Dental indices are needed in oral health surveys. Unless there is a numerical data available, it is difficult to ascertain the oral health care needs in a specific population. Indices are a useful way to:

• determine the prevalence of a particular condition in a population
• to determine the efficacy of certain oral health care devices, mechanisms or products
• to provide baseline data
• to educate and motivate individuals and groups in terms of oral health care maintenance

These indices may also be used in clinical practice to enlighten a patient about his or her dental condition and to compare the results of a dental treatment, or personal maintenance as against the data  recorded during the first dental visit.

Indices can be reversible indices or irreversible indices depending upon the reversible or irreversible nature of the disease factor. Those conditions which cannot revert back to normal fall under the irreversible indices.

Papilla Marginal and Attached Gingival Index (PMA)

It is a measure of the incidence and severity of gingivitis in a given population based on the examination and rating of the degree of involvement of the interdental papilla and the marginal and attached portions of gingiva in each individual.

This dental index was developed by Schour and Massler. They gave a score of 0 to 5 depending upon the severity of disease in the gingiva. This index is no longer actively used.

Plaque Index (PI)

• developed by Silness and Loe
• The thickness of plaque at gingival margins is assessed
• The tooth surfaces examined are: facial, lingual (or palatal), mesial and distal
• A plaque disclosing agent may be used
• 0 = no plaque present
• 1 = a thin film of plaque can be distinguished
• 2 = a moderate layer of plaque on tooth surfaces with little may or may not be present in the gingival pocket
• 3 = abundant layer of plaque on the tooth surfaces and within the pocket
• The total of all four surfaces is added up, and divided by the number of tooth surfaces examined. This gives the PI score for each tooth.
• The total scores of all teeth are totalled and divided by the number of teeth examined. This gives the PI score for the individual.
• The result may be calculated as follows:- 0 = excellent, 0.1 to 0.9 = good, 1.0 to 1.9 = fair and 2 to 3 = poor

Oral Hygiene Index (OHI)

Oral hygiene index developed by Greene, Vermillion and and Waggenor, measures the overall oral hygiene. It divides the dentition into six parts, and the surface with the greater amount of plaque or calculus is taken into consideration. Thus twelve surfaces are calculated.

It is further divided into : Debris Index (DI) and Calculus Index (CI)

Debris Index (DI):

Debris is the soft, movable, foreign matter consisting of bacterial plaque and food debris.

• 0 = no debris or stain
• 1 = debris not covering more than 1/3^rd of the tooth surface
• 2 = debris between 1/3^rd and 2/3^rd of tooth surface
• 3 = debris more than 2/3^rd of the tooth surface

Calculus Index (CI):

Calculus is the hard, stony, calcified deposit of inorganic material on the tooth surfaces.

• 0 = no calculus
• 1 = calculus not covering more than 1/3^rd of the tooth surface
• 2 = calculus covering between 1/3^rd to 2/3^rd of the tooth surface
• 3 = calculus covering more than 2/3^rd of the tooth surface

The final score is calculated by adding the scores for each tooth divided by the number of sextants examined. The total scores of the DI and CI give the score of the OHI. The lowest possible score is 0, and the maximum score is 12.

Gingival Index (GI):

The three major parameters that the gingival index measures are the color, consistency and bleeding on probing. This index was also developed by Loe and Silness.

The gingiva is tested for all the three parameters with the help of a probe. The following method of scoring is used:

• 0 = normal gingiva, coral pink color, and no bleeding on probing
• 1 = mildly inflamed gingiva, no bleeding on probing
• 2 = moderately inflamed gingiva, with soft texture and moderate bleeding on probing
• 3 = severely inflamed gingiva, ulcerated, soft with spontaneous bleeding. If the color is not red, nor is the gingiva ulcerated, but there is spontaneous bleeding, the score is still considered to be 3.

Each surface is given a score. The scores are added up, and divided by four. The new total is divided by 12, and this gives the GI for the individual. 0 = excellent health of gingiva, 0.1 to 1 = good, 1.1 to 2 = fair, 2.1 to 3.0 = poor health of gingiva.

Periodontal Index (PI)

This index developed by Russel, is somewhat more comprehensive and thorough as compared to the gingival index. Not only does it consider the appearance of the oral tissues, it also stresses upon the functionality of the tooth.

