Albany, NY 12210 Phone: 518-48607505 Fax: 518-402-3505

What is Oral Health Care? Oral health care means taking care of your mouth, including your teeth, gums, and jaws. To have a healthy mouth means brushing 2 or 3 times a day, flossing once a day and visiting a dentist every 3 to 4 months. Healthy teeth are very important for your overall good health. In this pamphlet, there is information to help you take care of your teeth.

What should I know about my permanent teeth? There are two major types of teeth, primary teeth (baby teeth) and permanent teeth. It is very important to take care of your permanent teeth.

Children aged 6 to 18 grow permanent teeth. In adults, there are four groups of permanent teeth. These groups are incisors, cuspids, pre-molars, and molars (See Figure 1).

Figure 1. Names and locations of teeth in the mouth

The front teeth, or incisors, cut food. There are central (front) incisors and lateral (to the sides of the front teeth) incisors. There are a total of eight incisors in the upper and lower jaw. Canines, or cuspids, cut and tear food. They are the third teeth from the center. There are a total of four (two upper, two lower) cuspids. Pre-molars (or bicuspids) grab and cut off food. These eight teeth (four upper, four lower) are located between the canines and the molars. Molars are the very back teeth and grind food. There are twelve molars (three on each side, upper and lower).

What are the parts of a tooth?

Figure 2. Parts of a tooth

The part of the tooth that you can see is called the crown of the tooth (See Figure 2). The root of the tooth is under the gum.

What does the inside of a tooth look like?

Figure 3. View of inside of tooth

There are four major parts of the tooth (See Figure 3), the enamel, dentine, pulp, and cementum. Enamel is the hardest substance in the human body and is strong enough to chew and grind food. Dentine (or dentin) is inside the enamel.

The pulp is in the middle of the tooth and is filled with blood vessels and nerves that enter the tooth at the very end of the root. The cementum is made of a bony substance that covers the root of the tooth. It is softer than enamel and dentine and helps to hold the tooth in place.

What is the most common problem with teeth? Tooth decay is one of the most common oral health problems. Tooth decay often results in tooth loss.

Figure 4. Image of a dental cavity

Dental cavities, or caries, is a disease that is caused by decay of the tooth (See Figure 4). Cavities may be small openings or holes in the teeth.

How do I know if I have cavities?

Figure 5. Black spot (cavity) in tooth

You may see a black spot on one of your teeth (See Figure 5). When you go for your checkup, the dentist may find cavities in your teeth. At first, they may not cause you any pain.

Figure 6. Dentist with instrument

The dentist will use instruments to find soft areas or cavities (See Figure 6). Dental x-rays may show cavities that you or your dentist cannot see.

If you or your dentist finds a cavity, you should get it fixed right away.

What can I do to prevent cavities? You can prevent cavities by brushing your teeth after each meal, flossing once a day, and visiting your dentist regularly. Besides brushing and flossing, you can ask your dentist about a special rinse that contains fluoride. Fluoride helps prevent cavities, especially on the smooth surfaces of teeth.

Figure 7. Mouthwash with fluoride

Fluoride can be found in toothpaste, drinking water, mouthwashes, and special treatments (See Figure 7).

Follow the dentist's instructions and make sure you don’t swallow any of the toothpaste or rinse. If you tend to swallow these, ask the dentist for other ways to get fluoride treatment. To help reduce cavities, you can ask your dentist for a pits and fissures sealant.

Figure 8. Pits and fissures in teeth

Pits and fissures are the anatomical tiny holes and grooves in the top surfaces of the teeth (See Figure 8). These spaces store bacteria that cause tooth decay. Sealants are made of a plastic-like substance. Your dentist can cover the pits and fissures with sealants to help prevent cavities.

Sealants are usually applied to the premolars and permanent molars. Sealants work best when these teeth first appear, from ages six to fourteen years. The sealant process is quick and painless. The teeth are first cleaned and polished before the sealant is applied.

What do I do if I have a cavity? You or your dentist may find a cavity. You should get it fixed right away. When you go to the dentist to get it fixed, the dentist will look at your tooth and take a picture, or x-ray, of it.

Figure 9. Dentist using drill

The dentist will use a drill, laser, or air abrasion to remove the decayed part of the tooth (See Figure 9).

Figure 10. Tooth with metal filling

Then the dentist will fill the hole with metal or resin (See Figure 10). The resin that is used is the color of your teeth. Resin is often used in the front teeth so the filling won’t be visible. High strength resin or metals are used in the back teeth because they are stronger and can hold up to all of the chewing you do.

