تسوس الأسنان – الوقاية و العلاج

تسوس_الأسنان

نخور الأسنان – الأسباب و الوقاية

نخور_الأسنان

1. Alcohol:
   
   • Dependence
   • Craving
   • Tolerance
   • Withdrawal symptoms
   • Loss of control
2. Tobacco:
   
   • Nicotine dependence
   • Habitual use
   • Respiratory issues
   • Withdrawal symptoms
   • Health deterioration
3. Cocaine:
   
   • Intense euphoria
   • Increased energy
   • Agitation
   • Paranoia
   • Rapid heart rate
4. Heroin:
   
   • Euphoria
   • Drowsiness
   • Needle marks
   • Respiratory depression
   • Nausea
5. Marijuana:
   
   • Altered perception
   • Memory impairment
   • Lack of coordination
   • Dependence
   • Impaired judgment
6. Prescription opioids:
   
   • Pain relief
   • Sedation
   • Dependence
   • Tolerance
   • Respiratory depression
7. Benzodiazepines:
   
   • Anxiety relief
   • Sedation
   • Dependence
   • Withdrawal symptoms
   • Memory impairment
8. Methamphetamine:
   
   • Increased alertness
   • Euphoria
   • Agitation
   • Psychotic symptoms
   • Cardiovascular issues
9. Gambling:
   
   • Compulsive behavior
   • Financial losses
   • Obsessive thoughts
   • Relationship strain
   • Chasing losses
10. Video games:
    
    • Escapism
    • Social isolation
    • Obsessive gaming
    • Impaired daily functioning
    • Disrupted sleep
11. Social media:
    
    • Constant checking
    • Fear of missing out (FOMO)
    • Validation-seeking behavior
    • Time distortion
    • Negative impact on mental health
12. Internet:
    
    • Excessive online time
    • Cyber addiction
    • Social disconnection
    • Impact on real-life relationships
    • Compulsive browsing
13. Shopping:
    
    • Compulsive buying
    • Financial strain
    • Temporary emotional relief
    • Hoarding tendencies
    • Impaired financial decision-making
14. Work:
    
    • Workaholism
    • Neglect of personal life
    • Burnout
    • Constant need for achievement
    • Difficulty delegating tasks
15. Exercise:
    
    • Compulsive exercising
    • Exercise as a primary source of identity
    • Physical strain
    • Disregard for rest and recovery
    • Negative impact on mental health
16. Food:
    
    • Binge eating
    • Emotional eating
    • Loss of control
    • Negative body image
    • Compulsive overeating
17. Sugar:
    
    • Craving for sugary foods
    • Energy crashes
    • Weight gain
    • Increased risk of health issues
    • Difficulty moderating intake
18. Coffee:
    
    • Caffeine dependence
    • Increased tolerance
    • Physical withdrawal symptoms
    • Disrupted sleep
    • Jitters and restlessness
19. Tea:
    
    • Caffeine dependence
    • Ritualistic consumption
    • Calming effect
    • Impact on hydration
    • Withdrawal headaches
20. Energy drinks:
    
    • Excessive caffeine intake
    • High sugar content
    • Stimulant-induced alertness
    • Potential health risks
    • Dependency for energy boost
21. Sex:
    
    • Compulsive sexual behavior
    • Relationship strain
    • Risky sexual activities
    • Obsessive thoughts
    • Impact on daily functioning
22. Pornography:
    
    • Excessive consumption
    • Escapism
    • Distorted views of relationships
    • Impact on sexual health
    • Relationship strain
23. Prescription medications:
    
    • Dependence on medication
    • Over-reliance
    • Impact on physical health
    • Potential for misuse
    • Tolerance
24. Codeine:
    
    • Pain relief
    • Sedation
    • Dependence
    • Respiratory depression
    • Misuse potential
25. LSD:
    
    • Altered perception
    • Hallucinations
    • Distorted sense of time
    • Potential for psychological distress
    • Flashbacks
26. MDMA (Ecstasy):
    
