Dental disorders

Last updated: April 27, 2022

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Tooth decay (dental caries) is the progressive destruction of dental tissue following the compromise of the enamel due to chronic exposure to oral bacterial acids (e.g., lactic acid produced by S. mutans). Manifestations include tooth pain and bad breath. Diagnosis is often made on the basis of tooth appearance (e.g., enamel breakdown, discoloration) and x-ray (increased radiolucency). Treatment depends on the size of the lesion and mainly includes caries excavation and restoration of the dental surface. A dental abscess is a collection of pus in the pulp of a tooth that can spread to local or regional structures. Causes include dental caries, trauma, and failed dental root canal treatment. Clinical features include severe pain, dysphagia, and possibly facial erythema, fever, and/or lymphadenopathy. On inspection, the surrounding gingiva is often erythematous and swollen. Treatment includes antibiotics, abscess drainage, and, if necessary, removal of the infected tooth. Malocclusion is any deviation from ideal tooth positioning that leads to irregular contact between the upper and lower teeth when the jaw is closed. While usually asymptomatic, malocclusion can cause symptoms (e.g., discomfort when chewing) in pronounced cases. Management includes correction of tooth deviation and jaw positioning with orthodontic treatment (e.g., braces). Dental injuries include dental avulsion, dental subluxation, and dental fracture. Dental avulsion is the complete displacement of a tooth from its socket due to trauma. Management includes manual replantation of the permanent tooth into its socket, followed by urgent splinting. Dental subluxation is the partial detachment of a tooth from its socket and usually does not require active treatment. Dental fracture is a partial or complete interruption in the continuity of tooth due to trauma. Treatment depends on the extent of injury and involves sealing and, in cases of root fracture, splinting.

Reference:[1][2]

Reference:[3][4]

  • Definition: any deviation from ideal tooth positioning that leads to irregular contact between the upper and lower teeth when the jaw is closed
  • Types: The most common forms are anterior crowding, vertical overbite, and sagittal overjet. [5]
  • Clinical features
    • Usually asymptomatic
    • In severe cases: discomfort when biting or chewing, frequent biting of cheeks or tongue, speech problems
  • Management: : correction of deviated teeth and jaw positions through orthodontic treatment (e.g., braces) to achieve proper occlusion
  • Prognosis: Whether orthodontic correction of dental alignment has a positive effect on dental health is still subject to debate. [6]

Dental avulsion

  • Definition: the complete displacement of a tooth from its socket secondary to trauma. Dental avulsion is a dental emergency.
  • Management
    • Manual replantation of the permanent tooth into the socket as soon as possible by the first capable person, followed by urgent referral to a dentist for splinting
      • The tooth should be handled by the crown to avoid injury to the periodontal ligament (PDL).
      • Any debris should be removed by rinsing the tooth with tap water or saline prior to replantation.
      • Do not scrub or sterilize the tooth as these procedures damage the PDL.
    • In case replantation is not possible, the tooth should be kept in a dental preservation culture medium, cold milk, or saliva.
    • Antibiotic prophylaxis

Dental subluxation

  • Definition: the partial dislodging of a tooth from its socket
  • Management
    • Serial dental radiographs to assess for evidence of a root fracture
    • Active treatment is not required.
    • Close follow up should be carried out to assess for complications (e.g., pulpal damage)

Dental fracture

  • Definition: a partial or complete interruption in the continuity of a tooth secondary to trauma
  • Management
  1. Sanders JL, Houck RC. Dental Abscess. StatPearls. 2021 .
  2. Yousefi Y, Meldrum J, Jan AH. Periodontal Abscess. StatPearls. 2021 .
  3. Rathee M, Sapra A. Dental Caries. StatPearls. 2021 .
  4. Yılmaz H, Keleş S. Recent Methods for Diagnosis of Dental Caries in Dentistry. Meandros Medical and Dental Journal. 2018; 19 (1): p.1-8. doi: 10.4274/meandros.21931 . | Open in Read by QxMD
  5. Bernhardt O, Krey KF, Daboul A, et al. New insights in the link between malocclusion and periodontal disease.. J Clin Periodontol. 2019; 46 (2): p.144-159. doi: 10.1111/jcpe.13062 . | Open in Read by QxMD
  6. Bollen AM. Effects of malocclusions and orthodontics on periodontal health: evidence from a systematic review.. J Dent Educ. 2008; 72 (8): p.912-8.

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