Christchurch teenager James Kelso will live with a brain tumour for the rest of his life.

It is a daunting prospect, the 19-year-old says, but not as bad as discovering an orange-sized tumour in your brain and being given a month to live.

Five years ago, doctors gave the then Year 10 student that prognosis after discovering a large cranial pharyngioma at the base of his brain. They diagnosed the growth after his eyesight started fading, although he had suffered migraines and vomiting for several years.

"I was just real freaked out, but it sort of explained my being sick," Kelso said of the diagnosis.

Surgeons at Christchurch Hospital successfully removed the tumour during a 12-hour operation Kelso was not expected to survive. He returned to Hillmorton High School, needing only regular scans and medication to maintain his good health. He also had to regularly inject himself with growth hormones because the tumour had affected his pituitary gland, which is linked to height.

Soon after Kelso finished Year 13, routine scans revealed the tumour had returned. The teenager spent his first year out of school recovering from a nine-week course of radiotherapy at Dunedin Hospital.

"I freaked out when they said that `we think it's here again and we have to go do a whole other lot of treatment', but I found out a couple of months ago that it has shrunk two-thirds because of this therapy. It will stay this small size for the rest of my life.

"Well, it should stay in my head. It shouldn't do anything ... Sometimes I just think you just don't know. It's in there. What if it grows and they don't know?"

Kelso will have routine scans and takes 12 pills a day.

He has short-term memory loss, tiredness and is blind in one eye because of his brushes with cancer, but is now enrolled in a youth-work course and is contemplating part-time work next year.

"It's definitely changed my view of life," he said. "I think twice before I do things now, because I know life is so precious. It just goes; like a click of your fingers, it can be over."

The Canterbury and West Coast branch of CanTeen, which supports young people living with cancer, yesterday launched its annual bandanna appeal.

By KATIE WYLIE - stuff.co.nz

A teenager collapsed and died of a suspected allergic reaction to drugs he had been prescribed for acne.

Shaun Jones, 14, developed breathing problems and collapsed after taking his first dose at home.

He was taken to hospital but could not be saved.

Shaun Jones (foreground) died after suffering a suspected allergic reaction to the tablets for his acne treatment

Speaking from the family's home in Rhydyfelin, South Wales, Shaun's father said he did not blame the doctor who prescribed the medicine.

'It's unbelievable. Shaun was a strong, fit lad and was loved by everyone. He was popular with the girls and had a couple of spots so the doctor gave him some antibiotic acne tablets.

'The doctor that gave him the tablets is really upset, but we don't blame him. It was just one of those terrible things. One minute he was here and now he's gone.'

He added: 'Shaun's little sister is devastated. She can't bear to leave our sides because she thinks something will happen to us too.'

An inquest into his death has been adjourned pending the results of medical tests. Mr and Mrs Jones are declining to name the antibiotic Shaun took until the results are known.

The pupil from Hawthorn Highschool in Pontypridd went to a GP after developing the common skin condition earlier this month.

Cardiff coroner Mary Hassell adjourned the inquest for more investigations into his death.

A spokesman for Rhondda Cynon Taff Local Health Board said: 'We cannot comment on individual cases but we would co-operate with any investigation.'

A spokesperson at the Medicines and Healthcare products Regulatory Agency said:
'Most medicines work well and are acceptably safe and most people take medicines without suffering any side effects. Every medicine has some side effects ranging from minor to severe. No product is risk-free.'

Updated from http://www.dailymail.co.uk/news/article-1081505/Schoolboy-14-dies-suffering-allergic-reaction-acne-tablets.html

The health of Canadians was ranked 10th among 16 developed countries in a study released Tuesday - good enough for a B grade, but down from the fifth-place finish Canada earned in the 1990s.

While Canada's health-care system still remains the envy of much of the developed world, individuals aren't as healthy as people in Japan, Switzerland or Sweden, according to the report by the Conference Board of Canada.

The study took into account a number of factors, such as deaths due to specific diseases, infant mortality and life expectancy. It concluded that a relatively high rate of deaths from complications related to diabetes was the main reason that Canada's ranking has suffered.

Canada's surging prevalence of diabetes - some two million cases, or one in 11 Canadians - and relatively high mortality rates for cancer patients suggest that more has to be done to encourage healthier lifestyles.

"New estimates suggest that one-third of cancers could be prevented with increased vegetable and fruit consumption, increased physical activity, and maintenance of a healthy body weight," the report says, adding that rising levels of alcohol consumption and obesity further contributed to declining health.

"It is becoming more apparent that individuals must be held more accountable for their own health and must understand the impact of their actions on the health system, especially in terms of rising rates of chronic diseases such as diabetes, cancer, and cardiovascular disease."