    • Increased empathy
    • Euphoria
    • Dehydration
    • Hyperactivity
    • Potential for overheating
27. Ketamine:
    
    • Dissociation
    • Hallucinations
    • Impaired motor function
    • Dependence
    • Bladder and urinary issues
28. Inhalants:
    
    • Euphoria
    • Dizziness
    • Short-term hallucinations
    • Potential for brain and organ damage
    • Sudden sniffing death
29. Caffeine:
    
    • Stimulant effects
    • Dependence
    • Withdrawal headaches
    • Increased heart rate
    • Insomnia
30. Nicotine:
    
    • Stimulant effects
    • Dependence
    • Withdrawal symptoms
    • Increased heart rate
    • Respiratory issues
31. Sex:
    
    • Compulsive sexual behavior
    • Relationship strain
    • Risky sexual activities
    • Obsessive thoughts
    • Impact on daily functioning
32. Pornography:
    
    • Excessive consumption
    • Escapism
    • Distorted views of relationships
    • Impact on sexual health
    • Relationship strain
33. Prescription medications:
    
    • Dependence on medication
    • Over-reliance
    • Impact on physical health
    • Potential for misuse
    • Tolerance
34. Codeine:
    
    • Pain relief
    • Sedation
    • Dependence
    • Respiratory depression
    • Misuse potential
35. LSD:
    
    • Altered perception
    • Hallucinations
    • Distorted sense of time
    • Potential for psychological distress
    • Flashbacks
36. MDMA (Ecstasy):
    
    • Increased empathy
    • Euphoria
    • Dehydration
    • Hyperactivity
    • Potential for overheating
37. Ketamine:
    
    • Dissociation
    • Hallucinations
    • Impaired motor function
    • Dependence
    • Bladder and urinary issues
38. Inhalants:
    
    • Euphoria
    • Dizziness
    • Short-term hallucinations
    • Potential for brain and organ damage
    • Sudden sniffing death
39. Caffeine:
    
    • Stimulant effects
    • Dependence
    • Withdrawal headaches
    • Increased heart rate
    • Insomnia
40. Painkillers:
    
    • Pain relief
    • Tolerance
    • Dependence
    • Risk of overdose
    • Respiratory depression
41. Sleeping pills:
    
    • Sedation
    • Dependence
    • Tolerance
    • Impaired cognitive function
    • Disrupted sleep patterns
42. Compulsive lying:
    
    • Habitual dishonesty
    • Concealing the truth
    • Strained relationships
    • Loss of trust
    • Need for constant validation
43. Plastic surgery:
    
    • Body dysmorphic tendencies
    • Constant pursuit of perfection
    • Psychological impact
    • Financial strain
    • Societal pressure
44. Cutting/self-harm:
    
    • Coping mechanism
    • Emotional release
    • Negative emotions relief
    • Risk of infection
    • Concealing scars
45. Powecontrol:
    
    • Manipulative behavior
    • Desire for dominance
    • Strained relationships
    • Lack of empathy
    • Fear-based control
46. Fame:
    
    • Constant pursuit of recognition
    • Validation-seeking behavior
    • Impact on mental health
    • Shifting priorities
    • Loss of privacy
47. Attention:
    
    • Constant need for validation
    • Disregard for personal boundaries
    • Impact on relationships
    • Social media-centric behavior
    • Self-worth tied to attention
48. Sugar-sweetened beverages:
    
    • High sugar content
    • Increased calorie intake
    • Weight gain
    • Tooth decay
    • Dependency on sugary drinks
49. Fast food:
    
    • High-fat content
    • High calorie intake
    • Dependence on convenience
    • Weight gain
    • Negative impact on health
50. Selfies:
    
    • Constant need for self-documentation
    • Validation-seeking behavior
    • Impact on self-esteem
    • Comparison to others
    • Social media-centric behavior
51. Cosmetic procedures:
    
    • Desire for physical enhancement
    • Psychological impact
    • Financial strain
    • Body dysmorphic tendencies
    • Societal pressure
52. Hoarding:
    
    • Compulsive accumulation of possessions
    • Difficulty discarding items
    • Impaired living space
    • Emotional attachment to objects
    • Strained relationships
53. Overeating:
    
    • Binge eating episodes
    • Emotional eating
    • Loss of control
    • Negative impact on physical health
    • Guilt and shame
54. Prescription stimulants:
    
    • Increased alertness
    • Improved focus and concentration
    • Dependence
    • Tolerance
    • Potential for misuse
55. Over-the-counter drugs:
    
    • Self-medication
    • Potential for misuse
    • Dependency
    • Health risks
    • Lack of professional guidance
56. Romantic relationships:
    
    • Codependency
    • Obsessive thoughts
    • Fear of abandonment
    • Emotional highs and lows
    • Strained personal identity
57. Codependency:
    
    • Excessive reliance on others
    • Neglect of personal needs
    • Difficulty setting boundaries
    • Fear of rejection
    • Strained relationships
58. Social approval:
    
    • Constant need for validation
    • Fear of judgment
    • Impact on self-esteem
    • Conforming behavior
    • Social media-centric validation
59. Thrill-seeking:
    
    • Constant pursuit of excitement
    • Risk-taking behavior
    • Impaired judgment
    • Adrenaline dependence
    • Impact on personal safety
60. Narcotics:
    
    • Pain relief
    • Sedation
    • Dependence
    • Tolerance
    • Health risks
61. Designer drugs (e.g., bath salts):
    
    • Intense euphoria
    • Hallucinations
    • Agitation
    • Increased heart rate
    • Severe health risks
62. Over-the-counter cough medicine abuse:
    
    • Euphoria
    • Dizziness
    • Hallucinations
    • Impaired coordination
    • Health risks
63. Social media stalking:
    
    • Compulsive checking of profiles
    • Intrusive thoughts
    • Obsessive behavior
    • Impact on mental well-being
    • Strained personal relationships
64. Fear of missing out (FOMO):
    
    • Constant need to be involved
    • Anxiety about social events
    • Comparison to others
    • Impact on mental health
    • Social media-centric anxiety
65. Collecting:
    
    • Compulsive acquisition of items
    • Difficulty discarding possessions
    • Emotional attachment to collections
    • Strained living space
    • Financial strain
66. Fantasy sports addiction:
    
    • Excessive time spent on fantasy sports
    • Impact on work or relationships
    • Obsessive tracking of player stats
    • Financial investment
    • Escapism from reality
67. Conspiracy theories obsession:
    
    • Constant consumption of conspiracy content
    • Alienation from mainstream information
    • Impact on critical thinking
    • Strained relationships
    • Difficulty accepting evidence-based information
68. Extreme diets:
    
    • Obsessive focus on dieting
    • Impact on physical health
    • Emotional distress related to food
    • Social isolation due to dietary restrictions
    • Negative body image
69. Extreme couponing:
    
    • Compulsive pursuit of discounts
    • Hoarding of coupons
    • Excessive stockpiling of items
    • Impact on financial well-being
    • Strained living space
70. Internet trolling:
    
    • Habitual provocative online behavior
    • Seeking emotional reactions
    • Anonymity-driven aggression
    • Strained online communities
    • Legal consequences
71. Spiritual bypassing:
    
    • Avoidance of negative emotions through spirituality
    • Denial of personal challenges
    • Strained relationships
    • Lack of emotional authenticity
    • Disconnect from reality
72. Extreme minimalism:
    
    • Compulsive decluttering
    • Obsessive focus on possessions
    • Strained relationships due to minimalistic lifestyle
    • Anxiety about material belongings
    • Rigidity in lifestyle choices
73. Gaming loot box addiction:
    
    • Compulsive spending on in-game purchases
    • Chasing virtual rewards
    • Financial strain
    • Impact on real-life responsibilities
    • Gambling-like behavior
74. Rumination:
    
    • Constant overthinking
    • Obsessive focus on past mistakes
    • Impact on mental health
    • Difficulty moving forward
    • Strained relationships
75. Approval-seeking behavior:
    
    • Constant need for validation
    • Fear of rejection
    • Impact on decision-making
    • Strained authenticity
    • Mental health implications
76. News addiction:
    
    • Compulsive consumption of news
    • Anxiety related to current events
    • Impact on mental well-being
    • Difficulty disconnecting from news cycle
    • Strained worldview
77. Anger addiction:
    
    • Habitual anger expression
    • Seeking confrontation
    • Strained relationships
    • Negative impact on mental health
    • Legal consequences
78. Religious zealotry:
    
    • Extreme devotion to religious beliefs
    • Intolerance of other perspectives
    • Strained relationships with non-believers
    • Willingness to harm others in the name of faith
    • Resistance to critical thinking
79. Mindless scrolling:
    
    • Excessive time spent on scrolling through content
    • Impact on productivity
    • Impaired attention span
    • Social isolation
    • Disrupted sleep patterns

The Importance a Confident Smile for Kids

What is Invisalign for Kids?

Advantages of Invisalign for Kids

1. Comfort Convenience:

1. Improve Oral Hygiene:

1. Aesthetics confidence

1. Fewer Orthodontic Appointments

1. Addressing Dental Issues Early

Is Your Child a Candidate for Invisalign?

The Invisalign Treatment Process

• Consultation: During initial consultation, orthodontists evaluate a child's dental condition and discuss treatment options available. explain Invisalign works answer questions concerns may.
• Custom Treatment Plan: If Invisalign deem suitable for a child, the team creates a custom treatment plan using advanced technology, such digital impressions. This ensures precise accurate fitting aligners.
• Aligner Fitting: Once the treatment plan is finalized, children receive first set aligners. wear set approximately one two weeks before progressing next set sequence

The Importance a Confident Smile for Kids

What is Invisalign for Kids?

Dental diseases and procedures are common, troublesome, and expensive, exceeding spending on other major health conditions, such as diabetes, ischemic heart disease, hypertension, dementias, and breast cancer, in the US. Dental issues are relevant for internists because unmet dental care needs can be painful for patients. Excluding teeth from medical health care is arbitrary.
Evidence-based medicine, a movement that gained prominence in the 1990s, has profoundly affected the practice of medicine. Unfortunately, little progress has been made on using data from clinical trials to determine best practices for dental care. Instead, most dental care relies on practice patterns influenced by the economic pressures of running a dental practice, dentists’ professional training and opinions, and patients’ expectations, all of which tend to favor excessive diagnoses and interventions. The result is that while many people who have low income go without any dental care, those who can pay are subjected to overdiagnosis and overtreatment.
Overdiagnosis
Overdiagnosis occurs when conditions that will never cause harm are identified. Unnecessary treatments resulting from overdiagnosis subject patients to potential harm and waste valuable resources that could be used for necessary and effective treatments.
For example, dentists may treat early noncavitated caries lesions, aiming to prevent more advanced lesions, such as dentine cavities. A noncavitated caries lesion is a demineralized enamel spot (white spot lesion) without evidence of cavitation. The majority of white spot lesions will not progress,1 and there is no evidence that early treatment, except with fissure sealants, is generally more effective than no treatment in preventing dentine cavities.2 Paradoxically, these sealants are frequently overlooked or underused by dentists. Dental cavities are routinely filled in children, despite evidence that dental pain and infection rates due to dental cavities in primary teeth are similar (about 40%) in children who are randomized to teeth being filled or not being filled.3
Decline in Caries and the Impact on Dentists’ Workload
In the 1970s, there was an unexpected, extraordinary decline in the number of cavitated caries lesions seen in dental patients.4 This decline in the number of patients’ cavitated caries lesions affected dentists’ workload and has played a role in overdiagnosis and treatment in dentistry so that dentists can support their practices. This financial need led to more recommendations for regular 6-month visits.5 Two randomized clinical trials failed to demonstrate that 6-month intervals between dental checkups result in better oral health compared with longer intervals (up to 24 months), which led the authors of a Cochrane review to conclude: “Whether adults see their dentist for a check-up every 6 months or at personalized intervals based on their dentist’s assessment of their risk of dental disease does not affect tooth decay, gum disease, or quality of life. Longer intervals (up to 24 months) between checkups may not negatively affect these outcomes.”6 Nonetheless, the standard for dental visits remains every 6 months.
Scaling and Polishing
Another commonly performed procedure is scaling and polishing to prevent periodontitis, a common condition in middle-aged persons. Scaling removes plaque and calculus from the crown and root surfaces of the teeth and is performed using hand or ultrasonic scalers. Polishing, which entails the mechanical removal of extrinsic stains and deposits, is typically done using a rubber cup or bristle brush loaded with a prophylaxis paste.
The assumption has been that scaling and polishing can prevent gingivitis and periodontitis, thus potentially preventing tooth loss, pain, and mobility. However, to our knowledge there are no published clinical trials assessing these outcomes.7 The existing evidence only evaluates short-term surrogate outcomes. It suggests that treating periodontitis, specifically through root planing, leads to a slight enhancement in the gum-to-tooth attachment level among individuals with moderate to severe periodontitis.8 However, there does not appear to be any advantage to scaling and polishing for adults without periodontitis.9
Changing Financial Incentives
The prevailing dental economic model based on fee-for-service creates an environment of dental overdiagnosis and overtreatment. At the same time, many persons who do not have dental insurance cannot afford to pay out of pocket for dental care, creating a situation where people with low income or who are part of a racial and ethnic minority group are often underdiagnosed and undertreated. A value-based model, in which dentists are paid to maintain oral health rather than to deliver treatments like fillings, cleanings, and fluoride applications, could be more positive for oral health. A study conducted in Rio de Janeiro (and coauthored by one of us [P.N.]) found that, among patients without treatment indications, an average of 2 teeth were treated during a 6-month follow-up period. This number increased to 3.6 teeth if the patient had changed dentists.10 A clear need exists for trials to compare different methods of paying dentists to assess the impact on oral health and on overtreatment and undertreatment.
What Is the Way Forward?
We do not want to give the impression that dental care is not important. On the contrary, dental pain, oral abscesses, broken teeth, and inflamed tissues surrounding the teeth are common presentations to medical professionals, especially those working in urgent care settings. Similarly, good dentition is nutritionally important for eating a full diet and psychologically essential to a person’s sense of appearance. However, dental procedures should be based on effectiveness and safety.
It is true that many important dental outcomes (eg, tooth loss) may take a long time to assess. On the other hand, the human mouth offers an easy trial design in which some procedures, such as filling a tooth, could be determined by randomization when there is more than 1 tooth in the mouth with a cavity. Other common abnormalities can impact adjacent teeth (eg, periodontitis) and require a refined design (eg, randomization to quadrants or sextants).
Identifying which dental procedures are beneficial and ensuring that relevant dental associations update their guidelines accordingly provide an opportunity to allocate resources to those who need them the most. The aim is to reduce overdiagnosis and overtreatment while increasing necessary treatment.
Corresponding Author: Paulo Nadanovsky, DDS, PhD, Oswaldo Cruz Foundation, FIOCRUZ, Brazil, Rua Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil ([paulo.nadanovsky@gmail.com](mailto:paulo.nadanovsky@gmail.com)).
Published Online: May 6, 2024. doi:10.1001/jamainternmed.2024.0222
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank Steven Woloshin, MD, MS, The Center for Medicine and the Media, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, and The Lisa Schwartz Foundation for Truth in Medicine, for his invaluable intellectual contributions to the development, writing, and critical revision of this paper. Dr Woloshin was not compensated for his contributions.