What word comes to your mind immediately when you hear the word "health"? Many of you will say "not to be ill." But what exactly is "health"? According to the World Health Organization, "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." In other words, health is not the opposite of disease; it is the state of the body existing in balance.

Recently, the "holistic medicine" approach has been talked about more often. We, three physician friends, explained the holistic perspective on health six years ago. We published a book called "Yeni İnsan (A New Human)." At that time, a pandemic was something that occurred in the early 1900s. Health was simply not talked about very much. Now, I feel as if we wrote that book specifically for these recent days.

The aim of holistic medicine is to increase people's physical healing capacity and to prevent illness. Eating properly/nutritiously, sleeping regularly/adequately, engaging in sports, and drinking water are indispensable companions of this process. In addition, countless factors including the environment we live in to the air we breathe, joy in life, and personal motivation come together to affect one's health directly or indirectly.

Oral health maintains a key position in holistic medicine. The surrounding gum tissues and teeth may be referred to as "Holistic Dentistry." Sometimes, people say "Oh, it's just a tooth, I can get it extracted and get rid of it!" Yet, most of the time, even a single extraction should be considered a significant body part loss. As much as possible, optimally, one's original teeth should be kept in the mouth avoiding extraction unless absolutely necessary.  Teeth and surrounding tissues exist in harmony and balance; veins, nerves, the lymphatic system, and teeth communicate with the whole body. Any type of issue within the body may affect an organ or tissue in a seemingly unrelated area.

Protecting one's health must precede efforts to cure disease. Within the framework of oral and dental health, the awareness of one's dental health is known as "Preventive Dentistry." Everyone knows from an early age about the importance of brushing teeth regularly; yet today, please realize that brushing alone is not enough. One's toothbrush should be replaced every three months. Regularly flossing is a definite "must." See your dental professional at least every six months, even if you experience no dental issues. If gums are not healthy, neither do teeth remain healthy, nor is the entire body able to be healthy. For these reasons, it is imperative to schedule and attend regular check-ups?to prevent tooth decay and gum loss.

Similarly, if tartars exist, one's mouth and teeth are not healthy. One common misconception is that dental scaling damages the teeth; it does NOT! Scaling does not scratch the teeth. Gum diseases are the leading causes of tooth loss and are closely associated to one's diet.

Just because no pain exists in the teeth and gums does not mean one's dental health is optimal. For example, one may not experience pain or symptoms if a chronic infection at the root apex of a tooth occurs; such an infection may only be detected by an x-ray film. Some infections may remain dormant for years, unbeknownst to the patient. If one has complaints either with or without knowledge of an infection, sometimes the thought is "I don't care, it is not harmful." While it is difficult to predict where the impact of a dental infection may occur in the body, problems will likely occur; this is known as a "focal infection." Food consumption may cause joint, neck and back pain due to misaligned or missing teeth (a unilateral issue). Teeth clenching is an increasing problem for many people and impacts the entire body. Impacted teeth may remain dormant for years, causing multiple difficulties at some point; these should be examined regularly and extracted if a risk is posed. Old and mismatched fillings, veneers, bridges, and removable prostheses need to be regularly maintained and replaced in a timely manner. The body is a whole. When the balance of this whole is disturbed, recovery is challenging. Please take care of your body! Maintain your health, as it is much easier to sustain one's health than to recover from pain/injury/infection.

On a flight to Germany, a middle-aged man sat next to me. I smelled that uncomfortable smell right from the very moment he began descending on his seat. As a dentist, I felt bad about it. What a difficult situation. A very well-dressed gentleman and clear to be a businessman. But you can't approach him because of the bad breath. How would you tell him? You can't, can you? It got me thinking about his colleagues, friends, and family.

Bad breath is one of the most sensitive topics around, which is also one of the hardest to mention to another person and can cause for the person in question to feel quite poorly. When your spouse mentions it, it can perhaps lead to an argument or resentment. When your colleague mentions it, it can lead to you feeling awful. When your child mentions it, it can lead you to try and find a way to resolve it. If your friends or best friends mention it, it is the type of problem which may cause you to grow apart from people, and sometimes it is such a private matter that people can refrain from saying it to your face.

The issue of bad breath dates back to ancient times. Since time immemorial, people with bad breath sought to get rid of this nasty smell. Sometimes they chewed on plant stalks or leaves. Sometimes people believed the mouth of sinners smelled. Even Hippocrates told young women to gargle with wine and chew aniseed and seed in order for their mouths to smell nice.

