Inside Dentistry. Student S Book

Inside Dentistry
A Comprehensive Course of
English for Specific Purposes
Student’s Book
Inside Dentistry
A Comprehensive Course of
English for Specific Purposes
Student’s Book
Author:
Luisa F. Acosta Ortega
In collaboration with:
Cecilia Venzant Fontaine

Raiza Texidor Pellón
Author:
Luisa F. Acosta Ortega

EFL Associate Professor
Head of the English Department, School of Dentistry
Santiago de Cuba University of Medical Sciences
E-mail: lacosta@ medired.scu.sld.cu
In collaboration with:
Cecilia Venzant Fontaine
EFL Assistant Professor, School of Dentistry
Santiago de Cuba University of Medical Sciences
Raiza Texidor Pellón, MA

EFL Associate Professor
School of Dentistry of Havana
ACKNOWLEDGEMENTS
We would like to thank all the dental specialists from our Dental Faculty of Santiago de
Cuba and colleagues who helped us with ideas and suggestions.
 Dr. Belkis Ferrer Callamo

Clinical Professor. Restorative Dentistry
 Dr. Teresa Ramos Aroche

Clinical Profesor. Surgical Dentistry
 Dr. Xiomara Montoya Migues

Clinical Profesor. Pediatric Dentistry
 Dr. José Suarez Lorenzo

Clinical Profesor. Orthodontics
 Dr. Javier Lozada Garcia

Clinical Professor. Orthodontics
 Dr. Julieta Rodríguez Pastó

Professor. Health and Society
 Dr. Leyco Ley López

Clinical Professor. Prosthodontics
 Dr. Noris Viscay Hierrezuelo

Clinical Professor. Periodontics
 Jaqueline E. Rosales Moreno, BEd

Head of the English Department. Faculty 1.
Santiago de Cuba
 Alfredo García Suárez, BEd

School of Dentistry of Havana
Design: Luis Alberto Montoya Acosta

Table of Contents
Unit 1
Approach to Dentistry
Unit 2
General Dental Practice
Unit 3
Periodontics
Unit 4
Endodontics
Unit 5
Radiology
Unit 6
Orthodontics
Unit 7
Pediatric Dentistry
Unit 8
Prosthodontics
Unit 9
Surgery
Unit 10
Oral Pathology
Read and Report

Unit Professional Communicative Listening
practice functions
1 -Dental fields -Expressing Text about dental curriculum

Approach to -The mouth and comparisons
Dentistry the teeth -Words used to
denote position
2 -Dental caries -Giving polite -Conversations dentist - patient at

General -Dental chart instructions the dental operatory room
Dental Practice -Procedure for -Comparisons to -Pronunciation of past regular verbs
dental express proportion
restorations -Describing and
defining things
-The use of other
and another
3 -Periodontal -Giving advice -Patient-dentist conversations

Periodontics diseases -The Gerund Pronunciation practice: new words
-Brushing and word stress
technique
--Periodontal
instruments
4
Endodontics -Diagnostic -Using impersonal -Conversations patient- doctor
procedures language -Pronunciation practice: blending ,
-Procedure for -Language used in new words
Root canal case reports
treatment -Suffixes -ist, -ic,
-Procedure for a -ics
pulpotomy
-Materials and
Instruments
5 -Types of -Expressing -Conversation at the x-ray
Radiology radiographs alternatives department
-Describing (either… or) -Pronunciation practice: new words ,
radiographs ( neither…nor) word stress
-Explaining
something to the
patient
--Praising
Unit Reading Writing Read and Report
1 - Dentistry as a Writing about the
Approach to career oral cavity and -Bad breath
dentistry -The mouth tooth eruption
-Tooth eruption
2 -Dental caries -Writing pieces of -Nature of dental caries

General Dental -Dental devices advice -Eating disorders
Practice and instruments -Describing work -Fluoride and oral health
places
Unit3 When periodontal

Professional -Writing a leaflet Listening
Communicative -The connection between Gum
Periodontics disease strikes
practice -Writing
functions in a disease and heart disease
dental record - Diabetes and periodontal disease
6 -Deforming -Two-part verbs - Herbal remedies
-Orthodontist –patient conversations
4
Orthodontics When tooth pulp
habits -Writing
-Expressinga case -Apical abscesspractice: third person
-Pronunciation
Endodontics is -Orthodontic
damaged report
necessity -Dental
–s, trauma
new words
treatment -Writing
-Prefixesadis-,
referral -Tooth bleaching
TMJ disorders -Writing
un-, im-/about
in- the
7 Prevention and steps to make a
-Explaining -Dentist treating a child at the dental
Pediatric Dentistry treatment of pulpotomy
purpose clinic
5 -Dental radiology
oral diseases in -Writing about
-Giving reasons -Fundamentalspractice:
-Pronunciation of dentalnew
radiology
words ,
Radiology -Most common
children radiology - Dental
word radiology for children
stress
radiographs used -Writing a
8 in -Patients
dentistry summary
-Infinitives -Conversation patient- prosthodontist
Prosthodontics rehabilitation -Expressing -Pronunciation practice:
-Process for a habituation new words , word stress
denture -Agreeing and
construction disagreeing
--Denture -Words Often
insertion and confused: lose,
adaptation loose
9 -Management -Reassuring -Conversation surgeon-patient
Surgery of a pregnant -Talking about -Pronunciation practice:
woman with an lab results new words , word stress
Impacted tooth -Suffixes – less,
-ness
Unit Reading Writing -Noun formationRead and Report
-Risk factors of -Discussing a -Conversation patient- dentist in a
10 oral tissue diagnosis regular check-up
Oral
6 Pathology lesions
When teeth -Writing -Reminding
about -Bruxism-Pronunciation practice:
Orthodontics -
are irregularOral Cancer
orthodonticthings to-Invisalign
the new words , word stress
braces
Screening patient
Program
-Procedure for
oral self
examination.
appliances -The TMJ syndrome.
-Writing a referral
-Writing about non-
verbal data
7 Pediatric .Writing about -Breast feeding and infant tooth decay.
Pediatric dentistry children’s teething -Pits and fissures sealants
Dentistry .Writing a case
report
.Writing about non-
verbal data.
8 When teeth .Writing a referral -Dental implants.
Prosthodontics are missing .Writing about the -Oral mucosal disorders in denture wearers.
process for a - Denture stomatitis
construction of a
denture
.Writing about the
importance of
prosthodontics
9 When .Writing a case -Pregnancy and oral health.
Surgery Surgery is report -Wisdom teeth extractions.
needed -Anesthesia at the dental office
.Writing a
summary
10 Oral Cancer -Writing a case -Biopsy

Oral Pathology report -Oral lesions common to AIDS
-Writing an article -Tobacco and oral health
about the oral
health
Introduction
Inside Dentistry is a post-intermediate course designed for dentistry students with the aim
of teaching the professional communicative competence. The course covers the skills of
listening, speaking, reading and writing as well as subskills and specific aspects of the
different subsystems of the language in correspondence with the possibilities offered by the
content.
Course Length.
This course is designed for about 100 hours of class instruction time. Suggestions for
optional activities are given in the teacher’s book to extend each unit; the same time there
are other activities to be done either in class or as homework
Course Components
Student’s Book: The student’s book contains ten units divided into three or four lessons.
After Unit ten there is a set of reading texts which can be used to develop Read and Report
activities or to any other purpose such as making summaries and translation.
Teacher’s book: It contains suggestions and answer keys for the activities of each lesson.
The teachers may find updated information about specialized dental fields as well as notes
about some important procedures carried out in the dental practice.
Methodology
Inside Dentistry is intended to provide enough practice of the language with the specific
purpose of achieving professional communicative competence in Dentistry students using
the English Language. There is a variety of meaningful activities where the students have
the opportunity to personalize the language making use of their socio-professional
experience.
The course has the following features:

 The four skills of listening, speaking, reading and writing are integrated and closely
related to the student’s socio-professional context.
 It harmonizes with methods and procedures of General English. Making use of
whole class activities role plays and tasks done in small groups, pairs or
individually.
 It is interesting and motivating as the students perform tasks they usually carry out
in their daily practice.
 Personalization is paramount in the development of tasks. Personal opinions,
experiences and preferences are exchanged among students.
Unit 1. Approach to Dentistry
Lesson 1
1. Quick Glance
French dentist Pierre Fauchard (1728), recognized as the father of modern dentistry,
provided a comprehensive and organized treatise on dental science. His work played a
key role in enabling the specialty to break away from medicine and establish itself as a
scientifically based profession.
Discuss:
 What do you know about the recognition of Dentistry as a specialty in your
country?
 Can you mention some precursors of Dentistry in your country? Have they made
contributions to this science?
2. Reading
An interesting career
Dentistry is the practical application of knowledge of dental science to human beings. A

dentist is a professional practitioner of Dentistry. In most countries, to become a qualified
dentist, one needs several years of training in a university and some practical experience
working with actual patients' dentition.
Dentistry involves:
 Detection of diseases: Dentists are often the first health care professionals to
recognize and identify a wide variety of diseases, ranging from hypertension to
cancer.
 Diagnosis: Dentists diagnose and treat problems affecting the teeth, gingival tissue,
tongue, lips and jaws. To accomplish this, they utilize new technology such as
computers and magnetic resonance imaging.
 Aesthetic improvement: Dentists improve patients’ appearance by using a wide
variety of cosmetic dental procedures. These services can make patients feel better
about their smiles.
 Surgical restoration: To repair, restore and maintain the teeth, gums and oral tissues
that have been lost or damaged by accidents or diseases, dentists perform trauma
surgery, implants, tissue grafts and laser surgery.
 Public education/prevention: Dentists teach good habits for good health. They
educate their patients, as well as the general population, on how to achieve oral
health and prevent disease.
Dentists treat people, not just teeth and mouths. They interact with people of all ages,
cultures and personalities. The dentist’s typical day is diverse and interesting. They should
have:
Creativity — Dentists are artists as well as scientists. To brighten one tooth or realign an
entire jaw, dentists must have an artist’s aesthetic sense to help their patients look their
best.
Prestige — Dentists provide an essential health care service. They are highly respected
within the community. Dentists are skilled, conscientious, civic-minded individuals who work
with community leaders, educators, other health professionals and government officials.
Flexibility — Dentistry allows you to be your own boss. Dentists can balance their personal
and professional lives to meet their individual needs and desires.
Dentists perform an important public service to help people maintain their health and
appearance. To serve the present and future oral health needs of their patients, dentists
enjoy the challenge of a lifetime of learning.
Most dentists practice general dentistry, which give them the capability of providing
comprehensive care to a wide variety of patients. Some dentists choose to limit their
practices to one of the nine recognized dental specialties.
(Taken and adapted from: http://www.blackwell-

synergy.com/doi/abs/10.1111/j.1532-849X.2006.00130.x)
3. Pair Work
Ask and answer
1. According to the text, what is needed to become a qualified dentist?

2. Describe briefly the areas dentistry involves.
3. Do you agree with the idea stated in the text that the dentist’s typical day is diverse
and interesting? Give reasons for your answer.
4. Apart from the personal characteristics mentioned, what others do you think a dental
professional should have?
4. Group Work
Discuss in groups the following:
 General Comprehensive Dentist versus Specialist of a dental field
5. Listening
Listen and complete the blank spaces.
A dental education usually requires five ______of dental school and to go into one of the
eight__________, students need a minimum of two years of __________schooling. The
dental curriculum generally includes:
-Basic health sciences, including__________, biochemistry, histology, microbiology,
pathology, pharmacology and____________, with emphasis on dental aspects.
- Application of these health sciences, providing _________ care in dental school clinics.
Practice management includes talking to patients, the use and management of _______
________staff, business management, professional ethics and ____________ health.
6. Class activity
1. Disorders of the oral cavity are diverse and treated through different specialties. Match
these specialties with the corresponding definition.
1.Operative Dentistry a__ It deals with the surgical procedures in and about
the oral cavity.
2. Endodontics b__ It deals with the alignment of teeth and arches as
they relate to function aesthetics.
3. Orthodontics c__ It deals with a wide variety of children's dental
problems.
4. Oral surgery d__ It deals with diseases of the supporting structure of
the teeth.
5. Periodontics e__ It is concerned with the preservation of the natural
teeth and the supporting structure as well as the
diagnosis, prevention and restoration of teeth.
6. Prosthodontics f__ It is the science and practice of root canal therapy in
a tooth, from which the vital pulp tissue has been
removed.
7. Pediatric Dentistry g.__ It deals with the replacement of missing teeth with
artificial materials, such as a bridge or denture.
7. Pair Work
 Which of the previous dental fields would you like to choose when you graduate?
Tell your partner about your preference giving the pros and cons.
8. Writing
Write one or two paragraphs about the most relevant aspects of dentistry as a career.
Lesson 2
1. Quick Glance
If the eyes are the "windows of the soul," then the mouth is the "doorway to the body."
 Discuss the above statement with your partner.
2. Reading
Make a quick reading of the text and say Yes or No if the following aspects are included in
it.
a. Function of different parts of the mouth

b. Different types of teeth
c. Description of the tissues of the teeth
d. Time of eruption of the teeth
e. Some disorders of the oral cavity
The Mouth
With our mouth and teeth we are able to talk, to smile, to express emotions and to enjoy
eating. The lips are the entrance to the oral cavity. The oral cavity is bordered by the lips,
the cheeks, the floor of the mouth and the tongue, and by the soft and hard palate, also
called “the roof of the mouth”.
There is always saliva in the mouth. Saliva contains substances that help digestion. It also
contains minerals and proteins that protect the teeth.
The tongue has a very important function, that of taste. It enables us to tell the difference
between sweet, salty, sour or bitter foods. When we eat, the tongue, lips and cheeks place
pieces of food between the teeth so they can be chewed and mixed with saliva. They can
then be swallowed and digested.
The teeth are arranged in two arches in the upper and lower jaws. They are surrounded by
the lips, cheeks and tongue. Each tooth consists of a crown and a root which join in the
slightly thinner part, called the neck. The crown is that part visible in the mouth. The root is
inside the jaw and holds the tooth in place. Teeth are of different shapes and sizes
depending on their functions.
The crown of a tooth is covered with enamel. This is the hardest tissue in the body. Under
the enamel lies the dentine. This is hard also and makes up the main part of the tooth.
However it is not as hard as enamel. It is a living tissue and become painful and sensitive
under certain circumstances.
In the middle of the tooth is the pulp. It contains nerves and blood vessels which enter the
tooth through a very fine hole in the tip of the root. The pulp connects the tooth to the rest of
the body and is the source of all nutrition to the tooth as well as all pain sensation.
The tissue that surrounds a tooth and covers the jawbone is called the gum or gingiva.
Healthy gingival tissue fits closely around the tooth and feels firm to the touch and does not
bleed if you press on it gently. Bleeding gingiva indicates gum disease and the need for
better cleaning of teeth.
The cementum, a bony substance, is very thin and covers the surface of the roots. Its
purpose is to attach the tooth to the jawbone and the gums.
(Taken and adapted from Manual for the Atraumatic Restorative Treatment, approach to
control dental caries)
3. Vocabulary
Find in the text equivalents for the following words:
1. flavour ______________ (P 3)
2. masticated ______________ (P 3)
3. a little _____________ (P 4)
4. support, bear ____________ (P 4)
5. adjust __________ (P 7)
4. The World of Words
The following words are used to denote position. They can be used either as prepositions
or adverbs.
Up
Around
Low
In / Inside
Between Over
On Under
1. Study the chart carefully and use the words in sentences of your own.
 There was redness around the first upper molar. (preposition)

5. Class Activity
1. Look at the picture of the mouth and identify the different parts.
2. Look at the following illustration of a section of a tooth. Identify its parts and tissues and
then describe each part.
6. Writing
Read the text again and write a summary about it
Lesson 3
1. Reading
1. Read the text carefully and say if the following ideas are mentioned in the text.
a. Teeth development in the fetus
b. Time of tooth eruption
c. Teeth disturbances caused by fetal trauma
d. Disorders of tooth development
e. Types of teeth and function
Tooth eruption
During our growing period we get two sets of teeth. They usually begin to appear (erupt)
when a child is about six months of age. Additional teeth will then appear at the rate of
about one per month. There is usually a range of plus or minus two to six months when
teeth erupt and when they shed (fall out). The primary teeth develop during the first two
years. These then are gradually replaced by the permanent teeth between the ages of 6 –
12 years.
There are 20 primary teeth, 10 in each jaw. In each jaw there are:
 Four front teeth: the incisors
 Two canines
 Four molars
The position of the teeth as they erupt depends on many factors. The teeth on either side
and the teeth directly opposing each tooth help give guidance for proper position. If the
teeth on either side or any opposing teeth are missing, a tooth may erupt incorrectly.
If baby teeth do not fall out on time, they may prevent the permanent teeth from developing
properly. In the attempt to erupt, the permanent teeth may find another path in which to
erupt, thus causing misalignment. Sometimes, more than the normal number of teeth erupt;
these extra teeth are called supernumerary teeth. They may cause overcrowding and may
have to be pulled. Some permanent teeth may not develop at all. In this case, the baby
teeth will not fall out and should be kept as long as possible. The position of teeth may also
be altered when baby teeth are lost too early due to decay, accidents, or other causes.
Adults usually have 32 permanent teeth, 16 in each jaw. In each jaw there are:
 Four front teeth (incisors)
 Two canines
 Four pre-molars
 Six molars
Incisors are the sharp, chisel-shaped front teeth used for cutting food. Cone-shaped
canines or cuspids are used for tearing food. The premolars or bicuspids have two cusps
that are used for tearing and crushing food. The molars are located in the back of the mouth
and have several cusps that are used for grinding food. The furthest (third) set of molars in
the back of the mouth is also known as wisdom teeth.
control dental caries)
2. Vocabulary
Find in the text equivalents in meaning for the following words or expressions:
a. variety, extent______________
b. way, route ______________
c. misaligned teeth closed together _____________
d. extracted ______________
e. the way third molars are called __________
3. Class Activity
1. Look at the pictures and write the names of each tooth.
1. Knife 2. Fork 3. Nutcracker 4. Mortar
2. These objects represent what each tooth does: (Grasp and tear, crush and tear, grind
and chew, cut.) Identify each object with the corresponding function.
4. Language in use: Comparatives
-A primary tooth is smaller than a permanent tooth
-Roots of primary molars are more slender than the roots of permanent molars.
- Having a good health in a primary tooth is as important as in a permanent tooth
1. Look at the illustration of a permanent and a primary tooth and keep on comparing them
according to:
 Size
 Roots
 Dentine
 Enamel
5. Class activity
Outline the ideas you would include in an educative talk to be given in a school of the health
area you assist. Include the most important aspects of this unit.
6. Writing
Expand the previous ideas into paragraphs
Unit 2. General Dental Practice
Lesson 1
1. Quick Glance
One of the first data referring to dental diseases is found in the

Sumerian boards of clay (5000 BC) engraved in cuneiform writing,
where it is stated that the toothache was due to small warms inside
the tooth, which gnaw it.
Discussion:
 Do you know about other ancient beliefs in relation to toothache?

 According to your own experience, what are the most common causes of toothache?
2. Conversation
Listen to the conversation between a dentist and a patient and be ready to say if the
following statements are true or false.
1. Mr. Suarez visits the dentist because he feels tooth sensitivity.___

2. He complains of a continuous pain.____
3. He has dental caries.____
4. A dental extraction will be required.____
5. Mr. Suarez needs several appointments to solve his problem.____
Mr. Suarez goes to the dentist.
Dr. Verdecia: Good morning, Mr. Suarez. What’s the problem?

Mr. Suarez Good morning, doctor
Dr. Verdecia: Would you sit here? (pointing). Lean back now, please. Put your head
on the headrest. Good! What’s the problem?
Mr. Suarez: I’ve been having a terrible toothache that is really bothering me.
Dr. Verdecia: When did the pain start?
Mr. Suarez: Three days ago while I was having an ice cream. Ever since, even
the air I breathe in bothers and hurts.
Dr. Verdecia: Open your mouth. Could you point to the tooth that hurts?
Mr. Suarez: Here doctor, this one. (He touches his tooth)
Dr. Verdecia: Does the pain last long?
Mr. Suarez: Only a few minutes.
Dr. Verdecia: What makes your tooth ache?
Mr. Suarez: Well…Hum…Mainly when I have cold or hot foods
Dr. Verdecia: What’s the pain like?
Mr. Suarez: A shooting pain like a stabbing knife
(The doctor examines Mr. Suarez’s mouth)

Dr. Verdecia: Well, Mr. Suarez, this tooth is badly damaged. You also have
another cavity and there is something I need to check in a tooth,
so I’d better take an X-ray.
Mr. Suarez: Is it serious, doctor? Do I have to have my tooth pulled?
Dr. Verdecia: Don’t worry. I think we can save it for the time being. You need a
temporary filling first.
Mr. Suarez: Oh, that’s a relief.
(Dentist talking to the dental assistant)
Dr. Verdecia: Miss Torres, we are going to treat this tooth immediately. There
is active deep dentin caries on the occlusal surface of the second
molar. Prepare the set for a temporary filling, please. Let me get
you numb, Mr. Suarez. Just breathe in and try to relax.
(After a while)
Dr. Verdecia: Well Mr. Suarez, finished for today. Don’t eat any solid food for
an hour. You need another appointment to continue treatment
and you should go to the preventive care department now. Just
follow the assistant.
Mr. Suarez: Thank you Doctor. Good bye.
Dr. Verdecia: Bye Mr. Suarez.
3. Vocabulary
Find in the dialogue a word that means:

a. incline or bend from a vertical position____________
b. annoy, irritate ________________
c. continue in time _____________
d. extracted ________________
e. anesthetize _____________
f. respire _______________
g. an arrangement for a meeting _______________
4. Pair Work
Go over the conversation again to answer the following questions.
1. What sort of problems does the patient have?

2. Describe the history of the pain.
3. What aspects did the doctor use to get to the diagnosis? What other diagnostic
procedures do you know?
4. Why do you send patients to the Preventive Care Department?
6. Language in use: Giving instructions in a polite form.
 Put your head on the headrest, please.

 Can you tell me about your family?
 Could you follow these instructions?
 Would you please sit here?
 Would you mind not smoking here, please?
 Go through the dialogue to find the polite instructions and make those instructions
that are not polite more polite.
6. Class activity
1. Study carefully the ways of questioning when interviewing a patient for the first time.
Note how the dentist might start the interview:

Chief Complaint
 What’s the problem?
 What’s brought you along today?
 What seems to be the problem?
 Could you tell me about your problem?
This first question should be followed by a series of other questions.
Inception
 When did you first notice this? / When did the pain start?
Now note how the dentist asks to get more information about pain or swelling.
Location
 Where does it hurt?

 Show me where the problem is, please.
 Where is it sore?
 Could you point to the tooth that hurts or the area that you think is swollen?
 Does it stay in one place or does it go anywhere else?
Duration
 Does the pain last long?

 When cold or heat causes pain, does it last for a moment or long?
Stimulated or spontaneous
 Does the pain ever occur without provocation? / What makes your tooth ache?
Quality
 What kind of pain do you get?

 What’s the pain like?
 Can you describe the pain?
 How would you describe the pain?
There are different kinds of pain. Look at the following expressions
 Continuous and intense,

 Throbbing like a pulse,
 A shooting pain like a stabbing knife.
 Excruciating ( terrible, sharp)
 Burning ( a fire-like pain)
2. You are taking the patient’s history. What questions can you ask to get information
about:
 Name
 Age
 Marital Status
 Main complaint
 Location of the pain
 Duration of the pain
 Kind of pain
7. Role Play
Dentist: A patient comes to see you complaining of a toothache. Ask him questions to get
information about his problem (location of the pain, duration, etc) to get to a diagnosis. Give
the necessary instructions to make the oral examination.
Patient: You’ve got a toothache. It’s a stabbing pain. You don’t know exactly where it hurts.
It started a few days ago. Answer the doctor’s questions.
Lesson 2
1. Conversation
Listen to the conversation and be ready to take notes about the following:
 Teeth affected
 X-ray results
 Treatment
Dental students and their professor meet for their regular case study. They are discussing
the case of Mr. Suarez.
Professor: This morning we have our case discussion activity. Let’s start with a case of
tooth decay. Student José Antonio will present this case for us.
Student: Thank you professor. Mr. Suarez first presented to the clinic last week
complaining of a toothache. Here I have the dental chart I drew up at that
time. There was active deep dentine caries in tooth 17. He also had proximal
caries on the distal surface of his first left upper molar.
Professor: Did you notice it on the oral examination?
Student: No, I ordered an X-ray because of the change in colouring in the marginal ridge
of the first molar. There was also enamel caries on the incisal edge of tooth
11.
Professor: Good! Were there any other remarkable findings?
Student: Yes, there were signs of poor oral hygiene, so I decided to send him to the
preventive care department.
Professor: Yes, that’s right, but didn’t you remind him the preventive measures he should
follow to keep a good oral health?
Student: Yes, of course, professor. I told him about brushing and flossing at least once a
day to remove plaque from all tooth surfaces. I also explained to him the
importance of regular check-ups.
Professor: And how did you manage this case?
Student: Well professor, I placed a temporary filling in tooth 17 and gave him another
appointment to make the final restoration and treat the other affected teeth.
Professor: You’ve done very well. Just remember to check your notes and the available
literature to improve your knowledge about tooth decay.
2. Vocabulary
Find in the conversation equivalents for the following words or phrases:
a. caries _______________
b. did, prepare ___________
c. border ___________
d. the results of an investigation______________
e. accessible, obtainable ________________
f. get better ___________________
3. The World of words: Other, Another
We use other + plural noun

 There are other teeth badly damaged.
WE use the others to mean the rest

 We finished with this tooth today; the others will be treated next week.
We use another + singular noun

 This patient needs another appointment to finish treatment.
1. Complete the following sentences.
1. This is__________ way of preventing dental caries.