The study concludes that countries with the best health status often have older populations and spend less on their health care systems than Canada, yet Canada's grade is suffering from a lack of innovation in health care and a shortage of personal responsibility.

On average through the 1990s, Canada ranked fifth in the health status sweepstakes, a position now held by Australia. For the decade starting in 2000, Canada has actually maintained an average grade of C, although a slight uptick in the most recent year brings the grade back up to B.

The U.S. finished in 15th place of the 16 countries evaluated, and Denmark has the unenviable last-place position.

By Mike Barber , Canwest News Service - canada.com

Research has given new light to preventing breast cancer.

The increasing number of women getting the disease can be fought with lifestyle changes, says breast surgeon Trevor Smith.

Without changes he predicts the figures will continue to escalate.

FIONA GOODALL

CANCER PREVENTION: Breast surgeon Trevor Smith has released a book with information about all aspects of breast care.

Through 12 years in the job Dr Smith has seen increasing awareness through October’s breast cancer awareness months and improved treatments, but the number of women being diagnosed with and dying of the disease hasn’t dropped.

Dr Smith says New Zealand has one of the highest rates of breast cancer in the world because of a similar lifestyle to the United States which leads the statistics.

Concern about the increasing diagnosis industry and lack of education about preventative lifestyle measures has prompted him to write a book covering all aspects of breast care.

"There is an increasing demand to fund expensive drugs and virtually no money is spent on promoting and improving lifestyle," says Dr Smith.

Figures from 2002 showed the rate of breast cancer in women in China was 19 per 100,000 people while in New Zealand it was 91.

Women from low risk countries who move here increase their chance of getting cancer because risk is based more on lifestyle than genetics.

He says only 5 percent of cancers are linked to genetics. World Cancer research shows 30 to 40 percent of cancer can be avoided by adopting the advice.

Hundreds of published studies identified risk factors which people can easily control and the challenge is to motivate people to want to change, Dr Smith says.

Healthy nutrition should be more plant-based and less processed and energy dense. A binge drinking culture contributes to the risk and alcohol should be limited to one drink a day.

He says he is not trying to promote elimination but moderation. Limiting alcohol is not a popular message, but drinking alcohol daily increases the risk by 10 percent.

"Every bit you do is an investment in your health."

From the age of 30 women should get an annual breast check and by the age of 40 be having mammograms.

The book, called Breast Care, was launched two months ago, providing a new approach presented in a positive way, he says.

It is available at bookshops for $30.

Information can also be found at www.thebreastcen tre.co.nz

Source: NICOLA WILLIAMS - Eastern Courier

ISLAMABAD- A sizeable child population living in areas of vulnerable security that stayed away from the anti-Polio campaign’s reach are feared to be carrying high risk of poliovirus presence.
Since the polio campaign staff is unable to cover these areas mostly due to security constraints thus the children living in these areas could not get any vaccination against the disease. Therefore, a large number of children with respect to theirs carrying poliovirus risk are as unpredictable as they were.

According official sources the situation in the country’s conflict ridden and security-compromised areas continues to affect provision of much needed health services.

“People in these areas are also becoming a source of spread of diseases to other areas in the country as lack of health interventions means outbreaks of diseases can neither be contained nor controlled and this is resulting in spread and spill over to other areas of Pakistan” he noted.
He said that the most critical is the spread of poliomyelitis in these areas a disease that causes permanent irreversible disability.

“Where the situation in the conflict areas is resulting in affecting peace in other parts of the country, it is also a cause for spread of diseases like polio” he added.
This in turn is spread to other children as these children are taken out of the conflict zones and settle in camps for the Internally Displaced Persons or in houses of their relatives and near and dear ones he opined.

According to careful estimates close to 0.7 million children belonging to security-compromised areas could not get the polio vaccine despite efforts of the local teams. The situation has indeed reached alarming proportions and has put health experts in a spin as despite best efforts by the provincial and federal teams there seems to be no let up in the polio cases.

Most of these cases have been reported from NWFP and FATA and even in Punjab and the Federal Capital Islamabad, majority of polio cases are genetically linked to the security compromised areas in NWFP and FATA and Afghanistan remarked an epidemiologist working for the polio eradication initiative.

Poliovirus circulation is restricted to transmission zones in NWFP and FATA and areas bordering Afghanistan, which present a major risk to the other polio free areas, said the expert.

By FOZIA AZAM - nation.com.pk

An investigation has been launched by Nelson's health board after a patient from its mental health unit got into a sixth-floor diagnostic area, broke a window and jumped out, landing two floors below.