What is bad breath? Is it normal? Or is it a disease? Is there a cure?

Let's look at the answers to these questions together. Because a person who thinks they have bad breath begin growing apart from other people and avoid close contact with them. This situation isn't really bearable for people who are in the same social circle with the person who has bad breath. Murat Aydın, M.D describes this situation in the most meaningful way, saying, "If more than one person can notice bad odor in the mouth of the same person at any hour of the day and this situation lingers on continuously or discontinuously for at least a couple of months, this clinical picture is called bad breath even if they don't notice this smell themselves.".

The World Health Organization describes health as "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.". From this point of view, we can call bad breath a disease, since it suits this definition of health, which includes the individual's physical, mental, and social well-being. It is possible to encounter various classifications in literature. Dr. Murat Aydın classifies bad breath as Type 0, 1 ,2 ,3 ,4, and 5.

Type 0: Physiological bad breath. It is used for defining the smell which is felt after waking up in the morning and goes away on its own in a couple of hours. It exists more or less in every living being. It does not require cure.

Type 1: Tongue smell. Patients with a bad odor in their tongue belong in this group. It is the unpleasantly smelling gas which is caused by the bacteria that settle between the plumy bulges on the back of the tongue and sulfurous amino acids.

Type 2: Bad breath of throat-sinus origin. This type originates from the back of the mouth due to a lasting infection on the nose, sinuses, and throat.

Type 3: Bad breath of digestive tract. It is the type of odor originating from the stomach. When the digestive organs or enzymes are not able to properly digest food, the duty falls upon the bacteria and decay begins. The gas which is a by-product from this process are involuntary and felt by the patient as bad breath in the mouth.

Type 4: The odor which originates from the lungs and is also called "breath smell". It can occur in two ways. First is feeling of the bad breath caused by an infection in the lungs. Second is the smell which is encountered in diabetics, gout and dialysis patients, pregnant women and patients coming out of anesthesia.

Type 5: Bad breath of psychogenic origin. Patients that belong to this group do not actually have bad breath in their mouth, however they are obsessive about the fact that they have bad breath.

So, how should the treatment be?

- It is imperative to visit your dentist. Because cavities in the teeth, inflammation of the gums, a filling going bad, broken harmony of crowns and bridges are needed to be treated and brought back to health with dentistry. Oral hygiene needs to be maintained carefully and the tongue also need to be brushed alongside our teeth.

- Avoid using mouth wash that includes alcohol (an example for alcohol-free, antiseptic mouthwash which also includes zinc can be given Pharmol ZN).

- Tooth paste which includes zinc should be preferred. (The toothpastes which include zinc in alphabetical order are Colgate Sensitive, Ipana Expert 7, Ipana Pro Expert, Signal Integral and Signal Nutriactive.)

- Chewing gum that includes zinc (Carbonated Vivident is an example of this.) should be used.

- It is important to remember that alcoholic beverages also cause bad breath.

- Yogurt that includes probiotics should be consumed.

These approaches help remove Type 1 and most Type 2 bad breath. If the patients have other types of bad breath, specialists need to be contacted for the treatment of causes which lead to bad breath.

May you have healthy teeth, happy and peaceful smiles.

Zerrin Işık Tüfekçi

August 2013 Ankara Life Magazine

Zerrin Işık Tüfekçi: Minimally Invasive Approaches in Dentistry

Many patients prefer dental procedures using minimally invasive procedures, particularly when dental tissue is preserved, and treatment time is minimized. Dr Zerrin Işık Tüfekçi, the founder of Evrensel Oral and Dental Health Clinic, describes a minimally invasive approach aimed at decreasing tissue damage.

Beyond doubt, the most eye-catching area of the human face is the mouth, and particularly, the teeth. A smiling person with smoothly arranged white teeth attracts attention and a positive personality. Beautiful and healthy teeth are an invaluable factor contributing to one's personal image.

Treatment alternatives aimed at decreasing tissue damage, known as "minimally invasive procedures" is a leading topic in modern medicine and dentistry today.

As opposed to the past, today's patients possess an increased level of awareness and treatment choices available. Most patients prefer quality treatment techniques which are affordable, easy, painless, time efficient, preserve dental tissue, and minimally disrupt daily routines. For instance, patients dissatisfied with the colour of their teeth may achieve the desired colour via bleaching methods rather than tooth reduction and coating. In addition, patients concerned about teeth malformation, discoloration, and spacing usually prefer porcelain or composite laminates?requiring little or no reduction of teeth rather than tooth coating. Such treatments are known as "bonding" and "porcelain leaf." Even in implantology, short implants or various surgical approaches provide alternatives for those patients preferring a timely treatment process.

