Nicolescu Adriana

8/6/2019 Nicolescu Adriana

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Facultatea de Medicina Dentara,

Craiova

PROIECT LA LIMBA ENGLEZA

Profesor,

Stefanescu Oana Cotulbea CorneliaTehnica Dentara

An 2 , gr 3


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Cuprins

1. Discussion Prognosis: How Much Do You Want To Know? Talking To

Patiens Who Are Prepared For Explicit Information

a. Speak About: Realism, Optimism And Avoidance When Discussing

Prognosis pag 3

b. How Much Do You Want To Know About Prognosis ..pag 7

2 Implantology..pag11

3. Taste Disorder pag 17

Exercices.. pag 20


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1. Discussion Prognosis: How Much Do You Want To Know? Talking To

Patiens Who Are Prepared For Explicit Information

a. Speak About: Realism, Optimism And Avoidance When

Discussing Prognosis

Optimal communication with health professionals (HPs) has been

identified by patients and their families as a critical aspect of end-of-life(EOL) care. Patients in developed countries are increasingly expressing a

preference to be well informed about their diagnosis and prognosis and to

be involved with decisions about their care. Having a doctor who is willingto talk about dying and who is sensitive to when patients are ready to

discuss this issue has been identified by patients and their families as one of

the most important needs at the EOL.

Choosing how and when to raise EOL issues with terminally ill

patients is difficult for HPs. Previous studies suggest that many patients feelit is up to the doctor to initiate discussion of EOL issues, yet doctors may bereluctant to raise the topic for fear of upsetting the patient.

Strategies with unintended consequences :realism, optimism, avoidance

The useful feature of realismis that prognostic information helpspatients and physiciansto make sound medical decisions. Both bioethical

reasoning andempirical evidence support the importance of accurate

patientunderstanding of prognosis. Yet patients also report that realisticprognostic discussions can be blunt and sometimes brutal. Aphysician who

presents prognosis realistically, but withoutstructuring the conversation

before the information or respondingempathetically afterwards, can beperceived as uncaring.


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Optimism can play a useful role in supporting a patient's hopesand

many patients report that they want a doctor who is hopeful.In discussions

about prognosis, however, physicians who deliberatelyexaggerate oroveremphasize optimistic information may risklosing the trust of patients

who later discover that the informationthey received was not entirely true.

Moreover, patients whoseare overly optimistic about their chances ofsurvival are morelikely to choose life-sustaining therapies in the last 6

monthsof life often when these therapies are least effective. A third strategy

is to avoid prognostication altogether, oftenby emphasizing individualdifferences, unpredictability of diseasecourse, or exceptional outliers.

Avoidance is basedon reasonable concerns.

How much do you want to know?

The approach proposed for discussing prognosis is based on work

innegotiation and patient-centered communication and the researchavailable

on what patients want to know about prognosis. Inaddition to the finding

that most patients want detailed information, surveys demonstratethat thereare many different possible prognostic questionsthat could be answered.

Discussing prognosis is more complex than other communicationtasks, suchas giving bad news, because it requires a synthesisof communication skills

and biomedical content knowledge. Not all patients want to be fully

informed or to discuss their prognosis. Some physicians tell patients andtheir carers early on that they are happy to answer questions about the

future at any stage. Other physicians said they endeavor to raise issuesabout the future indirectly or provide a space for it to come up in theconversation..

These doctors and nurses perceived a great fear among patients and

their families in discussing these issues. They said patients and carers mayfind it difficult to initiate the discussion themselves and needed permission

to feel comfortable in raising the topic. In addition, there was a sense of

professional responsibility in giving patients and their families the

opportunity to talk about EOL issues so they could decide how they wishedto spend their remaining lives, be adequately prepared, make arrangements

within the family for their care, and be less fearful. Peoples' unspoken fearsabout dying were felt to be frequently worse than reality. Some patients and

carers said that it is important that the doctor knows you and is sensitive,

then it would be acceptable for him or her to offer to discuss prognosis


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How do you want to know about prognosis ?