Figure 11. Image of crown

After the tooth is filled and you find that the filling is very large, a crown may be

placed over the tooth (See Figure 11). This helps protect the tooth from more decay.

What if my teeth are badly decayed?

Figure 12. Sometimes the nerve inside of tooth dies and the tooth abscesses.

Sometimes, if a tooth is badly decayed, the nerve inside the tooth dies (See Figure 12). If this happens, the root area can get very infected. The root area can become abscessed. An abscess is where pus gathers, making the area very painful. This tooth must be taken care of immediately to prevent pain and tooth loss.

Figure 13. Antibiotics

You may have to take an antibiotic to reduce the infection (See Figure 13). You should call your dentist if you have severe pain or swelling of your face or gums. A root canal can be done to save the tooth.

Figure 14. The dentist removes the center of the tooth and cleans the area

The dentist cleans the center of the tooth by removing the decayed area, the nerve, and blood vessels with an endodontic file (See Figure 14). The dentist fills the roots with a sealing material and often places a crown on the tooth to protect it from fracturing.

Figure 15. A post is placed inside the tooth. The tooth is filled and a crown is placed to preserve the tooth.

Sometimes a post is placed inside the tooth to make it strong enough to hold the crown in place (See Figure 15).

What are some of the causes of cavities? Besides not brushing and flossing your teeth, the loss of tooth enamel is one cause of tooth decay.

Figure 16. Man grinding teeth

One way loss of enamel occurs is when you grind your teeth (See Figure 16). Bruxism is another word for the clenching

or grinding of teeth. When you grind your teeth when there is no food in your mouth, the enamel on your teeth wears off very quickly. The enamel does not wear away much from normal chewing of food. Your tooth enamel may be lost in other ways, too. For example, when someone brushes his or her teeth too hard or too often, the enamel wears off the teeth.

Figure 17. Lemon slices

Lots of soda, or other carbonated drinks, lemon juice and forceful chewing also causes a loss of enamel (See Figure 17). Cavities are caused by a buildup of dental plaque.

Figure 18. Tooth with dental plaque

Dental plaque is a film that builds up on the teeth and contains bacteria (See Figure 18).

Figure 19. Boy brushing teeth

It can be removed by brushing (See Figure 19) and flossing, and by cleanings done by the dental hygienist. Gingiva are the soft pink or brown tissue around the teeth. Sometimes, the gingiva become irritated because of a build up of dental plaque. If dental plaque is not removed, it can cause cavities or gingivitis.

Figure 20. Gingivitis and plague buildup

Gingivitis is the swelling of the gums around the teeth (See Figure 20). The gums pull away from the tooth. Gingivitis can lead to loss of bone around the tooth which if left untreated may result in the loss of the tooth. If your gums become red and swollen, and they bleed easily when you brush your teeth, you may have gingivitis. You should go to your dentist right away. A periodontist is a dentist who treats problems with your gums and jaws.

What if my teeth need to be straightened?

Figure 21. Boy with braces

Dental braces are a device used to help straighten your teeth (See Figure 21).

Many children and teenagers get braces. Adults can get braces, too. Orthodontists are dentists who use braces to straighten teeth. They also fix malocclusions, or improper bites.

Figure 22. Boy with malocclusion

A malocclusion refers to the improper way the upper and lower teeth sometimes fit together (See Figure 22). Often, a malocclusion does not need treatment. Sometimes, though, surgery is needed to correct the bite.

Figure 23. Image of retainer

After your braces are taken off, you may have to wear a retainer that helps keep your teeth in their new position (See Figure 23). You will most likely wear the retainer everyday from 6 to 12 months. Retainers sometimes are worn a few nights a week for a lifetime.

When is it necessary to get a tooth pulled? Sometimes, a tooth is so decayed that it must be extracted, or “pulled.” Extracting teeth is a subject that you should talk about with your dentist or oral surgeon.

Figure 24. Impacted wisdom tooth

Once in awhile, a tooth will grow in the wrong direction. This tooth is called an impacted tooth (See Figure 24). This tooth can’t push through the gum because it may be growing under another tooth. Impacted teeth are usually pulled. If you and your dentist think that there may be a problem in the future with your wisdom teeth, you may want all four of your wisdom teeth pulled at once. Children under the age of 21 take less time to recover from this procedure than older people.

What else should I know about getting a tooth pulled? Before the dentist or surgeon removes a tooth, you should talk about the procedure. Ask about the type of anesthesia and sedatives he or she will use. Usually there will be no eating for six hours before the surgery; however, it is important to take medications on schedule. After surgery, there may be swelling of the cheeks, lips, and jaw. Eat only soft foods for a few days and follow the dentist's or surgeon's instructions for a fast and healthy recovery.

Figure 25: Socket with blood clot

Usually, the empty space, or socket, that is left will fill up with a blood clot that helps the gum and jaw to heal (See Figure 25). If you do not follow the dentist’s instructions or you smoke or drink using a straw, the blood clot could come out.

Figure 26. Dry socket

This causes a dry socket to develop (See Figure 26). The bone is exposed to food and air.

Figure 27. Woman in pain

A dry socket is very painful (See Figure 27). Call your dentist if this happens to you.

What do I do about the space left from a pulled tooth?

Figure 28. Image of a dental bridge

A prosthodontist is a dentist that makes dentures, bridges, crowns, and implants (See Figure 28).

These are made to replace missing teeth. These can also be used to make your teeth look better (cosmetic dentistry). If you break a tooth or a tooth has large cavities, you can go to a prosthodontist to fix these teeth. Family dentists are also trained to fix these teeth too, as well as place dentures, bridges, crowns, and implants.

What other oral health issues should I know about? There are other issues of the mouth and jaws that you should know about. An oral and maxillofacial surgeon is a special doctor who treats diseases, injuries, and other problems of the mouth, jaws, face, and skull. Oral & maxillofacial surgeons first study dentistry and then have more training in surgery. Oral & maxillofacial surgeons will pull impacted teeth.

They also do dental work on medically fragile individuals. Sometimes they do surgery that will help people to use dentures and bridges.

Unilateral incomplete

Unilateral complete

Bilateral complete

Figure 29. Three different types of cleft lip and cleft palate

Sometimes, people are born with a cleft lip and cleft palate (See Figure 29). Oral and maxillofacial surgeons work to fix a cleft lip or palate. The palate is the roof of your mouth. A cleft lip and cleft palate is a space in the lip and palette that does not grow together before a baby is born.

This leaves a gap in the baby’s lip and palate. Dentists who are surgeons can work with other doctors and join the parts of the lip or palate. It takes several surgeries over a number of years to completely fix this condition. Another oral health issue is called TMD. The full name for this disorder is temporomandibular joint disorder

(or dysfunction). The temporomandibular joint is the jaw joint in front of your ear. It is often called TMJ for short.

Figure 30. Temporomandibular joint

The name TMJ comes from the two bones that form the joint: the upper temporal bone, which is part of the skull, and the lower jaw bone or mandible (See Figure 30). Pain or problems with the temporomandibular joint is often just called "TMJ," although TMJ is really the name of the joint. TMJ or TMD involves the TMJs and the muscles, tendons, ligaments, blood vessels, and other tissues around this area. Some doctors include problems with the neck, back, or the whole body when diagnosing problems with the TMJs.

Figure 31. Man with facial pain

If you have headaches or facial pain, you may have this disorder (See Figure 31). TMJ disorders can be treated with medications, physical therapy, and plastic mouthpieces. Sometimes, joint surgery is needed to treat serious cases.

References: Medical Network, Inc. (d.b.a. Health A to Z: A World of Health at Your Fingertips. Impacted Tooth. Retrieved December 31, 2007 from healthatoz/Atoz/common/standard/transform.jsp? requestURI=/healthatoz/Atoz/ency/impacted_tooth.jsp

Ovard, C.F. (2002). Healthline: Dental Anatomy. In Gale Encyclopedia of Nursing and Allied Health, The Gale Group Inc., Gale, Detroit. Retrieved January 2, 2008 from utm_term=gingiva&utm_medium=mw&utm_campaign= National Library of Medicine. Dental X-rays. National Institutes of Health. Department of Health and Human Services. Retrieved February 4, 2008 from http://

National Institute of Dental & Craniofacial Research. Dental Care Every Day: A Caregiver's Guide. Retrieved on November 13, 2007, from Jolly, D.E. The Ohio State University. University of Cincinnati. Dental and Oral Health: Adults. Don’t let a disability keep the dentist away. Net Wellness, Consumer Health Information. Retrieved January 30, 2008 from faq2.cfm Centers for Disease Control and Prevention. The Community Guide. The Burden of Oral Disease: Chapter Five: Risk and Protective Factors Affecting Oral Diseases. Retrieved from burdenbook/pdfs/risk.doc Medical Network, Inc. (d.b.a. Health A to Z: A world of health at your fingertips. Tooth Extraction. Retrieved December 31, 2007 from http:// transform.jsp?requestURI=/healthatoz/Atoz/ency/ tooth_extraction.jsp Save a Smile Foundation. Awareness: Cleft Lip; Cleft Palette; Causes of Cleft. Retrieved August 19, 2008 from imagepages/9445.htm Images:

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