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Muscles of Head and Neck

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Muscles of Head and Neck Region

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Muscles of Head and Neck

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Muscles of  Head and Neck Region 

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Study Guide for Head and Neck Anatomy - Cranial Nerves

Dental Fluorosis

Epidemiology

Dental fluorosis is a developmental disturbance of dental enamel caused by the consumption of excess fluoride during tooth development. It's caused by overexposure to fluoride during the first eight years of life more commonly, the time when most permanent teeth are being formed. 

Dental Fluorosis

Common sources of fluoride includes, toothpaste (if swallowed by young children), drinking water in fluoridated communities, beverages and food processed with fluoridated water, dietary prescription supplements that include fluoride (e.g., tablets or drops) and other professional dental products (e.g., mouth rinses, gels, and foams). Increases in the occurrence of mostly mild dental fluorosis were recognized as more sources of fluoride became available to prevent tooth decay. These sources include drinking water with fluoride, fluoride toothpastes (if swallowed by young children) and dietary prescription supplements in tablets or drops. Moderate-level chronic exposure (above 1.5 mg/litre of water - the WHO guideline value for fluoride in water) to drinking water is typically the most significant source. 

Dental fluorosis can occur among persons in all communities at different severities, even in those with a low natural concentration of fluoride in the drinking water. However fluoride in water is mostly of geological origin. Waters with high levels of fluoride content are mostly found at the foot of high mountains and in areas where the sea has made geological deposits. Known fluoride belts on land include: one that stretches from Syria through Jordan, Egypt, Libya, Algeria, Sudan and Kenya, and another that stretches from Turkey through Iraq, Iran, Afghanistan, India, northern Thailand and China. There are similar belts in the Americas and Japan. In these areas fluorosis has been reported. Various studies from all over the world on the disease burden of different populations reveals different figures. But As of 2005 surveys conducted by the National Institute of Dental and Craniofacial Research in the USA between 1986 and 1987 and by the Center of Disease Control between 1999 and 2002 are the only national sources of data concerning the prevalence of dental fluorosis.

Data from the National Health and Nutrition Examination Survey, 1999-2004 and the 1986-1987 National Survey of Oral Health in U.S. School Children reveals that there were less than one-quarter of persons aged 6-49 in the United States had some form of dental fluorosis. The prevalence of dental fluorosis was higher in adolescents than in adults and highest among those aged 12-15. Adolescents aged 12-15 in 1999-2004 had a higher prevalence of dental fluorosis than adolescents aged 12-15 in 1986-1987. Another survey conducted in Indian subcontinent shows that fluorosis is an endemic disease prevalent in 20 states out of the 35 states and Union Territories of the Indian Republic.

Signs and symptoms

Symptoms of fluorosis range from tiny white specks or streaks that may be unnoticeable to dark brown stains and rough, pitted enamel that is difficult to clean. The severity of the condition depends on the dose (how much), duration (how long), and timing (when consumed) of fluoride intake. Since the 1930s, dentists have rated the severity of fluorosis using the following categories:

·

• Questionable -The enamel shows slight changes ranging from a few white flecks to occasional white spots.
• Very mild      -Small opaque paper-white areas are scattered over less than 25% of the tooth surface.
• Mild               - White opaque areas on the surface are more extensive but still affect less than 50% of the surface.
• Moderate        -White opaque areas affect more than 50% of the enamel surface.
• Severe             -All enamel surfaces are affected. The teeth also have pitting that may be discrete or may run together.

Classification of Dental Fluorosis

Treatment options

Depending upon severity of the disease, treatment option varies. Micro/Macro abrasion, Bleaching, Composite restorations, Veneers, Full crowns are the main options available. These are described in detail in another article.

Disease prevention

Removal of excessive fluoride from drinking-water is difficult and expensive. The preferred option is to find a supply of safe drinking-water with safe fluoride levels. If you rely on well water or bottled water, your public health department or a local laboratory can analyze its fluoride content. Where access to safe water is already limited, de-fluoridation may be the only solution. Methods include: use of bone charcoal, contact precipitation, use of Nalgonda or activated alumina (Nalgonda is called after the town in South India, near Hyderabad, where the aluminium sulfate-based defluoridation was first set up at a water works level).