Because studies show that a majority of patients want to discuss

prognosis, it is recommended that physicians ask explicitly how patients

want to talk about prognosis. Because many patients may not understandthe term prognosis, an alternative is to ask, "How much do you want to

know about the likely course of this illness? These questions invite a

response that goes beyond yes or no. A physician could even normalize arange of patient interest: "Some people want lots of details, some want the

big picture, and others prefer that I talk to their family. What would be bestfor you?" There are three kinds of answers to this question: the patient (1)

wants information; (2) does not want information; (3) is ambivalent.

Occasionally the patient will say that they want a lot of information, and yettheir body language will contradict them. A patient who says "yes" but is

hesitating, looking down, shifting in his seat, or has a facial expressionindicating distress may also be saying "no" nonverbally.

Patients who want information

The principle underlying this kind of discussion is that patientsare

more likely to try to understand and retain informationthey want.

Who and When to Initiate Discussions About Prognosis and Eol Issues

Patients, carers, and HP participants had diverse views regarding

who and when to initiate discussions about prognosis and EOL issues. In

general, participants preferred one of four main approaches: wait for thepatient/carer to raise the topic; HPs to offer all PC patients and their carers

the opportunity to discuss the future; HPs to initiate the discussion when the

patient/family needs to know; or HPs to initiate the discussion when thepatient/family seems ready. Some patients, carers, and a few HPs felt it

should be up to patient and/or carer to initiate the discussion. These HPs

said they would be directed entirely by patient or carer questions and wouldnot normally offer to discuss the topic. The reasons why HPs said they may

be reluctant to raise the discussion included fear of upsetting the patient or

imposing information on the person that they are not ready to hear. Inaddition, some doctors said the inherent uncertainty of prognostic

predictions made them concerned about volunteering inaccurate estimates


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that may only scare the patient. A few patients and carers spoke of the

patient's right to be protected and not have painful discussions about

prognosis. One patient said it would be intrusive if the doctor offered todiscuss prognosis.

Initiate the Discussion When the Patient and/or their Family Need toKnow

Some doctors said they would only offer to discuss EOL issues if thepatient had unrealistic expectations and/or there was an important decision

to be made or if patient was rapidly deteriorating. Likewise, all nurses saidthey would be more comfortable raising a discussion about EOL issues or

prognosis if they perceived a particular reason to do so. One physician said

he would only offer to discuss prognosis or EOL issues if it was necessary

for an immediate clinical decision, such as the need for a do notresuscitate' order. In addition, the nurses said they would talk about the

future with patients or families for the purposes of discharge planning whenthere had not been open acknowledgment that the person was dying and it

was not clear how they would manage at home.

Initiate the Discussion When the Patient and/or their Family Seem Ready

Some patients, carers, and HPs said that HPs should initiate the

discussion when they think the patient is ready. Most HPs emphasized theimportance of knowing the patient as a person and developing a trusting

and caring relationship so that the person would feel comfortable discussingtheir future. The importance of listening and providing emotional support,

while not feeling that you have to solve all problems, was highlighted. The

value of having a calm, unhurried, warm, and gentle manner was raised inparticular by allied health staff. Some doctors pointed out that the HP

themselves needs to be comfortable in discussing EOL issuesthat is, theyhave the knowledge base and have faced their own mortality. The use of

humor was also mentioned by a few HPs. Patiants said that it is vital for theHP to show compassion and respect and to ensure that adequate support ispresent. Some HPs also said they asked the patient what they thought was

the answer to their question, for example, how long they had to live or what

may happen.. Most patients and carers, if they wanted to have the discussionat all, wanted to discuss prognosis and EOL issues with a doctor or nurse.


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Another patient requested that the family be told first and for the family, not

the doctor, to be the one to tell him.

Physicians sometimes selectively convey prognostic

information to support patients hopes.However,the relationship betweenprognostic disclosure and hope is not known.Although physicians sometimes

limit prognosis information to presive hope. Instead disclosure of

prognosis by the physician can support hope,even when he prognosis ispoor.Physician and patients alike believe that the best medical

communication allows for hope ,no matter how difficult the situation .

The meaning of hope may not be tied to a cure in everysituation;instead patient with realistic perceptions of prognosis can

transform hopes to reasonable possibilities such as a meaningful enf of life

period.

