Tooth Pain Alternative Treatments Ebook

Dentists Be Damned

This eBook teaches you all the remedies and tricks that you need to know to Never visit the dentist again, and still have the most perfect mouth full of the teeth that you know of. This book contains a toothache remedy that will treat the root of the problem, how to restore your gums to full health, a supplement that makes plaque fall off your teeth in no time, and a solution that can stop cavities Forever. This book doesn't just teach you how to get rid of some pain, it teaches you how to Eliminate the source of pain once and for all. After taking to heart the information in this book, trips to the dentist will become a thing of the past. Alice Barnes has taken her 15 years of tooth research and compiled it all in this eBook for you. And when you order, you get two free eBooks! You will also receive How to Prevent and Cure Canker Sores, and How to Get Rid of Bad Breath. All of these resources will keep you OUT of dentists' offices as long as you live! Read more...

Dentists Be Damned Summary


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Enamel demineralisationcaries

Gorelick et al.5 in a study on white spot formation in children treated with fixed appliances, found that half of their patients had at least one white spot after treatment, most commonly on maxillary lateral incisors. The length of treatment did not affect the incidence or number of white spot formations, although O'Reilly and Featherstone6 and Oggard et al.7 found that demineralisation can occur rapidly, within the first month of fixed appliance treatment. This has obvious aesthetic implications and highlights the need for caries rate assessment at the beginning of treatment. Interestingly, Gorelick et al.5 found no incidence of white spot formation associated with lingual bonded retainers, which would suggest salivary buffering capacity, and flow rate have a role in protection against acid attack. Fig. 3 Obvious caries in the disto-occlusal aspect of a lower molar Fig. 3 Obvious caries in the disto-occlusal aspect of a lower molar

Direct Digital Radiography for Caries Detection and Analysis

Diagram Direct Radiographic System

Recent developments in the field of electronic imaging have provided a new set of imaging tools for intra-oral imaging and clinical diagnosis. In this chapter, we review the general structure and characteristics of image sensors used in digital radiography and their application for clinical caries detection and analysis. An overview of the literature, comparing the diagnostic accuracy of digital and film-based radiography and the impact of image-processing methods, is provided. We also describe several approaches for quantitative assessment of radiographic images for caries detection and assessment. Examples include digital subtraction radiography, and 2-D and 3-D density profiling. To increase the accuracy and reduce observer variability the use of 3-D imaging and computer-aided diagnosis is presented as future direction for clinical caries diagnosis. The primary focus of this chapter is to review and assess the application of DDR for caries detection and analysis. The general...

Dental Caries

The first step in the origination of caries is the formation of a dental plaque (2). An increase in the amount of plaque is responsible for the ultimate development of gingivitis. A variety of factors interact in the generation of dental plaque and subsequent emergence of caries. These include the presence of a susceptible tooth surface, the proper microflora, and a suitable nutritional substrate for that flora. Several oral acid producing aerobic and anaerobic bacteria, including Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces viscosus, are capable of initiating the carious lesion. However, S. mutans is consistently the only organism recovered from decaying dental fissures and is isolated in greater quantities from carious teeth than in non-carious ones (9). The overwhelming majority of microorganisms isolated from carious dentin are obligate anaerobes (10). The predominant organisms are Propionibac-terium, Eubacteria, Arachnia, Lactobacillus, Bifidobacteria, and...

Imaging of the Oral Cavity Using Optical Coherence Tomography

Optical coherence tomography is a new method for noninvasively imaging internal tooth and soft tissue microstructure. The intensity of backscattered light is measured as a function of depth in the tissue. Low coherence interferometry is used to selectively remove the component of backscattered signal that has undergone multiple scattering events, resulting in very high resolution images (< 15 m). Lateral scanning of the probe beam across the biological tissue is then used to generate a 2-D intensity plot, similar to ultrasound images. This imaging method provides information that is currently unobtainable by any other means, making possible such diverse applications as diagnosis of periodontal disease, caries detection, and evaluation of restoration integrity. This chapter presents an overview of this exciting new imaging technique and its current application to dental diagnosis. Optical coherence tomography (OCT) is a new method for noninvasively imaging internal tooth and soft...

Inflammatory Bowel Disease

The medical and dental literature abounds with articles describing extra-abdominal, oral signs of inflammatory bowel diseases (IBDs), which include aphthous-like ulceration, gingivitis, candidiasis, pyostomatitis vegetans, cobblestone appearance of the oral mucosa, oral epithelial tags and folds, persistent lip swelling, lichenoid mucosal reactions, granulomatous inflammation of minor salivary gland ducts, and angular cheilitis. Current dental literature focuses on the oral status of IBD patients with regard to the potential use of thalidomide against antitumor necrosis factor-a for the treatment of recalcitrant oral granulomatous lesions, caries rate, salivary antimicrobial proteins, and infections of bacterial and fungal origins. Interestingly, oral manifestations of IBD may precede the onset of intestinal radiographic lesions by as long as a year or more. IBD is of interest to both physicians and dentists because of their complicating oral sequelae and their diagnosis and...

Commiphora myrrha Engl Fam Burseraceae

For Damp-Heat with stuffiness and fullness of the abdomen or acute dysentery with jaundice high fever accompanied by impairment of consciousness restlessness and insomnia due to exuberant Fire spitting of blood and epistaxis caused by Heat in the Blood inflammation of the eyes acid reflux toothache diabetes carbuncles and sores externally used for eczema and other skin diseases with exudation purulent discharge from the ear.

Acupuncture And Moxibustion

Acupuncture was especially recommended for all disorders involving an excess of yang. Moxibustion was thought to be preferable when yin was in excess. However, the relationships among yin and yang, the five phases, and the organs are so complex that the use of either method could be justified. Moxa was generally recommended for chronic conditions, such as tuberculosis, bronchitis, and general weakness, but it was also used for toothache, headache, gout, diarrhea, and some psychological disorders. Pao Ku, wife of the alchemist Ko Hung (254334), was famous for treating skin diseases with moxibustion. Officials of seventh century China would not undertake a journey unless protected against foreign diseases and snakebites by fresh moxibustion scars. In modern China, physicians have been experimenting with moxa in the treatment of influenza, chronic bronchitis, and infections of the respiratory tract.

Pathogensesis And Pathology

Actinomyces species are agents of low pathogenicity and require disruption of the mucosal barrier to cause disease. Actinomycosis usually occurs in immunocompetent persons but may afflict persons with diminished host defenses. Oral and cervicofacial diseases commonly are associated with dental caries and extractions, gingivitis and gingival trauma, infection in erupting secondary teeth, chronic tonsillitis, otitis or mastoiditis, diabetes mellitus, immunosuppression, malnutrition, and local tissue damage caused by surgery, neoplastic disease, or irradiation. Pulmonary infections usually arise after aspiration of oropharyngeal or gastrointestinal secretions. Gastrointestinal infection frequently follows loss of mucosal integrity, such as with surgery, appendicitis, diverticulitis, trauma, or foreign bodies (1). The use of intrauterine contraceptive devices (IUDs) was linked to the development of actinomycosis of the female genital tract. The presence of a foreign body in this setting...

Joint Injury and Disease

Joint injuries were common indications for amputation before Park, Moreau, Syme, Fergusson and others developed knee and elbow excision (see Chapter 7) especially for caries, that is, bovine tuberculosis,which spread from joint synovium to bone, causing painful joint destruction. Later, wrist excision to avoid hand amputation for caries was introduced by Lister. In the 20th century, joint infection and destruction was managed by chemotherapy and joint fusion to avoid amputation. Open damage to joints, especially caused by gunshot injury and even minor penetrating injuries, frequently became infected, necessitating amputation before antiseptic and aseptic measures. At the beginning of the 21st century, surgical reconstructive techniques also include joint excision and replacement by artificial joints.

Factors Affecting The Decision To Extract

It is important to consider the patient as a whole in treatment planning. Medical history, attitude to treatment, oral hygiene, caries rate and the quality of the teeth are important. Patients with cardiac anomalies are at risk of complications during orthodontic treatment and consultation with a cardiologist is important. If necessary, extractions should be covered with appropriate antibiotics and impacted teeth may be best removed rather than aligned as traction to unerupted teeth may pose an increased risk to these patients.12

Travess1 D Roberts Harry2 and J Sandy3

Extractions in orthodontics remains a relatively controversial area. It is not possible to treat all malocclusions without taking out any teeth. The factors which affect the decision to extract include the patient's medical history, the attitude to treatment, oral hygiene, caries rates and the quality of teeth. Extractions of specific teeth are required in the various presentations of malocclusion. In some situations careful timing of extractions may result in spontaneous correction of the malocclusion. Scotland, orthodontics replaced caries as the commonest reason for extraction in patients under 20 years of age.10 All extractions are traumatic as far as the patient is concerned and clinicians will seek non-extraction solutions where possible. In the late mixed dentition, between 3 mm and 4 mm of space can be preserved in the lower arch by simply fitting a lingual arch. If this is coupled with molar and premolar expansion of just 2 mm (with no lower canine exapansion) and interdental...

Ease Of Extraction And The Presence Of Impacted Teeth

The extraction of teeth is a potentially traumatic experience. The decision to extract should be made with an awareness of the risks of treatment, including the psychological impact of the procedure. The General Dental Council in its guidance to dentists of professional and personal conduct makes it clear that dentists who refer patients for general anaesthesia must make it clear what justification there is for the procedure. The duties of the treating dentist include a thorough and clear explanation of the risks involved as well as the alternative methods of pain control available. The use of general anaesthesia is usually considered in dealing with unerupted teeth, first molars, multiple extractions in four quadrants and specific phobias.

Prevention of Hepatitis B

Are at significant risk of infection with HBV(ie, surgeons, dentists, phlebotomists, etc). Subjects who do not respond to a first series of immunization should be immunized again with a complete series. The persistence of antibody directly correlates with the peak level achieved after the third dose. Follow up of adults who were immunized with plasma-derived hepatitis B vaccine demonstrated that the antibody levels had fallen to undetectable or very low levels in 30 to 50 of recipients. Long-term studies of adults and children indicate that protection lasts at least 9 years, despite loss of HB antigens in serum. After 9 years of follow-up, HB antigens loss ranged from 13 to 60 in a group of homosexual men and Native Alaskans, two groups at high risk of infection. However, vaccine recipients were virtually 100 protected from clinical illness, despite the absence of booster immunization. Among people without detectable HB antigens, some breakthrough infections have been noted in later...

Body Architecture

With regard to ageing, teeth are a very instructive component of the body. After milk teeth are discarded, the larger adult teeth replace them. These teeth are subject to wear and tear, and also to bacterial attack. Although they contain nerves and a blood supply, they are essentially mechanical structures which cannot be expected to last forever. In the case of humans, the existence of dentists allow them to last much longer than they would normally do alternatively they can be replaced with artificial teeth. This is a clear case of intervention in the normal ageing process, which I will discuss more fully later on. Teeth show very clearly that the distinction which is often made between programmed ageing, and ageing through wear and tear, is quite artificial. Our genes determine the size, strength and structure of teeth. That is clearly part of the programme for development. The teeth, however, are subject to wear and tear, so gradually lost their normal structures. Clearly the...

Vomiting Laxative and Diuretic Abuse

Anorexics and bulimics who vomit to compensate for real or perceived binges may develop perimolysis, a loss of the enamel and dentin on the lingual surface of the teeth caused by recurrent exposure of the teeth to gastric acids. Patients may complain of increased sensitivity to heat, cold, and acidic substances, as discussed in the chapter on oral medicine (see Chapter 7, Oral Considerations in Patients with Gastrointestinal Disorders). The large amounts of carbohydrates consumed by bulimic patients during binges may further exacerbate the problem, contributing to an elevated frequency of caries. Parotid gland enlargement is a common manifestation of bulimia (Cuellar and Van Thiel, 1986 Jacobs and Schneider, 1985). No treatment is required, and the parotid enlargement usually subsides over time with cessation of vomiting. Some individuals abuse syrup of ipecac to induce vomiting, placing themselves at risk for cardiotoxicity resulting from accumulation of emetine in cardiac muscle....

Differentiation potential of dpscs in vitro and in vivo

Dpsc Stem Cells

Mineralization within the papal chamber is a frequent event that usually manifests as small calcified pulp stones because of caries, aging, trauma, and systemic conditions (46). Previous studies have established animal cell cultures from dental pulp tissue using a variety of culture methods and noted the ability of such cultures to form mineralized nodules in vitro (43,47-50). In analogy, human-derived dental pulp can also be cultivated in vitro and possesses the capacity to form mineralized deposits in the presence of inductive media containing ascorbic acid, dexamethasone, and an excess of phosphate (23,51,52). The use of methodology such as infrared microspec-troscopic examination and X-ray diffraction electron microscopic (EM) analysis has confirmed the dentinlike nature of the crystalline structures that comprise the mineralized nodules in vitro, which are distinct from the crystal structures of mineralized enamel and bone in vivo (47,49,51,52).

Disarticulation at the Shoulder

This major operation developed in the 18th century, promoted by detailed anatomical knowledge, including initial compression of the subcla-vian artery against the first rib, and acceptance of ligatures for major arterial bleeding, achieving great popularity during the Napoleonic wars. According to Ledran, his father performed the first disarticulation before 1731, for a patient with caries involving the humeral neck, achieving a successful outcome.93 French surgeons promoted many methods of performing this operation, confirming a need to vary approaches, dictated by individual pathology and in particular the state of skin flaps after gunshot injury. Indeed, scrutiny of Velpeau's 1840 survey reveals an astonishing list of 33 reported procedures employing circular, flap and elliptical incisions, including his own three variations of the latter.94 Larrey is famous for claiming 90 cures of 100 disarticulations using a racquet incision, although Malgaigne was sceptical in view of personal...

Laughing Gas Ether And Surgical Anesthesia

Laughing Gas Surgical Operation

The ingenious discoveries of the first pneumatic chemists provided new opportunities for quacks and charlatans. Conscientious experimentalists could not compete with charlatans promising miraculous cures for asthma, catarrh, consumption, and cancer through the inhalation of oxygen, hydrogen, and other ''factitious airs.'' Some physicians, however, attempted to find legitimate medical uses for the new gases. Fascinated by pneumatic chemistry, Thomas Beddoes (1760-1808) persuaded his friends Thomas Wedgwood (1771-1805) and James Watt (1736-1819) to help him establish the Pneumatic Institute, a hospital in which the inhalation of factitious airs was used in the treatment of lung disease. Many scientists, including Humphry Davy, were intrigued by his work. While suffering from toothache in 1795, Davy began inhaling nitrous oxide. In addition to feeling giddy, relaxed, and cheerful, Davy noted that the pain caused by his wisdom teeth had almost disappeared. Soon after the exhilaration wore...

Cluster Investigations

Clustering of disease has intrigued public health professionals for many years and some cluster investigations have led to important scientific discoveries. For example, the investigation of spatial clustering of enamel discoloration early in the twentieth century led to discovery of the relation between flouride levels in drinking water and dental caries (Rothman 1987). Another notable cluster investigation led to the epidemiologic discovery that clustering of vaginal cancer was linked with diethylstibesterol use during pregnancy (Herbst et al. 1971).

Ive heard that xrays of my teeth can be an indicatorfor osteoporosis Is that true

It is important to keep up with your oral health checkups throughout your entire life. When you go to the dentist, you may find out more than the condition of your teeth and gums you may find out that you should be tested for osteoporosis. Although osteoporosis cannot be diagnosed from conventional bite-wing dental x-rays, periodontal (gum, tissues, and bone supporting teeth) disease can suggest that you have osteoporosis. Loss of teeth and bone loss in your jawbone can also indicate that you may have osteoporosis. Bone loss, depending on its extent, is sometimes visible on oral panoramic x-rays. Calcium and Vitamin D intake is important not just for your bones, but for your teeth. So if you are not getting enough of either one, you are not only at risk for osteoporosis but also for tooth loss. If you have poor oral health, this does not mean that you definitely have weak bones. And on the other hand, if you have osteoporosis or osteopenia, it does not mean that you have bad teeth and...

Peptic Ulcer Disease

Physicians should advise dentists that aggravation of the peptic ulcer disease might be minimized by avoidance of actions that increase the production of acid. Thus, lengthy dental procedures should be avoided or spread out over shorter appointments to minimize stress. To avoid aspirations patients should not be left in a supine or sub-supine position for lengthy periods during dental appointments. Dentists should be advised to avoid administering drugs that exacerbate ulceration and cause GI distress such as aspirin and other nonsteroidal anti-inflammatory drugs. Instead, acetaminophen products should be recommended. Additionally, because many of the antacids containing calcium, magnesium, and aluminum salts bind antibiotics such as erythromycin and tetracycline, the dentist should be reminded that administration of one of these drugs Dry mouth (xerostomia) is a common complaint in patients taking anticholinergic drugs. Patients who wear either complete or partial dentures are...


During the eighteenth century, progress in anatomical investigation, and the acceptance of a localized, lesion-based, or solidistic approach to pathology, provided an intellectual framework for surgical innovations. From the patient's point of view, however, pain was a powerful reason for avoiding even the most desperately needed operation. Physiologists define pain as an ''unpleasant sensory and emotional experience associated with actual or potential tissue damage,'' which, nevertheless, is important to the maintenance and preservation of life. Pain provides an essential warning about trauma and injury, but it can also have strong negative effects on health. Usually, pain motivates behaviors that help prevent further injuries, but fear of pain kept patients from accepting the advice of surgeons and dentists. The medieval prototype of the ''sleep apple'' that appears in the story of Snow White usually contained opium, mandrake, henbane, hemlock, wine, and musk. Usually, the user was...


Hordes of demons and devils were thought to cause diseases and misfortune each evil spirit tended to cause particular disorders. As in the case of folk medicine and so-called-primitive medicine, Mesopotamian healers also attempted to rid their patients of disease-causing demons by the administration of noxious remedies. Enveloped in the aroma of burning feathers, and liberally dosed with dog dung and pig's gall, the patient hardly seemed an inviting abode for demons and devils. The magician might also try to transfer the demon into a surrogate victim, such as an animal or a magical figure. Sometimes healers engaged disease-causing demons in a formal dialogue, as in a conversation between the priest and the ''tooth worm'' recorded about 2250 b.c.e. While an incantation entitled ''The Worm and the Toothache'' hardly sounds like a major epic, this dialogue is a rich source of cosmological concepts and creation myths.

Bacterial infections

Dental caries and periodontal disease are both common among patients in palliative care. Established disease requires specific interventions from the dental team. Oral hygiene measures will help to prevent progression of disease (see above). Other bacterial infections are relatively uncommon.

Thomas D Koepsell

Fluoridation of the water supply to prevent dental caries automatically affects nearly everyone in a community. The word mass in mass media denotes the nonselective nature of public information dissemination that may be intended to change health-related attitudes and behavior (Flay 1987). Media campaigns about health topics typically seek to reach as large a share of the population within a media market as possible and can thus be regarded as community-level interventions.

Harmaline Tremor

Although tremor is a common sign of neurological disorders such as Parkinson disease, Wilson disease, and hereditary ataxia, most adults with clinically significant tremor have idiopathic or essential tremor (ET). Millions of Americans including at least four percent of adults over the age of fifty have ET, a bothersome and sometimes disabling movement disorder (Elble and Koller 1990 Louis et al. 1998). ET is a 4- to 12-Hz action tremor with a prominent postural and relatively milder kinetic component (Elble and Koller 1990). While ET mainly affects the arms, the head and voice are also often involved. Mechanical loads have little effect on the frequency of ET, which distinguishes ET from enhanced physiological tremor. The postural nature of ET often significantly interferes with activities of daily living such as eating and writing. For some patients, drinking from a glass without spilling becomes impossible. Persons with occupations dependent on manual dexterity such as secretaries...

Days In Culture

Medical intervention counteracts some causes of ageing, and the best example is care of teeth. Teeth wear out with age, and they get infected, but these problems can be dealt with by dentists. Examination of Egyptian mummies has shown that tooth abcesses were common, and in some cases lead to septicaemia which would usually have been lethal. With modern medical treatmentent, defective joints in the hip can be replaced kidneys, livers or hearts can be transplanted hearing aids alleviate deafness cataracts can be removed and replaced with an implant, and spectacles have been used for centuries to improve vision. New treatments for delibitating diseases in the elderly can be expected, but we certainly should not glibly assume that the fundamental causes of ageing will be prevented or reversed. The myths of life extension will be explored in a later chapter.

First molars

Ulcers After Extraction Second Molar

First permanent molars are often the first permanent teeth to erupt into the mouth. Their deep fissure morphology predisposes them to caries and poor tooth brushing combined with a high sugar intake, may result in gross caries. Heavily restored or decayed first molars should be considered for removal over other non-carious teeth (Fig. 12). First molars extraction requires careful planning. Their position in the arch means that whilst relief of premolar crowding is achieved the space created is far from the site of any incisor crowding or overjet reduction. The timing of the loss of first molars is also an important consideration. Fig. 12 Four first molars were extracted just after the optimal time, prior to fixed appliance treatment. The orthopantomogram (a) shows gross caries in the left first molars and heavy restorations in the right first molars. Notice the discrepancy in space available in the two arches. In the upper arch the second molars have erupted in close proximity to the...

Other Impactions

The only other impactions to be considered in a general form are first molars. These may impact in soft tissue and it is sometimes worth considering occlusal exposure where a first molar has not erupted. This usually occurs in the upper arch and can be accepted if the oral hygiene is good with minimal caries experience. Impacted molars of this type quite frequently self correct before or during eruption of the second premolar. There may also be primary failure of eruption and if the tooth fails to move with orthodontic traction this is usually a good indication that the tooth will not move. First molars may also impact into second deciduous molars as they erupt and the options then are to try and move the molar distally with a headgear or removable appliance, to consider using separators (brass wire) to relieve


Pulpitis is an inflammation of the dental pulp that can result from thermal, chemical, traumatic, or bacterial irritation. The most frequent inducer of pulpitis is dental caries that leads to destruction of enamel and dentin resulting in bacterial invasion. Secondary infection of the pulp by supragingival anaerobes occurs frequently in teeth with longstanding caries. Invasion of the pulp and spread of infection to the periapical areas can promote spreading of infection to other anatomical areas.

Dry mouth xerostomia

Xerostomia is associated with several other oral symptoms and problems, including oral discomfort, disturbance in taste, difficulty chewing, difficulty swallowing, difficulty speaking, difficulty in retaining dentures, dental caries, oral candidosis, and other oral infections. The various manifestations of xerostomia reflect the multiple functions of saliva. Acidic products are relatively contraindicated in dentate patients and should be used with caution in edentulous patients. A low pH predisposes to dental erosion, dental caries, and oral candidosis. It should be noted that some of the artificial salivas are acidic in nature.

Profile damage

Extraction of premolars has been condemned by some with very little evidence, as altering the facial profile of the patient.31 A large number of studies have shown that there is no significant difference in profiles treated by extraction or non extraction means. Boley et al 2 found that neither orthodontists nor general dentists could distinguish between extraction and non extraction treatment by looking at profile alone. A recent review examined the effects of orthodontics on facial profie and concluded that it does not, although it highlights areas where planning is crucial.33 It should be remembered that soft tissue changes occur naturally with age, regardless of orthodontic intervention. Proper diagnosis should take into account skeletal form, tooth position and soft tissue form to negate the possibility of any detrimental effect on profile by treatment mechanics.34

Dental Health

Surprisingly there is no strong association between dental irregularity and dental caries or periodontal disease. It seems that dietary factors are much more important than the alignment of the teeth in the aetiology of caries. Although straight teeth may be easier to clean than crooked ones, patient motivation and dental

Impacted Premolars

Appear to submerge as alveolar bone growth continues. This may indicate the absence of a second premolar, but sometimes this submergence can be seen when permanent successors are present. Most of these situations will resolve, but it is thought wise to consider removing the second deciduous molar if it slips below the contact points and there is then space loss as the molar tips forward. Where first molar mesial migration compromises the contact point relationship, space maintenance might be considered. Figure 26 shows a radiograph of a patient who appears to have generalised submergence since all second deciduous molars are seen to be submerging in all four quadrants. In this situation continued observation of the development of the occlusion with appropriate loss of deciduous molars is essential. With the extensive restorations and caries, an argument could be made for loss of all four first molars in this case.

Eating Disorders

The two most common eating disorders are anorexia nervosa and bulimia (Ruff et al, 1992). A variety of specialists, including gastroenterologists, psychiatrists, psychologists, dentists, internists, clinical social workers, nurses, and dietitians, must provide the treatment of eating disorders. There is a separate chapter on this topic (see Chapter 38, Anorexia Nervosa and Bulimia).

Mouth problems

Tinea Pedis Mouth

Hairy oral leukoplakia Dental abscesses caries Gingivitis Candidiasis Ulceration Bacterial Herpetic Aphthous and investigated. Oral hairy leukoplakia can be differentiated from oral Candida by its characteristic distribution along the lateral borders of the tongue and the fact that it cannot be scraped off. Although unsightly, this condition which is due to Epstein Barr virus reactivation is painless and temporary remission can be obtained with acyclovir, valaciclovir or famciclovir. Other oral conditions including dental abscesses, caries, gingivitis and oral ulceration (herpetic or bacterial) may occur. Mouth ulcers may be particularly difficult to treat and expert specialist assessment is recommended. Metronidazole, acyclovir, 0.2 chlorhexidine mouthwashes and analgesic sprays may all be effective depending on the cause and, in extreme cases, thalidomide has been used. Maintenance of good oral hygiene and dental care are important.

Crohns Disease

IBD patients appear to be at an increased risk of dental caries as well as bacterial and fungal infections. These are multifactorial in etiology but appear to be related to either the patient's altered immune status or diet (Benvenius, 1988 Malins et al, 1991 Muerman et al, 1994 Rooney, 1984 Sundh and Emilson, 1989 Sundh et al, 1993). Oral manifestations of anemia such as pallor, angular cheilitis, and glossitis may occur, particularly in undi-agnosed or poorly controlled disease has been reported in patients with active ulcerative colitis (UC).

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