II-ORAL CARE -GINGIVITIS

GINGIVITIES-PREVENSION

If we do not care our mouth and buccal cavity there are many problems would arise including gingival inflammations.Gingivas under the teeth is fixed and gingiva attached with our inner jaws are movable but both are proned to get inflammations.

A inflammation the gingiva will be enlarged with a bluish hue due to engorged gingival capillaries and a slow venous return

Causes Gingival inflammations are caused by microbial damages if cellular and intercellular gingival tissues.There are chronic and acute gingivities.In chronic the gingival inflammations markedly localised and generalised.The gum would readily bleed on probing and brushing.Painful sensitization.The patient should seek a medical assistance.

For OTC treatments oral anesthetics include euginol(clove oil) and benzocaine (Oragel) are available.Clove oil has antiseptic property also.Paracetamol can also give a pain releif but the patient should seek the medical advice to get cure.

Periodontal Disease is formed if gingivitis is left untreated.In periodontal disease the periodontal ligament attachment and the alviolar bone support of the tooth deteriorate

Acute Necrotizing Ulcerative Gingivitis (ANUG)

It is known by the name Trench Mouth in which necrosis and ulceration of gingival cells occur with underlying inflammations.This condition is usually seen in young adults and teens.

Symptoms are included as severe gum pain,with foul taste,bad odour,bleeding and increased salivary secretions. 

The causative organisms are unknown but it is well beleived that it is associated by the over growth of spirochette and fusiform organisms which are usually present in the mouth.

Anxiety,stress,smoking,poor oral hygeine,malnutrions may also contributors of risk.

Treatments should be carried out by a dentist.The prescription include Penicillin-VK the oral penicillin of phenoxy methyl or ethyl penicillin as a potassium salt is more preferable because of its acid stability.Metronidazole can also be used to controll the lesions.

OTC Products These are for a temperory releif includes paracetamol.clove oil and oragel.Aspirin and any salicylate should not be used if bleeding is there

An oral mouthwash contains 1.5% hydrogen peroxide solution may be used.

 

OTC DENTAL MEDICATION

COMMON TOOTH PROBLEMS-TREATMENTS

Dental caries or cavities

These problems start with when we are not following the proper tooth care,then our tooth are attacked with cariogenic microbes which are growing and implating in our tooth.

The causative organisms are Streptococcus muans and Lactobacillacae,these organisms release lactic acid which demineralise the enamel and produce cavities.

Diet contains high content of white sugar (sucrose) are also another causative.Sucrose is converted by the microbes into volatile acids that destroys enamel.Fructose and Lactose are less cariogenic.

Artificial sweetening agents such as xylitol,sorbitol,and aspartam are not cariogenic.

OTC products for a time being releif until to reach a doctor includes euginol,benzocaine (Anbesol,Oragel),Aspirin and Paracetamol

Plaques and Calculus

Plaque is a sticky material formed by the attachment of bacteria to the pellicle a thin mucoprotein that adhere with the enamel immediately after cleaning the tooth.When the bacteria attached with the pellicle it produces plaques.Plaques can be easily removed by brushibg the teeth with a dentifrice and can be prevented by brushing withou paste regularly after every meals containing sugar and milk.Night brushing with a paste is very important

Calculus or tartar is formed if the plaque is not removed in 2 to 3 hours.The plaque begins to calcify by the saliva and becomes calculus.Once calculus formed then it should be removed only by a dentist.

OTC Treatments

a.Soft and round ended bristles containing tooth brushes are perfect.

