Habitat : Rhododendron lapponicum is native to N. Europe, N. Asia. Northern N. America – Alaska to Quebec. It grows on the rocky barrens and sub-alpine woods.It is found in subarctic regions around the world, where it grows at altitudes ranging from sea level to 1900 meters.
Rhododendron lapponicum is an evergreen perennial Shrub growing to 1 m (3ft 3in) by 1 m (3ft 3in).Leaves are thick, leathery, evergreen, and 1 to 1.5 cm long, growing to 30 cm in height they are leathery, evergreen, elliptic, and covered with many small scales, much longer than wide. Flowers few, 1.5 cm wide, bright purple, bell-shaped, developing at the end of the branches. Fruits are 5 mm wide.
It is in flower from Apr to May. The flowers are hermaphrodite (have both male and female organs) and are pollinated by Insects Cultivation:
Succeeds in a most humus-rich lime-free soils except those of a dry arid nature or those that are heavy or clayey. Prefers a peaty or well-drained sandy loam. Succeeds in sun or shade, the warmer the climate the more shade a plant requires. A pH between 4.5 and 5.5 is ideal. Succeeds in a woodland though, because of its surface-rooting habit, it does not compete well with surface-rooting trees. Plants need to be kept well weeded, they dislike other plants growing over or into their root system, in particular they grow badly with ground cover plants, herbaceous plants and heathers. Plants form a root ball and are very tolerant of being transplanted, even when quite large, so long as the root ball is kept intact. Plants in this genus are notably susceptible to honey fungus. Propagation:
Seed – best sown in a greenhouse as soon as it is ripe in the autumn and given artificial light. Alternatively sow the seed in a lightly shaded part of the warm greenhouse in late winter or in a cold greenhouse in April. Surface-sow the seed and do not allow the compost to become dry. Pot up the seedlings when they are large enough to handle and grow on in a greenhouse for at least the first winter. Layering in late July. Takes 15 – 24 months. Cuttings of half-ripe wood, August in a frame. Easy
Edible Uses:: A tea is made from the leaves and flower tips.
Medicinal Uses: Not yet known.
Known Hazards: Although no specific mention of toxicity has been seen for this species, it belongs to a genus where many members have poisonous leaves. The pollen of many if not all species of rhododendrons is also probably toxic, being said to cause intoxication when eaten in large quantities. Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplement, it is always advisable to consult with your own health care provider.
More than 500 children aged 8 to 13 from two different towns were studied and tested. One city had fluoridated water, and the other did not.
PR Newswire reports:
“About 28 percent of the children in the low-fluoride area scored as bright, normal or higher intelligence compared to only 8 percent in the ‘high’ fluoride area … in the high-fluoride city, 15 percent had scores indicating mental retardation and only 6 percent in the low-fluoride city.”
Most cases are caused by Legionella pneumophila. The rest of the cases are caused by other Legionella species.
Spread of the bacteria from person to person has not been proven.
Most infections occur in middle-aged or older people, although they have been reported in children. Typically, the disease is less severe in children.
Legionellosis takes two distinct forms:-
*Legionnaires’ disease, also known as “Legion Fever,” is the more severe form of the infection and produces pneumonia.
*Pontiac fever is caused by the same bacterium but produces a milder respiratory illness without pneumonia that resembles acute influenza
Legionnaires’ disease acquired its name in July 1976 when an outbreak of pneumonia occurred among people attending a convention of the American Legion in
Philadelphia. On January 18, 1977 the causative agent was identified as a previously unknown bacterium, subsequently named Legionella. Some people can be infected
with the Legionella bacterium and have only mild symptoms or no illness at all.
Outbreaks of Legionnaires’ disease receive significant media attention. However, this disease usually occurs as single, isolated cases not associated with any
recognized outbreak. When outbreaks do occur, they are usually in the summer and early autumn, though cases may occur at any time of year. The fatality rate of
Legionnaires’ disease has ranged from 5% to 30% during various outbreaks. “The death rate for patients who develop Legionnaire’s disease while in the hospital is
close to 50%, especially when antibiotics are started late,” according to the NIH and U.S. National Library of Medicine service’s MedlinePlus. Most infections occur
in those who are middle-age or older.
Signs and symptoms:-
Symptoms tend to get worse during the first 4 – 6 days. They typically improve in another 4 – 5 days.
Symptoms may include:……….
•Coughing up blood
•Gastrointestinal symptoms, such as diarrhea, nausea, vomiting, and abdominal pain
•General discomfort, uneasiness, or ill feeling (malaisemalaise)
•Lack of coordination (ataxiaataxia)
•Loss of energy
•Muscle aches and stiffness
•Shortness of breath
Laboratory tests may show that patients’ renal functions, liver functions and electrolytes are deranged, including hyponatremia. Chest X-rays often show pneumonia
with bi-basal consolidation. It is difficult to distinguish Legionnaires’ disease from other types of pneumonia by symptoms or radiologic findings alone; other tests
are required for diagnosis.
Persons with Pontiac fever experience fever and muscle aches without pneumonia. They generally recover in 2 to 5 days without treatment.
The time between the patient’s exposure to the bacterium and the onset of illness for Legionnaires’ disease is 2 to 10 days; for Pontiac fever, it is shorter,
generally a few hours to 2 days.
L. pneumophila is specifically considered as a pathogen of the respiratory tract. Other infections have also been reported, including haemodialysis fistulae,
pericarditis, and wound and skin infections. Bacteraemia is often associated with Legionnaires’ disease. Intestinal infections may only occur as part of respiratory
infections, and where gastrointestinal symptoms have on occasion been described.
No animal infections have been specifically recorded.
Infections of protozoa such as Hartmannella vermiformis and related protozoa have been shown to be able to support the growth of L. pneumophila in tap water. Also
Acanthamoeba, Naegleria and Tetrahymena can be infected by L. pneumophila. pathway may be how these organisms survive in the environment.
