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I hate dental crowns and caps ... this statement may surprise you coming from dentist with more than 25 years experience (15 of those years as a holistic dentist). After all, caps and dentists go together like salt and pepper. Dental caps are considered by many to be the "definitive dental restoration". So how could a dentist be telling you to avoid caps and crowns?

If you've ever had a crowned tooth, you may have experienced this scenario:

* You get decay in your tooth

* An amalgam or a composite resin is installed to restore the decayed part of the tooth

* Over time, the tooth fractures or else the restoration fails

* The tooth will now be capped with gold, ceramic or ceramic fused to metal

* The process of capping the tooth kills the tooth nerve

* Dead nerves cause pain and must be managed with either a root canal or an extraction

The procedure to crown a tooth is very aggressive and may kill the tooth's nerve. Crowning involves grinding away all of the tooth's enamel and a substantial amount of the inner, living dentin. The scientific literature reveals that up to 15% of all crowned teeth will eventually need root canals or extractions because of a dead nerve. If you have a crown and did not need a root canal or an extraction, your troubles are not quite over yet.

If you're like most people, you probably believe that once a tooth is crowned it will never need any further treatment. After all, you just shelled out a lot of money because you a crown is supposed to be the most definitive way to fix a broken down tooth. You forget all about the tooth for 5 to 10 years, then out of the blue your dentist tells you that you have developed decay under the crown and it will have to be replaced. You're shocked by the news. You have questions: What do you mean the crown is bad? Crowns aren't real, how can they decay? How can a permanent crown need to be replaced? Most consumers are believe that once a tooth is capped, that tooth will never require treatment again. Their dentist defined the possibilities for caring for the damaged tooth and proposed a cap as being the best permanent alternative. And so they are alarmed when a number of years down the road they find out the cap has gone bad and requires replacement. Whenever a cap has failed, it implies that decay has developed inside the gap in between the tooth and the crown. About now most people are mystified ... how does a cap get a cavity?

When attempting to explain the reasons why your tooth needs to be worked on once again, your dentist may perhaps say things such as: "nothing lasts forever" or "the oral cavity is a really very hostile environment". He / She may even pass the responsibility on to you by implying that lousy oral hygiene and microbial plaque at the gum-line caused the crown the fail. The only problem with this answer is that if bad oral hygiene were to blame, every one of your teeth would likely be damaged by decay ... not just the single capped tooth.

I don't know about you, but this story doesn't make sense. I'll spare you from the technical mumbo gumbo, but in reality crowns are destined to fail over time. You see, natural teeth flex under pressure ... porcelain and gold crowns don't. Consequently, every time you close your pearly whites together, the tooth tries to flex at the gum line, but it is restrained by the 360 degree encasing effect of the crown.

At this point we're able to put the pieces together and clarify exactly why a number of crowns break down. Each and every time your teeth bite together (countless times daily), the tooth and the crown both want something different. Your tooth desires to bend, your cap doesn't. This struggle of rival forces creates tension at the gum-line that eventually breaches the seal in between the crown and your tooth. Once the seal pops and your crown begins to leak, bacteria rush in to the gap and then a cavity forms.

And so, what's the remedy for the issue of leaking caps? Wouldn't it seem reasonable to restore your teeth with techniques that mimic like they function in nature? That is the precise intention of the branch of dental research known as biomimetic dentistry. This is achieved by avoiding crowns on teeth and only placing flexible substances along the gum-line. By creating restored teeth that imitate the natural world, the dental restorations are not destined to leak and additionally unpredicted root canals end up being mostly avoided.

Biomimetic dental techniques are excellent substitutes to crowns, mimic the natural tooth under function, provide very long-lasting dental corrections and also radically decrease the requirement for root canals.


Fungal Ear Infection Treatment

Credit: David Benbennick

My Experience with a Fungal Ear Infection

One morning I woke up with a "stuffy" and congested ear.

A rare strain of flesh-eating bacteria was responsible for the death of Maine teenager Benjamin LaMontagne, who died in February after routine oral surgery to have his wisdom teeth removed.

A report by the state Medical Examiner's Office, obtained by The Portland Press Herald, listed the cause of death as cervical necrotizing fasciitis, a virulent infection that can quickly turn fatal.