• 0 = Normal tissues
• 1 = Mild gingivitis which does not circumscribe the tooth
• 2 = Gingivitis which circumscribes the tooth but there is no apparent break in the epithelial attachment
• 6 = gingivitis with pocket formation but there is no loss of function. The tooth is firm.
• 8  = Severely destroyed epithelial attachment, deep gingival pockets, and loss of function with mobility in the tooth.

Each tooth is assigned a score, and the scores are added up. The total is then divided by the number of teeth examined.

• 0 to 0.2 = good health
• 0.3 to 0.9 = mild gingivitis
• 0.7 to 1.9 = early periodontitis
• 1.6 to 5 = established periodontitis
• 3.8 to 8 = terminal periodontitis

Gingival Bleeding Index (GBI)

This index developed by Carter and Barnes, is used to determine the gingival bleeding. An unwaxed dental floss is used to measure the gingival bleeding index. A full complement of teeth has 28 proximal surfaces. The floss is passed in between the gingival sulcus on each side of the dental papilla. There should be no overt force exerted. The total number of bleeding surfaces is divided by the total number of surfaces examined, and a final score is arrived at.

Mobility Index (MI)

This index is used to measure the mobility of teeth. Developed by Grace and Smales, it scores in the following manner.

• 0 = no mobility
• 1 = mobility present but less than 1 mm buccolingually
• 2 = mobility more than 1 mm buccolingually but less than 2 mm
• 3 = severe mobility more than 2 mm, and present both buccolingually and vertically into the socket

Dean’s Dental Fluorosis Index (DFI)

Dental fluorosis is the presence of discolorations or defects on enamel, caused to do either faulty enamel production or less enamel production. Fluorosis presents in a varied number of ways. Sometimes seen only as small pits or striae on enamel surfaces, or milky white frosted lesions, or chalky appearances to grossly malformed teeth, these occur because of malnutrition at the time of teeth formation. The anterior teeth are most commonly affected and the molars are least commonly affected.

For the purpose of a survey, the two most severely affected teeth are selected. If the involvement of the two is unequal, the less severely affected of the tooth is selected for scoring.

• 0 = normal enamel
• 1 = questionable mostly normal looking enamel with tiny flecks or spots of white lesions seen
• 2 = very mild opaque milky white patches covering not more than 1/4^th the tooth surface examined
• 3 = mild clinically visible milky white patches covering 50% of the tooth surface
• 4 = moderate brownish stains and some amount of deformity causing visible disfigurement
• 5 = severe the tooth may be so badly affected by fluorosis that the normal shape of the tooth may be altered. The teeth appear brown and mottled with widespread corroded appearance

Decayed Missing and Filled Teeth Index (DMFT)

This is a caries index. The prevalence of caries in a population can be defined using DMFT. Careful examination with a mirror and probe is carried out to find small carious lesions. It is prudent to carefully check for tooth colored fillings to arrive at the accurate picture. Each tooth is assigned a score and all the scores are indicated in boxes on a DMFT chart.

• 0 = no caries present. Fluorotic areas, and those with hard white lesions are to be ignored
• 1 = caries is present. If the crown is affected, the crown is assigned the score of 1. If the root is affected then the root is assigned 1. Where the crown is entirely destroyed by decay but the root is present, the crown and root both are given a score of 1.
• 2 = Filled teeth with secondary caries
• 3 = filled teeth without caries. If a tooth is crowned because of a previous carious lesion, it is given a score of 3. If however a crown is present as an abutment or for aesthetic reasons, it is scored as 7.
• 4 = A tooth missing because of decay. Only crowns are recorded as 4. The roots of such missing teeth are designated a 7 or 9.
• 5 = A tooth missing for any reason other than decay
• 6 = teeth on which sealant has been placed
• 7 = Tooth which is a part of a fixed bridge. It is also used to denote a root replaced by an implant. Teeth that have been restored by bridge pontics are scored 4 or 5. The roots of such teeth are scored as 9.
• 8 = This is used for a space where the permanent tooth is unerupted but the primary tooth is not present. In case of a root, the surface of which is not visible in the mouth, the root is assigned an 8.
• 9 = A tooth which cannot be scored because of reasons such as orthodontic treatment. It also applies to the root of a tooth which has been extracted. The crowns of such extracted teeth will be assigned a 4 or a 5.
• T = trauma.

