The Relationship between Faith and Reason

â€Å"Faith and Reason resemble two wings on which the human soul ascends to the thought of truth† Explain the risks for a scholar when confidence and reason are separated from one another. Use at any rate one case of a Christian instructing that shows the agreement of confidence and reason The congruity of confidence and reason are the grounds whereupon numerous Christian lessons are assembled. This relationship upgrades components of the two develops, anyway the threat of isolating explanation from confidence is that reason will try to demonstrate actually and most sensibly which would make a definitive objective and question be lost in consultation and, then again, isolating confidence from reason would make confidence be seen as minor tale or odd notion. The two must collaborate in equivalent combination all together for the human soul to ascend to the consideration of truth as proposed in the encyclical letter ‘Fides et Ratio’ by the late incomparable pontiff Pope John Paul II. Reason could be essentially characterized as the obvious end result drawn from strict events or the affirmed idea of a custom or practice. Anyway more components of Reason remain constant notwithstanding the possibility of something that can be ‘proven’. Reason is commonly comprehended as the principals for a methodological request, regardless of whether scholarly, good, stylish or strict. 1 Any obtaining of scholarly information, through either direct understanding or contention is a portrayal of ‘reason’ The Internet Encyclopedia of Philosophy Hebrews 11:1 states that â€Å"faith is by and large certain about what we trust in and sure of what we don't see†. The premise of confidence is normally adjusted from the authority of disclosure whether that be immediate (God talking legitimately to an individual), or aberrant (books of the holy book, messages by ministers, and so forth). Confidence delineates a trust in God and his vows to his kin. Pope John Paul II expressed that through Christian lessons, what people can't see or contact is affirmed by faith2 Pope John Paul II, not just tends to the misleading affirmations of current thinkers, however offers a cure by exhibiting reality of the Aristotelian or Tomistic perspective, indicating that confidence and science are in no way, shape or form in opposition to each other, yet that it’s fundamental for the movement of humanityâ€of any kindâ€that confidence and science (or reason) be utilized together. 3 The partition of the two reason a disarray, recently experienced by thinkers, that areas confidence and science/reason as two confined substances. Review this separation in its most straightforward arrangement, the human scholar infers that for one to be dedicated to God, and a strict being, they should dismiss all components of reason and submit exclusively to the ideas of confidence. Then again, one who might have confidence in a more prominent level of reason must be agnostic as any dismissal of God is intrinsically a dismissal of confidence itself. As the world creates and people become increasingly learned, it gets difficult to deny certain realities; anyway this turns into a threat to every strict network as by least complex suspecting, confiding in any proof is seen as a dismissal of trust in God. In this lies the risks for scholars; earlier obviously to John Paul II’s Fides et Ratio 2 3 Fides et Ratio, John Paul II Catholic Champion that recognizes that â€Å"reason and confidence can't be isolated without decreasing the limit of people to know themselves, the world and God in a suitable way †¦There is therefore no explanation behind rivalry of any sort among reason and confidence: each contains the other, and each has its own degree for action† As people, we should emotionally reason inside our own specific circumstances and established understandings of the world which we live, in this manner this will assist us with taking part in our confidence to comprehend the world we watch. 4 Noticeably it tends to be comprehended that confidence, custom and thinking are interlaced inside each other, you can't have one without the other and every one of the 3 components are basic segments in understanding and living ones confidence. The congruity of confidence and reason is best observed through the account of creation. â€Å"By confidence we comprehend that the universe was framed at God’s order, with the goal that what is seen was not made out of what was visible†5. This section features the centrality of the commitments from both confidence and reason through Genesis and the early books of the good book to the legitimacy of conviction. Plato took a stab at clarifying man’s position on the planet and the start within recent memory through the purposeful anecdote of the austere cavern. In the most straightforward structure, the cavern presents the setting whereupon a play of shadows happens. The men in the cavern watch this play being executed from a light source as the main reality they know. While bits of gossip flare of an outside ‘world’ the play proceeds, and ‘reason’ makes theory over what is going to occur straightaway and speculations are created with respect to the reason. After some time, reason will clarify most parts of the show, yet would just hold 4 5 Fides et Ratio, John Paul II 94 Hebrews 11:3 vidence enough to comprehend the soonest snapshots of the show. To arrive at full truth, confidence should be acquainted with really have confidence in the underlying wellspring of light. Besides to the possibility, confidence and reason question what occurs if the light sources goes out; for the play won't â€Å"die† as death is simply a comprehended component of the play. Nobody was around at the hour of creation and nobody h as an immediate information on what occurred; so reason can't affirm whether God did it. In any case, reason recommends that the universe is working and consequently more likely than not had a start. It is complicatedly structured, from the essential laws of material science to the mind boggling intricacy of the human cerebrum. Regardless of whether an individual ganders at the excellence and shouts, â€Å"There must be a God! † or whether that individual needs to plunk down and ascertain the likelihood of these things occurring by some coincidence, the finish of the fair searcher is that nature doesn't account for itself. Besides the sensible confidence in Genesis 1:1, â€Å"In the starting God made the Heavens and the Earth† is a sheer advance of confidence instead of an ignorant cut in obscurity. The thoughts and speculations of past savants have incredibly influenced the separation among confidence and reason anyway John Paul II’s Fides et Ratio has essentially helped the congregation and her kin comprehend and feel good with the idea of a Ã¢â‚¬Ë œcircle’ holding the two elements together in a solid association where one feeds off the other. Scholars face a risk when figuring restricted to the late pope’s conversation as the idea draws inconsistencies and disarray from adherents that prompts the supposition that they are not exactly unwavering according to God for thinking about sensible and demonstrated proof. Olsen, Ross Faith and Reason: What is the Relationship?

How Personal Educational Experiences Influence Teaching Education Essay Free Essays

string(82) I discovered children are partial to making their ain readings based from their experiences. Educating is a remarkable calling that requires love, respect and devotion and great teachers could ever want to pass on enormous adjustments in kids ‘s lives. So as instructors we should be outfitted with subject, achievements, and grow new contemplations and procedures and sprout with adjusting political directions to elevate kids ‘s obtaining who might perpetually require rationale and backing. Instructors looking for long lasting procurement must concede and follow adjustment to all the more likely example ( Vossler, Waitere-Ang, A ; Adams, 2005 ) . We will compose a custom paper test on How Personal Educational Experiences Influence Teaching Education Essay or on the other hand any comparative subject just for you Request Now As we experience life, it is essential that we realize what our identity is, and can perceive and abandon our ain individual qualities and failings. Realizing what we are acceptable at and what we are feeble in is the solitary way we can truly turn as people. This cognizance encourages us to help through the closures we set for ourselves throughout everyday life. Pulling on an extent of writing beneath are my thoughts which region my rising precept of guidance and procurement upheld by ancient rarities from my guidance encounters alongside the spreads in my guidance design and my activity program on how I would go to these spreads. Analogy To me kids are separated from everyone else, skilled and sure researchers like crewmans who investigate the ocean which can be contrasted with a multi-educated and bi-social condition that gives interminable possibilities. The educator ‘s work in my similitude resembles an attendant who works in association with guardians to follow the children ‘s contributions. I unequivocally accept the connections between the child, teacher and parent is a cardinal factor which draws out the power, imagination and thought of child. The teacher as an attendant praises the decent variety of larning kids passing on from their universes as explorers because of grouped personalities. As an attendant the teacher makes abundance of fabulous larning possibilities or high spots characteristic possibilities that emerge. As a researcher, an educator takes part in enquires made by kids with kids †in the two capacities instructor will see kids ‘s enquires as important, motivate propelled thoughts, incite appreciation and go about as an empathetic being. Both the teacher ‘s and the child ‘s work depends on the build of Ako where they show each piece great as learn together. The connection between the teacher and the researcher depends on trust and the capacity of the educator is to develop positive, deferential and antiphonal relationship with the children and their family units and work cooperatively and bring various situations into position. The educator as an attendant watches, helps, proposes and when things are voyaging acceptable soften into the sides of the schoolroom since the researchers as crewmans know their completion. As an attendant the educator gives right level of difficulties to children to look into yet at a similar clasp takes consideration of their wellbeing aspects. The children ‘s works as crewmans include starting to lead the pack and research the universe through the entirety of their faculties. In my representation kids are dynamic researchers who search frontward for larning encounters which esteem their inclusion and use their semantic correspondence and finishing up for arranged purposes. Kids are enabled to parcel their inclusion and human advancement with others and perceive themselves as able and certain researchers. The teachers should move as positive capacity hypothetical records and do certain the standpoint of children ‘s venture is significant, energizing and dependable. The understudies will see themselves pondered this excursion and think of requests on this excursion and the two teachers and students will hold the ability to help them happen the answers. How my own instructive encounters affected my analogy As an understudy I was affected by the discussions of my shrewd keeps an eye on and through substance discernment and looks into I got mindful of how basic it is for educators to gracefully an invigorating and safe condition where kids ‘s association can be followed and continued. I saw how cultural constructivist speculations support quite a bit of youth showing technique and the significance of building up the multi-education achievements of children for which as instructors we have to rethink a methodological examination and setting for kids ‘s securing. My Lectors bestowed me with the significance of providing rich craftsmanship projects to advance the ideal procurement possibilities. As an educator from my point of view visual pictures are ground-breaking signifier of conveying since we live in numerous networks. So during my TE I set up tastefully pleasing condition by traping up pictures stand foring the various developments of my schoolroom which animated the children to inquire about and distinguish crafted by their equivalents and this empowered cultural connection among kids. Instructors should open children to numerous odds and back up them in their ideal exercises ( Young-Loveridge, Peters A ; Carr, 1997 ) I had the option to back up kids ‘s proficiency procurement by putting their own affinities. During both my Teaching Experiences I spoke with guardians by and by furthermore through letters bespeaking them to put their children ‘s leader stories and vocals and pass on it to classification for offering it to others which included parent commitment. I other than verified I was completely insightful of the inborn inside informations of my human advancement before turn toing the social education requests of my researchers which I feel is extremely significant. I figured out how to accurately articulate Karakia from Maori kids and their folks which mirrors the build of Ako in my allegory. During my first Teaching Experience a yearling James demonstrated extraordinary inclusion in perusing his leader book which had the picture of Mama and his angel sloth. I energized and strengthened his contribution by rehashing his preferred book at whatever point he needed me to and connecte d with self-created discussions with him to develop positive connections. I comprehended James had exhibited solid affirmation in me and believed that I would peruse his book at whatever point he required. I other than did an examination concerning why he was so partnered to this book by talking with my Associated Teacher and his parent and discovered this was because of the coming to of his new darling sibling. I discovered children are partial to making their ain readings based from their encounters. You read How Personal Educational Experiences Influence Teaching Education Essay in classification Exposition models All these encounters overallly affected my representation of guidance. Tenet What does it take to be a decent educator? I accept the undermentioned characteristics shape up a decent teacher. A decent teacher must be energetic about his occupation. The educators should consider all to be as certain, able researchers in multi-proficient and bi-social conditions and watch the assorted variety of larning kids passing on from their universes. A teacher needs to hold positive, aware, antiphonal connections and collaborations with their researchers and family units and occur out the various positions. Great educators would be mindful, empathic and interface at individual degree with the children and show echt association in their universe. â€Å" Good teachers are all around distinguished by students as the individuals who care † ( Day, 2009, p.5 ) . Instructors should esteem the impression of association and work turn in glove and cooperatively with guardians and collaborators to increase and advance children ‘s inclusion and basic idea. â€Å" Teachers need to set up positive connections dependent on civility, regular trust and detached speaking with guardians/f amilies and need to work turn in glove, parcel expertness and comprehension with collaborators † ( Groundwater-Smith, Ewing A ; Le Cornu, 2007, p. 334 ) . Great Teachs should work design great conduct, show warmth, energy and be stronger. Instructors have a cognizance of the cultural and social encounters of their researchers and make concrete larning encounters by providing an animating situation to do kids ‘s securing unequivocal. Instructors ought to adequately quantify, survey kids ‘s procurement, flexibly utile criticisms and feature the positive side of the researchers and part it with guardians. All the more significantly teachers need to tune in to their researchers and concede them consistently to advance and activate them. â€Å" Teachers can do seeable the children ‘s obtaining techniques and their ain guidance designs as they associate and tune in to kids † ( Taguchi, 2006, p. 262 ) . Great teachers will hold high viewpoints for their researchers and will take a comprehensive assault and fundamentally ponder their securing. â€Å" Having high standpoints of researchers and holding a very much educa ted program regarding activity is other than of import † ( Ball, Russell A ; Smales, 2005, p. 290 ) . What kind of situations upgrade student obtaining? I accept we should gracefully a sustaining and animating condition for the children to hold a feeling of having a place and uplift their front securing to do associations and straightforwardness cultural cooperations with rises to. Nature ought to approve them by providing opportunities to investigate for all encompassing turn of events. As instructors I accept the earth should esteem kids ‘s musings and parts and back up their dispositions. The assets ought to back up kids ‘s requests and obtaining. The children ought to be viewed as dynamic researchers and equivalent possibilities ought to be accommodated all understudies. â€Å" Teachers will require to create comprehensive assaults and a schoolroom situation where all children are esteemed as people in

Booth, John Wilkes

Booth, John Wilkes Booth, John Wilkes wilks [key], 1838â€"65, American actor, the assassin of Abraham Lincoln , b. near Bel Air, Md.; son of Junius Brutus Booth and brother of Edwin Booth . He made his stage debut at the age of 17 in Baltimore. He later toured widely, winning acclaim mainly for his swordplay and physical effectiveness in Shakespearean roles, rather than for his weak acting ability. Unlike the rest of his family, Booth was an ardent Confederate sympathizer. He had joined (1859) the Virginia militia company that guarded John Brown on his way to execution and falsely claimed to have aided in his capture, but Booth did not enter Confederate service in the Civil War. Instead, he continued with his theatrical career in the North. For some six months in 1864â€"65 Booth laid plans to abduct the president and carry him to Richmond, a scheme that was frustrated when Lincoln failed to appear (Mar. 20, 1865) at the spot where Booth and his six fellow conspirators lay in wait. On Good Frida y, Apr. 14, 1865, Booth, having learned that Lincoln planned to attend Laura Keene's performance of Our American Cousin at Ford's Theater in Washington on that evening, plotted the simultaneous assassination of the President, Vice President Andrew Johnson , and Secretary of State William H. Seward . Lewis Thornton Powell, who called himself Payne, guided by David E. Herold, seriously wounded Seward and three others at Seward's house. George A. Atzerodt, assigned to Johnson, lost his nerve. The main act the egomaniacal Booth reserved for himself. His crime was committed shortly after 10 PM, when he entered the presidential box unobserved, shot Lincoln, and vaulted to the stage (breaking his left leg in the process) shouting Sic semper tyrannis! [thus always to tyrants] The South is avenged! He then went behind the scenes and down the back stairs to a waiting horse upon which he made his escape. Not until Apr. 26, after a hysterical two-week search by the army and secret ser vice forces, was he discovered, hiding in a barn on Garrett's farm near Bowling Green, Caroline co., Va. The barn was set afire and Booth was either shot by his pursuers or shot himself rather than surrender. Although it has been said that no dead body was ever more definitely identified, the mythâ€"completely unsupported by evidenceâ€"that Booth escaped has persisted. For the fate of others involved, see Surratt, Mary Eugenia . See memoir by his sister, Asia Booth Clarke (1930, repr. 1971, 1996); biographies by R. G. and K. O. Gutman (1979) and G. Samples (1982); M. W. Kauffman, American Brutus: John Wilkes Booth and the Lincoln Conspiracies (2004); N. Titone, My Thoughts Be Bloody: The Bitter Rivalry Between Edwin and John Wilkes Booth (2010). The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2012, Columbia University Press. All rights reserved. See more Encyclopedia articles on: U.S. History: Biographies

An Introduction to Puritanism

Puritanism was a religious  reformation movement  that began in England in the late 1500s. Its initial goal was removing any remaining links to Catholicism within the  Church of England after its separation from the Catholic Church. To do this, Puritans sought to change the structure and ceremonies of the church. They also wanted broader lifestyle changes in England to align with their strong moral beliefs. Some Puritans emigrated to the New World and established colonies built around churches that fit those beliefs.  Puritanism had a broad impact on England’s religious laws and the founding and development of the colonies in America. Beliefs Some Puritans believed in total separation from the Anglican Church, while others simply sought reform and wished to remain a part of the church. The belief that the church should not have any rituals or ceremonies not found in the Bible united the two factions. They believed that the government should enforce morals and punish behavior such as drunkenness and swearing. However, Puritans did believe in religious freedom and generally respected the differences in belief systems of those outside the Church of England.   Some of the major disputes between the Puritans and the Anglican Church regarded the beliefs that priests should not wear vestments (clerical clothing), that ministers should actively spread the word of God, and that the church hierarchy (of bishops, archbishops, etc.) should be replaced with a committee of elders.   Regarding their relationships with God, Puritans believed that salvation was entirely up to God and that God had chosen only a select few to be saved, yet no one could know if they were among this group. They also believed that each person should have a personal covenant with God. The Puritans were influenced by  Calvinism and adopted its beliefs in predestination and the sinful nature of man. Puritans believed that all people must live by the Bible and should have a deep familiarity with the text. To achieve this, Puritans placed a strong emphasis on literacy and education.   Puritans in England Puritanism first emerged in the 16th and 17th centuries in England as a movement to remove all vestiges of Catholicism from the Anglican Church. The Anglican Church first separated from Catholicism in 1534, but when Queen Mary took the throne in 1553, she reverted it to Catholicism. Under Mary, many Puritans faced exile. This threat and the increasing prevalence of Calvinism—which provided support for their viewpoint—further strengthened Puritan beliefs. In 1558, Queen Elizabeth took the throne and reestablished the separation from Catholicism, but not thoroughly enough for the Puritans. The group rebelled and, as a result, were prosecuted for refusing to abide by laws that required specific religious practices. This factor contributed to the eruption of the English civil war between the Parliamentarians and the Royalists, who fought in part over religious freedom in 1642.   Puritans in America   In 1608, some Puritans moved from England to Holland. In 1620, they boarded the Mayflower to Massachusetts, where they established Plymouth Colony. In 1628, another group of Puritans founded the Massachusetts Bay Colony. Puritans eventually spread throughout New England, establishing new self-governing churches. To become a full member of the church, seekers had to testify of their personal relationship with God. Only those who could demonstrate a godly lifestyle were permitted to join.   The witch trials of the late 1600s in places like Salem were run by the Puritans religious and moral beliefs. But as the 17th century wore on, the cultural strength of the Puritans gradually waned. As the first generation of immigrants died out, their children and grandchildren became less connected with the church. By 1689, the majority of New Englanders thought of themselves as Protestants rather than Puritans, though many of them were just as sharply opposed to Catholicism. As the religious movement in America eventually fractured into many groups (such as Quakers, Baptists, Methodists, and more), Puritanism became more of an underlying philosophy than a religion. It evolved into a way of life focused on self-reliance, moral sturdiness, tenacity, political isolationism, and austere living. These beliefs gradually evolved into a secular lifestyle that was (and sometimes is) thought of as a distinctly New England mentality.

Henriette Delille New Orleans Religious Order Founder

Known for:  founding an African American religious order in New Orleans; the order provided education for free and enslaved black people, contrary to Louisiana law Dates:  1812 - 1862 About Henriette Delille: Henriette Delille was born in New Orleans between 1810 and 1813, most sources agree on 1812. Her father was a white man and her mother a free person of color, of mixed race. Both were Roman Catholics. Her parents could not be married under Louisiana law, but the arrangement was common in Creole society.   Her great great grandmother was among slaves brought from Africa, and she became free when her owner died.   She was able to earn enough to free her daughter and two grandchildren by payment for their freedom. Henriette Delille was influenced by Sister Marthe Fontier, who opened a school in New Orleans for girls of color. Henriette Delille herself refused to follow the practice of her mother and two siblings and identify as white. Another sister was in a relationship much like their mother had been, living with but not able to marry a white man, and having his children.   Henriette Delille also defied her mother to work with slaves, nonwhites, and whites among the poor of New Orleans. Henriette Delille worked within church institutions, but when she tried to become a postulant, she was refused by both Ursuline and Carmelite orders because of her color. If shed passed for white, she most likely would have been admitted. With a friend Juliette Gaudin, also a free person of color, Henriette Delille established a home for the elderly and bought a house to teach religion, both serving nonwhites. In teaching nonwhites, she defied the law against educating nonwhites. With Juliette Gaudin and another free person of color, Josephine Charles, Henriette Delille gathered interested women together, and they founded a sisterhood, Sisters of the Holy Family. They provided nursing care and a home for orphans. They took vows before Pere Rousselon, a white French immigrant, in 1842, and adopted a plain religious habit and a rule (regulations for living) written primarily by Delille. The sisters were noted for their nursing care during two yellow fever epidemics in New Orleans, in 1853 and 1897. Henriette Delille lived until 1862.    Her will gave freedom to a woman named Betsy who had been a slave owned by Delille until her death. After her death, the order grew from the 12 members it included at the end of her lifetime to a peak of 400 in the 1950s. As with many Roman Catholic orders, the number of sisters dwindled after that and the average age increased significantly, as fewer young women entered. Canonization Process In the 1960s, the Sisters of the Holy Family began exploring canonization  of Henriette Delille. They formally opened their cause with the Vatican in 1988, at which time Pope John Paul II recognized her as Servant of God, a first phase that can culminate in sainthood (the subsequent steps are venerable, blessed, then saint).   Reports of favors and possible miracles were reported, and investigations on a possible miracle were wrapped up in 2005. In 2006, after the Congregation for the Causes of the Saints at the Vatican received the documentation, they declared a miracle. The second of the four phases towards sainthood has been completed, with a declaration of Henriette Delille as venerable in 2010 by Pope Benedict XVI.   Beatification would follow once the proper Vatican authorities determine that a second miracle can be attributed to her intercession. Popular Culture In 2001, Lifetime cable premiered a movie about Henriette Delille, The Courage to Love. The project was promoted by and starred Vanessa Williams.   In 2004, a biography by Rev. Cyprian Davis was published.

Challenge in My Life How I Dealt with It Free Essays

I Just decided to take some medicine and went to bed. The pains still continue to happen the next day. So I went to the emergency room. We will write a custom essay sample on Challenge in My Life: How I Dealt with It or any similar topic only for you Order Now I told the doctor my situation. I had taken some x-rays. About thirty minutes later the results were back. The doctor had discovered a large mass In my stomach and wasn’t for certain. So I was recommended to the Broody School of Medicine. That place Is thirty minutes from where I live. The doctors there looked at my x-rays and did some more tests on me. The BOB-GUN had found an ovarian tumor on my ovaries. Then I was explained to that I was going to have immediate surgery. I never had a surgery before I was scared for my life. The doctors also mention that my being overweight that puts a risk with the surgery. The first thing I thought with that being stated I knew I was going to die. As the days went by I had to go the doctor every two weeks. It was like if I was having a baby. Matter of fact I look like I was pregnant with twins. I guess that was nothing but all that the fluid from the tumor. I would cry everyday and I became depressed. I began to get weak each and everyday. So I had to get a blood transfusion. I remember staying In the hospital the entire weekend. I did not want to all because it was holiday. It was Labor Day weekend. I wanted to stay home and enjoy my family. Once I had received the blood in my body I felt much stronger. Then it was time for my surgery. I remember my surgery was September 7, 2005. I was nervous, shaky and scared. My family was by my side. I remember waking up the next day after surgery. When I woke up I thought it was still Wednesday the day I had surgery. Scary right! I had all types of tubes and things I was hooked up to. I was in the trauma center in the intensive care unit. I felt awesome. God is so good. There was no pain my body. Everyday I still think about what I went through with the sickness that was In my DOD. There was so much pressure and pain all on the Inside In my body. The only thing I can’t do now Is to have kids. That still bother me but I am learning to overcome. I want to adopt children very soon. My plan Is to begin the adoption process when I am 30 years old. Has changed my life dramatically. Because if I didn’t have faith in me and God on my side I might be lying in my grave or my body will still be with pain. Challenges happen for a reason. It can be for good or bad. People are put to a test to overcome challenges. Most of all we deal the challenges and overcome it with a success. How to cite Challenge in My Life: How I Dealt with It, Papers

Challenge in My Life How I Dealt with It Free Essays

I Just decided to take some medicine and went to bed. The pains still continue to happen the next day. So I went to the emergency room. We will write a custom essay sample on Challenge in My Life: How I Dealt with It or any similar topic only for you Order Now I told the doctor my situation. I had taken some x-rays. About thirty minutes later the results were back. The doctor had discovered a large mass In my stomach and wasn’t for certain. So I was recommended to the Broody School of Medicine. That place Is thirty minutes from where I live. The doctors there looked at my x-rays and did some more tests on me. The BOB-GUN had found an ovarian tumor on my ovaries. Then I was explained to that I was going to have immediate surgery. I never had a surgery before I was scared for my life. The doctors also mention that my being overweight that puts a risk with the surgery. The first thing I thought with that being stated I knew I was going to die. As the days went by I had to go the doctor every two weeks. It was like if I was having a baby. Matter of fact I look like I was pregnant with twins. I guess that was nothing but all that the fluid from the tumor. I would cry everyday and I became depressed. I began to get weak each and everyday. So I had to get a blood transfusion. I remember staying In the hospital the entire weekend. I did not want to all because it was holiday. It was Labor Day weekend. I wanted to stay home and enjoy my family. Once I had received the blood in my body I felt much stronger. Then it was time for my surgery. I remember my surgery was September 7, 2005. I was nervous, shaky and scared. My family was by my side. I remember waking up the next day after surgery. When I woke up I thought it was still Wednesday the day I had surgery. Scary right! I had all types of tubes and things I was hooked up to. I was in the trauma center in the intensive care unit. I felt awesome. God is so good. There was no pain my body. Everyday I still think about what I went through with the sickness that was In my DOD. There was so much pressure and pain all on the Inside In my body. The only thing I can’t do now Is to have kids. That still bother me but I am learning to overcome. I want to adopt children very soon. My plan Is to begin the adoption process when I am 30 years old. Has changed my life dramatically. Because if I didn’t have faith in me and God on my side I might be lying in my grave or my body will still be with pain. Challenges happen for a reason. It can be for good or bad. People are put to a test to overcome challenges. Most of all we deal the challenges and overcome it with a success. How to cite Challenge in My Life: How I Dealt with It, Papers

Harry Potter and the Sorcerers stone Essay Example For Students

Harry Potter and the Sorcerers stone Essay The purpose of reading, once you get the hang of it, is not merely to follow the action of a plot, but to learn about the characters, explore different ideas and enter other minds. (Besotted with Potter, pg. 1) For many parents, witchcraft is dangerous and demonic. There is Good and Evil in the world. Times are changing and some believe children are now more vulnerable to deception than children of earlier times. This is clearly due to different times and culture, such as social activities influencing outcomes of many issues. Secondly, different types of fantasy, computer games, television and the media, movies and Books are all the birth of different imagination. Depending on the source of the childs imagination, specific bias, morals and values are reflected upon the childs feelings and imagery. Thirdly, different kind of classroom and education system where multicultural education and the global community call for a common set of values disclosing traditional beliefs and narrow minded opinions. There is much good in childrens books, capturing a world where strength, courage, hope, wisdom, and love strongly exist. Children seek affirmation of the goodness of life through the books they read. Children are simply different in their exploration for they lack experience and they carry a high overwhelming self-interest. Their basic ability to logic assumes the child must ultimately rely on his own understanding of this world. Fear of failure in certain circumstances may arise and thus he makes the storys action crucially important. Fiction, particularly fantasy creates these circumstances for his consideration. In a society adults and children must work together for the safety and self-realization of all. No individual can find self-realization at a cost of others, or a hierarchical system for society will fail. This is where realistic fiction differs from fantasy fiction; realistic fiction promises child self-realization within boundaries; whereas fantasy creates limitless possibilities for adventure and creativity. Books have magic in them, whether its magic of Shakespeare and Coelho or Lewis Carroll and Harry Potter. Whether its the bible or the Quraan, one may find magic in his own way of life through fantasy or realism. Show preview only

Capital Punishment Essays (1789 words) - Capital Punishment

Capital Punishment Capital Punishment Each year more and more people are added to death row. The death penalty is currently the harshest form of punishment enforced in the United States. The death penalty and its methods have become a controversial issue as death row becomes very populated. Important aspects of Capital Punishment are the methods of execution, costs, and the pros and cons. The death penaltys interesting history has made it what it is today. People who are against the death penalty say that it is immoral and no person should be sentenced to death (Winter 61). It has no place in a civilized society, and since the death penalty cannot be racially biased it should be banished. But people who favor the death penalty say that the criminals deserve it, and it is the only way for justice to be served. Major costs have always been an important factor when debating capital punishment. The death penalty is more expensive than life imprisonment. Lawyers are paid an extensive amount of money to keep appealing to the courts. These appeals delay the date of procedure, costing more money for taxpayers, but if there were a limit on the number of appeals allowed, the cost of the death penalty would be greatly reduced. In the end, it would cost even less than life imprisonment. It is irreversible and can be inflicted upon people who are innocent and there is no chance to make restitution to the victim and/or the victims family. Those people, who did commit felonies, deserve to be executed, and if not for capital punishment then they would be let off without paying fully for their crime. Most of the people executed are rightfully prosecuted, and it is very unlikely to make that mistake. There have been many problems concerning capital punishment. The process of convicting a felon and sentencing them to death is very long. With the conviction and sentencing always comes appeal by the convicted. The constant appeals can lead to years in court, which costs millions of dollars. This is where the problem with a convict not seeing the death penalty as a punishment for their actions. Some people might say to give the murderer life in prison. This is hardly a punishment at all. (McCuuen 28) Today, due to overcrowding in prisons, many prisoners do not serve their full sentence. Another thing about todays prisons is that the prisoners get free meals, clothes, bed, electricity, air conditioning and heating, cable and many other luxuries that make it a comfortable place to live if you get used to the people. The death penalty should be given the day after conviction. Many people believe that criminals live in prison off other peoples hard earned money. The cost keeping a person on death row and the many years, sometimes as many is twenty-five is excessively high. With new methods of presenting evidence of D.N.A., the process needs to be sped up to make the death penalty to be a more effective deterrent. Deterrence is defined, as the punishment should fit the crime.(Draper 72) Under this concept, the individual committing the crime and society are prevented from committing this action again. In the case of the death penalty, an individual kills another human and he is punished for it by death. Punishment is supposed to be a temporary penalization for a wrongful action. Death is far from temporary. One is to learn from one's mistakes. By imposing the death penalty, the individual does not learn from their mistakes and neither does society. Race continues to play an unacceptable and powerful role in capital punishment. In state death penalty cases, the race of the victim is much more important than the prior criminal record of the defender or the actual circumstances of crime. More than half of those inmates on death row are people of color, although they represent only 20% of the people of the U.S although they are about 6% of the U.S population, about 40% of those on death row are African American (Cole 33). The last problem that should be observed is that of innocence. At least twenty-three people in America have been executed who did not commit the crime they were accused of (McCuuen

The Benefits of Going Greek in College

The Benefits of Going Greek in College Weve all seen the movies and stereotypes in the media about students who join fraternities or sororities during their time in college. But given the millions of students who have gone Greek over the years, there must be some benefits, right? Despite the negative images of college Greek life, many Greek organizations have quite a lot to offer, both during and after your time in school. If youre thinking of joining a fraternity or sorority, consider the following benefits as you decide if going Greek is right for you: 10 Benefits of Going Greek in College 1. The high level of camaraderie with fellow members: The friendships you build through a fraternity or sorority often have a different feel to them than other friendships you make during your time in school. Perhaps its because of your shared values or your shared experience as members of your Greek organization. Regardless, youre likely to make strong, personal friendships that can last well past graduation day. 2. Lots of community service opportunities: Many Greek organizations are heavily involved in community service. Your Greek house may require a certain amount of volunteering each semester or may have an annual event that raises funds for a community non-profit. If youre interested in giving back during your time in school, a fraternity or sorority can offer you a lot of different options for doing so. 3. An academic support network: Even the newest college student knows to ask around when it comes to getting the skinny on classes, professors, and majors. And with the wide range of students that are members of a fraternity or sorority, you instantly have access to all kinds of knowledge about which professors, classes, and departments are the best. Additionally, if youre struggling in a class, your fraternity brothers or sorority sisters can be a great resource for tutoring and other academic advice. 4. A professional network after graduation: Many, if not most, Greek organizations offer networking opportunities to their members long after their college years. You can tap into alumni networks and make professional connections that might not have been available otherwise. 5. A wide range of leadership opportunities: Fraternities and sororities require a lot of work given their high levels of involvement and programs. Because of this, there are often multiple leadership opportunities available each year. Even if youve never held a leadership position before, testing out your leadership skills within your Greek house can be a great way to develop some skills and give back. 6. An endless stream of learning opportunities: One of the best benefits of going Greek is the wide range of learning opportunities youll be presented with. Youll meet all kinds of new people; youll participate in all kinds of new experiences; youll be presented with all kinds of new ideas. From formal, structured events to casual conversations in the house kitchen, fraternities and sororities are always challenging their members to do, learn, and act more. 7. An additional housing option: Not sure if you should live on or off campus next year? If your fraternity or sorority has a house on or near campus, the housing benefits alone might be one of the main reasons to join. You can have all of the benefits of being close to campus without all the chaos of living in a residence hall. Additionally, youll be able to build even stronger connections with your fellow sisters or brothers if you choose to live in your Greek house. Whats ​not to like? 8. There are often scholarships available: If youre a member of certain Greek organizations, you may be eligible for scholarships or other financial aid. Additionally, if youre worried about the cost of joining a fraternity or sorority, many have scholarships available to members who have trouble paying annual dues. 9. Becoming a part of a long-standing tradition: If youre on an older campus, your membership in a historic Greek fraternity or sorority might make you part of a very old, long-standing tradition. And if youre on a new campus or joining a new(er) fraternity or sorority, youre lucky enough to be at the start of something great. Either way, theres something to be said for having a role in a tradition that has stood the test of time. 10. The chance to prove stereotypes wrong: The way fraternity and sorority members are portrayed in society is unfortunate, especially given the amazing things these students do each and every day. Your role as a fraternity or sorority member gives you a great opportunity to prove these stereotypes wrong. The friendships you make, the community you build, volunteer work you do, and programs you put on can be part of a great college experience that embodies all that going Greek has to offer.

POVERTY AND STUDENT ACHIEVEMENTS Article Example | Topics and Well Written Essays - 750 words

POVERTY AND STUDENT ACHIEVEMENTS - Article Example This article looks at very important issues which are important to note in every way. The paper also tackles some issues which are very pertinent in the issue of poverty and education. It looks on the issue of social services, the definition of poverty and the need to protect families from indigenisation arising from depending on social services. This paper was written in the knowledge that of all the issues which affect the students such as race and ethnicity, poverty is the most difficult to understand because it is not discreet. In this regard, it becomes very difficult to know exactly when a child requires help in order to help them to not be affected by poverty. One of the major and most important factors which come out from this paper is the fact that it was revealed that the issue of poverty cannot be solved by money alone. In the Gift of Education Project, it become apparent that just giving the students financial aid did not help in making the students to be able to overcome the challenges poverty was giving them. This is a very important finding as it has very far reaching implications and to which solutions must be developed on order to make sure that it is possible to develop good solutions about the issue of poverty. ... r shows that it is necessary to understand that poverty is not just the absence of money of economic necessities, but rather that poverty is something that goes way beyond the issue money. This is important for policy makers in government in order to help them develop better ways of addressing the issue of poverty in schools. The authors also look at the relationship between poverty and race as well as locale. This is an important element and may be a good platform to create solutions to deal with the issue of poverty. The paper defined and determines some very strong links relating the economic abilities of families and their race as well as the location of a school or the students. This brings a new element to the issue of race and it is necessary to identify the need deal with poverty in a different manner. This study took a quantitative way of looking at the issue of poverty. Although 17% of all children under the age of 18 were in poverty, the study broke the numbers down to ind icate that children from African-American families were the most affected by poverty with as much as 33% of them being from families in poverty. While it is good to identify race related numbers with regard to student poverty, the authors however have not clearly indicated why these numbers are necessary and how why these numbers cna be utilised to punch out these issues. More importantly, the article tackles the issue of the difficulty of identifying big academic talent from poor families. The authors indicate that it is not easy for authorities to be able to identify those students with high academic potential who would then be given the support they need in order to prevent the academic talent from going to waste. While this is true in some ways, the authors have not been able to be

Week 7 questions Essay Example | Topics and Well Written Essays - 1000 words - 1

Week 7 questions - Essay Example He has seemed depressed, often a few minutes late for work, low-energy. One of Mitchs coworkers mentioned to you that Mitch told him he "just wanted to blast everybody", and at another time he "just wanted to close the door and turn off the lights." The coworker is concerned about Mitch. What should you do? As a supervisor of 10 employees, I have the responsibilities about their safety and health. I will talk to Mitch and will so that I would know his condition and if I found out that he is not really capable of working along with the other employee’s advice to leave will be highly recommended until he will be ok and ready to work again. As an employee he has the responsibilities to work safety along with the other employees and I do also have the responsibilities of protecting all my employees as a supervisor especially inside the premises of the workplace. Employers and employees have corresponding responsibilities to each their while in the workplace and I think it would just be relevant to give justice equally to all the members of the organization. You are the HR person for Midwest Aviation, a company that provides private charter flights and maintenance services for private planes. The safety guidelines and regulations require that pilots and maintenance people wear belts, harnasses, and other safety gear when performing their jobs in and around the airplanes. You know - from first hand experience as well as what others have told you - that most times they dont wear the safety gear. "It gets in the way," is the reason given. "Weve been doing it this way for years and nobodys been hurt yet," they say. Short of threatening to fire people, what are some ways you could motivate them to follow the safety procedures? Some of the ways I can do to be able to convince them to follow the safety procedure is that, I will try to talk to the high ranking position of

Gift Card Bring Advantages And Disadvantages

Gift Card Bring Advantages And Disadvantages A discussion text can be defined as a text which presents a problematic discourse. This problem will be discussed from different viewpoints. Discussion is commonly found in philosophical, historic, and social text. Generic Structure of Discussion The structure of a discussion text comprises: Statement of issue: Stating the issue which is to discussed; List of supporting points: Presenting the points in supporting the presented issue; List of contrastive points: Presenting other points which disagree to the supporting point; Recommendation: Stating the writer recommendation of the discourse Language Feature of Discussion Introducing category or generic participant Using thinking verb; feel, hope, believe, etc Using additive, contrastive, and causal connection; similarly, on the hand, however, etc Using modalities; must, should, could, may, etc Using adverbial of manner; deliberately, hopefully, etc Example 1 Hacking: Pro and Contra? Do you know what a hacker is? Well, a hacker is a person who enjoys exploring the details of programmable systems on computers and they like to stretch the capability of the systems. And you know what, the activities they do in the computers are called hacking. So, whats the problem with hacking and its hackers? Well, the problem is whether hacking and its hackers is legal or illegal? What I mean is that people in the world have many different views about hacking and the hackers. Some of them take sides, but many object. To get back to what I was saying previously, let us see the positive points of a hacker, shall we? Although in most places breaking into computer systems is considered illegal, I believe that hackers dont do anything illegal because they only want to know and try the systems. I dare to say that a hacker likes finding the strengths and the weaknesses of a computer system. They feel proud if they can find the weaknesses. So I dont really see the crimes in this case. In addition, these hackers sometimes help the police catch the white collar criminals, such as bank robbers, money launderers, credit card forgers. For example, in 2000, the U.S. hackers caught some Singaporean hackers who made Virus Love to break up the programs of the U.S. National Security system. Nevertheless, those who object to the good points of a hacker say that hacking is a crime. The reason is that some hackers use their brilliant skills to break into banks and other vital institutions where they can get money, destroy information, and the worst thing is they can get secret information and sell it to another country. This is a treachery. Take for example, in 1994, The U.S. government broke a conspiracy of computer hackers out of Majorca, Spain. These hackers were responsible for accessing and eliminating 190,000 telephone credit card numbers over computer bulletin boards in America and Europe. Seeing this fact, I dont blame those who think negatively about hackers. To put the whole thing in a nut shell, I personally think that hackers are not bad people with their brilliant skills. However, they could be bad because of money orientation to get the wealth. Thats just the point. Comprehension Questions: What is the main idea of the text? Where is the information about the main idea located? What supporting details can be found in the text? What is the function of the text? How do you know? What are the generic structures of the text? Can you identify each of the feature (generic structure) in the text? In which sentence? What are the language features of text? Example 2 Birth Control Most people agree that some form of family limitation or spacing is desirable for the good of the family and society. But individuals and groups-especially religious groups-differ sharply on the methods of birth control that they consider moral and acceptable. Couples that practice birth control do so for various reasons. They may want to limit or space their children, or to have no children at all. Young couples often postpone having children so that both partners can work full-time. Other couples space their children so they can give each child as much attention as possible. Some women are advised by their doctors to avoid pregnancy for health reasons. In many countries with rapidly growing populations, the government encourages couples to limit the size of their families. Even though birth control has gained in acceptance, opposition to the practice is continuous. Some people fear that birth control encourages sexual relations outside marriage or that government might impose birth control. Some religious groups oppose birth control on moral grounds. Some religious groups teach that artificial methods of birth control are immoral because they separate the two purposes of intercourse in marriage-conjugal love and the procreation of children. Although they oppose all artificial birth control, they consider natural family planning acceptable. Comprehension Questions: What is the main idea of the text? Where is the information about the main idea located? What supporting details can be found in the text? What is the function of the text? How do you know? What are the generic structures of the text? Can you identify each of the feature (generic structure) in the text? In which sentence? What are the language features of text? Example 3 Convenience or Care? When something issued by someone, we say it has been consumed. We as consumers use many things, both natural and processed. We consume more of the Earths resources than other animals do and, as a result, we cause problems for the environment. Like all animals, we need clean air and water, food and shelter for survival. Unlike other animals, however, we have certain want. These are items that are not necessary for our survival, but that we want because they make our lives easier or more enjoyable. Environments claims that a great deal of waste is created by both the production and the consumption of these items or product. Disposable products, such a pens, take away food containers, plates, shavers and cutlery, are made using the Earths resources. When these products are thrown away, the resources are lost. Another example of waste is the unnecessary packaging on many products. The material is often not recycled and used again. Throwing thing away also increases pollution. The amount of disposable plastic litter that ends up in waterways is a serious problem. When this waste reaches the oceans, it can kill marine life. Industrialist counter these arguments with their own point of view. They claim that consumers expect to be able to purchase food which is attractively presented, prepackaged to extent its life and easy to store. In a busy society, convenience is a priority. Products which make life easier, era in demand. Industrialist argue that they cater to this perceived need. Packaging is also big business and provides jobs for many people who might otherwise be unemployed and a burden to society. Environmentalist declare that for thousands of year, people survived perfectly well with re-usable products. However, people of the twenty-first century have become used to wing in a thrown-away society. It is up to each one of us to dispose of waste products carefully, recycle as much as possible and to reduce the stress on our environment. Think when buying pre-packaged goods and consider whether the same products can be bought without the extra wrappings. Lets make the best of what we have. Comprehension Questions: What is the main idea of the text? Where is the information about the main idea located? What supporting details can be found in the text? What is the function of the text? How do you know? What are the generic structures of the text? Can you identify each of the feature (generic structure) in the text? In which sentence? What are the language features of text? Example 4 Gift Card Bring Advantages and Disadvantages Gift cards become more popular during recent years. For example, in one season of holiday, sales reach $19 billion in United Stated and seem to grow more in the following season due to their convenience in the side of consumers and retailers. In retailers side, gift cards bring them some benefits. Selling gift card in simply selling product. When the cards are sold, they will get benefit. Additionally, gift card tends to be a matter of image and trend which means it is not strictly influenced by the functionality. Since gift card is the trend, the sales will increase significantly. However, there is potential disadvantages in the side of consumers. For example, itune gift cards apply process in the way of completing the shopping. they need do one step to another steps in processing the shopping. Likely, most of the steps apply time and date of validity or expiration. When certain step loose that validating date, the gift cards may be in risk. The gift card can be rejected to redeem. Again, in retailers side, producing card its self is costly. It means that there is additional cost which retailers have to pay. In whatever thing, we need to be wise. if we can use that gift. Comprehension Questions: What is the main idea of the text? Where is the information about the main idea located? What supporting details can be found in the text? What is the function of the text? How do you know? What are the generic structures of the text? Can you identify each of the feature (generic structure) in the text? In which sentence? What are the language features of text? Example 5 The advantages and Disadvantages of Distance Learning A few years ago, distance learning was seen as an inferior way but nowadays even famous and established traditional colleges and universities are providing distance learning courses and it is generally considered a way to improve ones life. However, people still argue whether distance learning give more advantage or disadvantage. Some of them who see the benefit of distance learning will say that distance learning needs no commuting. Of course it saves money and time that students would take. Furthermore, distance learning can be done at any students convenience. Mostly of the classes of distance learning are asynchronous. It means that students do not have to attend a lecture at a fixed particular time and place. Students can review the assignments and do their homework during off-hours or from home. Additionally, distance learning gives more accessibility. No one can deny it. People with limited mobility may encounter the problem when they take traditional class. With the online class system, the problem is absent. Despite the many advantages, the other people will see that distance learning is costly and needs complex technology. To attend online learning, student must have a computer with possibly access to the internet. Admitted or not, such technology devices are not always available for common students. Another disadvantage of distance learning is that it does not provide immediate feedback. Unlikely traditional classroom, students have to wait for the feedback and comment until the instructor has review the works and sent response to them. Most of the time students will study alone. Distance learners may feel isolated or miss that social physical interaction that comes with attending a traditional classroom Regarding the individuals learning style, some students are able to learn when there is a live interaction between them and the available of accompanying teacher while others dont really need it. So before deciding a choice of attending distance learning or not, each student needs to do a fair analysis regarding the kind of person he/she is. Comprehension Questions: What is the main idea of the text? Where is the information about the main idea located? What supporting details can be found in the text? What is the function of the text? How do you know? What are the generic structures of the text? Can you identify each of the feature (generic structure) in the text? In which sentence? What are the language features of text? Example 6 Pros and Cons National exam becomes the hot topic in most of discussions. Though the Supreme Court has rejected an appeal by the go-vernment on the organization of the national exams, the controversy over whether it is necessary to maintain the national exams (UN) has continued. Some debates include the primary questions such as; does the quality of Indonesia education depend on the national exam?, will the quality of the Indonesian education system worsen without natipnal exam? People, who support the national exam explain that the quality of the Indonesia education system will drop without the national exam, so they try to defend the current system. Hoever there are people who disagree with the opinion. Those who against this national exam kept in our high school education say that it doesnt need the national exams because the quality of education does not just depend on the national exam. Further, the national exam only measures a small portion of students competence in specific subjects, and does not measure students competences throughout the semester. In fact, the national examination can still be useful as an instrument to evaluate or detect the level of students cognitive competence in several subjects, on a national scale. Comprehension Questions: What is the main idea of the text? Where is the information about the main idea located? What supporting details can be found in the text? What is the function of the text? How do you know? What are the generic structures of the text? Can you identify each of the feature (generic structure) in the text? In which sentence? What are the language features of text? Example 7 The Advantage and Disadvantage of Nuclear Power Nuclear power is generated by using uranium which is a metal mined in various part of the world. The first large scale of nuclear power station was opened at Calder Hall in Cumbria, England in 1956. Some military ships and submarines have nuclear power plant for engine. Nuclear power produces around 11% of the worlds energy needed, and produces huge amounts of energy. It cause no pollution as we would get when burning fossil fuels. The advantages of nuclear plant are as follow: It costs about the same coal, so it is not expansive to make. It does not produce smoke or carbon dioxide, so it does not contribute to the greenhouse effect. It produces huge amounts of energy from small amount of uranium. It produces small amount of waste. It is reliable. On the other hand, nuclear power is very, very dangerous. It must be sealed up and buried for many years to allow the radioactivity to die away. Furthermore, although it is reliable, a lot of money has to be spent on safety because if it does go wrong, a nuclear accident ca be a major accident. People are increasingly concerned about this matter. In the 1990s nuclear power was the fastest growing source of power in many parts of the world. Note on the Generic Structure of Discussion Text Discussion is a process to find the meet point between two different ideas. It is important to to get the understanding between the two differences. In many social activities, discussion is the effective way to calm down any friction and difference in thought, perception and recommendation. This example of discussion text present the two poles, between the advantage and disadvantage of using nuclear plant to fulfill the energy needed. It is a case which need to be talked and discussed from two points. They are represented in the generic structure which is used: Stating the Issue: In the first paragraph, it is stated that using nuclear power can be the choice in fulfilling the needed energy. Supporting Point: In the second paragraph, it is presented the advantages of nuclear power plant to be used as the source of the worlds energy needed Contrastive Point: The third paragraph shows the balance. It gives the contradictory idea in using nuclear power plant as the resource of energy. Recommendation: This text is ended with a similar recommendation on how people should concern in the matter of nuclear energy. Comprehension Questions: What is the main idea of the text? Where is the information about the main idea located? What supporting details can be found in the text? What is the function of the text? How do you know? What are the generic structures of the text? Can you identify each of the feature (generic structure) in the text? In which sentence? What are the language features of text? Example 8 Hunting Fox Foxhunting is a subject that provokes very strong feelings. Many people believe that it is cruel to hunt a fox with dogs and totally agree with its ban. Many farmer and even conservationists, however, have always argue that the fox is a pest which attacks livestock and must be controlled. (Taken from: www.bbc.co.uk) Comprehension Questions: What is the main idea of the text? Where is the information about the main idea located? What supporting details can be found in the text? What is the function of the text? How do you know? What are the generic structures of the text? Can you identify each of the feature (generic structure) in the text? In which sentence? What are the language features of text?