Regarding dental misalignment and crooked teeth, physical and psychological problems may manifest within an individual's social realm. Rapid discoloration and decay in crooked teeth often occur. Teeth misalignment often displays an undesirable look, constrains smiling, and usually culminates in gingival issues. Orthodontic treatment options, best treated during childhood, offer "minimally invasive approaches." Adults may feel hesitant to use orthodontic braces due to aesthetic concerns in social situations and in professional positions such as marketing, sales, media, cinema, and theatrical endeavours.

People may lose their teeth for various reasons. When teeth loss occurs, one of the treatment options is to make up for the deficiency with dental implants. When missing teeth is more than one and especially in the upper and lower back regions, the bone resorption might be excessive if the duration without a tooth is long. In such cases, applying more advanced surgical techniques may be needed, and using different equipment might be necessary. Therefore, the cost would get pricier, and the waiting period for the final prosthesis would get longer.

When the all-on-four treatment is applied, having evaluated the amount of available bone, the dentist places four implants on the front regions without using advanced surgical techniques. The patient gets a fixed temporary prosthesis on the same day. And the patient?s comfort increases in terms of chewing ability, speech functions, and aesthetics. The patients can go on with their social life without interruption, and the duration of the treatment gets shorter.

The all-on-four treatment provides a much more efficient chewing ability when compared to removable full dentures used in patients without any teeth. In addition, because the implants prevent further bone resorption of the jawbone, bone tissue is preserved. This procedure is also suitable for patients with vomiting reflex and those who cannot use a removable complete denture. It is a treatment option with a high success rate when applied by a physician with sufficient knowledge and experience.

Major material losses in teeth and tooth deficiencies in the mouth can be restored with crowns and bridges. For this purpose, metal-supported porcelains have been used safely for many years. With the development of technology and new materials, zirconia restorations have also been widely used. Zirconia, which is a kind of compound of zirconium metal, is both durable and a more aesthetic material because it is white in color. Thanks to these properties, it is suitable for use in the treatment of anterior teeth and posterior teeth where chewing forces are concentrated.

Zirconias have become more preferred because of the disadvantages of metal-supported restorations such as matte appearance, gray metal reflection and causing discoloration on the gingiva. In addition , zirconia , crowns and bridges can be used successfully for a healthy and beautiful smile because their light transmittance is close to natural teeth, they are very compatible with the oral tissues and do not cause any harm.

Innovative Technologies In Dentistry

The world is rapidly entering a new age. Some of the professions are either going to extinct or will not be carried out as we know. COVID-19 has expedited the transition to the new era since the last two years. Although we dentists are not able to continue our work remotely, materials, technologies and processes are getting their fair share. First of all, it is quite clear that workflow is now getting more and more digital. The researchers are focusing on, "How can we bring personal oral care devices, modernized dental education and experiences of patients in the clinic to the best?"

With electronic data storing, data analyzing, innovative diagnosis devices, new preventive methods and various other treatment options the world changing digital revolutions is changing dentistry as well and bringing in a innovative perspective to the traditional dental practice. Here are some of the technologies which will impact the 21st century most:

Digital Dentistry

The more information we get in the field of dentistry, determining patient's age, medical and dental history, their genome, susceptibilities, potential diseases, gets easier and treatments can be optimized according to individuals, physiology and genetics.

With an electric toothbrush-sized device called "Canary", we can detect cracks and caries that are too small to show up on an x-ray by doing a three-second scan, an toothbrush-sized device emits pulsing red laser light. Another device, the "S-Ray" ultrasonically maps both teeth and gums in 3-D to find cavities and disease. Neither of the two systems expose patients to harmful radiation.

Bioprinting

One of the most important innovations in dental technologies is utilizing 3D printers in clinics. With the currently used CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) technology, dentists are engaged in new studies that will make a difference in their treatments. A group of academics at the University of Groningen in the Netherlands are working on structures that could add tooth decay-fighting chemicals to 3D fabricated teeth.

 A team at Wake Forest University in North Carolina is working on creating human body parts and jawbone using a mixture of living cells and gel, with the goal of creating living human tissues. These promising studies may be beneficial for patients with tissue loss due to oral cancers.