2. Some patients require only one appointment, ________ need more than one.
3. You can use ___________ solution to make mouth rinses.
4. The______ complication will be treated immediately
5. There are______ things you should know about oral health.
4. Group work
Look at the following dental chart and discuss in groups the patient’s problems and the
required treatment.
In the dental chart the teeth are coloured as follows:
tooth 18 - blue tooth 27- red
5. tooth 17 - red tooth 28 - blue Pair Work
tooth 15 - blue tooth 38- blue Now work in pairs to act out the
tooth 14 - red tooth 37 - blue conversation between Dr. Smith and Jose
tooth 12 - blue tooth 36 - blue Rodriguez during the oral examination,
tooth 25 -red tooth 48 - blue taking into account the information given in
the tooth 26- blue dental chart.
6. Writing
Write a note to your teacher summarizing the oral condition of this patient and the treatment
plan to solve his problems.
Lesson 3
1. Reading
In not more than five minutes, skim the text to find out what each paragraph is about.
Paragraph 1
a. Types of dental caries
b. The process of dental caries
c. Preventive measures
Paragraph 2
a. Factors to be considered in the mother’s diet

b. Dental caries control
c. Dental caries resistance
Paragraph 3
a. Preventive measures
b. Progress of dental caries
c. Importance of the diet
Paragraph 4
a. Restorative materials
b. Management of dental caries
c. Diagnostic procedures
Dental Caries
The most widespread oral disease in the world today is dental caries (commonly called
cavities). This is the disease that destroys the enamel and the dentine of the tooth. Cavities
begin on the surface of a tooth when various types of bacteria form breeding colonies in the
enamel. The bacterial enzymes change food sugar into lactic acid which is strong enough
to eat into the enamel and permanently destroy it. As soon as those tiny cavities are
formed, the bacteria are able to penetrate more deeply into the dentin. If at this point the
process of decay is unchecked by proper dentistry, it continues into the pulp, eventually
reaching the root canal, attacking the nerve, and destroying the tooth.
Many factors contribute to the resistance to teeth decay, some of which are not entirely
understood. Genetic inheritance of good or bad teeth is one such factor. The adequacy of
the mother’s diet during pregnancy is another cause. Early childhood diet is yet another.
Scientists are investigating the relationship between emotional stress and tooth decay, as
well as the reasons for greater immunity to cavities between the ages of 25 and 45 than at
any other time in life. Whatever the reasons for resistance to dental caries, there is little
doubt about the cause. Studies consistently show that caries-producing bacteria flourish
when the saliva contains a high content of carbohydrates which come from deposits
between the teeth and on the tooth surfaces.
The food deposit that leads to the most damage are bread, cookies, pastry, sticky and
chewy sweets- especially as frequent snacks, which are considered highly cariogenic. The
most effective way to reduce the incidence of cavities is to clean the teeth properly and to
avoid eating sweets and starches between meals and at bed time. In addition, extensive
research over a long period indicates that sodium fluoride helps to prevent or reduce tooth
decay. Public Health Services have strongly recommended fluoridation of the public water
supply. In areas deprived of this protection, dentists recommend fluoride treatment for
children teeth. Dental caries can also be controlled by regularly scheduled dental checkups.
Starting at the age of three, children should go to a dentist twice a year for examinations so
that they become accustomed to procedures of tooth care.
The earlier a dentist detects a cavity, the easier it’s to treat it and the better for the
continued health of the tooth. Some enamel destroyed by acid will not grow together again,
and since the body can not replace disease dentin, the dentist drills out the decayed area,
treats it with antiseptics and fills the hole with one of the variety of materials depending on
the size and location of the area to be filled. If the decay has gone deep into the tooth, he
may have to clean and seal the root canals. Usually after a deeply decayed tooth has been
filled, it is x-rayed regularly to make sure that further decay has not killed the nerve.
(Taken and adapted from Manual for the Atraumatic Restorative Treatment, approach
to control dental caries)
2. Vocabulary
Find in the text a word that means:

a. widely extended __________________ (P 1)
b. very small_________ (P 1)
c. grow, develop _________ (P 2)
e. lacking of something ________(P 3)
f. programmed________________ (P3)
g. make a hole______________(P4)
h. secure with a closure _________ (P 4)
3. Pair Work
Read the text again and answer the following questions:
1. Why is it important to have cavities checked as soon as possible?
2. According to the text, what factors may contribute to the resistance to tooth decay?
Do you agree with them?
3. What are some of the preventive measures to reduce the incidence of caries?
4. Make reference to the materials used to restore a tooth.
5. Talk about more cariogenic and less cariogenic foods. Give reasons.
4. Language in use: Expressing proportion
Comparisons used to denote parallel increase or decrease, to express

proportion or equivalent tendencies.
 The earlier you begin visiting the dentist, the better chances of
preventing dental problems.
1. Match the sentences in column A with their corresponding ending in column B.

Column A Column B
 Work with your partner to give more examples of your own like the ones above.
5. Class activity
1. Group the types of caries below according to the following classification: pits and fissures
caries, deep dentine caries, smooth surface caries, active caries, nursing bottle caries,
1. The more you study the practical guide a. the better for the patient.
2. The sooner we find out what it is b. the higher the risk of tooth decay
3. The deeper the caries c. the better prepared you will be.
4. The more you eat sweets d. the longer they will last.
5. The more you care for your teeth e. the greater the pain.
arrested caries, radicular caries, superficial dentine caries enamel caries
Classification of Dental Caries

LOCATION DEPTH
____________ ____________
____________ ____________
____________ ____________
____________ ADVANCE
______________ ____________
____________ ____________
___ ____________
______________ ____________
______________ ____________
______________ ____________
______________ ___
__________
2. Work with your partner and talk about the last patient you assisted with caries. Say what
type of caries he / she had and include the surfaces of the teeth involved.
6. Class activity
1. After the oral examination the doctor decided Mr. Suarez needed a dental restoration
(filling). Read through the following steps to make a filling and arrange them in the correct
order.
a) ___ Condense the amalgam in the cavity. After it is overfilled carve it.
b) ___ Open the cavity.
c) ___ Carry the amalgam to the cavity.
d) ___ After 24 hours finish and polish the restoration.
e) ___ Place the cavity liner immediately after.
f) ___ Check the bite using articulation paper and adjust the height of the restoration.
2. Work in pairs to explain each step more in details and when necessary give the reasons
for doing them.
7. Writing
Write a description of how to perform a dental restoration and give details about the steps if
necessary. Use words that show sequence such as first, next, then, after that, finally, etc.
Lesson 4
1. Reading
Read as quickly as you can and complete the following chart.
Equipment and devices Instruments
Dental Equipment and instruments
The Dental clinic offers the highest service in every discipline

including: General Dentistry, Periodontics, Orthodontics,
Endodontics, Prosthodontics, Oral Surgery, Central Sterile Supply
Dept (CSSD), laboratories, library etc. Apart from these, there are
other administrative (non-clinical/academic) departments such as:
accounts and finance, administration/management, buildings and
maintenance, central medical records & appointments (CMRA),
human resources, information systems. The main function of this
centre is to provide evaluation, diagnosis, prevention and treatment
(nonsurgical, surgical or related procedures) of diseases or disorders
of the oral cavity.
Many pieces of equipment and instruments that may be familiar to laymen are found in a
dentist’s office. In this room many routine procedures are developed. The dentist, dental
hygienist, and their assistants, work in a room called the dental operatory. The dental chair
is the largest piece of furniture in the room. It is used for sitting the patient for his comfort as
well as to allow the team easy access to the patient. It has the backrest, headrest and foot
platform. Next to the dental chair we have the foot controller. It rests on the floor and it is
connected to the dental unit by an electric cord.
The dental unit is the control center, which drives the revolving rotary instruments. It
includes the oral evacuator or the cuspidor, air/water syringe and operating light. The
evacuator tip sucks out saliva and any debris and fluids, which accumulate in the mouth.
The air water syringe is used to clean out and dry the area on which the dental team is
working. The cuspidor on the unit is where the patient can expectorate (spit) after rinsing
his mouth.
The operating light provides illumination upon the mouth. An arm of the dental unit holds a
tray for the instruments and materials that are needed. The dental engine is the electric
motor provided on the dental unit for the purpose of running the hand piece. The operating
stool (sit) is used to approach the patient as well as access to the necessary equipments
and instruments. The hand pieces have different designs: straight, angle and prophylactic.
The angle hand piece is subdivided into conventional or standard-speed, and high-speed
instruments. The burs are made of steel used to cut tooth structures in the process of
shaping cavities for fillings and also from removing old fillings from the teeth.
A wide variety of dental instruments are used in any dental operatory, among them we have
the diagnostic instruments such as: the dental mirror which is used not only for viewing
areas of the oral cavity but also for reflecting light on dark areas and for retracting or
holding back the lips, cheeks, or tongue for short periods of time. It is a single ended
instrument. The dental explorer is used to probe and examine tooth surfaces to determine if
caries is present. It is a handle with sharp points on each end.
The spoon excavator also has two working ends. It is used for the removal of decay from
the cavity. The cotton pliers with an angle tip are used to place objects such as cotton
pellets, cotton rolls to the mouth and from the mouth. The beaver tail is used to carry the
material (cement, Zinc oxide) to the cavity.
Other instruments used in a dental operatory room are the amalgam instruments. The
amalgam carrier is used to convey or carry the filling material into cavities. The amalgam
condensers are used to pack or condense the amalgam into a prepared cavity in a tooth.
The amalgam carvers are used to facilitate the carving of the fresh amalgam to give the
anatomic form immediately after the material has been condensed into the cavity. The
matrix retainer with the matrix band is used to retain the amalgam while it is being
condensed into a cavity that involves two or more surfaces of a tooth.
The wedge (wood or plastic) is used to hold the matrix retainer and avoid the sliding of
amalgam between the tooth and the gum. It is also used to reestablish the proximal contour
and contact points.
All the instruments used in dental procedures must be disinfected and sterilized.
Sterilization removes all microorganisms (bacteria and gems), while disinfecting removes
most, but not all, of the infectious organisms. Dentists often come in contact with saliva and
blood particles, all of which can carry bacteria and viruses such as HIV, Hepatitis B (HBV),
syphilis and herpes viruses. They
can spread from instruments and equipment dentists use. Universal precautions require all
dental staff involved in patient care to use appropriate protective garb such as gloves,
masks and eyewear. After each patient visit, the gloves are discarded, hands are washed
and a new pair of gloves is used for the next patient.
control dental caries and from a Web site).
2. Vocabulary
Find in the text the word that means:

a. non expert ______________ (P 2)
b. stuff, objects _______________ (P 2)
c. operates _____________ (P 2)
d. extracts____________ (P 3)
e. come near ____________ (P 4)
f. clothing _____________ (P 6)
3. Pair Work
Ask and answer the following questions.
1. What kinds of procedures are developed in the dentist’s office?

2. When is the angle design of hand pieces used?
3. How can the dental instruments mentioned in the text be classified?
4. What is the difference between sterilization and disinfection? In which cases do you use
them?
5. What protective barriers are mentioned in the text? What others do you know about?
6. Why are these universal precautions important in the dental practice? Do you follow
them?
4. Language in use: Describing and defining things
5. Class activity
Take turns describing or giving definitions for the following things:

 autoclave
It is a piece of plastic. It is used to hold the matrix retainer  tray
 air motor
It is a piece of plastic which / that is used to hold the matrix retainer  gloves
 mask
6. Group Work
Now think of something to describe to the class. Make notes about it without including the
name. The rest of the class will guess what it is.
7. Writing
Write a brief description of the place you work in.
Unit 3. Periodontics
Lesson 1
1. Quick Glance
Diseases of the teeth and gums have troubled humans for

thousands of years. Ancient Egyptian medical texts, dating back
to 3500 BC, refer to toothaches. The earliest record of dental
treatment also comes from Egypt, where gum swelling was
treated with a concoction of cumin, incense, and onion.
 What natural remedies do you use in the dental clinic nowadays to treat diseases of
the gums?
2. Conversation
Listen to the conversation and choose the correct answer.
1. The patient comes due to:

a. toothache
b. bleeding gums
c. tender gums
2. His oral hygiene is…

a. good
b. acceptable
c. bad
3. The patient has…

a. chronic periodontitis
b. gingivitis
c. ulcerative gingivitis
4. In this appointment the doctor does…

a. plaque control
b. scaling
c. curettage
(Mr. Acosta is at the Dentist's consulting room)

Mr. Acosta: Good morning, doctor.
Dr. Rosales: Good morning, Mr. Acosta. Sit down here, please. Could you tell
me about your problem?
Mr. Acosta: The problem is … Eh… my gums bleed and I think I have bad
breath doctor.
Dr. Rosales: How often does the bleeding occur?
Mr. Acosta: Whenever I brush my teeth.
Dr. Rosales: All right. Open your mouth, please. Oh, I see… How often do you
brush your teeth?
Mr. Acosta: Well, ah, in the morning, after getting up.
Dr. Rosales: Can you show me the way you do it?
Mr. Acosta: Like this doctor.(He shows him)
Dr Rosales: Oh, I see.
Mr. Acosta: Is that the correct way doctor?
Dr Rosales: No, not exactly, but don’t worry. I’ll show you the correct way later.
What kind of brush do you use?
Mr. Acosta: What do you mean by that?
Dr Rosales: Well, I refer to the bristles. Are they soft or hard?
Mr. Acosta: Hmmm, my tooth brush is rather old.
Dr. Rosales: Ok, don’t forget to bring it to the next appointment. Well, would you
mind answering some questions?
Mr. Acosta: No, not at all, doctor.
Dr. Rosales: How old are you?
Mr. Acosta: I’m 45
Dr. Rosales: What about your general health? Do you suffer from any disease?
Mr. Acosta: Well, yes, I am diabetic, doctor.

Dr. Rosales: Do you smoke?
Mr. Acosta: Yes, about 15 cigarettes a day.
Dr. Rosales: Oh! I see …
Mr. Acosta: What’s my problem doctor?
Dr. Rosales: Your gums are red and swollen and I can see you have neglected
your dental care.
Mr. Acosta: Is it serious doctor?
Dr. Rosales: No, not very. You have gingivitis and it can be worse if not treated
on time.
Mr. Acosta: Gingivitis? What’s that, doctor?
Dr. Rosales: Well, it is an inflammation of the gingiva mainly caused by dental
bacterial plaque.
Mr. Acosta: Do I need any treatment?
Dr. Rosales: Yes, of course. But first we’ll start by doing the plaque control with
this tablet. It is called plac dent. Chew the tablet and with the
tongue spread it on the teeth surfaces, please. It doesn’t taste bad.
(After a while)
Dr. Rosales: Ok, Mr. Acosta, look at your teeth in the mirror now. The stained
areas on your teeth show the presence of plaque. So as you see,
the most important thing to revert your problem is the good oral
hygiene. Next week we will continue the treatment.
Mr. Acosta: Is that all?
Dr. Rosales: Yes, for the time being. Just remember to brush your teeth four
times a day, but if you can’t, try not to forget to do it after breakfast
and before going to bed. I will give you an appointment for next
week.
Mr. Acosta: Thank you, doctor. Good Bye
Dr. Rosales: Bye, Mr. Acosta
3. Vocabulary
Find in the dialogue equivalents for the following words or phrases.

a. halitosis _____________________
b. lose blood ________________
c. inflamed ____________
d. uncared______________
e. apply in a surface, distribute_____________
f. coloured, marked _____________
4. Pair Work
a. Why did the doctor ask Mr. Acosta about the condition of the toothbrush?
b. Is it important for the dentist to know if the patient is diabetic? Why?
c. Are there any contributing factors to Mr. Acosta’s problem?
e. What is the course of treatment in this case? Do you follow the same course of treatment
in the clinic with your patients?
5. Class activity
Other ways of questioning the patient are:
Provoking factors
 Does heat, cold, biting or chewing cause pain?
Attenuating or aggravating factors

 Is there any thing that makes the bleeding better/ worse?
 Does anything make it better/worse?
Frequency
 How often does the bleeding occur?
 How often does this happen?
Intensity
 When you have pain, is it mild, moderate, or severe?
6. Role Play
Role A: You are the doctor. A patient comes to see you referring some disorders Ask him
questions to get information about his problem. Be very polite.
Role B: You are the patient. Answer the doctor’s questions.

 You have small ulcers that appeared suddenly, bad breath and bleeding
 You have yellowish-grey ulcers sensible to touch, pain when eating.
Lesson 2
1. Conversation
Listen to the conversation and number the following statements in the order they appear in
the conversation.
__Polishing of the teeth
__Showing the correct way of brushing
__Prescription of mouth rinses
__Removal of calculus
__Greeting the patient
(Mr. Acosta is in his second appointment).
Dr. Rosales: Good morning, Mr. Acosta. Please, sit down.

Mr. Acosta: Thank you doctor.
Dr. Rosales: You brought your dental brush, didn’t you?
Mr. Acosta: Oh! Yes, doctor. Here it is.

Dr. Rosales: OK. Mr. Acosta. I’ll show you now the correct way of brushing
and how to use the brush more effectively.
(After a while)
Dr. Rosales: O. K. now I’ll start removing the plaque and calculus from your
teeth.
Mr. Acosta: Is it painful, doctor?
Dr. Rosales: Don’t worry Mr. Acosta; you may be a little bit uncomfortable, but
nothing more than that. Open your mouth, please.
(The dentist is eliminating the calculus using the scalers)
Dr. Rosales: Rinse your mouth and spit out, please. Your gums are bleeding
a little but don’t get alarmed. It usually happens. O K. You will
feel better now, Mr. Acosta. I will use this brush and this paste to
polish your teeth.
Mr. Acosta: What is the paste for, doctor?
Dr. Rosales: It’s called prophyladent. It’s a polishing agent.
O K, We’ve finished.
Mr. Acosta: Ah! That’s a relief. Is there any other thing I have to do?
Dr. Rosales: Yes, You certainly do. You should use this powder to make
mouth rinses three times a day. It’s called clorhexidine. You can
also use verbena and guava rinses.
Mr. Acosta: Thank you for everything, doctor.
Dr. Rosales: Good bye, Mr. Acosta and remember to make an appointment
on your way out.
2. Vocabulary
Match the words in column A with the corresponding definition or equivalent in column B.
A B
1. show a. wash
2. remove b. refine
3. scalers c. instruct
4. polish d. instruments for cleaning tooth surfaces.
5. rinse e. take away, eliminate
3. Pair Work
1. Is dental brushing important in the prevention of periodontal diseases? Explain.

2. Why was scaling practiced to this patient?
3. How would you instruct Mr. Acosta to prepare and use clorhexidine?
4. What does Mr. Acosta have to do to avoid the recurrence of the disease?
5. What other remedies can be used in this case? Give reasons.
4. Language in use: Giving Advice
If I were you I’d better…

I think you should / shouldn’t… … visit the dentist more often
You ought to…
Why don’t you…?
Talk about it later
Mr. Suarez… to come again

I advised … him…
her… not to smoke
1. Go over the conversation again and write other pieces of advice you would give Mr.
Acosta.
2. Read what these patients are saying to the dentist and write possible pieces of advice
for each case.
a. …Well, I know how important my dental health is but I love eating candies and lots of
sweets.
b. …I have a lot of stress in my job and I smoke 20 cigarettes a day.
c. …When I get home in the evening I reward myself with a lot of bread and I usually go to
bed without brushing my teeth because I’m very tired.
d. …One of my teeth hurts whenever I drink cold water.
e. …I rarely go to the dentist because I’m terribly afraid of it.
3. How would you talk about them later? Tell your partner about it.
5. Class activity
1. At the preventive care department Mr. Acosta is being instructed to develop a proper
brushing technique. Match the steps with the corresponding picture.
1. Clean the inner surface of the lower teeth

2. Clean the outside surfaces of the upper then the lower teeth
3. Clean the chewing surfaces of the upper then the lower teeth
4. Clean the inner surfaces of the top teeth
A B
C D
2. You are at the preventive care department. Write a note to your patient indicating him the
proper brushing technique. Use connectors such as First, then, after that, finally…
6. Class activity
1. Study the following instruments and their application in periodontal treatment
Periodontal chisel Proximal surfaces –incisors with enough space
Mc Call hoe Buccal and lingual surfaces – posterior teeth
Straight sickle Proximal surfaces – anterior teeth

Contra-angle sickle Proximal surfaces – posterior teeth
Periodontal curette All surfaces – All teeth
2. The 1st year students are visiting the periodontal department for the first time. Use the
previous chart to explain the functions of these periodontal instruments
Lesson 3
1. Reading
1. Read the text as quickly as you can to say if the following ideas are included in it.
a. Incidence of the disease

b. Signs and symptoms of periodontal disease
c. Classification of periodontal diseases
d. Methods used to detect gum diseases
e. Treatment of Acute necrotising ulcerative gingivitis.
f. Conduct to follow to treat the disease at different stages
When periodontal disease strikes…
Periodontal disease is a slow, insidious condition that is responsible for about 70% of all
lost teeth. Periodontal disease develops in nine of ten adults during their lifetimes; however,
even children as young as 5 or 6 years can be affected.
As the disease is insidious and often initially painless you may not even be aware it is
affecting your mouth until it has done some serious damage. To avoid the havoc this silent
disease can cause; pay attention to the warning signs and symptoms for periodontal
diseases, which include:
 Gums that bleed when you brush your teeth.
 Red, swollen, or tender gums.
 Gums that have pulled away from the teeth.
 Pus exuding between the teeth and gums when the gums are pressed.
 Permanent teeth which are loose or separating.
 Changes in the way your teeth fit together when you bite.
 Changes in the fit of partial dentures or other dental appliances.
 Bad breath.
The disease occurs when the irritants in plaque -that sticky layer of harmful bacteria
constantly forming on teeth- inflame the gums, making them tender and likely to bleed
during tooth brushing. Dental Bacterial Plaque (DBP) is the chief cause of periodontal
disease but there are other risk factors. If not removed each day by brushing and flossing,
plaque hardens into a deposit called calculus and gathers under the gum line, making
plaque removal more difficult. As plaque continues forming over the calculus, the gums
become red, swollen, sore, and can bleed easily. This condition is known as gingivitis and
can be halted by meticulous oral hygiene and professional cleaning. Once calculus has
formed, only a dentist and dental hygienist can remove it, with the aid of special dental
instruments. Both adults and children need this cleaning (a prophylaxis). Professional
cleaning also helps prevent periodontal disease from occurring. Also prophylaxis gives you
an attractive smile and makes your mouth feel fresher. If left untreated, gingivitis may
develop into periodontitis.
In advanced periodontal disease, the irritated gums draw away from the teeth, forming
pockets that fill with bacteria and pus and gradually deepen. At this point, Surgery may be
needed to save the teeth. If the condition is ignored, the bone supporting the teeth is
destroyed, and the teeth begin to shift and loosen. Eventually, the teeth fall out or finally,
they must be extracted.
To diagnose periodontal disease, the dentist uses an instrument called a periodontal probe
to measure the depth of the pocket surrounding the teeth. An X-ray examination can show
the extent of bone destruction. The type of treatment recommended depends on the
severity of the disease.
Often, the only professional treatment required in the early stages of periodontal disease is
scaling and root planing. Scaling is the removal of plaque and calculus deposits on the
teeth; root planing calls for smoothing the tooth and root surfaces after periodontal debris
has been removed to allow the gums to reattach to the teeth. Curettage (surgical scraping)
also may be needed to remove the infected tissues lining the pocket to speed healing of the
gums. Defective or worn fillings, orthodontic problems, or other oral factors contributing to
the development of periodontal disease also may be corrected by the practitioner.
In advanced periodontal disease professional cleaning alone can not reverse the disease
process. It is often difficult for the dentist or hygienist to remove calculus deposits from
pockets deeper than 5 mm, and it is nearly impossible for patients to keep such pockets
free of plaque. Surgery is sometimes needed at this stage to remove calculus from deep
pockets, to reduce the pockets, and to arrange the tissue into a shape that will be easier to
keep clean.
Several types of Surgery are used to accomplish these goals. When pockets are present
but the bone is intact, a gingivectomy may be performed. This procedure involves removing
the soft tissue wall of the pocket so that the gums can reattach to the teeth. When pockets
are deep and the bone has been affected, flap Surgery is required. In this technique, the
gum is lifted away to allow the dentist access to the tooth root to remove calculus, plaque,
and any diseased tissue. The gum is then sutured back in place or into a new position. Flap
Surgery is at times accompanied by bone Surgery to reshape or remove part of the bone
surrounding the tooth.
Good oral hygiene is essential to keep periodontal disease from advancing or recurring; the
best periodontal treatment will be of little value if daily home care is neglected. You don’t
have to lose your teeth to periodontal disease. Brush and floss your teeth daily, eat a
balanced diet, use fluorides, and visit your dentist regularly. Ultimately, the success of
periodontal treatment is left to you.
(Taken and adapted from the Journal of the American Dental Association)
2. Vocabulary
Replace the words in italics with words or phrases from the text with similar meaning.
a) Dental bacterial plaque is an adhesive layer of bacteria constantly forming on teeth.

b) Plaque gets harder if not removed each day by careful oral hygiene.
c) Plaque gets together under the gum line making its removal more difficult.
d) Gingivitis can be stopped by meticulous oral hygiene and professional cleaning.
e) In periodontal disease the gums separate from the teeth forming pockets
f) When the bone is destroyed the teeth begin to migrate and let loose
g) Root planing is used for polishing the tooth after the removal of the plaque and calculus.
h) Curettage is used to remove the infected tissue surrounding the pocket to accelerate the
cure of the gums.
3. Pair Work
Ask and answer questions about the text
1. Why is periodontal disease a silent disease?