Health education regarding appropriate use of fluorides and parental vigilance is a key measure to prevent fluorosis. Keeping all fluoride-containing products such as toothpaste, mouth rinses, and supplements out of the reach of young children and monitoring your child’s use of fluoridated toothpaste are key facts. Only place a pea-sized amount of toothpaste on your child’s toothbrush. Also teach your child to spit out the toothpaste after brushing instead of swallowing it. To encourage spitting, avoid toothpastes containing flavors that children may be likely to swallow. Adult supervision of tooth brushing by children younger than 6 years of age and changes in recommendations for administration of fluoride supplements so that such supplements are not given to infants and more stringent criteria are applied for administration to children.

Teething in Infants

Teething is the phenomena accompanying growth of teeth through the gums. The effect of teething on infant health has been debated for at least 5000 years, and traditional beliefs on the issue have still not been entirely superseded by scientific findings. Sumerians believed teething and worm infestation were associated. Hindu writings, as well as work by Aristotle, Homer, Celsus, and others, describe associations between teething and illness. Many of these authors implicated tooth emergence in childhood mortality. The belief that teething led to childhood mortality, seizures, diarrhea, fever, or other serious conditions was criticized as early as the 17th century by Francois Ranchin. Yet in 1839, 5016 deaths in England and Wales were attributed to teething. Illingworth wrote in 1975 that “teething produces nothing but teeth.” However, as recently as 1979, parents and physicians were identifying teething as a cause of presenting symptoms in children admitted to the hospital. A medical evaluation of 50 of these children showed that in 48 cases the symptoms, ranging from upper respiratory infection to bacterial meningitis. Most medical professionals now agree that teething does not cause life-threatening illness, but they disagree about which symptoms may be associated with tooth eruption.

Teething in Infants

However several studies with different study designs has revealed symptoms believed to be associated with teething such as loss of appetite for solids and liquids, drooling, biting or chewing various objects, congestion or runny nose, cough, sleep disturbances, restlessness and irritability, rash, spitting up or vomiting, and diarrhea and fever or mild temperature elevation. Anyhow It is important to inform parents that none of these symptoms consistently and accurately predict when teething is about to occur and any of other organic disorders should be ruled out in infants with these symptoms.

The recommended intervention for teething is the use of cold items because the cold acts as an anesthetic for the gums. Refrigerated pacifiers, Spoons, Clean wet washcloths, Frozen bagels or bananas, refrigerated teething rings can be offered to the infants at this stage.Topical teething gels sold over-the-counter (OTC) are often used for teething but may carry serious risks, including local reactions, seizures with overdose, and methemoglobinemia. Benzocaine containing teething gels should not be used in infants or children under 2 years of age. If necessary, parents should be instructed on proper dosing of analgesic medications, such as acetaminophen or ibuprofen.

Problem based learning (PBL)

“True learning is based on discovery guided by mentoring rather than the transmission of knowledge.”

John Dewey

Introduction and History

In simple terms Problem-based learning (PBL) is a student centred education in which students learn about a subject through the experience of creating a problem. Problem- based learning or what we simply called PBL is based on research in the cognitive sciences on how we learn.

This educational strategy was developed at the McMaster University Medical School in Canada in the 1960s in medical education. Efficacy of this revolutionary learning method has made it popular among educationists and It is one of the big success stories in the education in the past few years.   But nowadays PBL is developed and implemented in a wide range of domains around the world. This approach empowers learners to conduct research, integrate theory and practice, and apply knowledge and skills to develop a viable solution to a defined problem .In simple words this simple revolutionary idea that problems should come before answers drives PBL.  Beginning with a problem puts you in the driver’s seat.  You can use your previous knowledge, your hunches, and your wildest ideas to try for a solution.  In the process you can develop an inventory of what you know and what you need to know to get to a solution.  Once you know that you can start questioning your instructor or your classmates, plundering the library, surfing the net, or bugging the many excellent experts to fill your needs. 

What is the difference between Subject based learning and Problem Based learning

What is wrong with the old teacher stand up and talk student sit and listen learning?  It doesn’t meet the needs.  It is too slow, too shallow, too inefficient and not much fun.  Students retain little of what they learn after even a few weeks.  Students rarely can apply what they have learned to the unpredictable problems of life and work. Students get little practice in developing their thinking skills and intellectuality or framing problems that interest them. As a result, students come to see learning as something grim to be avoided.

Problem based learning gives you opportunities to examine and try out what you already know; discover what you need to learn; develop your people skills for achieving higher performance in teams; improve your writing and speaking abilities, to state and defend with sound arguments and evidence your own ideas; and to become more flexible in your approach to problems that surprise and dismay others. Despite the work and effort it requires, PBL is never dull and is often fun.

Here is a diagram of the basic difference between subject based and problem based learning.

What is expected in Problem Based Learning?