The type of bacteria that caused the infection, called streptococcus A, is most commonly associated with strep throat, according to the National Necrotizing Fasciitis Foundation. However, some bacterial strains can cause much more severe symptoms, especially if the bacteria can find a way to easily enter the body, for instance through an open cut. The bacteria rapidly reproduces and attacks the soft tissue surrounding muscles.

If it is not detected soon enough and treated with powerful intravenous antibiotics and surgery to remove the dead tissue, it can lead to toxic shock, organ failure and death.

LaMontagne, 18, was a talented music student who planned to start college next fall. He started to experience symptoms of the infection after having four impacted wisdom teeth extracted on Feb. 19, 2014. The swelling on his left jaw got worse, spreading to his eyes and preventing him from eating and swallowing easily.

By Feb. 22, he was dizzy and too weak to get to the bathroom, according to the report in the Press Herald. At around 11:30pm, his mother helped him to crawl to the bathroom. She then left, and when she came back, she found him breathing but not able to respond verbally. She called 911, but emergency personnel were unable to revive him.

Chances of contracting this type of severe infection through during an oral surgery are extremely low, experts say.

"I have not heard of anything like that, with necrotizing fasciitis as a result of routine oral surgery extractions," Dr. John Molinari, infection control expert for the American Dental Association, told the Bangor Daily News.

About one in 20 people who have oral surgery experiences an infection of some kind, Dr. Thomas Dodson, professor and chair of the Department of Oral and Maxillofacial Surgery at the University of Washington, told the Portland Press Herald.

However, most of those cases can be treated with oral antibiotics, and most infections are caused by the numerous bacteria that are typically present in the mouth and throat, he said.

Dodson added that, in 30 years of performing oral surgery, including tooth extractions, he has treated just three cases of necrotizing fasciitis, and has advised colleagues on three cases, none of which have been fatal. However, hospitalization is usually long and complicated, he said, and can take up to four weeks.

"Usually, they're in the (intensive care unit) for most of that time, they're going back to the operating room many times (to have dead tissue removed)," Dodson said.

The local community is mourning LaMontagne's death.

"I know he's not my son, but I feel like I watched him grow up," Julia Frothingham, who taught LaMontagne on clarinet for six years at the local high school, told Tech Times. "I'll miss not being able to see where he goes from here."

The mandible or the bone of the jaw, not only defines the face but is also essential for speech and chewing of food. It is a U-shaped bone that has two bony extensions called ramus. The teeth are attached to the upper part of the mandible with the help of the periodontal membrane and the lower part of the mandible comprises thick layers that contain porous spongy bone tissue in between them. If a cancerous lesion is detected in the floor of the jaw or mandible, then the surgery that is performed to remove the cancerous tissue and its surrounding tissue, is termed as mandibular resection surgery. The extent of surgical removal of tissue depends on the extent of spread of cancerous cells in the region. Depending on the extent of affected tissue, resection surgery of the jaw is of two types: partial thickness resection and full thickness resection.

Diagnosis of Mandibular Cancer

There can be several causes of jaw cancer but proper and in-time diagnosis can always save lives. Let us have an understanding of the diagnostic procedure used to detect cancer of the jaw. The first step in the diagnostic procedure is to conduct an X-ray of the affected region. During normal checkup, if the doctor suspects the presence of cancerous cells, he might recommend an X-ray or a CT scan. If the scans of the jaw show some abnormalities, the doctor then removes some amount of tissue from the jaws of the patient and observes the same under a microscope. This procedure, termed as biopsy, is carried out under local anesthesia.


Mandibular resection is recommended when the cancer has spread to the jawbone or mandible, and involves partial or complete removal of the jaw. A partial thickness resection is conducted when the doctor feels that there is a risk of the cancer spreading to the jawbone, although there is no indication on the X-ray plate. Partial thickness resection involves removal of the upper thin layer of the jawbone that contains the teeth. Full thickness resection, however, involves the removal of the entire jawbone and is carried out only if there is evidence on the X-ray plate of the cancer having spread to the jawbone.

Mandibular resection surgery usually requires around 2 weeks stay in the hospital. During the surgery, tumor is removed along with the teeth and affected tissue surrounding the tumor. If the tumor has spread to a large portion of the jawbone, then the entire jawbone is removed and a metal plate is implanted to provide support to the jaw and to retain the structure of the mouth. Post operative care involves special sessions from speech therapists and physiotherapists who help bring the patient's speaking ability back to normal. Also, the doctor recommends a diet that comprises mostly liquid food, for a few days after the operation. For the first two weeks or so, post surgery, the patient is fed through a naso-gastric tube and is not allowed to eat or drink anything during this period. In case the infection builds up in the oral cavity, the patient is prescribed antibiotics. Also, analgesics or painkillers are administered to help the patient cope up with the constant pain.