Conclusion

Commonly used strategies for disclosing prognosis, including

realism, optimism, and avoidance, have unintended consequencesthat donot always serve patients, family members, and physicians.Asking patients

how much they want to know can facilitate anexplicit discussion that meetsindividual patient needs. Thesepatients may want to know information about

their prognosiseven if it is disappointing or upsetting.


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b. How Much Do You Want To Know About Prognosis

The sharing of medical information and opinions is a problem both

for the doctors and the patients (and their families). But if you explain howmuch truth you want to hear and how you would like to receive this

information, then your doctors will be able to communicate with you better.

This is a good place in your Advance Directive to tell your doctorsexactly how much you want to know about your medical situation.

Often doctors do not know how much truth the patient wants. Can the

doctor hint at the truth without 'tipping off' everyone that the facts are much

worse than everyone had assumed? If your doctor asks, "Do you want thewhole truth?", he or she has already suggested that the situation might be

bleak. Doctors often face the puzzle of how much to shareand with whom.

But if you say in writing how much you want to know, then this

hinting-and-guessing game can be avoided. You can decide how much you

want to know in advance,completely independent of the medical facts that might develop later.

You might decide you want the whole, unvarnished truth. Or youcould instruct your doctors to tell your proxies first, who would then decide

the best time to share the information with you. Perhaps you want a'softer' version of the truth. For example, if you are dying, perhaps you do

not want that information. You would prefer to continue to be treated as if

you would recover.

And when you discuss this Question in advance with your doctor,

before any health crisis emerges, your doctor can help you to clarify just


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how much you want to know. It might even be necessary to re-write your

Answer to this Question so that both you and your doctor understand just

when and how medical information will be communicated.

Such a prior agreement will simplify communication later when the

doctor has discovered some definite facts about your health. You and yourdoctor will not need to dance around the truth, the doctor trying to 'feel out'

just how much you want to know and you trying to 'read between the lines'

of what the doctor says to see if there is something further that is not beingdisclosed.

Dialogue between a doctor and a patient

PT: Good morning,dr Smith!

MD: Good morning!What brings you here today?

PT: I want to know exactly what is happening with me?Please tell memore about my desease

MD: Are you the kind of person who want to hear all the information,bothgood and bad about this illness?

PT: Yes,doctor I want to know everything about my desease

MD: Then let begin The body is made up of different types of cells thatnormally divide and multiply in an orderly way. These new cells replace

older cells. This process of cell birth and renewal occurs constantly in thebody.

Colon cancer is a common type of malignancy (cancer) in which there is

uncontrolled growth of the cells that line the inside of the colon or rectum.

Colon cancer is also called colorectal cancer.The colon, also known as the large intestine, is the last part of the

digestive tract.

The rectum is the very end of the large intestine that opens at the anus.Cancer or malignant growths occur when:

-Some cells in the body begin to multiply in an uncontrolled manner.-The body's natural defenses, such as certain parts of the immune system,

cannot stop uncontrolled cell division.

-These abnormal cells become greater and greater in number.

In some types of cancer, including colon cancer, the uncontrolled cellgrowth forms a mass, also called a tumor. Some tumors are benign, which


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means that they are not cancerous. Cancerous or malignant tumors grow

out of control and can invade, replace, and destroy normal cells near the

tumor. In some cases, cancer cells spread to other areas of the body.

There are two kinds of growths that occur in the colon:noncancerous growths, such as polyps

Malignant or cancerous growths. Colon cancer usually begins with the

growth of benign growths such as polyps.

MD: Did that make sense to you?

PT : Yes, I understand what you say

MD : If you have some question you can ask now?

PT: Yes I have: What causes colon cancer?

MD: The biggest risk factor is age. Colon cancer is rare in those under 40years. The rate of colorectal cancer detection begins to increase after age

40. Most colorectal cancer is diagnosed in those over 60 years.

Have a mother, father, sister, or brother who developed colorectal canceror polyps. When more than one family member has had colorectal cancer,

the risk to other members may be three-to-four times higher of developing

the disease. This higher risk may be due to an inherited gene.Have history of benign growths, such as polyps, that have been surgically

removed.

Have a prior history of colon or rectal cancer.Have disease or condition linked with increased risk.