According to the epistemological literature four types of knowledge can be identified.

• 1     Explanatory knowledge-Theories
• 2.       Descriptive Knowledge-Facts
• 3.       Procedural Knowledge-Knowledge of how to do things
• 4.       Subjective Knowledge- Personal convictions or attitudes of the learner

The PBL problems are in two varieties with regards to acquisition of above mentioned aspects of knowledge.

• 1.       During the course of their study, students acquire different kinds of, or categories of knowledge about relevant aspects of their domain of study.
• 2.       The problem types to be distinguished are meant to guide the learners towards these different knowledge categories.

In a problem based curricula four different kinds of problems have been identified.

• ·         Explanation problems
• ·         Fact-finding problems
• ·         Strategy problems
• ·         Moral dilemma resolution problems

Respectively they are effective in achieving explanatory knowledge, descriptive knowledge, procedural knowledge and subjective knowledge. Teacher, Mentor, or Guiding body has the freedom of designing the problems to drive learners to achieve the desired aspect of knowledge. Ideally it should be the combinations of all.

Characteristics of PBL

According to Barrows in 1996 there are six core characteristics of PBL are distinguished.

• A The first characteristic is that learning needs to be student-centred.
• B Second, learning has to occur in small student groups under the guidance of a tutor.
• C The third characteristic refers to the tutor as a facilitator or guide.
• D Fourth, authentic problems are primarily encountered in the learning sequence, before any preparation or study has occurred.
• E Fifth, the problems encountered are used as a tool to achieve the required knowledge and the problem-solving skills necessary to eventually solve the problem.
• F Finally, new information needs to be acquired through self-directed learning.

It is generally recognized that a seventh characteristic should be added: Essential for PBL is that students learn by analysing and solving representative problems. However authors also describes following features as essential components in PBL as well.

Students must have the responsibility for their own learning. The tutor is only a facilitator in this learning process.

The problem simulations used in problem-based learning must be ill-structured and allow for free inquiry. The real world problems are ill-structured and PBL should allow the trainers to develop their skill to identify the problem and develop realistic solutions.

Learning should be integrated from a wide range of disciplines or subjects. During PBL students should be able to access, study and integrate information from all the disciplines and reach to a more robust solution. The development of information systems and multidisciplinary approach in the present world support this task more than ever before.

Collaboration is essential. PBL provides the platform to share information and work productively with fellow people.

What students learn during their self-directed learning must be applied back to the problem with reanalysis and resolution.

A closing analysis of what has been learned from work with the problem and a discussion of what concepts and principles have been learned are essential.

Self and peer assessment should be carried out at the completion of each problem and at the end of every curricular unit.

The activities carried out in problem-based learning must be those valued in the real world.

Student examinations must measure student progress towards the goals of problem-based learning.

“Problem-based learning must be the pedagogical base in the curriculum and not part of a didactic curriculum.”

Rules in problem design

• ·         Problem should consist of a title
• ·         Well-formed problem consist of a concrete body text
• ·         Each problem needs and instruction as to what to do with it
• ·         A problem should be connected to the prior knowledge base students have
• ·         A problem should raise students curiocity
• ·         A problem should only introduce a limited number of issues for learning
• ·         A problem should not take too much self-directed study time to acquire a fair understanding of the issues at hand

Advantages and Disadvantages of PBL

As in any educational theory there are advantages and limitations found in literature when creating or implementing problem based learning curriculum. Some of the advantages which were perceived by several authors are as follow.

• ·        Students interest and benefit
• ·        Minimizing faculty workload
• ·        Long-term knowledge retention
• ·        PBL provide a more challenging
• ·        Motivating and enjoyable approach to education
• ·        Students become actively engaged in meaningful learning rather than traditional memorization
• ·        Increased responsibility for their learning and self-direction

Higher levels of comprehension and skill development occur than in traditional instruction and develop interpersonal collaboration and team work.

Following disadvantages has been encountered in PBL according to literature.

 Lack of systematic learning as in traditional learning in which the information is delivered in a well arranged manner

Difficulty in allocating time required in a course schedule

Students often express difficulties with self-directed learning whereas the teachers may have difficulties to break their traditional teaching habits.

Also selecting the appropriate question will be critical and challenging too.

However the traditional student assessment systems should be changed in assessing a student who was trained on PBL.

Summary

PBL has becoming a revolutionary method of leaning in the context of student centred learning. At the heart of PBL stands a problem. PBL process can be designed in the way the students achieve the different aspects of knowledge. As in any learning method PBL also has its own advantages and disadvantages.