Periodontics

Tissues of the periodontium (Chapter 2) Periodontium * The tissues that surround, support, and attach to the teeth Components of the periodontium 1. Gingiva 2. Periodontal ligament 3. Cementum 4. Alveolar bone Function of the periodontium * To support the teeth and oral structures The gingiva * The visible component of the periodontium inside the mouth * Described as: pink, pink-red, blue, purple, or pigmented * It can appear much darker when melanin pigmentation is present * Factors that mask the color change of gingiva: * Food * Medications The three types of gingiva 1. Free gingiva 2. Attached gingiva 3.Alveolar mucosa Mucogingiv al junction * Appears as a line that marks the connection between the attached gingiva and the alveolar mucosa Alveolar mucosa * The moveable tissue loosely attached to the underlying boe * It is attached but moveable * The surface is smooth and shiny Attached gingiva * Extends coronally from the mucogingival junction * It is continuous with the oral epit helium and is covered with keratinized stratified squamous epithelium * It is firmly attached to the alveolar bone unlike the free or marginal gingiva * It DOES have attachment fibers, which is why on the lingual aspect of maxillary teeth the ttached gingiva will blend with the attached palatal mucosa Rete pegs * Ridges of epithelium that form the connection between the free or attached gingiva and the underlying connective tissue * If gingiva is healthy, it appears stippled, which is due to the rete pegs * If gingiva is not healthy, it will appear flat and shiny, due to a lack of rete pegs Function of rete pegs 1. Add strength to the gingiva 2. Nourish the gingiva Free gingiva or free marginal gingiva * Surrounds the tooth and crests a cuff or collar of gingiva extending coronally about 1. mm * Usually a groove called the free gingival groove demonstrates the free marginal gingiva from the attached gingiva * Appears to be attached to the tooth but maybe separated by an instrument l ike a periodontal probe Gingival sulcus or crevice * A crevice or groove around each individual tooth * Sulcular epithelium is the continuation of the oral epithelium covering the free gingiva * Healthy sulcus is 1 to 3 mm probing depth Sulcular or gingival crevicular fluid * Liquid in the gingival sulcus Components diffuse through the basement membrane and the junctional epithelium Components of crevicular fluid 1. Connective tissue 2. Epithelium 3. Inflammatory cells 4. Serum 5. Microbial flora Functions of the crevicular fluid 1. Cleanses the sulcus 2. Antimicrobial action 3. Plasma proteins improve adhesion of the epithelium to the teeth 4. Antibody activity to defend the gingiva Junctional epithelium * Separates the periodontal ligament form the oral environment * Protects the attachment to the tooth to the surrounding tissues * Approximately 15-20 cells If the base of pocket is damaged, it takes 4-6 weeks to heal Interdental papilla (interdental gingiva/gingival papilla) * The gingiva that fill embrasure spaces, which is the interproximal space beneath a contact point of 2 teeth * Shape depends on the teeth it is between but we generally consider the papillae pyramidal or triangular * In health, it should fill embrasure and the tip pointed, not blunt or swollen * Other descriptions: pointed, bulbous, blunted, absent, or cratered Col Depression between the lingual and facial papillae in posterior teeth that conforms to the proximal contact area * Usually absent in anterior teeth because of the lack of lingual facial width at most coronal portion * Often susceptible to infection because of its non-keratinization Keratinization * The process whereby keratinocytes migrate from the basal layer of the epithelium to the surface and flatten out in the process * These flattened cells produce a superficial layer that is similar to skin where no cell nuclei are present * Least common form of epithelium in oral cavityOral epithelium * The oral cavity is primarily ma de of stratifies squamous epithelium cells * The majority of cells are keratinocytes and melanocytes which produce melanin which gives the gingiva a pigmented appearance (dark brown) Parakeratinized * The epithelium appears keratinized but the cells of the superficial layers retain their nuclei * Lightly keratinized (dorsal surface of tongue) Non-keratinized * No signs of keratinization (no keratin) are present (epithelial surface) Keratinized| Non-keratinized|Palate (most)| Sulcular epithelium| Tongue| Alveolar mucosa| Attached gingiva| Junctional epithelium| Oral epithelium| Cols of papillae| Cheeks (least)| Buccal mucosa| Components Gingival epithelium 1. Oral epithelium 2. Sulcular epithelium 3. Junctional epithelium Normal â€Å"healthy† gingiva Color| Uniformly coral or light pink varying with thickness and degree of keratinization may also vary due to amount of melanin (pigment)| Size| Fits snuggle around the tooth, not enlarged when healthy| Contour| 1.Marginal gingiv a: flat/knife edged 2. Papilla: 1. Pointed and pyramidal in normal contact 2. Blunted/absent if diastema is present| Texture| 1. Free gingiva: smooth 2. Attached gingiva: stippled of rete pegs| Consistency| Firm and resilient (bounces back quickly)| Bleeding| No spontaneous bleeding upon probing| Exudate (pus)| None| Probing depth| Average is 1. 8mm (0-3mm is the normal range)| Periodontal ligament * Fills the space between the cementum and bone * Remember that teeth have a â€Å"shock absorbing cushion† space of 0. -1. 5 mm next to the bone and they are not rigidly fixed in their sockets * The attachment apparatus consists of: 1. Alveolar bone 2. Periodontal ligament 3. Cementum * The fibrous connective tissue that surround and attaches the roots of the teeth to the alveolar bone * This connective tissue is made of fiver bundles (mainly collagen) and cells * The fiber bundles in the PDL are made of collagen arranged in bundles and spread throughout the PDL Function of the pe riodontal ligament 1.Maintains the relation of a tooth to hard/soft tissues 2. Supplies nutrients and removes waste via blood and lymph vessels 3. Protect the vessels and nerves from injury 4. Resists occlusal forces (shock absorbers) 5. Transmits occlusal forces to the bone Sharpey’s fibers * The terminal brush-like fibers of the principle fiber bundles in the periodontal ligament that are partially inserted into the outer portion of the cementum at 90 degrees and then attached to the alveolar bone at the other end Five principal fiber groups of the periodontiumApical fibers| * Run from the root apex to adjacent surrounding bone * Function: to resist vertical forces| Oblique fibers| * Run from the root above the apical fibers obliquely toward the occlusal * Function: to resist vertical and unexpected strong forces| Horizontal fibers| * From the cementum in the middle of each root to adjacent alveolar bone * Function: To resist intrusive forces| Alveolar crest fibers| * From the alveolar crest to the cementum just below the CEJ * Function: to resist intrusive forces| Interradicular fibers| * Run from the cementum between the roots of multi-rooted teeth to the adjacent bone * Function: to resist vertical and lateral sources| Cementum * Outer most layer of the root of a tooth * Helps anchor the teeth * Made of a mineralized fibrous matrix (collagen and fibers) and cells (cementoblasts and cementocytes) * Attaches teeth to the alveolar bone b anchoring the periodontal ligament * No vascular or nerve connections * Cannot transmit pain, therefore not sensitive to scaling procedures * Renewable Cementoenamel junction * The junction point between enamel and cementum * Not always smooth, can be due to alterations in cemented surface and the tissues involved Three scenarios occur at the CEJ 1.Cementum will overlap enamel (60%) 2. Cementum and enamel meet (30%) 3. Cementum and enamel fail to meet leaving a narrow zone of exposed dentin (10%) Alveolar process * Su pport system for teeth * Extensions of the bone from the body of the mandible and maxilla * Lines the sockets of the teeth and provides support for the sockets * The walls of the sockets are called the lamina dura * The process also provides attachments for the periodontal ligament Components of the alveolar process * Alveolar bone * Compact bone * Trabecular and cancellous bone The alveolar process functions as a unit, as indicated by it’s gradual resorption when teeth are lostCurrent concepts of microbiology and periodontal disease (chapter 4) Microorganism * Microscopic living organisms which include bacteria, viruses, and fungi * Bacteria: single-cell * Viruses: very small and not capable of growth or reproduction without living hosts * Fungi: plant-like organisms that occur as yeasts or molds Bacterial classifications 1. Morphologic forms (shape) 2. Cell wall structure 3. Oxygen environment 4. Metabolism 5. Motility Morphologic forms (shape) * Involved in plaque biofilm formation 1. Cocci: spherical, most common form in plaque is streptococci 2. Rods or bacilli: generally rectangular or rod like 3. Spirochetes: spirals Cell wall structure Bacteriologic technique (gram staining) of using a double dye staining system to differentiate the structure of the cell walls * Two wall types: 1. Gram positive: stains purple (crystal violet dye applied first) 2. Gram negative: stains red (safranin dye applied second) Oxygen environment Aerobe/Aerobic organism| Requires oxygen to live and grow| Anaerobe/Anaerobic organism| Grows in complete or almost complete absence of oxygen| Facultative anaerobic organism| Can use oxygen when present but can use anaerobic fermentation when oxygen is absent| Obligate anaerobe| Cannot survive in an aerobic environment| Aerotolerant anaerobes| Grow in both types of environment| Capnophile| Requires or prefers carbon dioxide for growth| Metabolism The sum of total of chemical changes occurring in the body; chemical process of tra nsforming foods into complex tissue elements and or transforming complex body substances into simple ones, along with the production of heat and energy * Anabolism: The building up of tissue; maintenance and repair of the body * Catabolism: The breaking down of tissue into smaller parts from energy production and excretion Motility * Bacteria either are or aren’t motile * Flagella are long fine wavy filamentous structures used for motility * May have one or more flagella * Flagella may be located at either end, both ends, or encircling cell Microbial succession * Flora: organisms together in a locale * Oral flora: various bacterial and other microscopic organisms that inhabit the oral cavity Normal oral flora * Predominant microorganisms present in healthy state: * Streptococcus mitis * Actinomyces species Streptococcus oralis (sanguis II) Dental plaque: â€Å"The cause† * Dental plaque is THE major etiologic factor in the initiation and progression of periodontal dise ase * Epidemiologic studies have shown that poor oral hygiene increases the prevalence and severity of periodontal disease * Microorganisms other than bacteria can be found in plaque (ex. yeasts, protozoa, and viruses) * The difference between dental plaque and material alba is the strength/adherence of the deposit * Material alba is loosely adherent, soft accumulations of bacterial/cellular debris and can be removed by mechanical action (ex. strong water) The definition of dental plaque (Not on test) An accumulation of bacteria on the surface of teeth or other solid oral structures and is not readily removed Plaque formation: 3 stages 1. Pellicle formation * The acquired pellicle forms on the tooth surface * It is acellular * It is an organic and tenacious film composed of glycogen proteins from saliva * It will start to form within minutes after a tooth surface is entirely polished 2. Bacterial colonization * Bacteria from indigenous oral micro flora attach to the pellicle and for m microbial colonies in layers as the bacteria grow and multiply * An intermicrobial substance is formed mainly from saliva and from polysaccharides produced by certain bacteria from sucrose or sugar in the diet 3. Plaque Maturation As plaque ages, a change in the types of microorganisms occurs within plaque * Plaque that is up to 2 days old consists primarily of cocci * By 2-4 the filaments replace the cocci * By days 4-7, filamentous forms increase and rods and fusiform bacteria appear * By 7-14 vibrios and spirochetes and more gram negative and anaerobic microorganisms appear * Bacterial plaque, if not mechanically disturbed, produces a great proportion of those microorganisms associated with periodontal disease Dental plaque growth * After the first day of plaque growth, gram (+) streptococci decrease in number * During the next 3 weeks of undisturbed plaque formation, cocci continue to decrease because of an increase in filamentous bacteria.These filaments actually invade and r eplace many of the streptococci that inhabit the deeper levers * As plaque increase in thickness, further changes occur in the environment * When plaque is allowed to grow undisturbed, it becomes more anaerobic * The level of oxygen diminishes as a result of O2 consumption by facultative organisms * This lowers 02 level and allows the growth of obligate anaerobes * A more mature plaque harbors increasing number of obligate anaerobic organisms such as spirochetes and gram (-) rods * At this point, no additional bacterial species join the plaque, although the volume of bacteria may continue to increase * Mature plaque has the potential to invade the subgingival space and to cause localized gingival disease Page 74 (figure 4-9) The difference between supra/subgingival plaque Characteristic| Supragingival| Subgingival|Location| * At or above (coronal to) the margin of the free gingiva| * Apical to the margin of the free gingiva, between tooth and gingival pocket epithelium| Origin| * Sa livary glycoproteins form pellicle * MO’s from saliva are selectively attached to the pellicle| * Apical growth of bacteria from supragingival plaque| Distribution| * Starts on proximal surfaces * Heaviest on areas not cleaned daily by patients * Cervical 3rd * Lingual mandibular molar * Pits and fissures| * Shallow pocket * Attached plaque covers calculus * Unattached plaque extends to the periodontal attachment| Adhesion| * Firmly attached to acquired pellicle, other bacteria and tooth surfaces| * Adheres to tooth surface: calculus| Sources of nutrientsFor bacterial proliferation| * Saliva * Ingested food| * Tissue fluid (sulcus) * Exudates * Leukocytes| Bacteria | * Early plaque: mostly gram + cocci * Older plaque: increases in filaments (3-4 days) * More complex flora increase rods (4-9 days)| * Depends on pocket depth. Apical part dominated by spirochetes, cocci, and rods; coronal part has more filaments. * Environment is conducive to growth of anaerobic population| Sign ificance| * Etiology of: * Gingivitis * Supragingival calculus * Dental caries| * Etiology of: * Gingivitis * Periodontal infections * Subgingival calculus| Pathogens in plaque The virulence for pathogenicity of a microorganism is its ability to cause disease * For a microorganism to be virulent it must: * Be established in close proximity to the periodontal tissue * Must be able to withstand the forces of saliva and gingival crevicular fluid that are capable of sweeping it away * Normally cellular defense systems are able to rid the microbe from the host * However, periodontal pathogens have developed a variety of strategies to evade or overcome these mechanisms * Example: Actinobacillus Actinomycetemcomitans (AA) defends themselves against phagocytosis by: 1. releasing inhibitors of directed migration (inhibits chemotaxis) 2.Produces anti-phagocytic surfaces that prevent the polymorphonuclear lymphocytes (PMN’S) or neutrophils killing mechanisms * Has very slippery surface: slippery surface makes it extremely difficult to latch onto bacteria, therefore PMN’s cannot properly engulf it and PMN’s may be destroyed releasing toxins that produce osteoclasts * AA is a major pathogen Plaque tissue destruction 1. Bacteria themselves do not need to be present within the tissue to be a major participant in the destructive process 2. Some bacterial products may directly injure the hose cells and tissues 3. Others may interact with a variety of cells and activate the humeral and cellular immune reactions that secondarily affect the integrity of the periodontium Direct effect of plaque * P. gingivalis * Produces collagenase, the enzyme that degrades collagen * LPS or endotoxins ( which is a component of a gram (-) bacterial outer membrane) nduces inflammatory reactions and stimulates osteoclasts Indirect effects of plaque * Toxins from p. gingivalis and other gram (-) organisms stimulate the immune response, releasing prostaglandin E2, and interleukin 1B from macrophages and fibroblasts, which can induce bone resorption Gingivitis associated plaque * Increase thickness and mass of plaque * Increase in gram negative motile rods and spirochetes which are usually aerobic (require o2) * Fuso-bacterium nucleatum * Various species of prevotella and treponema * Campylobater rectus Periodontitis associated plaque * Prophyromonas gingivalis * Prevotella intermedia * Bacteroides forsythus * Treponema denticola * Peptostreptococcus micros Plaque biofilm summary Plaque is a biofilm meaning that it is an accumulation of microbes on the surface of teeth or other solid surfaces, not readily removed by rinsing * Plaque biofilm provides some protection for its resident microorganisms, increasing their survival * Therefore essential to physically remove plaque biofilms DAILY to maintain gingival and periodontal health- keeps plaque immature * Bacteria that colonize in the first few hours do not possess pathogenicity as the bacteria that dominate plaque after 34 hours. (plaque virulence increase with age) The role of calculus and other extrinsic factors in periodontal disease (chapter 5) Calculus * Calculus (tartar) is mineralized bacterial plaque, a hard tenacious mass that’s forms on natural teeth, dentures, and other dental appliances generally by the deposit of calcium and phosphate salts * 90% of treatment time on calculus removal and 5 % on plaque control * Not all plaque calcifies.Generally it takes 24 hours to 2 weeks to begin mineralization * Plaque can be mineralized in 2 days and up to 90% in 2 weeks * Formation rates influenced by diet and composition of microbial flora * Calculus can reduce drainage from a pocket by helping to trap bacteria and debris * Healing is prevented and advancement of the disease is encouraged Role of calculus in periodontal disease- pathogenicity * Originally the focus was on calculus as a mechanical irritant * Now the focus is on calculus as a rough surface for plaque growth and retention, and a reservoir for toxic microbial and tissue breakdown products because of its permeable surface * Spicules: small pieces and usually subgingival * Granular: similar to spicules but are a lot smaller * Veneer: common in lower anteriors and the buccal of the upper molars. It is important to air dry before checking if all is removedComparison of clinical characteristics of calculus: supragingival vs. subgingival Characteristic| Supragingival| Subgingival| Also known as:| * Supramarginal calculus or salivary calculus | * Submarginal calculus or serumal calculus| Source of minerals| * Saliva| * Crevicular fluid| Formation starts| * Along inner surface of supragingival plaque| * In attached subgingival plaque| Attached to/by| * Acquired pellicle directly to tooth surface| * Penetration into cementum Intercrystalline bonding, mechanically locking into surface irregularities (caused by loss of Sharpey’s fibers)| Composition| * Inorganic Material(70-90%) :1. Calcium pho sphate(75. 9%)2. Calcium carbonate(3. %) * Traces of magnesium, sodium, potassium, fluoride, zinc, strontium| * Similar to supra but increase in calcium, magnesium and fluoride (higher % in crevicular fluid) * Sodium content increases with pocket depth| Factors that influence formation| * Elevated salivary pH * Concentration of calcium in saliva * Concentration of salivary bacterial protein and lipid * Low individual inhibitory factors| * Higher total salivary lipid levels * Some medications(beta blockers, diuretics, thyroid supplements reduce the formation of supra | Commonly found (individual teeth)| * Coronal to margin of gingiva * Can be fine line near gingival margin * Cover large portion of clinical crown | * Apical to gingival margin * Can extend to bottom of the pocket and follows contour of soft tissue attachment. * As tissue recedes, subgingival calculus can become supra| Common Distribution Patterns| * Lingual surface of mandibular anteriors (Wharton’s Duct) * Faci al surface of max. molars (Stenson’s Duct) * Does not necessarily mean there are SUB deposits.Generally symmetrical except when: * Teeth are malpositioned * Functional irregularities * Oral hygiene inconsistent| * Heaviest in interpoximal areas * Lightest on facial surfaces * Occurs with or without SUPRA deposits| Shape| * Determined by tooth anatomy, contour of gingival tissue, pressure from lips, tongue and cheeks * Generally bulky gross deposits may form ‘calculus bridge’ between teeth or cover gingival margin or extend to incisal/occlusal edges| * Generally flattened to conform with pressure from pocket wall: * Ledge or ring like * Thin, smooth (veneers) * Spiny, spur-like * Granular (grainy) * Spicules (irregular amounts)| Consistency/Texture| * Moderately hard * Porous (may come off in pieces that easily break off from adjoining calculus) * Newer deposits are softer| * Harder and more dense than supra * Brittle/flint like * May feel a ‘snap’ as calculus is dislodged * Newest deposits (bottom of pocket) are less hard| Size and Quantity| * Depends on: * Efficacy of personal oral care * Diet * Function/use * Tobacco use| * Related to same as supra plus: * Pocket depth * duration| Supragingival calculus * Porous and rough * Provides lattice on which plaque can grow * Brings the bacteria close to the tissue * Interferes with oral self-cleaning mechanism * Makes plaque removal more difficult * Found on the clinical crowns of any tooth above the margin of the gingiva * Readily visible * Tightly adherent to the teeth * Yellowish-white in color, darkens with age * It is an organic matrix of plaque, microorganisms, glucans, lycol-proteins and lipids * Calcium is deposited in layers * 70-90% is inorganic mineral content Subgingival calculus * Associated with the progression of periodontal disease * Periodontal pockets almost always contain subgingival calculus * Provides a reservoir for bacteria and endotoxins that are related to th e disease process * Can cause greater disease progression than plaque alone * Located below the gingival margin * Attached to cementum or dentin * Tenacious and black in color * Also dark green due to organic matrix products of the subgingival plaque * Color also comes from blood products * Commonly deposited in rings or ledges on root surfaces The mineral content is derived from crevicular fluid rather than from saliva as supra * Similar inorganic mineral content as supra * Can be found anywhere subgingivally * Attaches by means of attached pellicle or mechanical locking into undercuts and irregularities in tooth surfaces * Therefore more difficult to remove * Improper removal of calculus will leave a smooth outer collar called burnished calculus Calculus removal * Calculus is more readily removed from some tooth surfaces than others * Ease of removal related to mode of attachment of the calculus to tooth surface * Can be attached to acquired pellicle, mechanical locking into under cuts or minute irregularities in tooth surface or direct contact between intercellular matric and tooth surfaceConditions that affect periodontal health 1. Malocclusion * Is not a cause of periodontal disease * Poorly aligned teeth will make it harder for daily plaque control, but malocclusion is not an imitator of pathology 2. Missing teeth * Teeth harder to clean as they can tip in if one is missing 3. Bulky restorations * Poorly contoured restorations may cause plaque traps, increase gingival inflammation, may complicate plaque control and this does contribute to periodontal disease 4. Partial dentures * They should be cleaned daily * Calculus can stick on plastic teeth and stain on dentures * Poor fitting dentures can also irritate the gingiva Stress to remove dentures at night. Soak in water 5. Mouth breathing * This can lead to localized gingival inflammation * Usually on maxillary anterior facials * It is associated with an increase in plaque and gingivitis 6. Food impaction * A common local factor that contributes to the initiation and progression of periodontal disease * Food is an excellent breeding ground for bacteria * Forceful wedging of food may also tear epithelial attachment 7. Orthodontic appliances * Fixed appliances have increased plaque retention and are difficult for self-care * Minimal increase in periodontics but increase in gingivitis Tobacco use on periodontal disease It is a risk factor for periodontal disease (can help cause it) * Smoking will constrict white blood cell supply and retard PMN’s (type of leukocyte). PMN’s have reduced ability to phagocytosis * It has been determined that smokers are 2. 5 times more likely to have periodontal disease * The vascular reaction to inflammation is reduced in smokers THEREFORE Gums look normal and pink and there less bleeding and less response to fighting disease * Smokeless tobacco is associated with a specific type of gingivitis called gingivitis toxica it is associated with t he destruction of gingiva and bone underling the area where the smokeless tobacco rests in the mouth Systemic factors in periodontal disease (chapter 16) Systemic factors * Systemic: pertaining to or affecting the whole body Systemic factors may complicate or intensify the periodontal disease * Systemic problems in some patients may: * Increase their susceptibility to infection * Interfere with wound healing * Require modification of standard approaches to treatment * Complicate factors associated with patient cooperation * More significant responses to bacterial plaque and other local predisposing factors Blood disorders (Dyscrasias) * A blood dyscrasia is any disorder that affects cellular elements of the blood (red or white blood cells) * Most common are anemia (need to know tablet or capsule form of iron taken), leukemia, abnormal bleeding * Most have an oral manifestation * In addition to changes to tissue there is: * Increased bleeding Lowered resistance to infection due to th e impaired function of defensive white blood cells-polymorphonuclear neutrophilic leukocytes (PMNs or neutrophils) Aplastic Anemia * Bone marrow has very reduced ability to produce most of the components of blood * May be due to exposure to toxic chemicals or certain drugs * May have no known etiology, ie. Idiopathic aplastic anemia * Patients have: * Rapidly progressing periodontitis * Reduction in neutrophils Agranulocytosis * A rare disease involving destruction of bone marrow * Caused by antipsychotic drugs or an autoimmune diseases such as Lupus (corticosteriods) * Sharp drop in WBC’s; bacterial invasion is rapid * Patients have: * Ulcerations in mouth or pharynx Gingival bleeding * Increase in salivation * An odor in the mouth Cyclic Neutropenia * Unknown etiology * Periodic reduction in neutrophils * Patients have: * Flare-ups of periodontal disease during depletion of neutrophils Leukemia * Cell malignancies of bone marrow with a decrease in WBC and platelets * Etiolo gy is unknown, although linked to certain viruses and ionizing radiation exposure * Abnormal WBC proliferate and suppress the normal WBC function (fighting infection) * Reduction in blood platelets means clotting ability is reduced * Clients with chronic leukemia have: * Increase susceptibility to infections * Decrease healing ability Spontaneous gingival bleeding * Acute forms have sudden onset and lead to death if not treated in a few months * Oral manifestations include painful ulcerations, spontaneous gingival bleeding, dry mouth, and secondary infections Endocrine dysfunctions * Periodontal disease is associated with endocrine changes or endogenous sex hormone changes * Puberty associated gingivitis: dramatic increase in hormone levels causes gingival inflammation * Menstrual cycle associated gingivitis: significant observable changes especially at ovulation * Menopause: tissue can be fragile. May have osteoporosis with loss of alveolar bone Diabetes Mellitus Usually hyperglyce mic due to defect in insulin (hormone) secretions or insulin action * Either a relative or absolute lack of insulin or inadequate function of insulin * Type I (juvenile diabetes): absolute insulin deficiency * Type II (adult diabetes): most common * Insulin secretion may be lower or higher than normal * Cannot use insulin effectively * Oral findings: * Increased gingival inflammation * Periodontitis is more frequent and often more sever * Increase in tooth mobility * Decrease in saliva flow * Fruity (acetone) breath due to glucose in sulcular fluid * Delayed healing and an increased chance for oral candidiasis (thrush) Pregnancy Increase in gingival inflammation * Tissues are red, swollen * Can lead to periodontitis with loss of alveolar bone * Inflammation due to plaque * Due to increase in estrogen and progesterone * These can cause dilation of gingival capillaries and thus increase permeability and increase in gingival crevicular fluid. This allows for more bacteria to enter and form plaque Nutritional deficiencies * Healthy tissues depend on adequate supply of nutritive material * Hard or fibrous foods provide stimulation necessary for the maintenance of the PDL and alveolar bone and also stimulate the gingival tissues Vitamins| Function| Oral manifestations (deficiencies)|Vitamin A| Growth and bone development| XerostomiaHyperkeratosis of gingiva| Vitamin K| Synthesis of blood clotting factors| Prolonged bleeding| Vitamin D| Promotes absorption of calcium and phosphorus| Hypo-calcification of enamel, bone, dentin, and cementum| Vitamin B| Helps with growth and tissue regeneration and maintains integrity of the oral mucosa| Poor wound healing, gingival inflammation, angular chelosis| Vitamin C| Collagen formation, promotes healing| Blue to red gingiva, bleeding, loss of PDL support, poor wound healing| Infectious diseases * Acquired immune deficiency (AIDS) * Caused by HHHIV (human immunodeficiency virus) * Transmitted by: needle sharing, sexual activities , infected mothers to their newborns, transfer of blood, possibly saliva * HIV infects and eventually kills a wide range of cells but particularly ‘CD4-positive helper T cells’ * Helper T cells are thymus derived lymphocytes that promote certain immunologic reactions * The depletion of these helper T cells can result in severe immune-suppression that makes the person susceptible to any life threatening fungal, bacterial, and viral infections * Oral manifestations: * Hairy leukoplakia: usually on lateral border of tongue * Those with AIDS usually have rapidly progressive periodontitis Cardiovascular disease 1. Hypertension * Blood pressure exceeds 160/95 mmHg (systolic/diastolic) * Normal is 120/80 mmHg * Avoid elective treatment if uncontrolled * Typical medications are diuretics and vasodilators * Drugs often cause xerostomia 2. Cardiac arrhythmias * Irregular heartbeat * Often due to stress 3. Anticoagulant therapy * Blood thinners to reduce the risk of blood clots th at can block circulation to vital organs * Consult with doctor prior to seeing Instrumentation can cause prolonged bleeding * Usual medications are: a) Warfarin (Coumadin) (INR levels) b) Heparin c) Aspirin Psychological stress * Emotional stress is associated with an increased risk of developing periodontitis * Stress may induce secretion of Norepinephrine which may make the periodontal tissues more susceptible to damage from plaque Neurological disorders * Patients with nervous and neuromuscular diseases present with 3 basic problems: 1. Physical inability to perform adequate oral hygiene procedures due to a decrease in motor skills 2. May have a mental or physical inability to cooperate with the clinician 3.May have changes in oral tissues that increase the risk from dental disease * Ex. phenytoin-influenced gingival enlargement: gingival enlargement with administration of anticonvulsive drugs that are used to control seizures. Mechanism is not completely understood Oral Cancer * Most frequent type is squamous cell carcinoma, develops from epithelial cells * Strongly linked to tobacco and pipe smoking * Chronic use of snuff (smokeless tobacco) * Be suspicious of long standing un-healing sores (anything longer than 2-3 weeks) * Red or white lesions on the lips or in the mouth What you can do * A thorough head and neck examination should be a routine part of each patient’s dental visit.Clinicians should be particularly vigilant in checking those who use tobacco or excessive amounts of alcohol * EXAMINE your patients using the head and neck examination described here * TAKE A HISTORY of their alcohol and tobacco use * INFORM your patients of the association between tobacco use, alcohol use, and oral cancer * FOLLOW-UP to make sure a definitive diagnosis is obtained on any possible signs/symptoms of oral cancer The exam * This exam is abstracted from the standardized oral examination method recommended by the World Health Organization. The method is cons istent with those followed by the Centers for Disease Control and Prevention and the National Institutes of Health.It requires adequate lighting, a dental mouth mirror, two 2Ãâ€"2 gauze, and gloves; it should take no longer than 5 minutes Oral cancer screening Incidence and survival * Oral or pharyngeal cancer will be diagnosed in an estimated 30,000 Americans this year, and will cause approximately 8,000 deaths. On average, only half of those with the diseases will survive more than five years The importance of early detection * Early detection saves lives; deaths from oral cancer could be dramatically reduced. The five-year survival rate for those with localized disease at diagnosis is 76% compared with only 19% for those whose cancer has spread to other parts of the body.Early detection of oral cancer is often possible. Tissue changes in the mouth that might signal the beginnings of cancer often can be seen and felt easily Warning signs 1. Lesions that might signal oral cancer * Two lesions that could be precursors to cancer: a) Leukoplakia (white lesions) b) Erythroplakia (red lesions) * Although less common than leukoplakia, erythroplakia and lesions with erythroplakic components have a much greater potential for becoming cancerous * Any white or red lesion that does not resolve itself in two weeks should be reevaluated and considered for biopsy to obtain a definitive diagnosis 2. Other possible signs/symptoms of oral cancer A lump or thickening in the oral soft tissues * Soreness or a feeling that something is caught in the throat * Difficulty chewing or swallowing * Ear pain * Difficulty moving the jaw or tongue * Hoarseness * Numbness of the tongue or other areas of the mouth * Swelling of the jaw that causes dentures to fit poorly or become uncomfortable * If the above problems persist for more than two weeks, a thorough clinical examination and laboratory tests, as necessary, should be performed to obtain a definitive diagnosis * If a diagnosis cann ot be obtained, referral to the appropriate specialist is indicated Risk factors 1. Tobacco /alcohol use * Increases the risk of oral cancer Using both tobacco and alcohol poses a much greater risk than either substance alone 2. Sunlight * Exposure to sunlight is a risk factor for lip cancer 3. Age * Oral cancer is typically a disease of older people usually because of their longer exposure to risk factors * Incidence of oral cancer rises steadily with age, reaching a peak in persons aged 65-74 * For African americans incidence peaks about 10 years earlier 4. Gender * Oral cancer strikes twice as often as it does women Oral changes due to drugs 1. Xerostomia: dry, smooth, shiny mucosa * Diuretics (Dyazide) * Histamines (Benadryl) * Antidepressants (Tofranil) * Antihypertensive (Seroasil) 2.Glossitis/Stomatitis: lesions o the tongue; small multiple ulcers * Anticoagulants (Warfarin) 3. Lichenoid eruptions: white striations; red patched of ulcers * CNS drugs (Aldomet) * Diuretics (Las ix) 4. Oral candidiasis/thrush: multiple with patches * Antibiotics (Vibramycin) 5. Hairy tongue: elongations of filiform papillae * Antibiotics (Tetracycline) Dental hygienist’s role * Consult with other health care providers for clients with systemic factors * Hygienists may be in a position to recognize changes at an early stage * Cautions: 1. Heart attack: need to wait at least 6 months before treating 2. Pregnancy: must finish 1st trimester 3.Cancer: deep scaling could be open channel for infection to reach bone so treatment contraindicated during chemo and radiation 4. Medical histories * Antibiotics: a) What? b) How long? c) How much? * Cancer: a) How long ago? b) Advised against cleaning or pre-meds? * Kidney disease: a) On dialysis? b) How long has treatment been going on? c) Pre-med? * Blood thinners: a) Advised against cleanings? b) What are they on? c) Dose? d) How long on meds? e) Date of last work up? The diseases of the gingiva (chapter 6) Gingivitis * Inflamma tion of the gingival tissue with no apical migration of the junctional epithelium beyond the cementoenamel junction (CEJ) * Manifests as: Color change (red/pink-red) * Edema (swelling of tissues) * Exudates (pus) * Tendency to bleed readily * Major indicators of gingivitis are: * Bleeding in response to gentle probing * Clear gingival fluid flow, or exudates, which appears to increase with the severity of the gingivitis * Gingivitis appears directly related to the amount of plaque on the tooth surface and the amount of time that the plaque is allowed to remain undisturbed- the plaque is considered nonspecific because it is not associated with any specific type of microorganisms Three stages of gingivitis 1. Stage I gingivitis: (initial or sub-clinical) * No clinical signs yet Occurs in the first few days of contact between microbial plaque and gingival tissues * Is an acute inflammatory response characterized by dilation of the blood vessels * PMN (neutrophils) are the principal def ense in acute inflammation- they phagocytoze (engulf) bacteria and their products * Small amounts of plasma leak into surrounding tissues causing edema * Exudate from early gingival inflammation is composed mostly of serum and it is referred to as ‘gingival fluid flow’- the fluid is clear, not yellow like pus, because few cells are present at this point * Lymphocytes will also appear at this stage (almost all are T-lymphocytes) * Collagen degradation will start to occur (collagen will start to break down) 2. Stage II gingivitis (early stage) * These lesions begin to form 4-7 days after plaque has accumulated in the gingival sulcus * Increase in T-lymphocytes- they are localized in the connective tissue under the epithelium of the gingival sulcus * Exudates increases and may appear white or yellow Clinically tissues will appear slightly red and swollen * Collagen fibers in connective tissue is destroyed by the inflammation and is replaced by blood plasma and inflammatory cells * Collagen fibers that attach the underlying connective tissue to the junctional epithelium are also destroyed * Gingival stippling if present, will begin to disappear causing the gingiva to appear shiny * The junctional epithelium will slightly start to lengthen against the root surface * Bleeding will occur upon probing * This stage may continue for 21 days or longer * It is the earliest clinical evidence of gingivitis 3. Stage III (established stage) * Occurs between 15-21 days * T and B lymphocytes are found in equal amounts indicating that tissue destruction by the inflammatory reaction is taking place * More collagen destruction during this stage * Junctional epithelium also continues lengthening Clinical probing depths will increase for 2 reasons: a) Probe can penetrate deeper due to collagen destruction b) Edema causes swelling of tissue and therefore may present as a deepening of the pocket * The increase of blood vessels and inflammatory cells in that area will caus e visible plus formation * Capillary proliferation also causes the gingiva to appear red * Tissues may appear cyanotic (blue) in extreme cases of congested blood cells within the gingiva * The presence of many O2 depleted RBC’s give the bluish color * This stage can persist for many months or years Summary of stages Stage| Clinical signs| Pathogenic events|Stage I (Initial) | * None| * Blood vessels * Polymorphonuclear (PMN’s) leukocytes migrate into CT * Plasma leaks into CT * Gingival fluid exits pockets * T-lymphocytes predominate| Stage II (Early)| * Gingiva may redden * Stippling disappears * Exudates may appear * Bleeding usually occurs on probing| * T-lymphocytes increase * Cells congregate under sulcular epithelium * Gingival fluid increases * Collagen is destroyed * Lengthened JE is disrupted * Fibroblasts destroyed| Stage III (Established)| * Gingiva is redden * Gingiva may appear blue-red * Probing depths increase * Pus forms * Tissue swells| * Capillaries p roliferate * T and B lymphocytes occur in equal numbers * Extensive collagen destruction * JE thickens and rete pegs extend into the CT * Plasma cells infiltrate * Edema increases| Microbiology review * The mature plaque found in long-standing gingivitis has a large % of gram-bacteria (this change from gram (+) plaque associated with health, to predominantly gram (-) plaque, or pathogenic plaque is a characteristic of gingivitis) Types of gingivitis 1. Plaque associated gingivitis * Most common form of gingivitis in general population Directly related to presence of bacterial plaque on tooth surface * Clinically, gingivitis causes a redden gingival margin, with pocket formation as a result of gingival swelling and edema, hypertrophy, and deepened penetration of periodontal probes on clinical evaluation * Surface of the gingiva may appear glazed or smooth, and stippling when present in health, usually disappears; microscopically there is an increase in capillaries along the gingival margin, and the epithelium lining in the sulcus is ulcerated when periodontal probe is placed in the crevice 2. Necrotizing ulcerative gingivitis * A disease that occurs occasionally in young adults Is a periodontal disease that can occur with NO BONE LOSS and a bacterial component * Related to excess stress-common outbreaks at universities and colleges * Very painful * AKA ‘trench mouth’ widespread among soldiers in WWI (stress or poor oral hygiene) * Sudden onset of burning mouth and inability to eat * Disease most commonly begins in the interdental papillae after a few days, the tips of the papillae appear punched out and covered by a white necrotic pseudomembrane * Attached gingival tissues usually appear inflamed * Often a distinctive odor termed ‘fetor oris’ that is unique to the disease * There is a presence of two microorganisms a) Fusiform bacillus b) Spirochetes * May have a fever Antibiotics (penicillin and metronidazole) are useful in treatment, but only if the patient has systemic symptoms of fever and severe malaise * Treatment is to completely debride the tissues of plaque and to begin a home regiment of plaque control * Careful debridement with curettes or ultrasonic scaler can be performed over a few appointments; after appointment can rinse with a dilute solution of hydrogen peroxide and warm water * Untreated, this disease may lead to bone loss and become Necrotizing Ulcerative Periodontitis (NUP) or periodontitis 3. Endocrine-influenced gingival disease * Gingivitis is often influenced by steroid-type hormones produced by the endocrine glands. These include: a) Puberty b) Pregnancy: several changes in the gingiva have been associated 1. As hormone levels increase during 2nd trimester, gingival inflammation may * Increase, even with good plaque control The gingiva may be come dark red or hyperplastic and may bleed excessively * Changes may occur as the pregnancy progresses but most improves with good home care and r emoval of irritants- some not till after the baby is born 2. Some may also get a pregnancy tumor-tissue is highly inflamed, bleeds easily, and may cause teeth to become mobile * When female hormone levels are increased, there is an increase in some subgingival bacteria, such as bacteroids species, and gingival inflammation may be greater * Estrogen may also regulate cellular proliferation, keratinization, and vascular proliferation, and vascular fragility in the gingival tissues * The extent of hormone related changes is related to the level of plaque control- poor plaque control aggravates the condition 4. Drug-induced gingival enlargement Various medications can cause changes in gingival tissue * Anti-seizure meds most commonly associated with gingival overgrowth * Gingival tissue may become fibrotic and enlarged (enlargement may be caused by changes in the epithelial cells and the fibroblasts that create a more dense CT) * Overgrowth begins with interdental papillae which enlarge until they coalesce involving all of the attached gingiva * An increase in bacterial plaque causes an increase in gingival overgrowth in patients taking these medications-excellent plaque control is needed here * Patients may have heavy calculus and increased levels of inflammation because of plaque retention * Treatment requires good oral home care, regular debridement, root planning, and often surgical reduction of the enlargements * Some cardiac meds also cause overgrowth-include nifidine and verapamil used to control BP * Cylcosporine (immunosuppressant in transplant patients) also causes gingival overgrowth; also used to treat MS; can cause excessive accumulation of CT in many other tissues of the body Plaque induced gingivitis can be modified by: crowded teeth, restorations, orthodontic appliances, etc Gingival disease can be modified by malnutrition: vitamins A, B1, B2, B6, and C The Diseases of the supporting tissues of the periodontium (chapter 7) Periodontal disease * Bro ad term referring to any disease of the tissues surrounding teeth * 2 basic classifications: 1. Gingivitis 2. Periodontitis Periodontitis: an inflammatory disease of the periodontium characterized by the loss of connective tissue attachment, destruction of bone, and possible tooth mobility * Periodontal pockets: a clinical manifestation of tissue destruction associated with bone loss (apical migration of sulcus) Periodontitis: pathogenesis of periodontal pockets 1. Bacterial challenge from plaque biofilm * In the early stages of periodontitis, the bacterial flora of the gingival pocket is similar to that of gingivitis * As the disease becomes more sever, the flora become more complex 2. Connective tissue loss * Associated with enzymes secreted by healthy and inflammatory cells (collagenase degradation) * Phagocytosis of collagen by fibroblasts 3. Epithelial cells proliferate and migrate apically 4. Junctional epithelium detaches from root surfaces * As it becomes engorges with infla mmatory cells 5.Gingiva swells and moves coronally from increased amount of cellular and serum elements 6. Epithelial lining of pocket loses integrity * Leukocytes and products of inflammatory response escape into pocket space and in opposite direction the tissue is permeable to bacterial products * This process results in a periodontal pocket the patient cannot clean adequately. This the disease cycles as follows: * Biofilm > gingival inflammation > pocket formation >biofilm formation * Exposed cementum absorbs bacterial products and becomes soft and necrotic * Repair is minimal unless necrotic tissue is removed by root planning Periodontitis: microbiology The continued presence of pathogenic plaque bacteria causing the inflammatory process to extend into the PDL, cementum, and alveolar bone leading to the loss of attachment of the gingiva to the tooth and the loss of supporting bone * The predominant organisms are gram – anaerobic rods * P. gingivalis seems to be the most i mportant periodontal pathogen based on its numeric presence (highest in numbers) Periodontitis: spread * Two mechanisms have been proposed for the initiation of the spread of infection 1. The bacteria and their products may break down the wall between the junctional and sulcular epithelium and cause detachment of the JE 2.The bacteria products may interfere with the normal growth and maintenance of the junctional and sulcular epithelium permitting it to break down * In either case, as inflammation progresses the sulcular epithelium increases in thickness and begins to infiltrate into the underlying connective tissue * Pockets deepen because of the breakdown of collagen fibers by enzymes such as collagenase, which is released by some of the plaque bacteria and the hosts inflammatory response * Because bone is an active tissue with continuous resorption and formation it is not possible to determine histologically exactly when bone loss has occurred as a result of periodontitis * When bone resorption exceeds apposition, a net decrease in the amount of bone occurs Periodontal bone loss The loss of crestal alveolar bone through the inflammatory process * Osteoclast bone resorption is driven by plaque and most derived mediators such as bacterial enzymes, prostaglandins, interleukins, and tumor necrosis factor * When disease established, plasma cells and lymphocytes present * Plasma cells important in antigen-antibody reactions which activates events attracting additional inflammatory cells * These cells cause additional destruction of collagen fibers * Bacteria stimulate lymphocytes which release lymphokines * Lymphokines have many effects on inflammatory system including production of chemical factors that activate osteoclasts * Osteoclasts increase osseous resorption Types of bone loss 1. Horizontal: Occurs when entire width of interdental bone is resorbed evenly 2.Vertical: Defect produced when interdental bone adjacent to root surface is more rapidly resorbed, l eaving angular uneven morphology Two types of periodontal pockets * Describes relationship of pocket to crestal bone 1. Suprabony: base of pocket occurs above the crest of the alveolar bone 2. Infrabony: pocket base is apical to crest of alveolar bone Clinical attachment loss * Total attachment loss from CEJ * Combines recession and probing depth (pocket depth) (only exists when recession is present) * Provides more complete assessment of loss of support than probing alone * Why? Crest of alveolar bone is not at CEJ but 1-2 mm apical to it * Page 131 figure 7-2 Furcation * When attachment lose occurs vertically and horizontally between toots of multi-rooted teeth Etiology As in gingivitis, plaque biofilm is the principle cause of all forms of periodontitis * Therefore, treatment directed at its elimination or reduction * The composition of the flora differ significantly from patient to patient and from pocket to pocket, as does patients susceptibility to it * This variability makes causes of periodontitis less obvious than plaque biofilm + gingivitis relationship * All conditions that retain biofilms or prevent its removal play significant roles as they do in gingivitis * In addition, deeper periodontal pockets house greater amounts of subgingival plaque that is impossible for the patient to remove * Most patients with periodontitis have high proportions of anaerobic gram –ve bacteria Classification of periodontal disease * American academy of periodontology * Periodontitis can be: * Localized (? 30% of involved sites) * Generalized (> 30% of involved sites) The defining element for classifying periodontal disease is probing depth, the level of attachment loss from the CEJ indicates bone loss * Page 130 box 7-2 Chronic periodontitis * Most common form of periodontal disease * Bacterially induced inflammation of the periodontium * True periodontal pockets result from apical migration of JE * A degree of false pocketing resulting from gingival edema or fi brosis is commonly present * Characterized by bone resorption that progresses slowly and predominantly in a horizontal direction * May have pre-clinical onset in adolescence and if not halted by therapy it appears to progress continually for life * Usually not clinically significant until 35 years of age may occur at any age * More common in males than females Severity of this disease is directly related to the accumulation of plaque and calculus on the surface of the teeth * Preventable! (not associated with abnormalities in host defense) * Rate of periodontal destruction varies depending on disease activity and patient’s resistance * Can be localized or generalized * Progresses slowly until teeth are lost by exfoliation or extraction * Appears to occur in episodic bursts (can be quiet and then rapidly comes on) * Progresses in the presence of dental plaque * Disease activity halts or stops when the host resistance controls the disease process through therapy or natural defe nses * Classified as slight, moderate, or severe Aggressive periodontitis Applied to those periodontal diseases that progress rapidly with massive bone loss * Attachment loss > 1mm/year is considered to be an aggressive type * Can be localized or generalized * Often associated with young people * Microbiology similar to chronic periodontitis Types of aggressive periodontitis * Early onset periodontitis (page 137-140) 1. Prepubertal periodontitis * Rare; may affect 1o or 2o with bone severe gingival inflammation, rapid bone loss, early tooth loss 2. Juvenile periodontitis * Localized juvenile periodontitis (usually 2o molars and incisors, minimal plaque and calculus, AA) * Generalized juvenile periodontitis (rarer, heavy calculus and plaque, p. gingivalis +E corrodens with AA) * Rapidly progressive periodontitis (page 140-142) * Refractory periodontitis (page 142) Unresponsive to thorough and varied periodontal treatments) Class VI: periodontitis as a manifestation of systemic diseas e 1. Associated with hematologic disorders 2. Associated with genetic disorders 3. Not otherwise specified Class IV: periodontitis as manifestation of systemic disease * Lesions associated with HIV: * Oral candidiasis * Karposi sarcoma: type of oral cancer usually seen on the palate * A malignant neoplasm associated with HIV infection and manifesting as brown or purplish tumors on the gingiva near the teeth or on the skin * Xerostomia * Unilateral/bilateral swelling of the salivary glands * Gingivitis * Spontaneous bleedingClass V: necrotizing periodontal disease 1. NUG: necrotizing ulcerative gingivitis 2. NUP: necrotizing ulcerative periodontitis * Necrotic gingival tissue-pseudo membrane * Pain * Fetid breath odor * Punched out papillae * Gingival bleeding * Progression of NUG * Bone loss AND connective tissue attachment loss Class IV: abscess of periodontium * Acute localized purulent infection * Usually untreated choric periodontitis * Pockets’ pathogenic bacteria become s occluded (cannot escape) * Associated with rapid bone loss * Requires immediate attention * Untreated- seeks drainage route and becomes chronic * Episodes of localized swelling * Periocoronitis is associated with the 8’s Treatment involves debridement and systemic antibiotics Class VII: periodontitis associated with endodontics * Periodontal pocket can progress to join an endodontic lesion * Treatment: endodontic therapy must be completed before scaling Class VIII: developmental or acquired deformities and conditions The role of abnormal occlusion and jaw dysfunction in periodontal treatment (chapter 10) Normal * Occlusal function- the dynamic state during talking, chewing, swallowing * Orthofunction: the state if morphofunctional harmony in which the forces developed during function are within adaptive range; means health and comfort with no pathological change Abnormal Dysfunction is a state of morphofunctional disharmony in which forces developed during mastication cause pathogenic/pathologic changes in tissue Role of abnormal occlusion and jaw dysfunction * These changes can cause bone loss * Poor occlusion alone does not cause or create periodontitis, it only exacerbates it * Antiaxial forces directed along tooth and periodontium can cause resorption or a hypertrophic response * Some areas will break down, others show no injury Factors * Certain factors affect the response of teeth and periodontal structures to normal and abnormal functions: * Size/shape of roots * Quality/quantity of alveolar bone * Presence of plaque * Missing teeth * Oral habits (parafunctional activity ie. grinding and clenching) Parafunctional activity 1. Bruxism Grinding or gnashing of teeth when not chewing or swallowing , usually during sleep * May lead to acute pulpitis, wear faucets, occlusal trauma, and muscle fatigue (summed up in periodontal injury, pain and jaw discomfort) 2. Clenching * Clamping and forcing the teeth together without grinding 3. Crepitation (crepit is) * A grinding noise in the TMJ from damage to the disc and articulating joint surfaces Traumatic occlusion * An occlusion that has caused injury to the teeth, muscles or TMJ * Primary traumatic occlusion is made when heavy occlusal forces exceed the adaptive range causing injury to tissues and bone * Secondary traumatic occlusion is made when normal forces exceed capability of a periodontium already affected by periodontal disease (ie. denture wear or lack) Assessing TMJ/occlusal dysfunction 1. Muscle palpation Normal muscles are equal in length and they should contract and relax without discomfort or pain * Myalgia is a pain in the muscle 2. Mandibular movement * Normal opening/closing of the jaw should be smooth and symmetrical * On average a person should be able to open about 40 mm * Page 222 and 223 3. Assessing occlusion * There should be a firm well disturbed pattern of occlusal contacts * Observe the patient opening and closing * You should note on closing any deviation t o the left or right * The posterior teeth should have even contact and maximum inter-cuspation * Anterior teeth should have light to no contact 4. Radiographic evaluation These changes from excessive forces can be observed in periapical films * Widening of PDL (caused by resorption of bony support) * Increased density of surrounding bone (hypertrophic response) * Increased cementum at apices (hypertrophic response) 5. Subjective questionnaire * Screens for patient reported signs and symptoms * Several questions assessing pain, noises, comfort level, headaches, injury, arthritis, previous treatment * Ex. questions page 221 Prevention is key * Attention to form and function of aspects of head and neck: * Form: morphology of teeth, bones, and TMJ * Function: morphology including neuromuscular system * Masticatory system is complex but adaptive to function When adaptive capacity exceeded, dysfunction ranges from discomfort to debilitation Temporal Mandibular Disorder (TMD) * Group of mu sculoskeletal conditions that produce pain or dysfuction in the masticatory system * When it involves muscles and not joint, it is referred to as extracapsular * When it involves the TMJ, it is referred to as intracapsular Etiology * Multifactorial therefore difficult to diagnose and treat * Stress * History of other diseases: arthritis and psychological problems * Car accident * Sports injury Microtrauma * Number of minor habits or events that cause damage to masticatory structures: * Bruxism * Postural habits * Oral habits (pen, pin, nail holding, nail biting, etc. Symptoms of temporal mandibular disorder (TMD) * Pain and tenderness in the muscles of mastication * Pain and tenderness in the TMJ * Painful clicking of the joint during function * Limitation of mandibular motion * You may also see muscle swelling and patient may complain of ringing in the ears * Arthralgia: pain in a joint structure Consideration for treatment * Short appointments * Aids during treatment- bite blocks to help keep mouth open * Home care suggestions- small tooth brush heads * Post treatment care- no gum chewing, possible medication, soft diet, warm towel * Frequent recalls Clinical Assessment (chapter 8) Clinical assessment of periodontal disease Assessment: represents the 1st phase of the dental hygiene process, provides the foundation for the subsequent diagnosis, planning, implementation, and evaluation of dental and dental hygiene care * Data collection: a systemic process of collecting information from multiple sources to help evaluate the health status of the patient. An example of data collection is the medical history * Documentation: this is the information gathered during the assessment and is a reference tool, an historical record; also has a medical and legal function * Examination: includes extraoral and intraoral, oral hygiene, periodontal and dentition assessments * Evaluation: At this point, the patient’s current progress (or lack thereof), is compared with baseline data and the stated goal.The evaluation is used to determine if the patient should be re-treated, referred, or placed on a maintenance program * Interpretation: being able to decipher and understand your findings clinically or radiographically Examination of gingival tissues: clinical markers * Periodontal screening and recording system (PSR) * Was introduced in 1993 * Is a periodontal disease detection system * To be used in the screening process * A specifically designed probe is used * Bleeding, overhangs, defective margins, supra/subgingival calculus are assessed while pocket depth is measured * A PSR code is given to each sextant * The code that best describes the most periodontally involved tooth in a sextant is assigned to that sextant PSR scale Code| Description| | * Colored area of the probe remains completely visible * No calculus or defective margins are detected * Gingival tissues are healthy, with no bleeding on probing| 1| * Colored area of the probe remains c ompletely visible in the deepest probing depth in the sextant * No calculus or defective margins are detected * There is bleeding on probing| 2| * Colored area of the probe remains completely visible in the deepest probing depth in the sextant * Supra or sub gingival calculus is detected or defective margins are detected| 3| * Colored area of the probe remains partly visible in the deeper probing depth in the sextant| 4| * Color