Legionellosis infection normally occurs after inhaling an aerosol (suspension of fine particles in air) containing Legionella bacteria. Such particles could
originate from any infected water source. When mechanical action breaks the surface of the water, small water droplets are formed, which evaporate very quickly. If
these droplets contain bacteria, the bacteria cells remain suspended in the air, invisible to the naked eye but small enough to be inhaled into the lungs. This often
occurs in poorly ventilated areas such as prisons where a condensating air conditioner can spread it throughout the entire room, infecting anyone not immune to the
strain of bacteria. Potential sources of such contaminated water include cooling towers used in industrial cooling water systems as well as in large central air
conditioning systems, evaporative coolers, hot water systems, showers, windshield washers, whirlpool spas, architectural fountains, room-air humidifiers, ice making
machines, misting equipment, and similar disseminators that draw upon a public water supply. The disease may also be spread in a hot tub if the filtering system is
defective. Freshwater ponds, creeks, and ornamental fountains are potential sources of Legionella. The disease is particularly associated with hotels, cruise ships
and hospitals with old, poorly maintained pipework and cooling systems. A study published by the European Journal of Epidemiology points to automotive windshield
washing systems as a source, recommending the addition of an antibacterial agent to the system’s reservoir.In several cases Compost sparks Legionnaire’s fear as
The bacteria grow best in warm water, like the kind found in hot tubs, cooling towers, hot water tanks, large plumbing systems, or parts of the air-conditioning
systems of large buildings. Indoor ornamental fountains have been confirmed as a cause of Legionnaires’ disease outbreaks. In all documented cases submerged lighting
as a heat source was attributed to the outbreak. Controlling the growth of Legionella in ornamental fountains is touched on in many of the listed guidelines.
However, specific guidelines for ornamental fountains have also been published.
People of any age may suffer from Legionnaires’ disease, but the illness most often affects middle-age and older persons, particularly those who smoke cigarettes or
have chronic lung disease. Immunocompromised patients are also at elevated risk. Pontiac fever most commonly occurs in persons who are otherwise healthy.
The most useful diagnostic tests detect the bacteria in sputum, find Legionella antigens in urine samples, or the comparison of Legionella antibody levels to in two
blood samples taken 3 to 6 weeks apart. A urine antigen test which is simple, quick, and very reliable will only detect Legionella pneumophila serogroup 1. In
addition the urine antigen test will not identify the specific subtypes so it cannot be used to match the patient with the environmental source of infection.
Exams and Tests:-
The health care provider will perform a physical exam, and may hear abnormal sounds called crackles when listening to the chest with a stethoscope.
Tests that may be done include:
•Arterial blood gasesArterial blood gases
•Chest x-rayChest x-ray
•Complete blood count (CBCCBC), including white blood cell countwhite blood cell count
•Erythrocyte sedimentation rateErythrocyte sedimentation rate
•Liver function testsLiver function tests
•Sputum cultureSputum culture for the Legionella bacteria
•Sputum indirect fluorescent antibody test for the Legionella bacteria
•Urine tests to check for Legionella pneumophila bacteria
Current treatments of choice are the respiratory tract quinolones (levofloxacin, moxifloxacin, gemifloxacin) or newer macrolides (azithromycin, clarithromycin,
roxithromycin). The antibiotics used most frequently have been levofloxacin and azithromycin. Macrolides are used in all age groups while tetracyclines are
prescribed for children above the age of 12 and quinolones above the age of 18. Rifampicin can be used in combination with a quinolone or macrolide. Tetracyclines
and erythromycin led to improved outcomes compared to other antibiotics in the original American Legion outbreak. These antibiotics are effective because they have
excellent intracellular penetration and Legionella infects cells.
The mortality at the original American Legion convention in 1976 was high (34 deaths in 180 infected individuals) because the antibiotics used (including
penicillins, cephalosporins, and aminoglycosides) had poor intracellular penetration. Mortality has plunged to less than 5% if therapy is started quickly. Delay in
giving the appropriate antibiotic leads to higher mortality.
Antibiotics are used to fight the infection. Treatment is started as soon as Legionnaire’s disease is suspected, without waiting for confirmation by lab test.
Other treatments may include:
•Fluid and electrolyteelectrolyte replacement
•Oxygen (given through a mask or breathing machine)
According to the journal Infection Control and Hospital Epidemiology, hospital-acquired Legionella pneumonia has a fatality rate of 28%, and the principal source of
infection in such cases is the drinking-water distribution system.
Legionnaire’s disease can be life-threatening. The death rate is higher in patients with other diseases. The death rate for patients who develop Legionnaire’s
disease while in the hospital is close to 50%, especially when antibiotics are started late.
Legionnaire’s disease can be life-threatening. The death rate is higher in patients with other diseases. The death rate for patients who develop Legionnaire’s
disease while in the hospital is close to 50%, especially when antibiotics are started late.
Treating water delivery systems can prevent the spread of disease.
Various studies have shown that some 40% to 60% of cooling towers tested contained Legionella.
A recent research study provided evidence that Legionella pneumophila, the causative agent of Legionnaires’ disease, can travel airborne at least 6 km from its
source. It was previously believed that transmission of the bacterium was restricted to much shorter distances. A team of French scientists reviewed the details of
an epidemic of Legionnaires’ disease that took place in Pas-de-Calais in northern France in 2003–2004. There were 86 confirmed cases during the outbreak, of whom 18
died. The source of infection was identified as a cooling tower in a petrochemical plant, and an analysis of those affected in the outbreak revealed that some
infected people lived as far as 6–7 km from the plant.
A study of Legionnaires’ disease cases in May 2005 in Sarpsborg, Norway concluded that: “The high velocity, large drift, and high humidity in the air scrubber may
have contributed to the wide spread of Legionella species, probably for >10 km. …”
In 2010 a study by the UK Health Protection Agency reported that 20% of cases may be caused by infected windscreen wiper water. The finding came after researchers
spotted that professional drivers are five times more likely to be infected.