The inquiry is being classed as a sentinel event investigation, which follows any event where a significant failure of the hospital's care is possible.

The Nelson Marlborough District Health Board is not yet revealing how the man got into a Nelson Hospital stairwell in the sixth-floor diagnostic services area of the Percy Brunette Building - which contains no wards - about 9am yesterday.

The man, aged in his late 30s, smashed a window with a fire extinguisher before jumping out and landing on a cooling tower two floors below.

He was in the hospital's intensive care unit in a stable but improving condition this morning.

Health board incident controller Pat Davidsen said police had completed a scene investigation.

He could not say how long the sentinel event investigation would take but said it would be thorough.

Senior Constable Phil Wylie of Nelson police said an officer attended and, on advice from a physician, decided not to take any action.

Updated from http://www.stuff.co.nz/4744387a20475.html

Halloween is just a day away and you must decide whether to turn your little witches loose on their broomsticks in the neighbourhood or to keep them on a shorter rein. If you are going to allow them to trick or treat in the neighbourhood there are some things you can do to make their adventure fun and safe.

• Feed them before they venture out. This way they will be less tempted to sample their booty before returning home.
• Plan to have an adult accompany very young children and have the older ones travel in groups.
• Establish rules about gathering candy and treats. 1. Only go to well lit houses. 2.Never go inside a house. 3. Never eat anything at someone's house. 4.Never drink anything at someone's house. 5.Don't eat candy that another kid has gathered.
• Decide on a time for the older children to be home. They'll need to wear a watch and carry a flashlight.
• Make sure that costumes don't present a tripping hazard and that masks don't obstruct vision, makeup is a better option.
• Go over rules for crossing the streets safely with the older children.
• Take a spare bag in case the first one breaks.
• If big kids demand your loot bag, give it to them. Don't fight.

Many towns and cities now offer Halloween night activities that are free or low cost and allow the ogres and ghosts a chance to haunt in safety and warmth. Shopping centres seem particularly good at offering free or low cost trick or treating. You have the added assurance that the edibles are safe for kiddies. Some centres have parades, crafts, face painting and costume contest. For specifics, log onto you local shopping centre and look for the "events" category. In the Vancouver area, the Aberdeen Centre looked like a sure be for family fun. In Nanaimo, Woodgrove Centre provides a warm, dry venue for little demons to collect treats from merchants.

While many charitable organizations offer spooky haunted houses, many are too scary for the little haunts. In Vancouver, the Stanley Park Miniature Railway at $9 and 5.50 offers spooky pirates and more from the Ghost Train until November 1st. If you are in Toronto, the Cadbury Gladstone Chocolate Factory 08 is offering a tour of the chocolate factory and it's free. Donations are requested for the charity it's supporting this year.

Today would be a good time to think about how you are going to handle confiscating the treats that your little devils collected that aren't suitable for them. You might want to lay in a supply of nickels for bribe money.

Structured character education has flourished as schools seek to instill the values of integrity, respect, responsibility, fairness, honesty, caring, and citizenship in their students to strengthen the social fabric of the school and community. Though not without criticism, these efforts to strengthen children's character through school-based programs are welcomed by parents who want their children educated in a strong culture of respect, integrity, and self-control.

Social Learning - A Family Culture of Character

Parents who exhibit the qualities of good character powerfully transmit their values by modeling the choices and actions that are essential to being a person of good character. Are we honest, trustworthy, fair, compassionate, respectful, involved in the greater good of our family and community? How do our children know this? They see it in our everyday actions and choices. They see that it brings a sense of joy, satisfaction, and peace to their family life. Children also learn that when they violate these guiding ethics, parents will implement consequences with fairness and dignity.

In her books on moral development in children, Michelle Borba teaches that the first step is empathy. Empathy is the necessary condition in the parent-child relationship that allows us to teach all of the other character values to our children. When our children feel that we understand and care about them deeply, they have the intrinsic motivation to learn the lessons of love and character we share.

Direct Instruction - Teachable Moments to Build Character

Discipline strategies are an important tool to use teachable moments to build character. We should always take the opportunity to explain why our child's behavior is wrong when we correct him. Make a habit of identifying in your own mind the value you wish to teach the child based on the particular behavior. Choose a consequence that is appropriate to teach that value. One natural consequence that we can use is to 'make amends'. For example, dishonesty is best resolved when we confess and are held accountable. Sometimes an apology to the person wronged is enough; other times we must take action to right the wrong. Brief, but direct instruction about why we have a family rule and the underlying value we hold helps the child learn from consequences and discipline.