Periodontist Saso Ivanovski of Griffith University in Queensland, Australia, designed new jawbone and gum tissue with samples taken from a patient's cells in order to replace lost parts. Traditionally, bone and tissue taken from the hips or jawbones have been used, but this practice can revolutionize the field.

Smart Toothbrushes

New Generation toothbrushes are no longer just for people to maintain their dental and oral care, they are also becoming fun and informative. In the article "New Toothbrush Designs, Innovations and Technologies" published by Jon Love on January 13, 2022, there will be some features of the new generation toothbrushes. On new brushes: Sustainability will be provided with more environmentally friendly recyclable brushes and soil-soluble materials. Efficiency will be achieved with brushes that clean teeth in a shorter time and provide cleaner results and most interestingly, Connectivity will be provided by smart phone-supported smart dental products that can communicate with each other, aiming to improve oral hygiene routines. Recent studies show that electric toothbrushes provide a more effective cleaning.

Augmented Reality

Augmented Reality is a technology that we hear more and more. In dentistry, it has already started to use this technology in different countries of the world, both in the training of physicians and to enrich the treatment experience of patients.

Virtual Reality (VR)

 Virtual Reality offers the user an environment in which they can experience the real world one-on-one in a 3D virtual universe through a pair of glasses. With this technology, dentistry students and graduates are provided with the opportunity to improve themselves, learn about risky surgeries, and connect from their homes to operating rooms in different parts of the world, to surgeries with different doctors.

From the patient's point of view, VR reduces the anxiety of patients, giving physicians the opportunity to work with calmer, more comfortable patients and shortens the operation time.

Tele-Dentistry

One of the most important obstacles for dentists to help their patients is distance. Tele-dentistry: It is the physician's ability to make diagnosis and treatment planning for his patient who is far away. It could be a useful model for people who can't get to a physician easily, especially in rural areas, and receives inadequate service.

This practice may be real-time in the form of a video conference in which the patient and physician can see, hear, and communicate with one another, as well as the transmission of clinical information and static images collected and stored by the dentist, as well as consultation and treatment planning information. Patients can be connected to virtual dental health clinics thanks to technology advancements in the field of tele-dentistry, ushering in a new era of dentistry.

Tooth Clenching (Bruxism)

Clenching (bruxism) is a widespread habit. Approximately %50-96 of adults face this problem. This habit is seen in about %15 of children and generally stays unnoticed.

What Causes Bruxism?

Bruxism does not have a specific reason. Various problems causing stress in daily life (intense work schedule, problematic relationships etc.) may cause clenching during sleep. Consequently, the applied force on teeth may rise up to 4-5 times compared to chewing. Unnoticed by many, teeth clenching and grinding habits stand out with unwarranted pain on various areas of the face, jaw and teeth.

Grinding and clenching usually appears involuntarily during the night when sleeping. Although short-lived, the force that emerges during this time may cause serious damage to both the teeth and tissue. Depending upon the erosion, it can cause hot-cold sensitivity, fractures, pain on the jaw, face and temporomandibular joint.

Due to size reduction on the teeth during the advanced stages of erosion, patient's frontal vertical face height will be diminished as well as a decline is observed in cheek and facial structure and aesthetic issues will appear. Bite plate used for clenching treatment will prevent damage by greatly minimalizing the strain on your teeth created by force. These bite plates have various hardness levels to be utilized in advanced stages of the condition.

This condition is more frequently encountered in patients who have an inadequate bite (malocclusion), children with parents that have bruxism.

What Are The Symptoms Of Bruxism?

• Tooth abrasion,
• Fractures on teeth and fillings (especially front teeth),
• The grinding sound heard by the patient?s partner during sleep
• Pain on facial muscles and joint (temporomandibular joint),
• Sounds which are heard during the opening and closing of the jaw,
• Headache,
• Dangling on teeth and widening of the spaces in between them,
• Sensitivity

How Is Bruxism Treatment Handled?

The best treatment method is nightguards prepared by your dentist. Advanced treatment methods may be utilized if necessary.

Nail Biting Habit

Children usually don't start nail biting until the age of 3-4. %33 of children have nail biting habit. During puberty, the amount of nail biting children increases to %40-45. Children with nail biting habits also have parents possessing the same habit. Most of the children who get social validation abandon this habit altogether.

Causes of Nail Biting Habit

The underlying causes of this habit are usually psychological like thumbsucking. Nail biting is considered as a sign of insecurity. How patients treat their children is also an important factor. Having a strict, overbearing and authoritarian parenting atmosphere at home, jealousy, inadequate care and attention, psychological discomfort and anxiety. The habit is also acquired by imitating others. Any relative who takes up the habit of nail biting will catch the attention of the child. Discriminative or overbearing behaviour from parents can cause rivalry among siblings and trigger nail biting habit.

