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2	Dr. Hesham El-Essawy 121 Harley Street, London, W1G 6AX. hesham@el-essawy.com
3	What is ‘Normal’
4	What matters is; what is healthy
5	See what a miracle we all are!
6	Red is artery blue is vein and yellow is a nerve, all supplying every tooth and surrounding tissues.
7	A cross section of teeth attached to the alveolar bone
8	The dark pits is simple decay, see how far it advanced before a cavity appears!
9	Types of Teeth and their Functions
10	"Incisors" Incisors To cut with Canines To tear with Pre-molars To crush with Molars To grind with Wisdom Teeth
11	Structure of a Tooth
12	Deciduous Teeth
13	Permanent Teeth
14	Caries Affects 100% of the world population May lead to: unsightly loss of tooth structure sensitivity to cold, hot, sweets, intolerable pain and inability to chew infection and loss of vitality of the tooth systemic complications
15	Dental Plaque Types Supragingival Aerobe and facultative bacteria Mostly gram-positive Sub gingival Mostly anaerobic bacteria, frequently gram-negative
16	Supragingival Plaque 90-95% bacteria Streptococcus mutans S. sanguis S. salivaris (Enamel caries) Actinomyces viscus (root caries) 5-10% organic matrix, host cells, inorganic ions.
17	Subgingival Plaque Types Hard tissue Adheres to enamel, dentine and cementum Soft tissue Adheres to gingival tissues Loose Running loose in between, causing pocketing.
18	Subgingival Plaque Bacteria Spirochetes Actinomyces spp Eikenella spp Causes periodontal disease
19	"Do you know how long..." Do you know how long it takes for bacteria to make acids, enough to dissolve the enamel of your tooth? One hour? Two hours? One day? Two days? One month? Two months?
20	Believe it or not! Believe it or not! It takes the cariogenic bacteria just Five minutes to form acid with low enough PH to dissolve the enamel! When do you brush your teeth?
21	Do you want to live Caries-free? It is easy. Just join the Sweet Friday Club. Say: I promise whole heartedly to eat sweets whenever I want to, all day and all night on Fridays. And I promise to eat nothing at all that has any amounts of sugar however small during the rest of the week. And I promise never to allow the horrible germs to multiply on my teeth at all, day or night. So help me God!
22	When these four combine
23	This is a white lesion, minerals out but no cavity yet
24	White lesion under the microscope
25	And again
26	Bacterial advance troops stream down the dentinal tubules heading towards the pulp of the tooth
27	They work hard at eating out the dentine
28	Now they formed a big colony at the expense of the tooth
29	The collapse of the tooth structure follows, we call it a carious cavity
30	Gone to the pulp and caused an abscess
31	The nerve has degenerated and an apical abscess has formed
32	And now, there is a sinus oozing
33	And infection has spread to the surrounding tissues
34	The planes through which infection can travel
35	See how many vital tissues are close by!
36	The tooth is out. If infection is left behind it means trouble
37	Who said that dental surgeries should not look friendly?
38	Marcia (my capable nurse for 29 years) is a bit camera shy!
39	I once though it was OK!
40	Even under gold I still find amalgam leaking mercury
41	Sometimes I find amalgam under white fillings
42	Fluorides, Oh Fluorides! Drink it, cook with it, bath in it, wash with it, brush with it, rub it on your teeth, and fill your teeth with it! It is only one part per million!
43	To fluoridate or not to fluoridate!
44	Opponents say:
45	And they also say:
46	Other minerals and dental caries Epidemiological studies suggest: low DMFS scores associated with higher strontium and molybdenum content of the drinking water (not supported by some animal studies) High prevalence of caries associated with higher content of copper, aluminium, sulphur, titanium, nickel, silver, tin, selenium and lead (caries promoting in animal studies).
47	The Periodontium: when damage happens
48	Some of the bacteria that invades the periodontium
49	Halitosis What causes it? What does it cause? How do you treat it? Anaerobic bacteria Social and psychological problems Get rid of the bacteria that causes it, and scrape off their products.
50	It is not usually From your stomach From your lungs From your food Eliminated by breath fresheners Eliminated by excessive brushing
51	It is caused by anaerobic bacteria producing the following gases: Cadaverine : as from corps Hydrogen sulfide : as from rotten eggs Putrescine : as from decaying meat Methyl mercaptan Skatole : as from faecal matter Isovaleric Acid : as from sweaty feet Volatile Sulphur Compounds. We all have them!!! But if they are produced in excess, you have Halitosis.
52	BACTERIOLOGY OF PERIODONTAL LESIONS Prophyormonas gingivalis * Actinobacillus actinomycetemcomitans Campylobacter recta Fusobacterium nucleatum Provetella intermedia * Bacteroides forsythus * Eikenella corrodens * Treponema denticola
53	Risk factors in periodontal disease Poor oral hygiene Previous history Diabetes Smoking and tobacco use. There is an epidemiological association between periodontal disease and coronary artery disease and stroke
54	Got a light! Smoking kills A pack of ‘reds’ please!
55	Ingredients added to Tobacco in the manufacture of Cigarettes by major American Cigarette Companies
56	What else is in a cigarette?
57	Any more?
58	Cigarettes Kill, the box says, so why do people buy it? Non-smokers are surprised that smokers are still smoking after all the evidence! Smokers are surprised that the others are surprised! They say: Oh well, you got to die of something! Or, my father smoked and he died healthy!
59	There is something else in tobacco! A very high amount of mercury!
60	See what might happen when tobacco smoke hits the palate. His denture protected part of it.
61	In the mouth Why is a white lesion white? What is an ulcer?
62	A microscopic view of white lesions: keratin where it is not expected
63	He Tattooed his lip but with the wrong name!
64	What is an ulcer? When epithelial covering breaks down.
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66	"It is difficult" It is difficult to swallow!
67	"First," First, the vesicles, then it ulcerates.
68	"When he gets both white..." When he gets both white lesions and ulcers!
69	"Did you see that?" Did you see that?
70	"It is getting" It is getting a bit late!
71	A type of Lichen Planus!
72	Under the microscope
73	Certain drugs can make the un-brushed gums go like this!
74	Fungus can grow wild under a constantly worn denture when immunity is depressed
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76	All diseases are enzymatic diseases Prevent and combat disease, By taking the right nutrients. The nine piece nutritional jigsaw 1. Anti-oxidants 2. Carotenoids 3. Flavonoids 4. Omega-3 5. Isoflavones 6. Betaine 7. pre-Biotics 8. Vitamins and minerals 9. Q10 and glucosamine
77	Anti-oxidants Vitamin E Daily intake of 267 mg (400 IU) reduce the risk of heart disease by 50% (RDO 10 mg) Vitamin C daily intake of 500 mg can cut death rates by 50% (RDO is 60mg) Selenium optimum daily intake is 120-200 mcg (average DI is 35mcg)
78	2. Carotenoids Beta carotene, Lutein, lycopene from fruits and vegetable have anti-oxidant anti-cancer properties. Lycopene: a powerful cardioprotectant and anticancer properties Cryptoxanthin:reduce the risk of cervical cancer Lutein: blindness Astaxantin:gastric function and fertility
79	3. Flavonoids Powerful anti-inflammatory agents Defensive against heart disease, cancer and inflammatory conditions such as asthma, arthritis Anti-aging
80	4. Omega 3 oils Protects against heart disease Defends against inflammatory conditions like asthma, arthritis
81	5. Isoflavones Genisein force cancer cells to revert to normal Help to choke off blood supply to emerging tumours Minimises the problems of menopause
82	6. Methyl groups Betaine lowers levels of toxic amino acid homocysteine that can build up in the body and is a direct cause of hearts disease and is implicated in Alzheimer’s Betaine also increases the body’s resistance to stress, toxins, carcinogens and infections, enhances liver and kidney function by supplying essential methyl groups
83	7. Pre-Biotics Fruct-Oligo-Saccharide, and inulin. Protect against bowel and colon cancers And probably liver and breast cancer Normalises bowel function
84	8. Vitamins and minerals You know all about them, don’t you? You know about the others too! So
85	9. Co-enzyme Q10 and Glucosamine Maintain the inner and outer health of the trillions of cells that make up the body, maintains a healthy heart. It supports the mitochondria. Glucosamine strengthens the connective tissue in the body and helps protect joints and skin Delays aging
86	What is on your plate? You look at food and think of all those nutrients. But food also contains other unwelcome toxins You might not believe your ears when I tell you!
87	Looks horrible but means nothing
88	When blood vessels are not in shape!
89	And again
90	Dead teeth do not look nice!
91	Se what tetracycline can do to forming teeth!
92	View after veneers
93	Saliva that goes not to the outside can cause this little cyst
94	See what happens when enamel formation is interfered with!
95	And again!
96	Looks worrying, but it is actually protective melanin pigmentation!
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98	Not good for the confidence!
99	Lead poisoning!
100	He was only brushing his teeth too hard and with a hard brush!
101	They have to bite correctly!
102	A view of orthodontics
103	And another
104	And another
105	You should not leave the child like this!
106	Candida is a devil, watch out!
107	He could not accept dentures
108	Implants has helped him
109	You spend more time at work, so, your work place enjoyable!
110	Dental equipments should be hidden, but without being hidden! Give the eyes something pretty to distract!
111	Amalgam, I once though it was OK!
112	Mercury Is it a little toxic Very toxic Or Extremely toxic? Plutonium is the most toxic substance on earth. What is the second most toxic substance? You guessed it, It is Mercury!
113	The question of Amalgam You must know that: Almost all authoritative bodies controlling the practice of dentistry in the world say the following: There is no evidence that amalgam is harmful or produces any symptoms. Only a small number of patients may display some hypersensitivity to it.
114	But, may I ask? How much mercury is there in amalgam? Does it leak out or vaporize out of amalgam ? Where could it go when it vaporizes? About 50% Yes. Most of it will be swallowed or inhaled.
115	"Could it be detected from..." Could it be detected from the patient’s faeces? Could it be detected in the urine? Could it be detected from the blood? Could it be detected from sweat? Yes. Yes Yes Yes
116	"Does it cause symptoms in..." Does it cause symptoms in every one? Do these symptoms go when amalgam is safely out? Do the symptoms return after a while? No. Yes. No.
117	What symptoms? Tiredness and lack of energy. Sleep disturbances. Waking up tired. Loss of concentration Foggy brain. Short-term memory loss. Mood swings Depression.
118	"I call that" I call that Grade I mercury toxicity.
119	Any more? Feeling bloated Feeling unwell most of the time Hair problems Nail problems Food allergy Feeling cold and difficulty in getting warm Skin problems Frequent colds and flu and generally depressed immunity
120	"I call that" I call that Grade II mercury toxicity.
121	Any more? Frequent headaches Migraine Insomnia Feeling as if there is a a lump like potato stuck in the throat. Frequent ulceration in the mouth Post-nasal discharge Sore throat Candida overgrowth Thrush Metallic taste
122	"I call that" I call that Grade III mercury toxicity
123	Any more? Muscle pain Joint pains IBS-like symptoms Fibromyalgia-like symptoms MS-like symptoms Severe depression and loss of appetite Double vision Loss of visual acuity Fine tremors Tingling sensation Bladder problems Severe skin lesions Chronic fatigue-like symptoms
124	"That is" That is Grade IV mercury toxicity
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126	"Manic depression" Manic depression Insanity (Mad Hatters Disease) Severe loss of memory and diminution of faculties
127	"That is" That is Grade V mercury toxicity.
128	Did the patient seek treatment first through his doctors? Almost every patient sees his doctors first. They are carefully examined They are referred for every kind of test, x-rays, scan, and anything else their doctor considered appropriate, then the patient is told in the end: There is nothing wrong with you!
129	Then what? The patient gets his amalgam removed using the safe method, and he almost immediately starts to improve, and continues to improve, 100% of patients who had amalgam removed using the safe method improve by 80-100% It takes about a year to shed the body burden of mercury (half life of mercury in the body is 88 days)
130	What about detox and what about chelation The best possible detox is a careful and complete removal of amalgam and mercury from the patient’s mouth The patient’s own glutathione enzyme system and glutathione-s do the rest. But there are other things that can also help
131	The best detox is to remove the pool of mercury called amalgam, and making sure that the tooth reads zero mercury
132	She had that under her crowns
133	Now removed!
134	And detox with our wonderful environ
135	Until it read zero mercury
136	The best detox is the total removal of mercury from the patient’s mouth Amalgam removal is not enough. All mercury must be totally removed. We cannot remove mercury without the help of a mercury vapour analyser
137	Environ is made of: Lobelia, bugleweed, yellow dock root and burdock leaves in a specific combination.
138	How do we do it?
139	How do we do it?
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141	Amalgam is out now. How safe is the alternative? There is nothing that is totally safe for all. The best available option available to us is Pre-testing To see if that particular item is compatible with that particular patient. Several methods are available for that.
142	White fillings are not easy to make properly!
143	It is simple really! Pre-test every thing you are going to use on the patient Give conscious sedation and local anaesthesia Block the throat on the side you are operating on, with at least two lines of defence. Protect all tissues Oxygen tubes in the nose and monitor the patient. Cover the nose and the eyes with a gold mask. Remove amalgam with suction hugging the tooth Check for mercury vapour Detox till the MVA reads ZERO. Put temporary filling in. THE UN-NEGOTIABLE PRINCIPLE IS: LET NO MERCURY VAPOUR GET INTO THE PATIENT
144	Now, hear it from them. Hear the patient’s own unedited video recorded case reports. see videos!