Temperature affects the survival of Legionella as follows:-
*70 to 80 °C (158 to 176 °F): Disinfection range
*At 66 °C (151 °F): Legionellae die within 2 minutes
*At 60 °C (140 °F): Legionellae die within 32 minutes
*At 55 °C (131 °F): Legionellae die within 5 to 6 hours
*Above 50 °C (122 °F): They can survive but do not multiply
*35 to 46 °C (95 to 115 °F): Ideal growth range
*20 to 50 °C (68 to 122 °F): Legionellae growth range
*Below 20 °C (68 °F): Legionellae can survive but are dormant
Removing slime may be an effective control process.
Philadelphia, United States, 1976
The first recognized outbreak occurred on July 27, 1976 at the Bellevue Stratford Hotel in Philadelphia, Pennsylvania, where members of the American Legion, a United
States military veterans association, had gathered for the American Bicentennial. Within two days of the event’s start, veterans began falling ill with a
then-unidentified pneumonia. They were tachypneic and complained of chest pain. As many as 221 people were given medical treatment, and 34 deaths occurred. At the
time, the U.S. was debating the risk of a possible swine flu epidemic, and this incident prompted the passage of a national swine flu vaccination program. That cause
was ruled out, and research continued for months, with various theories discussed in scientific and mass media that ranged from toxic chemicals to terrorism
(domestic or foreign) aimed at the veterans.
The U.S. Centers for Disease Control and Prevention mounted an unprecedented investigation and, by September, the focus had shifted from outside causes, such as a
disease carrier, to the hotel environment itself. In January 1977, the Legionellosis bacterium was finally identified and isolated, and found to be breeding in the
cooling tower of the hotel’s air conditioning system, which then spread it through the entire building. This finding prompted new regulations worldwide for climate
United Kingdom, 1985
In April 1985, 175 patients were admitted to the District or Kingsmead Stafford Hospitals with chest infection or pneumonia. 28 died. The medical diagnosis showed
that this was Legionnaires’ disease and the immediate epidemiological investigation traced the source of the infection to the air-conditioning cooling tower on the
roof of the Stafford District Hospital. A Government Inquiry was set up to investigate how the infection occurred and why it became Britain’s largest epidemic of
Legionnaires’ disease. The infection was linked to one small zone in the hospital: the outpatients department. The initial investigation searched for engineering
reasons to explain why this particular zone was the risk area. More detailed and wider epidemiological surveys subsequently showed that staff working in the whole
area supplied with fresh air taken adjacent to the tower, had antibodies to the disease. The outpatients department was unique in having a very large transient
population of susceptible individuals either receiving treatment or accompanying friends.
In March 1999, an outbreak in the Netherlands occurred during a flower exhibition in Bovenkarspel. 200 people became ill and at least 32 people died. There is a
possibility that more people died from it, but these people were buried before the Legionella infection was recognized. The source of the bacteria were probably a
whirlpool and a humidifier in the exhibition area.
Melbourne, Australia, 2000
In April 2000, an outbreak of Legionella pnemophila serogroup 1 occurred in Melbourne, Australia. The outbreak resulted in 125 confirmed cases of Legionnaire’s
disease, with 95 (76%) hospitalised. It is reported that 4 died from the outbreak. The investigation traced the source of the infection to the cooling tower at the
newly opened aquarium. Since this outbreak, legionella infection statistics are required to be reported by the state government as a notifiable disease.
Stringent Regulations were introduced by the State to control legionella in 2001.
The world’s largest outbreak of Legionnaires’ disease happened in July 2001 (patients began appearing at the hospital on July 7), in Murcia, Spain. More than 800
suspected cases were recorded by the time the last case was treated on July 22; 636–696 of these cases were estimated and 449 confirmed (so, at least 16,000 people
were exposed to the bacterium) and 6 died (a case-fatality rate of approximately 1%).
A case-control study matching 85 patients living outside the city of Murcia with two controls each was undertaken to identify the outbreak source; the
epidemiological investigation implicated the cooling towers at the Morales Meseguer Hospital. An environmental isolate from these towers with an identical molecular
pattern as the clinical isolates was subsequently identified and supported that epidemiologic conclusion.
United Kingdom, 2002
Main article: 2002 Barrow-in-Furness Legionnaires’ disease outbreak
In 2002, Barrow-in-Furness in the U.K. suffered an outbreak of Legionnaires’ disease. Six women and one man died as a result of the illness; another 172 people also
contracted the disease. The cause was found to be a contaminated cooling tower at the town’s Forum 28 arts centre. Barrow Borough Council later became the first
public body in the UK to be charged with corporate manslaughter but were cleared. They were, however, along with architect Gillian Beckingham, fined for breaches of
Health and Safety regulations in a trial that ended in 2006.
In Fredrikstad, Norway, 56 people became ill and ten died from Legionnaires’ disease caused by bacteria growing in an air scrubber of a nearby factory.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Cryptosporidiosis is a parasitic disease caused by Cryptosporidium, a protozoan parasite in the phylum Apicomplexa. It affects the intestines of mammals and is typically an acute short-term infection. It is spread through the fecal-oral route; the main symptom is self-limiting diarrhea in people with intact immune systems. In immunocompromised individuals, such as AIDS patients, infection can cause permanent and life-threatening explosive diarrhea also known as “the Bangkok Blast” or the “Thai Fourth of July”. Despite not being identified until 1976, it is one of the most common waterborne diseases and is found worldwide. The parasite is transmitted by environmentally hardy cysts (oocysts) that, once ingested, excyst in the small intestine and result in an infection of intestinal epithelial tissue.
Most people with crypto get better with no treatment, but crypto can cause serious problems in people with weak immune systems such as in people with AIDS. To reduce your risk of crypto, wash your hands often, avoid water that may be infected, and wash or peel fresh fruits and vegetables before eating.
Infection is through contaminated material such as earth, water, uncooked or cross-contaminated food that has been in contact with the feces of an infected individual or animal. Contact must then be transferred to the mouth and swallowed. It is especially prevalent amongst those in regular contact with bodies of fresh water, whether through work or recreation. The source can be recreational water like swimming pools, contaminated water supplies, or contaminated food. Vacationers must be particularly careful about contamination. The high resistance of Cryptosporidium oocysts to disinfectants like chlorine bleach facilitates transmission of the disease. Some outbreaks have happened in day care related to diaper changes.