Possible Complications

Although mandibular resection surgery is relatively safe, certain complications might arise in rare cases. Fracture of the jawbone is one of the common complications. If the patient receives radiation therapy post the operation, then there is a risk that he might develop osteoradionecrosis or death of bone tissue on exposure to radiation. To prevent osteoradionecrosis, it is important to ensure that the facial artery is preserved and functions properly even after the surgery. This will assure proper flow of blood to the facial tissue, including muscles and bones and prevent them from decaying. One of the rare complications is the spontaneous generation of bone tissue, known as ameloblastoma.

Thus, we see that mandibular resection surgery can be safe and effective if proper care is taken to prevent the possible complications and risks. In the U.S., this surgery can cost anything between $20,000 to $30,000. Recovery time varies among individuals, as it depends on the ability of a body to heal quickly. However, it is a must to consult a doctor before going ahead with any kind of medical procedure, including surgeries.

All aspects of your appearance are important but without a doubt your face is the one physical feature that will be noticed more than others. Your face identifies you and each part is so unique that often they can become the main focus of attention. For instance, you may have heard people describe themselves as having a "pug" nose or "sleepy eyes. General dentistry, includes conventional bridges and crowns, dental veneers, replacement of missing teeth with dental implants and replacement of old amalgam fillings with tooth colored material. It may also include power stain removal and instantaneous laser teeth whitening. In general dentistry, the dental hygienist thoroughly cleans your teeth and advises you about your oral hygiene and how to look after your teeth. These days, flexible dentures are also available. These flexible dentures are based on a flexible material, they are easier to wear, comfortable, easily adapt to slight changes in the shape of the mouth (e.g. when eating) and are cosmetically indistinguishable from your natural teeth. What more is needed?

Dentists specializing in orthodontics, provide treatment for straightening of misaligned teeth and correcting bite problems. Conventional orthodontic braces are made from springs and wires that are often visible, permanently fixed to the teeth and can be unsightly and embarrassing. Fixed braces can also interfere with the oral hygiene. But this embarrassment can be avoided, thanks to advancement in cosmetic dentistry. Invisalign, the latest in cosmetic orthodontics, are virtually invisible, removable clear aligners. Now it is possible to have your teeth straightened without it being obvious to everyone around you. You can easily remove the clear aligners whilst eating and when cleaning your teeth.

Traditional dentures continue to be chosen by many people, but they have their limitations; removable dentures can be difficult to manage, sometimes they do not fit properly which causes problems speaking and eating. Wearers of fixed dentures which are attached directly to the jawbone and can only be removed by a dentist experience the same problem of achieving a comfortable fit that plagues the removable type of denture as well. Caring for your denture on a daily basis can heighten your sense of well being, and compliment your appearance. In addition, clean dentures help keep the tissues in your mouth healthy and free from unfavorable changes. Your dentures have been fabricated using high quality materials and it is extremely important that you provide them proper care to get the best service from them.

The cost of quality dentistry, especially cosmetic dentistry is best considered as an investment in your health. When you have experienced physical trauma and need to have teeth replaced, keep in mind that the cost of dental implants is based on their prominent function. Teeth play a role in your ability to speak clearly, prepare your food for digestion by your body and support your facial features. Your mouth is the gateway to your body and oral hygiene or the lack of it can be a contributing factor to the support or the deterioration of your health as a whole. Many dentists have flexible plans to accommodate credit cards, insurance and cash payments. But beyond financing the procedure, the most important thing is for you to discuss with your dentist whether cosmetic dentures or dental implants are the best choice for you.#

Story highlightsCross infection at the dentist's office is rare, but importantPatients should ask questions about their dentist's sterilization proceduresBe alert and watch the gloves and instrumentsAsk for validation of the sterilization machineThe recent news in Tulsa, Oklahoma, brings to light an issue that is rare, but nonetheless important -- cross infection in the dental office, or the transfer of infection from one patient to another in a health care environment.

The unfortunate reality is that you, as the consumer, have very little chance of knowing what's going on -- it's a huge trust relationship. Cross contamination is literally invisible because it's caused by microbes invisible to the human eye, so only the professionals can guarantee that it doesn't happen.

That doesn't mean it's out of your control. Use this checklist to find out how seriously your dentist takes the issue of infection control procedures.

1. Watch the gloves

You would never use a cutting board used for raw chicken to chop up some broccoli unless you washed it first -- and preventing cross infection in the dental office is no different.

Ask yourself:

-- How does my dentist put on gloves? Gloves put on by your dentist should come out of the glove dispenser, not off an unsterilized countertop.

-- What does my dentist touch with the gloves? Your dentist should only touch the sterile instruments or your mouth -- if anything else gets touched or if the dentist leaves the room, it's time for a new pair of gloves.

-- How many soap containers do I see in the office? Soap containers should be visible and everywhere and dentist and staff should be making use of them in front of you, in addition to using gloves.

Ask your dentist:

-- Do you change your gloves for every patient? Gloves should absolutely be changed in between patients.

2. Check out the office

A clean, uncluttered office can be an indication of how serious your dentist is about sterilization. If the office is cluttered, it's harder to clean.

Ask yourself:

-- How clean is the office? Is it tidy and uncluttered? If there's lots of junk on the countertops, that can make for surfaces that aren't easily sterilized.

-- Are there carpets? Carpets can't be sterilized, but hospital-grade linoleum floors can. These can all be indications of how serious a dentist is about cleanliness.

-- Are there special containers for disposal of needles and sharp items? If you can't see them, ask where they're kept. Devices have to either be sterilized or thrown away. A dentist should be using these containers to dispose of used devices and using new ones on the next patient.

Ask your dentist:

-- Are operatory rooms (the room where the dental chair is) cleaned between patients? The staff should be disinfecting the surfaces in the operatory between every patient.

-- Where do you disinfect instruments? There should be a single room or space in the dental office that is completely dedicated to the disinfection of instruments. Ask your dentist to tell you about this space and what the procedures are.

-- How do you sterilize your instruments? Instruments should be sterilized in between each patient, including the dental drill.

-- How do you know that the sterilizer is working properly? This brings me to my next point.

3. Ask for autoclave validation

In my office, this is a form that we keep on our bulletin board. It's a certificate from a third party company that sends the dentist a package full of envelopes of bacteria that are difficult to kill.

The dentist or staff will put these bacteria into the sterilization machine -- or autoclave, in dental terms -- weekly or monthly, put the package into the mail, and the company analyzes the package and sends a report to the dentist on how well the sterilization machine is functioning. Another word for this is biological monitoring.

Ask your dentist:

-- May I see a copy of your autoclave validation? If your dentist is willing and able to show you this report, this demonstrates a commitment and dedication to protecting your health. If your dentist doesn't want to show you or gets defensive, this could be a red flag.

4. Check the instruments

Your dentist should be unwrapping a sealed bag of instruments in front of you. A sealed bag indicates that the instruments have been sterilized -- or in dental terms, autoclaved -- by a machine. If bag is already open, then it's possible that those are used instruments that contain another person's germs.

Ask yourself:

-- Where did the instrument come from? Once instruments are out of the sterilized bag, your dentist should leave them on a sterile tray, not a dirty countertop.

Ask your dentist:

-- Do you use the bags that change color when they're autoclaved? Many autoclave bags have a color indicator on them to indicate that the instruments inside were properly sterilized. Not all bags have this, but it can start a good conversation with your dentist about sterilization procedures used in the office.

5. Speak up

Never be afraid to ask questions. A good dentist will be proud to tell you of the measures the office takes to ensure your safety, protection and well-being.

Ask your dentist:

-- "In your office, how do you guarantee that you do not cross infect patients?" The dentist's reaction to this alone is telling. The dentist and staff should be dedicated to answering your questions and making you feel comfortable.

And do your research. The more you know about this topic, the better able you will be to engage in a conversation with your dentist. Do a background check. Usually, there's a governing body that oversees dentists in your state. They keep a record of infractions -- call to find out if your dentist is on that list. Educate yourself about dental infection control standards. The Occupational Safety and Health Administration, the Centers for Disease Control and the American Dental Association can help.

If you ever see something that makes you believe that your dentist and the staff are not perfectionists when it comes to cleanliness, trust your instincts and go somewhere else, or at least speak up.

