General dental services Health Dictionary

An outdated term for the tertiary stage of SYPHILIS.... general paralysis of the insane

See TEETH, DISORDERS OF – Caries of the teeth.... decay, dental

Decay of teeth... dental caries

See TEETH, DISORDERS OF.... dental emergencies

A statutory body set up by the Dentists Act which maintains a register of dentists (see DENTAL SURGEON), promotes high standards of dental education, and oversees the professional conduct of dentists. Membership comprises elected and appointed dentists and appointed lay members. Like other councils responsible for registering health professionals, the General Dental Council now comes under the umbrella of the new Council for Regulatory Excellence, a statutory body. (See APPENDIX 7: STATUTORY ORGANISATIONS.)... general dental council

A form of practice in which medical practitioners provide a wide range of primary health care services to people.... general practice

Services provided by government to improve the social welfare of those who need them.... social services

See APPENDIX 8: PROFESSIONAL ORGANISATIONS.... british dental association

Usually managed by NHS trusts, these are a complex variety of services provided to people outside hospital settings. The key parts are the services delivered by district nurses, health visitors and therapists – for example, physiotherapists and speech therapists.... community health services

The blend of health and social services provided to an individual or family in his/her place of residence for the purpose of promoting, maintaining or restoring health or minimizing the effects of illness and disability. These services are usually designed to help older people remain independent and in their own homes. They can include senior centres, transportation, delivered meals or congregate meals sites, visiting nurses or home health aides, adult day care and homemaker services.... community-based care / community-based services / programmes

Willingness and/or ability to seek, use and, in some settings, pay for services. Sometimes further subdivided into expressed demand (equated with use) and potential demand or need.... demand (for health services)

A person quali?ed to carry out the scaling (removal of calculus [deposits]) from the teeth and to advise patients on how to keep their teeth and gums healthy. Hygienists usually work in a quali?ed dentist’s surgery.... dental hygienist

A dental surgeon, or dentist, is an individual trained to diagnose and treat disorders of the teeth and gums, as well as to advise on preventive measures to ensure that these areas remain healthy. Dentists qualify after a four-year course at dental school and then register with the GENERAL DENTAL COUNCIL, which is responsible for maintaining educational and professional standards. Around 25,000 dentists practise in the NHS and private sector.

Over the past four decades the ?nancial outlay on NHS dental services has been around 5 per cent of total NHS funding. This contrasts with 10 per cent during the service’s early years, when the NHS was coping with decades of ‘dental neglect’. The population’s dental health has, however, been steadily improving: in 1968 more than one-third of people had no natural teeth; by the late 1990s the proportion had fallen to 13 per cent.

Dentistry is divided into several groupings.

General dental practitioners Concerned with primary dental care, the prevention, diagnosis and treatment of diseases of the gums and teeth – for example, caries (see TEETH, DISORDERS OF). They also deal with diffculties in biting and the effects of trauma, and are aware that oral disorders may re?ect disease elsewhere in the body. They will refer to the hospital dental services, patients who require treatment that cannot be satisfactorily carried out in a primary-care setting.

Most routine dental prevention and treatment is carried out in general dental practitioners’ surgeries, where the dentists also supervise the work of hygienists and dental auxiliaries. Appliances, such as dentures, crowns, bridges and orthodontic appliances are constructed by dental technicians working in dental laboratories.

There are around 18,800 dentists providing general dental services in the UK. These practitioners are free to accept or reject any potential patient and to practise where they wish. Those dentists treating patients under an NHS contract (a mixture of capitation fees and items of service payments) can also treat patients privately (for an appropriate fee). Some dentists opt for full-time private practice, and their numbers are increasing in the wake of changes in 1990 in the contracts of NHS general dental practitioners.

Community dental practitioner Part of the public-health team and largely concerned with monitoring dental health and treating the young and the handicapped.

In the hospitals and dental schools are those who are involved in only one of the specialities.

Around 2,800 dentists work in NHS hospitals and 1,900 in the NHS’s community services. In some parts of the UK, people wanting NHS treatment are having diffculties ?nding dentists willing to provide such care.

Restorative dentist Concerned with the repair of teeth damaged by trauma and caries, and the replacement of missing teeth.

Orthodontist Correction of jaws and teeth which are misaligned or irregular. This is done with appliances which may be removable or ?xed to the teeth which are then moved with springs or elastics.... dental surgeon

Transportation for older adults to services and appointments. May use buses, taxis, volunteer drivers, or van services that can accommodate wheelchairs and persons with other special needs.... escort services

A hospital providing a variety of services, including medicine and surgery, to meet the general medical needs of the community it serves.... general hospital

Insurance which covers the risk of loss for most accidents and injuries to third parties (the insured and its employees are not covered) which arise from the actions or negligence of the insured, and for which the insured may have legal liability, except those injuries directly related to the provision of professional health care services (the latter risks are covered by professional liability insurance).... general liability insurance

A statutory body of elected and appointed medical practitioners and appointed lay members with the responsibility of protecting patients and guiding doctors in their professional practice. Set up by parliament in 1858 – at the request of the medical profession, which was concerned by the large numbers of untrained people practising as doctors – the GMC is responsible for setting educational and professional standards; maintaining a register of quali?ed practitioners; and disciplining doctors who fail to maintain appropriate professional standards, cautioning them or temporarily or permanently removing them from the Medical Register if they are judged un?t to practise.

The Council is funded by doctors’ annual fees and is responsible to the Privy Council. Substantial reforms of the GMC’s structure and functions have been and are still being undertaken to ensure that it operates e?ectively in today’s rapidly evolving medical and social environment. In particular, the Council has strengthened its supervisory and disciplinary functions, and among many changes has proposed the regular revalidation of doctors’ professional abilities on a periodic basis. The Medical Register, maintained by the GMC, is intended to enable the public to identify whom it is safe to approach to obtain medical services. Entry on the Register shows that the doctor holds a recognised primary medical quali?cation and is committed to upholding the profession’s values. Under revalidation requirements being ?nalised, in addition to holding an initial quali?cation, doctors wishing to stay on the Register will have to show their continuing ?tness to practise according to the professional attributes laid down by the GMC.

Once revalidation is fully established, there will be four categories of doctor:

Those on the Register who successfully show their ?tness to practise on a regular basis.

Those whose registration is limited, suspended or removed as a result of the Council’s disciplinary procedures.

Those who do not wish to stay on the Register or retain any links with the GMC.

Those, placed on a supplementary list, who do not wish to stay on the main Register but who want to retain a formal link with the medical profession through the Council. Such doctors will not be able to practise or prescribe.... general medical council (gmc)

The statutory body that regulates the professions of ophthalmic OPTICIAN (optometrist) and dispensing optician. It promotes high standards of education and professional conduct and was set up by the Opticians Act 1958.... general optical council

A network of organizations, usually including hospitals and medical practitioner groups, that provides or arranges to provide a coordinated continuum of services to a defined population and is held both clinically and financially accountable for the outcomes in the populations served.... integrated delivery system / integrated services network (isn)

The provision of assistance with laundry tasks for someone in his or her own home, either through a central facility or by a home help in the home.... laundry services

Housing not specifically designed for a particular user group.... mainstream housing / general needs housing

Comprehensive mental health services, as generally defined under some national (or state) laws and statutes, include: inpatient care, outpatient care, day care and other partial hospitalization and emergency services; specialized services for the mental health of the elderly; consultation and education services and specialized programmes for the prevention, treatment and rehabilitation of alcohol and drug abusers. They generally include a variety of services provided to people of all ages, including counselling, psychotherapy, psychiatric services, crisis intervention and support groups. Issues addressed include depression, grief, anxiety and stress, as well as severe mental illnesses.... mental health services

Health services concerned with the physical, mental and social well-being of an individual in relation to his/her working environment and with the adjustment of individuals to their work. The term applies to more than the safety of the workplace and includes health and job satisfaction.... occupational health services

See “ambulatory care”.... outpatient services

Health services targeted at populations with specific diseases or disorders.... population-based services

Health services re-orientation is characterized by a more explicit concern for the achievement of population health outcomes in the ways in which the health system is organized and funded.... re-orienting health services

Accommodation and support for people who can no longer live at home.... residential care services

The coordinated, or otherwise explicitly agreed upon, sharing of responsibility for provision of medical or nonmedical services on the part of two or more otherwise independent hospitals or health programmes.... shared services

In the UK, this NHS authority (UKTSSA) provides a 24-hour service for matching, allocating and distributing organs. It is also responsible for keeping the records of all patients awaiting transplants. Established in 1991, the authority allocates donor organs without favour, following protocols set by advisory groups. It also administers the Human Organ Transplant Act on behalf of the Department of Health. (See TRANSPLANTATION.)... transplant support services authority

A general practitioner (‘family doctor’; ‘family practitioner’) is a doctor working in primary care, acting as the ?rst port of professional contact for most patients in the NHS. There are approximately 35,000 GPs in the UK and their services are accessed by registering with a GP practice – usually called a surgery or health centre. Patients should be able to see a GP within 48 hours, and practices have systems to try to ensure that urgent problems are dealt with immediately. GPs generally have few diagnostic or treatment facilities themselves, but can use local hospital diagnostic services (X-rays, blood analysis, etc.) and can refer or admit their patients to hospital, where they come under the supervision of a CONSULTANT. GPs can prescribe nearly all available medicines directly to their patients, so that they treat 90 per cent of illnesses without involving specialist or hospital services.

Most GPs work in groups of self-employed individuals, who contract their services to the local Primary Care Trust (PCT) – see below. Those in full partnership are called principals, but an increasing number now work as non-principals – that is, they are employees rather than partners in a practice. Alternatively, they might be salaried employees of a PCT. The average number of patients looked after by a full-time GP is 1,800 and the average duration of consultation about 10 minutes. GPs need to be able to deal with all common medical conditions and be able to recognise conditions that require specialist help, especially those requiring urgent action.

Until the new General Medical Services Contract was introduced in 2004, GPs had to take individual responsibility for providing ‘all necessary medical services’ at all times to their patient list. Now, practices rather than individuals share this responsibility. Moreover, the contract now applies only to the hours between

8.00 a.m. and 6.30 p.m., Mondays to Fridays; out-of-hours primary care has become the responsibility of PCTs. GPs still have an obligation to visit patients at home on weekdays in case of medical need, but home-visiting as a proportion of GP work has declined steadily since the NHS began. By contrast, the amount of time spent attending to preventive care and organisational issues has steadily increased. The 2004 contract for the ?rst time introduced payment for speci?c indicators of good clinical care in a limited range of conditions.

A telephone advice service, NHS Direct, was launched in 2000 to give an opportunity for patients to ‘consult’ a trained nurse who guides the caller on whether the symptoms indicate that self-care, a visit to a GP or a hospital Accident & Emergency department, or an ambulance callout is required. The aim of this service is to give the patient prompt advice and to reduce misuse of the skills of GPs, ambulance sta? and hospital facilities.

Training of GPs Training for NHS general practice after quali?cation and registration as a doctor requires a minimum of two years’ post-registration work in hospital jobs covering a variety of areas, including PAEDIATRICS, OBSTETRICS, care of the elderly and PSYCHIATRY. This is followed by a year or more working as a ‘registrar’ in general practice. This ?nal year exposes registrars to life as a GP, where they start to look after their own patients, while still closely supervised by a GP who has him- or herself been trained in educational techniques. Successful completion of ‘summative assessment’ – regular assessments during training – quali?es registrars to become GPs in their own right, and many newly quali?ed GPs also sit the membership exam set by the Royal College of General Practitioners (see APPENDIX 8: PROFESSIONAL ORGANISATIONS).

A growing number of GP practices o?er educational attachments to medical students. These attachments provide experience of the range of medical and social problems commonly found in the community, while also o?ering them allocated time to learn clinical skills away from the more specialist environment of the hospital.

In addition to teaching commitments, many GPs are also choosing to spend one or two sessions away from their practices each week, doing other kinds of work. Most will work in, for example, at least one of the following: a hospital specialist clinic; a hospice; occupational medicine (see under OCCUPATIONAL HEALTH, MEDICINE AND DISEASES); family-planning clinics; the police or prison services. Some also become involved in medical administration, representative medicopolitics or journalism. To help them keep up to date with advances and changes in medicine, GPs are required to produce personal-development plans that outline any educational activities they have completed or intend to pursue during the forthcoming year.

NHS GPs are allowed to see private patients, though this activity is not widespread (see PRIVATE HEALTH CARE).

Primary Care Trusts (PCTs) Groups of GPs (whether working alone, or in partnership with others) are now obliged by the NHS to link communally with a number of other GPs in the locality, to form Primary Care Trusts (PCTs). Most have a membership of about 30 GPs, working within a de?ned geographical area, in addition to the community nurses and practice counsellors working in the same area; links are also made to local council social services so that health and social needs are addressed together. Some PCTs also run ambulance services.

One of the roles of PCTs is to develop primary-care services that are appropriate to the needs of the local population, while also occupying a powerful position to in?uence the scope and quality of secondary-care services. They are also designed to ensure equity of resources between di?erent GP surgeries, so that all patients living in the locality have access to a high quality and uniform standard of service.

One way in which this is beginning to happen is through the introduction of more overt CLINICAL GOVERNANCE. PCTs devise and help their member practices to conduct CLINICAL AUDIT programmes and also encourage them to participate in prescribing incentive schemes. In return, practices receive payment for this work, and the funds are used to improve the services they o?er their patients.... general practitioner (gp)

The multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviours affect access to health care, the quality and cost of health care, and ultimately health and well-being. Its research domains are individuals, families, organizations, institutions, communities and populations.... health services research

See “community-based care”.... home and community-based services; home and community care programme

Health services delivered on an inpatient basis in hospitals, nursing homes or other inpatient institutions. The term may also refer to services delivered on an outpatient basis by departments or other organizational units of such institutions, or sponsored by them.... institutional (care) health services

See: TEETH DECAY, TEETH EXTRACTION, ALOE VERA. DEOBSTRUENT. That which clears obstruction by dilating natural passages of the body. Usually of the intestines (Ispaghula seeds) or colon (Buckbean). ... dental problems

It is sometimes not possible to achieve worthwhile results from herbal medicine without due regard to the quality and type of food that enters the body. Suggested foods are those which experience has shown to assist recovery and conserve body energies that might otherwise be diverted towards elimination of metabolic wastes.

“A good and proper diet in disease is worth a hundred medicines and no amount of medication can do good to a patient who does not observe a strict regimen of diet.” (Charaka Samhita 300AD)

A healthy diet helps maintain the immune system, builds up reserves and hastens recovery from illness.

A good general diet includes foods low in fat, salt and high in fibre. All white sugar and white sugar products (chocolates, sweets, etc) should be replaced with natural sugars (honey, dates, figs, molasses, raisins etc). It should contain plenty of raw fresh fruit and vegetables; best prepared in a juice-press.

Vegetables should be conservatively cooked in very little water with little salt in a covered vessel. At least one mixed raw vegetable salad should be taken daily. Bread can be replaced by jacket potato, Soya- bean flour products or ripe bananas. Puddings, pastry and suety meals should be avoided.

Lean meat should be restricted to two or three parts a week with liberal inclusion of oily fish. Tofu, a Soya bean product, is an excellent alternative to meat. Three or four eggs, only, should be taken weekly.

Dairy produce (milk, butter, cream) contain cholesterol which thickens the blood, blocks arteries and increases resistance against the heart and major blood vessels, and should be taken sparingly.

Accept: Garlic, Onions, Lecithin, Muesli or Oatmeal porridge for breakfast or at other times during the day, yoghurt, honey.

Reject: fried foods, biscuits, confectionery.

Salt: replace with powdered Garlic, Celery or Kelp.

Alcohol: replace with fresh fruit or raw vegetable juices. Coffee is a risk factor raising cholesterol concentration; Dandelion coffee, Rutin or any one of many herbal teas available offer alternatives.

Avoid over-eating and meals when tired. Foods should be well masticated without liquid drinks; dry- feed. Plenty of liquid drinks, water etc should be taken between meals.

Supplements: Vitamin C 200mg, Vitamin E 200iu, morning and evening. Evening Primrose oil. Efamol produce a combined Evening Primrose and Fish oil capsule.

Dietary fibre can prevent certain colonic diseases. Treatment of disease by diet is preferred to drugs because it has the advantage of being free from side-effects. ... diet - general

 Pain along a nerve, i.e. pain in the shoulders from pressure on a spinal nerve serving the neck.

Alternatives. Black Cohosh, Cactus, Chamomile, Lady’s Slipper, Ginseng, Hops, Jamaica Dogwood, White Willow, Wild Lettuce, Valerian.

Chamomile tea (mild analgesic).

Tablets/capsules. Any of the above.

Formula. Ginseng 4; Black Cohosh 2; Skullcap 2; Mistletoe 1; Motherwort 1. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily. Children: see: DOSAGE. Cayenne pepper (Capsicum) sometimes successful.

Topical. Poultice: Chamomile, Hops, Linseed or Bran. Acute cases (cold), chronic cases (hot). Grated or bruised Horseradish root. Evening Primrose oil. Hot Cider vinegar, Tincture Arnica or Hypericum. Aromatherapy. 2 drops each: Juniper, Lavender, Chamomile to 2 teaspoons vegetable oil. Light massage. Diet. High protein. Calcium-rich foods.

Supplements. Vitamin B-complex, B6, B12, Niacin, Magnesium, Dolomite, Zinc.

See: FACIAL and INTERCOSTAL NEURALGIA; DYSMENORRHOEA (neuralgia of the womb). ANTISPASMODICS. ... neuralgia, general

The wearing away of tooth enamel, often accompanied by the erosion of dentine (the layer beneath the enamel) and cementum (the bonelike tissue that covers the tooth root), usually through too-vigorous brushing. Abraded areas are often sensitive to cold or hot food or drink, and a desensitizing toothpaste and/or protection with a bonding (see bonding, dental) agent or filling may be needed.... abrasion, dental

The movement of teeth by using either fixed or removable orthodontic appliances (braces) to correct malocclusion (incorrect bite).... alignment, dental

The bony cavity or socket supporting each tooth in the jaw.... alveolus, dental

A material, consisting of an alloy of mercury with other metals, that is used as fillings for teeth (see filling, dental).... amalgam, dental

Loss of sensation induced in a patient to prevent pain during dental treatment.

For minor procedures, a local anaesthetic (see anaesthesia, local) is injected either into the gum at the site being treated or into the nerve a short distance away (called a peripheral nerve block).

In addition, topical anaesthetics are often used on the gums.

For more complicated procedures, such as periodontal (gum) surgery and multiple tooth extractions, general anaesthesia is carried out (see anaesthesia, general).... anaesthesia, dental

A cosmetic procedure for lightening certain types of discoloured teeth, including nonvital ‘dead’ teeth.