Story Telling - Learning Qualities of Character from Literature and Life

Parents and teachers used stories to teach moral lessons long before the books were invented; and if you think about it, we still do. As we tell the stories of our lives and the world around us, we convey lessons of virtue and ethics to our children. Discussions about the stories we see on TV are opportunities to reinforce our values. Listening and responding to our child's stories about school and peers, we can help them think through the right thing to do. Being mindful of our children listening to the stories we tell other adults, we teach that our values guide all aspects of our life.

Children's literature abounds with great books that illustrate important values. Great books reach the inner child and teach their lessons without the parent's interpretation or instruction. About Children's Books will guide you to finding some good children's literature choices that teach character. Sharing real-life stories from the news and internet with our children inspires us all to pursue our values in life.

Experiential Learning - Practicing Qualities of Character

What is tooth decay?

• Tooth decay is a disease that destroys teeth.
• It can result in the loss of teeth if it is not treated.

What causes tooth decay?

• Tooth decay is caused by the bacteria in dental plaque.
• The bacteria feed on dietary sugars and release acids, which dissolve and destroy the teeth.
  

What are dental plaque, calculus and tartar?

• Dental plaque is a thin coating of bacteria and food particles that sticks to teeth.
  • It cannot be rinsed off, but it can be removed by brushing, flossing and dental scaling.
  • It causes tooth decay and gum disease.
  • The longer that plaque is allowed to remain on teeth, the greater are the risks of gum disease.
• If plaque is not removed, it can harden to form calculus, also called tartar.
• Calculus should be removed by a dentist or hygienist, as it cannot be removed by brushing.
• Diets rich in soft, sticky, carbohydrate foods (refined sugars) assist plaque formation.

How does decay progress through the tooth?

• The first layer of tooth to be affected is the outermost, the enamel.
• It then spreads to underlying dentine.
• The decay can eventually reach the pulp, which is the name for the nerves and blood vessels of the tooth.

Spread of decay

What are the symptoms of tooth decay?

• The symptoms of decay will vary according to the extent to which it has spread into the tooth.
  • Decay is quite painless in the early stages when only the enamel is affected.
  • When decay has spread to the dentine, pain can be caused by sweet foods, such as chocolate, sugary snacks and drinks.
  • When the decay spreads deeper, sensitivity can be felt with hot and cold drinks.
  • Severe ongoing pain that is caused by hot food and drinks indicates that the nerves and blood vessels have become affected by the decay.
    This condition is called a pulpitis.

Visit our Pain Chart to learn more about the causes of pain (#11 above)

How does the dentist discover decay?

• The dentist uses a special fine explorer instrument to discover cavities that have developed.
• Regular check ups by the dentist, and periodic x-rays will ensure that decay will be detected soon after it has started.
  X-rays can reveal decay that cannot be detected by visual dental examination.
• A dull white patch on the tooth could be a sign of early decay.

Illustration of x-ray showing decay

Which tooth surfaces are most likely to decay?

• The chewing surfaces of back teeth with their grooves and pits, are usually the first to decay.
  This is because dental plaque accumulates in these areas.
• The tooth surfaces where adjoining teeth meet are also common places for decay to start.
• Tooth decay can start around and under old fillings that have cracked, chipped or broken down.
• Decay can also occur at the gum line, which is at the neck of the tooth.

Why are regular brushing and flossing necessary?

• Plaque formation is an ongoing process which starts again soon after brushing.
  This is why regular brushing and flossing are necessary to keep plaque off the teeth.
  • Brushing cleans mainly the surfaces of the teeth that can be seen.
  • Floss removes dental plaque from between the teeth where the toothbrush cannot reach.
    

What measures should be taken to prevent tooth decay?

• Tooth decay can be prevented by home care and oral hygiene, professional care and diet control.
• Home Care and Oral Hygiene
  • Regular brushing and flossing are essential:
  • Brush your teeth at least twice a day, after breakfast and before bedtime.
  • Regular flossing will remove harmful plaque from the areas between teeth, that the brush cannot reach.
  • Special brushes and devices, prescribed by the dentist, can help to clean areas in the mouth that are difficult to reach.
  • Your dentist may recommend a mechanical or ultrasonic toothbrush to remove dental plaque.
  • The surface application of fluoride is made with the daily use of fluoride toothpastes and mouthwashes.
    Fluoride is a chemical that hardens the enamel of a tooth, and increases its resistance to decay. It can also help to stop the early stages of decay.
• Professional care
  • Adults and children should see the dentist twice a year.
  • Regular visits to the dentist for professional examination and cleaning are essential.
  • The early detection and treatment of decay and gum disease will only be possible with regular dental inspection.
  • X-rays will help the dentist to find early signs of decay.
  • Fissure sealants can be applied to back teeth to protect them from decay.
  • Fluoride applied to the teeth by the dentist will also help to prevent decay.