b.Irrigating products such as Dento spray,Hydro-pic are used.Withese spraying device one can rince and wash with high pressure stream of water through a nozzle.Gently lift the free gingiva to rince the cervix
c.Dental floss or tape are also can be used as perfect adjuncts for oral hygene.These are available as waxed or unwaxed as per our tastes of interests.Waxed floss or tapes are recommonded in case of tight teeth with little gaps as they can pass through the gaps very easily without shredding.
The American Dental Association (ADA) has recommended  the following brands Butler,J&J,Floser and Oral-B
d.Dentifrices are products that are used to remove plaques and stains with a brush.(e.g)Tooth pastes, Mouth washes,cosmetic teeth bleachers,desensitizind agents etc.etc.
1.Tooth Pastes These are very useful to clean the teeth like by a soap to look perfect by removing bad odour and taste,stains and plaques if use regularly at night and in a proper manner.
Whenever we buy tooth paste we should read its contents.A perfect T.P must contain the followings:-
A)Abrasives are meant for plaque and debris removal and includes any one of the followings 1.silicates;2.sodium bicarbonate;3.dicalcium phosphate;4.sodium metaphosphate;5.calcium pyrophosphate;6.calcium carbonate;7.magnesium carbonate and 8.aluminium oxides.9.Potassium flurides
B)Surfactants are soap forming substances acting as foaming agents and their detergent properties are very useful to clean the debris.(e.g.)1.sodium lauryl sulphate;2.sod.dodecyl benzene sulfonate
C) Humectants are wetting agents to keep the product away from drying.(e.g.)1.sorbitol;2.glycerin and 3.propylene glycol
D) Suspending agents are the agents giving proper thickness and rigidity to the produts (e.g.) Tragacanth;Methyl cellulose and Karaya gum.
E)Flavouring agents are agents to give odour and tastes includes sorbitol;aspartam;or sachcharin
Cosmetic Whitening Agents are special ingredients and the preparation should not be used for daily purpose but weekly once is advisable as they are bleeching agents to offer a cosmetic white shining to your teeth.(e.g)10% sodium carbamide;glycerin oxide;proxygel.
These preparations are harmful if used daily and frequently.The side effects include alteration of the normal flora;tissue irritation;teeth sensivity and gingivities
Desensitizing agents These are the agents meant for minimising teeth sensitive pains by cold,heat and touch.These ingredians are non-abrasives and could be included in special preparations and should be used as per the dentist's advice.(e.g.)5%Potassium nitrate containing such as Denquel;Promise;Fresh Mint Sensodyne
Disclosing agents These are the products at the doctors desk used to find out the exact place of plaque formations.These products after use should be thoroughly washed and rinsed out and should not be swallowed.The American FDA approved products includes D&C red No-28;FD&C Green No-3
Mouth Washes are the liquid preparations usually contains astringents,demulsants,detergents,flavours;germicides and fluorides.
There are many types as follows
cosmetic MW -The are used to remove bad odours and taste can be used cosmetically as a mouth freshner.These are prepared with or without alcohol but includes phenol and mint.
anti-plaque MW -These are medicated products include Listerine and Peridex.
fluoridated MW-These are meant for cleaning used as gargle for expectoration.After use any thing to be eaten or chewed should be atleast after 30 minutes only.American Dental Association has approved the following products such as Act anti-cavity Denal Rinse;Act for kids;Fluorigard Anticavity Dental Rinse 

 

   

THE DENTAl STRUCTURE

TOOTH CARE

The Anatomy Of The Tooth

The anatomy of the tooth is composed of two main parts as A)The Crown portion above the gingival line and B) The Root portion below the gingival line

A.The Crown

Again the crown portion is subdivided into 1.Enamel;2.Dentin;3.Cementum;4.Pulp

1.Enamel

This part is made out of calcium hydroxyapatite salts.It is covering the underline tooth structure known as the crown

2.Dentin

This is the largest part of the tooth located beneath the enamel.

3.Cementem

This is a bone like structure that covers the root and give attachments of the tooth to the periodontal ligaments

4.Pulp

This conains the free nerve endings 

 

 

MEDICAL INTERVENTIONS OF ANGINA PECTORIS

ANTI ANGINAL DRUGS

Among the three types of angina the classic stable angina which accounts 90% of the incidents and is treatable and reversible.On the other hand the other two types the unsable type,and varient type which are accounting 10% to very rare and are medical emergencies as mostly they are irriversible and can lead to heart attack

The tretments are based on the strategy that the stable angina is always due to the demand of oxygen exceeds the supply.Hence the reatments should be either 1)Increasing the oxygen supply or 2)Decreasing the oxygen demand by the heart muscles

Oxygen Demand

 One must know the fundamental of this strategy.We know our heart is hardly working without rest upto our death.Every time it is contracting and relaxing with an average speed of 70 per minute.Every contractions and relaxes are composed of the following events:-

1.Preload - the diastolic filling pressure.When the blood enters into the chambers the chamber has to expand to accomodate the filling blood.For this its muscles has to relax against an external pressure and need oxygen.

2.Afterload-the systolic ejection pressure against the peripheral or outside vascular resistance pressure,and need oxygen

3.Heart rate-To keep the heart contractions and relaxations at a constant rate per fixed time need oxygen

4.Wall tension

All the above cosequences need oxygen. 

Classes of Anti-Anginal Drugs

1.Nitrates

2.Calcium channel blockers

3.Beta adrenergic blockers

4.Aspirin

Nitrates

Nirates are acting on heart smooth muscles and relax them as follows:

Nitrates releases nitric oxide which increases in the blood an hormone like substance cyclic Guanosine Mono Phosphate (cGMP) which inturn dephosphorylate the myosin content of the heart and vascular muscles and relax them.

Because of this the veins get dilated and relaxed,the venous pressure is diminished and hence there is a reduction in preload pressure.As a result preload and cardiac output are reduced.

On higher doses nitrates dilates arterioles also followed by reduced peripheral resistance and B.P

Examples of Nitrates 

1.Glyceryl trinitrate for sublingual and intra dermal administration on emergencies as the onset of action is immediate and lost immediately

2.Isosorbide Dinitrate-for oral administration and the effect is not immediate but last for longer time

3.Amyl nitrate - same as above

1.Glyceryl trinitrate which should be taken sub lingually to prevent the first pass metabolism by liver if taken orally as the drug will be 90% deactivated by liver.Also this can be taken by skin patches

this medicine is useful for acute anginal attacks and the onset of action is in seconds to minutes.

As a prophylactic we can use the oral and transdermal forms 

Because of tolerance please keep up nitrate free periods for long time use.

Toxicity Side effects mainly due to its vasodilating effects such as

1.Postural hypotention

2.Dizziness

3.Reflux tachycardia

4.Headaches

Calcium Channel Blockers

1.Nifedipine

2.Verapamil

3.Diltiazem

The mechanism of action is blocking the calcium channels of the vascular muscles and thereby preventing the entry of calcium ions and thus relaxing the muscles.

These are the drugs of choice for treating the variant types of angina known as Prinzmetal's syndrome.

Out of the above three verapamil is more cardiac dependant.

It is he powerfull inhibitor of the conduction at AV node.

Nifedipine is acting mostly on arterioles and therefore it much reduces the B.P.It has no effect on AV coduction system.

Diltiazem is having moderate action on arterioles and AV conduction system

They can be taken I.V.;Oral and Sublingual.

Toxicity 

1. headache

2.Dizziness

3.Nausea

4.Vomiting

5.Constipation

More serious Toxicities

1.Congestive Heart Failure 

2.AV node conduction block.

Beta-Adrenergic Blockers

Examples  1.Propranolo

                  2.Atenolol

                  3.Metoprolol

                  4.Carvedilol

                  5.Labetelol 

                  6.Esmolol 

                   7.Pindolol

                 8.Timolol

They are useful in stable anginas by reducing frequencies and severity of the attacks by reducing heart rate,contractility and BP 

They have no much use in variant and unstable anginas

Contraindications

Beta blockers are contra indicated in Asthma,Diabetes,and Peripheral vascular diseases such as leg pains.

Calcium channel blockers are alternative for these patients

Selection Any medicine in this group can be used but atenolol, timolol,and metoprolol are more preferable as they are cardio selective.

They can be used in combination also as per the requirements

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CORONARY ARTERY DISEASE (CAD)

ANGINA PECTORIS

Coronary artery is the arterial blood vessel which is supplying nutritional pure blood to the muscles of the heart (Myocardium).For all actions of heart it need tremendous energy which is provided by the uninterrepted free flow of pure blood through this artery which is branched throughout the heart muscles into capillaries.

Atherosclerosis is a process by any injury on the inner portion of the blood vessels' wall caused by the rupture of LDL and releasing the sharp needle like molecules of cholesterol which make injury on the inner wall of the blood vessel.These injuries produces atherosclerosis and small portions of these sclerosis becomes plaques and shed as small particles causes clots which is a throbus which then shed small embols which will circulate the whole body and which when arrive he delicate coronary blood circulation it causes blockade.

A thrombus can be formed by any means directly at the coronary circulation.Either way if blood flow is blocked at a portion of coronary artery the area of the myocardium which receives blood from it is deprived of nutrition (oxygen) and become blackish and struggle to cooperate with the rhythmical heart contraction.This condition is known as Ischemia.In ischemia there is an insufficient supply of oxygen to the heart muscle so that oxygen demand exceed supply.

The ischemic muscle will produce pain,or discomfort or both on the chest which is known as Angina Pectoris.  
Angina Pectoris is one of the major contributors of Heart Attack and Heart Failure 
The symptoms of Angina is ranges from a mild to moderate pain on the chest.Some times as instead of a pain a heavy weight put on the chest.
When compared with Myocardial Infarction in which cell deaths occur and fatal ventricular fibrillation angina is reversible if properly attended.
The etiology is based on three aspects
1.Decreased blood flow
This is due to reasons like a)Atherosclerosis;
b)Coronary artery spasm.This condition is rare but often induced by external factors like inserting coronary catheter,or internal hemorrhage,exposure to exreme cold or ergot alkaloids.These angina may precipitate Prinzmetal syndrome or heart attack.
c.An severe traumatic impact of an heavy object on the chest like a car steering wheel,causes capillary hemorrhages
d.Entry of an embol into the capillaries can cause the blockade.
2.Oxygen demands exceed oxygen supply caused by
a)Hard exercises
b)Emotions
The above condition may not need medical intervention because it can be releived by sufficient rest and relax.Very rarely it may become pathogenic
3.Reduced blood flow such as in conditions like anaemias  

Types 

1.Classic stable angina,this is usually occurs during heavy work or exercises.

2.Unstable angina,this is pathologic and occur even in rest and suddenly become worse

3.Prizmetal's angina,this form is mostly due to coronary artery spasm and this condition is very rare.

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