The Treatment of Nail Biting Habit

The habit needs to be ignored by the parents till the ages of 3-4. If the habit continues, the causes of child's anxiety and maladaptation need to be investigated and resolved. Methods such as reprimanding, frightening or punishing the child will not be beneficial towards eliminating the habit. Children need to be sheltered from any kind of anxiety. Children being involved in violent events is ill-advised due to the anxiety it will bring to the child. Old and light gloves can be worn to prevent nail biting overnight. Rewarding the children every once in a while for their success may be beneficial as well. On the other hand, nails can be deeply clipped.

Thumbsucking Habit in Children

Thumbsucking is a habit which is observed in children up to the age of 3-4 without any kind of psycho-pathologic cause. Most of the babies suck their thumbs or other fingers. The most important reason of encountering the harmless habit in almost all babies is that infants adopt the habit inside the mother's womb.

Approximately half of 1-year olds have the habit of thumbsucking. After 9 months, it is observed that thumbsucking is closely related to sleep. The efforts of getting the children to shake their habit is met with resistance until the age of 3. While some babies do it as their teeth are erupting, others use this as a method of expressing embarrassment or boredom. Usually becoming frequent at 18 months of age, the habit is expected to vanish around the age of 4. Research shows that thumbsucking is harmless if it stops at ages 5-6. However, if continued, it could cause deformations in teeth.

Parents may worry thinking the effects of thumbsucking on jawbone and teeth. It is true that thumbsucking push teeth forward. How much thumbsucking affects the teeth depends on the duration of the habit and most importantly, the position of the thumb.

Patients receiving treatment due to cancer go through several changes in their dental health. Among the changes occurring on the oral mucosa, the most common is mucositis. It manifests after the beginning of the treatment, due to the decline or complete loss of epithelium. Mucosa becomes hyperemic (rubescent). Velum, pharynx, palate and cheek mucosa are the first affected regions. Patients have pain and burning complaints. Depending on the inflammatory changes in the mucosa, secondary infections may develop. Candida albicans is the most common oppurtunist infection that can develop. Sense of taste may change and this condition may occur on the first weeks of the treatment, especially on patients with head-neck cancers. It has been reported that parotis, submaxillar, sublingual and other minor salivary glands of patients receiving treatment for head-neck cancers are affected. Consequently, saliva flow and content is adversely affected, causing cotton mouth condition. The burning sensation that derives from cotton mouth, diminished masticatory ability, food getting stuck on teeth and mucosa, hot-cold sensitivity and fungal infections are all conditions which can be observed. Cotton mouth is also the most important cause for decays due to radiation. Saliva's antiseptic properties are disabled with radiotherapy, making saliva unable to perform its protective duties of removing bacteria. As a result, bacterial flora in the mouth undergoes changes and continues on for 4 years. One of the direct causes of raditation on teeth is reduction of minerals on tooth enamel (decalcification). Radiation also leads to insufficient development on teeth in development stage.

The most important complication is the changes forming on bone tissue. Exposed to radiation, the bone becomes brittle and there's a delay in the regeneration of the traumatized bone tissue. Changes are observed on the veins providing blood for the bone cell matrix. Sensitivity to infection increases and the rate of regeneration diminishes or stops altogether, inevitably causing osteoradionecrosis. Osteoradionecrosis is described as the development of bone necrosis and the presence of open bone with or without pain on the area of radiotherapy. Because of the fact that bone tissue is 1.8 times denser than soft tissue, a large portion of the radiation is absorbed by bone tissue. Lower jawbone absorbs more radiation due to its structure compared to upper jawbone. The risk of osteoradionecrosis is consequently bigger. Serious complications may occur when patients are exposed to radiation on head-neck area, aggressive periodontal treatment, infections or mechanic irritation. For this reason, the basic principle for radiotherapy patients is to receive their dental treatments at least 14 days before they are exposed to radiation. On some patients, trismus may occur due to muscle fibrosis following radiotherapy. Trismus is more frequently encountered on patients who require radiation on their temporomandibular joint and chewing muscles (masseter) or following the tumor treatments on nasopharyngeal, palatal and nasal sinuses.