Symptoms appear from two to ten days after infection and last for up to two weeks. As well as watery diarrhea, there is often stomach pains or cramps and a low fever. Some individuals are asymptomatic (have no symptoms) but are nevertheless infective, and thus can pass on the infection to others. Even after symptoms have finally subsided an individual is still infective for some weeks.
The most common symptom of crypto is watery diarrhea. Other symptoms include
*Stomach cramps or pain
Some people with Crypto will have no symptoms at all.
Symptoms usually last about 1 to 2 weeks (with a range of a few days to 4 or more weeks) in persons with healthy immune systems. Occasionally, people may experience a recurrence of symptoms after a brief period of recovery before the illness ends. Symptoms can come and go for up to 30 days.
While the small intestine is the site most commonly affected, Cryptosporidium infections could possibly affect other areas of the digestive tract or the respiratory tract.
People with weakened immune systems may develop serious, chronic, and sometimes fatal illness. Examples of people with weakened immune systems include:
*people with AIDS;
*those with inherited diseases that affect the immune system; and
*cancer and transplant patients who are taking certain immunosuppressive drugs.
The risk of developing severe disease may differ depending on each person’s degree of immune suppression.
Severe diseases, including pancreatitis, can occur.
Treatment is primarily supportive. Fluids need to be replaced orally. A lactose free diet should be taken as tolerated. In rare situations, intravenous fluids may be required. Antibiotics are not usually helpful, and are primarily reserved for persons with severe disease and a weak immune system. Sometimes relapses happen.
Prevention is through washing hands carefully after going to the bathroom or contacting stool, and before eating. If safety of the water supply is questionable, it can be boiled. It is not necessary to boil water for lengthy periods e.g. 15 minutes: simply bringing the water to the boil will kill any cryptosporidium oocysts in it. Suspect water supplies can also be carefully filtered before drinking, though boiling water is easier and requires no special equipment.
The parasite Cryptosporidium parvum is found in the feces of infected animals and people. Persons, dogs and cats become infected when they swallow this parasite. This is one reason why hands should be washed after contact with pets. Hands also should be washed after changing a child’s diaper and after using the toilet. Other activities that bring a person in contact with feces of another person can result in exposure. The parasite, which can be present in sewage or runoff from feed lots, can contaminate water sources, and several large waterborne outbreaks have occurred. Outbreaks also have occurred in child day care centers. In Illinois, 75-100 cases of cryptosporidiosis are reported annually.
The patient’s physician can order a special test to detect the presence of Cryptosporidium in a stool specimen. Routine stool examinations will not detect this parasite.
There is no reliable treatment for cryptosporidium enteritis — certain agents such as paromomycin, atovaquone, nitazoxanide, and azithromycin are sometimes used but they usually have only temporary effects. Currently, the best approach is to improve the immune status in immunodeficient individuals. The probiotic Saccharomyces boulardii sold over the counter in pharmacies and health shops (Brand name Florastor in US and DiarSafe in UK) has been found to be a helpful natural treatment in managing diarrhoea of various infectious origins including cryptosporidium.
The majority of immuno-competent individuals suffer a short (less than 2 weeks) self limiting course that requires supportive care with re-hydration and occasionally anti-diarrhoeal medication. In immuno-incompetent individuals (including some with HIV/AIDS) anti-retroviral therapy has been associated with improved outcomes. Several drug trials with high dose azithromycin look promising.
Symptoms can last for up to 30 days in persons who are otherwise healthy. In persons with weakened immune systems, including people with HIV/AIDS and cancer, transplant patients taking immunosuppressive drugs and people with genetically weakened immune systems, symptoms can persist indefinitely. Persistent diarrhea due to cryptosporidiosis in these persons can lead to death.
*Wash hands after handling pets or other animals.
*Wash hands after handling items that might be contaminated with the feces of other persons.
*Wash hands before preparing or handling food.
*Wash hands after gardening or other contact with soil.
*Wash produce thoroughly before eating.
*Avoid unpasteurized milk or milk products.
*Avoid exposure to calves and lambs and places where these animals are raised.
*Avoid sexual contact with other persons that involves exposure to their feces. Follow “safer sex” guidelines.
*Avoid drinking water directly from rivers, lakes and streams.
Correct Way of Washing Hands:
*Use a running stream of warm water.
*Lather hands vigorously with soap for at least 15 seconds.
*Rinse hands under running warm water so that the water flows from the wrist to the fingertips.
*If in a public place, turn off water faucet with a disposable paper towel after drying hands.
Choices if doctor advises not to drink regular tap water for infected areas:-
*Boil water before drinking or before using it for cooking by bringing it to a rolling boil for three minutes.
*Use a “point-of-use” (personal use, end-of-tap, under sink) filter. Only point-of-use filters that remove particles one micrometer or less in diameter should be considered. Filters in this category that provide the greatest assurance of Cryptosporidium removal include those that use reverse osmosis, those labeled as “absolute” one micrometer filters, or those certified by NSF (National Sanitation Foundation) International under Standard 53 for “cyst removal.” The “nominal” one micrometer filter rating is not standardized and many filters in this category may not reliably remove Cryptosporidium. As with all filters, people should follow the manufacturer’s instructions for filter use and replacement. (“Point-of-use” filters meeting the above criteria may not necessarily remove organisms other than Cryptosporidium that could pose a health hazard for severely immunocompromised individuals.)
