Health Blog

Sometimes, the often harmless toothbrush may also cause us some discomfort in the form of injuries. Toothbrush injuries are caused by chronic physical irritation from the toothbrush bristles to the marginal and attached gingival.
Although any area of the entire dental arch can be involved, these lesions are more seen in maxillary gingival over the premolar and canine region (since these are the locations where maximum pressure is exerted during brushing). Moreover, lesions can develop more frequently on left sided gingiva if the patient is right handed or vice versa.

Clinical Features:

• The lesions commonly appear as superficial linear erosions
• Some lesions might appear as white, red or ulcerated areas.
• Most lesions produce pain, especially during taking food and some of them can be infected secondarily.
• When the injury is very severe, it can produce deep clefts on the gingival margin with severe gingival recession.
• In long standing cases, there may be irreversible loss of the underlying alveolar bone in the gingival.

Histopathology:

• The traumatic lesion of the gingival histologically shows ulceration with focal loss of overlying epithelium.
• The adjacent normal epithelium at the border of the ulcer exhibits hyper-parateratosis and acanthosis.
• The ulcerated area is covered by a superficial zone of granulation tissue.
• The underlying connective tissue shows chronic inflammatory cell infiltration by lymphocytes and plasma cells.

Treatment:

Elimination of local factors causing injury (development of proper brushing habit) and symptomatic treatment of the injured area by specialist is the best way to treat toothbrush injuries.

Hello folks

I am finally free to blog again though I still have lots of things to do till February,2009. I did a blogpost about my professional training on my education blog. So today I’ll talk about Ghost Teeth.

Regional Odontodysplasia is an uncommon but unique non-hereditary developmental disturbance of teeth characterized by defective formation of enamel and dentln in addition to abnormal pulp and follicle calcifications.

The etiology of Regional Odontodysplasia is not fully understood but it is suggested that the disease develops due to some local ischemic change in the tissue during odontogenesis.

Both permanent and deciduous definitions are affected in this disease although it is more common in permanent dentition. But it is true there is no sex predilection in case of Regional Odontodysplasia. Also in this case the maxilla is affected more than mandible. The disease is called regional because it affects several contiguous teeth in a single quadrant. It also frequently occurs unilaterally, often affecting certain parts of the maxilla. The central and lateral incisors and the cuspids in the maxillary are also affected. The affected teeth show either delayed eruption or a complete failure of eruption. These teeth are often deformed, have a soft leathery surface and are yellowish brown in color.

The teeth having Regional Odontodysplasia have often been described as “ghost teeth”, since there is marked decrease in the rado density of these teeth as a result of defective mineralization.

The enamel teeth and dentin are very thin and radiographic distinction between these two structures is almost impossible. This accounts for the subdued or “ghostly” appearance of involved teeth. The pulp chambers of teeth are also extremely large and open and often contain pulp stones.

In case of Regional Odontodysplasia, the enamel layer is attenuated and disrupted. Dentin is very thin and globular and exhibits irregular tubules and a wide pre-dentin layer. Large pulp chamber exhibits numerous pulpal calcifications. The reduced epithelium persists and the follicular connective tissue contains numerous clusters of tiny droplet Calcifications.

Extraction of the affected teeth and fabrication of a suitable prosthesis is usually recommended in case of Regional Odontoldysplasia.

Gingivitis is relatively a rare condition and is characterized clinically by necrosis of the free gingival margin, the crest of the gingiva and the inter dental papillae etc.

Etiology:

Ulcerative gingivitis is a fusospirochetal disease and is caused predominantly by the fusiform bacilli and a spirochete called Borrelia vincenti.

Precipitatitng Factors:

• Sudden change in lifestyle
• Poor oral hygiene
• Lack of rest and sleep
• Local tissue damage
• Debilitating disease (viz. infectious mononucleosis, bacterial infection, diabetes, blood dyscrasias etc.)
• Emotional stress
• Down’s syndrome
• Smoking

Clinical Features:

• Ulcerative gingivitis usually occurs between the age of 15-35 years and males are to get infected more than females.
• Initially the gingiva becomes red and painful
• Erosion of the inter dental papillae occurs
• Gingiva is open covered by a “pseudo-membrane” and it has a pronounced bleeding tendency and produces extremely unpleasant fetid odor.
• Rarely gingiva lesion may extend to the mucosal surfaces of soft plate and tonsils
• Patients often develop headache, fever, malaise and lymphadenopathy etc.
• Difficulty in taking food due to increased salivation and a metallic test in the mouth
• Most of the patients develop systemic manifestations in the form of leukocytosis, tachycardia and gastro-intestinal disturbance etc.

Histopathology:

• The gingival tissue shows inflammation and extensive necrosis
• The stratified squamous epithelium is often replaced by a “pseudomembrane”
• The pseudomembranee usually consists of micro organism polymorphonuclear neutrophil and necrotic tissue debris etc.
• The unaffected areas of the gingival tissue shows a general lack of keratinization.

Treatment:

1. Local debridement of necrotic tissue with hydrogen peroxide
2. Administration of Metronidazole.