Similar oral changes and complications are observed on chemotherapy patients. Stomatitis in addition to mucositis are observed on such patients. Stomatitis occurs due to trauma on the mucosa with orthodontic apparatus or with infections. The difference between mucositis and stomatitis is that stomatitis is treatable and based on a specific reason while mucositis derives from the impact of chemotherapy on cells.

Candida Albicans is the most common oppurtunist infection. Although, HSV (Herpes Simplex Virus), gram-negative or positive coccus infections develop in addition. Fungal infections such as Candida Albicans are encountered mostly on tongue, cheek mucosa and pharynx.

Symptoms caused as a result of the infection are burning and prickly sensation, pain and ulcer formation on vesicle lesions due to tearing of vesicles. Oral bleeding may occur due to the thrombocytopenia and clotting disorder caused by chemotherapy. Various medications used in chemotherapy cause changes in the saliva quality and quantity on the second day of the treatment. Degree of cotton mouth is directly proportional with duration of treatment. Some medications can cause neurotoxicity. The amount of nerve damage is dependant on the dosage and duration of the treatment. Especially on cases with head-neck area cancer treatment, partial paresthesia may occur on the mouth and its surrounding area after being stimulated by trigeminal nerve. In addition, patients may have intense pain complaints described as toothache on the lower jaw area of molar teeth. It is difficult to diagnose neurotoxicity. Pain complaints subsiding after the cessation of chemotherapy medication confirms the diagnosis.

Precautions

• Patients should schedule their appointments with a dental professional at least a month before radiotherapy and chemotherapy. There has to be a window of at least two weeks between the tooth extraction with radiotherapy and chemotherapy.
• Calculus scaling needs to be performed before radiotherapy. Advanced periodontal treatments have to be performed if necessary. A perfect oral hygiene must be achieved and the patient needs to maintain discreet oral care. Chronic periodontal conditions may move to an acute stage. Oral hygiene is very important due to this condition.
• Fluoride application should be performed to prevent decay formation and the patient needs to use toothpaste with fluoride.

Things to Do During Radiotherapy and Chemotherapy

• Patient needs to maintain a pristine oral hygiene. A soft, small toothbrush should be used and the patient must be careful not to brush harshly. It is not recommended to use oxyjet or electric toothbrushes. If the patients are unable to brush their teeth due to nausea, burning sensation on the gingiva or any other reason, gargling with carbonated water will suffice.
• A proper oral hygiene is necessary in case of acute mucositis. It is highly beneficial to gargle every 3-4 hours with half teaspoonful of salt or soda in warm water. If there is pain during mastication, Dyclone (0.5%) solution should be used 20-30 minutes before every meal.
• Gargling with salty, warm mineral water or topical anesthetics is effective for symptomatic treatment in cases with candida albicans lesions in addition to mucosal changes. Acute or chronic oral fungi are effectively treated by taking "Nystatin". Performing the same treatment on partial removable dentures is essential in controlling the fungal infection.
• Inflammation or ulcerations can be treated with antimicrobial gargle (chlorhexidine gluconate, benzydamine HCl).
• Analgesic and surface covering sticky gel (anestol or protofix) should be used for treating ulceration and inflammations.
• In the case of xerostomia (cotton mouth), frequent hydration is needed with soda water, gum, candy and ice cubes. It is also highly recommended not to consume acidic or spicy food along with too hot or too cold food. Alcohol and tobacco product consumption needs to be discontinued. In addition, potassium iodide medication, lemon tablets, sialogogue agents (Biotene etc.) and artificial saliva should be used.
•  In case of Trismus, regular home exercises are highly recommended. Special apparatus should be made by the dental professional if necessary.

The increased amounts of glucose in patients with uncontrolled diabetes provide a comfortable environment for bacteria to reproduce. On some diabetic patients, saliva thickens and is reduced. As a result, the antiseptic cleaning process with saliva is interrupted. In addition, diabetes may affect venules over time, causing circulatory issues. Unable to receive enough blood, the gingiva becomes more susceptible to inflammation as well as a diminished rate of healing. High blood sugar is another factor which leaves the body defenseless to bacteria and slows the healing process. Diabetic patients have more than one factor causing oral health issues. Gingivitis may cause serious problems if it's not treated on time. Infections inside the mouth make it harder to control sugar and the condition becomes a vicious circle. Advanced cases of gingivitis are only treatable with surgical intervention.

Does Diabetes Hinder Teeth and Gingival Treatments?