2. Which of the signs and symptoms stated in the text are the most commonly seen in
patients you have assisted?
3. How does this disease develop? Explain briefly
4. What types of treatment are mentioned in the text? Do you apply them all?
5. Do you think the population knows what to do to prevent periodontal diseases? What
else could be done in this sense?
5. Language in use: The gerund
Subject of a sentence
 Bleeding was one of his complaints.
Object of a verb
 The treatment includes removing of infected tissues
Object of a preposition
 Root planing is used for polishing the tooth.
Complement of a verb
 The first preventive measure is brushing.
 Go over the text again and find similar examples. Add other examples of your own.
5. Class activity
1. Complete the word map with the words from the list.
Direct risk Indirect

factors risk
factors
Periodontal
diseases
List: plaque, hormonal changes, smoking, calculus, genetic anomalies, mouth

breathing, malocclusions.
 Add other more words to the map.
2. Discuss with your partner in what way these factors are related to periodontal diseases.
6. Writing
Prepare a leaflet for the health area you work in. Write about the things you would include,
motivating the population in the prevention of periodontal diseases.
Unit 4. Endodontics
Lesson 1
1. Quick Glance
An Ancient Science
Endodontics may have been practiced as early as the second or
third century B.C. A skull found in the Negev Desert in Israel had
a bronze wire in one of its teeth. Researchers believe the wire
may have been used to treat an infected pulp.
 Do you know any other way of treating an infected pulp in ancient times? Explain.
2. Conversation
1. Listen to this conversation and say if the following sentences are true or false.
a. ____The woman visits the clinic because of a toothache.
b. ____The tooth pulp is affected.
c. ____She had an accident a year ago.
d. ____She was diagnosed with a cyst.
e. ____The doctor starts treating the tooth today.
(Mrs. Rizo visits the dental clinic. She is worried about one of her teeth)
Dr. Ferrer: Good afternoon. Mrs Rizo. Isn’t it?

Mrs. Rizo: That’s right, doctor. Good afternoon.
Dr. Ferrer: Sit in this chair, please. What brings you to the clinic?
Mrs. Rizo: Well, doctor. I’m worried about one of my teeth. (she points to
the tooth)
Dr. Ferrer: What’s wrong with it?
Mrs. Rizo: It has become dark and I don’t like how it looks.
Dr. Ferrer: Open your mouth, please. Let’s check it out. Did you receive any
blow?
Mrs. Rizo: Yes, doctor. Three years ago I fell and this tooth became loose
but it’s tight now.
Dr. Ferrer: The change in colour is due to the blow. It seems the pulp has
been damaged. To be sure we’ll take an X-ray and do a vitality
test.
Mrs. Rizo: Is it painful doctor?
Dr. Ferrer: No, not at this stage. Open your mouth again, please. Do you
feel any cold sensation with this ice cube?
Mrs. Rizo: No, doctor
Dr. Ferrer: Any numbness?
Mrs. Rizo: No
Dr. Ferrer: O.K. Let’s take the X-ray then.
(10 minutes later)
Mrs. Rizo: Well, What is it, doctor?

Dr. Ferrer: Hmm, the X-ray shows a chronic process around the tip of the
tooth root.
Mrs. Rizo: Is it serious?
Dr. Ferrer: No, but if not treated on time it may become a cyst and then
surgery is needed.
Mrs. Rizo: So, then?
Dr. Ferrer: You need a canal treatment and later we’ll bleach the tooth.
Mrs. Rizo: Are you starting today?
Dr. Ferrer: Yes but today we are only drilling the tooth to remove the pulp and
shape the conduct. In the next appointment we’ll fill the tooth and
start bleaching it. So, there’s no need to be worried. I hope
everything will be all right.
Mrs. Rizo: I also hope so, doctor.
3. Vocabulary
1. Say if the following pairs of words are equivalent or opposite in meaning.
1. blow – hit
2. loose - tight
3. death – vitality
4. shape – form
5. bleach – darken
2. Now select words from the pairs to complete the following sentences.
a. The pulp has _________ so we can save the tooth.

b. Dentists use different files to _________ the conduct
c. Some of his teeth were affected with the _______ he received in the accident.
d. This patient has periodontitis and some of her teeth are ________.
e. Pulp injury may_______ the teeth.
4. Group Work
Discuss in groups the following diagnostic procedures commonly used in dental practice
and the way they are used.
 Radiographs
 Percussion
 Thermal tests
 Electric tests
 Transillumination
 Anaesthesia tests
5. Language in use: Interviewing a patient

Present ( be) Past (be)
Is / Are / Am + person+complement Was/ Were + person + complement
 Are you Mrs. Rizo?  Was it painful?
Present (action verbs) Past (action verbs)

Do/Does + person + verb (simple form) Did + person + verb (simple form)
 Do you feel any pain?  Did you follow my instructions?
Future Present Perfect

Will + person + verb (simple form) Has/ Have + person + verb (Past Part)
 Will you start the treatment today?  Have you noticed that before?
 Wh- Questions
Question word+ auxiliary + person + verb
Why did she come?
 In pairs, prepare questions to be asked to Dr. Ferrer about Mrs. Rizo’s case. Use
the chart above.
6. Class activity
Take turns asking and answering the prepared questions.
7. Writing
Write a brief summary of the most relevant facts of Mrs Rizo’s case. You can start using
one of these forms:
a. Mrs. Rizo came to the dental clinic complaining of…

b. Mrs. Rizo came to the dental clinic because…
Lesson 2
1. Conversation
Listen to the conversation and select the correct answer.
a. The patient is a child _____

an adolescent_____
an old man _____
b. The patient’s main complaint is bleeding____
pain _____
tooth mobility____
c. The tooth affected is the 21___

11___
16___
d. The treatment involves extraction ____

temporary filling _____
apex closure _____
(Dr. Lozada, a resident in General Comprehensive Dentistry, comes to consult Dr. Ferrer)
Dr. Ferrer: Yes?

Dr. Lozada: May I come in, Prof. Ferrer.
Dr. Ferrer: Certainly, Lozada. Come in, come in. What can I do for you?
Dr. Lozada: I have a new case and I would really appreciate your advice
on it.
Dr Ferrer: OK. Tell me about it.
Dr Lozada: Well, it’s an 8 year old boy who was referred to my office
approximately 6 months after suffering a traumatic injury with
pulp exposure.
Dr. Ferrer: Was he treated for this traumatic injury?
Dr. Lozada: Yes, a pulpotomy was performed and a temporary crown was
placed at that time.
Dr. Ferrer: What is his main complaint now?
Dr. Lozada: The patient now complains of a ¨hurting feeling¨ and the tooth
is sensitive when chewing.
Dr. Ferrer: What about the clinical examination? What did it show?
Dr. Lozada: Well, Ah! Swelling in the buccal area of tooth 11 and the tooth
was slightly loose.
Dr. Ferrer: Any other symptom?
Dr. Lozada: Yes, the tooth was sensitive to percussion.
Dr. Ferrer: You ordered an X-ray, didn’t you?
Dr. Lozada: Yes, it showed an incomplete formed root and an open apex.
Dr. Ferrer: So, well. What procedure did you use in this case?
Dr. Lozada: Well first, the patient together with his parents was informed
that endodontic therapy would now be required to save the
tooth.
Dr. Ferrer: Well done, Dr. Lozada. And what would you do concerning
the complication of the open apex?
Dr. Lozada: Well, some apexification procedures would be required to
create some type of apical closure.
Dr. Ferrer: Good. If it is successful, what would be the next step?
Dr. Lozada: The success of this procedure will be seen within 4-5 months.
Then completion of endodontic therapy, I mean the
restoration would be attempted.
Dr. Ferrer: Excellent Dr. Lozada. You seem to be coming on nicely.
2. Vocabulary
Match the words in Column A with their corresponding definitions or synonyms in column B.
A B
a. exposure 1. favourable result.
b. success 2. tried
c. attempted 3. the condition of being closed.
d. closure 4. the act of showing
3. Pair Work
Read and discuss with your partner the following:

 Patient’s present symptoms
 History of the disease
 Findings on examination
 X-ray test
 Treatment
4. Language in use: Using impersonal language.

(Verb be + past participle of the verb)
In this
table, Instead of using the active construction Doctors use the passive notice
the (impersonal) construction doctor’s
choice  The doctor sees the patient daily.  The patient is seen daily. of
 The doctor placed a temporary crown  A temporary crown was placed

at that time. at that time.
 The patient requires some  Some apexification procedures

apexification procedures. are required
 The doctor informed his parents  His parents were informed about
about the treatment the treatment.
structure
Note: We use the passive:
 when we don’t want to take responsibility
 to focus on what rather than who
 to avoid one or someone
 We use by + agent only when needed.
Make the following report more impersonal.
A general dentist referred a 30-year-old female patient to our office. She was asymptomatic
and the general dentist noticed a buccal fistula opposite tooth 13. On the radiograph the
dentist saw an apical lesion. The doctor detected no swelling and restored the tooth. The
doctor anesthetized the tooth and placed a rubber dam to establish an access cavity. Finally
he cleaned, shaped and packed the canal with warm gutta-percha.
5. Role Play
Role A: You are Dr. Lozada. Ask the necessary questions to the patient to fill in his dental
record.
Role B: Play the part of the patient. Use information of your own.
First name: Surname: Age: Sex:

Address:
Occupation:
Marital Status: ( S M D W )
Past medical history:
Present complaint:
Allergies:
6. Writing
Pretend you are Dr. Lozada. The boy you have already treated has an open bite. Write a
referral to the orthodontist giving all the necessary information.
Lesson 3
1. Reading
In not more than five minutes skim the article to complete the following sentences:
1. It is necessary to do _________ _________ to save a tooth with a damaged pulp.
2. When there is infection _________ and_________ may be present.
3. To complete the endodontic treatment several __________ ___________ are required.
4. Some _________ may be placed in the pulp chamber for the elimination of
____________.
“When tooth pulp is damaged...”

If the pulp of a tooth becomes badly diseased or injured, endodontic (root canal) therapy
may be needed to save the tooth. The pulp is a soft tissue containing nerves, arteries,
veins, and lymph vessels. It is located at the core of the tooth and extends from the tip of
the tooth root, where it connects to the jaw, through the centre of the root, and up into the
crown of the tooth.
If the pulp is injured- perhaps by a blow to the tooth, by a deep cavity, or by periodontal
disease- the pulp can become exposed to the bacteria in saliva. If the pulp is so damaged
that it can not repair itself, it dies and becomes a source of infection. The infection spreads
through the pulp through the tissues that surround and support the tooth in the jaw. A dental
abscess then forms at the tooth root.
Pain and swelling may accompany the infection. Even if no pain is felt, certain by-products
produced by the diseased pulp can damage the bone anchoring the tooth in the jaw. The
tooth also may become discoloured. When the condition reaches this stage, the dentist and
patient have only two choices: save the tooth by endodontic therapy or extract the tooth.
Left untreated, the tooth eventually must be removed.
Endodontic therapy is preferable in most cases and often is less costly for the patient.
When a tooth is extracted and not replaced, the teeth, surrounding the empty space begin
to shift, which could result in loss of additional teeth. Chewing ability and appearance also
are affected. If the tooth is removed, a replacement tooth (bridge) should be placed.
Endodontic therapy requires several office visits. To assure your comfort the dentist may
administer a local anaesthetic before beginning treatment. The first step involves drilling a
hole in the tooth to remove the pulp. The root canal is cleaned, enlarged and shaped to a
form that can be easily filled. Medication can be placed in the pulp chamber to help
eliminate bacteria. The dentist then places a temporary filling to protect the pulp chamber
between dental appointments.
If the infection is severe, the dentist may leave the tooth open for a few days to drain the
infection. You also may be given antibiotics.
The next step is to fill and seal the root canal with a material that prevents bacteria from re-
entering the canal. Finally, the crown of the tooth is restored to its natural colour and proper
function either by bleaching and filling the tooth or by placement of a crown (cap). Gold or
porcelain crowns often are used when a tooth has been badly fractured or decayed. The
type of material used depends on where the tooth is situated, the tooth colour, and how
much of the natural tooth remains. If an endodontist performs your treatment, he or she
may recommend that your family dentist handle this phase of treatment.
Your restored tooth could last a lifetime if you take good care of your teeth. The gums and
bones that surround and support the tooth must remain healthy. This means daily brushing
and flossing, eating a balanced diet and limiting sugar and starchy foods, using fluoride
daily, and visiting the dentist regularly.
(Taken and adapted from the Pathways of the Pulp. Cohen, S and Burnrs, R. 2000)
2. Vocabulary
Go through the article a second time to match the word or phrases on the right with their
corresponding meaning on the left.
1. core a.___ something produced in addition to the principal product

2. source b.___ the act of holding, fixing or supporting
3. by-product c. ___ the most vital part of anything.
4. anchoring d. ___ alternative, option
5. choice e. ___ finally, ultimately
6. eventually f. ___ point of origin, cause
3. Pair Work
Ask and answer the following questions:

1. What are the causes of pulp injury according to the article? Is there any other cause?
2. What would happen if an injured tooth is left untreated?
3. Can you complete an endodontic treatment in only one visit? Make reference to your own
experience at the clinic.
4. Explain simply and briefly the steps to follow to make an endodontic treatment.
5. How can a patient make his tooth last a lifetime?
6. How are traumatic injuries classified in your country nowadays?

Study the following chart about the use of suffixes in word formation.
Ending Meaning Lexico grammatical Class Example
-al - related to adjective Gingival

-ist - member of a party or an personal noun, adjective orthodontist
Occupation
-ic - having the characteristic of adjective prosthetic
-ics - related to certain sciences noun periodontics

and systems
informatics
1. Add one of the endings listed in the chart to the incomplete words in the following
sentences.
1. After the oral examination, the dentist drew up the periodont___ chart.
2. Seeing that the patient had red and swollen gums, the dentist sent him to see the
periodont____.
3. Endodont____ is the branch of dentistry dealing with diseases of the pulp.
4. The patient also had gingiv___ bleeding.
5. The margin___ ridge showed no change in colour.
6. The ability of self-cleansing of the oral cavity depends, among other things on the
physic___ character of the food.
7. To maintain a general oral health the physiolog ___function of the mouth is very
important.
8. The patient was given an appointment for a radiograph___ examination.
5. Group Work
Formocresol K- Files Hedström Files
Rubber dam clamp Physiologic serum
Physiologic serum Dental explorer
Clorhexidine Reamers cement

sealers
Precipitated chalk Dental mirror Pliers

Gutta Percha cones Punchers
Cresophene
In the square above you will find materials and instruments used in the endodontic practice.
Work in groups and discuss the situations in which you can use them. Give reasons for
your choice when needed.
6. Writing
A pulpotomy procedure consists in the removal of a portion of pulp to allow the application
of a dressing in an area of healthy tissue to maintain the vitality of the pulp in the radicular
conduct.
Look at the steps to make this procedure and expand them into sentences.
 Radiographic evaluation
 Application of anaesthesia
 Removal of carious tissues
 Isolation of the area
 Cameral access
 Removal of the coronal portion of the pulp tissue
 Water and physiologic saline lavage to clean the amputation site
 Haemostasis with cotton pellets
 Laser therapy
 Selection of medicament: Calcium hydroxide, Formocresol
 Radiographs for verification
 Application of intermediate base
 The tooth is acid etched and restored with a composite resin
 Clinical and radiographic control every 3 months
Lesson 4
Dental Records and Case Reports
1. Class Activity
Study the following aspects. They are considered in the dental record.
1. Patient’s data
2. Chief complaints
3. History of the present
illness
4. Pathological history
5. Habits
6. Oral examination
7. Physical examination
8. Dental chart
9. Diagnosis
10. Treatment plan
11. Evolution
2. Group Work
Discuss in groups what each of these aspects includes.
3. Class Activity
Reporting a case
Useful Language
A 16-year old female …
The patient complains of / reports / has …
Family history discloses…
The only significant history was…
The patient’s medical history is non-contributory /
unremarkable…
The patient is allergic to…
The patient was referred to…
The X-ray disclosed /showed /revealed…
The patient was given and injection / shot…

Dentists:
 report on (cases)
 refer (patient to other specialists)
 do (research)
 order (x-rays)
 prescribe (medications)
 give (treatment)
 make (diagnosis).
Technicians:
 do / perform / run tests.
 People suffer from (diseases)
5. Class Activity
Study the following case report and identify the aspects from the dental record included in
it.
Case report
A 48-year-old female patient was referred to our office with a failing root-canal treatment.
This tooth had been treated ‘a few years ago’ by another practitioner. Her tooth was sore
when chewing. Tooth no. 33 was sensitive to percussion. Her occlusion was normal. There
were no signs of mobility, and periodontal probing was within the normal range.
Radiographs revealed previous endodontically-treated teeth 32 & 33. Tooth 33 appears well
obturated in a vertical fashion; however a radiographic lesion is noted on the side of the
root.
With the rubber dam in place, the access cavity was opened. The tooth emitted a terrible
odor. The gutta-percha was easily removed. The canal was cleaned and shaped. On the
final appointment, the canal was obturated with the warm Gutta-Percha Technique. A post
space was also created for the future crown. As you can see from the first recall, the
endodontic lesion had reduced in size dramatically. The patient was comfortable, and she
was happy with the results obtained.
6. Pair Work
What is missing from the case report? Complete it and check it with your partner.
( ) was referred to our office approximately 6 months

after suffering a traumatic injury. ( ).
There was a pulp exposure, which occurred as a result of the trauma. A pulpotomy had
been performed and a temporary crown had been placed at that time. There was some
swelling in the buccal fold area of tooth 11. The tooth was slightly mobile. The patient was
not sensitive to temperature testing and the tooth was sensitive to percussion.
( )
An endodontic therapy was indicated to try to save the tooth, however due to the
complications of the open apex, apexification procedures would also be required to try and
create some type of apical closure. At last the tooth was obturated using the warm Gutta
Percha Technique.
7. Writing
Write out the following case report from the following notes.
Female, 15 / bleeding and sore gums
Clinical examination/ bad oral hygiene / 7mm pocket depth around first molars and patient’s
medical history / unremarkable
Radiographic examination / diffuse bone lesion round
tooth 15
Presumptive diagnosis / juvenile periodontitis
Treatment / tetracycline and Perio- aid.
Unit 5. Radiology
Lesson 1
1. Quick Glance
Radiology originated with the discovery of X-rays by German physicist

Wilhelm Conrad Roentgen in 1895. Roentgen was awarded the first
Nobel Prize in Physics (1901) for his work.
Discussion
 What did this discovery mean to the dental practice?

 How often do you use this diagnostic mean in your daily practice?
2. Reading
In not more than five minutes skim the text to select from the following ideas the ones that
appear in the text.
a.___ Importance of radiographs in making a diagnosis.

b.___ Description of the different types of radiographs.
c. ___ Requirements to be taken into account when taking radiographs.
d.___ Precautions to avoid exposure to radiation.
e.___ Limitations of radiographs in Dentistry.
Dental Radiology
Determining what to do in certain dental cases is not always an easy task for the dentist.
Symptoms described by the patient may not be sufficiently clear and they may be
influenced by the manner in which caries or any other dental ailment reflects on the
surrounding area. Hence, a clinical examination shows neither what’s happening in a
particular area nor which tooth is actually being affected by the disorder. It becomes then
necessary to take two or more X-rays of the area in order to determine the exact cause of
the pain or of any other symptom.
Radiographic or X-ray examinations provide the dentist with an important tool that shows
the condition of the teeth, its roots, jaw placement and the overall composition of the facial
bones. X-rays can help the dentist determine the presence or degree of periodontal
disease, abscesses and many abnormal growths, such as cysts and tumours. X-rays also
can show the exact location of impacted and unerupted teeth. They can pinpoint either the
location of cavities or other sings of disease that may not be possible to detect through a
visual examination.
Basically there are two types of radiographs. These are called intra-oral and extra-oral.
Each has been designed to fulfil a given purpose. The dentist will choose the one which
best serves his purpose, which will depend both, on the area being examined and what the
doctor is looking for.
When taking X-rays, to obtain a good image the dentist should be careful with proper
angulation of the cone, accurate film placement, correct processing of the exposed film,
good illumination, and position of the patient. The patient’s head should be in a fixed
position while taking intra-oral films using fixed angles.
Some patient’s are concerned about exposure to radiation when radiographs are to be
taken, but the dentist is trained to prescribe radiographs according to each patient’s needs.
By using the technology and staying knowledgeable about recent advances, the dentist
knows which techniques; procedures and X-ray films can minimize the exposure to
radiation. To achieve this certain precautions should be taken to ensure safety while using
the X-ray apparatus.
The patient should be protected with a lead apron at each exposure. When exposing films,
the clinician should stand behind a barrier. If there is no barrier, the clinician should stand in
an area of minimal scatter radiation: at least 6 feet away from the patient and in an area
that lies at an angle between 90 and 135 degrees from the beam.
Every effort should be made to keep the radiation dose to all individuals as low as possible
and to avoid any unnecessary radiation to exposure.
(Taken and adapted from Dental Radiology. 5 th Edition. Lear & Febiger)
3. Vocabulary
Read the text in detailed to find the words that fit with the definitions given.
1. disorder _____________(P 1)
2. complete _____________(P 2)
3. determine with precision ____________(P2 ).
4. exact, correct _____________(P 4)
5. dispersed _________(P 5)
4. Pair Work
Answer the questions about the text.

1. How useful are X-rays examinations?
2. What criteria do you follow to select the type of X-ray to be used?
3. What aspects should the dentist take into consideration when taking X-rays? Are you
familiar with them?
4. What should be done to minimize the exposure to radiation?
5. Language in use: Expressing alternatives
Co-ordinating conjunctions: either…or / neither… nor
…either… ___ It means one or the other
 During the oral examination dentists may use either

artificial light or natural light.
…neither…nor _
It means ¨not one and not the other¨
 After dental extractions patients should neither smoke nor

make mouth rinses.
1. Find in the reading text sentences with this structure.
2. Use the co-ordinating conjunctions above in examples of your own.
6. Class Activity
Read the following situation carefully:
A patient comes to the clinic after having received a blow in the upper right central incisor
(11) without evident clinical symptoms.
a. What type of radiograph is required in this case?
b. Write about the most important things to take into account when taking this
radiograph. Use these hints as a guide.
 Position of the patient

 Position of the film
 Angulation
 Point of facial incidence
7. Writing
You have to prepare an exposition for a seminar. Write about the things you would say
based on the following statement.
¨ Radiology, a useful tool in the dentist’s hands ¨
Lesson 2
1. Reading
1. Skim read the text and select from the list the types of radiographs described through the
paragraphs.
 Extraoral
 Periapical
 Occlusal
 Lateral
 Waters
 Interproximal
2. Go through the reading text again and suggest a title.
“ ”
Proper selection of the appropriate type of radiographs is paramount either to complete the
diagnosis or to design a treatment planning. In the odontologic practice the primary
radiograph used is the intra-oral, although in some cases it is necessary to take other types
because what is apparent through one type of X-ray often is not visible on another.
Intra-oral films are designed to be placed within the mouth while the exposure is being
made. They are made in three types: periapical, interproximal or bitewing, and occlusal.
Typically most dental patients have “periapical” or “bitewing” radiographs taken. These
require patients to hold or bite down on a piece of plastic with X-ray film on the centre.
( ) typically determine the presence of decay between teeth. They are all
characterized by a “wing” or “tab” on which the patient bites in order to hold the film in
proper position on the lingual aspect of the crown of the tooth. These film correctly exposed
are also useful to check either gingival margins of the fillings and crowns or to detect caries
on the mesial and distal aspects of the cheek teeth. Early carious lesions can also be
detected sooner than is possible through clinical examination alone. In Endodontics this film
may be useful as a supplemental film. It includes the anatomic extent of the pulp chamber,
the existence of pulp stones or calcifications, and any evidence of previous pulp therapy.
( ) are used to show root structure, bone levels, cysts and abscesses. They
are designed to show the apexes of the teeth and the surrounding bone. They are large
enough to show about three teeth and adjacent bone. In Endodontics it is the primary
radiograph used. It is used to identify abnormal conditions in the pulp and periradicular
tissues, to determine the number of roots and canals, location of canals, and root
curvatures.
( ) is the name given to those intraoral techniques where the film is

placed in the occlusal plane. It is used to show the position of an unerupted tooth in relation
to the arch, certain bonny changes and their extent, notable expansion of the jaw, the
position of retained roots and in the lower occlusal film, a calculus in Wharton’s duct. It is
also used to show large areas of the maxilla and mandible for the purpose of viewing large
pathologic areas, fractures, impactions, supernumerary teeth and foreign bodies.
( ) as related to Dentistry embraces the X-ray examination of the
larger portions of the mandible, maxilla, temporo-mandibular joints, and facial profile.
Radiographs of this type are used to supplement the findings in intraoral examination. They
are sometimes used when infection or fractures will not permit the use of intraoral films.
There are several types of extraoral films; the panoramic radiograph for instance allows the
dentist to see the entire structure of the mouth on a single image. Within one large film,
panoramic X-rays reveal all of the upper and lower teeth and parts of the jaw.
(Taken and adapted from Dental Radiology. 5th Edition. Lear & Febiger)
2. Vocabulary
Which words in the text correspond to the following definitions?
1. important ______________(P. 1)
2. tube _______________(P 5)
4. includes ______________(P. 6)
5. side view _______________(P 6)
6. permit ________________(P 7)
3. Pair Work
1. What is the most common type of radiographs used in Dentistry? Make reference to your
daily experience.
2. Why is the bite-wing radiograph called this way? When is it used?
3. In what kind of situations do you use periapical X-rays? Talk about your own experience.
4. Are you familiar with de occlusal X-ray? Explain.
5. How often do you use extra-oral radiographs? Explain.
4. Group Work
In the last few months you assisted different patients with the following pathologies:
 chronic periapical abscess
 granuloma
 cyst involving four teeth
 Interproximal caries
 radicular fracture.
1. What radiographs did you order to get to the diagnosis in each case? Give reasons for
your choice.
2. Talk about the radiographic aspects that allowed you to get to the diagnosis.
5. Writing
Write a 150- word summary on the article you have read.
Lesson 3
1. Conversation
Listen to the conversation to answer the following questions:
1. Did the patient provide the dentist with enough information about his problem?
2. Was the oral examination convincing to the dentist?
3. How many X-rays were taken?
(At the X-ray room, a resident is taking an X-ray)
Resident: This way please, Mr. Rodriguez.