The surface of the affected tooth is painted with oxidizing agents and then exposed to ultraviolet light.... bleaching, dental

Dental techniques that use plastic resins and acrylic or porcelain veneers to repair, restore, or improve the appearance of damaged or defective teeth.

It is sometimes used as an alternative to crowning (see crown, dental) and may also be used as a preventive technique to protect the teeth.... bonding, dental

See orthodontic appliances.... brace, dental

A pus-filled sac in the tissue around the root of a tooth. An abscess may occur when bacteria invade the pulp (the tissues in the central cavity of a tooth) as a result of dental caries, which destroys the tooth’s enamel and dentine, allowing bacteria to reach the pulp. Bacteria can also gain access to the pulp when a tooth is injured. The infection in the pulp then spreads into the surrounding tissue to form an abscess. Abscesses can also result from periodontal disease, in which bacteria accumulate in pockets that form between the teeth and gums.

The affected tooth aches or throbs, and biting or chewing is usually extremely painful. The gum around the tooth is tender and may be red and swollen. An untreated abscess eventually erodes a sinus (channel) through the jawbone to the gum surface, where it forms a swelling known as a gumboil. As the abscess spreads, the glands in the neck and the side of the face may become swollen, and fever may develop. Treatment may consist of draining the abscess, followed by root-canal treatment of the affected tooth, but in some cases extraction of the tooth is necessary. Antibiotics are prescribed if the infection has spread beyond the tooth.

An abscess in a periodontal pocket can usually be treated by the dentist scraping away infected material.... abscess, dental

Loss of sensation and consciousness induced to prevent the perception of pain throughout the body during surgery. General anaesthesia is usually induced by intravenous injection of a barbiturate drug and maintained by inhalation of anaesthetic gases such as halothane, which may be introduced into the lungs via an endotracheal tube. During the anaesthetic, the pulse, blood pressure, and other vital signs are continuously monitored.

General anaesthetics have become much safer, and serious complications are rare.

However, severe pre-existing diseases such as lung or heart disorders increase the risks.

Minor after effects such as nausea and vomiting are usually controlled effectively with antiemetic drugs.... anaesthesia, general

False teeth that are attached to natural teeth on either side of a gap left by a missing tooth or teeth. (See also denture.)... bridge, dental

The deposition of calcium salts in developing teeth. Primary teeth begin to calcify in a fetus at between 3 and 6 months gestation; calcification of permanent teeth (other than the wisdom teeth) begins between birth and 4 years. Abnormal calcification occurs in amelogenesis imperfecta, an inherited disorder of the enamel (see hypoplasia, enamel), and can also result from the absorption of high levels of fluoride (see fluorosis).... calcification, dental

A hard, crust-like deposit (also known as tartar) found on the crowns and roots of the teeth. Calculus forms when mineral salts in saliva are deposited in existing plaque. Supragingival calculus is a yellowish or white deposit that forms above the gum margin, on the crowns of teeth near the openings of salivary gland ducts. Subgingival calculus forms below the gum margin and is brown or black. Toxins in calculus cause gum inflammation (see gingivitis), which may progress to destruction of the supporting tissues (see periodontitis). Calculus is removed by professional scaling. Attention to oral hygiene reduces recurrence.... calculus, dental

See crown, dental.... capping, dental

Tooth decay; the gradual erosion of enamel (the covering of the tooth) and dentine (the substance beneath the enamel). Initial decay usually occurs on the grinding surfaces of the back teeth and areas around the gum line. The main cause is plaque, a sticky substance consisting of food deposits, saliva by-products, and bacteria that collects on the teeth. The breakdown of food deposits by bacteria creates an acid that eats into the enamel to form cavities. Unchecked decay spreads to the dentine, and as the cavity enlarges, bacteria may invade and destroy the pulp

at the tooth’s core. Advanced decay causes toothache and bad breath.

Treatment consists of drilling away the area of decay and filling the cavity (see filling, dental). In advanced decay, it may be necessary to remove the infected pulp (see extraction, dental).

Water fluoridation and the use of fluoride toothpaste helps prevent caries.

The risk of caries is also reduced by cutting sugar consumption, practising good oral hygiene, and visiting the dentist regularly.... caries, dental

A hole in a tooth, commonly caused by dental caries (see caries, dental).... cavity, dental

See overcrowding, dental.... crowding, dental

An artificial replacement for the crown of a tooth that has become decayed, discoloured, or broken. A porcelain crown is usually used on front teeth, but back teeth require the greater strength of a crown made from gold or porcelain fused to metal.

A crown may be fitted by filing the natural tooth to form a peg and cementing the crown over the top. If the tooth is... crown, dental

The scraping of the wall of a cavity or other surface with a dental curette.

Dental curettage is one method used to remove the lining of periodontal pockets and diseased tissue from root surfaces in periodontitis.... curettage, dental

A protrusion on the grinding surface of a tooth.... cusp, dental

The dissolving of minerals in a tooth. Dental decalcification is the first stage of tooth decay. It is caused by the bacteria in plaque acting on refined carbohydrates (mainly sugar) in food to produce acid, which leads to changes on the surface of the tooth. If the decalcification penetrates the enamel, it spreads into the dentine and permits bacteria to enter the pulp.

(See also caries, dental.)... decalcification, dental

An examination of the mouth, gums, and teeth by a dentist as a routine check or as part of the assessment a person complaining of a symptom. Routine examinations enable tooth decay and gum disease to be detected and treated at an early stage.

During a routine dental examination, the dentist uses a metal instrument to

probe for dental cavities, chipped teeth, or fillings. Dental X-rays are sometimes carried out to check for problems that may not be visible. Dentists also check how well the upper and lower teeth come together. Regular examinations in children enable the monitoring of the replacement of primary teeth by permanent, or secondary, teeth. Referral for orthodontic treatment may be made. dental extraction See tooth extraction. dental X-ray An image of the teeth and jaws that provides information for detecting, diagnosing, and treating conditions that can threaten oral and general health. There are 3 types of dental X-ray: periapical X-ray, bite-wing X-ray, and panoramic X-ray.

Periapical X-rays are taken using X-ray film held behind the teeth. They give detailed images of whole teeth and the surrounding tissues. They show unerupted or impacted teeth, root fractures, abscesses, cysts, and tumours, and can help diagnose some skeletal diseases. Bite-wing X-rays show the crowns of the teeth and can detect areas of decay and changes in bone due to periodontal disease. Panoramic X-rays show all the teeth and surrounding structures on one large film. They can show unerupted or impacted teeth, cysts, jaw fractures, or tumours. The amount of radiation received from dental X-rays is extremely small. However, dental X-rays should be avoided during pregnancy.... dental examination

The hard outer layer of a tooth that covers and protects the inner structures.... enamel, dental

Loss of enamel from a tooth’s surface due to attack by plaque acids or other chemicals. Erosion of the

outer surfaces of the front teeth is most frequently caused by excessive intake of fruit juices and carbonated drinks. Erosion of the inner surfaces of the molars may be a result of the regurgitation of stomach acid, as occurs in people suffering from acid reflux or bulimia. (See also caries, dental.)... erosion, dental

Removal of teeth by a dentist. Extraction may be performed when a tooth is severely decayed or too badly broken to be repaired, or when an abscess (see abscess, dental) has formed. Teeth may also be removed if there is crowding or malocclusion, if the teeth are loose due to gum disease, or if they are preventing another tooth from erupting (see eruption of teeth).

For most extractions, local anaesthesia is used (see anaesthesia, dental). Teeth are usually extracted with dental forceps, which grasp the root of the tooth. In difficult extractions, some gum and bone may also need to be removed from around the tooth.... extraction, dental

The process of replacing a chipped or decayed area of tooth with an inactive material. Dental filling is also used to describe the restorative material itself. Amalgam, a hard-wearing mixture of silver, mercury, and other metals is generally used for back teeth. If a front tooth is chipped, a bonding technique (see bonding, dental) may be used, in which plastic or porcelain tooth-coloured material is attached to the surface of the tooth.... filling, dental

The removal of plaque (see plaque, dental) and food particles from around the teeth and gums by

using soft nylon or silk thread or tape.

Dental floss may be waxed or unwaxed.

Flossing should be carried out as an adjunct to toothbrushing.... flossing, dental

A break in a tooth (see teeth) most commonly caused by falling onto a hard surface or by being hit in the mouth with a hard object.

Fractures may involve the crown or the root of a tooth, or both.

Fractures of the enamel can usually be repaired by bonding (see bonding, dental); in some cases, a replacement crown may be fitted (see crown, dental).

Pulpotomy may be performed if the pulp of a tooth is damaged.

Fractures of the root may be treated by splinting (see splinting, dental), root-canal treatment, or removing the tooth (see extraction, dental).... fracture, dental

Failure of a tooth to emerge completely from the gum. It may occur because of overcrowding or when a tooth grows in the wrong direction.

Impacted wisdom teeth are common, and, if symptomless, may not need to be removed.

In some cases, however, symptoms necessitate their removal.... impaction, dental

A post, surgically embedded in the jaw for the attachment of a dental prosthesis (an artificial tooth). Titanium or synthetic materials may be used. A dental implant is fitted under local anaesthesia. A hole is drilled in the jaw and a post inserted. Several months later, an attachment that protrudes from the gum is screwed into the post; a few weeks after that, the prosthesis is fitted.... implant, dental

A mould taken of the teeth, gums, and palate.

A quick-setting material, such as alginate, is placed in a mould over the teeth.

The mould is removed, and plaster of Paris is poured into it to obtain a model of the area.

This model is then used as a base on which to build a denture, bridge, or dental inlay.

Dental impressions are also used in orthodontics to study the position of the teeth and to make orthodontic appliances to correct irregularities.... impression, dental

A filling of porcelain or gold used to restore a badly decayed tooth.

An inlay may be needed for the back teeth or to protect a weakened tooth.... inlay, dental

The deposition of calcium crystals and other mineral salts in developing teeth. (See calcification, dental.)... mineralization, dental

A rough, sticky coating on the teeth consisting of saliva, bacteria, and food debris.

It is the chief cause of tooth decay (see caries, dental) and gingivitis, and forms the basis of a hard deposit (see calculus, dental).

Some of the microorganisms in plaque, particularly STREPTOCOCCUS MUTANS, break down sugar in the remains of carbohydrate food that sticks to the mucus, creating an acid that can erode tooth enamel.... plaque, dental

Excessive crowding of the teeth so that they are unable to assume their normal positions in the jaw. Dental overcrowding is commonly inherited and may occur because the teeth are too large for the jaw or the jaw is too small to accommodate the teeth. Premature loss of primary molar (back) teeth can cause the permanent teeth beneath them to move out of position and crowd the teeth further forward.

Overcrowded teeth may lead to malocclusion or may prevent certain teeth from erupting through the gum (see impaction, dental). They can be difficult to clean, increasing the risk of dental decay (see caries, dental) and periodontal disease.

Teeth may need to be extracted to allow room for others. Usually an orthodontic appliance is fitted to the remaining teeth to position them correctly.... overcrowding, dental

The branch of dentistry concerned with the replacement of missing teeth and their supporting structures. It includes dentures, overdentures (semipermanent fittings over existing teeth), crowns (see crown, dental), and bridges (see bridge, dental).

protease inhibitors A type of antiviral drug used to delay the progression of HIV infection (see AIDS).... prosthetics, dental

The soft tissue containing blood vessels and nerves in the middle of each tooth (see teeth).... pulp, dental

Replacement of a tooth in its socket after an accident so that it can become reattached to supporting tissues. The front teeth are most commonly involved. The tooth needs to be reimplanted soon after the accident and is maintained with a splint (see splinting, dental) while it heals. Healing may take several weeks.... reimplantation, dental

Loss of substance from teeth. The loss may be external (affecting the surface of the root) or internal (affecting the wall of the pulp cavity). External resorption is part of the processs by which primary teeth are lost. Some degree of external resorption also occurs as part of the aging process, and may also be due to injury, inflammation of surrounding tissues, or pressure, for example from an impacted tooth.

Internal resorption is rare, occurring in about 1 percent of adults.... resorption, dental

The reconstruction of part of a damaged tooth. Restoration also refers to the material or substitute part used to rebuild the tooth. Small repairs are usually made by filling the tooth. For extensive repairs, a dental inlay or a crown may be used. Chipped front teeth may be repaired by bonding (see bonding, dental).... restoration, dental

Removal of dental calculi (see calcuus, dental) from the teeth to prevent or treat periodontal disease.... scaling, dental

Plastic coatings that are applied to the chewing surfaces of the back teeth to help prevent decay.... sealants, dental

The mechanical joining of several teeth to hold them firmly in place while an injury heals or while periodontal disease is treated.... splinting, dental

See implants, dental.... titanium dental implants

See dental X-rays.... x-rays, dental

see domiciliary services.... community services

any of several professionals supporting a dentist, formerly referred to as dental auxiliaries and professionals complementary to dentistry. A dental hygienist performs scaling and instruction in oral hygiene. A dental nurse helps the dentist at the chairside by preparing materials, passing instruments, and aspirating fluids from the patient’s mouth. A dental technician constructs dentures, crowns, and orthodontic appliances in the laboratory for the dentist. A clinical dental technician provides dentures directly to patients. A dental therapist performs non-complex treatment under the prescription of a dentist. In the UK dental care professionals are required to be statutorily registered with the General Dental Council (GDC).... dental care professional

a reclinable chair on which a patient lies for dental treatment. Electric switches change the position of the patient, and the chair is frequently attached to the *dental unit.... dental chair

a fine thread, usually of nylon, used to clean the surfaces between teeth. A thicker version is known as dental tape. It may be waxed to help the user slide it past the tooth contacts.... dental floss

a piece of dental equipment (high-speed or low-speed) for holding a dental *bur or *file. It is made of corrosion-resistant materials to allow sterilization. See drill.... dental handpiece

see implant.... dental implant

either of two nerves that supply the teeth; they are branches of the trigeminal nerve. The inferior dental nerve supplies the lower teeth and for most of its length exists as a single large bundle; thus anaesthesia of it has a widespread effect (see inferior dental block). The superior dental nerve, which supplies the upper teeth, breaks into separate branches at some distance from the teeth and it is possible to anaesthetize these individually with less widespread effect for the patient.... dental nerve

see dental care professional.... dental nurse

(DPT) a special form of tomogram (see tomography) that provides a picture of all the teeth of both jaws on one film. Newer equipment can produce three-dimensional images of part of the jaw.... dental pantomogram

a major fixed piece of dental equipment to which are attached the dental drills, aspirator, compressed air syringe, and ultrasonic scaler. It is frequently integral with the *dental chair.... dental unit

(HHS) the major US government agency providing health care. The department was created in 1953 and assumed its current name in 1980. HHS administers more than 300 health and health-related programmes and services, including *Medicare and *Medicaid. Other activities include research, immunization services, and providing financial assistance for low-income families. Almost a quarter of federal spending occurs through HHS.... department of health and human services

(in Britain) health and social services that are available in the home and are distinguished from hospital-based services. They include the services of such personnel as community nurses employed by care trusts (see district nurse; community midwife; health visitor) and social workers and care assistants employed by social service departments of local authorities. The term community services is applied to these services.... domiciliary services

(GHQ) a reliable screening tool published in 1978 for identifying minor psychiatric disorders, still frequently used for research in the general population. The 28-question version (GHQ28) is most commonly used, but the GHQ is available in lengths from 12 to 60 questions.... general health questionnaire

a rolling survey carried out annually (1971–2007) in Great Britain by the *Office for National Statistics. It included questions about the household and questions to be completed by all individuals aged over 16 within the household. It covered a wide variety of topics, such as health, employment, pensions, education, and income. It was succeeded (2007–12) by the general lifestyle survey. See also census.... general household survey

(GMC) the regulatory body of the medical profession in the UK, which was established in 1858 by the Medical Act and has statutory powers. It licenses doctors to practise medicine and has the power to revoke licences or place restrictions on practice. The governing body of the GMC, its Council, comprises 12 members, 6 of which are medically qualified and 6 of which are not. Its purpose is to protect, promote, and maintain the health and safety of the public by ensuring proper standards in the practice of medicine and medical education and training. Following various high-profile cases involving malpractice, there has been a shift in the role of the GMC from one of simple registration to that of *revalidation of doctors.

GMC website: includes the Council’s guide to Good Medical Practice... general medical council

(GP) a doctor working in the community who provides family health services to a local area. General practitioners (also known as family doctors or family practitioners) may work on their own or in a group practice in which they share premises and other resources with one or more other doctors. GPs are usually the first port of call for most patients with concerns about their health. They look after patients with wide-ranging medical conditions and can refer patients with more complex problems to specialists, such as hospital consultants. Some GPs with additional training and experience in a specific clinical area take referrals for assessment and treatment that may otherwise have been referred directly to hospital consultants; these are known as GPs with a special interest (GPwSI or GPSI). Most GPs work solely within the *National Health Service but a few work completely privately. The current model of general practice allows for GPs to provide general medical services (GMS), the terms and conditions of which are governed by a national contract which is usually negotiated on an annual basis, or personal medical services (PMS), the terms and conditions of which are governed by locally negotiated contracts within a broad framework. The new primary care contract (nGMS contract) came into force in April 2004, allowing GPs to opt out of weekend and night (*out-of-hours) service provision for patients registered with their practice. In this period, patient care is usually provided by an out-of-hours cooperative or deputizing service. At the same time the government also introduced the *Quality and Outcomes Framework (QOF) as a means to improve the quality of care provided. Most GPs are *independent contractors although more recently there has been an increase in the number of salaried GPs. GPs may employ a variety of staff, including *practice nurses, *nurse practitioners, and counsellors.... general practitioner

(GPwSI, GPSI) see general practitioner.... general practitioner with special interest

see HEMS.... helicopter-based emergency medical services

(inferior alveolar nerve block) a type of injection to anaesthetize the inferior *dental nerve. Inferior dental block is routinely performed to allow dental procedures to be carried out on the lower teeth on one side of the mouth.... inferior dental block

a bony canal in the *mandible on each side. It carries the inferior *dental nerve and vessels and for part of its length its outline is visible on a radiograph.... inferior dental canal

(NHSBSA) a *special health authority formed in 2006 to provide a range of back office and financial services to NHS organizations, contractors, and patients. These include administering the NHS pension scheme, issuing European Health Insurance Cards to UK residents, and issuing penalty charge notices to patients who falsely claim to be exempt from paying prescription charges. NHSBSA also hosts NHS Prescription Services, which provides pharmacies with reimbursement for items supplied under NHS prescriptions.

NHS Business Services Authority website... nhs business services authority

(NHSPSA) see NHS Business Services Authority.... nhs prescription services authority

see Parliamentary and Health Service Ombudsman.... public services ombudsman