To arrive at score the total number of carious, missing or filled teeth are calculated. For primary teeth the index is called ‘deft’ or ‘defs’ (decayed extracted filled)

Dr. Gauri S. Kekre (B.D.S., M.B.A.)

A dentist by profession and a writer by choice, she has worked in the field of dentistry for over six years. Her passion lies in learning more about her profession and making her knowledge useful for everyone. She hopes that she will one day be successful in her endeavor to make proper oral hygiene the most understood and followed practice in as many households as possible.

Dry mouth resulting from insufficient production of saliva is called Xerostomia. Often patients complain of subjective symptoms more than clinical presentation like rampant caries. It causes significant discomfort for the patient, in that the tissues feel dry, abrasive and swallowing can become difficult.

Saliva is the watery fluid secreted into the oral cavity by the salivary glands. It contains proteins, and mucins which are lubricating agents. It also possesses antibacterial and anti-fungal properties because of its components like immunoglobulins, lactoferrin, thiocyanate etc. Saliva also contains a significant amount of potassium and bicarbonate, and traces of sodium and chloride. When salivary production decreases due to any reason causing dryness and soreness of oral tissues, it results in a condition called xerostomia.

A number of causes have been identified as resulting in dry mouth. The most common causes are:

• Physical injury to the salivary glands
• Dehydration
• Underlying diseases such as Sjogren’s syndrome, uncontrolled diabetes and Lambert-Eaton’s syndrome
• Sarcoidosis (noncaseating granulomas in the salivary glands)
• Amyloidosis (amyloid deposits in the salivary glands)
• HIV infection particularly in children
• Rheumatoid arthritis, systemic lupus erythematosus (SLE), scleroderma, cystic fibrosis, bone marrow transplantation, nutritional deficiencies, Bell’s palsy, thyroid diseases,
• Depression or anxiety can result in dry mouth
• Alzeimer’s or Parkinson’s may also result in decreased secretion of saliva.
• Excessive alcohol consumption leading to cirrhosis
• Excessive smoking
• Breathing continuously through the mouth instead of the nose
• Medications such as antidepressants, amphetamines and antihistamines
• Chemotherapy
• Radiotherapy
• Drug abuse – methamphetamine, cannabis and heroin use.

Xerostomia, other than being uncomfortable causes a host of other problems such as burning sensation in the mouth, soreness of the oral tissues and throat, difficulty speaking and swallowing, halitosis (foul mouth odor), rampant tooth decay or caries and result in the periodontal and other soft tissues being susceptible to ulceration and infection. If untreated for a long time, it can result in tooth loss and thrush.

Patients often complain about altered taste sensation (dysgeusia), and difficulty in eating and swallowing, especially foods which are dry and devoid of any moistness or lubrication. Tooth loss leads to denture fabrication, but it leads to a new problem. Denture retention is severely affected in patients having less saliva production as there is nothing acting as a retentive agent. It can therefore result in dentures falling out of the mouth while speaking, or eating, denture soreness and subsequent refusal to wear the dentures at all.

The tongue becomes fissured, and painful (glossodynia). The lips may become fissured and bleeding. Other problems include parotid gland enlargement, and salivary gland infection.

Diagnosis can be done by a number of clinical and laboratory tests including careful patient history analysis, sialometry, and the “lipstick sign” in women, where the lipstick often sticks to the front teeth in case of xerostomia.

• There is no pooling of saliva in the floor of the mouth
• the saliva may appear thick, stringy and ropy
• diagnostic instruments may stick to the oral tissues, especially the buccal mucosa
• rampant cervical caries (decay near the gum line of the teeth)  may be seen.
• Measurement of salivary flow rate by sialometry. The saliva is stimulated by citric acid application. Normal range of salivary flow rate is 0.3 to 0.5 mL/min/gland (resting) and 1 to 2 mL/min/gland (stimulated). Salivary flow rate of less than 0.1 mL/min/gland is considered as a sign of xerostomia.
• Sialography or salivary gland imaging is done to rule out salivary gland diseases

Treatment of xerostomia or dry mouth is targeted more towards relieving the symptoms and preventing infection and caries rather than treating the cause itself. Most of the time the cause of xerostomia can’t be corrected. If it is due to dehydration, sipping on water can help but if the cause is not dehydration then sipping on water will not improve the production of saliva and be a source of increased discomfort for the patient.

A more satisfying option is to frequently sip on a non-carbonated sugarless drink or chewing on a xylitol gum.

• Pilocarpine and cevimeline are anticholinergic agents which are also used in treatment of dry mouth.
• Changing the dry mouth causing medication can be effective in case the medication being used by the patient had anticholinergic effects.
• Using a cellulose based salivary substitute results in alleviation of the discomfort
• Calcium phosphate rinses help reduce discomfort in patients with Sjogren’s syndrome or those suffering from medication usage.
• Periodic fluoride application to prevent tooth decay
• Anti-fungal agents can be used to prevent candida infection
• Lactoferrin containing mouthwashes also possess fungistatic properties.

On the personal front a patient can take a number of precautions to maintain their oral hygiene. Regular brushing with a fluoride based toothpaste, using a mouthwash and flossing

to tackle interdental areas can significantly reduce plaque formation, cavities and periodontal or gum problems. Avoid products containing sodium lauryl sulphate as they can result in apthous ulcers and soreness. Dentures should not be worn at night while sleeping and should be kept immersed in water.

© Dr. Gauri Kekre (B.D.S., M.B.A.)

A dentist by profession and a writer by choice, she has worked in the field of dentistry for over six years. Her passion lies in learning more about her profession and making her knowledge useful for everyone. She hopes that she will one day be successful in her endeavor to make proper oral hygiene the most understood and followed practice in as many households as possible.

When the tooth still maintains its vitality, or the change in color is generalized, the bleaching is carried out on the external surface. Substances based on peroxides are usually used for this purpose, on stimulation by light or heat, these substances release nascent oxygen. The techniques vary in the concentration of the peroxide, and the patient can perform them at home or in the dental clinic.

The dissolution of the hydroxyapatite crystals by the action of acids is the cause of dental caries. The chemical nature of the organic material has not been fully elucidated, but it is considered to be of a proteic nature and to contain some polysaccharide material.

Due to its high mineral content, the enamel is hard tissue, this property enables it to withstand the mechanical forces acting upon enamel. The enamel is transparent in nature and have a color that varies from a light yellow to greish white.

Among all the layers of the tooth, Enamel is hardest layer. It is as hard as lightweight steel.

Due to its physical properties, dentin has an elastic quality that is important for the correct function of a tooth, as it provides flexibility necessary to avoid fracture of the fragile overlying enamel.

The dentin is intermediate layer of the tooth which lies between outer hard surface called the enamel and inner soft tissues called the pulp. Dentin is harder than the pulp but less harder than the enamel.

1] Malnutrition,

2] chemical factors such as tetracyclines and fluoride,

3] metabolic disorders such as maternal diabetes or malabsorption

4] neurological disorders

5] infections and irradiation.

It is interesting to note that the abnormalities may be observed in different teeth according to the stage of dental development at which the disorder occurred.

Factors causing Hypoplasia can also be classified as local and systemic, as follows:

Local factors:.

1] irradiation

2] trauma, surgery

Systemic factors:

1] chemicals

2] infections

3] birth injury

4] metabolic disorders

Attritions are the pathological wear due to bad habits, such as biting a pipe, a pen, or due to a piercing. Erosions are due to the chemical action of acids on the tooth enamel; they are often seen in patients with blumia.

Primary factors:

Primary factors interact together, such as the diet, the tooth and the bacteria, together with the time factor.

Secondary factors:

There are additional secondary factors, such as the position of the tooth, its composition, a salivary factor, age, systemic causes and race.

Tertiary factors:

There are tertiary factors such as social class, education, knowledge and habits.

An excessively high intake of fluoride can give rise to the condition known as dental fluorosis. In general, it is due to the excess intake of fluoride in areas in which the supply of drinking water contains high levels of this substance. In fluorosis, the excess delivery of fluoride gives rise to metabolic changes in the ameloblasts that can lead to the appearance stains that can vary from small matt white spots to large brown stains, and even to a deficient quality of the enamel. A very high consumption of fluoride can also lead to changes in the bones of patients, with sclerosis (increased bone density), calcification of the muscle insertions and exostoses.

In the case of caries affecting the dentin, four zones are observed histologically, from internal to external:

1] necrotic

2] infected

3] demineralized

4] Remineralized.

Remineralized zone is not always present.

When the roots are exposed to the oral environment, cementum caries can develop; these are initially visible as translucent stains that cause a rapid loss of dental tissue.

As dental implants are more expensive and unable to be managed at times, dental insurance can help you at once. Check for the verification of the coverage terms from your dental insurance company about the plan details. Look out for the addition of the conditions and provisions that adds up the dental implants together with the existing plan. Guardian, TESCO Insurance, MetLife Dental Insurance, Delta Dental Insurance, United Concordia are some of the dental insurance companies that offer dental implant insurance.

Ways to avail low cost dental implant insurance

It is difficult to offer the price that one needs over dental implants on the fallen tooth affecting the jaws later on time of aged. There are 3 different ways that one can make use of to avail low cost dental implant insurance.

1. Dental schools are helping institutions that offer charitable dental services over clinics helping with the dental services. They not only support with the installation of the low cost dental insurance but also lend a hand in gaining dental implant insurance plans at low cost especially for you. Dental professionals and experts help in assisting through the way of treatment and quick recovery. Such institutions offer Affordable dental implants treatment and care on various categories based on the yearly earnings of the patient.

2. Next option is to travel abroad to make use of the Asian, South American or East-European dentist in the dental implant treatment that offers you a dental treatment more comfortably within limits of affordability on dental implant treatment. They also provide several options of dental insurance plans that are more inviting and effective in developing countries. Special kind of dental insurance plans are available across dental traveling countries especially in India under low cost, which is termed as mini-implant type.

3. The third way to opt for dental insurance over implants is that you can accept over the clinic’s proposal by selecting the financial options. This way makes it easy for you to install the dental implant once you take the down payment and pay off the bill on a monthly basis to complete the full amount. It serves well at times of emergency with stronger necessity for low cost dental implant insurance options.

Recommended links:

ToothAche Remedies : From Dental Dean

Dental Insurance Plans : From Dental Insurance Helper

The periodontal ligament is the structure that surrounds the roots of the teeth and connects them to the bone in which they are held.  Periodontal ligament (PDL) is highly vascular, loose cellular connective tissue that is organized into different groups.

The most important bundles of fibers are called the principal fibers and include the alveolar crest fibers, the horizontal fibers, the oblique fibers and the apical fibers.

The periodontal ligament has various functions including support, formation, nutrition and sensation. The alveolar bone supports the teeth. It arises when the tooth erupts in order to provide a bony union to the forming periodontal ligament, and gradually disappears when the tooth is lost.

The spongy trabeculae of the alveolar bone are what absorb a large part of the pressure transmitted via the periodontal ligament, coming from the occlusal forces.

The dental pulp is a tissue of mesenchymal origin that occupies the internal space of the tooth. It receives its nutrients via the apical foramen, or apex.

The dental pulp has two functions:

1. Construction: It is able to form dentin throughout its life.

2. Defensive:  By initiating painful responses to aggressions to the tooth.

The high degree of sensitivity of the teeth is due to the abundant irrigation and innervations of the pulp. The odontoblasts, or dentin-generating cells are found in its most superficial region.

The fact that it is surrounded by hard tissues gives the pulp certain special characteristics, and after suffering an aggression, the edema that develops can easily give rise to cell necrosis.

The cementum is basically a calcified mesenchymal tissue that surrounds the root of the tooth. It also serves as the site of insertion for the periodontal ligament which arises from alveolar bone, thus It connects the tooth to the alveolar bone with the help of periodontal ligaments.

There are two types of cementum:

1. Acellular cementum: It is present at the upper part of the dental root. Acellular cementum contains extrinsic collagen fibers which are derived from periodontal ligament [PDL].
2. Cellular cementum: It is present in the apical region of the root. Cellular cementum contains intrinsic collagen fibers which are formed by cementoblasts.

Cementum is secreted by the cementoblasts and is formed by the apposition [layer by layer deposition] of small layers which are parallel to each other. Cementum is having greater thickness in areas where tooth receives greatest pressure.

Collagen fibers are present within the cementum: in the acellular cementum they are extrinsic and are derived from the periodontal ligament whereas, in the cellular cementum, they are intrinsic and are formed by the cementoblasts.

The Premolars:

The posterior region is formed of the first premolars, second premolars and first, second and third molars. The premolars are found behind the canines only in permanent dentition., and occupy the area occupied by molars in temporary dentition. They usually have single root, with the exception of the superior first premolars which may have two roots, and their occlusal anatomy corresponds to a transition between canines and molars, presenting two cusps and a central groove. The upper premolars present certain differences with respect to the inferior premolars. They are slightly larger, particularly in the buccolingual diameters. With respect to the occlusal surface, the upper premolars have a pentagonal form whereas the lower ones are ovoid in the first premolar and pentagonal in the second.

The molars:

The molars present a much larger occlusal surface than the premolars, They have a cuboid form and the mesiodistal diameter is larger in the lower molars than in the upper molars.

The upper molars have 3 roots, a stronger lingual root and two buccal roots, of which the more important is the mesiobuccal root.

The lower molars,

The anterior dental region is formed by the central and lateral incisors and the canines. The incisors are the first teeth to make contact with the food and are designed to cut it. They are also involved in the articulation of sounds. The temporary teeth of this region are usually replaced between 7 and 8 years of age.

There are four canine teeth, two per dental arch, following the incisors. They have the shape of a wedge with two faces and a vertex. These teeth have very strong roots and are very important not only in feeding but also in mandibular dynamics.

They usually erupt between 10 and 13 years of age. Both the incisors and the canines have a single root. The anterior region is vital in the movements of dis-occlusion.

The temporomandibular joint plays an important role in the processes of mastication, phonation and mandibular movements. It is a complex region from an anatomical and physiological point of view.

The joint consist of the condylar process of the mandible, the articular fossa, belonging to the base of the skull, the articular disc, the capsule surrounding the joint, and the temporomandibular ligament. Superiorly, the TMJ is related to the base of the skull, posteriorly to the bony and cartilaginous parts of the external auditory meatus, inferiorly with a venous plexus, arteries and nerves, and externally with the skin, from which it is separated by adipose tissue through which branches of the facial nerve and the transverse facial artery run. In the classification of the joints, the TMJ is a bicondylar diarthrosis.

Gingivitis (also known as) Inflammation of gingiva, is pathological change in gingiva (gums) due to presence of microorganisms in gingival sulcus (area between gingiva and tooth). These microorganisms secrete different metabolic products which cause damage to epithelial and connective tissue cells and other constituents of gingiva.

Progression of gingivitis can be divided into 4 main steps:

1] Initial Lesion: It is characterized by vascular dilatation and gingival fluid flow.
2] Early lesion: It is characterized by Vascular proliferation and Erythem as well as bleeding on probing.
3] Established lesion: It is characterized by vascular proliferation and blood stasis andchanges in color, size and texture of gingiva.
4] Advanced lesion: It is characterized by Extension of lesion into alveolar bone and periodontal breakdown.

Gingivitis can be grossly divided into 2 categories as:

1] Localised gingivitis: Which is confined to the gingiva of a single tooth or a group of teeth.
2] Generalised gingivitis: which involves the gingiva of the whole mouth.

Furthermore, Gingivitis is of three types, as follows:

1] Marginal gingivitis: It involves only marginal part of gingiva, but may extend to attached gingiva (attached to tooth).
2] Papillary gingivitis: It involves interdental papilla (V-shaped gums between two teeth) and extend to adjacent marginal gingiva.
3] Diffuse gingivitis: It involves all the parts of the gingiva including Marginal gingiva, Attached gingiva, Interdental gingiva.

Effects of Gingivitis on our Dental Health:

1] Gingivitis is always associated with increased gingival fluid production rate and bleeding from the gingival sulcus on gentle probing or even brushing.

2] Most common cause of bleeding from gum is chronic inflammation to gums. Usually bleeding starts from tooth brush, toothpicks or due to food accumulation between gums and teeth or even biting on hard foods like apple.

3] Gingival bleeding is because of thinning of epithelium of gingival sulcus and dilatation of blodd capillaries, which rupture on ordinary stimuli like tooth brushing or biting on hard food, thus causing beelding.

4] Acute bleeding are caused by injury or laceration by toothbrush bristles during aggressive toothbrushing or by sharp pieces of hard food. This can be present even in absence of gingival disease.

5] Gingival bleeding may be caused by systemic factors such as Vitamin C deficiency, allergic reactions, platelet disorders, vitamin K deficiency due to liver disease, or other blood diseases.

6] Color of the gingiva changes from coral pink (healthy) to bright read to shiny slate gray which can become dull whitish gray.

7] Consistency of gingiva changes from firm, resilient consistency to edematous and fibrotic consistency.

8] Usually surface texture of gingiva is stippled, but in gingival disease it becomes either smooth and shiny or firm and nodular.

9] Gingiva may change its position and shift to apical area, which is called recession, and it results in exposure of root surface of tooth.

•  Its important to determine the type of pain in patient which in turn helps us to determine what kind of medication will be better choice for initial treatment of pain management.

•  We need to have our eyes on different pain pathways in order to get the idea about the particular pain, and to know wether the pain is involving one or multiple parts of particular pain pathway. In optimizing the pain management therapy, we may need to provide different kind of medications which act on different parts of pain pathways.

•  We cannot prescribe single type of medication or dose for each and every patient. We need a therapeutic trial of whatever medication we are providing to patient, in order to get an idea wether medication will be prove itself effective for a particular kind of pain in specific patient or individual. These trials may extend from weeks to months because the dose need to be adjusted to optimize its effect in order to completely rule out benefits and side effect of that medicine.

•  Pain pathways is important in one more way, If initial medication provided to patient is not working or is having lot of side effects, then we can replace it with another medication which works on a site other than that of the previously tried medication, within the pain pathway.

• There are cases, when initial medication in the prescription provides only partial pain relief, in that case, to improve the results and eliminate the pain, we can add another medication in the previous prescription.

Muscles of mastications are muscles which are used

Muslces of mastication: short overview

The masticaroty muscles are those that move mandible; there are principal and accessory muscles and they are classified into elevators and depressors.
The principal elevator muscles include the temporalis, the masseter and the medial pterygoid muscles;
The principal depressor muscles are the lateral pterygoid and the digastric.
The accessory muscles are the anterior belly of the digastric, the mylohyoid and the geniohyiod.

Introduction and Composition of saliva: short overview

Saliva is produced in human body in quantity of 1000 to 1500 ml per day. pH of saliva is 6.35 – 6.85. It is composed of 99.5% water and 0.5% of solutes.

0.5% solutes in saliva are divided further as described below:

 Ions:
o Sodium
o Potassium
o Chloride
o Bicarbonates
o Phosphates

 Dissolved Gases

 Organic substances

o Urea
o Uric acid
o Mucin
o Globulin
o Serum Albumin
o Lysozyme
o Salivary amylase.

Anatomy of The Salivary Glands: Short overview

All glands that secrete their products into the oral cavity are called the salivary glands.
There are two groups, the first is formed of numerous, small, mucosal, or sub-mucosal glands, with short excretory ducts.

Classification:

They are classified according to their location into labial, zygomatic, palatine and lingual.
The second group is made up of large glands with longer excretory ducts. They are paired and symmetrical, distributed along the body and ramus of the mandible. This group includes the parotid, sub-mandibular and sublingual glands.
The principle function of the saliva is to protect the oral cavity, although it also has digestive functions.

The gustatory papillae are found covering the dorsal surface of the tongue, giving it a rough appearance. They include: fungiform papillae, which have the shape of a mushroom and are located principally on the borders and tip of the tongue; circumvallate papillae, which are larger and mark the so-called lingual “V” region; foliate papillae, which have the appearance of a fold or sulcus, found on the posterior part of the lateral margins of the tongue; and finally, the filiform papillae, which are not associated with the sense of taste as they do not contain buds.
These are three principal components of the sense of taste: the receptor organs, which are the gustatory papillae; the gustatory pathways, via the glossopharyngeal, vagus and lingual nerves, running to the hippocampal gyrus; and the gustatory centers, which are found in this region.

Resource : Dental Care Articles

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Anatomy of the Tongue: Short overview

The tongue is formed of a complex group of muscles that gives it great mobility. The functions in which the tongue is involved include mastication, phonation and swallowing.
Its muscles are attached to the mandible, the palate, the hyoid bone and the styloid process.
The hypoglossal nerve is the most important nerve in the innervation of the tongue, supplying all of its muscles with the exception of the palatoglossus muscle. The tongue plays a very important role in alveolar development and in the final position of the teeth, as well as possessing on its surface the majority of the receptors that detect the flavor of foods, called the gustatory papillae.

Resource: Dental Care Articles

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Anatomy of the Lips and Cheeks: short overview

The lips and cheeks are covered by three layers; the mucosa, the sub-mucosa, containing different types of salivary glands; and finally, a muscle layer.
The mucosa that covers the lips has a high sensory capacity derived from the mental, buccal and infra-orbital nerves. A number of small muscles are present around the lips and participate actively in facial expression. The lateral walls of the oral cavity, called the cheeks, are formed basically by the buccinators muscles that. In their mid-region, are crossed by the excretory ducts of the parotid glands, at the level of the upper first molar.

Resource: Dental Care Articles

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Chronology of the eruption of the permanent teeth:

Sequence of Eruption:
1. 1st molar
2. Central-incisor
3. Lateral-incirsor
4. 1st-premolar
5. 2nd-premolar
6. Canince
7. 2nd-molar
8. 3rd-molar

Eruption Sequence: (Age in years) [approx]
For Upper Teeth:
1. 1st-molar: 6 + 1/4
2. Central-incisor: 7 + 1/4
3. Lateral-incirsor: 8 + 1/4
4. 1st-premolar: 10 + 1/4
5. 2nd-premolar: 11
6. Canince: 11+ 1/2
7. 2nd-molar: 12 + 1/2
8. 3rd-molar: 20

For Lower Teeth:
1. 1st-molar: 6
2. Central-incisor: 6 + 1/4
3. Lateral-incirsor: 7 + 1/2
4. 1st-premolar: 10 + 1/2
5. 2nd-premolar: 11 + 1/4
6. Canince: 10 + 1/2
7. 2nd-molar: 12
8. 3rd-molar: 20

Resource: Dental Care Articles

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Permanent dentition: Short overview

The permanent dentition is formed by thirty-two teeth, sixteen upper and sixteen lower; these are called:
1. Central-Incisors
2. Lateral-Incisors
3. Canines
4. 1st premolars and 2nd premolars
5. 1st , 2nd and 3rd molars

These teeth usually complete their eruption with the appearance of the canines at 13 or 14 yeas of age and, later, at 18 years of age and older, the 3rd molars appear.
The permanent dentition of women usually presents a more rounded form of the individual teeth and more harmonic angles whereas, in men, the angles are more marked and the free borders are flatter.

Resource : Dental Care Information

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Chronology of the eruption of the Temporary Dentition / Primary Teeth:

Sequence of eruption:
1. Central Incisor
2. lateral incisor
3. 1st molar
4. Canine
5. 2nd molar

Eruption Age: (After birth) [Approx]
For Upper teeth:
1. Central Incisor: 10 months
2. lateral incisor: 11 months
3. 1st molar: 16 months
4. Canine : 19 months
5. 2nd molar: 29 months

For Lower Teeth:
1. Central Incisor: 8 months
2. lateral incisor: 13 months
3. 1st molar: 16 months
4. Canine: 20 months
5. 2nd molar: 27 months

Resource: Dental Care Information

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What is Temporary Dentition: A short Overview

Temporary dentition is formed of twenty teeth, ten upper and ten lower; these are called : central incisors, lateral incisors, canines, first molars and second molars. The first teeth begin to appear between fourth and sixth months of life, and start to be replaced between 6 and 7 years of age, approximately. The principal differences of temporary dentition with the permanent dentition include their size, (the temporary teeth are smaller), color and resistance to caries (temporary dentition are more bluish-white and less resistant due to their lower level of calcification), and sensitivity, which is lower due to the smaller number of nerve terminals. Another difference is that separations between the teeth (diastema) are usually present in the temporary dentition due to the larger size that the new teeth will have which are going to replace the temporary dentition.

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