Mr. Rodriguez: Thank you (The patient comes into the department)
Resident: OK, sir. Sit here, please. Just relax. That is. This is the X-ray
film. You are going to hold it in place with your thumb. Now
open your mouth, please, and press the thumb against the film.
Move neither your hand nor the film. Stay still, please. Thank
you.
Mr. Rodriguez: Finished?
Resident: No, not yet. I’m going to take another one. You only have to bite
this tab firmly until I tell you to release it. Right, Thank you very
much indeed.
(At the X-ray department the resident is consulting his professor about the X-rays results)
Resident: Well, Shall we have a look at these films?

Professor Lugo: All right Carlos. Hand me them. Will you? What’s the patient’s
problem?
Resident: Well, during the interview the patient only told me that
whenever he had a cold drink, he had a sharp pain all over the
area surrounding tooth 14.
Professor Lugo: What about the clinical examination? What did it show?
Resident: Not much. I examined the area quite thoroughly and I couldn’t
find anything relevant. So I decided to take two X-rays.
Professor Lugo: Why? Wasn’t one enough?
Resident: No, it wasn’t. On percussion tooth 14 was painful but he also
reported that whenever he used the dental floss it got caught
between the 23 and the 24.
Professor Lugo: What kind of X-rays did you decide to take?
Resident: Well, ahh… I thought it would be wiser to take a periapical
X-ray and a bitewing one.
Professor Lugo: Excellent Carlos. But tell me something. What condition did
you take into consideration to take them?
Resident: Well, I considered several entities, such as periapical cyst,
chronic abscess and proximal caries.
Professor Lugo: And what was your diagnosis?
Resident: A chronic abscess in tooth 14 and proximal caries on the
mesial surface of tooth 24.
Professor Lugo: Good work, Carlos. You can start treating the patient now.
2. Vocabulary
Go through the conversation and find the equivalent of the following words or phrases:
a. motionless __________
b. free ___________
c. pass something to somebody ____________
d. in detail _____________
e. trapped ____________
f. more prudent ___________
3. Pair Work
Ask and answer the following questions in pairs.

1. What other instructions are given to patients while taking X-rays?
2. What questions do you think the resident asked the patient during the interview?
3. Why did the resident decide to take a periapical and a bitewing radiograph?
4. If you were Carlos what course of treatment would you apply in each case? Give
reasons.
4. Language in use
Explaining something to the patient

 Now, you are going to hold this in place
Praising
 Well done
 Find similar expressions in the conversation above.
5. Role Play
A student is taking a test. A professor is asking him questions about some X-rays he has
taken.
Role A: You are the student. Tell the professor about the case. The patient you assisted
complained of food packing between two neighbouring teeth and pain. Give reasons for the
types of radiographs chosen.
Role B: You are the professor. Ask the student about the patient’s disorder and the reasons
for choosing a given type of radiograph. Ask any other question you consider relevant.
6. Pair Work
Work with your partner and carry out the real conversation between the resident and Mr.
Rodriguez during the oral examination.
Unit 6. Orthodontics
Lesson 1
1. Quick Glance
Archaeologists have discovered mummified ancients with

crude metal bands wrapped around individual teeth. To close
gaps, it has been estimated that catgut did the work now
done by today's orthodontic wire.
"Hippocrates wrote of attempts to straighten teeth around
400 B.C
Discussion
 What other facts do you know about the history of orthodontics?
 How has this science developed from that time on?
2. Conversation
Listen to the conversation and take notes about the following:

 Patient’s main complaint
 Other patient’s disorders
 The treatment
(Mrs González is at the orthodontist with his 8- year old son, Luis)
Mrs. González: Good morning, Doctor
Dr. Garcia: Good morning. What’s your main concern about your son?
Mrs. González: Well, doctor, his teeth are spread outward and he doesn’t
look well.
Dr. Garcia: How long has he had this problem?
Mrs. González: Since his teeth erupted.
Dr. Garcia: Is there any other member of your family with the same
anomaly?
Mrs. González: Yes, Doctor. His father had the same problem when he was
a child.
Dr. Garcia: Does the child sleep with his mouth open?
Mrs. González: Yes, he does.
Dr. Garcia: Does he also suck his thumb?
Mrs. Gonzalez: No, not at all.
Dr. Garcia: Has he ever suffered from tonsillitis, pharyngitis, asthma or
any other respiratory disease?
Mrs. González: Yes, he has had sore throat several times and he has even
been on antibiotics.
Dr. Garcia: Did you see a specialist about that?
Mrs. González: Yes, the specialist saw him.
Dr. Garcia: What did he tell you about it?
Mrs. González: His adenoids are hypertrophic and have to be removed.
Dr. Garcia: The general dentist gave you some instructions. Didn’t he?
Mrs. González: Of course he did. My son Luis should do some exercises to
improve his way of breathing and some others after the
operation.
Dr. Garcia: Well, he has to wear an orthodontic appliance to take his
teeth to the right position. And he has to keep on doing the
exercises.
Mrs. González: Is that all?
Dr. Garcia: No, he should also massage his upper lip with the forefinger
and the thumb and try to stretch it to improve the perioral
muscle tone. We are taking the X-rays today and in the next
visit we’ll take the impressions.
Mrs. González: Thank you, doctor.

Dr. Garcia : Well, just follow the assistant to the X-ray department,
please.
3. Vocabulary
1. preoccupation __________________
2. external _______________
3. digit _____________
4. painful _____________
4. Pair Work
Discuss the following questions with your partner.
1. Mrs. Gonzalez is worried about her son’s appearance. Are there any other things to be
worried about in relation to this case?
2. What deforming habit is affecting this child?
3. In what way are the diseases mentioned in the conversation related to malocclusions?
4. Why are X-rays going to be taken?
Two-part verbs
Verb + preposition or adverb

Note: Some of these phrasal verbs have a literary meaning; some others have
a figurative meaning and should be learned as one unit.
give up ….. .stop

take out …… remove
come in ….. ..enter
put in………. install
keep on …… continue
 Write sentences of your own using these or other phrasal verbs.
6. Group work
Luis is a mouth breather.

 Make reference to other deforming habits you know about and briefly talk about
them.
 What popular measures do people generally use to avoid them?
 As a doctor what do you recommend?
7. Role play
A: You are the mother / father of a 7 year-old-girl visiting the dentist. You come
because your daughter is in the habit of biting her nails, and her gums are bleeding.
B: You are the dentist, ask A about the causes of the habit. Ask about the home
atmosphere / particular situation of stress / enough play time. Give her some pieces of
advice.
Lesson 2
1. Conversation
Read the following sentences. Then listen to the conversation and say if they are true or
false.
a. Luis is cooperating with the treatment ____
b. Dr. Garcia suggests a removable appliance ____
c. At this moment, Mrs. Gonzales is worried about his son’s appearance____
d. He can eat any kind of food with the appliance ____
e. He must be checked every three weeks ____
(A week later Dr. García is fitting the appliance to Luis)

Mrs. González: Good morning, doctor.
Dr. Garcia: Good morning, Mrs. Gonzalez. How are you, Luis? Did you
follow my instructions? Are you doing the exercises?
Luis: Yes, doctor, every day.
Dr. García: Well, today we are going to fit a removable appliance.
Open your mouth please. Let’s try it on. Do you feel any
discomfort?
Luis: Yes, it feels tight.
Dr. Garcia: Yes, you will feel some discomfort but only at the
beginning. It is due to the pressure on the anchorage teeth.
Perhaps you’ll find speaking difficult.
Mrs. Gonzalez: How will he get used to it?
Dr. Garcia: He will get used to wearing the appliance, if he wears it as
much as required.
Mrs. Gonzalez: Very well and how long will he wear the appliance?
Dr. Garcia: Well, it will depend on the time he wears it, how he uses it
and its care.
Mrs. Gonzalez: Is it true that the appliance can cause tooth decay, doctor?
Dr. Garcia: No, it isn’t. Poor oral hygiene is what actually causes tooth
decay, and it can be avoided through proper brushing. The
appliance tends to pack food, plaque and saliva; that is
why he should brush his teeth as well as the device.
Mrs. Gonzalez: Can he eat any kind of food?
Dr. Garcia: Just liquids while wearing the appliance as chewing may
fracture or distort the device.
Mrs. Gonzalez: How often does he have to be checked?
Dr. Garcia: Regularly, every twenty one days to activate the appliance,
check teeth movements and compare the changes with the
initial model.
Mrs. Gonzalez: Should I accompany him on each visit?

Dr. Garcia: Yes, indeed. You should know about your son’s
improvements and what he should do in each coming
period.
Mrs. Gonzalez: Thank you so much for every thing, doctor.
Dr. Garcia: You are quite welcome, Mrs. Gonzalez. Ask the dental
assistant for an appointment on your way out.
2. Vocabulary
Match the words in Column A with the corresponding meaning in Column B
Column A Column B
1. fit a. points of retention of the appliance.

2. anchorage b. deform, twist
3. actually c. put on
4. distort d. install, adjust
5. wear e. really
3. Pair Work
Ask and answer questions about the dialogue. Use the following question words:
Why…? What…? , When…? , How long…?,
Is…? , Are…? , Will…? , Must…? , Can…?
4. Language in use: Expressing necessity
... have to ... He has to come back again for another checkup.
The negative of have to, with the meaning “there is no necessity” is expressed by
have not to, haven’t got to or do not have to.
She doesn’t have to go to the dentist this morning.
1. Go through the dialogue and find any other expression showing necessity. Give some
examples of your own.
5. Class activity
You are the orthodontist now. Write a note to your patient reminding him what he has…/
must…/ mustn’t do… while wearing the appliance.
6. Group Work
1. Orthodontic treatment in adults or children.
2. Fixed or removable appliances. Pros and Cons
7. Writing
Expand one of the previous ideas into a paragraph
Lesson 3
1. Reading
Read the following excerpt
Title: “__________________________________________”
Orthodontic treatment includes the diagnosis, prevention, and treatment of dental and facial
irregularities. Such irregularities often take the form of malocclusions-problems with the way
the teeth fit together. Malocclusions can affect function, appearance and health. Most
malocclusions can be corrected by orthodontic treatment but if the problem results from
skeletal irregularities, orthognathic surgery may be needed.
Malocclusions affect more than just appearance. Crooked, crowded, or protruding teeth are
more difficult to clean, and the consequence could be increased tooth decay or periodontal
disease. If chewing is difficult because teeth are not properly aligned, softer foods may be
selected, often at the expense of nutrition. Misaligned teeth also can create tension and
pain in the jaw joints because of the excess stress placed on chewing muscles, weaken the
bones and gums supporting the teeth, cause abnormal wear of the teeth, and lead to
emotional problems because of the effect on speech and the unattractive appearance.
There are no age boundaries for orthodontic treatment. In most cases, malocclusion is
hereditary, caused by discrepancies in size of the jaw and teeth, and can not be prevented.
Sometimes malocclusions is the result of such habits as mouth breathing, finger- or thumb-
sucking, tongue thrusting, and lip biting, or by premature, untreated loss of teeth and the
behaviour of this disorder in the world ranges from 35% to 75% with differences in sex and
age.
The first step in orthodontic treatment is an oral examination and a review of your medical
and dental history. To determine the best treatment plan, the orthodontist then conducts a
series of studies that may include growth evaluations, facial measurements, photographs,
plaster study models, and radiographs of the head, jaws, and teeth. Any additional oral
problems, such as dental decay or periodontal disease, are treated before orthodontic
treatment begins.
Some appliances are fixed and some are removable. The choice depends on the problem
to be corrected and the patient’s special needs. All the appliances, whether fixed or
removable, do the job by exerting gentle pressure on the teeth and jaws, causing them to
move or stabilise into the desired positions.
The fixed appliances, or braces, can be attached to the teeth in two ways. The traditional
metal bands with brackets can be cemented around the teeth. Or, the brackets alone can
be bonded directly to the teeth, eliminating the dental band encircling the teeth. Throughout
treatment, pressure is applied to the teeth by adjusting the wire. Brackets also can be made
of transparent or tooth-colored material so that only the wire connecting the bracket is
visible.
Removable appliances, which are not cemented or bonded to the teeth, can be used to
correct some orthodontic problems. They are held (retained) in place by clasps or straps
and need be worn only for a certain period each day. Removable retainers also are used
after orthodontic therapy to hold teeth in their new positions until they stabilize.
Some discomfort or soreness may be present when fixed appliances, or braces, are first
attached to the teeth, but it should vanish after a few days. Proper oral hygiene is vital
during orthodontic treatment. Although the bands or brackets protect the portion of the teeth
they cover, plaque can collect on the unprotected areas of the teeth or under loose-fitting
bands. Patients should brush their teeth after each meal and snack and before bed, using
the method recommended by the dentist. They should follow the dentist’s advice about
foods that should and shouldn’t be eaten during the course of the treatment. Some foods
may damage the braces, and others may be difficult to remove from the teeth during
cleaning. Included among the forbidden foods are: chewing gum, ice, nuts, and toffee, hard
candy, corn-on-the-cob, and some uncut fruits.
In most cases, orthodontic patients must visit the practitioner every 3 to 6 weeks. During
these regular visits, the practitioner will check the progress of tooth movement and mend or
replace any parts of the appliance that have been broken. If other dental problems occur
during the course of the orthodontic treatment they will be diagnosed and treated during
these regular visits.
The average length of treatment for young people is 18 to 30 months. Adults generally face
longer treatment periods because the growth process, which helps teeth move, has
stopped. Other factors that determine the duration of treatment include the patient’s co-
operation, the severity of the condition, and the state of the oral tissues. Braces aren’t just
for kids anymore!
(Taken and adapted from the Journal of the American Dental Association)
2. Vocabulary
Find in the reading a word that means:
1. curved ______________(P 2)
2. debilitate___________ (P2)
3. limits _____________ (P 3)
4. cable___________ (P 6)
5. prohibited ______________(P 8)
6.repair ____________ (P 9)
Prefixes Meaning
dis apart, separation, the opposite of

un against, the opposite of
im / in not
1. Add prefixes to the following words to form new words
1. ___comfort 4. ___ formal 7. ___advantage

2. ___ probable 5. ___continue 8. ___ complete
3. ___ known 6. ___ healthy 9.___usual
2. Write sentences with some of the new words.
4. Group Work
Temporomandibular Joint (TMJ) disorders are frequently seen in patients at the dental
clinic. Discuss in groups the following:
1. Signs and symptoms of TMJ disorders

2. Etiology of these disorders
3. How to get to a final diagnosis.
5. Writing
You assisted a patient with problems in the TMJ. Write a referral for the Specialist with
the assessment you have made up to that time.
Unit 7. Pediatric Dentistry
Lesson 1
1. Quick Glance
The smile of little princes and princesses is a very

special gift.
Discussion
Let’s preserve it … for the life
 Is it important to preserve children’s oral health? Give reasons.
2. Conversation
1. Listen to the conversation and say if the following sentences are TRUE or FALSE.
a. The doctor started the treatment as soon as the child entered the office ___.
b. In the conversation with the child the dentist used a very simple language ___.
c. Tommy refused to be treated ___.
d. He has an upper molar with a deep caries ___.
e. Tommy’s tooth will be restored in another appointment ___.
(Tommy, a 4-year-old child, comes to the dentist with his father for the first time)
Dr. Alea: Hi, Tommy. Hello Mr. Diaz.
Tommy: Hello, doctor
Dr. Alea: OK, Tommy. I know this is your first visit to a dentist. Your father
says that you feel pain when you eat sweets. Today I’m going to
show you the things dentists use to treat children to keep a beautiful
smile. This is a little mirror used to look into your mouth. This small
broom is used to sweep your teeth and the little spoon to take out
dirt and the little bugs from your teeth. This shower is for washing
the tooth and taking out the bugs.
Tommy: (Crying) No, I don’t want to stay here. Let’s go home daddy.
Father: No, Tommy, if your tooth is not treated pain will worsen.
Dr. Alea: Ok, Ok, I promise I won’t do any thing today. I will see you tomorrow
but just let me see the tooth that hurts. Open your mouth, please,
Tommy.
Father: What’s the problem, doctor?
Dr. Alea He has a lower molar with caries and it is very deep.
Father: Why don’t you treat it now?
Dr. Alea: I promised Tommy I wouldn’t. It’ll be better for all of us if he is quite
and without apprehension.
Father: But, how can I manage the pain?
Dr. Alea: Try not to give him sweets to avoid the pain and come back
tomorrow to treat him. Just tell him treatment is necessary and if he
behaves well I will finish in a few minutes.
Father: OK, I will. Until tomorrow doctor.
Dr. Alea: See you tomorrow Tommy. Good-bye.
Tommy: Good bye, doctor.
3. Vocabulary
Find in the text words similar in meaning to the ones below:
1. insects, germs __________

2. intensify, aggravate ____________
3. fear, anxiety _________________
4. handle, control _______________
5. acts, conducts oneself_______________
4. Pair Work
Discuss with your partner the following questions:

1. Why is it very important to establish a good rapport with the child? How do you
achieve that in your consultation?
2. Do you think the doctor proceeded in the correct way with Tommy? Explain.
3. What other ways of reducing apprehension do you know of?
5. Group Work
In a professional practice in the health area you work in, children’s parents may ask the
following questions. Discuss in groups the possible answers to be given in each case.
1. When will my child’s teeth appear?

2. Is teething always painful?
3. What dental problems could a baby have?
4. Does my child need dietary supplements for strong teeth?
5. Will preventive dentistry benefit my child?
6. Writing
Write a paragraph taking into account the most important aspects discussed in the previous
exercise.
Lesson 2
1. Conversation
Listen to the conversation carefully and say YES or NO.
a. Tommy is ready to cooperate with the doctor ___

b. He has had an allergic reaction to penicillin ___
c. His mother says he is a healthy boy ___
d. Doctor uses a rude language while treating Tommy ___
e. Doctor praises him for his behaviour during the treatment ___
Tommy and his father are at the dentist’s the next day.
Doctor Alea: Good morning Mr. Diaz. How are you today Tommy? Is it
true you’ll let me treat your tooth today?
Tommy: Uhm. Will it be painful? I’m scared.
Doctor Alea: No, It won’t. First, you will feel a mosquito bite and your
tooth will sleep for some time. It won’t be painful. I assure
you. O.K., Mr. Diaz, Has Tommy had any allergic reaction
to any treatment or medication?
Mr. Diaz: No, never
Doctor Alea: Is he in good health? Has he suffered from any disease?
Mr. Diaz: Just, common illnesses, doctor.
(Doctors prepares to start treatment)

Doctor Alea: Ok, Tommy! Open your mouth. I want to see where the little
bug is. I am going to turn on the lamp. Open wider, please. Oh,
there are two bugs eating and damaging your tooth. That’s why
you have pain.
Tommy: Aren’t you going to take them away?
Doctor Alea: Yes, I’m going to use this shower to brush the tooth and take
out the bugs and with this little spoon I’m going to remove all
the dirt in your tooth. You see? You’ve done very well Tommy.
Mr. Diaz: Is it all finished?
Doctor Alea: No, not yet. Now, I’m going to use this little tap to wash and dry
your cleaned molar, and then with this shovel I’ll put the paste
to reconstruct your tooth again. Now yes! We’ve finished. Close
your mouth now and tell me if you feel any discomfort.
Tommy: No, none.
Doctor Alea: Good! Do you know why your tooth got sick Tommy?
Tommy: I don’t know. Why?
Doctor Alea: Well, when you eat sweets or candies you have to brush your
teeth after that to avoid bugs in your mouth and you should visit
me more often.
2. Vocabulary
If you had to report this case to a colleague, which dental terms would you use in your
report?
a. mosquito bite ____________
b. the tooth will sleep ____________
c. little spoon _____________
d. shower _____________
e. shovel ______________
f. lamp ______________
3. Class Activity
What other substituting terms can you use in the communication with children instead of the
following?
 dental explorer
 prophylactic paste
 X-ray set
 Impression material
 Anaesthesia
4. Pair Work
Ask as many questions as you can about the dialogue. Use the following clues:
What…? Should…?
When…? Is…?
Has…? Does…?
Did…? How often…?
5 . Language in use: Explaining purpose

Notice how the dentist explains the patient the purpose of a procedure
Now, I’m going to use this shower to brush the tooth

and take out the bugs.
1. Find similar expressions in the conversation.

2. Think of other procedures frequently used at the dental clinic. How would you explain
them to the patient?
6. Pair Work
You are assisting a child. He has come with his mother. Use the following map dialogue to
work out the conversation:
DOCTOR PATIENT
Greet the child Greet the doctor. Say

and the mother your child's main
Ask her about complaint
his/her problem
Make polite Follow the doctor's

requests to make instructions and answer
the oral the questions
examination
Explain the Give appropriate

purpose of each answers
procedure
Tell them you finish

and give the child Thank the doctor for
some instructions everything
7. Writing
Try to remember the last child you assisted at your clinic and write the case report.
Lesson 3
1. Reading
Say from the following list of topics the ones that appear in the text:
a. Importance of an early visit to the dentist
b. Baby’s discomfort at the time of teeth eruption
c. Importance of the diet in the prevention of tooth decay
d. Recommendations to keep oral hygiene.
e. Ways of treating tooth decay in children.
Pediatric Dentistry
Pediatric dentistry is the specialty of dentistry that focuses on the oral health and unique
needs of infants, children and adolescents, including persons with special health care
needs. This speciality focuses on prevention, early detection and treatment of dental
diseases, and keeps current on the latest advances in dentistry for children and has a goal
to help all children feel good about visiting the dentist and teach them how to care for their
teeth.
Getting an early start in regular dental care is an important step on the road to teaching
your child healthy lifetime habits. The first dental visit should occur shortly after the first
tooth erupts and no later than the child’s first birthday. Beginning tooth and mouth
examinations early may lead to detection of early stages of tooth decay that can be easily
treated. Early visits help children view dentistry positively so the earlier you begin, the better
the dentist chances of preventing dental problems. Parents should try to make the first visit
a pleasant adventure telling the child the dentist is a friendly doctor who will help keep him
or her healthy. A friendly relationship between the child and the dentist helps prevent the
fear that so often causes children and adults to postpone dental treatment. The parent’s
attitude and examples can colour the child’s perception of dental care for many years.
During the first visit, the dentist will examine the child’s teeth and gums, checking to see if
the teeth and jaws are normal. An x-ray examination may be needed to detect hidden
decay or to see how the teeth and facial bones are developing, but the dentist will make
such an examination only if the evaluation indicates it is necessary. Children who are
considered high-risk patients – those with haemophilia, Down’s syndrome, or a disabling
condition- should receive dental care at an early age because their dental health is closely
related to their overall health.
When a baby’s teeth are ready to break through (erupt) the gums, the gums usually
become swollen and tender and the baby becomes irritable and restless. If a baby is
extremely uncomfortable, the dentist may prescribe a medicine to temporarily produce
numbness the gums. Teething is a natural process; when the tooth emerges, the symptoms
vanish.
Even before the teeth begin appearing, parents should start cleaning the mouth to keep
food residue and bacteria from damaging newly erupting teeth. If plaque is allowed to build
on baby’s teeth, the tooth enamel could become decayed. If the decay is left untreated, the
primarily teeth may be prematurely lost. Children need all 20 of the primary teeth for proper
eating, speaking and appearance. These teeth also reserve space in the Jaw for the
permanent teeth that later erupt.
It is important to begin brushing and flossing the child’s teeth after each meal or snack and
before bedtime as soon as any teeth is in the mouth. Children need smaller brushes than
those designed for adults. Toothbrushes should be replaced when the bristles become bent
or frayed, usually every 3 to 4 months. Pre-schoolers often wear out toothbrushes quickly
because they brush imperfectly and chew on the brush. Sucking is one of the baby’s natural
reflexes that allows him/her to obtain nourishment. It’s a normal infant habit that makes the
baby happy and secure. After age 2, thumb sucking usually decreases and gradually stops
altogether. If vigorous and prolonged thumb sucking continues past age 4, however, normal
dental development could be threatened.
The dentition of children requires not only careful observation during each periodic
examination but also the need for diagnosis and intervention with timely treatment.
(Taken and adapted from:
http://www.aapd.org/pediatricinformation/brochurelist.asp)
2. Vocabulary
Find words to fit the following:
a. most recent, up to date: ___________(p.1)
b. remain out of sight, in secret ___________(p. 3)
c. having physical or mental impairment or defect____________ (p.3)
d. impatient, unquiet ____________(p.4)
e. food, nutrient______________ (p.6)
f. in danger_____________(p.6)
3. Pair Work
Ask and answer the following questions
1. What may happen if the first visit to the dentist does not occur in time?
2. What should parents do to avoid the child’s anxiety and fear?
3. Explain the following statement: A complete set of healthy primary teeth allows proper
development of a child’s jaw and face.
4. Briefly state some of the things to be done to keep the child’s oral hygiene.
5. In what way may thumb sucking threaten normal dental development?
4. Language in use: Giving reasons ( If-clauses )

If there is caries, - immediate treatment will be required
- you will need a filling
If you had a fracture, -a canal treatment could be required

-you would require a canal treatment
If you had done that, - that tooth could have been saved
-you could have saved that tooth
1. Give appropriate endings to the following sentences.