Before sealants

After sealants

• Diet Control
  • Reduce the amount of refined carbohydrate in your diet.
  • This includes the refined sugar found in table sugar, biscuits, cakes, chocolates, sweets, and fizzy soft drinks.
  • The acid in carbonated soft drinks, including diet drinks, is harmful to teeth.
  • Fruit, vegetables and juices, which contain natural sugars are preferable.

1. What is bruxism?

• Bruxism is the unconscious and involuntary habit of clenching or grinding teeth. This means that a person with bruxism is mostly unaware of, and unable to stop the habit.
  • It can take place at night when asleep or during the day.
  • As bruxism is related to stress, it is a fairly common problem.
  • Bruxism can affect the teeth, muscles, jaw joints (Temporomandibular joints), and the appearance of the face.

2. What are the signs and symptoms of bruxism?

• Excessive tooth wear caused by bruxism is not the same as normal tooth wear. These are the symptoms:
  • The teeth will be worn down, and become shorter. The dental term for this toothwear is attrition.
  • The teeth will become flattened, and the creamy/yellow dentine will be visible.
  • If bruxism is not treated, the teeth may be worn down to the level of the gums.
  • Teeth have a tendency to chip as a result of the grinding.
  • Tenderness and pain may be felt in the muscles and jaw joints on waking in the morning.
  • Eating may become painful because of restricted jaw movement.
  • Teeth can become sensitive, painful and loose, after they have been worn down or cracked by the grinding.
  • Extensive tooth wear can cause the jaws to close down too far, resulting in facial changes.
  • Unsightly creasing at the corners of the mouth will be evident.
  • Bruxism may also cause the development of prominent jaw muscles.
  • The sound of grinding teeth can disturb other people.

Severe bruxism

Moderate bruxism

Normal toothwear with ageing

3. What causes bruxism?

• The main causes of bruxism are stress, psychological problems, and medical conditions.
• It may occur in people with cerebral palsy, or learning difficulties.
  

4. How is bruxism treated?

• Bruxism is treated psychologically, dentally and by medication.
  • The psychological and medical causes are dealt with by psychologists, psychiatrists and doctors.
  • Behaviour modification through relaxation training may be used to treat bruxism.
• The dental treatment for bruxism is directed to preventing further damage to the teeth, and to the repair of the worn down teeth.
• The preventive treatment is to use a nightguard.
  • Nightguards can lessen the effects of bruxism:
  • They cannot cure the bruxism as they do not treat the cause, but they can protect the teeth from further damage.
  • Nightguards prevent the upper and lower teeth from grinding against each other.
  • An acrylic nightguard or bite plate may also relieve the symptoms of jaw joint disorders caused by bruxism.
  • Nightguards are provided by the dentist:
  • Impressions are taken of the upper and lower teeth.
  • They are sent to the dental laboratory where the nightguard is made.
  • Nightguards are designed to cover the biting and chewing surfaces of the teeth in one of the jaws, usually the upper.
  • They can be made from a soft plastic or a hard acrylic material.
  • A mouthguard is often supplied with the cast from which it was made.

Nightguard + cast		Nightguard
Nightguard in the mouth		Acrylic bite plate

5. How does the dentist treat the attrition caused by bruxism?

• Where bruxism has resulted in severe attrition, the teeth will need to be restored:
  • Replacement crowns or onlays can be used to restore the worn down teeth.
  • These measures will restore the teeth to their normal size, and the jaws will regain their normal position.
  • The dimensions and appearance of the teeth and face can be aesthetically improved with dental restorations.

Before

After replacement crowns

1. Why do we brush our teeth?

• It is important to remove the dental plaque and food that stick to teeth, and cause decay and gum disease.
• Brushing and flossing are the most effective ways of controlling plaque.
• You need to be aware of the fact that plaque is being formed continuously.
• Plaque formation and growth cannot be stopped. Plaque can only be controlled by regular daily removal.
  

2. What are the recommended techniques for brushing teeth?

• We recommend two methods for brushing teeth. They both use the same angled position of the brush:
  Place the brush at a 45-degree angle towards the junction of the tooth and the gum. This is the position for brushing the sides of the teeth.
• One suggested method is to brush gently in a circular movement.
• Another technique is known as the gentle scrub method.
  • The brush is moved backwards and forwards horizontally in very short strokes.
  • Each stroke is no more than the width of one tooth.
  • Brush all the tooth surfaces of all the teeth.
  • Brush behind the front teeth with an up and down movement using the end of the brush.
  • Brushing should be unhurried and thorough.
• Partial dentures should be removed for the efficient brushing of the remaining teeth.