Patients with uncontrolled diabetes need to be medically examined before dental treatment and glucose levels in the blood need to be adjusted. Only urgent treatment applications are recommended with antibiotics prophylaxis. Controlled diabetes and insulin usage are not direct obstacles or dangerous. However, delay in healing compared to normal individuals may be encountered. This period can go smoothly if the necessary precautions are taken.

How Can Teeth and Gingiva Problems Be Prevented In Diabetics?

In order to prevent gingiva, bacterial plaque needs to be eliminated by maintaining a good oral hygiene before anything else. Controlling diabetes will increase the gingiva's resistance against bacteria. In addition to regular oral hygiene maintenance, these patients should be under regular medical supervision.

It is a condition which occurs when the salivary gland function is reduced. For example; aging, several systemic diseases (AIDS, diabetes, Parkinson's), loss of masticatory ability, surgical removal of salivary glands, permanent damage on salivary glands after radiotherapy, various medications (blood pressure, antidepressants etc.), caffeine and alcohol consumption are major causes of xerostomia. As a result of the reduction in saliva, very serious conditions such as burning sensation on tongue, difficulty in consuming solid food, speech problems, frequent vomitting, difficulty in the use of dentures, lip dryness, reduced or distorted sense of taste (hypogeusia, dysgeusia) and oral malodor may occur. The antiseptic properties of saliva keeps teeth clean and prevents decay. On patients with xerostomia, due to the fact that bacterial plaque and food particles will not be able to be cleaned by saliva, tendency for gingival diseases and decay formation will increase.

How Is Xerostomia Controlled?

The patients need to frequently hydrate themselves and chew sugar-free gum. Tobacco and alcohol consumption needs to be reduced and artificial saliva tablets need to be used. Regularly using mouthwash that stimulates saliva flow and toothpaste are other types of precautions.

Braces consist of metal, ceramic and plastic selections. However, orthodontic treatments are usually performed with stainless steel braces. Ceramic and plastic braces are generally preferred due to aesthetic concerns. However, at the end of the treatment, plastic braces may become stained and discolored. On plastic or ceramic braces, treatment duration may extend due to increased friction between the braces and the bracket. Your orthodontist will present possible options with you.

Braces work by applying pressure on teeth towards their desired positions. They are used for an average of 1-3 years. Adjustments on braces are needed to be made due to the change in teeth positions. In the past, braces consisted of thick steel bands surrounding the teeth. Braces became progressively smaller thanks to technological advances and orthodontic bands became obsolete or rather, rarely used.

Your dentist will attach mini brackets to your teeth using special adhesive agents. Afterwards, your dentist will pass a spring wire through these braces. This wire will provide navigation towards the route for the teeth to move. Small elastic bands called ligature may be used for attaching braces to the wire, and the patient can select from different color selections on every appointment

Basically, there are two types of orthodontic treatments; removable and fixed apparatus. Removable apparatus can be removed by the patient at will meanwhile fixed apparatus are attached to the teeth by your dental professional. These apparatus divide into sub groups. For example; removable apparatus are for treatment and post-treatment reinforcement. Fixed apparatus are divided into two groups such as metal and aesthetic braces.

Every individual has different issues and expectations. It is imperative to establish an exclusive treatment plan for each patient. Materials and treatment options differ from one another. Treatment age also differs from person to person in addition to treatment duration, which is different for the characteristics of each problem. Shortest treatment time is 6 months. Treatment lasting 1-2 years are the most common. Treatment can also last for 3-4 years. It is definitely a painless process. Some minor issues regarding adjustment can be encountered in the first 2 weeks. The patients can continue their normal lives by adhering to certain dietary instructions given by the dental professional. Follow-up appointments for adjustments or changes under doctor supervision is necessary for a healthty course of treatment.

Dental floss cleans the microbial dental plaque and food debris between the teeth. The types of floss are waxed, non-waxed, nentol, flouride, chlorhexidine. Flossing is recommended after brushing.

When flossing, the rope has to be wrapped on both middle fingers and guided by two index fingers. If the patient is unable to floss with this method, slingshot-shaped special tools, including rope docked on a holder which is angled properly for the mandibula and maxilla, can be used.

During flossing, it is recommended to go underneath the gum tissue and clean the whole surface with the motion of a seesaw and refrain from cutting the gum tissue. It is recommended to floss at least once a day.

As known by many, the last teeth to erupt are third molar teeth. They begin erupting between ages 17 to 25. It is debatable whether to keep or extract these teeth. If erupted in correct position, they are harmless unless they damage the surrounding tissue. Tooth at an abnormal position on the jaw may be scheduled for extraction considering possible damage in the future. In cases with lack of space, the eruption remains incomplete due to teeth getting stuck between the gingiva-jawbone and the adjacent tooth, thus becoming completely or half-buried inside the jawbone.