Have a diet high in fat and low in fiber.

PT: What are the symptoms of colon cancer?

MD: The symptoms of colon cancer can be confused with those of a number

of digestive disorders:- Bleeding from the rectum.

_ Changes in bowel habits

- Pain in the abdomen or rectum- A feeling that a bowel movement cannot be completed


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- Unexplained weight loss, unusually low red blood cell counts or

anemia, paleness, fatigue, or a yellowish coloring of the skin or

whites of the eyes.

PT:Why isn't everyone screened for cancer?

MD: Screening for colorectal cancer is in its early stages. Not all doctors

screen for colorectal cancer, or some patients may be reluctant to go for

testing.

PT:Don't hemorrhoids, not colon cancer, cause rectal bleeding usually?

MD: True, hemorrhoids are a common cause of rectal bleeding. But a

symptom of colon cancer is bright red blood in the stool. Could you say

something about now you are feeling about what we have discussed?

PT : I feel a little scared but Im fine.I want to know how can colon cancer

be prevented?

MD: Schedule regular colorectal cancer screening tests with your doctor.Avoid diets high in fat, alcohol, protein, calories, and red and white

meat.

The use of nonsteroidal anti-inflammatory medications (such asaspirin) may decrease the risk of colon cancer.

Eat foods rich in fiber

PT: I Understand ,now I want to discuss with you How Is Colon CancerTreated?

MD: Three types of treatment are available for individuals with colon

cancer: Surgery is an operation that involves removing the canceroussection of the colon. This is the primary treatment for colon cancer for most

individuals.Chemotherapy involves treatment with drugs that destroy fast-growing

cells, like cancer cells. This treatment is given to persons with advanced

cancers that have spread outside of the colon.Radiation therapy is a specialized treatment using radiation to destroy

rapidly growing cancer cells. This is usually reserved for treatment of rectal

cancer and may be given before surgery, often in combination withchemotherapy. This treatment may shrink the tumor and improve the

chances of avoiding a permanent colostomy in select persons.

PT: In my case what treatment did you recomand to me?MD: In your case I am agree with the first option:the surgery


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PT: Not the chemotherapy?

MD: No,because your cancer is not so advanced,you are one lucky person

PT : Thank you drI have a last question to askMD: Please

PT: What is the follow-up care for colon cancer?

MD: Follow-up exams are important after treatment for colon cancer. Thecancer can recur near the original site or in a distant organ such as the

liver or lung. In addition to checking for cancer recurrence, patients who

have had colon cancer may have an increased risk of cancer of theprostate .

PT: I understand now.

MD: Is there anything else?PT: No ,its enough

MD: I have a question to you now! Who are you going to tell about this visit

when you get home?PT: I tell to my family,because they are very important to me and they

always supporting meMD: How do you feel now ?

PT : Im not scary ,because now I know a lot of information about my

cancer and I know what to do exactly before and after the treatment.MD: Im very impressed by your reaction about it. Congratulations. As you

should be all the patient.

PT: Thank you dr.Smith for the information this help me very much!MD: With pleasure. I expect you next week.

PT : I will certainly. Good bye and have a nice day.

MD: Good bye and you too.


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Implantology

Main article: Dental implant

Currently, implants are almost all made oftitanium. The most

commonly used are of the endostealtypes; in most cases they are

left submerged under the gum for a time period depending on their

position. Dental implantology is subdivided in endosteal and

justaosteal. This last one utilizes only grid shaped implants with an

exposed fixed head. Depending on how they are loaded, they may be

made of chrome-cobalt-molybdenum if they are not destined for

osteointegration, or they may be made of titanium and inserted withappropriate surgical techniques to favor the formation of bone above

their structure.

Endosteal implantology is much more widespread, uses cylinder or

cone-shaped implants, more or less threaded on the outside and with

variously shaped internal connections to support emerging

abutments. Less frequently, implants are cylinders or cones without

external threads, but with similar internal connections to support

abutments, or screws with emerging heads machined as singlepieces, therefore without any connections, or blades, or needles.