1. If you had seen the dentist regularly, …
2. If there is an abscess, …
3. If you followed my instructions, …
4. If she still uses a feeding bottle, …
5. If he used fluorides, …
2. Pair Work
Work with your partner the following questions.
a. What would you do if a patient didn’t cooperate to treatment?

b. What will happen if parents don’t take care of the child’s primary dentition?
c. What would have happened if a patient with gingivitis hadn’t seen a dentist regularly?
5. Group Work
Work in groups and discuss the actions carried out by dentists in your country in favour of
children’s oral health
6. Writing
Study the information in the following table:
Incidence of habits in children
Habits % Number of
children
Bruxism 12 18
Mouth breathing 30 45
Onycophagia 10 15
Postural habits 10 15
Cheilophagia 8 12
Feeding bottles and pacifiers 80 120
Thumb sucking 60 90
1. Notice how the following paragraph has been built up from the data in the table.
Complete the paragraph with the remaining data.
Table I shows the incidence of habits in children with maxillofacial anomalies. Of the total
group, 120 children used feeding bottles or pacifiers representing the 80 % of the total
group. Ninety children, who represented the 60 %, had the habit of thumb sucking as the
second most common habit, while…
Unit 8. Prosthodontics
Lesson 1
1. Quick Glance
Portraits of the first president of the United States, George Washington,

rarely show him smiling and for a good reason: George Washington’s
false teeth were made with wood. Though they were well sculpted by
his blacksmith friend Paul Revere, this crude set of teeth did not have
the same polish as nature’s artistry.
Discussion
 What information do you have about the time artificial dentures began to be used to
substitute natural teeth?
 How has denture making changed from ancient times to present times?
2. Conversation
Listen to the conversation carefully and take notes about the following
1. Mr. Torres lost his __________ , a premolar and a molar.
2. He had an accident _______ weeks ago.
3. He had a________ __________done some time ago.
4. He was treated for _______ _________once.
5. The patient needs ___________________.
(Roberto Torres is at the Prosthodontist‘s for the first time)

Mr. Torres: Good morning, doctor
Dr. Rey: Good morning, sir. I’m Dr. Rey. May I have your referral, please?
Mr. Torres: Here you are, doctor.
Dr. Rey: OK. I would like you to sit here, please.
Mr. Torres: Thank you, doctor.
Dr. Rey: Well… What’s your name, please?
Mr. Torres: Roberto Torres.
Dr. Rey: OK. Mr. Torres. Let’s go over your case.
Mr. Torres: I hope you can help me doctor. I lost my front teeth and it’s very
embarrassing for me to look like this.
Dr. Rey: Well, I want you to open your mouth, please. Oh! I can see you are
missing your front teeth, a premolar and a molar. How did you lose
these teeth? Did you have them extracted?
Mr. Torres: No, not extracted. I had an accident six weeks ago, doctor. That’s
how I lost them.
Dr. Rey: Ahh… I see. Do you smoke?
Mr. Torres: Yes, but not very much.

Dr. Rey: What about coffee?
Mr. Torres: Only in the morning.
Dr. Rey: Let’s have a look at your mouth again. There is something I need
to check in a tooth. Has this tooth been treated before?
Mr. Torres: Er…Now that I remember, I had a canal treatment done some time
ago.
Dr. Rey: Well, I’m going to take an Xray of this tooth before taking the
impressions.
(10 minutes later)
Mr. Torres: Is there any problem doctor?

Dr. Rey: No, there isn’t. The X- ray shows there is nothing wrong with that
tooth and the canal treatment was correctly done. Any other
discomfort?
Mr. Torres: Err… No, not that I have noticed.
Dr. Rey: Have you been treated for any other dental problem before?
Mr. Torres: Well, yes, uh-huh… I had gums trouble once.
Dr. Rey: Right. What do you expect from the treatment, Mr. Torres?
Mr. Torres: Well,…er, I wonder if the denture will really improve my
appearance.
Dr. Rey: Of course it will, Mr. Torres. Don’t be worried. Your gums and the
remaining teeth are in good condition. You need a removable
partial denture. I’m going to take the impressions today and give
you an appointment for next week.
Mr. Torres: All right, doctor.
Dr. Rey: Well, open your mouth, please.
3. Vocabulary

a. recommendation ______________
b. disconcerting ________________
c. wait, look forward _____________
d. get better _____________
e. being left ______________
4. Pair Work

1. What was the patient’s concern about the treatment?
2. How did he lose his teeth? Mention other causes for tooth loss.
3. Why did the doctor ask about smoking and coffee?
4. Is it important to take X-rays of the adjacent remaining teeth? Explain.
These words are often confused. Study the table carefully.

Lose (verb /present) If you lose your front teeth, you may look ugly.
Lost (verb /past / pp) Mr. Torres lost his front teeth in an accident 6 weeks ago
Lost (adjective) The lost teeth were replaced by a denture.
Loss ( noun) Periodontal disease may produce tooth loss
Loosen (ed) (verb) After a trauma teeth may loosen

Loose (adjective) Food may pack under loose brackets
1. Now complete the following sentences. Use your dictionary if necessary.
a. Food may be packed under _____________ dentures.

b. Early tooth _____________ may lead to malocclusions.
c. The patient needs a denture because he _____________ some of his teeth a year ago.
d. If patients with fixed dentures neglect their oral hygiene, they may __________ the
abutment teeth.
e. Sometimes dentures _______________ when eating.
3. Now use the words in sentences of your own
6. Language in use: Infinitives

Making requests:
Making
Verb (+requests
object) +and stating purpose or reason
to-infinitive
I asked her to answer these questions.
I want you to open your mouth.
Stating purpose or reason:

I went there to see the dentist.
I use the explorer to check if there is caries.
To improve his appearance is his main concern.

1. Work with your partner to make requests and state reason according to the following
situations:
a. Ask your patient to sit on the dental chair.

b. Tell your professor why you decided to take an X-ray.
c. Explain your partner the reason for doing a canal treatment.
d. Ask your patient to come back for a routine check up.
e. Ask your patient to practice reading aloud.
2. Give other examples of your own
7. Writing
Mr. Torres was referred by his General Dentist; if you had had to do that, what would you
have written in the referral for Dr. Rey?
Lesson 2
1. Conversation
Listen to the conversation and say if the following sentences are True or False.
1. Mr. Torres is satisfied with the denture____
2. After a week Mr. Torres is adapted to the new denture ______
3. After the installation the patient is having difficulty when eating_____
4 Mr. Torres is sometimes nauseated with his new denture.____
(Mr. Torres is at the try-in appointment)
Dr. Rey: Good afternoon, Mr. Torres.

Mr. Torres: Good afternoon, doctor. Am I going to take my denture today?
Dr. Rey: No, not yet. We are going to try the denture on today and in a
few days it will be definitely fitted.
Mr. Torres: I’m a bit anxious
Dr. Rey: Don’t be. Everything is going to be all right. I want you to open
your mouth please.
(Dr. Rey tries the denture)

Dr. Rey: Look at yourself in the mirror. How does it look? Do you like it?
Mr. Torres: Oh, yes doctor, they are fine.
Dr. Rey: What do you think of the colour and the size? Are they all
right?
Mr. Torres: Yes, they’re all right.
Dr. Rey: Bite down hard, please. Feel any discomfort?
Mr. Torres: No, not at all.
Dr. Rey: Now I want you to smile. All right. Say mum, Mississippi, fool,
pulse. (patient repeats the words). All right, Mr. Torres. So we
don’t have to worry. Make an appointment for your definite
installation, please.
(A week after the definite installation Mr. Torres is in his regular check-up appointment)
.
Mr. Torres: Good afternoon, doctor
Dr. Rey: Good afternoon, Mr. Torres. Sit here please. How have you
been doing with the denture?
Mr. Torres: Not very well, doctor.
Dr Rey: What’s the problem? Do you feel any discomfort when you
chew?
Mr. Torres: No, that’s not the problem, speaking is my problem and
sometimes I feel nausea.
Dr. Rey: Well, Mr. Torres, that’s quite normal. You’ll get used to
speaking with your new denture in a few days. It is a
temporary inconvenience and the nausea will disappear, I
assure you. Don’t forget to follow the instructions I gave you
about the oral hygiene.
Mr. Torres: Yeah, OK, I won’t.
Dr. Rey: Well you should come back again for another routine check-
up.
2. Vocabulary
Read the conversation again and substitute the words in italics by another word similar in
meaning.
1. The dentist must test the denture before the definite installation.
2. Having adjusted the denture the patient must be check regularly.
3. He was satisfied with the dimension of the teeth.
4. After the operation the patient was seen for a general examination.
5. I can’t guarantee the success of the treatment.
3. Language in use: expressing habituation
...get used to...

You’ll get accustomed to speaking with your new
denture in a few days.
You can say instead:

You’ll get used to speaking with your new denture in a
few days
Now give the idea of habituation in the following situations:
1. New denture wearers will become accustomed to eating with the new denture in a few
days.
2. If you seek professional help, you will find it easier to become accustomed to your
bridge.
3. If you get into the habit of biting your lips you can develop oral cancer.
4. These exercises will help your son get into the habit of not breathing with his mouth
opened.
5. If patients don’t become accustomed to sleeping without the denture they will damage
their gums.
4. Class Activity
1. Read carefully the steps to follow for the construction of a complete denture and arrange
them in the correct order.
Control and follow up check-ups ____
Final impressions ____
Taking the medical history ____
Frame work try-in and adjustments ____
Alginate impression for study casts ____
Recording intermaxillary relationships ____
Delivery of the denture ____
2. Talk to your partner about the importance of the steps:

 Control and follow up check-ups
 Frame work try-in and adjustment
 Recording inter maxillary relationships
5. Writing
Now write about the whole process. Use the connectors (first, then, after that…).
6. Class activity
1. The following symptoms may appear after the insertion of a denture. Match them with
their possible causes.
1.Loosens when talking ____Occlusal plane too high
2.Generalised soreness and redness ____ Too much vertical dimension
3.Generalised discomfort ____Improperly processed denture base material
4.Looseness of mandibular denture ____ Overextended in posterior region
5. Burning sensation ____ Heavy biting, strong musculature
2. Discuss with your partner the conduct to follow when these symptoms appear.
Lesson 3
1. Reading
Read the following text carefully and select from the following subtitles the one
corresponding to each blank space.
 Dental Implants
 Complete dentures
 Partial dentures
 Crowns
 Cleaning replacement teeth
“ WHEN TEETH ARE MISSING...”

Dental decay, periodontal disease, oral injuries, cancer surgery, birth defects and abnormal
development can all result in an absence of or damage to natural teeth or other oral
structures. Through prosthodontic treatment, these damaged or missing teeth or structures
can be replaced by placement of crowns (caps), fixed and removable partial dentures
(bridges), complete dentures and other prosthetic devices.
( )
They are used to restore badly decayed, broken, severely discoloured, or misaligned teeth.
To place a crown, the dentist prepares your tooth by reducing it in size with the rotary
instrument so that a replacement tooth can fit over the existing tooth. Impressions of your
teeth and surrounding areas are made, and life-size models constructed. Using this model
the actual crown is fabricated. You will be given a temporary crown to wear while the actual
crown is being constructed. After a “try-in” appointment, any necessary changes are made
and the crown is then cemented into place. Today, most crowns are made from a mix of
alloys. Sometimes these alloys are coated with porcelain for a natural appearance or with
porcelain fused to metal. All- metal crowns are sometimes used on back teeth to provide
extra strength for chewing.
( )
When a single crown is not enough to mask gaps or other defects and enough natural teeth
remain, a fixed partial denture can be worn. The partial denture is cemented to the crowned
teeth, and the partial denture can not be removed by the patient. With some dental
problems-such as insufficient remaining teeth, teeth affected by periodontal disease, or
small teeth or roots- a removable partial denture may be the answer. Rather than
cementing the partial denture to the existing teeth, the denture is held in place by clasps or
by precision attachments. Removable partial dentures are designed to fit your mouth easily
and should never be forced into position by biting down. To do so may bend or break the
clasps.
( )
If for some reason you lose all of your natural teeth, a complete denture will be needed. Full
denture treatment involves several procedures:
 A review of your health history is conducted so that a treatment plan can be
developed.
 A thorough examination is made, including radiographs to uncover any hidden
problem. Cysts, tumours, inflammation, bone loss, buried teeth or roots, and
abnormal jaw position must all be treated before dentures are made.
 Any necessary extractions are performed.
 The alignment and space between the jaws (the bite relationship) is measured to
ensure that the denture fits and operates smoothly.
 The completed dentures are examined and adjusted in the mouth. Follow-up
examinations are scheduled to safeguard your oral health and ensure that the
dentures are working properly.
 Any necessary counselling is provided to help adjust to speaking and eating with
dentures
Successful denture wearing requires an adjustment period. At first they may feel loose and
may tip while chewing, allowing foods or liquids to pass under them. The denture may feel
bulky, make the tongue feel crowded, or cause a slight gagging sensation. Until the gum
ridges become accustomed to supporting a denture, your mouth may feel sore or irritated.
Saliva flow also may increase temporarily. After a few weeks, the oral tissues adjust, and
these problems decrease. If irritation or excessive soreness continues, consult your dentist.
Your denture may need adjustment.
When you are first learning to use a denture, eat soft foods. Cut food into small pieces and
chew slowly. Avoid sticky or very hard foods until you gain more experience. With complete
dentures, it’s difficult to feel foreign objects, such as bones in your food.
Wearing a denture may affect the way you pronounce certain words. Practice reading aloud
to overcome any speech difficulties. If denture teeth click together, speak more slowly.
Initially, your denture may become loosen when laughing, coughing, or even smiling. To
reposition it, close the teeth together gently and swallow. With practice, you will be able to
keep the denture in place using the muscles of the tongue, cheeks, and lips.
( )
Denture- wearing does not eliminate the need for daily home care. For both removable
partial and complete dentures, clean plaque and food deposits from the denture each day.
Rinse the denture with water to remove any loose debris. Brush thoroughly, but don’t scrub
too hard. Many denture-cleaning agents are available; ask your dentist for advice for advice
about which products to use. Household cleaners and some toothpaste should not be used
because they may be too abrasive. Never clean a denture in bleach because it could alter
its colour or corrode the metal parts.
When removing a denture before sleeping, place it in a container of denture cleaning
solution or water. If a denture becomes dry, it could lose its shape. Never place a denture in
hot water; it could warp.
When cleaning or inserting a denture, hold it over a towel or basin with water to provide
protection. Dropping a denture even a few inches can break the denture base or a tooth.
Before reinserting your denture, brush your gums, tongue, and palate with a soft bristled
brush to remove plaque and stimulate circulation.
(Taken and adapted from the journal of the American Dental Association)
2. Vocabulary
Find in the text the word that means:
a. covered _____________ (P 2)
b. opening, space ___________(P 3)
c. curve ___________(P3 )
d. large _________(P 5)
e. wash ____________(P8)
f. turn out of shape, deform _______________ (P 9)
3. Pair Work
Read the text once more to answer these questions:

a) Are crowns widely used at the dental clinic? In what kind of situations?
b) What criteria do you follow to choose a particular type of denture?
c) How can dentures be cleaned?
Agreeing
4. Language in use: Agreeing and disagreeing
 Yes, I agree with you.
 Yes, you’re right.
 That’s exactly what I think.
Acknowledging an opinion and offering a different one
 Well, yes, but…
 That may be true. However…
 I see what you mean, but…
Disagreeing with an opinion and offering a different one
 I disagree. I think…
 I don’t agree. I think that…
 Well, I don’t think that’s true…
1. Tell your partner if you agree or disagree with the following statements. Give reasons.
a. Prosthesis is defined as the replacement of an absent part of the human body by an

artificial part.
b. With the insertion of a denture we restore only the appearance of the patient.
c. For the oral rehabilitation of a patient there are several types of dentures.
d. When enough natural teeth remain a fixed denture is the solution to the patient.
e. A complete denture is supported by remaining teeth.
f. It is always easy for a patient to tolerate and use dentures.
5. Group work
Work in groups to talk about the following:
 Talk about the dentist’s responsibilities when inserting a denture.

 Talk about what patients have to take into account after the insertion of a denture.
(Be ready to ask and answer questions to the other group or add information to what they
say)
6. Writing
A friend of yours hasn’t made up his mind about the specialty he will choose. You think
Prosthodontics is a good option. Write about the things you would say in favour of this
specialty to persuade him.
Unit 9. Surgery
Lesson 1
1. Quick Glance
In the period of the Middle Ages, surgeons in their works were

in favour of teeth extraction only as the last resort. They
advised fumigation and cauterization instead. They also dealt
with jaw fractures and dislocations.
Discussion
 Is this approach followed nowadays?

 What methods are used instead of dental extractions?
2. Conversation
Listen to the conversation and take notes about the following aspects:
1. Patient’s main complaint
2. Findings on the oral examination
3. Management
(Mrs. Ortega is pregnant. She was referred by her General Dentist to the surgeon).
Dr. Ramos: Good morning, Mrs Ortega. Sit here, please. Lean back now.
Your dentist told me that you are expecting a baby. Well, what
seems to be the trouble?
Mrs. Ortega: Oh, I’m very worried doctor. I haven’t been feeling well lately.
For the last two days a pain has been bothering me so much
that I can hardly eat.
Dr. Ramos: What’s the pain like?
Mrs. Ortega: Oh, I feel a pressure sensation and an unpleasant taste when I
bite.
Dr. Ramos: OK, let’s check it out. Open your mouth, please. Exactly where
does it hurt?
Mrs. Ortega: Back here doctor. (pointing)
Dr. Ramos: Any other pain? In your face? In your ears? In your jaws?
Mrs. Ortega: Well, yes, they also hurt.
Dr. Ramos: All right, Mrs. Ortega. I’ll have another look; open your mouth,
please. Wider, please. Well, there is some swelling and
redness around the third molar. It seems to be an impacted
tooth.
Mrs. Ortega: What is it, doctor?
Dr. Ramos: It is a tooth that is trapped below the gums, but to be sure I
want to take some X-rays. How far are you gone now?
Mrs. Ortega: Twenty weeks.
Dr. Ramos: Then, we don’t have to worry about the X-ray test.
(Ten minutes later)
Dr. Ramos: Well, Mrs Ortega the X-ray shows there is actually an impacted
tooth and you need an operation.
Mrs. Ortega: An operation, doctor?
Dr. Ramos: Yes, but you mustn’t worry about it.
Mrs. Ortega: Oh, I see. When will it be?
Dr. Ramos: As soon as possible.
Dr. Ramos: Have you had any other health problem? Anaemia?
Mrs. Ortega: No, doctor
Dr. Ramos: What about diabetes?
Mrs. Ortega: Well, yes, now with pregnancy. I’m worried doctor. Might the
operation affect my baby?
Dr. Ramos: There’s nothing to worry about, Mrs Ortega. I’ll put you on
antibiotics and pain relievers and I will also order some routine
studies before the operation. Please, don’t be anxious.
Mrs. Ortega: All right doctor. Thank you very much.
3. Vocabulary
Find in the text a word equivalent in meaning to the following:
1. to be pregnant______________
2. with difficulty ______________
3. retained ______________
4. really______________
5. anything used to alleviate pain ______________
4. Pair Work
1. Would you consider Mrs. Ortega a prioritized patient? Give reasons.
2. What other signs and symptoms are common to this condition?
3. Are x-rays important in the diagnosis of impacted tooth? Why?
4. Why were antibiotics prescribed to this patient?
5. What routine studies would you order in this case? What for?
6. What aspects do you have to take into consideration before developing any surgical
procedure?
5. Language in use: Reassuring
 You mustn’t worry about it.

 There is no need to be worried.
Act out the following situations in pairs using expressions of reassurance in each case.
1. A patient who thinks that his tooth cannot be saved.
2. A frightened child who is afraid of the needle jab.
3. A patient who thinks the treatment will last very long.
6. Role Play
Role A: You are the surgeon. Interview the patient before his or her canine extraction.
Role B: You are the patient. Give all the information requested by the surgeon.
7. Writing
Write about the most important facts of Mrs. Ortega’s case.
Lesson 2
1. Conversation
Listen to the conversation and say if the following sentences are True or False
1. Mrs. Ortega labs results are O.K.____
2. Her blood pressure is very high. ____
3. She will be operated under general anaesthesia ____
4. She must continue under treatment after the operation ______
(Mrs. Ortega is at the operating room)
Dr. Ramos: Good morning, Are you Mrs. Ortega, aren’t you?
Mrs. Ortega: Yes, I am. Good morning, doctor
Dr. Ramos: Sit here, please. I can see in your clinical history that you
are under treatment with antibiotics and your haemoglobin
and serology are within normal limits. How are you feeling
just now?
Mrs. Ortega: Well, I am very nervous.
Dr. Ramos: Ok, I’ll take your blood pressure and the pulse now, just
relax, please.
Mrs. Ortega: Are they all right?
Dr. Ramos: Yes, your blood pressure is quite normal. It is 120/80 and
the pulse is 84 regular. So, now sit back and put your head
on the headrest and just relax. I will give you a local
anaesthetic to numb the area.
Mrs. Ortega: Will that be painful?
Dr. Ramos: No, this is going to be painless. You will only feel some
discomfort, that’s all. (while waiting for the effects of the
anaesthetic).
Just let me know when you feel numbness.
Mrs. Ortega: (three minutes later)
I don’t feel my face and I have a tingling sensation in the tip
of the tongue.
Dr. Ramos: Well, I’m starting the operation now. You may feel some
pressure and manipulation while extracting the tooth. If you
feel any pain, let me know immediately. Are you
comfortable? Any nausea?
Mrs. Ortega: No, doctor. I’m all right.
(The doctor proceeds to extract the tooth)

Dr. Ramos: We’ve finished and everything was as predicted. See? You
have to bite this cotton gauze pad for 30 minutes. Apply cold
fomentation on your face for 24 hours.
Continue with the course of antibiotics and if pain, take
analgesics but never aspirin. I will give you an appointment to
come back in 7 days to take the stitches out. If there is any
problem before the appointment you should come back at
once.
2. Vocabulary
Find in the conversation equivalents in meaning to the following words.

1. completely
2. to anesthetize
3. end
4. pins and needles
5. suture
6. immediately
3. Pair Work
Ask as many questions as you can about the dialogue. Use the following clues:
What…? Should…? When…? Is…?
Has…? Does…? Did…? Why…?
Suffix –less
It is added to nouns in order to form adjectives meaning not having the thing
indicated by the noun.
 When teething, the baby usually becomes irritable and restless.
Suffix –ness
It is added to adjectives in order to form nouns meaning state, condition or
quality
 You will feel numbness in a few minutes.
1. Form adjectives or nouns from the following words using the suffixes – less or - ness.
Noun or verb Adjective Nouns

1. pain
2. care
3. nervous
4. use
5. red
2. Write sentences with some of the words above to illustrate their meaning.
4. Language in use: Results of investigations.
… abnormally high
… raised / elevated
Blood pressure is… … normal / within normal limits
… low
… abnormally low
… dramatically low
 Now talk about the following results:
1. The blood pressure is:

a. 160/ 120 b. 120/80 c. 90/60
2. His hemoglobin is:

a. 5 g/dl b. 12 g/dl c. 9 g/dl
3. Her pulse is:

a. 52 /min b. 140/min c. 82/min
6. Pair Work
The following are anesthesia techniques used when developing different surgical
procedures at the dental clinic.
 Infiltration anesthesia
 Conduction anesthesia
 Mandibular nerve block
 Maxillary nerve block
 Infra-orbital nerve block
1. What anaesthesia technique is used in each of the following situations? Try to use
different forms in each case.
- Maxillary nerve block is used to extract a second upper molar with a cyst.
- When extracting a second upper molar with a cyst, maxillary nerve block is used.
a. Extraction of an upper posterior tooth with a cyst.

b. An impacted lower third molar
c. Extraction of left upper canine
d. An impacted upper third molar
e. Extraction of supernumerary teeth in the anterior sector
f. Treatment of a periapical cyst in the lower anterior region.
7. Writing
Write a case report from the following data.
 Female 55 / Periodontology Department / asymptomatic nodular swelling/ attached

gingiva between/ mandibular first / second premolars.
 Clinical examination / round swelling / 1 cm in diameter / fluctuant to palpation /
attached gingiva / between the mandibular right premolars.
 Radiographic examination / round radiolucency / radiopaque margin / located / roots
/ first / second premolars.
 Diagnosis / lateral periodontal cyst/ developmental origin
 Local anaesthesia.
 Lesion / removed / surgical curette
Lesson 3
1. Reading
Skim read the text to outline some of the aspects it includes.
“When surgery is needed...”

Oral and maxillofacial surgery encompasses a wide range of treatment, ranging from
extraction of third molars (wisdom teeth) to reconstruction of the jawbone after cancer
surgery. The oral and maxillofacial surgery often is part of a team of health care providers
that might include physicians and surgeons, plastic surgeons, otolaryngologists,
orthodontists, prosthodontists, general dentists and psychologists. The oral and
maxillofacial surgeon’s skills are not limited only to the mouth but also include problems of
the cheek bones, jaws and the temporo-mandibular region.
Oral surgery often involves removal of diseased teeth that cannot be saved, teeth that must
be extracted for orthodontic treatment, and third molars. Third molars can appear in the
mouth in the late teens or early 20s and often develop at an awkward angle, partially break
through the gums, or remain below the gums, or remain trapped below the gums. The result
could be crowding, pressure, pain, or damage to the other teeth or the jawbone; and
extraction of the third molars may be recommended.
Oral surgery also may be necessary to prepare the mouth for wearing dentures. After
extracting any teeth that cannot be saved, the oral surgeon may remove excess soft tissue
or muscle attachments that might interfere with denture stability and any bony irregularities
in the gums that could cause irritation. The oral surgeon also may be called upon to rebuild
the lower jawbone with soft tissue or ridge augmentation with natural bone or biocompatible
artificial materials when the jawbone has deteriorated, usually as a result of wearing
dentures over a long period.
Patients who need orthodontic treatment also may benefit from oral surgery. If the
orthodontic condition being treated is the result of skeletal irregularities, such as too much
or too little growth of one or both jaws, oral surgery may be needed. For example, if a
patient’s jaws are not the same size-usually a hereditary condition- the lower jaw can be
moved backward or the upper jaw forward by cutting and repositioning the bone. Or, facial
deformities may involve only the upper part of the face and the cheekbones. These bones
also can be repositioned to achieve a normal appearance. The surgical procedure designed
to correct malformation in the facial skeleton is called orthognathic surgery.
The oral and maxillofacial surgeon also may be called on to help restore missing structures
caused by birth defects, cancer surgery or injuries. For example, treatment of infants born
with cleft lip or palate has been an important part of oral surgery for many years. Recent
research and advances in bone grafting procedures have improved treatment of children
with cleft lip and palate before they reach adolescence. Or, the oral and maxillofacial
surgery might be involved in rebuilding parts of the jaw or face after removal of a tumour.
More than 65% of injuries sustained in automobile accidents involve the head and neck.
Facial cuts and lacerations, broken teeth, and fractured bones in the upper and lower jaw,
palate, cheeks, and eyes sockets can affect breathing, eating, sight, and speech.
Treatment by the oral and maxillofacial surgeon could include aligning and setting broken
bones to allow them to heal and performing surgery to gain access to the injured areas.
(Taken and adapted from the Journal of the American Dental Association, )
2. Vocabulary
Find in the text a word that means:
a. comprise ______________ (P1)

b. ability_____________(P 2)
c. difficult, uncomfortable ______________ (P2)
d. development ______________(P 4)
e. obtain ________________.(P 4)
f. act of seeing ________________ (P 6)
g. cure______________.(P 7)
3. Pair Work
Read the text again to answer the following questions:
1. What are some of the disorders or pathologies treated in oral and maxillofacial surgery?
2. Why is oral surgery often needed to extract the third molars?
3. Surgery is sometimes used in edentulous patients before inserting the denture. Explain
why.
4. What is the role of surgery concerning Orthodontics?
Study this chart carefully. The following suffixes are used to form nouns.
Nouns -ment -ness -sion -tion -ty -al
Form nouns from the following verbs.
VERB NOUN
a. treat
b. remove
c. examine
d. prescribe
e. develop
f. specialize
g. extract
h. indicate
i. numb
 Make sentences with some of these words.
5. Pair Work
From the following affections or pathologies select the ones you can treat in your daily
practice belonging to the Primary Health Care.
a. Maxillary and soft tissue cyst _____
b. An acute periapical abscess _____
c. Alveolitis _____
d. Pre-malignant lesion of the oral cavity _____
e. Cleft lip or palate and their consequences ____
f. Exeresis of the impacted vertical lower third molar____
g. Lesions of the salivary glands ____
h. Immediate buco-sinusal communication _____
 Which of the previous affections can be considered complications of dental

extractions?
 In case you have to treat one of them, what conduct would you follow?
6. Writing
Write a 150 word- summary of the reading text
Unit 10. Oral Pathology
Lesson 1
1. Quick Glance
The incidence of oral cancer is associated with increasing age. Rates rise
dramatically after the age of 40, and reach a plateau around the age of 60, so
increased aging in the populations of many countries means there will be more
older adults at high risk for oral cancers.
 Do you agree with the previous statement? Why?