Cross infection, in general, is exceedingly rare because dentists follow strict state and federal guidelines. The risk of your health being affected by not seeing the dentist is far greater than the risk of cross infection.


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Smile Makeovers by Cosmetic Dentist in Florida, Deland, Deltona, Orange City, Volusia County, Victoria Park and Glenwood to Boost Your Confidence

Let's talk about dental crowns today, because it's my opinion that they are generally a misunderstood (and disliked) dental procedure. Misunderstood because most dentists do not explain crowns very well, and disliked because they are costly, and insurance companies typically do not cover more than 50 percent of the cost. For this article, we'll use the term "crown," but can also mean "cap" (as crowns were commonly called years ago).

What Is a Dental Crown?

A dental crown is, for lack of a better term, a permanent covering for a tooth. They can vary in construction material from all metal to porcelain fused to metal, all resin, or all porcelain/ceramic. They all have their advantages and drawbacks. All metal crowns are the strongest and longest lasting, but don't have the most attractive appearance (although some people opt for gold). Porcelain fused to metal is a popular choice, because they generally look good, and are strong as well. The only drawback to them is sometimes, you can see the metal right along the bottom of them. All Porcelain/All Ceramic also look really nice, but aren't as strong as porcelain fused to metal. Still, many people think they look the best for front teeth. All-resin crowns are the cheapest option, but they are also the weakest -- I do not recommend them.

The above dental crowns are almost always fabricated outside the dentist's office. This is where the extreme costs come in; indeed, it is a small item in stature, but a quality crown is made to fit your exact bite, and is handcrafted by a skilled professional. And even with a porcelain covered metal crown, the alloy under the porcelain is a quality metal -- Platinum/Palladium/Gold.

There are machine-made crowns, which are cheaper in price, but again, I'm not really a fan of them. They look fake, but the biggest problem is they don't fit very well. In my opinion, "good enough" is not an option when it comes to crown fit. Food and bacteria will get trapped, and defeat the purpose of having a crown in the first place.

Also contributing to the cost is the fact that a crown is a two-visit procedure: first, an impression must be made (so the crown will fit), and at this time, the tooth is prepared for the crown (sometimes with a post, sometimes by just shaping the tooth, and sometimes both. It all depends on how much "good" tooth there is to work with.) After tooth prep, a temporary crown is fitted to keep the tooth clean. Then, when the crown is finished, the patient returns, and the "temp" is replaced with the real crown, which is cemented in.

What are Dental Crowns Used for?

While the reason to get a crown can be cosmetic in nature (in fact, as a NYC Cosmetic Dentist, I see this more often than some other dentists who don't do cosmetic work), for most folks, a dental crown is generally a "save the tooth" procedure.

This is where the misunderstandings I mentioned above come into play. Indeed, there are plenty of instances where the need for a crown is evident (like a broken tooth), but oftentimes, the "need" for a dental crown is not apparent to the patient. Here are some "but it's not broken" instances that call for a dental crown:

To strengthen a tooth that has/had a very large (and usually old) filling.To repair a tooth that has a very large cavity.To protect a tooth that had a root canal.

In many of these instances, the "need" for the crown is not overly obvious. For example, we're used to getting fillings for cavities. But for very large cavities, fillings are usually not a good solution, as the larger the filling, the less tooth there is, and the greater chance that the filling will fall out (or the tooth will just crack). As a dentist, if I know a patient's tooth has a good chance of breaking, I feel it is irresponsible of me to let them leave my chair without telling them all of their options.

And trust me, there is a point where a filling is just going to be too big -- at that juncture, it's a crown, or another dentist (obviously, I prefer the second option is not taken, but again, there's a point where I am not going to do a filling I know won't last a reasonable amount of time.)

The problem comes in how does a dentist explain the above without it seeming like a money grab? Especially since there are other dentists out there who will happily do an overly large filling, despite the fact they know the tooth will likely soon break (which is not in the patient's best health interest). Of course, on the other side of that coin, there are also dentists that want to crown every tooth in sight, which, to me, is just as unscrupulous.

For me, the answer is trust. I work hard to build trust with my patients, and I try to present them with every option available to them, along with the pros and cons of each. I realize finances play a role in most dental decisions, but I make sure that it's the patient's finances that direct things, not mine. I feel it's in my patient's best interest (and mine, as a business professional) that I clearly explain the how and why of my recommendations, and they understand why I reach the conclusions that I do. Like I mentioned above, I won't do a filling I know won't work, and I also won't do an unnecessary crown. My patients know this.

Trust is important. If you trust your dentist, then you are likely in good hands. If you do not, it's time for a new dentist.

Until next time, keep smiling.

From Wikipedia, the free encyclopedia

Oral cancer, also known as mouth cancer,[1] is a type of head and neck cancer and is any cancerous tissue growth located in the oral cavity.[2]

It may arise as a primary lesion originating in any of the tissues in the mouth, by metastasis from a distant site of origin, or by extension from a neighboring anatomic structure, such as the nasal cavity. Alternatively, the oral cancers may originate in any of the tissues of the mouth, and may be of varied histologic types: teratoma, adenocarcinoma derived from a major or minor salivary gland, lymphoma from tonsillar or other lymphoid tissue, or melanoma from the pigment-producing cells of the oral mucosa. There are several types of oral cancers, but around 90% are squamous cell carcinomas,[3] originating in the tissues that line the mouth and lips. Oral or mouth cancer most commonly involves the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth). Most oral cancers look very similar under the microscope and are called squamous cell carcinoma, but less commonly other types of oral cancer occur, such as Kaposi's sarcoma.

In 2013 oral cancer resulted in 135,000 deaths up from 84,000 deaths in 1990.[4]Five-year survival rates in the United States are 63%.[5]


1 Signs and symptoms

2 Causes

2.1 Premalignant lesions

2.2 Tobacco

2.3 Alcohol

2.4 Human papillomavirus

2.5 Hematopoietic stem cell transplantation

3 Diagnosis

4 Management

5 Prognosis

6 Epidemiology

6.1 UK

6.2 India

7 See also

8 References

9 External links

Signs and symptoms

On biopsy, the three exophytic masses turned out to be a carcinoma, while the surrounding hyperkeratotic area showed histologic features of lichen planus.

Skin lesion, lump, or ulcer that do not resolve in 14 days located:

On the tongue, lip, or other mouth areas..

Usually small

Most often pale colored, may be dark or discolored

Early sign may be a white patch (leukoplakia) or a red patch (erythroplakia) on the soft tissues of the mouth

Usually painless initially

May develop a burning sensation or pain when the tumor is advanced

Behind the wisdom tooth

Even behind the ear

Additional symptoms that may be associated with this disease:

Tongue problems (moving it)

Swallowing difficulty

Mouth sores

Pain and paraesthesia are late symptoms.


Oncogenes are activated as a result of mutation of the DNA. Risk factors that predispose a person to oral cancer have been identified in epidemiological (epidemiology) studies.

Around 75 percent of oral cancers are linked to modifiable behaviors such as tobacco use and excessive alcohol consumption. Other factors include poor oral hygiene, irritation caused by ill-fitting dentures and other rough surfaces on the teeth, poor nutrition, and some chronic infections caused by bacteria or viruses. If oral cancer is diagnosed in its earliest stages, treatment is generally very effective.[6]

Chewing betel, paan and Areca is known to be a strong risk factor for developing oral cancer. In India where such practices are common, oral cancer represents up to 40% of all cancers, compared to just 4% in the UK.

Oral cancer often presents as a non-healing ulcer (shows no sign of healing after 2 weeks). In the US oral cancer accounts for about 8 percent of all malignant growths. Men are affected twice as often as women, particularly men older than 40/60.

Premalignant lesions

Oral leukoplakia on the buccal mucosa. Overall, leukoplakia carries a risk of transformation to squamous cell carcinoma that ranges from almost 0% to about 20%, which may occur in 1-30 years.[7]

A premalignant (or precancerous) lesion is defined as "a benign, morphologically altered tissue that has a greater than normal risk of malignant transformation." There are several different types of premalignant lesion that occur in the mouth. Some oral cancers begin as white patches (leukoplakia), red patches (erythroplakia) or mixed red and white patches (erythroleukoplakia or "speckled leukoplakia"). Other common premalignant lesions include oral lichen planus (particularly the erosive type), oral submucous fibrosis and actinic cheilitis.[8] In the Indian subcontinent oral submucous fibrosis is very common. This condition is characterized by limited opening of mouth and burning sensation on eating of spicy food. This is a progressive lesion in which the opening of the mouth becomes progressively limited, and later on even normal eating becomes difficult. It occurs almost exclusively in India and Indian communities living abroad. The overall prevalence of oral potentially malignant disorders in the Middle East was 2.8%. Lichen planus/lichenoid lesions were the most common lesions (1.8%) followed by leukoplakias (0.48%), chronic hyperplastic candidiosis (0.38%), and erythroplakia (0.096%). Smoking, alcohol, and age (>40 years) were the main identifiable risk factors.[9]