Based on surgical protocol, we may have submerged or

transmucosal implantology. Based on the time of use we may have

immediate, early or deferred load.
http://en.wikipedia.org/wiki/Dental_implanthttp://en.wikipedia.org/wiki/Titaniumhttp://en.wikipedia.org/wiki/Endosteumhttp://en.wikipedia.org/wiki/Dental_implanthttp://en.wikipedia.org/wiki/Titaniumhttp://en.wikipedia.org/wiki/Endosteum


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Endosteal implantology is basically subdivided into two important

schools: the Italian school and the Swedish school. Italian school

implantology historically preceded the Swedish school, is less

widespread, but conceptually just as important as the Swedish one.

The Italian school introduced the first implant specifically designed for

immediate load, titanium for implant fabrication (Stefano M.

Tramonte), the concept of biological space around implant bodies,

and the intraoral welder (PL. Mondani).

The Swedish school introduced the osteointegration method, first

developed by Invar Branemark, based on deferred load and aiming at

making the implantological surgery more predictable. It utilizes

endosteal, screw shaped implants with prosthetic connection,

deferred load, which imposes a waiting time of 3 to 4 months in themandible and 5 to 6 months in the maxilla. The original Branemark

protocol and the implants utilized have been modified in various ways

to shorten implant waiting times, and, in general, treatment times.

The Swedish school has introduced very important innovations in

production and surgical techniques: surface treatments for implant

surfaces, tissue regeneration techniques for bone and mucosa,

vertical and horizontal augmentation techniques. In general, the

Swedish school has introduced surgical techniques aimed at makingimplant sites more adequate for the placement of their implants,

because, by their very nature, they are less adaptable to anatomical

conditions than the Italian school implants.

The material most frequently used for implant production is titanium,

in commercially pure form or in its dental alloys. This is a

biocompatible material that does not elicit any reaction from patients

tissues (commonly known as rejection). Implants, positioned in the

patients bone, are strongly incorporated in it by physiological boneregeneration actions, bringing to osteointegration, both in the case of

deferred load (Swedish school) and in the case of immediate load

(Italian school). History

The history of the beginning of implantology is lost far back in time,

and we do not know exactly when the idea of inserting an artificial


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tooth in a socket first started. We only know for sure that it was done.

We have very interesting ancient archaeological findings displaying

insertions of pieces of carved shells, minerals or bones. In more

recent times, in the 19th century, the attempts to realize

implantological surgeries multiplied, but where inevitably stifled byinadequate materials, primitive surgical techniques and anesthetics,

the absence of antibiotics, the total ignorance of occlusal principles.

In the first half of the 20th century we witness a great variety of

attempts that are definitely more concrete, and the registration of

numerous patents. We should remember the patent by Adams in

1938 regarding the first submerged implant, very similar to the

subsequent one by Branemark, and the experiments by Formiggini,

considered as the father of modern implantology (1947). In 1961 thefirst implant specifically designed for immediate load was produced

(Tramonte), presenting a biological space, and 1964 saw the

introduction of titanium in implantology (Tramonte). In the years 60s

and 70s important histological studies where made by Pasqualini. In

1972 Garbaccio formulated the theory of bicorticalism and designed

the related implant. In 1975 Mondani designed the intraoral welder

(syncrystallizer), and at the end of the 70s the Branemark submerged

implant became more frequently used, solving some of the prosthetic

issues presented by immediate load implants. From then on,submerged implantology became widespread, thanks to its ease of

use by inexperienced implantologists. Submerged implants

multiplied, and were modified at a very rapid pace, in the attempt of

correcting the few chronic shortcomings affecting them, in spite of

their great success.

Reconstructive surgery was developed at the same time, to solve

many of the bone problems greatly limiting the use of submerged

implants. Modern implantology, with immediate or deferred load, is awell tested and reliable discipline, capable of solving almost all

edentulism problems, both functional and aesthetic.

Types

Osteointegration and fibrous integration


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With our current knowledge, we attribute to the word osteointegration

the meaning of union between bone and implant which remains

stable under load, and guarantees chewing functionality without

clinical signs or symptoms. We call fibrous integration a partial failure

that allows the implant suffering it to function for a few years with aprogressive loss of stability and increase of related issues (pain on

pressure, soft tissue inflammation, etc.)

Implants can have different shapes: cylindrical body and prosthetic

connection, threaded cylinder, conical, threaded conical, single piece

without prosthetic connection, blade, needle, net. These last ones are

much less used because of their inherent difficulty, but they adequate

to solve particularly difficult situations where bone reconstruction

techniques cannot be used.Endosteal implants using deferred load protocols are the most commonly

used, the most thoroughly clinically tested and the most verified with

international protocols published on the most important scientific journals.

However all implants osseointegrate, provided they are made of titanium.

The word osseointegrated referred to the surgical technique in the past,

to distinguish the deferred load the protocol producing osteointegration, as

opposed to immediate loading protocol producing fibrous integration,

therefore implant failure, can no longer be used with this meaning. Todaywe know that both implant surgeries, performed according to deferred load

protocol and according to immediate loading protocol, result in

osteointegration, provided that titanium implants are used. Titanium

produces that particular union between implant and bone defined as

osteointegration.

Implantology methods

Implantology methods consist mostly of two surgical techniques:

two stage: the first stage is submerged, where the implant is

inserted under the mucosa, which is then sutured. Then, after 2 to

6 months, the mucosa is reopened and an abutment is screwed

on the implant;


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one stage: the implant is inserted, but its head is protruding out

of the mucosa. It is then left to heal (always from two to six

months) by osteointegration, or it can be loaded immediately, with

an appropriate temporary or permanent prosthesis, depending on

the case. Of course, single piece implants are only one stage,immediate loading implants.

Professional qualifications

Normally, a dentist or a surgeon trained as a dentist is dealing with

dental implants. In Italy the professional specialty of Implantologist

does not exist. In France, for instance, there is the University

diploma of surgery and implant prosthesis (DUCPI), so that a non-

specialized dentist should not position any implants beyond themaxillary sinus. Pre-prosthetic and pre-implantar surgery, which is

the preparation of the alveolar bone for dental implant and prosthesis

placement, are performed by the dentist, or, in some cases, by a

maxillo-facial surgeon. Since these surgeries are specialized, it is a

good practice to verify that the specialist chosen to perform them is

properly qualified, by checking his/her qualifications in the Italian

national federation website (www.fnomceo.it), or by checking his/her

curriculum studiorum on the order of physicians site of the related

province.

Some European insurance companies demand proof of experience

from the dentist who places implants in order to provide insurance

coverage for the patient and the professional.

Surgery protocols

The implantologist and/or surgeon creates a site in the patients

bone (corresponding to the new tooth to be placed or replaced), by

using a set of calibrated burs, then inserts an endosteal dentalimplant. For the implant to osseointegrate, it is necessary to achieve

a good primary stability, with no mobility or movement limited to a few

microns (according to Brunsky et al.). The bone-implant interface is

of the order of a few millimicron, otherwise the implant does not

support its load and must be removed.


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According to some implantologists (Linkow), fibrous integration (a

body defense phenomenon that surrounds the foreign body with a

fibrous capsule) may be acceptable for loading a crown. Technically

the implant has failed and the surgery has not been successful, but,

in some cases, implants with fibrous integration can be functional foryears with full patient satisfaction. However, fibrous integration is a

failure.

Currently, the most commonly used implants are the ones of the

Swedish school, that can be inserted with a deferred load protocol,

with surfaces treated by various technologies, to facilitate the control

of all parameters and the highest degree of implant success

predictability. Generally, functional load with a fixed prosthesis is

applied later, after 3 to 4 months for the mandible, and after 5 to 6months for the maxilla. In some cases, but not all, it is possible to

immediately load the implants, but to be able to do it some basic

criteria must be followed:

the presence of a certain amount of bone,

primary stability of the implants after placement,

good gingival support,

absence of bruxism (teeth grinding) and of serious

malocclusion,

presence of a good occlusal balance (a correct occlusal plane).

Clearly, a serious specialistic evaluation is also necessary, to

examine the coexistence of all these factors, otherwise the choice

should fall on a traditional technique (of a submerged or non-

submerged type), using implants that require a longer, but safer

waiting time before the application of a functional load.