*Use bottled water. Water sources (wells, springs, municipal tap water) and bottled water treatment processes vary considerably. Therefore, individuals should not presume that all bottled waters are absolutely free of Cryptosporidium. Bottled waters derived from protected well and spring water sources are less likely to be contaminated by Cryptosporidium than bottled municipal drinking water because municipal drinking water is typically derived from less protected sources, such as rivers and lakes. Cryptosporidiosis has been acquired from contaminated well water, but water treated by distillation or reverse osmosis before bottling assures Cryptosporidium removal. Water passed through a filter that meets the above criteria for a “point-of-use” device before bottling will provide nearly the same level of Cryptosporidium removal as distillation or reverse osmosis. Bottled waters meeting the above criteria may not necessarily be free of organisms other than Cryptosporidium that could pose a health hazard for severely immunocompromised individuals.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
“Baby bottle caries”,Dental caries is an infectious disease which damages the structures of teeth. Tooth decay or cavities are consequences of caries. If left untreated, the disease can lead to pain, tooth loss, infection, and, in severe cases, death of the tooth.
There is a long history of dental caries, with evidence showing the disease was present in the Bronze, Iron, and Medieval ages but also prior to the neolithic period. The largest increases in the prevalence of caries have been associated with diet changes. Today, it remains one of the most common diseases throughout the world.
There are numerous ways to classify dental caries. Although the presentation may differ, the risk factors and development among distinct types of caries remain largely similar. Initially, it may appear as a small chalky area but eventually develop into a large, brown cavitation. Though sometimes caries may be seen directly, radiographs are frequently needed to inspect less visible areas of teeth and to judge the extent of destruction.
Tooth decay is caused by certain types of acid-producing bacteria which cause damage in the presence of fermentable carbohydrates such as sucrose, fructose, and glucose. The resulting acidic levels in the mouth affect teeth because a tooth’s special mineral content causes it to be sensitive to low pH. Specifically, a tooth (which is primarily mineral in content) is in a constant state of back-and-forth demineralization and remineralization between the tooth and surrounding saliva. When the pH at the surface of the tooth drops below 5.5, demineralization proceeds faster than remineralization (i.e. there is a net loss of mineral structure on the tooth’s surface). This results in the ensuing decay. Depending on the extent of tooth destruction, various treatments can be used to restore teeth to proper form, function, and aesthetics, but there is no known method to regenerate large amounts of tooth structure. Instead, dental health organizations advocate preventive and prophylactic measures, such as regular oral hygiene and dietary modifications, to avoid dental caries.
An estimated 90% of schoolchildren worldwide and most adults have experienced caries, with the disease being most prevalent in Asian and Latin American countries and least prevalent in African countries. In the United States, dental caries is the most common chronic childhood disease, being at least five times more common than asthma. It is the primary pathological cause of tooth loss in children. Between 29% and 59% of adults over the age of fifty experience caries.
The number of cases has decreased in some developed countries, and this decline is usually attributed to increasingly better oral hygiene practices and preventive measures such as fluoride treatment. Nonetheless, countries that have experienced an overall decrease in cases of tooth decay continue to have a disparity in the distribution of the disease. Among children in the United States and Europe, 60-80% of cases of dental caries occur in 20% of the population. A similarly skewed distribution of the disease is found throughout the world with some children having none or very few caries and others having a high number. Some countries, such as Australia, Nepal, and Sweden, have a low incidence of cases of dental caries among children, whereas cases are more numerous in Costa Rica and Slovakia.
Caries can be classified by location, etiology, rate of progression, and affected hard tissues. When used to characterize a particular case of tooth decay, these descriptions more accurately represent the condition to others and may also indicate the severity of tooth destruction.
Generally, there are two types of caries when separated by location: caries found on smooth surfaces and caries found in pits and fissures. The location, development, and progression of smooth-surface caries differ from those of pit and fissure caries.
Pit and fissure caries:
Pits and fissures are anatomic landmarks on a tooth where tooth enamel infolds creating such an appearance. Fissures are formed during the development of grooves, and have not fully fused (unlike grooves), thus possessing a unique linear-like small depression in enamel’s surface structure, which would be a great place for dental caries to develop and flourish.
CLICK TO SEE The pits and fissures of teeth provide a location for caries formation
Fissures are mostly located on the occlusal (chewing) surfaces of posterior teeth and palatal surfaces of maxillary anterior teeth. Pits are small, pinpoint depressions that are found at the ends or cross-sections of grooves. In particular, buccal pits are found on the facial surface of molars. For all types of pits and fissures, the deep infolding of enamel makes oral hygiene along these surfaces difficult, allowing dental caries to be common in these areas.
The occlusal surfaces of teeth represent 12.5% of all tooth surfaces but are the location of over 50% of all dental caries.
Among children, pit and fissure caries represent 90% of all dental caries. Pit and fissure caries can sometimes be difficult to detect. As the decay progresses, caries in enamel nearest the surface of the tooth spreads gradually deeper. Once the caries reaches the dentin at the dentino-enamel junction, the decay quickly spreads laterally. Within the dentin, the decay follows a triangle pattern that points to the tooth’s pulp. This pattern of decay is typically described as two triangles (one triangle in enamel, and another in dentin) with their bases conjoined to each other at the dentino-enamel junction (DEJ). This base-to-base pattern is typical of pit and fissure caries, unlike smooth-surface caries (where base and apex of the two triangles join).
There are three types of smooth-surface caries. Proximal caries, also called interproximal caries, form on the smooth surfaces between adjacent teeth. Root caries form on the root surfaces of teeth. The third type of smooth-surface caries occur on any other smooth tooth surface.
CLICK & SEE In this radiograph, the dark spots in the adjacent teeth show proximal caries
Proximal caries are the most difficult type to detect. Frequently, this type of caries cannot be detected visually or manually with a dental explorer. Proximal caries form cervically (toward the roots of a tooth) just under the contact between two teeth. As a result, radiographs are needed for early discovery of proximal caries.
Root caries, which are sometimes described as a category of smooth-surfaces caries, are the third most common type of caries and usually occur when the root surfaces have been exposed due to gingival recession. When the gingiva is healthy, root caries is unlikely to develop because the root surfaces are not as accessible to bacterial plaque. The root surface is more vulnerable to the demineralization process than enamel because cementum begins to demineralize at 6.7 pH, which is higher than enamel’s critical pH. Regardless, it is easier to arrest the progression of root caries than enamel caries because roots have a greater reuptake of fluoride than enamel. Root caries are most likely to be found on facial surfaces, then interproximal surfaces, then lingual surfaces. Mandibular molars are the most common location to find root caries, followed by mandibular premolars, maxillary anteriors, maxillary posteriors, and mandibular anteriors.
Lesions on other smooth surfaces of teeth are also possible. Since these occur in all smooth surface areas of enamel except for interproximal areas, these types of caries are easily detected and are associated with high levels of plaque and diets promoting caries formation.
Other general descriptions:
Besides the two previously mentioned categories, carious lesions can be described further by their location on a particular surface of a tooth. Caries on a tooth’s surface that are nearest the cheeks or lips are called “facial caries”, and caries on surfaces facing the tongue are known as “lingual caries”. Facial caries can be subdivided into buccal (when found on the surfaces of posterior teeth nearest the cheeks) and labial (when found on the surfaces of anterior teeth nearest the lips).
Lingual caries can also be described as palatal when found on the lingual surfaces of maxillary teeth because they are located beside the hard palate.Caries near a tooth’s cervixâ€”the location where the crown of a tooth and its roots meetâ€”are referred to as cervical caries.
Occlusal caries are found on the chewing surfaces of posterior teeth. Incisal caries are caries found on the chewing surfaces of anterior teeth. Caries can also be described as “mesial” or “distal.” Mesial signifies a location on a tooth closer to the median line of the face, which is located on a vertical axis between the eyes, down the nose, and between the contact of the central incisors. Locations on a tooth further away from the median line are described as distal.
In some instances, caries are described in other ways that might indicate the cause. “Baby bottle caries”, “early childhood caries”, or “baby bottle tooth decay” is a pattern of decay found in young children with their deciduous (baby) teeth. The teeth most likely affected are the maxillary anterior teeth, but all teeth can be affected. The name for this type of caries comes from the fact that the decay usually is a result of allowing children to fall asleep with sweetened liquids in their bottles or feeding children sweetened liquids multiple times during the day.
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………….Rampant caries as seen here may be due to methamphetamine use.
Another pattern of decay is “rampant caries”, which signifies advanced or severe decay on multiple surfaces of many teeth. Rampant caries may be seen in individuals with xerostomia, poor oral hygiene, methamphetamine use (due to drug-induced dry mouth, and/or large sugar intake. If rampant caries is a result from previous radiation to the head and neck, it may be described as radiation-induced caries. Problems can also be caused by the self destruction of roots and whole Tooth Resorption when new teeth erupt or later from unknown causes.
Rate of progression:
Temporal descriptions can be applied to caries to indicate the progression rate and previous history. “Acute” signifies a quickly developing condition, whereas “chronic” describes a condition which has taken an extended time to develop. Recurrent caries, also described as secondary, is caries that appears at a location with a previous history of caries. This is frequently found on the margins of fillings and other dental restorations. On the other hand, incipient caries describes decay at a location that has not experienced previous decay. Arrested caries describes a lesion on a tooth which was previously demineralized but was remineralized before causing a cavitation.
Affected hard tissue:
Depending on which hard tissues are affected, it is possible to describe caries as involving enamel, dentin, or cementum.
Early in its development, caries may affect only enamel. Once the extent of decay reaches the deeper layer of dentin, “dentinal caries” is used. Since cementum is the hard tissue that covers the roots of teeth, it is not often affected by decay unless the roots of teeth are exposed to the mouth. Although the term “cementum caries” may be used to describe the decay on roots of teeth, very rarely does caries affect the cementum alone. Roots have a very thin layer of cementum over a large layer of dentin, and thus most caries affecting cementum also affects dentin.
Signs and symptoms:
Until caries progresses, a person may not be aware of it. The earliest sign of a new carious lesion, referred as incipient decay, is the appearance of a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel. As the lesion continues to demineralize, it can turn brown but will eventually turn into a cavitation, a “cavity”.
The process before this point is reversible, but once a cavitation forms, the lost tooth structure cannot be regenerated. A lesion which appears brown and shiny suggests dental caries was once present but the demineralization process has stopped, leaving a stain. A brown spot which is dull in appearance is probably a sign of active caries.
As the enamel and dentin are destroyed further, the cavitation becomes more noticeable. The affected areas of the tooth change color and become soft to the touch. Once the decay passes through enamel, the dentinal tubules, which have passages to the nerve of the tooth, become exposed and cause the tooth to hurt. The pain can be worsened by heat, cold, or sweet foods and drinks. Dental caries can also cause bad breath and foul tastes. In highly progressed cases, infection can spread from the tooth to the surrounding soft tissues which may become life-threatening, as in the case with Ludwig’s angina.
Primary diagnosis involves inspection of all visible tooth surfaces using a good light source, dental mirror and explorer.
Dental radiographs, produced when X-rays are passed through the jaw and picked up on film or digital sensor, may show dental caries before it is otherwise visible, particularly in the case of caries on interproximal (between the teeth) surfaces.
Large dental caries are often apparent to the naked eye, but smaller lesions can be difficult to identify. Unextensive dental caries was formerly found by searching for soft areas of tooth structure with a dental explorer. Visual and tactile inspection along with radiographs are still employed frequently among dentists, particularly for pit and fissure caries.
Some dental researchers have cautioned against the use of dental explorers to find caries. In cases where a small area of tooth has begun demineralizing but has not yet cavitated, the pressure from the dental explorer could cause a cavitation.
Since the carious process is reversible before a cavitation is present, it may be possible to arrest the caries with fluoride to remineralize the tooth surface. When a cavitation is present, a restoration will be needed to replace the lost tooth structure. A common technique used for the diagnosis of early (uncavitated) caries is the use of air blown across the suspect surface, which removes moisture, changing the optical properties of the unmineralized enamel. This produces a white ‘halo’ effect detectable to the naked eye. Fiberoptic transillumination, lasers and disclosing dyes have been recommended for use as an adjunct when diagnosing smaller carious lesions in pits and fissures of teeth.