Toothbrush position

3. How can I be sure I am cleaning my teeth properly?

• Disclosing tablets can be used after brushing to check that all the plaque has been removed.
  • These are brightly coloured tablets, which are chewed and then rinsed out.
  • If your teeth are not clean, a pink stain will show where more brushing is needed.
  • If your brushing has been thorough, little or no stained dental plaque will be seen.
  • The disclosing tablets are only used occasionally, to confirm how well the teeth are being cleaned.
  • Disclosing tablets are available in a few colours.
• Teeth should be brushed at least twice a day, preferably after meals.
• It is most important to brush your teeth before going to bed at night.
• Brushing should not injure the gums and cause bleeding. If your gums bleed after gentle brushing you should see your dentist.

After disclosing tablets

After more brushing

4. What helpful aids are there for cleaning between the teeth?

• There are many dental hygiene products available for cleaning between the teeth. We describe and show them below.
• It is most important to clean between the teeth to prevent decay and gum disease.
  • Plaque and food particles stick to the teeth in these areas.
  • Normal tooth brushing cannot reach these tooth surfaces.
  • Plaque can only be removed by daily brushing and interdental cleaning.
• Flossing is the method of choice for cleaning between teeth.
  
  
• Why it is important to use dental floss.
  • Dental Floss is the most efficient way to clean between teeth.
  • Different types of floss are available, such as regular floss, dental tape and super floss.
  • Floss is also available on a plastic holder, in the shape of a bow. The string of the bow is slipped between the teeth and makes flossing more manageable.
  
  

  Superfloss		Dental tape
  Floss holders		Regular floss

• Here are a few tips for flossing as demonstrated below:
  • Use a 12-15inch (30-40cm) length of floss.
  • Wrap the floss around your middle fingers.
  • Hold the floss between the thumb and forefinger of each hand.
  • Leave about 2 inches (5cm) of floss between the hands.
  • The floss must be taut when it is used.
  • Gently guide the floss across the contact point between the teeth.
  • When the floss is in position between the teeth, rub it up and down a few times against each tooth surface, one after the other.
  • This is then repeated for all the teeth in the mouth.
  • Be careful not to cut your gums with the floss.
  • A sharp downward thrust of the floss will damage the gum and make it bleed.
  • Your dentist will be happy to show you how to floss, and choose which floss is best for you.
  • The floss holders shown above are easy to use, if you have difficulty using the conventional floss.
  
  

  Floss on hands

  Floss up

  Floss down

• Interdental (interproximal) brushes
  • These are triangular shaped small brushes, like little bottlebrushes.
  • They are very useful for cleaning between the teeth.
  • They fit onto a plastic handle, and are available in varying sizes.
  • Select the size of brush that is best suited to you.
  • Gently push the brush back and forth into the spaces between the teeth.
  • This interdental brush is best suited to teeth that have spaces between them, caused by gum recession.
  • Some degree of gum recession is seen in most mouths by middle age, and in those with gum disease, at any age.
  
  

  Interdental brushes

  Interdental brushing

  Interdental brushing

• End or single tuft toothbrushes
  • These are toothbrushes with only one tuft of bristles.
  • They are used where the normal, multi-tufted toothbrushes cannot reach.
  • These brushes are designed for brushing around crowns, bridges, displaced and rotated teeth.
  
  

  End tuft brush

• Interdental picks or sticks
  • These are specially designed soft wooden wedges for cleaning between teeth. They can be used after meals or at any time.
  • The end of the stick should be moistened and softened in the mouth before use.
  • Gently insert the stick between the teeth, with the flat edge facing the gum.
  • Then move it in and out gently to clean the teeth and massage the gums.
  • Food trapped between the teeth can be removed with these sticks.
  • They are effective for mouths where receding gums have left spaces between teeth.
  • The sticks should only be used where there is sufficient space to allow the free movement of the stick between the teeth. Do not force them into position.
  • They should not be used if they cause any bleeding.
  • They are not suitable for children.
  
  

  Interdental sticks

  Stick in use

  Stick in use

• Interdental rubber tip stimulators
  • These are pointed rubber tips that are fitted to a toothbrush handle.
  • They are used to stimulate and firm up the triangular soft gum between teeth.
  • Your dentist or periodontist will tell you if you need them.
  
  

  Rubber tip stimulator

• Pulsating water or medicament spraying devices
  • Irrigating devices provide a steady or pulsating stream of water under pressure through a nozzle. They are especially useful in mouths with fixed bridges, and for cleaning between teeth.
  • They should not be used as a substitute for toothbrushing.
  • Speak to your dentist before you buy one.

5. Can brushing damage teeth?

• Toothwear, the wearing away of the enamel and dentine, can be caused by brushing too vigorously, and by using a toothbrush with a very hard bristle.
  • This type of toothwear is called abrasion.
  • It usually takes place at the gum margin, where the enamel is thin, and is easily worn away.
  • Brushing across the teeth with long horizontal strokes is the main cause of abrasion. Gentle brushing is all that is necessary.

Abrasion

See Toothwear

6. What is the ideal toothbrush?

• The ideal toothbrush should meet the following requirements:
  • It should have a head that is small enough, and correctly angled, to reach all the teeth.
  • The brush should be multi-tufted, and have a medium/soft texture.
  • Hard bristles can damage teeth and gums, and are not recommended.
  • The bristles should be made of nylon, and their ends need to be rounded.
  • Bristles made from synthetic rather than natural materials are preferable for hygienic reasons. Natural bristles may be porous and are likely to absorb bacteria.

7. Are all toothbrushes made to the same design?

• There is a large selection of toothbrushes:
  • Some have bristles arranged in patterns that reach the greatest possible area of tooth surface.
  • Others are designed for cleaning between the teeth, and along the gum margins.
  • Yet another design is made with a row of coloured bristles that fade with use, and thereby indicate that the brush needs replacing.

Toothbrush bristles

Various toothbrushes

8. What type of toothbrush is suitable for children?

• A toothbrush with a small head is recommended, so that children can use it easily, and it will not cause gagging when they brush their back teeth.
• The handle should have the correct length and thickness. It must be easy to use and provide a firm grip.
• Toothbrushes can easily be modified if difficulty is experienced with a regular brush.
• Brushes for children often have handles and heads that are brightly coloured, and show cartoon characters. Brushing needs to be a fun experience!

Toothbrushes for children

Modified toothbrushes

9. How often should your toothbrush be changed?

• The toothbrush should be changed at the first sign of wear.
  • The bristles may become flattened and lose their shape.
  • Bristles wear differently from person to person depending on how the toothbrush is used.
  • Plaque removal becomes less efficient with an old worn toothbrush.
  • It is recommended that you to change your toothbrush every four to six months.

10. Should I share my toothbrush with another member of the family?

• Toothbrushes should not be shared as they can harbour infectious bacteria.
  • Using the same toothbrush can transmit hepatitis and other diseases.
  • Mothers should not share their toothbrushes with their children.
  • The initial immunity to infection that the child shares with the mother does not last indefinitely.
  • Toothbrushes should also be kept separately, as an added precaution.

11. Are electric toothbrushes recommended by dentists?

• Electric toothbrushes have proven to be very successful in maintaining good oral health, and removing plaque.
  • The action of the brush is more efficient than the manual brush for cleaning teeth.
  • Electric toothbrushes are recommended for the elderly and people with arthritis or other disabilities, who may find it difficult to manage with a manual toothbrush.
  • Children enjoy the fun of using an electric toothbrush. It will result in a more thorough cleaning of their teeth, particularly at an early age.
  • As they grow older it may be less important to use an electric toothbrush.
  • It is effective with fixed orthodontic appliances.
  • Remember that the cleaning of teeth will only be successful, if the motivation exists to have healthy teeth and gums.
  • Electric toothbrushes may provide interest and motivation for people who are reluctant to brush their teeth properly.
  • Consult your dentist and follow the manufacturer's instructions.

1. The Teeth and Their Parts:

• Each tooth has two main parts, the crown and the root.
• The crown and the root meet at the neck of the tooth, which is normally just below the gum margin.
  

The tooth

Normal teeth, gum and bone

• The crown
  This is the part of the tooth that we see in the mouth.
  It is made up of the enamel, dentine and pulp.
  The appearance of teeth varies in shape and size.
  • The front incisor teeth have a straight edge as a cutting tool.
  • The canine or eye teeth are the pointed long teeth between the incisor and premolar teeth.
  • The pre-molar and molar teeth are larger and have cusps.
  • A cusp is the raised pointed part of the chewing surface of a tooth.
  • The presence of large cusps on pre-molar and molar teeth marks the main difference between them and the front teeth.
  • Pre-molar teeth (bicuspids) have two cusps.
  • Molar teeth each have four or more cusps.
  • The four permanent lower incisor teeth each erupt with three small cuspettes that resemble a serrated edge. These cusps wear down with use and the teeth remain with a straight edge.
  • The four permanent upper incisors may erupt with three very small cuspettes. These are much less obvious than those on the lower incisors. They are also normally worn away to form a straight edge.

• Enamel
  • The enamel is the white hard covering over the crown of the tooth.
  • It is shaped into cusps, fissures and pits in premolar and molar teeth.
  • It is the hardest material in the body and does not have a nerve supply.
    Chipping or damage to enamel only will not be painful.
  • It also does not have a blood supply.
    This results in a chipped tooth remaining exactly as it is.
    Enamel cannot heal or repair as bone or dentine can.

• Dentine
  • Dentine is a cream coloured hard material that makes up the bulk of the tooth.
  • It is covered by enamel on the crown, and by cementum on the roots.
  • The dentine surrounds and protects the nerves and blood vessels (pulp) in the crown and roots.
  • Dentine is alive or vital in as much as more dentine can be formed, and it can register pain.
    • A protective layer of secondary dentine can be layed down over the pulp.
    • This happens in response to caries, attrition, abrasion, erosion, or fracture of a tooth, when the dentine becomes exposed.
    • The tooth becomes sensitive to temperature changes and feels painful, when the dentine is exposed in the above mentioned ways.

• Pulp
  The nerves and blood vessels of the tooth are called the pulp. The pulp occupies the root canals, and the pulp chamber i
  • n the crown of the tooth.
  • When it is exposed to infection by decay or injury it will die and cause severe pain. An abscess will develop on the root.
  • The tooth will have to be extracted if a root canal treatment is not performed to save it.

• The roots
  The roots are embedded in the tooth socket in the jaw bone.
  • The front incisor and eye-teeth each have a single root.
  • Pre-molar teeth (bicuspids) have one or two roots.
  • The molar teeth can have two or three roots.
  • Each root has a root canal for the nerves and blood vessels to pass through.
  • Roots are covered by cementum and held in place by the periodontal ligament.

• Cementum
  • The cementum is a thin calcified covering of the roots.
  • It meets the enamel at the neck of the tooth.
  • It has no nerve supply.
  • The cementum covers the dentine of the roots.
  • It is attached to the periodontal ligament.

• Periodontal membrane or ligament
  The periodontal ligament attaches the roots to the alveolar bone of the jaw.
  • It has both a nerve and blood supply
  • The ligament provides an elastic cushion between the tooth and the bone. Slight movement of a tooth is made possible by the ligament.
  • Teeth are not rigidly joined to bone. There is flexibility.
    

2. Tooth Names and Positions.

A. Baby Teeth
Tooth Names		Positions
Front Teeth: A. Central incisor B. Lateral incisor C. Canine or eye tooth		Upper Teeth
Back Teeth: D. First molar E. Second molar	Lower Teeth
A. Permanent Teeth
Tooth Names		Positions
Front Teeth: 1. Central incisor 2. Lateral incisor 3. Canine or eye tooth		Upper Teeth
Back Teeth: 4. First premolar 5. Second premolar 6. First Molar 7. Second Molar 8. Third Molar Or Wisdom Tooth	Lower Teeth

3. The Jaws and Jaw Joints (Temporomandibular Joints / TMJ)

• The temporomandibular joints are the two jaw joints, one at each side of the face.
  • Movement of the lower jaw is made possible by this joint.
  • The upper jaw is called the maxilla and is joined to the temporal bone.
  • The lower jaw is called the mandible or mandibular bone.
  • The term "temporomandibular" refers to the connection between these two bones.
  • Chewing and speech would not be possible without this joint.

Jaw joint (TMJ)

• The TMJ is a variation of a hinge joint. It is technically called a sliding hinge joint. This allows the jaw to be flexible and move in a number of directions:
  • The lower jaw moves up and down when the mouth is opened and closed.
  • When we chew food and speak the jaw movements can be forward and backward, sideways and circular.
  • In young children the jaw only moves up and down like a regular hinge.
  • The flexibility and other movements of the jaw develop with the arrival of the permanent teeth.

Jaw open

Jaw closed

4. Dental x-ray viewing and interpretation

A dental x-ray is a picture of the inside of a tooth and bone.

• How to read or interpret an X-ray:
  Soft objects appear black, solid objects are white on x-ray.
• What you see as grey/black on x-ray:
  • Decay.
  • Abscess.
  • Nerves and blood vessels (the pulp).
  • Gum in the spaces between teeth.

• What you see as white/cream on x-ray:
  • The enamel.
  • Metal fillings and crowns will be white.
  • The dentine appears as a creamy white colour.
• Bone has a mottled grey and white appearance. It has a fine white line at its margin around the teeth.

Illustration of x-ray showing tooth parts and bone

Abscess above root (the dark area)

Source: http://www.simplyteeth.com/category/sections/adult/aboutteeth/anatomy.asp?category=adult&section=1&page=1