Oral cancer in a 40-year-old male smoker

In a study of Europeans, smoking and other tobacco use was associated with about 75 percent of oral cancer cases,[10] caused by irritation of the mucous membranes of the mouth from smoke and heat of cigarettes, cigars, and pipes. Tobacco contains over 60 known carcinogens, and the combustion of it, and by-products from this process, is the primary mode of involvement. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes.

Tobacco use in any form by itself, and even more so in combination with heavy alcohol consumption, continues to be an important risk factor for oral cancer. However, due to the current trends in the spread of HPV16, as of early 2011 the virus is now considered the primary causative factor in 63% of newly diagnosed patients.


Some studies in Australia, Brazil and Germany pointed to alcohol-containing mouthwashes as also being etiologic agents in the oral cancer risk family. The claim was that constant exposure to these alcohol-containing rinses, even in the absence of smoking and drinking, leads to significant increases in the development of oral cancer. However, studies conducted in 1985,[11] 1995,[12] and 2003[13] summarize that alcohol-containing mouth rinses are not associated with oral cancer. In a March 2009 brief, the American Dental Association said "the available evidence does not support a connection between oral cancer and alcohol-containing mouthrinse".[14] A 2008 study suggests that acetaldehyde (a breakdown product of alcohol) is implicated in oral cancer,[15][16] but this study specifically focused on abusers of alcohol and made no reference to mouthwash. Any connection between oral cancer and mouthwash is tenuous without further investigation.

Human papillomavirus

Main article: HPV-positive oropharyngeal cancer

Infection with human papillomavirus (HPV), particularly type 16 (there are over 180 types), is a known risk factor and independent causative factor for oral cancer. (Gillison et al. Johns Hopkins) A fast-growing segment of those diagnosed does not present with the historic stereotypical demographics. Historically that has been people over 50, blacks over whites 2 to 1, males over females 3 to 1, and 75% of the time people who have used tobacco products or are heavy users of alcohol. This new and rapidly growing sub population between 30 and 50 years old,[17] is predominantly nonsmoking, white, and males slightly outnumber females. Recent research from multiple peer-reviewed journal articles indicates that HPV16 is the primary risk factor in this new population of oral cancer victims. HPV16 (along with HPV18) is the same virus responsible for the vast majority of all cervical cancers and is the most common sexually transmitted infection in the US. Oral cancer in this group tends to favor the tonsil and tonsillar pillars, base of the tongue, and the oropharynx. Recent data suggest that individuals that come to the disease from this particular etiology have a significant survival advantage[18], as the disease responds better to radiation treatments than tobacco etiology disease.

Hematopoietic stem cell transplantation

Patients after hematopoietic stem cell transplantation (HSCT) are at a higher risk for oral squamous cell carcinoma. Post-HSCT oral cancer may have more aggressive behavior with poorer prognosis, when compared to oral cancer in non-HSCT patients.[19] This effect is supposed to be owing to the continuous lifelong immune suppression and chronic oral graft-versus-host disease.[19]


A large squamous cell carcinoma of the tongue as seen on CT imaging

Histopathologic appearance of a well differentiated squamous cell carcinoma specimen. Hematoxylin-eosin stain

Early diagnosis of oral cancer patients would decrease mortality and help to improve treatment. Oral surgeons and dentists are the early diagnosers that diagnose these patients in early stages. Health providers, dentists, and oral surgeons shall have high knowledge and awareness that would help them to provide better diagnosis for oral cancer patients. An examination of the mouth by the health care provider, dentist, oral surgeons shows a visible and/or palpable (can be felt) lesion of the lip, tongue, or other mouth area. The lateral/ventral sides of the tongue are the most common sites for intraoral SCC. As the tumor enlarges, it may become an ulcer and bleed. Speech/talking difficulties, chewing problems, or swallowing difficulties may develop. A feeding tube is often necessary to maintain adequate nutrition. This can sometimes become permanent as eating difficulties can include the inability to swallow even a sip of water. The doctor can order some special investigations which may include a chest x-ray, CT or MRI scans, and tissue biopsy.

There are a variety of screening devices that may assist dentists in detecting oral cancer, including the Velscope, Vizilite Plus and the identafi 3000. There is no evidence that routine use of these devices in general dental practice saves lives.[20] However, there are compelling reasons to be concerned about the risk of harm this device may cause if routinely used in general practice. Such harms include false positives, unnecessary surgical biopsies and a financial burden on the patient. While a dentist, physician or other health professional may suspect a particular lesion is malignant, there is no way to tell by looking alone - since benign and malignant lesions may look identical to the eye. A non-invasive brush biopsy (BrushTest) can be performed to rule out the presence of dysplasia (pre-cancer) and cancer on areas of the mouth that exhibit an unexplained color variation or lesion. The only definitive method for determining if cancerous or precancerous cells are present is through biopsy and microscopic evaluation of the cells in the removed sample. A tissue biopsy, whether of the tongue or other oral tissues and microscopic examination of the lesion confirm the diagnosis of oral cancer or precancer. There are six common species of bacteria found at significantly higher levels in the saliva of patients with oral squamous cell carcinoma (OSCC) than in saliva of oral-free cancer individuals. Three of the six, C. gingivalis, P. melaninogenica, and S. mitis, can be used as a diagnostic tool to predict more than 80% of oral cancers.[21]


Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough, and if surgery is likely to result in a functionally satisfactory result. Radiation therapy with or without chemotherapy is often used in conjunction with surgery, or as the definitive radical treatment, especially if the tumour is inoperable. Surgeries for oral cancers include:

Maxillectomy (can be done with or without orbital exenteration)

Mandibulectomy (removal of the mandible or lower jaw or part of it)

Glossectomy (tongue removal, can be total, hemi or partial). When glossectomy is performed for smaller tumors (< 4
As a child, did you fall and break a tooth? Does the gap between your teeth make you look ugly? If the answer to that is a resounding 'yes', then you can opt for dental bridges. Dental bridge is the name given to a dental procedure through which the gap between one or two missing teeth is filled. A dental bridge is actually a fixed partial denture that acts as a replacement for missing teeth. A dental bridge cannot be removed by the patient. The replacement tooth is flanked by the crowns for the abutment teeth, which is referred to as a pontic. The pontics or the false teeth can be made of gold, porcelain, alloys or a combination of these materials. Dental bridges are provided support by implants or natural teeth.

Why opt for dental bridges

Dental bridges help you get a perfect smile and it also can restore your ability to speak and chew properly. Other benefits of having dental bridges are that it can maintain the shape of your jaw line and prevent the remaining teeth from getting out of their position. It replaces missing teeth perfectly and distributes the force of your bite evenly.

Three main types of dental bridges

1.Traditional bridges create a crown for the tooth or an implant on the side of the missing tooth, accompanied with a pontic in between. These bridges are the most commonly used dental bridges. A traditional bridge is made of ceramics or porcelain fused with metal.

2.Maryland bonded bridges also referred to as Maryland bridges or resin-bonded bridges are made of plastic gums and teeth which are supported by a metal framework. Metal wings are provided on both sides of the bridge and bonded to your existing teeth.

3.Cantilever bridges are used for a patient who has adjacent teeth on a single side of a missing tooth or missing teeth.

The procedure

Dental bridges can be implanted over multiple visits. On the first visit to the dentist, the patient is given local anesthesia and the dentist recontours the abutment teeth making it suitable for crowns to fit over them. Teeth impressions of the patient are taken by the dentist for the creation of the dental bridge. A temporary bridge is provided for acting as a shield for the exposed teeth till the final dental bridge is made. On the second visit, the dentist removes the temporary bridge and replaces it with the permanent bridge. For ensuring a proper bite, more visits to the dentist may be required. After about two weeks, the bridge is cemented permanently in place. Dental bridges can last for a number of years, if you adopt good oral hygiene and dental care habits.

By: Garret Lloyd

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HuntsvilleDentist Dr. Jonathan Renfroe, DMD is dedicated to excellence in general and cosmetic dentistry located in In Huntsville, Alabama (AL). Call us now at 256-417-6609.


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