There are four main criteria required for caries formation: a tooth surface (enamel or dentin); cariogenic (or potentially caries-causing) bacteria; fermentable carbohydrates (such as sucrose); and time. The caries process does not have an inevitable outcome, and different individuals will be susceptible to different degrees depending on the shape of their teeth, oral hygiene habits, and the buffering capacity of their saliva. Dental caries can occur on any surface of a tooth that is exposed to the oral cavity, but not the structures which are retained within the bone.
There are certain diseases and disorders affecting teeth which may leave an individual at a greater risk for caries.
Amelogenesis imperfecta, which occurs between 1 in 718 and 1 in 14,000 individuals, is a disease in which the enamel does not form fully or in insufficient amounts and can fall off a tooth.Dentinogenesis imperfecta is a similar disease. In both cases, teeth may be left more vulnerable to decay because the enamel is not as able to protect the tooth as it would in health.
In most people, disorders or diseases affecting teeth are not the primary cause of dental caries. Ninety-six percent of tooth enamel is composed of minerals. These minerals, especially hydroxyapatite, will become soluble when exposed to acidic environments. Enamel begins to demineralize at a pH of 5.5. Dentin and cementum are more susceptible to caries than enamel because they have lower mineral content. Thus, when root surfaces of teeth are exposed from gingival recession or periodontal disease, caries can develop more readily. Even in a healthy oral environment, the tooth is susceptible to dental caries.
The anatomy of teeth may affect the likelihood of caries formation. In cases where the deep grooves of teeth are more numerous and exaggerated, pit and fissure caries are more likely to develop. Also, caries are more likely to develop when food is trapped between teeth.
The mouth contains a wide variety of bacteria, but only a few specific species of bacteria are believed to cause dental caries: Streptococcus mutans and Lactobacilli among them. Particularly for root caries, the most closely associated bacteria frequently identified are Lactobacillus acidophilus, Actinomyces viscosus, Nocardia spp., and Streptococcus Bacteria collect around the teeth and gums in a sticky, creamy-coloured mass called plaque, which serves as a biofilm. Some sites collect plaque more commonly than others. mutans.
The grooves on the biting surfaces of molar and premolar teeth provide microscopic retention, as does the point of contact between teeth. Plaque may also collect along the gingiva. In addition, the edges of fillings or crowns can provide protection for bacteria, as can intraoral appliances such as orthodontic braces or removable partial dentures.
Bacteria in a person’s mouth convert sugars (glucose and fructose, and most commonly sucrose – or table sugar) into acids such as lactic acid through a glycolytic process called fermentation. If left in contact with the tooth, these acids may cause demineralization, which is the dissolution of its mineral content. The process is dynamic, however, as remineralization can also occur if the acid is neutralized; suitable minerals are available in the mouth from saliva and also from preventative aids such as fluoride toothpaste, dental varnish or mouthwash. Caries advance may be arrested at this stage. If sufficient acid is produced over a period of time to the favor of demineralization, caries will progress and may then result in so much mineral content being lost that the soft organic material left behind would disintegrate, forming a cavity or hole.
The frequency of which teeth are exposed to cariogenic (acidic) environments affects the likelihood of caries development. After meals or snacks containing sugars, the bacteria in the mouth metabolize them resulting in acids as by-products which decreases pH. As time progresses, the pH returns to normal due to the buffering capacity of saliva and the dissolved mineral content from tooth surfaces. During every exposure to the acidic environment, portions of the inorganic mineral content at the surface of teeth dissolves and can remain dissolved for 2 hours. Since teeth are vulnerable during these periods of acidic environments, the development of dental caries relies greatly on the frequency of these occurrences.
For example, when sugars are eaten continuously throughout the day, the tooth is more vulnerable to caries for a longer period of time, and caries are more likely to develop than if teeth are exposed less frequently to these environments and proper oral hygiene is maintained. This is because the pH never returns to normal levels, thus the tooth surfaces cannot remineralize, or regain lost mineral content.
The carious process can begin within days of a tooth erupting into the mouth if the diet is sufficiently rich in suitable carbohydrates, but may begin at any other time thereafter. The speed of the process is dependent on the interplay of the various factors described above but is believed to be slower since the introduction of fluoride. Compared to coronal smooth surface caries, proximal caries progress quicker and take an average of 4 years to pass through enamel in permanent teeth. Because the cementum enveloping the root surface is not nearly as durable as the enamel encasing the crown, root caries tends to progress much more rapidly than decay on other surfaces. The progression and loss of mineralization on the root surface is 2.5 times faster than caries in enamel. In very severe cases where oral hygiene is very poor and where the diet is very rich in fermentable carbohydrates, caries may cause cavitation within months of tooth eruption. This can occur, for example, when children continuously drink sugary drinks from baby bottles. On the other hand, it may take years before the process results in a cavity being formed, if at all.
Other risk factors:
In addition to the four main requirements for caries formation, reduced saliva is also associated with increased caries rate since the buffering capability of saliva is not present to counterbalance the acidic environment created by certain foods. As a result, medical conditions that reduce the amount of saliva produced by salivary glands, particularly the parotid gland, are likely to cause widespread tooth decay. Some examples include SjÃ¶gren’s syndrome, diabetes mellitus, diabetes insipidus, and sarcoidosis. Medications, such as antihistamines and antidepressants, can also impair salivary flow. Moreover, 63% of the most commonly prescribed medications in the United States list dry mouth as a known side effect. Radiation therapy to the head and neck may also damage the cells in salivary glands, increasing the likelihood for caries formation.
The use of tobacco may also increase the risk for caries formation. Smokeless tobacco frequently contains high sugar content in some brands, possibly increasing the susceptibility to caries. Tobacco use is a significant risk factor for periodontal disease, which can allow the gingiva to recede. As the gingiva loses attachment to the teeth, the root surface becomes more visible in the mouth. If this occurs, root caries is a concern since the cementum covering the roots of teeth is more easily demineralized by acids in comparison to enamel. Currently, there is not enough evidence to support a causal relationship between smoking and coronal caries, but there is suggestive evidence of a causal relationship between smoking and root-surface caries
Destroyed tooth structure does not fully regenerate, although remineralization of very small carious lesions may occur if dental hygiene is kept at optimal level. For the small lesions, topical fluoride is sometimes used to encourage remineralization. For larger lesions, the progression of dental caries can be stopped by treatment. The goal of treatment is to preserve tooth structures and prevent further destruction of the tooth.