Decay: Bacteria accumulates in the cavity of the newly erupting teeth, consequently becoming a threat for the adjacent molar and the wisdom tooth. It is difficult to realize and treat this type of decay. A harsh outcome may occur involving pain, infection and abcess formation.

Pericoronitis (inflammation of half-buried tooth): An infection site manifests at the accumulation site of bacteria and food particles on the gingiva of a partially erupted third molar. This condition causes malodor, pain, oedema and trismus (locked jaw). The infection may spread onto the cheek and neck via lymph nodes. This surface is prone to becoming infected easily.

Pressure Pain: During eruption, pain may be experienced due to pressure compression on adjacent teeth. On several situations this pressure may lead to erosion.

Orthodontic Causes: Many individuals seek orthodontic treatment in order to fix malformations on their teeth. Due to the eruption pressure reflecting on other teeth, condition of crowding may become worse.

Prosthesis-related Issues: Third molars are need to be considered when planning for prosthesis. Because, a prosthesis replacement may be needed according to the changing structure of the mouth after third molar extraction.

Cysts: Cystic cases caused by buried teeth are observed. Cyst causes bone loss, jaw widening and relocation or harm of adjacent teeth. The tooth must be extracted in order to prevent bone loss and cyst must be removed. Cysts rarely morph into tumors and reach dimensions big enough to cause fractures on the jawbone.

Why Does a Badly Positioned Third Molar Have to be Extracted?

• Third molars are on hard-to-reach areas with brushes or floss. Bacteria, acid and food particles causing decay easily accumulate on this area. If the tooth decays and isn't restored with filling, the tooth will be inflamed over time.
• Because of the difficulty in maintaining a proper hygiene of these teeth, bacteria and food particles may cause malodor.
• Horizontally buried tooth under the gingiva may apply pressure which can result in relocation of other teeth and crowding.
• Bacteria accumulating under the gingiva of buried teeth may cause infections.

When Is The Best Time for Third Molar Extraction?

Genç yaşlardaki operasyonlar teknik olarak daha kolaydır ve iyileşme daha çabuk olur. 40 yaşın üstünde operasyonlar epey zorlaşır. Ayrıca, yaşın artmasıyla birlikte yan etkiler de artar ve iyileşme dönemi uzar.

Can Teeth Be Extracted On Cases With Acute-Active Infections (Acute Pericoronitis)?

Generally, no. If the procedure is performed when there is an infection, it can spread to the environment and may cause a delay in healing. The infection is controlled with the help of mouthwash and antibiotics. It is recommended to extract the teeth after the condition becomes chronic.

Is It Different from Other Types of Teeth Extraction?

The difficulty of the procedure changes according to the position, size and shape of the third molar. After a simple extraction, there may be mild swelling, pain and bleeding. Various complex extraction methods requiring special processes may also be applied. The precautions and recommendations from your dental professional will minimize the side effects.

Following the extraction, a healing disorder called dry socket may occur. Blood won't accumulate in the extraction site and pain may be experienced. The symptoms subside in a few days. Additionally, if the patient follows the dental professional's instructions, the risk of dry socket dramatically decreases.

Bone structure becomes more dense and flexibility is reduced with old age. Consequently, extraction procedures are more difficult and healing periods may be longer.

Post-Operative Care Instructions

• Wound area should not be irritated. Otherwise, pain, infection and bleeding may occur.
• Avoid chewing with the extraction site for the first 24 hours.
• Avoid smoking for at least 24 hours. Because tobacco increases the amount of bleeding and interferes with the healing process.
• Avoid spitting. Otherwise, the amount of bleeding will increase and clot may change position.
• Bleeding should be checked for stitches. If there are no stitches, sterile gause should be applied as tampone. Gause should be kept in mouth about 30 minutes for clot formation. If the bleeding continues after gause is removed, a new one should be applied.
• After the procedure, circulation on the area is slowed in order to control the amount of swelling by applying cold compression. The procedure should be as follows: cold tampone application for 20 minutes - 10 minute rest - cold tampone again for 10 minutes.
• After the first 24 hours, it is beneficial to gargle with warm salt water every 2 hours. The mixture can be prepared by adding half spoonful of salt to a glass of warm water.If necessary, your dentist may recommend mouthwash as well. People with high blood pressure should be careful about salty water.