 What has been done in your country in relation to this?
2. Conversation
Listen to the conversation and say if the following sentences are true or false.
1. Mrs. Frómeta´s denture is broken _____
2. She has a lesion in the palate _____
3. The patient is fond of spicy food _____
4. She was advised to use herbal medicine ____
5. She smokes a lot _____
(Mrs. Frómeta has come to the dentist for a regular

checkup)
Dr. Calzado: Good morning Mrs. Frómeta. Sit here, please.

Mrs. Frómeta: Good morning, doctor.
Dr. Calzado: OK. What brings you to the clinic?
Mrs. Frómeta: Well, doctor. I’ve been wearing an upper total denture for 16 years
now. I don’t feel any discomfort, but I have heard that even when
there isn’t any, we should be checked regularly.
Dr. Calzado: You have done very well, Mrs. Frómeta. Open your mouth, please.
Let’s check it out.
Mrs. Frómeta: Ahh…
Dr. Calzado: Well, the denture is loose and there is redness in the roof of the
mouth.
Mrs. Frómeta: What is it, doctor?
Dr. Calzado: It is an inflammation of the mucous membrane of the mouth called
denture stomatitis.
Mrs. Frómeta: Do I need a new denture?
Dr. Calzado: It would be advisable after so many years.
Mrs. Frómeta: What do I have to do?
Dr. Calzado: Well, you have to stop wearing your denture.
Mrs. Frómeta: But I work, doctor. May I wear it while working?
Dr. Calzado: Well, yes, but the least possible time.
Mrs. Frómeta: And what about the redness?
Dr. Calzado: You should make mouth rinses of verbena or chamomile with fresh
water to reduce the inflammation. Do you usually have hot and spicy
food?
Mrs. Frómeta: Ahh… No, not spicy, but I really like hot food.
Dr. Calzado: Well, you’d better stop having hot food because it irritates the mucous.
Mrs. Frómeta: Is that all doctor?

Dr. Calzado: No, Mrs. Frómeta. I know you are a heavy smoker and if you don’t give
up smoking you are at higher risk of getting oral cancer.
Mrs. Frómeta: Thank you very much, doctor. You have warned me about a serious
problem. I will follow your advice.
Dr. Calzado: I’m glad to hear that. Follow the treatment and come back again in 15
days.
3. Vocabulary
a. reddishness __________
b. palate ___________
c. wise, prudent___________
d. highly seasoned, with spices ___________
e. intense _____________
f. abandon _____________
g. informed, advised _______________
Certain:
4. Pair Work It is…
He must have…
Ask and Fairly
answer Heabout
questions
certain: seems
thetoconversation.
have… Use the following question words:
What…? When…? Has…? He probably has…
How long…? Does…? Is…? Should…?
Can…? Why…?
Uncertain: He might have…
He could have
Negative diagnosis
can’t …
5. Language Ituse:
in can’tDiscussing
be… a diagnosis
exclude … We must exclude…
unlikely… It is unlikely to be…
1. Discuss with a fellow doctor the following diagnosis. Use expressions from the chart
above. Follow the example.
-Bleeding and red gums (gingivitis)

 The patient has bleeding and red gums, he probably has gingivitis.
a. Pain and an increase in volume in that area (maxillary and soft tissue cyst)
b. Pain, swelling, pocket formation and alveolar bone loss
( an acute periapical abscess)
c. Sharp pain in the alveolus 2 days after extraction (alveolitis)
d. A recurrent superficial painful erosion of the mucous (pre-malignant lesion)
e. Inflammation, pain and salivary secretion when eating (a lesion of the salivary glands)
f. Liquids and air passing through the nose (a buccosinusal communication)
6. Role Play
Imagine you are a resident talking to a fellow doctor. Act out the following case:
 A 47-year-old female patient presents to the clinic with a protuberant lesion on the
right side of the tongue. She has no history of pain.
Lesson 2
1. Conversation
Listen to the conversation and say if the following sentences are true or false.
1. The lesion isn’t cured yet _____

2. The lesion must be carefully studied._______
3. The result of the test was positive _____
4. A new therapy is needed to heal the lesion _____
5. The healing of the lesion will take a long time ____
(15 days later Mrs. Frómeta comes for her second appointment)
Dr. Calzado: Good morning, Mrs. Frómeta. How are you feeling today?
Mrs. Frómeta: Well I’m all right doctor. I don’t feel any discomfort but I can
see that the lesion is still there.
Dr. Calzado: OK. Open your mouth, please, wider. Oh, I see. We’d better
make a biopsy to study the lesion. You shouldn’t be worried.
It is a simple procedure.
Mrs. Frómeta: When will the biopsy be?
Dr. Calzado: As soon as possible. I’m going to order some tests before the
biopsy.
(7 days after the biopsy)
Dr. Calzado: How have you been feeling, Mrs. Frómeta?

Mrs. Frómeta: I’m much better now but it’s been terrible. The pain was
unbearable.
Dr. Calzado: Yes, that’s quite normal after the effect of the anesthesia.
Mrs. Frómeta: Well, doctor, tell me about the results. Is it anything bad?
Dr. Calzado: No, not at all, but I wanted to be sure.
Mrs. Frómeta: That’s a relief. I was scared to death.
Dr. Calzado: Well, now I’d like you to receive laser therapy.
Mrs. Frómeta: Oh, Laser doctor?
Dr. Calzado: Yes, Mrs. Frómeta. This therapy is very effective because it
helps in the healing of the injury and in a few days you will be
back with a good repair and relief.
Mrs. Frómeta: It’s good to hear that.
Dr. Calzado: But remember to visit the dentist at least twice a year, brush
and floss your teeth daily after each meal and try to eat a
balanced diet.
Mrs. Frómeta: Yes, doctor. I won’t forget.
2. Vocabulary
Say if the following words are equivalents (synonyms) or opposites (antonyms) and be
ready to use them in sentences of your own.
1. wide – narrow
2. worried – concerned
3. sure – uncertain
4. scared – terrified
5. soon – late
3. Pair Work
Ask and answer the following questions
1. What did the dentist prescribe in the first appointment?

2. Why was a biopsy ordered to Mrs. Frómeta?
3. What other tests do you think would be necessary in this case?
4. How did Mrs. Frómeta feel after the biopsy? Explain
5. Have you ever ordered laser therapy to any of your patients? What for?
4. Language in use: Reminding
 Remember to come again.

 Don’t forget to brush your teeth after each meal.
 Work with your partner and practice these expressions in situations similar to the
ones you have at your clinic. Give appropriate answers in relation to each situation.
6. Group Work

1. The role of the dentist in the detection of pre- malignant lesions of the oral cavity.
2. The incidence of these lesions in your community.
7. Writing
Report the case of Mrs. Frómeta to your Pathology professor. Make reference to your
findings on the oral examination as well as the lab results, diagnosis and treatment.
Lesson 3
1. Reading
Read and say if the following ideas are included in the reading text.
1. Causes of oral cancer.

2. New therapies to treat the disease.
3. Steps to follow to make the self-examination.
4. Frequency and incidence of oral cancer.
5. Preventive measures to avoid oral cancer.
2. Read again and say which other ideas are included.
Oral Cancer, to know about it is to prevent it.

Oral cancer is the sixth most common frequent cancer in the world. Malignant lesions
constitute the major group life-menace diseases within the field of dental profession and in
the last two decades there has been an alarming rise in incidence. The vast majority of oral
cancers occur in people older than 45 years; with men being twice as likely as women to
develop the disease.
The most frequent oral cancer sites are the tongue, the floor of the mouth, soft palate
tissues in back of the tongue, lips, and gums. If not diagnosed and treated in its early
stages, oral cancer can spread, leading to chronic pain, loss of function, irreparable facial
and oral disfigurement following surgery, and even death.
As this problem has a global extent, efforts are being made to control it and the general
dentists have a key role to play and should develop different actions to help reduce the
havoc of this silent disease. They can carry out screening programs and advise patients
about the risky factors and their control.
Scientists aren’t sure of the exact cause of oral cancer. However, the carcinogens in
tobacco products, alcohol and certain foods, as well as excessive exposure to the sun have
been found to increase the risk of developing oral cancer. Risk factors for oral cancer may
also be genetically inherited. Other factors that influence the prevalence are social and
cultural practices.
Oral cancer-represented by red, white or discoloured lesions, patches in or around the
mouth-is typically painless in its early stages. As the malignant cancer spreads and
destroys healthy oral tissue, the lesions or lumps become more painful. However, oral
cancer is sometimes difficult to self-diagnose so routine dental exams are recommended
and patients should visit the dentist immediately if they observe: any sore that persists
longer than two weeks; repeated bleeding from the mouth or throat; difficulty swallowing or
persistent hoarseness.
The dentist should screen for oral cancer during routine checkups. He or she feels for
lumps or irregular tissue changes in your neck, head, cheeks and oral cavity, and
thoroughly examines the soft tissues in your mouth, specifically looking for any sores or
discoloured tissues. If the dentist suspects oral cancer, a biopsy of the lesion is required to
confirm the diagnosis.
Treatment for oral cancer causes pain and suffering, loss of speech, hearing, salivary and
chewing functions and loss of time from work. Head and neck surgery is required to remove
the tumors, which may cause disfiguration and makes social interaction and acceptance
difficult for patients. Advances in treatment have been more marked in reconstructive
techniques, and these have improved the quality of life for patients. Within the mouth,
factors that influence survival are: the site, the size of the lesion at diagnosis, the
involvement of lymph nodes and if metastasis is present.
People can help prevent oral cancer by not smoking, using spit tobacco and drinking
excessive alcohol. When tobacco and alcohol use are combined, the risk of oral cancer
increases 15 times more than non-users of tobacco and alcohol products. Patients should
also avoid habits such as lip biting and cheek chewing and check ill-fitting dentures.
Research suggests that eating plenty of fruits and vegetables may safeguard against oral
cancer. Because successful treatment and rehabilitation are dependent on early detection,
it is extremely important to see the dentist for an oral cancer screening and regular check
up at least every six months.
(Taken and adapted from: http://www.rvi.net/~fluoride/000213.htm)
2. Vocabulary
Find in the text equivalents for the following words:
a. increased, ascend ______________(P.1)

b. location, place _____________(P.2)
c. examination, investigation _______________(P.3)
d. spot, mark ____________(P.5)
e. swelling, protuberance ______________(P.6)
f. protect, defend _________________(P.8)
3. Pair Work
1. Why do malignant lesions represent a health problem all over the world nowadays?
2. If you had to make a report about oral cancer what aspects from the text would you
include?
3. Mention the risk factors of oral cancer. Which in your opinion are the most common?
4. What are the most commonly sites of the mouth affected by oral cancer in your country?
5. When assisting a patient what signs you should watch on to detect oral cancer?
6. What are the most common therapies you know about to treat this disease?
4. Class activity
The following steps are followed to make the self-examination. Study them carefully and
complete the missing parts.
Look at and feel your:
Head and neck: Look at your face and neck in the mirror. Normally the left and the right
sides of the face have the same shape. Look for any lumps, bumps, or swellings that are
only at one side of your face.
Face:
Neck: Press along the sides and front of the neck. Do you feel any tenderness or lumps?
Lips:
Cheek: Use your fingers to pull out your cheek so you can see inside. Look for red, white,
or dark patches. Put your index finger on the inside of your cheek and your thumb on the
outside. Gently squeeze and roll your cheek between your fingers to check for any lumps or
areas of tenderness. Repeat this on the other cheek.
Roof of the mouth:
Floor of the mouth and tongue: Stick out your tongue and look at the top surface for colour
and texture. Gently pull your tongue forward to look at one side first and then the other.
Look for any swelling or colour changes. Examine the underside of your tongue by placing
the tip of the tongue on the roof of your mouth. Look at the floor of your mouth and the
underside of your tongue for colour changes that are very different from what is normal.
Gently press your finger along the underside of your tongue to feel for any lumps or
swelling.
5. Pair Work
Be ready to instruct your partner how to perform the self exam.
6. Writing
Write a short article about the following statement:

“Oral health is paramount for general health”
Read and Report
Bad Breath.
Bad breath (halitosis) can cause embarrassment, create social and psychological barriers,
and even affect marriages.
CAUSES:
The majority of bad breath problems begin in the mouth.

- Bad breath that is of oral cavity origin can be traced to a sulfur compound produced by
bacteria. Dead and dying bacterial cells release this sulfur compound which gives the
breath an unpleasant odor.
-Bacterial plaque and food debris accumulate on the back of the tongue. The tongue's
surface is extremely rough and bacteria can accumulate easily in the cracks and crevices.
Large amounts of sulfur compounds can be produced in this area, making it a frequent site
of origin for bad breath.
-The tooth attracts bacteria containing plaque and if not cleaned regularly and thoroughly,
this can result in large accumulations of bacteria which result in bad breath.
-People who have periodontitis often experience bad breath because of bacteria
accumulating in areas that are not cleaned easily, such as deep pockets around teeth.
-Fortunately, treatment is very effective for people who have bad breath of mouth origin.
Other reasons for bad breath (other than the mouth) are:
-infections, especially in the sinuses or lungs
-diabetes mellitus (acetone smell to the breath)
-kidney failure (can produce a fishy odor)
-malfunction of the liver
-disorders of metabolism (foul, fishy odor that comes and goes and may be difficult to
diagnose)
-fasting (when the body is not provided with fuel in the form of food, fat and protein will
begin to be broken down; the result is bad odor from the waste products of this metabolism)
If bad breath continues once potential oral health problems have been treated, the patient
should see the doctor to rule out any other causes.
(Taken and adapted from: www.ada.org/public/topics/bad_breath.asp - 38k)
Nature of Dental Caries
“Caries” is Latin for “rot” or “rotten”. Rot happens in wood and other materials. In medieval
Europe the word became used inn medicine to describe rot in bones (which we would call
now osteomyelitis) and rot in teeth. “Rotten teeth” is sign of a disease which is called
“dental caries”.
When the epidemic began in ancient societies no-one understood its cause. All that people
could do at that time was to treat its consequences. Treatment was by surgery, usually by
extracting the tooth and was very difficult for the surgeon and very painful for the patient.
When the enamel caries epidemic began, the disease was thought to be gangrene of the
teeth so caries was treated as gangrene of other parts of the body was treated at that time,
by surgical removal. Extraction was the equivalent of amputation of gangrene limbs.
An alternative method of surgical removal and a simpler one than extraction was local
debridment by cleaning out the decayed area. This had some advantages because it was a
simple treatment and the decay was slow to recur. But it also had the disadvantages that
food tended to lodge between the teeth and the teeth tended to move over the time.
Local removal and then filling the resultant cavity was also attempted. The decay was
removed with excavators or rotating burs. The early fillings sealed badly and tended to fail
within months or a few years at most. Early fillings were metal-lead, tin or gold. Each of
these metals could be pressed or hammered into the cavity. A mixture of silver and
mercury, called dental amalgam, was also used to fill cavities.
In the 1970s the concept that caries was caused by dental plaque became widely accepted.
Patients were advised to brush and floss teeth to remove plaque. The epidemiological
discovery that fluoride in the diet and then the experimental demonstration of topical
application of fluoride both decreased caries experience led to the dietary fluorides in
dentifrices, rinses and gels.
By mid-century the principal method of treatment of caries had become the restoration.
Extraction was reserved for extensively restored tooth which could no longer retain a
restoration or which had fractured.
Throughout the late 20th Century an increasingly detailed concept of the nature of caries
developed, because of scientific research. There is now strong evidence that the disease is
no gangrene.
A large body of data shows that caries is the progressive loss of tooth mineral, followed by
bacterial invasion into demineralised tooth. It is relatively complex disease.
The nature of caries can be described in terms of the following five interrelated factors:
 Caries is a bacterial disease.
 Caries is dependant on dietary sucrose
 Caries is driven by frequency of eating
 Caries is modified by fluorides
 Caries is modified by saliva
http://www.dentalfind.com/glossary/tooth_decay_also_known_as_dental_caries.html )
Eating Disorders
Bulimia Nervosa is an eating disorder that harms your overall health and is particularly
destructive to teeth. It involves secret repeated binge eating followed by purging—self-
induced vomiting, use of laxatives, fasting, diuretics or diet pills. The digestive system
contains strong acids that break down food. When vomiting is used to purge food from the
body, these acids attack tooth enamel. Repeated vomiting can severely erode tooth enamel
and over time, teeth will become worn and translucent. Your mouth, throat and salivary
glands may become swollen and tender and bad breath may result.
Anorexia Nervosa is another eating disorder that is characterized by an intense fear of
weight gain, the desire to be thinner, and an inability to maintain a minimally normal weight
for height and age. It’s self-induced starvation.
Each of these disorders robs the body of adequate minerals, vitamins, proteins and other
nutrients needed for good health causing potential injury to teeth, muscles and major
organs.
The frequent vomiting and nutritional deficiencies often associated with eating disorders
can severely affect oral health. According to the National Eating Disorders Association,
studies find up to 89 percent of bulimic patients have signs of tooth erosion, due to the
effects of powerful stomach acid.
Over time, this loss of tooth enamel can be considerable, and the teeth change in color,
shape and length. They can also become brittle, translucent and sensitive to temperature.
The salivary glands may swell, causing the jaw to widen and appear squarish. Lips may
become reddened, dry and cracked, and the patient may also experience chronic dry
mouth.
(Taken and adapted from: http://www.mirror-mirror.org/ed.htm)
Fluoride and Oral health.
Fluoride is a compound of the element fluorine, which is found universally throughout

nature in water, soil, air and in most foods. Existing abundantly in living tissue as an ion,
fluoride is absorbed easily into tooth enamel, especially in children's growing teeth. Once
teeth are developed, fluoride makes the entire tooth structure more resistant to decay and
promotes remineralization, which aids in repairing early decay before the damage is even
visible.
"Systemic" fluoride is ingested when added to public and private water supplies, soft drinks
and teas, and is available in dietary supplement form. Once systemic fluoride is absorbed
via the gastrointestinal tract, the blood supply distributes it throughout the entire body. Most
fluoride not excreted is deposited in bones and hard tissues like teeth.
"Topical" fluoride is found in products containing strong concentrations of fluoride to fight

tooth decay. These products, including toothpastes and mouthrinses, are applied directly to
the teeth and are then expectorated or rinsed from the mouth without swallowing. Dentists
recommend brushing with fluoride toothpaste at least twice a day or after every meal,
combined with a regimen of flossing and regular dental checkups.
Professionally-administered topical fluorides such as gels or varnishes are applied by the
dentist and left on for about four minutes, usually during a cleaning treatment. For patients
with a high risk of dental caries, the dentist may prescribe a special gel for daily home use,
to be applied with or without a mouth tray for up to six weeks.
Fluoridated water protects against cavities and root caries-a progressive erosion of adult
root surfaces caused by gum recession-and helps remineralize early carious lesions.
Thanks to these preventive benefits, public water fluoridation is considered the most
efficient and cost-effective dental caries prevention measure available.
In general, the use of fluoride is considered safe unless it's misused or overconcentrated.
Drinking excessively fluoridated water can cause dental fluorosis, a harmless cosmetic
discoloring or mottling of the enamel, visible by chalky white specks and lines or pitted and
brown stained enamel on developing teeth.
Patients should avoid swallowing toothpaste, mouthrinses or other topical supplements,

check with the dentist on proper dosage, and they have to be careful not to accidentally
take too much.
Children are more vulnerable to dental fluorosis because their developing teeth are
sensitive to higher fluoride levels. They are at greater risk if they swallow or use too much
toothpaste and fluoride supplements, or regularly drink water containing excessive fluoride
levels. Parent’s should monitor their child's intake and use of fluoride, and consult with the
dentist on the matter.
(Taken and adapted from: http://education.jlab.org/itselemental/ele009.html)
The Connection between Gum Disease and Heart Disease
Most people believe that a little bleeding while brushing their teeth is normal. It is such
myths and misconceptions that have resulted in more than 80% of the population with gum
disease. Periodontal disease (gum disease) is an infection that causes chronic
inflammation of the gums, with one of its signs being bleeding while brushing or flossing.
Recent studies have found that there is a direct correlation between heart disease and gum
disease. The understanding of this relationship and what to do about it is a matter of life
and death.
Research describes the affect of gum disease and heart disease at least as strong as the
link of heart disease to cholesterol, smoking or body weight. These recent studies have
found blood clots escape into the bloodstream, increasing the risk of heart attacks and
stroke. These same blood clots were found to contain the most common strain of bacteria
in dental plaque.
Unfortunately, there are no early warning signs to gum disease, it progresses silently, often
without pain. Since there is no pain or discomfort present during the initial stages, people
often ignore the signs and symptoms, believing them to be normal occurrences. The
disease eventually destroys the gum and supporting bone that holds the teeth in place.
What is alarming is that other health concerns are also being found to relate to gum
disease. Bacteria in plaque have also been found to have a link in a weakened immune
system that can slow wound healing; higher risk of premature; low birth weight infants;
stroke; and lung infection in people with chronic lung diseases.
The mouth is an extremely important organ and is the doorway to the body. Digestion
begins here, many diseases, such as diabetes and AIDS show initial signs here, and our
confidence in how willing we are to smile, depends on how we feel about the appearance of
our teeth. The teeth are made to last a lifetime and even after;, as seen in excavated
ancient skulls. It is a myth to think that with age, teeth become loose and are lost. Many
factors affect tooth loss: heredity, diet and nutrition, stress, and the health of the gums. We
have no control over heredity, but we can counteract any week links in our genes with the
other factors.
Numerous studies have established the importance of diet and nutrition, stress
management and exercise for a healthy body. The same rules apply to the health of the
oral cavity. Fresh food free of chemicals, preservatives and additives are essential for
prevention of disease. However, stress can deplete our body of vital nutrients if
supplements are not taken to replace those needed vitamins and minerals. Bleeding gums
have been associated with deficiency of vitamin C. Calcium and it’s importance for healthy
teeth and bone is well documented. During menopause, a woman’s body decreases the
production of the hormone estrogen, which helps bones absorb and retain calcium. If
calcium supplements are not taken (at least 1200-1500 mg/ day) the first place the needed
calcium is taken from is the jaw bone. This may lead to loose teeth.
Proper oral hygiene is the other factor which may counteract any bad genes passed down
for gum disease. There are many tools available to take responsibility towards good daily
hygiene.
(Taken and adapted from: http://www.perio.org/consumer/mbc.heart.htm)
Herbal Remedies.
Herbal remedies have a long history of use for gum and tooth problems. In many traditional cultures, there are
no plastic-bristle brushes, rather, the use of herbal "chewing sticks" are common. Chewing sticks are usually
taken from plants, shrubs or trees with high anti-microbial activity. The ends of selected sticks are shredded
and they are used to massage the gums and "floss" the teeth.
An herb, botanically speaking, is any plant that lacks the woody tissue characteristic of shrubs or trees. More
specifically, herbs are plants used medicinally or for their flavour or scent. Herbs with medicinal properties are
a useful and effective source of treatment for various disease processes. Many drugs used in Western
medical science-called allopathic medicine-have their origin in medicinal plants.
During the Golden Age of Western herbology, which occurred from 500 B.C. to 200 A.D.,
Western physicians and scholars classified hundreds of plants useful in healing. By the
Middle Ages, every household had an herb garden to supply it with medicines. By World
War II, herbology was losing popularity in the West. Penicillin and other "wonder drugs"
seemed to be cure-alls. And the war itself had cut off supplies of herbs from around the
world. The advent of the drug industry with its synthetic medicines seemed to ring a death
knoll for herbology, yet plants remain a major source of drugs today.
Herbs, which are powerful healing agents, must be used appropriately. Always know what
you are taking. Keep in mind that not all plant life is beneficial. Certain herbs may be toxic,
especially when used over a long period of time or in too great amounts. Herbs contain
active ingredients that may interact negatively with prescribed medications or other
remedies. It is wise, therefore, to consult a health-care professional in situations in which
you question the appropriateness of the herb or its interaction with other remedies. The
herbs described below are commonly used for dental problems:
Rosemary
Native to the Mediterranean region, this evergreen shrub is widely grown for its aromatic
leaves, which are used as a seasoning, in perfume, and for medicinal purposes.
Precautions and Recommendations
 Drink rosemary tea as a stimulant; do not drink more than three cups a day.
 Use rosemary mouthwash for the treatment of gum disease and bad breath.
Sage
A member of the mint family, sage grows wild in fields and along roadsides. Today, the
leaves are used to treat laryngitis, tonsillitis, and sore throats. The herb also has
antiflatulent and mildly laxative properties.
 Lactating women should not drink sage tea; it can interfere with production of breast
milk.
 As a mild antiseptic, this herb will help heal bleeding gums and mouth ulcers (cold
sores).
 Drink a cup of hot sage and chamomile tea to ease apprehension before dental
treatment.
Chamomile
Chamomile grows in well-drained sunny soil in temperate regions everywhere. Commonly
used as a nerve tonic, sleep aid, and digestive aid, chamomile is also a homeopathic
remedy. It contains calcium, iron, magnesium, manganese, potassium, and vitamin A.
 Use chamomile as a poultice for pain and swelling

 Drink as a hot tea to promote relaxation.
 Use as a mouthwash to soothe inflamed, irritated gums.
(Taken and adapted from: dent.info.md/dental-care/ importance-of-herbs-for-dental-health/ -

31k )
Diabetes and periodontal disease.
Periodontal (gum) disease may result from gingivitis, an inflammation of the gums usually
caused by the presence of bacteria in plaque. A number of factors increase the probability
of developing periodontal disease, including diabetes, smoking, poor oral hygiene, diet, and
genetic makeup; and it is the primary cause of tooth loss in adults.
It is estimated that 12 to 14 million people, or one-third of the population in the United

States, have diabetes, but only one-half of these individuals are diagnosed.
Studies have shown that diabetics are more susceptible to the development of oral
infections and periodontal disease than those who do not have diabetes. Oral infections
tend to be more severe in diabetic patients than non-diabetic patients. And, diabetics who
do not have good control over their blood sugar levels tend to have more oral health
problems. These infections occur more often after puberty and in aging patients.
Diabetics may experience diminished salivary flow and burning mouth or tongue. Dry mouth
(xerostomia) also may develop, causing an increased incidence of decay. Gum recession
has been found to occur more frequently and more extensively in moderate- and poorly-
controlled diabetic patients because plaque responds differently, creating more harmful
proteins in -9the gums. To prevent problems with bacterial infections in the mouth, the
dentist may prescribe antibiotics, medicated mouth rinses, and more frequent cleanings.
Patients should make sure to take extra good care of their mouth and have dental infections
treated immediately. Diabetics who receive good dental care and have good insulin control
typically have a better chance at avoiding gum disease.
Diet and exercise may be the most important changes that diabetics can make to improve
their quality of life and their oral health. Diabetic patients should be sure both their medical
and dental care providers are aware of their medical history and periodontal status. To keep
teeth and gums strong, diabetic patients should be aware of their blood sugar levels in
addition to having their triglycerides and cholesterol levels checked on a regular basis.
These may have a direct correlation on your chances of obtaining periodontal disease.
If patient’s blood sugar is not under control, he should talk with both his dentist and
physician about receiving elective dental care. Dental procedures should be as short and as
stress free as possible. Also patients should make morning appointments because blood
glucose levels tend to be under better control at this time of day.
If they have a scheduled appointment, they have to eat and take medications as directed.
Diabetic patients should see the dentist on a regular basis, keep him or her informed of
their health status, and keep mouth in good health.
(Taken and adapted from: www.agd.org/consumer/topics/diabetes/main.asp - 10k)
Apical Abscess
Apical abscess is a localized, purulent form of apical periodontitis. It may present clinically
as a fluctuant buccal or palatal swelling, with or without a draining fistula. Regional
adenopathy is usually present. If pus is draining, pain usually is not severe. Antibiotics are
not necessary unless concurrent cellulitis is present. Acute incision and drainage of a
fluctuant area by an appropriately trained physician would be reasonable. Definitive therapy
is root canal treatment or extraction. Patients should be seen by a dentist within one to two
days and provided with appropriate pain medication in the meantime.
Cellulitis may follow apical periodontitis if the infection spreads into the surrounding tissues .
Diffuse, tense, painful swelling of the affected tissues occurs. Regional lymphadenopathy is
common, and fever may be present. The infection can spread into the major facial spaces
of the head and neck, with the attendant risk of airway compromise. Maxillary infection also
may
spread to the periorbital area, increasing the risk of serious complications that include loss
of vision, cavernous sinus thrombosis, and central nervous system involvement.
The examination should focus on determining if the cellulitis remains localized or has
spread regionally. Patients with localized cellulitis that is deemed appropriate for outpatient
therapy should be treated by the physician with antistreptococcal oral antibiotics, such as
oral penicillin in a dosage of 500 mg three times daily in adults or 50 mg per kg per day
divided into three doses in children.
In the event of true penicillin allergy, erythromycin or clindamycin (Cleocin) may be

substituted. Appropriate pain medication should be provided. Definitive therapy is root canal
treatment or extraction, which in selected cases may be delayed until swelling has
subsided.
If infection extends regionally into the deep spaces of the head and neck as evidenced by
severe swelling, the risk of life-threatening complications such as airway compromise is
substantial. Generally, these patients should be hospitalized and provided with surgical and
infectious disease consultation.
In general, the same principles of initial evaluation and management apply to the primary
and permanent dentition. However, carious lesions of the primary teeth less frequently
cause pain and abscesses and more frequently drain cutaneously than lesions of the
permanent dentition. The systemic effects of infection are more pronounced in children,
with rapid temperature elevations, greater risk of dehydration, and more rapid spread of
infection.
(Taken and adapted from: www.aafp.org/afp/20030201/511.pdf)
Dental Trauma
Dental trauma is extremely common. Children are particularly affected, with one third of five
year olds having suffered injury to their primary teeth, and one fourth of 12 year olds having
suffered injury to their permanent teeth. Injuries to teeth and their supporting structures can
be classified as fractures, lateral or extrusive luxation (loosening and displacement of the
tooth), intrusion (displacement of the tooth vertically into the alveolar bone), and avulsion
(complete displacement of the tooth out of its socket).
All patients with traumatized teeth ultimately need follow-up with a dentist for complete
diagnosis and long-term care. Long-term sequelae can include pulp death, root resorption,
and displacement or developmental defects of permanent tooth successors.
Tooth fractures may involve the crown, the root, or both, with or without exposure of the
pulp. Fractures limited to the enamel and small amounts of dentine that are not sensitive
may not require immediate treatment but should be checked by a dentist. Fractures
exposing the pulp are often painful, and patients with this condition require timely referral to
a dentist. Tooth fragments should be kept hydrated as they could possibly be reattached.
Definitive treatment may involve root canal therapy or extraction.
Fractures of the root usually require a radiograph for detection unless the tooth is
particularly loose and the fracture occurred close to the gingival margin. Treatment may
involve root canal therapy, splinting, or extraction, depending on the exact nature of the root
fracture.
Teeth subject to lateral or extrusive luxation have been displaced and are loose. In the
primary dentition, if the traumatized teeth are so loose that they are in danger of being
aspirated or if they interfere with normal occlusion, immediate referral to a dentist for
extraction is required. Luxated permanent teeth require dental referral for repositioning,
splinting, or root canal therapy, along with long-term follow-up. Any luxated tooth that
interferes with normal occlusion requires immediate dental evaluation and treatment to
avoid pain and further complications.
Teeth subject to intrusive luxation have been intruded into the alveolar bone, which may
occur to the point that the teeth are not visible. With regard to injuries to the primary
dentition, dental referral is required for monitoring to determine if the teeth will re-erupt. For
injuries to the permanent teeth, dental referral is required for monitoring or treatment to
promote re-eruption (surgical or orthodontic), often coupled with root canal therapy.
Avulsed teeth are a true dental emergency. Primary teeth are never reimplanted. In the
case of permanent teeth, time is of the essence. Immediate on-scene reimplantation is the
preferred method of treatment. If the tooth is visibly contaminated, it should be gently rinsed
in cold running tap water and then reimplanted. Care should be taken not to touch, rub, or
clean the root, which could remove periodontal ligament fibers and reduce the chance of
successful reimplantation. The patient should then see a dentist immediately for splinting
and antibiotic prophylaxis.
If immediate on-scene reimplantation is not possible, the tooth should be transported in the
patient's buccal sulcus, milk, or a specialized tooth transport container to the physician's or
dentist's office. The tooth should then be immediately reimplanted. If rinsing is required,
normal saline should be used, and any clot present in the socket should be flushed out
before reimplantation.
Antibiotic prophylaxis with penicillin should be prescribed, tetanus vaccine should be

administered if the patient has not received it in the past five years, and the patient should
be immediately referred to a dentist for splinting and further therapy.
(Taken and adapted from: www.aafp.org/afp/20030201/511.html - 46k -)
Tooth Bleaching.
Tooth bleaching is offered for cosmetic purposes. Many individuals who have discoloured
enamel are not satisfied with the appearance of their teeth and go to great lengths to
achieve the perfect smile. Tooth bleaching can be a solution. This can be done by a dental
professional in the dental office or at home.
There are two types of tooth stains:
- Intrinsic stain (internal stain) this means the stain occurs from within the tooth. This type of
stain cannot be removed by brushing and flossing and sometimes bleaching may not be
effective. Some causes of intrinsic staining are injury to the tooth, certain medications (such
as tetracycline) taken during tooth formation or an excess fluoride ingested during the
formation of teeth.
-Extrinsic stain (external stain) this is staining of the tooth surface. Some sources of
extrinsic stains are cigarettes, cigars, coffee, tea, or foods that contain a lot of spices. This
type of staining can sometimes be removed by good tooth brushing habits or by
professional prophylaxis (cleaning).
Different stains require different solutions; therefore it is important to have a consultation
with an oral health professional.
A small number of people experience temporary discomfort during the bleaching treatment
series, such as gum or tooth sensitivity. These symptoms disappear within one to three
days after completion of the treatment. It is important that the manufacturer’s directions are
followed precisely. If any side effects are more than mild or persist, patients should see the
dentist. Overall, tooth bleaching under professional supervision is an effective method for
whitening the teeth.
(Taken and adapted from: .umanitoba.ca/outreach/wisdomtooth/bleachin.htm - 5k)
Fundamental of Dental Radiology.
Oral radiography is the art of recording images of a patient’s oral structures on film by
using X-rays (roentgen rays). The rays were recognition of Wilhelm Konrad
Roentgen, a scientist, who first discovered X-rays in 1895. While experimenting with a
device called a Crookes tube, which generated cathode rays, he noted that a
photographic plate completely wrapped in black paper and lying near the tube was fogged
when developed. He realized that some form of invisible ray, able to pass through
the black paper, must be coming from the tube. Later, while in his darkened
laboratory, he noticed that a fluorescent screen located six feet away was glowing. He
knew that the cathode rays could travel only short distances outside the cathode tube and
realized he was 1-1 observing a new, unknown ray, which he called an X-ray because
the symbol "X" is used for the unknown in mathematics.
The first dental radiograph was taken the same year by Dr. Otto Walkoff. Within
10 years, radiographs were being used for diagnosis of medical and dental conditions,
for X-ray therapy, and-for scientific studies. Although technology over the years has
made tremendous improvements in X-ray equipment, the basic concepts are the same.
Like visible light rays, X-rays are electromagnetic rays that travel in a wave motion. The
measurement of this wave motion is called a wavelength.
The basic difference between X-rays and other electromagnetic rays is in their wavelength.
X-rays have an extremely short wavelength, which enables them to penetrate matter
that usually absorbs or reflects light or other electromagnetic rays with longer wave-
lengths. Although X-rays share the properties of other electromagnetic rays, their
action is considerably different.
Some of the characteristics and properties of X-rays are: They travel in straight lines at the
speed of light. They affect photographic film by producing a hidden image made visible by
processing. They cause certain substances to fluoresce (glow). They cause irritation of
living cells and, in large amounts, can cause necrosis (death) of the cells, a fact that
necessitates caution in using X-rays.
(Taken and adapted from: www.tpub.com/content/medical/14275/css/14275_11.htm - 27k)
Dental radiology for children
Diagnostic radiology is essential to provide adequate dental health services. Dental

radiology examinations are the most frequently performed radiographic examination for
children. The public has become increasingly concerned about the potential harmful effects
of ionizing radiation and parents frequently question the dentist about the need for
radiographs of their children. The actual risk from dental radiography appears very low, but
the prudent dentist must take every reasonable precaution to minimize a child’s radiation
exposure.
There is no danger of acute radiation injury from proper use of modern dental x-ray
equipment. The danger lies in the possibility of injury from repeated exposure to low levels
of ionizing radiation. Long term exposure to low- level of ionizing radiation can produce
genetic or somatic injury. The genetic effects appear in the offspring of the exposed
individual while somatic effects result in direct injury to the exposed individual.
For years the primary concern surrounding dental radiography was the possibility of genetic
defects in the offspring of patients who received gonadal exposure during dental
radiographic examination. Modern dental x-ray equipment, fast film and a lead apron have
reduced patient’s gonadal exposure to extremely low levels. This is a very important benefit
for children as they have their entire reproductive period ahead of them.
Radiographic examination is the only means available to detect early Interproximal carious
lesions, numerous developmental abnormalities and many pathologic conditions. The
number and type of radiographs must be determined individually based on clinical findings
and a knowledge of the diseases and developmental anomalies encountered in children.
Radiographic examination should be made with the underlying principle of obtaining the
maximum diagnostic information with the minimal radiation exposure to the child. Intraoral
radiographs frequently employed for children include bitewing, periapical and occlusal films.

http://www.infoplease.com/ce6/people/A0842231.html)
Bruxism
Bruxism is the technical term for grinding and clenching that abrades teeth and may cause
facial pain. People who grind and clench, called bruxers, unintentionally bite down too hard
at inappropriate times, such as in their sleep. In addition to grinding teeth, bruxers also may
bite their fingernails, pencils and chew the inside of their cheek. People usually aren't
diagnosed with bruxism until it is too late because so many people don't realize they have
the habit. Others mistakenly believe that their teeth must touch at all times. About one in
three people suffer from bruxism, which can easily be treated by a dentist.
People who have otherwise healthy teeth and gums can clench so often and so hard that
over time their teeth become sensitive. They experience jaw pain, tense muscles and
headaches along with excessive wear on their teeth. Forceful biting when not eating may
cause the jaw to move out of proper balance.
When a person has bruxism, the tips of the teeth look flat. Teeth are worn down so much
that the enamel is rubbed off, exposing the inside of the tooth which is called dentin. When
exposed, dentin may become sensitive. Bruxers may experience pain in their
temporomandibular joint (TMJ)-the jaw-which may manifest itself as popping and clicking.
Women have a higher prevalence of bruxism possibly because they are more likely to
experience tissue alterations in the jaw resulting from clenching and grinding. Tongue
indentations are another sign of clenching.
Stress and certain personality types are at the root of bruxism. For as long as humankind
has existed, bruxism has affected people with nervous tension. Anger, pain and frustration
can trigger bruxing. People who are aggressive, competitive and hurried also may be at a
greater risk for bruxism.
During regular dental visits, the dentist automatically checks for physical signs of bruxism. If
the dentist or patient notices signs of bruxism, the condition may be observed over several
visits to be sure of the problem before recommending and starting therapy.
The objective of therapy is to get the bruxer to change behavior by learning how to rest the
tongue, teeth and lips properly. When some people become aware of their problem, simply
advising them to rest their tongue upward with teeth apart and lips shut may be enough to
change their behavior and relieve discomfort. However, the dentist can make a plastic
mouth appliance, such as a night guard that's worn to absorb the force of biting. This
appliance can prevent future damage to the teeth and helps change the patient's
destructive behavior.
Biofeedback is used to treat daytime clenchers by using electronic instruments to measure

muscle activity and to teach patients how to reduce muscle activity when the biting force
becomes too great. Researchers are looking for other ways of treating bruxism, especially
for those who tend to clench in their sleep. One researcher developed an experimental lip
simulator that electrically stimulates the lip when a person bites down too hard while
sleeping. However, that method is being refined because the stimulation can wake sleepers
several times in a night.
(Taken and adapted from: http://en.wikipedia.org/wiki/Dentistry )
Invisalign Braces
Adults who have braces can be just as, or even more traumatizing than youngsters. Simply
because adults take more care in their appearance (hence the desire to fix one’s teeth) and
a disruption like braces can prevent smiling and other social necessary protocol.
That’s why Invisalign was developed. While not braces at all, Invisalign is a small tray
custom designed to the contours of your mouth that attempts to straighten your teeth much
like braces would, but remain invisible and easy to remove.
For instance, when you place the Invisalign system in your mouth it immediately goes to
work straightening your teeth…and you’ll feel it. But, if you have a presentation, a big date,
or a meal, you can easily remove the system and joy the activities with your normal
exposed teeth.
The price for the standard orthodontic procedure varies on the costs somewhere between
3,000 and 8,500 dollars, depending on what the patient wants done.
Many people do not like the thought of braces because they are required to wear them for
several years. The Invisalign system is so radical that most people only use it for 6 months.
However, this short time period may compromise some long-term benefits associated with
regular braces.
Naturally though, the choice is up to the patient. A consultation with the dentist will give the
patient a better picture of whether he is a candidate for the system or not.
(Taken and adapted from: http://en.wikipedia.org/wiki/Dentistry)
Temporo-Mandibular Joint (TMJ) Syndrome
Diseases of the temporo-mandibular joint(s) can cause pain, usually in front of one or both
ears. The TMJ hinges the lower jaw (mandible) to the skull. Pain in the temporo-mandibular
joint(s) can be caused by acute trauma (such as a blow to the face), inflammatory or
degenerative arthritis, or by the mandible being pushed back towards the ears whenever
the patient chews or swallows. Sometimes, muscles around the TMJ used for chewing can
go into spasm, causing head and neck pain and difficulty opening mouth normally. These
muscle spasms are aggravated by chewing or by life "stress," which cause the patients to
clench their teeth and further tighten these muscles. Temporary muscle spasms can also
be caused by dental injections that are used to deliver local anesthetic for dental work or by
the trauma of extracting impacted wisdom teeth.
Treatment of temporo-mandibular joint pain usually involves oral anti-inflammatory drugs

like ibuprofen (Motrin) or naproxen (Naprosyn). Other measures include warm moist
compresses to relax the joint areas, regular aerobic exercise to reduce stress, eating soft
foods that do not require much chewing, and/or repositioning the mandible forward with a
TMJ dental splint.
Repositioning the mandible forward with a splint relieves pressure on the nerves and blood
vessels of the TMJ, and relieves pain. The splint changes the position of how the upper and
lower teeth meet. To maintain this new position, the TMJ splint needs to be worn all the
time, including mealtimes, indefinitely. In patients who do not wish to wear the splint
indefinitely, alternative measures to maintain the new position include placing full-coverage
crowns on all of the back teeth (bicuspids and molars) or by using dental braces.
(Taken and adapted from: http://en.wikipedia.org/wiki/Dentistry)
Pit and fissure sealants

Sealants are a safe and painless way or protecting your children’s teeth from decay. A
sealant is a protective plastic coating, which is applied to the biting surfaces of the back
teeth. The sealant forms a hard shield that keeps food and bacteria from getting into the
tiny grooves in the teeth and causing decay.
Sealants are only applied to the back teeth – the molars and premolars. These are the teeth
that have pits and fissures on their biting surfaces. Your dentist will tell you which teeth
should be sealed after they have examined them, and checked whether the fissures are
deep enough for sealing to help. Some teeth naturally form with deep grooves which will
need to be sealed, others with shallow ones which will not need sealing.
They work in two ways to prevent caries development:
1. Keeps substrate (i.e. food and bacteria) out of deep pits, grooves and fissures on the
teeth.
2. Create an anaerobic environment which eliminates the aerobic bacteria and other
decaying matter residing in this area of the tooth. In cases where a little decay may
have been left in deep grooves, cavities may be prevented from spreading since the
bacteria are unable to thrive.
Generally, there are two criteria used to determine whether or not a patient is a suitable
candidate for a sealant placement, namely:
- Deep occlusal fissures present in a carious tooth
- Deep occlusal fossa present in a carious tooth.
The process is usually quick and straightforward taking only a few minutes per tooth. The
tooth is thoroughly cleaned, prepared with a special solution, and dried. The liquid sealant
is then applied and allowed to set hard – usually by shining an ultraviolet light onto it. It is
totally pain free, and the teeth do not feel any different afterwards.
Sealants usually last for many years, but the dentist will want to check them regularly to
make sure that the seal is still intact. They can wear over time, and sometimes the dentist
needs to add or replace some sealant to be sure that no decay can start underneath them.
The sealant forms a smooth, protective barrier, by covering all the little grooves and dips in
the surface of the tooth. Dental decay easily starts in these grooves.
Sealants are often applied as soon as the permanent teeth start to come through. This is
usually between 6 and 7 years of age. The rest are usually sealed as soon as they appear
which can be any time between 11 and 14 years of age.
It is still vital that children maintain cleaning their teeth. The smooth, sealed surface is now
much easier to keep clean and healthy with normal tooth brushing. Using a fluoride
toothpaste will also help to protect children’s teeth. Pit and fissure sealing reduces tooth
decay and the number of fillings a child might need.
(Taken and adapted from: www.whitetooth.us/default.asp?id=61 - 42k)
Breastfeeding and Infant Tooth Decay
Infants who are strictly breast fed are more resistant to tooth decay than those who are fed
sugar-rich foods together with infant formulas and cow’s milk. But when sugary substances
are alternated with breastfeeding, breast milk becomes a dangerous catalyst that can lead
to rampant dental caries.
Researchers have investigated the decay potential of human breast milk. In laboratory
studies, breast milk alone did not damage tooth enamel. But when combined with another
sugar source, the breast milk/carbohydrate combination is highly cariogenic.
Researchers concluded that breast milk prohibits acid and bacterial growth in the mouth.
However, breast milk has a “low buffering capacity” and does not buffer the addition of acid.
When breast milk is alternated with sugar, the rate of caries development is faster than that
of sugar alone.
From an oral health perspective, pediatric dentists believe that breast milk alone is indeed
the healthiest option for infants. But introducing sugar from food and beverages into the
infant’s diet while breastfeeding is hazardous. Gaining proper nutrition from breast milk or
food is the primary goal of infant health, and early dental intervention and monitoring may
be the best way to prevent early childhood caries in the breast- and bottle-fed infant.
Pediatric dentists recommend that parents schedule their child’s first dental examination
when the first tooth erupts or no later than the first birthday. Infants who are evaluated by a
pediatric dentist at an early age are less likely to develop dental caries and oral diseases
that can interfere with nutrition, learning to speak, or oral-facial development.
Pediatric dentists are primary care providers who also provide comprehensive treatment for
infants, children, adolescents, and patients with special health care needs. It focuses on
prevention, early detection and treatment of dental diseases, and keep current on the latest
advances in dentistry for children.
Pleasant visits to the dental office promote the establishment of trust and confidence in the
child that will last a lifetime. The dentist’s goal, along with the staff, is to help all children feel
good about visiting the dentist and teach them how to care for their teeth.
To prevent tooth decay it is very important to know that four things are necessary for
cavities to form: 1) a tooth; 2) bacteria; 3) sugars or other carbohydrates; and 4) time.
The pediatric dentist is continually doing research to develop new techniques for preventing
dental decay and other forms of oral disease. Studies show that children with poor oral
health have decreased school performance, poor social relationships and less success later
in life. Children experiencing pain from decayed teeth are distracted and unable to
concentrate on schoolwork.
(Taken and adapted from: www.aapd.org/media/pressreleases/breastfeeding-99.asp - 12k )
Dental Implants
A dental implant is a small titanium screw-like fixture that serves as the replacement for the
root portion of a missing natural tooth. The dental implant is placed in the bone of the upper
or lower jaw. After the placement, the implant has to fuse with the bone (titanium is one of
the best materials to integrate with natural bone) which can take a couple of weeks.
Treatment time will vary depending on situation of the patient. It is possible to get well
functioning and esthetic looking teeth within a few days. In some cases it may be necessary
to wait a longer time period before finishing the restoration in order to obtain the best
results.
Dental implants can be used to replace a single lost tooth or a number. Implant supported
replacement teeth look, feel and function like natural teeth, they preserve the integrity of a
facial structure and improve the look and function of a jaw. Once the screw-like fixture is
safe, a dentist will screw in an actual implant that is made to look and replace natural tooth.
Basically anyone who is missing one or more of their teeth due to injury, disease, or decay
may be a candidate for dental implants. Sometimes if there’s a number of teeth missing
dental implants in conjunction with a crown or bridge can replace them. The rule of thumb
is that if a patient is healthy enough to have a tooth extracted, he is probably healthy
enough to receive dental implants. Additionally, the dentist will study the family and
patient’s medical history in order to make final decision about replacing his teeth.
Dental professionals claim that most patients report that there is little discomfort and that
they were much more comfortable following the procedure then they anticipated.
Anesthesia and patient sedation are used to eliminate any discomfort at the time of the
procedure so there is virtually no pain during the process of implant insertion. There may
be some discomfort after the procedure but this is usually minimal and can be significantly
reduced – or eliminated – with a help of painkillers. Also, it is a good idea to get the doctor
to put the patient in touch with someone who’s had a tooth implant procedure done.
Naturally, there are many benefits of dental implants. The benefits of implant treatment
include improved appearance and self-esteem as well the enhanced ability to chew and
enjoy your food, and often protection of your remaining teeth and jawbone.
(Taken and adapted from: www.whitetooth.us/default.asp?id=61 - 42k)
Denture stomatitis (Thrush)
It is a yeast/ fungus called candida or thrush, which causes an infection in the mouth. It is
not a type of infection that can be passed on to others as everybody has some thrush in
their mouths, even babies. It is possible to get thrush elsewhere.
Denture wearers are the most common group to be affected along with people who have
difficulties keeping their mouths clean. Diabetics and anyone who takes steroids either
through inhalers or by mouth may also have problems. Some antibiotics are responsible for
causing thrush and many people find that taking certain antibiotics encourages a
recurrence of infection, especially if taken over a long period of time.
Denture stomatitis is a common oral mucosal lesion in the world. Prevalence rates of 2.5-
18.3% in adults aged 35-44 years or 65-74 years are reported, with predominance in the
latter age group. Although patient age and denture quality alone do not predispose
individuals this mucosal condition, the odds of developing stomatitis, denture-related
hyperplasia, and angular cheilitis are increased almost 3-fold in denture wearers.
Mucosal factors have been implicated in the etiology of this condition, as have behavioral
and manner-of-use factors in patients who wear complete dentures. In these patients, the
nighttime wear of the prosthetic appliance is the most significant factor.
Although the dominant etiologic factor now appears to be fungal infection, other factors
must be considered; these include the prosthetic device itself and also local and systemic
factors in patients who are aging and edentulous. Trauma has been shown to have a role in
the production of basement membrane alterations involving expression of type IV collagen
and laminin (alpha1), thus indicating a possible relationship between these elements and
denture stomatitis.
Regarding the prosthesis-related factor, an allergy in the form of contact mucositis is

suggested. This reaction may be related to the presence of resin monomers, hydroquinone
peroxide, dimethyl-p-toluidine, or methacrylate in the denture. Furthermore, contact
sensitivities such as this one are more common with cold or autocured resins than with
heat-cured denture-base materials.
The disease is more common in elderly persons than in young persons because elderly
persons are more likely to wear dentures and because their level of oral and denture
hygiene is reduced. In addition, age-related chronic disease (eg, type 2 diabetes mellitus),
iatrogenic drugs, and age-associated immunocompromise contribute to this risk level.
Denture stomatitis usually occurs in a patient who wears a complete maxillary denture or a
partial denture. The presence of deteriorating temporary soft denture lining material and an
improperly matched cleanser (which generally is the case) is associated with an increased
presence of candidal organisms within the biofilm.
 In most patients, the elimination of mechanical and traumatic factors, the consistent
use of oral hygiene measures, and the administration of local antimycotic therapy
usually enables the inflammatory lesions to heal rapidly. Recurrences are common
when exacerbating factors are reintroduced.
(Taken and adapted from: www.royalberkshire.nhs.uk/omfs-denture-stomatitis - 10k)
Oral mucosal disorders in denture wearers
The changes that occur within the oral cavity of edentulous persons differ from the changes
in dentulous patients because of the special nature of the denture-bearing oral mucosa.
The soft tissue beneath dentures is not readily displaced and is often subjected to higher
levels of stress than it was designed to bear. Histologic examination of these tissues has
shown that denture may induce a proliferative or degenerative response in the oral mucosa.
Dentures can also produce other changes. The flora may be altered as a result of food
debris and plaque that collects between the mucosal surface of the denture and the palate.
In addition, the saliva that is present between the maxillary denture and the mucosa may
have a lower pH than usual.
A variety of intraoral changes are found in denture wearers, one of which is inflammation.
Inflammation of the denture-bearing mucosa can take several forms. Diffuse inflammation
as a result of trauma and candidal infection is the most common type seen. The diagnosis
of candidiasis is based on smears taken from inflamed mucosa or from the inner surface of
the denture.
Pinpoint inflammation due to trauma is seen with less frequency than candidal stomatitis.
The most common traumatic lesion found intraorally was nondysplastic hyperkeratosis.
Excess keratin may be formed in response to mild chronic irritation from poorly fitting
dentures.
A number of systemic conditions can predispose to denture intolerance. Diabetic patients
may have difficulty accepting dentures because of their altered physiologic activity, the
reduced blood supply to the denture-bearing mucosa, the susceptibility to candidal
infection, and the increased rate of alveolar bone resorption.
(Taken and adapted from: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&

db=PubMed&list_uids=3856660&dopt=Abstract)
Pregnancy and Oral health.
It's a myth that calcium is lost from the mother's teeth and "one tooth is lost with every
pregnancy." But women may experience some changes in their oral health during
pregnancy. The primary change is a surge in hormones-particularly an increase in estrogen
and progesterone-which is linked to an increase in the amount of plaque on your teeth.
If the plaque isn't removed, it can cause gingivitis-red, swollen, tender gums that are more
likely to bleed. So-called "pregnancy gingivitis" affects most pregnant women to some
degree, and generally begins to surface in the second trimester. If the woman already have
gingivitis, the condition is likely to worsen during pregnancy. If untreated, gingivitis can lead
to periodontal disease, a more serious form of gum disease.
Pregnant women are also at risk for developing pregnancy tumors, inflammatory, benign
growths that develop when swollen gums become irritated. Normally, the tumors are left
alone and will usually shrink on their own. But if a tumor is uncomfortable and interferes
with chewing, brushing or other oral hygiene procedures, the dentist may decide to remove
it.
Women can prevent gingivitis by keeping teeth clean, especially near the gumline. They
should brush with fluoride toothpaste at least twice a day and after each meal when
possible. They should also floss thoroughly each day. If tooth brushing causes morning
sickness, they should rinse the mouth with water or with anti-plaque and fluoride
mouthwashes. Good nutrition-particularly plenty of vitamin C and B12-help keep the oral
cavity healthy and strong. More frequent cleanings from the dentist will help control plaque
and prevent gingivitis. Controlling plaque also will reduce gum irritation and decrease the
likelihood of pregnancy tumors.
If they are planning to become pregnant or suspect they are pregnant, they should see a
dentist right away. Otherwise, they should schedule a check-up in the first trimester for a
cleaning. The dentist will assess the oral condition and map out a dental plan for the rest of
the pregnancy. A visit to the dentist also is recommended in the second trimester for a
cleaning, to monitor changes and to gauge the effectiveness of the oral hygiene. Depending
on the patient, another appointment may be scheduled early in the third trimester, but these
appointments should be kept as brief as possible.
Nonemergency procedures generally can be performed throughout pregnancy, but the best
time for any dental treatment is the fourth through six month. Women with dental
emergencies that create severe pain can be treated during any trimester, but the
obstetrician should be consulted during emergencies that require anesthesia or when
medication is being prescribed. Only X-rays that are needed for emergencies should be
taken during pregnancy. Lastly, elective procedures that can be postponed should be
delayed until after the baby's birth.
(Taken and adapted from: www.agd.org/consumer/topics/pregnancy/main.asp - 9k)
Wisdom Teeth extractions.
Wisdom teeth are third molars. Normally people have three permanent molars that develop
in each quadrant of the mouth; upper, lower, right and left. The first molars usually grow into
the mouth at around six years of age. The second molars grow in at around age 12. The
third molars usually will try to grow in at around age 18 to 20 years. Since that is considered
to be the age when people become wiser, third molars gained the nickname, "wisdom
teeth." Actually, they are no different than any other tooth except that they are the last teeth
to erupt, or grow into the mouth. They are just as useful as any other tooth if they grow in
properly, have a proper bite relationship, and have healthy gum tissue around them.
Unfortunately, this does not always happen.
When wisdom teeth are prevented from erupting into the mouth properly, they are referred
to as impacted. Teeth that have not erupted are not necessarily impacted. It may be that it
is still too early in someone's dental development, and if time passes they might grow in
properly. A dentist must examine a patient's mouth and his or her x-rays to determine if the
teeth are impacted or will not grow in properly. Impacted teeth may cause problems.
Impacted teeth can result in infection, decay of adjacent teeth, gum disease or formation of
a cyst or tumor from the follicle, which is the tissue which formed the crown of the tooth.
Many dentists recommend removal of impacted wisdom teeth to prevent potential
problems.
Erupted wisdom teeth may also need to be removed. The dentist may recommend this if
the tooth is non-functional, interfering with the bite, badly decayed, involved with or at risk
for periodontal disease, or interfering with restoration of an adjacent tooth. Once again,
every case is different and only your dentist can determine if there is a reason for you to
have a tooth removed.
The following symptoms may indicate that the wisdom teeth have erupted and surfaced,
and should be removed before they become impacted-meaning; the teeth have surfaced
and have no room in the mouth to grow. However, each individual may experience
symptoms differently. Symptoms may include:
 pain
 infection in the mouth
 facial swelling
 swelling of the gumline in the back of the mouth
Many oral health specialists will recommend removal of the wisdom teeth, (when the roots
are approximately formed, or three-fourths developed, usually in the adolescent years), as
early removal will help to eliminate problems, such as an impacted tooth that destroys the
second molar. Third molar impaction is the most prevalent medical developmental disorder.
Some of the problems associated with impacted third molars are:

 bacteria and plaque buildup
 cysts development (a fluid- filled sac)
 tumor development
 infection
 jaw and gum disease
Wisdom tooth extraction involves accessing the tooth through the soft and hard tissue,
gently detaching the connective tissue between the tooth and the bone and removing the
tooth.
(Taken and adapted from: en.wikipedia.org/wiki/Wisdom_teeth - 49k - 17 Abr 2007)
Anesthesia at the Dental Office
To make the dental visit as comfortable as possible, the dentist may suggest anesthesia to
reduce or eliminate any pain or anxiety that may be related to dental treatment. The type of
anesthesia required for any dental procedure depends on the needs or preferences of the
patient.
The dentist will decide what level of anesthesia is right for the patient. Some patients prefer
a higher level of anesthesia than others. Children, people with special needs, such as
mental retardation, and those with a condition, such as a dental phobia may require a
higher level of anesthesia. The type of anesthesia administered by the dentist is more
dependent on individual patient preferences than specific dental procedures.
Local anesthesia is produced by the application or injection of a drug to eliminate pain in a

specific area in the mouth. Topical anesthetics are frequently used by your dentist to numb
an area in preparation for administering an injectable local anesthetic. Injectable local
anesthetics, such as Lidocaine, numb mouth tissues in a specific area of your mouth for a
short period of time. The dentist will probably inject a local anesthetic before filling cavities,
preparing teeth for crowns, or for any surgical procedure. Local anesthesia is the most
commonly used form of anesthesia in the dental office.
Conscious sedation can be used to help patients relax during a dental procedure. The
dentist may administer an anti-anxiety agent, such as nitrous oxide, or a sedative, in
combination with a local anesthetic for pain. During conscious sedation, the patient will
remain calm during treatment, yet rational and responsive to speech and touch. Anti-anxiety
agents and sedatives can be administered by mouth, inhalation or injection.
Deep sedation and general anesthesia is used for complex procedures and for patients who
have trouble controlling their movements or need a deeper level of anesthesia during
treatment. During deep sedation the patient will be unable to respond appropriately to
verbal commands. During general anesthesia patients are unconscious.
The dentist needs to know about all the medications that the patient is taking, any allergic
reactions he’s had to medicines in the past, and the past and present health conditions. It's
important that patients answer the dentist's questions completely and ask about his
concerns. This way the dentist will be sure to tell the patient everything he needs to know
before receiving treatment. For example, in some cases, the anesthesia treatment may
require that the patient suspends certain medications or abstain from eating or drinking for
a period of time before the treatment.
Although taking any medication involves a certain amount of risk, the drugs that produce
anesthesia are entirely safe when administered by a trained anesthesia provider. Good
communication between the dentist and the patient is the best way of insuring safety.
(Taken and adapted from: www.prestonwooddental.com/dental_anesthesia.htm - 20k)
Biopsy
After the physical examination of the mouth, if the doctor finds any areas that are
suspicious, he may recommend a biopsy. This is simply taking a small portion of the
suspicious tissue for examination under a microscope.
The most traditional type of biopsy is incisional. It may be done by the doctor who examines
you, or you may be referred to another doctor for the procedure. In an incisional biopsy, the
doctor will remove part or the entire lesion depending on its size and his ability to define the
extent of it at this early stage. The sample of tissue is then sent to a pathologist who
examines the tissue under a microscope to check for abnormal or malignant cells.
Another form of incisional biopsy is referred to as a punch biopsy. In this case, a very small
circular blade is pressed down into the suspect area cutting a round border. The doctor
then pulls on the centre of this area, and with a scalpel or a pair of small tissue scissors
snips it free of the surrounding tissue, removing a perfect plug of cells from the sampled
area. As before this is sent to a pathologist for examination.
Another new way to test for oral cancer before incisional biopsy is beginning to be used by
dental professionals -- a system called Oral CDx. Here, a dentist uses a small brush to
gather cell samples of a suspicious area. The specimen is then sent to a lab for computer
analysis.
This oral brush biopsy procedure is simple, and can be done right in the dentist's chair. It
results in very little or no pain or bleeding, and requires no topical or local anesthetic.
The benefits of CDx are the possible avoidance of surgical biopsy, and the ease of
sampling, which can be performed during a routine dental examination.
Other ways to determine the presence or extent of oral cancer exist. For instance,
radiographs also referred to as x-rays, can assist in determining the potential growth of a
tumor into bone. While oral cancers unlike many other malignancies can usually be seen
with the naked eye, some cancers are located internally in the body, making their detection
difficult. Different scanning options, some of which assist in determining the presence of
tumors or growths, and some of which can even detect malignancy, are necessary in these
instances.
CT, or CAT (co-axial tomography) scan technology has developed rapidly over the last few
decades, and these scans can provide images of great diagnostic quality and usefulness. A
CT scan could be described as a series of x-rays, each one a view of a 3mm section of the
area being scanned, which is then manipulated by a computer, allowing doctors a dynamic
view of the affected soft tissue areas of the body with much greater detail than a simple x-
ray.
Another recent technology, Magnetic Resonance Imaging (MRI), is helpful in providing

accurate views of the affected area. MRI is a procedure in which pictures are created using
magnets and radio frequencies linked to a computer imaging system. The hydrogen atoms
in the patient's body react to the magnetic field and emit signals that are analyzed by a
computer to produce detailed images of organs and structures in the body. Occasionally a
dye is injected into the bloodstream during scanning to bring greater detail to the soft tissue
areas of the scan. Again, this procedure is only able to detect the actual presence of
masses, and it still requires a biopsy for confirmation.
(Taken and adapted from: www.oralcancerfoundation.org/diagnosis/ - 19k)
Oral lesions common to AIDS
Candidiasis is the colonization and infection of the oral mucosa by Candida albicans and it
is among the earliest and most common findings in HIV-infected patients. Lesions range
from white to red or red/ white combinations. Candidiasis has a typical appearance of on
the lateral tongue; and it may have a resemblance to hairy leukoplakia. The lesions may be
asymptomatic or there may be mild discomfort.
AIDS patients are vulnerable to a variety of oral malignancies including Kaposi's sarcoma,
malignant lymphoma and squamous carcinoma. Kaposi's sarcoma is the most common.
The palate is the most common site. In the early stage, the tumor appears as a red to
purple bruise. The tumor grows and eventually appears as a hemorrhagic mass .The cell of
origin is endothelium; thus Kaposi's sarcoma is a variety of angiosarcoma. They are locally
invasive, cause pain and bleeding and interfere with normal function. Radiation is the
preferred treatment but laser resection and intralesional viblastine provide palliation.
The hairy leukoplakia is the variety of leukoplakia that was first recognized in HIV-infected
patients but it has been encountered in other immune deficiency states such as organ
transplant patients who are intentionally immune suppressed. The lateral tongue is the most
common location. Lesions are of rough texture, adherent and asymptomatic. The diagnosis
of hairy leukoplakia can be suspected on routine biopsy specimens, but confirmation
requires demonstration of the presence of the causative virus, the Epstein-Barr herpes
virus. This is ordinarily achieved by DNA in situ hybridization. Hairy leukoplakia may be
confused with candidiasis. A patient who presents with a white lesion should be treated with
antifungal therapy first. If it fails to heal, it most likely is hairy leukoplaquia.
HIV infected patients are vulnerable to gingivitis, periodontitis, and necrotizing ulcerative
gingivitis (ANUG-like). The organisms recovered from these lesions are the same as those
in non-HIV-positive patients, but they are present in greater numbers. Lesions are treated
by dental phophylaxis, debridement, and metronidazole. Good oral hygiene and daily rinses
with chlorhexidine are beneficial.
Others-HIV patients also develop major aphthous-like lesions that respond to topical
tetracycline and topical steroid therapy. Other patients have painful palatal and gingival
ulcers that have been found to harbor cytomegalovirus. The human papillomavirus has also
been found in mucosal papules. Herpes virus may cause painful and protracted oral ulcers
that are responsive to treatment with acyclovir. Lastly, xerostomia secondary to a Sjogren's
syndrome-like illness has been reported.
(Taken and adapted from: www.zhub.com/pathology/listings/69.html - 5k)
Tobacco and Oral Health
Tobacco remains one of the most important preventable causes of addiction, sickness and
mortality in the world. The development of potentially malignant oral lesions as well as
various other undesirable conditions are the direct result of tobacco use, yet on the whole
knowledge of these implications amongst the general public is very limited. This is a
worrying situation that requires urgent attention given that the mortality rates associated
with oral cancers are high and that the main causes of them are directly attributed to
lifestyle habits such as smoking, betel quid chewing and excessive alcohol consumption.
With early diagnosis, cancer treatment is straightforward, survival rates high and many of
the associated side-effects, such as severe gingivitis, are non-permanent and improve over
time.
The smoking and chewing of tobacco products has a number of well documented side-
effects on the oral cavity. These cover a range of implications from those that alter a
person’s appearance to others that are potentially fatal. The following are the main areas
that tobacco is known to affect:

The smoking and chewing of tobacco products can have a dramatically detrimental effect
on the appearance of people, ranging from yellowed fingers to smoker’s face. Specifically
tobacco use affects the aesthetics of the face and mouth.

Tobacco is a peripheral vasoconstrictor which influences the rate at which wounds heal
within the mouth. Carbon monoxide and other chemicals produced during the combustion
of tobacco can reduce the capillary blood flow within the mouth - research has suggested
that a single cigarette can reduce the peripheral blood velocity by 40%
for one hour. Consequently healing is much slower and not as successful following oral
surgery on smokers. The resulting absence of blood clotting that follows the removal of
teeth (referred to as dry sockets or localised osteitis) occurs 4-times more frequently in
smokers than in non-smokers.
There is increasing debate as to whether poor oral health (in particular periodontitis) can be
a cause of pulmonary heart disease. Studies from the 1980s and 90s have shown that
there is an association between the two, though the precise mechanisms of how this
occurs are not fully understood.
Studies suggest that the incidence of oral cancer among smokers is between 2 to 18 times
more frequent than with non-smokers. Smokeless tobacco users are also at an increased
risk. Stopping smoking eliminates the increased risk of oral cancer after 5-10 years. Most
cancers occur within the oral cavity itself: the most common place for them to exist are the
tongue , with other areas including the gingiva (gums), floor of mouth , lip and salivary
gland.
(Taken and adapted from: www.ash.org.uk/html/health/pdfs/oral_health.pdf)
Acupuncture
An introduction to the practical application of acupuncture in dentistry is presented in the

light of current research. It is concluded that acupuncture could supplement conventional
treatment modalities. Its value in the treatment of temporomandibular dysfunction syndrome
and facial pain has been well documented and supported by randomised controlled trials.
Although it may be useful in the control of post-operative pain, its use as sole analgesia for
operative care is questionable. The mode of action of acupuncture can be explained with
reference to modern neurophysiology. A short training course can allow the technique to be
an effective tool in every dentist's hands.
In brief
 Acupuncture is not a miracle cure and is not going to replace the drill. However, the
technique can be a supplement to conventional treatments in TMDs, facial pain and
in phobias and anxiety.
 Acupuncture does have a scientific background and the efficacy has been tested in a
number of clinical trials including pain management, facial pain, TMD and increasing
of the pain threshold.
 Acupuncture is not without adverse effect and therefore proper training is essential.
 The technique can be achieved by any dentist after a short training programme.
Acupuncture originated in China more than 3,000 years ago and involves insertion of
needles into various parts of the body with the intention of curing disease. Two recent
papers have reviewed the use of acupuncture in dentistry ; Both authors have concluded that
it is effective in a number of conditions encountered in dental practice such as
temporomandibular dysfunction syndrome (TMD) and pain management. In addition Blom
et al. have demonstrated its value in Sjøgrens disease. Despite its long history there still
exists a great deal of scepticism in the professional community as to its efficacy. This is
understandable as the scientific study of acupuncture has occurred only relatively recently.
A commonly held view of acupuncture is that it is a complicated technique involving a
substantial knowledge of ancient Chinese philosophy whose action is largely a placebo
effect and in any case of limited application to dentistry. However, Richardson has shown it
to be effective in a wide range of musculo-skeletal conditions, Lundeberg has demonstrated
that it may improve the immune response, and Tao recommends its use in stress
management, a topic that interfaces with dental practice. The aim of this paper is to give a
broad introduction to acupuncture to the general dental practitioner and to emphasise the
scientific background for acupuncture. Before doing so it is necessary to briefly review
some of the scientific evidence in support of acupuncture.
(Taken and adapted from: www.nature.com/bdj/journal/v189/n3/full/4800704a.html)

Appendix
Irregular verbs
Past Past Past
Present Past participle Present
simple simple participle
be was, were been lend lent lent
beat beat beaten let let let
become became become lie lay lain
begin began begun light lit lit
bend bent bent lose lost lost
bite bit bitten make made made
blow blew blown mean meant meant
break broke broken meet met met
bring brought brought pay paid paid
build built built put put put
burn burnt burnt read read read
buy bought bought ride rode ridden
catch caught caught ring rang rung
choose chose chosen rise rose risen
come came come run ran run
cost cost cost say said said
cut cut cut see saw seen
dig dug dug sell sold sold
do did done send sent sent
draw drew drawn set set set
drink drank drunk shake shook shaken
dream dreamt dreamt shine shone shone
drive drove driven shoot shot shot
eat ate eaten show . showed shown
fall fell fallen shut shut shut
feel felt felt Sing sang sung
find found found sink sank sunk
fly flew flown sit sat sat
forget forgot forgotten sleep slept slept
freeze froze frozen speak spoke· spoken
get got got spend spent spent
give gave given stand stood stood
go went gone steal stole stolen
grow grew grown stick stuck stuck
hang hung hung sweep swept swept
have had had swim swam swum
hear heard heard swing swung swung
hide hid hidden take took taken
hit hit hit teach taught taught
hold held held tear tore torn
hurt hurt hurt tell told told
keep kept kept think thought thought
know knew known throw threw thrown
lay laid laid wake woke woken
lead led led wear wore worn
learn learnt learnt Win won won
leave left left write wrote written
Tense Active Passive

Present simple She takes it. It is taken.
Present continuous She is taking it. It is being taken
Present perfect She has taken it. It has been taken
Present perfect continuous She has been taking it
Past
Past simple She took it It was taken
Past continuous She was taking it It was being taken
Past perfect She had taken it. It had been taken
Past perfect continuous She had been taking it
Future She will take it. It will be taken
Future continuous She will be taking it It will be being taken
Future perfect She will have taken it. It will have been taken
Future perfect continuous She will have been driving it.
Active and Passive Voice
(Perfect continuous tenses are very uncommon in the passive.)
Web Sites used in the Quick Glance Sections
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1532-
849X.2006.00130.x
http://en.wikipedia.org/wiki/Dentistry
http://www.aapd.org/pediatricinformation/brochurelist.asp
http://en.wikipedia.org/wiki/Dentistry#History
http://www.healthy.net/scr/article.asp?Id=1486
http://more.studentdoctor.net/wiki/index.php/Dentistry_Wiki#History.
http://www.firn.edu/doe/programs/doc/cmmi1.doc
.
http://www.aae.org/welcome/history.htm
http://www.infoplease.com/ce6/people/A0842231.html
www.archwired.com/HistoryofOrtho.htm -
http://www.healthy.net/scr/article.asp?Id=789
http://www.bium.univ-
paris5.fr/sfhad/iahd/iahd05e.htmhttp://www.rvi.net/~fluoride/000213.htm

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Inside Dentistry

Luisa F. Acosta Ortega

Cecilia Venzant Fontaine

Luisa F. Acosta Ortega

Raiza Texidor Pellón, MA

 Dr. Belkis Ferrer Callamo

 Dr. Teresa Ramos Aroche

 Dr. Xiomara Montoya Migues

 Dr. José Suarez Lorenzo

 Dr. Javier Lozada Garcia

 Dr. Julieta Rodríguez Pastó

 Dr. Leyco Ley López

 Dr. Noris Viscay Hierrezuelo

 Jaqueline E. Rosales Moreno, BEd

 Alfredo García Suárez, BEd

Design: Luis Alberto Montoya Acosta

Read and Report

1 -Dental fields -Expressing Text about dental curriculum

2 -Dental caries -Giving polite -Conversations dentist - patient at

3 -Periodontal -Giving advice -Patient-dentist conversations

2 -Dental caries -Writing pieces of -Nature of dental caries

Unit3 When periodontal

10 Oral Cancer -Writing a case -Biopsy

The course has the following features:

Unit 1. Approach to Dentistry

Dentistry is the practical application of knowledge of dental science to human beings. A

(Taken and adapted from: http://www.blackwell-

Ask and answer

1. According to the text, what is needed to become a qualified dentist?

Discuss in groups the following:

 General Comprehensive Dentist versus Specialist of a dental field

 Discuss the above statement with your partner.

a. Function of different parts of the mouth

Find in the text equivalents for the following words:

4. The World of Words

 There was redness around the first upper molar. (preposition)

Read the text again and write a summary about it

1. Look at the pictures and write the names of each tooth.

1. Knife 2. Fork 3. Nutcracker 4. Mortar

-A primary tooth is smaller than a permanent tooth

- Having a good health in a primary tooth is as important as in a permanent tooth

Expand the previous ideas into paragraphs

Unit 2. General Dental Practice

One of the first data referring to dental diseases is found in the

 Do you know about other ancient beliefs in relation to toothache?

1. Mr. Suarez visits the dentist because he feels tooth sensitivity.___

Mr. Suarez goes to the dentist.

Dr. Verdecia: Good morning, Mr. Suarez. What’s the problem?

(The doctor examines Mr. Suarez’s mouth)

(Dentist talking to the dental assistant)

Find in the dialogue a word that means:

Go over the conversation again to answer the following questions.

1. What sort of problems does the patient have?

 Put your head on the headrest, please.

Note how the dentist might start the interview: