[{"id": 134988, "created": "2019-09-04T17:33:34.014677", "project_id": 379, "task_id": 74774, "user_id": 138, "user_ip": null, "finish_time": "2019-09-04T18:20:58.734227", "timeout": null, "calibration": null, "external_uid": null, "media_url": null, "info": {"other": "The last sentence is incomplete with the verb on the next page. This will have to be joined.", "translation": "ensure that this already damaged tissue is kept strong and tough. Thirdly, there is the bite factor. I don't want to load you up with long and tiring details. Suffice to say that through careful grinding, especially into the upper jaw, a flat overbite needs to be achieved, in which at best all teeth align on top of each other and are loaded equally during the final phase of the bite, and during the bite off phase at least six of the upper jaw's front teeth are in contact with those in the lower jaw. Is this not achievable through grinding, more technical work (bridges, cast fillings and removable dentures) has to achieve the necessary modifications. The nightly grinders are best cured through an especially construkted bite rail, which avoids single-point loads on one or several teeth. On the factor of constitution, the dentist best consults the internist, whose specialist diagnosis yields conculusions about the already mentioned internal illnesses. The absolute necessity of collaboration between dentist, the internist, the surgeon and the Otho-Rhino-Laryngologist should be pointed out here.\r\n\r\nA large share of patients underestimate the influence of dental- and jaw diseases on the entire organism. It is not like one could consider ones chewing tools as something less or irrelevant, but as a part , and a very impotant part, of the overall organism. Every human, who has gone through a longer, severe illness, thereafter knows to appreciate the value of their health. Neglect, especially of the oral cavity, which as the entrance to the respiratory organs and the digestive system is particularly sensitive, always takes its toll.\r\n\r\nAfter this small detour, which seemed necessary to me, we arrive at the factor of the soul. This is a particularly difficult problem, which I can only scratch on the surface.  This first requires an absolute trust of the patients in their doctors, who have to be physicians in the best sense. Needs of the soul and pathological inclinations of patients are the doctors' business, who can do a lot, if he is given the necessary trust on the side of their patients. The patients have to feel that the doctor does not want to nose around in their private inner,  but wants to stand on their side as friend and helper, and that there is nothing a human has to be ashamed of in front of their doctor. Together, it is often possible to relieve oneself of their complexes and spiritual needs, which are a contributing cause of the parodontosis.\r\n\r\nWe now get to the last point, the treatment of horizontal and vertical Atrophy (loss) through surgical means. Here I also cannot go too deep due to lack of space. In lesser forms of the atrophy, let's say with a pocket depth of 5-6 mm, and recalling that a normal pocket depth amounts to 1-4 mm, we approach with a thermal cauter. This is a thin needle, which is passed along the gum line with a low voltage current, relatively painlessly burning off the granulations, which are the inflammation-affected tissue parts. Into the pockets themselves, one can insert a mixture of sulphur and ether, which is capable of separating the superficial granulation.If the pockets extend beyond 5-6 mm, but still present a horizontal atrophy, one has to apply a knife. Under application of local anaesthesia (Novocain, Provcain) one removes the gum tissue line like a garland and scratches out the interdental space (the gap between two teeth) clean to the bone rim. In one session, one can generally cleanly treat 6-10 teeth.Thereafter a Trypaflavin cover and  later 8-10 days oral treatment.\r\n\r\nTher treatment of vertical atrophy is probably the most difficult in existence in the field of oral surgery. This not only requires the removal of the granulations (inflammed affected tissue parts) with knife and gum scissors, but one has also, in a very limited space, to ??? the inflammation affected bone substance"}}, {"id": 135414, "created": "2020-01-11T21:12:55.908430", "project_id": 379, "task_id": 74774, "user_id": 1957, "user_ip": null, "finish_time": "2020-01-11T21:13:06.101388", "timeout": null, "calibration": null, "external_uid": null, "media_url": null, "info": {"other": "", "translation": "ensure that already damaged tissues remain strong and resistant. And now to the third point, which is the bite factor. I don't wish to bore you with long and tiresome details. I'll just say that with careful grinding, especially in the upper jaw, a flat overbite should be obtained in which as far as possible all teeth rest on top of one another in the final bite phase and are equally burdened, and in the bite off phase (?) at least the six upper front teeth are in contact with those of the lower jaw. If this cannot be achieved by grinding, these essential modifications must be achieved by technical work, such as bridges, fillings and removable protheses. Teeth grinding during sleep is best cured by a specially made bite plate, which prevents one-sided stress on one or more teeth. The dentist should consult the internist about possible internal complaints. It should be stressed that it is essential that the dentists works in close cooperation with internists, surgeons and ear, nose & throat specialists.\r\nMany patients misunderstand the impact of dental and jaw complaints on the body as a whole. Teeth should not be seen as inferior to the rest of the body, but as part of it, indeed an important part of it. Anyone who has been through a long, serious illness appreciates the importance of their health. Neglect of the mouth, which impacts on the lungs and digestive system, will always rebound on the patient.\r\nAfter this small but important digression we should discuss pyschological aspects. It is a particularly difficult problem, which I can only touch on here. It assumes an absolute trust of the patient in his doctor, who should be a doctor in the best possible sense. Mental distress and pathological tendencies of a patient should be addressed by the doctor, who can do much to help the patient if the trust is there. The patient should feel that the doctor is not just rummaging around in his body out of sheer curiosity, but as a friend and helper, and that the patient should have nothing to be ashamed of before his doctor. With his help it is often possible to solve the mental distress and complexes which were the cause of the periodontosis in the first place.\r\nNow we will turn to the last point, which is the treatment of horizontal and vertical atrophy of the jaw by surgical means. Again, I cannot go into too much detail due to space restrictions. The lesser form of atrophy, meaning a cavity depth of 5-6 mm (where the normal depth is 1-4 mm), can be treated by thermal cauterisation. This is a fine needle, through which a low electric current passes, which is drawn along the tooth-gum interface and burns away the granulations, or inflamed tissue, in a relatively painless manner. A mixture of sulphur and ether can be placed in the cavity to dissolve the granulations. If it is a horizontal atrophy with cavities over 5-6 mm deep, surgical intervention is necessary. Under a local anaesthetic (Novocain, Procain) the gum interface is sliced off around the tooth and the interdental space (i.e. between two adjacent teeth) is scratched clean to the bone edge. Groups of 6-10 teeth can be treated in this manner in one session. A trypaflavin bandage is applied followed by 8-10 days oral treatment.\r\nTreatment of vertical atrophy is the hardest operation in dental surgery. It is not merely sufficient to excise the granulations (inflamed tissue) with a scalpel and scissors, it is also required to treat the inflamed bones in the smallest of spaces."}}]