Generally, early treatment is less painful and less expensive than treatment of extensive decay. Anesthetics local, nitrous oxide (“laughing gas”), or other prescription medications â€” may be required in some cases to relieve pain during or following treatment or to relieve anxiety during treatment. A dental handpiece (“drill”) is used to remove large portions of decayed material from a tooth. A spoon is a dental instrument used to remove decay carefully and is sometimes employed when the decay in dentin reaches near the pulp.Once the decay is removed, the missing tooth structure requires a dental restoration of some sort to return the tooth to functionality and aesthetic condition.
Restorative materials include dental amalgam, composite resin, porcelain, and gold. Composite resin and porcelain can be made to match the color of a patient’s natural teeth and are thus used more frequently when aesthetics are a concern. Composite restorations are not as strong as dental amalgam and gold; some dentists consider the latter as the only advisable restoration for posterior areas where chewing forces are great. When the decay is too extensive, there may not be enough tooth structure remaining to allow a restorative material to be placed within the tooth. Thus, a crown may be needed. This restoration appears similar to a cap and is fitted over the remainder of the natural crown of the tooth. Crowns are often made of gold, porcelain, or porcelain fused to metal.
In certain cases, root canal therapy may be necessary for the restoration of a tooth. Root canal therapy, also called “endodontic therapy”, is recommended if the pulp in a tooth dies from infection by decay-causing bacteria or from trauma.
During a root canal, the pulp of the tooth, including the nerve and vascular tissues, is removed along with decayed portions of the tooth. The canals are instrumented with endodontic files to clean and shape them, and they are then usually filled with a rubber-like material called gutta percha. The tooth is filled and a crown can be placed. Upon completion of a root canal, the tooth is now non-vital, as it is devoid of any living tissue.
An extraction can also serve as treatment for dental caries. The removal of the decayed tooth is performed if the tooth is too far destroyed from the decay process to effectively restore the tooth. Extractions are sometimes considered if the tooth lacks an opposing tooth or will probably cause further problems in the future, as may be the case for wisdom teeth.
Extractions may also be preferred by patients unable or unwilling to undergo the expense or difficulties in restoring the tooth.
Prevention: Oral hygiene
Personal hygiene care consists of proper brushing and flossing daily. The purpose of oral hygiene is to minimize any etiologic agents of disease in the mouth. The primary focus of brushing and flossing is to remove and prevent the formation of plaque. Plaque consists mostly of bacteria.As the amount of bacterial plaque increases, the tooth is more vulnerable to dental caries. A toothbrush can be used to remove plaque on most surfaces of the teeth except for areas between teeth. Toothbrush are commonly used to clean teeth
When used correctly, dental floss removes plaque from areas which could otherwise develop proximal caries. Other adjunct hygiene aids include interdental brushes, water picks, and mouthwashes.
Professional hygiene care consists of regular dental examinations and cleanings. Sometimes, complete plaque removal is difficult, and a dentist or dental hygienist may be needed. Along with oral hygiene, radiographs may be taken at dental visits to detect possible dental caries development in high risk areas of the mouth.
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For dental health, the frequency of sugar intake is more important than the amount of sugar consumed. In the presence of sugar and other carbohydrates, bacteria in the mouth produce acids which can demineralize enamel, dentin, and cementum. The more frequently teeth are exposed to this environment, the more likely dental caries are to occur. Therefore, minimizing snacking is recommended, since snacking creates a continual supply of nutrition for acid-creating bacteria in the mouth.
Also, chewy and sticky foods (such as dried fruit or candy) tend to adhere to teeth longer, and consequently are best eaten as part of a meal. Brushing the teeth after meals is recommended. For children, the American Dental Association and the European Academy of Paediatric Dentistry recommend limiting the frequency of consumption of drinks with sugar, and not giving baby bottles to infants during sleep. Mothers are also recommended to avoid sharing utensils and cups with their infants to prevent transferring bacteria from the mother’s mouth.
It has been found that milk and certain kinds of cheese like cheddar can help counter tooth decay if eaten soon after the consumption of foods potentially harmful to teeth. Also, chewing gum containing xylitol (wood sugar) is widely used to protect teeth in some countries, being especially popular in the Finnish candy industry. Xylitol’s effect on reducing plaque is probably due to bacteria’s inability to utilize it like other sugars. Chewing and stimulation of flavour receptors on the tongue are also known to increase the production and release of saliva, which contains natural buffers to prevent the lowering of pH in the mouth to the point where enamel may become demineralised.
Other preventive measures:
The use of dental sealants is a good means of prevention. Sealants are thin plastic-like coating applied to the chewing surfaces of the molars. This coating prevents the accumulation of plaque in the deep grooves and thus prevents the formation of pit and fissure caries, the most common form of dental caries. Sealants are usually applied on the teeth of children, shortly after the molars erupt. Older people may also benefit from the use of tooth sealants, but their dental history and likelihood of caries formation are usually taken into consideration.
Fluoride therapy is often recommended to protect against dental caries. It has been demonstrated that water fluoridation and fluoride supplements decrease the incidence of dental caries. Fluoride helps prevent decay of a tooth by binding to the hydroxyapatite crystals in enamel. The incorporated fluoride makes enamel more resistant to demineralization and, thus, resistant to decay. Topical fluoride is also recommended to protect the surface of the teeth. This may include a fluoride toothpaste or mouthwash. Many dentists include application of topical fluoride solutions as part of routine visits.
Furthermore, recent research shows that low intensity laser radiation of argon ion lasers may prevent the susceptibility for enamel caries and white spot lesions. Also, as bacteria are a major factor contributing to poor oral health, there is currently research to find a vaccine for dental caries. As of 2004, such a vaccine has been successfully tested on non-human animals, and is in clinical trials for humans of May 2006.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose