| Dental disorders refer to conditions that result in damage to the structure of the tooth. In mammals, all teeth consist of three layers. The outer layer called the enamel is the hardest tissue in the body. The middle layer called dentine is not as hard as the enamel and is similar in composition to bone. The pulp is the innermost layer and provides nourishment to the tooth.
Tooth decay begins when bacteria that are normally present in the mouth between teeth and gums combine with saliva and debris from sugary and starchy foods to form a sticky substance (plaque) that adheres to the teeth.
The plaque contains acids that destroy the tooth's enamel and dentine by removing calcium and other minerals from them. Tooth decay usually begins on the surface enamel and in pits and fissures of the teeth or between adjacent teeth, creating holes in the tooth. From the enamel, the process of decay spreads to the underlying dentine and may ultimately involve the tooth pulp. Cavities are usually painless until they grow very large in the dentine and the pulp layers of the tooth. Tartar, or9 calculus, is hardened plaque that forms a white covering at the base of the teeth.
Other forms of dental disorders include tooth abscess, discoloration, faulty alignment, and wisdom teeth complications. Tooth abscess occurs when a cavity left untreated enables bacteria to infect the nerve tissue within the pulp of the tooth. Tooth discoloration can occur as a result of damage to the pulp layer of the tooth from extensive tooth decay or trauma. Faulty alignment entails an abnormality in the relationship between teeth in opposing jaws (malocclusion); the misalignment of one or more teeth; or the misalignment of one side of the jaw with the other. Wisdom teeth complications include crowding, gum disease, and poor positioning. Medications and coexisting medical illnesses (e.g., diabetes mellitus, human immunodeficiency virus [HIV], infection) may increase the likelihood of dental disorders.Risk: Dental disorders are more common in individuals whose personal behaviors (e.g., tobacco use, alcohol abuse, poor diet), increase the risk of oral pathology. Individuals who practice poor oral hygiene (lack of regular brushing, flossing, and dental examination and cleaning), eat chewy, sticky foods between meals without brushing or at least rinsing afterwards, and constantly sip sugary drinks or frequently suck on candy or mints are at risk for dental disorders. Incidence and Prevalence: The average adult in the US has 10 to 17 decayed, missing, or filled permanent teeth (Overman). |
Source: Medical Disability Advisor
| History: Symptomatic individuals with tooth decay present with sensitivity to sweets, cold or hot foods and liquids, and tooth pain that manifests itself especially when individual is eating. Individuals with tooth decay in its early stages may have no symptoms. Physical exam: The dentist performs a complete oral exam that may or may not reveal pits or holes (cavities) in the teeth. Most cavities are discovered in the early stages during routine checkups. The surface of the tooth may be soft when probed with a sharp instrument. Pain may not be present until the advanced stages of tooth decay. Tests: Dental x-rays can show some cavities before they are visible to the eye. The most common x-ray procedure is a bite-wing where a small piece of film is placed in the mouth behind a section of the teeth. The individual bites down on the paper tab around the film that holds the film in place. The x-ray machine is aimed at that section of teeth and a picture is taken. Most dental x-rays include four or more views of the teeth.
Sinus x-rays may also be taken if disease of the sinuses is suspected. |
Source: Medical Disability Advisor
| For tooth decay, the decayed material is removed by drilling and replaced with a restorative material such as sliver alloy, gold, porcelain, or plastic. Porcelain and plastic more closely match the natural tooth appearance and may be preferred for front teeth. Silver amalgam (alloy) and gold are stronger and are often used on back teeth.
For tooth abscess, root canal therapy may be recommended in an attempt to preserve the tooth. The center of the tooth including the nerve and vascular tissue (pulp) may be removed along with decayed portions of the tooth. The root and surface of the tooth remain in place. The cavity created in the core is filled and repaired and a crown may be placed over the tooth. In some cases, excision (surgical drainage) of the abscess or extraction of the affected tooth may be necessary.
Anesthetics (local, nitrous oxide gas, or other general anesthetic) may be required in some cases for drilling or other treatment of tooth decay or abscess.
Tooth discoloration may be corrected cosmetically through the use of a bleaching gel dispensed in soft, thin plastic bleaching trays custom fitted for the individual's mouth.
For misaligned teeth, a dentist specializing in the treatment of misaligned teeth (orthodontist) prescribes and oversees the use of a retainer or braces. If misalignment is caused by or involves the wisdom teeth, they are frequently extracted to provide additional room for the remaining teeth. |
Source: Medical Disability Advisor
| Outcome of tooth decay treated by a filling is usually positive. The effectiveness of root canal therapy will probably last a lifetime but occasionally an abscess persists even after root canal therapy is performed. In such an instance, another surgical procedure is required to remove the diseased tissue from the tip of the root and reseal it with another filling. Tooth discoloration is ongoing so the bleaching procedure will probably need to be repeated from time to time. Most of the time, misaligned teeth remain aligned if the individual closely follows the recommendations of his or her orthodontist with regard to the prescribed retainer or braces. Extraction of wisdom teeth is a typically uncomplicated process, but may be associated with some short-term discomfort. |
Source: Medical Disability Advisor
| Complications of tooth decay include abscess of the tooth/gums caused from bacterial infection of the tooth root or periodontal infection, chronic discomfort in the mouth, exposure of bone in the socket after a lower back tooth has been removed (dry socket), and fractured tooth. The restorative material used to fill a cavity may need to be replaced over time due to looseness and damage.
Individuals taking medications that cause dry mouth are at higher risk for bacterial infections since saliva buffers bacterial acids, flushes loose bacteria, and remineralizes early areas of tooth decay.
Individuals with prosthetic valves and some heart conditions, such as valvular disease or atrial fibrillation may be at increased risk for bacterial endocarditis when burdened with significant tooth decay. |
Source: Medical Disability Advisor
| The individual can usually return to work the same day if dental disorders are treated in the early stages. A day or so of sick leave may be required for more complicated treatments such as a root canal or multiple tooth extractions. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has type and origin of dental disorder been confirmed through thorough dental x-rays?
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Have similar conditions, such as sinus infection, been ruled out?
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Has individual experienced any complications?
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Is there an underlying condition that puts individual at increased risk for dental disorders?
Regarding treatment:
- Were dental procedures able to preserve the tooth?
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Did individual experience any complications related to the procedure?
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Would individual benefit from the use of a retainer or braces?
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How effective was the procedure?
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Did individual adhere to prescribed treatment plan?
Regarding prognosis:
- Did procedure accomplish the anticipated goal? If not, what further or additional treatments are now warranted?
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Is individual willing to modify detrimental personal behaviors (tobacco use, alcohol abuse, poor diet) and initiate good oral hygiene (brushing, flossing, and dental cleaning) in return for better dental health?
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Would individual benefit from consultation with a nutritionist?
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Is individual willing to have regular dental check-ups in order to monitor or ward off further dental disorders?
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Source: Medical Disability Advisor
| Overman, Pamela R. "Biofilm: A New View of Plaque." Journal of Contemporary Dental Practice 1 3 (2000): 018-029. 1 Jun. 2005 <http://www.thejcdp.com/issue003/overman/01over.htm>. |
Source: Medical Disability Advisor