Italian school immediately loading implants, and the related surgicaltechniques, give success percentages comparable to the ones

obtained with deferred loading, but involve a longer learning curve

and require greater experience. However, this system allows the

patient to have fixed temporary teeth at the end of the implant


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surgery session even in cases where a deferred load would have

been necessary with Swedish school implants.

Implants have an almost unlimited lifetime (the longest studies span

25 years), if daily maintenance is performed. The greatest risks for

implants are:

immediately after placement peri-implantitis can set in; this is

an inflammation and infection of the structures surrounding the

implant, followed by failed osteointegration

incorrect load of the implants, with incorrect crowns or

prostheses, that can create bone resorption in time, with bone loss

reaching the deepest implant threads, possibly causing implant

loss. In order to avoid such implant failures, it is necessary to buildgood fixed or removable prostheses, with well balanced occlusion,

to maintain a good daily hygiene, and undergo regular checkups.

Also, it must be pointed out that smoking and diabetes can

compromise osteointegration and implant duration. Implants can

replace a single tooth by placing a crown over an implant, a group of

contiguous teeth (bridge on implants), a full arch, or they may be

used to stabilize an upper or lower overdenture.

Implant success criteria

Absence of persistent pain at implant site

Absence of recurring infection

Absence of implant mobility

Absence of radiolucency around the implant

ReferencesBibliography

Clinica Implantoprotesica di Ugo Pasqualini, Marco Pasqualini,

Ariesdue, 2008,


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Insuccessi in implantologia: definizioni, cause, classificazione,

terapia, aspetti medico-legali. Odontoiatria pratica, di Antonio

Pierazzini, UTET, 2001.

Il successo in implantologia, di Enrico G. Bartolucci, C.

Mangano, Masson, 2004. Osseointegrazione clinica: i principi di Brnemark, di Gian

Antonio Favero, Masson, 1994.

Annali di Stomatologia - Su alcuni casi particolarmente

interessanti di impianto endosseo con vite autofilettante - Vol XV -

Aprile 1966


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Taste Disorders

How common are taste disorders?

Many of us take our sense of taste for granted, but a taste disorder can have

a negative effect on a person's health and quality of life. If you are having aproblem with your sense of taste, you are not alone. More than 200,000

people visit a doctor each year for problems with their chemical senses,which include taste and smell.

The senses of taste and smell are very closely related. Some people who go

to the doctor because they think they have lost their sense of taste are

surprised to learn that they have asmell disorderinstead.

How does our sense of taste work?

Our ability to taste occurs when tiny molecules released by chewing,

drinking, or digesting our food stimulates special sensory cells in the mouthand throat. These taste cells, or gustatory cells, are clustered within the

taste buds of the tongue and roof of the mouth, and along the lining of thethroat. Many of the small bumps on the tip of your tongue contain tastebuds. At birth, we have about 10,000 taste buds, but after age 50, we may

start to lose them.

When the taste cells are stimulated, they send messages through three

specialized taste nerves to the brain, where specific tastes are identified.Each taste cell expresses a receptor, which responds to one of at least five

basic taste qualities: sweet, sour, bitter, salty, and umami. Umami, orsavory, is the taste we get from glutamate, which is found in chicken broth,

meat extracts, and some cheeses. A common misconception is that taste cellsthat respond to different tastes are found in separate regions of the tongue.

In humans, the different types of taste cells are scattered throughout the

tongue.

Taste quality is just one aspect of how we experience a certain food.

Another chemosensory mechanism, called the common chemical sense,
http://www.medicinenet.com/script/main/art.asp?articlekey=26021http://www.medicinenet.com/script/main/art.asp?articlekey=26021


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involves thousands of nerve endings, especially on the moist surfaces of the

eyes, nose, mouth, and throat. These nerve endings give rise to sensations

such as the coolness of mint and the burning or irritation of chili peppers.Other specialized nerves give rise to the sensations of heat, cold, and

texture. When we eat, the sensations from the five taste qualities, together

with the sensations from the common chemical sense and the sensations ofheat, cold, and texture, combine with a food's aroma to produce a

perception of flavor. It is flavor that lets us know whether we are eating a

pear or an apple.

Many people who think they have a taste disorder actually have a problem

with smell. When we chew, aromas are released that activate our sense of

smell by way of a special channel that connects the roof of the throat to thenose. If this channel is blocked, such as when our noses arestuffed up by a

coldorflu, odors cannot reach sensory cells in the nose that are stimulatedby smells. As a result, much of our enjoyment of flavor is lost. Without smell,

foods tend to taste bland and have no flavor.

http://www.medicinenet.com/taste_disorders/article.htm

Exercices:

1. Read the second paragraph and translate it2. Complete the text below with the following words:

Stimulated, tastes, receptor, Umami, glutamate, misconception, scattered

When the taste cells are, they send messages through three specialized

taste nerves to the brain, where specific are identified. Each taste cell

expresses a , which responds to one of at least five basic taste qualities:sweet, sour, bitter, salty, and umami. , or savory, is the taste we get from

, which is found in chicken broth, meat extracts, and some cheeses. A

common is that taste cells that respond to different tastes are found inseparate regions of the tongue. In humans, the different types of taste cells

are throughout the tongue.

3. Imagine a dialog between a dentist and a pacient about What arethe taste disorders?. 10 to 20 lines

4. Use this 4 words in one sentence: sweet, sour, bitter, salty.
http://www.medicinenet.com/script/main/art.asp?articlekey=100372http://www.medicinenet.com/script/main/art.asp?articlekey=100372http://www.medicinenet.com/script/main/art.asp?articlekey=330http://www.medicinenet.com/script/main/art.asp?articlekey=365http://www.medicinenet.com/script/main/art.asp?articlekey=41104&page=2http://www.medicinenet.com/script/main/art.asp?articlekey=41104&page=2http://www.medicinenet.com/script/main/art.asp?articlekey=100372http://www.medicinenet.com/script/main/art.asp?articlekey=330http://www.medicinenet.com/script/main/art.asp?articlekey=365http://www.medicinenet.com/script/main/art.asp?articlekey=41104&page=2http://www.medicinenet.com/script/main/art.asp?articlekey=41104&page=2


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5. Choose the right word:

Aspect, chemosensory, sensations, irritation, texture, chemical, food's,

know

Taste quality is just one of how we experience a certain food. Another mechanism, called the common chemical sense, involves thousands of nerve

endings, especially on the moist surfaces of the eyes, nose, mouth, and

throat. These nerve endings give rise to such as the coolness of mint andthe burning or of chili peppers. Other specialized nerves give rise to the

sensations of heat, cold, and . When we eat, the sensations from the fivetaste qualities, together with the sensations from the common sense and

the sensations of heat, cold, and texture, combine with a aroma to

produce a perception of flavor. It is flavor that lets us whether we areeating a pear or an apple.

6. Put the word in the wright time and form to complete the text below:

Many people who they have a taste disorder actually have a problem with

smell. When we chew, aromas are released that our sense of smell by wayof a special channel that connects the roof of the throat to the nose. If this

channel is , such as when our noses arestuffed up by a coldorflu, odors

cannot reach sensory cells in the nose that are by smells. As a result,much of our enjoyment of flavor is lost. Without smell, foods tend to taste

bland and have no flavor.

Words: think, activate, block, stimulate.

7. Write youre opinion about Why are the taste important? (5 to 10lines)

8. Choose the best answer in order to complete the following sentences:When the taste cells are ... , they send messages through three

specialized taste nerves to the brain, where specific tastes are identified.

a. stimulateb. stimulated

As a result, much of our enjoyment of flavor ... .

a. is lostb. are lost

More than 200,000 people a doctor each year for problems withtheir chemical senses, which include taste and smell.
http://www.medicinenet.com/script/main/art.asp?articlekey=100372http://www.medicinenet.com/script/main/art.asp?articlekey=330http://www.medicinenet.com/script/main/art.asp?articlekey=365http://www.medicinenet.com/script/main/art.asp?articlekey=100372http://www.medicinenet.com/script/main/art.asp?articlekey=330http://www.medicinenet.com/script/main/art.asp?articlekey=365


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a. visited

b. visit

9. Write the correct word (from the list on the right) to describe each

picture:

sweet, sour, bitter, salty

10. Compose a text of 10-15 lines about The senses of taste.

Nicolescu Adriana

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